Baystate Race Report

Victory!!!

October 20th, 2019.  Perhaps not the single best day of my life, but one of the best.  Certainly life doesn’t get much better than this.  It was a year and a day since my cancer diagnosis, and I just ran close to a perfect half-marathon.

I feel extraordinarily blessed and lucky and all that because not all cancer patients are able to celebrate surviving their first year with cancer by running 13 miles.  I know of one man who celebrated by dying exactly one year after diagnosis, after the doctor estimated he maybe had a year to live.  You hear a lot about the cancer patients who beat the odds, and not so much about those who don't unless they're a celebrity.  Eddie Money comes to mind.  These things bother me while I'm running around having a great day.  Call it survivor's guilt.  It's a real thing.

One of the epiphanies I had in the past year was that "beat cancer" is a vague and poorly defined goal.  Some people define "beating cancer" as dying of something other than cancer, but I personally think that is a horrible goal.  By definition you can't achieve it and be around to have a victory celebration.  That's why I chose to define "beating cancer" as running a half marathon.  It puts the focus on how to live instead of how to die.  It also allows me to win a battle, declare victory, and bask in the glow for a moment before moving on to the next goal.

The Perfect Half-Marathon

Perfect doesn't mean fast, it simply means running the race according to plan and getting the best possible performance out of your body.  Like most runners, I tend to go out too fast and crash later in the race.  Or I hold myself back too much and finish with reserves on energy that could have been used to get a faster time.

I started off slow for the first mile or two in lieu of doing a separate warm-up run before the race.  I'm not in good enough shape to waste calories warming up for longer races.  Shortly after the start I had an equipment malfunction.  The chest strap that reads my heart rate was too loose and it kept sliding down my chest.  Eventually I gave up trying to fix it for the moment and let it go all the way down to my stomach and try to take the pulse of my belly button.  My belly button has no pulse, if you were wondering.

My strategy was to take walk breaks at the water stops, and so at the first water stop I walked and fixed my strap.  Then it was time to pick up the pace a little bit.  I was estimating effort based on my breathing as well as the heart rate and pace reported by my Garmin.  I was on goal pace and it felt like I could run it all day.  At water stops I'd find myself a bit ahead of plan, and would walk until my watch indicated I was back on plan.  It's really hard to not go faster than plan early in a race, particularly when it's ideal weather conditions.

Speaking of water stops, since it was cool I ended up taking the Gatorade option more in the interest of caloric intake rather than hydration.  Instead of spending the morning online debating the dangers of sugar intake in cancer patients, I'm out pounding down cup after cup of sugar sweetened beverage.  Somehow though, I don't think my blood sugar was spiking very high.  It's a very different context than having a soda with a 1,000 calorie sit-down dinner.

After about halfway I started pushing myself slightly instead of holding myself back.  The net effect was that my pace remained about the same.  In the end, I ran the second half of the half about a minute faster than the first half (should a half of a half-marathon be called a quarter marathon?).  Things started to hurt, but what surprised me more was the realization that things weren't hurting for the first number of miles.  I started to take really short walk breaks at water stops or skip them entirely.

I became a man on a mission, running with purpose and a bit of anger.  Then I realized that I was alive and running a half marathon and started to tear up a bit.  What a curious mix of emotions!  It was becoming more and more difficult to continue running, but I was on pace to meet my goal without a lot of time in the bank (by design).  Damn it Scotty, I need more power!

When the last mile arrived I went all out and my pace dropped below 10 minutes a mile.  That's the kind of blistering speed that keeps me in the back half of most races.  When the finish line was in sight I sprinted, pumped my fists in the air, shouted, and made loud noises.  Actually, I don't quite remember exactly what I did.  I just know it felt like taking back another piece of my life that cancer tried to take from me.  It was a beginning, not an end.  Perhaps next time I'll be a little less rabid about finishing.  I think I may have spooked some of the other runners and volunteers.

Me vs My 41 year old self

Here's what my Garmin watch had to say about my race:

10 years ago this same race was my first-ever half marathon.  I thought it would make a great story if I could beat my time from that race.  There are those who warn me about competing with my past self, and they have a point.  But, in this case, I knew from my regular runs that I was in the ballpark of being able to do just that.  Here's what my Garmin said 10 years ago:

These aren't the official times, but the story is still the same.  Three minutes faster with almost the exact same heart rate.  Being an experienced 51 year old runner with cancer beats being a neophyte 41 year old runner.  Weather and luck probably have also played a factor.

