Getting Ready for the next Thrill

February 7, 2009 - Since the good news of my last entry at the end of 2008, I’ve been recalcitrant in catching you up with my roller coaster ride. Things continue in a positive direction, however, I have a bit of excitment coming up.

January and 2nd Opinion
My scoping procedure in early January went very well. According to Dr. P (see below) who performed it, there were no signs of tumors or strange cells, except for scar tissue at the sites of my previous surgery in September. I got to watch on a TV screen ... imagine looking inside a big sea urchin!

I had a 4th round of chemo on January 8, 9, 10 and that went OK, although there was a dip in my energy & spirits for 2 or 3 days immediately after.

On January 12th, I had consultutations with an oncologist and urologist at the University of Washington Medical Center. Both are part of the community of cancer specialists linking UW, Fred Hutchison, Swedish, and VA hospitals in Seattle. Virginia Mason is plugged in, too, but not in a formal way. The purpose my visit was to get a second opinion on my diagnosis and treatment. Both of the UW doctors said they agreed with the diagnosis (small cell bladder cancer), its rarity, aggressive nature, and the approach of chemo prior to surgery. They were encouraging about my response to chemo. Both, however, strongly recommended bladder removal surgery because; a) bladder cancer has a high rate of recurrence, and b) removal of my bladder is the surest way to remove the source. We also talked about radiation treatment as an option, but it has not shown to be that effective with the bladder cancers.

Surgery - the next Thrill
This brings me to yesterday, Feb 6th. Daren and I went to Virginia Mason to consult with Dr. “A”, oncologist, and Dr. “P”, urologist. Dr. A has been my primary specialist and has been excellent. Dr. P is also extremely good and held in high regard by the other doctors I’ve seen. Both of them recommended the bladder removal surgery, technically called a cystectomy. The date has not been set as yet, but will likely be in mid-March. In the meantime, I’m going to have a 5th round of chemo starting next week, Feb 12th.

Dr. A reaffirmed the notion that radiation is iffy and can lead to more problems than warranted when applied in the bladder. His opinion, which represents the collective opinion of most cancer specialists, is that there is one best chance to cure a cancer patient. Rather than wait & monitor my situation, with a chance that the cancer will come back with a vengence, he recommends going ahead with the best chance of a cure.

For me, that is to get what I think of as the nasty little buggers cut out, with surgery called a cystectomy (say that 3 times, fast!). It will involve complete removal of my bladder, plus lymph nodes and most of my prostate. If interested, you can follow these links for more info (http://www.webmd.com/cancer/bladder-cancer/cystectomy-for-bladder-cancer or http://en.wikipedia.org/wiki/Cystectomy ). Of course there will also be a need to coordinate carefully with Dr. A and Puget Sound Blood Center to deal with my mild hemophilia. I expect I’ll receive pretty big doses of replacement clotting factor (Factor 9).

Dr. P will be performing the surgery … the really cool thing will be what he has in mind to replace my bladder. He’ll create a new bladder (neobladder) from a section of small intestine and hook up my plumbing so it works close to the original bladder! The tricky part will be maintaining the blood vessels on the neobladder. Dr. P has done several hundred of the bladder removal surgeries and about 150 of the neobladder surgeries. I would have to go to Los Angeles, St. Paul, or New York to get a more experienced surgeon.

Expected Recovery Period
Following 7 – 10 days in the hospital at Virginia Mason, I’ll be home for another 10 days to heal up. Dr. P said it will twelve weeks following surgery for complete recovery, so that puts it at the middle of April.

None of this will be fun, but I accept that the surgery is the best and surest way to lead to a cure. I’m steeling myself for it. Eating well and exercise continue to be a priority.


I hope you are all managing well enough in these tough economic times.

I'll let you know how things progress as I get ready for my next steps.

Spring is just around the corner!