Where is the leak?

Post op Steph with 4 tubes

I apologize for my lapse in posts but Stephanie and I have tried to find some long lost normalcy in our lives and we have filled our schedules with busy errands, work around the house, and other things.  However, today she had a very important appointment with her Urologist to discuss the plan of care for her plumbing issues.  

We have learned to arrive at the doctors’ appointments with a long list of questions, a detailed description of what has changed since the last correspondence, and a sturdy notebook to write as many details down as possible.  I like to think that Steph and I are pretty good at this.  In our first appointment with her first oncologist we actually made him sweat a bit because we bombarded him with questions about not only Stephanie’s cancer but also his credentials and experience.  Needless to say, we were very prepared today for this appointment.  

Her doctor is what I would describe as a jolly guy.  He has a commanding presence boisterous voice and an accent that hailed from the hills of Paintsville, Kentucky.  You can't help but like this guy because he always enters the room with something sweet to say to Stephanie and no matter how bad things are going he has a smile on his face when he greets you.  When he first walked in today he started laughing loudly without explanation for about thirty seconds and then explained that Stephanie has done a better job concealing her 4 tubes and collection bags better than any patient he had worked with before.  I looked at Stephanie and saw a look that I am all too familiar with.  It was that look she gives when she is thinking "you're damn right" I do a good job at concealing these tubes.  

We began to discuss her case and it was a lively back and forth discussion.  Stephanie and I were pushing him for a plan of care moving forward that would help us understand when she will have her tubes removed and when she will be able to have the IP chemotherapy treatment that increases the survival prognosis significantly for her type of cancer.  

After about 30 minutes we determined that there are two potential care plans.  One plan would be chosen if her bladder has healed and is no longer leaking urine into her pelvic cavity.  The second plan would be chosen if the bladder is still leaking.  Below I will provide a few more specifics about the two plans and explain why one is more ideal than the other.  

• If the bladder is no longer leaking...
• This is the ideal scenario because the doctor will be able to remove the left nephrostomy tube and remove the foley catheter.  It would also trigger the ureter reimplantation surgery to be scheduled within the next 6 weeks.  This surgery would fix her plumbing issues and allow her to go through the chemotherapy without the added burden of an external urinary system.  
• If the bladder is still leaking...
• This scenario is much more complicated and would require Stephanie to keep all of her tubes for around 6 months.  She would undergo the full chemo treatment including both IV and IP chemotherapy over the next several months and when she is healthy enough for the reimplantation surgery, they would operate.  This is not ideal because, as you can imagine, having external plumbing sucks.  However, it sucks much more if you are going through chemotherapy.  

How will we learn if the bladder is still leaking and when will we know?

Next Wednesday is the very important day when she will have a test that will fill her bladder with contrast and show any leaks via x-ray.  It is a simple test but so much is riding on this 15 minute radiology procedure.  Tubes or no tubes for 6 months.  That is what is at stake for Stephanie.  I can't imagine what is going on in her head as she considers the magnitude of the test results. I hope you keep her in your thoughts and prayers.  She has been so incredibly strong through this process and I sincerely hope she catches a break next Wednesday.