Tuesday, August 10, 2010

Last questions before go

Even as Wife and I drove to the first chemo appointment this morning, I wasn't sure whether I was going to do it. My doctor sat with us for more than half an hour and we talked again about how this stuff really works and why we should do it now. The first time we talked it was like Chemo 101 for me. This time I had studied up and I was prepared. I think I gave him the tough questions about side effects and mechanisms and he couldn't side step the answers by saying; " it's too complicated."

After taking a blood sample to test for blood count and kidney function, I met with the oncologist again.


  1. Indiscriminate (blast away and hope we get the cancer).

  2. "The principle function of cisplatin is to bind to DNA during replication which is part of cell division that replaces current cells (organ maintenance and repair) or adds to current cells (normal growth and development or Cancer tumor growth). The consequence of this, is the activation of repair processes which eventually cause cell death (Apoptopsis).

    • Chemo (cisplatin) attacks the cancer (and all other cells) when they are actively dividing (mitosis). Basically it kills 'anything that moves'. But cancer cells aren't constantly dividing and they don't divide any faster than a normal cell. But cancer developes in a cascading sort of growth and the initiation of apoptopsis has the effect of breaking up these chains and either shrinking the tumor or causing it to disipate intirely.

    • Side effects on normal tissues is more of a loss of individual cells that are replaced after the chemo leaves. These new cells repair the damage and fill the void and that's all.

  3. Permanent side effects (nerves, kidneys, hearing, sight, mental ability):

    • Again, the therapy is not a one shot deal producing all or nothing results or side effects. It is a process composed of multiple treatments and cycles of treatments. Each step is carefully monitored for signs of developing side effects (and results) and these signs and symptoms are dealt with before therapy treatments continue. Much has been learned over the years about how to deal with these and adjust medications to maximize effect and minimumize (eliminate) side effects.

    • Reports of permenant imparements of mental capacity have not been substantiated and have to be taken with a grain of salt. Like all side effects, the over all side effect is a combination of actual physical effect and the individual patients sensitivity to changes in the effected system (tolerance to pain, etc.). Or - some people are just whiners.

So in the end it came down to his three main arguments:

  1. We don't loose anything by doing this first. (two or three rounds of chemo)

  2. We get started faster if surgery finds cancer has escaped the bladder - nipping it in the bud. Many studies, and general consensus in the field has this making a difference with this cancer.

  3. Won't impact surgery. I will be perfectly ready for surgery two weeks after last chemo.

Chances are good that even if they don't find any evidence of spread during surgery, They would still want to do some chemo and I'm in much better shape to successfully handle chemo now than I will be after surgery.

Finally he asked me if I really wanted to forget it and just do the surgery and I said; "no". Lets do this.

So we did it.

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