Kidney/Renal issues/cancer

[Hflyr51]

Hey POA,

This is my first post on this website but I know there are AME's and/or people who have had similar situations to myself. I'm going to post an edited email that I sent to my AME about a week ago (he's a super busy man, as I'm sure all AME's are) discussing my current situation in hopes to hear back from him. In the mean time, I have chosen to ground myself until I have clarification on what's going on with me and what I should be doing. This is a super long post, so I really appreciate anyone's time they take to read and respond.

Email:

I'm Tyler, I last saw you for my 1st Class Medical in September of 2019. Since then I've had renal issues that for a time were thought to be kidney stones. I asked my primary care Dr to order a KUB to verify that I have or didn't have anymore kidney stones. I hadn't had any symptoms for some time, which on a couple occasions were blood in urine and intense pain. Those symptoms would subside and I would feel fine for quite awhile.

The first episode was in Nov of 2019, but there was no pain associated with the hematuria. I went to urgent care and it was determined to be acute cystitis. Then again on Jan 16, 2020 but with no pain. I mentioned to the urgent care that I often wasn't staying very hydrated, and hadn't been that prone to UTIs. They advised me to stay more hydrated and urinate before and after flying, and it was also considered a UTI. All was good until Nov, 2020 and I had another blood in urine episode, and this time was followed by pretty intense pain and was discharged suspecting Kidney Stones. Within a couple hours, or an hour a blood clot passed and the pain subsided. I was prescribed traMADol, and stayed grounded for 48+hours after the last dose. I thought all was good, but then another episode happened on Feb, 2021, with the same result. I haven't since had the same episode.

After doing some research and coming across the kidney stone worksheet and CACI worksheet, I saw that I needed a KUB to indicate whether or not I was clear of kidney stones and my PCP had diagnosed me with. I need to renew my 1st class since I was offered a class date at Mesa Airlines. I had a KUB on Apr 20, 2021, and it showed negative for kidney stones, however, unfortunately there was a masslike opacity and a CT scan was ordered. May 11th I had a CT scan w/contrast that showed a lesion on my left kidney measuring 3.4x3x2cm and was considered suspect for Malignancy.

May 25th, I saw a urologist oncologist, Banner MD Anderson. He advised me that this mass is highly suspicious for malignancy and ordered an MRI w/contrast as well a biopsy. My biopsy is scheduled June 9th, and MRI will follow up on June 17th with doctor. He advised me that if the further tests show malignancy it would require a radical nephrectomy.

I'm confident under the circumstances even in the event that I have to have my kidney removed, I will make a full recovery. I'm concerned that this will have a dire effect on my medical, and that maybe I waited too long to advise you as my AME. I've never had a situation like this so I'm not exactly sure how to think and what to do. I do know that the FAA has guidance for Kidney stones and the CACI - renal cancer worksheet. I just wanted to reach out to you, and ensure that I'm doing everything correctly or maybe get some guidance on what I should do. I see where it says that if I do have surgery (which seems highly likely) that I can be considered acceptable certification when I've essentially recovered. Is this something I need to entirely ground myself for in the meantime, or once I find out if it's malignant!? I'm fairly confused on what I should do, like I said, I've never had this kind of situation.

End of Email:

After that email I had my biopsy done on the 9th and it turned into a 2 1/2 day admission into the hospital. Essentially, the biopsy caused the "kidney stone like" symptoms to return and severe pain followed by gross hematuria and clots. Before the procedure I assumed that this would happen, and I was correct. Once the pain was under control, and the loss of hemoglobin wasn't decreasing they discharged me. During the stay the doctor performing the biopsy said that the mass was very solid, and my urologist confirmed with me following a visit to my room. Either way it seems as if a procedure to remove my kidney will be needed even if the mass is determined benign.

