The Last Day of Radiation

Monday, July 27, 2016 was my last radiation day. My first radiation day was April 25, 2016. That is 9 weeks, 5-days-a-week, which comes up to 44 sessions excluding one day the machine broke down (just an ordinary plug), and a day off for Memorial Day.

Customary to the radiation center, “the graduate,” (myself) brought food to the last day of radiation (i.e., veggie plate, fruit plate, baba ganoush, pita bread and cream puffs). What follows is a short ceremony where I ring the bell and am presented with a small gift packet containing candy, a prostate cancer awareness bracelet and inspirational cards. I was also awarded a certificate of completion signed by all members of the staff. 

Throughout the program the staff at the radiation center has been welcoming, warm and encouraging.

All throughout and beyond the radiation center Nora has been a constant supportive and irreplaceable presence.

Strangely enough the radiation staff referred to my completion of the program as a “graduation,” and although this was not on the certificate of completion it certifies that I underwent treatment with fortitude and strength. All I did was passively lay down on the bombardment table.

These last 3 weeks of radiation has zapped me of energy. I am slugging on as best I can but not accomplishing much. I am way behind in terms of moving into James A Reed, we have stuff in storage, there is the Holly house that needs to be organized, there is this house (James A Reed) which needs organization as well, and there is the question of what to get rid of and what to keep. I am afraid we will be far from done by the time the Fall semester begins.

The nurse said things should begin (begin, not end) to turn the corner after 7 to 10 days. The effects of the injection (testosterone blocker) lasts up to 6 months (that means December).

My mother (mommy as she is called), was remarkable. She was under no medication for the duration of most of her life. However, the last years before her death she developed numerous difficulties. Among other things, she was anemic and diabetic. Just when things became stabilized in terms of her health, some problem would present soon after. Even though her diet did not change she lost considerable weight and looked anorexic. All throughout she retained calm and took everything well in equanimity and grace.

This Fall semester, Sophia and Nickolas are college freshmen, Nathaniel is a college sophomore, Alethea is a high school junior, Froilan is in 8th grade, Carlo in 6^th grade and Izzy is in second. Lanny has two grandchildren (a toddler and an infant). This is the generation that will inherit our bungling and glory to do their own bungling and glory. I trust that justice and love will weave into everything they do.

Where do I stand? What is the success rate (hit rate) of the treatment I just completed? Of course there are statistics. But statistics are group indexes and there is no direct way to go from a group index to a particular person. These indexes have the disadvantage of lumping everyone eliminating diversity, and many lack an adequate sample size to begin with.

However, taking into consideration my special situation (early detection and a low Gleason score), success means that my PSA will be stable over a 10 year period. My PSA has to be taken every 3 months initially, then every 6, then once a year. I understand that 5 years is the cut-off when one can claim the distinction of being a cancer survivor. My PSA as of June 8 is down and normal (PSA = 0.4)

PSA is the primary and the only routinely used marker for prostate cancer. They have to take your blood to get PSA. If my PSA does not stabilize in the future they may have to do another biopsy, a bone scan and (?). Neither of the above are welcome events.

For now, I will not miss my son’s wedding, my children’s and grand children's birthdays, graduation days, etc. Most importantly I will thrive in marital bliss.

June 5, 2016

What is messing me up is Lupron, the $1000 injection I took 3 weeks before radiation with another due the eight of June. Lupron is a testosterone blocker.

It robs me of physical drives. Eating has become cerebral which is not to say that food does not taste good. Rather, eating is more determined by taste, habit and expectation than by drive. Otherwise, irregularity is the norm. I may be sleepy all day and have problems keeping my eyes open. On other days I am wide awake all day.

I have hot flashes and very frequently break out in a sweat. I do not drip but if you run your hand across any part of my body like my brow or arm, your hand will be wet. This happens anytime during night or day. I may get under the covers feeling cold only to toss them away shortly after when I break out in a sweat. I get up and turn the overhead fan on. It is very much of a nuisance.

In general I do not push as much as I normally would and tire easily. This became very evident in moving into James A Reed. I could not move for a whole day. I would not be able to sustain that expenditure of effort. If I mow the lawn 2 days in a row, I will feel spent the whole of the third day

However, this tiredness is not just a lack of testosterone but also because my body is recovering from radiation.

The other listed side-effects of Lupron is constipation and memory problems. Sometimes, I do experience difficulty finding the right word to say.

That's it, this serves more-or-less as a record of my experience.

