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Thursday, October 11, 2012

Doctor visit and test results

Last night we had a great dinner with Kevin and Angie at Ruby Tuesdays.  Good food, good company.  Got back to hotel around 9:00 and relaxed.

This morning we got to the Anschutz Cancer Center at 9:30 and went straight to the lab for the blood draw.  Then we saw the doctor at 10:30.

The last few visits we've seen what it's like to be at a teaching hospital.  Last time -- in September -- we spent lots of time with a resident (Dr. Huo) and much less time with Dr. Flaig.  That was confusing because we didn't expect it so we didn't get the answers to questions we wanted (although we sent Dr. Flaig an email and he responded quickly).

So today we saw a Fellow (Dr. Sumey) and we were prepared to ask questions of both Dr. Sumey and Dr. Flaig and that part of the visit went smoothly this time.  Dr. Sumey addressed our questions and concerns for quite a while and then Dr. Flaig came in to talk about test results.  I will see if I can correctly relay what Dr. Flaig said.

He said the bone scan showed little or no change from the bone scan that was done back in April when Marshall was initially diagnosed.  That disappointed Marshall, but Dr. Flaig said he was pleased.  He said the CT scan showed slightly more activity in the hip area than previously.  And he asked how Marshall was feeling, whether there was any pain, etc.  Marshall told him that he hasn't had any pain to speak of and had a bit more energy than back in August and September, and he still had hot flashes.

So Dr. Flaig said that, first of all, in his opinion, the bone scan "trumps" the CT scan and since the bone scan showed no real change, he considered that a good thing.  And then when you take the bone scan along with the fact that Marshall has been feeling pretty good, he thought that indicated things were going along pretty good.  However, he thought Marshall should also get an x-ray today just to have one more comparison done at the same time as the other tests.  (We stopped at Radiology on our way out and Marshall had that x-ray done and we'll get that result tomorrow).

Then he told us that the PSA went up to 10.01.  That was disappointing, but Dr. Flaig said not to be disheartened.  He has added a new drug to the mix -- Casodex.  Casodex is a testosterone blocker.  Marshall will be taking a Casodex pill every day for the near future.  It is supposed to create a block that will stop testosterone from feeding the cancer.  So we will now be watching the testosterone level as well as the PSA level.  He said that after a certain period of time on Casodex, if it drives the PSA level down the way he expects, he will stop the Casodex and see how things go.  He told us about several patients who took the Casodex along with the Lupron and then stopped the Casodex when the PSA level got down to undetectable and those patients then went on to enjoy several years of "remission."  So that is our plan going forward.

Next, we talked about Marshall's dangerously low Vitamin D level.  Marshall had been taking Citracal and Dr. Flaig said Marshall should continue on that.  But he added another drug that will give a megadose of Vitamin D (50,000 Intl Units in one pill).  Marshall will take one of those every week for 12 weeks and we will measure the Vitamin D levels again.

So we left there feeling pretty good.  And Marshall's frame of mind stayed good.  He had one or two instances of the "demons" showing up.  But Marshall has a technique of forcing the demon in a box and when the demon closes the lid, Marshall moves on feeling better.

On the way home, we stopped at Harley to see if his motorcycle was ready (he had taken it in last week for its 5,000-mile tuneup and to try to get the satellite radio fixed).  The bike was ready so he got to ride it home and that was a good end to the day.  The satellite radio problem turned out to not be fixed so that will be another battleBut we are now home and all in all, it was a good day.  We go back on October 25 for his next Lupron shot and his next Xgeva shot.

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