Cancer

My arm a few minutes before surgery...

Warning! I started this page after undergoing surgery for bladder cancer on June 12, 2006. In addition to a blog entry, I think I started this page, mostly, to track an event that really scared me. My experience was only a very small glimpse into the world of cancer. Very small. First, it all started with a cancer diagnosis that scared me witless. The diagnosis was followed by waiting for surgery and then waiting for results. The surgery went well in that they "got everything" (I'm sure there's a more proper medical term but it escapes me at the moment). After that there was a few day's wait for what turned out to be a favorable pathology report. That report was followed by minor medical complications and then a disclosure from my doctor suggesting they weren't exactly sure what they had found. A year of close observation and regular testing showed no reoccurrence so it appears (at this time, at least) that I got off light and easy...   Anyway, the main thing for you, gentle reader, is to understand that I am not a medical expert; everything you read here is just my own opinion/experience - you should always, always, always, follow the advice of your doctor and other competent medical practitioners for any of your health concerns!

"You have cancer." Nearly 1.5 million Americans will hear these sobering words this year. You may know some of these people, or you may be one of them. Cancer is no longer necessarily a death sentence, but about 1,500 Americans will die from the disease today - and a similar number tomorrow, and the day after tomorrow." - BusinessWeek
May 7, 2007 p. 94

One of the most extraordinary moments comes immediately after the death of a 7-year-old. Dr. Robert Arceci, chief of the children's oncology unit, calls the staff together to talk about the child and her death. Viewers see and hear Arceci read from "The Plague" by Albert Camus: "Until my dying day," he quotes an "old doctor" in the book as saying, "I shall refuse to love a scheme in which children are put to torture." The passage is perfectly pitched to the sense of sorrow and rage felt by the medical caregivers."

Schrödinger's Cat:

In physics there's a paradoxical thought experiment that provides a small glimpse into the atomic world and quantum mechanics. In 1935 the German magazine Naturwissenschaften ("Natural Sciences") published Erwin Schrödinger's description of an experiment where the random decay of an atom could trigger a death device in a box containing a live cat. Observers, according to Schrödinger, can never know the cat's real condition until they actually look into the box - in the quantum world, that same cat can be both dead and alive (at the same time!) until the final moment the box is opened!

So, that's kind of where I'm at as I create this entry on the evening of the 2007 Summer Solstice (June 21st): Tomorrow I return to the urologist for my one year anniversary exam (cystoscopy) - Has a tumor returned to my bladder? If there is a tumor, is it cancerous? Or will there be nothing but a future free of such examinations? At this time tomorrow we'll have looked into the box and I will know...

Good news! The urologist declared me "tumor free" a year after my surgery (Schrödinger's Cat was alive all this time!). Although I am extremely relieved, and thankful, I can only wonder about cancer patients much less fortunate than me - the tests, the chemo, the radiation treatment - if you have somebody in your life going through all of this they need every bit of your love and support - never give up!

June 07, 2006 (The Diagnosis):

[Urologist's Chart Comments]

Roger J. Wendell is a 50 year old male who is consulted to Urology for evaluation of gross hematuria.

CYSTOSCOPY:
  URETHRA: unremarkable
  BLADDER: 4 cm midline posterior bladder tumor at the bladder neck

Procedure Description:
The patient understood the reason for the procedure and agreed. The patient was taken to the cystoscopy suite. The patient was prepped and draped in the usual fashion. Lidocaine was gently instilled per urethra. Systematic and complete examination of the bladder and urethra was performed. The patient tolerated the procedure well.

Post-procedure antibiotic: ciprofloxacin 500 mg 1 tab

PLAN:
Patient has bladder cancer. Transurethral resection of bladder turmor was recommended and the patient agrees. Nature, risks, and expected course of TURBT discussed. Consent was obtained. Surgery will be scheduled.

