Wednesday, January 21, 2009
When I woke from anesthesia I found that the doctor left me a gift, a thread, six inches hanging from the normal channel. "Doc where are you? You forgot something here!" I then learned that it was connected to a stent which was to remain in-place 3-4 days, a small hollow tube placed in to keep the channel open. The removal of said stent can be completed by just pulling the thread? "Are you kidding me? Hey doc you put it in, you’re taking it out."
This has been one of the most painful experiences to-date, it feels like my lower back (right kidney) has been bruised and battered. A lot of heat and a few Loritab are helpful, I can only imagine what the stone passing or the shock wave feels like. My analogy is compared to the "google earth" vehicle driving a street near you to capture images, well the doctor drove around my kidney doing the same thing, kind of like the "magic school bus."
Doctors do not always know what causes a stone to form. A person with a family history of kidney stones may be more likely to develop stones.
For more info:
Sunday, January 18, 2009
So Dr. Jenkins is going to use a little shock and awe, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass from the body along with the urine. The patient lies on top of a soft cushion or membrane through which the waves pass. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes.The key is that he can actually see it on a x-ray and that it resides in the collection area of the kidney otherwise we are going to have to use "the normal channel."
The "normal channel" you know, no man's land, where everything is meant to flow down and out, not up and in. The medical term is Ureteroscopic Stone Removal, for stones found in the lower part of the urinary tract, the doctor may pass a ureteroscope (a hollow tube-like device) up into the bladder and ureter (through the normal channel.) A basket-like device may be passed through the tube to grasp and withdraw the stone.
Although the procedure is fairly common any procedure requiring general anesthesia and a hospital gown make me a bit uneasy.
Saturday, January 17, 2009
So most people ask "How was it?" It was an awesome challenge. It was an awesome experience. It was a first of many new experiences for me this year.
It was not only a physical challenge but a psychological and spiritual challenge. For those of you who have never run 26.2 miles (like myself) around mile 20 the mind and the body decide that they are separate entities not working in unison. The mind tells you that you've had enough, the heart rate jumps to 187 bpm, the body becomes cold and chills with goosebumps while the legs continue to labor forward. Each mile was significant so walking was not an option for the remaining 6.2 miles. I finished the race set before me in 4 hours and 19 minutes, with joy, pain, tears and ice packs.
When the marathon began at 5:50 am under a full moon and 57 degrees I stood alone anxious and praying amongst 20,000 runners. At that point the prayer was simple, God please be with me (and the all the runners) throughout this marathon and help me complete it for your glory, without stopping and without injury. I made a quick decision to join a 4:15 goal "pace group" led by an energetic Clif gal from Pennsylvania named Marie (the angel of inspiration.) I ran with this group through the Magic Kingdom, Grand Floridian and the Animal Kingdom until mile 20 where I was, yes, dropped. Although I managed to complete Disney Studios, the Boardwalk and Epcot to finish just 4 minutes behind them with Marie waiting to greet me! I met some peers along the way; Luke from Miami, Jose from Bal Harbour, Erin from Lakeland, Marsha from Fayetteville and Kathleen from Ohio, all of these angels played a roll in my accomplishment.
The ironic story I want to share is about Kathleen from Ohio who sauntered in around mile 12.5, we discussed my current diagnosis and the upcoming challenges. It turns out that she works for a cancer unit in Ohio where Dr. Vipul Patel was prior transferring to the Global Robotics Institute and that she knows him well. Kathleen stated, "you couldn't be in the hands of any better surgeon, he is the best there is, I am going to call him and tell him we met on mile 13." We spoke some more until she jogged off to support other marathoners along the route. I am convinced that Kathleen was the angel of assurance.
It was truly a great venue and an incredible adventure.
Saturday, January 10, 2009
With retrospect into the 26.2 miles I’ll attempt to run tomorrow I again look at it as I look at my recent diagnosis, a challenge to overcome. Tomorrow will be a morning of reflection not only from the past but also for the future, I am told to expect a battle throughout the run physically, mentally and spiritually. For some who don’t partake in this endurance craze they would ask “Why?,” for those running, all 23,000 entrants, each would give you a different answer.
I’m personally running for all those who cannot run from the cancer, running for the cure. My goal is not to win this race but to run with perseverance the race marked out for us. We all have the passion to compete we’re just wired that way, but it’s more about accomplishment, purpose and heart. I plan to focus on my relationships throughout the run tomorrow, 26 to be exact; I am going to try to dedicate each mile. I’ll share a few of those specifically with you, mile 1 God, mile 2 Jesus, mile 3 Holy Spirit, mile 4 my incredible wife Kim, mile 5 my first gift from God Allison, mile 6 my second gift from God Kari, mile 7 my beautiful sister Leisa, mile 8 my closest friend and sister Leslie, relatives, friends…and mile 25 all those cancer patients and survivors.
