Thursday, December 29, 2011

7) Diagnosis and Beginning to Heal

We made an appointment with Dr. Zink to go over the Prostate Biopsy results and discuss Treatment. I entered the office fully expecting to hear the words Radical Prostatectomy, and was prepared with my research on da Vinci Surgery. Dr. Zink explained that the Biopsy had found prostate Cancer in three of the cores, the right apex, left apex and left mid at core amounts of 10%, 15%, and 5-10% respectively. The Prostate Cancer found had been rated with a Gleason Score of 3 and 3 for a total score of 6.

Gleason Scores for rating Prostate Cancer have been around for a reasonable time, since 1966 when Dr. Donald Gleason, a pathologist created a scoring system on information derived from studies of the biopsies from around 3,000 patients with Prostate Cancer. It now provides a standard of measurement as to the severity of the Prostate Cancer. From a patients standpoint, the lower the score the better. It is important to note that the process is a bit subjective and depends on how the cells look to each individual pathologist under the microscope. About 1.5% of the time an inaccurate diagnosis of Prostate Cancer is made where none really existed. Generally speaking a Gleason score of 5 or 6 are generally low grade tumors, a Gleason score of 7 is rated as intermediate and moderately aggressive, while a Gleason score of 8, 9, or 10 are high grade tumors, very aggressive and fast growing.

The location of the Prostate Cancer is also very important when considering removal of the Prostate for treatment. In my case a Radical Prostatectomy because of the Cancer’s location would most likely damage/remove the nerves leaving me without sexual function but still with adequate urinary function. This option, if required, is still preferable to me over radiation treatment because of its long-term results. Too many Prostate Cancer patients previously having radiation treatment find themselves without options 5 to 10 years down the road when they have a relapse.

During our chat I felt best when Dr Zink looked at me and said, “Your Prostate Cancer is low grade and slow growing. You will not die of Prostate Cancer, there are so many treatment options.” Of course he was talking of all the accepted medical options including hormone therapy, various radiation treatments, and surgery, etc, while in my mind I was already exploring other alternatives.

Dr. Zink said there was no immediate action that needed to be taken and put me on a process he termed Active Surveillance. We scheduled another PSA test for 6 weeks out. He also recommended I have another Prostate Biopsy in 6 months and pending those results, another again a year from that one. I am weighing the risks and considering all options regarding scheduling these possible future biopsies.

With diagnosis in hand I went back to the Internet looking for answers. My research led me to Paul Reilly, ND at Seattle Cancer Treatment and Wellness Center in Renton WA, who co-authored along with Dr. Michael T. Murray the book: How to Prevent and Treat Cancer with Natural Medicine, published by Riverhead Books. This is a remarkable book and a must read for anyone diagnosed with Prostate Cancer. From that book and other studies I began my treatment.

I also returned to Bastyr Center for Natural Health to explore other ways to improve my own immune system for natural healing. Their treatment has already improved my physical well being and their methods will be discussed here.

Next installment: Treatment Begins

Thursday, December 15, 2011

6) The Dreaded Prostate Biopsy

Both my wife and I met with Dr. Zink at Group Health to discuss options regarding potential Prostate Cancer. Regardless of how you feel about it, this is not something you want to hide from your family, or try to bull your way through on you own. Allowing your loved ones to be part of the process is a good thing, and will lead to a much faster healing along with an improved quality of life.

From the start Dr. Zink told us he had performed over 1,000 Prostate Biopsies over the years. He could only think of two infections as a result of his Biopsies, which was much lower than the National Average for Prostate Biopsy Complications. Because of his success rate, he was reluctant to change his protocol at this point and would stick with the Cipro to prevent Prostate Biopsy Infections.

I told him I was a wimp when it came to medical procedures and very worried about the pain during the process. I’m the type of person who can hit my hand with a hammer, then use duct tape and a paper towel to stop the bleeding and keep on working. But when it comes to even small little needles and someone else poking around, I just might pass out. He said there was no way to avoid needles. He would be using a local lidocaine for a periprostatic block at the time of the procedure and he would prescribe an oral sedative as long as I had some to drive afterwards.

