Day 70, Running With Cancer

Just a brief bit of news before diving into the topic for today:  I had my second chemo infusion yesterday and it went much smoother than the first one.  The requisite blood test showed that my PSA is now down to 0.19, and my alkaline phosphatase level continues to drop.  Most patients do respond to treatment at first but not everybody gets their PSA under 2.0.  Under 0.1 would be even better and is about the limit of the current test as it starts measuring other substances at extremely low levels.  Such low levels don’t mean I’m cured, it just means the cancer is under control and very likely not progressing.  This is the time my tumors will shrink if they’re going to do that.

About 5 hours after completing the second round of chemo, I went to the indoor track.  I felt much better than expected, and attribute that to the drug not having had much time to show its effects.  I even attempted to do the stair drill which was the workout of the week, which does involves sprinting.  The first couple were really fun, as I enjoy running FAST.  The third one caused my lungs to hurt afterwards.  The fourth caused my lungs and throat to hurt.  That pain would be the drug affecting the linings of my lungs, mouth, and throat.  It basically affects the entire digestive tract, lungs, skin, hair follicles, anything that has fast dividing epithelial cells as a barrier between the body and the outside world.

Given that I would have been happy with walking around the track for a bit, I’m ecstatic to get away with a bit of exuberance.  Now let me explain why running, or any exercise, is of vital importance when you have cancer and are dealing with cancer treatments.

Exercise is what stimulates growth in the body.  It builds muscle.  It strengthens bone.  It spurs the production of more blood cells.  It does a lot of other things but what I’ve already listed is in direct opposition to the effects of cancer and its treatment.  My cancer has spread to the bones and was damaging them.  Weight loss from treatment is causing muscle loss.  Radiation and chemo drastically reduce blood cell counts.

If the blood cells don’t recover, treatment is put on hold giving cancer a chance to bounce back.  During my treatment yesterday I got talking to another patient who had her treatment delayed by a week due to low blood cell counts.  My counts had fully recovered before my second treatment.  Dare I say they recovered so well they may have been higher than I’m used to seeing before I had cancer, though I haven’t dug out my old blood tests to be sure.

Another woman was talking about how she has to climb three steps to get into her apartment building, then another five steps to get into her apartment, and after that amount of exertion she lays down on the couch for an hour and a half.  Compare that to me complaining about brief lung pain after sprinting across a basketball court then running up the stairs to the balcony track above.

To be fair, I’m much younger than both of these women, and can fairly guess that I started with much more physical conditioning in reserve.  This past summer I would go out for three hour explorations in Vermont involving running and walking on roads and running and hiking on abandoned roads and trails in the woods.  I found a number of abandoned houses, and more surprisingly, structures that weren’t abandoned more than a mile from any maintained road.

I’d cover about 10 miles on these journeys.  I also spent time clearing downed trees and making new trails on our property, as well as cutting, splitting and filling our wood shed with over a cord of firewood.  And of course, this was when I was working full time which also involved commuting for 12 hours a week when you include Massachusetts traffic.

Using that as a reference point, I see nothing spectacular about going for a three mile run while on leave from my job.  I have ample time to rest and recover when not going to appointments.  I spend significant time now trying to learn as much as possible about my disease and what options are available should the cancer adapt to the initial treatments and begin advancing again.

On the other hand, if your references for “cancer patient” are the relatively frail people I see at my chemo treatments, then yes, getting off the couch and doing any activity is an amazing accomplishment.  I personally am keenly aware of how cancer has slowed me down and reduced my activity, and how chemotherapy causes even further reductions.  Happily, the lesson from my first round of chemo is that by the end of the third week I seem to be back to about where I was before it started, so hopefully the effects won’t accumulate with each round.

And let me stress the importance of being a habitual exerciser before some major health crisis strikes.  Many health issues can cause you to become deconditioned, to lose muscle mass, and generally place stressful burdens on the body as it fights the disease and tries to heal.  Starting from a point of decent physical condition means you have more in reserve, and can maintain a better quality of life during your illness.  It doesn’t have to be running.  Anything that gets you active, uses more than 50% of your muscle strength, burns a bunch of calories and gets your heart rate up really high will help.  For a symbiotic effect, eat healthier too (always my weak point).  Get out there and use your body as much as you safely can!

Besides the direct health benefits already mentioned, running is a great way of coping with the stress and uncertainty of life, particularly when you have a deadly disease.  I’ve also built a social life around running, and runners are some of the nicest and most positive people you could ask for.  Despite the very low cure rate for advanced prostate cancer, everybody has me focused on that possibility, and given the progress I’m making so far with treatment that’s not as outrageous as it may sound.

Day 62, Cancer Hurts

My pain has returned in the last several days.  While generally I’m able to move around okay, if I move the wrong way or sit in the wrong position, I get a pain in my hip or back.  Unfortunately, sitting in the wrong position includes sitting in a car seat and holding my foot on the gas pedal.

This pain could be cancer dying a slow and torturous death at the hands of chemotherapy.  It brings me some amount of consolation to think of my anthropomorphic cancer cells writhing in agony.  Die bastards die.

To get a bit sciency, one of the hostile things cancer cells can do is produce prostaglandins for no reason.  Prostaglandins are normally only produced when tissue is injured and produce the inflammation and pain associated with the injury.  It helps bring in blood and an immune response to heal the tissue.  Many pain relievers work by blocking the production of prostaglandins, which relieves pain but can also slow down the healing process.

Prostaglandin production is one of the ways cancer can cause pain. When the cancer cell is killed, all the prostaglandins in it are dumped out at once. Kill a lot of cells at the same time and inflammation and pain is the result, or so the theory goes.  In the long run this is a huge benefit but in the short term it kinda sucks.

In addition to the pain, I fear my hair is starting to fall out.  Detangling my ponytail has produced much more hair in my comb than I’m accustomed to.  So the transformation form long haired hippy to skinhead has probably started.  I’m not taking it well, my long hair has been part of my identity for longer than a decade now.

I worry that by Christmas day I’ll be a half-bald, half long haired freaky looking person.  To make matters worse, I’m convinced that the hair which started growing out of my ears a few years ago will continue to be as healthy as ever.  I didn’t want to worry about hair loss until it started happening and now it looks like it will happen at what is supposed to be that most wonderful time of the year.  NOT!  Oh well, it’s not like there are large social gatherings during the holidays while I’m trying to adjust to sudden hair loss and not feel awkward about it.

In spite of all this, my blood test numbers continue to improve.  While I don’t have an updated PSA number, my liver enzymes are back to normal and my alkaline phosphatase (a marker of turnover in bone tissue, and excessive amounts can result in liver damage) is down to only double what is considered normal.  This implies the bone damage is being repaired.

So I find myself in the paradoxical position where treatment appears to be working, but I feel worse.  At some level, this is expected as my body has been through a lot in the past couple months, and chemotherapy is yet another insult to every system in my body.  However, at an emotional level I respond to how I feel, not blood test numbers on a computer screen.

At the moment I find myself unmotivated, in a bit of pain, and mourning the impending loss of my hair.  Even more distressing is that this is happening at the point in the chemo cycle when I expected to be feeling my best, as the body has a chance to recover ahead of the next cycle.  This too shall pass, hopefully before the start of the next cycle but at worst sometime after all the cycles are completed about 16 weeks from now.

Day 55, One Week Into Chemo

I am in extremely good spirits at the moment.  Chemo treatment started a week ago, and so far it has been a cakewalk (or in my case, a cakerun/walk) compared to what I went through at the beginning of November.  More good news: The blood draw just before chemo showed that my PSA is already down to 2, which implies the previous treatments have been wildly, jaw-droppingly successful.

This isn’t to say chemo hasn’t been without its challenges.  The first challenge was finding a vein to infuse into.  Two nurses tried four times before having success.  I also had a scary reaction during the infusion and had to be given oxygen, but was able to eventually complete the treatment.  The nurses said reactions like this sometimes happen when the body is first exposed to the drug, and it’s less likely to occur in future treatments.

Yesterday was my weekly follow-up appointment.  We talked about various side effects such as digestive issues, being easily winded, and general malaise.  I learned a new word, phlebitis, after showing off the shocking pink and swollen back of my hand where the infusion was done.  Everybody in the oncology office had to see it.  The was some disagreement about how rare this is with my particular drug, but no real panic.  In general all signs are that I’m tolerating the treatment well, and with a few tweaks the next cycle should go better.

