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Bob New Heart

Bob New Heart
Life is Good

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Wednesday, April 16, 2014

I am back after a round trip to UCSF to see Dr. Alexander Gottschalk, Director of the Cyberknife Radiosurgery program and Professor of Radiation Oncology. Sort of stuffy but very knowledgeable. We reviewed all the radiation options and also took any invasive procedures off the table.  If I decide to enter a treatment program, it will be the Cyber Knife procedure. It is short and to the point with the fewest side effects.  4 Treatments of about 60 minutes each on a Monday-Wednesday and Friday and Monday schedule.  I would be able to drive myself back and forth, he says. I was however pooped driving back this afternoon. There would be at least three pre-radiation appointments to do another ultra sound and an MRI of the prostate; a second appointment to insert some tracer seeds that would be done by my new UCSF Urologist, Dr. Cooperberg and a final dry run of the procedure. They actually make the patient lie down and adjust the equipment and make a model of his body etc. Interesting.They want to make sure the  focused radiation bursts don't do any damage along the way to the prostate.

My combined Gleason score is 7 . I am in the mid-range of danger. The one hundred thousand dollar question is: How long will I live with the new heart and this older body.I need to make that decision and the sooner the better so I can enjoy the end of summer hopefully with few side effects.

The other option is to do nothing. If I do nothing for the time being, there is a danger the cancer migrates to other organs such as the lymph glands and/or enters the bone marrow. I lean towards doing the procedure and getting it over with.


Life is Good

Tuesday, April 15, 2014

Next Step

April 15, 2014

Tomorrow I go back to UCSF to meet with the chief of the Radiology Dept., Dr. Alexander Gottschalk. The discussion will be what non-invasive options are available to me to kill this prostate cancer.
 As a heart transplant recipient I take two meds every day specifically designed to suppress my immune system to prevent rejection. That is the big concern each transplant recipient faces the rest of his life.

 If you have major surgery then you need a stronger immune system to promote healing. It’s a double edge sword. If you increase the strength of one’s immune system you open the door for rejection of the heart while you are healing from the operation.It is for these reasons that any invasive procedures is off the table.
The options I assume are different forms of radiation. UCSF specializes in a new technologycalled CyberKnife  used to fight cancer . Google it...Interesting reading. Dr. Gottschalk is an expert in this new technology.

I like what I read about it as it is completely non-invasive and one needs only a few zaps and it is over. I hear from others who have had this procedure it requires no more than five or so treatments. All of my information at the present time is from others prostate cancer patients I have talked with and what I have read. Tomorrow I get the real scoop. More on that later
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On the other side of the UCSF ledger, my heart transplant, I am in fine shape other than I am getting fat which impacts my heart . I gained ten pounds in less than ten months. Part of the reason is in that same time period I have had no aerobic exercise because of my back issue. I fell last June 28th and I had a compressed fracture of # 3 and # 4 vertebrae. That is on the mend slowly and I have just begun to start  using the stationary bike at the gym. Back still hurts a bit but I can no longer afford any more weight gain.

One interesting note is with the heart transplant, I was never emotionally affected by the heart failure prior to my new heart. I was in bad shape but never had any depression. It was an east fix. Get on the list, wait for the new heart, have the operation and move on. Don’t get me wrong the recovery time was long. I was in poor shape before transplant and was weak for months following.. I am in pretty good shape now except for the weight gain.

In this prostate cancer deal, I have had emotion swings and sudden flashes of temper more than my usual lack of patience. I am not concerned about dying as that is out of my control . I am just pissed off. I thought the heart transplant was my deal. Each of us in life gets one big deal and that was mine. Now I have this sudden arrival of something I can’t see nor do I have any symptoms other than the old man prostate issues not cancer related.

The other thing that is bothering me is this time I am on my own. I have no support group of friends as they are all busy and after all everyone gets prostate cancer sooner or later. It is not interesting and is viewed as quite mundane. My family is busy and I have this feeling that I am really on my own. I drive myself back and forth to the City for my appointments and I expect to do so while I am having the treatments.

Every man has prostate cancer.sooner or later. No very many people have heart transplants. I will report back after this appointment tomorrow. Later this month on the 30th , I have another appointment with my new oncologist, Dr. Matthew Cooperberg, where we will discuss the options and make a decision.

Life is Good

Friday, March 28, 2014

What is CyberKnife?


