Bladder Cancer Awareness - April 30, 2011

Next Saturday, May 7, 2011, will be Bladder Cancer Awareness Day in the United States. One primary activity, sponsored by the Bladder Cancer Advocacy Network (BCAN), will be a "Walk for Bladder Cancer - Leading the way to a cure." The purposes of the day and the walk are simple and clear - to raise "awareness" about bladder cancer in the community and to raise money for BCAN. The purpose of BCAN is equally simple and clear: to foster communication, education, and still more "awareness" about bladder cancer. And perhaps more importantly "to raise funds for bladder cancer research and education."

So what is all this talk of awareness? For myself, awareness is a binomial distribution. Before I was diagnosed with Bladder Cancer I was blissfully unaware of its existence - my awareness was zero. Now, of course, I am aware of it literally every time I need to urinate, every time I eat the foods I should (and avoid ones I shouldn't), every time I take a supplement or vitamin, and every time I look at this blog. My awareness is pretty pervasive - near 100%. And even though Bladder Cancer is the #4 or #5 most prevalent form of cancer (depending on who is counting from day to day), many people are indeed fully unaware as I formerly was.

Contrast my impression above with a survey of more than 1600 people conducted last May in the UK. Half of those surveyed had no idea what the most common cause of bladder cancer might be. A quarter had no idea about the warning signs for the disease, with 18% guessing that the most common cause of bladder cancer was drinking too much alcohol. Only 5% correctly cited smoking and only 1% mentioned using chemicals at work - the factors which actually are main causes of bladder cancer. Industries involving dye, rubber, aluminum and leather are linked to an increased risk of bladder cancer. And the most common symptom or warning sign for bladder cancer is blood in the urine, but only half of those surveyed knew about this.

I digested the information and the messages for quite a while. Now that I am painfully aware of Bladder Cancer, what has changed? My lifestyle certainly is healthier now. But if I did not have it and was equally aware, what difference would it have made? I am pretty sure that without the threat of imminent and painful death, I would have changed nothing in my lifestyle. So that is why I often tell folks that bladder cancer may be the best thing that ever happened to me. Certainly it made my cousin Rick put down cigarettes forever - something he would have told you was not even possible. So awareness makes sense for those that have the affliction, but what sense does it make for those that don't? Some other factor must be hidden beneath all this awareness talk.

Both the UK survey and the BCAN literature point to the same conclusion - one that seems to be a default conclusion for nearly every problem today in western society. Awareness must be raised so that (government) funding can be increased to address the underlying problems. The equation is simple: low awareness = low government priority = proportionally lower government funding. I think it pays to be honest. While education and information and communication are cited as the goals, these noble factors are really the means to an end - to increase awareness and increase proportional government funding. Private funding increases are also welcome, but we all know the real money these days comes from the government. And that's what the awareness is all about.

Please don't think I am trying to rain on anybody's parade here. Given all the odious things that governments overspend money on these days, doing something that might benefit me directly seems like a good trade. I simply think that the goal should be more clearly stated. And given the state of most government deficits these days, spending more on anything at all may well be questionable. Still as common as it is, bladder cancer is not really difficult to understand, diagnose, or treat. As such, many doctors (like my second opinion guy Dr. X) find themselves drawn to fields such as liver or testicular cancer - as they present unsolved problems and intellectual challenges not found in boring stuff like bladder cancer. So guys like Dr. Lamm who pioneered the BCG treatment continue to dabble and experiment with new ideas, but younger physicians tend to focus on more elegant problems. I suppose raising awareness and associated funding might serve as a carrot to draw some of these bright minds into new research areas. And to the degree that funding is moved from something awful, it could be a net gain.

As you can tell, I remain a bit ambivalent about it all. Not because my danger period is past - I shall have scopes once per year for LIFE to remind me, plus BCG treatments until the year 2020 (if all goes well). Just because it seems like such a futile and hopeless game to chase after government money for your favorite causes. But if awareness is your thing, next Saturday is your day. Advertise, walk, donate, pray, write blogs, or whatever. And you may as well reach out to someone you love and give their bladder a gentle squeeze. Trust me - that will get a lot of attention and awareness going!

