The trip to the doctor went smoothly. As has become usual, we saw Dr. Hopkins about 25 minutes after our appointment's scheduled time. Some of this delay is normal - you have to give a urine sample which they quickly test on-site, and my reduced dosage also takes extra time. The procedure to make it has caused some general consternation amongst the staff. All are freaked out by Dr. Lamm's suggestion to mix it dry, so they activate it with water in a sealed container, pull out a partial dose for me, and dump the rest in biohazard disposal. Very odd, since they claim to lose about $15 per dose on what it costs versus what they insurance companies and medicare reimburse. I asked the doctor about follow-up CT scans. He told me that with lower urinary tract (bladder) cancer, there is a small chance of additional growth in the upper tract (ureters and kidneys). The only way to check for that is by CT scan of the upper tract/lower abdomen. He pointed out that the probability was very high to develop lower tract tumors if upper tract was present (logical, as everything flows "downhill"), so I was at least on the better side of the equation. After he was done we discussed schedule. My next scope would be due in late April, only 11 months after my TURBT "all clear." He decided to delay it into May and get a CT scan in advance. This provides him with a lot of data for the 1-year post surgery diagnosis, and he agreed that this is indeed a milestone as far as improving the downside should the tumors recur. He would consider re-setting everything (although BCG would stay in sets of 3) after another TURBT after that point instead of radical surgery, unless the lab indicated that something was worse. So Judgment Day #3 is a biggie, and it will be on May 14 at 1:15PM MDT.
We also reviewed the BCG schedule going forward per Dr. Lamm, the cystoscopy schedule (quarterly for 2 years, semi-annual for 2 years, annual for life) and the CT schedule (every 18 months after the 1 year check for life). I updated my schedule accordingly. It's important to note that the upper time-elapsed count starts from the May, 2008 TURBT when I was initially declared cancer free, while the bottom time-elapsed count (in blue) starts from the Initial 6 BCG treatments, and loses a month or two over time. I also note that I will be 60 years old when I have my last BCG treatment. I should live so long! With this schedule, making short term plans even for this summer is difficult, but an all-clear in May should provide some level of confidence. I have tentative plans for a motorcycle rally right after my August scope, which would delay the BCG into September - no problem according to the doc. Still living life 3 months at a time. To that effect we have a vacation trip upcoming to Carmel and San Francisco in March, and another to Las Vegas in April. Make hay while the sun shines!
As for the BCG round, it was very similar to last week. Not a wonderful experience, yet certainly tolerable. Some interesting things to note as I do more of these. First, it's important (for men) to stand while urinating after the biohazard period. While this probably goes without saying, if you attempt to reduce mess or splashing, or if you're just tired, continuing to sit afterwards will increase cramping and abdominal pain quite a bit. Another important thing is that the next day you feel a lot better, which is not the same as actually feeling good. After every BCG I end up waking up at 4AM and getting out of bed by 5AM or so. Last week I made the error of going in for a 1.5 hour meeting after lunch on Friday, and it lasted 5 hours. Then we had dinner guests. I was a zombie that night and for the next several days. Even if you do feel much better, your body is fighting what it perceives as the flu internally, and pressing on will take its toll. Lastly, while the BCG is active for a couple of days after instillation, the warnings of when you need to go are not very strong, but ignoring/delaying them for very long to finish something out (like typing a blog post) can result in some very sharp pain. Latest misery index chart appears below:
For those interested in details, they are described on the Series 2 Backup Page (7/10 on the "ick" scale, from the first week).