Kathy Hipsher had a terrible year.
She spent months fighting a malignant gastric virus, followed by persistent nausea and pain, which made her dependent on a mild diet that consisted largely of wheat cream and applesauce. Her abdominal pain was accompanied by such extreme fatigue that at times she could hardly go up the stairs of her home in Bellevue, Idaho.
In October 2016, Hipsher was recovering from the 45-year mark ̵
Over the next 13 months, she underwent numerous tests performed by specialists who were unable to determine what caused the bleeding.
] "Maybe you're just someone who has blood in their urine," Hipsher recalls of a urologist who said one year after the first appearance of the problem.
Less than a month after this October 2017 announcement, Hipsher learned the reason for the bleeding. A final diagnosis would take almost three months.
"It was really difficult to hold on," said Hipsher, whose testing was hampered by recurring digestive problems and exacerbated by the distance. Visiting specialists sometimes meant a five-hour return trip from their home outside Ketchum to Boise.
But the most frustrating part, said Hipsher, who has worked in a medical clinic, was trying to convince skeptical doctors that their persistent symptoms seemed to point to something serious. She was flatly told that she was "too young" for the disease that ultimately diagnosed her.
In October 2016, Hipsher prepared for a 16-day river trip when she noticed that her urine was pink.  "I thought," That's weird. "I had not eaten beets," which could cause the temporary discoloration of urine, known as beeturia, Hipsher recalled. She had no pain or other symptoms and had never experienced chronic urinary tract infections that could lead to visible urinary hematuria.
A urinalysis the following day, after the bleeding was no longer visible, confirmed the presence of red blood cells and protein in their urine. Proteinuria can be caused by diabetes, high blood pressure or familial kidney disease, none of which applies to Hipsher. Her family doctor ordered a CT scan of her abdomen and pelvis and referred her to a urologist.
The CT scan revealed that two tiny, non-obstructive kidney stones were not present at any problematic site. The radiologist also noted atrophy in the upper part of her left kidney, which he said was "most likely a chronic injury." The urologist performed a cystoscopy, a bladder test; it was normal. The doctor suggested that Hipsher drink more fluid to fight off a future kidney stone attack.
After the bleeding recurred, Hipsher consulted a second urologist, who sent her to a kidney doctor.
The nephrologist suggested that the intermittent bleeding can be caused by IgA nephropathy, a disease that damages the filters in the kidneys and can occur after illness.
The nephrologist advised further surveillance of the normally functioning Hipsher kidneys. He hesitated, for reasons he had never articulated, according to Hipsher, to do a renal biopsy that could definitely determine if IgA nephropathy was the problem.
In May 2017, Hipsher decided she needed a new nephrologist. Meanwhile, the bleeding was a daily occurrence.
The second nephrologist planned a needle biopsy for the following month. The test excluded IgA nephropathy and found nothing that could explain the bleeding. Sometimes no cause can be found and the condition is called idiopathic hematuria.
Hipsher was not reassured; her urine was sometimes bright red. She decided that she needed non-governmental expertise, so she called a prominent medical center and made an appointment. In July she spent four days with a comprehensive nephrological work-up.
Records describe her as "very healthy-looking" and noted her "excellent outer" work-up. A pathologist reviewed the nine-month CT scan, but did not repeat it.
The doctors came to the same conclusion. They could neither find an explanation for their bleeding, nor did they discover anything of concern.
When Hipsher asked the nephrologist if he could rule out cancer, she remembered wiping it aside. The first kidney doctor told her she was "too young" for kidney cancer.
Over the next few months, Hipsher focused on her recurring and difficult-to-treat stomach problems, which were due to the overgrowth of small bowel bacteria, can cause nausea, diarrhea and fatigue and later a parasitic infection. The family doctor she visited told Hipsher she was at a loss, and sent her to Thomas Archie, a family medicine specialist.
"She was referred to me because her case was confusing and I do a lot of strange cases." said Archie, whose practice combines conventional western medicine and alternative practices, including the use of Chinese herbs and acupuncture.
In October she returned to the second urologist to request a CT scan for the worsening of the bleeding, including the apparent blood clots. The doctor, she said, was afraid.
"I would not re-radiate you," she recalls, adding, "We will not worry about the blood."
