Another shoe drops

November 20, 2017

Hi, Tracy.
Just when I think I know what's going on, new information pops up. Apparently my UTI is a UTI after all, but maybe no longer.

In my last post I said the problem with my urinary tract infection was that it wasn't an infection, but more likely the result of irradiation, and that I had been prescribed medication. Well, the story has changed.

First the information was that a specimen showed no indication of bacterial infection. The doctor used a cystoscope to peek into my bladder and found it inflamed, theorized it was from radiation and  authorized medication to calm things down. Before his examination, my symptoms had already calmed down and after the exam they went away almost entirely. I concluded that the meds were likely keeping at bay a problem that was already diminishing.

But then, after I passed the information on to my radiology team, I heard back that I indeed had an infection after all -- involving e-coli! And then the urologist confirmed that. However, before he he had sent a camera up my urethra to study my bladder, he took the cautionary step of an antibiotic injection in my hip to prevent potential infection.

Put that all together, and now the theory is that I indeed had a UTI, that the radiation from last spring was not the source of the problem, and that the antibiotic I was given as part of the examination is what took care of the UTI.

So I purchased, a month's supply of bladder-soothing Elmiron for $40 (cost to Kaiser Permanente: $750), and I only took a few pills before the doctor said don't bother, wait and watch.

And that's where I'm at. Things have calmed down. I store my pads and diapers for the next crisis. I will just sign off with the same moniker as the famous author of "Yellow River" --  call me I.P. Daily.
Love,
Dad

Cystitis

November 13, 2017

Hi, Tracy.
My urologist may have solved the mystery of the symptoms I've been experiencing that are similar to a urinary tract infection (UTI). It appears that my bladder is inflamed for reasons other than a bacterial infection. The most likely explanation is a residual effect from the radiation treatments I experienced for eight weeks in February and March.

For the past couple weeks I've had symptoms; then they disappeared; then they reappeared. On one occasion, I was passing cranberry-colored urine, and then it suddenly cleared up. And I do mean suddenly. At one moment urination was painful and bright red, and then it wasn't. This past weekend I decided to cancel travel plans in December because I was suddenly needing to urinate several times a day. Yesterday I stayed home because I was not willing to leave the house. And I have been wearing the adult equivalent of diapers.

This morning I saw the urologist, who gave me a dentamicin shot in the hip to fight possible infections from the procedure that soon followed -- the uncomfortable numbing of my urethra, and then the insertion of a foot-long tube with a camera on the end, that slipped past my prostate and into the bladder, to take a look. This procedure is called a cystoscopy, and it uses a cystoscope, a tube with a lens on the end. It has about the thickness of a catheter. It stung a little, but with the anesthetic squirted in ahead of time, it wasn't much worse than the hot sensation that occurred during urination. In fact, while the cystoscope was entering, I felt like I had to pee. Afterward I did, comfortably.

 Normally, the bladder appears pink, but there were places where mine was red -- inflamed. In the absence of any bacteria, the most likely explanation was collateral damage from radiation dating back to the end of March. The painful symptoms prior to and during urination probably fall within the definition of "referred pain," which means one part of your body is experiencing discomfort that is expressed at another point.

The meds I'm going to take to deal with the inflammation are not inexpensive.  My prescription for pentosan (a.k.a. Elmiron) is $750, but because I have health insurance I pay only $40. Pity those who aren't covered.

PSA update

Buy the way, kiddo. I got more information clarifying what my PSA scores will indicate from now on. My PSA will continue to rise from it's present level until it reaches a new baseline. After radiation, you'll recall, it was less than 0.02. It is now 0.4. My understanding is that it should level out at about 2 or whatever is my "new normal." And then it should stay there. If it doesn't, that will get our attention.

Love,
Dad

PSA score, 7 months later . . .

Nov. 3, 2017
Hi, Tracy
What I thought is a urinary tract infection apparently isn't. My urologist says my urine culture proved negative for a UTI. However, I've been prescribed three doses of Monurol instead of the single dose I took Oct. 21. I take these at two-day intervals. So we'll see.

And now for the big news: When they drew blood due to all my excitement yesterday, they used some of that blood to test my PSA score, and  the results are listed below, showing what the score was historically. You will recall that my radiation treatment ended March 28, 2017.

Lab Results

Component     /  Value Date 
PSA 0.400      11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 25.0         09/13/2016
PSA 19              05/09/2016
PSA 16              02/17/2016
PSA 12              09/02/2015
PSA 10              02/23/2015

You can see from these results that the PSA peaked at 25 on September 13, 2016; dropped to 0.08 % of  that score on April 25, 2017; then recovered to 1.6 % of that highest score by November 2, 2017.

Here is what the doctor had to say about the score and rebound:

You may get some increase in the PSA as the testosterone levels get back to normal. Once the PSA level is steady, then a recurrence would be consider your nadir stable PSA plus 2. So, the PSA response it good so far.

The next blood draw to measure my PSA would be in March, 2018.

Love,
Dad

It's baaaaaaack. Has UTI returned with a vengeance?

Nov. 2, 2017
Hi, Tracy,
In Jaws, the tag line is "just when you think its safe to go back into the water..."
Well, everything looked like it cleared up from the last UTI. And then that tingling sensation returned a bit this week, so I made it a point to stay hydrated. But I was noticing that there were these little Dr. Pavlov moments continuing. Just the thought of peeing made it happen. But if I moved fast enough, no disasters.

Until yesterday, when I walked to Seattle City Hall a couple times for a demonstration by the homeless community. Things got dicey walking home.

I woke early today and walked back downtown for the "die-in" at city hall, taking time to use the portable toilet outside city hall where the camp out was held last night. I photographed the die-in and headed home.

I can't remember the exact order of events, but they were exciting.  Either before or after I went to city hall I passed a lot of red urine and a really healthy blood clot. I went to urgent care, and a medic put an IV in my arm. I was given a specimen bottle. I had an empty bladder, so I hydrated in the exam room and he left a plastic bottle for the overflow. But when the time came, things happened very fast. Not all of the urine got in the overflow bottle, and only a small amount got into the specimen bottle -- but enough to test. I could barely stop peeing. The fluid was a cranberry red. After that session, I rehydrated, and later passed another sample, which was almost clear, and that's the way its been for the past 10 hours -- clear urine. No blood at all. Go figure.

This is really strange.

But the initial prognosis is another UTI. The technician told me the fact that the blood had been clotting earlier in the day was a good sign. I left there about 1:00 p.m., and walked to the downtown library branch for a short meeting. There is almost no tingling, although there is still some urgency when it's time to pee.

