PSA, Testosteron Levels

March 1, 2018
Hi, Tracy. I had my blood draw today, as part of the on-going process to monitor my prostate following radiation and hormone reduction therapy.  Here are the results:

Testosterone:

My value: 295 ng/dL Standard range: 170 - 800 ng/dL

PSA (Prostate specific antigen):

My value: 0.520 ng/mL Standard range: 0.0 - 4.0 ng/mL

In September 2016, my PSA score was 25. In November 2017, seven months after radiation ended, it was 0.4. So the score is recovering toward the normal range, but slowly. I take this as a very positive sign that this will have been a once-in-a-lifetime experience.

Love,

Dad

P.S. Msg from Dr. on March 2:

Your PSA is as follows:

Lab Results
Component Value Date
PSA 0.520 03/01/2018
PSA 0.400 11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 25.0 09/13/2016
PSA 19 05/09/2016
PSA 16 02/17/2016
PSA 12 09/02/2015
PSA 10 02/23/2015

We should repeat it in 4 months to see if it remains stable or continues to increase. I will place an order for July 2018.

Chacala, Mexico UTI

March 1, 2018
Hello, Tracy.
UTI's are never convenient, particularly when they occur in a foreign country and your cell phone has become difficult. This was the situation I faced Feb. 13-20 when I visited Joanie in Chacala, Mexico,

Here's a map showing how I got there, and some information from Wikipedia about this little Shangrila on the Pacific Coast of Mexico:

Chacala is a beach-town set in a small cove on the Pacific coast of Mexico in the State of Nayarit. It is located about 100 kilometers (62 mi) north of Puerto Vallarta. The name means "where there are shrimp" in Náhuatl, and is part of the coastline known as the Riviera Nayarita.[1] The population consists of approximately 300 full-time residents, but can swell to over 1000 during Mexico's most popular vacation periods such as Semana Santa, (Easter Week) and Christmas. Chacala is known for its physical beauty, unhurried lifestyle.

Chacala's small bay has a gently-sloped sandy beach ideal for wading out into the crashing waves.

I decided, spur-of-the-moment, to fly there, using airline miles on American Airlines. But after I purchased the tickets, I found myself with preliminary indications of a Urinary Tract Infection. (After a while you learn to see them coming.)  It came in the form of frequent needs to urinate, with a hint of discomfort. I tried to hydrate and clear it out, and it calmed down on my flight to Puerto Vallarta. I arrived, and hailed a taxi to the bus station. But enroute I decided I was tired and taking the bus to Las Varas and then taxis to Chacala seemed like more complication than I needed. So I paid the taxi drier to take me there.

Balking phones and missing passwords

After I arrived, the fun began. My new Verizon phone reads a finger print or requires a PIN for access, and for a while it opted for the PIN, but the interface didn't provide an "action" button once the PIN was entered. When I tried to e-mail Kaiser Permanente, I realized that I had not brought my updated password for my laptop -- had changed the password after losing my original phone in Zurich. Meanwhile, I was enduring sudden urges accompanied by incontinence. I had brought a diaper along as well as several absorbent pads similar to what ladies use. Joanie and I decided to take a bus to Las Varas, where there was a pharmacy where I could purchase diapers and she could have her non-working cell phone fixed. At the cell phone repair facility my phone decided to display its number pad with a new symbol -- a check; to my embarrassment the lady at the counter pressed the check and I was into my phone for the first time in a couple days. That was handy, because Verizon requires your phone to be working so that they can send you a text message so that you can get your phone working. Technology like this is very aggravating when you are in Mexico with a UTI.

There's a small mountain near the beach -- it's actually an extinct volcano, and we hiked to it's caldera.

The caldera of a small extinct volcano overlooking the bay.

Too late the banyo

And down the beach there was a tapas bar protected by a structure with a thatched roof. We went there to read one day, when the urge hit me just before the bar opened for business. The surf and the calm lulled me to a sense of complacency, and I failed to act before the urge hit. By the time the owner had unlocked the bathroom, I was pretty sure it was already too late, and I was right. Afterward I quietly offered her 100 Pesos and apologized to her for losing control and directing fire to the waste can in the banyo. (Where, in Mexico, they normally deposit the tissue due to plumbing problems.) A few days later she joined Joanie and me at our Valentine's day dinner, acknowledging by that gesture her forgiveness and understanding.

