Yesterday was sunny and pleasant.  We left Topeka at 8:45; it seems no matter what the traffic is like, it takes exactly 75 minutes to get to the KC Cancer Center.  The parking garage was nearly full, but we found a place on the roof (and, being able sometimes to read lips, got cursed by an elderly person of indeterminate sex who wasn't happy that we'd beaten him/her to the spot).  Although the waiting room was packed, we were called almost immediately by Anisa, one of our favorite nurses there.  She took my vitals, all of which were good.  Despite my erratic eating, my weight remains stable; I've lost about 10# over the last 18 months--none of it, it seems, from my stomach.  I guess that's ok, since it gives Mohamed plenty of targets for my daily shot.

Our first visitor in the consultation room was an intern (or resident) who seemed moderately informed about my condition.  He got off to a good start by noting that the problems had started two years ago in my left shoulder.  His knowledge quickly went downhill, though, when he didn't know about the surgery on my femur or which chemo medication I was taking.  He was quite confident, indeed overconfident, and I finally asked whether we were actually going to see Dr. Hozbeierlein.  He got the hint and left "to have a conference with Dr. Holz."  Luckily, Dr. Holz entered immediately and was friendly and frank.  From the first, we felt confidence in him.  Dr. Vanveldhuizen speaks slowly and softly.  Despite the fact that we were in a small, windowless room, Dr. Holz talked fast and loudly.  He said that if we decided to have surgery, he would do a nephrectomy and remove the entire kidney.  Trying to remove just the tumor would require open surgery and would be more invasive and dangerous.  The entire kidney could be removed laproscopically with two or three days in the hospital and, perhaps, a three-week recovery time before I was able to return to my normal routine and, for example, lift heavy objects (as if I worked on a loading dock).  He said that there are some data that suggest that removing the kidney might prolong my life by a few months, but that there aren't many data and certainly not enough to make real predictions.  He also said--and this was new information--that a nephrectomy might further compromise my immune system and thus actually be counterproductive.  He suggested that if I decided to have surgery, I would probably want to wait till after the holidays.  I said that if I chose that option, it would probably be better to do it between semesters, since Mohamed would be tasked with the increased caregiving.

Finally, I asked the question that I would think doctors don't really like (though that's just a guess): if he were in my position, what would he do.  He said that the trajectory of my cancer wasn't "normal," that it's quite common for chemotherapy for kidney cancer to be effective against secondary tumors (as mine has been) but not so much against the primary tumor.  But although my tumor has grown, at 4.1 cm. it is still relatively small.  His approach would be to wait and watch.  I have a Dec. 10th appointment with Dr. Van, but just for bloodwork and discussion.  The next CT scans will be about six weeks after that, and he saw no harm in waiting to see how the kidney tumor has progressed (that doesn't seem like the appropriate word) at that point.  What did I think of that option?  Since my inclination had always been not to have the surgery and was more so after his point about the possibility of  a more severely compromised immune system, I was perfectly happy with that decision.  So the status quo remains in place till the end of January, and then we'll re-evaluate where I am.  We were both pleased with Dr. Holz, whose opinions were clear and balanced.

We left the Center, and met two KC friends, TJ and Scott, for lunch on nearby 39th Street, which is a restaurant row.  I don't think I made the best choice of places to eat, but I was the one who made the choice, so I won't be too hard on myself.  Both TJ and Scott are funny and smart, so that compensated for the so-so food.  For some reason, though we hadn't had to get up early and though there was nothing stressful about the consultation, I fell asleep on the car ride home, and then slept for an additional two hours once we got here.  The waves of energy followed by sudden and lengthy crashes are one of the most frustrating parts of my daily life.

Scott is coming in today for a visit.  Mohamed will have a less fun day, as he has tests in statistics and microeconomics on Tuesday.  And, having finished an article on Kid Rock in The New Yorker, which came yesterday, I have an article on Diane Ravitch, whom I find the sanest of writers on education, to look forward to before the rest of my day unfolds.