ABOUT THOSE PROSTATE CANCER TREATMENTS

The chronology of a patient’s early prostate cancer treatments told with a sense of humor

BY Jim Higgins

3/13/18

Today I start irradiating my prostate. While I would rather be irrigating my ears, cleansing my colon or gazing at my navel. I have been journeying toward this treatment since the cancer diagnosis four months ago. I opted out of other treatments—surgery, hormone therapy, watchful waiting, or traveling to the Philippines to have it healed by a shaman. Every doctor tells you that prostate cancer advances as slow as molasses and that you will more likely die of something else. Anxiety is my guess. Though the idea that the fear of dying from cancer can be supplanted by the joy of a possible heart attack, brain tumor or a home invasion offers little comfort.

Anyway, I am not as concerned about beating the cancer as I am about handling the side effects of radiation—namely diarrhea, chronic fatigue, bladder and rectal issues and that other thing.

I only have to do about 40 sessions over the next two months about 20 minutes from my home.

I visualize it as a two month Monday through Friday gig with an end date mid-May. I have worked with tighter deadlines in my working days. I would say I could do this standing on my head but they prefer I lie on my back and remain still while Goldfinger shoots rays into my nether region. Then again, I think I will visualize lying on a beach in Maui getting a sun tan.

Yeah, that’s the ticket.

I have to follow a low fiber diet—a major departure from my high fiber diet. Now I look for things with 1 gram or less of fiber—mint flavored dental floss comes to mind. That means no fried food, no spicy food, in short no flavorful food. Just white rice, white bread and pancakes. Yes, pancakes are on the list of foods I can eat. I’m getting a booth at the Waffle House.

Stay tuned.

3/14

Radiation is not free. Before the first gamma ray falls (I think a Freddy Fender song), let’s talk money. Health insurance is not unlike Trivago. Same room, different prices. The same treatment regimen with a Medicare Advantage program is about $18,000 but with regular Medicare and a Blue Cross supplement, it is $30,000. Same facility, same doctor, same treatment, same country. My co-pay under the latter plan (30K room) is about $2,000, but under the former (18K room) it would be $0. But since I have the latter insurance and not the former, Uncle Sam and I pay more than we should. Health care needs a dose of radiation. But I digress.

My fist session was eezy peezy. Once situated on my back looking up at Dr. Robot (the ray machine that circled me like an alien probe), I remained still for 10 minutes while my pelvic region is scanned like so much baggage at LAX. Once the daily exposure is complete, the technicians who were safely ensconced in another room a county away, it seems, returned to place three permanent tattoos on my lower abdomen Christening me one “bad ass dude.” Not that I am about to join a biker gang but I do now have street creds though I have to drop trou to prove it. Then they asked me what time of day I preferred doing this 39 more times. We settled on 12:30 p.m.

I know there are changes in my bodily functions coming down the road but for now it’s all good.

Stay tuned.

My tech team—Kim, Nicole, Sydney and Lauren—made it smooth sailing. So, for the next two months—Mondays through Fridays only because cancer takes the weekends off—I will return to my Ground Hog Day-like radiation treatment. So far, so good.

3/15

It’s beginning to feel like Ground Hog Day in the sameness of the daily routine so I may skip a few blog days till something else pops up, as it were. Yesterday I was in and out of the room in under 10 minutes, almost like a fast track tanning salon. Lay down, zap, get up, see you tomorrow. Glow and go.

Still no discernible side effects. I sometimes feel like I am waiting for a freight train to arrive.
There is one prep that is problematic. Thirty minutes before my treatment they want me to drink 16 oz. of water so my bladder is fairly full allowing better definition of the neighboring prostate.

The prostate is like tiny Andorra nestled in the Pyrenees between France and Spain, if France is the rectum and Spain is the bladder. In order to see tiny Andorra, Spain must be full of Sangria, so to speak, and France must be as empty as Paris in August. So, I down a bottle of water 30 minutes prior and check in on time. But, if they are running late, I am running to the restroom and must start all over again. The good news is the transit time from a bottle of water to Spain is about the time it takes to transit a tube shoot at a water park. So, full and ready to go I assume the position on the metal table and am told to remain perfectly still.

