September Morn

Love New England, especially in early September.  Generally the days are sunny and warm and the evenings, although a bit darker, are cool and great for sleeping. Last night I got some much needed sleep.  I had four booster shots on Sunday (Covid; RSV; Pneumonia: and Flu).  I don't usually get multiples, but I decided it was wise to get it done.  The worst part was the sore arms (both).  Being a side sleeper, Sunday was basically sleepless in Haverhill.  Although the arm pains have dissipated (pretty much), last night was good, sleep-wise.

Today I had my in-office cystoscopy with Dr Previte in North Andover.  I had completed my three rounds of BCG in July and today was 'look-see', to see if the treatments are keeping the bladder cancer away.

I arrived for my appointment on this gorgeous day.  Parking lot was packed so I ended up finding a place on the far end of the building.  Beautiful day for a walk.  Of course there was basically no one in the lobby.  I waited to check in and was charged a co-pay and 'paid up' my outstanding debt.  I still can't figure it out, but I'm paid.  Now I'll have to see if I get a check from Medicare again.

I gave my sample and waited to be called.  After a bit, my name was called and while walking to yet another examination room, I was quizzed on my personal information.  At least this room was not like the meat locker.  If anything, it could have used more air exchange, but it is what it is. I prepared myself and awaited the arrival of Dr Previte. 

The doctor arrived and reviewed my chart and verified a few things then got to work.  I was not able to see the monitor screen this time, but I was attuned to his utterances. He didn't seem to make any 'bad' sounds.  He did say that I had two diverticulars.  (First I heard of it).  He exclaimed that all the tissue was clean.  He spent extra time looking in the diverticulums and said they look good.  He removed his instruments.

Upon updating my file, he said that I had one more round of BCG and another cystoscopy to go.  He did say that he wants another cat-scan.  He mentioned that sometimes cancer is in the kidney, but wanted to rule that out.  This was troubling, but his due diligence is appreciated.  He said I would receive a call for the BCG dates and scheduling of the cat-scan.

When I got home, I had a voice message indicating that the next round will begin in November and a cystoscopy for December 19th.  I still have the cat-scan to be scheduled before 12/19.

More to come!

Third Round Completed

Today I had my third dose of BCG.  

Another early appointment.  The drive was uneventful and there was no problem finding parking since my appointment would be one of the first today.  I figured I'd be in and out, but they were short staffed. It was just Carmen working the counter.  Although she was the whole show today, she remained in good spirits and announced that she was all alone and she will do the best she could.  Well that's all we can ask for.

I stood in line and waited for a spell when she called me to the counter.  I gave her my name and the reason for my visit.  She looked in her computer and  turned to find my folder.  Like other times she verified my vitals and checked to see if there were any changes. Luckily everything was the same.  She gave me a specimen jar and asked that I provide a sample and have a seat.  Easy enough.  Done.

I returned to the waiting room and had a long wait.  I brought the daily paper with me and I read the whole thing and I still hadn't been called.  I arrived at 7:45 and it was now 8:30.  I almost approached her and asked if I had been forgotten, but my plans were halted when my name was called.

The medical professional requested that I follow her.  On the way to the examination room, I was grilled for my identification vitals.  We finally reached my destination.  So many examination rooms; I had not been to this one before.  I was told to prepare myself and wait for Morgan (Physician's Assistant).  I dropped my pants and covered up with the large napkin I was provided and waited.

Morgan arrived and indicated that the examination seat/table was wonky and might not work.  Apparently a replacement is in back order.  Luckily, she was able to position it so she could give me my treatment.  Although the device had seen better days it was actually pretty comfortable (like a padded couch).

Morgan is very good at this.  She inserted the catheter and instilled the BCG with very little discomfort.  She was very quick and efficient.  She said, "We're done".

She had confirmed that this was my third dose and asked if I had my cystoscopy scheduled already.  I said, "It hasn't been".  She instructed me to schedule the appointment before leaving.