When Hipsher persisted, the urologist agreed to consult a colleague in Boise to find out if a CT scan is advisable.
Two weeks later, the urologist ordered the scan to look for abnormal blood vessel involvement known as arteriovenous malformation, which sometimes causes bleeding.  The imaging test revealed something quite different: a grape-sized mass on the left Hipsher's kidney at the same site where the atrophy had been detected 13 months earlier. The urologist, who referred Hipsher to a surgical oncologist in Boise, told her that the 2.5 centimeter tumor might be benign.
Hipsher was sure that was not the case. The surgical oncologist agreed and told her it was probably malignant.
One week before Christmas, the surgeon removed the part of Hipsher's left kidney that contained the tumor, which he characterized as anything other than what he had seen.
Oddly enough, pathology specimens were sent for analysis to the Johns Hopkins Medical Laboratory in Baltimore.
A few weeks later, in early January 2018, Archie Hipsher gave the devastating news. She had a rare and very aggressive disease called sarcomatoid renal cell carcinoma.
Sarcomatoid carcinoma, which typically affects men over the age of 60, is characterized by poorly differentiated cells that resemble sarcoma, a cancer that develops in tissues such as blood vessels or tissues in bone. The degree of differentiation reflects the aggressiveness of the tumor: the higher the percentage, the more aggressive the tumor.
The Hipsher tumor was 100% sarcomatoid. The average survival time of sarcomatoid kidney cancer is about eight months.
Pathologists were unable to determine if the cancer had developed in the Hipsher kidney or in their bladder or ureter, the tube that carries urine from the kidney to the bladder. (Blood in the urine and fatigue are common symptoms of kidney cancer.)
Hipsher was devastated – but not surprised.
"I knew it was cancer deep in my bones," she said. "I'm not sure how to explain it." One of her aunts diagnosed a rare sarcoma at the age of 53. Another aunt died of colon cancer one month after the diagnosis. Over the past two years, doctors had told her that they could not pinpoint the cause of her double-digit weight loss and severe abdominal pain.
Archie said doctors have re-examined Hipsher's CT scan from 2016 to determine if it is a tumor missing; He said no sign was found. "I think the imaging was done at such an early stage that you can not even see it," he said.
Had Hipsher completed a CT scan about six months after the onset of bleeding, Archie said the tumor might have been visible.
Hipsher regrets that she did not push for a second CT scan earlier.
"I definitely wish I had taken pictures or a sample of bloody urine early," she said. "Somehow I believe that doctors believe patients when something is visible or tangible, and not just our words."
The Hopkins pathology report contained some good news: The tumor was small and seemed to be confined to her left kidney. Most sarcomatoid tumors are much larger and have been widely metastasized upon their discovery. A PET scan showed no signs of disease.
CT scans were performed three and six months after surgery, while Hipsher performed complex genetic mutation tests that could guide future treatment. They were clean. And her lab tests were normal.
Having seldom contracted cancer, Archie suggested Hipsher should contact the MD Anderson Cancer Center in Houston and helped arrange a visit.
In August 2018, Hipsher and her husband Mike flew to Texas. She had received standard initial treatment – an operation – but the Houston oncologist told her that too much time had passed for chemotherapy or immunotherapy, which was sometimes used after surgery to prevent recurrence treatment outweighs the potential benefit wrote an oncologist.
MD Anderson specialists advised Hipsher to undergo active surveillance that includes CT scans and lab tests every three months.
When her cancer recurs, doctors expect her to Hipsher chose treatment in Houston, so far the news was good: she remains cancer-free, and her next visit is scheduled for mid-August.
The couple lives thrifty and has excellent health insurance, as Hipsher characterizes "amazingly grateful" that they could afford the travel and non-reimbursed medical expenses, which totaled $ 21,000 last year. "I really have a feel for the people who do not even consider such a thing," she said.
Although she still grapples with the events, Hipsher said she has largely succeeded in surpassing the bleak statistics and is generally optimistic. "It was hardest to see what that meant to my husband," she said, adding that he was her rock.
With help from a therapist, Hipsher said she has found a metaphor to live by: live life like a river cruise. You pack and plan and prepare the best that you can. And although you do not know everything that will happen downstream, start. "