Home and Exhausted

Slept a solid 8 hours last night and was going to see Dr. Bob this AM but realized that due to the chaos of the week, my car and keys are at brother Ed's.  So Ima reschedule with Dr Bob...he'll totally understand.  I just might actually need a bit more sleep.  Besides, he called me at the hospital yesterday and had a good conversation, one in which he expressed how pleased he was that Dr. Kaspar was my new oncologist.  He stated "I trust him like you trust me." Pretty damned good recognition.  More sleep.

Software, Possibilities Part II

Whizkid pulmonary guy found that Seton SW didn't save the CT views he needed.  So I'm about to get a new CT Scan which Whizkid guy will then analyze and determine by Monday if I'm a good candidate.  If I am, then we'll schedule the procedure next week.

Yet another stop on The You May or May Not Have Prostate Cancer Hurry Up and Waite Train,,,,,,,,,

Thursdays, Lesions, Software and Possibilities

Possible check – out today.  The gold standard would be to have one of these small (.8mm) lesions in my lung biopsied to see if it’s the same cancer as in the prostate or a different pathology altogether.  Why this is important in just a sec.   We tried the standard needle biopsy (handled well and hardly felt a thing under the good hands of Dr. Chia) but alas, he was unable to grab that little bugger!  But, there’s a pulmonary whiz kid with his high falluttin’ software that can map a path to one of the eligible samples so that the biopsy can be done using my own, naturally existing, web-like bronchial pathways rather than dissecting a slice of lung, via a meat cleaver.  I prefer the former.  It will take him a day or two to fit me into his schedule to see if it can be done in my case and, then, if it can, a day of so to schedule the Videos Assisted Mapped Pulmonary surgery.

This is important because if the cancer from the prostate is the same as that of what’s in the lung, my options for treatment are much fewer as you are basically treating Stage 4/End Stage PC that has escaped the gland.  If the cancer is different, surgery and radiation remain options that I could choose, giving me the possibility of being cancer free after some pretty brutal treatment.  Send visions of seeing this tall, white, high paced skinny surgeon doing has magic and grabbing a piece of different, easily treatable tumor please!

5 Nights at Seton and It Doesn’tz Lookz Any Betterz Folkz

Late Saturday, after having increased abdominal pain deep down in the area of one’s prostate, Derrell finally took me to Seton Southwest  Hospital where they fully narcated me (is narcated a word?) Either way, I felt nothing on that old 1-10 scale thing.  They also did a CT scan of my lower abdomen and when you shoot the lower abdomen on a short guy, you pick up the bottom lobes of the lungs.  Funny things about my lungs is they had all these little black dots…(up to 8mm in some cases)……suspicious by any standards so, they did a full chest CT and turns out my lungs have about 19 of these odd blue dots.  Not much happens in hospitals during weekends (“We’re open ugh 8-5, Monday through Friday only folks …….unless you are in the imminent process of dying”).

So with two lungsfull of odd black dots, I then get the pathology reports from the biopsy.  Gleason Scale 8 (Gleason1-6 nothing to worry about and often debated as to whether the term cancer should be used at all) with 7-9 being progressively worse.  Mine’s a strong 8, quite aggressive and  has escaped the prostatic shell.  They attempt to do a biopsy of my lungs and I am heavily sedated.  They can’t quite get the piece of tissue they want and decide to try again for another  time under total sedation where they can get  a full sample. Tests are also run to determine if there has been metastasis to my bones.  The theory is that I am one of very, VERY few men who have used finasteride (i.e. Propecia) and not only went on to get PC but a very aggressive form of PC that  has moved to places PC doesn’t usually metastasize to (i.e. the lungs).

Oncologist Dr. Peter Kasper has just come to pay a visit and feels we must first focus on what’s going on with the lungs. The bone scan came back negative so at least for right now, there is no need to worry about bone involvement.  Next stop on the Train:  More Pulmonary Work!

Can Cannabis Oil Cure Prostate Cancer?

If I lived in a civilized state, I'd be a candidate.

http://www.prostate.net/2013/prostate-cancer/can-cannabis-oil-cure-prostate-cancer/

Not safe for the delicate

So they poked umpteen holes in my P yesterday and the way the get there is via the rectum. I don't remember any of this as the kind medical professionals drugged me into oblivion. I was told to expect blood in my urine which there was although it has decreased quickly.

What no one mentioned was that perhaps when I had that First of the Morning My Partner Has Left the House So I Can Safely Get a Bit Flatulent Without Bothering Anyone moment, I should have done so on the throne as opposed to while standing in my nice white W Hotel robe on the white tile downstairs. Reminded me of a Scorsese movie or what it might be like for a young woman on her first period. At least it was tile and not carpet.

