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In the Rearview Mirror, Two Weeks

Shooting the radiation machine before it shoots me.

Today was treatment #10 (26 to go) — so two weeks of salvage radiation are now in the rearview mirror. All’s gone well, but…

It’s a bit early for side effects to set in, and exactly what they’ll be, how severe they’ll be and how long they’ll last — well, those are the uncertainties, all of them idiosyncratic to each one of us. However, they did caution me today to be prepared for some side effects: There’s no get-out-of-jail-free card.

Fatigue, though, is a given, but then, fatigue is cancer’s spectral companion and a hidden cost of its treatment.

I’ve now experienced one full cycle of the treatment protocol: Radiation every weekday afternoon followed by a rad onc appointment (on Mondays) and a blood draw (on Thursdays). The blood draw is for a complete blood count (CBC) to keep tabs on what the radiation to my pelvic bones may be doing to the marrow that makes blood cells. Thursday’s CBC proved to be fine.

This is a short post, just a reader-board update. The best news is: There’s no news.

An Uneventful Event

Radiation Treatment #1 (complete with red laser)

I had radiation treatment #1 today, with 35 more in queue each weekday afternoon through Nov 8. No side effects expected for the nonce.

It was easy and uneventful — well, uneventful to my eye. We’ll hope some little prostate cancer cells met an invisible and violent death, but that was nothing for me to see or even feel. The treatment itself involved radiation doses from nine different directions into a band around my pelvis. Ground zero was the prostate fossa, the area where my prostate resided until surgery.

“Lay still and breathe normally,” they told me as I lay on a hard table. The radiation machine circled my pelvis, and the therapists occasionally tweaked the positioning. Some kind of red laser beamed at me from the ceiling next to a sign that warned, Do Not Look at the Laser. All cut and dried, chop-chop. Except.

Except for the frisson, the palpable sensation I’d not had since surgery four years ago. You know how something can happen, and it just drives home and makes vivid the reality of a situation? Surgery drove home, italicized and put in bold my stark reality of 2007: I’ve got cancer, and that’s not good.

Same thing today at Radiation Oncology at the Seattle Cancer Care Alliance. I can’t remember whether today’s realization came while waiting for my first treatment or while talking to the guy waiting for his last; whether I was arranging the schedule for future treatments or was looking helplessly at the radiation machinery arrayed around me. But that old, familiar reality came back and drove itself home:

I’ve still got cancer, and that’s not good.

Surgery + 4 (and More)

Cumberland Gap, TN, KY & VA

Cumberland Gap, TN, VA & KY

It was four years ago today that I had surgery for prostate cancer, and in nine days I’ll begin “salvage” radiation for prostate cancer. Surgery, hormone therapy, now radiation. This strikes me as a lot of treatment in a relatively short period of time — and I spent more than half of the past four years on hormone therapy! All courtesy of the two tiny tumors they found in my lymph nodes after surgery.

The much-awaited phone call came Friday with the date and time to begin rad treatment at the Seattle Cancer Care Alliance. I’m thrilled to get this on the calendar at last, and I’ll be even happier to get the actual treatment underway (remind me of this when the side effects kick in).

Yes, it’s my fault we’ve put radiation off for so many months. Too many travels planned too many months ago, but all the doctors were comfortable with the delay. I’m cutting it close, though: We’ll get back to Seattle on a Monday afternoon, and I’ll report for radiation duty at 9:00 the next morning (Sep 20).

My cancer is microscopic for now and shows up on no scans. So I just have to hope that it resides precisely where the radiation will hit, but there’s no guarantee of that.

As we say all too often in the cancer journey: It is what it is.

Cancer Park

Sri Lanka Aug 2011

Sri Lanka, Aug 2011 (Photo by Rebecca Curry)

Truth be told, my prostate cancer journey has thus far been a relative walk in the park compared to the medically invasive and dramatic, life-altering experiences of others. In the time since my diagnosis, the most disruptive event has been surgery, my radical prostatectomy, and that was only two nights in the hospital, plus recovery.

Contrast that with my friend Toby, who was diagnosed in March with Mantle Cell lymphoma and whose life was abruptly up-ended. He’ll undergo his sixth (and final) R-CHOP 21 chemo treatment today — and that’s just a prelude to his stem cell transplant later this month.

So while they’ve been busy poisoning Toby this summer, I’ve been off traveling in Peru and Sri Lanka, living life much as it was before my diagnosis. (Heck, I was traveling when I received my diagnosis!) Oh, Peru and Sri Lanka brought some unintended weight loss and hot flashes from hormone-therapy, but, as I say, a relative walk in Cancer Park.

