Officially Toxic - July 3, 2008

About 75 minutes ago I had my first instillation of BCG Bio-Immunotherapy. The instillation procedure (2 out of 10 on the gross-out scale) was painless and lasted less than 2 minutes. I asked Dr. Hopkins if the idea was to melt/replace the entire bladder lining or something less than that. He said there are receptors on the cancer cells that the BCG will bind with, triggering an immune response. My sister-in-law (Nicole) described it as a biological cruise missile, which seems a good metaphor. I asked if that meant that guys who discharged a lot of tissue had more cancer, and the Doc opined that more likely they'd had a stronger immune system response. Despite this and the article from Dr. Lamm (see sidebar on THIS PAGE) that I left him to read, he likes to use the full dosage of BCG each time. I told him he was the Doc and it's his call, and to his credit he took the article to read, recognizing Dr. Lamm's reputation.

There has been a tingly burning at the tip of things, possibly from the iodine disinfectant. On the ride home I lay in the back seat, turning side to side and front to back every 15 minutes or so. In 45 minutes from now, I get to void this BCG, which is an active strain of tuberculosis bacteria, and for the next six hours after that my urine is a class 2 biohazard requiring special handling. More on that later.

In other news Dr. Hopkins informed us that the BCG vaccine now costs him more than he is allowed to bill the insurance, creating a problem. In future he may have to give me a prescription to fill and bring the stuff with me. The difference is about $5, but it can add up in a practice like his where they may do over 100 treatments a week. He also said I could start taking fluids immediately, and that it would not dilute the solution too much. Since I've had no food or fluids for 12 hours, this was good news. I have been ultra-cautious, though, not wanting to overfill the bladder so that I can't hold the BCG for the full 2 hours, and have had only 16 ounces of water until now. No real discomfort at all, but it all feels strange. Possibly mostly a mental thing. The first week is purportedly the easiest, so I shall not rest on my laurels for next time. 35 minutes before pee-minus-zero. Stay tuned for more details later today!