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Wednesday, October 22, 2014

Keeping the pain at bay

Marshall is having some pretty bad pains in his back and the only thing that will relieve the pain is oxycodone. So he's been taking oxycodone several times a day. We've been concentrating on pain relief, laying low and getting rested.

Nothing else to report right now.


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Monday, October 20, 2014

Radiation

We got up at 4:45A this morning and headed to Denver for our appointment with the radiation oncologist, Dr. David Raben. He and his associate, Dr. Chad Rusthoven, put up all of Marshall's scans and x-rays and pointed out the "hot spots." They took as much time as we needed and we really liked both of them.

There were two hot spots that they said need attention now. One in the spine and the other in the left hip. Both are places where Marshall has been having some pretty bad pain which has caused him to be on every-six-hour oxycodone.

Dr. Raben is going to talk to Dr. Flaig to see if they think it's necessary to see an orthopedic guy first to check the strength of the hip area before radiating it. He said his opinion is that the area is strong enough to handle the radiation without fracturing but he wants other opinions on that.

Assuming we don't have to see an orthopedic doctor first, we have an appointment for next Wednesday with Dr. Raben to get the radiation areas "mapped" and start preparing for the actual treatments. Then, if everything goes as planned, we will be given our radiation schedule. Dr. Raben says it will be between 5 and 10 treatments (to be determined later) given daily (not sure if that includes weekends or not). So we will just move up to the hotel for that period of time because it is right across the street from the hospital.

If anyone remembers Marshall's last radiation sessions two years ago, you will remember he developed severe radiation colitis which put him in the hospital for three days.  Dr. Raben has promised us that won't happen this time....

Also next Wednesday, we will get lab work done and then we see the Nurse Practitioner to get the results. They want to keep close tabs on the blood counts now that Marshall is on the chemotherapy pill. And I am guessing they will also check the PSA again to see if the chemo has had any effect yet.

We asked if getting chemo and radiation at the same time could cause any problems and both doctors said no, that was actually a really good approach.

So far, Marshall has been experiencing EXTREME fatigue, but no other side effects of the chemo have shown up. Let's hope it stays that way. And we are told that the radiation will probably also add even more fatigue to the mix.

Now we move on to our older dog, Marlee. He is deaf and partially blind and he has some doggie dementia. He walks into corners and can't figure out how to back out of them, when he goes outside he can't figure out how to get back in the house, he falls a lot, etc. etc. But he does not appear to be in any pain. We've done a bit of crying over this because it probably won't be very long before we have to make a decision about him. It is heartbreaking. We're going to get him to the vet this week to have her check him out. It just kills us to leave him behind when we are in Denver for long periods of time because we want to spend time with him.

That's the story for today. It was a very long and emotional day. I had to ignore my job today and I thank the gals who covered for me even though they were already being pulled in ten directions.


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Sunday, October 19, 2014

3rd day of chemo

Marshall has now taken the chemo pill for three days (and the prednisone was reduced to 4mg twice a day instead of 5mg twice a day -- I think they may wean him off of the prednisone) and so far the only possible side effect he feels is fatigue.  But he's had that all along with the other medications, too, so not sure if it's the chemo or not.

The pain he was having in his back has let up.  He didn't take any oxycodone today at all.  So it probably was stress related.  He does still have the hip pain when he moves in certain ways.

Tomorrow we need to get up at 5AM to hit the road back to Denver to see the radiation oncologist and find out what our plan of action is going to be.  Boy, I wish we could just say "Beam me up, Scottie" for these trips to Denver!

Tonight we got on the internet to see what rent costs are in Denver so that maybe we could rent an apartment and we could take our animals with us on these trips rather than agonize over trying to get a dogsitter.  But the rents are pretty high so that may not be an option for us.

Through an interesting series of events, we were able to get a second opinion on Marshall's treatment.  Our oncologist is Thomas Flaig.  Dr. Flaig's boss is Dr. David Crawford at the University Hospital.  It turns out that Dr. Crawford knows Fred (my boss).  A few weeks ago Dr. Crawford was coordinating a big charity golf tournament to benefit prostate cancer research and I got a call from Wendy, a gal who works with him.

