A most disappointing tattoo

Dec 7, 2016

Tracy,
I wasn't expecting the American Flag, Betty Boop, an eagle or the Battleship Arizona. But the technician did say something about maybe a small Mickey Mouse or something recognizable. Instead, what I got, is shown below:

Kind of looks like a tiny bruise on the back of a plucked holiday turkey, doesn't it?

I showed up Thursday, Dec. 1, for an MRI, CT scan and a tattooing. The point was to see whether the gold beads were in place in my prostate so that they could line up the X-ray equipment next February for my radiation treatments to kill off my cancer cells. Part of the procedure involved figuring out where to put some tattoos on the surface of my body to be used for aligning the X-ray machine. There was one on each hip, which wasn't unpleasant, and then this one, in my fatty little belly. That definitely felt like a puncture. But it doesn't look like anything. How they are going to use that to sight on my prostate remains a mystery.

Normally my lower belly isn't quite so defoliated. I gave the spot a quick snipping with a scissors and then an even quicker shave. I intentionally didn't do a perfect job, so that I wouldn't be mistaken for a Chippendale. Between now and the end of January, that may grow back. We'll see.

Love,
Dad

My very first UTI

Nov. 18, 2016

Hi, Kiddo.
Well, questions anwered. Today I found out I've having my very first ever urinary tract infection. Yesterday I peed into a bottle at the HMO and today my doctor called to tell me to pick up some bactrium, an antibiotic used for UTIs.

That led me to check UTI for men on Google, and here's what I found out: Women hit the jackpot more often than men. There are a number of causes, including sex. One Web site said women should pee after having sex in order to avoid them.

For men, the symptons include having to pee frequently; a burning sensation when you pee; releasing only small amounts of urine at a time; and in those special cases, stinky, cloudy urine and lower back pain. The back pain may indicate a kidney infection. There is also discussion of fever, and I have had hot flashes, but I think that's from the bicalutamide, which I've been taking to diminish the amount of testosterone that's available to feed the cancer.

Ways to avoid it: pee after sex (presuming you'e not flying solo) or wear a condom; and drink lots of water to flush out the bacteria from your system. (Interestingly enough, after a couple of painful little pees the other night while I was driving, I exited the car and had a fine follow-up instance with greater production, and there was no pain at all. So there you have it, I guess.)

And the cause: There are several, but the two that ring the bell for me are an enlarged prostate and bladder catheter insertion. The sites didn't mention biopsies of the prostate and the insertion of the gold pellets I'm packing around, but I wouldn't rule those out, either.

By the way, bladder infections are becoming increasingly resistant to antibiotics. I start mine this afternoon and keep them up for 10 days.  Here's hoping I got the lucky strain.

Love,
Dad

Nov 22 update: change in antibiotic; e-coli infection

I began immediately treating my UTI with Bactrim (a.k.a. Sulfamethoxazole) Friday, Nov 18, on the understanding that I would check in with the consulting nurse to see whether further analysis of my specimen called for a different antibiotic. I attended a memorial service on the 19th and didn't make the call, then forgot to follow up. On Monday, the 21st, the doctor telephoned me, leaving a phone message that had such low volume I saved it for a quieter time, and forgot. Today he called to say the Bactrim won't likely be sufficient and he ordered a new prescription: Nitrofurantoin. I took the Bactrim twice a day; I will take this new drug four times a day.

This is a case of hypothetical risk becomeing a reality. When I had the gold beads implanted in my prostate, this was done through the wall of my intestine. It seems likely that some e-coli was dragged along and got into my urinary tract. My UTI symptoms have been improving -- no pain when urinating, for example. So maybe the Bactrim was having an effect. One method for fighting the infection could involve using an intravenous (IV) drip, but for now we're going with the Nitrofurantoin.

Incontinence: Get me to the loo on time!

Nov. 16

Hi, Tracy.

In the clothing hamper, my trousers, drawers and the furry supplemental seat cover I use on the driver's side of my Honda Del Sol are drying out a bit and awaiting a washing tomorrow. Tonight, enroute home from a meeting on a dark and rainy night, I had an accident -- not of the automobile kind. It occurred on the 520 Bridge over Lake Washington. I felt I had to pee, and imagined only briefly that I was going to be able to control the urge. The true struggle was coming to grips with the fact that I wouldn't, and that nothing was going to prevent it. Also, the term "urge" is not quite right, because the "urge" was only a moment that passed, after which the real urge was to try to stop the unstoppable. Things happened without any urge at all,  while I was driving in the dark on the freeway bridge with cars around me.

