Fifth hospital visit (Thursday 3rd March 2016)

The Saudi German Hospital phoned me at 9:30 am this morning, to inform me that Dr. Hossam had a large number of operations to perform today, so they had to cancel my appointment at 2:20 pm today.

At 1:15 pm, the hospital phoned me again, asking me to be there at 1:30 pm. I had to explain that because we live 95 kms away from the hospital, I need at least 1,5 hours notice, so the soonest that I could be there today was 3:00 pm.

On my arrival, Dr. Hossam pumped my bladder full of a clear liquid, then removed the catheter and asked me to pass urine. I had no feeling that I needed to go to the toilet, and even when I pushed hard, no urine came out .... it seems that the bladder muscle wall is now so weak or has been replaced by the tumor, so I no longer have any control over it ....hence I had to receive a new catheter and colostomy bag.

The results from the tumor samples (6cm x 4cm x 2cm) cut out of my bladder on Monday were back from the Pathology laboratory. It confirmed that I have bladder cancer, with a mixed tumor that is the same size as my bladder (and only half of the tumor was removed with the resectoscopy).

Dr. Hossam explained that the next steps are a CT scan (once authorisation for this has been granted by my health insurance) to establish whether the cancer has exited through the bladder walls and spread any further in my body, and to inject the chemotherapy drugs into my bladder (starting on Tuesday 8th March, then each Tuesday for the next 2 weeks, then miss a week, then another three sessions of chemo over the next three weeks), then do another (but more invasive) resectomy operation to try and remove the remains of the tumor. If that is not successful, he will have to consider removing the bladder.

THOUGHTS

If the tumor has embedded itself so deep into the muscle of the bladder wall that it could not be removed last Monday for fear of perforating the bladder wall .... and if this tumor then expands slightly further into the muscle wall and breaches it, I will have cancer cells traveling freely around in my bloodstream, looking for any other organ or location to attach themselves and start growing again. Why isn't the only known source and location of the cancer cells removed immediately ? I appreciate that bladder removal is a long and complicated operation with a typical recovery period of at least 3 months, but surely that is better than having to return to the hospital every 3 months for further cystology investigations to establish if the tumor is still growing, or has breached the bladder wall and spread elsewhere in my body ?

If the petrol tank on your car was wafer thin in several places and could break at any moment, pouring petrol onto a hot exhaust pipe and potentially causing a fatal explosion, would you try to guess where the weak spots in the petrol tank are and cover these up with sellotape ? or would you remove the dangerous petrol tank immediately and connect a few pipes from bottles full of petrol to feed into the engine, so that you could keep driving without risk of a fatal explosion ?

I have asked for a meeting with a Consultant Oncologist on my next visit to the Saudi German Hospital on Tuesday 8th March, preferably before the CT scan and chemotherapy, for a second opinion as to whether the bladder should be removed (and hopefully all cancer cells with it).

Fourth hospital visit (Monday 29th February 2016)

On arrival at the Saudi German Hospital at 6:30 am, I checked in and was taken to my room in the ward.

At 9:30 am, I was taken to the Radiology department for a chest x-ray (from the front and side).

The operation was scheduled for midday. At 12:40 pm, I was taken to the operating theatre, where the Anesthetist gave me an epidural whilst the rest of the team prepared the warm saline solutions that would be used to flush out my bladder during the operation. I asked to be sedated, but was told that there was no need.

The operation itself began at 1:00 pm. Dr. Hossam did an initial investigation with the cystoscope,

but then realised that the tumor in my bladder was significantly larger than he thought earlier. Hence he decided that instead of removing a small piece for the biopsy analysis, he would cut out as much as possible today, and hence he switched from a cystoscope to a resectoscope.

The operation lasted for 2 hours 15 minutes, with Dr. Hossam giving me a running commentary as I watched the images from the resectoscope on the monitor. He decided to end the operation when he couldn't cut any more of the tumor away, because it was embedded in the muscle wall of the bladder, and he feared that if he cut any deeper, he would perforate the bladder wall.

The reason why the harder that I tried to urinate, the less urine could exit, was now clear - a large piece of the tumor was covering the exit to the bladder, and when the urine was being pushed against the tumor, it completely sealed off the exit to the urethra and penis. This was one of the areas of the tumor that was removed during this resectoscopy.

I then spent an hour in the recovery area, before being returned to my room in the ward. I was given saline and antibiotic drips via the cannula in my left hand, with another saline solution flushing my bladder out via the catheter.

After a restless night (my lower back was incredibly sore after the anesthetic wore off), I was unplugged from the drips and irrigation at about 11:00 am on Tuesday 1st March, so could finally walk around a little. At 12:40 pm, I had a blue fluid (allegedly antibiotics) injected through the catheter into my bladder, and was told to lie for the next 15 minutes on my back, then 15 minutes on one side, 15 minutes on my stomach, and finally 15 minutes on my other side. After 1 hour, I was told to lie another 15 minutes on my back and 15 minutes on my right side (to give the largest remaining pieces of tumor an extra dose), and this fluid was drained out of my bladder after a total of 2,5 hours.
Shortly after that, I was discharged from hospital to go home, with an appointment to revisit on Thursday 3rd March for a checkup.

