Let’s continue our journey with my patient from last month’s article ( https://www.imaramedical.com/blog/handling-covid-19-at-home ). She returned to see me about one year after the removal of the kidney which had the cancerous tumour. I enquired about the results of her blood work and the function of the remaining kidney. I was advised that her specialist was happy with her last results. I asked her to do some blood work to check on the kidney function, and to repeat an ultrasound to ensure there was nothing compromising that solitary left kidney. Though she had no complaints she agreed. You may recall that she had uterine fibroids that previously were not a concern. The ultrasound showed that her left kidney which previously had no blockage, now showed evidence of mild blockage due to compression of the draining passage by her uterine fibroids. This was a new finding. Also concerning was a decrease in the function of her remaining kidney evident on the blood work. She had no symptoms. The remaining kidney function was sufficient to maintain normal function. However, it was imperative to act quickly to relieve the compression of her remaining kidney to avoid further decline. She could not believe it. Another surgical procedure would be necessary. This was arranged and performed quickly, I am happy to say without any complications. My patient was worried about her kidney function and sliding into depression. Certainly she had been through a lot. We talked. I reminded her that as hard as it seemed we had caught it early enough to prevent disaster. It was very hard for her to face another operation. Imagine thinking that the health issues are over only to have another challenge to overcome. It was not surprising that her spirits flagged a bit. It really seemed too much. She stayed focused though and did what as necessary. . She is doing well. Her kidney function remains stable and I continue to monitor her. She remains on her iron and her blood count has improved a lot. She was sent to a specialist in kidney function (a nephrologist) early. The nephrologist sees her periodically to monitor her kidney function. This is very important in order to detect any decline early and address it. The kidneys clean the blood which are excreted in the urine. We are able to maintain normal urine output even when we have lost 70% of kidney function. Renal failure occurs when so much function is lost that the waste products build up in the blood and special measures are needed to remove them. This usually means some form of dialysis, which is expensive especially for the uninsured. The kidneys also support production of red blood cells which transport blood around the body. When they fail anemia results.

Most people have heard of uterine fibroids. These non-cancerous growths are common in black women and often do not cause sufficient problems to justify the risks of surgery. Fibroids can cause heavy periods, and can compress important structures such as nerves, vessels and the bladder. When they compress nerves they can cause back pain. Compression of the large veins that come from the legs can result in clots forming in the legs. This is known as deep vein thrombosis or DVT. If these clots then travel from the leg veins to the lungs they can cause death, usually quite suddenly. Uterine fibroids may also compress the drainage system of the kidney, as they did in this young lady. In some instance depending on their location, they may contribute to difficulty achieving or maintaining a pregnancy, although most women with fibroids are able to conceive and carry their baby to term. They may also distend the abdomen giving an appearance of being pregnant that some ladies do not like. In women who are young or have borne no children only the fibroids are usually removed. Surgery for removal of uterine fibroids is performed by a gynaecologist. This procedure is called myomectomy. My patient made the decision given her medical issues, and the fact that she had a child, not to get pregnant again. In discussion with the gynaecologist and considering the real risk to her solitary remaining kidney, she decided it was best to remove the entire womb. She has done really well and her health status is good.

This patient’s journey was a great lesson in persevering through hard times. I am so impressed by her resilience. For me it highlights the need for regular monitoring to detect changes in a patient’s health status. It is tempting to relax. I am happy we did not.

 Dr. Simone French is a Consultant Emergency Physician, and the Medical Director at the Emergency Medicine Division of the UHWI. She is the physician owner of Imara Medical Centre where she practices general and urgent care medicine.

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