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 Tales from real life |
| Well, if they're not true, they oughta be! |
| Part 2 - Decisions "The Blue Ribbon (part 1)"  Sadly, cancer is big business these days with a much too large customer base. Halvorson Cancer Center is just one part of the cancer complex in the west wing of Evergreen hospital. It’s a modern facility that opened in 2012, with wide corridors, pleasant décor, and the latest equipment for cancer diagnosis and treatment. Virtual Tour: https://www.youtube.com/watch?v=sbYjQFEXYoI That’s where I went to meet with the radiation oncologist. Debbie went with me to offer her support. The self-described ‘concierge’ who checked me in for my appointment with Dr. Taylor is a nice guy with a friendly smile. He welcomed me to the oncology ‘family’ and insisted on taking my picture. “So everyone will recognize you and know your name,” he said. “Sure, thanks,” I replied with an automatic smile. No, I don’t want this, I objected silently in my head. I don’t want to join your stupid family. I’m going to get this thing cut out and be done with it. I don’t belong here and I won’t be back! I wasn’t in a receptive frame of mind, but I held my tongue and listened politely as Dr. Taylor shook hands and launched into a detailed explanation of my particular case. He covered a lot of the same ground as my urologist, Dr. Dai, but I’d been too shaken up at my meeting with her to take it all in. He also revealed that he was a cancer survivor himself, having undergone prostate removal twenty years earlier. Dr. Taylor explained that the tissue samples from each cancerous area are evaluated and given what’s called a Gleason score. The numbers range from one to ten and higher numbers are worse. Mine were mostly sixes and sevens. That meant my case was, in fact, serious. Based on my Gleason score, physical exams, PSA level, and various scans, I was given an overall cancer stage of T2a. Or, in simpler terms, unfavorable intermediate risk. My face must have shown dismay at the word unfavorable. “Don’t panic,” Doctor Taylor told me. “It’s not as bad as it sounds. You don’t need to put your affairs in order just yet. Your cancer is still very treatable. Your outlook is a matter of years rather than months.” Somehow, the word years wasn’t very comforting. We all expect to have a long, vague number of years. Hearing the word months was disheartening. It made the end seem a lot more specific. But I still had a decision to make about how my cancer treatment would affect those years. Dr. Taylor showed us projected outcomes based on thousands of case histories of similar patients. There’s a progression of cancer treatments, beginning with a surgical removal of the tumor. If that isn’t successful, the next option is radiation therapy. And the final option, for metastatic cancers, is chemotherapy. The data from similar patients showed that even with immediate surgery, I would have a 76% chance of needing radiation therapy in the next ten years. And there was a 91% chance that cancerous cells were already beginning to invade the surrounding tissues. That wasn’t what I’d hoped to hear, so I had to pause and rethink my options. Dr. Taylor gave us a description of intensity-modulated radiation therapy (IMRT). It combines a CT scanner and a radiation beam powerful enough to damage cancer cells. The damaged cancer cells are unable to reproduce and can then be broken down by the body’s natural healing processes. The IMRT machine scans as it rotates the beam around the patient. That allows the beam to precisely target the prostate gland and a computer program varies the power as it moves. The radiation beam is always focused on the prostate, but the angle of the beam varies as it rotates to minimize damage to the surrounding tissues. Healthy cells can recover from radiation damage if it isn’t too severe. That can preserve at least partial prostate function. Even so, side effects of radiation therapy can include fatigue, urinary distress, abdominal pain, and diarrhea. Dr. Taylor explained that IMRT therapy can treat cancerous cells around the prostate gland as well as those within. Another advantage of IMRT is that the side effects are usually less severe than surgery and certainly less immediate. With IMRT, I could spare myself the trauma of an invasive surgery, enjoy a more normal life in the short term, and possibly in the long term as well. Suddenly, being in the oncology family didn’t seem so bad. I felt like I should go back and apologize to our concierge. Deb and I met a second time with Dr. Dai to give her a chance to offer a rebuttal. She looked at the projected outcomes and agreed that Dr. Taylor’s numbers were valid. She also conceded that surgery couldn’t guarantee removal of all the cancerous tissue, and it would put an end to my prostate function. One common reason to opt for surgery, relief of urinary problems caused by an enlarged prostate, wasn’t a factor for me. Dr. Dai did point out