When a Cancer Doctor Becomes the Bladder Cancer Patient

September 30, 2025

Transcript

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit BCAN.org.

Rick Bangs:

Hi, I’m Rick Bangs, the host of Bladder Cancer Matters, a podcast for, by, and about the bladder cancer community. I’m also a survivor of muscle-invasive bladder cancer, the proud owner of a 2006 model year neobladder, and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it BCAN, producers of this podcast. I’m pleased to welcome today’s guest, Rick Zera. Rick is a recently retired chief of surgical oncology and program director of the general surgery residency at Hennepin County Medical Center in Minneapolis, Minnesota. A man with many degrees, he holds a BS in chemistry, an MS in medicinal chemistry, an MD and a PhD in surgery, which was actually a medicinal chemistry project. He dedicated most of his professional career to treating breast cancer, and has been an active investigator in breast cancer clinical trials since 1983. He has been married to Diana Zera for 52 years, and credits her with any success he’s had. They have three children and four grandchildren. Rick enjoys feeding birds, listening to deep house music, photography, and most of all being a grandpa. Rick, thanks for joining our podcast.

Rick Zera:

Oh, it’s my pleasure.

Rick Bangs:

So your story has some interesting twists and turns that we’re going to get into, but I want to start with your professional role, which was in the treatment of cancer as an oncologic surgeon. So what got you interested in that role?

Rick Zera:

When I was applying to med school I didn’t get in the first year. And I went to grad school and had developed an interest in medicinal chemistry through my advisor, and we were working on drug delivery systems. And you have to remember this is 45 years ago, and the number of chemotherapy agents was really, really small, the kinds of drugs available were very toxic, and we were trying to figure out ways to deliver drugs that might be more specific, understanding that cancer cells are just your normal cells going crazy. So all the biochemistry in there is standard from normal to cancer, other than there’s just more of it going on. So that was the background. And in that regard, I started looking at a drug called tamoxifen, so that got me interested in breast cancer. When I got into med school I saw that the surgeons were having more fun than the medical oncologists.

Rick Bangs:

Go with the fun, Rick, go with the fun.

Rick Zera:

And honestly, if you’re going to do something you might as well try to have fun doing it.

Rick Bangs:

Yes.

Rick Zera:

The other impetus, my wife worked at the hospital and she happened to work in the surgery clinic. So that got me interested even more in the surgery side of things. And it so happened that our hospital, Hennepin County Medical Center, was very early into projects with a group called NSAVP, which is a treatment trial group that was centered around breast and colon cancer. And my boss, Dr. Claude Hitchcock, was an early adopter of the idea that more surgery was not better. This was in an era when radical and super radical mastectomy, for example, were being promoted. And he was a bit ahead of his time in thinking that less might be better. And he got me involved in going to that group’s meetings.

And from there I got very, very interested in pursuing that I idea with someday, and I would tell my patients, “Someday I’ll be out of a job because there’ll be treatment.” There will be treatments that take care of your breast cancer that don’t involve surgery. And two or three years ago, we completed a pilot trial in that group looking at chemotherapy treatments before surgery and can you eliminate tumors and prove it with a needle biopsy, and therefore prevent surgery that wouldn’t be necessary otherwise. So that was my goal, was figure out a way to be out of a surgical job anyway.

Rick Bangs:

I think that’s great because we’d all like to live in that world, not the surgeons at the moment, but that’s long term, yeah.

Rick Zera:

And it’s relevant to the bladder cancer debate that’s going on right now with all of the interest in pre-operative treatment. And that made me, as I became a patient in an area that I knew nothing about, much more inclined to at least think to myself, boy, these guys are a little behind the curve as far as [inaudible 00:06:22].

Rick Bangs:

Right, right, right. Okay, so now we want to talk about becoming a patient. So like many of us, you were surprised to find blood in your urine. So tell me what happened in the summer of 2023.

