Treatment BEGINS

November 29, 2023 -  My Social Security and Medicare application was approved.  Medicare was retroactive to desired start date of Nov 1 in by October application.  Because of the delays, I paid for 1 month of (very expensive) COBRA extension of my former employer insurance to cover any claims in November.   I notified my providers at the University of Tennessee Medical Center of my new coverage and prepared to start first treatment on Dec 7.   Somehow the new coverage didn't make it through the system.  I had a bit of anticipation and anxiety regarding delivery and adverse effects of treatment and was quite crestfallen to learn that the treatment would not begin that day.  It  had been 2 months since my TURBT surgery.

At the same time - had I proceeded earlier the treatment options afforded by standard of care based on information at the time - Radical Cystectomy  or Trimodality Therapy would have been quite different.  My wife and I spent our nervous energy and disappointment on retail therapy - we had lost our home to first on March 29 and decided to shop for some furniture and appliances to populate a new manufactured home we had recently ordered to replace it.

Dec 11:   I was introduced to the mechanics of my first line treatment:  Prior to any treatment, I have two tu es of blood drawn and the lab results are reviewed to determine that there is no indication that would prevent adminstration.  At the beginning of each cycle I meet with my medical oncologist and he would give the go ahead to proceed with a treatment cycle.  Two hours are allocated for the blood work and consultation.

I then proceed to the infusion center waiting room.  When they are ready I am called back to one of several suites of rooms with chemo chairs: recliners with side tables on each arm.  I choose an available seat and wait for the pharmacy to give a green check for preparation of the iv bags of the agents to be infused.  I am offered a warm blanket as I settle in and blood pressure is taken. When the green check from the pharmacy arrives, a nurse looks for a place to insert a needle for an IV line.  Ideally the first insertion is functional - otherwise the needle is removed and another site chosen and tried.  The IV line is connected to a bag with saline.  When the agents are prepared they are brought in.  I first receive a syringe push of Kytril.  On first day of the cycle I receive an infusion of Keytruda and then an infusion of Padcev - each taking 30 minutes to complete.  On completion my blood pressure is taken and I am free to go..