Michael’s Cancer Journey(s)

Bladder cancer is an insidious disease and has a high rate of recurrence.  Michael Morigi of Staten Island, NY, has had bladder cancer.  And prostate cancer.  Bladder cancer was his first bout with the “Big C.”

In 2009, Michael was feeling off.  He described it as a strange, “itchy” feeling in his stomach.  He would continually scratch his stomach but the sensation would not go away.  During a routine physical, his doctor told him that they had found blood in his urine, microscopic hematuria, which is not visible to the naked eye.

Michael’s bladder cancer diagnosis

After some initial tests, the doctors told Michael that he was fine, but in about six months, the itchy feeling returned and he went to see a trusted nurse practitioner, Evelyn Goldstein.  After some careful examination and a couple of tests, Evelyn told him “you have a problem with your bladder.”  She recommended that he see a urologist and he went to see Dr. Louis Faiella, Director of Urologic Oncology in the Department of Urology at Winthrop University Hospital in New York.

Dr. Faiella ordered some further tests for Michael.  Then came the day to get the results.  On a date that is etched in the memories of many bladder cancer patients, Michael remembers the exact day that he got his diagnosis.  It was December 31, 2009.

His doctor looked at him and said, “You have bladder cancer.”  He further explained that it was muscle-invasive.  Michael told BCAN “I couldn’t hear. I really could not hear at one point. I saw his mouth moving, but all I kept thinking about was, ‘I have three kids. I have a wife and three jobs. Who’s going to carry the ball?’”

Dr. Faiella asked him, “Do you understand what I am saying?” but all he was thinking of was his family.

Michael told BCAN, “When someone says, ‘you have cancer,’ those are the worst words you hear in your life.  I call it the ‘empty drum syndrome.’  My stomach felt hollow, like someone was banging on an empty drum.”

TURBT

Michael’s bladder cancer was non-muscle invasive, so the next step in the process was a TURBT, a transurethral resection of a bladder tumor.  Michael was concerned about the possibility of losing his bladder, but when he woke up from the procedure, the doctors let him know that his cancer was not muscle-invasive and that his bladder would be spared.

The doctors also told him that they did not think that they able to remove all the cancer and that he was to undergo BCG treatments.  Soon after, he began the BCG regimen and went through six rounds.

Because of his prognosis and the fact that cancer had reappeared in his bladder only to be removed, Michael was under close medical supervision.   Between 2010 and 2016, Michael had routine cystoscopies every three months.

More bad news

In the summer of 2016, he was diagnosed with prostate and metastatic urothelial cancer of the renal pelvis.

Since prostate cancer progresses slowly, his doctors had opted for watchful waiting and would monitor his condition carefully.  As for the urothelial cancer of the renal pelvis, Michael told BCAN “I said, okay. Again, this would be the third time they’re telling me cancer, cancer, cancer. It’s not that I wasn’t scared, but I had been through this.  I was handling it better.  Then they told me that they wanted to remove both of my kidneys.”

His doctors and Memorial Sloan Kettering told him that they would have to remove both of his kidneys and he would be facing a lifetime of dialysis.  Eager to preserve one of his kidneys, Michael did research and pursued multiple second opinions and finally opted change his medical team and be treated at Winthrop University, where they told him that they would work to spare his second kidney.   Once again, he underwent surgery and the doctors at Winthrop removed one of his kidneys and its ureter, a nephroureterectomy.   The cancer that appeared in Michael’s remaining kidney was treated with BCG, which also had been used to treat his bladder cancer.  He had six rounds of BCG treatments for his kidney cancer and responded well to those treatments.

Finding a clinical trial

Finally, given that Michael had metastatic urothelial cancer, his doctors, advised that he seek future treatments at another facility that would be better equipped to handle his diagnoses – and perhaps even a clinical trial.  His urologists, Dr. Louis Faiella and Dr. Joseph Jamal, recommended that he see Dr. Matt Galsky at Mt. Sinai Hospital in Manhattan.

Dr. Galsky is a Professor of Medicine and the Director of Genitourinary Medical Oncology, and Co-Director of the Center of Excellence for Bladder Cancer at The Tisch Cancer Institute at Mt. Sinai Hospital.  Dr. Galsky has long been affiliated with BCAN and sits on its Scientific Advisory Board.

Michael lights up when he talks about Dr. Galsky.  He recently told BCAN “He is the guy. Besides being my doctor, he’s become my friend. I have done many, many rounds of treatment and he’s been with me every step of the way. Dr. Galsky is an amazing man.”

Dr. Galsky happened to be running at keeping Michael’s cancers at bay.   The trial that Michael enrolled in was the use of first-line single-agent immune checkpoint blockade for metastatic urothelial cancer, using Atezolizumab as part of a Phase III clinical trial.  Dr. Galsky told BCAN, “…A subset of patients have remarkably durable responses to this treatment and often in the setting of few side effects. This has clearly been the cause with Mr. Morigi, reinforcing the importance of first-line single agent immune checkpoint blockade as a treatment option.”

No Evidence of Disease

Michael never really went through a “blame phase” but has thought about what might have caused his cancers.  Before retiring because of his illnesses, he worked installing elevators in high rise buildings in New York for 30 years.  Because of his experience, Michael worked extensively at the World Trade Center in New York, after both the bombing in 1993 and the destruction after September 11, 2001.  In fact, he worked at the World Trade Center site for two years following 9/11.

At the time of this writing, Mr. Morigi is 100% NED – No Evidence of Disease. After so many rounds of treatment, it was only natural that he was wondering if he should continue in the clinical trial.  He told BCAN: “I feel that the treatment is working for me. I’m not getting sick, I have no side effects and it would be terrible if I stopped and then something happened to me.  So, I’m going to continue.”

With treatments every 26 days, full body scans every three months and a comprehensive blood work up every 28 days, Michael is used to spending time with his doctors.  He joked that he feels like the “Six Million Dollar Man” because of all the care he receives.  Having no evidence of disease has enabled Michael to do many of the things he loves, like cooking, caring for his grandchildren and exercising daily.

Despite everything he has gone though, Michael sums up his philosophy simply: “Every day I wake up is a privilege.”