Cytology Results

 

It’s been seven days since the Foley Catheter extraction. I can report with complete confidence on how much pleasure it is to pee like a man.

Don’t laugh.

I find it amazing that I missed something so simple, so basic, and so vital. Okay, I was still able to go, but that experience was so artificial and unnatural. Speaking as a guy, there is no comparison as to which method is better. (Ladies, I can’t compare, yet I’m sure your experiences are similar.)

The day after the Foley came out; I began feeling weak and unenergized. The next day I was off from work and spent the day laying around, too weak to do anything. That afternoon, I got very cold and found myself shivering. It got so bad that I put on my PJs, pulled on a heavy robe, climbed between the sheets, and pulled a heavy blanket over me. This was Wednesday, when Carle and I usually go to midweek church service. Not this time. I woke up the next morning, all hot and nauseated. My best friend, Johnny Toilet, and I are well acquainted. I wipe the sweat from my forehead and shed some clothing. I call in sick to work. Friday morning is the same. I call in sick again. I figure out it’s the darn Flu. I’d had the annual vaccine, about a month late, and it seems to have not worked. On the other hand, perhaps I received it too late.

Anyway, it’s a warm December morning here in Jacksonville, FL. I’m sitting in the same exam room where they removed the Foley. Again, I’m apprehensive a little, because I’m to find out the Cytology results. (After the surgery, Surgeon told Carle that the growth was cancerous, based on his observances from many similar occurrences. I, on the other hand, held out for the official report.)

There’s a knock on the door and it swings open. In walks PA (Physician’s Assistant). “Sorry, Mr. New, but Surgeon got called away to an important surgical meeting. You’ll have to deal with me.” She smiles. Briefly.

What? I’m not important enough for Surgeon? I feel important, a little anyway. After all, I’m alive, I’m breathing, and I’m able to do my work. Well, there’s no sense in making frantic out of forgotten. Enough of that goes on at any workplace.

Oh, wait, I haven’t been forgotten. PA sits across from me. “Oh, that’s okay. You know as much as he does about this.” I smile, and keep smiling. “Surgeon did tell my wife on surgery day that the growth was cancerous.”

PA returns her attention to the papers she holds. “Well, it was. Sorry, Mr. New. However, the good news is, we got it all. Are you ready for the details?”

“Yes, fire away. I want to write them down.”

PA waves a hand at me. “Don’t worry about trying to write it all down. I’ll give you a printout.”

“Oh. Great.” I’m a man of few words. Sometimes.

“We call this ‘Malignant Neoplasm of the Bladder.’ Of course, you know that ‘malignant’ means cancerous, and ‘neoplasm’ means tumor. The comments are: ‘TA, high grade, TCC, papillary.'”

PA looks me in the eyes again. She has this direct stare sometimes.

“Got all that?”

“Well, sure. I got it.” I take a breath. “What does it mean?”

PA smiles, this time for real. “‘TA’ means the tumor was in a staging, as opposed to a growing state. In other words, it was gathering it’s strength, so to speak, for another growth spurt. ‘High grade’ means it’s a more aggressive type of cellular material. ‘TCC’ stands for: Transitional Cell Carcinoma. And ‘papillary’ means the growth was on a stalk like arrangement.”

“When Doc first examined me by Cystoscopy, he said the tumor looked like a small mulberry bush,” I said. “I guess the papillary, or stalk, caused that reference.”

“Yes. Well, Surgeon went after the tumor in his usual direct way. While he had the cystoscope inside your bladder, it has a tool with a blade much like a tiny golf club head. He made a series of ‘divot cuts,’ as if he’s playing golf, which created a loose piece of bladder wall holding the tumor. This he removed and sent to Cytology. Back at the, umm, ‘excavation site,’ Surgeon took a few grabs of tissue from the bladder wall, below the tumor site. There were about six to eight of these, all sent for further cytological testing. Then, using the same ‘divot tool,’ Surgeon laid it on the bladder wall site and passed an electric current though the tool, which cauterized the tissue. He did this several times to cover the entire hollowed out area.

“The ‘pickings’ from inside the surgical site indicate the need for BCG,” said PA. “Your treatment will consist of one dose per week for six weeks, followed again by Cystoscopy. The treatment regimen will slow after that to something like a quarterly dose with Cystoscopy.”

“BCG? What’s that?” I ask.

PA glances at another paper. “Bacillus of Calmette and Guerin, a strain of Mycobacterium bovis. It is a vaccine prepared from a living, attenuated, culture.”

“Attenuated? Living? Sounds dangerous.”

“‘Attenuated’ means the severity, virulence, or vitality of the culture is reduced. It is still a live culture, just weakened enough to encourage your own immune system to—to rise to the occasion, to send troops to the battle site, and to root out any remaining trespassers it finds!”

Wow. She got excited there!

“Specifically, your B and T lymphocytes get activated and antibodies are produced. Phagocytic macrophages become involved also. Other tissues, like the spleen and lymphatic system get involved. This all happens on the cellular level, Mr. New.”

“Antibodies and white blood cells. I can follow that. So, what happens next?”

“Tomorrow, you will be two weeks post-op. We can’t do any of this until you’re past those two weeks. So, I’m going to schedule you for this coming Thursday to see the technician involved with the treatment. She’ll tell you the details then.

Final Result: Tumor Resolved and Treatment Plan!

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