Bladder Cancer and Diet/Exercise Reports - April 9, 2011

I am a bit surprised at how long it's been since my last update. As I tell most folks, "No news is good news." It is a bit of an adjustment that must be made. During the first 30 months having bladder cancer, learning about it, and dealing with it was pretty much a daily occupation. Now having just passed 33 months cancer free with no BCG to occupy the month after diagnosis, I have until September 8 until I really have to think about bladder cancer again. For the first time since this journey began, I have NOT thought about bladder cancer very much at all. I have had pretty good updates from folks in our little "bladder cancer fraternity" to be thankful for, but somehow it is a bit more distant from me now. Good news is meant to be shared, so let's do that:

Ken H. from Richmond, Virginia reports ALL CLEAR cystoscopy following 6 initial BCGs. He begins maintenance if his next cysto is clear in 4 months.

Ben F. from Baton Rouge, Louisiana has completed two TURBTs and begins his initial 6 BCGs next week on April 14. He has been asking questions and getting mentally prepared. I advised him not to judge the experience based on the first two or three which are pretty easy.

Roy B. in Alabama had clear biopsies in February and clear cysto in March, and so he gets to experience 3 maintenance BCGs in April.

Brian S. in Atlanta, Georgia is having a miserable time recovering after BCG with constant urination throughout the night. Delayed cysto until swelling and pain diminished, but clear cysto and FISH for the first time - now 36 months in to the process.

Ronnie in Colorado Springs reports ALL CLEAR for 11 months now. No BCG maintenance for him, but cystos every 6 months for a while.

David F. in England has nearly forgotten about having cancer, keeping himself busy with starting a new business. But the deaths of many friends and acquaintances from other forms of cancer serve as a near-constant reminder. David and I agree, if one has to have cancer, bladder cancer is a pretty good option. Still David notes the effect his cancer experience has had on his day to day life and modus operandi. Some good and some bad, and all difficult to grasp or explain.

HK in Toronto has had several months off after a miserable reaction to BCG. He has a cysto coming up next week on Tuesday, April 12, and he would appreciate all your prayers and positive support.

The real warriors are Joe and Heidi in Washington state. He has bladder cancer and she has breast cancer, and they are dealing with both constantly. Joe also reports burning and urgency as much as 2 weeks after his final BCG, which is a bit rare and unfortunate, but not "out of family" as symptoms go. He also has a cysto next Tuesday, April 12.

Turning back to what's up with me, as I note that blogs are in general a narcissistic outlet, most long-time readers are aware that I made several quite radical dietary changes - increasing veggies and reducing meat to a 2:1 by volume ratio, going with organics and all natural foods, eliminating pork and shellfish, eliminating (mostly) sugar and simple starches, eliminating all sweeteners except stevia extract, eliminating all preservative-containing foods, eliminating deep-fried foods, adding vitamins and supplements, and even quite reluctantly adding routine exercise three times per week. My weight dropped dramatically, then stopped and increased back to around 230. Not nearly as bad as before cancer, but still visibly overweight. Minor tweaks in the exercise routine made it less miserable and almost bearable, but not something I enjoy or look forward to. Net effect has been to hover around 230 pounds (16.4 stone) since Christmas of 2009. Although there was considerable weight gain in March as we prepared to do something new. So the diet worked to a point, and I believe it has had a significant corollary contribution to my improved attitude and cancer-free state. But clearly, while it has made me less fat, it has not made me thin - not that thin was ever the primary goal.

Anyone who has tried diets knows they always work quite well as long as you stay on them. But cheating inevitably happens, and always leads to more cheating, which ultimately leads to dumping the whole diet in frustration.
We are trying a new diet, or eating pattern, that addresses this key failure mode. The diet is VERY strict for six days per week. Limited types of low-glycemic carbohydrates are permitted, no dairy or cheese, no starch, no sugar, no artificial sweeteners, plus all the no-no's listed above (for cancer purposes). Almost like a super-strict form of Atkins. Given all the restrictions, there is not a ton of stuff left to eat. How could anybody survive this for long without cheating? Let me tell you about the seventh day. Day 7 of each week is a built-in cheat day. On Day 7 you are permitted to eat ANYTHING in ANY QUANTITY without limits. I still follow the cancer no-no's (except for sugar and starch) on Day 7. But everything else is fair game. Insanity you say? Of course, but insanity for a purpose.