That’s about to change with my impending “salvage” radiation. My radiation oncologist is now working on the specific treatment plan — the nitty-gritty to maximize the radiation dosage to offending tissue and minimize collateral damage to the healthy. Sometime in the coming days, a phone call will come with my start date for treatment: then five days a week for seven weeks.

I’m ready — even more than ready. I have my Calypso transponders in place, and on Aug 24, I completed the remaining preliminaries: three tattoos to assist in the targeting of the radiation; a custom-made leg cradle to hold me in place; simulation scans for aiming the radiation, and the official signing of the consent form. All I need now is that telephone call.

Radiation will be my third cancer therapy in four years, not counting the experimental drug I took as part of a clinical trial, and not counting the hormone therapy and the chemo med I’m currently on (both are part of the radiation protocol). But there’ll be no more radiation after this — they just don’t do it twice. There are no do-overs, no mulligans.

It either eliminates the remaining prostate cancer in me, or it doesn’t.

This Week in Cancer

Shaman's Ceremony -- Cusco, Peru. During this offering by fire, I learned via phone that my June 17 oral biopsy was negative. Interesting coincidence.

Monday, July 25, 2011. Lots of cancer doings this week, starting today with a full day at the Seattle Cancer Care Alliance. I’m writing this in the infusion waiting room on the fifth floor, soon to be summoned to resume hormone therapy (officially: androgen deprivation therapy). It’s my second round of ADT; the first time, I had one injection of Lupron every three months for a total of nine injections. This time, I’ll be on it for six months (two shots). Oh, and I’ll also be on Casodex, a chemo pill.

I dread the side effects of ADT — hot flashes, fatigue, mood swings, and general chemo-brain. They worsen with time, the longer I go with no testosterone. But prostate cancer feeds on testosterone, and so ADT is a good systemic treatment. While it works. Eventually, some cancer cells become androgen independent and grow quite nicely without it.

My Lupron injection is to be accompanied by an infusion of Zometa, a bone-strengthener to deal with my osteoporosis (another side effect of ADT). Cancer is so special: We get side effects that, for non-cancerians, are their own dreaded diseases.

It’s been so long that I’d almost forgotten that good news is possible in the cancer experience: My PSA today is sideways. There’s this little mind game men play with their PSA tests: What will it be? How much higher will it go this time? A little? A lot? What’s the number I’d dread to hear? So this PSA test, I played the PSA head game yet again: Q: What’s the best number I can hope for? A: No change.

And that’s what I got! Three months ago, PSA was 0.11; same today. Not sure what to make of it, what it all means, but I sure prefer “stable” over “raging.”

Wednesday, July 27. Today was my maiden voyage to an oncologic naturopath, a huge step for me. I grew up knowing medical care as something that came from a pharmacy, a syringe or a scalpel. But I went to a Survivorship symposium at the Fred Hutchinson Cancer Research Center in June, and they had a break-out session on ‘complementary’ (nee alternative) medicine. I was impressed with the two oncologic naturopaths who presented, and now one of them, Dr. Laura James, is on my side.

This step seemed fully consistent with my diet/nutrition efforts and no different than my looming “salvage” radiation (don’t you just love these terms they come up with?): It’s one more weapon to wield, one additional thing I can do and have some control over. I now have four, naturally occurring compounds in my repertoire of daily therapies, thanks to Dr. James. We’re off to a great start.

Thursday, July 28. Final cancer appt of the week (if you’re trying to keep track, the line score is: 1 infusion; 1 injection; 1 blood draw; 2 doc consults; and, today, 1 implant procedure). I now have three tiny Calypso beacon ‘seeds’ in my pelvis. These gizmos are part of my prep for radiation in the fall. Essentially what they’ll do is keep the radiation zapper on target. If my innards move, or I move, the Calypsos tell the zapper to move accordingly. That keeps the rad beam on target and thus reduces collateral damage to healthy tissue.

Since I leave Sunday for three weeks in Sri Lanka, I’m thinking it’s going to be v-e-r-y interesting dealing with TSA when I march through the airport security scanner with these little Calypsos in me.

What’s wrong with me(n)?

Until July 24

Since poking my head up into the cancer blogosphere, I’ve been looking about a bit, reading blog posts here, there and everywhere. It’s been a grim revelation to see and hear the emotional pain that can accompany cancer.

And, I’m sorry to report, how often men are the wellspring of much of that pain.