Although this event is not a fundraiser of sorts for cancer, it will be, in my heart. I am planning a second Athletes For A Cure Triathlon in Sep 2009, which will be an opportunity for ALL of you to support the fight of prostate cancer specifically with proceeds going directly to the Prostate Cancer Foundation, http://www.afactri.com/. I will post the actual Brett Troia fundraising website soon. This is a great venue for a great cause.
I want to THANK all of you for your emails and support since the posting of this blog. I need to tell you that I’m a bit embarrassed with the fact that I’m posting this blog, I want you to understand that truly the blog is not meant to be about me, but about HIM, all those that know HIM, those that don’t know HIM and those that will come to know HIM. It’s for those yet to be diagnosed and those already diagnosed. I don’t claim to be a doctor, a pastor, a surgeon, or anyone even worthy of posting a blog, just someone trying to remain faithful and help others through it.
Thursday, January 8, 2009
I want to provide two thoughts;
1. Become proactive, be your own advocate, do the research, ask the questions, seek second opinions, interview doctors, cancer patients, cancer survivors; this is your life at stake.
2. Ensure the websites you visit are legitimate i.e. http://www.prostatecancerfoundation.com/, http://www.americancancersociety.com/, http://www.conquerprostatecancernow.com/, www.cancer.gov/cancertopics/types/prostate, www.webmd.com/prostate-cancer/default.htm
Don't discredit the blog sites, they can be very helpful when it comes to actual cancer survivors experiences.
When discussing treatments you have six options;
In watchful waiting, you get no treatment, but you see your doctor often. If there's no sign the cancer is growing, you continue to get no treatment.
Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. There are two options the open surgery or the daVinci robotic assisted surgery.
There are 2 types of radiation therapy. In one type, called external beam radiation therapy, radiation is given from a machine like an x-ray machine. In another type, radioactive pellets (called "seeds") are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy. The external beam therapy option has an alternative method called “proton therapy” www.floridaproton.org/, www.protonbob.com/proton-treatment-homepage.asp
The purpose of hormone therapy is to lower the level of the male hormones, called androgens, which are produced mostly in the testicles. This is because androgens, such as testosterone, help the prostate tumor grow.
liquid nitrogen freezing of the cancer
In our research there were only two options for us; surgery or external beam radiation. So I will attempt to explain our decision. Here is our argument; we have the option to remove the cancer from my body for good, using cancer and cure in the same sentence vs. treating a cancer with the ability to kill it but still having to monitor the PSA, the DRE and possibly follow-on biopsies while both treatments can/could have the same side effects. What quality of life are you seeking? We opted for the surgery utilizing the daVinci system and seeking out the best surgeon for the procedure.
I would never attempt to provide advice to any other prostate cancer patient on what treatment would be best for them. It is all based on the individual’s situation regarding cancer stage, patient age, health and quality of life thereafter. So take control and you make the decision.
I am not a resolution type guy, but I do know that this year will be different in many ways. I wish all of you the best and appreciate all your prayers, calls and cards.
I plan to challenge this cancer within and use it for God’s glory.
I have always loved Hebrews 12:1
Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God.
Florida Hospital was the first institution in Central Florida to offer the da Vinci® robotic radical prostatectomy in 2004. Dr. Vipul Patel is Medical Director of the Global Robotic Institute at Florida Hospital, and has personally performed the most robotic prostatectomies in the world. Dr. Patel leads one of the world's most experienced teams which is renowned for providing excellence in patient outcomes with respect to cancer control, urinary continence and maintenance of sexual function.
I should add that the anticipation of this consultation was much worse than the biopsy, although nothing was taking place today my anxiety level was maxed out. I am thankful that Kim was able to be with me, her presence was calming and reassuring. We were greeted very warmly and processed through admissions with much efficiency, although I did have everything organized and ready for processing. If Dr. Patel were to offer surgery tomorrow I was ready. We waited in the exam room for about 15 minutes which provided ample time for my A.D.D. to kick-in and I searched the entire room, the overhead cabinet was full of Depends, my mood quickly calmed.
Our first interaction was with Geoff Coughlin, MD a medical fellow of Dr. Patel’s that has been with him for over two years. Dr. Coughlin had reviewed my chart and had begun to explain the surgery, recovery and effects in detail. He answered a majority of our questions before we ever asked them. (I have provided his answers in red)
We had prepared a list of questions for our consult;
After reviewing my labs, family history, age and physical condition what is your recommendation for treatment? Surgery
Do you feel I am the right type of patient for a radical prostatectomy utilizing the daVicni robotic system? Absolutely, a prime candidate based on my physique, my age and the fact that I have a small prostate.
