How to help my Grandpa?

 Dear Granddaughter:

 How sweet of you to want the best care for your grandpa.  Being grandparents, we are so pleased that the grandkids still remember that we were there for them when they needed us.  After all we took care of your “daddy and mama”.  And in fact, when one member of the family has cancer, the whole family has cancer.  And I’m sure your grandpa loves you as much as he loves your parents.  There’s no way to put into words the love that grandparents have for their grandkids.  That is if the families are normal, as they were when we lived back in the 50’s.  Nowadays, seems like some of the “older folks” are trying to relive their childhood and to H_E_L_L_ with their children, much less their grandchildren. 

Just yesterday, my youngest grandson came over and when I told him how my own Stage IV Ovarian cancer was once again on the advance, he threw his arms around me, hugged me, and said in a quivering voice and a tear in his eye,  “I love you so much grandma.”  And it brings a tear to my eyes even as I write this note to you.  So I think I can “get inside your grandpa’s head and heart” and know how your grandpa feels about you.  He has lived long enough to “welcome you into the world” and I bet you are the love of his life, as much as he is of yours.  Otherwise, you wouldn't be writing here.

That said, a few things come to mind as I read your letter this morning.  EC recurrences are many, and survivals few, so I know you don’t want to see your grandpa have problems this early out.  Not knowing where he was treated, or what his Stage was, leaves me wondering if Grandpa is considering having a SECOND OPINION.  The last words we want to hear is “there’s nothing more we can do!”  That is so final, so I wouldn’t just listen to one doctor’s opinion, unless he speaks as one who primarily operates on Esophageal Cancer patients, and that is his specialty. 

Even then, Grandpa should not settle for only one opinion.  Let’s be honest, sometimes doctors look at a person at a certain age, and throw in the towel before the patient does.  On the other hand, they are not miracle workers.  Sometimes people are of the mind and think, “What do you mean, you can’t fix it?”  I’ve talked with many a person in denial.  That’s a “no man’s land” for sure.  But at this point, the most I would say is that sometimes “medicine makes us sicker before it makes us better.”  Your grandpa wants to live out his days and live to welcome “greatgrandchildren” into his world.  So at this point, the most I can say is Grandpa should choose to go to a medical facility and have a second consultation with doctors who specialize in Esophageal Cancer.  Another doctor who lives “close by” is never a good choice. 

And there is always one more consideration, there does come a time when "enough is enough" and we all pray we will know when it is time to stop the treatments that just keep on making us sicker rather than better.  QUALITY of LIFE should always trump "quantity" of life in my opinion, and that will dictate my choices which will increasingly diminish with the passing of time.  But I must interject here, that I serve a God Who promises to never leave me or forsake me, and I do pray to Him for guidance.  He is the "ultimate" second opinion.

Grandpa deserves the same good medical attention as do younger folks, and I hope to hear that this really is something than “can be fixed” and is not a recurrence.  In any event, usually most doctors will suggest undergoing chemotherapy to stave off the cancer’s further advance.  Wish I could do more, but keep us posted.

Love & prayers for you and Grandpa and the rest of your family,

Loretta Marshall

Wife of William Marshall, now into his 14^th year of surviving Stage III (T3N1M0) Esophageal Cancer.  Dr. James D. Luketich performed Ivor Lewis Minimally Invasive Esophagectomy on May 17, 2003. 

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Places to start looking for help

1.  http://www.cancer.net/cancer-types/esophageal-cancer

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 2.  http://www.cancer.net/cancer-types/esophageal-cancer http://www.cancer.net/cancer-types/esophageal-cancer/questions-ask-doctor

 “…Questions to ask about planning follow-up care

 What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will I need them?

• How do I get a treatment summary and survivorship care plan to keep in my personal records? 

• Who will be coordinating my follow-up care?

• What survivorship support services are available to me? To my family?

