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Part one of this story addressed the diagnosis date and the weeks and months that followed soon thereafter ending with a second TUR in September of 2007. That is where I'll pick this up -beginning with the results of that second procedure and the associated pathology.

As with the first experience, the second TUR pathology confirmed the disease was Ta Stage I noninvasive papillary carcinoma. No real surprise there. Dr. Dato assured me before the procedure that a significant percentage of the time noninvasive cancer - if it reoccurs - reoccurs in the same form and usually in the same area of the bladder. Good news for me! I mean, if you're going to end up with cancer at least it can be the "good kind" right?  A significant change this time - however - seemed centered on a debate concerning that reoccurring versus persistent disease issue.  Dr. Dato felt it was reoccurring while his associate felt it might be persistent and I -of course- had no idea.

"When in doubt, ask" is something I live by (in everything except driving directions) and if ever I needed to ask I thought now was the time. My mind told me to begin with my wife since before retiring to be a full time musician and mother, my wife worked as an oral surgical nurse and had a much better understanding of all this medical stuff. But, to be perfectly honest here I was hesitant. I was the husband, the father and the breadwinner - no way could I burden my family with this load. I would have to play this confident and bold with nary a blink when the "C" word was mentioned. So, my heart was betraying my head and yet another battle raged inside.

Need I say it? That was mistake number one!

At some point soon after , when I fianlly worked up the intestinal fortidude, Deborah and I shared a very candid discussion and I encouraged her to express her fears out loud honestly and - I hope - openly. That was the toughest day of the entire experience to be sure. To sit across the table from my wife and life partner and watch as her face settled into the fact that her husband had a chance - however remote- of dying before reaching that moment in time we had been promised alone together. There were also serious financial and emotional concerns. Thoughts of a house we were in for a little over a year, life insurance, possible disability, well you get the idea. Topics that at fifty-two years young I had heretofore ignored and put off until I was older, sicker, more prone to life changing events. If only one dream could be granted as a wish to come true I would erase the need for that day. Never before had I felt like such a failure in my own eyes. I mean - other than smoking for three decades - it really wasn't my fault this happen but, it was my fault I wasn't better prepared.

In the end, I leaned on the amazing strength offered by my wife and the love of my children and granddaughter for daily emotional support; turned to God for spiritual well being and asked my sisters for medical advice since they both work for UCSD and are both "scientific" in their endeavor. The youngest pointed me toward a second opinion and hooked me up with the head of UCSD's Oncological Urology Department - I was very impressed to say the least. We met in late October for a consultation. As it turned out he shared Dr. Dato's opinion with one exception and yet another twist.

Dr. Dato recommended BCG therapy to ward off any future reoccurrence while UCSD felt BCG would be little if any use and should be avoided at the risk of potential side effects. He further advised an in-patient cystoscopy to check the ureter since the tumor was located at the entrance of the right ureter and had potentially made a nasty little side trip toward the kidney.  Kidney?  What kidney?  Who said anything about a kidney for God sake? This entire experience was moving way too fast and spinning out of control!  Dang, I was just starting to adjust to the concept of bladder cancer (the "good kind" remember) and now these guys were blindsiding me with this kidney issue. After taking a deep breath, for about eight days, the sense of being overwhelmed while feeling like a walking time bomb were forced deep enough back into my thought process to allow for some rational consideration as I listened to Dr. Dato explain the difference between the in office cystoscopies I had in the past and the more invasive procedure being recommended.

Apparently this scope of the tube leading to my kidney - the ureter - was going to be a little painful and since pain is not in my program he wanted to knock me out - from my point of view - that was just fine. As a guy (women too I am sure) having a narrow tube with a tiny flashlight and camera attached navigated through tiny hole that is usually only used to evacuate urine (you get the drift) is not an experience I look forward too. It was very uncomfortable and somewhat emasculating to be truthful. The office procedures (three at this point) left me with bladder spasms and infections requiring medication with their best little friends, side effects. To be sure it was a long period of headaches, dry mouth, sore throat, memory loss, an inability to concentrate and a general feeling of blah. Given that history (he says tongue in cheek) I could hardly wait for what was waiting over the next treatment horizon and set out to discover as much as I could about this BCG stuff.

And that. I will discuss in the next post.

Thanks for your comments.