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Answered in 2 hours by:
10/6/2011
Kxav
Category: Oncology
Satisfied Customers: 4,106
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Hello there,
Please be patient, as I may be in the operating room, with a patient, or driving but will get back to you ASAP.

yes, I have responded to that

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Customer reply replied 6 years ago

Hello Docs:

I was posing a lengthy question to you and I lost it. I will start over continuing from last answers.

After getting unit of blood on 9/22 Mrs was released to home from hospital with a follow up appt for CBC on 9/26, Urology followup on 9/27 and appt with her Oncologist on 9/30.

Mrs. released weak, blood in urine still present.

Blood Work results were pleasant for a change.

WBC 3.4

RBC 3.69

Hemoglobin 11.4

Hematocrit 35.9

Platelets 94.0

Dramatic change from pre unit in hospital draw.

On 9/27 appt with Urologist Mrs basically had two ?s. When is bleeding going to stop or Do we have to do something else?

Urologist indicated at this point he does not know when bleeding will stop however he is not jumping at other solutions. " Less aggresive is better and at present he would not actively pursue embolization or removal of left kidney"

He indicated several symptoms could force more aggresive action such as plumetting BP's, severe kidney or back pain, increased blood flow and loss, fatique "

But he has a sense this will resolve itself.

Stated there are no active clots and they were not able to to find or isolate clot, diagnosis of Renal Vein Thrombosis is now a Patent diagnosis.

Set follow up in a month.

Urine is cranberry colored.

Oncology appt on 9/30.

Mrs weight down to 112 at home. She is weak. Appetite so/so BP's 115/90 temp normal, still bleeding, horseness in voice, a bit short of breath, fatiqued.

She is just "OK".

Ordered a chest x-ray which was done that day. results unknown.

BP's...Doc told her to eat six times a day, increase fluid intake, salt her food and in effect make her own saline solution.

Blood draws once a week. No evidence of RVT on renal arteriogram(?)

Doctor prescribed a biggie however in order to stop bleeding. A drug call Amicar. Clotting med.

She actually started this today 10/6. 1000 milligrams, 3X a day.

This drug is scary both to Mrs. and the family. Her mother died of pulmonary embolism, and is very mindfull of clot dangers.

Given all factors, including no sign of metastatic cancer, Lungs good, heart good, all of the tests in hospital pointing to a non specific bleed from kidney and now the addition of Amicar, what are the options of that have not been medically pursued?

If Amicar does not work can that drug just be stopped?

Can Amicar cause a life threatening clot?

Despite no signs of metastatic cancer are there other tests which could be done to possibly point to a source of blood loss?

Are we just facing a yet undiagnosed progression of post Whipple Pancreatic Cancer? and that bleed is a first sign other cancer issue in lining of kidney, ureter lungs etc.?

What about a PET scan?

What about a blood test MD 70? ( I think this is correct) Should we request another CA19-9 at next blood draw?

Or should we just manage the blood loss until other symptoms present?

Thanks.

Customer reply replied 6 years ago

I just received partial results of CBC done on 10/4/11

WBC 2.9

RBC Not in

Hemoglobin 10.7

Hematacrit 33.3

Platelets 69

Chest X-Ray Impression: "No accute Abnormalities"

Thanks

Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 47,938
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
Verified
Hello, this is Dr. David. I have read your question and am ready to help.

the options not pursed are removal of the kidney, embolization of the kidney, but these are much mroe dire options.

yes, the Amicar can be stopped.

yes, the amicar has a small risk for causing clots.

sounds like the hemoglobin is dropping fast from 11.4 to 10.7 I think something should be done. Does she like green leafy vegitables? they have a lot of vitamin K in them and could also help stop the bleeding. You could try her on lots of spinich and kale for a week and see if that helps stop the bleeding and if this doesn't work, try the amicar.

good luck. let me know if you have other questions.
Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 47,938
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer reply replied 6 years ago

Doc I have further questions.

Furthur cancer marker tests? What kind? PET Scan?

What is Mrs. cannot eat leafy vegetables because of Whipple? Is pill form of K acceptable.

Embolism and kidney removal off the table for now. Next urology appt. not for 3 weeks.