Mainly, I'm concerned that even in my situation with a very good recovery outcome, that I may have issues with the FAA and recertifying my 1st class that I hope to have by September. I've been offered a class date with Mesa Airlines as an FO on Sept. 27th. I've never had a situation like this, so naturally I'm expecting I may have or could make a mistake that would cause issues with the FAA. Up until now, I've only had any thing major like this when I broke my ankle in 1999 and some dental procedures. Like I mentioned in the email, I am aware of the FAA's AME guidance for kidney stones and renal cancer checklists and worksheets. I am looking for clarification on what I should do, need to do, or maybe I'm doing what I'm supposed to do.

Thanks for your time!

 

[Cervieres]

Look up renal cryoablation and ask your urologist if you are a candidate. It will depend on multiple factors, but if you are a candidate, a minimally invasive treatment could be used as opposed to a partial or total nephrectomy, which would greatly reduce recovery time and risk of complications. You will be in good hands at MD Anderson no matter what.

 

[danhagan]

Look up renal cryoablation and ask your urologist if you are a candidate. It will depend on multiple factors, but if you are a candidate, a minimally invasive treatment could be used as opposed to a partial or total nephrectomy, which would greatly reduce recovery time and risk of complications. You will be in good hands at MD Anderson no matter what.

Am in medical imaging ... In my area, cryo used to be generally for non-surgical candidates (like over 80 years old). I'd do whatever MD Anderson recommends. Quite often nephrectomy without chemo-radiation occurs. Not sure of the impact on a Class 1 ...

 

[steingar]

Health first, flying later.

 

[Hflyr51]

Look up renal cryoablation and ask your urologist if you are a candidate. It will depend on multiple factors, but if you are a candidate, a minimally invasive treatment could be used as opposed to a partial or total nephrectomy, which would greatly reduce recovery time and risk of complications. You will be in good hands at MD Anderson no matter what.

My urologist didn’t seem to think cryogenic treatments would be necessary. My renal mass is located in the middle of my kidney and the dr basically said the only way to handle it is by removing the kidney since it’s so close to my blood vessels. Basically there is no way to partially remove it! Thanks for the vote of confidence in MD Anderson!

 

[Hflyr51]

Am in medical imaging ... In my area, cryo used to be generally for non-surgical candidates (like over 80 years old). I'd do whatever MD Anderson recommends. Quite often nephrectomy without chemo-radiation occurs. Not sure of the impact on a Class 1 ...

My urologist didn’t say anything about needing chemo. He made it sound like nephrectomy would do the job! Thanks for the vote of confidence in MD Anderson!

 

[Hflyr51]

Health first, flying later.

Absolutely! Hence why I’ve grounded myself and am asking questions way above my head.

 

[Cervieres]

Am in medical imaging ... In my area, cryo used to be generally for non-surgical candidates (like over 80 years old). I'd do whatever MD Anderson recommends. Quite often nephrectomy without chemo-radiation occurs. Not sure of the impact on a Class 1 ...

Agree, if you are otherwise healthy and don’t have a family history of kidney issues, surgery is a better long term option. Great that you caught it early, hope you have a quick recovery.

 

[Lowflynjack]

I had Renal Cell Carcinoma. Chemo doesn't help with this disease. I had cryoablation done at Johns Hopkins by Ron Rodriguez, who is an amazing doctor. He was doing studies on cryo at the time and I begged him to do it on me even though I was 35 and way below the age of the average person in the study. I promised him I would come back for a visit and testing any time he asked me to and I did... every 4 months for a couple of years, 6 months for a couple of years, and now yearly. Luckily for me, he moved to Texas now, so it's a lot quicker trip than going to Baltimore! I'm cancer-free for 12 years.

I understand that cryo probably isn't an option for you, I only put this much info in case it helps others. Surgery is not the better option if it's on a part of the kidney they can reach easily. It's way less invasive. After many years of studying the results, they've concluded it's as effective as surgery. It was way more effective early on, but as they collect data, it's leveled off.

The part of my story you need to hear is, I went to 5 doctors before making my decision. I was told everything from full nephrectomy to partial nephrectomy, from a year to make a decision to I needed it out in weeks, from we needed a biopsy quickly to no biopsy at all! Get more opinions before going under a knife. Dr. Rodriguez told me it was cancer. He didn't need a biopsy to tell that, it was obvious. He said when they do a biopsy, you risk the needle going through and spreading the disease. My two cents have been added.

