PSA

My own little beta test

Advanced Prostate Cancer, David Emerson, Firmagon, PSA, Xgeva, XL 184 -
Monday we visited with my local Oncologist, Dr. V. M PSA was 1,663, that is down 130 points from the previous month. Although we are not screaming from the rooftops, psychologically, we always feel more positive when we see the PSA moving in a downward direction.

Back in January we discussed with Dr. V the fact my Potassium level was low. This is a known side effect from my current long term diarrhea issue. While I was someone who used to eat at least one banana a day, with my current appetite, bananas are off the menu. We have tried coconut water and have now added a prescription Potassium pill to the regime and will test again next month. Just another side effect to add to the list.

Additionally, I received my usual monthly shots of Xgeva (bone strengthener) and Firmagon (testosterone suppressant).With so many variables going on with my case, sometimes it’s hard to track down the cause or correlation of certain side effects. The past two plus weeks I have been relatively pain free. I have not had any Advil and I stopped having to sleep on a heating pad at night. This was not true for the ten days to fourteen days that followed my last shots of Xgeva and Firmagon.

Where I am going with this is I believe that I have figured out the pattern. Starting a few days after receiving these two shots, I begin to have pain. It may start in my shoulders, hips, legs, middle or lower back, but it never starts in the same place. It usual moves around every day or two and like I said above, it will last around ten days. I treat it with Advil every twelve hours or so and sleeping on a heating pad helps considerably. The pain ends rather abruptly, and the second two week period will be closer to normal ~ free of bone pain.

This is all just a theory right now, but over the next few days you can bet I will be very in tune with each little ache and pain.
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After a very mild winter, spring is right around the corner! Our tulips and hyacinth have popped out of the ground. I cannot wait for warmer days. Mary and I went for a walk around the neighborhood on Sunday. It felt great to get out and enjoy the fresh air. This this is something we really plan to continue.

7 year itch, of a different type

Advanced Prostate Cancer, David Emerson, PSA, XL 184 -
Today is the 7th anniversary of my blog. Seven years, almost 700 entries later, and I’m still here.
 
The last line of my first ever post holds more true today than ever:
But I worry about them both emotionally and psychologically. I can’t imagine going on without her or him, it saddens me deeply. I pray a lot more than I ever have….. 
 
Physically, the seven years and eight different types of treatment for this disease have taken their toll. Not being able to play disc golf or even work out gets to me. The lack of both make me feel lethargic at times. I want to do more, but can’t in some cases and shouldn’t in others.

A friend said today, ‘I don’t know how you get through one or two of the side effects, and you’re dealing with all four’. I told Mary the other night that I am so sick of it (the side effects). Just like always though. I trudge along and just keep praying that the reduced dosage, or one of the new meds, or a combination of the two will end at least one of the side effects. That alone would be a huge burden lifted from my shoulders.

You know the saying “If I could go back and do “x” over again, I wouldn’t change a thing…..” in this case I’m calling BS early and often. I’d change most of the last ten years if I knew it wouldn’t lead me here, now. At times it just sucks, this is one of those times.
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Though it started this way, this post isn’t going to be 100% about me being sorry for myself. There are so many other good things in life that I celebrate on a daily basis. I have a wife and son that I love dearly. I have family and friends that remain close and are so very important to me. I live in a world so full of hope and possibilities I have to stop and appreciate that fact from time to time.

Novena to Saint Peregrine
Oh great Saint Peregrine, you who have been called “The Mighty” and “The Wonder-Worker” because of the numerous miracles which you have obtained from God for those who have had recourse to you. For so many years you bore in your own flesh this cancerous disease that destroys the very fiber of our being, and who had recourse to the source of all grace when the power of man could do no more. You were favored with the vision of Jesus coming down from His Cross to heal your affliction. Ask of God and Our Lady, the cure of these sick persons whom we entrust to you.

Aided in this way by your powerful intercession, we shall sing to God, now and for all eternity, a song of gratitude for His great goodness and mercy. Amen.

