BCG Special Handling Requirements - July 4, 2008

The written instructions from the Urology Clinic and on the Bladder Cancer WebCafe Site were both pretty clear:

For maximum effect the solution should be instilled when the bladder is completely empty and remain in direct bladder contact for 2 hours.

Patients are recommended to limit fluid intake for 8-12 hours, and to have no fluid intake for 4 hours before treatment is scheduled. Avoid direct skin contact during and after urinating as it may cause skin rash and irritation. You are advised to sit while urinating and to empty the bladder completely. Thorough cleansing of genital area and hands is advised.
The toilet must be neutralized of any live bacteria; this is done by pouring 2 cups of household bleach into the water and letting it stand for 15-20 minutes.
The bladder should be thoroughly flushed after BCG instillation by increasing fluid intake.

The documentation is pretty long on instructions and pretty short on practical matters. For instance, cleanse hands and genital area with what? Increase fluid intake from zero to what? Starting when?
Here's what I came up with to make the best of the situation:

Scheduled instillations in the midmorning to avoid rush hour going from and to the clinic (an hour's drive for us).

Scheduled on Thursdays to limit work loss to 2 days maximum. Also leaves Friday as a work day to contact the doctor if there are any unexpected problems.

Got a doctor's note to allow working from home on Thursday from zero to 8 hours as tolerated, and permission to work from home OR return to work on Friday from zero to 8 hours as tolerated.
Filled in the world's greatest boss on the scenarios. Best case: Work a bit from home (maybe) on instillation day, and perhaps up to a full day of work (probably from home) on Fridays. Worst case: no work at all on Thursdays or Fridays. Advise her that the range will vary between those on a weekly basis unpredictably, and get some assignments that can be worked easily from home.

Set up a designated biohazard bathroom near my bedroom and home office and outfitted it for dealing with BCG. See the What You Need For BCG Treatments list. This link has also been added to my "Useful Links" section at left.

Drink no fluids other than to rinse the mouth, brush teeth, etc. after 11PM on Wednesdays.

Arise, shower, dress in loose clothes (see LIST), and drive to Clinic.

Return home, flipping front to back and side to side every 15 minutes to distribute the BCG.

Begin sipping water immediately, total of 8 ounces the first hour. Add another 8 ounces in the next 30 minutes, another 8 the next 15 minutes, and as much as you can take the last 15 minutes.

Go to the designated bathroom; remove shorts, undies, and man pad; and don 2 rubber gloves. (This may be accompanied by squirming and dancing and humming if your urgency is very great. Ensure no video or web cameras are present.)
Open container of Wet Ones antibacterial and place in front of the toilet within reach.

Urinate from a sitting position to avoid splashing.

Don't assume you're finished right away - sit quietly and relax.

Grab an antibacterial wipe and come to a semi-standing position and sit again to see if more comes out. Be careful not to leak outside the toilet or emergency towels on floor.

Clean the genital area with the antibacterial wipe and discard. Ensure no dribbling is imminent.

DO NOT FLUSH. Put on underwear and man pad.

DO NOT FLUSH. Lift toilet seat and wipe anything that may have come into contact with the urine with another antibacterial wipe. Discard wipe and gloves.

Pour 2 cups of bleach into toilet, ensuring that you get some on the upper porcelain part where the pee flowed in.

Rinse bleach dispenser with clean water and set aside to drain.

Start kitchen timer for 20 minutes.

Put on shorts, come back in 20, and flush.

After some practice, all of this may be done in 5-7 minutes. At this point I presume that future episodes may involve burning, blood, blood clots, tissue, and a fair amount of cursing, all of which will tend to increase the time limits.

On a positive note, unless you are on a medication that precludes it, beer is a fine and valid fluid for hydration!