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.

Treadmill Season

The dreadmill.  The human hamster wheel.  Satan's sidewalk.  Why would anybody run on a treadmill when they could run outside instead?

The answer to that question occurred to me last Sunday.  The roads near my house generally don't have sidewalks, so I run on the shoulder and jump off the road when a passing car refuses to move over and leave some room.  Last Sunday we had a heavy cold rain.  The road was narrowed by previous snow accumulations, and the rain had left large ponds in the shoulder.

This left me running in the middle of the road, as I prefer not to run in ankle deep ice water.  When a car would approach through the foggy rain, I'd leap over the flooded shoulder and find out that the snow on the side of the road was a sheet of solid ice.  Not the most fun I've ever had running.  Did I mention my shirt was soaked and chafing?

So I've spent several hours this week making peace with the treadmill in the company fitness room.  The key is to accept that there are some big differences compared to running outside, and take advantage of what a treadmill does well.

For example, I find it very difficult to hit moderate heart rates outside.  Walking briskly will get me up to about 120, while a slow jog usually gives 150 or more.  On the treadmill, a 4% incline at a brisk walking pace of 3.6-ish mph will put me right in the middle of the 130s.  Adjusting the speed up and down allows fine adjustment of effort level and resulting heart rate.  Even better, my pace can't drift on the treadmill.  Well, technically my pace can drift, but not for long as I'll fall off one end of the belt or the other and end up on YouTube under "treadmill fails".

So my plan is to use the treadmill several times during the work week to train at the moderate intensities that are difficult for me to find outdoors.  When I am able to run outdoors (mostly on the weekends), I'll focus on longer and/or more intense workouts, and hope to find that those are higher quality since I haven't exhausted myself with the weekday runs.

And if I'm really lucky, all that time at moderate effort will give me a big boost of aerobic capacity, and allow me to more easily find that elusive moderate effort when jogging outdoors.

New Year's Resolutions

I resolve to lose weight and become a faster runner.  To eat healthier and get better quality sleep.  To help old ladies cross the road.  To end hunger and spread peace.  To,… to,.. OMG how am I ever going to do all of this?!?

I'm not really a New Year's resolution type of guy.  When I crossed the 160lb level and had to start wearing the next size larger jeans, I vowed to lose weight and today am closer to 165.  That's still in the "healthy weight" range on the BMI charts, but the trend is in the wrong direction.

But my company shuts down over the holidays and that gives me a chance to reflect on what my goals are and what's working and what's not.  Obviously whatever I'm doing to lose weight is in the "not" category.  Actually, I'm not sure quite sure how the weight is supposed to come off, as I vowed to lose weight and then kept right on with my usual eating and exercise habits.

In truth, I have tried to cut back on my calorie intake, but the results were not as expected.  I expected to be hungry and perhaps a bit tired.  If only it were that easy.  When in calorie deficit, my body prefers to do a good imitation of fibromyalgia combined with depression.   As a result, everything hurts and any activity that might result in a single extra calorie being burned seems pointless.

It's also true that "lose weight" and "become a faster runner" are at odds with each other.  Building muscle generally requires a caloric surplus and hard running.  Even with the calorie surplus, all the hard running will lead to joint and muscle pain and a temporary diminishment of enthusiasm for, well, everything.  Running hard while in calorie deficit is just asking for trouble.

It's quite the quandary without any easy answers.  My latest experiment was limiting myself to only two slices of pepperoni pizza, then getting up from in front of the TV and organizing my sock drawer.  That's not the sexy answer that will sell a diet book, but it is an incremental change that seems to work in reality.  As a bonus, I can now spend more time running and less time looking for a matching pair of socks.

Still Running

I haven't been posting about it much, but yes I am still running regularly.  I don't have any goal races planned, so there isn't much to talk about.  I've just been focused on ramping up the quality and quantity of my mileage, and my knee has been well behaved until recently.

Ah yes, that bout of runner's knee.  It's been doing well for quite some time, so I got a bit lazy about working on strengthening and stretching the legs.  As I get better, faster, and stronger, my knee is definitively telling me that it's not bionic, and won't tolerate all the abuse imposed by muscles that aren't doing their jobs properly.  It's tired of being the person at the office that fixes everybody else's mistakes.

I'm also approaching my running differently than before.  While still a fan of walk breaks, I'm now trying to do more of my shorter runs without them.  It's actually pretty challenging in unexpected ways.  Briefly, walk breaks work by allowing tired sections a muscle a chance to recover.  However, muscle that's allowed to recover doesn't get damaged, and thus doesn't have a chance to rebuild itself with new infrastructure that will prevent future damage.  So when first giving up walk breaks, it quickly becomes apparent which sections of muscle have been slacking off.  It's an experience in running very slowly in lots of pain.  To compound matters, tired muscles cause bad form which aggravates things like runner's knee.

