A Surprise Ending

A toast to you, my dear friend. We had a great ride together. I miss you already.
You would have been so interested in everything that happened yesterday. Here's your final EKG strip.
No more suffering....

Another puzzle bites the dust.

It went from vexing to complete in one day. Wow! And the weeks click by. Jack is halfway through the radiation treatment, and is doing brilliantly. No side effects to report. Good spirits abound. The biggest news item is probably the hickory stick Jack uses for stability when he walks. Lin says he's known as Moses in the waiting room.



The puzzle is complete!



That would be the actual puzzle, not the human puzzle which is Jack. Little joke there. Three weeks down, four to go. So far, so good. Now on to a new puzzle for the waiting room....a ROUND one!

Radiation. Finally!

Dorky but comfortable "ugly-ass pants." perfect for a 40 second zap of radiation to kill those little tumor cells.

Caregiver II gets in on the action. Lin will be in charge of getting Jack to and from his radiation treatments. She has all the unique skill sets: good driver, knows the ins & outs of hospital oncology centers, is reliable and caring. Oh, and Jack likes and trusts her. She's one of his angels...

There are two jigsaw puzzles set up in the wating room of the radiation oncology treatment center. Nice distraction. I managed to place 3 pieces.

Here's a shout-out to whomever decided to add two fish tanks in the cancer center.One is in the radiation therapy check-in area, and the other is in the treatment waiting room. If you don't want to work on a puzzle or read a 2-month-old People magazine, you can at least watch the fish.

Jack with a tattoo? Nah.

X marks the spot. These laser crosshairs mark the tattoo location (one of three) for the external positioning each time Jack gets his radiation treatment. Every time Jack sees someone with a tattoo, even on television, he asks, "Why do people get tattoos? It's body mutilation." Jack is now the proud owner of three tattoos. Ha. Ha.

A clever little trick for keeping the arms tight against his body during the scan: this ring.

Nov. 9 - Radiation Set-Up Day

Our buddy Chris started things out. He's from Pacifica and has been with Stanford Urology for years. Next, Lillian inserted the probe, through which the long plastic sticks are inserted. At their tips are the gold-plated seeds, not radiation ones. The three marker seeds are used for 3-D positioning during radiation.

Another shot

Another Lupron shot, this time the big mother. It will last for 3 months. Status quo this week. I ordered some roomier pants for Jack. He needs to have a rotation of clothes for his daily outings for radiation in November. No constriction, no metal parts, comfort.

Throw in a Kidney Stone!

Oh, why not? Yes, last week had a new twist. It was apparently a small stone, just enough to cause bleeding, and with an elevated INR (coumadin blood thinner a little too high), lots of bleeding, resulting in a clot in the ureter, which then goes into spasm, causing all the same symptoms as a larger kidney stone. At lease he was spared the excruciating pain of a larger stone scraping its way from the kitney to the bladder. It was painful enough to cause cold sweats and nausea and a trip to the Sequoia Hospital ER, since it was on our way home. Six hours later, painkillers and a urinary strainer in tow, Jack was back in bed. Now, for the cancer treatment. More hot flashes.

Fever?

I came home Friday night to a worried Jack. "Feel my forehead. I think I have a fever." Aha! I think you are finally having a hot flash! And it subsided after a while. Because Jack takes niacin supplements to increase HDL cholesterol, he's familiar with occasional niacin flushes, which can last for at least 2 hours. So hot flashes seem easy by comparison. Throw off the covers, grab a fan. Welcome to Menopause.

This is a "side effect?"

For a chronic insomniac, the warning label "May cause drowsiness" is a welcomed sight. Jack is sleeping in 5-hour stretches. Unheard of.....

A Shot in the Butt

Lupron: $2000 per shot. Just like that. No photos.

Visualize little tumors shrinking......

Well, it wasn't the best news

Yes, the cancer was outside the capsule. According to Jack's research, that makes it a Stage 4 cancer. But Dr. Schultz called and then later Dr. Hancock called. Hancock was optimistic about the capabilities of both hormone therapy and targeted radiation to knock it out. So here's the exciting photo this time:

Not much you can do about a container of pills. Wednesday afternoon 9-28-11 Jack gets his first monthly Lupron injection to go with these tablets to stop his testosterone production, thus removing the food source for the cancer. I'll let him borrow my fan for his hot flashes.