Now here is the very important point: I've embraced modern medicine and had very aggressive treatment.  The result is an undetectable PSA and I'm running around more or less exactly like I did 10 years ago.  If this is the result of having my veins filled with poison, I'll have some more please!

Footnote: While I did manage to beat my 41 year old self, I'm still behind my 42 and 43 year old self.  In those years I had a combination of experience, relative youth, and lack of terminal disease that's going to be harder to beat.

Technically, I Cheated

It turns out that two of my medications are on the WADA banned substances list.  Surprisingly Lupron, suppressor of testosterone, is considered a performance enhancing drug.  When used to treat prostate cancer it's about as far from a performance enhancement as you can get.  But used differently, it could also boost testosterone, and that would give an advantage.

The other banned substance is Prednisone.  This I find interesting, as it's a relatively common drug.  Prednisone gives you extra energy and acts as an anti-inflammatory which can suppress pain.  A related but stronger drug, Dexamethasone (also on the banned list), allowed me to go for runs during chemotherapy.  These drugs can make you feel super-human.  Perhaps Dexamethasone was the substance that turned me into my superhero alter ego, "Obstinate Man", during chemotherapy.

This gets very interesting when you think of all the runners in the full marathon trying to run a Boston qualifier.  Seconds matter, and any advantage can make a difference.  Luckily for Suzy, she accidentally fell into a patch of poison ivy on purpose thus making Prednisone medically necessary and legal.  She used the advantage to out-qualify a peer whose skin was unfortunately rash-free.  Gotta wonder if those sorts of scenarios happen.

Happily for me, I'm so far down the results sheet that nobody is likely to complain.  But if they did, I'm pretty sure I'd quality for a therapeutic use exemption.  Hold on a minute... phone is ringing... it's my 41 year old self calling through a wormhole in the space-time continuum.  He wants me to withdraw my result.  Sorry younger Tom, but old age and treachery does beat youth and enthusiasm.

The Aftermath

It's now a couple days after the race, and I'm doing fine.  The back/hip pain that had been bothering me leading up to the race was a nothing-burger.  It was noticeable but not problematic at the start of the race.  By the end, the entire lower half of my body was uniformly painful and any pre-existing pain was lost in the noise.

I did take this week off from work in the expectation of being out of commission for a day or two, and then wanting to enjoy the fall weather.  Many times I talk about the ability of exercise and running in particular to fight fatigue, but in this case it was too much of a good thing.  Monday was rough, I spent a fair amount of time laying on the couch and in bed.  My mood was low.  My big audacious goal was now behind me, and it's time to pick the next one.  I have a couple ideas in mind.

One final thought: I ran the whole race without having to stop at a porta-john.  That's over two hours I went without needing a pee break, and I didn't wet myself either.  As much as I'm happy and thankful for my ability to run, I'm generally more happy and thankful about my bladder control.  It's something men with prostate cancer will understand.

Day 366, Happy Cancer-versary!

A year ago today I had a 7am appointment to get a biopsy done on my prostate.  When your urologist calls you up just a few hours after a CT scan to schedule an early morning appointment the very next day, it’s a sign that things are bad.  At the time, things were moving so fast that I was mostly numb to it all.

Immediately after the biopsy, my wife and I were given the news:  Metastatic prostate cancer with spread to multiple bones.  No need to wait for the biopsy results to make the initial diagnosis and start treatment with a shot of Eligard that same day.  The biopsy and a subsequent bone scan would later provide more details, and I suspect provide the documentation needed to get my insurance to cover aggressive treatment, and back up my disability claim.

After that came a diagnosis of bladder cancer, because one cancer simply isn’t enough.  Then radiation to the spine, bladder surgery, and chemotherapy.  Through it all the only thing that was ever said to me in terms of prognosis was “I have patients that have lived 10 years with this”.

Fast forward to today, my cancer-versary.  I’ll be celebrating by running a half marathon tomorrow morning.  That effort will be slightly complicated by some back and hip pain that’s flared up in the last few weeks, but I’ll deal with it.  The biggest fear I have is sleeping through the alarm and missing the race.  That’s my biggest fear for most early morning races.

