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

The hot sheet experience

February 3, 2017

Hi, Tracy,

 Yesterday's experience brought back a memory of a term I learned 20-30 years ago from Jack Gordon, the executive director of the state's restaurant association. He was referring to motels that rented out rooms for four hours at a time. They were "hot sheet" motels, I believe he said. The name implied the reason for the short rental periods.

I had that experience when I went in for radiation today. When I went into the dressing booth prior to  my second treatment (The first was Thursday, Feb. 2.),  I put on the pajama bottoms and then had to wait because someone else was ahead of me. When I walked in and saw the platform I would lay on,  it struck me that these enormous machines are pretty expensive and take up a lot of room, so that don't have a whole bank of them. There's just one platform, and I was about to climb onto the surface that someone else had just used a few minutes earlier.

My colon

As I will for all the treatments, I had walked to Group Health after waking early, eating an apple, and then a smoothie. I don't have those famous five-minute Gravensteins we grew in Pacific -- the ones that, for some pavlovian reason caused me to do my business quickly every morning that I ate one. But the Costco Pink Ladies were pretty good at that. It didn't happen this day, however, because I've started my weight-loss diet, the one that took off 35 pounds about 12 years ago. I have  regained 25 pounds, and I want to descend back to 185 pounds, so I ate light yesterday. The only thing the doctor saw in my lower bowel today, when he scanned my body prior to the radiation treatment, was gas. That's good. You want an empty colon.

My bladder

But you want a full bladder. The fuller the better, so it's a bit of a juggling match to figure out how to fill it just full enough that it enhances the radiation treatment without requiring a potty call before it's over. Yesterday my bladder wasn't full enough, so today I pre-loaded it with a banana-OJ smoothie and then headed out to radiology, where I drank more than a pint of water prior to the procedure. We went through with it, but the doctor would have liked a fuller bladder. Next time, walk to the hospital with your "Platypus," the technician suggested. That's a type of water bladder that backpackers carry. They can walk and drink at the same time, with their hands free.

My "private parts"

I smiled to myself one time when your mother was having her stem cell transplant and the assistant was bathing her. She asked whether your mom wanted to bathe her "private parts" herself. Yeah. Like there's anything private in a hospital. I crawled up on the platform, lay back, and one of the three female technicians present started pulling my pj's and undershorts down. They do that every time. Maybe they think they're the president -- you know how people just let celebrities do that. In this case, however, there was no grabbing. She claimed they were looking for my tattoos (the ones they use to target the machines). OK, whatever. They're celebrity technicians. Who am I to resist?

The machines

It's hard to describe them, particularly because I'm laying on my back, very still, holding a rubber donut on my chest to keep my arms immobile. I only get to stare at the floral design on the ceiling, while the metal monstrosities -- which remind me in an abstract way of praying mantises -- roll around above and beside me as they scan or radiate. I didn't feel a thing, although I had a hot-flash lying there. I don't think it was all those excited prostate protons, just the bicalutimide--the hormone suppressant. One of the attendants noted I looked warm as she helped me rise up following the procedure.

It started at 8:45 a.m. or thereabouts. I was back on the street at 9:17.  I still can't believe it was that fast.

The  treatments resume next week.

Love,
Dad

Results of Jan 19 MRI

February 1, 2017

Hi, Tracy.
I've returned from a week in Mazatlan and my test results were waiting for me. I had an x-ray and MRI before I left to determine whether my prostate had changed significantly before I begin radiation, and most likely to figure out how to calibrate the radiation when I get treatment. On Thursday I go in for my first radiation as well as a consult on the schedule for this procedure over the next two months.

Here is a summary statement of the January 19 scan:

MRI OF THE PELVIS WITHOUT CONTRAST 1/19/2017:

HISTORY: Preradiation planning, repeat needed due to delay in initiation of radiation therapy.
(The "repeat" comment refers to the postponment of radiation due to taking vacation.)

TECHNIQUE AND FINDINGS: Axial T2-weighted images were obtained through the pelvis without contrast for the purposes of radiation treatment planning. The prostate gland is enlarged. There is no adenopathy. Visualized marrow signal is unremarkable. There is a focus of dark T2 signal in the left peripheral zone posteriorly which may correspond to the primary tumor. No extraprostatic tumor extension is appreciated.

("Adenopathy" refers to enlargment of lymph nodes. "T2 signals"  in magnetic resonance imaging are signals that occur when protons begin to relax and wobble after their subjection to a magnetic field causes them to align. The comment makes me wonder whether the tumor(s) that were not detected before -- except via biopsy -- are now visible to MRI. Something to ask on Thursday.)

Love,
Dad