I'll be taking antibiotics, but the one they wanted to give me -- Monurol -- was out of stock until Friday afternoon. So I've decided to take it easy and not go anyplace special for a couple days until I have the antibiotic and things calm down again.

The medics took several vials of blood--enough to check my PSA levels for the first time since the end of my radiation treatments. I expect to have a consult with my urologist in a few days, and there will be more to tell.

Love,
Dad

P.S. Nov 3: Test results show  1,000-10,000 colony forming units of bacteria per milliliter in the blood.  Internet research (and who doesn't trust the internet?) suggests that the measure for whether I have a urinary tract infection is 100,000 cfu's. So maybe I don't have an infection, but in that case, what is going on?

UTI? No UTI? That is the question.

Sunday, Oct. 29, 2017
Hi, Tracy.
As far as I know, the latest urinary tract infection is gone, but it has left reluctantly. Until a day or so ago, I still had to visit the loo several times a day, with some urgency. One afternoon when I arrived home I was fortunate enough to have a coat I could hold in front of me as I made my way to the apartment, where I could get out of my wet jeans. On another occasion, there was some blood in urine. And even now, when I first enter the condo, or pour myself a drink of water, I sometimes feel Dr. Pavlov tapping me on the shoulder and I hasten to the bathroom.

Rather than panic, I took a Flomax the other day, started drinking plenty of fluids, and placed a pad in my underwear. I thought I was done with those, and almost donated the package, but now I've decided to hang on to them for a while longer. For the time being I plan to continue with plenty of hydration until I'm confident that I have flushed out the demons.

The adventure continues . . .

Love,
Dad

P.S. Oct 31, 2017 (Halloween). Hiked Tiger 3 today and had "urgencies" at least five times, involving a couple minor accidents. 

Yet another pesky UTI

The "egg"

Saturday night, Oct. 21, 2017
Hi, Tracy.
This time the UTI came on rather rapidly. In the morning there was a little tingling when I peed, and I noted it, and wondered whether I needed to drink more fluids. By afternoon I was peeing small amounts over short intervals,  the stream was pink with small clots of blood, and there was a burning sensation. By nightfall, I was suffering incontinence and having to rush to find a bathroom.

I had spent the afternoon with a friend who came in on the ferry and left by the same route. So I had to walk up Madison, not confident that I would make it without an incident. Fortunately, there were places with bushes along the Madison street route. As soon as I got home I called the Kaiser Permanente on-call nurse, who suggested that I come in. I also began drinking lots of fluids, and that helped to relieve the discomfort when I urinated.

The experience made me wish I hadn't been so quick to stop carrying absorbent pads. I got some out for the trek to Kaiser Permanente and they were used. I drank more water as I awaited in the urgent care facility for the medical staff to see me.

When I was  consulted by a member of the medical staff, I raised the question as to whether my recent self-administered test for libidinous responsiveness might have irritated the prostate and caused a problem. Was this the "ex post" fallacy, or was there a connection, I asked. He noted that I had experienced several UTIs and said this was definitely a legitimate question and I should ask the urologist.

Before heading home I picked up two medications from the pharmacy: Azo tablets for urinary pain relief; Monurol, an antibiotic which I dissolve in water and drink. I will take yogurt two hours before or after, to put some probiotics into my system, because the Monurol can cause diarrhea. And the Azo also give you very orange sweat and urine. (Check out the "egg" in the accompanying photo higher on this page.)
Cost for this adventure:\
$20 co-pay
$4.95 for the AZO, which I purchased as an over-the-counter medication. It would have been more expensive if I used a prescription. (Go figure.)
$38.68 for the Monurol (fosfomycin tromethamine)

Sunday morning, 7 a.m. 
I took the Monurol at midnight, two hours after eating the yogurt. I rose a couple times during the night to pee, and the pain was mostly gone. This morning I peed a clear stream with no pain and  no evidence of blood.

And the night shall be filled with music, 

      And the cares, that infest the day, 

Shall fold their tents, like the Arabs, 

      And as silently steal away.  --Longfellow

Love,
Dad

Cost for the most recent UTI

Sept. 15, 2017

Hi Tracy.
Today I got the bill for treating my latest urinary tract infection (UTI). I include this in the blog because I never had a UTI until I was treated for prostate cancer. So here is the information from my Aug. 31, 2017 statement, for as best as I can understand the statements I get in the mail.
$106     Ertapenem sodium inj (the antibiotic)
$228     IV infusion
$171     Doctor's office visit
The total billed here is $505, the total allowed is $470, and all of that was covered $20, my co-pay.

Lab fees

$11 for urine analysis
$29 for urine test for bacteria
$31 for testing antibiotic effect
$29 for testing for bacteria
The total billed was $100 and the total allowed was $93, which the plan paid. There was no co-pay.

Grand total

The total amount paid by my health plan was $563. I sustained mild diarrhea for a few days, then everything cleared up and I haven't had a problem since.

Love,
Dad

The cost of cancer treatment

Aug. 14, 2017
Hi, Tracy.
I thought it might be informative to share what cancer screening and treatment has cost over the years. I don't have all the figures, but I've got a pile of documents dating back to 2005, when I had my first biopsy based on an elevated PSA. By searching through all the documents I've accumulated, I have a rough idea of what my treatment has cost. Because of the complexity of the records, I don't vouch for the accuracy or completeness of the figures here, but this will serve as a tight synopsis showing many of the costs involved:

• Insurance: I pay Aflac about $13 a calendar quarter for supplemental insurance to help cover out-of-pocket costs for cancer treatment. This mirrors a policy that yielded a payment following your mother's death in 2002 following her stem cell transplant for lymphoma.
• 2005: first discovered elevated PSA, followed by biopsy with negative results. two more biopsies follow over the years, along with regular blood tests; cost figures not immediately available.
• 2010 Biopsy; 50 samples taken, paperwork unavailable.
• 2012 Periodic six-month blood test for PSA: $88
• Feb 2016: Lab work: $66; Bladder function test; doctor visit: $480;  PSA has shot up to 16; 21% chance of high grade prostate cancer. 62% chance biopsy is negative for cancer.
• June 2016: Doctor visit, Lab work, Pharmacy services, MRI procedure, MRI of pelvis, $2,364
• June 2016: Surgery (biopsy -- 20 samples) anesthesia, lab work, etc: $8,109. cancer detected
• July 2016: Irrigate bladder (prior to catheter removal): $313
• Bone scan, radiation, doctor visit: $1,649 
• October 2016: Lupron hormone blocker: $5,633
• November 2016: Implant gold (target) beads in prostate and scan to check placement: $1,675
• Dec 2016: Pelvis MRI $2,972
• January 2017: Calculating radiation dose, MRI, radiation treatments: $11,285
• Feb 2017: Bicalutimide hormone blocker, for month: $18.55
• Feb 2017: Second Lupron shot: $5,671
• Feb 2017: Beginning of 39 radiation treatments at $1,159 per treatment: $45,201
• Feb 2017: Radiation-related services: CT Guided: $388 x ?; physician's services: $626 x ?; QA: $267 x ?; x-ray guided target: $253 x ?;  There are a lot of these charges and I didn't tally them all.

