Today I was scheduled for my "routine" annual cystoscopy and I had already scheduled 3 maintenance BCGs for the next 3 Fridays (early, at 8:30AM). Unlike the past, I did not have a day where I began to think about it in advance, nor had I much time to develop any trepidation. Even my sleep and dreams last night were neutral, not even thinking about it then. While it's hardly a non-event, I suppose by now it has become routine, and I am coming to expect ALL CLEAR results each time. Not that a recurrence couldn't happen at this late date, but any recurrence now is highly unlikely to be more than a major nuisance. One factor is that retirement has mellowed my outlook on almost everything, and the business is up and running now - so no first year stresses from that startup activity either.
Today began as crisp, cool (maybe cold) and clear, then developed into one of those crisp, clean Utah Spring days that are so typical most locals take them for granted. Around 60 degrees (F) and clear skies with unlimited visibility - absolutely breathtaking. Check out this view from the back porch of our rented accommodation as I type this:
With a beautiful day as a backdrop, I went through my morning routines: baking soda, stretching exercises for low back and sciatica, some other general stretches, check email and business status, and so forth. I had about an hour to use before we needed to head to the clinic, so I began work on our April accounting for the business, still not thinking about the upcoming procedure. We left at 9:35 for the 25 minute drive to the clinic, which has been renamed. Check in was quick, but the renaming meant filling out on paper ALL the previous information they already had, on new paper forms, because "in the merger, our systems were incompatible." Any decent Lean or Six Sigma practitioner could tell you that such a statement is absolute bullshit. It would have been a simple matter to format the data and arrange it for import, or at worst case print it all out and pay someone to type it in again - which they were already doing after NOT paying me to fill out my portion by hand. But such thoughts are a lifetime ago in a galaxy far, far away. We were shown into the major exam room, a bit more comfortable and less creepy than the small one we had last year. Still, one could get some deja vu feelings of "Little Shop of Horrors" from the setup...
I finished my paperwork duties and around 10:15, and around 10:30 they told me I was next, so I got arranged on the table, stress balls in hand, and Dr. Hopkins strolled in around 10 minutes later. He reviewed my PSA (0.73) and informed me that my IVP X-rays from last week looked clean. He went about the cysto quickly, not really waiting for the local anesthetic to take hold, and I gave both my stress balls quite the workout at first. We all watched on the screen and saw absolutely nothing of note - not even the famous "red spots" that others have experienced. After that and a quick DRE, we began discussing treatment and the path forward. Dr. Hopkins said he had seen recurrence early and he had seen recurrence late, and 10 years is the target to reach for "remission" in Bladder Cancer. He added that there is a VERY low chance of progression (that the cancer would be worse) in late recurrence where I would be now. Most likely we would do another TURBT and re-evaluate treatment going forward from that. A major nuisance at worst. He also said about half the BCG community does not do ANY maintenance BCG, and the other half does it routinely. There is still a dearth of evidence to support long term maintenance, and he was willing to call it finished now, at 8 years tumor-free. I mentioned that the original Lamm protocol for my case was to do it now, and again in 2018, and a final one in 2020. He was willing to go with that, but I suggested an alternative - wait a year, do a series in 2017, and then a final one at 2020. This skips only one out of the original Lamm protocol maintenance treatments and keeps maintenance going for the specified period. He agreed, and we quickly canceled the BCGs for the 3 upcoming weeks. That's a great feeling of FREEDOM now!
After cleaning up and discharging the saline used for the cysto, we headed to our favorite place to eat in SLC for a splurge lunch. If you are ever in the area, I highly recommend it: Pago at 9th and 9th. We both had the soup of the day, a delicious carrot and ginger. Kathryn had the special tacos (steak and cauliflower) while I had the famous Pago burger. They have an excellent and very pricy wine list, so we chose some very nice organic Hefeweizen beers for our libation. An excellent place, with and excellent meal and service. God is good, ALL THE TIME!
Posted by Steve Kelley