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