Second Opinion

Shortly after this my sister Kathy called to check up on me. During the course of our conversation she asked me if I would do something for her, which I agreed. She suggested that I talk to Dr. Hayes, the primary Doctor in the area who utilized Brachytherapy. She was very cautious and sensitive in her approach but she felt that it would be worth getting a second opinion for a treatment plan. She actually had done some work for Dr. Hayes in a hospital that they both work at and she knew him personally. Because of our relationship and my respect for her opinion I agreed that we would talk to Dr. Hayes.

Although I did not know it at the time Maili was feeling really strong that she did not want to go through with our current treatment plan. She felt that the surgery was too invasive and that the quality of life afterwards would be unacceptable.  Maili was quick to support Kathy’s suggestion. That Monday I did call and schedule an appointment at the Gamma West Cancer Services clinic in Salt Lake City for three days later on September 19th. Although I was fine to go down and meet with Dr. Hayes I had no plan on changing our current treatment plan.

Gamma West & Dr. Hayes

One of the great things about the area that we live in is we have Potato Harvest every Fall. The local region is a premier growing area for Idaho Potatoes. The schools are usually out for two weeks while many of the students help with the harvest. We typically have taken a family trip during this time, often a short one to Yellowstone National Park or Jackson Wyoming. This year we had the opportunity to spend three days at Bear Lake. Maili’s uncle Bill and Aunt Joy have a cabin in the mountains overlooking the lake and have allowed us to spend time there on different occasions. We love it there as it is a place of peace and tranquility. We usually play games, read books, watch DVD’s and just relax. We had planned to spend three days there, leaving after my work and Steven’s football game. Not wanting to disrupt our plans we still went and then the next day drove to Salt Lake City from the cabin.

As we drove up to Gamma West I felt fine about going for a second opinion but I still had zero interest in changing what we were doing. I knew that Dr. Hayes would tell me that my cancer was too far along for him to help us with and to go ahead with the planned surgery the next month. This is now nine days after we had the bone scan and had scheduled the surgery. We each said a prayer before we went into the clinic.

As with Dr. B., we felt comfortable with the staff. They were professional but not stiff and were pleasant to talk to. We had been scheduled at 3:00 PM, the last patient of the day as Dr. Hayes wanted to be able to spend whatever time was needed with us. Both Maili and I enjoyed Dr. Hayes and his personality. He was a little more easygoing than Dr. B. Unfortunately he did want to do a complete exam again. Although I was not thrilled about this I understood the need. He felt (literally!) that the Category was a T2C whereas Dr. B had it listed as a T2B.

After looking through all of the records from Dr. B and doing his own complete exam he told us what he would recommend and it did not include invasive surgery. Because of the advanced stage that my cancer was he recommended a three stage treatment plan or has he said “Combined Modality Treatment”:

1. Four months of Hormone Therapy (Bicalutamide)
2. External radiation, 25 treatments
3. High dose Brachytherapy, 4 doses

Our concerns were confirmed that the cancer was further along than it should have been but was encouraged that he thought that he could treat it. Having a prostatectomy gave me a 95% survival rate, which I thought was excellent. There was a lot of data available with Dr. B. and the John Hopkins approach but not as much data with the Hormone Therapy/Radiation/Brachytherapy. As we were talking with Dr. Hayes I told him that I really needed to live for 5 years but 10 would be great. Did he think that he could prolong my life that long so that I could take care of my family responsibilities. His answer was great. He was not trying to prolong my life but to eradicate the cancer and give me a normal lifespan, as if I didn’t have cancer. Not only did he think that I was going to live but that I would have a normal life. I was surprised with his positive outlook and optimism.

We did not leave his office until after 5:30 PM, we had spent almost 3 hours there and Dr. Hayes spent most of that time with us. We really liked that he had scheduled time to spend with us and answer all of our questions. Maili was relieved as this seemed to be what she was looking for, thorough treatment now with a quality of life afterwards. As we left his office and sat in our car for a few minutes talking about it we said another prayer, asking for guidance. We talked a lot on the way back to the cabin about the two options. Even though I like Dr. Hayes I was still emotionally and mentally invested in having the prostatectomy. It is hard to explain now but as well as we liked what Dr. Hayes to offer I still had no intent on changing treatment plans.

Maili liked the new option presented to us but she wanted me to come to the same conclusion, although she was insistent that I seriously consider it. The next few days at the cabin I did consider it. I finally asked her if it was her decision what would she do? I then quickly followed up with a disclaimer that this was entirely my decision and that although I would take her opinion under consideration that I would decide, not her. Simply I didn’t want to do what she wanted and then have my life cut short and have her blame herself for that. The responsibility would be mine and mine alone.