CyberKnife® is a non-invasive option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery. The CyberKnife system enables our radiation oncologists to deliver high doses of radiation with pinpoint accuracy to a broad range of tumors throughout the body.
Potential benefits of the CyberKnife system include:
  • No incision
  • No pain
  • No anesthesia or hospitalization
  • Greater comfort (patient can breathe normally during treatment)
  • Little or no recovery time
  • Immediate return to normal activities

How it works

The CyberKnife system’s continual image guidance software allows us to deliver high radiation doses with pinpoint accuracy, while automatically correcting for tumor movement. Since radiation beams adjust in real-time to the patient’s breathing cycle, there is less damage to surrounding healthy tissue.
“The CyberKnife VSI is the latest CyberKnife technology available and offers faster, higher radiation energy, as well as upgraded software,” says Dr. Michael Payne, Medical Director of Radiation Oncology.
Prior to the procedure, a high-resolution CT scan determines the size, shape and location of the tumor. The image data is then digitally transferred to the CyberKnife System’s workstation, where we precisely plan treatment to match the desired radiation dose to the exact tumor location.
Once treatment planning is complete, the patient is comfortably positioned on a cushioned table and the system’s computer-controlled robot slowly moves around the table, targeting radiation to the tumor from various angles while sparing surrounding healthy tissue.
The system’s sophisticated software allows us to track the tumor and continually adjust the radiation treatment to account for patient or tumor movement.
Each treatment session lasts between 30 to 90 minutes for one to five days, depending on the location and type of tumor being treated. Patients can typically complete treatment in 1 to 5 days versus several weeks for traditional radiation therapy.
I copied this blurb about CyberKnife for your information. There is tons of information on Google about this form of robotic surgery. As a heart transplant recipient, the best for of treatment for my prostate cancer is a non invasive form of surgery. My new transplanted heart is at risk of rejection or infection with the normal form of surgery. All of my medical team both heart transplant and  oncology agree that removing the prostate is not an option.. 
My new UCSF Urologist, Dr Matthew Cooperberg is keen on this potential solution. The decision to make at this point in time is  whether to wait or to get it over with. Complicating this decision is the life expectancy issue. As I blogged yesterday, the issue of whether I can expect to live for another ten years or not  affects the decision whether or not to do any form of surgery. Only God can answer that question. 
For my own part in this discussion , all I can say is that .I love all my UCSF doctors and am in their hands and in the hands of God.
Life is Good!


Thursday, March 27, 2014

Back From UCSF Urology/Oncology

Howdy,

I had my introduction to the University of California San Francisco Oncology Dept yesterday. I really liked the young doctor assigned to my case. I am now officially a patient of two UCSF Med Center Divisions; Heart and Lung Transplant on the Parnassus campus and Urology/Oncology on the Mt Zion campus.

Dr  Matthew Cooperberg is just 40 years old and has been at UCSF for seven years. He a professor at the School. See attached photo. Really nice guy. He laughed at my jokes and put me at ease.

We covered the test results  which they refer to as a Malignant Neoplasm of the Prostate..Dr Cooperberg said he is asking their pathology folks to review the results themselves and compare notes with the Sutter Docs and their pathology analysis. It won't be necessary right now to do another prostate biopsy. I may have to at a later date depending upon a decision of treatment if that becomes an option.  I asked him to summarize his notes and send them to be to share with all of you later. As you now I am not a good listener..

The part of the discussion I paid attention to was the sex part. We talked about options to improve function. He said there was some new technology  in play and wants me to see  one of their sex experts ( not a real term ) when I come back to see the radiologist.Excuse me darling while I go into the other room and give myself s shot. Just like my diabetes pen.It is worth discussing I guess.Glad I didn't have anyone in the room for that discussion..I am so shy when discussing those issues..

Dr Cooperberg wants me to see their Radiation oncologist, Dr Gottchalk,,in the next few weeks to get a clear idea of the treatment options available. Surgery is off the table All participants agree; the Transplant docs, The Oncology docs and me. No operation. The treatment  that Dr Cooperberg seems to prefer and the one he wants me to get a real understanding of what is involved is called  CyberKnife. Sounds evil but it is a five day treatment program of targeted radiation ( I think). Would have to live in the City of 5 days.

I will see the  Radiation guy, see  Dr Demarco at Heart Transplant for my 6 months check up and then followup with Dr Cooperberg all in the next eight weeks or so.  The treatment  plan depends upon the answer to the question: How long do the transplant folks think I will live? If it is over ten years then  he recommends treatment now while I am young, strong and healthy. If it is five years or less than the heck with any treatment. 

The rub here is how do you make those  assessments. How do you accurately  determine lifespan.I am pretty sure the transplant folks will not make a guess  .

My cancer is not fast moving  right now .It is in his words in the intermediate range of danger.Sort of  moderate cancer in political terms.

I will do another PSA test before I see Dr Cooperberg in eight to ten weeks. No need to run out and get a plot at East Lawn just yet . hoho

More later with specifics when I hear from Dr Cooperberg .I feel much relieved.


