Tuesday, June 26, 2012

Oh, boy, here comes juicy part about prostate cancer treatment

One typically harvests in the fall, not sows with seeds in autumn.

In my case, though, dumping about 80 radioactive titanium pellets - called “seeds” in official oncology parlance - into my slightly larger-than-walnut-sized prostate gland on Sept. 10 will be a good thing.

Finally, after week after seemingly endless week of visits with white-coated doctors talking about the black threat of cancer, a date with the surgery room was announced.

Only that Dr. Jon Prescott bulks at calling his seed-sowing work surgery. If anything, the good radiological oncologist fumes about surgery the way a surgeon might dismiss anything else but.

What’s going to happen on that date is something called a “brachytherapy,” a really fancy word with all kinds of Greek-to-me meaning.

In this hour-long procedure I’ll be wheeled into an operating room reserved just for me - and probably several other men in need of Prescott’s handiwork that day - and be conked out with some sort of happy juice.

Good thing, too, as what will come next is not really something that I have any desire to undertake while awake and kicking.

During a brachytherapy procedure the unconsciousness male (this is after all, a guy thing) is laid out on his back. His (my) legs are then spread-eagle-split-apart while the feet are harnessed into stirrups.

Yep, if you think this is just how a woman undergoes a pelvic exam you’d get a lollypop from a doctor.

It’s really the closest thing a man can get to experiencing child birth, though in all honesty us guys are fast asleep while the women folk are very much awake.

Yeah, we may be wimps but we’re SMART wimps.

For the next hour Prescott will work with my urologist Dr. Lawrence Wolcoff in a two-person tag-team. Their collective goal is to hunt down and search out the cancer during their seek-and-destroy mission.

A ultrasound fluoroscopic device will be inserted into my rectum, guided the short distance to the nearby prostate gland. This tool will help lead the doctors to the promised land where the nasty business of cancer is found.

Prescott will make a minimalist insision into what's called the "perineum," that piece of flesh located just down the street from the scrotum and slightly up hill from the rectum.

He'll then employ his dart gun, so speak. He’ll fire the 80 or so roughly rice grain-sized pellets, each of them strategically placed so as to maximize the power of the Iodine-125 radioactive isotope that is the delivery system’s warhead.

In brachytherapy’s Dark Ages of the 1960s and 1970s doctors would install seeds indiscriminately. That shotgun approach left useless gaps and seed overlays.

Such random, hit-and-miss procedures didn’t help brachytherapy’s reputation. That is, until starting in the 1980 and working through the 1990s the researchers hit on the capital idea of accurate targeting.

Seed implantation further blossomed in the full sunshine of the 21st Century.

Now, says Prescott, for men with early stage prostate cancer like what I have, the 10-to 12-year survival rate by undergoing a brachytherapy is equal to or better than the radical surgical removal of the prostate.

Thus, the one-time “gold standard” for curing prostate cancer - surgery - is being outrunned and outgunned by sending in the titanium canisters with their fully primed radioactive isotopes.

It’s going to take some time for the radiation to work, of course. What it does is not kill the cancer cells outright as much as the radiation destroys their DNA. This prevents the cancer cells from reproducing.

Then too, says Prescott, there are fewer adverse side effects than with radical surgery. Just as these side effects are less severe also, says Prescott.

What I can anticipate following the seed implantation is just a few hours of recovery in the hospital and more than likely I'll be discharged the same day. That compares to a several-day hospital stay when surgery is undertaken.

Also, says Prescott during his most effective sales pitch, very few men who’ve have a brachytherapy must likewise wear a catheter inserted into their penis for a period of days. Say “ouch” if you wish at this juncture. If you’re a male you are permitted.

At home a patient should take it easy for a few days, relax and not lift anything much heavier than a call to your wife to bring you a beverage and snack along with the television remote control device.

On the downside is that I’ll likely encounter frequent night-time urination, possibly on the order of every 90 minutes or so, for a couple of months. And this necessary bodily function will also probably come with some pain for a while, too.

But I encountered that condition a few weeks back when my prostate gland’s four nearby lymph nodes were removed for their biopsy. So I understand what’s ahead.

Considering that men who elect or must undergo surgery likewise must often wear a protective undergarment for up to several months, the brachytherapy further became a no-brainer.

Another goody: The odds for encountering erectile dysfunction and impotency are lessened via a brachytherapy than with the removal of the prostate gland through surgery. Besides, there's all kinds of stuff that a doctor can prescribe for those conditions.

About the only suggestion that a urologist offers is for a patient to wear a condom for the first few intercourse trysts. That's to protect against an escaped radioactive seed from being accidentally implanted into a woman's vagina.

