My grandfather, after whom partially named, died of lung cancer before three years before my birth. My grandmother, who I vaguely remember, died of ovarian cancer when I was six. My father died of metastasized prostate cancer unusually at 52. He hid it from my mother by calling it hip cancer. It didn’t help that he was a five o’clock alcoholic. My mother died of recurrent breast cancer that in the nearly fifteen years between the initial case and the last when it had metastasized to her abdominal wall, spinal cord, brain, and lymph system. It might have helped if she wasn’t such a boozer. Finally, cancer has made its appearance in my urinary bladder. I’m over 55, male, smoked cigarettes, and at the end of a chain of ancestors who died of bladder cancer. The fact that I drank alcohol for more than 50 years probably doesn’t help.
Around the end of May, I began seeing blood in my urine. Since I had this previously on two occasions and no one seemed super concerned at the time, I tried ignoring it this time. I “knew” that an appointment with Urology at the Seattle VA Med Cent was in the offing. Then I would get a cystoscopic exam of my bladder. Like a colonoscopy, except the fiber-optic instrument is smaller, you’re awake, and you get to watch. You also get to take pictures home to show the family. Nothing would be found, and I’d be on my way.
This time the urine went from orange to a deep red. Then it was almost normal, except being cloudy. Then it was back to deep red with no recognizable pattern. In early June, I had a video appointment with my primary care physician where discussed the blood in my urine. She ordered a urine test that came back positive for red and white blood cells. She ordered another one. That one also came back positive. The next one followed suit, but she didn’t order another. She had put in a referral to Urology at the VA Medical Center, probably figured they’d order more urine tests.
This time around I was given a CT scan of my urinary tract from inlet to exit. My kidneys were clear, as were the ureters. The bladder was something else entirely. Seems CT scans with contrast aren’t the best for imaging for bladder cancer, hence the need for a cystoscopy.
On August 9, I had an appointment with an ARNP in Urology to discuss what could be causing the blood. He gave me the traditional, “I’m scheduling you for a cystoscopy to look inside your bladder. Now, cystoscopies use a tool like this.” As he held up a show-and-tell copy of the instrument to be used on my lower urinary tract. I nodded by head at the appropriate moments and said “uh, huh, I see,” where required. I’d seen the presentation before, but did my part in the whole undertaking.
A month later, I walked into the Cystoscopy Lab at the Medical Center. Since the Seattle VA Medical Center is a teaching hospital associated with the University of Washington School of Medicine (Strangely, not named the Punch & Judy Attaboy School of Medicine or after any of the billionaires who live in the Seattle metro area who seem to have other things to do with their money.), the young man (not cute, so no daydreaming there) who welcomed me had an ID badge hanging from his lanyard that said at the bottom: MEDICAL STUDENT. He gave me a repeat of what to expect and had me electronically sign consent for the procedure. I pulled my t-shirt up and pushed my pants, underwear, and compression stockings down. I sat down on the table, scooted into position, and laid down. I was as ready as could be. The Resident gave me another repeat of what was going to happen.
The show began with the Resident telling the student to fill my urethra with anesthetic gel. The way she said that gave me the impression he hadn’t been paying attention during exams of earlier patients. Once that was finished, she told him to take the cystoscope from the nurse who was holding it out to him. Detailed instructions followed as he inserted the instrument into my penis. She gave him encouragement, which was repeated by two of the nurses. If this was to be a solo flight for him, I would’ve been more nervous.
The scope entered my bladder, and the Resident requested irrigation. The picture cleared and there on one of the walls stood medium sized (doctor talk) tumor sticking out. The Resident said, “You better let me have the scope.”
At least, now, I knew where all the blood was coming from. The Resident started taking pictures of that tumor, a plethora of little (doctor talk) tumors, and a pebbly surface on the bladder’s dome.
Post procedure, the Resident tried to be upbeat, but she had to admit my bladder was in sorry shape. The key thing, though, is a repeat of this cystoscopy under anesthesia to remove all the suspected cancer. That will be sent down to Pathology where, hopefully, a definitive diagnosis can be made. There are a number of cancers that can affect the bladder. Where the cancer is located also matters. The lining is best. The connective tissue is second best. The muscles move the indicator toward negative the deeper you go. The outer fat layer is very bad.