that surgery isn’t done following radiation therapy, so I couldn’t change my mind later. But when I asked directly for a recommendation, she demurred Dr. Taylor hadn’t given a recommendation either. My case resides in that anxious gray area of who knows? If my cancer was less aggressive or less advanced, then surgery would be the best choice for a cure. Get it out and get on with my life. That had worked out well for Dr. Taylor. If my cancer was more advanced, then radiation or chemotherapy would be the only choices. Managing the disease more so than curing it. But I was in between with my unfavorable intermediate risk. Surgery might be successful for me, but the odds weren’t great. In addition, the numbers showed that my fifteen-year survival outlook would be almost the same with either treatment option. In the end, I chose to avoid surgery and go for a better quality of life in the short term. And I can still hope that my prostate function returns over time while the cancer doesn’t. So, I embraced my oncology family and asked Dr. Taylor to schedule me for radiation therapy. I was ready to get started right away, but it turned into a case of hurry up and wait. The first step was yet another scan on November 27th. This time it was a CT scan to get a more accurate map of my prostate gland and my pelvic bones. The scan confirmed that my prostate was enlarged (53 cc). It also showed that my pubic arch is high enough to make me a candidate for Brachytherapy. There are two methods for irradiating prostate cancer. IMRT is external and Brachytherapy is internal. IMRT requires 15-minute sessions at the hospital five days a week for six to ten weeks, while Brachytherapy is a one-time outpatient procedure. Brachytherapy involves implanting radioactive seeds within the prostate gland to deliver radiation directly to the cancer cells. A needle is used to place the seeds, and they're inserted through the pelvic opening. Women have a wide pelvis with a high pubic arch to accommodate childbirth. Men have a narrower pelvis and the pubic arch may be too low to allow access for Brachytherapy. For those cases, a full 10 weeks of IMRT is required to deliver the desired radiation dosage. DDr. Taylor used all of my diagnostic data to prepare a customized treatment plan and presented it to the oncology review board the first week of December. I was approved for 6 weeks of IMRT followed by Brachytherapy. The IMRT sessions would treat the cancerous cells in and around my prostate from the outside in. Then the radioactive seeds would finish the treatment from the inside out. For me, the combination of the two therapies would be more effective than either alone. But I still wasn’t quite ready for irradiation. I learned that there’s a less obvious fourth therapy for prostate cancer and I would actually be starting with that one first. It seems that prostate cancer cells feed on testosterone, and they also need it to reproduce and spread. Using an androgen blocker prevents a man’s body from producing that testosterone fuel. That starves the cancer and shrinks the prostate gland. And a smaller prostate enhances the effectiveness of the radiation treatment and reduces the impact on surrounding tissue. So, on December 4th I got my first dose of hormone therapy. It comes with its own set of side effects, similar to menopause, including fatigue, irritability, and hot flashes. There are many supplements advertised on TV for low-T. Well, I’m operating on no-T. It’s frustrating to deal with, but it might save my life. I struggle with my usual yard work and some days I just nap all afternoon. And the hormone therapy also causes smug comments from the women in my life, "Now you know what we go through." The hormone treatment is effective though, my prostate volume shrank by half, to 24 cc, over the next three months. By March of 2025 I was already showing real improvement, even though I still hadn't received any radiation. |
| Part 1 - Diagnosis My blue ribbon story begins with a routine yearly physical in September of 2024. My blood pressure and cholesterol numbers landed in the normal range for a 67 year-old male, but my A1C had risen just high enough to qualify for diabetes. That was a bit disappointing, but not unexpected. My family has a history of type II diabetes and I’ve always had a sweet tooth. My doctor and I agreed that I would modify my diet, get more exercise, and recheck my A1C in six months. A bigger concern was that my PSA had jumped from 4 to 18. I hadn’t experienced any physical symptoms, but an elevated PSA is usually an indication of prostate cancer. My GP told me not to be overly concerned, though. He said that there are other conditions that can cause a high PSA and he ordered another blood draw to confirm the result. The second test came back at 16. Diagnosis confirmed? Not quite. Doctor Chan wasn’t ready to use the C word just yet. “There’s no reason to panic,” he told me. “I sometimes see patients with a PSA in the hundreds. But l