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Wednesday, July 6, 2016

Adventures in Cancerland

I mentioned in January that I had been diagnosed with prostate cancer. (There's nothing more boring than listening to someone talk about his physical ailments, so you might want to stop reading here.)

After the initial shock of my diagnosis, I read a lot about prostate cancer, and quickly calmed down. (Samuel Nock, who comments on this blog occasionally, was quite helpful in that regard, sending me all sorts of reassuring information about the disease.) Prostate cancer is the slowest-growing, most easily treatable form of cancer. In fact, many believe that the disease is over treated, and many doctors who get it don't even follow their own advice and get treatment, opting for "watchful waiting" instead.

I ended up speaking to two more doctors. The first, at Sloan Kettering, recommended a prostatectomy. But the side effects from that operation (a higher chance of incontinence and impotence) seemed pretty grim. Plus, I didn't like the doctor. I got the strong sense that he was showing off the entire time for the young female Spanish doctor who was accompanying him on his rounds.

The second doctor worked at Procure, which specializes in proton therapy, a type of radiation which has fewer side effects. Protons, as opposed to the photons which are used in traditional radiation, just dissipate after they hit the target, and don't pass through the rest of the body before exiting.

By that point I had pretty much made up my mind to go with proton therapy anyway, and the doctor I met there, Henry Tsai, helped confirm that decision. He was both extremely knowledgeable and down to earth, the combination you want in a physician. And he didn't oversell the treatment. He also didn't give the impression that he was rushing me into anything, even telling me that I could wait a year, or two, or even three, before treatment and probably not have to pay a price, though he didn't recommend that.

I didn't want that uncertainty hanging over my head, so I moved the process forward.

The only unpleasant part of the entire treatment was having the markers installed in my prostate. As I drove to the doctor's office that day, I thought mostly about the upcoming humiliation: you lie down on what is basically a gynecological table, your legs in stirrups, and he injects the markers through your perineum while you have an ultrasound up your rear end. But once the five needles started going in (dunno about you, but that's always been a pretty sensitive area for me), I forgot all about the humiliation.

The nurse offered to hold my hand. I felt a little foolish doing so at age 61, but ended up squeezing her hand so hard I thought I might have hurt her. It did seem to help. (Pain trumps embarrassment.)

The next step was the CT scan. By this point, I was pretty much resigned to the lack of dignity, and to the idea that I was nothing more than a blob of protoplasm to be poked and prodded, and wasn't even that embarrassed.

Next was an MRI, which is basically twenty minutes in a coffin, a little foretaste of eternity.

And then, nine weeks of daily radiation sessions. My son suggested I ask for the kind of radiation that gives you superpowers, like Spiderman got. But evidently that wasn't available.

You never feel the radiation. (It's like going to the dentist to get an x-ray.) You lie down on a table (you have to remain still), and a few minutes later the technicians come into the room to tell you it's over. (You only get about 45 seconds of actual radiation in each session.)

People would always ask how my treatment went that day, as if it might be some sort of ordeal. My reply was always the same, that it was uneventful.

I almost felt guilty about the amount of sympathy I was getting. I never once felt pain, other than the original biopsy, which was mild, and the implantation of the markers, which was pretty intense. As far as the cancer itself, I never felt a thing; it was just a poisonous little seed that had started to grow in my prostate and that had to be taken care of. I've had colds that were more painful.

I opted not to under go chemotherapy, which for prostate cancer consists of taking drugs which lower your androgen levels. (I didn't really want to write a blog from Caitlyn's viewpoint.)

I had originally said in that post in January that I'd be blogging less, thinking that either the cancer or the treatment might be debilitating. But neither ever were. In fact, after five weeks of radiation, on Memorial Day, I ran 200 meters in 27.2, my best since 2007.

This, of course, didn't stop me from playing the cancer card. ("I'm dying of cancer and you want me to take out the garbage?!!")

There were patients at Procure who had more serious forms of cancer. I saw two without noses. And there were little kids with cancer, a stark reminder of how unfair life is.

The staff was friendly and cheerful. It's a tough thing to put a smiley face on a cancer ward. But the nurses and radiation therapists must be told it's part of their job to act like happy hostesses, and they did a good job.

I won't know if I'm cancer-free for another year or so, depending on whether my PSA level goes down. I expect it to; if it doesn't, I'm sorta screwed.

And the radiation itself can cause cancer down the road (I had 47 x-rays to go along with my 44 proton therapy sessions), so the future seems less certain. I no longer see my life stretching out another 40 years until I'm 100.

In the meantime, I guess I'm supposed to have absorbed some lessons about how precious and fleeting life is, and how I'm supposed to savor every moment of every day. Have I? Nah, not really.

I'm still the same obnoxious guy, as I plan to demonstrate on this blog.

33 comments:

Anonymous said...

