January 15, 2017 in Observations Of A Sisi and tagged Cancer, Medical, Prostate, Radiation Therapy | Leave A Comment

November 23, 2016

Tattoos, so common now as to be clichéd talismans of adolescent angst or narcissistic souvenirs, I have avoided.

Condemned to one of those odd loci of non-abrogation of the Mosaical Law, tattoos were anathema to my childhood home even while pork, cream sauces, and lobster were ushered in to glad cries, when available. Then, meaning the 50’s, tattoos were a mark of the outsider: sailors, soldiers after the second war, the down, the out, and the grubby. Moreover, tattoos had a well-deserved horror to them as well, a meticulous line of numerals along the wrist revealing those who had emerged alive from the obscenity of Hitler’s death camps.

Tattoos were not for real people; you know what I mean … real people.

Thus the indescribable titillation, once I had heroically freed myself from darkest suburbia (only with the financial, emotional, and intellectual support of my bourgeois parents), in learning that some vaguely acquainted colleague, a few years older, had a tattoo, there, right on her ass, never to be seen or referenced. But there! My imagination tended to butterflies.

Then, (the mid 60’s) I dissuaded myself from getting a tattoo of my own for several reasons. Not insignificantly, as a professional student, tats were déclassé.

Richard Gere, in An Officer and a Gentleman, demonstrates the point nicely. He is enrolled in flight school, a first step to the gentleman thing, and the last thing he does before leaving the ranks of the enlisted is attempt to hide his ink (unsuccessfully) from the drill sergeant (Brian Gossling). An object lesson was provided me by my patients in the Veterans’ Administration Hospital, moreover. These were mostly WWII vets and mostly in their late forties. They made a game of sneaking off the floor to smoke cigars and buy milkshakes in the commissary. All were well tattooed, and all said that they had gotten them while drunk, young and dumb. Other than their service tats, they wished they had never gotten them. As a very young medical student (twenty when I started), I tried to absorb worldly wisdom where I could; they seemed to have it.

Ray Bradbury’s Illustrated Man was made into a movie in 1969, emphatically freaking me out. Rod Steiger is not who I wanted in my dreams. I was still hung up on butterflies on intimate flesh.

Then came the deluge.

Tattoo came out in 1981 with Bruce Dern as an obsessive tattoo artist, kidnapping Maud Adams to receive, rather involuntarily, his magnum opus. Not the kind of image I wanted for my personal life as physician, husband, and father.

Subcutaneous ink became the rage, moving centripetally from arms to torsos to genitalia as if it were a pernicious rash. Actors, those you might think would abjure marring the tools of their trade, began to sport more and substantially more bizarre tats. Pugilists indulged, when not biting each other. The NBA, showing more skin than most sports teams, became a menagerie of mobile ink, moving pictures indeed.

Tats have become clichéd self-expression, a message, if an inchoate one, commemorating some act, thought or conviction. Simultaneously, tats, the poorly done variety, have become a sign of membership in criminal organizations of various ilks.

So ink has been, at one time or another: membership credential, souvenir, bookmark in a life story, curse, rape-substitute, curriculum vita, and de-humanizer of the despised.

I add one more.

Currently, three small blue marks mark my pristine (if one discounts an assortment of scars provided me by several surgeons, a motorcycle, a knife-wielding gentleman of my rather brief acquaintance, and various mishaps of my own manufacture) pelt. My new tats are not close together being port, starboard and amidships. There is no great art involved. They are each single dots. My big sister, never one to pass up a chance to criticize me, starting in about how our mother would be so disappointed in me when I announced my new ink.. 

In a week’s time, I start radiation therapy for a recurrent cancer in the hope that I may be cured of it and have to find something else from which to die.

It’s nice to finally join the club.

January 12, 2017

Finished.

38 of 38 done today. No significant side effects. No great tribulation.

Now we wait, off meds, to see if the dreaded number, currently bumping along near zero, ticks up or embraces its zero-ness. My odds are about 45:55 for a cure, an actual cure.

April 22, 2017

Prostatic Specific Antigen, PSA, is a name about 20 million men in this country do not know when they are thirty but are highly concerned about it a mere twenty years later. It rises and falls with the success of treatment of Prostate cancer, the most common cancer of men after lung cancer. When I had my original surgery in 2003 it had gone from 1 to10.1. After surgery it went to zero, along with a lot of things. In 2015 it started to rise and was a convincing 1.7 when I started treatment. After the radiation and the waiting for the neoplastic dust to setttle, it has now returned to zero. If it stays there until I die, I am cured. If not, I am not.

October 29, 2017

I am not. PSA has risen to 0.4, definitely non-zero. I am to have it checked in four months. Basically, the radiation, being based on merely a best guess, missed some cells.

Treatments there are aplenty. Most are rather unpleasant. I am persuaded that a slowly advancing untreated cancer may give me 8-10 years. I might live as long as my parents, 81. It does not look like I will exhaust retirement savings or see my granddaughter graduate high school.