do want you to see a urologist and get checked out more thoroughly. Next week.” The urologist’s office confirmed my appointment immediately and the quick response seemed ominous. I’m used to waiting weeks to get a non-emergency appointment at our primary health clinic. But only four days later, I gave up a urine sample to be tested while I was being poked and prodded in the exam room. I faced a battery of questions from the urologist about my personal habits. Questions that no one even wants to hear, let alone answer. But that became a recurring theme over the next weeks and months. The prostate is both a gland and a muscle. It produces part of a man’s seminal fluid and also provides the ‘push’ required for ejaculation. The prostate gland completely surrounds the urethra and sits next to the rectum. Issues with the prostate can affect urination, bowel function, and sexual performance. This guarantees that the health questions required for diagnosis will be intrusive and embarrassing. My urine test at the urologist’s office didn’t reveal anything unusual, but they did find cause for concern during the ‘digital’ exam. There weren't any obvious nodules or masses, but my prostate was noticeably enlarged. “No reason to panic,” Doctor Dai told me. “It may be nothing serious. But l do want you to have an MRI. Next week.” The MRI appointment was confirmed immediately. Again, the urgency seemed ominous, and again, the doctors all said it was premature to use the C word. Nevertheless, my anxiety level ratcheted up. A few days later, I was lying on my back in the claustrophobic tunnel of the MRI machine. I kept my eyes tightly closed, partly because I don’t like tight spaces and partly because I was dreading what they might find. Still, I needed to know if the outlook would be good or bad. And I got bad. The MRI images showed lesions on my prostate gland. The MRI also showed a prostate volume of 63 cc, a significant enlargement over normal. “There’s no cause for panic,” Doctor Dai said. “It probably isn’t serious yet. But we’ll have to do a biopsy to see exactly what we’re dealing with. Let’s schedule it for next week.” Despite all assurances, the trajectory of my diagnosis seemed to be headed downhill. I’d gone from not serious to not serious yet. And the sense of urgency remained. I tried to stay calm and keep a positive attitude for my wife, Debbie, but I had a bad feeling and I did a poor job of concealing my anxiety. The biopsy was performed by Dr. Dai on September 30th, less than three weeks after my GP first noted the elevated PSA level. Prostate biopsy is a relatively minor outpatient procedure, similar to a colonoscopy, with the patient under a light general anesthesia. A hollow needle takes tissue samples from suspicious areas of the prostate as identified by the MRI scan. The doctor is guided by an ultrasound probe and also does a more thorough physical exam of the gland while they’re ‘in the neighborhood’. The side effects are mild, and recovery requires only a few days of restricted physical activity. The emotional impact was far more severe. I didn’t want to think about a negative outcome, but simply having the procedure forced it on me. Debbie and I met with Dr. Dai the following week to discuss the results. This was the meeting where we finally used the dreaded C word. Ten of fourteen cores taken from my prostate were positive for cancer. It had already spread throughout most of my prostate gland. Dr. Dai explained the surgical treatment option, total removal of the prostate and surrounding lymph nodes. She also described the probable side effects of surgery such as incontinence, impotence, and infertility. And my case would be complicated by the presence of a surgical mesh that had been implanted in 2021 to treat an inguinal hernia. There wasn’t any good news. My initial reaction was a panicky impulse to get the tumor cut out immediately, today if possible. I wanted the damned thing gone. But there’s a mandatory six-week recovery period between biopsy and prostate surgery. That meant waiting until mid-November at the earliest. And Dr. Dai recommended that I get a second opinion from a radiation oncologist before making a final decision about treatment. She also scheduled a bone scan to determine whether the cancer had spread beyond my prostate. There weren’t any more comforting assurances, the cancer diagnosis was serious. The only question left was how serious. I spent the next two weeks in tense apprehension before getting back to the hospital for my second another scan. The urgency felt very real now, and time dragged slowly as I waited for the next piece of bad news. In my mind, the bone scan would reveal whether my case was treatable or terminal. I could almost feel those insidious cancer cells breaking away and spreading through my body. What if today is that day? What if next week is too late? A bone scan is done to look for cancer cells that have migrated to other parts of the body. A radioactive marker that