Bill has a consultation appointment with oncologist/urologist Dr. Meng at University of California San Francisco Medical Center on March 4. We have been told he is internationally regarded to be among the best. So after that some decisions will be made. We will stay in SF for 2 nights, March 3 and 4. Greg and Alex will meet us for dinner.

The pathology report was a huge disappointment late yesterday. The biopsy showed a more aggressive cancer although it is not yet invasive. So big decisions have to be made. One option is to go back in and take out all remnants of tumor. One is very near the kidney duct and a temporary stint would have to inserted in the duct. This causes pain and irritation. Then do another round of the BCG treatments and cross our fingers, since that didn't work last time. In the meantime the cancer can become invasive and if it gets to the lymph nodes, not treatable. The other option is remove the bladder before the cancer travels. There are two ways to go with this. One is an exterior drain and bag. This can hard on the kidneys over the years. The other is to fashion a replacement pouch out of a section of small intestine. This is risky to the intestines and would require a much longer hospitilization and recovery. But urination would be somewhat normal if it all goes well.
Bill is being referred to UC San Francisco Urology Department and will see a urological oncologist there to discuss the next step. We do not yet have that appointment. In the meantime he is feeling relatively okay, up and about taking walks.

This morning Bill's surgery had no surprises. It lasted about 40 minutes, ending with a dose of chemo in his bladder. So it was almost noon when we came home due to a longer recovery room stay while the chemo did its job and then was flushed out. Three small tumors were removed. A special procedure to check his kidneys showed them to be in great shape. The path report will be in later this week. The doctor thinks that in about 3 weeks, Bill should begin another 6-week round of BCG treatments. This could delay our Southeast trip a bit. That would be a great disappointment because my cousin Robert Bentz has arranged for us all to go to the Wednesday practice round of the Masters! We will see!