I asked Dr. Zink about taking Pectasol-C and Tagamet prior to, and after a Biopsy. He said he had never seen a paper that shows a Biopsy could Spread Prostate Cancer and he would not recommend the Tagamet. He did not have an opinion regarding the Pectasol-C. Yes, I did keep taking the Pectasol-C! In fact, I upped the dose around the time of the Prostate Biopsy. Nor did he have an opinion of any supplements to take before the procedure. I wrote this off as the standard medical response from someone in his profession. With all the malpractice, insurance issues, and internal regulations of a large medical operation such as Group Health, there just isn’t the time or inclination for doctors to explore other options no matter how good they may be. Let’s face it, Dr. Zink may be really good at what he does, but he totally resides within his narrow line of expertise. To expect him to reach beyond that standard norm, is asking way too much for medicine in America today. (Later in this Blog I will be sharing the options I have personally chosen for my own alternative healing, Releasing the Prostate Cancer.

Based on Dr. Zink’s Biopsy results, and with a desire to see if there actually was a serious problem, we decided to go ahead with the process. The first thing I did was to call Group Health to acquire an 'Estimate' on their costs for the procedure as I am on a high deductible insurance plan. A few days later I called again for another estimate. (More on this to follow)

At Dr. Zink’s request for 10 days before the Prostate Biopsy I abstained from aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), fish oil, Vitamin E, clopidogrel (Plavix), aggrenox, and any other blood thinners. There is some bleeding with this procedure and there is no sense creating further risk. Dr. Zink also prescribed a single diazepam just before the procedure as a sedative/relaxer, and of course there was the enema and cipro for me to take at home before I came into his office for the biopsy.

My wife and I walked into his office about 20 minutes early for my appointment. Were both nervous, but I was beginning to feel the diazepam and becoming increasingly calm. When call back we were told that we both could come. Surprise. My wife was there with a direct view of the entire procedure. Of course for the most part she had seen most of it before. In her own words this is her experience:

When Steve made his appointment for the biopsy I knew that I would go with him. He decided to get some medicine to relax before the procedure. I thought it a good idea.

When we arrived at the Doctor’s office he checked in, got the usual weigh in, blood pressure etc and then he took a pill to relax. Wish I had some for me.

After 20 minutes or so the nurse said we ‘both’ could go into the Room and gave instructions on how to prepare for the Biopsy. I was surprised when they said I could accompany Steve. Ohhhhkay…I didn’t expect that, and didn’t quite know quite what to expect… but I was all for it.

Dr. Zink explained exactly what he was going to do. He had the ultrasound machine right at his side. As the nurse and Doc got ready for the procedure I was surprised… no ‘shocked’ at the Length of the Needles that were used. Oh my God - - these things are long, and looked wickedly sharp.

He first put the Probe up Steve’s ass and I could see the picture of his prostate. This was actually very interesting. The doctor explained what I was looking at, the size, the placement and so on. Never having seen a prostate up close and personal - - it was really cool.

The first needle that went in I could feel my body tighten and get uncomfortable. As I saw that Steve didn’t seem to feel it and couldn’t see a thing. I got more relaxed and just viewed the process.

The nurse and doctor were precise, methodical, careful and continually checked in with Steve as to how he was doing. That put me at ease.

The entire procedure of getting out all the samples was done in maybe 15 minutes. After waiting another 10 minutes or so to make sure Steve was okay, we were on our way.

I was glad to be there for support and getting information but don’t look forward to another Biopsy if Steve chooses to have one.

My experience of the Prostate Biopsy was a bit different. I lay on my left side with my but hanging out over the medical table facing Dr. Zink and my wife. It was a reasonable comfortable position. Insertion of the ultrasound probe was a bit uncomfortable but not a problem. Then came the lidocaine. It was done in several shots and stung like the dickens, not unlike a strong bee sting for a short time, then drifted away. Dr. Zink was very good about asking how I was doing throughout the process. When it was time for to take the Prostate samples, I could feel the process of the needle going in, and hear the sound of the spring loaded mechanism taking the sample, but there was no, or very, very, little pain. In all the Prostate Biopsy was uncomfortable but not unreasonable.

When I got home I lay down and rested for a short time. Dr. Zink had warned me about blood in my urine and sure enough there was some. By the second day the reddish urine ting was passing, and thankfully with the help of the Cipro I did not experience any infection. Generally for the next week I consciously moved slower than usual, did not lift anything heavy, and just focused on healing my body. The results arrived 5 days after the Prostate Biopsy. Sure enough I had Prostate Cancer in three areas. Bummmmer!! The good news was that it was ‘Slow Growing’.