Lessened as well is the risk of post-operative infection. That is because the brachytherapy procedure is minimally invasive, a term I’ve picked up during my Internet wanderings regarding prostate cancer and its various treatment options.

Is everything all bright, cherry and roses? Not at all.

Since we are dealing with radiation, the government has to stick in its regulating nose. The standard protocol says that young children can’t sit in your lap for two or three months and that you and a pregnant woman need a three- to six-foot diameter no-fly-zone for about the same duration. The government’s concern is radiation exposure to these at-risks groups.

I asked Prescott if this advisory includes dogs, since my two Labrador retrievers view my lap as their personal bed sheet.

His answer was “no.” Thank heavens, too. I was worrying that I would have to find a used lead apron of the kind radiologists use when giving X-rays.

Another item or two; the chances for temporary diarrhea exists along with possible fatigue due to the radiation, some Internet sites suggest.

Yet I consider all of these potential and probable short-comings to be trifling when compared to radical surgery.

Or, worse, doing nothing at all.

And that, alas, would have happened if I were living in Sweden with its government-run health-care program. Or any other similarly run state-sponsored health-care program, says Prescott.

The reason being is that such systems are far more stingy about doling out preemptive medical care than in the United States.

If I were in Sweden, says Prescott, the best I could hope for with my stage of cancer would be to undertake a watch and wait requirement that would track how fast the cancer grows with a likely seven-year wait until some sort of action is taken.

And that, I’m afraid, very well could have led to the cancer in my prostate spreading and becoming a truly life-threatening disease.

All without so much as a government “oops, we’re sorry” apology from a bureaucrat who thinks of numbers, risks and life expectancy odds more than the needs of a patient with a time bomb ticking away in his groin.

Thanks, but no thanks. September 10 can’t get here soon enough for me. After all, Ohio’s archery deer-hunting season is right around the corner.

- Jeffrey L. Frischkorn
JFrischkorn@News-Herald.com
Twitter: @Fieldkorn

Tuesday, June 12, 2012

Worst part is the waiting


You have your good news when the boss presents you with a $1 per hour raise.

Your great news comes when your daughter announces that in nine months you’ll become a grandfather.

And then you have your everyday variety of life-saving news; the kind you know means that you’ll have the opportunity to collect on your boss’ generosity and your daughter’s unspeakably wonderful gift.

Last Friday I was awarded the last of these news announcements, thanks to a cell phone call from my urologist, Dr. Lawrence Wolkoff.

(Amazing, isn’t it that when a person is bushwhacked by some sort of serious ailment that all of a sudden a physician becomes “my” doctor? Sorry, I digress.)

Wolkoff called to say that the four lymph nodes he extracted from around my cancerous prostate gland were all clear. Thus, that most horrible of all horrible diseases remains locked away in my slightly larger than average-walnut-size prostate. Consequently, the enemy is surrounded.

The lymph nodes were removed with precision care three days earlier, sent to a pathologist who was assigned the task of reading the organs’ tea leaves.

From this rather mundane procedure I was pronounced fit for active duty on an operating table at some point within the next several weeks. That is when Wolkoff will team up with radiological oncologist Jon Prescott to snipe away at the diseased prostate.

While Wolkoff will insert an image-making tool into my rectum and guide it to the nearby prostate gland, Prescott will arm and then man the cancer-fighting armament that will fire rice grain-sized radioactive titanium capsules into the two cancerous tumors and surrounding tissue.

With careful and deliberate motions Prescott will squeeze the trigger anywhere from 75 to 150 times.

All the while I’ll be slumbering thanks to some really potent happy/sleepy juice poured into my system by anesthesiologist John Hagopian.

Don’t get me wrong, though. I’m not complaining about the medical equivalent of the Three Musketeers taking on my case. Just the opposite, in fact.

That last Friday I cleared a really tall hurdle to find myself in front of this next one leaves me happy. And thankful.

For half a week as I recuperated at home from the lymph node removal/biopsy phase of the process I was something of a basket case.

I’ve never been one to handle anxiety very well, and it showed as friend upon friend upon co-worker upon church brother/sister told me they were thinking of me, praying for me and more typically, both.

Finally the prayers had sunk in along with the observation that I’d have to deal with the cancer regardless of any actuary table on survival rates.

So on Friday morning when I awoke I found myself curiously - and refreshingly - at peace. Hopeful, of course, that the news would be rated AAA-grade yet as prepared for any bad news as one possibly could be under such circumstances.

Sometime around 10:30 a.m., I believe, Wolkoff called to say the pathology report was written as a clean slate.