This occurred in the context of several days of occasional bright redness, a burning sensation during several uncomfortable and brief urination sessions each day; suspecting deydration and therefore tanking up with water to create the effect of more flow and less pain; and finally the event tonight of both discomfort and no control while driving, followed by a painless pit stop off the road with a good volume of liquid. So, is it the bicalutimide? Do I have a urinary tract infection? Is this just the next stage of an enlarged prostate? Should I start keeping depends handy? Dare I take long trips away from the bathroom? And am I going to have to put up with this for long?

This used to be a joke about getting old. Now it's a daily concern.

Love,
Dad

P.S. Nov. 17 -- heading to lab for a specimen to see whether I have a urinary tract infection.

Cancer--The Crab

Going for the gold doesn't have to be a pain in the ass

Nov. 11, 2016 -- Veteran's Day.
Hi, Kiddo.

This afternoon I acquired some gold nuggets. Tiny nuggets. Three tiny nuggets. Too small to get me scanned with a wand at the airport, but big enough for the right equipment to hone in on, when I get my radiation treatments next year. The picture below shows where it happened.

An ultrasound machine, and the gurney where my prostate became a tiny bit more valuable.

It kind of amuses me that my blood pressure was above 150 over 70 before we started, because there was almost no discomfort.

That  big screen in the photo appears to be the ultrasound display. Using it to monitor his procedure, my urologist stood behind me and slipped this probe into the place where the sun doesn't shine (although other sources of light do, for instance when they perform a sigmoidoscopy. I know, because I watched the screen as that snake went looking for polyps several years ago.)

I lay in the fetal position on the gurney facing away, so I didn't get to watch the display. Afterward, when the medical staff left and I was getting dressed, I took the photo, noting that the screen says the needle he used on me was about 1.5 inches long. I'm not sure what that means, because I never saw the instrument.

Before he salted the mine, he probed around, causing a couple little stinging senations. I thought that was when he placed the gold beads, but that was probably just the numbing shot.

The most unpleasant part of the whole procedure was imagining what he was doing to me. But before I knew it, the implantation was over. Previously, for biopsies, I had waited in anticipation, listening to a device build up pressure before there was that sudden pulse as the needle puffed through my intestine wall and into the prostate to grab a tiny snippet of tissue. For the minor biopsies, for which I was awake, there were eight of those attention-getting moments. Today there was no pulse, just a little bit of probing, and I couldn't even tell for sure when the implants were occurring.

Afterward I went to a different building through another set of bowels -- this time the labyrinthine bowels of the Group Health basement chambers to a separate building where I underwent an MRI to determine whether the beads my urologist placed were properly situated. After a brief ride through the doughnut,  I was assured the procedure worked and I wouldn't have to go back upstairs for another try.

The next step -- which occurs next week, is another MRI to make sure they are staying put, followed by a tiny bit of tattooing at my waist, to provide another set of reference points for aiming the radiation equipment when it comes time to zap my tumor(s).

Love,
Dad

Cancer--The Crab

You give me fever, in the evening, fever all through the night ...

Nov. 6, 2016

Well, Kiddo,

Remember what I told you about Bicalutamide, the drug that's going to starve my cancer by reducing my testosterone? I think it's having its side effects. I've noticed that I have trouble regulating my temperature. I'm either too hot or two cold. I first noticed this at night. I use a mattress heater, which, I understand can lead to dehydration by warming the capillaries and causing me to sweat more. So I wondered whether my night sweats were due to the mattress heater.

But last night I went to an Argentine tango class and dance, and I found myself sweating with what normally was very little exertion. My forehead and lip were beading so much that you might have wondered whether I just got out of an IRS audit. This is accompanied by a diminishment of energy and an enthusiasm that declines toward the normal.

I'm taking it all in stride, I think. But it is a curiosity and I'm wondering what other symptoms I'll be seeing over the next few months. Meanwhile, I'm making it a point to drink lots of fluids and eat right. And after I dispose of a couple major projects, I intend to start hiking again to maintain my stamina.

By the way, this is easy so far. I went shooting pool with my friend, Roger, and his pool buddies the other day. A man with a perfectly bald head joined our group briefly. Roger explained that he had been treated for prostate cancer for more than 20  years, and that his PSA score had reached 500, which would be 20 times the level I show. It also jumps around significantly, I understand, dropping as many as 200 points. He's using chemo to control it. His road has to be a rocky one. By comparison, mine promises to be a cake walk.

