Treating kidney cancer when you can’t afford to lose a kidney

One of the biggest problems with kidney cancer (also known as renal cell carcinoma or RCC) is removing it. Obvious, you say.

However, the reason is not what you might think.

 The surgical options for resecting (cutting-out) kidney cancer are well-developed and usually pretty straightforward. The kidney containing the tumor is removed (nephrectomy) or just a part of the kidney might be removed if the tumor is small (partial nephrectomy). All of this is just fine– as long as you have a second kidney that is normal and can pull duty for the one you are about to lose. But some people don’t have this option due to chronic kidney disease from diabetes or high blood pressure.

Two cancers in the right kidney (arrows)-- oh my. You are looking at a CT "slice" (cut section of the human body) from the patient's feet looking toward the head.

Two cancers in the right kidney (arrows)– oh my. You are looking at a CT “slice” (cut section of the human body) from the patient’s feet looking toward the head.

Years of these conditions can lead to so much kidney damage that these patients cannot afford to lose even a part of one kidney– They risk permanent renal failure and may need kidney dialysis treatment for the rest of their lives.

 The patient in this picture has 2 kidney cancers in his right kidney (arrows) and has no options for surgery due to long-standing kidney disease and poor function. What are his options?

renal cryo

Several “cryoprobes” inserted through the back. The tips are guided into the tumors using guidance from CT scanner images

  1. Remove the kidney and probably start dialysis treatments three times per week for the rest of his life. This is very difficult for families’ finances/schedule and for the patient’s sense of well-being
  2. Do nothing and hope the cancers grow slowly and don’t spread. This is unlikely to happen.
  3. Perform regional tumor therapy consisting of needle-puncture and ablation (destruction) of the tumors only, while preserving as much of the kidney as possible. This option was chosen for this patient to treat his cancer in a way that maximized tumor destruction but minimized risk of permanent renal failure. 
Grey fuzzy blobs (“iceballs”–white arrows) surround the bright needles that are embedded into the kidney cancers

Figures 3 (right) and 4 (below) show the “Cryoprobes” inserted into the tumors with guidance by a CT (computed tomography) scanner. “Ice-balls” (white arrows)  form as the freezing process envelopes the tumors. This treatment takes about 2 hours and involves admission overnight. Post procedure pain is minor and goes away in less than a week with pain medications or just Advil/Tylenol.

 By the way, the patient’s renal function dropped slightly after the procedure but returned to baseline about a week later and he requires no dialysis. To monitor how successfully we killed these tumors, we repeat a CT or MRI scan in about 3 months. If some tumor remains alive, further treatment is considered and is generally easier and safer than the first procedure.

UTMB Perinatal Hospice

We have recently updated the website for our Perinatal Hospice Program at UTMB and we are honored to have a contribution from the parents of our first enrolled family.  Please visit our site and see Abby’s story.  If we can be of help to anyone dealing with a lethal diagnosis in an unborn baby, please feel free to contact us through our website’s contact page.  http://www.utmb.edu/perinatalhospice/

Perinatal Hospice and Palliative Care

Cara Geary, MD, PhD, is an associate professor of pediatrics in the Division of Neonatology and director of UTMB’s Perinatal Hospice and Palliative Care Program. Among her interests, she works to enhance humanism and compassion in medicine.

UTMB uses 3-D brain simulator teach neurosurgery students

In brain surgery, a mistake can mean a disability or death. So how do you teach a neurosurgeon without mistakes? In this recent newscast by the Houston ABC affiliate KTRK, Christi Myers shows how Dr. Jaime Gasco uses a 3-D brain simulator. UTMB has one of only five simulators in the United States. In the first two UTMB studies, they found that medical students who were going into neurosurgery were 30 percent to 50 percent more accurate if they trained on the computer brain simulator.

Kale: Can you really eat it?

Dr. Victor Sierpina

Dr. Victor Sierpina

At a recent fundraiser for Meals on Wheels, the wonderful chef at the Galveston Country Club served a lovely salad made with kale.

A friend sitting with us who runs one of Galveston’s finest healthy eating establishments expressed an opinion that many of us may hold about kale: it is a nice ornamental in your garden or a garnish on the plate, but who would eat that bitter stuff?

So why, when a friend of my wife’s gave us a couple big bunches of organically homegrown kale was I as happy as a 10-year-old with a new pony? Because kale is a really healthy, nutrient-dense addition to the menu plan and offers many ways to enjoy it. Americans are falling in love with kale like never before, even raw kale. Continue reading

Make room for some down time

Dr. Victor Sierpina

Dr. Victor Sierpina

It seems to be a mark of status in our society to be forever busy. Ask someone how they are and a likely response is, “Busy.”

Now there is nothing wrong with attending to business, family and other responsibilities. However, it seems to me that the slavish value we give to always being busy often goes too far.

