Life Under The Sword Of Damocles

Life Under The Sword Of Damocles

Since my last post, things are slowly returning to normal (down there).  However, I'm reminded more often that I need to visit the porcelain buddha to eliminate.  Razor blades have ceased to bother me, but I can't seem to get to the two hour mark before nature calls.  I do recall that this happened for a spell last time, so I plan accordingly.

I had a scheduled tele-health call at 11 today, but I received a call at 10:55 AM rescheduling it to 2PM because the doctor was called into surgery.  So I rearranged some of my chores so I could give my full attention to my follow up.  Well 2PM came, then at about 2:40, the phone rang.  Doctor Ingham apologized for his tardiness and said he appreciated my flexibility. So with pen and paper, I began taking notes.

Dr. Ingham said that he did a lot of cauterization within the bladder. He did mention that the diverticulum looked really good.  He said that Dr Hurley did a good job cleaning up.  In this latest 'look/see' there was no significant sign of the disease.  However, within the bladder there were many satellite lesions that he scrapped away.  He did send to pathology and it was not surprising that they were deemed cancerous. But, it definitely confirmed that I do have bladder cancer.  He did say that the lesions were superficial in appearance and he was able to brush them off with the loop.  He indicated that 'stirred cells' can grow in clusters (seeding) and he spent a lot of time to find and remove them all.  There were no obvious tumors that MRI had shown on different views. However, between the MRI and this cystoscopy/TURBT things not 'appreciated' in the MRI got taken care of.

Next Steps

At this point in time, he doesn't believe that a removal of the diverticulum is a great option.  And, removal of the entire bladder is not needed.  He did strongly recommend a medicine treatment.

Medicine In The Bladder

Dr Ingham discussed IVT and BCG.   

Intravesical therapy (IVT) refers to a procedure in which physicians place liquid anti-cancer medication directly into the bladder through a catheter rather than giving it by mouth or injecting it into your bloodstream. The medicine, BCG (Bacillus Calmette-Guerin) is a weakened form of Tuberculosis that stimulates the immune system (immuno-therapy of sorts).

• BCG is given by intravesicular infusion. This means it is given directly into the bladder through a urinary catheter. The urinary catheter is inserted through the urethra (the tube which carries urine from the bladder to the outside of the body). The BCG solution is injected into the catheter, which is then clamped. Clamping the catheter allows the medication to remain in the bladder. The patient is encouraged to roll from side to side and to lie on their backs to help the medication reach all areas of the bladder. After a predetermined time (usually about 2 hours) the catheter is unclamped and the fluid is drained. The catheter is then removed.
• BCG treatment is given as an outpatient procedure.
• The treatments are usually given on a weekly basis for 6 weeks followed by treatments once a month for 6 to 12 months. Your doctor will determine the exact treatment schedule and dose. And follow-up of maintenance therapy.
  

Side effects:

• Most people do not experience all of the BCG side effects listed.
• BCG side effects are often predictable in terms of their onset, duration and severity.
• BCG side effects will improve after therapy is complete.
• BCG side effects may be quite manageable. There are many options to minimize or prevent the side effects of BCG

In very rare instances a side effect of sepsis (infection) can happen.  Basically, this is treated like one has TB with anti-biotics.

Of course BCG is difficult to get and has been back ordered, but Dr. Ingham indicated that it has become obtainable, but  can be difficult to get if one is not clinically approved.  He said that I am clinically approved.  (Versus a soft call for another patient).

Dr. Ingham said that this could be done with Dr. Hurley at his location, and feels that BCG might be easier to obtain given his location away for Boston/Brighton and the demand. He said that there are other options as well as chemotherapy, but his preference is BGC.  He said it's been around longer and there is more data available to support it. He did say the others are relatively new, but he feels there isn't enough data yet.  BGC has been used and proven to be effective.

Game Plan

I have to wait 4-6 weeks so things can heal.  His office will reach out to Dr Hurley's office.  Dr. Ingham indicated that if I don't hear something in about 3-4 weeks, I should reach out.  [Which I have no problem doing].

So there's more known than not known, but that sword of Damocles and feeling of imminent danger persists.  I'm hopeful that the BCG is easier to get and my day treatment (for 6 weeks) goes off without a hitch.  I'm happy that I can drive the 14 miles (each way) on familiar roads to have this done.  But it is always something.

More To Come!