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Today's Appointment with the Nephrologist

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mp327
Posts: 4144
Joined: Jan 2010

I just returned home from my follow-up appointment with the kidney specialist.  I saw a different doctor this time, as the doctor I saw the first time was not scheduled to be in the office today.  The one I saw today was very young and I liked him very much.  Prior to my meeting with him, blood was drawn and a urinalysis done.  When he came into the exam room, he had all the results and, to my pleasant surprise, everything looked very good!  My renal function tests were all within normal limits!  Woohoo!  He told me that it's possible that my kidney issues are due to my used of NSAID's (Advil) over the many years and that stopping them a few months ago has begun the process of reversing some of the damage done to my kidneys.  He feels that I am at Stage 2 instead of Stage 3 and that it's even possible for me to go back to Stage 1 if I avoid the Advil, continue to exercise, and eat a balanced diet.  Even though I am not hypertensive, he said it was good that I was reducing my sodium intake.  He gave me the green light to continue drinking coffee--YAY!--and alcohol in moderation--YAY!   I am scheduled to go back in 6 months for labs and a follow-up appointment.  At that time, I will be seeing the doctor I saw the first time.

I am putting this in a separate paragrph to bring attention to this part of the story.  I discussed with him the fact that I was a cancer survivor and had had numerous scans with contrast over the past 7 1/2 years.  I brought this up because contrast can be very damaging to the kidneys and I alerted him to the fact that my medical oncologist has ordered a CT scan with contrast for me, which is scheduled in February.  He recommends that I find out from my oncologist if the scan can be done without contrast.  If not, he recommends loading my system with fluids prior to the scan.  He emphasized that this does not mean the normal 2 liters of water per day, but even more.  I am going to call my med onc's office next week to discuss this with his nurse and ask her to get his take on this.  I do not feel that the scan is even necessary, but he will balk at cancelling it altogether, so I will have to wait and see what he has to say.

For any of you who may be getting CT scans with contrast, PLEASE, PLEASE,PLEASE drink lots of water prior to and after the scan!  Do not let this stuff damage your kidneys!  I discussed this with my friend who is a pharmacist who told me that in pharmacy school, the kidneys are studied more than a lot of other parts of the anatomy, so he is very knowledgeable and someone I trust.  We both agree that no matter the amount of water intake prior to or after a scan, there is most likely still some harm done to the kidneys, perhaps only minor.  However, like in my case, when numerous scans are done, the effects can be cumulative.  I guess that, in addition to the radiation exposure, is another good reason to limit scans. 

So, I may not be out of the woods entirely, but I am certainly feeling better about all of this and breathing a bit easier.  I will have to watch my water intake and make sure I get enough every day.  So, tonight when I go out to my favorite hangout, I will be asking for a tankard of water, along with my small margarita--with NO salt!

I hope everyone has a good weekend and I thank you all for your concern and continued support!

Martha

jcruz
Posts: 379
Joined: Jan 2013

I'm so glad you had such a positive appointment, both with the doctor and with the good results.  Sounds like a manageable issue now.

Regarding scans, I know that they can put both us and our doctors more at ease as we continue to be followed up but I do wonder about the necessity of still doing them after the 5 year mark.  Thanks again for sharing that information about the contrast issue for our kidneys.  That's something I was unaware of. 

Enjoy that margarita (my favorite cocktail!) and cheers to your good health.

Janet

 

 

mp327's picture
mp327
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Thank you so much!

Martha

RoseC's picture
RoseC
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Great news Martha! And thanks for the added information - good to know.

z's picture
z
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This is great news, and very encouraging that you might even go back to stage 1.  Thank you for the advice about the contrast.  I only have ct scans for the lung cancer not the anal cancer.  My gyno checks out my anal and I just had a clear colonoscopy.  Have a great weekend, and continued great news.  Lori  Cool

TheNewNormal
Posts: 7
Joined: Nov 2015

Even though I have not "cyber-known" you for very long, your post made my night.  To hear somebody in a  white coat deliver GOOD news must have been such a delicious thrill for you.   For my part, I think I'm going to break out in hives for the rest of my life every time I cross paths with anyone even remotely connected with the medical profession...sheesh.  But congrats, and great advice about the water. 

Enjoy your margarita tonight, as well as your coffee tomorrow morning.

