Light At The End Of The Tunnel (albeit, dim)

July 2022

Having survived my latest adventure, July hasn't been the best. Starting out badly and continuing with various challenges, the latest record breaking heat wave just seemed to make matters worse.  Being so unhealthily hot and being forced to remain inside trying to remain cool with a portable AC was a challenge unto itself.  While the temps outside soared to 100 + degrees, afternoon sun made inside temps read in the mid eighties.  When the sun went down and after running all night, the next day would often start at a nice 72 degrees before inching up as the day progressed.  Finally the heat wave ended and we've been having very pleasant (dry) weather.  Unfortunately, we've had no rain so we are in a severe drought.

July is just about over and I had a few follow up appointments with both my primary care and urologist.  My primary care had asked that I have a blood test/panel done prior to my appointment (7/27).  I had scheduled an appointment with Quest Diagnostics months ago to coincide with a two week window.  Of course I had no knowledge of what July had in store for my bladder, so I was quite concerned when I saw the results of the tests in my account.  It seemed I had more red flags that green.  I did some research as to what the reading might mean and was not happy at what 'might be'.  So instead of worrying, I'd let the doctor tell me.  But it was on my mind.

I had my follow up with Dr Previte at Northeast Urology in N Andover yesterday.  Although I had no bleeding, I had much on my mind.  What was the pathology results?  Given I had 5 tumors removed, does this make me ineligible for the BCG treatment? Will I have to have my bladder removed?

After an easy check in, I has given a cup to collect urine.  After completing that task, I returned to the waiting room and was called soon after.  The nurse directed me to an examination room and I was told that Dr Previte would see me shortly.  Said some prayers and waited.

Dr Previte arrived and after exchanging pleasantries, he asked if I had any bleeding and how I was feeling (recovering).  No bleeding to report and all the plumbing was working OK.  I did report that I had to get up once or twice a night to 'go', but other than that I've resumed life and like everyone, was dealing with the heat (we had).  The doctor said that I was still healing and having to get up, was normal under the circumstances.  Then he pulled up a surface and started arranging my file, paperwork and some printed literature. He then provided a recap of what had transpired and some results.

He said, "No surprise that pathology reported bladder cancer.  But, it's still T1 (lowest level before having to have a bladder removed) non-muscle invasive bladder cancer and treatable". He reiterated that they were high-grade tumors, very abnormal and disorganized, but most aggressive and more likely to grow into the muscle.  He took out 5 tumors and showing an illustration of the bladder, he pointed out their proximity.  The one that was bleeding and the biggest was at the top, the next large one was off to the side, and there were three smaller tumors scattered on the surface. He then said something that made me less anxious, "We can begin the BCG treatments".

Bacille Calmette-Guerin (BCG) vaccine is an immunotherapy drug.  This form of therapy is designed to boost the body's natural defenses to fight the cancer.  It uses substances either made by the body or in a laboratory to bolster, target or restore immune system function.  Given through the catheter placed directly into the bladder, BCG attaches to the inside lining of the bladder to fight the tumor.  BCG is used mostly for patients with non muscle invasive high grade bladder cancer to reduce the risk of cancer recurring or progressing.  Before BCG treatment, patients need to have a TURBT (Trans Urethra Resection Bladder Tumor) [Which I just had on 7/6] to make sure that the cancer has not spread to the muscle.  BCG treatment may help patients avoid cystectomy (removal of the bladder).

The Benefits:    

First-line treatment for carcinoma that has not spread outside the bladder.

The Risk:          

It cannot be used immediately after the surgery because the risk that it will be absorbed into the blood stream.  It may cause flu like symptoms in some patients as well as infection in a small number of patients.  Pain and burning may occur during urination and patients may feel the need to urinate frequently.

The Plan

After the healing, probably mid August, I will begin a 6 week Induction.  My understanding that I will go to the office once a week for 6 weeks where the drug will be induced.  Sent home and told to marinate for two hours, I then pee it out.  I have to refrain from having fluids so as to not dilute the drug.  I'll need to monitor my temperature to ensure that I hasn't gotten into my blood stream

After the induction phase, Maintenance will begin.  My understanding is I'll be having more of the drug but at greater intervals.  At the three month mark, I'll have a cystoscopy.  He did say that the first would be under anesthesia, but out patient.  Down the line, they would be in office.

Finally, BCG!

I got home and had a voice message that a surgery date has been scheduled for October 25th and a pre-op appointment with Dr Previte the week before.  I was confused because I thought he first appointment would be the induction.  So I called and was told that surgery dates are booked first then they work backwards.  Made sense now.  I just need to hear when the induction will begin.  Hopefully I'll hear today or tomorrow.

Primary Care

Had my annual today with Dr Mitchell.  After checking in and getting SAT's to complete, I was called in by the nurse.  My weight and vitals taken, I was told Dr Mitchel would be right in.  Wasn't long and she arrived.  I brought her up to speed and she reviewed notes and test results.  I was dreading that those red flags I saw from my blood test would open up Pandora's box of maladies, but she said my numbers looked good and some of the anomalies were due to my recent surgery.  She did want me to get re-tested in a few weeks.  She said, "It takes a while for the body to recover and get all the red blood cell counts up again considering you had lost a lot of blood".  [I was hoping for that diagnosis].

She checked everything and 'nothing jumped out'.  She did provide a referral for an overdue colonoscopy (because of Covid) and a mail in test for colorectal (fecal blood test).  She said, "I won't need to see you for a year."

July started out horribly wrong, but ends with much optimism.

More to come!