Form is another weak point of mine.  My natural inclination it to take long bounding strides, sort of like I'm doing a series of long jumps rather than running.  I read a lot of advice online, such as increasing stride rate will automatically lead to shorter strides and better form.  Or to lean forward from the ankles.  I haven't quite figured out how to lean forward from the ankles.  Instead I try to keep my foot on the ground longer, it ends up being further behind me when it does come off the ground, and that forces me into a leaning from the ankle sort of form, at least for that end of the stride.

It's also difficult to make tired legs take more steps per minute.  Here a Jedi mind trick is useful.  It's much easier to swing your arms faster.  Since the legs and arms want to move opposite each other, a faster arm swing will automatically cause a faster stride rate, and the mind is focused on the arms, which are very happy not to be the legs about now.  Life is good if you’re an arm out for a long run.

So no exotic destination races for me at the moment, just running around the same old routes, swinging my arms faster, pushing my legs behind me, and gritting my teeth while not taking walk breaks.  And also the occasional ice pack on the knee and strengthening and stretching.  Can't forget about those.  Again.

Let's talk about streaking

Back in the spring I promised to run or walk every day until the end of August.  The idea was that it would be too hot and humid to get quality runs in, so rather than sitting around complaining that it's too hot/humid/whatever to get outside, I'd work on building a habit of getting exercise in regardless of the weather.  And by that measure, the streak was successful.  Funny thing is that in a streak of 94 days it only rained once or twice, and the rain was so severe I ended up using the treadmill.  I have no problem running in the rain, but when there's flooding and poor visibility it's a different matter entirely.

Sadly, the streak ended very early in September at the same time my father-in-law was in the final days of losing his battle with cancer.  It wasn't really an appropriate time to celebrate a great accomplishment, so I had an emotional meltdown instead.  But now a month removed from those events I can look back and say "mission accomplished".

I'm planning another streak for this winter and for much the same reasons.  It will be dark, cold, snowy, icy, and all kinds of brutal.  Getting in a token amount of daily exercise will be an accomplishment.  I can see myself clearing a blizzard out of the driveway, then strapping on some snowshoes and doing laps around the woods behind my house.  Given the speed I go in deep snow, it may make sense to make 20 minutes the minimal qualifying effort instead of 1 mile.  This isn't so I can register on any running streak website, so I get to make up my own rules.

I also want to start a streak of posting to my blog every week, starting with this post.  Writing is a very therapeutic thing for me.  It's an opportunity to take the thoughts that are constantly stirring around inside my head, put them down on paper (or LCD, as the case may be), and look at them from the outside.  I can re-arrange them, sculpt them, keep the good thoughts and backspace out the unhelpful ones.  Even if nobody ever reads the blog there's great value in the creation of it.  For those keeping track, this is about the third time I've written this particular post, and it's the first version I sorta like.

Also, it's time to get serious about running another marathon.  I don't have a specific event or date picked out yet, but do have a rough idea of the level I need to reach as a runner before committing to an event.  Intrigued?  Look for my next post!

Crap… in a few more words

My father in law is dying of cancer.  Dawne has left her job to take care of him with the help of a Hospice service.  I’m splitting my time between working, helping Dawne where I can, and clawing my way out of the dark emotional pits I occasionally fall into.

I struggle with uncertain situations and with the feelings of powerlessness that happen when you simply don’t know what to do.  My job can push those buttons enough when customer issues come piling in, but at least it’s reassuring to know that we have lots of customers and business is booming.

It’s tougher to think positively about death, but let’s try anyway.  We all have do die, so there should be nothing tragic about going through the process relatively comfortably at an advanced age, at home and with visits from friends and family.  Feelings of loss and sadness are inevitable, but to think this won’t happen someday is delusional.

But there are challenges too.  As a person loses the ability to walk or even stand, some bodily functions take on a peculiar combination of difficulty and messiness.  In a hospital or nursing home there’s trained staff to deal with this.  When doing hospice at home, it’s all learned on the fly and usually without warning in the wee hours of a Saturday night.  This is when you learn what “Primary Care Giver” really means.

In such a situation it’s surprisingly easy to rise to the occasion and do things you didn't think you were capable of.  For a brief moment the emotions shut down and you simply act.  But then at some later time the emotions turn back on and suddenly everybody at the Stop and Shop is an idiotic moron who’s just in the way.  I can’t handle the uncertainty of deciding which style of pasta to buy, and am flooded with feelings of helplessness.  And when I get back to the office and try to get back into the work routine I suddenly find myself in another of those dark pits.  Why can’t emotions function in a more logical manner?

Things will be okay.  We are living through an exceptional time in what had already been a challenging year.  It’s a time of change, of personal growth, of tears and dark humor.  We will come out the other side and return to normal.  We'll be slightly older, wiser, and have a different perspective on what’s really important in life.