Medical Update

Feeling fine, looking good.

Went through my annual physical on Tuesday, and all seems well. Blood work will be done next week to reveal what’s going on under the skin.

I went through the TURBT procedure for bladder cancer in late June. Next steps are the BCG wash. My urologist first said it would start in July, maybe August.

I mentioned this to my PCP on Tuesday. She was surprised. “Oh, they’re doing them? There was a nationwide shortage.”

Oh.

Forward to today. The BCG wash won’t start until the end of October.

The reason: a nationwide shortage of BCG. The United States has one source, a Merck facility. They’re trying to increase production but that won’t be successful — if it happens — until the end of 2026.

This is only a US issue:

The BCG shortage in the United States has been primarily due to a reliance on a single manufacturer, Merck, which produces the TICE strain of BCG. This dependency became critical after Sanofi Pasteur ceased production of the Connaught strain in 2012, leaving Merck as the sole supplier for the U.S. and many other countries . In contrast, other countries have access to multiple BCG strains produced by various manufacturers . In the U.S., the stringent FDA approval process has limited the availability of foreign-produced BCG strains, contributing to the prolonged shortage.

I’m simultaneously happy that the BCG wash is available and I have the means to have the procedure and frustrated by this continuing trend in the US. We become dependent on one source, and live and die by it.

It’s not just BCG; an article I read the other day recounted the US shortage of 155mm howitzer shells:

Manufacturing woes hamper US 155-mm ammo production

Businesses love to consolidate, buying up competitors, merging to ‘improve production’. Rarely works. Instead, we find ourselves more and more with just one location, putting all our trust and faith in them.

We often won’t modernize infrastructure until it reaches the brink of failure.

And in the US, we tend to wait to earnestly fix things until a crisis is clear. Witness what’s going on with Lake Meade and the growing water shortage. Even there, instead of actively addressing the problem, the Trump administration is paying to reduce consumption.

Something to think about as news and entertainment companies continue to merge.

Medical Update

Received my biopsy results the other day and saw my urologist today.

The TURBT procedure seemed to get all of the cancer. Didn’t get into the muscle tissue, blood, or connective tissue.

That’s all good news.

My bladder seems to be healing well, based on observations. No pain, clearer urine.

The next steps begin in August, maybe September. After my bladder has healed from its surgery, we’ll begin a series of BCG washes. This is an instillation of tuberculosis bacilli into the bladder. This trains the immune system to attack the disease. It then also attacks any cancer cells which dare to show. I’ll go through that once a week for four to six weeks. There’s a less than 1% chance that I’ll develop TB from it.

CT scans with contrast will follow after the BCG wash protocol to see what shows in my bladder. Cystoscopy if or as necessary to see what’s in there. Three-year follow up program of checking and washes.

First steps have been taken. While it’s all positive to date, it won’t be done for a while. Meanwhile, I’m energetic. In good spirits. Overweight — got to eat less and exercise more, but I can’t exercise properly for two more weeks — but optimistic.

Thanks for all the support. I’ll try to reciprocate to the best I can.

Cheers

Post-Op Update

TL/DR: My bladder cancer surgery went well yesterday. Two tumors were removed. I’m at home in recovery and awaiting biopsy results. We don’t know when they’ll be in.

The longer version…

I’m standing up to type. I have an 18 French Foley catheter in me. It’s inflated with saline solution.

Sitting is hugely uncomfortable. Taking a few drugs for that but whenever I sit, an enormous urgent need to pee wells up and doesn’t end, even as I see urine going down into my collection bag.

All went great yesterday. First, just as we were leaving the house, the surgery called and asked if we could hurry in. If we could, my surgery would be moved up by an hour. Yes! Let’s go.

I head to the Self Check-in Kiosk. A young volunteer rushes over to help me. She’ll type for me. Okay. I read faster than her, so I answer before she finishes asking. We zip through.

