I had a good checkup with Dr. Villa Forte yesterday. Spent about 40 minutes with her and got everything on my mind addressed (lists help!).

I asked her how she would differentiate between kidney involvement and bladder cancer (I was on ctx for 16 months). She said the tests are essentially the same, but in the microscopy of the urinalysis, there will be other types of cells in the urine which are indicative of cancer. That would lead to a cystocopy (no fun, but not as scary as I thought it was going to be when I had my first one 2.5 years ago) and other tests to confirm the diagnosis.

We chatted about the impact of Dr. Hoffman's upcoming retirement on her. She's happy about it because she will pick up a number of new (to her) patients - all of whom have some type of vasculitis. She now only sees vasculitis patients - 12 a day, 5 days a week. She is taking new patients.

I'm holding the pred taper at 3 mg/month for the next three months while reducing mtx to 15 mg/wk (6 pills). Hope the minor side effect of light fatigue on the day after I take mtx goes away. If I have no symptoms during the next three months, I expect to either resume the pred taper or come off mtx (15 mg/wk is the minimum dose). If I had my druthers, I'd come off mtx as I have never had any issues with pred other than weight gain and occasional sleeplessness at higher doses (> 40 mg/day. (I'd also like to resume having a nice glass of wine or a cold real beer a bit more frequently than once every month or six weeks.)

At any rate, I'm grateful for the current state of my health and the excellent care I get from Dr. Villa Forte and my local PCP.