[Note: At the time I created this page I had been clearly diagnosed with cancer, but they didn't know to what extent. It wasn't until a few days after my surgery that that they told me the tumor they removed was stage 0 and eradicated *). It took me another week, after that me, to actually believe them. Now, of course, I feel as though I've won the lottery! However, I don't want to make light of this situation as so many, many people are battling cancers much worse than what I experienced. This page is not meant to diminish their experience or what they're going through - it's all very serious stuff. Nevertheless, I thought I'd leave this page pretty much intact, the way I created it when I was diagnosed with cancer, if for no other reason than to remind myself of how poorly I was feeling at the time. Besides all of that I'm very, very happy to be here and almost feel as though my experience were a gift. I can only hope your own battle with cancer, if that's what brought you to this page, goes anywhere near as well - never give up!]

How it all started:

Okay, it all started on June 7th, 2006 (Wednesday morning) when my doctor diagnosed me with bladder cancer. My doctor is very professional and calmly indicated that the horrendous tumor we were both looking at, through a live scan of my bladder wall, was cancer (Actually, the tumor appeared "horrendous" to me - in reality it was about half the size of my thumb...). Even before he said anything I almost gasped when I saw this horribly ugly, twisted, knotted clump of tissue clinging there as though it were some monster from Hell. The doctor took a look from another angle, withdrew the monitoring equipment and had me clean up to meet him in his office. So there would be no misunderstanding, he had me sign a consent form that clearly spelled out the word c-a-n-c-e-r and my option to either accept his proposed treatment or take no action and suffer the consequences. I made very sure I signed the correct portion of the form indicating I wanted him to do what was ever necessary to correct the problem. I double-checked to make sure my signature was in the right place - ha!

For the month prior the diagnosis I had been traveling on business and started up a jogging program in an attempt to stay in shape while on the road (Usually, while at home in Colorado, I climb a local mountain each weekend for physical fitness). Anyway, the moment I started the jogging program I noticed blood in my urine after each run. Friends and coworkers suggested this was almost always due to kidney stones. Either way, I checked into a local clinic, in San Antonio, since I wasn't near my doctor in Denver. Although the clinic found microscopic evidence of blood in my urine, they had no indication of stones or infection. So, my doctor in Denver scheduled me for an IVP (Intravenous Pyelogram [IVP] is an x-ray examination of the kidneys, ureters and urinary bladder) upon return from business travel.

From San Antonio I went to Norman, Oklahoma and attempted to start up my jogging program, again, hoping that whatever the "problem" was had corrected itself. Boy was I wrong! The blood was worse, and I even began to notice an occasional piece of tissue or mucus in my urine since I was watching it so closely each time! The company nurse, there in Oklahoma, had no answer, so I was beginning to get really worried...

Finally back home, in Colorado, I was able to make that IVP appointment. The procedure seemed pretty straightforward - they inject you with some kind of dye and then use x-rays to scan your kidneys, bladder, and connecting tubes and tissues. Everything looked fine so I was feeling more confident despite the occasional issue related to blood and exercise.

Like I described above, the doctor performed a visual scan of my bladder on June 7th, 2006. He stated (and spelled out) it was cancer and I spent the next two days getting an EKG and other tests in preparation for surgery. During the preparation process the hospital gave me a copy of the Five Wishes document to complete. Although the concept scared me, even more, it began to make a lot of sense and I was eager to complete the ten or so pages. I highly recommend everyone take advantage of this bit of FREE legal work as it lets your doctors, and the world, know exactly how you hope to be treated should your condition worsen, etc.

Anyway, on Monday, June 12th, they removed what they believed to be the entire tumor but needed a few more days for a pathology study to see if further action was needed (I was advised of all kinds of possibilities, from removal of my bladder to Chemo therapy and radiation, etc.). Since this was an outpatient procedure I was home by Monday afternoon, albeit very uncomfortable and bleeding even more than before (but now in a "good" way...), with extra time on my hands to throw up this web page. It was midweek, after I had started this page, when the doctor called to say he believed they removed the tumor in its entirity, that there was little concern that further action was necessar! However, there was a small percentage of uncertainty, due to some minor complications, but his words were very reassuring. Strangely, it took me another week, after actually reading the "Final Pathologic Diagnosis," that I started to believe him!

