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Ask Dr. Lamm: BCG Side Effects

BCG and Crying

Sunday, March 28th, 2010

I had my fourth bcg treatment on Thursday. Friday I was very tired, and sort of out of it - not thinking too clearly. I figured I was just very tired. But Saturday I started crying in the afternoon and continued crying until late into the night. It’s 5:22 am, and I  have been up for three hours reading, and crying (which makes reading somewhat difficult). I don’t even know why I’m crying.  I have never been depressed in my life, and I feel depressed. But I don’t know why. This is such a strange feeling for me, as I’m usually a really quite a happy person. Can BCG treatment cause depression?

Thank you.

Dear Friend

I hope your mood has improved.  Maybe you were overdue for a good cry?  Having a diagnosis of cancer is like getting hit by a truck.  I have not seen any reports of BCG causing depression, but having bladder cancer certainly can cause depression.  With appropriate treatment, and the best we have is still BCG, you should do very well.  You may need to have the dose of BCG reduced to avoid increasing side effects.
I hope you will soon be back to your happy state.

Best wishes,
Don Lamm, MD

When does quality of life require stopping BCG maintenance?

Monday, March 8th, 2010

Dr. Lamm,

I am a 65 year old woman who was diagnosed with bladder cancer last March. I am happy to report that all tests done in January showed no new cancer cells!  I am currently having my second set of maintenance treatments.  I am not sure if I am receiving the full strength now.  I have been thinking that I should ask for a reduced strength from now on.  I cannot tolerate more than 10 minutes on each side now.  Is 40 minutes effective?   At what point does quality of life become a factor in continuing treatments or not?  My doctor said he likes to get in at least 12 treatments, but he said any time I want to call it quits I could.

Also, as you can well imagine, I am urinating frequently, up every two hours  at night when I’m in between the maintenance series. Last night I was up every hour (my last treatment was Thursday).  Because my bladder has shrunk so much,  I  really have to plan my trips carefully and limit fluids before I leave home. How do you respond to these concerns?

Thank you very much for the opportunity to ask you these questions.

Dear Friend,

It is good to hear that you are cancer free, and in my opinion YES, YOU NEED TO CUT BACK ON BCG!  There seems to be no end to the misconception that more is better with BCG.  There is no need to suffer.  From your symptoms, it sounds like you need to hold off on BCG and when you start back, reduce the dose to 1/10th or less.  We are indebted to the Scandinavians who demonstrated that by holding BCG for only half an hour, the benefit of reduced dose can be obtained without having to do the math of dilution.

Thanks for asking,
Don Lamm, MD

Long Term 3 week Maintenance BCG: Cure Worse than the disease?

Monday, March 1st, 2010

My husband has been taking BCG treatments for six years. He had one reoccurance of non-invasive bladder cancer a year ago. The problem is he can hardly tolerate the treatments anymore and they have changed his antibiotics, frequent urination pills and he is in terrible pain, burning and hurting all of the time. He takes three in a row for three weeks and skips two weeks and has his scope.  The urologist has been told so many times but he has not done anything to help him. Is there an alternative to BCG and if so what is it?  Should he get a second opinion or does he need to see an oncologist instead of urologist?  We live in Baton Rouge, LA so if you have any recommendations for any physicians he could really use your help. He is discouraged so much he wants to stop the treatments. It is saving his life but he is miserable.

Thanks for your time.

D. R., Baton Rouge, LA

Dear Friend,

There is no need to suffer with 3 week maintenance BCG.  The dose can be reduced to 1/100th, and Ofloxacin or Cipro can be taken 6 and 20 hours after instillation to reduce side effects.  Also, when side effects are strong, the interval between treatments can be increased.  You should do fine with 3 weekly instillations every 2 years now.

Good luck, and thanks for asking,
Don Lamm, MD