Pain Pump Installed

Glad to hear. He is lucky
Glad to hear. He is lucky to have you as a daughter

Many challenges but glad things are looking up
Roxy,

With all the info you’ve provided on your other threads, it appears that your 79 yr old dad has endured and faced many medical challenges but, you’ve been there for him all along as a caring and supportive daughter. It’s obvious how much you love your dad. I wonder if this is an accurate, or mostly accurate, account based on your previous threads: Your dad suffered a massive heart attack in ’86; had quad bypass in ’87; in ‘07/’08 had add’l stent placed in a blocked artery; dx’d with CHF and taking Rx diuretics; skin cancer survivor; normal cholesterol level but taking RRY supplement and no Rx statin; has had hip replacement surgery.

Prostatectomy in ’98; Pre-tx PCa biopsy pathology was Gleason 7 (G7), PSA 17; post op pathology G6; PSA 19 and DRE in ’07 found palpable mass, biopsy pathology was G8, PCa recurrence tx’d 40 SRT txs in ’07 (type of RT and total Gy?); issues/side effects from SRT; nerve blocks and subsequent spinal fusion on 2 discs; AUS 800 implanted; continuous HT w/Lupron every 3 months since ’07 with calcium and vit D; PSA consistent at 0.01 for 5 years.

Feb 2012 pre-op MRI & CT w/contrast for 2nd AUS 800 surgery for new valve replacement revealed bone mets "up & down spine,” however went forward with AUS valve replacement surgery; all regular previous bone scans since start of HT in ’07 were “clean;” Xgeva injections started April 2012 (for bone mets found during pre-op tests in Feb); recently broke 3 ribs pulling off his shirt; within 6 wks, went from no/minimal pain to debilitating pain and had to be taken to ER where add’l broken ribs were identified (cause or dx given?); Dad's urologist onc indicates PSA did not follow the typical PCa characteristics and PSA remains at 0.01.

Worsening & continuing pain required increased Rx pain meds including Percocet, Fentanyl patch, Gabapentin, Aleve; add’l pain med “Lyrica” may have been Rx’d; bloody sinus mucus and painful coughing episodes caused difficulty breathing (cause unknown or possible side effect of Rx pain meds?); sinus x-rays ordered; last bone mineral density test was in ’09 (results?); no new comparative follow up bone density test requested or ordered; recent PET scan ordered but HMO insurance denied, however charitable organization will cover PET (F18 PET/CT?), date TBD, and possibly also cover other medical cancer expenses; latest bone scan on 5/7/12 is “unimpressive” according to RO, finding two hot sports on spine and 4 broken ribs; scheduled endoscopy with biopsy of thickened esophagus lining (other cancer suspected or related issues?); RT txs for bone mets postponed/refused due to previous issues with SRT in ‘07; chemo postponed; Fentanyl pain pump initiated with goal of managing/eliminating extreme pain.

Along with many questions still unanswered, there seems to be a number of different medical specialists involved in dad’s care. If this was my dad, I’d want to find one top notch experienced and skilled PCa oncologist who would be able to manage dad’s overall medical care and oversee coordination & communication with all the various specialists who were currently treating dad. I’d want to know if all the docs on my dad’s medical team were in agreement about his dx (or multiple dx’s) and txs, and if not, why? I'd want to know what they suspect is the source(s) of pain, bone mets, broken/fractured ribs since it appears to be undetermined i.e., possibly PCa, another primary cancer (esophageal?), other complications such as osteoporosis or combination of factors? If the pain symptoms are managed/controlled, but the source of the pain is undetermined, what is the plan to identify the source, how will future pain symptoms be addressed, and what txs might be best for dad based on the dx (such as IG/IMRT, SRS/SBRT, second line HT, chemo?). Will these txs be considered curative or palliative? If his PSA does not follow the typical PCa characteristics (or if PCa and/or another primary cancer is dx’d) how will his progress be monitored and tracked? What is the explanation for MRI and CT bone met findings in Feb (up and down spine) vs bone scan in May (two hot spots)? Does the latest bone scan indicate oligometastases and treatable bone mets? I’d obtain copies of all my dad’s medical reports, including previous bone scans, bone mineral density reports, PSA and blood work lab reports, and the ’07 SRT report to understand the RT modality and dosing used and why dad may have had complications or severe side effects from SRT (did older RT technology or Gy dosing cause collateral tissue damage, etc?) I’d ask or gently insist that my dad consider a 2nd opinion consult ASAP with another PCa oncologist who would review my dad’s complete medical history, request a new blood panel using a different lab than previous labs, and who hopefully could provide an overview of dad’s case or, at least, offer some 2nd opinions and recommendations for add’l diagnostic tests, a dx, txs and prognosis.

Knowing how involved you seem to be in your daddy's care, you've probably done this and more. You certainly deserve a lot of credit for everything you are doing and continue to do to help your dad and your family get some relief and find answers. You mentioned in another post that your dad is a real fighter. It sounds like he is trying to stay strong for himself and his family. And you’re staying strong for him as his daughter and his advocate. Your strength and determination are to be admired. I hope things continue to look up and work out for all of you.