The oncologist is very happy with my PSA numbers, even though he can’t take any credit yet.  I mentioned that such a dramatic drop seems to be exceedingly rare, based on the personal stories I’ve been reading on an online advanced prostate cancer forum.  He suggested not to think too much about it, and just be happy with the result.  Very good advice I’ll try to follow.

After my appointment I stopped by the office where I work for a visit.  I went on a sudden and unexpected medical leave right at the time of my diagnosis.  The original plan was to take a week or so off while getting diagnosed with an inflamed prostate and waiting for the antibiotics to work.  Suffice to say that plan changed rather suddenly.

It felt awesome going to the office and talking with the people I work with.  Everybody is very supportive and interested in my condition.  Somebody even went so far as to decorate my office for the holidays.

On my good days I find myself starting to look forward to returning to work.  Then I remember that today’s blood draw had virtually no white blood cells, and avoiding the bugs that seem to go around in office environments is probably a good thing for the time being.  Catching a routine cold during chemo can be very dangerous, as the infection can spread much further than usual before the weakened immune system is able to respond.

I also still have many bad days and bad moments.  A bad moment is when I’m getting dressed and need to stop and rest to catch my breath.  Another bad moment is when acid reflux gets so bad I can only sit on the couch and whimper.  Yet another is when the pain flares and it gets very uncomfortable to even sit.  A bad day will have multiple bad moments, and a general theme of fatigue and malaise.

But these bad moments and days are becoming fewer.  I can see progress in how much pain relief I’m taking and when.  I used to wake up in the middle of the night in pain, and need to take something to get back to sleep.  That evolved to sleeping through the night, but needing to take something first thing in the morning.  This week I haven’t been taking anything except coffee or tea when I first wake up.  Progress!  And of course the oncologist is very pleased with this as well.

On a parting note, while I still have my hair, it normally takes about two weeks before hair loss starts to occur.  That means there’s still a few more days to go before the ponytail death watch needs to begin.  At this point I’m optimistic I might keep my hair, but most people do lose at least some.

Day 51, The Vermont Power Outage Story

This is a story about a rare time I had a great attitude going into a challenging situation and turned it into a positive experience.  We had planned to visit our weekend getaway in Vermont during a couple free days between treatments.  While the weather was good on those days, the days prior had lots of heavy wet snow.  That snow broke a lot of trees that proceeded to take a lot of power lines down with them.  It would be days before the power would be back.  It was also due to get colder, putting the plumbing at risk of freezing.

When we arrived it was 35 degrees inside.  Each exhale left a cloud of fog.  Coats and hats remained on while starting the wood stove.  While the stove warmed up, we went outside to shovel the walkways and deck.  My wife did most of the heavy lifting, I only did what my back would allow.  That meant chopping the heavy snow into relatively tiny blocks and not trying to throw them for distance as I usually do.  Still, I was outside, being active, and doing what I could to maintain as much bone and muscle as possible.

Shovelling complete, it was time to drain the plumbing.  This was a simple matter of attaching a hose to the drain of the well tank and hot water heater and letting the water run outside.  Afterwards it occured to me this would be much more difficult if the place didn’t have a walk out basement, as water typically doesn’t flow up stairs very well.

Draining gets most of the water out, but some stays in the pipes, particular in the horizontal runs.  Normally, you’re supposed to hook up an air compressor and blow the water out.  However, we didn’t have a compressor and didn’t have electricity to run one if we did.  Desperate times call for desperate measures, so I went to each faucet and literally used lung power to blow water through the pipes as best I could.  The bathroom sink was the most challenging, as my head barely fit under the faucet.

At around this time the wood stove had warmed the place into the 50s and we decided to stay for the night.  It gets dark early this time of year, leaving hours before bedtime without any light.  We decided to go out for dinner.  After that, we listened to a few Abbott and Costello radio shows from the 40s on Spotify.  Radio shows are a different experience than a TV show.  You can talk during many TV shows while still watching without missing much.  With radio, you have to listen.  The dim candle-lit atmosphere also added to the experience.

At this point, I should mention that my father-in-law built a one room cabin back in the 60s.  No power, no plumbing, just basically a wooden tent.  We have experience living without amenities for a short time, so this actually felt like old times and was a bit nostalgic.  One luxury the cabin did have was a commode in the closet, for times when we didn’t want to walk outside in the wee hours to go wee in the outhouse.  That cabin is still ours and is right across the street.  That commode would come in handy after winterizing the toilet.

The next morning we snowshoed across the street to get the commode.  I’m pretty sure that carrying a chamber pot on snowshoes and hoping that nobody drives by to see me doing so is an experience you can all relate to.  It’s just part of the universal human experience, isn’t it?

The moral of this story is that it would have been so easy to be negative.  A lot of my luck has been very bad recently, between advanced cancer and urinary retention.  It would be very natural to throw an extended power outage onto the pile of bad news.  But instead I was able to view it as a problem with a solution (in this case, “solution” can be taken as RV antifreeze poured into the water traps).  It was rather fortunate this happened just prior to starting chemo.  Now I don’t need to stress about further power outages or a furnace failure if I’m unable to travel while recovering from treatment.

Day 46, Chemo Starts Tomorrow

Tomorrow begins the latest and most aggressive attack in my war on the bastard that is advanced prostate cancer: chemotherapy.  It's very likely that chemotherapy will kill a large number of the cancer cells, adding both years and quality to my life.  However, it is very unlikely to kill all of them and be a complete cure.  Having said that, I'm hopeful that it will not only kill the majority of the cancer, but combined with all the other chemicals going into my body will activate the dormant X-Men mutations inside of me, giving me new and exciting super powers.

The drug I will be given is Docataxel, which is a synthetic form of a toxin first discovered in a plant.  Even though it was patented in the 80s and approved in the 90s, my treatment is considered state of the art.  Several recently completed studies have shown that combining hormone therapy and chemotherapy at the same time improve outcomes.  Previously, chemotherapy was held in reserve until after the cancer mutated to become resistant to the hormone therapy.  So while the drugs are relatively old and boring, they way they're being combined is relatively new and exciting.

Tomorrow I will go to the oncologist's office and before treatment my body weight, blood counts, and probably a few other things will be checked to ensure I'm healthy enough for treatment.  Assuming everything checks out, I'll be given the drug through an IV and that will take a little over an hour.  Then there will be follow-up appointments for the next two weeks to see how I am doing.  That will make one round of treatment lasting three weeks.  Then plan is for me to get 6 rounds of treatment, lasting 18 weeks (4-ish months!) total.

To say that this is a bit intimidating is an understatement.  I'm still recovering from the radiation treatment and bladder surgery from a month ago.  My weight is down about 10 lbs in that time and I haven't been able to regain anything.  On the bright side, I've discovered the secret to easy weight loss.

Continued weight loss is one of the risks I face.  Fighting cancer requires a lot of high quality calories and protein.  If I'm not able to eat, or my body isn't able to absorb the nutrients from what I do eat, the weight loss will continue.  This makes it more difficult for my body to recover from the treatment, and also raises the risk that I will need to delay or miss a treatment.  Delaying or missing a treatment makes the treatment less effective, as it gives the cancer an opportunity to recover.

I'm also feeling a bit frustrated.  The radiation was supposed to address the back pain I've been feeling, and I was hopeful that after a couple weeks I'd feel healthy and be regaining weight.  I could use the time between radiation and chemo to travel and visit family and friends.  But as I read more about radiation treatment it seems I underestimated the time it can take to work and the duration of the side effects.  Full recovery could take as long as a couple months.

While I have been able to run occasionally and travel to Vermont, there's also been a lot of resting on the couch between activities, which adds to the frustration.  Then there's the unpredictability of life as well.  On the last trip to Vermont the power was out for days due to a heavy wet snow.  We decided to drain the plumbing to avoid frozen pipes as the weather was getting colder and there was no guarantee the power would be back soon.  It was actually an epic handling of a difficult situation, and should be the subject of a future blog post, but it also took a lot out of me.

After getting back home from Vermont I planned to spend most of the next day on the couch watching TV and generally recovering from several relatively active days which had spiked my pain.  Of course, that was the day the TV decided to quit working, so my rest day involved a trip to the store during the height of the holiday shopping season, not to mention physically swapping the old TV with the new one.