On June 23rd, about 11 days after the surgery, the doctor removed the stint from my ureter and bladder. I was surprised at its length as he dangled it in the open air before me - easily 10 inches long except it was curling and twisting without the pressure of surrounding tissue to keep it straightened out. The stint, also, appeared to be about the width of a common number 2 pencil led and was colored white and blue alternately. I asked to keep it, as a souvenir, but was reminded that it was a biohazard and would be destroyed as medical waste. Anyway, my lower back pain almost immediately disappeared after the stint was removed. I think that improved physical state also added to my belief/acceptance that the tumor had been completely removed...

- Roger, June '06

Note: In January '07 I was able to make it back to Denver for a routine follow-up examination. Unfortunately my
Note: doctor detected a small problem and said he suspected the tumor may return. He planned to take another
Note: look, by mid summer. It's not my intent to make web entries for every single change or problem that it's
Note: associated with cancer. However, it just goes to show how difficult a disease cancer can be and that it
Note: needs to be watched closely...

Additional Note: At the top of this page, on June 22, 2007, I was happy to announce
Additional Note: that my one year anivesary checkup found me to be tumor free - Yahoo!

Preparing for surgery...

Anesthesia:

I've been under Anesthesia (sometimes spelled anaesthesia) about a half dozen times in my life for things like the removal of my appendix, serious arm surgery, and other medical stuff a lot of us encounter throughout life. Although I can't say I ever "liked" anesthesia I was always very appreciative of it's ability to shield me against pain and help make me forget. For me, the anesthesia experience has always been relatively pleasant in that I sometimes (in the early days when I was very young) would drift off to "sleep," with a quick dream (when I was five, and had my tonsils removed, I saw my parents and siblings sitting around the kitchen table when it started to slowly spin with them, in a circle, until the pace quickened and I was completely "out..."), and then complete "nothingness" followed by a surprise wakening surrounded by family and loved ones.

My anesthesiologist gave me an option, for this cancer surgery, of three different types of anesthesia procedures. As is my usual custom I leave choices like that up to the doctor and simply told him I trusted his professionalism and would go with whatever method he recommended. He made his choice, I was completely "under" (I had no dreams, no visions, no thoughts - nothing - I had no sense of being alive or dead - it was simply a couple of hours of absolutely nothing - probably what death is gong to be like but that's another story...), and woke up a few hours later to the smiling faces of my wife, daughter and parents.

Anyway, I kind of mention anesthesia here because the good ol' Internet allowed me to research it a bit this time around. And, like every other subject on the Internet I saw and read things about anesthesia that were astounding (and questionable). The impression I received, from the Internet, is that there may be a group of people out there critical of the science - suggesting the effects can linger for nearly a year after surgery and that death can occur unexpectedly. I don't know about all that and, as always, advise folks to talk with a doctor (and not webmasters like me) when it comes to medical issues.

That being said, I admit that I have experienced some temporary aftereffects from anesthesia but am happy to live with 'em anytime I need to go through surgery. In my case I seem to sweat, profusely, for a few nights of sleep immediately after the surgery. And, to me (and my wife!) it's a perspiration that kind of smells "mediciney" - unlike anything I'd experience during a hot day of work or exercise. Also, anesthesia seems to create unexpected mood swings in wild directions - one moment I'm sad and then suddenly chuckling, etc. Finally, my short-term memory takes a beating for a few days after the surgery as well. Sometimes it gets so bad that I even forget that I'm forgetting something!

Despite all of this it's still my belief that anesthesia is a great medical aid and I will continue to rely on my doctors for guidance in these and all other medical matters - I hope you'll do the same as well!

Drawn by my daughter at age 6!

Friends and Family:

For me, being diagnosed with cancer was a terrible blow that really muddled-up my thinking for a few days. I'm a little embarrassed to say I probably fired off a few too many emails and phone calls to folks saying things like, "Sorry, I can't make that Monday night meeting because I'm going into surgery for cancer," or "Wish I could join you on that hike next week but I think I'll be too weak after cancer surgery," etc.