Use it up, wear it out, make do, do without.

I should be able to finish publishing the books.

Why do I think I got cancer? Probably because I am a man. 1:16 of us will get it. When I am feeling particularly maudlin, I imagine it is due to a little too much radiation in an NICU over the last 45 years. Intensive care means stuff happens. Lots of times I was in the field when an xray was taken. The baby needed it. Small price.

Oct 17, 2019

My PSA is rising with a doubling time of 200 days, 30ng/dl at the moment. I am no longer taking the anti-testosterone Lupron and felt some improvement in stamina and strength. I went on a solo 15 mile hike this summer in Denali and felt good the morning after. A slow doubling time (in the way of years) would be a good sign. This is very quick. I have no symptoms or evidence of a metastasis. it cannot last.

Book 4 (now named The Silence and the Gods, is completed. I am awaiting one more beta reader comment before sending it off. This one deserves a map (didn't you always love the books with maps of far off magical lands?) It should see the light of day in a year or so. I am working on book 5 which at present is wanting for subplots. It is obvious (to me) how this must end and even the mechanism of its action, but the emotions of the players need to drive it. I made the significant mistake of killing off my best villain at the end of book 3 and now have to gin up a new one.

I should be able to finish book 5. It is well. Friends and family abandoning me faster than the books.

Jan 23, 2020. PSA 48. No clinical change. Book 5 is 48,000 words. 

July 2020. I have seen the oncologist twice since January with a level up to 54 and now down to 48 again. Book 5 is 86000 words,

Sept. 11, 2000 No new news. I decided in January to attempt losing weigh when I realized I hit 233 pounds. I started Noom and have lost as of this morning 50#, about 18% of my original weight. I weight what I did when I was 14, after reaching my full height. I was in better shape, then, having traded muscle mass for what is still a bit of a paunch. Officially, I am no longer "overweight" for my height. I feel a lot better and suddenly have no clothes that fit. My face borders on the gaunt. My oncologist is deeply suspicious of this rapid weight loss. It is the first "diet" I have attempted in my 70+ years. I suppose I could lose some more of the paunch, but am afraid that perhaps the ease of my weight loss means something sinister. The book is stalled at 85,000 words as I carve out narratives that I now perceive to have been "scaffolding" and am taking a break to rework some short fiction for submission to periodicals, garnering a refusal from FSF within 24 hrs, so far.

October 6, 2020 I may need to retract the implied pride of the last entry.  My weight loss may have other etiology than my own efforts. On complaining to my oncologist of sore ribs (due I thought to my ongoing battles with the forces of nature and entropy which characterize yard work) he ordered a CT scan which I got during the 96 hrs I have free every 10 days on my current schedule. I read the record of the encounter as I was unable to visit with the doc prior to going back on service in NC. New diagnoses have popped up, presumably from data obtained from the CT: abnormalities of ribs and lung, and "metastatic lesions in intrathoracic lymph nodes." In short, after 18 years of dealing with this disease, it will kill me. I have no idea how long before that eventuality. I am busy with a lot of interpersonal stuff right now as well with my wife of 43+ years abandoning me, promising a divorce.

November 16. Doing a promotion on Malila, dropping the kindle price to $1. I found out yesterday that the result of the biopsy on 11/11 was positive for prostate cancer rather than a lymphoma. Other than winning a small wager with my oncologist, I am not surprised; this is what is to be expected. I have elected to start, on the advice of counsel, hormonal therapy again. It has about a 2/3 chance of having an effect. If I come out on the short end, I am promised only one more, and rather eventful, year. If it works, it gives me a 50% chance of living until March of 2024. We all live with indeterminate sentences in a seemingly indifferent penal system. I for one know whom have I have believed and am persuaded He is able to keep that which I have committed unto Him against that day. 

What changes have I made? I have retired, mostly because I have no desire to be the pawn of what will be a disastrous day for American medicine after this contentious election. I can, thank you Lord, afford to. I will dedicate my remaining time to getting the books published and seeing if I can find a literary heir to whom to leave the rights.

November 18, PSA 59.4, an all time high, but within the error of the method from the last high of 58. Started Eligard instead of Lupron because of drug shortage of the latter. The Wizard of Omaha, the Great and Powerful, are considering whether giving me Xtandi, another androgen inhibitor. So far, ten days removed, they are still debating whether my continued existence is cost effective for them.

June 2021

Xtandi and Eligard work wonderfully, reducing my PSA, sex drive, and body hair to a minimum. It means I have perhaps most likely three more years, the last of which will be very unpleasant.

December 2022

I continue on my same regime with the added burden of my Onco having discovered I have systemic acquired immunodeficiency. How T-cells, low Ab, low complement, and more infections. Just got over my 5th bout of shingles, this one inside my eye. The Wizard of Omaha continues to debate how best to prevent the next bout: Acyclovir which rots my already bad kidney function or IVIG which they do not think works. PSA <0.04