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.

Hi Guys,

I know some of my last blogs sound a like what one would expect in a last will and testament. I do not mean this to be, but I guess I am getting business out of the way.

There is one (hopefully) last request I have to make and that is that is that all you guys stay connected. I know you three older boys (hereafter referred to as the oldies) are naturally brothers as you were raised together. The same may be said for you three younger ones (the young-ens) . I request that at a minimum, you oldies become comfortable in relating to the young-ens and vice versa. Feel free to call upon each other and regularly interact with each other. 

One venue is this new cyberculture.  Face-to-face, vis-a-vis interactions may become the exception rather than the norm. The more of one, the less of the other. Some of you may have seen the mover “Her.”  (The visual presentation is pleasantly unique and different.)

In any case and however things work out, you oldies may be the only connection the young-ens have to the Flores legacy. In some Philippine families, the “kin keeper” tends to the be oldest patriarch or matriarch.  Unless, someone takes over when they pass, the umbrella of connectedness tends to branch off and divide

The following is a video about social classes in the Philippines

http://www.youtube.com/watch?v=kiyMPeJUFlM

Have a fine day

Walang sukat

Good evening to all, the youth, the yet-to-be-youth and all those in-between.

For course I will write more than just about death. I felt death is a subject I had to address, get it out of the way.

In this regard, unless some very very unlikely accidental fortune should come my way, I will not have much by way of a material inheritance to pass on. I will not apologize or bemoan this reality, it is just what it is; besides, I would rather give you what I can give while I am alive.

For your information, I have always carried a substantial term life insurance policy - never whole life insurance. What this means is that if I died, you would have had an amount that would carry you through for a sufficiently reasonable amount of time without the necessity of other resources. When I retired I took out my last term-life policy for $500,000. I believe it expires in 2015 or 2016 after which time nobody gets anything. Continuing the policy after the expiration date is too expensive, surely not anything I can afford.

Back to present concerns. Paulo said he tried to post a comment on this blog but it was not accepted. I will get this corrected as soon as possible because I want you to comment. Alternatively, if you want to make a post, then use my email address and password. I recall I emailed this information to you. If you do not have it, let me know and I will email it to you again.

I am surprised none of you asked about the title of the blog. Walang sukat means without measure or cannot be measured or without a metric that can measure what one may desire to measure or what one may think needs to be measured. “Walang” means without and “sukat” means measure.

I am sure you all realize that what I write and will write is biased, maybe even shamelessly so. You are duly warned that while what I say will contain material truths what is selected and how these are woven together and given value will reflect by myopia. I will almost always try and portray myself as a tragic hero, a victim of time, circumstance, biology, misfortune and history that struggles to transcend it all. It is my opinion that everyone should portray themselves in like manner, a champion. This being said, I will backtrack and say that mythologies of the champion usually ignores or distorts one's relationship with others, the family community and the environment.

However, this is not to say this is or was – hardly so. There is everything else that is worthy of recollection, too numerous to grasp in a few lines of prose – walang sukat. A good example would be – and I was witness to it all – the moment of each of your births, your first breath, your initial response to the world only to quickly lapse back into a state of quiet and sleep.

When one of you was born (I will not say who), the nurse immediately placed you on a table with a very bright warming light so she could take an impression of your footprint and whatever else she had to do. Right after laying you down, she left, presumably to get whatever she needed.

I was not paying attention. I was focused on you laying there naked as the day you were born. You did not like where you were. You cried, made random movements with your arms and legs. I spoke to you as I leaned over and covered you with my two bare hands. You immediately stopped crying and calmed down.

When the nurse returned I withdrew my hands at which time you started up again. I was in the process of laying my hands on you again when the nurse informed me the light would keep you warm. She evidently thought that was the reason I was placing my hands on you. “It is not the light I said,” and preceded to lay my hands on you. You immediately stopped crying and calmed down. The nurse was surprised. She did her thing quickly, wrapped you in a warmed blanket and handed you to me. I believe I was the first one to hold all of you immediately after birth.

Bias is neither good nor bad, it is just there. One cannot not be biased. Ideally, we know many different biases, those of ourselves and others. Ideally, we know the difference between material facts, opinion, theory and myth. So, it may do you well (I cannot tell you what to do), to take whatever I say with hesitation and caution, maybe as a springboard for further deliberation or as a reason to be curious. At the end of the day, you choose and make for yourself what is best for yourself.

Maybe I am rambling so I will leave it here.