MRI on Sept. 23

Jack managed his own medical appts like a caseworker. He was scheduled for Oct. 11, then asked if he couldn't get one sooner, and then arranged for the lab work in conjunction witht the MRI (creatinine to see how his kidneys can handle the dye) for 2-1/2 hrs before. All I have to do is show up and get him to those two locations. As he pointed out, he was able to accomplish all these 8 phone calls because he got humans who answered the phone calls, not answering machines. Jack doesn't like to leave messages.

The Treatment Plan

First Jack will have an MRI to see if the the cancer has broken through the capsule and invaded the pelvic lymph nodes. MRIs can show information about soft tissue, unlike the bone scan he had last week.
Then he will have hormone therapy for 8 weeks, followed by 7 weeks of daily radiation. Hormone therapy really means "knock out testosterone" using two antagonist drugs. Testosterone feeds the cancer, so without it, the tumor shrinks and the cancer cells die.

This protocol is overseen by Steven Hancock, M.D. (below) and his resident David Schultz, M.D., Ph.D.

Finally some good news!

The bones are clear! No metastasis! This means he is now able to have radiation. Had it already spread, then only a course of hormones would have been the treatment. Now it will be hormones AND radiation. Now begins the tether to Stanford, our regular haunt daily for weeks to come.

A long day at Stanford

First Dr. Gill at 8 AM. We came with a prepared list of questions, a copy for Dr. Gill, and bless his heart, he just tackled each one down the line. That was that and we were off to radiology for a bone scan.

This is Paolo, from the Philippines. He's a teacher and technician. He injected the radioactive tracer (Technetium, who knew it was on the Periodic Table of Elements?) which circulates in the system for about 4 hours before the scan. The tracer is concentrated where there is metabolically active tissue (assume cancer) in the bone. It shows up as hot spots. Below is the machine that did that detection in about 45 mintues.

After the scan, the images were reviewed by Paolo and a radiologist Dr. Wong who asked if Jack had pain in his right hip, at the ball and socket. Sure. There's been soreness there. That called for yet another scan in yet another machine, a Spect CT--a CT scan of his hip area.

Those are Jack's arms over his head held in place by a pillow case.

By now it was 4:00. We went to the film library to pick up a CD of the images. We don't have the software to view the first set of pictures. The second set means nothing to our untrained eyes. We have to wait till Friday to get the results from Dr. Gill.

The Stanford cafeteria has gone green. All the take-out containers, drink cups, and utensils are made of recyclable materials. Utensils are of corn "plastic" and even the straws are now thin, shiny, cardboard tubes. I liked the straws very much--not so sharp in the mouth.

Has it metastasized? Gulp.

We don't know yet. Apprently when prostate cancer advances it heads to the lymph nodes and to bone. Unfortunately this is way too familiar to me and my family since we saw our father through this progression. It's not comfortable, that bone cancer. It's a deep aching pain that can't be relieved with massage.

The next step is a bone scan, set for Thursday, September 7, at Stanford. We're hoping for a cancellation before that so we can have the results early in the day when we meet again with Dr. Gill. It's hard to wait.

Biopsy

Twelve needle shots to the prostate, six of which were at numbable sites. With this information we can know the Gleason Score, which tells the agressiveness of the cancer.

The score has two numbers. The first is a number from 1 to 5 of which cell structure is the most prevalent. See above illustrations of cells in the sample tissue. The second number is which cell type is the second most prevalent type.

Bad news and bad news again: 4 and 4-or-5.

So far every new piece of information is not encouraging. We're ready for some good news.

The Good Dr. Gill

Tracey Ullman played the character Fran Rosenblum in her series Tracey Takes On. In one episode, Fran's husband Harry has had a heart attack and is sleeping in his hospital bed when Fran pays a visit. Observing the surroundings, she notices an IV line NOT connected and freaks out. Turns out it's on a back-up bag, but she doesn't know that. She runs out to the hall and yells, "Doctor! Get me a Doctor! Get me a Jew!"

Dr. Gill is Pakistani, not a jew. But he's an honorary jew. Brilliant, skilled, kind. Jack knows he's in good hands.

After Jack's physical exam, Dr. Gill said, "There is definitely something there; it isn't rubbery, which is what you want." You need a biopsy.

Dr. Gill has new glasses which lessen his resemblance to Groucho.

BPH PSA

He's always had Benign Prostatic Hyperplasia---enlarged prostate---but when a routine PSA test came back at 19, Jack said, "either I have cancer or I have one mother of a prostate." A second test for Free PSA came back at 2.5. Positive news would have been 9 indicating merely a large prostate. The low number suggested cancer.