You get the idea, Kiddo. I think that, so far, I've pushed well past $100,000, considering the items not tallied and for some not even listed. Old age ain't for sissies, and cancer ain't for the uninsured.

Love,

Dad

Another UTI

UPDATE:  Monday, Aug. 7

The UTI has been serious enough that I was called in for an intervenous injecton of antibiotics. I was also told to start taking my temperature to check for any fever. And surprisingly, a hot flash does not register as a fever. They are different phenomena. I do not have the name of the medication in the i.v. that I received this evening; tomorrow (Aug 8) I will take one dose of Monurol, which I mix with four ounces of water. That ends the treatment. The cause of this UTI isn't clear; I am instructed to drink lots of water to flush out any infection.

Addendum, Aug 9: This UTI involves an  "Extended Spectrum Beta Lactamase producing (ESBL)
gram negative organism." Details: Bacteria that produce enzymes called extended-spectrum beta-lactamases ( ESBLs ) are resistant to many penicillin and cephalosporin antibiotics and often to other types of antibiotic. The 2 main bacteria that produce ESBLs are Escherichia coli ( E. coli ) and Klebsiella species....Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent.

At this writing the UTI seems to be in remission. The Monurol was followed by diarrhea, and that seems to have run its course as well.

Original post, Aug. 5, 2017

Hi, Tracy.
I think it was Wednesday, Aug. 2, when I noticed it stung a little bit when I peed. On Thursday it burned a lot. On Friday I sent an e-mail to my PA in oncology at Kaiser Permanente (KP) before heading south to have lunch with a friend.

Red face

I stopped at the Federal Way library to look up dining places, and while there I felt the urge to use the restroom. It was urgent, but not painful. I glanced at the mirror and realized my face was very dark pink. I'd never seen it that pink; it was another hot flash and the sweat was just pouring off me.

At lunch I fielded a call and learned that I could leave a specimen at the Federal Way KP facility. I told the nurse who had called me that the burning sensation had subsided, but I still left a specimen, just to be sure, with the outcome to be known by Monday.

Incontinence

Today, Saturday, I went to the rental property to remove some dangerous limbs from the broad-leaf maple tree. It was hot and I was having hot flashes, and feeling quite tired. I had to pee several times without much production. The stinging was starting to return. I wondered whether the night sweats had dehydrated me due to limited liquid generation, so I drank some water at Barb's and took ice water in a pape cup on the way home.

When I parked the car near the condo and got out, it hit. Not only just anurge to pee, but an uncontrollable urge, wich a bladder fully primed. There was no stopping it. I made it to the apartment without encountering anyone who might have noticed my pantleg was soaked. I took off my socks and glasses and stepped fully clothed into the shower, rinsing my clothing in the process. Then I placed an absorbent adhesive pad in my underwear. I walked to the car after a while to retrieve my new glasses, and again experienced an accident. Later, around 10:30 p.m. I had the urge to pee come on so strong that I barely made it in time.

No question: I have a UTI. How that infection got there is anybody's guess; good reason to revive the theory of spontaneous generation.  It will be Monday before I can have an antibiotic prescribed. Tomorrow I purchase some depends to replace the pads, which are not sufficient.

Love,
Dad

Weight and energy: asked and answered

July 10, 2017

Hi, Tracy.
I had the shock of my life a few days ago (my recent life, anyway) when I got on the scales and was approaching 220, the weight I endured a few years ago before I took off 35 pounds. That led me to have an e-mail exchange with my oncology PA:

Asked:

 It's been 90 days. I'm still having hot flashes and night sweats, and I understand that this is probably normal. I am trying to drink lots of fluids, because once the hot flashes pass their greatest intensity I end up drenched with sweat.
I have two questions:
1. Does the treatment I had contribute to weight gain? I'm finding I am moving toward my greatest weight, and I'm not sure whether this is due to lack of discipline, or whether  this is naturally due to the effect of the hormone blockers, radiation, etc.
2. Is there a good strategy for regaining stamina? A little while ago I went on two short hikes (3 miles, 500-foot elevation gain) two days in a row, and my energy level was low. I had to stop a lot and rest, and then plod along slowly. But a week later I went on the same hike and had all sorts of vim and vigor. I'm wondering whether it was because I took a 30-minute nap in my car and then chugged a Mountain Dew (sugar and caffeine) before heading out. Based on that experience I'm tring to stress my body with a hike that takes a bit of work, and then rest 2-3 days to allow it to recover before challenging it again. Do you have any thoughts on this?

Answered:

Hello there. I hope you are enjoying your summer despite the hot flashes. 

1. Weight gain can occur with lupron injections (reported <13%). It usually occurs when men take it for a longer period of time but I have seen it. You may need to see how many calories you are taking in and how many you are burning. I am not an expert in calculating any of this. If you write down everything you eat and the amounts you can often see that you might be taking in more that you thought.

2. The testosterone blocking effect is leaving your body but it can take time for you to continue to recover your stamina. I am glad to hear you are hiking. I think it is important to do a little exercise every day. The nap and then the caffeine in the Mountain Dew most likely did fuel you short term for your hike. On the days where you are not hiking, walk 1-2 miles per day to keep your body moving. It does not have to be strenuous, just keep moving daily. Some days hikes go well and others not as well. Don't give up. Listen to your body and slow down if you need to. You are out there and that is good. 

That's all she wrote

Having read this after an afternoon of hiking at Flaming Geyser State Park, I said screw it and had a mug of whole milk and two pieces of Jessie's Key Lime Pie -- with meringue.
Love,

Dad

90-day energy report

June 30, 2017
Hi, Tracy.
It's been 90 days since my radiation treatments and the taking of hormone blockers. I'm still having hot flashes and night sweats, and they can occur several times a day. But I seem to be getting strength and stamina back -- intermittently. And I'm also having a problem keeping weight off.

