May 30, 2013 - 11:16 pm
Hello everyone, I am here with an update on my father, and the news is fairly good. He is recovering from his bilateral pulmonary emboli pretty well and is getting around quite well for all that he has been through the last month and a half or so. He is on home health care and they are doing physical therapy twice a week, and the therapist is pretty pleased with his progress. He has been able to do his excercises with out a whole lot of trouble outside of some of the tougher ones, but he still gets through those pretty well in my opinion. He just finished his 2x daily 15 mg xarelto dosage and is now on 20 mg of xarelto 1x daily for the next 6 months to help keep his blood thinned out. It was explained to us that the blood thinner doesn't actually bust up the clot, but rather, it thins the blood enough so it can flow around the clots. And from all indications, his blood thinners seem to be doing what they are supposed to do; hes got good oxygen saturation levels, 98% most of the time, even after doing his excecises and walking. Blood pressure is also quite well, even though part of the post treatment report did mention some possible ventricular damage to his heart, and some dialation of the pulmonary artery. His surgical incisions look great, no signs of infection, swelling, or redness, and appear to be healing quite quickly. CT Scans of his head and chest taken the day of his collapse in the yard showed no tumors in his head or lungs, no brain hemmorhaging, swelling, or abscess, no pneumonia, and sonogram of his heart revealed some right branch bundle block, but the doctor didn't seem to be terribly concerned about that, the main thing he said was the clots.
What does this have to do with his cancer some may ask? Well, for those whom havent read my previous posts, he was diagnosed March 19 with(at the time clinical stage 1) prostate cancer, with 5 of 12 cores positive, gleason 6, 3+3. He is 63 yo, and opted for the DaVinci Robotic prostatectomy, and the operation was performed April 23, stayed overnight, and sent home the following day(even though his Oxygen saturation was only 91%, that should have raised a red flag right there). And then on May 8th, around 4:30 in the afternoon, as he was getting ready to go back to the doctor for a high fever(103.1 F), he collapsed, my sister rushed to the door as I was coming out, and I found him crumpled on the ground, though he still appeared to be trying to breathe. I looked at his eyes and they were rolled to the back of his head. I then called 911 and let my sister talk to them, as I was in too much of a panicked and histerical state to talk to them. Was able to get him up and seated in the front seat of my sisters car, where his eyes started rolling to the back of his head, and I kept saying his name loudly and asking him where he was at and what was around him, to try to help him stay conscious until the EMTs arrived. At their arrival, his Oxygen saturation was 84%, and he was taken to the local hospital(with no lights and sirens on), and there he had a battery of CT scans, Xrays, and Blood work. His D dimer on his blood work came back extremely high, over 5000, which was suggestive of DVT/Pulomonary embolism. CT scan showed he indeed had extensive bilateral pulmonary emboli. He had already been given heparin through an IV before they did the scans, because they were suspicious of clots before they did the tests anyway. And finally once he was stable enough, he was transferred to the hospital located next to his Urological surgeon's office; while there, he spent 2 nights in SICU, and 2 in a regular room, and he continued to recieve Heparin through an IV during his stay in that hospital. Their scans and blood work confirmed extensive bilateral pulmonary emboli, that had in their opinion, came from behind his knees in the popileatal veins. The doctor said tests done there suggested no clotting disorder, and his history of physical activity suggested that the clots were a result of the prostate surgery and the immobilization that followed after that. He took his 15 mg Xarelto as told and is now currently on the 20mg regimen he will be on 1x daily for 6 months.
And of note, once we got the paperwork for his insurance, the surgical pathology report showed that the cancer was in both sides of his prostate, involved 10% of his prostate, and perineural invasion was actually present according to both the surgical pathology report and initial biopsy report. He was given a pathological stage of pT2cNXMX.(Why the lymphnodes were not assessed, and nothing was done to assess for metastasis is beyond me, I figured that would have been something they would have done anyway), and also it mentioned on the surgical patology report that 1 "block" showed a minimally focal positive margin. That doesnt sound too great in that regard, sounds like it could have been stage 3 according to that, and having perineural invasion. However, seminal vesicles showed no presence of cancer, and there was something else sampled in the report that also said there was no evidence of cancer there either, though I cant remember exactly what that was. Sounds to me dad is/was dealing with either a stage 2b or stage 3 cancer. He will have his first post-op PSA test next month, and with no prostate there, it should come back 0.0. If it does come back ANYTHING other than 0, I would suspect that perhaps some micrometastases were present, and further treatment with radiation therapy and/or chemotherapy and/or hormone therapy would be the next step, provided that it doesnt become much more aggressive and metastasize to the point of large lesions being visible. But hopefully with the gleason score remaining a 6 after the surgery, that wont be likely to happen.
Sorry for the large wall of text, and perhaps I jumped around back and forth too much, but I figured I would give you guys an update on his condition and let yall know where we stand. Let us hope the upcoming PSA test is absolute 0 and those blood clots get resolved(we were told the body will actually be what dissolves the clots; if they do dissolve, and not the blood thinner). For those of you who are dealing with this cancer, or have loved ones/friends who are dealing with it, I wish you all the best and I hope to hear successful stories from you all. Thanks for the advice and input you guys have given me, it is GREATLY appreciated.
I know I made a topic about his prognosis being poor, but perhaps, and hopefully, that was just me jumping to immediate conclusions and not giving everything I saw full thought. Hes told me himself that he definitely feels much better than he did that day, and the couple days prior to him collapsing, and he has stated that he is focused on recovering and hopefully making it back to work, though I told him not to rush it by any means. As I stated above his vital signs have been very good, seems to be getting stronger as time progresses(heck, before the treatment for the embolisms, I was having to help him out of bed and put his pants on and tie his shoes. He can now get out of bed with no assistance, bathe and put his pants on with no assistance, and is pretty much able to walk at his own discretion without having to ask for help. Though he has lost a bit of weight since before the surgery, a net loss of 12 lbs, I attribute that to him not eating as much due to his fear of becoming constipated to the point of being compacted, but I'll save that bit for another time. And as far as the doc goes, I think he did a pretty good job with the operation, especially considering he had to work around 3 inguinal hernia meshes that were put in during a prior operation last year. He was able to work around them and had no complications with them at all, so maybe thats a plus in terms of his skill and preciseness(probably not a word, but you get the just of what Im saying). Again, thank you all for reading and your input, it is very, very much so appreciated.