I’d also like to take a moment to recognize my bladder cancer, which doesn’t get the respect it deserves.  My dad battled bladder cancer for about a decade before succumbing to what is best described as complications of treatment.  My biggest fear prior to diagnosis was following in his footsteps of repeated surgeries and recurrences.  Yet somehow, I hardly ever think about my bladder cancer.  It shows how serious my prostate cancer is when it allows me to almost forget about the bladder cancer.

Fatigue and Pain

“Hey doc, those shots you give me don’t cause me enough fatigue and joint pain, is there something else you can do?”

“How about adding a flu shot?”

“Sounds great!”

For most men with my diagnosis, treatment continues for the rest of their life.  Prostate cancer, having started in the prostate, relies on testosterone as signal to grow and flourish.  Take away the testosterone, and you can stop the prostate cancer in its tracks, for a while at least.  Eventually the cancer mutates and finds a way to grow and flourish without testosterone.

The cheapest and easiest way to take away the testosterone is a surgery called orchiectomy, or more bluntly, castration.  The downside of course is that it’s irreversible, and most men including myself really don’t want to have our balls cut off.

And so we go to our doctors every three months to get a shot to suppress testosterone.  This isn’t much fun because the shot has its own side effects in addition to the very real side effects of having no testosterone.

What’s really annoying is that I was doing exceptionally well in late September, then had the inevitable “two steps back” week, caught a cold, got my injections, got my flu shot, and generally got a very clear reminder that I’m still a cancer patient.

At my lowest point, I found myself wondering if an orchiectomy would be preferable to getting a shot every three months.  Quite literally, I’d give my left nut to have fewer side effects, and my right one too!  But at the moment I’m still holding out hope that I might be in the very tiny minority of men that can eventually go off treatment for a while and not have the cancer come roaring right back.  Or maybe there will be an immunotherapy breakthrough which could have the potential to be curative.

Body Changes

My body has gone through some drastic changes in the past year.  Many healthy men have difficulty coping as they gradually go bald over many years.  I’ve had to cope with going from a wavy ponytail, to having a gollum comb-over, to having a head full of unmanageable curly hair all within a year.  And it’s quite possible my hair will go back to wavy in time.

I wonder sometimes why I still feel like a cancer patient, while my hair is showing visually the drastic changes that are going in my body.  If my hair follicles are having trouble adapting to treatment, chances are many other cells in the body are too.  Certainly my blood tests are showing that my immune system and platelets are still trying to recover after the nuclear and chemical warfare.

It’s taken most of this past year for the emotional numbness that got me through diagnosis and months of chemo to begin wearing off.  In addition, lack of testosterone makes men more emotional than normal.  I’m now starting to emotionally process everything with hormonally enhanced emotions.  I can’t find the words to describe what it’s like, other than to say “roller-coaster”.  “Holeee ^&*@* also comes to mind”.

And then there was that moment, while bending over to towel off my legs after a shower, when I noticed that my pectorals seemed to be hanging a little lower than usual.  Actually it wasn’t the muscles, but a small layer of fat that gravity was acting on, causing my skin to hang there and wobble.  Hey look!  I’ve got an iddy biddy man-boob!  But it’s nothing you’d notice when I’m dressed unless I stuff my man-bra.

So… man boobs and thoughts of having my balls cut off.  That’s gotta put a few demerits on my man card.  Try to process all that with an emotionally enhanced brain.

Work and Writing Code
One of the brighter spots of the past year is that I’ve returned to work and am doing well, both in terms of my enjoyment of work and my job performance.  At its best, my job involves writing software to solve problems.  It’s sort of like the ultimate puzzle game.  When I was a teenager, I used to spend hours on end in my bedroom writing BASIC and assembly code on my Apple //e for fun.

Now I do the same thing in C++ and get paid for it.  Of course, like any job there’s the work aspect involving deadlines and meetings and generally trying to keep other people happy.  But recently I was able to spend several hours alone reworking some code so we can add new features to it.  To complete the high school flashback, I had Cyndi Lauper playing on my headphones.  “Girls just wanna have fu-un”... and there’s another demerit for my man-card.

