Leap Year

Leap year comes once but every 4 years and every 4 years I do a double take when I look at a calendar and see February 29th.  I've did a double take after I found out that my next step in prostate cancer treatment, seeding the prostate gland with little bits of a radioactive substance, was scheduled for the morning of February 29th.  

So imagine my surprise when I received an email from the builder of our new house in Arizona saying that they'd like us to come on down for the closing on our house to trade a large sum of cash for title and keys on February 29th. What are the odds?  

By the time you read this I'll be move in ready!

The builder broke ground the day I received my cancer diagnosis.  So in the race to see whether I'd beat cancer first or have to cough up money for a house I can't move into until I beat cancer is over, the house won. Needless to say I can't hand over money in Arizona while I'm sedated and having an invasive medical procedure performed on me in Seattle so my wife called the builder and sweet talked them into a no cost extension, because moving into a new house is a really big deal but becoming cancer free is job #1 prime directive now.  Only after recovery can I seriously think about job #2: paying for the new house, moving to the new house and selling the old house.  New house closing date is now March 15, the oncologist says I should be roadworthy by then.

I'm in the home stretch of daily radiation treatments and can't wait to hit the 5 week finish line.  The most annoying radiation side effect so far has been on my bladder.  Driven crazy by radiation it's in perpetual freakout mode, always alerting me that it's full and ready to burst. "I gotta go!!!!!", Right NOW!  There are no half measures, no stalling, no putting it off for the next rest area on the freeway.  It's always seems like a matter of desperation.  I sometimes awake every hour during the night to stumble to the bathroom and pee and man, is that annoying.  My oncologist says that this should diminish when the daily radiation stops, only to pick up again in March when radiation will be permanently installed in the prostate gland itself.  It should permanently diminish as the radiation half life decays the radiation away, kills the cancer and the seeds become inert.  Those inert seeds will go to the grave with me.

So how is this seed installation done?  What happens after the radioactive seeds are implanted?  If you're curious click here and read,

WHAT TO EXPECT FROM A SEED IMPLANT: THE FIRST TWELVE MONTHS

I received that in the US mail and it was most likely written by my oncologist as his name is first on the masthead. 

I had been under the impression that they would place these radioactive seeds in my prostate gland through my back door just as the urologist previously biopsied it but this isn't so. 

Following anesthesia, thin needles containing radioactive seeds are precisely placed under ultrasound guidance through the skin between the scrotum and rectum and into the prostate.

Yow!  That sounds like a frightening thing to let strangers do in a very tender place.  Anesthesia isn't what I thought it would be either:

The first choice is a spinal anesthetic where a thin needle is inserted in the lower back and a Novocaine-like medication is injected. With spinal anesthesia, patients are temporarily numb from the waist down and will not feel any of the needles being placed. In addition to the spinal anesthetic, patients commonly receive a sedative intravenously so that they are more relaxed and often sleep through the procedure. The spinal anesthesia is the most frequent choice of patients and the one that we usually recommend whenever possible. 

The second choice is a light general anesthetic so the patient is completely “out.” This works well but patients are often groggy for some time after the procedure. The anesthesiologist will review the details including both pros and cons of these two approaches. Sometimes the type of anesthetic is determined by the patient’s overall medical condition; other times it is a choice for the patient to make.

Make mine choice #2, light general anesthetic. I don't want to experience the lower half of my body turn numb while I watch people insert things into me.  I know that this work needs to be done, wake me when it's over.

Radiation Treatment for Prostate Cancer

I'm into my second week of 5 weeks of daily radiation treatments for prostate cancer.  Each morning I take the bus to the Polyclinic on Pill Hill, change into pajama bottoms, lay down and position myself into a plastic cast of my calves and feet and present myself to huge round device above me that looks like something out of a planetarium.

Technicians come in to verify my identity by asking for my birthday.  Then they pull my pajama bottoms down around my hips so they can find my little freckle tattoos in order to align me properly and hopefully avoid irradiating of any innocent bystander organs.

Once alignment is complete the technicians leave the room, close the door and the process begins.  I feel nothing and hear little.  Other than an occasional click there's no sensation of any kind.  When there's music it's been jazz or country.  After 10 or 15 minutes a technician comes in and we exchange pleasantries and it's over until the next time.  See you tomorrow!  I change back into my street clothes, leave the hospital and get back on the bus. 

That's it?  Beating cancer can't be that easy.  And it's not.  I've been warned that side effects are coming, specifically weakness.  And there might be some skin burning.  And other more invasive and unpleasant procedures will come after my 5 week course of radiation is complete and my diseased parts have been properly prepped.

