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I know that this stuff can be confusing. And of course scary. And sometimes being scary makes it more confusing or being confusing makes it more scary, so let me give you a little more information.

This test, the GFR (glomerular filtration rate, words you can quickly forget) or nuclear scan, is one of the best measures of kidney function. Better than, say, the weekly blood tests of Austin’s creatinine level.  And it’s a test that he must have prior to getting the particular chemo he’s scheduled for this weekend. So he’s had this test twice before and, as I mentioned yesterday, we were pleasantly surprised with the results both times.

This time we were expecting it to be a little worse. A little worse. We have put that kidney under major stress after all, with both radiation and twelve weeks of chemo. And there have been red flags in the past weeks: his blood pressure medication has quadrupled since December, he’s been spilling small amounts of blood and protein into his pee. So we’ve been realistic, aware that the aggressive nature of this treatment will not doubt put the kidney at risk.

But — and this is a big but — he still is not showing signs of being in kidney failure. He’s peeing regularly, he’s not at all puffy or lethargic. And there are other valid explanations for the blood in his pee, most notably the blood thinner he was taking twice daily for that clot (the dreaded shot which has thankfully been discontinued since the clot has thankfully cleared) and the Heparin he has flushed in his PICC line three times a day (also a blood thinner). Plus the acute trauma of the chemo itself, all of which is flushed out through the kidneys. I mean, kidney.

So, there are excuses for these other bad signs. (Can you see who I’m trying to convince here?) And, importantly, his creatinine (a measure of kidney function we’ve been watching for years) has remained relatively steady. It did go up from its pre-chemo baseline, but hit a plateau still within the normal range.

And mistakes happen in medicine. All the time, unfortunately. One tiny thing goes awry and the whole test is rendered irrelevant. The man I spoke with today to reschedule the test said that they’ve ordered new contrast from California in case there was something wrong with their current batch. And he said this “happens sometimes.”

So, we’re still hopeful. I mean, my mind has definitely started to go down those roads, so well-traveled in October and November, of save-the-kidney versus attack-the-cancer. But we’re hopeful. The test will be done tomorrow and we should have results by evening or Wednesday morning at the latest.

Until then, we hope. And after that, we deal. As always.

After last week’s emotional high, we’ve begun that speedy descent downward. Well, no, that’s not true, we haven’t begun it yet. It’s more like we’re perched at the top of the roller coaster, having slowly crept up with the creak creak creak of the wheels and are now poised at the top, awaiting the plunge. Only this plunge is not for fun.

Last Thursday, Austin had another of those major kidney function tests, a GFR, where they take a series of blood draws over the course of the day to see just how well the kidney can filter out the test-fluid they first inject into his blood stream. This is the one (also called a “nuclear scan”) that we were so pleased was normal back in December following the kidney-sparing surgery and then were even more pleased in January when it was even more normal. Well, his result on Thursday was so far from that, so totally not normal, that they think there was some sort of “interference.” I have no idea what might have interfered with the results, but I hope something did because if that score is correct, the kidney is pretty much done for. As in just-go-ahead -and-remove-the-damn-thing-now-so-we-can-finish-chemo done for.

Not panicking yet. Worrying? Yes. But not panicking. He doesn’t appear to be in kidney failure, for what that’s worth. I mean, I think we’d notice something. His weekly lab results are fine, he’s not puffy, still peeing, the whole bit. So we wait for the repeat test, which will happen on Tuesday, and take it from there.

Perched at the top of that roller coaster, not sure when we’ll fall.

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February 2020
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