Four weeks later, when the last Ciprofloxasin was in his mouth and he still had this pain, it was clear to us that the antibiotics hadn't worked.
Worse, when an email to the doctor (our health plan's desired way of contacting one's physician) went unanswered, I made a number of phone calls to the doctor's office, the first of which resulted in being told, Ciprofloxasin is the best antibiotic for this condition. But had the doctor diagnosed the correct condition, I wondered? at which time I insisted he be referred to a Urologist: thinking it would be the same Urologist who two years earlier had related the news to us that he had prostate cancer.
As with some health plans, doctors come and go for a variety of reasons. So, the Urologist we met with two weeks later was not the same doctor who had diagnosed his prostate cancer and subsequently referred him to the Radiation Oncologist who oversaw the radiation therapy.
At the outset, we were both pleased with this new Urologist. (I accompanied him into the examination room.) The Urologist appeared confident and competent. (How does one conclude this in a first meeting I wonder? Naivete on the part of the patient?)
Another urine specimen was examined; this time there was some concern about the fact that Ciprofloxasin had not killed the bacteria and that numerous pieces of protein (tissue) were in the specimen, along with some blood. While the Urologist did not refer us to the Radiation Oncologist at this time, he seemed to hear our comment that we suspected this might have something to do with the radiation treatments. Maybe I should have insisted. Definitely I should have been more cautious.
The Urologist performed an in-office test: a cystoscopy (bladder scope) used to determine the health of the urethra and the bladder. We were out of our league; at the mercy of the doctor and his knowledge, diagnosis, and recommendations.
The Urologist told us he had seen a growth in the bladder that could be a cancer or it could be something resulting from the radiation. Either way, he said, I need to do a bladder biopsy. It would be simple, an out-patient procedure, he assured us, at a local hospital. It should be done tomorrow.
From that moment, we were in a race to get a lot of things done, and he wasn't feeling strong. Over time, pain wears one down; and he'd been experiencing a lot of pain for three months. Although he'd been prescribed Vicodin (Hydrocodone bitartrate and acetaminophen), it had not alleviated the pain.
But we got it all done that day: visiting the hospital to complete their admission forms and make the co-pay, visiting a number of facilities to have lab tests performed, picking up more prescriptions at the pharmacy, and finally arriving home at the point of exhaustion. We had the help of a relative who did all the driving; without that help we'd have been in deep doo-doo.
So, all we had to do now was get some rest and make it back to the hospital in the morning for the bladder biopsy surgery.
Piece of cake.
Tuesday, March 29, 2011
2. A pain, a doctor, a diagnosis
Late in 2010, a year and four months after he'd finished the last radiation treatment, he first spoke up. Typical of many males, he'd waited more than a month before he told me he'd been having this pain.
That's what he called it: this pain.
I can't exactly describe it, he said. It's just this pain when I urinate. Well, actually, after I finish. Then, there's this pain.
I immediately recalled a pain I'd had many years earlier. The doctor had diagnosed it as cystitis. So, I told him about it, describing it as a spasm that occurred the instant I finished urinating, as if more urine wanted to be released, but couldn't. A urinary tract infection, I said. Then, You've got to see a doctor.
He reluctantly agreed, and we made the appointment.
Let me add a disclaimer here: most doctors don't have a clue about what happens to the human body during or after radiation treatments for cancer; they only know the procedure works--it cures the cancer and keeps the patient alive.
So, although we didn't realize it at the moment, we didn't have a high expectation that the doctor would arrive at the right diagnosis.
The doctor behaved normally at the appointment (and I regret that I didn't insist on accompanying him into the examination room); took the usual vitals; asked a few questions (but didn't listen to the answers); took a urine sample and ran a cursory check on it. A Urinary Tract Infection, the doctor said after seeing bacteria, blood, and protein in the sample. I'll send the sample to the lab for a more thorough test. And here's a prescription for an antibiotic: Ciprofloxasin. It will kill the bacterial infection.
If I'd been in the examination room, I'd have asked when he needed to come back for a follow-up.
There was no follow-up. There was no referral to a Urologist. And even though his medical record showed HISTORY OF CANCER and even though he told the doctor, I think this might be related to the radiation treatments I had a year or so ago for prostate cancer, there was no referral to the Radiation Oncologist.
So, he and I were on our own to determine if the antibiotic was working. It's a scary feeling to realize that one's doctor is too busy to pay close attention to one's health issues.
That's what he called it: this pain.
I can't exactly describe it, he said. It's just this pain when I urinate. Well, actually, after I finish. Then, there's this pain.
I immediately recalled a pain I'd had many years earlier. The doctor had diagnosed it as cystitis. So, I told him about it, describing it as a spasm that occurred the instant I finished urinating, as if more urine wanted to be released, but couldn't. A urinary tract infection, I said. Then, You've got to see a doctor.
He reluctantly agreed, and we made the appointment.