Carolyn

eihtak
Posts: 1255
Joined: Oct 2011

Oh my, I am so happy for your good news!!! Though you may not be out of the woods entirely, you are on a clear path.  Your added info on contrast and kidneys is very concerning to me and I will surely discuss with my doctor...he'll love that, lol. I unfortunately have quit counting how often I'm scanned but it must be a minimal of 2/yr for almost 5yrs. (mine is not standard follow-up as I have had a second cancer after anal and a recurrance of the initial anal) so a lot of tests. I am scheduled to be scanned again in January but will be interested to hear what my doc has to say.

Please do enjoy your salt free margarita and I'll join you for cofee in the morning!

katheryn

mp327's picture
mp327
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Thanks for your messages of support.  I am very happy with these results and need to just continue with the fluids (including coffee and margaritas!).  I may slosh when I walk, but as long as my kidneys are happy, so am I!  Have a good weekend, my friends.

Martha

TraceyUSA
Posts: 316
Joined: May 2013

Glad to hear your research and corrective meausres are paying off.

I was told a long time ago that every drug either goes through the liver or the kidneys and this definitely proves that. Less is best as far as I'm concerned and I will definitely be questioning tests with contrast now.

Enjoy your margarita & coffee!

Tracey

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sephie
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hey martha,  so glad that you got great news!!!!!  now---you are very intelligent....were you not stage 1?????  you know the NCCN guidelines ..... i think it is smart that you would  carefully consider not having another scan after 7 years NED.....just for info:  .I stopped my scans at MD anderson after 4.5  years.  i was stage 2 no mo.....we will see later if this was smart..... take care.....sephie

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Lorikat
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Sephie, you did drop your scans?  I'm due for my 4 1/2 year cans soon and was wondering.  Will you ever go back for a ck up with scans?

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sephie
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i did request for them to stop mine..... the radiology team looked at all my results and i was stage 2 NO MO and decided it was ok  but they did put my request in the record to cover themselves ..... the NCCN guidelines have changed since i was diagnosed in 2009.....they do not do as many anymore..... sephie

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sephie
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forgot to tell you that i have been released by the oncologist , surgeon and the radiation team..... no more check ups at all for anal cancer unless i find something.... sephie

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mp327
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I have composed the following message to my medical oncologist regarding my upcoming scan, which I really think is unnecessary and puts my kidneys, intestines and bones at further risk.  All I have to do is hit "send."  Any thoughts?

I am a patient of Dr. xxx and have a CT scan (chest/abd/pelvis) scheduled on 2/18/16 with a visit with Dr. xxx on 2/23/16, as continuing follow-up post anal cancer in 2008.  In recent months, I have been undergoing testing for Chronic Kidney Disease and have been diagnosed with Stage 2, possibly Stage 3, as per Dr. xxx and Dr. xxx at xxx.  I have been advised to avoid IV contrast if at all possible.  Due to the fact that I now have compromised renal function, a history of intestinal obstructions, and osteoporosis of hips and spine, I am asking if this upcoming scan is absolutely necessary.  I am now over 7 years out of treatment for cancer and am not having any symptoms of recurrence at the primary site and no complaints that would lead me to believe there is any metastasis.  I am concerned about receiving any more radiation and also getting IV contrast, given the above issues, and would like to avoid any further potential damage to my intestines, kidneys and bones, if at all possible.  I continue to be followed by my colorectal surgeon, Dr. xxx, every 6 months for DRE and anoscope.  I will be seen in 6 months by Dr .xxx to see if my kidney function has improved by increasing fluid intake, discontinuation of Niacin and reduced dosage of Aspirin, both for elevated cholesterol.  I respectfully ask for Dr. xxx's opinion, after careful consideration of the above, regarding the necessity of this CT scan.  Thank you.   

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sephie
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great letter....does not offend anyone....states your concerns clearly.......  push send.....hugs....sephie

mp327's picture
mp327
Posts: 4144
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Thank you!

jcruz
Posts: 379
Joined: Jan 2013

Excellent letter.  Spells out your concerns with a just the facts style.  You ask for the Dr.'s opinion but you don't have to go along with it.  Have you spoken with your colorectal surgeon about the necessity of scans given that you still see him/her every six months for exams?

I say hit the send button.

Janet

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Lorikat
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Cheering Sephing!  Cheering!

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nonichol
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Martha, 

I am happy about your results. Cheers!