A week ago I hiked Twin Falls. The elevation gain was only a few hundred feet and I hiked only about 3 miles. But I had to stop several times due to fatigue. Then the following day, Saturday, I hiked it again, and again I was quite tired. As a measure of my stamina, when I was in shape, I could sustain a heart rate of 148 beats per minute. On those two hikes, the best I could do was 128, and only for short periods. This is the same speed limit I reported here June 12.

But almost a week later, I visited the Twin Falls again, this time hiking 5 miles and reaching greater elevation. And throughout most of the last I had great energy. (I also had a 30-minute nap in the car just before hiking, and a 16-ounce can of Mountain Dew, giving me a sugar and caffeine shot.) There were a couple hot flashes, but only a couple. And that night I went to a dance class without taking a nap first.

That was yesterday. Today I rested at the condo and had a long nap, but at the dance tonight I found my legs tired and my energy level poor.

My emerging theory is that I need to exercise to keep from back sliding as well to improve my condition, but I also need a lot of rest afterward to let my body recover from the stress it hasn't endured for some time.

I also need to eat more moderately. I am closing in on 215 pounds, five below my maximum weight. More than 10 years ago I took off 35 pounds from that top weight, and lately I've been putting it back on. I want to return to 185 pounds if possible, and that will be my goal for the summer.

Love,
Dad

128 bpm

June 12, 2017

Hi, Tracy.
I'm back from my travels to the Banff-Canmore area of Alberta, Canada. Magnificent scenery.  As I said in the prior blog, when I was there I found myself exhausted with minor hikes, and then realized it was because the elevation there was about 5,000 feet higher than Seattle. Makes a difference. At the same time, however, my heartbeat at rest was as low as 46 beats per minute. That was a surprise.

Yesterday morning it was 48 bpm. I would have expected it to be lower than the Canmore rate, because I was at about 400 feet above sea level. But I'll settle for 48 bpm, because that still puts me in the top 3 percentile.

A new metric

A bit ago I walked to the waterfront and then came back uphill. My heart rate got to 128 bpm and I had to stop for breath. This is a new metric to keep track of, because it marks a new boundary. When I was in hiking shape I could trudge along with at least 20 pounds on my back and my speed limit was sometimes as high as 148 bmp -- and sometimes in the upper 150s. So the fact that 128 bpm is now my new speed limit shows how far I have to go to full recovery.

Love,
Dad

Short, challenging hike

June 7, 2017

Hi, Tracy.
Today I went on a hike that was surprisingly difficult. My traveling companion, Valerie Vessey, and I have been staying at a time share in Canmore, Alberta, Canada, and we drove to Banff National Park to see Moraine Lake. I wanted to hike there because of stunning photographs I had seen of that location, and because I wanted to build up my stamina.

Moraine Lake in Banff National Park

The hike was short, but surprisingly difficult. I had to rest along the path that lead to the headwaters of the lake. Afterward, when we climbed up on the moraine at the opposite end of the lake to get the "$20 view"  (the view that appeared on Canada's $20 bill), I climbed a staircase that just wore me out. It could not have amounted to more than 200 feet, elevation gain, but I had to stop and rest a couple times.

Later, I learned from a park employee that the lake was at an altitude of 5,000 feet, the elevation of Denver, the "mile high city," and I realized the elevation change from Seattle may have been the reason.While I didn't hike well, I believe the effort will have a positive impact on getting me back in shape.

Before we left the park, we talked with an individual who was directing traffic who told us he had just been watching a young female grizzlie bear which had just disappeared over a knoll. He shared information about the nature of the bears and how park staff co-exist with them -- including entering their dens to tag the young while the adults are away!  Afterward we drove up to look at Lake Louise before heading back home for dinner. We plan to do at least one other hike before we return to Seattle.

Addendum: June 8

At mid morning I took my pulse with amazing results: about 46 bpm. I don't get that. It's extremely slow, I'm at 5,000 feet, and I haven't exercised for months.


Love,
Dad

More rebounding: Little Si Again

Memorandum: May 30, 2017

Today I'm not writing a letter to Tracy because Tracy was part of the event. The two of us climbed Little Si, the first real hike since I climbed Little Si on April 11. Last time it took four hours to reach the top; this time it took two hours. My knees were a little weak, and I was tired afterward, but I'm encouraged. Normally what takes 90 minutes took only 120 minutes. The day was a cool 60 degrees or so and I was able to complete the hike with a minimum of eating and moderate water. I had hot flashes and had to rest at times, but this was a triumph compared to the difficulty of just climbing from Alaskan Way to the Condo via Madison Street. My pack weighed under 20 pounds.

In June I hike the Canadian Rockies near Banff. I feel up to it.

Recovering stamina

May 21, 2017

Hi, Tracy,
This week I'm starting to focus on restoring stamina. Yesterday I hiked 2.6 miles round drip to Recreational Equipment Inc. to use up a rebate coupon to purchase camping supplies. The climb up Denny Way isn't that long, but I felt myself worn down by the walk back home.

And last night I went dancing with a friend. I found myself surprisingly weak and sitting out several dances. Before the evening was over, I was soaked with sweat. I think the weakness from my treatments has discouraged me from getting enough exercise, and that this has led to a decline instead of a recovery from the radiation and hormone-blocking treatments. So I believe it's time to stop recuperating and start exercising.

June 4-11 I plan to be hiking in the Canadian Rockies near Banff. Between now and then I'm going to try to get in a small hike every day to recover my stamina. And when I return from Banff I intend to hike regularly the remainder of the summer.

Love,
Dad

Collateral damage: $237.44 light bill

The May light bill is three times the level of the previous year.

May 13, 2017

Hi, Tracy.
Just when you think the story is winding down, another shoe drops.

Most of the effects of the Lupron shots and bicalutimide pills, as well as the radiation treatments will have worn off by the end of this summer, but a collateral effect has shown up in the form of a humongous bump in my City Light Bill.

What's that got to do with cancer treatments? It's the "manopause" I've undergone as my internal symptoms responded to hormone blocking and radiation effects. You know that I've had hot flashes followed by cold sweats, but I haven't told you how I coped with them. First of all, in February and March I spent most weekdays around the house, and I wasn't gone hiking on the weekends. That was coupled with a lot of time spent at the computer -- sometimes dawdling, sometimes being creative, and sometimes spent on a class on Web design, well after the radiation treatments ended.

That was matched with chills that I alleviated with help from my space heater -- and hot flashes, which I mitigated with a small table fan. Sometimes I would turn off the space heater, take off a wrap, and then turn on the fan because I became chilled. Sometimes I would turn off the fan and turn on the space heater -- or grab a wrap.

