Dear Doctor:
As per previous notes, Mr. Patient 2183 was found to have an invasive B2 (1) ________ cell carcinoma of the bladder on (2) ________ and TUR bladder tumor. Random biopsies showed no evidence of carcinoma (3) ________. However, since the tumor is invasive, we feel that this 52year-old male would be best with his bladder removed.
We discussed the alternatives, including radiation therapy alone; radiation therapy plus (4) ________; or radiation therapy, chemotherapy, and radical (5) ________ with urinary (6) ________. After presenting the statistics to the patient, it was decided by the patient to go ahead with a combination of chemotherapy, radiation therapy, and radical cystectomy with diversion. We will contact his oncologist, who will give 2 or 3 courses a month apart of MVAC therapy, followed 2 weeks thereafter by radiation therapy, 2000 (7) ________ over 5 days, to the bladder. Two weeks after completion of radiation therapy, a radical cystectomy will be performed and diversion at the same sitting.
In addition, we discussed the various forms of urinary diversion, including the production of a (8) _________ versus a continent (9) ________ versus the standard (10) ________ loop. The patient, after discussion, decided to go ahead with the standard ileal loop since he desires the minimal complication rates. Continent urostomies and neobladders have complication rates as high as 25 to 50, requiring repeat surgery, and the patient is not willing to run those risks. We will inform you of his followup.
Sincerely,
Question 2
Two weeks post hydrodilatation of the bladder, with the findings consistent with (1)________ cystitis. At this time, she continues to have, and in fact may have, worse symptoms of (2)________, frequency, dysuria, (3)________ discomfort, and low back pain. Her frequency appears to be less than prior to hydrodilatation. She has completed her course of (4)________ 100 mg p.o. b.i.d., (5)________ 5 mg p.o. b.i.d., and Pyridium 200 mg p.o. q.i.d.
We plan to instill DMSO into the bladder on a weekly basis 4 starting today, reevaluating in 6 weeks, at which time we will probably decrease her dosage to one bladder (6)________ every other week 2 months. We expect the DMSO to improve her (7)________ and allow for a gradual decrease in the frequency of DMSO bladder instillation. We discussed the possible utilization of Elmiron, a new drug available for patients with interstitial cystitis; however, she is aware that we will first try DMSO bladder instillations on a regular basis to resolve her problems. She is also aware that 95 of the patients using DMSO get significant relief, with gradual improvement in their symptoms and possible long-term resolution of their interstitial (8)________. She is also aware that this is a chronic disorder that she will be living with for the remainder of her life.
DMSO 50 mL was instilled in the bladder, to be held for 20 minutes up to as long as 2 hours. A bladder urine was obtained during the (9)________ process, and culture and (10)________ will be performed on the urine. Will return weekly for the next 3 weeks for DMSO bladder installation by my nurse practitioner and will see for followup office visit in approximately 5 to 6 weeks.
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