Twas the night before cancer surgery, when all through the house

Not a creature was stirring, not even the mouse

We don’t have cats to catch the mouse, thank you very much. When you have dogs, who see cats as vermin to be kept out of the house, our yard, the neighbors’ yards, and everywhere else that is within their field of view, you learn to live without cats no matter how cute they naturally are. The dogs don’t like any kind of vermin, especially the squirrels who think being chased by a dog is a game that they’re especially good at. Dog on ground, squirrel in trees. First this one, then the next. Resting on a limb in full view of a dog will totally drive said dog nuts. This is especially true with Sara our five-year-old German Shepherd Dog. You have to say it’s a dog, so that no one will confuse the dog with a German shepherd with a flock of fleecy beasties.

Okay, back to the cancer surgery on September 21. In my situation, the surgeons (Resident and Attending) performed a TURBT (transurethral resection of bladder tumor) looking for the medium size tumor sticking out toward the middle of my bladder. This was done under anesthesia because to get into the bladder with all their surgical tools, they have to dilate the urethra to very uncomfortable dimensions.

Post surgery, the Resident informs me they removed the tumor, a bunch of smaller tumors that resembled sea anemones, and pebbly tissue that is similar to beach sand. That basically removes a bunch of material from the surface lining of the bladder down through connective tissue into the muscle layer to see how deep the cancer went. The Resident said they believed they removed all of the cancer, but they won’t know until the pathology report is issued. Then she said that they were going to let the bladder heal for four to six weeks, and then go back in to remove the tissue again to be certain they got all of the cancer the first time. An added benefit of the surgery was the placement of a Foley catheter. It has an inflated balloon that prevents it from sliding out on its own.

On September 25, to have the catheter removed and have a pee test to determine if I could do that on my own. Unfortunately, the intake nurse checked my vitals and my blood pressure (which is controlled with a number of drugs intentionally or as a side effect) was 61 over 40. She sent me to Emergency to get that cleared up. Needless to say, I kept the catheter for another day or so. An outcome of the Emergency was the elimination of two of my BP meds.

The pathology report came out on the 25th, but it was not available online until the 27th. The result was: invasive papillary urothelial carcinoma, high grade; and muscularis propria (muscle layer) present and not involved, which I think is a good thing. So, I have an invasive carcinoma that is bad. High grade in pathology terms is not good. A high grade in most situations is a good thing, but with carcinomas it’s a very bad thing.

I had the catheter removed on the 29th and just passed the pee test, so I didn’t have to go home with another Foley catheter. I did have to monitor my urine output, or lack thereof, which would’ve meant going to the local ER to have another catheter. I made it through the night with continued urine output. Now, I’m back on a liter or two of fluid intake to flush the blood out of my bladder to prevent clots, which might block the channel and having to get a new catheter.

The worst problem of having cancer is the lack of knowing what comes after the next step. VA doctors commonly don’t let you in on what comes next with your case. Worst case scenario: removal of the bladder (cystectomy) and having the ureters from the kidneys connected to an artificial bladder made from a piece of the small intestine and being fitted with catheters. Worse than that is routing the ureters into the bowel. With all the bacteria in the bowel that might get up into the kidneys, refusing to do that and just let the cancer do its worst, and become another statistic of not living to the magical 5-year survival goal is an option I’m not ready to consider. Even worse than not doing a removal is the real chance of the cancer coming back, which cancer of the bladder has a real reputation of occurring.

I suppose being given a tentative end to this life is a real slap in the face. There were lots of things I had planned to do in the years to come. Now, I’m being forced to think about what I should be doing before being given the notice to vacate this body and go wherever it is my spirit desires. I’ve done all the required religiosity within the Protestant canon, but there’s not much comfort when only an actual miracle is the only answer. Unfortunately, miracles are for those who need a wake-up call, not for those who’ve been baptized twice, read the Book cover-to-cover five times in three different versions, and professed belief in the required Deity.