With my eyes closed and a relaxed exhaling of air I silently said “thank you” to the One who delivers before verbally repeating it for the record to Wolkoff.

This trip is not over, of course. I still have to meet with Prescott, take in the actual two-hour “seed” implantation, face possible unfortunate and uncomfortable side effects as well as in the very long-term encounter a stretch of follow-up tests.

Yet now the trail appears not so steep nor the path ensnared by the vines of distress. I’m going to make it, this I believe.


- Jeffrey L. Frischkorn
JFrischkorn@News-Herald.com
Twitter: @Fieldkorn

Wednesday, June 6, 2012

We're not alone

It was a bad day that ended well.

And any day when you’re troubled to the marrow of the bone that can catch a glint of sun through the shadows that haunt us all is by its very definition a good day.

Some 24 hours after having urologist Lawrence Wolkoff poke three holes into my gut to extract four lymph nodes I was anxious, nervous over the prospects that the cancer I’m feeding has begun to pillage beyond the two tumors contained within my prostate.

As if the pressure waiting for a reply as to the biopsy were not enough the stress of what the good doctor and his staff said regarding post-surgical ticks was becoming a heavy hammer blow. Small things, you know, like when you head for the loo to “make water” and the stream becomes a fiery icicle.

Not pleasant, I assure you. At least that plumbing was in order, however.

More uncomfortable to deal with – and not any easier to discuss – is the traffic jam backed up in the colon. This rather sad state of affairs is the dog that hunts me whenever I have to go under the knife and get some sleepy-time juice poured into my blood system by a smiling anesthesiologist like Dr. John Hagopian.

(As an aside Dr. John would later tell me that the whole operation was “rather boring,” which gives an entirely favorable meaning to the word, I assure you.)

In any event here I am with a bladder that sloshes to the point of being dangerously topped off  along with a digestive system that is held hostage by one very nasty road block.

And still no word from Wolkoff as to what the pathologist found – or hopefully didn’t find - by examining a quartet of lymph nodes arrested from the prostate’s neighborhood.

The day, in short, stunk.

Fortunately God was not done for the day, or with me, as it turned out.

Enclosed by a chain-link network of people who have sent their best wishes and thoughts my way I am in good hands. And with countless prayers ascending heavenward as a sweet savor offering I consider it an honor that Bev and me are so bundled in such love.

First came dinner, prepared some time ago by a cadre of women who attend our church; Bible Community Church of Mentor, to be exact.

These women of the church’s Heart and Hands group anticipate that sooner or later a church family would undergo a trial and might like having a meal awaiting nothing more then being nuked in a microwave oven.

These fine ladies have a keen eye on such things.

So do the men and boys of the church’s congregation. The lads are part of Bible Community’s Christian Service Fellowship. They meet briefly on Wednesday evening and then launch themselves into some service opportunity, mating their grunt work with a member’s need.

In our case that invitation was to spread five tons limestone gravel; about two tons to be confined within a 9-foot-by-12-foot corral of landscaping timbers and the rest to gloss over the low spots in our driveway.

The frame is for the base to support a new shed that will occupy the space and assembled there by my two older brothers. No doubt Terry and Rich will argue as to how best assemble that shed as well as chase me away without even allowing me to supervise their work. Which is fine, considering that how older brothers are suppose to act.

As for the church lads they attacked the small mountain of dusty limestone, carting enough fill to flood the wooden frame to its brim.

At that point they worked to raise the driveway’s low spots.

Remember that scene in the 1960s movie “Cool Hand Luke” where Paul Newman leads his fellow chain gang inmates into feverishly tossing gravel onto a rural road’s freshly laid tar?

Well, that is what the lad’s tribal elders Scott Stabler and Alex Mclean had their six youngsters perform. A little late to arrive but still tossing some pretty mean-sized coal shovels of stone of his own was Dustin James.

Before one could say “what we have here is a failure to communicate” the team was finished. Not only was the shed’s future home prepared but better than one-half of the driveway was smoothed over with a fresh deposit of crushed limestone.

The kids especially enjoyed the grilled hotdogs, cans of soda and being able to grab fistfuls of chips, cookies and pretzels that Bev had made ready

Storms of tears began to well up as Bev and I thanked them, one and all.

Not just because of the cheap labor, either; rather because of their unspeakable gift of brotherly compassion.

It’s been a tough sled ride and I can still see a dark line of clouds out on the horizon. But at least I am comforted in knowing that somewhere behind it all is a silver lining, sewn there by Heaven’s Master and never forgotten by those who will never let me – or Bev – forget that we are loved.

Hopefully, prayerfully, I will have good news to report at the next meeting here.

- Jeffrey L. Frischkorn
Twitter: @Fieldkorn