Post biopsy

Largely uneventful because I have a good Uro using MRI guided mapping to guide his biopsy needles into the tumor (although as large as this beast is, he'd have had a hard time missing). Because I was sedated with versed, fentanyl and Michael's favorite, propofol, it was pain free and was over before I knew it. Very little bleeding either rectally or in my urine. Did have some post procedure pain which they jumped right on. Now I'm home and fed and resting a still having some pain that is easily controlled with the meds  he was thoughtful enough to call in.

So we'll find out Weds the Gleason score and just how aggressive this bad boy is. What treatment options I'm eligible for, how soon to start,, etc, etc. I'll meet with Dr. Bob to discuss the whole thing and get his input......and then will begin the process of second opinions of diagnosis, pathology and BRI.

Based on a couple of friemds who had nonsedated biopsies and numerous online postings about the gut wrenching pain that can accompany them as well as huge blood loss, I feel like I made the right decision to be sedated and the extra cost was worth every penny

Up and off for the biopsy

Nothing to drink or eat, a shower and a Fleets. Lovely way to start the day but the nurse, Stacey, assured me last night she'd start an IV stat and fill in with Schedule 2,3 and 4 RXs as soon as I got there. I like the way she thinks.

Thank god for Dr. Bob

Dr. Bob called to check on me after he'd read the full MRI report. His comments were (in a loving way) "well, you've never done anything half assed." He also insisted (suggested strongly) that he and I have an appointment after the post biopsy Giesler appointment. But the best thing he said to me and the reason I am so blessed to have him as my physician is he said, "Scott, know that I'll be right next to you through this whole journey." Too bad there aren't more Dr. Bobs.

Just pissed

I'm angry. Really angry. For well over a decade Dr. Bob and I have gone through the yearly physical including PSA and DRE. Always normal until a year ago. Now it turns out that I have a tumor that encompasses damn near the whole gland and is "extracapsular" (i.e. has escaped the prostate) not to mention it abuts one set of nerves that control erection. I'm 52. I have a sexy, young partner. Once this prostate is removed, it's unlikely I'll ever have an erection again. I just want to scream and throw things. I'm so fucking angry.

Bad news.........It's no longer a case of "may" have cancer

Derrell, Dr. Giesler and I reviewed that MRI films and, as is stated in the radiology report, "There is what appears to be fairly extensive tumor throughout the gland." "In the right peripheral gland there is a probable tumor throughout the peripheral gland and extending into the transitional zone and likely central gland extending from the apex to the base."
"Similar findings are seen on the left posterior peripheral gland. On the right at approximately the level of the mid gland near the apex there is likely extracapsular extension (i.e. it's not contained inside the gland, but has moved outside of it) and the tumor abuts the right neurovascular bundle (i.e. one of the two sets of nerves that control erectile function." Dr. Giesler's best guess is that it's a fairly aggressive tumor. We'll know more after the pathology reports from the biopsy Thursday morning.

Bottom line, I have prostate cancer, a relatively large tumor and there's a strong chance it's very aggressive.  To say that I'm emotionally devastated would be an understatement.

One amazingly bright spot from the weekend........but off to the Dr's to see the MRI images in a hour.

I had the exciting honor of being one of four men invited onstage with the unbelievable Patti Labelle and she allowed me to tell of ten years ago waiting tables at a party she was singing at and having her wave at me from her limo and when I yelled "I love you Miss Patti," she rolled the window down and yelled back "I love you too darlin'!" On stage with her Saturday night, she told me she still loved me and gave me a heartfelt hug. Little did she know how much I needed that. And then she and I sang a couple of lines for Lady Marmalade.

But back to reality as I see the Uro in an hour to review the MRIs and discuss Thursday's biopsy.

Checking out.

Tonight, Derrell and I are checking out, mentally and physically. Between the MRI results last week and the upcoming biopsy, all either of us has done is worry. Tonight is a worry free zone. We are going to SA to celebrate his birthday/Valentines/the fact we are both lucky and alive. We will see the one and only Miss Patti Labelle....and I found a good (not great) rate at the Grand Hyatt on the Riverwalk. The stress of potential PC doesn't just affect me, Derrell struggles with it too......but tonight, just relaxation, Miss Patti, kindness to others, love and company of each other. Have a good night peoples :)

My visit with my Dr. Bob

I had an appointment with my long time PCP, Dr. Stonecipher ("Dr. Bob") yesterday. He'd not yet seen the MRI report that I will discuss with the Uro on Monday, but he, being the straight shooter that he is, basically told me that the question really is no longer if I have PC, but rather what grade, how large and how aggressive. When asked what treatment he would have if it were him, he stated just plain old fashioned open radical prostatectomy. He felt that in the hands of a surgeon who'd done a thousand or more the chances for completely removing the cancer were the best and that in his experience most of his patients who had undergone the surgery regain erectile function (as long as the nerves could be spared) and quickly regained continence although a few would wear a pad when doing strenuous exercise.

