“Jodie, what the heck does this mean?”, I grumbled.

Jodie peered over my shoulder at the report for the CT scan that was performed on me two weeks prior. The report indicated, as my surgeon Dr. Kane had told us during my last appointment, that my prostate and compromised lymph node were now normal-sized. However, a little further down it read this :

Significant stool burden throughout the entire colon, indicating severe constipation.

SMALL & LARGE BOWEL: Significant stool burden throughout the colon.

“I think it means you were full of food.”, she replied.

“Well, YES. I mean, they had me fast for four hours ahead of time, so I crammed as much food in as I could.”

Jodie shrugged.

“And I am NOT constipated!”, I said with, in retrospect, a little too much bravado. I fired a quick email off to Dr. Stewart pleading my case and forgot all about it.

Fast forward a week.

Jodie and I were, once again, waiting in an exam room at UCSD’s Koman Outpatient Facility. We didn’t have to wait long before Dr. Stewart burst through the door.

“Oh my God, are you okay ?!?” 

“Huh? What? Yeah, I’m fine, wh…”, I stuttered.

“I read your CT scan report and it sounds like you were very full and constipa ( smirking ) ….”

Dr. Stewart couldn’t keep it together and started laughing. In a prior post I wrote about doctors having to walk a fine line when using humor with their patients. Dr. Stewart nailed it this time. Jodie and I started laughing with him.

“Radiologists often point out things like this. I’ve looked at your scans and everything looks normal to me.”, he reassured me.

“Can you at least see what I ate in the scans?”, I asked, half jokingly.

Chuckling, Dr. Stewart brought up my scans on his computer and, although I thought they were as indecipherable as a rorschach test, he did his best to show me my full stomach and colon. 

“So, how are you doing?”, he asked. 

“Well, I’ve been on Lupron and Zytiga for over three months now.”, I told him, “The hot flashes are getting better, but I feel like I have had a lot less energy.”

“That’s because when you first started therapy it was a new challenge, but now that you’re in the thick of it, the honeymoon period is ov…..”, Dr. Stewart started.

“I’d hardly call it a honeymoon!”, I interrupted, smiling.

“Good point.”, Dr. Stewart chuckled, “Anything else?”

“Well, I got the paperwork for my radical prostatectomy next month, and I am a little relieved that I do not have to do an enema.”, I replied. In my opinion, food goes in the mouth and comes out the bottom, the reverse is never a good thing.

“Let’s talk about your surgery”, Dr. Stewart said.

He then told me that I would remain on Lupron during surgery, but I would take a two week break from Zytiga. When I asked him why, he told me that there’s not a lot of precedent for men being on Zytiga while having a radical prostatectomy. I would, however, remain on Prednisone the entire time. A week after surgery, the same day that I was to get my catheter removed, I would get my second shot of Lupron. I briefly envisioned how that day would go, and quickly changed channels. One step at a time, right?

“After surgery should my PSA be zero?”, I asked. PSA measures prostate inflammation. No prostate, no PSA.

“Yes.”, said Dr. Stewart.

“And if it’s not?”

Dr. Stewart started talking about radiation and I stopped him.

“For now, let’s just assume that the surgery is going to work and everything is going to be okay. I really don’t want to talk about radiation when I won’t really know if the surgery worked until I’m off of hormone therapy.”, I interrupted. 

Hormone therapy starves prostate cancer cells. It’s why my PSA has dropped from 103 to 1.14 while I have been on it. As I am to remain on hormone therapy for up to two years, worrying about any residual cancer after surgery seemed premature. 

Next, we discussed my genetic screening results. 

Since being treated by Dr. Stewart I have had two genetic screening tests performed, the first by Tempus and the second by Invitae . These tests scan for BRCA1, BRCA2, and HOXB13 mutations in your DNA. While having these mutations greatly increase your chance of getting Breast, Ovarian, or Prostate Cancer, the mutations, being as common as they are, have been targeted by pharmaceutical companies in the development of newer, very effective medications, such as Lynparza. 

Given my family history of cancer,  Dr. Stewart thought that I might have had one of these mutations, but the results from both companies came back negative.

“Is that good or bad?”, I asked him.

“It’s neither good nor bad. It is what it is.”, Dr. Stewart replied.

I was almost disappointed. Having a known mutation would have likely made me an easier target for therapies. But then Jodie snapped me out of it.

“It’s good! It means that our daughters aren’t carriers, either.”, she said.

Thanks, honey. Very good point.

“Any other questions?”, Dr. Stewart asked.

I shook my head no which, in reality, was far from the truth. I had lots of questions, but realizing that not all of them had answers and that our appointment was winding down, I relented. 

As it turns out I won’t see Dr. Stewart again for over two-and-a-half months. He explained that, after surgery, my cancer treatments will quickly become a routine of hormone therapy,  bloodwork, and PSA tests for the next year or so. I understood, but I will miss our monthly pow-wows nonetheless. Dr. Stewart is a fantastic doctor. As he left the room I held up my arms in a mock embrace and smiled. He smiled back and closed the door behind him.

Take care. Stay healthy. Live life.

-Scott

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