 

[Rushie]

Another endorsement for MD Anderson, they cured my daughter’s cancer, but then she had a “good” cancer. I don’t know anything about kidney malignancy. Hopefully one of the forum AMEs will be along soon to address the certification issues. Good luck, I hope it gets quickly resolved and you get back on your career path.

 

[tspear]

Good Luck.
The only point I would make is medical tech is changing pretty quickly. My mom had colon cancer with tumors migrating to the liver. The doc said at the time, a year ago they would not be able to operate, now they can go through the liver like a jigsaw puzzle and remove the 1/3 that is the tumor.

Tim

Sent from my HD1907 using Tapatalk

 

[danhagan]

He said when they do a biopsy, you risk the needle going through and spreading the disease. My two cents have been added.

That's called "seeding" which is spreading the cancer cells during each biopsy pass (a HUGE no-no on ovarian cancers). If the person doing the biopsy is knowledgeable, it could be done with a co-axial needle (needle within a needle) so the biopsy needle is actually passing through a "tunnel" and not tissue on each pass ...

 

[Hflyr51]

Agree, if you are otherwise healthy and don’t have a family history of kidney issues, surgery is a better long term option. Great that you caught it early, hope you have a quick recovery.

I don't have any other major health concerns and overall healthy. Just some minor stuff I could control with diet more or less. It's a good thing that I pushed the KUB imaging or it might have taken much longer to find it!

 

[Hflyr51]

I had Renal Cell Carcinoma. Chemo doesn't help with this disease. I had cryoablation done at Johns Hopkins by Ron Rodriguez, who is an amazing doctor. He was doing studies on cryo at the time and I begged him to do it on me even though I was 35 and way below the age of the average person in the study. I promised him I would come back for a visit and testing any time he asked me to and I did... every 4 months for a couple of years, 6 months for a couple of years, and now yearly. Luckily for me, he moved to Texas now, so it's a lot quicker trip than going to Baltimore! I'm cancer-free for 12 years.

I understand that cryo probably isn't an option for you, I only put this much info in case it helps others. Surgery is not the better option if it's on a part of the kidney they can reach easily. It's way less invasive. After many years of studying the results, they've concluded it's as effective as surgery. It was way more effective early on, but as they collect data, it's leveled off.

The part of my story you need to hear is, I went to 5 doctors before making my decision. I was told everything from full nephrectomy to partial nephrectomy, from a year to make a decision to I needed it out in weeks, from we needed a biopsy quickly to no biopsy at all! Get more opinions before going under a knife. Dr. Rodriguez told me it was cancer. He didn't need a biopsy to tell that, it was obvious. He said when they do a biopsy, you risk the needle going through and spreading the disease. My two cents have been added.

I really appreciate the detailed response. Part of my issue is that my mass is interpolar or what I understand as damn near the center of my kidney which makes a partial nephrectomy off the table.

The part of my story you need to hear is, I went to 5 doctors before making my decision. I was told everything from full nephrectomy to partial nephrectomy, from a year to make a decision to I needed it out in weeks, from we needed a biopsy quickly to no biopsy at all! Get more opinions before going under a knife. Dr. Rodriguez told me it was cancer. He didn't need a biopsy to tell that, it was obvious. He said when they do a biopsy, you risk the needle going through and spreading the disease. My two cents have been added.

Since I am doing this through community care approved through the Phoenix VA. I have only seen my Urologist Oncologist at MD Anderson in Mesa, AZ. I am confident based on his credentials from many people that I've talked to and the other doctors that I've talked to. Though, I've only had my initial diagnosis from my Urologist, I'm confident that he knows what he's doing. Also, because of where my mass is, my age and what he got from the imaging he said he's 90% sure the mass is malignant, but due to my low family history of cancers, age and overall health he wanted the biopsy and MRI to confirm. I already had the biopsy done, and I was talked to about seeding and I chose to continue. I'm pretty sure it was done with a co-axial needle as someone already mentioned. I have my MRI tomorrow morning followed by an appointment with my urologist to discuss treatment details and options.