One side effect that I am experiencing is an unusual flatulence.  It doesn't seem to matter what I eat.  It starts in the afternoon and continues for most of the night while I sleep, a sort of bubbly and near constant, sometimes painful production of gas.  Radiation is administered 5 days a week so when the flatulence faded over the long holiday weekend I suspected the radiation.

During my 5 weeks of radiation I get 5 minutes a week to talk to my oncologist so I asked him if the flatulence and radiation were related.  He smiled weakly,  nodded affirmatively and added, "there's going to be some mucus too".  Oh goody, gas and liquids.  "Will I get any warning or will it just happen?".  He smiled again.  "You'll get a warning".

It's not much of a warning though.  I'm starting to find the whole radiation experience to be just a bit creepy.  It's a treatment that I can't hear, see or feel yet I'm starting to experience the side effects.  The radiation has inflamed my bladder so I urinate frequently.  When I go anywhere my first task is to seek out and note all bathrooms.  I can't sleep more than 2 or 3 hours without having to get up to pee.  I'm looking forward to a period when I can recover from my treatment and prepare myself for the next much more invasive phase.

Golden

The implantation of the gold markers inside of me has been completed.  They had me take off my clothes and lay on my side to expose my behind. I thought that I heard the urologist come in and say hello but I don't recall seeing him.  But I sure felt what he was doing, it was knuckle bitingly painful, for hours after it felt as if someone had yanked a bath towel made of Brillo through my back door.  But by the next day the burning pain had subsided.  Bring on the next procedure, of which there will be many.

Perhaps I've been kidding myself.  Maybe the last stage was something other than acceptance.  Maybe it was denial.  Denial of the fact that while mundane daily life goes on around me I've been able to briefly put this looming life challenge out of my head for 2 weeks.  I sometimes forget how serious a slow motion terror this is but get shocked back to reality. The other night I was on the phone with a friend and we were discussing rock stars who had died prematurely.  I knew that Dan Fogelberg, a moderate star in the 1980's, had died in his 50's but I couldn't remember of what.  My friend was near his PC so he looked it up.  "Oh no, sorry", he said.

In May 2004, Fogelberg was diagnosed with advanced prostate cancer. After undergoing therapy, he achieved a partial remission. On August 13, 2005, his 54th birthday, he announced the success of his cancer treatments. He said that he had no immediate plans to return to making music but was keeping his options open. However, his cancer returned, and on December 16, 2007, Fogelberg died at the age of 56 at his home in Deer Isle, Maine.  His ashes were scattered into the Atlantic Ocean.

The prostate cancer in a man in his 40's or 50's is often much more virulent than the prostate cancer in a man in his 60's.  Mine's bad enough but as far as I know I don't have advanced prostate cancer.  

This is my fight but medical mercenaries help me fight it as I can't run the radiation machine or decide how much radiation is just enough to keep suppress cancer without French frying my insides and I can't reach in somehow and seed my own prostate gland with just the right amount of radioactivity. I'm glad that there are people who do this work because I sure can't. All I can do is report on time, clean and prepared for treatment, to bite down and bear the pain, to be cooperative with the doctors, nurses and techs and to pay the bills after the numbers been filtered, massaged and spit out by the medical/insurance industrial complex.

How much should curing cancer in an individual cost? I'm seeing lots of fancy and expensive equipment overseen by highly trained and talented people who administer fancy sounding tests and drugs to me, surely none of this comes cheap. But the numbers on my itemized bills don't mean much to me as I have no basis to assign a value to the various tests and procedures that I'm being subjected to; in some cases I don't even know what they are or what I'm paying for. 

The insurance company knocks the numbers down, in some cases substantially, and on the bottom of each bill I'm left with a sum to pay. And I pay that sum and pay it promptly because I'm paying people who say that they have a track record in doing what a few years ago was nearly impossible: saving the lives of people with cancer and that is where the real value is to me.

Cancer Coming Attractions

I'm starting to realize that emotionally for me cancer appears to have stages. The first one was the I'm gonna die stage. It started with the moment of my diagnosis, lasted for 2 weeks and was marked by emotional instability, no sleep and the desire to "get my affairs in order". It was an awful time when I didn't want to do anything or see anybody.  There was going to be no further retirement, no new house, no future, no nothing. Cancer and death tinged my every thought.

I'm in the 2nd stage now, acceptance. I have doctors and a plan so I have some confidence that I'm in good hands. Things could be much worse, at least I don't have a gruesome big league cancer like glioblastoma multiforme, or GBM. In this 2nd stage not much has happened. I got a hormone shot and I took some pills and got a mildly invasive back door ultrasound but other than that I've resumed my normal retired life and haven't thought about cancer much. But I sense a gathering treatment storm, I now have so many upcoming medical appointments that I've had to use Google Calendar to track them all.

