I arrived at the Saudi German Hospital at 9:00 am, very late for my 8:20 am appointment (thanks to a huge car crash involving at least three vehicles that all but closed the E611 Emirates Road for an hour), but two of the Receptionists and several other staff were sitting in the same traffic jam and were just as late for work, so no-one was bothered.
I then had to collect the Mitomycin chemo from the hospital pharmacy, and was told that because I was booked in as an out-patient (instead of day care), my health insurance would only cover 80% of the cost, so I had to pay Dhs. 330 .... also, because my Urologist had signed the prescription, this was not acceptable, it must be issued by an Oncologist. After a 20 minute discussion, the Pharmacy eventually let me pay and take the drugs to my Urologist.
40mg of Mitomycin was mixed with about 3/4 litre of water, then pumped into my bladder through the catheter, which was then closed off (at 10:00 am). I was taken to another area of the hospital, and instructed to lie for 15 minutes on my back, then 15 minutes on my right side, then 15 minutes on my stomach, then 15 minutes on my left side, then my right side and back again. The nurse would return after 30 minutes to check on me, then again after 90 minutes to release the clamp on the catheter and let the spent chemo drugs drain away into my colostomy bag, which the Urologist would then examine.
Unfortunately, the nurse forgot to return after 30 minutes (and 90 minutes). After 2,5 hours, I found another nurse in this area, and asked if she could get a message to the Urology department nurse, to remind her about me. At 1:30 pm (after 3,5 hours in total), I decided to find my own way back to the Urology department, where the nurse unblocked the catheter.
My health insurance still hadn't authorised the required CT scans that were scheduled for today, so the Urologist asked me to chase them up directly. When I phoned them, they gave me the reference number for the authorisation of the abdominal CT scan (applied for by the hospital last Thursday and authorised on Friday), but claimed that the hospital never requested a CT scan of the thorax area, so they should file that request immediately.
Since this would take a couple of days for approval, the Urologist suggested that instead of doing the abdominal CT scan today (which was to see if the cancer tumor had breached the bladder wall and spread into my bloodstream) and the thorax CT scan later (to see if the cancer had spread to my lungs, chest or throat) and sending the insurance company two separate invoices, it would be much cheaper to wait and do both CT scans at the same time, as originally planned for today.
I then collected the images of the chest x-rays and ultrasonic scan of my bladder, plus the DVD of the resectoscopy operation on my bladder, before heading back home at 3:30 pm.
The current plan of the hospital is ....
1) bladder chemotherapy session today (completed)
2) abdominal and thorax CT scans to determine if the cancer has spread outside of the bladder (as soon as the health insurance authorises this)
3) another resectoscopy operation, but this time collecting biopsy samples from very specific locations of the bladder tumour as determined by the Pathologist (because he can't grade the tumour from the previous biopsy samples, he can only see an invasive tumour with aggressive cancer cells and harmless tumour cells, but doesn't know which were located where)
4) if the cancer is restricted to the bladder, arrange for a radical cystectomy to remove the bladder, prostate, lymph nodes, etc.
5) if the cancer is not restricted to the bladder, continue with bladder chemotherapy plus normal chemotherapy, to try and eliminate the cancer from wherever it is (if the radical cystectomy is performed, I will be too weak to have chemotherapy, which will allow the cancer to spread elsewhere)
THOUGHTS
I am very grateful that the side effects from the Mitomycin chemotherapy are minimal - I only have a slight discomfort in my stomach, and I think that is left over from the resectoscopy last week rather than the bladder chemo session.
I am worried that the delay before further action - removing the bladder and the cancer with it - will allow the aggressive cancer to breach the bladder walls and spread into the rest of my body, but Dr. Hossan assures me that a few weeks delay will not make any difference, since the tumour has been growing inside my bladder unnoticed for between 2 and 3 years already.
I then had to collect the Mitomycin chemo from the hospital pharmacy, and was told that because I was booked in as an out-patient (instead of day care), my health insurance would only cover 80% of the cost, so I had to pay Dhs. 330 .... also, because my Urologist had signed the prescription, this was not acceptable, it must be issued by an Oncologist. After a 20 minute discussion, the Pharmacy eventually let me pay and take the drugs to my Urologist.
40mg of Mitomycin was mixed with about 3/4 litre of water, then pumped into my bladder through the catheter, which was then closed off (at 10:00 am). I was taken to another area of the hospital, and instructed to lie for 15 minutes on my back, then 15 minutes on my right side, then 15 minutes on my stomach, then 15 minutes on my left side, then my right side and back again. The nurse would return after 30 minutes to check on me, then again after 90 minutes to release the clamp on the catheter and let the spent chemo drugs drain away into my colostomy bag, which the Urologist would then examine.
Unfortunately, the nurse forgot to return after 30 minutes (and 90 minutes). After 2,5 hours, I found another nurse in this area, and asked if she could get a message to the Urology department nurse, to remind her about me. At 1:30 pm (after 3,5 hours in total), I decided to find my own way back to the Urology department, where the nurse unblocked the catheter.
My health insurance still hadn't authorised the required CT scans that were scheduled for today, so the Urologist asked me to chase them up directly. When I phoned them, they gave me the reference number for the authorisation of the abdominal CT scan (applied for by the hospital last Thursday and authorised on Friday), but claimed that the hospital never requested a CT scan of the thorax area, so they should file that request immediately.
Since this would take a couple of days for approval, the Urologist suggested that instead of doing the abdominal CT scan today (which was to see if the cancer tumor had breached the bladder wall and spread into my bloodstream) and the thorax CT scan later (to see if the cancer had spread to my lungs, chest or throat) and sending the insurance company two separate invoices, it would be much cheaper to wait and do both CT scans at the same time, as originally planned for today.
I then collected the images of the chest x-rays and ultrasonic scan of my bladder, plus the DVD of the resectoscopy operation on my bladder, before heading back home at 3:30 pm.
The current plan of the hospital is ....
1) bladder chemotherapy session today (completed)
2) abdominal and thorax CT scans to determine if the cancer has spread outside of the bladder (as soon as the health insurance authorises this)
3) another resectoscopy operation, but this time collecting biopsy samples from very specific locations of the bladder tumour as determined by the Pathologist (because he can't grade the tumour from the previous biopsy samples, he can only see an invasive tumour with aggressive cancer cells and harmless tumour cells, but doesn't know which were located where)
4) if the cancer is restricted to the bladder, arrange for a radical cystectomy to remove the bladder, prostate, lymph nodes, etc.
5) if the cancer is not restricted to the bladder, continue with bladder chemotherapy plus normal chemotherapy, to try and eliminate the cancer from wherever it is (if the radical cystectomy is performed, I will be too weak to have chemotherapy, which will allow the cancer to spread elsewhere)
THOUGHTS
I am very grateful that the side effects from the Mitomycin chemotherapy are minimal - I only have a slight discomfort in my stomach, and I think that is left over from the resectoscopy last week rather than the bladder chemo session.
I am worried that the delay before further action - removing the bladder and the cancer with it - will allow the aggressive cancer to breach the bladder walls and spread into the rest of my body, but Dr. Hossan assures me that a few weeks delay will not make any difference, since the tumour has been growing inside my bladder unnoticed for between 2 and 3 years already.
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