Dear Dr. Lamm,
My father recently had radical cystectomy and neobladder put in. Ten to fifteen years prior to this he had kidney stones successfully removed. He is currently taking his chemo and radiation. What do you suggest he should be taking and how much of a dose for Oncovite.Can he combine it with Essiac tea cause I heard that Essiac has the oxalic acid in it and is not good for people with the history of kidney problems even though he doesn't have it now? He has some mild stomach problems and Essiac might be good for that too.
Thank you,
D.
Dear D.,
Cystectomy is the best treatment we now have for muscle invasive bladder cancer, and by removing the bladder and lower ureters, it greatly reduces the amount of tissue (urethane, or lining of the urinary tract) that is
at risk of forming new tumors. Oncovite was found to reduce the formation of new bladder tumors, and would be expected to reduce the risk of new tumor elsewhere since it is distributed throughout the body and secreted
in the urine. The standard dose for people over 100 lbs is two tablets twice a day.
Regarding your father's history of kidney stones, the standard recommendation is to increase fluid (water is best) intake. Since it has been 10-15 years since he had stones, I suspect he has been doing a good job at that. Cystectomy and diversion can increase the risk of stones, so his doctors will be checking on that during his follow up. Essiac tea, to my knowledge, has not been associated with stone disease. Calcium oxalate
is the most common type of stone, but oxalate is in a lot of foods that are basically good for you. Many stones are related to decreased inhibitors of crystallization in the urine. Urocit K is useful in many
stone patients and might be considered as a preventative.
Dear Dr Lamm,
I have cis and have just completed my 6 week BCG treatment. It has been recommended to do a biopsy again at 3 months or if not at least at a bladder wash. Is this part of your maintenance program? Which do you
recommend?
Thank you for your time.
P
Dear P,
Yes, in my opinion it is very important to confirm that CIS has responded completely, that is has been eradicated, with BCG (or other) treatment.
This is even more important if there is associated lamina-propria invasive tumor. While CIS is, by definition "in situ" or "in place" it has a high
propensity to not stay in place but invade or grow into the bladder wall.
Fortunately urinary cytology, particularly if it is combined with the "bladder wash" technique, is a very sensitive and specific (i.e. accurate) test for CIS. Cancer cells have defective connections with surrounding
cells, so with in and out irrigation of saline (water with enough salt in it to match serum and not break or "lyse" cells)in the bladder cancer cells are preferentially collected. By combining that specimen with the urine in the bladder, which of course comes from the kidneys, which are also at risk of developing CIS, a quite thorough check of the urinary system is accomplished.
The biopsy adds information as well, because sometimes the cytology is falsely negative. The lining of the bladder can grow over nests of cancer cells deeper in the bladder, and sometimes a biopsy is required. I would recommend that you go with doctor's recommendation, because only he has seen your bladder and is familiar with your condition, but in general if
patients have only CIS, are responding symptomatically (less burning and frequency, if present before treatment), and at cystoscopy the bladder looks good, I would be satisfied with a wash cytology at 3 months. I
like, however, to do biopsy at 6 months to be sure the disease is completely gone.
Dear Dr. Lamm,
My husband, age 53, a type 2 diabetic, was diagnosed with stage 1 bladder cancer in June 2005. August 22 he began receiving BCG. On September 8 (his 4th treatment) his eyes began to water. The 5th treatment was on September 15. He felt ill went to bed that night but
went to work the next day. He complained about his throat feeling sore on the outside but there were so signs of a problem. Then his neck began feeling stiff.
By September 18, we were in the ER; they prescribed painkillers for the neck and back pain and an antibiotic. On September 20, he spit up 3 large
blobs of blood while showering. Complained his right finger knuckle hurt. Admitted to the hospital with bronchitis. Did a spinal tap for meningitis - 1 point over but they thought it was still okay. By Wednesday
he had pneumonia. His back, neck and left shoulder hurt so much he could not walk to the restroom and was on morphine and Lortab. The middle finger and ring finger on both hands were now swelling and he could not
straighten them. An infectious disease doctor put him on Rifampin and Isoniazid. After 8 days in the hospital he was sent home to recover. He had surgery on his right on November 8 because the swelling was so bad.
