First of all, thank you thank you thank you for the enormous outpouring of support and love and sadness that came from all corners yesterday. It means so very much to us to know there are so many people out there thinking about us and praying for us and pulling for us. I have said it before and I will say it again (how many more times I am not sure): We draw strength from all of you.
As I read through the flood of messages yesterday, here and on Facebook and via email and even that old-fashioned thing called the telephone, I smiled and I cried and I felt you around us. When I listened to the morning message from my fellow non-believing friend that said she was wishing for a Christmas miracle, I laughed and I cried and I thought, yet again, yet again (how many more times I will think it I am not sure) how very lucky we are.
We have a plan, of course a very different plan from the one we thought we had yesterday. We’ve decided to skip the needle biopsy because we realized, as Jeff walked us through it, that our next action would be the same (surgery) no matter what the biopsy told us (or didn’t tell us). Confused, yet? Here’s the deal: As I’ve mentioned before, these needle biopsies have a high likelihood of providing no definitive information. So if it gave us “unconfirmed findings,” we would opt to do an open surgical biopsy. If the needle biopsy told us this mass was a nephrogenic rest (one of those pre-Wilms tumor tumors), we would have done a surgical resection (removing at least the mass because if it doubled in size in three weeks it was probably well on its way to being a full-blown Wilms tumor anyway). And if the needle biopsy revealed that this was indeed another Wilms’ tumor, then we would have done a surgical resection.
Ultimately, the needle biopsy is a waste of our time, as it’s not going to give us any information that will change what comes next.
So . . . what comes next is a CT scan on Thursday just to make sure that his cancer has remained local (that it hasn’t spread to his lungs or liver, as Wilms tumor sometimes does). We don’t expect this because it hasn’t spread in more than two years, but we need to make sure, just in case. We’ll check into the hospital tomorrow (Wednesday) evening for pre-hydration, have the scans on Thursday at 2, and then be released home after another 6 hours of hydration.
Then, after what I hope will be a very happy and Christmas-y weekend, we’ll check back into the hospital on Sunday afternoon for surgery Monday morning. And this is where things get interesting (that’s a cue to start paying close attention). We have decided, upon the recommendation of both our oncologist and the surgeon, to attempt a kidney-sparing surgery. Yes, you read that right. After all that back and forth over the past few months about the pros and cons of another kidney-sparing surgery, and after initially deciding that it wouldn’t be successful and wouldn’t be wise even if it happened to be successful, we are going to roll the dice and give it a go.
The cons (because I know they’re already running through your minds): It might not work. We might place all our hope on this one procedure and the kidney might fail anyway. We know this and are preparing for it, and I don’t just mean mentally. The surgeons will actually place a dialysis catheter in his thigh (or neck?) for temporary use if he does indeed end up needing dialysis. They figure the surgery for inserting it is considerably more difficult than the surgery for removing it, so we might as well be ready. And even if the surgery works, he still might need temporary dialysis, like he did after his first kidney-sparing surgery in October 2007, so this will make that process easier.
The other con, and this is the big one, is that by leaving the kidney in, his cancer might recur again, in another six months or another year, and we’d have to go through all of this yet again. That possibility is real, and scary, but remember that we are in uncharted waters. We have no stats on any other kids with this exact kind of Wilms and, truth be told, we have no way of knowing or predicting if it will return and when and why and what we might do to prevent it.
Which brings us to the pro. The big pro, the huge pro, the reason we’re willing to take this chance in the first place, is that it just might work. We might open up my little boy’s body, for the sixth time in his short life, and manage to remove just the cancer, and all of the cancer, and the kidney might keep on filtering and keep on working and keep on peeing and we just might make it through. This surgeon, new to us since Austin’s last surgery, has actually done two kidney-sparing surgeries on the same child before, and it has worked. Plus, this tumor is still very small, and it’s solid, so they could get clear margins. There are huge and forbidding hurdles in our way, we certainly know that, but . . . BUT it might work.
And that little shred of hope is all we need. That is enough.
We might get our Christmas (or our Hanukah) miracle after all.