June 27, 2017

An innovative approach to curing bladder cancer

An innovative operation resulted in a new bladder for Henry Diaz, who after cancer has resumed an active life.

Henry Diaz of Hayward, California, doesn’t complain.

While some may say that every day is a gift, he believes it. High on his gratitude list is family and friends.

And his health.

Diaz’s glass half-full approach to life is in response to making it through the toughest challenge imaginable — a cancer diagnosis, chemotherapy, radical surgery, and recovery.

A fast-growing tumor

Diaz, 55, began experiencing pain urinating in 2014. His kidneys and back hurt. But he didn’t have any health insurance at the time, so he let it slide.

Diaz’s mother had had kidney stones, so that was his immediate concern.

Eventually, it got so bad he paid out of pocket to go to Urgent Care at a local hospital. Later, referral to another hospital resulted in tests showing Diaz had a 3-centimeter tumor in his bladder. Alarmed about both his health and the potential costs, Diaz told his boss at the time about the crisis.

Diaz was put on the insurance plan for Kaiser Permanente coverage — where he was about to experience speed and integrated care from a whole team of physicians.

Fast-tracked to fight cancer

Diaz first saw Eric Brondfield, MD, Internal Medicine, at Kaiser Permanente San Leandro, who ordered blood and urine tests. A little over 3 hours later, Dr. Brondfield called Diaz, asking him to come in immediately for a CAT scan.

“The reading came back the next day, a Friday,” Diaz remembered. He immediately saw urologist Gregory Chen, MD. “He said the tumor was now 4 centimeters — it had grown a centimeter in a week,” Diaz said.

Back after the weekend, Diaz underwent endoscopic surgery in San Leandro that involved cutting the tumor into small pieces and assessing whether it was invading into the muscle wall of the bladder. That Friday, Diaz returned to Dr. Chen’s office, where he learned a biopsy had confirmed cancer and that it was invasive.

By Monday, he was seeing Derek Shek, MD, an oncologist, who arranged to have a port inserted into Diaz’s body on Wednesday. That Friday, the chemotherapy began.

Chemotherapy — and an inventive solution

Henry Diaz had chemotherapy treatments for 4 months, from October 2014 through February 2015. Then, after a 2-week break, Diaz geared up for yet another hurdle: 6 1/2 hours of surgery performed by Joseph Presti, MD, a urologic surgeon at Kaiser Permanente Oakland. It involved removing the prostate, bladder, 9 lymph nodes, and 18 inches of small intestines.

“Dr. Presti was very communicative and frank. He told me I had to have the surgery,” Diaz said.

There was some good news that day, though.

In addition to removing any cancer, Dr. Presti took Diaz’s small intestines and fashioned something called a “neo bladder,” essentially a new bladder that would save Diaz from having to have a bag outside of his body collecting his urine.

Adjusting … yet thriving

“Mr. Diaz was in good health and also motivated,” Dr. Presti said of the decision to create a neo bladder for his patient. While the surgery can have some side effects, including an excess of acid in the blood stream or anemia, Diaz recovered successfully and has been cancer-free ever since.

“I had to learn to urinate again,” Diaz concedes. “A normal bladder holds 12 ounces; my neo bladder holds 4.” Undaunted, however, after recovery Diaz drove with his 29-year-old son from California to Tennessee, and back again. He has a new job and is now a grandfather.

“Throughout, Dr. Presti and Dr. Shek have called me just to see how I am doing,” Diaz added.

Dr. Presti is part of a multidisciplinary team based at Kaiser Permanente Oakland that includes medical oncologists, urologists, radiation oncologists, pathologists, and a urologic oncologist, Andrea Harzstark, MD.

Doctors Presti and Harzstark run a medical review of patient urologic cancer cases and have developed a protocol for bladder cancer that is a model for other physicians throughout the Kaiser Permanente system. Their ability to advise patients and other clinicians, in effect lending their expertise throughout Northern California, benefits people such as Henry Diaz, who is not only alive thanks to his cancer care — but living well.