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Back in the Soup: Cancer Again
Almost exactly one month ago, I noticed thrice in one day that there was bright red blood in my urine. At my wife’s suggestion, I mentioned it to my physician the following Wednesday, and one week to the day after the appearance of the blood (which did not recur), I had a CT-Scan, and the radiologist at the Hillsdale Hospital noticed a nodule on the wall in my bladder.
Having been down a similar road back in 2012, I got on the phone, and the wheels began to turn. This past Friday, at the National Institutes of Health, Dr. Piyush K. Agarwal conducted a transureth resesection, removed the tumor, which was located on the right lateral wall of my bladder whence it extended onto my right ureteral orifice, and resected down to the muscle and fat of the bladder. Here is what the tumor looked like before it was removed:
Dr. Piyush and his team found other similar material elsewhere on the bladder wall and scraped it off. The pathologists will be looking at it all in the next seven to ten days. It is in all likelihood cancerous. Whether it is slow-growing or aggressive I will learn in due course.
I cannot say that I enjoyed the operation. But it was less invasive than the prostatectomy I had in 2012 and the removal of my gall bladder in 2010. You can read about what was done here, where they report,
This procedure, also called “transurethral resection of the bladder tumor,” is common for early-stage bladder cancers, or those confined to the superficial layer of the bladder wall. This bladder cancer surgery is performed by passing an instrument through the urethra, which avoids cutting through the abdomen. The surgical instrument used for this operation is called a resectoscope. A wire loop at one end of the resectoscope is used to remove abnormal tissues or tumors.
What they do not tell you — lest you be too horrified — is the path they take to get to the urethra in the first place. All that I will say is that, in the aftermath, my male member was rather tender.
The good news is that I did not have to watch the procedure — anesthesia helps — and that I bounced back rather quickly and was on a plane home the next day. The bad news is that, if they find cancer, I will have to undergo the same procedure in three months and then repeatedly for a while after that because there is no other way to examine what is going on inside my bladder.
It will be worse if the cancer is aggressive — for then I will be slated for six treatments at weekly intervals via a catheter (and there will be numbing of the male member but no anesthesia). The standard treatment is called intravesical immunotherapy, and here you can find it described as follows:
Bacillus Calmette-Guerin therapy: Bacillus Calmette-Guerin (BCG) is the most effective intravesical immunotherapy for treating early-stage bladder cancer. BCG is a bacterium that is related to the germ that causes tuberculosis (TB), but it does not usually cause serious disease. BCG is put directly into the bladder through a catheter. The body’s immune system cells are attracted to the bladder and activated by BCG, which in turn affects the bladder cancer cells. Treatment is usually started a few weeks after a transurethral resection of the tumor and is given once a week for 6 weeks. Sometimes long-term maintenance BCG therapy is given.
Treatment with BCG can cause symptoms that feel like having the flu, such as fever, chills, and fatigue. It can also cause a burning feeling in the bladder. Rarely, BCG can spread through the body, leading to a serious infection. One sign of this can be a high fever that does not get better when you take a pain reliever (such as aspirin, ibuprofen, or acetaminophen). In such cases, you should see a doctor right away. These infections can be treated with the antibiotics used to treat TB.
I am told that BCG was discovered more or less by accident when bladder cancer patients who contracted tuberculosis magically recovered from the former condition.
There are other possibilities — none of them pleasant to contemplate. If the tumor dug into the muscle, the cancer may have spread beyond the bladder. About that, I will learn also in seven to ten days.
I apologize for subjecting you all to this. But there is a moral, and you ought to give it thought. Most cancer can be treated … if it is caught early on. The problem is that one rarely gets any kind of warning that one has bladder cancer. I had bright red blood in my urine. Many women and men with this condition do not ever have this symptom. So the thing tends to sneak up on you, and when you learn it is already too late. I was lucky (at least, I think that I was lucky. We shall see). If you see blood in your urine, seek medical help. It does not generally happen unless something significant is wrong.
There is another moral. Listen to your wife (or your husband). Your spouse cares more about your welfare than you do.
Published in General
Thanks to all of you. I expect to get through this, as I did with the prostate cancer. Do be alert. In these matters, knowledge is power.
You are in all of our prayers, Dr. Rahe: Godspeed.