There were flaky things (pathology is still trying to determine what was removed) – the orthopedic surgeon has never seen anything like it. Right knee, right foot involved also.
The Rifampin was halted on November 12 due to the severe vomiting. November 13, Isoniazid is making him throw up also. He has lost 30 lbs. Have you dealt with a reaction like his before? He looks sallow and no one here seems to know what do.
Thank you,
Mrs. B.
Dear Mrs. B.,
I am very sorry to hear about your husband's illness. I have not heard of a similar reaction to BCG, but BCG can do many strange things. I would
hope that he can stay on (antituberculous) antibiotics for at least 3 months to be sure that if the reaction is BCG it is adequately treated.
Cipro or one of the other fluoroquinolones can be used, along with isoniazid and ethambutol. Generally we like to keep at least two antibiotics going to prevent the development of resistance.
Please let me know how he does.
Dear Dr. Lamm,
I could sure use your help. I had an aggressive 3 tumor stage 2a. I had a complete radical cystectomy surgery 4 weeks 3 days ago. I am 66 year old lady. I am recovering well.
The pathology report came back everything was clean not a speck of cancer cells to be found.
The Urologist did not remove the lymph glands as he said they looked great as the other tissue did as well. He did not recommend any chemo.
I guess this puts me somewhere in the 65 percent+ range for survival. What can I do to fight this stuff? I never smoked or did anything the feel causes this problem. I did have reoccurring bladder infections. Will Oncovite help and what else can I do or do I just have to wait and feel I am helpless to fight.
Thank you so much for your help,
A.
Dear A.,
I am glad to hear that you are doing well, have recovered from your surgery, and had no evidence of disease remaining in your bladder. You are wise not to think that the surgery was not needed, as some mistakenly do. Your prognosis is excellent, but certainly you want to do all you can to improve your chances.
The good news is that you do not need chemotherapy. That would be more certain if the nodes had been removed. It is good that they looked normal, but we can't say they are disease free unless they are removed and examined microscopically.
What should you do? Keep your positive attitude. Try to exercise every day, and do some vigorous but enjoyable exercise at least 3 times a week. Diet is important. Our National Cancer Institute recommends having at least 5 servings of fruit or vegetables a day, and 8-9 is probably better. That may be more than you want to take, in which case you can add vitamins. It is probably good to add vitamins regardless. Oncovite, 2
tabs twice a day for people who weigh over 100 lb reduced tumor recurrence in patients with superficial bladder cancer. It has not been tried in
advanced disease. Please see our section on prevention for more suggestions.
Dear Dr. Lamm,
My wife is getting BCG for grade 3 bladder cancer. She has had 3 treatments and after each she has a metallic taste in her mouth within minutes and then begins to have a cough that is intermittent. The last treatment she went on to develop severe congestion and now a cough 7 days later. Is the metallic taste normal or is she reacting to the BCG?
Thank you,
D.
Dear D.,
Yes, I have had one other patient who noted a metallic taste after receiving BCG. He got his BCG in Northern California, and I do not know what preparation was used. It appears to be a very rare, but real, occurrence. If the cough persists your doctor may request an Xray to be
sure she does not have pulmonary BCG. Usually such an infection would be accompanied by fever, chills, and weakness.
Dear Dr. Lamm,
I have superficial bladder cancer. I have received several BCG treatments with some success. My doctor is going to include interferon with the next BCG treatments starting in three days. Do you have an opinion as to the feasibility of including the interferon?
L.
Dear L.,
Yes, interferon will "rescue" about 60% of patients who fail BCG therapy. If you are still a BCG success, my own preference, however, would be to wait until you need it. I like to keep a few extra arrows in my quiver.
Hello,
My father was diagnosed w/ superficial bladdar cancer a few months ago. Immed. after removal of the tumor, his ankle swelled, and was unable to move it much. He started 6 weeks of BCG Therapy. Although, he had a few side effects, they usually subsided.( he did, although grew increasingly tired (slight chills) and started to have joint pain in his legs). Before the 4th treatment, he started to have terrible head/ neck pain, mental confusion and unable to walk along w/ a low grade fever. We called his Dr. who told us it was not connected to treatment. 3 weeks ago because of the ongoing fever, severe pain and inability to now walk, we
brought him to Columbia Med. Ctr. where he went thru a battery of tests.