I rarely disagree with Dr. Bob but my reading is that treatments such as Hi Intensity Focused Ultrasound, cryotherapy, focal laser ablation made more sense to me due to their lower incidence of the wretched sexual and urinary side effects. He made the argument that there weren't enough long term studies to show that the cancer was fully removed and that at my age, I should have as my number one goal complete removal of the cancer from my body.

I'll know more Monday after the Uro reviews the MRI with me and certainly more after the biopsy. Dr. Bob walked me to the door and put his arm around my shoulder and told me that whatever treatment I chose, I'd have his full support. He gave me a hug and I said with my voice quivering and eyes welling with tears, "Thanks for being my doctor." He replies with all sincerity, "It's my honor Scott." I've stumbled into a great job, I stumbled into a great relationship and I stumbled across one of the best family/personal physicians in Austin. The honor is mine, Dr. Bob.

MRI Results back.........."Highly suspicious for tumor"

At my request, Dr. Giesler called with the results of the MRI. "We need to move forward with the biopsy. The nodule I felt (and the two other Dr's had felt) is highly suspicious for a tumor." Meeting with him Monday to review the MRI and he's scheduling a sedated biopsy on Thursday. The train keeps chugging on down the track..............

MRI done....but bad reaction to injected contrast.

I had my 3T MRI this morning and as I was getting dressed to leave, became nauseous. Long story short, they kept me for a bit until I assured them I could drive home and then I came home where I have stayed all day. I should have a radiology report in 245 hours or so.

Courtesy Reminder Call for MRI Tomorrow

I nice gal from Austin Radiological Association called to confirm my 8:30am appointment for the MRI of my prostate in the morning. After assuring her I planned on being there, she went over the list of prep:

• 32oz of water this afternoon between lunch and dinner (on my first 12oz can post lunch as I write this) • Non-dairy based soup for dinner • Between 5-9pm, 2 Dulcolax • After dinner, only clear liquids until the MRI (white wine counts as a clear liquid, right?)

I should be grateful I guess. With the new 3T MRI, the use of an endorectal coil is no longer necessary. But an IV with contrast is. Ce’st la vie.

Medical Marijuana use for Prostate Cancer?

http://www.prostate.net/2013/prostate-cancer/medical-marijuana-for-prostate-cancer/

Sometimes you just cry.

I find myself weeping this afternoon. Just sobbing. I ask out loud, "Why me?" as I'm sure anyone faced with the threat of deadly and/or life altering disease asks at some point. And then you just cry. You just cry.

MRI scheduled

My 3T MRI of the prostate has been booked for Wednesday morning, February 12th at 8:30am. My out of pocket is $715 which applies to my $2000 deductible. Even with "great" health insurance my company offers, the deductible and $55 dollar specialist copays will eat you up financially.

Post Dr's visit report

Moving forward with 3T MRI. If the MRI shows suspicious areas, then will move forward with biopsy targeting those areas. The urologist, Dr. Richard Giesler, has been very cautious and thoughtful during this whole process and has impressed me with his reluctance to do anything invasive unless he's absolutely sure it's required. He also understands my desire to move forward and know exactly what I'm dealing with. Additionally, he answered my questions about the radiologists he uses and satisfied my concerns that they are well versed in reading prostatic MRIs. When asked about past patient's with similar PSA trend, FreePSA score and abnormal DRE's as to the percentage that actually had PC, he replied about 55%....so based on that, I have almost a 50/50 shot that it's not PC. There could be worse odds and they were better than I expected.

My body's reaction to stress

Despite comfort and love from Derrell, a good bit of Bulleit bourbon and trying to calm myself, I didn't sleep well last night. In addition to being very tired at work and quite unfocused, I find myself sweating in our slightly chilly office. One thing is certain, at tomorrow's meeting with the urologist, I will insist that we move forward with MRI and then biopsy. I need to know what I'm facing. Soon.

Test results are in and my numbers went the wrong direction.

I called the urologist's office after lunch today and was given my PSA test results. The level had increased from the 4.9 n/ml in late October to 5.2 n/ml. Despite doing everything I could to give my prostate a fair shot at a reduced reading (eating fish and veggies all month, taking a variety of supplements known to have a positive effect on the gland, no ejaculation for the 3 days prior to the blood draw, regular exercise), the trend continues upward. The doctor's office moved my February 18th appointment to two days from now to discuss the next steps. These are likely an MRI and then a biopsy guided via the images from the MRI. Every test has gone the direction of this being cancer. The PSA tests, the trajectory of same, the FreePSA test, 3 different physicians who can feel irregularities/nodules on the upper right quadrant, having zero symptoms of Benign Prostatic Hyperplasia (BPH)...........these all coupled with my use of Finasteride to prevent hair loss just don't bode well. I am shaking. I am angry. I am scared as hell. Trying to focus on anything work related is all but impossible.