In this column, I'd like to introduce Solveig & Phil Ingersoll.  For almost 38 years they have been a couple--raising a family, building a business, working together, sharing their lives.  The past year has brought them even closer together.  But now they share something neither of them imagined nor wanted.  Here is their story. 

DC:  Welcome to the Prostate Net.  We really appreciate your willingness to share with us.  Solveig, please tell us about your family.

Solveig:  Phil and I are looking forward to our 38th wedding anniversary in a couple of months.  Phil is an electronics engineer who worked in research for the Department of the Army for his entire career.  After retiring, he came to work with me as computer guru, advertising mogul and general advisor.  I have a private practice in audiology, with clinics in Wheaton, Frederick and Hagerstown, Maryland, testing hearing for diagnostic purposes and fitting hearing aids when indicated.  This is particularly fortunate for Phil since he has considerable hearing loss and is one of my very best beta testers.  We have a son who lives in Boston.

DC:  You had some significant news about your health in the past year.  Please explain.

Solveig:  In July 2002, a routine mammogram showed an abnormality:  a thickening of skin but no definable "lump."  I had to have hernia surgery in August and the surgeon agreed to biopsy the questionable area.  Two weeks later, a modified radical mastectomy was performed.  The diagnosis was Stage III invasive lobular breast cancer.

DC:  What phase of treatment are you in now?  How are you feeling?

Solveig:  Given the aggressive nature of my particular cancer, aggressive treatment made sense to me.  Six months of chemotherapy was begun in October and my last cycle was completed in early March.  Thanks to drugs, most of the dreaded side effects have been minimal.  Next is the radiation phase of my treatment.  We are exploring some of the available alternatives.  Generally, I feel and function pretty well, though the week immediately after a treatment can be rough.  Phil is amazingly patient when I cry and whine and just run out of energy.  The schedule of treatment and the uncertainty on any given day of how I will feel has necessitated a change in how my business is run.  More responsibility is delegated and I am not regularly scheduled to see patients. 

DC:  As if that isn't enough to deal with, I understand that Phil was diagnosed with prostate cancer last fall.

Solveig:  Yes, his PSA tests two years ago showed a slight elevation (slightly over 4) and a biopsy was performed with no significant findings.  When the PSA was even more elevated last fall (over 6), we sought a different urologist to do the biopsy.  The Head of Urology at Washington Hospital Center performed the biopsy.  This time the pathology report was positive for prostate cancer, with a Gleason Score of 6. 

DC:  What resources did you find to help you decide what to do next?

Solveig:  We had a wonderfully comprehensive counseling session with the urologist at the Washington Hospital Center who discussed many options:  Active Surveillance, seeds, radiation therapy, and traditional prostatectomy.   We were provided with suggestions of local experts in each of the treatment procedures and advised to do nothing until after the Christmas holidays.   The delay gave us time to research all of the options he suggested.  Phil's engineering background and his interest in cutting edge technology really helped us during this decision process also.  The Internet was extremely helpful to us in learning about treatment options.  Additionally, my brother-in-law is a physician and he was most gracious in helping us navigate the language of pathology reports and medical terminology.  Because Phil's cancer was detected at a much earlier stage than mine, more options were open to him. 

Phil:  I wanted to be back on my feet as quickly as possible so I wouldn't complicate my wife's treatment schedule.   I also considered which procedure would allow additional treatments if they were needed in the future.  If I had radiation first, I couldn't have surgery of any kind later.  Surgery now wouldn't rule out radiation or other procedures later.   So I ended up selecting Laparoscopic Radical Prostatectomy (LRP) mostly because of the comparatively short recovery time and reduced surgical trauma.   Interestingly, LRP wasn't even one of the treatments we were originally told about.

[DC Note:  With a Laparoscopic Radical Prostatectomy, the surgeon makes several small incisions (unlike the usual 5-10" abdominal incision for traditional prostatectomies) and is guided by a tiny camera for the removal of the prostate.  There is generally much less  blood loss  and pain and, therefore, a shorter hospital stay and quicker recovery.

We found some excellent information on several websites and selected Dr. Arnon Krongrad of Florida to do the surgery because of his extensive experience.   Then I scheduled the surgery between Solveig's breast cancer treatments.

DC:  Phil, please tell us more about the surgery.

Phil:  My wife and I drove to Florida from Maryland and arrived on Sunday.  We visited with Dr. Krongrad and the hospital admissions department on Monday; had the surgery on Tuesday; walked around in the hospital Tuesday afternoon; left the hospital Wednesday; and enjoyed walking on the beach Thursday.  Saturday morning we left for Maryland and, amazingly, we had a pleasant drive up Interstate 95.  We were back at work on Tuesday.  On Wednesday, I pulled out the catheter in the shower with no pain or side effects.  Two weeks later (21 days after the operation) I shoveled two feet of snow off of our porch with no difficulty or problems.  Not bad for a 65 year old, right??

DC:  Not bad at all, I'd say!  How do you coordinate the logistics of both treatment schedules?

Solveig:  Actually, the only tricky part was to plan just when to schedule Phil's surgery.  I needed to be able to help with the driving from Maryland to Florida and wanted to be alert enough to be helpful and attentive during his hospital stay.  My oncologist moved up my treatment date by a couple of days so we could see if I had adverse reactions and have time to deal with them before leaving town.  Things went pretty smoothly on that front. 