THOUGHTS

The resectoscope was not as bad as I had feared. It didn't seem real, watching the images from inside my bladder on a large monitor as many large pieces of the tumor were cut away and then extracted for later analysis in the Pathology laboratory.

Third hospital visit (Saturday 27th February 2016)

Saudi German Hospital phoned me at 8:30 am, saying that my health insurance had authorised the cystology and biopsy operation, so I needed to visit immediately to discuss this further.

After being informed by Dr. Hossan that the operation was scheduled for Monday 29th February, I had a meeting with the Anesthetist, and was informed that I would only receive an epidural / spinal anesthetic, so I would be awake during the operation.

Just before we left the hospital, further blood samples were taken.

THOUGHTS

I didn't know what was involved in a cystology and biopsy, so I didn't like the idea of being awake whilst the surgeons were digging around inside of me. The Anesthetist said that if I insisted, I could be sedated after the epidural , so would effectively sleep though the operation.   

Second hospital visit (Thursday 25th February 2016)

The Saudi German Hospital made a follow-up appointment for me for Thursday 25th February.

Dr. Hossam first ensured that my bladder was empty, then made an ultrasonic scan. He then removed the catheter, and told me to keep drinking water until I felt that my bladder was full and I needed to go to the toilet urgently, and he would then rescan the bladder. When I went to the toilet, he wanted to measure how much urine I could pass, and rescan the bladder again afterwards to see if I had fully emptied it.

After drinking more than 30 cups of water over a 1 hour period, I still didn't feel any need to go to the toilet. I was then sent off to the Radiology department for another ultrasonic scan, but with a higher resolution machine. Whilst waiting for this, I kept drinking water, and my stomach began to feel very painful. A few minutes later, I vomited about 1 litre of water out - it obviously couldn't pass into my full bladder, but my stomach didn't want to store it either.

Despite an obviously (over) full bladder, I could not pass any urine, no matter how hard I tried, so a new catheter was inserted into my bladder, to drain into the colostomy bag.

The ultrasonic scans showed that my bladder wall was about 4 cm thick (instead of only 1 cm), so I was told that I will need a cystology and biopsy next to establish why this is, followed by surgery to correct this. However, the hospital needed authorisation from my health insurance first before proceeding any further.

The PSA test results from the blood sample last week returned a value of 2.2 and 2.5 - apparently anything below 4 is normal and indicates that there is no prostate cancer. Dr. Hossam gave me a scan of my prostate through my rectum, which showed that I have about 4 stones in my prostate - these will have to be removed surgically later, but are not the cause of my urine retention, and hence this is not a major issue.

THOUGHTS

Relieved that I do not appear to have Prostrate Cancer, but the large tumor in my bladder was obviously a concern now.

First hospital visit (Thursday 18th February 2016)

On Thursday 18th February, I drove to the Saudi German hospital in Al Barsha, Dubai to see a Urologist (Dr. Hossam Saker Allahyani). He confirmed (via ultrasonic scans) that my bladder was full, and that I was suffering from urine retention despite a hugely inflated bladder. He inserted a catheter into my bladder via my penis, and over 2 litres of urine drained into the colostomy bag. Blood (and urine) samples were taken for analysis, specifically for the PSA test to establish if I had Prostate Cancer.

THOUGHTS

At this stage, I thought I only had a bladder infection. Although it was nice not feeling as if my bladder was about to burst all the time but still not be able to pass any urine, the catheter was a fairly stiff plastic tube, so every time I moved, it pulled or rubbed on the urethra (inside my penis), which was extremely uncomfortable .... and I could only lie on my back at night, so it was difficult sleeping.

Background

Starting in mid-November 2015 .... we went out for the day in our small fishing boat, and a couple of days later, I had a severe cough and sore throat, and started to have problems urinating. I visited our local GP practice, where the female Arabic doctor diagnosed acute bronchitis and an allergy to oranges.
After a 5 day course of antibiotics, my sore throat and constant coughing started to ease up, and my bladder no longer felt full the whole time.

About a month later, the same symptoms reappeared. Another visit to our local GP practice, where I saw the male Indian doctor - he diagnosed acute bronchitis and an allergy to sand and dust. After another 5 day course of antibiotics, my sore throat and constant coughing started to ease up, and my bladder no longer felt full the whole time.

Another month later (mid-January 2016), and the same symptoms reappeared yet again. After another 5 day course of antibiotics, my sore throat and constant coughing started to ease up, and my bladder no longer felt full the whole time.

Another month later (mid-February 2016), the same symptoms reappeared yet again. However, this time, my urine retention was much more serious. My bladder felt permanently full again, but only a few drops of urine (sometimes up to half a cup full) would come out whenever I went to the toilet.

Since it was obvious that the two local GPs had no idea, I checked which hospitals I was covered to visit under my health insurance, and made an appointment at one of these hospitals for a checkup.

Introduction

I will attempt to document my battle against bladder cancer and my emotions here, although I am sure there will be many times that I won't feel like posting any updates.