Physical Training Sept 2010
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The Invisible Enemy Within

copyright 2010 Ken Goldstein, all rights reserved

I'm not sure if anyone else has ever called a kidney stone a "blessing," but if it wasn't for one persistent stone, I'd be dead today, and not writing this article.

I've trained in martial arts since 1951, when my father decided that the judo and fencing training he'd had would be a great way to teach me some of the discipline he expected. After training for a dozen years in the U.S. and Japan, I had my own judo dojo until my draft number came up as number 2 in 1970, and had also managed to achieve my fencing master certification, and so considered myself fairly aware of what my body was doing.

Moving forward a few decades to last year, I was by then studying Muso Jikiden Eishin Ryu iaido and Shinto Muso Ryu jodo along with my wife, kept myself in decent shape, and still thought that I knew my body pretty darn well. So it most certainly came as a shock to suddenly find out that I had stage 1 kidney cancer. I inherited my Dad's tendency to have kidney stones every few years, but after 15 years of them, it had gotten to the point where nearly all the lovely jagged stones just passed on through my system, albeit with quite a bit of associated pain. But one stone decided to take up permanent residence in my right kidney, and after about a week of feeling really rotten, I headed for the local emergency room one Sunday morning right after jodo training.

The ER doctor sent me for a CAT scan, and found that the stone was small, and would likely pass within a few hours, but she sat my wife and me down and told me that she had also spotted a suspicious mass around my left kidney. Sending me back in for a higher-resolution scan with an intravenous pyelogram to increase contrast, the radiologist told me to get my okole into my urologist's office the following day. It didn't take my urologist 30 seconds to diagnose me with what's called a renal papilloma, or kidney cancer, and two days later, I was on the operating table having my left kidney removed, along with the fist-sized tumor surrounding it and one of my adrenal glands.

The nephrectomy consists of laparoscopic surgery where the surgeon inserts two tubes into the abdomen, one to inject nitrogen to inflate the area so he can get to the kidney, and a second tube with a camera to see what he's doing. In my case, he made a vertical cut about six inches long through my belly button, just big enough to safely remove the kidney and tumor, both of which had been carefully enclosed in a plastic bag to make sure no cancer cells got loose. He then used super glue - it was originally invented to minimize surgical trauma - to seal me back up, and then wheeled me back into the recovery room after the roughly 45-minute operation.

My recovery was surprisingly fast, mostly because I was in good shape and I refused to just lie in bed as the ward nurse demanded. I got clearance from my surgeon to walk as much as I felt able, and managed about 1-1/2 miles around the ward the day after my operation. Three of my fellow sempai in our MJER dojo are physicians, and all came to visit me in the three days before they finally kicked me out. One of them laughingly said that I had really caused quite a stir in the ward because no one had ever managed to exercise so much so soon after major surgery. But I was back in the dojo swinging my iaito just nine days after the operation. If you ever have the chance to choose surgical glue after an operation, I strongly suggest that you do so. No itchy stitches to remove in the doctor's office, and when the glue starts peeling, you just pull it off and you're done.

In between the ER and my surgery, I was of course on the Internet researching kidney cancer, especially what causes it. To my surprise and dismay, I found that nearly 100% of the people who are diagnosed with kidney cancer are very likely to be in stage 4 when they find blood in their urine. And as there is no treatment yet for kidney cancer, other than immediate removal of the kidney and tumor, 80% of those patients die within two years, and 95% within five years because at stage 4, the cancer cells have metastasized and spread throughout the body.

So I was incredibly lucky to have found the cancer in its earliest stage, as it was still completely encapsulated and hadn't spread at all. With no way to treat it, I was at least spared radiation therapy and chemotherapy, but was still in shock that something like this could have happened to me, especially when I felt great, had no symptoms whatsoever, and frankly had never even heard about kidney cancer.  There are only two risk factors for the disease, including smoking and misusing over-the-counter pain medications for a long time.

There are also possible signs of renal cancer, including:

        Blood in the urine
        A lump in the abdomen
        A pain in the side that persists
        Loss of appetite
        Weight loss for unknown reasons

Unfortunately, these possible symptoms are associated with many other problems, most of which have nothing to do with the kidneys or cancer, so kidney cancer would likely be a long way down the list of what even the most conscientious doctor would be looking for. I had had a full physical exam less than a month before my diagnosis, and my long-time family doctor didn't see anything at all amiss.

The other problem is that it takes specialized tests to diagnose renal cancer, and these tests would be unlikely to be prescribed under normal circumstances. Normal blood tests and urinalysis don't show the problem, and even a liver function test will only show that the cancer has spread to that organ. The CAT scan is really the mostly likely test to find kidney cancer, although an MRI or even an ultrasound exam may find some sign of the disease. But from a practical standpoint, unless your doctor is lucky enough to find the problem while looking for something else, you're not likely to have a good prognosis.

About 50,000 patients are diagnosed with renal papilloma annually, a quarter of which die that year, just in the U.S. Although there is currently no diagnostic test, research is being done to find ways to identify the disease in its early stages. In my continuing Internet studies, I found a May 2010 article in Mayo Clinic Proceedings that described a study at Washington University School of Medicine in St. Louis which has identified a pair of proteins excreted in the urine that could lead to earlier and more accurate diagnosis of the disease. But having this type of test as routine screening in your doctor's office is still at least a few years in the future.

As a cancer survivor, all I can say is good luck, and suggest that you ask your family doctor whether he or she knows of any new diagnostic procedures for kidney cancer the next time you go in for an exam. If it can happen to me, believe me that it can happen to anyone!

Ken Goldstein lives in Hawaii.

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