David Emerson

Summer time, summer time, sum-sum-summer time!

alkaline phosphate, CTC, David Emerson, hrpca, PSA -

On Monday we met with Dr. V for my monthly appointment.

PSA = 39.75

This is up slightly from four weeks ago (36.16) but not significantly.
He reviewed the letter from Dr. L at MD Anderson and we discussed the recommendations at length. He is in agreement with the recommendations and he ordered the two new tests. We will use a combination of these three tests two determine when we make our next move.

I already have total alkaline phosphates measured each month as part of a standard CBC Blood panel but the first new test will break it down further. Here are some details from my friend Howard at hrpca.org:
Alkaline Phosphatase, serum Bone-specific alkaline phosphatase (BAP.) When alkaline phosphatase is measured, it is actually the sum of the bone-specific and liver-specific components (isoenzymes.) BAP can indicate excess osteoblastic cell activity which may indicate bone metastases. Metra Systems, Inc., says that Bone Alkaline Phosphatase is an osteoblast membrane-bound molecule which is involved in bone formation. Levels of this enzyme are thought to be indicative of the activity of osteoblasts.

Another description of AlkPhos is that it is an enzyme that is found on the surface of osteoblasts(the cells that build bone) and as such is used as a serum marker of increased osteoblast activity. Since bone is being added at prostate cancer bone metastases, an increased alkaline phosphatase can mean increased bone met formation. A recent paper by MR Smith et al in Urology discussed BAP and NTx in their role as predictors of skeletal complications in HRPC patients (MR Smith, et al, Urology 70: 315-319, 2007.) Their conclusion was that elevated baseline levels of BAP are associated with a greater risk of adverse skeletal outcomes – events such as shorter time to radiotherapy or shorter time to first pathologic fracture. NTx was also found to be of value in monitoring patients on bisphosphonates.

The second new test will measure the amount of CTC’s or Circulating Tumor Cells. Recent studies suggest that for men with advanced disease, measuring whether the number of cancer cells circulating (CTC) in the blood stream is rising or falling may be a more accurate method for determining response than PSA. CTC’s are found in many cancers but are most common in prostate cancer.

So we ran both tests in order to establish a baseline and I will have the tests repeated in three months along with an updated bone scan and MRI. So unless my PSA goes crazy or I develop pain somewhere, no foreseen changes for the next three months.

Not sure if you caught that, three months, as in July!!!

Woo-hoo!!!

Spring and a few other things

Charity Disc Golf, David Emerson, FLHW, florida, Provenge, spring -
This might finally be the week when we put winter behind us. I say that with some trepidation, not wanting to jinx things. I planted spinach about a month ago and it is finally making some real progress, however harvest and a fresh salad from the bounty are weeks away.

We played in a rain soaked disc golf tournament on Saturday and I hope to get out a few times this week and weekend. Additionally, plans are well under way for our second annual FLHW disc golf tournament on May 9th. Details are at http://www.flhw.org/2009discgolf.htm

Since returning from Houston, I’ve really been trying to take the doctor’s advice to just get on with it. We have been really wanting to get back to Florida and may try to plan a trip for when school gets out. I could use some sand between my toes!

My next appointment with Dr. V is next Monday and for once I am not real concerned. Well maybe just a little. There is potentially some good news on the horizon for those of us with advanced prostate cancer.

I’ve written about this new drug, Provenge, a number of times over the years. My first post on Provenge was on October 24, 2006. Next week the company is scheduled to announce the results of their Phase III trial and rumor has it, the news is good. What that means is, in the best case scenario, the drug may be available in the first quarter of 2010. Available and approved or paid for by insurance are two completely different things as well. It is still good news and apparently there may be more regarding other treatments in the months ahead. Again, nothing curative, simply drugs or treatments that may extend the life of those with advanced PCa.

And now for today’s dose of emotional stew

Advanced Prostate Cancer, David Emerson, Susan Boyle, the Big C -

I’m sure many of you have seen this:
Susan Boyle

If this didn’t make you laugh, cry, cheer, I’m not sure what would.
As I watched this it made me thinkabout how sad it is that we are such a judgemental society. Yours truly included.

I know this has nothing to do with Prostate Cancer however, I wish this woman the best and hope she goes on to become a big, big star!!

Eggs, and bunnies, and candy oh my!

Advanced Prostate Cancer, David Emerson, disc golf, PCa -

We made it home safely on Friday, but not in a timely manner. Southwest Airlines, who I usually find to be reliable, did an absolutely miserable job of getting of us home. I’ll forgo the details, but it involved delays, missed connections and arriving home six hours late.

I played disc golf yesterday and today with the gang. I really need them and appreciate them in my life. I am trying my best to take the doctor’s words to heart and just get on with my life. Easier said than done!

Today is about the Lord and family and now relaxation with just Mary and Brad – this I also need!

Happy Easter everyone, peace be with you all.

