But For a Dream

by Doctor Axiom

Document 1: Referral

From: Dr. Vital Stroke
To: Dr. Second Glance
Subject: Morphograft referral for recurrent renal SCC

Patient Referral
13-5-2013
Hazel Dreams, 14 y.o.

Hazel Dreams is an astute, pleasant 14 year old thestral with locally recurrent small cell renal cell carcinoma. Due to her young age. I am recommending her for the morphograft procedure viz. total organ replacement at the Sparkle Institute. She is a Polomare Textile Fire survivor and I believe she is an ideal candidate for the procedure.

History of Present Illness:
Hazel first presented roughly 18 months ago to me with progressive painless hematuria and a 1 cm nodule on her right kidney found on amniomorphic scan. Biopsy showed high grade small cell renal cell carcinoma. Given her young age and the assumed low probability of recurrence she was treated with partial nephrectomy in May 2011, pathology report showed negative margins, 0/7 lymph nodes positive for tumor. Tumor genetic analysis showed MVHCII mutation which historically has been associated with spontaneous tumors.

Follow up scans at 4 months, and 8 months showed no evidence of disease.
Followup scan at 1 year showed one new nodule (0.3 cm) in the left kidney, too small to biopsy. She was asymptomatic at the time, and surveillance was decided upon as the best course of action.
Followup at 16 months shows one new nodule in the left kidney (1.1 cm), and a new nodule in the right kidney (0.6 cm). Biopsy of both kidney nodules show high grade small cell renal cell carcinoma.
Genetic analysis showed MVHCII+TRAD mutation consistent with histophenoline exposure.

In early April two weeks after that scan, Hazel presented emergently with severe flank pain. A left sided hydronephrosis secondary to enlarging mass was discovered for which a nephrostomy was performed.
Amniomorphic scan at that time showed left sided kidney nodule at 1.2 cm, and showed apparent breach of the capsule with perinephric local spread. She was started on Tiwrex+Cisplatin.

She has received 4 cycles of Tiwrex+Cisplatin to date. Followup scan last week at 19 months showed minimal response- left kidney nodule is at 0.5cm and her right kidney nodule is at 0.7cm. She has also since developed persistent pain from scattered nephrolithiasis in the left kidney, likely secondary to Tiwrex treatment. Chemo was halted 4 weeks ago for bone marrow recovery. Blood counts have normalized and bone marrow quality is expected to be sufficient for morphograft procedure.

Social History:
Hazel currently lives in the Happy Home for Youth in East Manehattan. She expressed some concern about not being able to see her friends, but seems amenable to a stay in Canterlot for several weeks as she has friends in the area who will be able to visit her.
She has no drug or alcohol use history.

Her case matches similar cases from the upper east side of Manehattan, thought to be to in-utero exposure to histophenolene from the Polomare plant. Though the long term effects of histophenolene are not fully known, it is agreed upon by experts that it greatly increases the risk for renal cancers regardless of age group.
It is for this reason that I believe Hazel would benefit greatly from total organ replacement.

Family History:
Her family history is insignificant for any cancer syndromes.

Thank you for your continued dedication to excellent care, and I hope you will consider taking Hazel Dreams as a patient.

Sincerely,

Vital Stroke, M.D.

---

From: Dr. Second Glance
To: Dr. Vital Stroke

I'd be happy to!
Looks like she's been through a lot. She indeed seems like an excellent candidate.
Will keep your office posted about her progress.

Thank you for your referral,

Second Glance, M.D.

---

From: Dr. Second Glance
To: Dr. Vital Stroke

Vites, our coordinator here mentioned her bill is being footed by the ROYAL TREASURY directly instead of the Canterlot Charity fund like usual. What!?

-S.G.

---

From: Dr. Vital Stroke
To: Dr. Second Glance

You're in for a real treat.

-V. Stroke

Author's Note:

TL;DR: Thanks to some kind of toxin (histophenolene is not a real chemical) released by the “Polomare plant” into her home for years on end and while her mother was pregnant with her, Hazel is going to keep getting kidney cancer no matter how many times they treat her. She's already had part of her kidney removed, and she's been on some kind of chemotherapy. She's only 14, so that kind of sucks for her. Her cancer doctor, Vital Stroke, has referred her to Second Glance, a doctor at the “Sparkle Institute,” for “total organ replacement” with something called a “morphograft procedure.”

I tried to leave it more readable than the usual doctor’s note but still leave it with the feel of one. Let me know if I succeeded.

MVHCII is also a fake gene. TRAD is supposed to be a fake gene, although TraD is a protein in some bacteria. No relation.

Comments

[Reclusive]

I understood some of those words. Appreciate the TL;DR, although maybe it'd be better suited for the Author's Note field?

[Doctor Axiom]

11216658
You're right. I've just moved the whole author's note to the end.

Thank you!