I returned to the waiting room and there were quite a few people waiting to be checked in.  I took my place in line and waited my turn.  Mind you, I'm usually on my way home to begin the 2 hour marination, but I had to wait in line.  Upon reaching her, she told me to go to the scheduling window.  There was another line.  The attendant needed to call another office to find out the availability.  She asked if I could go to the Salem, NH office, but corrected herself by saying I needed to return to this office.  Looking at the calendar she said the doctor is booking September.  I said fine.  So she gave me September 19th at 3:30PM.  On the way out Carmen got my attention and indicated that I owed a co-pay.  Whatever.  I whipped out my card and she collected $15.00.  [I still don't understand how that works.  I had been charged $50.00 in the past then received a refund form Medicare.]

So I wasted about a half hour that I could have been marinating.  Once home I started.

The first hour and a half was pretty much normal, but the last half hour was excruciating.  I was uncertain if I was having a similar issue as last week, but I tried my best to hold out.  I had 15 minutes to go, but I was in agony.  I gingerly got up and slowly walked to the bathroom hoping not to have an "accident".  I emptied my bladder, but once I was done, I had the urge to go (like last week).  Actually I had two deposits.  (I know - TMI).  Well that explains my discomfort.  I hope that my not doing the last 15 minutes won't change anything.  Although I had an extra half hour of standing marination in the office.  (I'm sure it's not the same).

For most of the day, I was running back and forth to the toilet.  My bladder felt full, but the output was low.  The burning was really bad. I took the pills, but they hadn't gone through my system yet.  So I surrendered to the fact that I would be tethered to the toilet.

I made coffee.  I hoped that would help flush my system out.  I had some bleeding (expected).  By 6PM I was making fewer visits.  But I did not take my walk today because I didn't think it was wise, considering.

So I'm glad this round of 3 is completed.  I trust that things will begin to return to normal over the next few days.  I do have concerns about not making the whole two hours.  Recalling my very first treatment, I had a few times when I couldn't make the whole two hours.  Not sure if that was the reason why it wasn't successful the first time. So I'll worry about that until September 19th.

More to come!

I Remember This Now

The brutal heat wave continues.  Had just a brief thunderstorm last night.  Didn't really rain much and only made the air more humid.  They always talk about the dog days of Summer being in August.  Doesn't provide much comfort from my view in mid July.  Well at least there's no shoveling LOL!

I went for round two of the BCG this morning.  The early morning 'seemed' cooler, but by the time I arrived in North Andover, the sun was in full force and started cooking.

Being one of the first patients to be seen today, I figured I'd be in and out.  But I had to wait longer than usual.  Of course, there was another Richard in the waiting room.  So when they called the name I immediately approached the medical professional, but could hear the other party asking if they wanted [Last name not heard].  The response was affirmative.  So it wasn't my turn.

Finally I was called.  I was grilled for my identification verification and must have passed the pop quiz because I was directed to follow the medical professional to an all familiar examination room I call the 'meat locker'.  With the weather being what it has been, one would find the 'freezing' room a pleasant respite, But wearing "Summer-attire", and only having an extra large napkin for coverage, I had memories of the Seinfeld episode where George Costanza had 'shrinkage' issues.  Well enough of that.

The Physician's Assistant, Morgan, was the BCG administrator again today.  Like last time she was very quick, efficient and performed her duties with very little discomfort.  Once completing her task, she reminded me about my marination responsibilities and what to do if I had an adverse reaction.  She looked at her notes and said, "Until next week".

Upon arriving home, I commenced the marination.  Past instances, I experienced discomfort during the last 15 minutes of the two hours.  But today was a tough one.  About half way through I was so uncomfortable.  Being a 'regular' guy, I can set the clock on when it's time to "go".  But not having coffee today, the body decided that maybe now was a good time. Oh my god, between having a full bladder and a full colon, the last hour almost brought me to tears.  It was reminiscent of my extra long commutes to work and having to 'hold it in'.  I made it to almost 2 hours.  (Just shy of 5 minutes).  I gingerly waltzed to the bathroom and made a huge deposit.  (Sorry for the visual). This is the first time I've had this.  I hope it doesn't repeat.