 

[Hflyr51]

That's called "seeding" which is spreading the cancer cells during each biopsy pass (a HUGE no-no on ovarian cancers). If the person doing the biopsy is knowledgeable, it could be done with a co-axial needle (needle within a needle) so the biopsy needle is actually passing through a "tunnel" and not tissue on each pass ...

The Dr who did my biopsy told me about seeding, but said it was a very very small chance but had to have that disclaimer. I believe he did it with a co-axial cable, but for some reason I can't confirm with my memory. The DR who did it is VERY revered and experienced so I felt comfortable allowing the go ahead.

 

[gacoon]

Hey POA,

This is my first post on this website but I know there are AME's and/or people who have had similar situations to myself. I'm going to post an edited email that I sent to my AME about a week ago (he's a super busy man, as I'm sure all AME's are) discussing my current situation in hopes to hear back from him. In the mean time, I have chosen to ground myself until I have clarification on what's going on with me and what I should be doing. This is a super long post, so I really appreciate anyone's time they take to read and respond.

Email:

I'm Tyler, I last saw you for my 1st Class Medical in September of 2019. Since then I've had renal issues that for a time were thought to be kidney stones. I asked my primary care Dr to order a KUB to verify that I have or didn't have anymore kidney stones. I hadn't had any symptoms for some time, which on a couple occasions were blood in urine and intense pain. Those symptoms would subside and I would feel fine for quite awhile.

The first episode was in Nov of 2019, but there was no pain associated with the hematuria. I went to urgent care and it was determined to be acute cystitis. Then again on Jan 16, 2020 but with no pain. I mentioned to the urgent care that I often wasn't staying very hydrated, and hadn't been that prone to UTIs. They advised me to stay more hydrated and urinate before and after flying, and it was also considered a UTI. All was good until Nov, 2020 and I had another blood in urine episode, and this time was followed by pretty intense pain and was discharged suspecting Kidney Stones. Within a couple hours, or an hour a blood clot passed and the pain subsided. I was prescribed traMADol, and stayed grounded for 48+hours after the last dose. I thought all was good, but then another episode happened on Feb, 2021, with the same result. I haven't since had the same episode.

After doing some research and coming across the kidney stone worksheet and CACI worksheet, I saw that I needed a KUB to indicate whether or not I was clear of kidney stones and my PCP had diagnosed me with. I need to renew my 1st class since I was offered a class date at Mesa Airlines. I had a KUB on Apr 20, 2021, and it showed negative for kidney stones, however, unfortunately there was a masslike opacity and a CT scan was ordered. May 11th I had a CT scan w/contrast that showed a lesion on my left kidney measuring 3.4x3x2cm and was considered suspect for Malignancy.

May 25th, I saw a urologist oncologist, Banner MD Anderson. He advised me that this mass is highly suspicious for malignancy and ordered an MRI w/contrast as well a biopsy. My biopsy is scheduled June 9th, and MRI will follow up on June 17th with doctor. He advised me that if the further tests show malignancy it would require a radical nephrectomy.

I'm confident under the circumstances even in the event that I have to have my kidney removed, I will make a full recovery. I'm concerned that this will have a dire effect on my medical, and that maybe I waited too long to advise you as my AME. I've never had a situation like this so I'm not exactly sure how to think and what to do. I do know that the FAA has guidance for Kidney stones and the CACI - renal cancer worksheet. I just wanted to reach out to you, and ensure that I'm doing everything correctly or maybe get some guidance on what I should do. I see where it says that if I do have surgery (which seems highly likely) that I can be considered acceptable certification when I've essentially recovered. Is this something I need to entirely ground myself for in the meantime, or once I find out if it's malignant!? I'm fairly confused on what I should do, like I said, I've never had this kind of situation.