 3.   https://www.oncolink.org/support/coping-with-cancer/dealing-with-a-recurrence-or-second-cancer 

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4.   https://www.oncolink.org/oncopilot/second-opinions

  “…There are many reasons to get a second opinion, including: a rare type of cancer or unknown primary site, you live in a rural area that does not treat many cancers, you have been told "there is nothing we can do", or you just don't feel comfortable with the first doctor you saw.

 Second opinions are also a way to educate yourself about the options. If one doctor says treatment A is the best, but doctor number 2 does not agree, ask them to explain why. Many patients fear offending their doctor by getting a second opinion. A good doctor understands the need to research all of your options, particularly when dealing with something as scary as cancer. If your doctor discourages a second opinion or infers that you can't get better care somewhere else, all the more reason to get another opinion. You do not need the permission of your doctor to get a second opinion, except in the case of needing a referral from your primary doctor for an HMO insurance carrier.

The "big cancer center" is not near my home. Getting a second opinion at a major medical center does not mean you have to get your treatment there. In many cases they can provide recommendations for treatment that can be taken to your local doctor. It can be well worth a long drive or overnight visit to get a second opinion on your options…”

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ralphsgranddaughter27 said:

Thank you

Thank you for your responses. My grandpa is very important to me and the rest of our family. I tear up whenever I think about his pain. He's just not happy with not being able to enjoy food like he used too, and it's a real shame because grandma is an excellent cook. I will see about him going to see a different doctor. He's been to 2 different ones at least. I checked with my mom and grandpa is actually on his 10th year of survival and longer than that for his prostate cancer. He had prostate cancer first.

 Hello again Granddaughter –

 Since Grandpa has survived Prostate Cancer for 10 years, have the doctors done the proper tests to see that this cancer has not spread sometime between then and now?

 Mayo clinic has some good information about Prostate cancer.  I think it is a very simple “down to earth” explanation of all types of cancer.  There are tests that can determine if indeed Grandpa’s Prostate cancer may have spread to another place in his body.

 Have you taken him to a doctor that will perform a PET scan for instance? It shows live activity throughout the body.  Although these tests may be done to determine the extent of the Prostate cancer, the same test such as a PET can also once again determine if cancer is elsewhere in Grandpa’s body.  I would want to consult a doctor who would agree to perform some actual tests instead of just looking at Grandpa and saying, “Ummph…nothing to see here!” 

 Grandpa is worthy of a complete physical that includes some of the tests outlined below to see if indeed this is possibly a spread of the cancer he was diagnosed with years ago.  In other words, has metastasis been ruled out?  And how can that be done if no definitive tests have been done?

 Loretta

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  1.  http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/tests-diagnosis/con-20029597

 “…Determining how far the cancer has spread

 Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as these may be recommended:

 Bone scan

• Ultrasound

• Computerized tomography (CT) scan

• Magnetic resonance imaging (MRI)

• Positron emission tomography (PET) scan

  Not every person should have every test. Your doctor will help determine which tests are best for your individual case.

  Once testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options. The prostate cancer stages are:

• Stage I. This stage signifies very early cancer that's confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren't considered aggressive.

• Stage II. Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.

• Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.

• Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs…”

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  2.  http://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer-metastasis/faq-20058270

  “In theory, prostate cancer cells can spread anywhere in the body. In practice, though, most cases of prostate cancer metastasis occur in the lymph nodes and the bones.

  Prostate cancer metastasis occurs when cells break away from the tumor in the prostate. The cancer cells can travel through the lymphatic system or the bloodstream to other areas of the body.

  More commonly prostate cancer metastasis can occur in the:

 Bones

• Lymph nodes

• Lungs

• Liver

• Brain

•  

  Rare locations of prostate cancer metastasis include:

 Adrenal glands

• Breasts

• Eyes

• Kidneys

• Muscles

• Pancreas

• Salivary glands

• Spleen

•  

  If you've been diagnosed with prostate cancer and you're concerned about prostate cancer metastasis, talk with your doctor about your risk of prostate cancer metastasis and your treatment options…”