I'm trying to be hopeful that the chemotherapy won't be as harsh on my digestive system as the radiation was, and that the initial treatment will bring more relief than side effects.  But I also have worries about how bad the side effects will get, and whether they will interfere with my ability to stick to the treatment plan.  Simply put, this is a tough fight, and I'm trying my best to give it my best shot and stay positive.

Day 41, Medical Mary Jane

Yesterday I got to use my MMJ "card" for the first time.  I put "card" in quotes because I don't have the actual card yet, just a temporary one sent to me via e-mail.  This surprisingly is the first time I've ever used MJ, despite having multiple opportunities to try it starting in high school, through college, and afterwards.

If you haven't heard, I start chemo next Tuesday, so I was very eager to get access to MMJ before hand because it supposedly is very good at treating the side effects.  Here is the story of my journey from cancer patient to Cheech and Chong fan.

I asked both oncologists about MMJ.  The radiation oncologist thought it might be a good idea, but didn't want to be involved in the process for fear of it affecting his medical license.  The medical oncologist was very happy to print out an instruction sheet complete with an ID number I could use to register with the state.

Okay, onto the MA state website to set up an account and go through the process.  The instructions said I'd need to upload a photo of my ID (in this case, my driver's license) as well as a photo to be used for the MMJ ID.  It had to be a head and shoulders shot with eyes open in front of a white or off white background.  After much trial and error, I finally got a decent picture of myself posing in front of our off-white refrigerator.  Of course, when I got to the corresponding step in the online registration, they said they had my driver's license photo on file, and recommended that I use that.  So much for the kitchen photo shoot.

Fast forward a couple weeks and I get a confirmation e-mail with my temporary ID.  Now, normally I'd expect I could just show the temporary ID on my phone screen, but when I called the dispensary to ask if that was sufficient they said no, they wanted a paper printout.  Grr.  I don't have a printer, so off to the library which turned out to be closed on Mondays.  Double Grr.

The next day, after much trial and error in the library involving my laptop not connecting to the printer, and my library card number not working on their computers (it's been years since I checked out a book, so they purged it from their system), and a spontaneous treasure hunt involving me looking for my glasses that I left somewhere at random while all this was going on, I had my printout about 30 minutes later.

So off to the dispensary.  I had to show my MMJ ID at the security camera at the door, then got buzzed into a small room where somebody was sitting behind a bullet proof window.  They check your ID against another form of ID, and since I hadn't been there before they took a couple minutes to enter me into their system, then I was buzzed into the main area with a number of forms and disclaimers to sign, including a promise that I wouldn't allow any product to be used by anybody but myself, for fear of immediately having my MMJ ID invalidated.

It occurred to me after the fact that all this security wasn't just to keep non-patients out, but also because dispensaries can't take credit cards or checks because the banks don't want to be involved with a business that is illegal at the federal level.  Thus, they have a lot of cash on hand, not to mention a valuable product that is not freely available to anybody.  A high level of security seems rather appropriate.

After filling out the paperwork, I get a menu and have a talk with one of the assistants that can make recommendations, answer questions, and take my order to get filled by the staff in the back room.  I'm a complete newbie at this, and talk about the various strains, THC vs CBD content, etc., just goes over my head.  I order a small selection of edibles since I don't want to smoke, and am unsure about vaping at this point.  Alright, I am now a MMJ customer!

After driving home while brazenly thumbing my nose at federal laws, I started my journey with half of a THC infused dark chocolate, or about 5mg of actual THC.  Now the thing with edibles is that they take a couple hours to have an effect, but then the effect can last for hours and hours.  If you don't get an immediate effect, do not continue eating because you might regret it later when they finally kick in.

The experience was interesting.  Like an opioid, it did seem to reduce my pain for a while, and any remaining pain I simply didn't care about.  It also gave me an odd combination of being both wired and mellow at the same time, as if I was very alert but everything was okay.  I lost the ability to filter or apply tact to what I said, so if I thought something in your presence you'd hear it.  It also caused some obvious short term memory problems, where I'd be talking about something and go off on a tangent, and then stop talking without ever getting back to what I was talking about in the first place, or even remembering that I was talking about it.  And then the munchies came.

Munchies are good because I'm struggling to regain weight lost after my surgery and radiation treatments.  I expect to lose more weight during chemo, so anything I can put on between now and then is to my benefit.  Munchies, short term memory problems, and an everything is okay attitude are an interesting combination.  Let me explain.

I decided to make myself a bologna sandwich.  I went to the fridge, proceeded to take the bologna out and put it on the counter, then went looking for white bread.  After looking over every shelf twice, I came to the conclusion we didn't have white bread, so took out the wheat and put that on the counter.  Now to look for the bologna.  I know there were a couple slices left because I'm the only one who eats it, and I really wanted to enjoy these last couple of sandwiches because when it's used up we won't be buying any more.  But it was nowhere to be found.

Now, realize that I'm the type of person who turns lights off when leaving a room, turns the faucet off while brushing my teeth, and generally has a high level of disdain for people who leave the fridge door open for an extended time.  To paraphrase George Carlin, take a picture, close the door, figure out what you want, then go and get it.  So me spending a long time calmly looking for the bologna is very unlike me.  Eventually I gave up, put the wheat bread back into the fridge and decided to eat the Chinese leftovers instead.  After nuking those I saw the bologna sitting on the counter.  Duh.

At bedtime I was really tired and completely unable to sleep, and yet the pain was starting to return, perhaps because I had spent a fair amount of time sitting with bad posture because I simply didn't care if it hurt a little bit.  So a couple acetominophen and a melatonin at midnight allowed me to get a few hours of decent sleep.

So that was my first experience with a rather low-ish dose of MMJ.  Based on my experience with other psycho-active medications, I expect my body to build up a tolerance and future adventures won't be quite so extreme.  I'll also be experimenting with dosing as well as THC vs CBD.  It's actually quite a bit like trying to find the right medicine and dose when dealing with anxiety and depression, except I don't need to go to the doctor's office repeatedly to get different prescriptions.

To sum up, my first impression is that it's not a miracle cure, but it is another tool in the toolbox for fighting cancer and the side effects of treatment.  I expect it will be very useful on those days where I can't get off the couch, have a general sense of malaise, and tend to slip into a sour mood.  It's not really useful for days where I want to get something accomplished, as driving and operating chainsaws while under the influence is a bad idea and generally frowned upon.

Day 39, A 5K and a Flare

Thanksgiving morning started off clear but very cold with temps around ten degrees and just enough of a breeze to make a cold headwind for the start of the Ayer 5K.  Four of us started near the back of the pack, each with our own particular excuse to stay in bed on such a cold morning which we chose to ignore.  We were two cancer patients, an Achilles tendon injury, and an arthritic knee.

Fast forward to Sunday, as this post will jump around the timeline like a trendy science fiction movie.  I'm having a symptom flare which means pain that won't respond to ibuprofen or acetaminophen, laying on the sofa all afternoon watching football, and generally feeling very down.  To answer my own question from my previous post, I'm not the least bit thankful for cancer as I find parts of the experience to be very sucky.

The race starts and we're off.  I didn't do a warm up run so am very slow and stiff at the start.  It's uphill into a cold breeze.  At about the half mile mark I start losing feeling in my fingers and adjust my gloves so that my hands are balled up into a fist in the palm area of the gloves.  It helps warm my fingers just a tad.  It may not sound pleasant, but so far the race is going exactly as expected.

As my body loosens up the pace gradually increases until I'm approaching 10 minutes per mile.  That's slow by my usual 5K standards but fast compared to the practice runs I had done in the previous week.  By now it's just me and my running buddy Kelly from our original group of four.  We're quite talkative and conversation turns to details of bodily functions and our personal issues with them, sprinkled with bits of inappropriate humor.  It's quite typical of a running conversation, as there's something about endorphins that makes any topic fair game.

The weather in Vermont on Saturday would have been ideal in late December or January.  It was perhaps a bit cool for November and there was almost of foot of snow in the woods, but it was above freezing and without any notable wind.  I had visions of getting the chainsaw out again and cleaning up some other, smaller fallen trees, particularly the one leaning against one of the wood sheds, but my body advises against it.  So instead we went for a brief snow shoe around the property, and then later for a walk down a road with a good view of the distant mountains.  When not moving about outside, I spent way too much time staring at the screen of my cell phone.

