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Report post · February 19, 2009

Thanks Alan that is a very good point.

>

> > ... I am already planning to get a second opinion on possible

> > treatments at the University of Wisconsin Hospital. Madison

> > ...

>

> ,

>

> Since the two main, well accepted therapies are surgery and

> radiation, I recommend that you get at least one consultation

> with a surgeon and one with a radiation oncologist.

>

> The treatments are, of course, radically different and the two

> kinds of specialists don't always understand each other very

> well. The surgeon my HMO sent me to told me that radiation was

> no good for me, but the radiation oncologists disagreed and, in

> fact, my radiation treatment seemed to have worked very well.

>

> I think you may get a better understanding of the options if you

> let each kind of specialist talk to you about his own specialty

> and how he would treat you rather than having opinions from two

> surgeons or two radiation oncologists.

>

> My HMO (Kaiser) agreed with my request for that and paid for

> both consultations.

>

> Alan

>

Report post · February 20, 2009

> I found out today that my Gleason scores are 3+3. After much reading I

> am seriously

> considering getting a second opinion on my biopsy from Dr. Epstein at

> s Hopkins.

(snip)

Welcome to the club no one wants to join.

I have some suggestions that will help to make well-informed decisions.

Anecdotes contributed by other patients can be interesting, but should

never, ever, be relied upon as authority for one's own decisions. In

other words, what helps me might harm you and vice versa.

There is a lot to do.

(1) If applicable, I recommend having the biopsy specimens examined by

a pathology lab that specializes in prostate cancer (PCa). Everything

that is done from here on depends upon the accuracy of the Gleason

scoring. Here is a list of such labs:

Bostwick Laboratories [800] 214-6628

Dianon Laboratories [800] 328-2666 (select 5 for client services)

Jon Epstein (s Hopkins) [410] 955-5043 or [410] 955-2162

Grignon (Michigan) [313] 745-2520

Jon Oppenheimer (Tennessee) [888] 868-7522

UroCor, Inc. [800] 411-1839

This is a " second opinion " and should be covered by insurance/Medicare.

The cost, last I heard, was about $500. More if further tests, which

might be prudent, are ordered.

(I am astounded that thoer's insurers refuse to pay for a second opinion)

The chosen lab can give instructions on shipment arrangements.

In civilized jurisdictions, those specimens are the property of the

patient and not the medic, not the lab. Sometimes it is necessary to

educate them on that point.

(2) The authoritative website of the Prostate Cancer Research

Institute (PCRI) at http://prostate-cancer.org/index.html

is an excellent beginning.

See also http://prostate-cancer.org/education/education.html#newly_diagnosed

Some medics who specialize in treatment (tx) of PCa are listed via

this portal: http://prostate-cancer.org/resource/find-a-physician.html

If a particular medic is not suitable due to distance (but there are men

who travel thousands of miles for treatment) or otherwise, there is no

harm and much possible gain in simply asking for a referral.

There are also men whose primary medic is some distance away, but who

receive their routine treatment (tx) near home.

(3) I heartily recommend this comprehensive text on PCa: _A Primer on

Prostate Cancer_ 2nd ed., subtitled " The Empowered Patient's Guide " by

medical oncologist and PCa specialist B. Strum, MD and PCa warrior

Donna Pogliano. It is available from the PCRI website and the like, as

well as Amazon (30+ five-star reviews), & Noble, and

bookstores. A lifesaver, as I very well know.

(4) Personal contact with other patients can be very helpful. Local

chapters of the international support group Us Too can be found via

their website at http://www.ustoo.com/chapter_nearyou.asp

Regards,

Steve J

" Empowerment: taking responsibility for and authority over one's own

outcomes based on education and knowledge of the consequences and

contingencies involved in one's own decisions. This focus provides the

uplifting energy that can sustain in the face of crisis. "

--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

" The Empowered Patient's Guide. "

Report post · February 20, 2009

Thanks Steve,

(For clarification - thoer is me - .) My insurance will pay for second

opinions as part

of an appointment process ie I can have a second opinion on my biopsy while I am

at the

UW Hospital but they won't pay for ones sent off not as a part of an exam. I

have no

problem with the $225 that Dr Epstein is listed as charging in the material they

sent me. I

plan to have that arranged when I see my local urologist on March 5th. So I will

end up

with 3 opinions on my biopsy which hopefully will provide enough info.