Do you believe with my cancer that by electing surgery we can successfully cure me from prostate cancer? Yes, after surgery you should have a PSA level of 0.
What are my chances of recurrence provided a successful surgery outcome? Would any chemotherapy or radiation be required? A minimal chance of recurrence, almost nil.
What is the success rate of surgery? The success is that you will forget you ever had cancer. For ages 55 and below we base it on the return of continence and erectile function.
Based on my age and physical condition what should I expect for the return of continence and erectile function? Continence within 3 weeks and erectile function within 3 months, we would be surprised if the rehab would be any longer for your situation.
How long should I expect to be out from; Work? Approx. 1 week Running? Approx. 4 weeks Biking? Approx. 12 weeks Lifting? 30 days no more than 10 lbs.
What determines the amount of time the catheter will be required? Approx 5 days. It will be removed following a cystogram. A cystogram is where contrast is injected into the bladder via the foley catheter then an x-ray of the bladder is taken in search of any leaks.
What would the timeline be for registration, surgery, release and returning to Panama City? We would require you stay for approx. 7 days following surgery, 24 hours after the removal of the foley catheter.
Would you require follow-up appointments or release me to my urologist? It is the choice of the patient, appointments at 30, 60, 90 days and then throughout the following year.
If you were diagnosed with prostate cancer tomorrow what treatment would you elect? I never asked this question, it was pretty apparent. Although I did ask Dr. Jenkins this question. Surgery.
Dr. Coughlin added that he has worked in various facilities across the world and that Dr. Patel is one the finest surgeons currently performing this procedure. Dr. Vipul Patel has personally performed the most robotic surgeries in the world, and is one of only two surgeons to have performed 2,000 robotic prostatectomies.
Next we met Dr. Patel; our first impression was what a humble and gentle man. He was more than willing to answer any remaining questions, concerns or hesitations.
1. We discussed the issues with early detection in men and how the PCP is handling PSA, more important he noted that any PSA is suspect, but over 1 is evident of some abnormality.
2. We discussed family history, I shared the Troia MD Anderson Cancer Tree, and he noted that with my brother’s prostate cancer and my diagnosis that most definitely my brothers, cousins and nephews would develop prostate cancer at some point.
3. Dr. Patel explained that all I am reading and researching doesn’t necessarily apply to me with my age and health considerations. There is not a lot of data available for men in their early forties. I personally used this website to gauge some of my information http://darrenritch.blogspot.com/ and an excellent book by Rabbi Ed Weisenberg called Conquer Prostate Cancer Now http://conquerprostatecancernow.com/
4. We then discussed possible surgery scheduling; he noted that he will not operate within 8 weeks of biopsies due to the bleeding and trauma (so that pushes it to Feb 1.) Next his schedule is booked through March, so I asked him if he had any “live case” coming available. For those of you that don’t know, a live case is the live robotic radical prostatectomy performed by Vipul Patel, MD while being fed into the World Robotic Urological Symposium 2009 held in Orlando, FL April 6-9. He told us that he had one available April 6 2009. So we elected to secure that spot on his schedule. http://www.globalroboticsinstitute.com/en/urology-robotic-prostatectomy/world-robotic-urology-symposium
5. We also discussed my past athletic venues, mainly the Athletes For A Cure Triathlon (2008 Orlando, FL) and my upcoming Disney 2009 Marathon (Orlando Jan 11 2009.) He was excited to hear of my involvement and even mentioned that maybe we might work together in unison with some future events. Lastly Dr. Patel shook our hands and said, “See you in three months and come back in good shape.” He doesn’t realize that I will use that as motivation to be in the best shape possible for me, I will treat this next 90 days as if I were training for another endurance event, my most important ever, one that could alter my life and my family’s lives forever.
6. So I guess that makes me a Prostate Model of sorts, either a model prostate or a prostate model.
Here is an excerpt from an email my wife sent her work associates…
“I can't begin to put it all into words, but let's just say, he will, without a doubt, be in the hands of the best the world has to offer! Long story short, his surgery is scheduled for April 6 - the Monday we return from spring break. The World Robotic Urology Symposium will he held in Orlando beginning April 6. Brett's surgery will be the "live case" for the symposium - telecast to the venue for hundreds to see. As it turns out, Dr. Jenkins will also be in attendance and was ecstatic when Brett told him that he was going to be the live case for the symposium. Our next mission will be for Dr. Jenkins to try to find a way for me to sit in on the telecast of Brett's surgery! How darn cool would that be! Patients usually are released from the hospital 24 hours after surgery but are asked to remain in town for at least a week post-op..” Kim Troia Jan 1 2009
Kari and Allison Cocoa Beach sunrise
My sister Leslie and her husband John provided us with a stress free 5 day vacation on the shores of Cape Canaveral at their condo. We had beautiful weather, we laughed, lived and loved, things that always emanate from Leslie no matter what the situation.