The mural urinal

The trip back to the airport was punctuated by several needs to stop -- the advantage of taking a taxi instead of the bus. It also represented an introduction to a Mexican custom -- peeing on a wall in plain sight. We were stopped in traffic and I exited the taxi, crossed in front of stalled cars, descended to a lower street, and looked in desparation for a banyo. The driver caught up with me and direted me to a wall. The next stop was a few miles down the road at a gas station, where he purchased a bag of peanuts. In the car he offered me some and laughed when I noted that this trip came with a meal. There was a significant language barrier, but we were able to share that joke.

Incident on the plane

There were other accidents, of course, and I learned that the best solution was just to walk out into the surf, so that no-one would wonder why my safari pants were wet. That didn't work on the plane home, however, when I made the silly mistake of sipping water while I was waiting for a passenger to exit the bathroom. I was pleasantly surprised at how the absorbent pad had caught most of the urine so that it wasn't obvious to others on the plane what happened to me in the aisle.

Things are better now. I got home, drank lots of fluids, and eventually urinated the offending bacteria out of my system. It was just one more aggravating experience on what I believe will be the final stretch toward recovery.

Later this morning I go to Kaiser Permanente for my blood draw to see what my PSA level is.

Love,
Dad

Recovery

Dec. 6, 2018

Hi, Tracy.

I went to a movie tonight -- the latest Star Wars episode. I was able to sit through the whole movie without having to get up and rush to a bathroom. I will continue my antibiotics for the next few days, but it appears that my UTI is a thing of the past. I will continue to drink lots of water and do pre-emptive peeing, But I think the bad is over with.
Love,
Dad

Another UTI: Managing incontinence

Jan 1, 2018

Hi Tracy

As I explained, two days ago I had another UTI. It came on about 2 p.m. when I was at a phone store, trying to have technical support connect a new phone with my existing phone number. I had just urinated before going there -- yielding up a small amount -- and already it was time to urinate again. And after a few minutes, when the phone assignment had been completed, I had a need to urinate yet again; only this time there was an off color in the liquid -- a trace of pink.

I knew what that meant. I drove straight home, peed again, and first saw blood, and then clots in the urine stream. I went to urgent care, where I passed a small specimen because I really didn't have much in my bladder. (I stopped hydrating so that I could  be dry at my next destination.) I met with a doctor and asked why I was having recurrent problems. She offered the observation that there's a distinct possibility that the microbes causing the problem come from outside the body and work their way up the urinary tract. Recommended treatment -- plenty of flushing activity, attention to bathing regularly and perhaps (my opinion) changing underwear more than once a day.

When I got home I drank water every time I urinated, and tried to pee before I had to. By midnight the urine was clear. I had already started on antibiotics.

However, although the urine was clear, sometimes the urge can accelerate rapidly from a mild sensation of need to an accident. And so I continued the practice of hydrating, but peeing before I even feel the need. In other words, stay ahead of the process.

What I'm finding is that it's also a policy of staying ahead of Dr. Pavlov. The moment I enter a bathroom the urgency accelerates, or in cases where there was no perceived need, an urgency emerges. So, yes, if you were wondering, I keep pads handy while this temporary aggravation exists, and I have been known to wear diapers -- but manly diapers, the kind that remain undetected beneath my trousers.

It has been a full nine months since my last radiation treatment and my second (and last) lupron shot, and the after effects are still being felt. The good news is that, while this effect is aggravating, it is manageable.

Love,
Dad

Another shoe drops

November 20, 2017

Hi, Tracy.
Just when I think I know what's going on, new information pops up. Apparently my UTI is a UTI after all, but maybe no longer.

In my last post I said the problem with my urinary tract infection was that it wasn't an infection, but more likely the result of irradiation, and that I had been prescribed medication. Well, the story has changed.

First the information was that a specimen showed no indication of bacterial infection. The doctor used a cystoscope to peek into my bladder and found it inflamed, theorized it was from radiation and  authorized medication to calm things down. Before his examination, my symptoms had already calmed down and after the exam they went away almost entirely. I concluded that the meds were likely keeping at bay a problem that was already diminishing.