Wendy and I talked a lot while coordinating Fred's foursomes for the golf tournament and last week when we were at the cancer center Wendy met us for lunch.  She brought Dr. Crawford with her!  So I couldn't resist asking his opinion.  He said he would check Marshall's records and let us know what he thought.

He sent me an email last night saying that he agreed with Dr. Flaig's plan of action but there was one other drug that he might suggest to add to the mix.  He said he would talk to Dr. Flaig about it and they would get back to us.  That was kind of cool.

And it turns out that Wendy is a patient advocate for many doctors and medical facilities so she is going to be a huge resource for us.  She brought us a ton of information when we met.  We were very fortunate to make her acquaintance.

Off to bed -- tomorrow will be a long day.

Thursday, October 16, 2014

Radiation and chemo

On Wednesday, Marshall saw the dentist. He worked on the dentures some more and Marshall said they felt pretty good when we left the office but within a few hours -- and after eating lunch -- the pain was back. So we will need to see him again.

This morning he got lab work done and then we saw the oncologist. The PSA is now up to 33. Dr. Flaig brought up the scans taken this week and compared them to the scans taken last month and on the bone scan there is a new area in the mid-back. However, when he looked at the CT scan, that new area didn't show up. He said that CT scans take over a thousand images but they can still miss things.

And there is cancer growing in the left hip area.

Dr. Flaig said that even though the PSA is rising, the progression of the cancer is fairly slow. But he says it is time to move on to new treatments. So we are discontinuing the Zytiga immediately.

And he scheduled us with the radiation oncologist to get radiation on Marshall's left hip. We see him on Monday to get it in place.

Then he said there are three options for going forward:

1. A new drug called Xtandi. Dr. Flaig does not recommend Marshall going on Xtandi because a small percentage of men have had seizures as a side effect and have fallen and fractured a bone, which in his words would be "devastating."

2. Old-fashioned chemotherapy (docetaxel) by infusion. Dr. Flaig does not recommend this either because he thinks Marshall has weakened over the past 2-1/2 years and that this type of chemo would weaken him more and make it more likely that he might fall.

3. Chemotherapy by pill (cytoxin). This is what Dr. Flaig recommended, so we are starting cytoxin tomorrow. He said that compared to the docetaxel, the cytoxin is a VERY low dose and the side effects should be minimal. He also said that the cytoxin works in about 40% of men. Marshall will be monitored every three weeks to check his blood counts and kidney function.

So we went to the pharmacy at the hospital and got the cytoxin prescription filled and we had to pay $181. Good grief.

We talked to the doctor about the excruciating pain Marshall has been having and he said that the way Marshall describes the pain it sounds muscular to him. He recommended taking 2 oxycodone every 6 hours and seeing if the pain lets up over the next few days. I personally think the pain could be related to stress (he's been worried about this visit for 5 weeks). I think it will let up now that we have a plan of action.

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Tuesday, October 14, 2014

Scans are done

We got to the hospital at 9:30 and by 1:30 his scans were all done and we headed back to the hotel.

As usual, they had a tough time finding a vein for the port and he had to be sent to the experts who use a computer of some sort to locate a good vein. He was in a much better frame of mind than he usually is for these scans, but he still has a lot of pain so he was taking Ativan and a muscle relaxer, as well as 4 Advils every 4 or 5 hours.

Tomorrow is the dentist and it's not till 11:45 so we get to sleep in and then we will have the afternoon free.



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Monday, October 13, 2014

Getting ready for tomorrow

We made it to Denver and are in our hotel. Trying to stay calm while waiting for tomorrow's tests. Marshall has been having LOTS of pain and has a swollen area in the left part of his back. Scary.

We need to be at the radiology department tomorrow by 10:00A so that he can get prepped for the various scans and tests. We should be done by 2:00.

We will try to relax the rest of the day. Wednesday is the dentist appointment. The dentures just aren't working out and Dr. Dhawan has stayed in touch with us to have Marshall come back in and try to figure out what's going wrong.


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Sunday, October 12, 2014

Back to Cancer Center

We will be there all week to see where we stand and what we do next. Keep Marshall in your prayers.


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