Mets Day 991: Welcome to NIH's Urology Department

Today I met with Dr. Piyush Agarwal, NIH's chief urologist, and his nurse practitioner, Rebecca Dolan. THis was my first contact with NIH's urology department. It is an efficient and well-oiled team. I reviewed my case history with Ms. Dolan, who closely questioned my on when I started and stopped each blood thinner, and when my bleeding began. I had to refer back to my prior blog entries to confirm some of the dates. I also pointed out an odd little rash that recently had formed on my knees. I told her that I hadn't changed any soaps or lotions or detergents, and that the I noticed the rash a few weeks after I started taking the Xeralto. She allowed as that it was a possibility that the two might be connected, but doubted it. Keep an eye on it, she said. She was far more emphatic that there was a rather clear cause and effect between my taking the Xeralto and the gross hematuria.

When Dr. Agarwal joined us, he said that there was relatively little experience with Xarelto, metastatic cancer, and neobladders. Although he suspected that my gross hematuria was the likely result of the Xeralto loosening some tissue in my neobladder, he said that he wanted to rule out the possibility that my metastatic cancer had emerged in either my kidneys, ureters, or elsewhere in my urothelium. So next Monday I'll have a CT urogram to check and (most likely) rule that out. He also scheduled me for a cystogram for January 20. I'll be under general anesthesia for that, so in case he sees anything that needs to be cauterized, he can take care of it. He'll do that first thing in the morning. I was previously scheduled to have a CT that morning followed by a clinic visit with Dr. Apolo; we'll see if we can postpone that by a couple of hours so I can walk myself to the CT scanner.

Dr. Agarwal recommended that I resume taking the Xeralto, although I should stop it two days before coming in for the cystography. He said that having gross hematuria was better than having pulmonary embolisms. He said that it was a shame that I was allergic to the low molecular weight heparins, and mused that, if I was unable to continue on the Xeralto, I might have to consider an IVC filter. I'm not excited about that idea. It's an option to consider later, and only if I have to.