Receiving a diagnosis of bladder cancer is not easy at any age, but Larrie Wanberg, PhD, had someone close who had been treated for it successfully to guide him through the process — his son.
Twelve years earlier, Lars Wanberg got his life back on track by going to Keck Medicine of USC for a radical cystectomy with urinary diversion.
“I said, ‘I know exactly what we’re going to do — we’re going to see Dr. Djaladat,’” Lars says of Hooman Djaladat, MD, associate professor of clinical urology at the Keck School of Medicine of USC and urologist at the USC Institute of Urology at Keck Medicine of USC, who had taken over his care in recent years. “From the minute we walked in the door, there was the feeling that we were in good hands because they really care about their patients, family and extended family.”
It’s unusual for a son to have bladder cancer before a father, but Lars’ experience with the USC Institute of Urology and USC Norris Comprehensive Cancer Center allowed him to take care of the man who had raised him and three siblings following the untimely death of their mother in a horse-riding accident.
Lars was only 42 when he got his diagnosis, young for a disease that strikes at a median age of 70. Surgery was an easy choice — the only choice.
At 85, Larrie could have decided to accept this ending to his life. He had already lived it fully enough for three lifetimes — receiving the Legion of Merit award and reaching the rank of colonel in the U.S. Army for his 27 years providing social services at military hospitals, dedicating another quarter century to the University of North Dakota as an adjunct professor in community medicine, and in his retirement becoming a journalist and Norwegian historian.
However, Larrie had another chapter in mind for himself. With the elderly population on the rise, USC Norris sees many octogenarians with bladder cancer, even operating on a patient over 90.
“Not many centers would consider such a radical treatment at this age,” Dr. Djaladat says. “They’d say he’s too old and it would probably be better just to do a palliative treatment, but that’s not the mentality we have at USC. We really push hard and fight on with this disease.”
Options for Active Lifestyles
The radical cystectomy was similar for father and son — removal of the bladder, prostate, seminal vesicles and nearby lymph nodes. Larrie received four months of chemotherapy before the surgery, which increases the survival rate by 5 to 6 percent in patients with invasive bladder cancer, according to Dr. Djaladat.
Their experiences diverged at the urinary diversion. Lars got a neobladder in which a piece of the small intestine is made into a pouch that is connected directly to the urethra.
For octogenarians, the most common method involves a urostomy bag. To fit Larrie’s active lifestyle — even at his age, he was freelancing for newspapers in North Dakota and serving as features editor for a Norwegian-American newspaper — he and Dr. Djaladat decided on an Indiana pouch, a reservoir made from intestine and connected to the belly button through which a catheter is used intermittently to drain.
“The whole culture of going there is uplifting, even though you might be going in with some discouraging health issues,” Larrie says. “I always went away feeling really good inside.”
Enhanced Recovery After Surgery
Dr. Djaladat noted that USC Norris has pioneered an “Enhanced Recovery After Surgery” protocol that has decreased the median length of hospital stay for this complex procedure from an average of nine to 10 days down to four. Patients recover faster after surgery with lower complications and readmission rates.
“With an elderly person, there’s a lot more a doctor needs to deal with in terms of the psychological state of the patient,” Lars says. “I saw how Dr. Djaladat dealt with my dad, always asking about his writing and talking about getting him on an airplane back to North Dakota. He knew how to motivate him.”
Larrie, who turned 87 in February, still hopes to return to North Dakota at least to visit. He has been living in Santa Ynez with his daughter, near Lars in Santa Barbara and close to his nine great-grandchildren. He has plans for the years to come, chief among them to partner with the charity BraveHearts for Kids to be editor of an online magazine featuring children with cancer telling their stories.
“I’m very grateful for the extension on life I received and want to make value and fulfillment come from it,” Larrie says. “I want to move to a new challenge.”
By Matthew Kredell