Norma

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mp327
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Since learning that I do have Chronic Kidney Disease, I have been trying to learn as much as I can about it.  DaVita Dialysis Centers has a support forum, which I joined.  I received notice from them about seminars being held at their centers to educate people about kidney disease.  I signed up to attend one at my local DaVita center, which I will be attending today.  I will try to take good notes and pass on any information that may help any of my friends here.

Martha

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mp327
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Notes From Kidney Seminar on 12/8/2015

 

My husband and I attended the educational seminar at the dialysis center yesterday, and as promised, I am passing on some important information presented.  We were the only ones in attendance, which was nice because it allowed us to freely ask questions.  So, without getting into too much detail about late-stage Chronic Kidney Disease (CKD), I will focus on some general information that I hope will be helpful for everyone regarding causes, detection, maintenance and prevention.

Kidney function decreases with age.  The two main causes of CKD are hypertension and diabetes.  One important test that measures kidney function is the GFR—Glomerular Filtration Rate, which measures the rate at which the kidneys eliminate waste from the blood.    

The Stages of Chronic Kidney Disease are as follows:

Stage 1—GFR greater than 90

Stage 2—GFR 60 to 89

Stage 3—GFR 30 to 59

Stage 4—GFR 15-29

Stage 5—GFR less than 15

Other blood tests that may be included in a renal panel can also indicate reduced kidney function, including:

Creatinine (measures level of waste product from muscles—usually higher in men than women). 

BUN (Blood Urea Nitrogen).  This measures the waste product from protein.

Albumin (Measures nutrition and protein status)

BUN/Creatinine Ratio (calculated using creatinine and BUN levels)

My last creatinine level was .90, which is within normal limits.  However, due to my CKD, the nephrologist would like to see it even lower.  My last GFR was 69, which puts me at Stage 2.

A few very important things I have learned are:

A urinalysis alone cannot detect CKD—blood tests are needed to measure how well the kidneys are removing wastes from the blood, which leave the body through urination.  Also, urine output is no indication of either healthy kidneys or poorly functioning kidneys.  My urinalysis results have all been normal, despite my diagnosis of CKD. 

Kidney function can fluctuate, even in short periods of time.  In my case, my renal panel was normal on a Friday, but abnormal the following Tuesday.  When a person is monitored for possible CKD, their physician is looking for an overall trend in their lab results over a 3-month period.  Fluctuations may be present, but an overall "trending down" in their lab results can indicate possible renal impairment.

Dehydration causes our kidneys to have to work harder to remove waste and may, over time, cause kidney damage so drink up!  The recommended amount of fluid intake per day for healthy kidneys is 2 liters.  Anyone diagnosed with CKD needs at least 72 ounces of fluid per day.  Water is best, but even coffee counts, according to my nephrologist.  Also, anything that melts at room temperature adds to our fluid intake. 

Things that can damage our kidneys include NSAID’s (Advil, Aleve, Motrin, Naproxin, etc.) and should be avoided whenever possible.  Long term use, as in my case, can cause kidney damage.  The good news for me is my CKD may be partially reversible, since I do not have hypertension or diabetes.  My goal is to get back to Stage 1 CKD.

High protein diets for extended periods over time can cause kidney damage.  I am guilty as charged!  We all know we should follow a healthy diet and that sodium is not good for us or our blood pressure!

Some prescription medications, OTC medications, supplements and vitamins can cause kidney damage, so make your doctor aware of all that you are taking.

Since we have all been diagnosed with cancer and are subjects of lots of lab tests, scans, etc., I think it’s very important to know this:  IV Contrast used for CT scans CAN damage your kidneys!  I would highly recommend that before anyone has a CT scan, that they ask their doctor to check their kidney function beforehand to make sure it is safe for them to have the contrast/scan.  Then, and I cannot emphasize this enough, be sure to drink LOTS of water prior to and after having a CT scan.  This will flush it out of your body, inasmuch as is possible.  It is probably impossible to get rid of it all immediately.  Whenever I’ve had scans, I am always handed a slip of paper advising me to drink a certain amount of water after the scan.  However, I was unaware until my CKD diagnosis how vitally important this was to protect my kidneys.

If I think of anything else to pass on, I will.  I hope this information is helpful.