Thanks again!

>

> > I found out today that my Gleason scores are 3+3. After much reading I

> > am seriously

> > considering getting a second opinion on my biopsy from Dr. Epstein at

> > s Hopkins.

>

> (snip)

>

> Welcome to the club no one wants to join.

>

> I have some suggestions that will help to make well-informed decisions.

>

> Anecdotes contributed by other patients can be interesting, but should

> never, ever, be relied upon as authority for one's own decisions. In

> other words, what helps me might harm you and vice versa.

>

> There is a lot to do.

>

> (1) If applicable, I recommend having the biopsy specimens examined by

> a pathology lab that specializes in prostate cancer (PCa). Everything

> that is done from here on depends upon the accuracy of the Gleason

> scoring. Here is a list of such labs:

>

> Bostwick Laboratories [800] 214-6628

> Dianon Laboratories [800] 328-2666 (select 5 for client services)

> Jon Epstein (s Hopkins) [410] 955-5043 or [410] 955-2162

> Grignon (Michigan) [313] 745-2520

> Jon Oppenheimer (Tennessee) [888] 868-7522

> UroCor, Inc. [800] 411-1839

>

> This is a " second opinion " and should be covered by insurance/Medicare.

> The cost, last I heard, was about $500. More if further tests, which

> might be prudent, are ordered.

>

> (I am astounded that thoer's insurers refuse to pay for a second opinion)

>

> The chosen lab can give instructions on shipment arrangements.

>

> In civilized jurisdictions, those specimens are the property of the

> patient and not the medic, not the lab. Sometimes it is necessary to

> educate them on that point.

>

> (2) The authoritative website of the Prostate Cancer Research

> Institute (PCRI) at http://prostate-cancer.org/index.html

> is an excellent beginning.

>

> See also http://prostate-cancer.org/education/education.html#newly_diagnosed

>

> Some medics who specialize in treatment (tx) of PCa are listed via

> this portal: http://prostate-cancer.org/resource/find-a-physician.html

>

> If a particular medic is not suitable due to distance (but there are men

> who travel thousands of miles for treatment) or otherwise, there is no

> harm and much possible gain in simply asking for a referral.

>

> There are also men whose primary medic is some distance away, but who

> receive their routine treatment (tx) near home.

>

> (3) I heartily recommend this comprehensive text on PCa: _A Primer on

> Prostate Cancer_ 2nd ed., subtitled " The Empowered Patient's Guide " by

> medical oncologist and PCa specialist B. Strum, MD and PCa warrior

> Donna Pogliano. It is available from the PCRI website and the like, as

> well as Amazon (30+ five-star reviews), & Noble, and

> bookstores. A lifesaver, as I very well know.

>

> (4) Personal contact with other patients can be very helpful. Local

> chapters of the international support group Us Too can be found via

> their website at http://www.ustoo.com/chapter_nearyou.asp

>

> Regards,

>

> Steve J

>

> " Empowerment: taking responsibility for and authority over one's own

> outcomes based on education and knowledge of the consequences and

> contingencies involved in one's own decisions. This focus provides the

> uplifting energy that can sustain in the face of crisis. "

> --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

> " The Empowered Patient's Guide. "

>

Report post · February 20, 2009

Thanks Steve,

(For clarification - thoer is me - .) My insurance will pay for second

opinions as part

of an appointment process ie I can have a second opinion on my biopsy while I am

at the

UW Hospital but they won't pay for ones sent off not as a part of an exam. I

have no

problem with the $225 that Dr Epstein is listed as charging in the material they

sent me. I

plan to have that arranged when I see my local urologist on March 5th. So I will

end up

with 3 opinions on my biopsy which hopefully will provide enough info.

