March 22, 2009

I was unsuccessful altering the "Consent to Anesthesia" form. I just hate it when I have to admit losing an argument. When I inquired about the "others" that might preform "medical acts" upon me, it was suggested that "you may not want to have this procedure done today"...... This was repeated several times. I did find out that it is a highly trained nurse that actually administers the anesthesia, that the Anesthesiologist oversees at least two operations at a time, and will be there in the event of problems. I guess that presumes that there is no problem elsewhere, and that the nurses are "highly trained" and not "in training". In any event, it was sign or no service, so I caved in, and survived.

So, I had my surgery on Monday, and it turned out to be far more complicated than expected. It appears that the Doc. in Az. did not attempt to remove the bulk of the tumors, but instead, merely took samples to confirm his opinion that the the bladder should be removed. I don't want to be to hard on him though, I think that he had every reason to believe that the cancer was far advanced..... He knew that the cancer was the invasive type, (from a prior biopsy), and that it covered 80% of the bladder wall. I had told him that my symptoms may have gone back 2 years. (I may have been wrong on this point, it is possible that I did have a UTI, or a series of UTI's, back then.) I know that he was very surprised when the pathology report said that the cancer had not invaded the bladder muscle, and did recommend another attempt to save the bladder.

In any event, my team spent 3 1/2 hours removing all of the cancer that they could find, and placing a stint into each of the tubes that lead from the kidneys to the bladder. They felt that the openings into the bladder might swell shut, causing the kidneys to back up, and cause sever complications. I am not able to describe what a swollen bladder feels like, but I can say that it is not recommended.

I was, and still am, surprised at the debilitating affects of the cancer fighting procedures, the anesthesia, and the pain controlling drugs. The combined effect is to bleed away your resolve and good nature. Trying to function normally while under the influence of pain and drugs is nearly impossible, and the bad part is, that you know that you are doing a bad job of it. So far, I have endured little compared to the others that I know of, but I am beginning to understand the fight with cancer, and have a new found respect for the people who have traveled this path.

I can't let this post go with out relating a light hearted moment..... On the trip east, I had the pleasure of much conversation with Sandy. (Those of you that know Sandy, or me, will understand. Lol) Traveling for 5 days with someone that you really don't know, turned out to be very interesting, and informative. We had the chance to exchange many ideas, theories, and opinions. One of Sandy's ideas is that you need to ask the universe (God, for the religious among you) for what you want.... specifically. Well, there I was, lying on a bed naked, surrounded by attractive women, with all of their attention on my genitalia....... What came next was not the procedure that one would expect or want..... Guess that is when I realized that I wasn't specific enough. LOL


THE PROGRONOSIS.....

Bladder cancer comes in 4 stages:
Ta, Involving the mucous lining only.
T1, Penetration into the lamina propria..... apparently this is the layer between the mucous lining and the muscle.
T2, Penetration into the muscle of the bladder.
T3, Penetration through the muscle of the bladder.

I am not clear on this, but it seems that there is a distinction between invasive, and non invasive cancer as well.

My cancer is the invasive type T1. At this point my cancer is not life threatening. It is however, bladder threatening. I have a bit less that a 50% chance of still having a bladder in 5 years. The doc. thinks that it is worth trying to save my bladder.

This type of cancer almost always comes back, and is always a threat to penetrate the bladder muscle, and set up camp in my other organs. Regardless of the success of the treatment, I will need to have regular monitoring, every 3 months at first...... To be clear, this is not a scan or a blood test, this is an up close and very personal, lights, camera, action kind of look see. The Doc. thinks that it is very unlikely for the cancer to spread if I maintain this schedule. I am trying to remain aware that, though uncomfortable, treatment and monitoring has to be much better than death.

It is still possible that the trauma to the bladder may render it nonfunctional, even if the cancer is eradicated.

THE TREATMENT.....

I have a month to heal up, and for my bladder and other systems to begin working normally again. I am told that I should feel better every day for a while. In one month...... another look see, and another bladder scraping..... Like I said, they can't seem to get enough. The Doc. says that my last surgery was so involved, that after the first couple of hours, the entire bladder was so inflamed, that it was difficult to be sure that he got every last little bit of the cancer. I guess that this is standard practice in cases like mine.

After that, another month to heal, and then a BCH treatment once a week for 6 weeks. BCH treatment is a process of filling the bladder with a weak form of tuberculosis, which seems to inspire the bladder's immune system to kick into high gear. For reasons that are not fully understood, the newly vigilant immune system recognizes the cancer, and goes after it as well as the tuberculosis. Just an aside.... My hat is off to the first person to have this done..... I can just picture the bedside conversation.... "You see, we have this idea...... we want to put a deadly disease into your bladder"......

If my math is correct, it means about 3 ½ months till the end of the BCH treatments, and brings me into the first part of July.

THE PLAN.....

I expect to stay in this area until the end of my treatment. If possible, I will visit the rest of my family in Pa. and Maryland, and perhaps manage to visit with the Win's as they travel through nearby states. When my treatment is complete, I will head back to Ca, and try to resume my normal life.