And .... I'm done (the first part, anyway)

This week was really challenging. I felt pretty good on Tuesday, so did some chores around the house for a couple of hours .... mistake. I spent the rest of the week on the couch, and really thought that the nurses would send me home on Friday because my bloodwork was bad. 

Turns out, my bloodwork was OK even though I felt like sh*t. So I got my last treatment (Gemcitabine) on Friday. Brother Don and daughter Kathryn came to the Cancer Agency for the appointment, and tag teamed sitting with me while the poison slowly leached into my body (being pretty dramatic here, aren't I).

So with this last session, I'm done with the chemotherapy part of my cancer treatment. The next step is to wait eight to twelve weeks to recover, and then bladder removal surgery. I had some hope that there might still be an option on the table to avoid the surgery, but Dr. Noonan (Oncologist) put that to rest last week - the standard of care for my situation is four cycles of chemo, followed by bladder removal. 

I'm impressed by BC Cancer for this - when I look into the evolving standards of care around the Western World, only a small percentage of health care systems have adopted this as best practice.  Many have these same studies, but have a hard time moving to the latest/best strategies.

She Quit!

 

OK, so click bait. 

Laura and I met with Dr. Noonan (Oncologist) this morning. 

I've been off for two weeks, so am feeling better - certainly not normal and still a little tired, but improving every day.

The CT scan I had last week showed no evidence of disease outside the bladder - which doesn't mean a whole lot because it's microscopic disease we're worried about. The chemo to date has not shrunk the bladder tumour(s), but it isn't supposed to. It is supposed to hunt down and destroy any cancer cells it finds in my entire body. Except my left foot.

So all signs point to finishing off this chemotherapy round with sessions seven and eight. Starting this Friday (cisplatin and gemcitabine) and next Friday (gemcitabine). After that, she calls Dr. Wong (my Urologist) and she gives him the go ahead to schedule surgery.

I'm on track to finish all the chemo on December 22, so surgery ideally would be the end of February or beginning of March. I talked with Dr. Wong last week and confirmed that his calendar is open on those dates, so scheduling shouldn't be an issue.

When I talked with Dr. Wong he said that "all options are still on the table", although "some are not optimal". This held a glimmer of tri-modal therapy (bladder preservation), but Dr. Noonan pretty much put the stink eye on that option this morning. We're too far down the path of chemotherapy, and TMT isn't optimal for me for a number of reasons (multi-focal tumour, location of tumour near a ureter, bent ureter). 

So back to the "I quit" theme at the beginning. Unless something extraordinary happens, I won't see Dr. Noonan again. She is done. 

Now I look forward to be waited on hand and foot over the Christmas break. 

Party on Garth.

And Now For The Bonus Round

I had the final "Cycle Three" chemotherapy last night. This was the more tolerable of the sessions - Gemcitabine alone for a total of about an hour. Compared to the previous week (Cisplatin and Gemcitabine for a total of three hours),  this is easy.

When we first started, Dr. Noonan (Oncologist) said that "we'll try to get three cycles done, four if you can tolerate it". I wasn't so sure I was tolerating the Cisplatin very well (some kidney function markers and general malaise) but the bloodwork was better this week.

So once I recover from this cycle (two weeks off), I meet with Dr. Noonan again and we decide on Cycle Four (or not). As I've mentioned previously, the stats are pretty glaring - four is better than three, so do four if you can:

[Results: One hundred and twenty-one patients were identified. Patient characteristics are described in the table below. Eighty-six patients received 4 cycles of GC and thirty-five patients received 3 cycles. Ninety-five patients proceeded to cystectomy: 93 received a radical cystectomy, 1 received a partial cystectomy, and 1 was aborted due to positive lymph nodes. There was a statistically significant difference in OS between those who got 3 or 4 cycles (p=0.03) and PFS (p=0.014). Median OS for those who got 3 cycles and 4 cycles was 52 months and 92 months respectively.]   *Note: OS = Overall Survival

If I do four, I'll be done on Dec 22. Just in time for Christmas. 

Five down, three to go

 

This week I had a meeting with the Oncologist (Dr. Noonan) on Wednesday, and the CIS-GEM chemotherapy yesterday (Friday, Nov 24). 

This is the beginning of Cycle 3 (2 sessions per cycle). Ideally, we'd like to get 4 cycles done, but 3 is considered acceptable. 

The title of this post is a little confusing. I'll visit the chemo ward (ideally) 8 times. 4 courses of 2 sessions/course. Session 1,3,5 and 7 are the big ones (CIS-GEM) and 2,4,6,8 are GEM only (CISplatin and GEMcitabine).

Because I'm curious I went looking into the stats for 3 cycles versus 4, and found this. TLDR - 4 is twice as good as 3. Do 4 if you can.

The other curve-ball in this is that my kidney function markers are starting to be affected. It was a question this time as to whether I get a "full dose" of Cisplatin or not ... Dr. Noonan decided that I can get the full meal deal this time, but I'm wondering if this will change moving forward. 

I've had a couple of questions about scheduling surgery. The way it will work is that at the end of the chemo (3 courses or 4), Dr. Noonan will call Dr. Wong (Urologist who will perform the surgery) to schedule. I've read different "ideal" surgery timings, but they're all within an 8-12 week window. It seems that "do it as soon as your healthy enough to do it". In our health care system, I'm sure there are other variables out of everyone's control ... 

PS: If you hover over the photo a caption should come up. If it doesn't, this is my bladder and the arrow is pointing to the tumor. This is pre-chemo, and I'll have another CT on Dec 4th to see any changes.

Tinnitus anyone?

