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Cancer Is Multi-Faceted: So Is Treating It

Last year Kimberly Kynard was experiencing tummy aches and cramping. At first they were mild and would come and go. She often wondered if she had eaten some­thing disagreeable or had food intolerance issues.

But the cramps started returning more frequently and with more force. The 46-year-old Southern California-native couldn't eat as much and started losing weight- something she had been trying to do, so at first, was thankful. But when walking to the door of her bedroom became "ex­hausting," Kynard knew some­thing was wrong. Still, as many of us do, she put it out of her mind and continued going to work every day as a customer services/data entry representa­tive for a furniture company. After three grueling weeks at work, she finally drove herself to Torrance Memorial Medi­cal Center. That was November 2010. While she knew she was sick, she wasn't prepared to re­ceive devastating news.

"I was told I had kidney can­cer, renal cell carcinoma, stage 3 or 4, with a big ole mass on my right kidney. They also dis­covered that the cancer traveled up to my heart chamber," Kynard explains in a raspy voice, as her throat is still healing from months of using a tracheostomy tube.

After the first diagnosis, Kynard was referred to Joy G. Paul, MD, of South Bay Urology Medical Group, as he has extensive experience with complicated renal cell carcinoma cases.

"We did further studies on Kim after she had been di­agnosed with a mass on her right kidney. We saw that it had moved into the vena cava all the way to the right side of her heart," Paul explains. At that point, Paul and his colleague, Tim Lesser, MD, contacted John Stoneburner, MD, a car­diothroracic surgeon with the Torrance Memorial Cardio­thoracic Surgery Program, to address the tumor's impact on the heart.

And finally, after discovering that the tumor had grown into her liver, the physicians called upon Stanley Klein, MD, with the As­sociation of South Bay Surgeons. Within a short period of time- since the tumor affected her right kidney, the main vein, liver and heart-Kynard was prepared to have major surgery by a team of surgical sub-specialists, headed by doctors Paul, Lesser, Stone­burner and Klein. The procedure would require stopping her heart for eight hours to remove the cancerous right kidney and part of her liver. The more unusual and technically challenging por­tion of the procedure required the removal of the tumor exten­sion in to her inferior and superior vena cava, and in to the right atrium of the heart.

While stopping her heart for so long seemed frighten­ing, Stoneburner explained that it was necessary.

"Total hypothermic circulatory arrest was used to pro­tect the heart and body during the extraction of the tumor from the heart and vena cava. This allowed the complex op­eration to be performed safely," he says.

Kynard was told by her physicians that she might not survive the surgery. And since her mother died of breast cancer at 51 years old and one of her brothers died of Hodgkins Lymphoma two years earlier at the age of 48, Kynard was understandably "terrified."

"I thought I was a goner but I'm cancer free right now. Some say say it's a miracle. They say I'm a wonder woman or what have you," she laughs.

Why A Multi-Disciplinary Approach is Crucial

If her surgery had been required years ago, before Torrance Memorial instituted a multi-disciplinary ap­proach to managing cancer and heart disease, Kynard might not have fared as well. Certainly physicians worked together in the past, but they didn't necessarily consult in a group meeting and discuss all options for care as they do now. With most cancer cases, multi-dis­ciplinary meetings are held that include all physicians who will be working together and any other nursing and clinical personnel involved in order to discuss all aspects of the case and agree upon a plan for treatment and post-operative care. In fact, Torrance Memorial physicians and medical personnel attend tumor board and cardiothoracic meetings regularly.

"The multi-disciplinary approach didn't used to happen that much until the last few years. For example, if you had a heart prob­lem, you would see your family practice doctor and then if you had an event, you'd go to see your cardiologist who would work you up. If it was necessary, the cardiologist would send you to a cardiothoracic sur­geon. The cardiologist would send over all the paperwork and might discuss his/her findings, but would basically hand over the case to the surgeon who would then decide what to do from there on. It would be his decision how best to manage that person," explains Sedgwick who has 32 years of ex­perience specializing in cardiac and general anesthesia at Torrance Memorial.

As mentioned, today, all physicians and other medical personnel pertinent to a case meet to hash out all scenarios for care and re­covery. So for Sedgwick's scenario, the cardi­ologist doesn't just hand over the files, he/she also attends a meeting to discuss the best op­tions for treatment and post-operative care. This is particularly helpful as it allows physi­cians to discuss ahead of time their varying ideas, any emergency scenarios or to just con­firm the agreed upon plan, and outline how best to proceed.

"It creates a better plan than [one made] with just one doctor's input. It's a more complete plan with a wider view," Sedgwick reiterates.

And a wider view was definitely necessary in Kynard's case, involving physicians from four separate disciplines.

The Silver Lining

Ten months after her extensive surgery, Kynard is no longer on any medication, walks with a cane (or a walker for longer trips), has a raspy voice and sore throat from her trach, but is "getting stronger by the day." In fact, Kynard plans to go back to work at the first of the year.

"I'm much better. I don't smoke anymore of course. ... I don't have any tubes anymore, do have some stomach cramps, but nothing like before," she explains.

While her body is getting stronger-it's her soul that is really evolving. She says the support of family and friends helped her get through the dark days and onto a more spiritual path.

"This experience made me a whole other person. I look at life much differently. I try to do more things, be with my family as much as possible. I'm going to Kansas City in Novem­ber for Thanksgiving and I haven't seen them in 20 years!" Kynard says, obviously excited.

She says she was touched by her little brother, Bradley Kynard, an opera singer liv­ing in San Francisco, who took time off to stay with her.

"Bradley stayed with me through the whole ordeal. He was here for a month by my side."

Kynard also said that her physicians at the hospital were incredibly supportive.

"Definitely a lot of support at Torrance Memorial. Dr. Paul was always checking in on me. And Dr. Stoneburner is superb."

I got a glimpse into what she meant when interviewing Paul. He was warm and friendly and asked how Kynard was faring. When I told him fine, but she said mentioned having blurry vision, he insisted that she come back in to see him "just to be on the safe side."

"Everyone at the hospital was very, very kind to me. And I'm not one of the best pa­tients all of the time," she says with a laugh.

That's hard to believe today, but she claims she's a changed person.

"I'm a much more positive and spiritual person. Life is just too short. Try to be around family and friends as much as possible. Life is about loving everybody."

And who could argue with that advice?

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