No, I’m not saying all men. There are uncountable numbers of men out there who are loving and supportive caregivers all. You can read that in the blogosphere, too: In toting up her cancer blessings, Nicole, larynx cancer, thanked from her heart, Don, my husband — industrial strength, flawless diamond support and escort service for all my treatment needs. My indefatigable rock, he always finds a way to time his jokes when I’m not trying to swallow.

But there is a Guy Thing out there, make no mistake, and I did not set out to find it. I was merely skimming posts, literally just looking out the window while on my cancer journey. And this is what I saw:

A woman with breast cancer, metastasis to her lungs: Don’t know how I’m going to find the strength to do everything I need to do to get rid of this cancer & still work full time which is what my husband seems to think I need to do 😦

A woman with ovarian cancer, in her 40s: Facing a second recurrence, and I am terrified right now. My mother died 18 months ago, after an 11-month bout with OC. Then my father passed away nine months ago of heart failure. So I already had grief and stress in my life, plus my main source of comfort and support is gone. My former husband was not the best of support, but our marriage ended five months before my mother died. So I am crushed at the daunting prospect of going through treatment again.

Another woman with breast cancer: I’m so depressed. I don’t know if it’s my cancer, my new fake breasts, my nasty husband or just life…. I hate my new nipple-less fake breasts, they don’t feel like a part of me and my marriage has fallen apart because my husband refuses to be a part of my cancer afterlife. He won’t touch me, he hates me and wants the old me back.

A woman with stage 4 kidney cancer: My relationship fell apart because of cancer. He couldn’t come to terms with it, and I got tired of the guilt of focussing on my self.

And then I recalled the lady on a Survivor Panel, June 26, 2010, “Moving Beyond Cancer to Wellness” at the Fred Hutchinson Cancer Research Center here in Seattle. She had been diagnosed with lymphoma, I believe, and the prognosis had not been good.

“My husband came to me one day and said, ‘I’ll take care of the kids, but I can’t handle your cancer.’” She then explained that there was no way she was going to put her husband, her children and herself through the stresses and pains of divorce only to…die. However justifiable a divorce might have been, she just wasn’t going to cause a family wreck and then leave the scene. (What a classy lady, I thought then, and I think so still.)

She finished her remarks about cancer’s impact on families and then came the Q and A. Someone in the audience finally asked about the elephant in the room: “What became of your marriage?”

“When I realized I was going to live,” she answered, “we separated.”

Today: Cancer 1, Bill 0

When it's nice in Seattle, it's *really* nice.

First off: This is not a complaint. It’s a simple illustration, a sketch — maybe even just a scratchpad doodle — of the ways in which cancer is always a companion, calling attention to its unwanted self. A reminder that cancer is a grift that keeps on grifting.

It’s a warm, sunny day here in Seattle, and I’m inside in bed.

During a routine check-up, my dentist had observed an unusual spot on my tongue and some sun damage on my lower lip. A second cancer? A distant outpost of the first? She wanted someone to look at it all, maybe even do a biopsy. So off to the specialist yesterday for a look-see, and back to him at 7 this a.m. for the biopsy and some laser treatment. Heavy sedation, stitches, pain killers — sleep it off.

I’m judging it was a difficult call for the oral surgeon. The areas in question presented themselves pretty much as non-threatening. He thought in silence and finally began his conclusion: “With your history…”

My cancer. And neither one of us would take a chance: There would be no spin of the cosmic roulette wheel, no hopeful gamble that the ball would drop into a No Cancer pocket. So we’d do the biopsy and the laser, and I’ll heal. But when the biopsy results come back, we’ll know, not hope.

No, I’m not whining or grousing. I’m just still discovering how cancer works. In the larger scheme of cancer and others’ circumstances, a twist like this is No Big Deal. It’s nano-to-micro.

But that’s how cancer works: Its affects on life come in all sizes.

Sticky Note #1

Throughout my cancer journey, I’ve made mental and physical notes to myself about cancer, about people with cancer, about my cancer. They’re random, casual and brief — almost all would fit on a sticky note. This is my first sticky note.

Early on after my cancer diagnosis, Kristina, a friend then in a courageous contest with breast cancer, advised, “Don’t get caught in the Calendar Game” — that bell curve of statistics that seeks to bracket the X and Y of years of probable longevity. “Those numbers include all kinds of people,” Kristina said. “Focus on your disease, your treatment and your health.” I’ve always thought that was sound advice: There are people in those numbers with multiple health problems, people who never took care of themselves, people who don’t follow their doc’s advice, and on and on. They become part of the odds, and probabilities, and chances. It’s about all, not about you. Or me.

Focus on your disease, your treatment and your health.