What’s Next

I’m doing exceptionally well.  Some people are diagnosed when they aren’t healthy enough to tolerate treatment.  Others don’t respond to the first treatment and then are too weak to try other treatments.  Collectively these are the cancer patients that fall far short of the survival statistics.  Happily I’ve proven not to be in that group.

If there’s a silver lining to my diagnosis, it’s that prostate cancer is hormone sensitive.  While life without testosterone kinda sucks, it is a treatment option that isn’t available in most cancers.  Many men can keep the cancer away for years and years through hormone treatments alone.  My initial response foretells that I am likely to be one of them, but there are no guarantees.

Everything is looking good for me right now.  I do have to deal with treatment side effects, but have largely figured out how to control those through a combination of sleep, exercise, and more medications (as I’ve said before, I’m a human chemistry set).

It is vitally important that my prostate cancer stays under control, and my bladder cancer stays away entirely (my urologist says I’m cured, but I’m still holding my breath).  My body needs time to continue healing and recovering from radiation and chemotherapy.  I must stay in otherwise good health so when the time comes to go onto the next treatment I’m healthy enough to withstand it.

And of course, staying healthy will help keep the cancers away.  In my more optimistic moments, I even dare to hope that a complete lack of testosterone will keep the cancer in such a deep slumber that my own immune system is able to slowly pick away at it, and won’t have the chance to figure out how to work around the treatment.  Maybe one day, I’ll even be able to go off treatment and find that any remaining cancer cells are so scattered and disorganized that they can’t get together and form a tumor.

Cancer with a Head Cold

In about 72 hours from now I’ll be getting my first blood draw in three months, and right now I need to feel healthy and energetic to provide mental armor against the possibility that the test results might hint at the cancer making an all-too-early return.

But instead I’m pretty sure I’ve caught at least one of the colds that’s been going around.  First there’s the usual bug that’s going around the office.  My boss was away from the office at the time, but he came back with an imported European head cold to add to the office virus pool.  Around this same time my wife also got sick with something she probably picked up at the doctor’s office.  There’s just so many bugs to choose from I don’t know which one to pick!  Can I have them all?  Ugh.

I have advanced prostate cancer.  If there were any justice in this universe, I’d never catch another cold ever again.  But my sore throat and hints of nasal congestion disagree.  F*** cancer.  F*** the universe.

My cold is also magnifying my usual aches and pains, and adding to the usual fatigue from treatment.  To a cancer patient, this feels uncomfortably like a return of symptoms.  I know that it’s probably the cold and not the cancer, but only testing can say for certain.  It’s extremely hard to be rational about this as I approach my one year cancer-versary, and remember how every test I had a year ago brought more and more bad news despite my attempts to be positive and hope for the best.  Neither worry nor positivity have much effect on test results, at least in the short term.

Half a page is enough of a pity party.  Let’s be proactive about this.  I’m signed up to run a half marathon in two weeks to celebrate my cancer-versary, and exercise is one of the best things you can do to prevent or delay cancer recurrence.  I’m taking this afternoon off from work to get in my last long run before the race.  I’ll be both training for the race and studying for my future blood tests.

Out of respect for my cold, I’ll be taking the pace extra easy.

We also have dinner plans with friends this evening, and that adds an extra bit of complication.  My cancer medication has to be taken on an empty stomach, at least two hours after eating and an hour before eating again.  After dinner I expect to go straight from the car to bed, so taking it at bedtime is out.  Instead, I’m planning to take only water on my long run, down the pills as soon as I get home from that, then have a pre-dinner snack an hour later, which gives me time to take the celebratory post-run shower.

Speaking of which, some days the best part of running during the workday is having an excuse to soak in a hot shower afterwards.

None of this is conduct becoming a cancer patient with a cold, and that’s why I’m generally feeling confident going into Monday’s tests.  I do have a whole list of minor symptoms to discuss with the oncologist, but each one has a perfectly reasonable non-cancer explanation.  Still, I will mention them so when he looks at my blood test results he can form a more complete picture of my current health.  I’ll also be sure to mention my half marathon, and ask him how the Pan-Mass challenge went for him this year.  Sometimes my appointments take a bit longer because we get talking about endurance sports.

And now I must go.  It is time to make another cup of coffee and attend a work meeting via the internet in my proverbial pajamas.  For my coworkers reading this: I’m not wearing any pants, film at 11.