By the end of mile 2 we had only taken one brief walk break and I was no longer feeling cold.  I've run this race every year for the last decade and it follows the same pattern every year.  Cold for the first mile, comfortable for the second, and starting to overheat a bit in the final mile.  Just past mile 2 there's a modest bit of an uphill stretch leading to a bridge over the railroad tracks.  Kelly asks if I want to walk, and I say we should wait until we get to the climb up to the bridge.  Halfway up the climb she notes that we aren't walking.  I had simply forgotten about it.

The further I run, the better my body feels.  Endorphins have banished all pain, I'm breathing hard and feeling near my limit, but still have some reserve to use to pass other runners.  Kelly is still keeping up with me, though I'm not actually trying to outrun her.  Halfway through the last mile my body decides to stop feeling better and the slightest bit of nausea hits me.  I decide now is a good time to walk, as the final uphill section is almost here.  At the top of the hill we start running again, it's all downhill to the finish.

As I write this on Monday morning, it's a dreary weather day outside.  While I'm not as down in the dumps as I was yesterday, I'm still feeling neither enthusiastic nor pain free.  I'll get more accomplished today, though that will be mostly through sheer will and determination rather than any natural feelings of euphoria.  It's very frustrating when I can't predict how I will feel from day to day, as it makes planning difficult.  Bad days also feed my worst fears about my condition and the chances for a meaningful recovery.  Suffice to say I'm more optimistic when running without pain than when watching TV in pain.

We pick up speed down the hill, now running at well under a 10 minute pace.  I see the finish line and instinctively try to sprint for the finish, but again my body feels a bit off so the sprint is muted.  Kelly matches my acceleration and we cross the finish line dead even.  5K completed in just a tad over 35 minutes.

This was my second slowest 5K ever, but by far the most enjoyable.  To get the best 5K time involves some masochism  and willingness to push your body well into the zone of discomfort.  While I did push myself to the edge of discomfort, I didn't really feel like torturing myself.  Doing so would have only netted a couple minutes faster time at most.  As it was, all four of us that started the race together finished faster than we had expected.

Between hanging around talking to friends before the race, the race itself, and then eating apple crisp and more socializing after the race, I was on my feet for about two hours.  As the endorphins wore off the familiar back pain started returning with a vengeance.  I went home and spent most of the afternoon on the couch, until it was time to travel to a friend's house for Thanksgiving dinner.

My condition generally seems to be improving, but it's a few good days alternating with a number of bad days.  The current string of bad days seems to have started just before the 5K, but I was able to ignore it for a while due to enthusiasm for the race and the holiday.  When the enthusiasm is used up and the symptoms remain or get worse, it's emotionally devastating.

I think it's about time to force myself outside for a gentle run on this dreary Monday morning.  Then there are errands to run and the general business of life to attend to.  There are no epic adventures on the immediate horizon.  It's time to focus on the here and now, and simply put one foot in front of the other.

Day 34, A Thanksgiving Challenge For You

Tis the season for posting gratitude lists on social media.  I've been meaning to make one for myself, but it somehow seems superficial.  Yes I'm thankful for the usual things such as friends, family, having a place to live, my health... oh, wait a minute, can I be thankful for my health when cancer may cut my life drastically short?

I've been struggling emotionally with my cancer diagnosis the last few days.  It's a period of relative calm as I've mostly recovered from surgery and radiation but haven't started chemo yet.  Thinking positive thoughts and spending time with friends helps for a while, but it's a temporary fix and sooner or later I have a moment alone when all the fears and worries come out.  It hits me that I could do everything possible and the cancer could still kill me in a few short years.  Hysterical sobbing usually follows.

It's not an inspirational moment and probably the less said the better.  Let's leave it at I do have my weak moments as it's exhausting being strong all the time.  I also worry that these moments of being an emotional and worried wreck aren't helping my chances of a recovery, which feeds more worry and negativity into the mix.

So what is the way forward?  How do I find peace with a major health issue and so much uncertainty?  One possible answer is radical acceptance.  This is the idea that everything is as it should be.  It doesn't mean approving of everything, just accepting it.  In other words, not denying reality.  It's part of the Buddhist concept of seeing everything correctly.

In my mind, it's a small step from acceptance to thankfulness, which raises the question, "Can I be thankful for my cancer?"  Of course, the instinctive answer is "Hell No!", but let us consider the consequences of that answer.

Cancer is an undeniable and decidedly imperfect part of my body.  If I'm not thankful for my body as a whole, then where does that leave me?  Can I be at peace if I don't like my body?  Everyone has to play the hand they're dealt (or in this case, the entire body, not just the hand, but I digress).  My challenge is to be thankful for still being in the game and having a hand to play, even if I don't like some of the cards that are in that hand.

And while cancer is generally considered "a bad thing", there is some undeniable good that has come out of it.  I didn't know how many friends I had and how much they loved me before, and for that I am truly thankful.  I am slowly learning to make the most of each day even though no day is perfect, for which I am also thankful.  As an example, I can't wait to run the Thanksgiving 5K tomorrow morning, and the fact that it will be super-frigid-cold will just make the experience more epic.

So my challenge to you on this week of Thanksgiving is to find something bad in your life and try being thankful for it.  Look for the silver lining in the clouds.  See how both the good and the bad have made you what you are today, and continue to shape who you will be tomorrow should you be lucky enough to have a tomorrow.

The astute reader will note that at no point did I explicitly express thankfulness for my cancer.  I'm still struggling with that, and may decide that simple, non-judgmental acceptance is good enough.  If it were that easy I wouldn't call it a challenge.

Day 31, The Cabin Lifestyle

We have a humble weekend getaway in Vermont.  Thoreau would think it ostentatious, but unlike the suburban practice of putting the largest possible house on the smallest possible lot, it's a small structure on a large lot.  It's a combination that encourages spending as much time as possible outside  enjoying the woods and the pond.

While it does have a furnace, the main room is best heated using the wood stove.  In the winter this necessitates regularly carrying firewood from the wood shed outside to the small rack next to the stove.  After the heating season is over there's more activity in the form of harvesting firewood (usually from trees on the property that have recently blown down and need to be cleaned up anyway), cutting to log length, and splitting the larger logs down to something that will fit into the stove.  It is a lot of work, but it's also great exercise out in the fresh air, and if you enjoy that sort of thing like I do it is a lot of fun.

What I call the cabin lifestyle is mostly periods of physical activity alternating with lazing around reading a book, enjoying the scenery, or having a meal.  Of course, having spent this past weekend living the cabin lifestyle, parts of my body are now fondly remembering the catheter, and how I'd lay around on the couch all day.  Since the removal of the catheter, I've been steadily increasing my activity level until today when I ran into my current limitations.

A few weeks ago a fir tree blew over across one of the trails that we regularly walk on.  This made it very difficult to traverse as it required doing the limbo under the trunk while trying to find a way through all the branches.  Today I decided to see if I was well enough to cut up the tree, with mixed results.

While I did get the trail cleared enough to walk through, I only cut up the minimum amount of tree needed to accomplish that goal.  There's still much more of the tree that will need to be cleaned up in the spring before I can drive the pickup truck down this trail.

There are two ways I could look at this.  The first way was to note that a couple months ago I would have had no trouble cutting up the whole tree, so currently I'm only able to do about a quarter of what I'm used to doing.  This would be called a results or goal oriented view and thinking that I didn't finish the job left me very depressed and focused on what I'm not able to do at the current time.

The other way to look at the situation is to note that I tried and actually did end up accomplishing something meaningful.  It's not natural for me to look at things this way.  It feels like getting a participation medal where the results don't matter, only that you tried.  But a more zen way to describe it would be that it focuses me on what I can control: effort and having reasonable expectations.  I had no way of knowing if my back would tolerate this, and while it did do better than expected, it's still not 100%.

It should also be noted that in any other year I'd wait until spring had arrived and the snow had melted before attempting this cleanup.  After all, the six inches of snow adds another layer (no pun intended) of challenge to the cleanup.  Did I mention that it required a quarter mile hike through the woods, up and down hills and over a couple streams to get here?

And of course the tree didn't cooperate either.  There's a bit of a guessing game in the cut shown in the photo.  Should the cut be top-down, expecting the log to fall down on the right side?  Or bottom-up, expecting the log to fall down on the left side?  I chose bottom-up for the final cut, which makes for a great action photo as you can see me crouching and lifting the saw to make the undercut.

