On July 11 of this year I wrote a blog about a friend who had cancer. My 'friend' was about to undergo a procedure that was intended to kill a tumor on his adrenal gland. As some readers might have guessed, that 'friend' was actually my husband. Last Friday he had the planned procedure. I think writing about a 'friend' was easier for me than admitting it was my husband who is challenged by cancer and has been since 2016.
Watercolour of Shen Nung, Chinese deity of Medicine etc.This file comes from the Wellcome Collection, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom. Lcensed under the Creative Commons Attribution 4.0 International license.
As I explained in my blog, my husband has had several tumors either removed or zapped. We've been lucky that way. But cancer really isn't lucky, and while we were grateful the doctors felt they could deal with his tumors singly, in isolation, still each event was a serious medical procedure.
The most recently discovered tumor was (actually still is) on the adrenal gland. The tumor had metastasized from kidney cancer he had back in 2016--at least that was the theory. My husband is 79, so taking the adrenal tumor out surgically would have been a dangerous and invasive operation. Therefore, a less invasive process, microwave ablation, was planned.
It sounded simple: Go in with a fine needle and 'cook' the tumor so all the cells are killed. The tissue of the tumor may remain, but the tumor should be dead--that is, no longer able to grow. That would be the best outcome.
We had to hurry, because microwave ablation is more successful, and safer, on small tumors, preferably under 5cm. As we made preparations for treatment, his 1.9 cm tumor was growing.
*Two doctors preparing medicine, from Dioscorides' De Materia Medica, arabic translation, 1224. Walters Art Museum Illuminated Manuscripts. [Creative Commons CC0 1.0 Universal Public Domain Dedication](https://commons.wikimedia.org/wiki/File:Illuminated_single_leaf,_Two_doctors_preparing_medicine,_Walters_Art_Museum_Ms._W.675a.jpg)*. Unfortunately, most medical procedures, even the minimally invasive kind, carry a risk and this one carried significant risks.
First of all, when mentioned to us originally the plan was to have two distinct procedures. First my husband was supposed to have a biopsy done, to make certain the tumor was a renal (kidney) metastasis. If the pathology report showed that the cells were indeed from the original 2016 cancer, then we were supposed to make a second appointment to have the microwave ablation done.
If, however, pathology showed that the cancer was a primary adrenal tumor then we could not do the ablation. We'd have to have a plan B. Would that be surgery? Systemic treatment? The oncologist didn't tell us. But with two procedures--biopsy and then ablation--my husband would be exposed to the risk of two minimally invasive medical events.
The doctor we consulted was the head of interventional radiology in our hospital (a top ranked hospital). His specialty is in this sort of procedure. I know he has written research papers on the subject, so he is well qualified. His plan differed from the original plan. He wanted to do both biopsy and microwave ablation at the same time.
Although doing both procedures in one event would remove one sort of risk, it would introduce others. There was no way to know for sure that the tumor was a renal cell carcinoma (RCC). Everything pointed to an RCC. This was not my husband's first metastasis. Also, RCCs are known to migrate commonly to the adrenal gland. Plus, we had a targeted blood test done to ascertain if there were any abnormalities in his hormones. If these were normal, given his history, then the tumor was almost certain to be a metastasis from his 2016 renal cancer. Almost certain, but not quite.
If the tumor turned out to be an adrenal mass rather than a renal mass, then my husband could have a severe, life-threatening hypertensive crisis. Massive amounts of catecholamines (adrenaline and noradrenaline) would be released into his bloodstream. Puncturing a tumor comprised of renal cancer cells would not elicit this reaction, if everything went well.
An added risk to doing the two procedures at the same time was that doing the biopsy first might cause bleeding. Blood in the area might interfere with the doctor's ability to have a clear view of the tumor. Throughout the procedure, of course, his actions would be guided by imaging (likely ultrasound or CT scan).
*MWC-Medicine Wagon. Traveling Medicine Show Wagon, on South Bass Island. Done in a Moleskine Watercolor Notebook.Maroonic. Used under [Creative Commons Attribution-Share Alike 2.0 Generic license](https://commons.wikimedia.org/wiki/File:MWC-Medicine_Wagon_(3826554264).jpg).*We knew the risks when we agreed to having the biopsy and ablation done at the same time. But we felt these were mitigated by two things: one, the doctor was outstanding and two he insisted on having a certain anesthesiologist on hand to monitor my husband's blood pressure throughout. Should there have been a hypertensive crisis, that anesthesiologist would have been prepared to handle it.
Friday was a rough morning for me.
As my husband lay in pre-op, with the IV inserted, ready for surgery, the doctors, both the interventional radiologist and the anesthesiologist, came to talk to us. The anesthesiologist was quite serious. He made us understand that the most significant risks for this procedure were heart attack and stroke. He explained that he would be monitoring my husband's blood pressure every second...literally. He said that if there was a sudden change in blood pressure then he, the anesthesiologist, would handle it instantly. He would do his best to keep my husband safe. He did mention that the two doctors had done this together, before, as a team.
I asked him, as he was ready to leave, "Everything is going to be alright, isn't it?"
He declined to answer in the affirmative. All he did was look at me earnestly and say, "That's the goal."
No reassurances. This was serious and he wanted to make sure we knew the risks. He also made my husband sign off, with his signature, on the risks.
That was five days ago. My husband has since gone to play cards with his friends. It's true he ran a slight fever the day after the procedure (normal for that to happen apparently). And he does have a little pain in the area of the biopsy/ablation, but he hasn't taken any medication for pain, besides one Tylenol before he left for the poker game.
As I observe my husband, I think he may be a little more tired than usual, but not so tired that he wanted to skip his poker game.
The only scheduled followup to the procedure is an MRI scan, to be conducted in early September. The doctor has to make sure he zapped the whole tumor and that it is not still growing.
When you live a long time--my husband and I have done that (we're the same age)--stuff is going to go wrong. You hope that when it does you can deal with it. You hope your family will stick by you and your doctors will treat you well. And you hope you will have luck on your side.
That's where we are now. We're grateful, although it's not easy on my husband. Every time a tumor is addressed, it takes something from him. He had to give up a large part of his tibia last year. But he's here and he's with his family. He plays cards, follows sports and politics and chuckles at the cat.
What is the future? What is anybody's future?
We have to continue to go for scans. We have to look for new tumors as they appear. That's life the way we live it now. So far, it's a good (though not perfect) life.
Thank you for reading my blog. Health and peace to all. Hive on!