Electrical heating and cooling affects your usage of electricity. When my electrical bill arrived (the image at the top) the tale was told. My electric bill had tripled over the prior year. It probably didn't help that this was a record year for rain.

Love,
Dad

The ambiguity of remission

May 8, 2017

Hi Tracy.
This is an update from my follow-up consult of May 4, illustrating that there's always something else to think about.

The small print on my "report card"

After the exit interview I took time to read the paperwork they provided me on the way out the door. At the bottom, there was this phrase:

"Cancer of prostate w/high recur risk (T3a or Gleason 8-10 or PSA>20)

That got my attention, and I sent off an e-mail to my  physician's assistant. My question was:

I remember (that) once before my numbers indicated I was stage 3, but you told me that this was likely due to my high PSA, which was likely distorted by my enlarged prostate.
So my question is, do I fall into a catetgory with a high recur risk, or is this a result of a computer algorithm that doesn't really apply in my case? How should I interpret that phrase?

And here is the clarification:

You are still considered to be high risk based purely on the numbers; however we suspect you are more likely a favorable candidate and that is why we only did a short course of hormones instead of two years of shots.
For diagnosis purposes we have to put in the high risk. It is difficult to squeeze you into a specific category because of the low risk Gleason and the high risk PSA.
Your report card is that you have an A.
You responded well to the hormone blocking injections, hormone blocking pills and the radiation as evidenced by your dramatic drop in your PSA.
I would recommend you interpret this as you were in a high risk category, but did not quite fit into that full bell curve of that, so we believe you will likely fare better than other gentleman with a high risk prostate cancer (for example Gleason 8).
Hope this helps.
Take care.

Making ends meet

Many years ago you gave me a present -- a small wooden desk sign with a brass inset that said, "Just about the time you think you can make ends meet, SOMEBODY MOVES THE ENDS.

It's still sitting on the roll-top in the apartment -- a reminder that the only certainty in life is its uncertainty.

But I'm feeling good.
Love,
Dad

Follow-up consult

May 4, 2017
Hi, Tracy.
Today was my follow-up consult following the end of my radiation treatments March 28 and my blood draw that showed such good results. Now we just watch and wait. This high points of the interview:

• The hot flashes and night sweats could continue for a few weeks or perhaps up to 6 months.  (I'm having a hot flash as I write this, and my arms and face have become damp.) The fact that I can arise from a chair easily indicates my strength is returning, but I still have periods of weakness, particularly when I have hot flashes. Since I have no significant other at this time to entice me, I have not taken the measure of the other side effects, although I'm confident that I could interview for a position as towel attendant at a harem shower room and be pretty sure of landing what now would likely turn out to be for me an insufferably boring job.
• The precision radiation has meant that my bowel and bladder have fared well. It's still possible for my urethra to develop scarring, and there are treatments for that, if they should occur.
•  My urinary tract infection seems to be gone, yielding improved control. I can taper back on the Flomax.
• The Lupron shots and Bicalutimide pills had both the effect of preventing testosterone from feeding the cancer and also fighting the cancer as well as a type of chemotherapy. They, along with the radiation, have killed the cancer cells. There's the possibility that all cancer cells were eradicated, or that those that weren't don't have an environment that will nourish them, and they will not survive. The prostate's ability to produce PSA and generate seminal fluid is reduced, and a share of the mass is now represented by scar tissue. It's not the same old prostate.
• My PSA will likely rebound slightly. If it gets up to a score of 2, it's something I should pay attention to. That would be 100 times its current level.
• Around Halloween I will have another blood draw to measure my PSA, after which I will consult with my urologist.
• I remain a little lethargic; I take afternoon naps; and I have gained weight. I'm going to do something about that.

Love,

Dad

Post radiation results

April 25, 2017
Dear Tracy and Shira (the daughter-in-law gets included in this one)

 I am still experiencing fatigue, hot flashes, moments of weakness and night sweats following my 39 radiation sessions, which ended March 28. This morning I had a blood draw to measure my prostate specific antigen (PSA) levels. The results came back in almost record time--and they are good.

A normal level is ................................................................................................4 or less.
 Last September 13, my score was .............................................25 -- more than six times the maximum normal level, and right in the range where you worry about my prostate cancer spreading.

But I was only considered to be at stage two, because my enlarged prostate may have boosted the score beyond what the cancer was causing. (Note: the PSA score can be misleading, but my doctors were convinced that the PSA was relevant in this case, because it was shooting up rapidly from a score of 13 a few months earlier, after 10 years of gradual growth.)

Well, the latest figures are in:...............................................................0.02. Uh, that's not quite right. The score is actually less than 0.02, or less than 1/200th of the maximum normal of 4.

I think Dr. Canning had expected it to be in the neighborhood of 0.5. Amazing.

Love,
Dad

 Test result language: 

Date:  4-25-2017 
 COMPONENT                YOUR VALUE                            STANDARD                      RANGE
PSA (BECKMAN)           LESS THAN 0.02 ng/mL             0.0 - 4.0 ng/mL The
Beckman PSA method was used to perform this assay. Results obtained with different assay methods shouldn't be used interchangeably. It is recommended that one assay method be used consistently to monitor a patient's course of therapy.

Date: 9-13-2016
 PSA (BECKMAN)           25.0 ng/mL                                 0.0 - 4.0 ng/mL            H (high)
The Beckman PSA method was used to perform this assay. Results obtained with different assay methods shouldn't be used interchangeably. It is recommended that one assay method be used consistently to monitor a patient's course of therapy.

Yet another UTI

April 14, 2017
Hi, Tracy,

This morning I stopped  by Kaiser Permanente (formerly Group Health)  Pharmacy to pick up a prescription of Sulfamethoxazole/Trimethoprim, a.k.a. Bactrim or Septra. OK, I think you can just call it a sulfa drug. It's a combination of two antibiotics to treat bacterial infections. Cost: $13.67

Because of a repeat of UTI (urinary tract infection) symptoms, I had taken a urine test, which revealed the presence of bacteria in the urine, along with a level of red blood cells slightly above the norm and white blood cells well above the norm.

I'm not sure why this is happening. I believe my first UTI (Nov. 18 blog) may have resulted from the procedure to implant gold beads in my prostate prior to radiation. Who knows!  My second UTI treatment (March 1 blog) followed discovery of E-coli in my urine--where that came from is anybody's guess. After taking antibiotics appropriate to E-coli, my follow-up urine test showed it cleared up.

But here I am again, and . . .