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lizdeli
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I am glad you received better news and appreciate all the info you have provided. I do remember having blood tests before each scan.  I was told that the combination of chemo and scans can be hard on the kidneys. I think it is great that you are questioning whether or not you need a scan after 7 years. I am anxious to hear your doctor's response. 

Liz

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mp327
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I don't remember ever having bloodwork prior to scans.  I now know that was NOT good!  Rather, I would have the scan, then see my med onc a few days later to discuss the results, at which time blood work would be done.  I still haven't heard anything from my doctor after dropping off the letter.  I'll post when I do, you can be sure!

Martha

Phoebesnow
Posts: 563
Joined: Apr 2011

I took a look at the chart that you printed, my results haVe consistently been greater than 89 NB. Whaaatttttt!  No one has ever mentioned kidney disease to me.  I am shooting an e mail to my doctor immediately!  

 

THANK YOU MARTHA!

mp327's picture
mp327
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If your GFR results are always higher than 89, then that's great!  It means that you have kidneys that are functioning well, so you are in good shape!  As I stated in my post, kidney function declines as part of the normal aging process and it's doubtful that anyone will ever test at 100% (which would be a reading of 100 GFR).

Martha

Phoebesnow
Posts: 563
Joined: Apr 2011

Hi,

 

In reviewing the charts at times it was as low as 71!  I am waiting to hear from my doctor.

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mp327
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The thing to remember is that an overall trend is what is looked for over a period of at least 3 months.  Kidney function fluctuates greatly, even from day to day, which is why kidney function should be evaluated for at least a 3-month period to see if the numbers continue to get worse.  Something as simple as dehydration can cause numbers to be abnormal, which is obviously easily resolved just by hydrating.  Other things that can influence numbers are strenuous exercise done within 48 hours of the tests, use of caffeine and high protein diet. 

Please let me know what your doctor has to say.

Martha

TraceyUSA
Posts: 316
Joined: May 2013

Once again, thank you for sharing this. 

I've never been told to drink lots of water prior to scans, in fact most times I have to fast 8-12 hours before.  This last time is the 1st I remember being to told to drink a lot of water afterwards (but no reason why.)

7243
Posts: 242
Joined: Feb 2011

I'm glad for this good news Martha!

 

Note to everyone ... It is a basic standard of care to check creatinine prior to administering contrast.  If they don't, they are not following evidence based practices and they should not administer contrast.  Be sure to ask and know!  FYI. 

mp327's picture
mp327
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Thank you for that reminder!  In all the years I've been having CT scans, my local hospital has never checked my creatinine level prior to the scan, but has only asked on the form I fill out for the last date it was checked and the reading.  Now, always took that information with me, knowing it would be asked.  But I have to wonder how many people do not and they get the scan anyway.  It is disturbing to me!

I thank you for your support and congrats on my recent improved numbers!

Martha

7243
Posts: 242
Joined: Feb 2011

Clarification ... A recent test is acceptable, however top-notch centers want a current creatinine level performed at their lab.  OR They can do it as a "point of care" test ... FYI.

 I had PET - CT scans every 3 - 4 mmonths for 2 years and CT with and without contrast every 6 months up to this last one at 5 years post treatment.  My kidney functions were tested at every scan.   Currently normal ... Important to track this.  I have access to all labs and every scan result via "my chart" EPIC electronic medical record.  

After long discussion with my oncology team, I accepted the risk of scans for the benefit of early detection of recurrence.  A tough decision ... Because there are many risks, like kidney damage and radiation exposure (Exposing me/us to other cancers).  Navigating cancer treatment and subsequent follow-up surveillance is not a task taken lightly.  Each of us must educate ourselves about the options and participate in our care decisions ... We must expect and demand informed consent.  And then we choose ... Not easy.  Especially considering this is our life, our long-term daily quality of life, physically and emotionally.  Not to mention we are usually scared shitless ... Literally! 

And so, we do our best.  This is not the journey I would ever choose, however it is where I found myself.  After 5 years I'm still figuring my way ... Through the haze that is cancer.  

Peace to all of you navigating this same course ... at times I have a strong hand on the  rudder, others, it's a rough ride.  Thank you for being here for me ... 

Phoebesnow
Posts: 563
Joined: Apr 2011

I am happy to say that I do not have kidney disease.  The other tests performed are all normal.  Thank you for this information and yours 7243.

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mp327
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I'm so glad your tests were normal!  I hope you are feeling more at ease now.