Well, thankfully people could see through my fear and were so gracious and loving that I ended up spending more time answering emails and phone calls than worrying about my problem! What a blessing - friends, family, coworkers, neighbors, business associates, and even strangers offered me their thoughts, prayers, and best wishes. It really, really helps a person's spirit so I'm going to make a point to be a little more "available," myself, the next time somebody wants to talk about their condition or simply vent - it'll be good for the both of us!

In my case I was lucky in that my wife, parents, and daughter are the relatives I still have left in town so they were with me every step of the way. My wife, especially, worked so hard to keep me comfortable that it brought me tears of joy at times. And, as can be expected, it was quite the "rush" to wake up, from the anesthesia, so see my wife and then parents and daughter at my bed. Although I didn't realize it at the time, I was also lucky in that bladder cancer is probably a relatively manageable form of cancer - especially if you catch it early. Just a week or two before my own diagnosis I learned that my cousin Sheryl was battling a very serious brain tumor so the subject was already heavily on mind. And, like most everyone else, I've had friends, family, and other associates succumb to all kinds of different cancers over the years.

Apparently cancer strikes one third of us at some point in our lifetime or another. After winning his seventh Tour de France, in 2005, cyclist Lance Armstrong questioned why we were spending so much on the war in Iraq and so little on cancer research. Armstrong suggested that much less needed to be spent on war and a whole lot more on cancer research. I agree...

Technical Stuff:

At the time of my diagnosis, and when I was creating this web page, I was too numb/scared to ask anything meaningful about my condition. On June 23, 2006 (Friday morning) I finally mustered up enough courage to ask for the Pathologic report after the doctor removed the stint from my ureter. Here's what it said:

 

Final Pathologic Diagnosis

 

Bladder tumor, transurethral biopsies:
-Benign, inverted papilloma of bladder.

Comment:
This case has been reviewed by Drs. Gxx and Bxxxx who concur.
Telephone discussion with Dr. Cxxx 6-13-06 at 12:00 noon.

 

Specimen
--------------
Bladder tumor, biopsy

 

Clinical Data
-----------------
Bladder cancer.

 

Gross Description
-------------------------
Received in a formalin filled container labeled "Wendell, Roger, bladder tumor biopsy" is a 1.8 x 1.2 x 0.4 cm aggregate of soft tan fragments. In toto in JS06-3919.

 

Microscopic Description
----------------------------------
Sections show a relatively uniform, festooned proliferation of bland urothelial elements, as an apparently endophytic process., underlying a thin attenuated surface layer. In areas, the proliferating elements form small luminal structures filled with secretory product. There is no significant cytologic atypia., mitotic activity, convincing exophytic, papillary neoplasm or evidence of invasive or in situ carcinoma.

A Related Issue:
(Related to my bladder problems, that is...)

Calcium Oxalate Stones     Readi-Cat oral contrast

As I've said, I was very lucky that my tumor turned out to be benign. That being said, there were still a number of after-surgery concerns that took their toll on me. The biggest problem was the continued bleeding anytime I undertook strenuous activities (exervising, jogging, climbing, and cycling). Despite waiting many weeks to heal, once I started exercising again the blood returned. So, the Urologist asked that I discontinue vigorous activities until he could take a closer look during my September '06 appointment. Unfortunately, while on business in Florida, I passed these Kidney Stones (photo at left) after climbing 11 flights of hotel stairs on August 24th. I was surprised the kidney scans didn't detect these earlier in the summer. Anyway, although the passing was painful there was, strangely, no blood associated with the event. During my September visit the doctor was pleased to note that there was almost no scarring left in my bladder after June's surgery. However, what he did find was a bit of kidney stone clinging to the bladder wall - something I could even seen on the video monitor myself! A few weeks later, after laboratory testing, the Urologist confirmed that I had passed calcium oxalate Kidney Stones. His specific instructions asked that I avoid nuts, peanut butter, chocolate, tea, spinach, rhubarb, beets, wheat bran, and other oxalate containing foods. In addition to drinking more water he also asked that I limit animal proteins. For the most part this is all pretty easy since I'm already a vegetarian. Nevertheless, some foods have been difficult to give up so I even made a Food page to kind of remind me of what to avoid. On October 20th (still 2006) I was diagnosed with a kidney cyst that was confirmed, through a CT scan 10 days later, as being benign (thankfully!). In preparation for the scan I drank the two bottles of Readi-Cat, at left, and was also injected with a contrast agent. The injection made my neck and other body parts feel warm, for about a minute, but that's a normal reaction. The good news is I made it through the entire ordeal with only a small kidney cyst problem that I'll be able to live with... Finally, as always, I remind readers to follow the advise of their own doctor anytime they want to make a dietary or health change or are experiencing any of a number of medical complaints or problems. As you can see from my medical experience, both the bladder tumor and kidney cyst turned out to be benign - and unusually lucky set of results that are far from what can be expected for such symptoms. Remember, each and every one of us is very different and there can be all kinds of overlapping problems and symptoms - please see your doctor!!