So how does one survive during the week of six days? Day 1 is easy, having indulged nearly every food fantasy the day before you feel a bit "hung over" and don't want anything bad. The first week I did not eat at all until after noon. Day 2 - 6 you will have various desires and cravings that can easily be fought off because of two simple factors:
1) You eat quite a bit of the allowed foods - four meals per day, and you are never really hungry
2) Anything you crave you CAN HAVE within a few short days
I make a list of things I want during the week to eat on Saturday, my Day 7. I quickly found that what you WANT to eat on Day 7 is quite a bit more than my capacity to stuff it in - a shock to anybody who has seen me pile in the food.

What about the hated exercise? Still 3 days per week, but the exercise part is also quite simple, not aerobic, and easily accomplished without any hassle or misery in 25 minutes or less.

So - a diet where you eat more, are never hungry, cheat routinely without limits, and exercise easier for less minutes. Can't possibly work. The purest form of insanity. Stupid, really. Just my sort of thing! I am a big fan of counter-intuitive solutions that work, so I resolved to give it a try. Plan was to implement after my last clear cysto and weekend of celebration thereafter. Goals were set for six months trial: lose 2.5 clothing sizes (to pants waist size 34 inches) and lose 10% bodyfat. Decided to do it right and have bodyfat measured professionally using the Bodpod system. Cost $20 apiece at the local university health sciences center.
I am starting at 32.0% and shooting for 22.0 or less. My wife's numbers and targets are classified and will never be disclosed here. My weight goal? None. Think about it - if you could drop over two clothing sizes and 10% bodyfat, would you care if you gained 50 pounds in the process? My expectation is that I won't gain weight but lose it, but it's pointless if the new weight does not LOOK better as it is distributed around your frame.

Before we get to the punch line, let me tell you about cheat days. At the end of the first week I had an extensive list to execute. Did not accomplish all of it but here's what happened:

Breakfast 1 - normal diet breakfast (same as other days) to set the stage
Breakfast 2 - Six Krispy Kreme donuts (assorted) and a quart of whole milk
Lunch 1 - Chocolate milkshake of the same type I had on the day I was diagnosed (1.75 quarts worth) plus a can of Pringle's Original
Lunch 2 - Half a box of Girl Scout thin mint cookies
Dinner - Veritable feast at Frida Bistro with drinks, wine and dessert

The subsequent cheat days have been along the same lines, substituting things like half a large apple pie and ice cream, pizza, beer, etc. The fact that I have a limited capacity has made me become much more selective in what I choose to eat to cheat.
This week we have moved cheat day to Sunday to accommodate a dinner out with friends. Other than requiring advance planning and procurement (for both days 1-6 and day 7), the diet has been pretty simple to implement and follow strictly. If you get the impression that I am completely guilt free and a bit proud of my larcenous gluttony, you are exactly correct!

By now many have stopped reading, assuming (perhaps correctly) that I am some sort of wacko. And also assuming that such abject foolishness could never possibly work to achieve the desired results. While it's early days yet, we have objectively measured evidence to the contrary (at least on this second point). The tale of the tape and scale:

Weeks completed: 5 (including 5 full days of travel to Florida)
Non-approved cheating: Zero, zip, zilch, nada, none whatsoever
Inches LOST: one half clothing size (38 pants now fit quite neatly, was spilling over before with muffin-top extremis)
Bodyfat: Due to expense, will not re-measure until September
Pounds LOST (because everyone wants to know): 12 (yes TWELVE)

My wife, who is thin to start with, is also pleased with her results to date. Since she bears the brunt of the food preparation hassles, this is a very good thing!

Again, it is MUCH too early to declare success or victory. Stay tuned for future updates!