An interesting thing happened on the way…….

Advanced Prostate Cancer, David Emerson, PSA, XL 184 -

Monday was my monthly oncologist appointment here in Kansas City. It went rather well, in fact I’d almost say it went great!

Dr. V provided new prescriptions to try to help with managing the side effects. The first is an appetite enhancer. I wish it had been prescribed for me initially when I started experiencing the nausea. The first dose seemed to help with dinner last night, I took the second dose before lunch today so should have an indication soon if it is consistently effective. Last night it really helped with nausea. I am hopeful that it will be the same today. The doctor is understandably concerned about my fatigue and weight loss due to the on-going nausea and intestinal issues. With not many treatment options, Mary and I are doing our best to stay positive and make informed decisions.  The doctor is very compassionate and open to helping us choose the right path.

The other three scripts were for potassium (mine is low!), another type of medicine to try as an option to combat the nausea, and a refill on another drug I take to help me to sleep.

I also received an update on my PSA, the last three measures were:
Dec 5:  1,961
Jan 3:    1,317
Jan 30:  1,799

Those are rather wild swings and we are trying not to focus on the PSA, although it is rather difficult to ignore a number that high. We continue to try to focus on the good news from Boston last week after the bone and CT scans, with increased shrinkage in the tumors in my bones and the CT scan showing that the organs are still clear. We have very much to be thankful for!

The Cake Gets Bigger

Advanced Prostate Cancer, birthdays, David Emerson, PSA -

Today is my 49th birthday. Frankly, I wasn’t sure I was going to make it, seriously.

The first birthday post I publishedin this blog was in 2006:
http://flhw.ddmpreview.com/were-going-to-need-a-bigger-cake/

Although a number of names would need to be added to the acknowledgment portion, I likely could have re-posted the entry word for word this year and the message would have been then same.

It’s a weekend of friends, family, relaxation and celebrating 49. It also marks the beginning of all the sorted milestones, initial diagnosis, first scans, official diagnosis and the beginning of living with this dreaded disease. I’ll do my best to mark each of these with a post.

For now, HBD2ME!!

Winter’s got a hold on me

5K Prostate Cancer, Advanced Prostate Cancer, David Emerson, PSA, Steve Jobs -
As I mentioned in my last post, I had this big plan to blog a lot this year. I’ll eventually catch fire and start to post more, but for now, winter’s got a hold on me and I just don’t feel very creative or motivated. I can’t complain about the weather that we have had so far this season, but it is still winter.
There are no real changes in my health. The fatigue is a little better. I have been in the office full time for seven straight days. The lack of appetite and diarrhea continue. The former is constant, the latter day to day.
I will share that I am reading the Steve Jobs biography. While I was always a fan and thought highly of him, this book has totally changed my opinion. To me, his management style and the way he treated people completely take away from his creative brilliance. I’m just half way through with the book, but cannot image there is some hidden gem in the latter half of the book that will change my perception of the man. Once again, his work and the products Apple created upon his return in the late 1990’s are unheralded,  but at what cost to his family, friends and those that worked for him. This is just my opinion, you can decide on your own. The book is a thousand pages, and for the most part, a page turner.
Since we didn’t go to St. Louis over the holidays, we have been pleased to have family visit here in KC. Last weekend  my brother Doug and his wife Michelle came in.   We didn’t do much except watch some movies and football, but it was good to have the house full and spend time with them. The weekend coming up my other brother Dan, sister Barb and nephew Zach are coming. I look forward to that as well.
For now I will continue to trudge through winter. It has been extremely mild here in Kansas City and it looks like it might continue for the next several weeks. The next thing you know it will be spring, my favorite season of the year.

1961

Advanced Prostate Cancer, David Emerson, PCa, PSA, XL 184 -

First of all, although things are slightly better, my intention to start the year off with a bang and my goal to post multiple blogs has fizzled. I’ll try to get better the year goes on, I promise.