When “nothing” makes you happy

Advanced Prostate Cancer, bone scan, David Emerson, MD Anderson, PCa -

The taste of saline was strong, stronger than I remembered. It had been awhile. The tears themselves started from laughter and evolved to tears of sorrow.

Mary and I watch “Marley & Me” last night here in Houston. I won’t talk much about the movie so as not to spoil it for those of you who may not have seen it yet, however, it was a great movie. It won’t win any awards mind you, but for those of us with dogs, and Labradors to be specific, the reality is spot on. As the movie evolved on the screen the tears of laughter turned to tears of sorrow. It was not just about the fate of the dog, but the thoughts of death itself.

It all hit too close to home for me.

It was the culmination of the day’s events, and the fact that it is Holy Week.

Yesterday we spent the day at MD Anderson Hospital in Houston. Through a few contacts we were able to secure an appointment with the Chair of the Genitourological department, who I will refer to as Dr. L. More on him later, but in a nut shell, what an incredible doctor, man, care giver.

After checking in at 10:00am and going through the paper work process we headed to the lab so the vampires could extract seven vials of my blood. The lab area was a stark shot of reality; packed with cancer patients in various stages of treatement. From wide eyed newly diagnosed patients to those poor souls that chemo has obviously ravaged. Silent Hail Marys streamed through my concious thoughts as we waited.

After the finishing up at the lab, we ate lunchand then returned to the seventh floor to wait for our 1:00pm appointment with Dr. L. As is typically the case, we did not follow the planned schedule… we actually met with the doctor at 2:15pm. The wait was a much different experience. Much of the time was spent completing a lengthy review and clarification of my status, x-rays and scans with his nurse practitioner, so the hour flew by.

Our time with the doctor was approximately thirty minutes, no more. The thirty minutes were, for the lack of a better term, incredible. After four years, we think we know a lot about prostate cancer, but we learned more in that thirty minutes than most of the last four years combined. In this case it was specific to me, but it really opened, or re-opened my eyes to my current status.

Since I’ve rambled quite a bit, here is the bottom line – his recommendation? Do ‘nothing’ for now. On the one hand, this is fantastic, on the other, as someone with a demon called cancer living inside him, doing ‘nothing’ is one hard pill to swallow. After listening to and letting his recommedation sink in, it really makes sense. The highlights are this; the bone tumors are ‘attached’ to the bone, not attacking or destroying from within the bone. Two, chemo is still working, we need to allow it to complete it’s full course before we jump into the next treatment. The doctor advised us to approach our treatment strategy as one would any chronic illness. To fully consider my symptoms and current condition when making treatment decisions and making sure we reap the full benefits of each treatment. He was quite complementary regarding how we and our doctors have managed my case to date. So we return to Kansas City with orders to watch a few new blood markers because given my condition, the PSA level should not be the exclusive marker to track the activity of the cancer cells. Details of the new markers will be shared in a future blog.

The doctor also provided a lot of hope for the future. There a number of drugs in clinical trials that are or may become available when I may need them in the months and years ahead. It is the current research and clinical trials that reinforces our hope.

Our experience with MD Anderson this time was so different than in 2005. 180 degrees different and in a wonderful way. The compassion, and strategic approach that the staff shared with us was exceptional. Primarily, we credit this experience to Dr. L and his staff. The other factor is that Mary and I have matured in our knowledge and approach to managing this beast called prostate cancer.

On my way out….

Advanced Prostate Cancer, Dana Jennings, David Emerson, MD Anderson, MDV3100, PCa -
Before I head out I thought I’d share two things.

First, there was a bit of good news today as it relates to treatments.

Here’s the story from Bloomberg.

Interesting note, the research was funded via the Prostate Cancer Foundation. Perhaps
FLHW.org is doing some good!

Second item is from another, more prominent PCa blogger. I may have mentioned him here before? Dana Jennings, (a New York Times editor writes each week about coping with an aggressive form of prostate cancer) His latest blog is here. His words say so much better was I was trying to get across at the end of my last blog.

Stay tuned, more from the road…..


5 hours of pain followed by 90 minutes of pleasure!

Advanced Prostate Cancer, Blue Koi, David Emerson, PSA, University of Kansas Cancer Center -

First and foremost, PSA: 36.36, down a fraction from last month.

It’s all about stability right now and this was great news. I was pretty worried before the appointment.,

Overall yesterday’s visit to the cancer center was a great big drag! As usual we arrived at 8:30 for labs, then our meeting with Dr. V, and then it was off to treatment. On a normal day we would have been done and on our way by 11:00am. Everything was proceeding as expected until I checked in at the treatment center at just before 10:00am. We waited, and waited and finally were called back at 11:40ish. One thing led to another and it turns out we didn’t leave until 1:15pm, nearly five hours later. I’m not sure what the issue was? Too many patients, too few nurses, but it was frustrating! Oh well, I’m just hoping it was an anomaly.