Rick Zera:

Yeah, I’m on vacation in Cape Cod, and about a week before we left I got up in the middle of the night, and I don’t have my glasses on and the bathroom’s dark, and I thought the water was a little darker than it should have been, but chose to ignore it. Like many guys I know, we deny things that are going on.

Rick Bangs:

So wait, you didn’t turn the light on is what you’re telling me?

Rick Zera:

You are correct.

Rick Bangs:

Nothing to see here.

Rick Zera:

Well if I don’t confirm it it didn’t happen.

Rick Bangs:

Exactly.

Rick Zera:

And then I’m on vacation, and I can’t deny it because it’s bright red and it was on a white tile floor, so I knew exactly what it might portend. And that was again, my wife said something about it and I said, “Oh, I don’t know what it’s from,” again deny, deny, deny.

Rick Bangs:

Yeah, that’s right. Then it goes away.

Rick Zera:

Yeah. And it turned out that she was having her own health issue at the time, so we got to delay it for at least a week. And when we got back to Minneapolis I made a phone call to a urologist. Ultimately after a few weeks of getting in to see somebody had a scope in the office and he said, “Yeah, I see something and you should have it removed, and we need to do that in a more formal setting. And here’s the card for my scheduler, go tell her you need to get in.” And the scheduler it turns out, well the first time you can get in is three months from now, which seemed like a long time to me.

Rick Bangs:

Well it’s unfortunately familiar to many of us as patients. Oh my gosh, three months.

Rick Zera:

And this is where my journey, I’m thinking I am the patient here, I’m not the physician. In breast cancer treatment we actually have metrics, time of first evaluation to time of actual treatment.

Rick Bangs:

Of course.

Rick Zera:

And we get judged, we’re a nationally certified breast center at Hennepin, and so we pay attention to how quickly we get people from their diagnosis to their first treatment, and I’m not sure that happens with bladder cancer. On the other hand, I don’t know a urologist that isn’t super busy.

Rick Bangs:

Oh yeah, yeah.

Rick Zera:

They’re all, everyone I know. And for a few years I was actually chief of the department and it was always, I need more help, from my urology division. So I’m thinking, all right, I’ll set this up. And I’m told I need a preop history and physical, and I called to get that started, and it occurs to me that there’s more to a bladder cancer evaluation than just a system. And I suggested to the primary care provider, “Shouldn’t I have a CT or a urogram?”

Rick Bangs:

Maybe, maybe.

Rick Zera:

This is where the gray zone between being a physician and being the patient started to, and there’s an element on my part of I really want to be a good patient and I don’t want to abuse the MD part of my [inaudible 00:11:05].

Rick Bangs:

We could have a whole podcast on defining what it is to be a good patient though.

Rick Zera:

Oh gosh, yeah. Okay, so it is freaking me out, my wife is not super thrilled with this delay. And finally I called a friend of mine, one of the guys I ended up hiring who’s a urologist at Hennepin, and I’ll give you his name is Ian Schwartz, he’s a fantastic guy. And I said, “Ian, I’m trying to be a good patient and here’s the deal.” And he goes, “Why are you trying to be a good patient?”

Rick Bangs:

Really. Actually, you’re being the opposite of a good patient.

Rick Zera:

Oh, god. Well I was going to behave and do what I was told. So he got me in very quickly after that and expedited getting into the OR and the first resection. So he was able to review the CT urogram, and we sat in the office and I said, “Is it cancer? Because that comment had been brought up as a possibility.” “Oh yeah, oh yeah, that’s cancer. I’m not sure what kind but that’s it.” And the fact that we see thickening of the bladder wall, we see that in 70 year old men all the time so don’t worry about that so much. That all said, I went into the transurethral resection with the idea of coming out with a cancer diagnosis, and he had planned to instill Mitomycin C knowing that, yeah, there’s something bad in there. My wife, well he told my wife and later me, “Yeah, I’ve never seen anything like this. It was weird looking,”

Rick Bangs:

Oh, my. Not the words you want to hear from a seasoned professional.