End of Email:

After that email I had my biopsy done on the 9th and it turned into a 2 1/2 day admission into the hospital. Essentially, the biopsy caused the "kidney stone like" symptoms to return and severe pain followed by gross hematuria and clots. Before the procedure I assumed that this would happen, and I was correct. Once the pain was under control, and the loss of hemoglobin wasn't decreasing they discharged me. During the stay the doctor performing the biopsy said that the mass was very solid, and my urologist confirmed with me following a visit to my room. Either way it seems as if a procedure to remove my kidney will be needed even if the mass is determined benign.

Mainly, I'm concerned that even in my situation with a very good recovery outcome, that I may have issues with the FAA and recertifying my 1st class that I hope to have by September. I've been offered a class date with Mesa Airlines as an FO on Sept. 27th. I've never had a situation like this, so naturally I'm expecting I may have or could make a mistake that would cause issues with the FAA. Up until now, I've only had any thing major like this when I broke my ankle in 1999 and some dental procedures. Like I mentioned in the email, I am aware of the FAA's AME guidance for kidney stones and renal cancer checklists and worksheets. I am looking for clarification on what I should do, need to do, or maybe I'm doing what I'm supposed to do.

Thanks for your time!

Hey POA,

This is my first post on this website but I know there are AME's and/or people who have had similar situations to myself. I'm going to post an edited email that I sent to my AME about a week ago (he's a super busy man, as I'm sure all AME's are) discussing my current situation in hopes to hear back from him. In the mean time, I have chosen to ground myself until I have clarification on what's going on with me and what I should be doing. This is a super long post, so I really appreciate anyone's time they take to read and respond.

Email:

I'm Tyler, I last saw you for my 1st Class Medical in September of 2019. Since then I've had renal issues that for a time were thought to be kidney stones. I asked my primary care Dr to order a KUB to verify that I have or didn't have anymore kidney stones. I hadn't had any symptoms for some time, which on a couple occasions were blood in urine and intense pain. Those symptoms would subside and I would feel fine for quite awhile.

The first episode was in Nov of 2019, but there was no pain associated with the hematuria. I went to urgent care and it was determined to be acute cystitis. Then again on Jan 16, 2020 but with no pain. I mentioned to the urgent care that I often wasn't staying very hydrated, and hadn't been that prone to UTIs. They advised me to stay more hydrated and urinate before and after flying, and it was also considered a UTI. All was good until Nov, 2020 and I had another blood in urine episode, and this time was followed by pretty intense pain and was discharged suspecting Kidney Stones. Within a couple hours, or an hour a blood clot passed and the pain subsided. I was prescribed traMADol, and stayed grounded for 48+hours after the last dose. I thought all was good, but then another episode happened on Feb, 2021, with the same result. I haven't since had the same episode.

After doing some research and coming across the kidney stone worksheet and CACI worksheet, I saw that I needed a KUB to indicate whether or not I was clear of kidney stones and my PCP had diagnosed me with. I need to renew my 1st class since I was offered a class date at Mesa Airlines. I had a KUB on Apr 20, 2021, and it showed negative for kidney stones, however, unfortunately there was a masslike opacity and a CT scan was ordered. May 11th I had a CT scan w/contrast that showed a lesion on my left kidney measuring 3.4x3x2cm and was considered suspect for Malignancy.

May 25th, I saw a urologist oncologist, Banner MD Anderson. He advised me that this mass is highly suspicious for malignancy and ordered an MRI w/contrast as well a biopsy. My biopsy is scheduled June 9th, and MRI will follow up on June 17th with doctor. He advised me that if the further tests show malignancy it would require a radical nephrectomy.

I'm confident under the circumstances even in the event that I have to have my kidney removed, I will make a full recovery. I'm concerned that this will have a dire effect on my medical, and that maybe I waited too long to advise you as my AME. I've never had a situation like this so I'm not exactly sure how to think and what to do. I do know that the FAA has guidance for Kidney stones and the CACI - renal cancer worksheet. I just wanted to reach out to you, and ensure that I'm doing everything correctly or maybe get some guidance on what I should do. I see where it says that if I do have surgery (which seems highly likely) that I can be considered acceptable certification when I've essentially recovered. Is this something I need to entirely ground myself for in the meantime, or once I find out if it's malignant!? I'm fairly confused on what I should do, like I said, I've never had this kind of situation.