It turns out I guessed wrong.  The right side of the log decided to start falling and pinched the bar of the saw in the cut.  Insert foul language here.  I'm a quarter mile from any other tools and the only saw I have available is stuck in a tree.  Trying to simply pull the saw out didn't work, it was more stuck than I am strong.  Lifting the right end of the log to take the weight off with my right arm, while pulling the saw out with my left did the trick.  But it also made my back complain.

When I'm healthy, I can use all my strength without hurting myself.  What I'm pushing, pulling, or otherwise trying to move will either move in response to my best effort or it won't.  My back is currently the weak link in the chain.  If I try to use a majority of my strength in a manner it doesn't like, it will hurt and continue hurting for some time afterwards.  On a good day that happens when trying to wrestle trees.  On a bad day that happens leaning over the sink to spit out my toothpaste.

I'm making solid progress and daring to push myself to but not quite past my limits.  In my mind, the cabin lifestyle is key to increasing my chances of making a full recovery.  The periods of activity are good for building endurance, strength, and flexibility without the drudgery of working out in a gym (though I could probably use some of that as well). The periods of inactivity are ideal for resting and recovery.  At no time am I watching TV and stressing out over the evening news, which it seems is something I do all too often in my normal life.

Day 28, Poetic Torture and a Run

Let's start off with a quick recap.  In the last four weeks I've been diagnosed with two cancers (local bladder and advanced prostate), and have subsequently had hormone therapy, surgery, radiation, the catheter from hell, not to mention test after test and every doctor wants a vial of blood to check something or other.  Somehow I'm still surprised that this has left me fatigued, nauseous, and in pain.  On the bright side, I've easily lost 8 pounds without even trying.

Today's test was a bone scan.  It was poetic torture of a sort.  To understand why, you first must know what I do for a living.  I work in a machine vision company named Cognex and spent a significant portion of this year integrating a new 3D camera into our VisionPro software product.  This camera produces high resolution 3D images of a part by shining a laser stripe across the part and then using a sensor set at an angle to the laser to triangulate the 3D positions where the laser is illuminating the part.  To get a full 3D image, the part must be moved through the laser plane while the camera slowly builds up a 3D image slice by slice.  While it is extremely accurate, the need to move the part and take individual slices takes considerable time relative to other technologies.

In a similar fashion, the bone scan involved building up a model of my bones by taking individual slices as I was moved under the sensor at an excruciatingly slow speed.  I was told to breathe normally keep my fidgety body as still as possible while it took the image.  We're talking 30 minutes during which I'm not supposed to move.  That's a considerable amount of time to focus on how much one's ribs move up and down in normal breathing.  Does that still count as laying still?  Still there I was, a victim of the same relatively slow line scan imaging technology I work with for a living.

To add to the torture, before the scan I was injected with radioactive phosphorous and told to come back for the scan 3 hours later after it had a chance to absorb into my bones.  The cancer in my back causes pain if I sit too long.  So, figure an hour long car ride to the hospital, sitting in the waiting room, then a walk over to the local library to read and kill time while sitting, then back to the hospital cafeteria for a sit-down lunch, and more sitting back in the waiting room again.  My back started complaining so I improvised by laying down across some chairs:

Once again fighting cancer isn't always an exciting action movie, but more like a montage of what would otherwise be dull and boring scenes waiting for the next appointment or test.

That's enough about back pain and medical tests.  As I've committed to running a 5K on Thanksgiving day, after getting back home I forced myself out the door to do my first run in weeks.  I had a disparate set of goals:  Cover three miles, get acclimated to running in the cold, and get my heart rate up over 180 briefly.  The run was a success on all counts even if dreadfully slow.  My body simply does not respond well to time off from running, but should bounce back quickly if I get back out a couple times over the next week.  I'll still be slow from being out of shape and having low blood counts from the radiation treatment (I now have medical proof of that), but should be able to take maximum advantage of whatever fitness I do have, which isn't something I was able to do today.

The other reason that got me out for a run was yesterday's meeting with the onco.  He stressed that getting out of bed and off the couch improves my prognosis considerably.  When I mentioned that ibuprofen helps with the pain but may be causing digestive issues (mostly due to collateral damage from the radiation, but the ibuprofen seems to make it worse), he said to add Prilosec and keep taking the ibuprofen if it helps me keep moving.

So while I'm still in pain, the general trend is that I'm able to do more and more for the same amount of pain.  I'm almost back to where I was before all the treatments and surgery started.  Better yet, my latest PSA number is half what it was a month ago.  It all points to the cancer being slowly beat back even before chemotherapy begins.  The onco wants to give me a couple more weeks off before starting that, so I should be feeling pretty good before the next round of torture, which should be starting sometime in the first week of December.

Day 24, Life Part 3

October 19, 2018 was a day that changed my life forever.  It's when I got my cancer diagnosis and started hormone treatment.  It's not the first time my life changed drastically.

On May 19, 1989, I graduated college and moved to Massachusetts to begin my career.  The world opened up.  I was no longer the short and scrawny outsider that was bullied in school.  It was the end of part 1 of my life, and the beginning of part 2.

Now of course this transformation actually happened over a number of years while I was at college, but the ceremony and symbolism of graduation made it easy to pick that as the point when everything changed.  In a similar manner my cancer developed over time (but unknown to me), with a rather dramatic unveiling in the urologist's office, though happily not involving confetti, or the need to wear a cap and gown.

Life part 2 started off with some of the best years of my life.  I was making new friends in Massachusetts and hanging out with old friends from college.  I began dating as women finally seemed to take me seriously.  Yes you read that correctly: my first girlfriend didn't happen until after college graduation.  I got married, bought a house, then bought a Mustang.  I changed jobs twice and ended up in a good position in a good company.

And I lived happily ever after?  Not quite.  The big problem with life part 2 was the feeling that something better was always around the corner.  While this was generally true in my 20s, after a while things stopped getting better.  In reality, my parents and in-laws were aging and friends got busy with family responsibilities.

Now to go off on a tangent, here's a tip for all you guys out there:  When you observe that your life was on an upward trajectory until approximately the time you got married, do not state this verbally to your wife!  Correlation may not be causation but that doesn't keep you out of the doghouse.

It wasn't all downhill after my 20s.  I joined a running club, made new friends, and got to run the Boston marathon in 2011.  I've wanted to run a second marathon but the situation never seemed right.  I'd get injured during training and just think that next year would be better, as if there was an infinite supply of next years.

Living in life part 3 with cancer, there is no guaranteed "next year".  It's possible I'll continue to live for months, years, or even decades but I really just don't know and can't know.  If the cancer does get beat into remission (which I think is likely) I'll still have to undergo regular testing to see if it's making a return.  There will be side effects from treatment that may linger for months or years.  And of course, I'll still be subject to the normal processes of aging as all of us are.

Thus, the secret to life part 3 is embracing life in all its imperfections and focusing on the positive, the good, and the funny.

Today was the monthly brunch gathering of the running club.  Yesterday was a rough day for me, as everything I ate seemed to give me abdominal discomfort, which in a way was an improvement over having little interest in food.  However, the temptation to avoid a social activity centered around food was great.  In the past I would have noted that there will be another opportunity next month, so if this one isn't going the way I want I can try again later.  Not anymore.

Today also started off a little rough, but I went to the brunch anyway.  Happily my body responded to the challenge and the good weather, and I got a walk in (not quite recovered enough for running yet) and was able to have a modest amount of food and a cup of coffee without major problems.  While I may not have felt perfect, being surrounded by supportive friends was a great morale boost that I definitely needed.

After a little bit of peer pressure was applied I signed up for the Ayer 5K on Thanksgiving day.  It's a race I've run for over 10 years straight.  Unless my onco insists on starting my chemo a day or two before, 5K is a distance I know I can run/walk/crawl and still finish ahead of dozens of others even if I'm not having the best day.  I can almost guarantee that Thanksgiving won't be a perfect day, but I'm learning to look past that and see that it's likely to at least be a good day.

So in closing, it seems that fate decided that my life part 2 had to end suddenly.  I could just as easily have had a fatal car accident or a heart attack, and the tragedy would have been my sudden departure without a chance to fight.  It might be a morbid thought, but given a choice between sudden death and cancer I'll happy take the chance to fight on in part 3, and intend to savor every positive moment it allows.

