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.