The 3rd active, invasive and radioactive stage is about to get underway. Soon I'm going in for the internal implantation of gold markers. I was told that it's just like a prostate biopsy (!) except with no snapping sounds (the peeling of the prostate is accompanied by snapping sounds as the harvesting instrument does its back door deeds). That means an experience as close to prison rape as I'd like to get, urinating blood and other jarring side effects. Perhaps carrying the gold markers will be something new to explain to airport security screeners if I get x-rayed by the TSA, assuming that I get through all of this and live to fly again.

Soon after I report to the downtown radiation/oncology center for something that on the phone sounded like a simple consultation session. Then an envelope arrived in the mail containing a flyer with an ominous heading that read, 

PLANNING APPOINTMENT FOR RADIATION TREATMENT 

An excerpt: "A bean bag mold of your hips will be used to position you in the same way each day. A few tiny, pin point tattoos will be placed on your skin. These tattoos will assist in positioning throughout your daily treatments".  My first tattoos!

The flyer goes on to instruct me about my sit down bathroom habits (they want daily and on schedule production), what to eat to get the desired solid and gas levels, when to pee and how much pee to leave inside for them. "We would like your bladder to be partially full for your CT and each day when you are treated. Please, urinate 30 minutes before your CT and then each day before your treatment time to empty your bladder. Then drink 8 ounces of water or non caffeinated fluid and do not urinate until after your CT or Tx". I don't even know what a Tx is but for all I know I'll be getting one (or more) daily starting before New Year's Day.  Radiation treatments will be daily and last for 5 weeks so hello again daily commute, bring out those lead lined King County Metro buses.

The power of radiation

After all of this will come the 4th stage, one so invasive that anesthesia will be required and when I awake I'll leave sore and with even more radiation. The anesthesia is a good thing, please bomb me back to the stone age if the hands of strangers and their medical tools must enter me there.

Now men have their own unique and manly exam room stirrups

After that the healing can begin and if everything goes according to plan an old home can be sold and a new home purchased and I'll be able to gratefully add cancer survivor to my list of life accomplishments.

Man Plans and God Laughs

I've encountered a major obstacle in my retirement plan of selling our home and moving into our new home presently under construction in Arizona. I've been diagnosed with an aggressive form of prostate cancer.

My urologist and oncologist say that it's probably treatable with a triple play of hormones, radiation and something called brachytherapy ("seeds"). One thing is for sure, the house in Arizona is being built and cannot be cancelled, the only way for me to get out of this financial legal responsibility would be for cancer to win and for the builder to sort it all out with my widow and my estate. On the day that I received my cancer diagnosis I also received an email with a picture of the first home site construction activity, the foundation being poured, so now the race is on.

This is the sort of health crisis that I've always feared even as I knew it would increase in probability as I aged. It means having for the first time to stick my head deep into the mouth of the medical/insurance lion. When we move to Arizona we will lose my wife's insurance and be cast into the Obamacare cauldron.

There have been bright spots though. My GP and urologist say that they found it early. Bone and CT scans show that the cancer has not spread. Right now I feel fine physically, if the doctors hadn't told me I'd never know. My wife is down for the struggle and as long as she's working we both have good insurance. I contacted my surgeon friend in San Diego and he was much more than just supportive, he spoke with my oncologist and asked him the questions that I'd never know to ask. He also checked out the triple play I'm about to undergo with several oncologists and urologists at his hospital, in essence giving me a 2nd and 3rd opinion because when it comes to complex life and death personal medical questions like this WTF do I know?

When the house in Arizona is completed the builder will summon me to come with payment. I can have the money to give them if we sell the house here. I can only sell the house here if my treatment is complete and I'm cancer free. So as I said earlier, the race is on. Assuming I'll be cured, will the house be completed first or will I be cancer free first? As of last contact all of the wooden bones of the new house are up and the new home is quickly taking shape down there. Here's my to do list, any one item alone would be a major undertaking:

• Beat cancer 
• Cough up a large sum of money and give it to the builder in Arizona 
• Sell our old house  
• Pack all of our belongings and get them to AZ (method to be determined) 
• Unpack and then move in to our new home and feather the new nest with appliances, bed, utilities and the basics 
• Obtain and pay for new health insurance on the open market (Obamacare) 

So I guess that my retirement won't be as peaceful as I had planned, at least not in the short run. I'm glad that I managed to get in the Asia trip last year and the cross country drive earlier this year. It appears that I'm in for quite an eventful tail end of 2015 and 2016 and if/when I emerge on the other side of all of this I might be a changed man, at least emotionally if not physically as well. But we play the hand that we're dealt, nothing in life is guaranteed and nobody gets out of life alive. It's just that as we age these truths that we've heard all of our lives slowly become more obvious.

I'm an MRI machine, let me see if your cancer has spread.