Rick Zera:

Exactly. It was very low on the list of things you want to hear. You never want to be that weird case.

Rick Bangs:

No.

Rick Zera:

That’s exactly how it turned out.

Rick Bangs:

Yeah, okay. So let’s talk about how weird your diagnosis was. So very unusual case, what was your diagnosis?

Rick Zera:

So I have an osteoclast-rich, poorly differentiated carcinoma of the bladder. It went from our pathology department at Hennepin to the University of Minnesota, and the longer something like that takes you know as on the receiving end, well in particular as my role as a provider, if I had pathology sent out to some other institution I knew it was going to come back weird. And normally at our institution it takes two or three days to get a path report back, it was almost two weeks. So it’s making the rounds, I have subsequently, it’s gone to other institutions, and that diagnosis was confirmed. So being the guy I am, I look up every case in the path report. This is a very unusual diagnosis with a poor prognosis is the comment from the pathologist. And again, those are words you do not want to see.

Rick Bangs:

No, no.

Rick Zera:

So I look up all these cases, he kindly provided a reference in the path [inaudible 00:15:05], I look it up and I start doing my literature search. And there’s similar tumors anywhere in the urinary tract, they can affect the kidney, the ureter, or the bladder. And I kind of focused on the bladder cases, and there’s about 20 of them.

Rick Bangs:

20 total?

Rick Zera:

Roughly, yeah.

Rick Bangs:

Across a number of years?

Rick Zera:

As far as I could find. And so none of the patients were doing well is the bottom line. There was one report of a patient who had a transurethral resection who was alive two months later, and then there was another one that was about 11 months out who had only had a transurethral resection, but everybody else was dead. So that colored a lot of my thinking about how and how quickly to go forward. And the bottom line, Dr. Schwartz and my wife and I met and he said, “Number one, this is a very unusual diagnosis. Two, we don’t do that kind of surgery with any frequency. What I’m going to recommend is that you have your whole bladder removed, and we don’t do it here at Hennepin with enough frequency that I would feel confident for you. So you need to go to a high volume center.” And he gave me some recommendations at Mayo.

And meanwhile, my wife is also looking online and Sloan Kettering was highly recommended. So in the meantime I’m also, gee, this is a bad thing. How big a problem do I have? And that’s often my first approach with patients is I need to bring the temperature down a bit. And I had had the CT urogram so it wasn’t anything obvious on that. But I worked in a cancer center and was able to get a referral for a PET scan, which was negative. And then I went off and started having my consultations.

Rick Bangs:

Wow. Okay, so now you’re going to get the treatment. So you got to figure out where you’re going to go, you’ve had at least one suggested referral. So what did you decide, and where did you go, and how did that all evolve?

Rick Zera:

Well I live in Minnesota, so Mayo Clinic is 75 miles away, and that was the first visit. Really an excellent consultation, I met with a urologist there and had a great conversation. We were able to debate the pros and cons of bladder conservation, and he was better versed on the literature than I was of course. Just again, based on your histology no, not a good idea. And at that point, actually with the first resection there was no muscle seen on the edge of the tumor, so they called it a T1 tumor but could not comment on muscle invasion or not. And unbeknownst to me, I was offered a repeat resection at Mayo to see if there was muscle invasion and was fairly quickly told, “But it won’t change my recommendation.”

Rick Bangs:

Well by all means, do the surgery that doesn’t change anything.

Rick Zera:

Well you have to understand, I’m also very, I’m still in that mode of maybe less is still okay. Philosophically I’m there, but knowledge-wise I’m not.

Rick Bangs:

Right, right.

