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09/25/2003

Personal Images

You may be too young to remember the days when medical
imaging consisted essentially of just the plain old X-ray images
of your chest, your teeth or that broken bone. Today we have
invasive procedures for viewing directly one’s innards such as
the colonoscopy, the cystoscopy, the sigmoidoscopy and the
endoscopy. Then there are the more exotic noninvasive
procedures such as MRI (magnetic resonance imaging) and
ultrasound imaging to name just a couple. If you aren’t familiar
with all these imaging techniques, you may have been lucky
enough not to have needed them. Over the past decade or so, my
wife and I have had experiences with all of them.

Occasionally, a particular set of images focuses your attention on
a part of your anatomy that you’ve taken for granted. You may
not even know an organ’s location or function, at least not in
detail. A set of ultrasound and MRI images has suddenly
focused my attention on the kidney. Every so often there’s an
item in the paper or on the news about some brave and generous
soul who has donated one of his or her kidneys, sometimes to a
total stranger. Most of us are endowed with two kidneys at birth,
although occasionally a baby is born with only one and is none
the worse for it. Obviously, Nature has given us the ability to
operate rather well with a solo kidney.

A few weeks ago, I met a fellow who said that 13 years ago he
had all but a quarter of one kidney removed. The fellow looked
to be in good shape and he has lived all these years with that
small fraction of a kidney! For those like myself who haven’t
paid much attention to their kidneys, let’s see what a kidney is
good for. A friend wondered if the kidney is hollow? The
answer is no, far from it. It contains a million or so little units
known as nephrons, whose function is to remove waste products
from the blood. These waste products are passed to the bladder
in the form of urine. The bladder is indeed essentially hollow,
serving as a retainer for the urine until it is excreted through the
urethra.

Each nephron is a rather complex arrangement of a bunch of
various types of fine capillaries and connects to the main blood
stream through veins and arteries feeding and extracting the
blood for and after purification. I won’t go into detail except to
mention the glomerulus, which is a tuft of capillaries. The
glomerulus filters water and other materials from the blood for
passing along to the bladder. Each nephron has a little collection
tube for the urine that feeds into the ureter, which feeds the total
output of the kidney into the bladder. My 1962 World Book
Encyclopedia, from which much of this material was obtained,
says that the ureter is “about as large as the quill of a crow’s
feather”. I don’t know about you but I don’t recall ever having
examined a crow’s feather. There must have been a different
sort of audience for the World Book in 1962.

I imagine that the word nephron shares the same origin as the
term “nephrectomy”. When any medical term ends in “ectomy”,
it’s an ominous sign that something is going to be removed. Sure
enough, a nephrectomy is the removal of a kidney. By this time
you probably suspect that I have more than just an academic
interest in the kidney. You’re right. If this column appears on
schedule, it means that I have had the experience of undergoing a
partial nephrectomy, the removal of part of a kidney. At least
that was the intended surgery.

The surgery was prompted by my routine annual physical exam
with a new young doctor, Dr. Craig (first name). Dr. Craig was
the doctor who, earlier this year, diagnosed our Lamb guy, Harry
Trumbore, with Guillain-Barre Syndrome, a difficult diagnosis.
In my case, the young doctor scored again when he found subtle
changes in my blood chemistry and prescribed ultrasound and
MRI tests. They showed a 2 cm diameter tumor in my right
kidney. This seemed pretty large to me but I was assured by
other medical personnel that it was small and that such tumors
are typically substantially larger when detected. Now, if Dr. Carl
(first name) has performed his skilled surgery, the tumor is
history and I have at least one kidney and, hopefully, part of
another purifying my blood.

All this was written before going to the hospital. If I feel as
washed out as I expect to, next week’s column may be a rerun of
an earlier one. Otherwise, be prepared, doesn’t everyone want to
talk about his or her operation?

Allen F. Bortrum



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-09/25/2003-      
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Dr. Bortrum

09/25/2003

Personal Images

You may be too young to remember the days when medical
imaging consisted essentially of just the plain old X-ray images
of your chest, your teeth or that broken bone. Today we have
invasive procedures for viewing directly one’s innards such as
the colonoscopy, the cystoscopy, the sigmoidoscopy and the
endoscopy. Then there are the more exotic noninvasive
procedures such as MRI (magnetic resonance imaging) and
ultrasound imaging to name just a couple. If you aren’t familiar
with all these imaging techniques, you may have been lucky
enough not to have needed them. Over the past decade or so, my
wife and I have had experiences with all of them.

Occasionally, a particular set of images focuses your attention on
a part of your anatomy that you’ve taken for granted. You may
not even know an organ’s location or function, at least not in
detail. A set of ultrasound and MRI images has suddenly
focused my attention on the kidney. Every so often there’s an
item in the paper or on the news about some brave and generous
soul who has donated one of his or her kidneys, sometimes to a
total stranger. Most of us are endowed with two kidneys at birth,
although occasionally a baby is born with only one and is none
the worse for it. Obviously, Nature has given us the ability to
operate rather well with a solo kidney.

A few weeks ago, I met a fellow who said that 13 years ago he
had all but a quarter of one kidney removed. The fellow looked
to be in good shape and he has lived all these years with that
small fraction of a kidney! For those like myself who haven’t
paid much attention to their kidneys, let’s see what a kidney is
good for. A friend wondered if the kidney is hollow? The
answer is no, far from it. It contains a million or so little units
known as nephrons, whose function is to remove waste products
from the blood. These waste products are passed to the bladder
in the form of urine. The bladder is indeed essentially hollow,
serving as a retainer for the urine until it is excreted through the
urethra.

Each nephron is a rather complex arrangement of a bunch of
various types of fine capillaries and connects to the main blood
stream through veins and arteries feeding and extracting the
blood for and after purification. I won’t go into detail except to
mention the glomerulus, which is a tuft of capillaries. The
glomerulus filters water and other materials from the blood for
passing along to the bladder. Each nephron has a little collection
tube for the urine that feeds into the ureter, which feeds the total
output of the kidney into the bladder. My 1962 World Book
Encyclopedia, from which much of this material was obtained,
says that the ureter is “about as large as the quill of a crow’s
feather”. I don’t know about you but I don’t recall ever having
examined a crow’s feather. There must have been a different
sort of audience for the World Book in 1962.

I imagine that the word nephron shares the same origin as the
term “nephrectomy”. When any medical term ends in “ectomy”,
it’s an ominous sign that something is going to be removed. Sure
enough, a nephrectomy is the removal of a kidney. By this time
you probably suspect that I have more than just an academic
interest in the kidney. You’re right. If this column appears on
schedule, it means that I have had the experience of undergoing a
partial nephrectomy, the removal of part of a kidney. At least
that was the intended surgery.

The surgery was prompted by my routine annual physical exam
with a new young doctor, Dr. Craig (first name). Dr. Craig was
the doctor who, earlier this year, diagnosed our Lamb guy, Harry
Trumbore, with Guillain-Barre Syndrome, a difficult diagnosis.
In my case, the young doctor scored again when he found subtle
changes in my blood chemistry and prescribed ultrasound and
MRI tests. They showed a 2 cm diameter tumor in my right
kidney. This seemed pretty large to me but I was assured by
other medical personnel that it was small and that such tumors
are typically substantially larger when detected. Now, if Dr. Carl
(first name) has performed his skilled surgery, the tumor is
history and I have at least one kidney and, hopefully, part of
another purifying my blood.

All this was written before going to the hospital. If I feel as
washed out as I expect to, next week’s column may be a rerun of
an earlier one. Otherwise, be prepared, doesn’t everyone want to
talk about his or her operation?

Allen F. Bortrum