Thanks again!

>

> > I found out today that my Gleason scores are 3+3. After much reading I

> > am seriously

> > considering getting a second opinion on my biopsy from Dr. Epstein at

> > s Hopkins.

>

> (snip)

>

> Welcome to the club no one wants to join.

>

> I have some suggestions that will help to make well-informed decisions.

>

> Anecdotes contributed by other patients can be interesting, but should

> never, ever, be relied upon as authority for one's own decisions. In

> other words, what helps me might harm you and vice versa.

>

> There is a lot to do.

>

> (1) If applicable, I recommend having the biopsy specimens examined by

> a pathology lab that specializes in prostate cancer (PCa). Everything

> that is done from here on depends upon the accuracy of the Gleason

> scoring. Here is a list of such labs:

>

> Bostwick Laboratories [800] 214-6628

> Dianon Laboratories [800] 328-2666 (select 5 for client services)

> Jon Epstein (s Hopkins) [410] 955-5043 or [410] 955-2162

> Grignon (Michigan) [313] 745-2520

> Jon Oppenheimer (Tennessee) [888] 868-7522

> UroCor, Inc. [800] 411-1839

>

> This is a " second opinion " and should be covered by insurance/Medicare.

> The cost, last I heard, was about $500. More if further tests, which

> might be prudent, are ordered.

>

> (I am astounded that thoer's insurers refuse to pay for a second opinion)

>

> The chosen lab can give instructions on shipment arrangements.

>

> In civilized jurisdictions, those specimens are the property of the

> patient and not the medic, not the lab. Sometimes it is necessary to

> educate them on that point.

>

> (2) The authoritative website of the Prostate Cancer Research

> Institute (PCRI) at http://prostate-cancer.org/index.html

> is an excellent beginning.

>

> See also http://prostate-cancer.org/education/education.html#newly_diagnosed

>

> Some medics who specialize in treatment (tx) of PCa are listed via

> this portal: http://prostate-cancer.org/resource/find-a-physician.html

>

> If a particular medic is not suitable due to distance (but there are men

> who travel thousands of miles for treatment) or otherwise, there is no

> harm and much possible gain in simply asking for a referral.

>

> There are also men whose primary medic is some distance away, but who

> receive their routine treatment (tx) near home.

>

> (3) I heartily recommend this comprehensive text on PCa: _A Primer on

> Prostate Cancer_ 2nd ed., subtitled " The Empowered Patient's Guide " by

> medical oncologist and PCa specialist B. Strum, MD and PCa warrior

> Donna Pogliano. It is available from the PCRI website and the like, as

> well as Amazon (30+ five-star reviews), & Noble, and

> bookstores. A lifesaver, as I very well know.

>

> (4) Personal contact with other patients can be very helpful. Local

> chapters of the international support group Us Too can be found via

> their website at http://www.ustoo.com/chapter_nearyou.asp

>

> Regards,

>

> Steve J

>

> " Empowerment: taking responsibility for and authority over one's own

> outcomes based on education and knowledge of the consequences and

> contingencies involved in one's own decisions. This focus provides the

> uplifting energy that can sustain in the face of crisis. "

> --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

> " The Empowered Patient's Guide. "

>

Report post · February 20, 2009

On February 20, replied to me:

> My insurance will pay for second opinions as part

> of an appointment process ie I can have a second opinion on my biopsy

> while I am at the UW Hospital but they won't pay for ones sent off not as a

part of an

> exam.

(snip)

Interesting. And something I have not heard of before. Perhaps they are

trying to keep it in-house, regardless of what's best for the patient.

Please let us know the identity of that insurer. I'm sure that many of

us would want to know.

Meanwhile, all the best.