binds to cancer cells is injected into the patient’s bloodstream and the scanner creates a full-body image of where the marker accumulates. For some odd reason, cancer cells show up in the bones first, so that’s where the doctors look. If there’s no cancer in the bones, then it hasn’t spread. The marker injection is relatively painless but awkward. It’s done slowly, over the course of a minute or so, and the patient has to stay still. Then there’s a waiting period of two to four hours while the body absorbs the marker. I was told that the amount of radioactivity in the injection is less than what is received during a CT scan, and that no one ever has an allergic reaction to the marker chemical. The only recovery advice is to drink extra fluids to flush the marker from the body. It’s important to look beyond the initial tumor site because metastatic cancer is much more serious. The treatment options are more invasive, the side effects of treatment are worse, and the long-term outcome is less likely to be positive. Thankfully, my bone scan was negative (although it did show significant wear in my arthritic knees). I felt considerable relief at this bit of good news. Maybe there is light at the end of the tunnel. At least, I wouldn’t have to start out with chemotherapy. But I still needed to decide on surgery versus radiation. So, the next step was to schedule an appointment with Dr. Taylor at Evergreen hospital for November 12th. It was at this point that I ‘came out’ to my friends and family. I hadn’t wanted to frighten them until I had a firm diagnosis. Their outpouring of support was encouraging. My daughter Megan immediately brought me a T-shirt emblazoned with a cat giving the double bird and a caption that reads simply Hey, Cancer. Debbie gave me a St. Peregrine medal to wear. He’s the patron saint of cancer patients. I’m not sure if I believe in the intercession of the saints, but I haven’t taken it off either. When I’m feeling down, I can reach up and touch it. It’s comforting to know that Deb is praying for me. My daughter-in-law Mary gave me a ball cap with a row of colored ribbons that represent different types of cancer. It says Cancer Sucks in Every Color. I knew about the pink ribbon for breast cancer, but I had to search online to find out that there are actually many colors for many cancers. My ribbon, for prostate cancer, is light blue.  "The Blue Ribbon (part 2)" |
Winston Churchill said, "History is written by the victors." And he literally did that with his 4-volume book A History of the English-Speaking Peoples. I bought it as a box set years ago, and I still intend to read it – someday. I'll paraphrase Churchill and suggest that personal history is written by the survivors. As writers, we get to choose the stories we tell as well as the way we tell them. Especially family stories that no one else is left to remember or contradict. An old friend from my college days reached out after our usual exchange of Christmas cards. Dave and his wife had visited us ten years ago when he was in the early stages of Parkinsons and they were going to be in our area again this spring. It was good to see them again and we spent a pleasant evening together at a nice restaurant. His symptoms are progressing quickly now, and I'm undergoing radiation treatment for prostate cancer. We commiserated about aging poorly and our diminished expectations. Neither of us has a certain future in front us. Dave was intrigued to learn that I've taken up writing in my forced retirement. He told me that he really enjoyed a short piece I'd sent him, "Xfinity and Beyond" , and paid me the compliment of comparing it to the humorous work of outdoor writer Patrick Mcmanus. I was flattered enough to give Dave a physical copy of my memoirs, Terry Tales . He emailed me this week to say that he was especially touched by the stories about my dad and asked if I'd ever shared them with him.My dad passed away in 2007, so he never saw any of my stories or poems. I would like to have shared them, but I'm not sure that I could have. His last few years were diminished by strokes and diabetes. He could no longer do a full day's work, and he sank into an angry bitterness. One of the many reasons I detest Fox News is that dad wasted his final days watching their news-actors spewing lies and selling hate. He wouldn't even turn it off during our infrequent visits to the ranch. That made me feel resentful and made our visits seem like a chore. It took some time and distance to come to terms with those feelings. I know that bitter old man wasn't really my dad anymore. He may even have been suffering from early symptoms of dementia. So, I choose to remember the good times with my stories and honor the man he was for the first seventy years of his life. Sure, he had his faults, but he worked hard, laughed often, and dealt honestly with his neighbors. That was my dad, and no one is going to contradict me. |
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