Much to my shock, and some embarrassment, I’ve just realised that it’s been a month since my last update. In my defense I’ve been spectacularly busy recently (both at work and with my family) and not a lot has happened on the medical front in that time. Until today.
There was a positive output from my various tests; namely that there are some signs of improvement in the output from the Gastrografin test. That’s not to say that the abscess has healed – nothing so dramatic – but that there are signs of improvement. Which means we keep on fighting.
On the other hand, the results from the MAG3 Renogram were far less positive. The function of my left kidney is continuing to decline. The split of filtration between my kidneys is now about 70/30, rather than the normal 50/50. So my left kidney is down to 3/7th’s function (about 43%). This is still more than enough that were I to lose my right kidney in some catastrophic accident, I could live on the left without dialysis, so it’s important to try to preserve that remaining function.
And so we’ve spent the last couple of weeks planning what to do about the kidney problem, culminating in my coming into hospital today to have the urologists give me a serious going over. Under a general anaesthetic, thank goodness. The high level plan was to do a more thorough endoscopic investigation, including some work with contrast agents and x-rays to see if the problem was a stricture in the ureter, or constriction of the ureter due to external pressure. My urologist also decided to draft in some assistance from a urologist who specialises in endoscopic treatments.
And so today I checked back into hospital.
After a morning of pre-op tests (including a game of “chase the vein” to draw some bloods) and catching up with all the people who I’ve got to know so well here, I got taken down to theatre first thing this afternoon. Only to discover that despite my surgical team booking the necessary radiological kit well in advance, someone had pinched it for a different operation, much to the frustration and embarrassment of my team. It did make me smile to see that even in a hospital the same human games go on.
Once we’d rounded up all the necessary kit, we did the usual dance with Fentanol and Propafol, and I blinked and woke up in recovery again. I love that trick!
And the conclusion is that the narrowing of the ureter is confined to the lowest point of the ureter, nearest to the bladder (and my abscess) and is caused by external pressure. Apparently there was considerable discussion about the merits of trying to effect a cure by going ahead and dilating the ureter with a balloon catheter, but the final view was that the potential advantages were significantly outweighed by the risks of introducing infection into my urinary system. So for now the urologists have chosen to restent that ureter again which ought to preserve the function I have while we continue to deal with the abscess. Rather sensibly they want to ensure that the stent really is maintaining my kidney function adequately, so they’ll schedule another MAG3 renogram for me in a few weeks time.
Clearly the hope here is that once the abscess is dealt with, the pressure on the ureter will go away, and (ideally) no further intervention will be necessary. And if intervention is required then at least there will be no infection floating around to add any complications.
And as before, the ultimate plan is that if we can’t resolve the abscess then they’ll just sort out everything at once in one massive operation to end all operations. Fun.