Like plants all drugs have multiple names. A pharmaceutical name, a user name, a marketing name, and then maybe some other easy to pronounce handle used by medical staff. Here’s the run for BCG, formally Bacillus Calmette-Guerin but no one ever calls it that: TheraCys, TICE, Vaccin Bilié de Calmette et Guérin, Pacis BCG, Glaxo 1077 or in NHS Wales’ case – Oncotice.
In the clinic office they are loading me with data. Booklets, guides, leaflets. Advice reaches me in a torrent. I’m sat in the practise nurse’s side room, locked door, desk, files, couch, screens, cabinets containing Dr Caligari’s secrets. The deal seems to be that BCG might work. They put this stuff into your bladder. A more than 50% success rate is quoted which means that more than 40% fail. A bit like spinning a coin I guess.
Lying on the couch the nurse empties my bladder with a catheter and then fills me with 50 ml of the virulent stuff. BCG is a form of TB, “created in the lab” as Dr Montezuma put it. “You could catch TB from it but people don’t.” The idea is that it will infect the inside of the bladder kicking the body’s own immune system into high gear. In this state the hope is that the cancer will get knocked to hell. You have a future then of maintenance doses and BCG and a fair amount of cystoscopy checking but it’s a future.
According the all the US information web sites (and there are dozens of these) patients who have had BCG inserted should now put a peg over the ends of their willies and roll about for several hours. There’s a sequence of moves and diversions that involve shifting position every 15 minutes. This will ensure, the sites assure me, that every part of the bladder’s oh so pink lining comes into contact with Calmette Guerin’s wondrous creation. The bladder will react and become angry. It’ll bleed and debris will be released. Infection will be total.
“That’s what we need,” the nurse tells me. “The angrier the better. But we don’t do all that lying around anymore. Take a walk down to the concourse and come back in two hours. So long as you pee it all out in the special toilet we have here you can then go home.”
There’s absolutely no sensation at all to having BCG inside you. There wasn’t that much in having the catheter inserted and then withdrawn either. The only discomfort is having to sit in place where almost everyone is drinking coffee and not be able to join in. No liquids for two hours before insertion and none for the two hours that follow either.
When time’s done and the pee disposed of I go home. I drink tea and then more tea. The advice is to drink as much as possible for the next 48 hours to get the BCG out of your system. I’ve been given a list of expected side effects as long as your arm. I hardly experience any. A bit of tiredness, some head fog. Beyond that it’s life pretty much as normal.
BCG insertions are done six times initially, weekly and then there’s a gap. This is followed by a further rigid cystoscopy and the taking of more samples from the inside of the bladder to be tested in the lab. Should be a piece of cake. But something there in the back of my head tells me that, given the way of medical things, maybe it won’t be.
In my study I put on my new compilation from the Bill Black Combo. He was the man who led the band backing Elvis for all those early and wondrous Sun rock and roll smashes. Without the front singer the band sound limp, historically perfect but tame. In the early sixties, riding the wave, Black formed five versions of his rocking combo and sent them all out on the road simultaneously. Make hay while the sun shines. I should learn from this. Do it now. According to what I’ve read BCG instillation #2 is a tougher beast to deal with. We shall see.