Thursday, November 11, 2010

The Background to the Path Forward

On Friday, October 22nd, 2010 Julia came home from school complaining about a stomach ache. That evening we realized she also had a high fever and we assumed she had a some sort of stomach bug. Her stomach ache seemed to come and go during the day Saturday, but still had a fever. We became concerned about her “stomach ache” when we realized it was more a pain in her side or back rather than a nauseous feeling. We called the River Falls Clinic's on-call doctor Saturday night and he said to bring her in in the morning if the pain is still there. The pain was still there on Sunday morning so we took her to the clinic. They did a CT scan to confirm or rule out appendicitis. The images did rule out appendicitis but showed, what looked to be, an abscess on her kidney. The doctor sent us on our way to the emergency room at Children's Hospital in St. Paul.

Julia was admitted to Children's on Sunday, October 24th. On Monday a surgery was performed to insert a drainage tube into the kidney bubble (Julia always referred to it as, “her bubble”). The doctors were surprised that rather than pus, only blood came out. There was also a surprise when none of the urine or blood samples grew anything, i.e. no sign of infection. The plan was then to leave the drainage tube in for a few days to see what came out. The blood flow from the tube soon tapered off and so it was removed on Thursday. Also, starting on Tuesday, Julia had most of her normal personality back, fever gone, and pain gone, and on Wednesday, besides the IV's attached to her, you wouldn't even know anything was wrong with her.

Julia was released from the hospital on Friday, October 29th. The plan was to have a followup ultrasound the next week to make sure the mass was getting smaller or to discuss other options if it wasn't. The ultrasound was done on Thursday, November 4th and we were able to see the same pediatric urologist who had been part of Julia's team of doctors the week before. He explained that the mass was still approximately the same size and that surgery would be needed to remove it. The plan was that the mass would be biopsied and sent to the lab to be looked at and an initial conclusion made while surgery was still going on. This would allow the entire kidney to be removed if need be.

The two-hour surgery was performed on Tuesday, November 9th, by the same pediatric urologist who we had been talking to from the start. The mass turned out to be a Wilms' Tumor, a form of kidney cancer that only affects young kids. For as rare as it is (500 or so cases per year in the U.S.) there is quite a lot known about it and continuous ongoing studies add more knowledge to the pool every year. Most cases of Wilms' Tumor have a very high survival rate, but at this point we don't know all the details, so we don't have an exact prognosis yet.

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