Oh, dagnabit. Praying that the tests will come out the most positive that they can.
So sorry to hear this. As others have said saying prayers for you and your family.
Prayers coming your way. A speedy and complete recovery!
Professor Rahe,
I’m so sorry to hear this.
Your positive response to this struggle, and your sharing of it, in all of its facets, will be used for good.
Prayers for recovery and peace.
Good luck and God Bless, Dr. Rahe. Thoughts and prayers to you and your family. Thank you for the valuable information, and may we be reading positive updates and keen historical and political insights from you for years to come!
My best wishes and prayers are with you. I had that procedure for a little look around a few years back. I told the doctor at the time that that day was worse than the day a was drafted in to the Army.
No apologies necessary. Thoughts and prayers for you and I hope that cancer knows it’s in for a good fight.
Ain’t that the truth. I’ve been darkly joking that I need a form letter: Dear friend or relative, I am terribly sorry to learn of your Stage [fill in blank] cancer of the … ”
Paul, I am terribly sorry to hear that. And I send my very best wishes.
Modern medicine is at the same time wonderfully powerful and terrifying. I’m glad to hear that you will be receiving immunotherapy. I’ve no expertise, but it makes so much more sense than traditional chemotherapy. Wishing for a free lunch, but praying for your recovery.
Your calm toughness is so admirable. Good luck, Professor Rahe. Prayers.
Dr. Rahe,
Keeping you in my prayers.
Paul, thank you for your courage in sharing this. I too will pray for you, as one double cancer survivor to another. Remember that the hardest part is what you do not know. Knowledge is, indeed power.
All others, this perfectly-handled case illustrates why medicine is so costly. CT scans, urethroscopes, anesthesia and immunotherapy do not grow on trees, nor do skillful urologic surgeons, oncologists and radiologists. That was a *nice* pickup on the radiologist’s part.
Please add my name to the list of well-wishers.
You are in my thoughts and prayers. We 67-year-olds need to stick together.
Back when I had my own prostate cancer diagnosis and my wife got a bit excited about the delays in getting surgery to deal with it, I decided that at least I had the excitement of living life on the edge. Not sure I’d have guts enough to say that if I had all the additional issues you have. It is encouraging to see you taking it as calmly as you are, so thank you for that example.
Like many others here I, too, have had family members and friends who have suffered from cancer. My thoughts are with you and your family.
Indeed. Will be praying for you, as well, Paul.
Charlotte is exactly right. Cancer is a huge jerk.
Godspeed, Professor. You are in my prayers.
In my prayers!
You have my prayers. Good luck and good health, sir.
Also reading the good doctor’s book. Love the stuff on military and political strategy. Could do with less of the exegesis on Spartan life, though, which was craziness in the raw. Every place you put that stuff, maybe put a map instead in the next book(s). Love maps. More maps please. And pictures. I love pictures. More pictures please…
Here’s hoping your writing career doesn’t suffer from this setback.
So sorry to read this, Professor R. I pray for your doctors’ wisdom and skill, your recovery, and your and your family’s consolation and strengthening. I ask for the intercession of SS. Vitalis of Assisi (bladder disease) and Peregrine Laziosi (cancer), as well as that of the deceased members of my family who suffered from cancer.
Earlier, I forgot to thank you for the warning in your piece.
Thank you.
If it be His Will, may the Great Physician heal and comfort you and your family. Let the Spirit guide and enlighten your doctors, nurses, and caregivers in their healing work.
Yours in Christ, FG
Hmmm. That was my favorite part.
The Spartans were crazy people, and much to be despised, IMO, Except for their considerable military prowess and martial courage, history would properly lump them among the barbarian cultures where they belong. Can’t wait for Dr. Rahe to write about Epaminondas and the Thebans taking their empire apart! Yeah, can’t wait. (“The Battle of Leuctra …was a battle fought on July 6, 371 BC, between the Boeotians led by Thebans and the Spartans along with their allies amidst the post-Corinthian War conflict…The Theban victory shattered Sparta’s immense influence over the Greek peninsula which Sparta had gained since its victory in the Peloponnesian War.”)
Dr. Rahe
Our family’s thoughts and prayers are with you.
Dr Rahe, We’re praying for you right now.
Prayers–prayers for you, your wife, and your splendid, brilliant, marvelous children.