Next installment: Diagnosis and Beginning to Heal

Tuesday, December 6, 2011

5) Decision for the Prostate Biopsy Step Two

Along with the Allergy testing at Bastyr Center for Natural Health several other lab tests including Blood Panel, Lipid Study, Thyroid Test, CRP - Cardiac/Enzyme Marker Inflammatory Test, and new PSA Total and Percent Free tests were ordered and processed. The testing was done through Pacific Physician’s Laboratory, Inc. In addition, as a direct result of my discussions with Dr. Jones and Students at Bastyr, I decided to seek out another ‘medical’ opinion regarding future Prostate Biopsy should one be needed.

Still disappointed with the quality of service I had been receiving at Group Health, I made an appointment at Urology Northwest after a thorough Internet search. They appeared to have some of the best recommendations. My appointment was pretty standard for a Prostate exam. We discussed past test results and chatted about possible Prostate Cancer Treatment. The doctor performed a DRE and ran a Urine Analysis to check for any infection. Based on my Prostate history and lack of urinary infection, the doctor recommended I have a Prostate Biopsy. He was ready to do one at his office in a matter of days. I left with the very words I didn’t want to hear echoing in my ears.

About this time the lab results from my Bastyr tests came in. Medically I was sound. Everything looked good with the exception of my PSA tests. My PSA Total came in at 6.83, a substantial increase. My PSA Free came in at 13%, again another slide in the wrong direction. Both of these were a shock to me because I'd experienced much better results directly after the cessation of the Cipro. This was not good news. As mentioned before, the specter of Prostate Cancer can be a really scary thing. The unknown possibility can be even worse than the known quantity. At least if you are diagnosed with Prostate Cancer, you can decide on a form of treatment and move on with your life. With these latest results my wife began lobbying for a Biopsy just to get the question answered. Of course she was hoping for good results.

I began to toy with the idea of having a Prostate Biopsy. Sure there was risk but I reasoned certain physicians and facilities may present less risk than others. It also appears Prostate Biopsies can be uncomfortable to very painful. I found that some doctors use a surface acting anesthetic first on the rectum wall, and then a needle anesthetic to numb the prostate. Some doctors do not. While the anesthetic appears not 100% effective, the studies seem indicate it may reduce the pain of the procedure by an average of 30-40%. In some other settings doctors are even using a general anesthetic, knocking the patient out prior to the procedure. Then there was the risk of spreading of any potential Prostate Cancer cells as a direct result of the Biopsy. I was already taking Pectasol-C to prevent this from happening. Additional studies indicated taking Cimetidine (Tagamet at 800 mg daily) may modulate the body’s immune response (immunomodulation), interfere with tumor growth, and inhibit tumor cell migration and metastasis. I was wondering about this as an additional option, but didn’t want to damage my ability to absorb healing nutrients.

I started to make a list of pre-Biopsy questions to refine my search for a Prostate Biopsy physician. They included:
            Question 1: What is the number of prostate biopsies you have performed, and what is the number of cases you have had where there have been serious antibiotic resistant infections as a result of the procedure?
            Question 2: Is Cipro the only antibiotic you use prior to, and/or after the biopsy?
            Question 3: Have you read about Dr. Schaeffer’s new protocol at Northwestern University Feinberg School of Medicine, Chicago, of targeted antimicrobial prophylaxis that has significantly cut the incidence of prostate biopsy infections?
            Question 4: What processes(s) do you use for pain management during, the procedure?
            Question 5: Is it acceptable for me to be taking Pectasol-C and/or Tagamet prior to, and after a Biopsy?
            Question 6: Are there any other ‘supplements’ I should consider taking, or not taking, before, during, or after a Prostate Biopsy? 

Then too, should a Biopsy find I have Prostate Cancer what would be my next step(s)? I began this process by looking at all the standard forms of treatment currently available. Then I sought out alternative forms of treatment. My research led me to one conclusion. Should I have Prostate Cancer that needed some form of ‘radical treatment’, the da Vinci® Robotic-Assisted Prostatectomy is the only form of treatment I would accept. This form of treatment appears to have significantly better long-term results when compared to Open or General Laparoscopic Surgery and Radiation Therapy. (More on this to follow) With this conclusion, I decided to keep my search of potential Prostate Biopsy physicians to those qualified with, and having local access to, the da Vinci® method of treatment. Lo and Behold, this led me back to Group Health, and I made an appointment for a Prostate Biopsy 'discussion' with Dr. Jerome Zink in Seattle.

Next installment: The Dreaded Prostate Biopsy