Life  is Good




Dr Matthew Cooperberg
 

Wednesday, March 19, 2014

UCSF Medical Center-Oncology

March 19, 2014

After a couple of weeks  gathering all my recent test info , the latest PSA report and the pathology  report and slides and shipping them off to UCSF Medical Center, I have  an appointment  next Wednesday March 26th at UCSF. I will now have two separate but somewhat connected departments and campuses at UCSF. My almost 4 and ½ year love affair with the Heart Transplant Division and now a completely new relationship with the Urology and Oncology Dept.

The Oncology folks are not at the Parnassus campus but up the hill and around the block so to speak at the Mt Zion campus on Divisadero St. My plan is to park at familiar territory in the Parnassus garage and take the shuttle over to Divisadero and back. As soon as I get the lay of the land at Mt Zion I will make the trip over myself. Still Golden Gate bridge and out 19th Ave and up that familiar hill to UCSF Med Center.

It is amazing how many people I know who have come forward and either blogged me, commented on Face Book’s messenger site or just plain emailed me about their own past or current experience with prostate cancer. I don’t feel alone anymore
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My plan of action right now is no action. I am not spending hour’s goggling all sorts of random info about prostate cancer and starting to worry and fret about treatment options. I am holding my powder until I actually see a doctor and have the conversation about what treatment option is right for me. The reason I am at UCSF and not here at home with Sutter Hospital is the connection between my heart transplant folks and the new team.My Sutter doctors were the ones who suggested I get treatment at UCSF.

Next week, I may start worrying and breaking out in anxiety fits but not right now.Who knows I may just take it all in stride. I am after all the man with the new heart. I had major and I mean major surgery and here I am with a new heart and new life. This cancer stuff is just a bump in the road.

Life is Good.

Wednesday, February 26, 2014

Feb 28, 2014

I have been waiting for the machinery at Sutter Health to mesh with that of UCSF Med Center. I still have not been able to get a referral and an appointment with the JCSF Med Center Oncology dept. I am impatient to learn the options to deal with this cancer and get on with the treatment.

My heart is doing great. No rejection to date which has been four years and two months. My back seems to be better. It is amazing how things just fall into sort of a personal human pecking order. Right now my body is aware of this cancer and everything else seems to take a back seat.

My hope is to become a patient of Dr.  Peter Carroll, the head of the UCSF Oncology dept. I have been fortunate to have had and continue to have excellent care from the UCSF heart transplant Dept. The UCSF Oncology dept. is also excellent and I want to become part of that team.

This all sounds quite selfish wanting to have the very best doctors and an immediate plan of action in place. I am selfish and a bit scared.

As always I am grateful to my donor ‘s family for the gift of a new heart and the excellent team of doctors I have both here in Sacramento in at UCSF. I have been very fortunate for this wonderful care and great insurance coverage. One might ask is this worth it spending all this money and  health care on this fellow from Sacramento when there are  millions of people  still seeking a heart transplant and as many fighting cancer without good insurance coverage, without  fine doctors and without the love of as many friends I  am lucky to have. I have no answer to that question.

I just thank God for my good fortune and my friends.

Life is Good.

Friday, February 21, 2014

Cancer, What a Scary Word

Cancer, What a Scary Word

Recently I had a very high PSA score after a routine blood test. My urologist was concerned. She was subbing for my regular doc who has taken a leave from his practice. She recommended a biopsy.This procedure is not too pleasant but on February 13th I had the procedure and hoped that would be the end of it. I am 70 plus and every man that age worries about Prostate cancer.

The following Thursday, February 20th, I met with the doc and before I could do my usual routine of a few jokes and howdy hi, she said “the news is not good.” I gasped a little and listened to what she said. She said there is cancer all thru the Prostate.

Dr. Thompson said she wanted to bring my UCSF team into the discussion regarding possible options .All heart transplant recipients live the reality of rejection caused by changes in the level of the anti-rejection drugs. Our immune systems do not take major surgeries well. There is a fine balance between raising the immune system back up by adjusting the meds to allow for a surgery and then lowering them back to the base level to prevent rejection.

There are non-surgical procedures as well as actually cutting out the entire prostate which we will also discuss. The concern is allowing the cancer to spread to other near bye organs.

I am lucky to have super docs in San Francisco as well as my Sutter Docs here in Sacramento. I am fortunate to have a wonderful insurance package including Medicare. I know that my docs will propose the best course of action accommodating my new heart as well as my poor tired old prostate
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I urge all men over 50 to get a PSA test once a year and don’t blow it away as not an accurate measure of cancer. If I had not had the biopsy following the PSA result, my doctors would not have be aware of the level of cancer I had living in the prostate
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I appreciate the support of all of my friends, fraternity brothers, family as well as my faith community at St Francis Church. This is not the end of the world, just a bump in the road. Pray for me but also pray for all those men living with prostate cancer and for your own love ones. We all need a lot of prayer; a lot of good wishes and a lot of love in our own lives.

Life is Good!

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