What about down time? What about taking time when we just stop our endless busyness to rest, reflect, recuperate, and recharge? Isn’t this just as great a value to our health and happiness as constant motion?

My favorite Chinese philosopher, Lao Tsu had much wisdom to offer us on this topic. More than 2,500 years ago, Lao Tsu said “Always be busy, and life is beyond hope.” And on the benefit of quietude: “Who can wait quietly while the mud settles? Who can remain still until the moment of action?” Here’s another: “A truly good man does nothing, yet leaves nothing undone. A foolish man is always doing, yet much remains to be done.” Continue reading

Sex is a window into who we are as a person

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and
Catherine Hansen

We treat women, sometimes men and, ultimately, couples for sexual dysfunction. A lot of the time, problems in the bedroom are an indicator of something much bigger. The relationship needs help.

Research has found that married men and women are healthier, happier and live longer than their unmarried counterparts.

We understand on many levels something that our patients may not be aware of when they ask for help — that healing a sexual relationship heals people. It restores individuals, couples, marriages and even families.

Studies have shown that growing up with married parents is associated with better physical health in adulthood and increased longevity.

Keeping our patients’ relationships strong can improve their individual overall health and improve how they function at home, work and in the community.

All relationships go through stages, with the first stage marked by an inability to use necessary brain functions, mainly critical thinking. This is the “honeymoon phase” of infatuation and romance. Continue reading

Bodies change after birth

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and
Catherine Hansen

Bringing a new life into the world is truly a miracle. Yet in the aftermath of the birth and all the excitement surrounding bringing the baby home, many women find themselves noticing something not so miraculous — their body is not the same.

The uterus, vagina, pelvic muscles and nerves undergo tremendous change during pregnancy, delivery and postpartum.

The uterus shrinks back to approximately its pre-pregnancy size within six weeks. Bleeding can persist throughout this time, but resumption of an actual period is variable and often significantly delayed if a woman decides to breast-feed.

The hormones a woman’s body produces around the time of delivery empower the cervix and vagina with the tremendous capacity to expand and contract.

Frequently, though, the baby exceeds the body’s powers of expansion and tears the vaginal skin. Minimal tears or abrasions will heal on their own (although they can sting with urination during the healing phase), while deeper cuts require stitches. Continue reading

How can we detect early prostate cancer?

small prostate caThis is a high-resolution high-strength magnetic resonance (MRI) image of the prostate gland below the bladder. Notice the 6 mm dark spot to your left (white arrow on the right side of the prostate). This represents an early prostate cancer confined to the gland. Often, these small cancers can be treated with lasers and no surgery.

 

 

 

 

 

The Right Choices for a Healthy, Smart, Super Baby

Dr. Victor Sierpina

Dr. Victor Sierpina

Infertility, premature birth, children with neurological conditions such as autism spectrum and attention deficient disorders, obesity, and diabetes are now rampant in our society.  Scientists have determined these problems have been increasing rapidly over the last decade and longer.  

No single cause for these trends been agreed upon by specialists. Factors such as brain injury, genetics, behavioral, and social problems all play a likely role.

I am going to suggest a not so radical idea. These problems in the ability to conceive, to have a healthy pregnancy, and a healthy baby are primarily linked by several common causes: nutrition, lifestyle, and environment.

To put it basically, we are living very different lives than our ancestors whose diet was mainly whole, home-cooked foods, without the chemicals that are part of our contemporary environment. In the past, babies were all breast-fed and obesity in adults or children was rare.  And how about daily activity levels? Stress?

Our environment has changed radically. Foods are now highly processed, pesticides and insecticides in them are common, chemicals from plastics disrupt vital hormonal pathways, and nutrient deficiencies alter expression of genes and increase birth defects. Continue reading

Study Shows Big Improvement in Diabetes Control Over Past Decades

At the Stark Diabetes Center, one of the ways we strive to improve the health and quality of care for Texans is through  a specific emphasis on prevention of diabetes and its complications. So, we’re very encouraged when we hear more people are meeting recommended goals in the three key markers of diabetes control, according to a recent study conducted and funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

The report, recently published online in Diabetes Care, shows that, from 1988 to 2010, the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2 percent to about 19 percent. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010.

The measures are A1C – which assesses blood sugar (glucose) over the previous three months – blood pressure and cholesterol. They are often called the ABCs of diabetes. When these measures fall outside healthy ranges, people are more likely to be burdened by complications of diabetes, including heart disease, stroke, kidney disease, blindness, and amputation.

Despite improvement, the results show continued need for better diabetes control. In particular, young people and some minority groups were below average in meeting the goals. Read more and access the full report…

Lynn Maarouf is a registered dietician offering diabetes education and nutrition counseling at the Stark Diabetes Center at the University of Texas Medical Branch at Galveston.