Next blood work next Tuesday, the 11th.

If Amicar and or veggies are effective will results be noticible by then.

Side effects of Amicar, if any, will they be immediate or will it be cumulative.

If Mrs. decides to stop Amicar does it need to be gradual?

Thanks

if she has pancreatic cancer history, she should have her CA19-9 and CEA levels monitored. She can have a pet scan, but I don't think a PET scan will show if there is cancer in the kidneys because the kidneys light up substanially by filtering out the FDG contrast marker used in PET scans even when there is no cancer in the kidneys. she can try a pill form of vitamin K. if the amicar or vitK works, then she might not have to have her kidney removed. I'm sure she has already had a dedicated kidney ultrasound. some of the very rare serious side effects from amicar are immediate. but if she doesn't get these, there are still chances of side effects such as nausea, diarrhea, high blood pressure, headaches, rash, upset stomach, swelling in the legs. these are not all guaranteed side effects. she can stop amicar right away.
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Customer reply replied 6 years ago

Thanks Doc! Good information. One more question.

Mrs. was placed on Warfarin after a serious clot issue in August 2010 while undergoing chemotherapy and just after palative radiation treatments.

At this point vascular physician placed IVC filter just above outlet from left kidney. It is now tilted in the Vena. The physicians think it is still effective, however the tilt is very evident on CT scans.

When Mrs. went in hospital last month, they took her off Warfarin of course, because of the bleeding.

Is Vitamin K, which is available by prescription only, an antidote to Warfarin?

If yes, is it preferable to Amicar because of side effects (potential clotting) of Amicar?

Mrs. is weak, nausea and vomiting are not happy options either. Especially as she has been told to eat 6 times a day to put on weight.

Does Vitamin K in pill form have side effects.?

My understanding is that Mrs. was told not to eat leafy veggies because of contraindications while using Warfarin. That ban has now been lifted.

Thanks for your help. I will await your reply.

vitamin K is an antidote to warfarin.

vit K is not preferable to amicar.

I think she is in a very tough situation. she is at very high risks for future blood clots but she is bleeding as well. I am wondering if the tilt of the IVC filter is causing the bleeding from the kidney. if her blood gets too thin, her kidney bleeds more, if we clot her too much, she will make some clots in her legs or elsewhere. these very difficult situations and often times patients can go downhill very quickly from either problem and pass away because of the issues.

I would talk to your doctor about the option for vit K. I think that has less side effects than amicar. but I think both medications can be risky and cause clots. ask them if the IVC filter is the cause of the bleeding or if it can be removed or adjusted. I sort of doubt it.
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Customer reply replied 6 years ago

One more Doc.

I have questioned the IVC being a source of the bleed. It is possible.

I have asked if another filter can be placed above the present one, as an insurance filter, as they are reluctant to take the current one out.

Is this posible?

Is it advisable.

Can Kidney bleed be a long term management issue with no Amicar and no Vitamin K.?

None of us in the family, nor does Mrs. have good feelings about Amicar or any clotting

agent at this point.

If bleed is from Vena and not Left Kidney how is that resolved? It would be terrible to embolize the Kidney if that did not stop bleed.

Thanks Doc.

I wouldn't put another filter in. if it is tilted, it should still work.

kidney bleed is a real pain in the neck long term issue because she will need blood transfusions routinely.

I think the bleed is probably from the IVC filter which could be localized very close to the left renal vein or the renal pelvis and this irritation is probably what is causing the bleeding.

Most IVC filters are permanent, but some filters are now available that are "retrievable." I suspect she has one of those permanent ones.

yes, that would be terrible to embolize the kidney if it didn't stop the bleed. I don't think the bleed is from the vena cava. because if it was, it would not come out from the ureter. but I do think it is from the IVC filter in the vena cava which can be very close to the left renal vein and renal pelvis.
Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 47,938
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Dr. David and 87 other Oncology Specialists are ready to help you
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Customer reply replied 6 years ago

Thanks for help Doc. I am leaving you to other problems tonight. Lots of good information today and clarification of issues.

I am sure we will have more.

thank you for the accept and bonus.

best of luck to you and your mrs.
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