Glad that you're doing well!

-birdie

John Craig said...

Thank you Birdie.

Mark Caplan said...

I saw online that construction of a new proton beam radiation facility was priced at $180 million. There are two centers in China, otherwise none in the rest of the Third World. Also, none in single-payer health care countries such as Canada, Australia, and Spain.

"Operating clinical proton centres"
http://www.proton-cancer-treatment.com/proton-therapy/proton-therapy-around-the-world/operating-clinical-proton-centres/

Rona said...

I'm glad therapy is going well and you're in a great shape. I've never heard of proton therapy, it's good you got it done right away and can soon put this behind you.

Thing about profound realizations about life is they only last for a short while. Soon you're back to your old self, worrying about unimportant stuff and losing the bigger picture.

Stay obnoxious John, what fun would this blog be if you got all high-minded ;)

Rona

John Craig said...

Mark --
Interesting observation. I'm surprised how many there are in Japan.

Yes, they are expensive. One of the things I liked about the Procure place in Somerset NJ was that they said that if your insurance doesn't pay for some reason, all you have to pay personally is $10,000. That's amazingly cheap considering the number of treatments, etc.

John Craig said...

Thank you Rona.

You're absolutely right about those profound realizations. I've had those in the past, and they didn't last.

Samuel Nock said...

John, glad to hear you are doing well, and that the information I sent your way was helpful and put your mind at rest somewhat.

It is one of the great tragic ironies that we are often forced to make major decisions about our health in a state of panic and (frequently) ignorance. Some doctors certainly abuse this and use it to their own advantage. I have to say, John, that you seem to have kept very level-headed about the whole thing and you managed to make excellent choices.

Your experience with the surgeon brings me back to a point I have thought about before, and it certainly isn't original with me. Namely, that narcissists and sociopaths are probably over-represented among surgeons, of all types of doctors. Maybe psychologists too, but certainly surgeons. Its kind of understandable to a certain extent: surgery requires extreme confidence and grace under pressure, traits that narcissists and sociopaths tend to be able to cultivate. I am not saying that most surgeons are narcissists and sociopaths (or that they guy you encountered necessarily was), just that those personality types are probably over-represented in that profession.

Again, glad you are doing well and keeping your spirits up!

John Craig said...

Samuel --
Thank you very much, and thanks again for the stuff you sent.

I agree about surgeons often being narcissistic personalities? Sociopaths too? Yeah, probably, though I'm less sure of that. The doctor at Sloan Kettering I met whom I didn't like was neither a surgeon nor a radiology doctor, which is why I chose to meet with him. (Specialists tend to recommend their own specialty.) And it's possible that if I'd met him in different circumstances he wouldn't have rubbed me the wrong way. And I can't even entirely blame him for having wanted to show off in front of the young Spanish doctor, she was quite attractive. He said the right things to me, was even complimentary at points, but the whole time, he came across just a little too pleased with himself.

Luqman said...

This may be rather personal information John, but what was your gleason score and staging?

John Craig said...

Luqman --
My Gleason score was 3 + 4, which is evidently better than 4 + 3, don't ask me why. That made my cancer "intermediate" in terms of aggressiveness. Don't know what my staging was, haven't heard of that. My PSA was 5.6.

Anonymous said...

I agree about narcissistic doctors. My daughter has a non-life threatening condition that requires her to see a specialist. Her last doctor retired, so now she has a new doctor (he looks like he has middle eastern heritage). He always has another person(s) accompanying him to our appointments (residents, in a teaching hospital). He comes across as pleasant, but also seems quite pleased (impressed) with himself.

- birdie

Steven said...

I haven't been commentating because I've been focusing on the brexit shitstorm.

It sounds like its going all right & you managed to make a cancer treatment story reasonably engaging. I've never heard of proton treatment but when my grandad got treatment his PSA score went down to 0. something from like 6. I guess something like that will happen for you.

John Craig said...

Birdie --
I think there must be a fair amount of that going on, especially in teaching hospitals (as SK is).

John Craig said...

Steven --
I'm hoping so. Thank you.

Which way did you vote, if I may ask? (If you don't want to answer, that's fine.)

Steven said...

I voted remain. I think being in the single market is good for the economy but more than that I see the single market and internal free movement in Europe as historical progress. I really valued having full citizenship rights in 27 other European countries. As for immigration, I have no problem whatsoever with European immigration to Britain. I do want restrictions on non-eu immigration but that's a separate matter. I am conservative in some ways but I'm a europhile and pan European conservative if I'm a conservative.

I hope we can make the best of it and if I'm wrong and it turns out for the best I'll be glad.

Anonymous said...

Yikes, I only drop by here occasionally so didn't realize any of this. I think you are handling it like a real trouper.

To me, the worst part sounds like the enclosed MRI. I had one once and it was the worst experience of my life. If I ever do it again they will have to put me out.