Maili felt that 5 great years with me would be better than 30 miserable years. She wanted quality of life for both of us, not a grouchy old man who existed on this earth for a long time (my words, not hers). I didn’t know what to think but I finally seriously started looking at Hormone Therapy/Radiation/Brachytherapy as an option. It was quite a process to change the plan but by the time we left the cabin I came to the same conclusion as Maili had. The next Monday I called Dr. B’s office and cancelled the surgery. They were very kind and there was no problem cancelling it although they did ask if I would let them know why. I simply told them that we were going a different route for a treatment. That call actually was hard for me to make as I had bonded with not only Dr.B but was fully invested with the treatment plan.

The Treatment Begins

And now the fun begins. We went home Friday night so that I could go with my dad to a BYU football game with Dr. Jim, our lifelong family friend who had advised me early on in this process. The seats were wonderful for the game, right on the 45 yard line but sadly we lost. BYU football broadcast most of their football games on ESPN now or for the few that ESPN does not carry they will broadcast their own on BYUtv. This is great as we can now watch all of their games from the comfort of our own home. Unfortunately it also means that several of their games have a late start, as did this particular game. We did not leave Provo until after midnight and had a 3 hour drive home. On the way down I did stop at Walgreens pharmacy to get my Hormone Therapy prescription. They had to call around to a couple of local stores to get it but assured me that they would have it when we came back through. We picked it up around 1:30 am  in North Salt Lake City and I took my first of 120 doses then. I later found out that Walgreens are more expensive for the hormone therapy pills, about $165 per month or $5.50 per pill. I would have saved a substantial amount of money had we gone to Costco or Walmart instead. The good news is that after the first few months I found a website, www.rxcut.com,  that we were able to print a coupon for that brought the cost down to $45 per month, a very substantial savings.

The following Thursday we drove to Ogden for a Hormone Injection. The needle was huge but the injection was smooth although about 3 days later it did start to hurt and did so for a few days. That injection and the pills were phase one of the new plan. Apparently cancer that grows in the prostate has to have testosterone for it to grow in. It does not cure the cancer but is one tool to help along with other treatments.

October 1, the following Tuesday, we met with Dr. Callaghan, a radiologist in Pocatello, a city about an hour away. We were going to receive the 25 doses of Radiation from him rather than travel 2.5 hours to Salt Lake City each day. This initial consultation provided him a chance to review my case and for us to get to know him. We really did like him and immediately was comfortable with him and his care. We would start the Radiation in a month, after the Hormone Therapy had a chance to work for a while.

Three days later on Friday, October 4 I went in for a CT Scan. I did have to drink a milky, chalky goop but it wasn’t as bad as I was led to believe that it would be. The Scan indicated that the cancer was not outside the prostate. The Doctor did see a few spots on the lungs that normally would not have been a concern but due to the cancer he suggested that we follow up the next year. Even though it is about time now, I’m not sure if I’ll get another CT Scan or not.

October was a great month for us as a family. Michael came home from New York and spent four days with us. Michael, Steven and Scott and I camped out one night and enjoyed hiking through the mountains, 4-wheeling and just spending time together. During the month Jason and I went pheasant hunting a few times. We also watched BYU Football every weekend. That became a good distraction for me and gave us something to look forward to.

The Hormone Therapy did cause me to be very tired and it was hard to keep up my normal schedule. I did continue to run several times each week, like I had for the previous seven years. Up until this time I had struggled sleeping well at night but I was so exhausted at the end of the day that I was in bed by 10:00 PM. Unfortunately my prostate had continued to have issues, I assume from the cancer and the treatment. Where I had been getting up 3-4 times a night to urinate it was now 5-6 times each night. Fortunately I would fall asleep as soon as I got back in bed. I also was able to experience first hand what hot flashes were like as they became a part of my life for the next few months. Although they weren’t terrible I was glad when they eventually went away.

There was one more CT Scan with Dr. Callihan which helped them to make a mold for me to lay on while receiving radiation. They also gave me three “medical marks” that would help them in future years in case they ever had to do radiation again. Although I was not happy about these marks they are discreet and were necessary. This was 12 days before the radiation was to start. We had one last chance to go to Bear Lake before winter would set in and the Radiation would start. Spending a few days at the cabin always clears my head from the worries of life and this weekend was no exception. I was learning to appreciate the small things in life more.