Martha

mp327's picture
mp327
Posts: 4144
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 Hello Everyone--

I hope you all enjoyed your holidays and are looking forward to a healthy and happy new year.

I wanted to catch you up on my situation. As I stated in an earlier post, my kidney function was improved with the last round of testing. However, while out of town for Christmas, I seem to have had a possible gout attack. I woke up Monday morning and could barely walk, with pain, stiffness and swelling in my left big toe. Since gout is caused by excess uric acid that has not been removed by the kidneys, I can only presume this is what's going on, since gout often manifests itself in the joint of the big toe. I know, self diagnosis can be dangerous.

Now for some very sad news. I was out of town visiting family for Christmas and received a phone call Sunday evening from my friend and neighbor who is a radiologist at the local hospital. He called to inform me that my medical oncologist dropped dead over the weekend while doing yard work. I am quite devastated. He was such an excellent doctor and not only an M.D. but also a PhD.--a brilliant man. He was an advocate for his patients and loved by all. Despite spending day after day seeing patients who were very sick or dying, he was always pleasant and took time with me and all of his patients, never making one feel rushed. He had the knowledge to save many peoples' lives, but in his moment of crisis, there was no one there to save him. As we traveled home yesterday and passed a federal prison, I thought how unfair life can be sometimes. Prisoners who, some of them are incarcerated for taking a human life, live on and even get free medical care from taxpayers dollars. Then there is this dear man who had spent his career helping people who were very sick, saving many lives, including mine, and he was taken out. I am heartbroken. As a cancer patient, I know how much faith we put in our doctors, and I could only imagine the crushing blow this news will have on his patients, especially those who just began their treatment. How do you walk into the chemo infusion room for that first round of chemo and have hope when you've just learned that your doctor has died? I am beyond sad.

Martha

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nonichol
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Martha, I am sorry to hear about your Dr. I know the attachment that can develop, my Oncologist stoped seeing patients a year ago in clinic as he is moving towards retirement ( he was my favorite). I hope you can get relief for you toe as I know you like to run. Take care.

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mp327
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Thank you so much.

eihtak
Posts: 1255
Joined: Oct 2011

I am so very sorry about the unexpected loss of your doctor......a similar situation happened in my area last year with one of our oncologist, but he had a fatal heart attack while in his own office at work with patients in the waiting room! (This was not my doctor) Earthly life does surely seem unfair at times but I am reminded that it is not we who are the final judges of that, none the less, difficult to accept, especially in a situation such as this.

I will pray that your "self-diagnosed" gout does not present you with continued problems, as well as keeping all the lives of people your doctor has touched (including you) in my thoughts and prayers that continued hope is abundant in this New Year!

katheryn

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sephie
Posts: 648
Joined: Apr 2009

words escape me.... i know that you are very sad about this.....i am sorry that you have to feel this emotional pain for your friend and doctor.....i do so hope you find relief for the gout.... my goodness... it just goes on and on.....hugs to you....sephie

pializ
Posts: 454
Joined: Nov 2012

I am so sorry to hear your news!

It's hard to make sense of life sometimes. There are those who abuse their bodies with drugs, alcohol & just plain bad behaviour, sometimes just plain evil, but they go on to live life, whereas, like your oncologist who does nothing but good, or little children born with terrible conditions, or develop awful diseases. Where is the sense in it all? 

Hope your physical pain eases soon. My old neighbour used to suffer with bouts of gout if he overdid the wine. It looked mightily painful. 

Virtual hugs and Joe's ice cream (made in Wales and many consider to be the best in the World)

Liz

jcruz
Posts: 379
Joined: Jan 2013

I'm so sorry about the sad news of your doctor's passing.  I immediately thought of his patients.  It will be such a hard thing for them and for his staff.

As for your health, I hope you get some relief soon for the gout or whatever is causing the pain in your toe.  