I’d like to start with two prayer requests. There are multiple men I could list but tonight my mind is on Terrance from Seattle and a former neighbor of ours Jennifer. Terence had his 4th chemo infusion this week as well as a blood transfusion. He’s having a rough time, so please find a minute for T.  Jennifer is battling stage IV colo-rectal cancer. She is planning to head to MD Anderson in a few weeks and I hope and pray that she will find a clinical trial that proves to be an effective treatment for her cancer. Again, please include them both in your prayers.

This week I had my monthly Oncologist appointment here in Kansas City. A few of my blood markers are borderline low, potassium was one. Initially, we are going to try to increase the level with diet.Mary already came back from the store with lots of bananas, avocado and coconut water. As bad as my appetite has been, I was happy that more things weren’t out of whack!

Before I break the big news I have to remind you all of a few things: first the clinical trial medicine that I am taking addresses bone tumors. Though they measure my PSA in Boston, the doctor and I don’t discuss it. It is the bone scan that is the key marker.

We knew my PSA would rise because as part of the trial I had to stop taking androgen blockers. It was a risk we were willing take at the time. This week we asked my local Oncologist for my PSA and though Tuesday’s measurement was not ready, my December 5th reading was 1,961. That is up from 1,043 in November and around 400+/- when we started the trial on August 30th.

On one hand, it’s just a number, the scans are what’s important (I tell myself in a semi-convincing manner). On the other hand I think, “Holy Roger Maris! 1,961”! From there the questions begin to mount, questions that I will be discussing with Dr. S when I return to Boston later in the month. Short term, I’m not to worried, what this might mean and how it will impact my treatment long term is what I am concerned with mostly.

My Compass

Advanced Prostate Cancer, David Emerson, PSA -

There are those people you meet in your life, you know the ones, teachers, friends, professors, etc., those people that have a profound impact on your life. I married mine.

She, without meaning to do so, changed me in so many ways. She also supports, encourages and helps me through the cyclone that has become my life.

When we met I was a wandering soul. I was working, had finished two years of college but had no long term direction or short term goals. Since then, I earned my undergraduate and graduate degrees, have a relatively successful career, was blessed with a wonderful son, a comfortable home and a non-profit foundation provides me with an immense sense of pride. The cancer battle aside, we are genuinely happy and content.

Now, more than ever, she needs me for that same support. I am with you Mary, I love you more than ever and I am here to help you get through your challenging times, as you have always been there for me. I am blessed that you came into my life over 24 years ago and am honored that you married me on that wonderful Saturday in August, twenty years ago.

Here’s to many, many more years ahead for us to share.