They think he has arthritis, borderline dementia, and pneumonia. Dr.'s say there is nothing more they can do and we are now waiting for a bed in a rehab/nursing home. 24 hour care is now what they say is needed, and hopefully he will show some long term progress. Can all this be caused by the BCG therapy? They seemed to dismiss this idea. Before treatment, my father was a 72 year old active (daily paddleball player ), very sharp and in good health. If there is anything you can recommend, it would be greatly appreciated. Note: He is still in a lot of pain. Now his legs and feet are very swollen. They think it is a lack of protein. We don't know where to turn. His urologist can not offer any answers, but thinks it's probably not connected.
J
Dear J.,
I am very sorry to learn about your father's deterioration and am hoping that he will improve. Disorientation and dementia can occur with hospitalization and illness such as pneumonia, or surgery. It is usually reversible.
BCG can cause arthritis, and can cause infection in the spine. Generally the spine infection would be associated with fever and chills. Treatment of BCG infection is with antibiotics that specifically kill the organism, and combinations are generally used to prevent resistance. Antibiotics (such as ciprofloxacin, insoniazid, and rifampin) are generally continued
for 3-6 months.
My mom has stage 4 bladder cancer, which has invaded the wall and lymph nodes and possibly other. She has had chemo and has helped reduce the lymph nodes from 3 cm to 1 cm or normal size. The bladder walls have thickened. The doc seems to be unsure of prognosis. They have scheduled the removal of the bladder for later this month. What is difference of stage 3 and stage 4 I read that stage 4 is not cureable. Is this true and if so how long might someone expect to live and what might be done to extend this.
Dear Friend,
Sorry to hear about your mom. It is good that she has responded to chemotherapy with regression of the disease in her lymph nodes. The general approach, as recommended by her doctors, is to go ahead and remove
the bladder because of the increased risk of residual disease there. You can't say that stage 4 disease is always incurable, or that stage 1 disease is always curable. Obviously the chance of cure is highest with
lower stage, lower volume, lower grade disease, but some patients are long term survivors even with widespread metastasis.
Does BCG Therapy cause males to become sterile?
BW
Dear BW,
Perhaps I should ask "why do you ask?" BCG cannot be used as birth control, but yes, it is possible, though unlikely, that one could become sterile after BCG. Very rarely BCG can cause an infection in the testes, and patients have even had to have surgical removal of a testis due to infection.
Dear Dr. Lamm,
I have been taking Oncovite since I was first diagnosed with bladder cancer. Your office was kind enough to recently send me a month's supply. But I have had a metastasis and am about to begin a clinical trial using Alimta and Taxotere. It's recommended I take Folic acid
supplements for the Alimta side effects. Is the folic acid in Oncovite a good formulation for this, even though the tablets are an anti-oxidant?
Thank you,
H.
Dear H.,
Sorry to hear about your metastasis. My compliments to your for participating in the clinical trial and to your doctors for the innovative chemotherapy combination they have devised. I would recommend that you follow their instructions on how much folic acid to take with the Alimta.
One tablet of Oncovite has .4mg, the full recommended daily allowance, and it is a good formulation. There is considerable controversy about taking antioxidants with
chemotherapy now, especially following the article publised in CA. Unfortunately the very true fact that we have insufficient information now to uniformly recommend antioxidants came out as a recommendation to avoid
their use with chemotherapy. The author neglected to include a randomized study addressing just that question. Again, the results were not statistically significant, but patients taking high doses of vitamins C, E and beta carotene with chemotherapy for lung cancer had a response rate of 37%, compared with 33% in those taking chemotherapy alone. Two patients in the combination therapy group had complete response, none in the chemotherapy alone group. Survival was similarly increased from 33% to 39%. With 136 patients in the study, none of these differences were statistically significant (p = 0.20), but clearly these results do not
support the concern that antioxidants might protect cancer cells from the free radical damage induced by chemotherapy. (Reference: J Am Coll Nutr. 2005 Feb;24(1):16-21).
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