My treatment last week was pretty easy to tolerate.  But given the corrosive properties of the BCG and second barrage, my bladder wasn't happy.  Frequent urination with very little output, burning and feelings of pins and needles through my entire body.  As cautioned, I have had some blood.  I'm sure it will clear up by tomorrow.  I did take Phenazopyridine Hydrochloride (AZO tabs), but it takes a bit to go through the system.  That has helped in the past.

So a do nothing day today.  Staying near the toilet and drinking a lot of water to flush things out. I do remember that these side effects are sort of cumulative.  So I'm not looking forward to next week in that regard.

More to come!

A Necessary Evil

Since my last in office cystoscopy on D Day (June 6th),  Dr Previte scheduled my next round of maintenance BCG. Seems like a hot minute when July 3rd came around for my pre-treatment check in. Being the day before the 4th, it was quite busy, but it ended up being a quick check-in and specimen drop off.  This was to ensure I was still a candidate for this next round.  Yes, I passed!

We happen to be in the grips of an extended heatwave.  Temps have been in the 90's and humidity hovering around 76%.  Pretty hellish.  Luckily for me my portable AC is working overtime and is pulling lots of moisture out of the air.  It's by no means cool, but it's far better than the weather outside.  In the afternoon (as the house bakes in the sun) the inside temps get into the mid 80's.  But with copious fans strategically placed, the 'semi-cooled' air gets moved around making it tolerable.  After the sun goes down, the temp in the house gets to 72 degrees, so sleeping isn't too bad.

I had an early appointment today for my first round of 3 doses.  I arrived at 7:45 and after the standard check in and specimen, I was called in.  The nurse was really liking my mustache.  (Go figure).  After verifying my vitals stats, I was brought to a familiar room where I was told the PA, Morgan would be with me briefly. I've had Morgan before.  She is very efficient and knows what she's doing.  The instillation was relatively painless (mostly uncomfortable) but quick.  I got out at 8:30.  Not bad at all.

Just in the short period of time the temperature was already 88 at 8:30AM.  Car ACs are nice, but when you leave the confines of the car, the oven awaits and even though the house AC had been on, it didn't feel very cool.  Oh well.

I did my 2 hour marination.  I actually dozed for a bit and probably had an extended period on one side, but I did make it through without having much discomfort.  (I didn't have any coffee or tea so there was little water in me).

Just taking it easy today.  More to come!

And So It Begins.....again

On the anniversary of D Day, I had an appointment with Dr Previte for my in-office cystoscopy to ensure that the cancer hasn't returned and ultimately 'clear me' for my next round of BCG. 

It was cloudy and a bit humid today.  Most cars are looking green because of all the pollen.  We are supposed to get some rain later, so cars will return to their normal color for a day or two.  Spring!

I arrived to a full parking lot today, but manged to find a slot not far from the door.  The lobby was busy, but patients were being processed rather quickly.  I checked in and gave my obligatory specimen and waited to be called.

It wasn't too long before hearing my name announced.  I followed the nurse who was grilling me for my personal information, but I knew which room we were going to.  Once there she did some prepping for the doctor then asked me to drop trousers and assume the position.  I waited for Dr Previte to arrive.

Not too long after, the nurse arrived with Dr Previte.  After some pleasantries and reaffirming my medical situation and last round of treatments, he asked if I was experiencing any blood or difficulties urinating.  Answering to the negative, he then prepared the device to begin it's descent into my bladder.

I had a clear view of the screen and he was a bit more descriptive as to what we were seeing.  I was concerned when I saw some spots, but as he zoomed in, they were just 'puckering' of the tissue that once had cancer cells removed.  The camera moved all around as the doctor examined the walls.  To my eyes the skin looked like baby's new skin.  He interjected,  "We are now at the opening to the diverticulum".  He stated that this is the area I previously had much of the cancer.  It looked squeaky clean.  He said, "I'm about to say you are cancer free, but I want to check out the urators (vessels that carry urine from the kidneys to the bladder)." He navigated to what my eyes looked like, an exposed vein, then he zoomed in to a tiny opening.  He said, "The watched pot never boils, but I want to see it open and see if the urine is coming through alright". But while watching, I could see the tiny while open up like a whale's blow hole.  He said, " That's what I wanted to see".  The human body is amazing.