Day 19, Bouncing Back

People warned me that fighting cancer would be a roller coaster ride.  When you consider that I'm normally a person of emotional extremes, calling this a roller coaster is an understatement.

Today was my last scheduled radiation treatment.  However, like last Tuesday the machine was down, and they weren't sure if they'd get it back online, but they'd know in about an hour.  Was this more bad luck?  Or just a transient hiccup?  Sometimes fighting cancer is as simple as staying calm and being patient (no pun intended).

It turns out it was a transient hiccup, and after my 5 minute treatment I literally jogged back into the waiting area as my form of taking a victory lap.  Not bad considering an hour earlier I had made an offhand comment about back pain and the uncomfortable chairs, and the staff happily found a gurney for me to lay down in and rest while waiting.  I felt obliged to mention that laying down in the gurney made my back much better and my pain can be very specific to what I'm doing.  Walking typically isn't a problem, while bending over to feed the cat can be excruciating.  The cat has no sympathy however, and thought I was just being the biggest tease when I very carefully and slowly bent at the knees instead of the back before dumping his breakfast into his bowl.

Part of my improved mood today is due to better management of symptoms.  Yesterday I met with the radiation doc and mentioned my pain and nausea.  I came away with a script for the nausea which helps greatly and a better plan for pain management.

There's basically 4 options for pain management each with their own downside:

• Tylenol, which can cause liver damage if you take just a little more than the recommended daily maximum.
• NSAIDs (aspirin, ibuprofen, etc.), which can cause bleeding and thus are bad after surgery.
• Steroid anti-inflammatories, which suppress the immune system, and besides I'll be getting plenty of that when starting chemo.
• Vicodin, see "opioid crisis".

The doctor convinced me that Vicodin is a good choice, as my use will be short term and he hasn't seen problems with cancer patients wanting to stay on the drug.  Besides, ibuprofen will become an option again soon enough, and if the radiation treatments work I won't need much if any pain management.  That said, I'm only taking the Vicodin at night, which means I can use more of my daily allowance of Tylenol during waking hours.  (important side note: Vicodin actually contains some Tylenol, so when employing a strategy like this you have to count all medications which include Tylenol against the daily limit)

Great, so symptoms are under control and radiation treatments are completed.  My mood and optimism are greatly influenced by how I feel.  Generally speaking, if I'm not in pain and able to go for a run, how sick can I really be?  It also helps that last night as I slept I dreamed of playing ultimate Frisbee.

Also of note, I voted today!  Some call it a civic duty, I called it a good reason to shower and get out of the house for something other than medical reasons.

Next up is to see the urologist on Thursday about the catheter.  It's an ongoing annoyance, but not nearly as annoying as urinary retention.  For the time being I'm happy to count the catheter as part of my penis length and will note that it hangs nearly to my knees.  Good luck getting that image out of your head!

Assuming I can lose the catheter on Thursday, I'll have almost a week of "time off" before meeting the medical oncologist to talk about starting chemo.  That's my window to get back to daily walks, focusing on eating healthier, and generally getting rested and ready for the next battle.

Day 17, A Week of Setbacks

At the end of a rough week, I am in a dark place right now.  In my last post, a polyp in my bladder was described as "little more than a speed bump in the grand scheme of themes".  While that is still generally true, there have been some complications.  Suffice to say that in a span of 48 hours I had to seek urgent medical care twice just to take a piss.

The first hiccup of the week was when my first radiation appointment, scheduled for Tuesday, got cancelled when the machine broke down.  That meant my first radiation treatment wasn't until Wednesday, just a couple hours before surgery for the polyp.

The surgery itself went well enough.  I was put under general anesthesia, and then all sorts of equipment was shoved into my penis, up the urethra, and into the bladder to remove two growths, followed by a catheter to fill the bladder with a chemotherapy solution and hold it there for 30 minutes while I was in recovery.  The main points here are that there is anesthesia, as well as incisions inside the bladder and some amount of wear and tear to the urethra to recover from.

There were two decisions made after surgery that in hindsight turned out to be poor decisions.  The first was the decision to remove the catheter used to fill and then drain the chemotherapy solution from my bladder.  The second was to send me home after only passing a small amount of bloody urine, despite my protestations that it seemed as if something was preventing me evacuating normally.  Apparently this is a common post-surgical complaint, and most of the time it turns out to be a false sensation.

In my case, it was a real sensation.  After a 90 minute ride home including a stop at the drug store to fill some post-op prescriptions, I was feeling every pothole in the last several miles.  But I still wasn't able to pass more than a few drops at a time.  A call back to the hospital netted the suggestion to have a cup of tea and use a heating pad near the bladder to trigger the urination reflex, and if that didn't work by midnight go to a nearby ER.  Of course, the tea did little more than provide more fluid to fill the bladder and up the urgency.

It became exceptionally painful, even though I was on a prescription pain reliever.  The bladder hurt because it was distended and had just had growths removed.  What did pass caused extreme pain in the irritated urethra.  By the time midnight rolled around, I was screaming in pain with each unsuccessful attempt.  There was a brief flash of hope when more than a few drops came out, but that effort couldn't be repeated.

So off to the ER at half past midnight, and I walked in with my hand cradling my much abused and hurting penis and lower abdomen.  At this point all thoughts of being a strong person had left me.  I simply didn't want "urinary retention" as my cause of death.

So to make a long painful story a tad bit shorter, they eventually got a catheter put into me on the second attempt.  The first attempt was excruciating.  The second one with a different catheter even more so.  I was exhausted and in agony and had given up all self respect and freely screamed in pain throughout this procedure.  It is easily the most pain I have felt in my entire life.

Happily, after about a quart of fluid was drained the pain had largely gone away and I was sent home with a catheter into my bladder and a baggie strapped to my leg.  Unfortunately that catheter clogged on Friday morning.  At least that was during normal business hours so off to the urologist for an urgent appointment.

At the urologist, after another several hours with a very uncomfortably full bladder, the plan was to estimate the amount of urine in my bladder using an ultrasound like machine, then remove the catheter and see how much I could void naturally.  Of course, with the luck I'm having this week the batteries in the machine died so the nurse had to go fetch a fresh set.

The estimate was 650 cc, and I naturally passed maybe 50 of that.  Shit.  Hello catheter number three.  The good news is that my pain levels were much lower, so I was able to deal with it using deep breaths and trying to relax, and no screaming was involved.  The urologist didn't have great things to say about the configuration the ER had left me with, and instead of a bag he put a valve on the end which makes life with the catheter much simpler.

What's troubling is the urologist doesn't know why I'm not able to piss naturally.  It could be inflammation and swelling in the bladder, as the growths were near the bottom where it necks down into the urethra.  It could also be nerve damage due to the metastasis in my spine.  It's hard to tell since the surgery and the first radiation treatment were so close together.  We'll re-evaluate the situation next week after finishing the radiation treatments, and if needed there are less extreme options than a full catheter.

While this was going on I had three radiation treatments.  In addition, the third front of this cancer war is the hormone therapy injection I was given a little over two weeks ago, which should be starting to take effect now.  All of these things can cause side effects such as fatigue and nausea, so it's no surprise I've spent most of the last couple days laying around on the couch or in bed feeling sick to my stomach.  That is, when I'm not in a complete panic about my ability to urinate.

Which brings us to today.  Much of the past week has gone by in a haze of stress or napping (sometimes aided by a prescription opioid).  Today I've recovered enough to occasionally get off the couch for 30 to 60 minutes at a time, including writing this post.  The emotions are starting to hit me.

Last Tuesday, before this latest skirmish in the cancer war, I was able to go on a 2 mile walk and haul a load of trash and recyclables to the town dump.  I could go out to a restaurant for lunch.  I could travel to Vermont and at least enjoy the scenery and maybe even an easy stroll by the pond.

Today, I've got a catheter hanging out of my wanker that tends to chafe and irritate me with any significant movement.  My back pain seems to be flaring up as a result of the radiation treatments.  I sleep for about 12 hours a day, lay around most of the other 12, have little interest in food, and generally worry about whether the current catheter will continue to function.

At some level, this is all perfectly expected after what I've been through in the past week.  But on the other hand, I still have two more radiation treatments, then a short break, and then chemo begins.  The though that I'll be stuck in this loop of sleeping, pain, and nausea for weeks scares me deeply.

