Bladder Cancer Survivor’s Quick Recovery Surprises Even His Doctor

June 15, 2018 | by Samantha Bonar

David Gabbay, 62, was fit and active, a frequent hiker in Joshua Tree, when on Thanksgiving nearly two years ago his world changed as painfully and suddenly as a rattlesnake bite.
“I went to go to the bathroom in the morning and it looked like I was peeing pure blood,” Gabbay, a carpenter and cabinetmaker who lives with his wife Michele in Twentynine Palms, California, recalled. “I’d never had a drop of blood in my urine before.” Terribly alarmed, he headed to the emergency room, where tests confirmed blood in his urine but couldn’t determine the cause.
Gabbay followed up with his regular doctor about a week later and had an ultrasound, which showed a thicker-than-normal bladder wall. He was referred to a urologist, who used a scope to thread a tiny camera up his urethra to his bladder, which spotted a tumor on his bladder wall. Doctors tried to remove it through his urethra but were unable to get it all, and told him it would probably grow back. At that point, Gabbay headed to City of Hope for a second opinion.

A New Bladder

“Right away I felt really good about them, about what they said they would do,” Gabbay said, so he transferred to City of Hope in Duarte for treatment — about 150 miles from his home. 
After undergoing chemotherapy treatments for a few months to shrink his Stage 4 tumor, Gabbay’s bladder, prostate gland and 35 lymph nodes were removed by Kevin Chan, M.D., associate clinical professor, Division of Urology and Urologic Oncology, Department of Surgery, and head of reconstructive urology at City of Hope, using minimally invasive robotic surgery, on Dec. 27, 2017.
Remarkably, Chan fashioned a new bladder, or “neobladder,” out of a portion of Gabbay’s intestine, a procedure that is performed at only a handful of hospitals in the United States. While only about 5 percent of all cystectomy (bladder removal) patients nationwide receive a neobladder, at City of Hope the ratio is closer to 50 percent.
Improving recovery is a major motivation behind the neobladder procedure. Instead of an Indiana pouch or an external collection bag, the substitute bladder in time functions much as the original.
In addition, the minimally invasive, laparoscopic robotic technique allows for a more precise, controlled surgery with less blood loss and nerve damage.
Still, “When I woke up from that operation, I was so messed up,” Gabbay said. “They told me it could take six months to a year to recover.”

A Swift Recovery

The surprises weren’t over for Gabbay. His recovery after such a major surgical ordeal astonished both him and his doctors. “The first week I was hospitalized,” he said. “The second week I was back and forth getting treatments. After two weeks, I was out taking walks with the dogs. Within three weeks, I was hiking mountains.”
“I always tell patients, the better you are before surgery, the better you're going to be after,” Chan said. “David is fit. He's heart-healthy. Nothing about one day of surgery is going to change that. That always helps us. It makes the surgery easier anatomically when the patient is more fit. It also minimizes complications. They can handle anesthesia better. When you're heart-healthy, everything kind of goes the way it should.”
“For many years I was out of shape,” Gabbay admits, “but for the last five to six years my wife and I have been hiking a lot and I’ve been in pretty good shape. It’s been three and a half months now since the operation and I feel completely normal. I have no pain. I go on 4-5 mile hikes. I just have a tiny bit of leakage — they said that could take up to a year to resolve.”
“I think it was his good health that allowed him to make those adjustments earlier,” said Chan, who said it takes most patients at least two months to start to feel better. “It's a tough surgery to recover from. There's about a 60 percent complication rate. Interestingly, we threw another curveball at him, which is that he had chemotherapy before surgery, which usually delays recovery, and he defied that as well. What David Gabbay has, there is no metric for. He just feels great sooner.”
For his part, Gabbay gives credit for his rapid recovery back to his physicians. “The doctors were fantastic, from oncology through surgery — every aspect of it. They are the nicest people. I’ve only had great experiences with them. I couldn’t imagine a hospital being better. Dr. Chan couldn’t believe it when I told him what I was already doing.”

Bladder Basics

Bladder cancer, a disease that strikes about 70,000 Americans each year — 90 percent of them patients who are over 55 years old and about 80 percent of them men — is a stealth disease. “Unfortunately, the bladder has a decent amount of space to grow a tumor before you show blood in the urine. It's about the size of a grapefruit,” Chan said, adding that “painless blood in the urine is the most common symptom.” When the tumor gets large enough, one of the blood vessels feeding it can leak into the bladder. This can happen when someone engages in some sort of strenuous activity, for example, and pops one of the vessels. Often it happens one time and people ignore the symptom, Chan said.
Unfortunately, Chan added that many primary care physicians dismiss blood in the urine as a urinary tract infection (UTI), which often leads to a three- to four-month delay in proper diagnosis, particularly in men. “Men should not have UTIs. They don't get them like women,” Chan said. “If you notice blood in your urine, you should see a urologist. If they're saying UTI but cultures aren't showing infection, you need to see a urologist.” The average age of a bladder cancer patient is 73, he added.
Once diagnosed, “It's almost impossible to cure bladder cancer without removing the bladder, because cancerous cells return,” Chan added. “But with surgery, we can achieve a cure rate of 70 percent.”
As for Gabbay, he’s staying positive, and those walks in Joshua Tree are certainly helping. “I want to live a long time. That’s my goal. I feel very optimistic. I’m just going to keep on doing what I do — hike, enjoy life. I feel that I’m going to beat this some way or another, and I’m going to keep that attitude.”

If you are looking for a second opinion about your bladder cancer diagnosis or consultation about your treatment, request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.


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