bone scan

“Stable”, adjective, from Latin stabilis

Advanced Prostate Cancer, bone scan, CT scan, David Emerson, metastatic -

Main Entry: stable
Function: adjective
Inflected Form(s): sta·bler l “”
Etymology: Middle English, from Anglo-French estable, stable, from Latin stabilis, from stare to stand Date: 13th century

1 a: firmly established : fixed, steadfast b: not changing or fluctuating : unvarying c: permanent, enduring 2 a: steady in purpose : firm in resolution b: not subject to insecurity or emotional illness : sane, rational 3 a (1): placed so as to resist forces tending to cause motion or change of motion (2): designed so as to develop forces that restore the original condition when disturbed from a condition of equilibrium or steady motion b (1): not readily altering in chemical makeup or physical state (2): not spontaneously radioactive

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Are you scratching your head yet wondering what the heck I am getting at?

Well I picked up my copy of the scans and the Radiologist’s report and within the seven page report lies the bottom line, the conclusion the good news!

CT Scan: Impression
Abdomen:
1) Stable sclerotic foci within L2 vertebral body consistent with blastic metastatic disease from the patient’s known prostate cancer. No new sclerotic metastses are identified.

2) No evidence of hepatic metastatic disease or abdominal lymphadenopathy.

Pelvis:
1) Stable sclerotic lesions within the hips and bones of the pelvis consistent with metastatic disease from the patient’s known prostate cancer. No new osseous lesions are indentified.

Full Body Bone Scan
Stable bone scan with uptake in multiple pelvic osseous metastases. There is no scintigraphic evidence of new osseous metastatic disease since February 23, 2009

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All this means is that the overall disease appears to be stable. On Monday we will find out what the blood and other markers (PSA, CTC, BAP etc) are indicating and we’ll go from there.

Not sure what the options are, but we’ll be sure to let you know once we discuss with Dr. V, and perhaps Dr. L in Houston

How did you react?

Blue Koi, bone scan, CT scan, David Emerson, iodine allergy -

In this case I broke out in hives!

Today I had a follow up bone scan and C/T Scan. Like everything else with this disease, it all takes time.

At 1:00pm I was injected with a radioactive isotope in preparation for the 4:00pm bone scan. Not much to the prep other than accessing my port and injecting me with a syringe they take out of a lead container that contains a warning symbol for radioactive material. It’s kind of ominous.

Immediately after the injection I spent the next hour drinking a “creamy vanilla” mixture in preparation for the C/T scan. This scan was approximately my 4th or 5th in the last four and a half years. It’s a relatively easy process that seems to have gotten easier over the years. My memory isn’t the greatest but I do remember that the first few times the liquid was dreadful and it seemed to take a lot longer to consume, or perhaps it’s just that the wait used to be longer after consuming the liquid. Anyway, after I finished drinking the required dose I was immediately escorted to the scan room. The C/T device is not like the scanner you see on TV or in the movies. It’s like a gigantic donut. I lie on a table that slides me in and out of the donut hole. Before the scan starts however they injected me with some type of iodine that reacts
with the “Creamy vanilla” liquid in order to make ‘areas of concern” light up on the scan. I can tell when they begin the injection, as I feel a weird warming sensation in my lower abdomen and bowels…lovely!

Today, shortly after the injection I started feeling a little itchy but thought it was the chigger bites from recent rounds of disc golf. As it turns out, I was was having an allergic reaction to the iodine and started breaking out in hives. I didn’t put two and two together until they were done and I was back in the waiting room with Mary. I told her I was itchy, she pulled up my shirt and discovered a few hives on my stomach. I returned back to the procedure area and the doc, the nurses and techs knew right away what it was and 50mg of Bendryl took care of everything. The only problem was the Benadryl wiped me out and I needed a 45 minute nap when I got home. Also, now anytime I need a C/T I’ll have to take Prednisone (steroids) the day before. Hopefully, it’s low dose and at least my knees will feel good for a day! We were surprised that I had an allergic reaction, as I’ve had numerous scans previously, and I never had a problem. The doctor explained that one’s immune system can be altered after going through chemotherapy, so we will assume that’s the case.

Mary and I had 90 minutes to kill before the bone scan so we ran out to one of our favorite places to eat, the Blue Koi. Ever since chemo my favorite dish at the Blue Koi has never tasted quite the same. I am glad to report that today it was great once again! We both enjoyed the meal and our time together mid-afternoon.