DC:  How have the side effects of treatment been for both of you?

Solveig:  Improvements in managing the side effects of chemotherapy have certainly made my situation far better than magazine testimonials had led me to expect. Anti-nausea medications really have helped me and other women in my situation.  It turned out that I was allergic to the agent used in the second  half of my chemo regimen.  I broke out in severe hives from head to foot.  Pretty scary!  Because of my diabetes, use of steroids was not desirable though that turned out to be the compromise we chose.  While my blood sugar levels skyrocketed after each chemo cycle, increased insulin seemed to control it eventually.  My hair now is trying to grow and I look forward to giving up my wigs.  I don't know yet what my reaction to radiation will be, but it feels like the end of this process is in sight.  I think Phil has had as hard a time as I in dealing with my treatment.  It is hard to watch a loved one in distress.

Phil:  I never experienced any pain and did not take any pain medications either in the hospital or on the way back to a full schedule.  My post-surgery pathology report gave me a clean bill of health--the margins were clear.  So there are no additional treatments scheduled for me at this time.  I will have another follow-up test in a couple of months.

Solveig:  Phil has enjoyed a truly remarkable recovery.  As he mentioned, two weeks after the surgery, he was out on the porch roof shoveling several feet of snow.  It is still too soon to know whether there will be long-term problems with incontinence or sexual function, but there are enough improvements to encourage us to view the future with optimism. 

DC:  One person in the family facing cancer is frightening enough.  How do you manage when both of you are fighting the same battle?

Solveig:  Frankly, we don't give it a great deal of thought.  Our small business requires an enormous amount of time and energy so we are too busy to dwell on the cancer.  It is just one more thing on the list of cares and responsibilities.  For example, you can't stop and worry when you are trying to chase a squirrel out of one of the clinics, like Phil was doing two days ago.

Phil:  Overall this was a surprisingly pleasant experience.  The hospital staff in Florida was friendly and obviously competent.  Dr. Krongrad and his wife are nice, helpful, competent people as well.  We got answers to all of the questions we could think to ask and were supported in our decision to get back to work as soon as possible.

DC: Solveig, what impact has Philip's diagnosis had on your own treatment decisions?

Solveig:   Having learned through Phil's experience of gathering information on recent treatment options and the success of his choice, we are putting his research talents to work investigation radiation options for my next series of treatments.  While I was given names of several radiation treatment centers, I have more recently learned that there are significant differences in the equipment that delivers the treatment.

DC:  What kind of support system do you have besides each other?  How is your family dealing with this?

Solveig:   We have received a zillion wonderful cards and notes from family, colleagues, neighbors and friends.  The prayers and encouragement from members of our church have been of great help.  Many of those good folks have already dealt with these same issues and some have practical suggestions about diet, rest, and how to cope with various side effects of treatment.  My sister calls at least once a week to check on our progress and her husband, a physician, has been a wonderful resource on medical issues and in interpreting various reports.  Our son has made more opportunities to visit from Boston and keeps in touch with calls and e-mail.

DC:  Solveig, you began this journey sooner than Philip.  What were you able to share with him to help him prepare himself?

Solveig:  Ask questions. Write down answers. Be vigilant about medications and dosages.  Crying helps.  Concentrate on breathing when coming out of anesthesia.  Express thanks.  People are amazingly kind and compassionate.

DC:  Phil, what words of advice do you have for other men going through this same process?

Phil:  My advice is to get yearly PSA tests, even if the insurance companies won't pay for them.  Then, if the numbers start moving up, even if they are still low, get a biopsy done by a competent urologist.  Read the pathology report, even if it's negative, to see if you think it was thorough.  For example, my two biopsy reports were like night and day.  The first was vague and sketchy.  It mentioned the appearance of the sample with very little detail other than color and type.   The second took more samples and the pathology report was incredibly detailed.  It included the complete lab report which itemized the percentage of cancer cells per sample, pictures of slides and a transcript of the entire pathology report.  In retrospect, it's possible that the first biopsy was also positive and they missed it. 

Finally, if you catch the cancer early enough so that it's still contained in the prostate, I recommend that you consider the LRP surgical technique as your solution.  Experience counts in all types of surgery, so ask your doctor how many of these procedures he has performed.  Dr. Krongrad had performed more than twice as many LRP's as any other surgeon that I researched.

DC:  You've been together for 38 years.   Have you learned anything new about each other from all of this?  Has your relationship changed?

Solveig:  There is a positive side--Phil and I spend more time together.   That is one of the unanticipated benefits of this whole business.  I must say, though, that having Phil diagnosed with cancer also is more togetherness than anyone should have to endure.
It is hard to believe that we were smart enough all that long ago to have made such good choices in mates!

DC:  In closing, please say a few words about how you find the strength and perseverance to keep fighting in the face of such an overwhelming situation.

Solveig:  I don't think we have done anything that special.    There is a tremendous will to live.  Coping with cancer is just another one of life's challenges.  There are certainly down times when I whine and cry and generally mope around.  Fortunately, so far, both of us have not hit that emotional wall at the same time, so we can prop each other up when needed.

DC:  Thank you both so much for sharing your story with us.  You are both a tremendous example of courage, love, and perspective.  It's clear how much you cherish life and each other.  I think you are a great team and an inspiration. 
This type of situation will surely, and sadly, become more of an issue in the future.  Several doctors and organizations are already noticing the trend and beginning to develop resource materials and support groups.