When good isn’t good enough, then you get more

Advanced Prostate Cancer, alkaline phosphate, Boston, David Emerson, PSA, XL 184 -
Tuesday was my four week check up with my Oncologist, along with the usual blood tests and shots. The appointment was uneventful for the most part, the doctor was away and we saw the Physician’s Assistant. She is great, but no decisions were obviously made with the doctor away, this was all expected from the last appointment.
Last month I switched a few drugs around; I stopped Lupron and started Firmagon (testosterone blockade), stopped Zometa and started Xgeva (bone strengthener). After making these changes four weeks ago I did have mild to moderate pain a few times during the weeks that followed. As almost always happens, the week leading up to the doctor’s appointment was as close to normal as I’ve had in a while. I felt great and remain that way this week as well. The side effects from the Firmagon shot (tenderness, redness and slight swelling at the injection site) seem to be much less than June. Or maybe I am just more tolerant this time around.
The exciting news is my PSA was actually down to 421 (it was 433 the month before). Though this is somewhat good news, the drug I started back in January (Zytiga / Abiraterone) is not having the impact we had hoped. However, I am very grateful for the result. An additional marker we track closely is Alkaline Phosphatase. Normal levels are approximately 40-110, mine had been between 50 and 60 for years. With the rise in my PSA this year, the AlkPhos has also gone up. According to one specialist my type of prostate cancer is creating PSA primarily via the bone tumors. Hence, my need to find a treatment that targets bone.
Speaking of treatments that target bone, yesterday we received a call from the doctor’s office in Boston. Without looking too far ahead, it was good news and we now have an appointment with the doctor leading the trial the first week of August. We are cautiously optimistic as there is not a guarantee that I will qualify for the XL-184 trial the purpose of this meeting is to determine if I am eligible. The appointment will include a blood test, a bone scan, CT scan and exam by the doctor.  Although I appear to be an ideal candidate on paper, things can always pop up. Once again, we are cautiously optimistic!
Assuming that the tests and the appointment go well, I will have to return 4 weeks later to start the trail. The delay is where this gets a little risky. I will have to stop taking a number of medications for those four weeks. This includes:
– Zytiga (Abiraterone) and Prednisone (the current hormone blockade I have been on since January)
– Lovenox (a blood thinner I have been on since last fall when I was on DES and had several clots in my leg)
– Finisteride (I have been on this drug for almost 5 years, the short story is it blocks a form of testosterone)
Stopping the blood thinner is the least risky in my mind. The clots I developed on two separate occasions can be attributed to my treatments at the time, one being Taxotere and one being DES. I have been off DES since December.  As a precaution, Dr. V suggested I add a low dose aspirin to my daily regimen. Finisteride is also a minor risk since my testosterone level is always extremely low. Zytiga is the big risk but the potential of this new drug is so great that it is a risk I am willing to take.
So if the crazy schedule of ours wasn’t busy enough, now we add a trip to Boston the mix!

No time to slow down

Advanced Prostate Cancer, David Emerson, PSA -

After spending the start of last week in Chicago, I looked at our calendar and July is packed with plans. Every weekend through the end of the month finds us busy, busy!

Between parties, dinners, visits with family, celebrating a friend’s 40th and an event for our charity, and the highlight….closing the month with Kenny Chesney and an out of town visit from a of friend and fellow PCa survivor.

The first week in August is our 20th wedding anniversary, then two weeks later school will be starting. It might as well be late August!

I’m sure the following thought has been penned in a more eloquent fashion, but right now I find myself living as such…. Don’t wait for the moments in life to happen, make them happen!

Would someone stop the carousel and remind me I’m in the midst of a little crisis! On second thought, don’t bother, the ride is a blast!

Piling on.

Advanced Prostate Cancer, David Emerson, PSA, St Peregrine -

Last week was one filled with nothing but crappy news!

First it was my PSA increase on Monday (up to 430). It’s just a number and overall I am more focused on the other aspects of the disease like pain.  While things seemed to be better over last weekend, by Wednesday my back reminded me that even when I feel good, I need to just chill out for awhile. That continues to be a struggle for me, I cannot be idle. I have been taking 4 Advil every 8-10 hours in order to function.

Last week we took one of our favorite books (‘There’s No Place Like Hope’) over to a neighbor who was about to have surgery to remove her colon. Wednesday was the surgery and it turns out things were worse than expected and the cancer had already spread. They scrapped the surgery and now she will start intense chemotherapy. They are younger than us but also have an ‘only’ (single child). I ask that you add them to your prayers and/or thoughts. They have a long, tough road ahead of them but their positive attitude is both infectious and admirable.
To the ‘C’ family, this one’s for you:

Oh great Saint Peregrine, you who have been called “The Mighty” and “The Wonder-Worker” because of the numerous miracles which you have obtained from God for those who have had recourse to you. For so many years you bore in your own flesh this cancerous disease that destroys the very fiber of our being, and who had recourse to the source of all grace when the power of man could do no more. You were favored with the vision of Jesus coming down from His Cross to heal your affliction. Ask of God and Our Lady, the cure of these sick persons whom we entrust to you.

Aided in this way by your powerful intercession, we shall sing to God, now and for all eternity, a song of gratitude for His great goodness and mercy. Amen.