Vol. 2, No. 11

November 2003

Jerry Bylander, Editor  jerryby@texoma.net

FEATURE ARTICLES

The Managing Director's Column
To our members and friends, I have recently suffered my Brother's death due to a massive stroke. He also had an incurable staph infection of his heart valve.  I learned some things about asking doctors for more information, provided you can get them to take the time (Medicare rules lead to a sharply lowered patient contact time).  Remember this is not the country you grew up in, but medicine has the capability of lengthening your life.  Also remember that the quality of life is also important.  Also there is the internet, and relatives or friends who are medically trained to ask.

John was on dialysis for 5 years. The dialysis was necessary in part as a result of blood flow tests to diagnose an itch between two right toes.  My guess is that the itch was from a sciatic nerve irritation in his spine, since he had back problems similar to mine, and which are congenital.  One of the tests uses a dye which my primary care physician tells me has lead to a number of kidney failures in his patients referred to specialists. So check with your doctor about  side effects of tests.  Find out if the tests use dyes.

When my wife had to have a heart cath procedure, I asked my MD cousin about it.  "Be sure they don't use too much dye", he said.  Jane's doctor said he was cognizant of the problem and always used care.

I wonder if, since we must sign releases before tests can be run, if it wouldn't be unusual to ask the doctor to draw up and sign a side effects list.  If he refuses, maybe the test can be avoided.  Remember. tests are run to rule out  or in a tentative diagnosis.  We used to go with that diagnosis when these costly tests were unavailable.  You can still ask and refuse - it is your life.  You may have to change doctors if he refuses and drops you.

Back to dialysis We just learned that dialysis patients have an average life expectancy of five years after dialysis starts - of course life expectancy can be only a few months without dialysis.  Two points:  you may choose to avoid the dye tests if you determine they are of high risk nature and two, the last three years of John's life were all down hill as far as quality of life goes.  

Further, I found that an iodine indicator is used as for blood vessel image enhancement  used for the all pervasive CAT (or CT) scans so popular today.  How do you know if you are allergic to iodine?  One indicator is that you are allergic to shell fish.  No CT scan site on the internet mentions this, and I looked at about ten major centers.  When I took my CT scan at MD Anderson, as part of a research protocol, I broke out in hives. Benadryl was the antidote, but I had to leave my car and get my daughter to drive me back to her house from the effect of the Benadryl.  The nurse in the "recovery" area noted that some people have died from this test.  I estimated from the number being done that day, that about 1% to 2% of  CT scan patients have an adverse reaction.  This number is quite low unless you are Mister One Percent.  I had e-mail correspondence with the Riffed (laid off) director of Malinkrodt's dye research area (The company is one of the main dye suppliers.  I found him through another ex-employee related to me).  He replied that rats given massive doses of the dye had no ill effects.  I then asked, "did you test diabetic rats, or rats with heart problems or sick rats?"  No reply.

Finally, does your hospital have problems with incurable staph infections?  Ask if you are concerned.  If so find out the risks; that is, what are the percentage of surgery patients that are infected.  The particular staff infection John had can be recovered from if a patient is in good health; one of his daughters is a nurse and reported a patient with the infection recovered after three months, as I recall, and he was on three different antibiotics and he is reported to still be weak. 
See you at our next meeting in November.  Please recall that there will be no December meeting.

    Dr. Jerry Bylander, Managing Director, USToo! Texoma

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    Next Meeting


    "    Seeds"      

    Date: Tuesday Evening, October 21, 2003
    Location:  Wilson N. Jones North Campus Senior Center, south entrance, 3305  Calais Dr.  

    6:30 PM - Social & Coffee
    7:00 PM - Program

    Speaker:  Dr. Gregory Echt,  Radiation Oncologist, 800 W. Airport Freeway, Arlington, TX & Radiation Dept., Medical City    

    Program: You have asked for it and here it is.  Dr. Echt will discuss all aspects of seed implantation therapy for your cancer treatment.  He will also be prepared to discuss the usual side effects and the  ways they can be mitigated.*   At the end of the program, Dr. Echt will be available to discuss your particular options.  Also we will have a few minutes to discuss prostate cancer treatments of interest to you based on members' experience who have had radiation, brachiotherapy, or radical prostatectomies.  
    *  This therapy is not HDR (High dose external beam radiation)

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    Last Meeting
    Date & Time: Tuesday, October 21,  2003, 7:00 PM
    Place: Wilson N. Jones, North Campus
    Attendance: approximately 12 attendees


    Old Business

    None.

