We made the 180-mile trip to the cancer center and it was a miserable trip. Marshall was in a deep hole of depression and there was basically no conversation at all. Miserable.
His lab work all came back in normal (or very close to normal) ranges and his white blood cell count raised some more, which is really good. The Nurse Practitioner said things were going well. His PSA was 65 (it was 64 two weeks ago so it only went up one point), so even though it's a high number it didn't move hardly at all and that is a good thing.
We discussed some urinary problems Marshall has been having so they took a urine sample and we are still waiting for those results. They did an ultrasound to be sure he was voiding his urine completely and he was.
Then we discussed depression and fatigue so Kathryn went over his medications and we are making some changes. He will be weaned off of Effexor and Remeron and he will start on Wellbutrin. She said that Wellbutrin can generate some energy so he should take it in the morning. She is hoping that in the next four weeks he will notice less depression and a higher energy level. And then they will also wean him off of Provigil. This all sounds very positive to me, but he is still very very depressed. (We discussed Abilify but Kathryn said that she thought it could cause agitation and that Wellbutrin would be a better way to go.)
Kathryn advised that he start seeing a psychologist on a regular basis to try to help keep him in a more stable mood.
We go back in four weeks to see the oncologist and do lab work again.