Be well.

Puzzled

Anonymous said...

Oh, about that life being fleeting stuff. I'm getting that too now (combination of age & injury, which is healing, no big), and it sucks. It doesn't teach me anything. It just brings me down. So life is fleeting, so what?

Puzzled

John Craig said...

Steven --
I would have voted leave, but I can certainly understand your reasoning. And I'd have had no problem with European immigration to England either, but importing more Muslims is basically national suicide for them. I've heard that more Muslims in the UK have joined ISIS than have joined the British military. It's too bad the vote couldn't have been restricted to the more narrow issue of immigration, without all the economic stuff thrown in.

John Craig said...

Puzzled --
Thank you very much. But you're giving me too much credit. I was in a daze for a week or two after I got the news. And really, prostate cancer isn't that bad unless it spreads, and mine was -- theoretically, at least -- caught early. And the radiation was nothing, literally like the x-rays you get in a dentist's chair. Plus, I'm 62, so whatever happens at this point, I've led a full life. Seeing kids with cancer of course drove home how lucky I was to have perfect health until this age.

I don't like MRI's either, but had a small drink beforehand -- sort of the placebo effect -- and it was fine.

John Craig said...

Puzzled --
Ha, you're like me. Every now and then it would occur to me that this was supposed to be giving me more "perspective," or some crap like that. But all I could think was, this is a big nuisance.

Steven said...

I think our aim now is to stay in the single market but get some restrictions on immigration (a so called Norway plus deal), which may not be possible.

We already have control of non-eu immigration but its quite high anyway, I think around 100,000/a net. That's our own choice. We accepted very few Syrian refugees, unlike Sweden and Germany. An issue is if the Muslim migrants get citizenship in one of those countries they could then come here as EU citizens. But I am concerned for the whole of Europe, not just Britain, and would ideally prefer European unity and strong external borders. I think we stand or fall together.

John Craig said...

Steven --
I agree about that. Europe has to stand together, with strong external borders. It's the only way they survive.

Taylor said...

I also would have voted to leave. All the talk about economic fallout seemed overblown to me, the whole thing will take years... And regardless of policy stance, the british people should decide british policy.

It is really good to hear that your treatment is going well and congrats on the 200m 27.2!

John Craig said...

Thank you Taylor.

I actually finished in a dead tie with my son in that 200.

Anonymous said...

I wish that the USA had strong "external borders." If we had this, I imagine that our country would be in better shape. As it is, we are letting in too much rubbish.

- birdie

Mark Caplan said...

I was going to comment on your earlier post about blacks being happy-go-lucky, amiable chaps. Idi Amin and numerous other blood-curdling African and Haitian dictators, and the Rwandan genocide immediately came to mind. Instead of commenting, though, I thought I'd just let news events speak for themselves.

John Craig said...

Mark --
I'd still say that blacks in general have a different style of murder than whites. With blacks, it's more of a life-is-cheap-in-the-inner-city, I'm-not-thinking-about-the-future, I'm-sort-of-a-brute type of thing. And last night, it was in an I'm-completely-uninhibited-about-sticking-up-for-my-race sort of way, which is also not rare among blacks, though it seems to be nonexistent among whites. But with the exception of the last type of killing, I'm guessing that even black murderers (of the first-described type) tend to have less poisonous personalities than some whites. An ignorant, uninhibited savage is not the same thing as poisonous white sociopath. In terms of the damage they do, yes, they are. A killing is a killing. But the nature of the races is different, and that difference even applies to many murderers.

Whites are capable of holding a grudge longer, as a rule. And they are more likely to plan things out, as opposed to just losing their temper and exploding.

Baloo said...

I've had lots of things done, being age 70, and it's amazing how unimportant the dignity becomes when the pain goes up. And I'm constantly reminded of the instinctive "caring" tendency medical women have. Males have to learn it, females for the most part just automatically do it.

John Craig said...

Baloo --
You're so right about that difference between women and men. it's sort of like the difference in the way that women will gush over a baby, or a cute dog. Most guys like babies and dogs, at least if they're theirs, but the instinctive gushing over a stranger's does not occur.

That said, there were a few male radiation therapists at Procure, and they were all good. I preferred to be attended to by the women, but the guys were all professional and polite and never a negative presence in any way.

Anonymous said...

I myself wake and urinate every hour all night from the enlarged prostate.
I don't even tell the doctor about it.
GOOD LUCK TO US BOTH.

------ FAKE BABA

John Craig said...

FAKE BABA --
Yes, thank you, and good luck with that.

Anonymous said...

In the news - Ben Stiller was diagnosed with prostate cancer about two years ago.

-birdie

John Craig said...

Birdie --
Just looked him up, he's only 50, which means he got it pretty early, at 48. Wow.