The second round of my chemotherapy treatment begins early tomorrow morning. I have no reason to think it will be any different than before.
Dreams
Over the past few months I seem to be having more dreams than ever before. I don’t know why? Parkinson’s Disease? The medication that treats Parkinsonism? Subconscious thoughts about my cancer?Increasing age? Something else? My neurologist does say that vivid dreaming and acting out dreams is a hallmark of Parkinsons. I’ve fallen out of bed while dreaming late last year, the first time I did that since early childhood. Also, there was another occasion last month where I might have fallen out of bed while asleep, save for the wall on one side and bedrails on the other.
Most dreams follow the same motif; that I’m at work, occasionally in the Air Force, but most of the time on campus. Usually it’s my last day at work. Last week I had a dream where I was at an activity (convention?) that involved large rooms on several floors. I was talking to another participant, when I pointed out President Eisenhower to the person who was only twenty feet away. The woman replied “Who?” I repeated myself because she never heard of him and mentioned that he was the allied Supreme Commander during World War II. She replied she never heard of World War II. I asked her what the last war she remembered and she said “the Civil War.” It seems like I had been transported back in time more than a century and most of the people at the activity lived in the past. At least that is the more plausible hypotheses, even at that. When I left to go to another room, someone mentioned to me that they had not seen so many people gathered in one place since the war of Saint-Nazaire (or some other exotic sounding place.) When I asked him to explain what he meant, he used another reference to an event that I was unfamiliar with and it was clear that he was from the future, even as I was from the first person’s future, myself.
Last night I had a dream with my late parents in it. What does it all mean if anything at all?
MONDAY, JULY 3, 2023 (C DAY +157)
Had my first dose of chemotherapy (second round.) I also learned today that I may likely be receiving monthly doses of chemotherapy as long as I have my bladder and prostate. This may be one reason that bladder cancer is the most expensive cancer of all to treat. This is actually good news for patients who have good health insurance, because it may indicate in some circumstances that bladder cancer patients survive longer than people with other cancers do.
It was a bit of a bumpy road this morning. We had to wait almost an hour for the medication to arrive, and then there was more “discomfort” than usual when they filled my urethra (a term from the word “οὐρήθρα,” first used by Hippocrates (the Father of Medicine) with Lidocaine, a local anesthetic. The catherization went really smoothly, however. The administration of the two chemotherapetic drugs went uneventfully, too.
When I got home, I had a news story in my e-mail inbox called “‘Disappearing’ Y chromosome in aging men may worsen bladder cancer, mouse study shows.” While the article doesn’t indicate the initial cause of bladder cancer, it does focus on how bladder cancer, whether genetic, a consequence of smoking or, in my case, presumably from Agent Orange (Dioxin) exposure can proliferate (i.e., spread.). Al least in mice.
FRIDAY, JULY 7, 2023 (C DAY +161)
I received my cytology report a few moments ago and it was “benign.” As a reminder, the last thing my oncologist did last week before removing the cystoscope was to remove a speciment cup of fluid from my bladder. And while the news was good, there was a caveat. The cytologist reported the presence of “reactive urothelial cells.” According to Modern Pathology:
Reactive urothelial cells show mild abnormalities that are shared by low-grade neoplastic cells and require considerable screening time from pathologists and cytologists. The presence of significant abnormalities warrants a diagnosis of atypias suspicious for malignancy. Such diagnosis usually may force the urologist to undertake additional unnecessary investigations.”
Têtu, B. Diagnosis of urothelial carcinoma from urine. Mod Pathol22 (Suppl 2), S53–S59 (2009). https://doi.org/10.1038/modpathol.2008.193
What the literature is saying is that there was the presence of cells that grow on the inner lining of the bladder (like the different cells that line the stomach, esophagus, sinuses, etc.) The urothelial cells in my specimen were not normal. They showed some of the same abnormalities found in cancer cells, such as unusual sizes and shapes of the cell, the cell membrane, the cell nucleus and so on. I’m not being precise or entirely accurate here for the sake of clarity and brevity. The presence of reactive urothelial cells meant that the cytologist had to take a closer look, perhaps have a colleague weigh in to have another set of eyes examine the cells, to see if they could possibly be cancer cells. The concolusion reached was that these abnormal cells were benign. With my September cystoscopy, this will be repeated.
SUNDAY, JULY 9, 2023 (C DAY +163)
I came across an interesting article from the BBC today. It is called “The Mystery of Microbes that Live Inside Tumours.” It deals with bladder cancer tumors as well as breast and pancreatic tumors.
