Wednesday, December 16, 2015


The latest news isn't as good as I'd hoped, but it's not so bad. I don't worry about it--what never? No never? What never? Well, hardly ever! (A little ditty from Gilbert and Sullivan's HMS Pinafore). Okay, so maybe a little, which is why I'm writing more in the blog. It's therapeutic. I do however wish to repeat my standard disclaimer that there is nothing special about my little problems; millions of people have cancer, or worse.

The good news is that the lymph nodes are stable. The cancer is still there, apparently, but nothing has grown. If it progresses to bones, liver, lungs or other organs, you're pretty much hosed, so it's nice to know it's been held in check nodewise.
On the other hand, just before Thanksgiving I experienced a recurrence of the canonical symptoms (blood in the urine, if you must know) that led to the cancer diagnosis in the first place. The symptoms were identical to April 2014, and were pretty obviously an indication of the cancer starting up again in the bladder. This wasn't a surprise, since we knew that the chemo had not completely eliminated it. I reported it to the doc with the suggestion we just wait for the next CT scan, already scheduled the following week.
According to him there is no question that the blood is from the cancer; the CT scan, although not definitive, also indicated
a resurgence. A urine test revealed cells suspected to be cancerous, although the people who do these tests don't like to commit to the diagnosis without an actual biopsy (as opposed to just looking at cells that are floating around loose). Since a biopsy requires
the dreaded transurethral resection (which I had twice last year), before doing that they're just going to take a look via cystoscopy, a lovely procedure done in the office. It isn't so bad, except that it screws up bladder control for a period of time, which is the last thing I need these days. The procedure is interesting though, as I'll get to see for myself what's going on in there. This will happen the first week of January (on the second day of classes, wonderful!).
To sum up, it's clear the cancer has started growing again; the purpose of the cytoscopy is to determine the extent of it.

At my clinic visit following the CT-scan, I was a bit surprised that I only saw Sarah, the nurse practitioner, and not the oncologist.
It's always fun to see Sarah, because of her new-found and boundless enthusiasm for opera: I just LOVED Ariadne auf Naxos!
I just LOVED Nabucco! I just LOVED The Pearl Fishers! Next up is the Marriage of Figaro, and I'm certain Sarah will just LOVE it. She's great. However, after we left I realized that I really wanted to talk to The Man himself, the oncologist. I met with him this morning, partly to better understand the reasons for the cystoscopy but mainly to get a better understanding of the big picture.

We've discussed it before, but, understandably, it takes some prodding to get a direct, uncensored reply. I have to keep reminding him that it really, truly, doesn't bother me in the least to talk about death and whatever gruesome events might preceed it. Moroever, from a purely intellectual point of view I'm just curious: What is the typical progression? What are some typical outcomes? And so on.
I've asked these questions before, obviously, but now that I'm a year and a half into it I wanted to see what he'd say. It's pretty much what he said before: About ten percent of patients are actually ``cured'' by chemotherapy, and he was (is?) hopeful I'm in that 10 percent. That would be nice, although one round of chemo doesn't seem to have done it. At the opposite extreme, bladder cancer being very aggressive, some patients die within 3 months of diagnosis. Fine, I'm well past that bar. For patients with metastatic cancer (which I have), the median survival rate is two years. Now, it would be soooooooo embarassing not to beat the median. I would be mortified! I fully intend to crush that mark. (Seahawks fans will be familiar with ``Beast Mode'', which I can assure you is nothing compared to ``Mad Dog Mode''. In fact with all the injuries the Seahawks are getting so desperate for running backs that I recently got a call from Pete Carroll asking me to fill in. Unfortunately, due to teaching obligations I won't be available.) At any rate, the oncologist and I share the view that there's really nothing to do but take it one step at a time.
It makes it a bit tricky to plan a trip to Italy, say, with the possibility of another round of chemo looming out there in the future. His suggestion was ``travel insurance''. That might sound harsh, but actually it's a great idea and fits well with my ongoing philosophy, i.e. one should never worry about this kind of thing, but one can't completely ignore it either.

So that's where I am. I don't worry about any of it, including death, because none of that has any relevance to today. I'm here now, I feel great, and it's a wonderful life! (Sorry...I couldn't resist that last one, seasonally speaking...and besides, it IS a wonderful life!)

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