Max..if you're about to hit the wall your uro might want to cut the dosage down at least a l/3. Lamm has even gone to l/100th of a dose. If anyone knows the answer to your question its Dr. Lamm...and he will answer you.
somewhat late to this thread, but I am from the UK and was vaccinated with BCG years ago, so always test positive. It does seem strange that the physician would shy from further treatm,ents after giving the first 6, as the risk of not being able to detect systemic TB infection is still there. In the absence of acute symptoms, I would assume your status would be the same as when you entered therapy.
What was alarming to me is that on starting BCG, nobody in the centre where I was treated had the least idea what prior exposure meant in terms of reaction to BCG and response to multiple therapies.
In short, the literature appears to suggest that the pre-immune should respond more quickly and more robustly, as for follow up therapy in maintenance cases.
The risks would appear to be 1) excessive repetition of the BCG instillation with attendant risks 2) too many treatments (which has been postulated to lead to loss of immune response and 3) my poor urethra !
Anyone else has experience of the effect of pre-immune status as I am BCG 2/6 and about to hit the wall.
courage to all
Thanks so much for all the comments and info. I feel better now. I will do more research and talk more to my Uro. I do trust her and feel she is thorough and she was going to look more into the situation before we actually did the first BCG which is still 2 weeks away.
As usual, Pat is right on. A positive PPD without signs of active tuberculosis (no symptoms [night seats, weight loss, cough] and negative chest x-ray) is latent TB. The treatment with isoniazid (INH) for 6-9 months is aimed at preventing reactivation TB later in life.
To the best of my knowledge BCG does not increase the risk of developing reactivation TB. In fact, BCG is used as an immunzation against TB in areas outside the US where TB is more prevalent.
In addition, I don't think the PPD would be a reliable way to decide if the BCG is causing a problem, since the decision must be made on the basis of symptoms. A negative PPD would not be adequate to decide that the BCG wasn't causing a problem if one was suspected.
Even though you need your urologist for his expertise treating the cancer, you need him to consult with an infectious disease specialist, who you should consult with as well. Then your concerns will be accurately addressed and an appropriate TEAM will be making the decisions. Don't forget, you're a member of that TEAM, so you need accurate information to make your decisions
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant...
TheraCys should not be administered to persons with active tuberculosis. Active tuberculosis should be ruled out before starting treatment with TheraCys. A test for detecting Mycobacterium tuberculosis infection should be performed if PPD (purified protein derivative of tuberculin) status is unknown. A positive Mantoux test, by itself, is not a contraindication to using TheraCys but an assessment must be made regarding whether the patient has signs, symptoms and/or a chest x-ray consistent with active or latent tuberculosis that requires treatment with antimycobacterial drugs.
In other words he needs to run the tests or at least go to an infectious disease specialist who will run the tests and determine if you can take the BCG.
I am certainly not a medical expert on BCG. However, it does not make sense to me that your medical history would interfere with your receiving BCG treatments...and if it did, why would six be OK and not the maintenance? Statistics show that the maintenance regimen is much more effective that just an intitial series.
I would ask Dr. Donald Lamm, if I were you. He is a recognized expert in the use of BCG and has developed the protocol most of us in the US are on. He is wonderful about answering questions...something many doctors do not do. Go to his web page
and there is an "Ask Dr. Lamm" button on the left side.
Good luck to you
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society