Cancer tumors are again normal cells that run amok. When you get a large colony of these abnormal cells, you have a tumor. The BCC article referenced above begins by mentioning that tumors are not always just abnormal body cells, but communities of other life forms as well, including bacterial and fungi which is one reason some cancers are hard to treat effectively. For example . . .
An Israeli scientist named Ravid Straussman discovered in 2017 a certain type of bacteria name Gammaproteobacteria, that lived in the presence of pancreatic tumors which actually protected the tumor from chemotherapeutic drugs like gemcitabine (the drug that I am taking for bladder cancer.) So, this bacteria tended to confer some sort of immunity on the tumor or otherwise rended gemcitabine less effective in treating the cancer. The solution was simple. Administer an antibiotic along with the gemcitabine.
However, not all bacteria were helpful to the cancer. Many types of bacteria helped the patient. As Straussmann conntinued his research he noted:
The research is continuing, according to the same article:
There are already some clues. For example, a 2022 study by scientists in China suggests some bacteria in breast tumours might make it easier for cancer cells to spread to other parts of the body. The researchers found bacteria living inside breast tumour cells that were circulating in the blood of mice. These circulating cancer cellsare shed from the primary tumour and can travel to other parts of the body, where they can metastasise and grow. However, as the tumour cells rattle around in the bloodstream, they are exposed to stress that causes some of them to break apart.
“The Chinese researchers found that the microbes inside these mobile tumour cells seem to protect them from some of the stress they experience. They appear to do this by helping to reorganise internal cellular support structures known as the cytoskeleton so the cells are more robust. When the scientists eliminated these bacteria from the mice tumours, the tumours appeared to lose their ability to metastasise, although the primary breast cancer continued growing.
“‘There is growing evidence that specific microbes in the gut, the skin, and other mucosal organs, as well as in tumours, can either promote tumour growth and progression, or alternatively antagonise it,‘says Douglas Hanahan, an oncologist at the Swiss Institute for Experimental Cancer Research in Lausanne, Switzerland, and the author of Hallmarks of Cancer: New Dimensions. However, the picture remains murky. “The landscape is very complicated, and while there are clues, there is no definitive clarity about who does what.
The BBC article is fairly technical as you can surmise. But it provides tantalizing evidence of how cancer is either inhibited or helped by other symbiotic lifeforms than the cancer, itself. Again, the entire article can be found here.
p.s. I’ve started going to the gym again as it is too hot to walk regularly outside during these summer months. It helps to be in the best possible shape when dealing with health issues (or, at least it can’t hurt.)
SATURDAY, JULY 29, 2023 (C DAY +183)
Deena and I had lunch yesterday with a bladder cancer survivor who had a cystectomy in January of this year. A cystectomy is when they remove your bladder, remove a piece of your intestines in order to made a makeshift bladder, reroute the ureters from the kidneys into the small piece of gut and then construct a conduit for the urine in the ersatz “bladder” to run through the abdominal wall into a bag. The piece of repurposed intestines does not tell you when you need to void, so you have to stay on top of checking it regularly to see if the bag needs to be drained. Usually in men, the prostate is removed, too. Our friend who is a few years older than me seems to be doing well and tolerated the surgery well, but he has a problem with urinary tract infections which may require hospitalization in some cases. So, in an abstract and uncertain way I see myself in him in the event they ever do a cystectomy on me. I have risk factors that might make my recovery more problematic than for some people, but then again, he has different risks than I. So, it’s all in God’s hands.
Yesterday, I sent my CPAP machine back to the vender. Usually I can deal with change, learn to adapt and so on, but with this I just could not. I’m not claustrophobic, but the thought of falling asleep with a mask over my face was more than I wanted to ponder or risk. Nor could I use the cannula in stead of a mask because I have a deviated septum and the air felt like gale force winds hitting my nasopharynx. So, while I full appreciate the benefits I would have enjoyed with a CPAP, I just couldn’t deal with it. Maybe if I had an extended trial period and some tech who could “coach”me it would have gotten me over the initial hump, but then that wasn’t an option.
Still having dreams of my deceased parents and first wife. I’ve rarely ever dreamed of my parents and I loved both of them. After a year or so of my wife’s demise, I stopped dreaming about her. Perhaps the fact that last Monday was our anniversary had something to do with that. Most of my dreams deal with students, classes or colleagues. I either have an approaching end of course exam and I have not covered the material in class, or I forgot I had an evening class and never met with them at all during the semester. . . something like that.
Meanwhile, Deena is only a month away from starting classes of her own.
My next chemotherapy treatment is this coming Thursday, the 3rd of August. I have no reason to believe that it won’t go well.