Just last week I noticed that the door that led into the LINAC room where I am bombarded by radiation is about 18 inches thick and looks like a 7 foot square. It is massive. The radiation therapist said it weighed 20,000 lbs. The nurse said it weighed 35,000 lbs. The other radiation therapist said it was 28,000 lbs. The door is a sandwich of steel, wood (stops neutrons), lead and concrete. The walls, except for the roof, are likewise insulated. The doctor said it whole setup costs about 3 million. Once I am in position, everybody leaves, the door closes, then LINAC comes to life. I am bombarded with photons. There is a prominent sign on the outside of the room that lights up “BEAM ON” during bombardment . What is remarkable about treatments today is that they have achieved a considerable amount of specificity.

June 8

I had my second Luprin injection. It took me 2 days to get back to normal. The effects could last up to six months which will be in December. My treatment ends June 27 or 28.

June 14,

We have been staying at James A Reed since the end of May.  For two week, we now have a fully functioning kitchen.  We are sleeping and eating here but there is still a lot of arranging and moving to do.  We have two households of historical junk.

A fine day to you all

May 24, 2016

This week begins the fourth week of radiation? How am I doing? Basically the same as the first three weeks in terms of radiation. (Well not exactly.) There is no skin irritation even though the oil and sweat glands in the line of bombardment are supposed to shut down.

I have the routine down pat. I lay on the slab, the radiation therapists see to it I am properly aligned, then retreat to the control room.

The linear particle accelerator (LINAC) is like the mouth of a gigantic squid with three tentacles extending outward, two short ones on each side and a long bigger one in the middle. You can see pictures of this monster on the Internet. The design eliminates the claustrophobic feeling one gets in scanners where one lays still in a a tube. 

Once I am on the slab and the technicians throw the “On” switch, the machine comes to life. I am elevated to midline of the squid’s mouth, the two side tentacles extend outward and whir around me. One is an x-ray, the other a CT scan. It stops and takes about 5 minutes to align and calibrate the exact location of my prostate.

Then the main tentacle extends forward. I am bombarded from different positions nine times for between 11 and 15 seconds each. LINAC revolves in a 360 degree arc choosing these 9 positions. The radiation shoots right through me. Each of these bombardments intersect in my prostrate. Other organs and tissues receive minimal radiation.

The goal of radiation is not to kill malignant cells. Rather, it is to influence the DNA of malignant cells so they cannot divide and proliferate. This is why the treatment lasts 9 weeks Monday through Friday. I was looking at the scan and though the prostate, bladder and surrounding organs were clearly visible, there is no differentiation in the view of the prostate itself. In other words, there is no visible change in the view of the prostate as a result of radiation. Neither is there any change in size. In other words, there is no feedback.

After treatment it is the PSA that is monitored periodically. If the PSA is within an acceptable magnitude and stays the same indicates the success of the treatment.

Blog:  Radiation treatment series:  April 28, 2016

Tomorrow, Friday marks the first week, 5 treatment sessions of radiation which will eventually add up to a total of 45 sessions, Monday through Friday.  My last session is scheduled for June 24.
  

I lie down on the CT machine slab placing my feet in a mold, custom-made just for me so my body and feet are in the same position every time.  I have a pencil-mark-like dot tattooed just below my navel and one on each side of my body the same level as the one on my navel.  This helps insure I am in the same position every time and helps the scanner orient to me. 

-o-o-o-

When I had my pacemaker put in, everything happened so fast.  I mentally processed events in terms of a medical procedure just like when I had my appendectomy.  It was just something that had to be done.  Now, when I go to have my pacemaker checked (4 times a year), I know that I would not be here without this silent embedded contraption that keeps my heart beating. Tragically, I would have missed my wedding.  I am like Darth Vader without the “darth.”

So the cat is out-of-the-bag.  I am mortal, not that I never thought otherwise, I just never thought about it.   I never accepted the death of my parents or anyone that I loved.  That are just not there.  When kids or whomever goes to school or to work or elsewhere, they are just not there.  The departed have not been there for a while.  One can choose to think they are somehow somewhere and we will all meet again.  For a reckoning perhaps?  One can choose to think they are nothing more now than just dust or ashes.  If either of these fancies improve one’s life or gives meaning to it, then so be it.  For myself, I will not even say I do not know because this raises the trap of what it means to know or not know.   For myself I know they are alive because I am alive, at least they will be alive for so long as I live.

-o-o-o-

To be continued with more about the radiation procedure.

Living with Prostate Cancer

We sit at the same doctor's office where we had been 6 months before.  Dr. Billy Perry is a urologist. He has called Luis for a consultation because the prostate cancer biopsy which was at 7 per cent 6 months ago is now at 21 percent. He wants to discuss treatment options.

