Update - Advanced Metastatic Prostate Cancer

VascodaGama said:

The bodyguard

Grace,

You may see the doctor's expression from the positive side of it. Your presence at the consultations leads the doctor to feel better in going through the treatment. He is more relaxed for knowing that there are someone caring on the developments when he is not arround. Your presence gives him more assurances that his instructions are followed by the patient.
It is true that they do not like to be contested not just by patients/family but even by other doctors. However, you have been polite and your presence becomes noticeable for whatever your personality has leaded. They like patients that are educated (to certain extent) on the problem so that they do not need to become professors to teach in much detail the occurrence. He may have missed your presence.

Regarding Prednisone, this is a drug full of tricks. I would recommend you to read the details as it should be taken with some caution, and it should not be cut-off at once, in the end of the treatment. Depending on the dose taken daily, Prednisone may cause atrophy of the adrenal glands leading to shock. It is also linked to bone loss which may require the use of bisphosphanates we discussed above. Please read this link and request for instructions, from the doctor, as advertent of a possible occurrence;

https://www.verywell.com/prednisone-10-things-you-should-know-190239

I would insist requesting full tests (lipids, kidney and liver function, cardiovascular, DEXA scan, etc) because of Prednisone, but politely.

Best wishes for improvements.

Grace,

I agree with Vasco's take of what the oncologist said. His reaction was more likely from disappointment that you were not present.  He no doubt knows that the patient is difficult, and appreciates your role.

I went to every appointment my friend had for his last 6 months of life during PCa; usually we saw an N.P.  The friend was, like your own friend, educated, smart, but disengaged; he would not remember anything the NP told him on the way home. I know that she would have been concerned if I had not been present for any appointment.

Doctors, like everyone else, can mean well but say the wrong things, or be misintrepreted.  I was in ICU once on a ventilator and had developed liver failure. The lung doctor was a young hotshot **** whom all the nurses disliked, but he was the best Pneumonologist around. He did not see me often, only when there was a lung problem.  One day he was walking out of the ICU after seeing another patient, and noticed that I was still in there. 

He turned and essentially yelled in the door, "You're still in here !  Did your liver ever start working again ?"   I was still on the ventilator, and hence could not speak -- something  you would think he would have known better than anyone -- so his response was pathetic.  But I guess he meant well. So what that he yelled at a man near death,  "Those organs ever start workin' again ?"

I would let the comment roll off of me and move on for your friend's welfare,

max

"If it gets worse go to the ER". Been there done that. This may not help at all, but I and several others had a bit more success using 5mg Cialis in the morning, and full doseage Flomax in the evening. It only keeps the pipes open slightly, but it is better than a trip to the ER. One guy I know switched exclusively to Cialis. So individuals react differently, so what worked for one may not work for another. And Cialis is expensive. But often a GPs and Urologists have free Cialis one month supply to give away because Lilly is really pushing 5mg Cialis as a BPH relief drug. It wouldn't hurt to ask.

I really appreciated your comment about helping your neighbor, not for reward, but its part of your nature to do it. That's what Paul says about our new nature doing things because that is just what comes naturally now... Even though we still have the " old man" still trying to discourage us or demanding some kind of reciprocation or reward. Hang in there. 

FinishingGrace said:

Thanks Grinder

We will definitely ask about the Cialis.

It has been a blessing to help him. It isn't always easy but it is not a burden.

Can we clone you?

The unbalance level in circulating hormones is seen as the main reason for the hot flashes. Increasing estrogens to balance may be the best alternative for the lack of testosterone that will not indulge the bandit. I would recommend him to try estrogen patches or eat foods that help boost estrogen naturally like: soy, olives, rice, carrots, tomatoes, pomegranates, apples, plums, etc.

Surely he can also use a small fan. In any case, the condition will not last forever. Our body temperature system will accommodate to the situation and will hold the control to distribute the fewer existing androgens among the systems in need for it.

Best wishes for continuing improvements.

VG

If at all possible, encourage your neighbor to take a daily walk and to exercise. He needs distraction; sitting in front of a fan isn't good for the mind. Yes, I know, exercise is hard when one feels tired and without energy to begin with. 

Glad to read that he is responding to the therapy. 

I wonder if his estrogens level is right. Prednisone could be causing atrophy of the adrenal glands, indirectly affecting the manufacturing of androgens (in addition to the LHRH agonist 3-months shot). Discuss the matter with his doctor/nurse and proceed with due tests. This is needed not just to help in the hot flashes saga but to control other healt issues (eg; kidneys, liver, etc) for avoiding further damage.

It is good to know on the lower PSA. The results from Chemo punch take about 6 months, the life cycle of cells, before it acertains success. I believe that still more good news will come.

Best,

VG 

FinishingGrace said:

It's hard isn't it?

He is bored out of his mind. There is nothing much for him to do. He has no friends and no family except those who occassionally turn up to see what they can get from him. I visit with him almost every day but working full time prevents me from doing much else beyond managing his care.

How about

A puppy

Volunteer work (library, food kitchen etc)