Rick Zera:

So unbeknownst to me, Dr. Schwartz has already scheduled me for that. So I get a call from him and say, “Oh, by the way, next week I have you on the schedule to see if there is any muscle invasion.” So I went down to Mayo, I got their thoughts, and there I was tentatively set up for an open radical prostate cystectomy or prostatectomy and lymph node excision. And in the meantime another friend of mine, Doug Rausch, who is a medical oncologist, he got things going on the tumor evaluation with the idea that maybe you need chemotherapy or immunotherapy. And it turned out that the genomics of my tumor were such that Keytruda would’ve been an option and there were some other targeted therapies available should I need them. Which was reassuring but oh good, if you need them they’re there. But we had a conversation about, he and I, that adjuvant treatment with that would not be covered by insurance. And Keytruda is what, about $100,000 a month?

Rick Bangs:

Yeah, it’s another cheap date.

Rick Zera:

Oh yeah, yeah. Anyway, so I’m tentatively scheduled for this surgery. My wife is still very, very interested in getting another opinion, I am also interested. I’m still looking for is there easier way out of this? Easier but also as good. And that was kind of the backdrop. So I actually went to my pre-op at Mayo and there was concern about where to put my stoma, and I had opted to go for an ileal diversion for a variety of reasons. One, it was more straightforward in my mind. Neobladder, you can tell me how long a recovery that was, but I was still working-

Rick Bangs:

Weeks.

Rick Zera:

Weeks.

Rick Bangs:

Maybe months, yeah.

Rick Zera:

Okay. And that was sort of the message I got, that it’s a longer recovery. And I heard it described as, well a neobladder is more like a Maserati.

Rick Bangs:

I’ve heard this before. I knew where you were going to go. It was either the Maserati or the Ferrari, I knew it.

Rick Zera:

Yeah, okay. And an ileal diversion is more like an Accord.

Rick Bangs:

I knew you were going to go for the durable Honda.

Rick Zera:

I did not come up with that line.

Rick Bangs:

Yeah, right. I got you.

Rick Zera:

That must be an industry-wide kind of comparison. But in my thinking about it there are a couple related concerns. One, I had been pretty well-educated there at Mayo by them, but there are some complications related to the neobladder that are unique to it. One is stricture, and you might be self-cathing for at least a period of time, or you might have incontinence, and particularly nighttime stuff. And neither of those had any appeal.

Rick Bangs:

Surprisingly.

Rick Zera:

Oddly enough. Well the unspoken thing that in private physicians talk to each other, physicians that are surgeons will talk about is what I call the Murphy’s law of taking care of healthcare providers, which is if it can go wrong it will. And as the patient I’m thinking, I was told about a 15% chance of stricture or incontinence. In my mind, it’s 100%.

Rick Bangs:

Because of Murphy’s Law.

Rick Zera:

Oh yeah, yeah.

Rick Bangs:

Murphy’s clinicians law.

Rick Zera:

Exactly. And it has nothing to do with the actual surgeon that’s doing it, it’s just the thing. And so I went for what I believed would be a simpler option.

Rick Bangs:

I gotcha.

Rick Zera:

And as a surgeon, my nighttime job at Hennepin is trauma surgery, so I did a lot of stoma creations in my lifetime as a surgeon related to trauma, and a bad stoma is a real problem. So it’s not a trivial, the other end of the spectrum is not that trivial. So at any rate, I get some significant questions about where are we going to put your stoma? Because as a kid I had had a ruptured appendix and I had a retracted scar that created an issue for where are we going to put it that it’s going to be-

Rick Bangs:

Right, because the stoma is going to go on the right side normally.

Rick Zera:

Yeah. So I had questions about where they were marking me, and ultimately that helped lead me to Sloan Kettering. And by chance I ended up getting to see Dr. Alvin Goh there, who’s head of robotic surgery. And I had a very similarly great visit with him about the pros and cons of everything. And it was one of those things that where, again as a patient, and this is what I would tell my own patients who asked about second opinions, I always encourage them to do that, number one. And number two, you end up going where you’re comfortable, where you feel the most connected to the provider. And if that’s me, wonderful, I’m going to be delighted to take care of you. If it’s not, I will help make sure everything happens to expedite your care wherever. And it was just one of those things where it clicked very nicely at Sloan Kettering, Dr. Goh had a little bit of a sense of humor that I appreciated, and he was going to do it robotically.