Regards,

Steve J

Report post · February 25, 2009

Hello All,

(This will now apply to many people, but I thought I would post it in case

someone else

with a similar history shows up here). In my research it seems that having had a

hip

resurfacing has some important impacts on PCa treatment options. It seems that

all

radiation therapies carry a known risk (small but existent) to the bones closest

to the

prostate -even proton beams. Having that large chromium cobalt metal joint

affixed to my

hip introduces an extra risk that has never really been studied as far as I can

tell. So, for

me, it seems that surgery introduces the least unknowns. Having my hip

resurfaced gave

me my active lifestyle back and I want to do everything possible to continue

that way.

Thanks as always for your support and thoughts.

> >

> > Hi,

> >

> > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > requested was 4.13. My brother and cousin both were diagnosed at about my

same

age

> so I

> > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

on

> each

> > side showed involved tissue and my Gleason score is 6. I do not yet know the

2

numbers

> of

> > which it is comprised but will call tomorrow and find out. I have been

researching on

the

> web

> > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

surgery,

> but

> > am open to all options.

> >

> > Thanks for being here,

> >

>

Report post · February 25, 2009

Hello All,

(This will now apply to many people, but I thought I would post it in case

someone else

with a similar history shows up here). In my research it seems that having had a

hip

resurfacing has some important impacts on PCa treatment options. It seems that

all

radiation therapies carry a known risk (small but existent) to the bones closest

to the

prostate -even proton beams. Having that large chromium cobalt metal joint

affixed to my

hip introduces an extra risk that has never really been studied as far as I can

tell. So, for

me, it seems that surgery introduces the least unknowns. Having my hip

resurfaced gave

me my active lifestyle back and I want to do everything possible to continue

that way.

Thanks as always for your support and thoughts.

> >

> > Hi,

> >

> > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > requested was 4.13. My brother and cousin both were diagnosed at about my

same

age

> so I

> > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

on

> each

> > side showed involved tissue and my Gleason score is 6. I do not yet know the

2

numbers

> of

> > which it is comprised but will call tomorrow and find out. I have been

researching on

the

> web

> > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

surgery,

> but

> > am open to all options.

> >

> > Thanks for being here,

> >

>

Report post · February 25, 2009

Hello All,

(This will now apply to many people, but I thought I would post it in case

someone else

with a similar history shows up here). In my research it seems that having had a

hip

resurfacing has some important impacts on PCa treatment options. It seems that

all

radiation therapies carry a known risk (small but existent) to the bones closest

to the

prostate -even proton beams. Having that large chromium cobalt metal joint

affixed to my

hip introduces an extra risk that has never really been studied as far as I can

tell. So, for

me, it seems that surgery introduces the least unknowns. Having my hip

resurfaced gave

me my active lifestyle back and I want to do everything possible to continue

that way.

Thanks as always for your support and thoughts.

> >

> > Hi,

> >

> > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > requested was 4.13. My brother and cousin both were diagnosed at about my

same

age

> so I

> > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

on

> each

> > side showed involved tissue and my Gleason score is 6. I do not yet know the

2

numbers

> of

> > which it is comprised but will call tomorrow and find out. I have been

researching on

the

> web

> > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

surgery,

> but

> > am open to all options.

> >

> > Thanks for being here,

> >

>

Report post · February 25, 2009

Typo - that should say (This will NOT apply....) Sorry.

> > >

> > > Hi,

> > >

> > > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > > requested was 4.13. My brother and cousin both were diagnosed at about my

same

> age

> > so I

> > > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

> on

> > each

> > > side showed involved tissue and my Gleason score is 6. I do not yet know

the 2

> numbers

> > of

> > > which it is comprised but will call tomorrow and find out. I have been

researching

on

> the

> > web

> > > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

> surgery,

> > but

> > > am open to all options.

> > >

> > > Thanks for being here,

> > >

> >

>

Report post · February 25, 2009

Typo - that should say (This will NOT apply....) Sorry.

