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Father Newly Diagnosed

9 years 9 months ago #29977 by Patricia
Oh my gosh you're right by one of the best bladder cancer centers in the country at USC/Norris and my surgeon who did my surgery laparoscopically in 4hrs and 20mins and is considered one of the top urologist/surgeons in the country..Dr. Inderbir Gill..and he's such a personable man. He's also Head of Urology.
http://www.usc.edu/schools/medicine/util/directories/faculty/profile.php?PersonIs_ID=3840
just call the main number and ask for Blanca , Dr. Gills assistant ..she'll set you up.
http://www.usc.edu/schools/medicine/patient_care/hospitals_clinics/usc_norris.html
Pat

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9 years 9 months ago #29976 by wsilberstein
mmlaphillips2 wrote:

Oncologist is the one who said he can't do the surgery, just by looking at him and seeing him on oxyogen. I don't think he had his medical file but could be mistaken.

A pateint with severe COPD should be under the care of a pulmonologist. The pulmonologist should determine whether your father is a surgical candiadate in consultation with the surgeon.Then the pulmonologist should take an active role in perioperative care if your father is a candidate for surgery. All surgery has risks. COPD increases the risks. Doing nothing carries a risk as does chemo and radiation. Its all a matter of balancing the benfits against the risks to make a decision. You need the pulmonologist to weigh in on your father's COPD.

-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant...

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9 years 9 months ago #29971 by sara.anne
There are some superb urological cancer specialists in your area and I am sure than Pat will be giving you a run-down on them. Most oncologists and even urologists are NOT experts in the area of bladder cancer, so I wouldn't take their advice too seriously until you have had him seen at a major urological cancer center. He may be very pleasantly surprised at their recommendations and prognosis!!

Will be keeping good thoughts for you both.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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9 years 9 months ago #29968 by mmlaphillips2
Thanks.
It is the Ureter not the uretha. He lives in Southern Los Angeles. The urologist said if he had to have surgery he would have it at UCLA that he would not do the surgery because he felt it would be better there.

Oncologist is the one who said he can't do the surgery, just by looking at him and seeing him on oxyogen. I don't think he had his medical file but could be mistaken.

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9 years 9 months ago #29966 by Patricia
Just want to clear up one thing....are we talking about his urethra or one of his ureters...makes a difference. As far as COPD patients undergoing surgery its done all the time but ONLY at a high volume hospital that specializes in the procedure he needs done.
The difficulty in predicting the risk an individual patient actually faces means that doctors who treat advanced COPD patients often face a knotty decision: Should potentially lifesaving surgery be withheldor notwhen the risk of postsurgical pulmonary complications seems high enough to cancel the benefits?

A major comfort, when contemplating surgery, is that more and more doctors are learning to avoidor at least minimizepostoperative complications by recognizing the severity of a patient's COPD, then taking appropriate preventive steps before, during, and after surgery. We note these steps below.

Before Surgery

One of the most important presurgical issues is which hospital to choose. Our advice is to choose one that does a high volume of the procedure you need. It's been shown time and again that the number and severity of complications following a particular surgical procedure go up as the experience of both surgical and nursing staff go down. With more procedures, the postoperative course is substantially smoother and any complications that do arise are far more effectively controlled.

Next is having a good preoperative plan, to minimize your obvious vulnerability to pulmonary complications. The general aim of the plan is maximizing your physical condition. And it helps substantially. Research indicates, for example, that proper preoperative care can reduce the postsurgical occurrence of pneumonia by 60%.

Although the details of your presurgical program would depend on the severity of your lung disease, the basic components apply to any COPD patient
So your dad is very young and seems pretty stubborn. His chances of surviving this depends on his getting to a major center. Don't know where you are but Johns Hopkins and Memorial Sloan tops as is Mayo and a few other places. So give me a hint as to where you are so we can change his mind.
Pat

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9 years 9 months ago #29954 by mmc
While the location of the tumor has a lot to do with a diversion creation if he were to have the cystectomy (removal of bladder), it doesn't have quite so much to do with treatment otherwise. The main thing is how deep did it go and if it spread. T3 is clearly not good and as Pat said, almost always involves chemo.

52 is pretty young but it sounds as if his COPD is pretty bad if the doctors are saying that he can't have surgery because of it. They even do surgery to alleviate symptoms of COPD sometimes but I don't know details about that.

Hopefully, he's quit smoking.

Pat's advice on getting to a bladder cancer specialist center is the best advice there is. They deal with bladder cancer of all stages and grades every single day. If he was only just referred to the oncologist last week, it doesn't seem like there could be that much attachment to him/her already.

The best outcomes come at major bladder cancer hospitals and Pat knows all of the best ones.

Clearly your dad already knows that the 'doing nothing' option is certain death and probably not that terribly far down the road.

Where he goes for treatment has everything to do with the quality of care he will receive, the recommendations for treatment he receive, and the outcome of treatment.

I can't really advise on what's best between chemo, radiation, or a combination of the two. I'm 50 and had my bladder out a bit over a year ago and am doing fine. They said I had some signs of COPD but not to the point of needing oxygen. It is clearly very different though as I was just barely stage 2 when I had my bladder removed and they made a new bladder for me.

Have him come to this site if he can so he can ask questions. We have people in all different situations and all different stages of treatment that he can communicate with.

The more information he has, the better equipped he will be to make the best decision for himself and his family.

Mike

Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...

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