Hold the presses! This just in . . .

I just this afternoon had a phone call with my radiologist, who thinks I should have a different antibiotic: Nitrofurantoin/Nitrofurantoin Macrocrystals. What a name. When I picked it up this afternoon ($20) I asked the pharmacist whether it was safe for me to jump off curbs. She laughed at me. I don't mind the fact that I had to dispose of this morning's prescription -- that just suggests to me that health team is staying on top of things. I can afford the $13.67 discard for that kind of quick follow-up.

My radiologist asked me about symptoms and then came up with his recommendation. He also told me that this is not a hygiene problem (i.e., little beasties are not swimming upstream)  and that it's not clear where the bacteria are coming from. They may just be lingering in the bladder, which it is my duty to empty as completely as possible. They can also move around the body, so this is a general antibiotic  on a search and destroy mission. I take the Nitro twice daily for a week. Hope it works.

At least I'm getting an expanded vocabulary out of this experience.

Love,
Dad

On the rebound: Climbing Little Si

Another recovery milestone: Near the summit of Little Si

April 11, 2017
Hi, Tracy
Today I enjoyed another milestone. Facing an uncertain outcome, I climbed Little Si at the invitation of my occasional hiking friend, Sue Butkus. Sue wanted to check out the hike for a group of lady friends who will be making the hike as a group. After finding myself winded climbing Madison Street from the waterfront and having to stop for breath or take the "indoor" route up the hill, courtesy of escalators in buildings along the way, I had my doubts. But we came to an agreement:

I would join Sue at 9 a.m. today in North Bend and we would start the hike. If I got winded, I would return to the car and curl up with a good book while she finished the hike. Well, we did it, and I got winded, but we just took breaks and then forged ahead. Reaching the peak of Mount Si usually takes me less than 90 minutes when I'm in shape. Today it took four hours, and another 2.5 hours to return to the trailhead. But I did it! I was tired coming down and quite prudent to make sure that I didn't injure myself due to a slip and fall from exhaustion. Afterward we celebrated with milkshakes at Scott's Dairy Freeze Ice Cream.

The downside: I wore rain pants over my long underwear and safari pants, to keep warm and dry. But when it came time to pee, all those garmets were a burden, and sometimes urgency overcame frantic attempts to get ready. This proved especially true when I found myself back home without my apartment key and I had to use the loo while I waited for the locksmith. I took off my rain pants and then was confronted with reality and had to put the rain pants back on over my wet safari pants. The good news was the locksmith was able to get me into the apartment in just a couple minutes and at a very favorable rate, including additional keys.

Another down side was the fatigue of my legs and joints. I put them through a workout, and had the beginnings of a charlie horse when I climbed out of my car as I arrived home. I took steps to cut it short and will hope it doesn't return during the night.

The photo below is of a boulder field greened with moss. The photo doesn't do justice to the rich hues of the verdent velvet on those big boulders.

Love,
Dad

Recovering my stamina

April 1, 2017
Hi, Tracy.

Now that my radiation therapy is over, my next goal is to recover my stamina, and  believe me, it's not there right now. After spending a couple years mountain hiking, I find it a bit of a surprise to find out that climbing up Madison Street for a few blocks can leave me winded. Most of my recent life has been spent "on the flat," near the crest of Capitol Hill.  Walking from the Condo down Madison street to the Alaskan Way Viaduct is easy enough, but coming back up the hill can sometimes sap my energy.

I think this is because of the medication I've been taking, as well as the x-ray therapy. Prime suspects for me are Lupron and Bicalutimide -- hormonal medications. According to a Mayo Clinic Web page, hormonal changes can lead to significant fatigue. (So does sitting around the house and not getting enough exercise.) And that fatigue may be short term or last several months. I am now in the process of finding out just how long that lasts. Radiation can also sap your energy, and the effect can last 1-3 months after the radiation stops.  Here's what I found on the Internet:

Radiation therapy works by destroying diseased, cancerous tissue – creating a “wound” that sparks an immune response. . . Fatigue may occur as your body tries to repair the damage to healthy cells and tissue.
Your cancer can cause changes to your body that can lead to fatigue. For instance, some cancers release proteins called cytokines, which are thought to cause fatigue.
If you're sleeping less at night or if your sleep is frequently interrupted [for instance, getting up to pee several times a night or waking up with hot flashes and night sweats], you may experience fatigue.

A friend came to visit by ferry two days ago and we knocked around the downtown area -- Pike Place Market and the Seattle Art Museum, enjoying a view of the waterfront from Lowell's restaurant and then indulging ourselves with some gelato.

A view of the great wheel from the third floor of Lowell's at the Pike Place Market.

Seattle's inside passage

Afterward, she headed back, and I headed up. And that's when I realized that I had had enough fun for the day. After less than two blocks ascending Madison, I started seeking the "inside passage." At Third and Madison, there's a small grocery/eaterie called Mel's Market, a "simple spot for American breakfast & lunch fare, including bagels, burgers & salads, with carryout," situated one street below Safeco Plaza.

A Google street view of Mel's Market at 3rd and Madison

An interior door at Mels opens out to a spacious lobby. I purchased a can of Mountain Dew and found a chair. Yes, it rots your teeth and is a lot of sugar, but it is my drug of choice because of the caffeine boost. And my mouth was parched. I finished the can and took the escalator to the level of Fourth Avenue, discovered a bench, and rested again. Then I exited the Safeco building, crossed Fourth into the Seattle Public Library and took the escalator to 5th Avenue. That took me to within a block of where the climb up Madison becomes more gentle, and I made my way home.

On Friday I went to the rental to prune a grape arbor and some trees, and before long I was tired again. Time to go home for a nap.

Today I'll walk to the waterfront again, I think.

Regardless, this has been an easy cancer. I am sooooo fortunate.

Love,
Dad

Graduation Day: March 28, 2017

I'm a certified graduate of radiation therapy!

Tracy,
Free at last! Free at last! Thank God Almighty, I'm free at last!

Well, OK. Now that I've got that out of my system I can calm down and bask in the realization that my radiation treatments are over and my night sweats may soon be a distant memory.

But today is still special because I've been under the photonizer for the 39th time without any deleterious effects. No soreness from what might be called "collateral damage" from the radiation that was directed at my prostate. No diarrhea and no apparent scarring of the urethra. It's been an easy ride.