My wife and I laugh about this whole process. Weird to have a self-check in that isn’t a self-check in. We’re sent over to another area. This is where my wife gets her information about waiting for me. We go into the waiting area. We’re only there for three minutes before Sophia arrives to take us back.

She confirms my name and birth and gives me my wrist band, asking me to confirm it’s right. I strip down and answer Sophia’s questions. Bowel movements, eating, drinking, then she left. Another nurse came in, Sarah, and asked questions, verified information, checked my BP and pulse, and put inflation leggings on my calves. I wondered to them, when will we get Tricorders? She laughs.

Everyone always looks at my wrist band and ask me to say why I was at the hospital – *TURBT* — Transurethral Resection Bladder Tumor with Gemcitabine bladder instillation — name, and birthday. Did I do the Hibiclens shower the night before? Under Sarah’s guidance, I wash with more wipes, get into my gown and the bed. BP and pulse taken, IV port installed. Then…waited.

My anesthesiologist, huge, grinning guy, came in with his questions and explanations. It’s a three-minute drill.

My surgeon comes in. She looks like a little blue and raspberry Samurai warrior in her surgery garb.

Another nurse came in, Sarah. She was wheeling me to the operating room. During the ride, I mentioned that she was my second Sarah of the day. “Yes, it was a popular name during the eighties,” she says.

I reply, “Yes, Michael was popular when I was born.”

Sarah answers, “I was going to be Michael. They thought I was going to be a boy.”

“Were you named after a specific Sarah?”

“No, my brother picked my name. He said he would only play with me if I was named Sarah.”

We arrived at the surgery and introduced to more team. Slid myself from the bed to the operating table. Ugh. Much less comfortable. “There’s a hole in the table,” Chris says as I move. “Aim your rearend for that hole.”

Alrighty.

Monitors were attached. The anesthesiologist said, “I’m administering your anesthesia now. Deep breaths.”

Three deep breaths later, I was gone.

Awakening, I think, oh my God, I have to pee. I’m scrambling to get out of bed. Except there’s a bar in my way.

A nurse grabbed me on the other side. “Whoa, whoa, whoa. Go back to sleep.” She pushed me back down. I remembered, oh, yeah. I’m at the hospital. Man, do I have to pee, though.

I’m in the recovery area. Looking around. “How long am I going to be here?” I ask the nurse. She glances at the clock on my monitor. “Another twenty minutes.” I checked the time so I can track it myself.

Other recoverees are wheeled in. We’re half-surrounded by curtains and equipment but I can see three. I can’t see Grace, but Grace doesn’t hear well, so I hear everything that they’re telling Grace.

I’m in space 18. The guy in 19 is awake. I wave at him. He seems to be looking at me. I wave again. He waves back. I smile, give a thumbs up. He does the same, then lays back and closes his eyes. They wheel him back out ten minutes later.

A new woman is wheeled into 17. Her bare shoulders and upper chest are exposed. I wonder what’s going on with her. A nurse or tech wheels in an x-ray machine and tells her that she needs to get some shots. I expect the curtains to be pulled. They’re not. I look away, trying to give 17 some privacy. She’s wheeled out a little later.

I check the time. Still ten minutes left. Man, recovery time is going so slowly. Classic first-world complaint.

Sarah the second returns to wheel me back to my room. “How long have you been doing this, Sarah?” I ask.

“Three years.”

I nod. She’s a vet.

She maneuvers me back into my original little room SUU 3. Paula, another nurse, comes in to begin my post-op care instructions. She asks if I have anyone with me. “Yes, my wife.” Paula goes out and has someone go find my wife in the waiting area.

Fifteen minutes later, I’m dressing. Absorbing instructions. My penis is attached to my groin’s right side via a tube stuck on my thigh so the tube and collecting bag can go on my right, because that’s how I get out of bed, on the right side. It’s a bummer because I hang to the left. Sorry if that’s TMI.

I’m given mesh underwear to put on. A pad is thrust in there to absorb bleeding, and there is bleeding. Then I dress.

