The fourth instillment was very smooth.  I did a couple things differently.  First, I asked the nurse if I could lie on my stomach for a few minutes before leaving the office (to try and get the BCG up into the "bubble" area in my bladder early).  Once home, I followed my usual routine, but this time pushed past the "bladder spasms" as long as possible.  This was the first day that I had blood (not clots) in my urine, but it was only a very small amount.  I am realizing a pattern: soon after the treament (within the first two hours) I begin to get an unusual feeling in my nose, and begin to develop a headache (similar to how I have felt in the past with migraine headaches).  Along with drinking a lot of water, I try to nap about six hours after the treatment.  This seems to help keep the symptoms low-grade, and helps me recover more quickly.