The bone scan was routine: lie on the table and 45 minutes later, you’re on your way. After receiving the Benadryl, I think I might have dosed off for most of the procedure and my ride home as well!

I’ll pick up the CD’s tomorrow and we’ll review with Dr. V on Monday.
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I’m not sure where this thought came from today, it may have been the murder/mystery I was reading or the article on Elizabeth Edwards from an old dog eared People Magazine, but I was thinking two things; I think Mary and I are doing a pretty good job of living a “normal” life. I’m not sure what normal looks like anymore, but my guess is there is some semblance of it in our day to day lives. That makes we happy.

The other thing I was thinking is I am grateful. Grateful for what you may ask? I am grateful for all the time God has blessed me with since this happened. So many people in this world die quickly, unexpectedly and without any warning. I was just reflecting on how lucky I actually am!

Doc, are you serious?

Advanced Prostate Cancer, bone scan, CT scan, David Emerson, Ketokonizol, PCa, PSA -

Today was my monthly doctor appointment. I am not sure where the time went…June is nearly over.

For the past weeks I have felt the same, no new aches and pains, no need for Advil or the like. As reported, my knees hurt but Glucosamine is helping a little. I think chemo pretty much trashed my cartilage. As for cancer related pain, I really have none.

So, on to the test results. A little history; after leaving MD Anderson we agreed to pay more attention to everything going on instead of focusing primarily on PSA.

My PSA today was: 66.14
This is up from 55.13 last month. I was not at all surprised considering I am only taking Lupron at this time.

The three new tests came back looking like this:

Alkaline Phosphate (bone portion) – 6 [very low!]
Circulating Tumor Cells – 0 [excellent!!]

This was all followed by the fact they once again screwed up the forth test (the urine test). I could only ask, “Seriously?”. Doc tried to lessen the blow by saying the other markers are indicating good things. I had to just bite my tongue and move on. He promised to write out very, very specific instructions for my appointment on the 14th. I’m not holding my breath.

So then we were off to the treatment center for a shot of Lupron and Zometa [a 25 minute infusion to strengthen my bones]. Turns out someone wrote the orders for next week, so it took 45 minutes to get that straightened out and then another hour to wait for the pharmacy. I’m really finding it hard to be patient in regards to the the service at the cancer center, but I will.

In the end, the plan is this; on the 14th I will have a bone and CT scan. The following week will be my usual four week appointment on the 20th. If at that time, my PSA has continued to climb we might start High Dose Ketoconazole once again. By then it will have been 17 months since I last took Keto and it MAY work again? Like a broken record, I guess we’ll just wait and see.

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.

Eight…..is great?

bone scan, chemotherapy, David Emerson, PCa, xrays -

On Monday I will undergo chemo treatment number 8. Wow, how time flies.

I pray, and ask for your prayers, that my PSA decreases once again. I myself am hoping for a number in the twenties, it was thirty-four on the 13th. As part of the clinical trial I also will need to undergo a bone scan again the following week. Other than the inconvenience, these are really no big deal. What does concern me is the amount of radioactive material that will have been injected into my body this year. This will be my fourth set of scans since the first of the year. With each, as preparation for the bone scan, I have an injection of a radioactive isotope. This is what lights up the hot spots of the scan (x-ray).

Work is busy and now somewhat stressful as our company was just bought out. Yesterday a number of my co-workers were let go. Telecommunications is not a very stable industry to be in at this time. If I had the opportunity I’d go back or switch to health care. For now, I’m relatively guarded from lay offs but only because I am working on a very strategic and successful product. My thoughts and prayers go out to those that were impacted. I have been there before, the stress is unbelievable.
This weekend is supposed to provide ideal Fall weather with temperatures in the seventies.
Of course there will be disc golf tomorrow morning, and likely on Sunday as well – we have to take advantage while the weather is good.

Hi, remember me?

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

Back in September 2006, I posted this.

Tomorrow I have to go in for what I am estimating is my 8th bone scan. This is a routine part of the clinical trial I am taking art in, so don’t get worried. There’s not much to it; I’ll go in at 8:00, get injected with some radioactive fluid, then I’ll come back two hours later and lie on an x-ray machine for about 40 minutes and that will be it!

Tuesday I’ll review the results and they my provide me with chemo transfusion number five.

We have a big, busy weekend planned, more details on that in a later post.

Here’s to long weekends, may each of you your Labor Day: be safe and enjoy some time with your family and friends!