That all said it was going to be a delay in the time for surgery by about three weeks. And we’re now going from August and we’re into December for a planned surgery at Sloan. And I’m thinking, oh my God, this is dragging on a lot longer than I thought it should. So delaying another few weeks between Mayo and Sloan was a big concern. And fortunately, my daughter, who is also a physician, had come to the visit in New York, and she had the good sense to sit me down and write out, okay, pros and cons of both approaches and both places.

And in the end it was, gee, in my role as a program director at Hennepin I’m trying to get my young surgeons all interested in robotic surgery and qualified to do it, and that’s a big, huge part of general surgery nowadays. And why wouldn’t I want to have that myself? And so that helped make the decision. And the second thing was in my enthusiasm for ileal diversion I expressed my only concern to Dr. Goh is that you do a good stoma. And he said, “Well it so happens I just recently operated on a colorectal surgeon who assures me his stoma is great.” And that was the reassurance I needed.

Rick Bangs:

Yeah, that would be a seal of approval for a fellow surgeon. Excellent.

Rick Zera:

Yeah.

Rick Bangs:

Excellent.

Rick Zera:

Meanwhile, to figure out do I really want to do this, the diversion rather than the neobladder, I got an appliance and stuck it on with some water in the bag, and walked around with it for a day, well not a day, a few hours to see what it would be like. If I put scrubs on do I look semi-normal or is it something you can see? And I thought, well this is going to be okay. I mean that was the final factor, I guess, if you will.

Rick Bangs:

Yeah. And these kind of test runs are really important. They’re more commonly done now, but test runs like you’re describing with having a pouch and testing out and seeing what that’s like. Or for the neobladders they sometimes have people self-cath before their surgery to confirm that they’re going to be able to self-cath if they need to after.

Rick Zera:

Yeah. Well that didn’t appeal.

Rick Bangs:

Well trust me, it doesn’t appeal. Yeah, it’s never an appealing thing.

Rick Zera:

No. So anywho, I will say in retrospect I should have, I call it cosplaying on our support group meetings, I’ve suggested for a new patient who’s thinking about one or the other, get an appliance and cosplay for a weekend. I don’t think a couple hours is long enough to fully appreciate what it’s like. But at any rate, I made my decision and that was that. So I had my surgery.

Rick Bangs:

All right. So now tell me, what did you learn about yourself during your journey?

Rick Zera:

Oh boy, so many things. Number one, I think was how risk-averse I really was. And this is again, something I talk to my own patients about when we were looking at what kind of therapies are appropriate for your breast cancer, and sometimes chemotherapy up front was really mandatory. That wasn’t an option for me, nor in the end did it turn out to be necessary. But the idea of not knowing that I had lymph node involvement or not, if I chose bladder preservation, and oh by the way, I did have my second resection and there was no muscle invasion. So I was able to breathe a little easier but still nobody said, good news, you don’t need a radical operation.

So I looked at it as you’re going to go through a big operation to find out how big a problem you have, and that is philosophically where I would be as a provider of I need to know how big a problem you have before we talk about all of the treatment that might be necessary. And there was going to be no way to know that without a big operation. And so risk aversion in a philosophical sense came home to roost big time as a patient. It was do you want to live with the uncertainty that you might have a microscopic more advanced problem, and three months or nine months from now have it blossom into something untreatable? And that was sort of the natural history based on the cases I reviewed, it was they all recurred within a year and were dead, and so that had no appeal.

Rick Bangs:

Yeah, okay.

Rick Zera:

And then I was very surprised to learn how fragile I was emotionally. It took a long time to recover from that side of it. Physically I was out of the hospital in four days, I went sightseeing the weekend after my surgery. Not successfully, I had a drain leak and I was, anyway, long story. But I was physically up to the idea of going to the Wold Trade Center Monument. The emotional side of things was a real eye-opener for me, and it took me a lot longer to recover that way than I thought. Again, you think you are on top of things intellectually, and no, I wasn’t. So that was the biggest hurdle.