One of the side effects of Cistplatin, and one the doctors and nurses check and recheck all the time, is hearing loss.

As I woke up this morning, and all was quiet, I could "hear" a very low level, very constant, ringing in my ears. I have several instances of "serious" tinnitus during the day, but they only last for a few seconds and then go away. I had been concerned that this what what they were looking for. Maybe it is.

It's not especially bothersome (at this level), and I'll report it to the nurses on Tuesday. If this is as bad as it gets, I can live with it. If it gets much worse than this, they might have to adjust the amount of Cisplatin I'm getting next time.

Right to the edge, huh?

Through the first round of chemotherapy, I thought "well, this isn't so bad". Sure there were unanticipated side effects, but they all had fixes and it was just a matter of a few days to get them under control.

Then I had a couple of weeks off, and felt almost like myself. On Friday, November 3, Round Two started. It's the heavier session with both Cisplatin and Gemcitabine - in total takes about three hours to infuse.

I was hit by a truck. Zero energy, upset stomach, leg and arm pain. I could sleep on the couch from 2pm till 7am the next morning and still feel tired.

But today (Friday, Nov 10) I get the Gemcitabine by itself - takes about a half hour. And I feel OK. It's almost like they know what they're doing...

Introducing Doug 4.0

So since the beginning of this blog, I've changed up the title from Doug 2.0, to 3.0. to 3.1, 3.2, and now 4.0.  These have corresponded to some pretty big medical events in my life:

• 2.0 - CABG (heart bypass surgery in 2006)
• 3.0 - Ischemic Stroke in 2009
• 3.1/3.2 - Stroke related events that happened during recovery
• 4.0 - My latest diagnosis

The latest...

Late this spring, I noticed blood in my urine. After my doctor and I had eliminated a UTI as the cause, he referred me to a Urologist (Dr. Nathan Wong). Early in the summer, I had a cystoscopy which confirmed that I had bladder cancer, and then followed up by a TURBT procedure which  both cleaned up what was in the bladder, as well as determine the extent of the damage.

When the results of the TURBT biopsy came back, it was determined that I have Stage 2, Muscle Invasive Bladder Cancer. The course of treatment for this will be:

A course of chemotherapy - four rounds of two sessions each

• Session 1 - Gemcitabine and Cisplatin 
• Session 2 - Gemcitabine

Once the four rounds of chemotherapy are done (probably late December), I'll recover for a couple of months and then have bladder removal surgery (which will include the prostate, vas deferens, local lymph nodes, and maybe other assorted body parts). I still have to make a decision about the post-bladder direction I choose - there are a couple of options which include having a stoma with an external urine collection pouch, or the creation of an internal pouch out of intestine.

Right now, I'm leaning toward the stoma/urostomy, as it seems the simpler operation with the fewer chances for side effects. Although it does mean a radical change of life for me - I know from past experience that human beings can get used to just about anything.

So there we are. I'm right in the middle of chemo while I write this. I know it's the first time I've updated the blog in several years, but I want to log this as I go so maybe somebody will get something out of it.

PS: I've got three doctors that are working with me through this:

• Dr. Peter La Voi - my GP here in Port Coquitlam, who was the first to jump on this and has intervened to speed things up when they started to lag.
• Dr. Nathan Wong - my Urologist working out of New Westminster. Very focused and to the point. Reminds me of an engineer. I like that.
• Dr. Krista Noonan - my Oncologist with BC Cancer. Very warm, knowledgeable, and works hand in hand with Dr. Wong. She's the one with the bedside manner.

I'm very happy with the team I have, and I'm most encouraged by their age - I doubt any of them is over forty.

Citizen Chronomaster "The Citizen" AQ4030-51E

 

I have had over a dozen entry level luxury watches over the course of the last few years (thank you global pandemic). I had a 2000's era Omega Seamaster Pro for a long time, until a trip to Japan reignited my love of watches. That was the start of it, and it cascaded from there.

I'm sad that I let some of them go. Perhaps the hardest to come to grips with is the now "impossible to find" Grand Seiko SBGX115.

There's been a couple of others, too. When I look back at photos of my collection, I often wonder why I didn't stop then and hang on to all I had.

But on with my thought. I think I might just have the "one and done" watch in the Citizen. It's absolutely below the radar. It looks like your standard shopping mall Citizen. But it's not.

• The watch is made of high-grade titanium with a Duratect protective treatment
• 40mm diameter, 12.5mm thickness
• Double domed sapphire crystal with excellent AR
• Traditional Japanese tosa-washi paper dial - close examination shows the character of the paper
• Citizen Eco-Drive movement, solar powered
• Excellent visibility day or night with polished and lumed hands, dial and rehaut
• Perpetual calendar with quick date set
• Hacking and independent setting of hours hand
• High Accuracy Quartz (HAQ) movement with specified accuracy of +/- 5 seconds/year. I'm getting about +/- 10 seconds/year based on my wear/use case.
• 100m of water resistance with screw down crown
• Titanium bracelet and clasp that is honestly the best I've ever worn
• Screw down titanium case back
• Zaratsu polished case - easily competes with Grand Seiko and Rolex. Actually in Japan - it does.

It's the best finished watch I've owned.

It's the most comfortable watch I've owned. 

It's the most legible watch I've owned.

It's the most accurate stand-alone watch I've owned (not syncing to some external time source).

But don't take my word for it. I first got onto this watch when I watched a video (since removed from YouTube) from jandrese. Here's his post on Reddit.

Just the other day, a popular Aussie watch vlogger (Jody at Just One More Watch) did a review. It's worth a watch.