End of Email:

After that email I had my biopsy done on the 9th and it turned into a 2 1/2 day admission into the hospital. Essentially, the biopsy caused the "kidney stone like" symptoms to return and severe pain followed by gross hematuria and clots. Before the procedure I assumed that this would happen, and I was correct. Once the pain was under control, and the loss of hemoglobin wasn't decreasing they discharged me. During the stay the doctor performing the biopsy said that the mass was very solid, and my urologist confirmed with me following a visit to my room. Either way it seems as if a procedure to remove my kidney will be needed even if the mass is determined benign.

Mainly, I'm concerned that even in my situation with a very good recovery outcome, that I may have issues with the FAA and recertifying my 1st class that I hope to have by September. I've been offered a class date with Mesa Airlines as an FO on Sept. 27th. I've never had a situation like this, so naturally I'm expecting I may have or could make a mistake that would cause issues with the FAA. Up until now, I've only had any thing major like this when I broke my ankle in 1999 and some dental procedures. Like I mentioned in the email, I am aware of the FAA's AME guidance for kidney stones and renal cancer checklists and worksheets. I am looking for clarification on what I should do, need to do, or maybe I'm doing what I'm supposed to do.

Thanks for your time!

 

[bbchien]

It it really is interpolar, the only recertifiable option will be nephrectomy with all disease confined within the capsule. Such is the nature of the carcinoma.

 

[Rushie]

The Dr who did my biopsy told me about seeding, but said it was a very very small chance but had to have that disclaimer. I believe he did it with a co-axial cable, but for some reason I can't confirm with my memory. The DR who did it is VERY revered and experienced so I felt comfortable allowing the go ahead.

Isn’t seeding kind of theoretical anyway? How do you prove the cancer hadn’t already seeded occultly before the biopsy? Maybe they’ve done a lot of controlled studies showing a big statistical difference between those who had a biopsy and those who didn’t but wouldn’t that be difficult? You’d have to otherwise equal the factors which would mean equal treatment which would mean a lot of ‘ectomies without biopsy confirmation.

Maybe they’ve done that, what do I know?

 

[Hflyr51]

It it really is interpolar, the only recertifiable option will be nephrectomy with all disease confined within the capsule. Such is the nature of the carcinoma.

As of today it's confirmed to be clear cell renal cell carcinoma. It is interpolar and the surgeon and I decided to go with the radical nephrectomy based on the complications of a partial under my conditions. I'm confident that I'll make a full recovery and be healthy. My concern is making sure I have my ducks in a row so that I don't hit any snags with my 1st class medical renewal.

 

[danhagan]

The Dr who did my biopsy told me about seeding, but said it was a very very small chance but had to have that disclaimer. I believe he did it with a co-axial needle, but for some reason I can't confirm with my memory. The DR who did it is VERY revered and experienced so I felt comfortable allowing the go ahead.

You're in good hands. They'll follow-up with some imaging modality at 6 month intervals checking the renal fossa (space kidney used to be after removal).

Isn’t seeding kind of theoretical anyway? How do you prove the cancer hadn’t already seeded occultly before the biopsy?

Kidney cancer likes to take path of least resistance (but not always), which would be using the renal vein to metastasize ...

As of today it's confirmed to be clear cell renal cell carcinoma. It is interpolar and the surgeon and I decided to go with the radical nephrectomy based on the complications of a partial under my conditions. I'm confident that I'll make a full recovery and be healthy. My concern is making sure I have my ducks in a row so that I don't hit any snags with my 1st class medical renewal.

Get documentation as you go. Saw Bruce Chien weighed in here earlier, he's the "go to" doc for medicals around here. Now as an imaging guy and not a doctor, you have to be vigilant protecting that remaining kidney. When you are born, you have 4x the capacity needed, but at age 60 you lose upto 50% ... don't let hypertension go unchecked, damaging that kidney and throwing you into dialysis.