Always wishing you the best,

Janet

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z
Posts: 1411
Joined: May 2009

I'm so sorry about your oncologist, I know I have bonded with mine over the years and would'nt want anything to happen to him.  I asked him one time how do you do it and he jokingly said I see a therapist and then he said he was kidding, he has a funny sense of humor but, I know I would have to see a therapist if I had to watch what my patients had to go through.  He then said I see all the good things that treatment helps people to live. Some people are just made to be care givers.  It makes me wonder how much stress our drs really have going on inside of them.  Lori

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mp327
Posts: 4144
Joined: Jan 2010

I want to thank you all for your expressions of sympathy over the loss of my wonderful medical oncologist, Dr. Thomas Seay.  This has left such a big void, not only in my heart, but the hearts of so many--other patients, colleagues and peers of this great man.  I attended both the visitation and the memorial service, which was quite moving.  Some of the partners in his practice spoke and reflected on some lighthearted memories of him.  He had such a dry sense of humor and some of the stories elicited laughter, which helped a little to ease the pain of his loss.  My friend and neighbor, Dr. Mac, was there.  After the service we hugged and cried.  My colorectal doctor was in attendance, to whom I told I needed her more than ever now.  She said "I'm here," and gave me a big hug.  That gave me some comfort, although I feel as though a big piece of my security blanket has been torn away.  However, I am over 7 years out now and not in the dire situation that many of his patients are, just having been diagnosed or beginning treatment.  I know Atlanta Cancer Care is scrambling right now to make sure all of his patients' care will be covered by another one of their doctors.  I had already planned to cancel my February scan ordered by him, and I still intend to cancel it.  However, unless I'm contacted by his office to make other arrangements regarding the appt. that I would have had with him about a week after the scan, I intend to keep the appt. and see what lies ahead for me.  Perhaps I will be discharged from further care under an oncologist at that time, due to being so far out from treatment.

I did want to post a link to Dr. Seay's obituary.  I know none of you knew him, but I just wanted you to see what an accomplished person he was.  There are many things that aren't even listed in the obituary, such as his tour of duty in Desert Storm and many awards.  The one thing that everyone knew about him is that he owned and flew his own helicopter.  Apparently, just about everyone wanted a ride in that thing, judging from the comments made by the speakers at the service, which had everyone laughing.  He was such a brilliant man, but simple and down to earth in his personal life.  If you watch the video, you'll see that side of him.  His casket looked like it was made from old weathered barn boards--that says a lot about him.  

http://www.memorialsolutions.com/sitemaker/sites/MCDONA6/obit.cgi?user=55436248_TSeay

One of the speakers the other evening was a patient of his who has been dealing with colorectal cancer for 8 years.  She is an attorney and has become quite involved in the foundation set up by Atlanta Cancer Care.  I am posting a link to the foundation's site so that you can hear her story.  I was quite impressed by her desire to help others and all the efforts she has made for several years to organize events to raise funds to help patients who cannot afford transportation and/or treatment.  She mentioned that Dr. Seay often pulled money out his own pocket to help these patients.  He was that kind of person.  The link below is to the foundation's website if you wish to listen to her video.  I am in no way soliciting for donations, I just found her story very inspiring and thought you might be inspired by it as well.  Her name is Sherri Graves Smith.

http://atlantacancercarefoundation.org/

My final thoughts have to do with the passion Dr. Seay had for animals.  If you watch the video on the obituary, you'll see that he was a cat lover, which was quite a surprise to me.  He had mentioned loving horses at one of my visits, and since he had a farm, I just presumed he had horses and perhaps dogs.  I am a cat lover, so when I saw that pic of him and his cat, my heart melted.  There were also pics of other cats he had over the years displayed at the funeral home.  The obituary included a couple of organizations to which donations can be made, along with a request that people adopt a pet in his honor.  So, with that, despite the fact that I already own two older cats, I convinced my husband that we needed to give another kitty a home because Dr. Seay would have liked that.  So, yesterday we brought home a 7-month old black and gray tabby kitty from our local animal shelter who we named "Chopper," after Dr. Seay's other love--his helicopter.  It's a funny name for a female cat, but one that has a lot of meaning to me, so Chopper it is!  She is sitting on my lap right now, purring up a storm.

Thank you for letting me get out all of my feelings about Dr. Seay's loss.  I wish you all could have known him.  He was a crusader in the war against cancer.  The medical community and the effort to find a cure for cancer have lost a person who, IMO, could have made a real difference.

Martha 

 

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sephie
Posts: 648
Joined: Apr 2009

I love cats too.... i love dogs...but really love cats.....as you can see by my photo.....sephie

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nonichol
Posts: 170
Joined: Jul 2010

Martha, 

Have you noticed you are becoming quite the author ? I sure have. This brought years to my eyes.

Norma

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