And I will say that having a very, very supportive wife, and family, and friends, and a really great outpatient social worker at Sloan Kettering, that made a huge difference in getting through that. So the importance of those people around you as a support system, I did not fully appreciate going into it. I came out of it as, boy, that matters a lot.

Rick Bangs:

Yep. Okay, so now what did you learn about your colleagues? And I’m using this not in terms of people you’ve worked with daily, but just people who are on the clinical side?

Rick Zera:

That’s a question that’s a little harder to answer, but the people I work with day to day, I can’t say enough great things about them. They’re tremendous to me and my whole institution was fabulous, I’m very proud of them. That I’ll say. So the experiences I’ve had in getting consultations are what I would hope for for other patients in that a lot of information gets provided, very thorough discussions in both institutions where I sought surgical consultations. Again, it wasn’t for lack of information that I chose one or the other, it was just who did I click with? And then I will say that I had the luxury of resources to be able to do that, to go somewhere out of state.

Rick Bangs:

Not everybody can.

Rick Zera:

How lucky can you be? And that made a big difference is that I could weigh choices. So in terms of just the experiences, it was one of those where I love New York, no. It’s funny because at one of my visits Dr. Goh said, “Do you really want to come back to New York?” And I said, “Well yeah, I like it here.” One of the things that I’m struck with, and maybe it gets to something you might ask later, but I have a lot more vested in the relationship with him than he does with me, I think, just emotionally. Again, I value his expertise, I value his skill, and the fact that he got me through it without any complication. I know, as a surgeon I know that my investment in that is stronger than what’s coming back probably. And I’m okay with that. It’s kind of a weird dynamic, I think, but not a weird dynamic but interesting dynamic.

Rick Bangs:

Yeah. Okay, so I want to weave these learnings from your journey on both sides into a question here. So I read this book, Prostate Cancer for Dummies, and I remember nodding my head when it was revealed that the two authors who happened to be in the urology space, they were doctors in the urology space, and they were both prostate cancer survivors. And they acknowledged that now that they had had prostate cancer and they had had to wear the catheter after surgery, they were now much more liberal, meaning the catheter can come out earlier because they had been on the receiving end of the catheter. Okay, so now how does this relate to you? So what insights have you gained that you can apply or could apply in your professional role? Or what advice would you have for your colleagues now that you have this end to end view of things?

Rick Zera:

Oh boy, I would double down on the fact that encouraging prospective patients to talk to people that have already gone through it. And that didn’t happen for me and I didn’t think to ask, oh, could I talk to somebody that has a neobladder? Could I talk to somebody that’s got a diversion? As I said, I frequently, at least in the meetings that we have for the bladder cancer support group at Sloan, there are new patients that come in on the Zoom call and then they get hooked up if they want with patients that have been through it. There is a difference between talking to somebody who’s five years out or somebody that’s three months out.

Rick Bangs:

Oh, yeah. Yep.

Rick Zera:

So I in retrospect would have valued more conversations of that type. And then from a provider standpoint, do you encourage that too much or not? I don’t know. I think the reality of having a stoma is way different than two hours of walking around with an appliance taped to yourself. So that’s something.

Rick Bangs:

You’d be in a great position to explain to somebody, hey, if you walk around for two hours you’ll have a sense for it, but here’s what that experience doesn’t provide you.

Rick Zera:

Right, exactly. And I went from, oh yeah, I could still go to the operating room wearing scrubs and people are not going to look at me funny because they can see an appliance sticking through, that was sort of the baseline evaluation I made. And that wasn’t adequate. I’m sure from a standpoint of a neobladder there’s much more subtlety involved in the recovery process, the pros and cons of being, I’m not sure I would want to talk to somebody in the six weeks out from it, but maybe six months out how’s it going? Things like that.

Rick Bangs:

Right, right, right.