As the saying goes "If you're going through hell, keep going", and I'm clinging desperately to the hope that eventually I will emerge on the other side.  It's just that after a week where every light at the end of the tunnel seems to be an oncoming train, it's very difficult.

As always, the silver lining is the love and support I have received.  Please continue sending the thoughts, prayers, hugs, care packages, well wishes, whatever you can do.  It seems I'll need them in increasing amounts in the coming weeks.

Day 11, Much Mixed News

Just a quick dump of of the latest developments, without much wordsmithing or looking for the sliver lining, because there is a lot going on.  Today started off with an 8am cystoscopy, which involves inserting a scope into the bladder to have a look around through the only way in: the "urethra", which I put in quotes because I'm using it as a euphemism for the most personal part of a man's anatomy.

And despite the use of a "numbing agent", this HURT!, not unlike a hot knife being inserted.  I screamed out in pain like a little kid.  My wife in the waiting room heard me.  I'm sure everybody in the office heard it.  The doctor described my "urethra" as "a little sensitive".  No shit!

The result of this was the finding of a polyp in the bladder, which is probably cancer unrelated to the prostate cancer.  Great!  But this is little more than a speed bump in the grand scheme of things.  Wednesday I'll go in for an outpatient operation which will remove the polyp and fill my bladder with a chemotherapy fluid to prevent recurrence.  This is highly routine and low risk.  The only concerning thing is that my dad had this exact same procedure about a dozen times because it kept recurring no matter what they tried to stop it.  We won't think about that right now.

The biopsy and MRI results were also discussed.  Yes, it is cancer, and yes, it is aggressive.  But the cancer was only in half of the prostate, which means it didn't spend long there before spreading to other parts of the body.  Generally, the urologist thought this was better news than he was expecting.

So from there off to the radiation oncologist.  We'll ignore the bit about this doctor being a bit more straight spoken with zero tendency to sugar coat things.  But his role in my treatment will be limited.  Starting tomorrow and for the next 5 days I'll be getting beam radiation treatment aimed at addressing the sources of pain which hopefully will get me moving around easier.  This nuclear attack is just the opening salvo focused on the problematic metastases.  The system wide chemical attack will come after.

On Wednesday morning, I'll be meeting with the medical oncologist.  This is the doctor which will likely prescribe chemotherapy, and this will be the cornerstone of my treatment.  In fact, the radiation oncologist's urgency to get me into treatment quickly was so he could "get out of the way" of the chemotherapy he expects is coming.

Despite the radiation oncologist's rather pessimistic demeanor, he did say that the field of chemotherapy is exploding with new options.  Dawne also pointed out that even though he spoke in terms of "extending life" and not "cure", that extension provides more time for better treatments to become available.

So if you've been keeping track of this all, you'll notice that Wednesday will be a packed day of meeting the medical oncologist, getting a radiation treatment, and finally surgery for the bladder polyp.  Of course, the surgery means I can't have food after midnight, so I'll be starving through all of that.  If this doesn't count as an all out assault on cancer, I don't know what does.

So hopefully by next week I'll be feeling less pain, just in time to go onto chemotherapy and probably be sick to my stomach and lose my hair, so I got that goin' for me (to make a Caddyshack reference).  Stay tuned!

The Painful Post

It's been almost a week since my last post and there's not much news to report.  No test results, no update on a treatment plan, and generally no drastic change in symptoms.  So I'll use this opportunity to go into some detail on the symptom that's causing me the most grief: pain.

For several weeks now I've been dealing with a pain that can be approximately described as if my back has gone out.  It hurts to sit.  It sometimes hurts to roll over in bed.  If I move wrong, such as bending over to spit my toothpaste into the sink, it can feel like a knife being stuck in my back.  All that said, I've also managed to carry the window A/C unit down two flights of stairs and go on a 4 mile run so not all activities cause pain, at least if I don't overdo them.

Ibuprofen and/or acetaminophen help, but bring up the prospect of doing too much, and being in a world of hurt when they wear off.  Last night when I tried to go to bed I had severe pain from my back all the way down my right leg to the foot.  That strongly implies a nerve is getting pinched somewhere.

This pain is best explained by the CT scan results.  I had mentioned earlier that my cancer has spread.  Let me see if I can tell you the bad news in a good way:

Imagine you're watching a cheesy animated high school science film about prostate cancer.  The tumor is depicted as a busy bustling city in the prostate.  There's lots of animated anthropomorphic cancer cells.  Most have that silly happy grin that cartoon characters like to have.  However a few are sad, and becoming disenchanted with city life, so they pack up their suitcases and decide to go on a cruise.

There are only a handful of cruise ships to choose from and they sail the bloodstream and lymphatic system to a relatively small number of destinations.  These vacationing bastards decides to move to my vertebrae, where they proceed to interfere with the normal turnover of bone tissue.  This can have all the expected effects of pain, inflammation, and pinching of nerves.

The point of this silly analogy is that while prostate cancer can spread, it usually spreads to very specific spots, and my CT scan was consistent with this.  There are bone lesions in my hip and back, and apparently one very swollen lymph node (assuming I understand the medical jargon in the summary).  This explains the pain I have and continue to feel.

And now the tricky part: viewing this revelation as a good thing.  My advanced cancer wasn't caused by the CT scan, though honestly it feels that way much of the time.  It's just never easy to find out that your most hypochondriac thoughts weren't anxiety, but were actually a pretty accurate assessment.

So here's the interesting thing that I didn't know before: Prostate cancer in the bone isn't bone cancer, it's still prostate cancer.  This means it's still affected by any treatment that targets prostate cancer.  For example, denying testosterone will stunt the growth of the cancer cells, and I've already had an injection of Eligard that will do just that.  There are also radiation treatments that selectively seek out the weakened areas of bone where the cancer is located, and I'm hoping the oncologist will agree that that's a good option for me.

So now those vacationing cancer cells have arrived at their vacation destination to find they're no longer in a cheesy science film, but in a cruel Monty Python animation.  There's no food at the destination, and a bright sun radiating down on them, and gosh darn it they forgot their sunscreen.  They're starving, listless, and sunburnt.  Suffer and die you little assholes.  May you be squashed by a big bare foot descending from the top of the screen.

Obviously, I've been doing some research on the web about my condition.  It's a difficult balancing act.  It's very easy to have a positive attitude if I'm not reading about cancer and not having any observable symptoms.  It's diabolically difficult when it hurts to simply sit in a chair, and I'm reading about how easy it can be to actually die from this, and how unpleasant the treatments can be.

It's important to do research to understand the disease, what's happening to me, and what are the options for fixing it.  But it can also be extremely depressing and stressful.  So many people have reached out to me to offer their support.  Please please please continue to do this!  Get ready for a long drawn out fight.  Be ready for me to withdraw into myself at times and when I do, slap me out of it.

There is much reason for hope!  The CT scan notes that the vital organs in my abdomen are normal.  To my mind, this means the cancer hasn't moved into any areas that will immediately kill me.  It also means my kidney and liver are up to the task of dealing with the treatment regimen (they have to break down and eliminate the drugs after they've done their job).  I'm also starting out with strong bones and a reasonable amount of lean mass and fat mass.  In short, I am strong where I need to be to withstand treatment.

Let's beat this!

A Hero Emerges

Grrr I hate cancer, I just want to grab my chainsaw and go running after cancer cells and cut them up like Ash going after the Evil Dead.  Not quite a practical idea, but it is the image I want to have in my head, and it's a great excuse for a campy photo opportunity:

It's super easy to be worried right now.  I've been given a diagnosis but have to wait my turn to see the oncologist before the heavy artillery can come to my rescue.  What can I do in the meantime to fight the battle against this aggressive and vile enemy inside me?  It turns out there's a number of things.

For starters, I can share my story and reach out to others for help and support.  This has worked wonderfully.  I've received so much love, support, advice, and general well wishes that I am in awe.  It also led to a wonderful phone call this morning with "Coach Jeff", a stage 4 prostate cancer survivor who has completed two ironman triathlons since his diagnosis 4 years ago.  He is living proof that people with late stage cancer can beat back the disease and thrive.  I'm finding other survivors to use as a source of knowledge and inspiration as well, but when one is both an ironman and a late stage cancer survivor, you gotta call them out by name.