Along the way, I've met some nice people, such as the fellow pictured next to me in the photo below. His name is Robert, too, and he has had lung cancer since 2013. I had met him a few days ago, and he had such a positive attitude I wanted to include him in this blog. He wasn't supposed to be here, but he has survived, possibly because of stubborn cheerfulness and a good heart. Robert said he would pray for me, but I've had one of the easiest rides a cancer patient could ask for. If prayer works, I suggest everyone pray for him, because the world needs more people with his attitude.

Robert and me on my last day of radiation.

It wouldn't be a special day without a statement of thanks to my health care team, most of whom were too tied up to join me for a group shot today. But they are not forgotten. Bartell's had a twoferone on Whitman's Chocolates 10 oz. box. I had wanted to get the biggest 40 oz. box, but I couldn't track it down. Then I found out I could get the smaller ones on special. Wow! Winners all around.

I bought four for the price of two and gave one for the staff and the clients at the front desk; one for my team of technicians; one for my radiologist and his staff; and one for my urologist who tracked me for years, keeping an eye on my PSA score and performing the operation that uncovered the cancer. They have all been a great, nurturing team. Here's a photo of the ones who were present for the final photonizing:

Juergen, Shelly, me and Kari (the one holding the Whitman's chocolates)

The photo's focus is pretty soft, because I set up my droid phone to take a movie. A still would have been sharper, but who cares? We all feel great.

This final picture is of me, setting up the camera.

Immortalizing that special milestone. . .

We'll see how long it takes before I don't have to wear that balaclava headband. I met with the radialogist after my final photonizing and was told that I can stop taking the bicalutimide, which put me through the hot flashes and night sweats of manopause. And I can start easing off that celibrity medication, Flomax, which shows up in TV ads about old gaffers who have to pee all the time. By the time you're my age they'll probably have something better, but for now it works pretty good.

In a month I have a blood test to see what my PSA level is, and a week later I meet with the radiologist again. Then every six months I have a blood test to see what the PSA is doing.

But tomorrow, I can sleep in. Or I can get up and go someplace beside the hospital. Those weekday visits with the photonizer are oh-ver.

Love,
Dad

Mid-course consult: prognosis, radiation, fatigue

March 8, 2017
Hi, Tracy.
Today, about halfway through my radiation program, I had a productive consult with my radiologist. We talked prognosis, fatigue, and the nature of the  radiation I'm receiving.
The prognosis:
This was the first thing on my mind, because of this line of information on a report I received last week:

"Cancer of prostate w/high recur risk (T3a or Gleason 8-10 or PSA>20 - Primary." 

I looked that up on the Internet and  came up with the startling conclusion that my cancer might be Stage III, high risk cancer. But that apparently is not the case. What spiked the conclusion was the fact that, unbeknownst to me, my PSA count has reached 25, almost double the level before it started escalating rapidly last spring. Until today's consult, I  had forgotten that my PSA had already reached 25, even way back in September, which led to my taking the hormone suppressing medications. I have been having so much fun that I  had forgotten that key piece of information.

Obsolete information

Sometimes I wonder whether you really need all this information, because by the time you have to worry about your prostate, you may be able to take a pill for it. I read in the Wall Street Journal today about research into dealing with cancers that is informed by the nature of pregnancy: the fetus apparently releases a chemical that keeps the mother's body from rejecting this foreign organism in her belly. Turns out, the same chemical is used by cancer to prevent the immune system from rejecting the tumor. Block that chemical, the theory opines, and you allow the immune system to eliminate the problem. In that light, radiation seems so crude!

About the radiation

You can read about radiation at "Radiation Answers," but to sum it up, I'm not being hit with Alpha or Beta particles, which have limited penetration. I'm being hit with photos. I thought that was interesting, because I always thought of photos as the light we can see. But photons are just part of the spectrum of x-rays, and they are the part we don't see. The room I'm in when I get x-rayed is surrounded by concrete to protect the staff when they are illuminating my prostate with photons.

Fatigue

I have been feeling very good, but when I even mildly test my body, I'm disappointed.  Remember the Madison Street Marathon, when I climbed from the waterfront to the crest of Madison Hill nine times to promote the One World Futbol? I was understandably tired after 27 miles of hill climbing. But now I get tired just walking halfway from the waterfront to the condo. Two nights ago I had to stop and rest twice. My radiologist says this is normal; the body is spending energy healing the damage the x-rays do in the course of curing the cancer. He told me to engage in moderate exercise and feel free to take a nap of no more than an hour. (Too long a nap and you get groggy, he said.)

Well, that's the latest.

Love,

Dad

Time for some celebrity medicine

March 1, 2017

Hi, Tracy.
I've had some surprises during the weekend, so I sent this note to the Advanced Registered Nurse Practicioner (ARNP) that I meet with every Wednesday:

I was under the impression that "incontinent" referred to the place where the tourists went when they got off the cruise ship. I have since been reminded otherwise. The most memorable time I've had this experience was on the Evergreen Point Bridge at night in a rainstorm, when there was no place to pull over and my urinary tract infection that resulted from the implantation of the gold beads in my prostate had not yet been diagnosed. 

Well, it's gone, but something has replaced it, and I have a sneaking suspicion it has to do with all those protons you people have been spraying at my prostate. I think at least one of the neighbors -- my urethra -- may have been listening to it moan and got aggravated the only way it knows how. Lately it felt a little tingly and when I passed water, sort of like someone ringing the doorbell. I noted the effect but didn't act on it, so today my urethra ran out of patience and decided it wasn't going to wait for me any more.
This happened twice today. I was wearing an absorbent pad which was in the wrong place at the wrong time, so it didn't help much. Fortunately, I had a spare set of undies in the backpack I took on my outing to with two ladies to Blaine, and I don't think they caught on. I thought I was OK, and didn't bother to put another absorbant pad in the fresh undies. Smart, huh?
Anyway, what would you suggest I do? (I can already imagine your ambiguous answer: Depends!)

 Well, as it turned out, maybe the radiation was contributing, but I also had another Urinary Tract Infection. So right away I got an antibiotic (Ciprofloxacin) and then some celebrity medication: It's called tamsulosin, but the stage name is Flomax -- yes the very one they advertising on TV for men who have to pee all the time. Wow.

However, the very next day the medication changed. The laboratory found E Coli in my urine,  As I understand it, the E-coli is resistant to Ciprofloxacin, but the laboratory test showed it responded to the new medication, Trimeth Sulf DS.

Here's hoping...

Love,
Dad

My hot flash booster shot

In this Mosaic, medical staff in the USSR direct x-rays on Cancer (the crab).