The Anticancer Lifestyle A promising new strategy for avoiding a killer disease - or keeping it from coming back by David Servain-Schreiber, M.D. AARP Magazine, March/April 2009, pp. 38-41

"More than one third of Americans will develop detectable cancer. But nearly two thirds will not; their natural defenses will have kept the disease from taking hold."

"Cancer rates increased steadily for decades before beginning a slight decline in recent years. And cancers that have no screening test - lymphomas, and pancreatic and testicular cancers, for example - are still rising. While the aging of the population plays a role, it is not the sole cause: cancer in children and adolescents rose at a rate of 1 to 1.5 percent per year during the 30 years ending in 1999. Asian countries have not experienced the same trends. Yet within one or two generations, Asian Americans get some cancers at rates similar to those of Caucasian Americans."

"This tells us we don't get cancer by genetic lottery alone. A study in The New England Journal of Medicine conducted by the University of Copenhagen found that people who were adopted at birth had the cancer risk of their adoptive parents rather than that of their biological parents."

"When it comes to surviving cancer once it is diagnosed, there are no proven substitutes for conventional treatments: surgery, chemotherapy, radiotherapy, immunotherapy, or, soon, molecular genetics."

"For prevention or better disease management, it is important to change the environment - the 'terrain' - that surrounds cancer cells. Research suggests that cancer grows much faster under three circumstances:

1. When our immune system is weakened and less capable of detecting and destroying budding tumors;
2. When low-grade chronic inflammation in our body supports the invasion of neighboring tissue;
3. When tumors are allowed to develop new blood vessels to feed growth.

When we strengthen our immune system, reduce inflammation, and reduce the growth of new blood vessels, we help create an anticancer terrain."

"So, what are the cancer-fighting behaviors? Some you already know are good for you, such as exercise. But others are surprisingly simple habits that could make all the difference for you - as I believe they have for me."

• Sugar fuels cancer growth and triggers inflammation. Avoid refined sugar wherever it lurks, including sodas and ketchup.
• Adding known cancer fighters such as spice turmeric to your diet will go a long way toward building up your body's defenses. (He goes on to list: thyme, rosemary, mint, basil, sage, turmeric, ginger, salmon, sardines, mackerel, walnuts, green vegetables, broccoli, cauliflower, cabbage, garlic, onions, leeks, raspberries, blueberries, blackberries, dark chocolate, green tea, pomegranate juice, red wine (in moderation)
• Regular physical activity has been shown to improve survival rates for many types of cancer.
• Stress causes inflammation and weakens your immune system, two disadvantages in the fight against cancer. Practices such as yoga, qigong, and mindfulness can transform our response to stress and strengthen our resistance to disease.
• Though they can't be avoided completely, common household toxins should be minimized.

"Most people who start on this health journey notice a difference within a few weeks. Recent studies suggest that healthy habits start improving mood and well-being after two to four months, and can have an impact on cancer statistics within a year or two."

Links:

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