D-Day - Diagnosis - March 31, 2008

It's Monday afternoon, and I showed up to the Urologist's office with my packet of X-rays and my collection of tiny stones. Really it was a tiny collection of specks. After the sign-in (where they took the X-rays) and a short wait I was shown to the exam room with a shorter table and the scope tidily covered with a big napkin-like thing. The assistant came in and had me remove my shoes, slacks, and shirt and gave me a gown. I did the pee-in-a-cup thing, and then she did a quick ultrasound on my empty bladder. The ultrasound is not a big deal - sort of being pressed gently by a warm baseball through a puddle of clear (and also warm) goo. As she prepared to leave, I produced my stones and asked who would want them. She said she would take them. I said that I was hoping Doctor Hopkins would see them, and we could skip the rest. She said, "I don't know. I'll ask him." She seemed hopeful. I certainly was.

You may recall that the doctor had promised that, after his scope inspection, that I would NOT ask him for another one. And Dr. Hopkins is kind of a stone specialist, so he would now know that what we have here is no big deal. After about 10 minutes she returned and said that he wants to proceed anyway, so I should lose my underwear also. Sigh. About 20 minutes later the doc came in. "How did you like those films?" I asked in a preemptive strike. "Saw a few things. You have diverticulosis." I had no idea what that was, so he explained it to me. Click the link above if you're curious, but it turns out that it's something to watch, and not a big deal. And not related to the problem at hand. "I also saw a couple of bumps in your bladder that I want to take a look at." As he and the assistant began washing and donning gloves, I contemplated that. Surely the ultrasound should have shown anything significant? What a waste of time and money that was!

The inspection procedure was very quick. Details of the procedure are a bit graphic (6 out of 10 where 10 is max gross-out), and they may be interesting to some. To spare our more sensitive readers, such details are provided on a backup page.

When he was finished he announced, "You have two papillary tumors in your bladder. They are a form of cancer, and they are usually pretty easy to take care of. Go ahead and get dressed and come see me in my office, so we can go over the details when you are more comfortable." Then he and the assistant left the room.

There's no good way to convey that kind of news, and I appreciated the doctor not leaving me in the dark while I cleaned and dressed, and the upbeat attitude that it was no big deal. But he had dropped "The C Word," and I was in a state of shock physically from the procedure (which turned out to not that big of a deal after this first time) and mentally from this new and unwelcome information.

So I have been diagnosed with bladder cancer. It changes your life. It's up to you (a little) and God (a LOT) whether that will be for the better or not. I went in to see the doctor. He used a 3-D model of the bladder to explain it to me. I have two papillary tumors, and they protrude into the bladder from the walls. He was going to schedule me to have surgery to remove them. It was Monday and he did surgeries every Wednesday. Because I take allopurinol for gout, I could not go this week - you have to be off of it for a week. So we were looking at the following Wednesday. I was scheduled to fly back to the DC area the Sunday after that to teach a class. He mused, "We do this on an outpatient basis. You will go home after surgery Wednesday, two days to recover is Friday, you should be fine to travel on Sunday. We're not going to cut into you - it can all be done with a scope, with general anesthesia." Thank God for that last part.

I had to love his cavalier attitude. Sounded hardly worse than having a tooth filled - or maybe a root canal. I can do this. He continued, "There's a 60-70% chance that these are non-invasive, and depending on the staging, we may pretty much be done after next week. I'm going to give you an hour of chemo, post-surgery, to make sure all the bad stuff is killed. They often grow back, though, so we will have to do some periodic checks." I knew that he meant the scope, but I planned to negotiate for a pee test or something later!

I reconciled the information quickly into a model I could understand. These things sounded very much like internal moles (my description, not the doc's). High probability is they are OK, and maybe they will grow back like moles sometimes do. Really seems like no big deal. But until the lab comes back, we still don't know if it's invasive (Big-C Cancer) or non-invasive (Little-c cancer). That 60-70% chance of the non-invasive is on the right side of 50/50. I'd like bigger numbers, but we are at least on the right side of 50/50. I can do this. And the doc says no reason to suspect the worse alternative.

The procedure using the scope is laughingly characterized as "non-invasive surgery." Guess it depends on who's being invaded and how!

I gathered my thoughts and paperwork and headed back to my vehicle. It was after 5, and the very full parking lot was buzzing with folks headed home. I picked up my cell and called my parents. They took the news well, and were very supportive. My mom made notes of all the technical terms, and I knew she would research it pretty well on the internet and in her medical books. Then I called my pastor. I laid it out as no big deal, but he seemed pretty upset by the news. Then I called my boss, a great lady who has had her own issues with dire diseases, and she took it pretty well. I insisted that I would be OK to travel and do the training, and she urged me to reconsider. I agreed to sleep on it. My boss asked how my wife was taking it, and I said that I wasn't ready to call her yet. But I called her next, and she took it really well, accepting it as no big deal. This is exactly the reaction I needed from her, and it was helpful for me not to need to worry about her.

It should be said that she was in Tucson at the time, visiting her birdwatching friend, and that was probably a good thing. Because there she could share her real feelings and get some comfort from her friend, and save the brave face I needed for me. We had opted not to cancel her trip, because, up until now it was no big deal. It's still not THAT big a deal, but the "C Word Bomb" had been dropped, and there's no return after that happens.

I looked around and the parking lot was deserted. I had been on the phone with various people for about 90 minutes. I took the scenic drive home, through Parley's Canyon and Park City. I resisted the urge to stop somewhere for a beer, and got home around 8 PM. My mind was reeling. How could it be that I've got bladder cancer?

The best (and most probable) outcome for all this is that next week will be unpleasant, followed by an unpleasant recovery, and that's the end of it. No guarantees about regrowth, so I will need to be watched somehow for recurrence or other cancers, I think. At this point there's no reason to expect less than the best outcome, so I am proceeding along those lines. Or so I led myself to believe...

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