Let me add a disclaimer here: most doctors don't have a clue about what happens to the human body during or after radiation treatments for cancer; they only know the procedure works--it cures the cancer and keeps the patient alive.
So, although we didn't realize it at the moment, we didn't have a high expectation that the doctor would arrive at the right diagnosis.
The doctor behaved normally at the appointment (and I regret that I didn't insist on accompanying him into the examination room); took the usual vitals; asked a few questions (but didn't listen to the answers); took a urine sample and ran a cursory check on it. A Urinary Tract Infection, the doctor said after seeing bacteria, blood, and protein in the sample. I'll send the sample to the lab for a more thorough test. And here's a prescription for an antibiotic: Ciprofloxasin. It will kill the bacterial infection.
If I'd been in the examination room, I'd have asked when he needed to come back for a follow-up.
There was no follow-up. There was no referral to a Urologist. And even though his medical record showed HISTORY OF CANCER and even though he told the doctor, I think this might be related to the radiation treatments I had a year or so ago for prostate cancer, there was no referral to the Radiation Oncologist.
So, he and I were on our own to determine if the antibiotic was working. It's a scary feeling to realize that one's doctor is too busy to pay close attention to one's health issues.
Thursday, March 24, 2011
1. Prostate cancer and radiation. The beginning ...
This is a true story. It is meant to help others who are experiencing or have experienced similar circumstances with radiation being both cure and enemy, and who are now searching for answers.
Two years ago, in the Spring of 2009, he was diagnosed with prostate cancer. Not unusal, since it's said that most men, if they live long enough, will develop prostate cancer. That's the bad news. The good news is, medicine has advanced to a point where most prostate cancers are cured. Treatments range from wait-and-see to the surgical removal of the prostate. Wait-and-see was not an option for him; his cancer had spread throughout his prostate. The prognosis was good, however. His oncologist said it could most likely be cured.
His options at this point were surgery, external radiation, or radioactive seed implantation. I'm not sure now why he chose external radiation; at the time it seemed the best option: the one that would provide the most satisfactory outcome with the fewest and most moderate side effects. Little did we know.
External beam radiation treatments for prostate cancer fall in the category of medical marathons. At the outset, the number of treatments didn't seem like a lot, even when spelled out clearly to him. Even the fact that we lived 50 miles from the cancer center (and those 50 miles consist of a winding two-lane canyon road from the mountains to the valley below) didn't seem daunting. Not at first. Not until we'd driven it every day for a week, then thought about the remaining 40+ treatments.
I've chosen to skip ahead, to bypass the actual radiation treatments. Instead, if you're curious about these, I will provide links that speak to the subject of radiation for prostate cancer. Since the medical arena is always evolving, by the time you read this, some of the methods will have changed. At the time of his treatment, however, this is what was available. State of the art. As quoted from UC San Diego Moores Cancer Center website: ".... External beam radiation uses a special machine to aim a high dose of radiation directly at the cancer cells and a small portion of healthy tissue at the margins of the tumor. In exernal beam radiation, the machine circles around the body, sending radiation from many directions to the exact part of your body that needs it. External beam radiation usually involves 15 minute treatments, done once a day, five days a week, for about six to eight weeks...."
I'd been told about the treatment equipment. I'd experienced bone density tests so was familiar with a piece of medical equipment revolving around my body. The radiation machine at the cancer center was something else again, appearing an ominous monster when I first saw it. Before the treatments started, I sat with him through consultations while a radiation oncologist intoned everything we wanted to know about prostate cancer and its cure. He told me about the measurements the radiation staff took. He told me about the pads they created especially for him to make sure he would be comfortable on the table but wouldn't move. He told me about, then showed me the tattoos they made in his groin area: black dots that would show the radiologist where to aim the beams so they would destroy the cancer in the prostate and do little or no damage to surrounding organs and tissue. A medical art, or so it seemed. We felt secure. See Stanford University Cancer Information/Description.
When the treatments began, we were innocent babes, and even while sitting in the waiting room and gazing at the faces of other males who were in the beginning, middle, or last stages of treatment ... we could not imagine the toll it would take on us: physically, mentally, emotionally (maybe if I'd looked closer at those faces, I would have seen our future). First, making the 50-mile drive to the cancer center was tiring and emotion-filled. He drove down the canyon to the center; I agreed to drive back up the canyon and home. After a few treatments, we saw the wisdom in this decision; the radiation was beginning to leave him exhausted, physically and emotionally depleted.
We ate little in those weeks. It was all we could do to pull ourselves up each morning by our bootstraps, and face yet another 100-mile roundtrip. When we got back home, we often fell into bed and slept through to the next morning. Life went on around us. Yet our lives were filled with this new priority: make it through the next treatment, then the next, the next, and hopefully to the last.
That's all we had: hope for the future. Hope that he would be cured. Hope for some future years together where we could both enjoy a high quality of life. It was worth it going through this challenge to reach that goal. After all, that's all we really wanted: a decent quality of life to enjoy in our retirement years.