Paula explains how to use the catheter. I’m familiar with it. The one difference this time is that I was given chemo. Gemcitabine was instilled. It’ll take 48 hours to flush. I’m instructed to flush twice after emptying the bag, and to be very careful because of the gemcitabine.

Four medicines have been prescribed for pain, the urge to pee, and stool softeners.

I later read two tumors removed. Largest was a posterior papillary bladder tumor measuring 2cm x 3cm.

We’re back home by 4 PM. I have a light lunch, then read and nap for several hours.

It often burned when I urinated last night and this morning. That’s faded a lot, thank dog.

Per Paula’s instructions, I showered last night. My penis tip was caked with drying blood, and pubic hairs were trapped in it. Once that was washed off, a lot of discomfort went away.

I’m due to remove the Foley catheter on Monday. Get in the shower, cut a valve off, let the saline drain, jerk the catheter out.

It’s good to have something to look forward to.

All ‘Bout Me

Just got a text reminder. I’m due to receive my next dental implant on June 25. That’s exactly a year since the molar and cyst were removed.

Since then, I’ve had my gallbladder removed. Stones and sludge in there, you know?

That was about a year after my ruptured tendon surgery. About two years after my broken arm, itself about two years after my kidney stones emergency room visit, which was about two years after my obstructed bladder emergency.

Now I’m due for Transurethral Resection in my bladder to remove cancer.

On June 25.

Damn, what are the chances that those two things would end up scheduled for the same day?

I’ll need to change the implant appointment. Although I’ve waited a long time to get that completed, facts: the bladder cancer is a greater priority, and it’s harder to schedule. I began noticing blood in my urine in March, and there’s been long periods between blood tests, examinations, CT scans, cystoscopy, and surgery. I don’t want to extend it yet more.

From the half-full point of view, though, I’m fortunate to be able to get any and all of this treatment. So, sure, I’m whining, but it’s first world blues.

It’s way worse for my wife, who has had to visit me to all these different appointments and help me recover. Don’t know where I’d be without her and her support.

My Situation

I officially have bladder cancer.

This started as blood in my urine a few months back. A CT Scan with contrast showed a lump in my bladder. I went to have a cystoscopy yesterday.

That was an interesting appointment. A med tech, Chris, did the standard intake to update my records. Then he explained that they didn’t have the cystoscopy equipment.

Whaaaat?

It was going to arrive later that day. So I could come back…

Chris left. Ten minutes later, the doctor entered the room.

She did a double take: like, why wasn’t I gowned and in the chair? Pretty funny expression, very human.

Then she sat and we talked. I explained to her that Chris said that the cystoscopy equipment wasn’t there. Oh, the doctor realized she’d misunderstood the staff that morning. She thought they were telling her more equipment was arriving.

She left. I went out to talk to Chris about the situation. Another tech hung up her phone and announced that the equipment was at the hospital warehouse. She was going to race over and pick it up.

Okay. I stayed and waited.

“This might pinch,” Chris said twenty minutes later.

I was naked from the waist down on the chair. Reclined, a flimsy paper sheet covering me. Until Chris uncovered me and injected lidocaine up my urethra.

Pinch? No, it stung in a big way.

That was just the beginning.

The doctor came in. Lubed up her camera. Inserted it into my urethra. She and I watched on a monitor as the camera went up my urethra.

“Arrgh.” I arched up in pain.

She nodded. “Yes, your urethra narrows a lot here. Did you have a Foley catheter before?”

“Yes. Twice.”

“That explains it. Okay, I’m in the bladder. There’s the tumor. Yes, cancer. See it? Looks like a small coral reef on your bladder wall.”

A three cm posterior bladder tumor.

She pulled the camera out. Explained next steps. Surgery in six to eight weeks. I’d be sedated. She’d put a tube up my urethra and then scoop the cancer out. TURBT (transurethral resection of bladder tumor), gemcitabine.

Referral to another doctor for PCNL – Percutaneous Nephrolithotomy – to remove the 1.4 cm stone in my right kidney.

I’ll let you know how it all goes.

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