The next thing I can do is eat healthier.  Rumor has it that cancer cells rely on sugar to survive.  Of course, the rest of the body needs some to survive as well, but excess sugar makes life easier for the cancer cells and makes life harder for the normal cells as they struggle to cope with the excess nutrition.  So, less sugar, cut out the dairy, less processed foods, more plants and less animals, and the balance of power should shift to the healthy cells.  It's not a cure for cancer by any means, but it does put a finger on the scale in favor of recovery.  It's also an excuse to post a picture of last night's dinner, salmon with raw veggies and quinoa:

But wait a minute.  That would also mean no bowl of chocolate ice cream sundae while lounging in front of the TV.  Man this cancer thing does suck!  What a crappy disease!  Truth is I've been wanting to eat better for a long time, but faster running times aren't as compelling a reason as simple survival.

Next, I can spend more time resting, relaxing, and even napping.  The immune system can go after and attack cancer cells (though it's not clear if they use chainsaws to do so), but if I'm stressed and sleep deprived, my immune system won't be up for the job.  Like diet, this won't cure cancer on its own but it's another finger on the scale.  So here is what a hero fighting cancer actually looks like:

Not as exciting as running around with a chainsaw, but trust me, that's what I dream of when asleep.

And finally, the one universal bit of advice I've been given is to keep a positive attitude!  I've had my dark moments, but right now I'm totally pumped.  Writing this blog post required me to put thought into what I can do to fight the battle in this very moment, instead of anxiously waiting for the next doctor's appointment.  I'm writing it because people are interested in my story.  Thus, your interest and support are inspiring me to do everything I can to beat this disease.  I am standing on your shoulders.  Thank you!

The Dark Days

In my ongoing story, this is a chapter where the hero is beaten up and the villain appears to be winning.  It makes for great drama as the hero gets to seek revenge in a future chapter.  But suffice to say that my wish for a short story with a happy ending won't come true.  So sit down, grab a box of tissues, and keep reading.

Thursday morning was my CT scan.  This was a rather straightforward procedure and the only challenge here was the barium sulfate prep drink.  The instructions said "may cause loose stools in some patients".  What they don't tell you is it may cause explosive movements in other patients, like me.  Luckily that didn't last long and we were soon back home where I went upstairs to take a nap, then the phone rang.

It was my urologist's office, wanting to know if I could come in for the prostate biopsy at 7:30 tomorrow (Friday) morning.  It was only after getting off the phone that it occurred to me that there might be a connection between the scan results and moving the biopsy earlier.

Let me say, the biopsy was an experience unlike anything I've ever had.  First, they shove a piece of ultrasound equipment up my rear, and then proceed to inject Novocaine, and then insert a needle into the prostate to withdraw a sample 12 times.  This does quite a bit of damage to rather sensitive tissues, the consequences of which I'll get to near the end.

So after the biopsy, the doctor spoke to me and my wife about the CT scan results.  They weren't good, but they did explain some of the pains I've been developing.  Metastases.  Advanced cancer.  The biopsy results won't be in for about a week, but the working diagnosis is an aggressive form of prostate cancer.

This is not unexpected given the high PSA result that started the week, but it's still devastating news to hear.  We both cried.  Then we went out to lunch with one of Dawne's friends that happens to be a survivor of multiple cancers.  We talked a lot about cancer and maintaining a positive attitude and actually laughed quite a bit.

In the evening, we called my sister and mom and told them the news.  Breaking the news to mom is the single most gut-wrenching thing I've done in my life.  Dawne had to do most of the talking, as I could barely hold myself together.  Just writing this paragraph was difficult, and used up a fair share of tissues.

Back to the disease itself.  "Prostate cancer" is actually an umbrella term that covers multiple forms of cancer that can attack the prostate.  Unfortunately the younger you are, the more likely you are to get one of the aggressive forms, and that seems to be what's happening with me.

Prostate cancer also depends on testosterone to grow, which might explain why in the general case it's more aggressive in young men who have naturally higher testosterone.  It also means that it's sometimes possible to manage the advanced form of the disease by blocking the body's production of testosterone, and I've already been given an injection of Eligard that is intended to do just that.  Unfortunately it will take a few weeks before we know if it begins to work.  In the meantime, there will be more tests and a meeting with an oncologist.

As for me, I'm in pretty rough shape at the moment.  My pain levels are currently pretty bad, as I had been managing them with ibuprofen but that promotes bleeding so I can't take it again until everything down there heals from the biopsy.  Tylenol helps some, but not as much.  Mostly I'm feeling beat up from tests, emotional stress, and the resulting sleep deprivation.  Right now my focus is on resting and recovering over the weekend when not writing a blog post.  It's a depressing part of the story, and things will probably continue to get worse for the next week or two.  But it's also a setup for the epic hero (that would be me) to come fighting back in a future chapter.  After all, how can you tell a good story without a good antagonist?

Several lighter observations:

The "biopsy site" was bleeding for a good while yesterday, and I still had gas from the barium sulfate drink.  Combine the two and there were several episodes of farting blood.  My solution was to put a panty liner in my underwear.  Practical and effective if not very macho.  It's all part of the absurd adventure I'm on.

After a digital rectal exam and the biopsy in back to back weeks, I'm planning to get a tattoo on my butt that reads "Exit Only".

Side effects of Eligard include hot flashes and possible breast growth.  I'm worried I may have to turn in my man card shortly.

My Prostate is Broken

It's been a few years since I've posted here, but my life has recently become eventful so I feel the need to write again.  Hopefully this saga, this absurd adventure on which I am embarking, will be brief and have a happy ending.

But before we get to the entertaining part of the story, I need to get very honest and a bit graphic about my current situation.  This is not something to be discussed in polite company over dinner, but on the other hand I think it ridiculous that guys never seem to talk about important issues specific to men's health.

So as the title says, my prostate is broken.  There's occasional blood in fluids that do not normally contain blood.  There's pain in my groin region that may or may not be related to other pains in my hip, back and abdomen (which could be overuse injuries from running).  There's a confirmed nodule on the prostate itself, and my PSA came in at over 200 (it was a perfectly normal 2.1 only 13 months ago).  Wow.  This is not the typical case of a slightly elevated PSA on a routine blood test with no observable symptoms.

There are three things that could be causing this, and my bizarre quest is to work with the wizards and sages (aka medical establishment) to eliminate two of the three possibilities

• Prostatitis, an inflammation and/or infection of the prostate
• Prostate stone, which may or may not be related to Prostatitis
• Cancer, which is far and away the most scary possibility given the sudden high PSA number

The other purpose of my journey is to bring awareness to the topic of prostates.  It's been my observation that breast cancer has much better marketing than prostate cancer.  September is prostate health awareness month and prostate cancer is symbolized by a light blue ribbon.  October is breast cancer awareness month and is symbolized by a pink ribbon.  Given that, I found it quite remarkable that the NFL used to explode in pink for the month of October, after not hearing a peep about prostates in the month of September.  Luckily that seems to be changing, as the NFL recently decided to broaden its October focus to include more cancers.  Suffice to say I still think men in general would rather talk about breasts than prostates.

With all that out of the way, on with the story.  My adventure begins with a conversation with a rather attractive woman, and within a few sentences was discussing my genitalia and sexual habits.  Of course, the context for this was a urologist's office, which makes the preceding sentence a bit less exciting.

And of course that lack of context works both ways, as a short while later a man I'd never met before walked in, introduced himself, proceeded to shove a finger into a body cavity, and I was strangely okay with that.  It was in this compromising situation that I found out about the nodule, and remembered Chevy Chase singing "Moon River".

I left the office with a prescription for an antibiotic to cover the possibility of prostatitis and a long lists of tests to undergo.  I felt overwhelmed and a bit sick, but the latter part could be a side effect of the antibiotic.

Then first thing on Monday morning I got a call back from the doctor, and found out my PSA results were "worrisome", so add a biopsy to the list of tests.

And that's about where I am now.  I'm really hoping I have an infection and/or stone.  How many times do you wish for that?

Tomorrow is my CAT scan, and I'll be taking the day off from work to focus solely on that.  All these tests seem to have an element of the bizarre about them.  In this case, I have to drink two bottles of liquid before hand that "may cause diarrhea like symptoms in some patients", which may be problematic when it's an hour long car ride to where I'll be having the test.

The adventure continues, stay tuned for the next exciting installment.