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