Life’s Challenges, Additions, and Rewards

Challenges

A few of you know this, but not many. I was diagnosed with Prostate Cancer in 2017 after a long overdue PSA test followed by a prostate biopsy. The Doc said it was at a very early stage and that like most men at this stage, I could just continue getting a periodic PSA test and a biopsy once a year. The “wait and watch” approach. Many men will get prostate cancer and eventually die of something else before cancer becomes an issue so waiting and watching seemed to make sense.

By the fall of 2021, my PSA results had been slowly going up and the results of the last biopsy indicated that perhaps a more aggressive approach was warranted. We were ready to depart for the winter and the Doc assured me that waiting another 6 months wouldn’t make any difference. So I made the appropriate appointments for the following spring and we left.

There were two approaches at the time to deal with prostate cancer, surgery to remove the prostate gland or radiation. Both have advantages and disadvantages. I chose a surgical path, it was more definite. The radiation option while usually effective made a follow-up surgical approach if needed much more difficult.

Surgery was scheduled for July 2022 with a two to three month recovery. The surgery was robotic and scheduled for 280 minutes. It didn’t take quite that long. As they were starting the initial sedatives all I wanted was to get it done and wake up. After the surgery I stayed overnight in the hospital and went home the next day.

The recovery process wasn’t too bad. I had five or six incisions from 1 to 2 inches long, it looked like I was in a knife fight and lost. I had a couple of follow-up appointments and all was progressing well. I was scheduled for a PET scan to see if there were any indication that the prostate cancer had spread. A post-surgical pathology report detected a very small amount of prostate cancer in one of eight lymph nodes that were routinely removed with the prostate.

The PET scan showed no other indications of prostate cancer but did show a positive indication of something in a lymph node in my neck. There was no swelling or pain there. The medical oncologist scheduled a biopsy which indicated a type of lymphoma cancer. A bone marrow biopsy confirmed cancer had not spread into my bones. And another lymphoma-specific PET scan confirmed that it was confined to the lymph node where it was found.

So when we were just over a month away from leaving for the winter, we met with the medical oncologist and a radiation oncologist who both recommended a 12-session focused radiation treatment. I scheduled the initial visit and scheduled the 12 sessions of radiation. These went over the Thanksgiving period so it stretched out a bit. We ended up leaving about 10 days later than we anticipated but still got off for the winter.

In the initial visit, the technicians make a mask that holds your head in exactly the same place for each of the radiation treatments. You are the mold for the mask so it is rather snug, with not much wiggle room. The radiation machine is sort of like a CAT scan machine. You lie on a bed (plank) that goes up and down and in and out and the radiation machine rotates around you. part of the machine is what emits the radiation and part is like an x-ray machine to do real-time scanning. Radiation is a high-energy form of x-rays. The high-energy beam kills the cancer cells or damages their DNA so they can’t reproduce.

Each session lasts about 15 minutes from the time you walk in to walking out. The actual radiation time is about 2 minutes. In what seemed to be a fairly short time the radiation treatments for the lymphoma cancer were completed, follow up exams and blood work confirmed there was no indication of any remaining lymphoma cancer. These tests and exams are repeated every six months for 5 years.

Before we left I had a follow-up PSA test. The results indicated that the prostate cancer was undetectable. The prostate surgeon urgently wanted me to start a hormone treatment before we left. They are very cautious when there is any indication of cancer may have spread outside of the prostate. A six-month dose would work while we were gone and a follow-up after we got back would determine what was next. So I agreed, got the shot and we left.

This was a pretty brutal treatment. I had no idea what to expect but found out quickly that it was like a very severe and intense menopause, often called manopause. Intense hot flashes, fatigue, muscle and joint pain, loss of strength, mood swings, loss of muscle mass and endurance and weight gain. It also really screwed up my diabetes care. My diabetes insulin use doubled. These drugs are in the same group that are used for chemical castration. They stop testosterone production and starve any remaining prostate cancer. There was no backing out once you get the six month dose and no means to ease the effects. It made for a pretty uncomfortable winter.

When we got back and we met with the prostate surgeon I told him I did not want to continue on with the drugs. He said OK and said I had to wait 4 months to get another PSA test to see how I was doing.

My primary care doc started me on Trulicity to help reestablish some diabetes management. This is another story.