The prostate is a walnut sized organ in men,that sits just under the bladder in front of the rectum and wraps around the urethra where urine and semen flow into the outside of the body.  Its main job is to store the seminal fluid that lubricates and maintains integrity of the sperm.  It receives seminal fluid from two sacs on either side called seminal vesicles.  It is made active by masculinizing hormones called androgens, the most important of which are testosterone and dihydrotestosterone. They also stimulate prostate cancer growth.

Image from American Cancer Society

Statistics from the American Cancer Society March 2015:
Prostate cancer is a very slow growing cancer usually found in older men and rarely in men under 40. The average age at diagnosis is at 66 years. It is the second most common cancer in American men next only to skin cancer and the second leading cause of cancer death next to lung cancer.  About 1 in 7 men will be diagnosed with prostate cancer in their lifetime and 1 man of 38 will die of this disease, (27,540 deaths from prostate cancer in  the US in2015.)

Although a very serious disease, the fact that it is a slow growing cancer, usually diagnosed in late life, most men with the disorder die of other causes such as heart disease or complications of diabetes. More than 2.9 million men diagnosed with prostate cancer in the US are still alive today and in autopsies of men who died of other causes, a good number showed asymptomatic and undiagnosed prostate cancer.


Dr. Perry outlines treatment options.  In the past year the treatment has mainly been active surveillance meaning watching and monitoring the growth with prostate specific antigen (PSA) levels, a surveillance blood test run on men over 40 (much like women get routine mammograms), digital rectal examinations (DRE) and prostate biopsy.  He tells us that since this biopsy result showed cancer cells 3 times more than the last one, the cancer has moved from a Gleason 6 to a Gleason 7 staging and 7 is not good.  (Gleason scoring is a microscopic scoring indicating the degree of aberration of prostate gland cells and is used with other parameters to determine the aggressiveness of the cancer.)

It is time to move towards more aggressive treatments.  These include surgical removal of the prostate, radiation therapy, androgen hormone blocking or a combination.  Dr. Perry says, "I am a surgeon but if I get prostate cancer at age 74, no way will I let anyone operate on me." With that emphatic non-endorsement, surgery is ruled out.  Thank goodness because it is frought with complications such as bladder incontinence, erectile dysfunction, etc. etc. He recommends radiation therapy possibly with hormone blocking therapy, still with side effects especially those related to testosterone loss but much less invasive.

Dr. Perry refers Luis to the radiology oncologist and off to the radiation center for a next stop. He will receive the hormone blocking therapy followed by 9 weeks of radiation.  Essentially radiation is a massive concentration of sunlight, killing the tumor by sunburn so to speak.  The technology has become so precise that my radiology technician once told me she could zap a fly off the wall without chipping the paint.  (That is not what my radiology oncologist told me since he had to read off all the possible complications including benign effects such as third degree sunburn to death.)

Luis starts hormone chemotherapy next week and radiation therapy in April. The doctors give their usual 5 year survival prediction which usually does not mean anything other than if you are cancer free after 5 years you have better odds of not dying from cancer for many more years.  Once you have cancer, you are never cancer free.  It is only undetectable, lurking in some place, waiting to create havoc if you live long enough.

This five year time table on life is at the same time limiting and liberating.  Everyone believes that they will be alive tomorrow, a contemporary yogi once said.  Being given some kind of time table puts you on notice of the finiteness of earth life and time.  At the same moment, you are free to do whatever you think you want in life, to make amends, to fulfill your bucket list or to simply keep on with what you are already doing with your life. You already know you are not getting out of it alive anyway.

Dying has a different implication for Luis than it does for me.  My children are 40 something. They now worry about and sometimes take care of me. I live in the present. I enjoy each and every moment and dying for me is nothing more than another phase of living. Healthy time is very important to Luis because he still has teenage children to raise and mentor.  He has six sons and they have always been the most important people in his life. He will live for as long as he can for them.  He is a wonderful person that way and I have always admired him for that.

Luis and I got married 3 months ago.  On the way home from the doctor, he gets very pensive and says, "Five good years is all I can give you.  (As if anyone can guarantee time.) Is that all right with you?"  I remind him, 5 years is the same odds my oncologist gave me after breast cancer therapy.  It is not quite that long but I am still here.  He does not realize, of course, that when you get married at 73, your odds of having very many years together are very very slim.  So 3 years, 5 years, 10 years, what's the big deal?  Gratefully, we are already living on bonus time.  And while we cannot say how many years we yet have together, we already promised ourselves and each other that they will be the very best years of our lives.