> > >

> > > Hi,

> > >

> > > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > > requested was 4.13. My brother and cousin both were diagnosed at about my

same

> age

> > so I

> > > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

> on

> > each

> > > side showed involved tissue and my Gleason score is 6. I do not yet know

the 2

> numbers

> > of

> > > which it is comprised but will call tomorrow and find out. I have been

researching

on

> the

> > web

> > > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

> surgery,

> > but

> > > am open to all options.

> > >

> > > Thanks for being here,

> > >

> >

>

Report post · February 25, 2009

Typo - that should say (This will NOT apply....) Sorry.

> > >

> > > Hi,

> > >

> > > For my details, I am 58 years old, my first high PSA test was 4.25 and the

followup I

> > > requested was 4.13. My brother and cousin both were diagnosed at about my

same

> age

> > so I

> > > decided on a biopsy. My Dr phoned me this am with my results. Of the 12

sample, 3

> on

> > each

> > > side showed involved tissue and my Gleason score is 6. I do not yet know

the 2

> numbers

> > of

> > > which it is comprised but will call tomorrow and find out. I have been

researching

on

> the

> > web

> > > since my first over 4 results and so far am leaning toward the Da Vinci

robotic

> surgery,

> > but

> > > am open to all options.

> > >

> > > Thanks for being here,

> > >

> >

>

Report post · August 25, 2012

Hello

I am very happy to be here. I have been on Zoloft 150 mgs for 8 years. My

doctor and I decided that it is time to slowly withdraw from it now.

Where I live Zoloft only comes in 100, 50, and 25 mgs....so every four months I

lower the Zoloft 25 mgs at a time. (is this too long in between lowering).

Lowering to 125 was okay, but I am finding now that I am on 100 mgs....I am

experiencing aching bones, light headedness, low feelings (which is not clinical

depression) lethargic. The aching bones is the one that bothers me the

most....Is this one of the withdrawal symptoms.

Like most people who have been on antidepressants it is scary to decide to go

off them...

I am glad I found you....and looking forward to your encouragement and courage

to keep on.

Divalee

Keep a song in your heart, even though at times it is but a whisper.

Report post · August 28, 2012

Dear Divalee, You said:

Hello

I am very happy to be here. I have been on Zoloft 150 mgs for 8 years. My doctor and I decided that it is time to slowly withdraw from it now.

Where I live Zoloft only comes in 100, 50, and 25 mgs....so every four months I lower the Zoloft 25 mgs at a time. (is this too long in between lowering).

Lowering to 125 was okay, but I am finding now that I am on 100 mgs....I am experiencing aching bones, light headedness, low feelings (which is not clinical depression) lethargic. The aching bones is the one that bothers me the most....Is this one of the withdrawal symptoms.

Like most people who have been on antidepressants it is scary to decide to go off them...

I am glad I found you....and looking forward to your encouragement and courage to keep on.

Divalee ** These are symptom telling you that you dropped too much of the drug or dropped it too soon after the last decrease. In your case, you are dropping too much at once. Btw, 4 months is much longer than you need to stay at a dose but your decreases should be much smaller.

The best thing to do at this point is to go back up to 125 mg. Then, when you feel better (I call it feeling " stable " or being " stabilized " ) then do approximately a 10% decrease. In other words, drop about 12 mg. so you end up taking approx. 113mg. You can round it out to 115mg.

You can accomplish this either by cutting the pill into the approximate size you need, or dissolving the pill in 5 oz. of liquid (hot water usually works best) and then pouring off 0.5 oz. This is 10 mg. . This means you'll take 115mg.

Then, you allow yourself at least two weeks on this drug at this dose (could be longer on other drugs). At this point, ask yourself this question: " Right now, do I feel as well or better than I felt prior to doing this last reduction? "

If you can say yes it i time for your next 10% reduction. If you are unsure or say no, wait longer. If you really feel poorly, really poorly after a 10% reduction, go back up again, wait to stabilize, then do a 5% decrease instead. There is plenty of flexibility in this.

Regards,

Report post · August 28, 2012