Rick Zera:

So that. I was provided with a lot of really good information about how to recover well. And one of the things, in all of my anxiety about complications, I would refer back to the materials. As I said, I was trying to be a really good patient so I memorized the patient handbook.

Rick Bangs:

Wow.

Rick Zera:

Not quite, but it says, oh, you have to get up in the first 24 hours and walk around the nursing station.

Rick Bangs:

Yep, yep.

Rick Zera:

And I woke up in the recovery room, my surgery didn’t start until about 4:00 in the afternoon, and it’s about 11:00 at night and I’m pretty sure I’m having a pulmonary embolus because I can’t breathe. And it’s not true, it’s the normal chest pain that laparoscopic surgery or robotic surgery create. Anyway, in the back of my mind I knew that. However, I’m thinking, uh oh, I got to get up. So I can barely breathe and the nurse in the recovery room is dragging me around the station to make sure I do what I’m supposed to do.

Rick Bangs:

Get that first lap in.

Rick Zera:

Oh yeah, I’m going to be the best patient they’ve ever had. So at any rate, I think there’s a lot to be said for that information. But again, where I’m talking to a new patient that’s what I would emphasize. Yeah, these things are there for a reason. And you’re not going to feel great that first night, but it’s important that you do these things.

Rick Bangs:

All right, so do you have any thoughts on physician-patient relationships or shared decision making that you would like to offer as a result of your experience?

Rick Zera:

I think that going into a consultation with as much information as you can handle is real important. And as a provider I always felt it was more fun to deal with patients who came in well-prepared. Does that sound awful? The idea that you might know something about yourself or your situation that could change their recommendation. And if you don’t share that upfront it really is not to your advantage. Your level of engagement as a patient in your choices I think matters a lot. A physician’s willingness to meet you at that place and not say, well this is the way I always do it and that’s it.

I did not run into that myself, and I would hope it’s because I was a patient, not a physician patient. But I assume that might happen occasionally where, well I’m telling you this is what you need, and that’s a circumstance I might run from. But at any rate, the amount of trust that you have in a provider is really critical. And you get that, I think, from a back and forth of I’m sharing information and oh, that’s going to, on the physician side, maybe inform them about what makes sense for the recommendation that they provide.

Rick Bangs:

Okay, that makes a lot of sense. All right, so any final thoughts?

Rick Zera:

Oh, I just can’t say enough about going in fully armed with as much information. The notion that you shouldn’t Google things, don’t believe that, Google everything. I will say for the more typical urothelial bladder cancer, life is so much more complicated today than it was five years ago. I am struck by how much progress has been made, how many new options are available. So I’m sure there are urologic surgeons that are almost as confused as you, what is the right thing for somebody that is BCG resistant, those kinds of things? In my mind and as somebody interested in progress in treatment, the ideas that are happening now will probably be different than two years from now, it’s fascinating. And thank God. I’m hopeful, I believe that maybe there’s enough of us out there with this variant kind of histology where they might get a little more information about options, but I wouldn’t pin too much on that. At any rate, I think get as much information as you can stand. For me, that was a lot because I believe I could read the literature, but it’s not for everybody.

Rick Bangs:

Right, right. So calibrate to your own needs, and wants, and what you’re able to consume mentally, emotionally, whatever, right?

Rick Zera:

Right.

Rick Bangs:

Excellent. So Rick, I want to thank you for giving us a cancer insider’s view of the bladder cancer experience. If you would like more information on bladder cancer, please visit the BCAN website, www.BCAN.org If you’d like to get in touch with Rick, you can email [email protected] and your messages will be relayed to Rick. Just a reminder, if you’d more information about bladder cancer you can contact the Bladder Cancer Advocacy Network at 1-888-901-2226. That’s all the time we have today, be sure to like, comment, and subscribe to this podcast so we have your feedback. Thank you for listening, and we’ll be back soon with another interesting episode of Bladder Cancer Matters. Thanks again, Rick.

Intro/Outro:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network, or BCAN. BCAN works to increase public awareness about bladder cancer, advance bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit BCAN.org.