He removed the device/camera then said, "You are OK to begin your next round". He said, " You'll be done with 'all this' in 2025".

More to come!

Short And Sweet

I had a check-up with my oncologist, Dr Mehta at Dana Farber today.

It was quite busy today, not sure why, but things moved right along.  I didn't need any blood work today since this appointment was scheduled to discuss the results of my mammogram and any other issues that have surfaced since my last visit.  I already knew my results because the hospital sent me a letter that nothing was found. 

After being called in after a very short wait, I had my vitals checked and recorded.  I was brought to an examination room and not too long after, Dr Mehta arrived.  After exchanging pleasantries and discussing the status of my bladder cancer treatment, he said he really had nothing for me.  So he said my 10 year mark will be next summer (2025), but until that time he wants to see me in 6 months.

My next appointment with him is October 2nd. So I was in and out in less than an hour.

More to come!

It's Always Something

I had my annual ultra-sound and follow up for my triple A (Abdominal Aortic Aneurysm) at Umass Medical in Worcester.

I got an early start and join the throngs headed off to their work.  I'm happy that traffic cooperated and I made it to my appointment with a few minutes to spare despite my spacing out and missing my exit.  The detour didn't take me too far off course.  I attribute this navigation error to my lack of caffeine since I had been fasting since 11PM last night.  So I had a serious case of brain fog.

My appointment is a two-parter: Ultra Sound then review/follow up with the doctor (or his associate).

I was called in for my ultra sound and I had someone in training observing and talking medical jargon.  Like most of my ultra-sounds, the attendant had a tough time due to bowel gas.  She had me take deep breaths and exhale a number of times in hopes that the gas would 'move along'.  I was hoping it didn't move further south and escape.  This could have been quite embarrassing if flatulence permeated the confines of the exam room.  I guess it was lucky for them that we had no disturbance, but the trapped gas made their job a bit harder.  I did notice there was some 'hubbub' as the were quickly riffing into medical-speak.  To me, this is generally alarming and makes the mind reel when no explanation is provided.  Eventually the hard pressing was done and I was dismissed.

I returned to the waiting room and was almost immediately called in. I was weighed and had my vitals checked and recorded.  I was told that the Nurse Practitioner will be with me shortly.  Since 2017, I've seen both a NP/AP and Dr. Schanzer. 

Nurse Practitioner, Shauneen arrived and initially said all my tests looked good.  I had no endo leak and my sac is continuing to shrink.  She said it was 3.4cm versus 3.8 last year.  She checked the pulse in my lower extremities and indicated that I had a strong pulse.  She added that I'll be returning in a year.

I got home and had a message indicating my visit notes were available in my portal. I think I found what the hubbub was about, but apparently it's not a concern.  But of course I had to look it up to see what it was.  Of course the results are varied and may or may not indicate a cancer. But since it doesn't seem to be a concern for the doctor and staff, I'm going with that.

Basically the findings were:

 

•  Duplex ultrasonography of the endovascular stent graft appeared patent.

•  No flow was seen in the residual aortic aneurysm sac by duplex ultrasonography.  The residual aneurysm measured 3.4 cm.

•  A linear hyperechoic structure was noted along the vessel wall at the level of the distal fixation. It was not possible to distinguish dissection versus plaque. This appeared to be consistent with CTA findings from 3/20/2023. The distal stent edge appeared to be poorly adhered to the vessel wall. This did not appear to be of hemodynamic significance.

 

ASSESSMENT: Satisfactory progress 7 years following endovascular repair of a an infra renal aneurysm

 

PLAN: We will plan to see him back in 1 year with a repeat EVAR duplex. He should continue on his aspirin and statin indefinitely.

 

Next appointment will be March 24, 2025.

 

More to come!