Additions

And while doing all of this we decided to become dog parents. At this point, we just got on the list to pick from a litter not yet conceived. A Petite English Multi-Generation Goldendoodle. This will be another ongoing story. We are excited to have this prospect to look forward to. Sally and Jax’s puppies are expected to be 25 to 30 pounds as adults, right where we wanted.

While waiting we went to Michigan for a month, more on that later. It was a nice diversion

When we got back from Michigan my PSA test was again undetectable. Wonderful. The prostate Surgeon was unimpressed. He wanted me to start a 39-session radiation treatment. We were shocked. With no prostate cancer indicated, Why? We got no good answer from the prostate surgeon. I called and we got in to see my medical oncologist the next day and the radiation oncologist the day after. While I was uncomfortable with the prostate surgeon both of these oncologists took the time to help us understand why this was suggested and why it made sense to do it. The radiation oncologist made it pretty clear, this was the best path going forward to minimize the chances of prostate cancer reoccurrence and the best quality of life going forward. We agreed.

The next step was the initial session where they did CAT scans to locate the targets and apply tattoo alignment marks on either side of my pelvis and below the belly button. Rather than a mask which held you in a very fixed position for a tightly focused radiation beam, these treatments used the initial CAT scans and alignment tattoos to get you aligned so that the radiation where it needs to get. This happened the next day. My 39 day schedule was set up at the same time. This was on a Thursday, treatment started the following Monday morning. I met with the radiation oncologist every Thursday.

I had to be very careful to not get sick with Covid or anything else during this process. There is no pause in the treatment process, you just start over. And we had a puppy on the way and a departure date on the calendar.

Puppy Selection Day

In late October, about halfway through radiation treatment, puppy selection day came. Sally and Jax’s brood were six weeks old. We were #4 on the picking list and while we had looked at all of the 5 female puppies online and had a couple in mind, we had no idea who would pick which puppies in the choices ahead of us.

Our time came, we were on zoom with the breeder in Georgia. She told us that they had the first choice, #2 chose a male, and #3 chose a male. And then she surprised us by saying they were going to pass on their selection, they had enough females for breeding at that time. We had three choices. One was higher on the personality evaluation scale and the breeder suggested that she would be a bit harder to train and more independent. Pink Girl was very cute and right where we wanted on the personality scale. Blue Girl was also very attractive, same score on the personality scale, and weighed 1 pound less. The breeder said this would probably mean a 5-pound difference as an adult. We chose Pink Girl. We had already decided to name her Maggie Mae.

Rewards

We had thought about driving to Georgia to pick up Maggie but we were in the last half of radiation treatment. The breeder connected us to a Flight Nanny who would pick up our puppy and deliver her to us at the Minneapolis/St Paul airport. The cost was about the same as it would have cost for a 6-700 mile side trip and several days in RV parks. So when Maggie was 8 weeks old she flew to Minnesota with Tosha, the flight nanny.

We stopped at Fort Snelling National Cemetery to introduce Maggie to John and Dorothy, my parents, and to give Maggie a chance to do what she might have needed to do. We are sure my folks would have liked Maggie as much as they did our last dog, Xenia.

It is hard for us to recall just how tiny Maggie was as we were finishing up radiation treatments and getting ready to depart right after Thanksgiving. She got her first Vet visit and the next set of vaccinations. All was good.

All the while radiation treatment were continuing I had been showing the staff at the clinic pictures of Maggie. She arrived about 10 days before my last treatment. We brought Maggie into the Clinic a couple days before my last treatment to meet the Staff. It was our first hint at just how popular she might be. They were all glad to meet her.

And finally the last radiation session, ringing the bell is a significant event at the end of this process. I was glad to do it and at the same time immensely grateful for the support and guidance I got from Susan and from my oncology team to make this treatment choice, to get it scheduled so that we could leave on time and to have the very good chance of no reoccurrence of this cancer and opportunity for a longer and healthier life. And at the same time to have chosen to add Maggie to our lives.

If your a guy and have not had a PSA test, check with your Doctor and get one done. It is a simple blood test. Then you will know how you are doing. Stay ahead of this, don’t ignore it, a sooner solution is usually going to be simpler.

Life’s Challenges, Additions, and Rewards. Life is not static. All of this was going on while the projects in the last post were going on and we had a really great trip to Michigan. An eventful last year and a half.

More Later, Much Love.

Roger and Susan and Maggie Mae