Mary and I were famished at that point so I agree to have lunch with her at the Blue Koi. The history on the Blue Koi is this; it was one of our favorite places to eat until last summer. We would go there for lunch everytime I had treatment or doctor appointments. However, after about my third or fourth chemo treatment, I couldn’t eat it anymore. It tasted horrible. It was a shame that the one thing chemo had to ruin was my ability to eat at one of our favorite places.
So yesterday we returned for the first time since last summer. The result? All is well, it was wonderful, again!

After lunch I returned home and finished some work for a few hours before my next appointment, my massage. Mary had given this to me for my birthday back in January. This was only the second time I had a massage. Te first was over two years ago in Tucson. This time it was quite a bit longer, but I have to tell you, the 90 minutes went by like five! Bottom line, I slept like a baby and am feeling good today!

Out like a lion….

Advanced Prostate Cancer, Charity Disc Golf, David Emerson, MD Anderson, World Disc Golf Championship -

With the beginning of Spring and the end of March came a nice little reminder from Mother Nature as to who’s in charge! We received a late season snow storm yesterday that delivered about 5 inches of snow on our house. It was very pretty to wake to this morning, but rather heavy to shovel from the driveway.

Tomorrow is my four week appointment with Dr. V, as well as a Lupron shot and Zometa infusion. I am rather concerned about my PSA, being that my sole treatment right now is Lupron. It has been two months since my last chemo treatment. Where did the time go?

Overall, I am still feeling very good. I worked out four mornings last week, I was able to shovel the driveway this morning and even played disc golf again yesterday morning before the snow arrived. I have been experiencing mild pain in both knees throughout the day. Nothing real bad, in fact I have yet to take Advil to deal with the pain. I’m not sure of the connection, but this all started after I weaned myself from the daily steroids I was taking until about two weeks ago. I was taking the prednisone during the chemo regimen. I had to slowly withdraw over two weeks. We definitely will discuss with Dr. V tomorrow.

At this point MD Anderson has received my records and we are expecting a call early this coming week to begin the scheduling process.
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A few non-David health related updates:

On May 9th we will be holding the 2nd Annual FLHW Disc Golf Tournament. We were fortunate enough this year to gain access to one of Kansas City’s newest private courses. A wonderfully generous man built the course for the express purpose of providing non-profit foundations an alternative venue for fund raising events in Kansas City. I recently discovered that the course will also be used for this summer’s World Disc Golf Championship being held here in KC. We are hoping that this might attract a few more teams that are looking for ways to get on and practice before this summer’s major event.

The man who owns the property and course is the owner of Suburban Lawn and Garden. He does some unbelievably philanthropic things here in Kansas City. As we began to plan the disc golf event he extended an offer for a new program at the greenhouse and garden center at 135th and Wornall. Each Friday, for six consecutive weeks, a different charity will receive 10% of all sales between 5 and 8 pm. Also, during the week leading up to the event the charity will be able provide information about their charity to Suburban’s customers. FLHW has secured Friday, June 5th! We are very pleased that will give us yet another opportunity to promote the importance of early detection for prostate cancer and make men and women more aware of this disease that kills 28,000 men annually. More details regarding this event will be forthcoming as the date approaches.

Advanced Prostate Cancer, David Emerson, PCa, wes witcher -

Last year at this time we were returning from Spring Break in Florida. It was at this time when I received the news of the passing of one of our PCa brothers, Wes Witcher (this is the post I wrote)

Today, I received the above from Sheri. It reminded my of both how fast time is passing and exactly how blessed I am.

To Sheri, Taylor and Haley may God’as grace continue to bless you all and may peace always be with you.

Hail Mary,
Full of Grace,
The Lord is with thee.
Blessed art thou among women,
and blessed is the fruit
of thy womb, Jesus.
Holy Mary,
Mother of God,
pray for us sinners now,
and at the hour of death.

Amen.

Spring and a break!

Advanced Prostate Cancer, David Emerson, disc golf, PCa -

Spring found KC in a big way! The weather since last weekend has been wonderful, and we couldn’t have asked for better timing since we stayed home for Spring Break!

Oh course there has already been four rounds of disc golf and Saturday we helped some of the guys from the local club out by orking on the course in the woods. It was only two hours,but back breaking work!
Monday Brad and I played 9 holes of ball golf and he did really well. He showed much improvement from last year at this time.
Yesterday I played disc in the morning, washed and detailed cars for two and a half hours then played another round of disc golf. This year the FLHW disc golf tournament is being held at a private course, just two minutes from the house. It’s long, there are a lot of trees that come into play, and it took two of us two hours to play. We primarily went out to determine how to lay out the course for our event on May 9th. It’s going to be great, a real challenge, and I really hope the local disc golf community (and others) come out to play and support the cause!
Well, that’s really it for now, I’m really tired after yesterday and I still have two or three basketball brackets to fill out!