Then, finally, one day it was over. Although he still battled issues with "his plumbing" and lack of appetite, which meant he lost a lot of weight, the doctors gave him a clean bill of health and added into his medical record: HISTORY OF CANCER. Meaning, the cancer was gone. Now, all he had to do was get his strength back, get his plumbing working again, and show up regularly for his PSA blood tests. His PSA level had gone from somewhere in the high 20's to .01. A miracle, we decided.
Worth every minute of those 44+ treatments, those 88 50-mile trips to the cancer center, those days and nights that seemed to never end ... but that finally did. And we were home free.
Or so we thought.
Two years ago, in the Spring of 2009, he was diagnosed with prostate cancer. Not unusal, since it's said that most men, if they live long enough, will develop prostate cancer. That's the bad news. The good news is, medicine has advanced to a point where most prostate cancers are cured. Treatments range from wait-and-see to the surgical removal of the prostate. Wait-and-see was not an option for him; his cancer had spread throughout his prostate. The prognosis was good, however. His oncologist said it could most likely be cured.
His options at this point were surgery, external radiation, or radioactive seed implantation. I'm not sure now why he chose external radiation; at the time it seemed the best option: the one that would provide the most satisfactory outcome with the fewest and most moderate side effects. Little did we know.
External beam radiation treatments for prostate cancer fall in the category of medical marathons. At the outset, the number of treatments didn't seem like a lot, even when spelled out clearly to him. Even the fact that we lived 50 miles from the cancer center (and those 50 miles consist of a winding two-lane canyon road from the mountains to the valley below) didn't seem daunting. Not at first. Not until we'd driven it every day for a week, then thought about the remaining 40+ treatments.
I've chosen to skip ahead, to bypass the actual radiation treatments. Instead, if you're curious about these, I will provide links that speak to the subject of radiation for prostate cancer. Since the medical arena is always evolving, by the time you read this, some of the methods will have changed. At the time of his treatment, however, this is what was available. State of the art. As quoted from UC San Diego Moores Cancer Center website: ".... External beam radiation uses a special machine to aim a high dose of radiation directly at the cancer cells and a small portion of healthy tissue at the margins of the tumor. In exernal beam radiation, the machine circles around the body, sending radiation from many directions to the exact part of your body that needs it. External beam radiation usually involves 15 minute treatments, done once a day, five days a week, for about six to eight weeks...."
I'd been told about the treatment equipment. I'd experienced bone density tests so was familiar with a piece of medical equipment revolving around my body. The radiation machine at the cancer center was something else again, appearing an ominous monster when I first saw it. Before the treatments started, I sat with him through consultations while a radiation oncologist intoned everything we wanted to know about prostate cancer and its cure. He told me about the measurements the radiation staff took. He told me about the pads they created especially for him to make sure he would be comfortable on the table but wouldn't move. He told me about, then showed me the tattoos they made in his groin area: black dots that would show the radiologist where to aim the beams so they would destroy the cancer in the prostate and do little or no damage to surrounding organs and tissue. A medical art, or so it seemed. We felt secure. See Stanford University Cancer Information/Description.
When the treatments began, we were innocent babes, and even while sitting in the waiting room and gazing at the faces of other males who were in the beginning, middle, or last stages of treatment ... we could not imagine the toll it would take on us: physically, mentally, emotionally (maybe if I'd looked closer at those faces, I would have seen our future). First, making the 50-mile drive to the cancer center was tiring and emotion-filled. He drove down the canyon to the center; I agreed to drive back up the canyon and home. After a few treatments, we saw the wisdom in this decision; the radiation was beginning to leave him exhausted, physically and emotionally depleted.
We ate little in those weeks. It was all we could do to pull ourselves up each morning by our bootstraps, and face yet another 100-mile roundtrip. When we got back home, we often fell into bed and slept through to the next morning. Life went on around us. Yet our lives were filled with this new priority: make it through the next treatment, then the next, the next, and hopefully to the last.
That's all we had: hope for the future. Hope that he would be cured. Hope for some future years together where we could both enjoy a high quality of life. It was worth it going through this challenge to reach that goal. After all, that's all we really wanted: a decent quality of life to enjoy in our retirement years.
Then, finally, one day it was over. Although he still battled issues with "his plumbing" and lack of appetite, which meant he lost a lot of weight, the doctors gave him a clean bill of health and added into his medical record: HISTORY OF CANCER. Meaning, the cancer was gone. Now, all he had to do was get his strength back, get his plumbing working again, and show up regularly for his PSA blood tests. His PSA level had gone from somewhere in the high 20's to .01. A miracle, we decided.
Worth every minute of those 44+ treatments, those 88 50-mile trips to the cancer center, those days and nights that seemed to never end ... but that finally did. And we were home free.
Or so we thought.
Subscribe to:
Comments (Atom)