Love,
Dad

Cancer--The Crab

I've got a travel plan--put cancer on hold!

Oct. 6, 2016

Hi, Kiddo

It looks like my travel plans to see you don't have to be delayed. I found out today that we can delay the cancer instead. There are some other things that will probably be delayed as well, and I'll get to that in a moment.

Here's what's up: After returning from my road trip to Colorado I had an interview with the radiologist today, and we worked out the plan. Now, I could have radiology begin almost immediately, but I can put that off and greatly slow down the progress of the cancer by blocking a chemical we all generate naturally: testosterone. This morning I got jabbed in the right hip with a shot of Lupron, and that will be followed by daily Bicalutamide pills, which won't lower my testosterone; instead they will just block the effect of the testosterone, starving the cancer into dormancy.

In technical terms, bicalutamide is a non-steroidal antiandrogen that acts as a "selective antagonist" of an androgen receptor." (Testosterone is an androgen.)  It does not lower androgen levels. It just prevents androgens from mediating their effects in the body.

I will take this for four months, and then, beginning in February I will start the radiation treatments that will kill the cancer cells, and presumably eradicate the cancer. That allows me to put the cancer on hold so that I can visit you in December and go to Mazatlan in late January.

Now in some cases you'd want to get right on this disease, but based on theory and statistical outcomes, the doctor has high confidence that rushing is not necessary. Somewhat counter-intuitively (from my point of view) this process has been tested and works. There are side effects of lowering testosterone, of course--hot flashes, some depression, sweats, fatigue, bowel changes, etc.

One of the changes can be kind of poignant. When I went to family medicine at Group Health for my Lupron shot, the receptionist had to check to see whether they had any in stock. Well, she told me, I "got lucky." They had some. As I understand it, once I start taking the medications, that may be the last time I get lucky for at least several months.

Today I had a blood draw to measure my PSA, the hip shot and the pills. Packing a slumbering libido, I am about to embark on the monastic wasteland.

Now one of the questions you may have is this: If I still have cancer, can it spread? Well, cancer cells have probably already gotten into my bloodstream and moved to other parts of my body, my radiologist explained. However, virtually all these cells will land on sterile ground and die a lonely death. Every now and then there is one mutant that is particularly virulent and takes hold in places like bone marrow or lymph nodes, but that is a very unlikely event. The most certain outcome is a greatly delayed cancer and the improved ability to kiss the most stunningly beautiful and evocative women as if they were my sisters.

Anyway, I'm now trying to figure out how to visit you in December and whether to include other locations along the way. As long as I'm coming to Europe, I might as well make the most of it.

Love,

Dad

Cancer--The Crab

PSA: 25. Time to pay attention

Sept. 15, 2016

Hi, Kiddo.

I just received a phone call from the doctor who did my June 27 saturation biopsy, which confirmed that I have prostate cancer. Only 1 percent of the prostate was sampled in the biopsy, and the cancer that was found from that sample didn't appear particularly aggressive. But it was something to keep an eye on.

At the time of the most recent biopsy, my PSA had been measured at 19. It is now 25, a 31 percent increase in less than three months.

In May 2006, the score was 8.1, when 4 would be the standard range. It climbed and fell a bit over time, but in May 2014 -- eight years later -- the score registered at 8.9. Sometime after that it began climbing, and now the climb seems to be accelerating. This has my doctor's attention.

My understanding is that radiation is a very effective way to kill off prostate cancer, so I am scheduled for a consult with a radiologist on October 6, after I return from a road trip to Colorado. If the radiologist gives the go-ahead, then my doctor will have me in the office for a procedure very much like a standard biopsy to place what he calls "markers," and what I call "targets" in my prostate so that there will be a means of aiming the X-ray machine at the offending organ. You'll recall, I hope, my description of my non-anasthesetic biopsies over the years. The procedure will be something like that. A little uncomfortable, but nothing miserable.

The greatest inconvenience will be that, if I have the radiation treatments, they will require me to be on hand for several office visits, which may postpone my plans to visit you this winter. I'll let you know more when I know more. Because of the timing, whether I go ahead with radiation treatments and how that will affect my travel schedule won't be resolved until October 6.

Sorry about that.

Love,

Dad

Cancer--The Crab