But then, after I passed the information on to my radiology team, I heard back that I indeed had an infection after all -- involving e-coli! And then the urologist confirmed that. However, before he he had sent a camera up my urethra to study my bladder, he took the cautionary step of an antibiotic injection in my hip to prevent potential infection.

Put that all together, and now the theory is that I indeed had a UTI, that the radiation from last spring was not the source of the problem, and that the antibiotic I was given as part of the examination is what took care of the UTI.

So I purchased, a month's supply of bladder-soothing Elmiron for $40 (cost to Kaiser Permanente: $750), and I only took a few pills before the doctor said don't bother, wait and watch.

And that's where I'm at. Things have calmed down. I store my pads and diapers for the next crisis. I will just sign off with the same moniker as the famous author of "Yellow River" --  call me I.P. Daily.
Love,
Dad

Cystitis

November 13, 2017

Hi, Tracy.
My urologist may have solved the mystery of the symptoms I've been experiencing that are similar to a urinary tract infection (UTI). It appears that my bladder is inflamed for reasons other than a bacterial infection. The most likely explanation is a residual effect from the radiation treatments I experienced for eight weeks in February and March.

For the past couple weeks I've had symptoms; then they disappeared; then they reappeared. On one occasion, I was passing cranberry-colored urine, and then it suddenly cleared up. And I do mean suddenly. At one moment urination was painful and bright red, and then it wasn't. This past weekend I decided to cancel travel plans in December because I was suddenly needing to urinate several times a day. Yesterday I stayed home because I was not willing to leave the house. And I have been wearing the adult equivalent of diapers.

This morning I saw the urologist, who gave me a dentamicin shot in the hip to fight possible infections from the procedure that soon followed -- the uncomfortable numbing of my urethra, and then the insertion of a foot-long tube with a camera on the end, that slipped past my prostate and into the bladder, to take a look. This procedure is called a cystoscopy, and it uses a cystoscope, a tube with a lens on the end. It has about the thickness of a catheter. It stung a little, but with the anesthetic squirted in ahead of time, it wasn't much worse than the hot sensation that occurred during urination. In fact, while the cystoscope was entering, I felt like I had to pee. Afterward I did, comfortably.

 Normally, the bladder appears pink, but there were places where mine was red -- inflamed. In the absence of any bacteria, the most likely explanation was collateral damage from radiation dating back to the end of March. The painful symptoms prior to and during urination probably fall within the definition of "referred pain," which means one part of your body is experiencing discomfort that is expressed at another point.

The meds I'm going to take to deal with the inflammation are not inexpensive.  My prescription for pentosan (a.k.a. Elmiron) is $750, but because I have health insurance I pay only $40. Pity those who aren't covered.

PSA update

Buy the way, kiddo. I got more information clarifying what my PSA scores will indicate from now on. My PSA will continue to rise from it's present level until it reaches a new baseline. After radiation, you'll recall, it was less than 0.02. It is now 0.4. My understanding is that it should level out at about 2 or whatever is my "new normal." And then it should stay there. If it doesn't, that will get our attention.

Love,
Dad

PSA score, 7 months later . . .

Nov. 3, 2017
Hi, Tracy
What I thought is a urinary tract infection apparently isn't. My urologist says my urine culture proved negative for a UTI. However, I've been prescribed three doses of Monurol instead of the single dose I took Oct. 21. I take these at two-day intervals. So we'll see.

And now for the big news: When they drew blood due to all my excitement yesterday, they used some of that blood to test my PSA score, and  the results are listed below, showing what the score was historically. You will recall that my radiation treatment ended March 28, 2017.

Lab Results

Component     /  Value Date 
PSA 0.400      11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 25.0         09/13/2016
PSA 19              05/09/2016
PSA 16              02/17/2016
PSA 12              09/02/2015
PSA 10              02/23/2015

You can see from these results that the PSA peaked at 25 on September 13, 2016; dropped to 0.08 % of  that score on April 25, 2017; then recovered to 1.6 % of that highest score by November 2, 2017.

Here is what the doctor had to say about the score and rebound:

You may get some increase in the PSA as the testosterone levels get back to normal. Once the PSA level is steady, then a recurrence would be consider your nadir stable PSA plus 2. So, the PSA response it good so far.

The next blood draw to measure my PSA would be in March, 2018.

Love,
Dad