    New Business

     We discussed the low turnout and what to do about it.  Tom suggested other venues.  We will wait until January to decide whether there is enough interest to continue.  We welcome all suggestions.

    Program:   "I have prostate cancer.  Do I choose surgery or radiation or what?"

    Speaker: Dr. Patrick  McGrael,  Urologist,  Denison,  TX

    Program:  Dr. McGrael reviewed options for CaP treatment.

    The meeting adjourned about 9 PM.

    Henri Plunkett, Program Chair/by the Editor

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    Other Important Events
    Your organization's meetings listed here.  Contact the Editor at jerryby@texoma.net

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    Editor's Notes

    Random thoughts from your editor

    Deprivation Therapy Side Effects and their Treatment
    Watchful Waiting
    News you can use

    Deprivation Therapy Side Effects 

                                        
Male hormonal suppression of testosterone is used as a neo-adjuvant 
therapy before forms of radio therapy and sometimes surgery. HOWEVER its 
most common use is when prostate cancer recurs. If a salvage therapy 
fails to cure, hormonal blockade is then usually suggested. There are
volumes of information on the effectiveness of this therapy, both 
negative and positive. To put a fact to conflicting information, the 
Dept. of Defense, (DOD) announced this year that the average patient they 
have been treating on full androgen blockade has had a 10 year survival 
time. This is up from 2 to 3 years just a short time ago. The 
disadvantages of this therapy is that it is suppressive, not curative so it 
requires ongoing surveillance. It reduces or eliminates libido, results in loss of 
muscle strength and also weight gain, hot flushes, and sometimes depression is
associated along side these factors. In my studies, here are 
some major side effects, and their treatments (print this and check with your doctor):
    • Osteoporosis which is the loss of calcium from bones is treated with biphosphanates such as Fosimax, Actonel or Aredia.
    • Hot flashes are treated with Effexor, Neurontin, or Megrace.
    • Joint pains respond to celebrex and glucosamine. Muscle atrophy or tiredness can be prevented with strength training. 
    • Emotional swings are reversible with low doses of  Paxil or Zoloft.
    • Impotence or penile atrophy can be reversed with viagra. 
    
      
      
        
    • Anemia (if it occurs) reversible with synthetic 
        erythopoetin.  
    I hope one would grasp from this information this therapy can be well 
tolerated, and can certainly extend ones survival time by many good 
productive years, that should say it 
all..................................Henri Plunkett


    
      
    Back to Editor's 
      Notes
    WATCHFUL  WAITING      
                                                                            
      It is known that low grade prostate cancer is present in 30% of 
the general population over 50. In the great majority the disease lies 
dormant for life. In the case scenario of elderly men or men in poor 
health, if the indicators are right, to watch and wait may be a good 
decision. What you and your physician need to determine is if you have 
indolent cancer. This is prostate cancer that has a gleason score of 6 
or below. Also there were not more than two biopsy needles cores present 
with cancer, and with these core samples less than 30% core involvement.  
Be sure and ask him about the nature and number of CaP cores. 
Also your digital rectal exam was negative, and your psa is less than 6. 
These guidelines are basics at determining, first you have organ 
confined disease, and also it probably will be slow in growth. HOWEVER, 
watch and wait, really doesn't mean do nothing. You should be working 
closely with your doctor in the situation, and your PSA should be done 
at six month intervals rather than yearly, and also your doctor should 
be doing digital rectal exams during your PSA exams.  You SHOULD watch 
your diet and eat plenty of lycopene and use selenium supplements, watch 
your level of fats, as we believe these are a leading contributor to all 
kinds of cancer.   GOOD LUCK......................................henri 
plunkett

    
      
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      Notes
    News You Can Use

    
      
    You 
      can find news you can use at the 
      USToo International web site: http://www.ustoo.org/.  Check it out for the latest 
      references.
    
      
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    Jerry Bylander - Newsletter 
      Editor
    

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