PT/PTT blood work 10.7 sec within the range of 9.7-13.2 seconds, acceptable for surgical procedures.
Chest-Xray No active cardiopulmonary disease
Bone scan No focal abnormalities are demonstrated in the appendicular or axial skeleton to suggest significant degenerative change or metastatic disease.
Abdominal-Pelvic CT CT of abdomen and pelvis show nephrolithiasis (kidney stone 6 mm) of the right kidney and small cyst on the right kidney (9.8 mm) but otherwise within normal limits
Test day, more prep-work 2 bottles of Berry Barium, outstanding stuff. I checked into Gulf Coast Hospital, to start with blood work, then off to Radiology. I first had a chest x-ray where the technician told me I had big lungs, a compliment I guess. Next I headed to Nuclear Testing to have the CT done, my first IV ever, except this fluid had a warm, flushing sensation during the injection of the contrast materials and left a metallic taste in my mouth that lasted for a few minutes. The next stop was for the bone scan where they inject radionuclide into your iv. The radionuclide will be allowed to concentrate in the bone tissue for a period of one to three hours and then I return for the bone scan. I returned at 2:00 and the scan procedure lasted about 25 minutes.
We did our best to explain to them that Prostate Cancer is not a death sentence, a slow grower, treatable and curable. It's the preferred Cancer. What does that even mean?
We laid out our current plan of how we as a team were going to attack this disease. We explained that we were going to seek out the absolute best doctor and treatment available.
We assured them that everything was going to be just fine and that God was in control.
If you are not familiar with Team Winter and Michael Vinecki's current fight, please visit http://michaelvinecki.blogspot.com/
Wednesday, January 7, 2009
He is very confident that we are looking at Stage 1, somewhere between T1 and T2 and doesn't feel the necessity for any further testing i.e. bone scan or CT pelvic scan.
Information on Gleason Score:http://www.phoenix5.org/glossary/Gleason_Score.html
We informed Dr. Jenkins that we would be leaving Panama City for any type of treatment of surgery. So my Doctor has asked me to do some of my own research with respect to procedures and he provided me two facilities utilizing the Robotic method that he would use if the need arose, the first being the Global Robotics Institute in Celebration, FL (Dr. Vipul Patel) http://www.globalroboticsinstitute.com/ and the second UF Shands Gainesville, FL (Dr. Parekattil) http://www.shands.org/find/service/roboticprostatectomy.asp
Our initial research was based only on the daVicni prostatectomy, below is the available propaganda.
Robotic Prostatectomy Benefits – Short-Term and Long-Term:
The cutting edge da Vinci® Surgical System has revolutionized prostate cancer treatment with the advent of robotic prostate surgery, also known as robotic prostatectomy. Benefits of this minimally invasive procedure are realized by both the surgeon, through enhanced precision and visualization, and the patient, in short-term and long-term recovery.
Robotic prostatectomy benefits may include:
· Quicker return to normal activity
· Shorter hospitalization – most go home the next day
· Reduced risk of incontinence and impotence
· Less blood loss
· Reduced pain – most patients don’t even need narcotics after surgery
· Fewer complications
· Less scarring than traditional open surgery
· Less risk of infection
The biopsy was scheduled for 1:30, instructions were no food after 10 pm the previous night and to cleanse yourself with one bottle of Fleet enema. As I waited in the office the anticipation of the biopsy was worse than the actual biopsy, looking at the tools of the trade are not advisable. Dr. Jenkins took 12 samples from various regions of my prostate through the rectum wall (12 little disciples off to the lab and # 9 really hurt!) I should tell you that he administered lidocaine prior to the actual removalof the core samples. Following the procedure, the doctor explained that I would have blood in my urine, my stool and my ejaculations for approx. the next two weeks. He was not bluffing.
That evening I experienced some of the utmost discomfort ever, it wasn’t painful but it felt like I had a dull headache in my rectum. The discomfort lasted approx. 4-6 hours until I started to feel less violated.
Huh little did I know...this little walnut sized organ is made up of thousands of tiny fluid-producing glands. It is an exocrine gland that produces fluid that is part of semen which is stored with the sperm in the seminal vesicles. In addition to that it also plays a part in controlling the flow of urine, it is wrapped around the urethra from the bladder to the penis. It is also wrapped tightly by a nerve bundle that controls erectile function.
Needless to say it is involved with two major functions for us men.
A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. PSA is released into a man's blood by his prostate gland. http://men.webmd.com/prostate-specific-antigen-psa
Total prostate-specific antigen (PSA)
Men younger than 40: Less than 2.5 nanograms per milliliter (ng/mL)
Men age 40 to 50: 0–2.5 ng/mL
Men age 51 to 60: 0–3.5 ng/mL