Yesterday was the day for the bladder cancer procedure. It was intended to be an outpatient procedure but I stayed overnight in the ICU.
Why? First, one of the ducts between a kidney and my bladder was partially blocked so a stent was put in. Second, as I outlined in A Busy Cancer Day, I had made sure that the anesthesiologist was aware of the risk of Carcinoid Crisis. Here was what he told me when we met before the surgery:
- He had hit the books on carcinoid and found out that Carcinoid Crisis was a “real thing” in his words.
- He had read the recommended octreotide protocols that I had given him.
- He had spent time with the anesthesiologist who had presided over my five and a half hour liver surgery last year and decided to use the same protocol that was used then. This was a modification of Dr. Pommier’s protocol.
- He thought that the risk of crisis was enough to schedule me overnight in ICU for monitoring and the octreotide drip was continued for hours after the surgery was over.
I was extremely impressed with his willingness to go the extra mile for me.
No crisis occurred! Rah Rah! Three tumors that we had seen in the cystoscopy (interesting to see the inside of your bladder on TV) were removed and the urologist found a fourth that had been hidden and removed it. The urologist said that he “plucked” the tumors out and scraped the inside surface of the bladder to remove any cells that might be there. The larger tumor hid the opening of the duct from the kidney so the urologist had to put a stent in to make sure the duct stayed open. He intends to remove the stent in two weeks (office procedure).
After the procedure, I was taken to ICU where I spent the night. There I was interviewed, poked and prodded by doctors, interns, nurses and med students, all of whom expressed thanks for learning about a rare disease. Most of them did not seem very interested in the bladder cancer. I overheard one nurse tell another that I seemed to know more about carcinoid than the doctors.
The hospital medical team was concerned because my pulse rate was low through much of the night, often around 45 bpm. So I have to visit my PCP next week. He knows all about it and I had a Cardiology review just three days before! My resting heart rate has often been that low for at least the last nine years. I do not think anything will change.
Now I must have a cystoscopy every three months for a year and then yearly because this cancer is known to come back. The urologist says the cancer looks like a low grade cancer but we will wait for the lab tests to tell us. I asked that the lab test for any carcinoid cells in the tumors.
Overall, this was not at all as bad/painful as I had anticipated. I am very thankful for that.
Surely this was my best possible outcome,
EDIT: June 6, lots of pain today. They gave me no prescription at the hospital so I have had to call the doctor to get a prescription called in to the pharmacy. Did not expect it to be this bad.