February 10, 2017
Hi, Tracy.
Today I got my second lupron shot. Lupron is the big time hormone blocker. All the while I've been crediting bicalutimide for those wonderful hot flashes and night sweats, which have been diminishing. On my Wednesday consult I found out that the reason for the tapering off was that the lupron shot I received at the first of this process was the heavy hitter, to which the bicalutimide takes a back seat. I learned the lupron was probably wearing off, and it was time for a second shot. Well, today I received my second lupron injection, which goes in the hip and makes the leg a little stiff for a day or so. I can hardly wait for the renewed vigor of my night sweats.

Incidentally, I recently remembered and retrieved the photo at the top of this post, which  I shot in 1972 when your Mom and I were traveling through what was then the Soviet Union. Someplace along the route we came across a building that we realized was a facility that used radiation to treat cancer. I don't recall trying to make out any wording on the facility, but the symbology of the Mosaic in front of the building gradually sunk in.

At that time, the Soviet Union was characterized by pretty unimaginative art that followed standard themes. This particular creation was remarkable for its styling, its departure from standard Soviet art, and the powerful message it conveyed. The Russians had lived under what was close to feudalism 70 years earlier and they still were pretty primitive. But they got some things right. There were book stores everywhere; they had the best ice cream and bread I had ever eaten. And they put a lot of effort into health care. They had come a long way.

Love,
Dad

Day 6 accident: the show must go on

February 9, 2017

Hi, Tracy,

The important thing to remember is that the radiation technicians have seen it all before. So when I had an accident on the scanning table, they took it in stride. It was an aggravation, but not an embarrassment.

I started the day with Campbell's chicken soup for my cold. That added fluid. I think I peed later, knowing that I would be prepping for the 9:15 a.m. appointment. At 7:50 I began in earnest, with two cups of lemonade followed by a cup of hot Jello. At 8:30 it was time to hit the road and I was sucking on my Platypus all the way to Group Health. Today I think I was unnecessarily earnest. I continued to suck right to the point where they called me in, and then I realized that, for the second time, I was going to practice voiding without peeing. And I did that, but I sure wanted to pee. Gotta have a full bladder for the procedure, though.

Halfway through the radiation, during a pause of the machine, I raised the alarm that I was starting to pee involuntarily. The technician came out, assessed the situation, and gave me permission. And then the process was completed, as the machine continued its rotation and radiation while I gradually soaked my lap.

As this was going on, I realized that I wasn't the first to have this problem. The machine can take it, and the staff understand. They brought out towels, provided a large plastic bag for my undies, and walked me to the john, where I changed clothes and peed again, this time proudly, and with more volume. I was dry and back on the street, 25 minutes after the treatment began. It's now 10:15 a.m. and I've peed three times since I got back to the condo.

I guess I need to learn how to curb my enthusiasm--and pack extra undies in the future.  I've got seven weeks to get it right.

Love,
Dad

P.S. Late night discovery when I removed my Platypus from my backpack. It holds 1.8 liters of fluid, and it was almost entirely drained. I had no idea how much water I chugged enroute to Group Health -- at least a quart. No wonder!

Prognosis: expect diarrhea

February 8, 2017 the consult

Hi, Tracy.

According to dictionary.com, the word "diarrhea" traces its roots to Middle English, Late Latin and Greek. I've been told the tendency toward it is inherited--you can find it in your genes (spelled j-e-a-n-s). It's something I can look forward to, along with reinvigorated hot flashes, including night sweats, which until now had been diminishing. How serious will the diarrhea be? Depends.

The Middle English use of the term literally means "flow through," which is what my future  meals may do when they hit the far end of the alimentary canal, starting with the Sigmoid Colon depicted in the image immediately above.

Diarrhea can be an outcome of radiation. This my fifth session on the block. It's a Wednesday, and I met with my treatment team following today's irradiation of my prostate, which took about 10-13 minutes.

Lotsa liquids

I prepped for it by drinking a cup of hot raspberry Jello first thing, to put some heat in my chest along with some sweetness to prompt my salivary glands to kick out some fluid to loosen the phlem from the cold I acquired after my trip to Mazatlan. That was followed by four cups of lemonade (easier to drink than water) and then probably at least 2-3 more cups of liquid I sucked from my hiker's Platypus on the 15-minute walk to radiology. All that water and the hike gave me the opportunity to learn that I can clear my bowel at the clinic without draining my bladder, which they want as inflated as possible. That helps to push the bowel out of the way and also reposition the bladder so that it receives less x-ray.

Regarding the colon

The colon will take a hit. After enough radiation, it will experience a diminished ability to retrieve water. When food and liquid leave the stomach, the small intestine performs yoeman service in transferring liquid to the kidneys; it's the job of the large intestine to collect the rest, and if it doesn't, stools may be quite liquid. Things may get interesting.

Diet

To limit the interest, I may be changing my diet -- reducing roughage. This will depend on the effects with my particular treatment. Right now I'm dieting to take off weight -- I've gained 20 pounds over the weight I prefer: 185 pounds. I've focused on low-calorie foods and vegetables as well, bringing my weight down a few pounds. That reliance on vegetables may diminish to temper any diarrhea I have.

Night sweats

One of the staff members referred to my night sweats and hot flashes as "manopause." They  have been diminishing in frequency and intensity. I though it was the bicalutimide pills I've been taking that caused them, but today I learned that the major cause of my temperature swings is probably the lupron shot that blocked my testosteron, and I'm due for another one, so I think I'm going to be experiencing a manopause rebound in a week or so after that shot.

End of sweats

Fortunately, when the radiation treatments stop, the hormone blocking will stop as well, and my temperature regulating system will settle down and stop exaggerating its response to the extra-body heat and cold stimuli.

Also is to be expected:

My prostate, which is about 87 cc's in size, and which is already shrinking, will continue to diminish in size. Of course, it may start increasing again gradually once treatments end. The smaller prostate will mean easier urination, but the radiation may scar the urethra, meaning more difficulty, and the necessity of clearing out the scar tissue at a later date.

My PSA (prostate specific antigen) will be way down. "Normal" is a score of 2-4. My first biopsy over 10 years ago was about 6, and it continued to grow slowly until it was in the range of 13, and then the score accelerated to 16 and finally 19 the last time it was checked. My radiologist expects my score may drop to to as low as 0.5 following treatments, with very diminished growth afterward over time. They will measure it about two months after treatment, and then every six months.

While the PSA isn't necessarily a trustworthy indicator for the general male population, once it's associated with cancer it becomes a more relevant indicator -- possibly because other explanation for high PSA get ruled out. So my understanding is that tracking it will become the gold standard for determining whether I am cancer-free.

Love,
Dad