Scanning the horizon

Advanced Prostate Cancer, bone scan, chemotherapy, David Emerson, PCa, PSA, xrays -

I had my sixth set of scans Tuesday. Chest X-Ray (as part of the clinical trial), CT scan of my abdomen to look for organ and lymph node ‘involvement’ and a full body bone scan.

Not much to report on items one and two, the results will be discussed on Monday prior to my first chemo treatment. (By the way; 96 hours and counting).

The bone scan was the usual process; lie on my back, the first few minutes are very claustrophobic [I just say a few Hail Mary’s and keep my eyes closed] but after twenty minutes it’s over. This time they took extra pictures from the side focusing on my ribs and pelvis. These are the areas that have always had noticeable tumors.

I was able to talk the technician into showing me the x-rays! The following is only my unprofessional opinion; full body scan: looked the same; spots on my left rib, pelvis area (a.k.a tumors) and the ankle I broke last May appeared the same as in February. Best news – my spine appears to remain tumor free! Finally, no new areas showed up (again, the radiologist may say differently).

As for the side views: not much was revealed on the rib scan, the side view of both hips showed three tumors on the left side and two on the right. I hate to describe these as ‘substantial’, they are there are have been there throughout. I’ll post the scans after I get the CD on Monday.

Happy Birthday Trevor and Happy Anniversary Doug and Michelle!

that is all…..

Looking West

Advanced Prostate Cancer, bone scan, chemotherapy, Colorado, CT scan, David Emerson, Lake of the Ozarks -

A few medical updates after Monday.

I / we were not real comfortable waiting an additional week to start chemo (until June 16th).
Tuesday, Mary did the leg work, called the doctor’s office and inquired if if there was anything we could do in the next four weeks, or if there were any alternatives/options.

Yesterday they called back with some encouraging news. I will start treatments on the 9th as originally planned! This means on the 3rd I will have to spend most of the day at the hospital getting; a chest x-ray, a C/T scan and full body bone scan. This will mark the 6th set of the latter two tests. I imagine I might begin to glow at night, as they have to inject me with low-dose radiation each time they do a bone scan.

These last three weeks have been draining. Not only are the days longer, but the weeks seem to drag on and on. I never thought I would look forward to starting chemo. It’s just this; we made a decision, let’s get on with it.

Another somewhat stressful aspect is that we can’t really plan our summer. We wanted to take Brad to Colorado, I was going to take him camping, a trip to the lake, a weekend at my brother’s property, a trip to see my dad in St. Louis, and the annual get together with my sister from Ohio. Well all of that is currently in limbo. The whole chemo process could go according to plan; very few side effects, little fatigue, white and red cell counts stay high or near normal etc. but because we don’t know, we have to be careful not to plan too far ahead.

I pray for results like I had with Ketoconizal and other medications. I consistently responded well to previous treatments. Our hope is that the chemotherapy will get the cancer under control, my PSA will decrease, we can follow it up with other meds to keep it under control and resume a somewhat normal lifestyle for years to come. We’ll see.

I thank God daily for such a loving wife and wonderful, understanding son. I know he’ll love Colorado, when we finally get there……

Spoken like a politician, weatherman or economist…

Advanced Prostate Cancer, bone scan, CT scan, Nilandron, PCa, radiologist -

I finally got the radiology report from last week. The CT report needs to be re-done because it states “no previous exams are available for comparison”. Kind of funny (but not ‘ha-ha’ funny), being that my previous scans were done at the same hospital!

As for the bone scan, they apparently were able to locate the previous exams. Here is the Radiologist’s report:
Impression:
1. Stable foci of activity involving the left ilium, right acetabulum and pubic ramus as well as left 7th rib posteriorly. Initial patient’s known history of prostate cancer and elevated PSA levels these lesions are suspicious for stable metastatic lesions.

You get it, right? This is the report, word for word. Reminds you of a politician, economist or weatherman doesn’t it? For those of you who don’t speak the language of radiology, the last sentence is the key take away: “…are suspicious for stable metastatic lesions.” Interpretation – So PSA aside, things are stable!

I asked the doctor to have the radiologist re-write the CT report based on a comparison of the previous report. After this screw up, we might be in the market for a new diagnostic imaging center in the future!

Nilandron, which I started the day before the scans, might be working; back pains are all but gone. We’re definitely keeping the positive attitude going!

More updates later….work beckons.