Consult with Dr Myer

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BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 7/29/2010 7:30 AM (GMT -6)   
I had my long awaited consult with Dr Myer yesterday and, to me, it was well worth the cost and effort (left the house at 5:30am and didn't get back home until after midnight). Got a complete physical exam and assessment of my condition and current treatment. Generally he agreed but did some tweaking. Increased the frequency of PSA testing and added some other tests. Discussed diet, suppliments and next steps if SRT is not effective. Was also very concerned about the impact of HT on my general health as I am pre-diabetic and have been treated for high BP and lipids for years. Added some tests and increased the frequency of other tests to monitor.

I know many of you are very happy with your current doctors and treatment, but I was not. It was very reassuring to have someone as knowledgeable as Dr Myer do a complete assessment of my condition and modify treatments. Many times on this board I have seen recommendations to see a PCa specialist in your area if you have concerns about your condition or treatment. I believe it is well worth it if for nothing more than piece of mind.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 7/29/2010 8:57 AM (GMT -6)   
I believe you will still need a trusted doctor in your own area for issues that do not fit into the 1-2x/yr visits. I agree with the peace of mind and confidence factors. Good doctors of ANY specialty are hard to find.
Next time spend the night in Charlottesville. Make it a small vacation.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/29/2010 9:05 AM (GMT -6)   
So how long in real time did you spend with the doctor? And how much opportunity did you get to ask direct questions to him? If I remember, he is a doctor that won't take or work with insurance companies, is that true too?

David in sC
Age: 58, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 7/29/2010 9:45 AM (GMT -6)   
Adding to David's response, would you mind sharing cost information?
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Second post-op PSA on 6/21/10--0.02--Not too bad!


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 7/29/2010 10:06 AM (GMT -6)   
It was expensive. All in the trip/appt cost about $2000. $1600 for the consult, 2 hours. and $400 for the plane ticket and other expenses. However my insurance will pick up about $1100 of the consult fee for an out of network provider. I just have to file for reimbursement. Before I left the office I was given a complete package for the claim filing. The office manager told me what I would need for the filing and told me to call if there was any problems. They won't file themselves, but are very helpful in assisting you in getting reimbursed. I have to head out for my first radiation treatment now, but will post more tonight. I would like to respond to Dave's question.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 7/29/2010 10:22 AM (GMT -6)   
BB what a great post. Very pleased that you got info you were looking for.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/29/2010 2:13 PM (GMT -6)   
Always good to have further opinions and doing so sooner than later is a plus. Happy that you found some solace in his advising, that is worth alot to a patient.
Youth is wasted on the Young-(W.C. Fields)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/29/2010 2:31 PM (GMT -6)   
Another option on the west coast is Dr Scholz. His initial appointment is well over an hour and all insurance including Medicare is accepted. The only cost I incur is a $45 phone consult charge, because that's cheaper and easier than driving 150 miles to see him.

JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 7/29/2010 4:01 PM (GMT -6)   
I understand that Dr. Strum does this too, though I do not recall reading of anyone on this board who consulted with him (other than via P2P).
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 7/29/2010 4:22 PM (GMT -6)   
In response to Dave's questions, initial consult is a two hour appointment. I did have about an 80-90 minutes of face time with him. He needed about 20 minutes write-up my treament plan with his recommendations, lab orders and prescriptions. We finished about 15 minutes early. I had the opportunity to ask all the questions that I wanted and didn't feel rushed at all.

His office wasn't that busy. I arrived 2 hours early due to my flight, and he started my appointment an hour earlier than scheduled. When I arrived there were two people in the office, one with him and one waiting. When I left about 3 hours later, there was one person waiting to see him.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

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