You try to let your mind catch a pleasant thought so you can remain “perfectly” still. Now if they had asked me to just “remain still” and not “perfectly still,” I would not think twice. But being told to take it up to a notch to “perfectly still,” challenges a meandering mind (“Am I really still. What if I twitch? What if I sneeze? Leg cramp? What if a fly landed on my nose? Did I leave the oven on?”). By the time I ran through every possible un-still scenario, it’s over and I am free to leave after first relieving Spain of its national beverage. Then it is off to lunch. France is famished.

3/28

It has been a couple of weeks since I last posted but that is because every session resembles the last one. Once a week you meet with the oncologist for five minutes to see how you are doing. I seem to be doing okay. My techs tell me I am a most compliant patient. I have been called many names in my life but never “compliant.” Remaining perfectly still may be the reason. I assume the position of a corpse on one of those CSI shows.

I do ask a lot of questions. I asked to see the CT photos they shoot daily. Not possible, I am told. How about letting me watch you radiate someone else? HEPA says no. Okay, how about letting my son watch from the control room? This is not a take-your-son-to-radiation day option. I would still like to have some photo souvenir of the procedure to share with grandkids—much as expectant parents pass around an ultrasound photo of the developing baby— “And this, grandson, is me on my radiation journey to Andorra in the Pyrenees between Spain and France.”

Of course, I will be grateful once the cancer cells are zapped but perhaps a framed and signed CT Scan, a before and after photo of Andorra, or a photo coffee mug to remind me of my journey. For what I am paying out of pocket, can I at least get a tote bag?

The radiation techs know what they are doing. This is no Radio Shack.

Four years in training just to run the technology. I asked how often the linear accelerator is calibrated and you’d thought I’d asked Doc Brown how the flux capacitator works. I was told it was calibrated daily, Marty. Good. I worry needlessly since after all it is a fine-tuned machine controlled by a prescribed algorithm based on my unique needs that shares my personal data with a team of experts. Wow! It’s Facebook!

I have lost a few pounds and noticed my BP is lower. I attribute that to consuming less sodium and fewer fats. Breakfast is a cup of coffee, orange juice, a banana and a piece of white toast. That is also the Texas Department of Corrections Diet. Lunch is soup and crackers or a Subway roasted chicken sandwich with just white bread and nothing else. Raw veggies and lettuce are not your friend during radiation. Dinner, however, is more substantial but limited to cooked veggies, skinless potatoes and fish or fowl. Laura cooks for two different palates as she is still on a paleo diet. Andrew Zimmern will not be dining with us.

Throughout the day I drink a lot of water—sometimes as many as 12 8-oz glasses. Water has always been a friend but since I started radiation, we are inseparable. If I am not drinking it I am voiding it. They want you to drink lots of water to flush out the bad bacteria and to prevent dehydration which can be a side effect. Believe me, I will not get dehydrated as long as my eyeballs are floating which they are right now.

Anyway, as of today I am one-fourth of the way into my treatment with only about 28 sessions to go. I am counting.

Stay tuned.

4/13

Friday the 13th and I am half way through the treatment. Next week they start zapping the rays within a smaller area, sort of like refocusing from the country of Andorra to the city center. My urologist tells me it takes about a year after the treatment ends for them to determine if all the bad guys are gone. As for side effects, thus far the only one is nighttime bathroom visits.

I am taking Oxybutynin, a drug that fools the brain into thinking you don’t have to pee. I am all for fooling the brain about a lot of things.

And that got me thinking. Lying on the table in my daily meditative state, I recalled a wedding we attended near Kansas City 10 years ago where locals suggested we visit the town of Weston outside KC where a local museum housed Einstein’s brain. Seems the pathologist who removed Einstein’s brain at Princeton in 1955 opened a practice in Weston and kept the brain in a jar next to the Highlights magazines and the water cooler. Not one to miss a hoot, we drove to Weston Monday morning before flying home but found the museum closed. We strained to see inside—past the antique farm implements and historical photos—searching for a glimpse of the great one’s brain. A woman working inside came out to tell us the museum closes Mondays. She then said that we were a few years too late for the celebrated cerebellum. The brain had left the building and had been sliced and diced like so much deli meat and transported to several research hospitals around the country for further study. In fact, someone had written a book about driving Einstein’s brain across country. Before we left town, the museum worker pointed across the street to the old doctor’s office where the brain had resided undisturbed for decades. Now when I think everything is up to date in Kansas City, I think of barbecue, the Blues, and Einstein’s brain.

4/20

Today I am 2/3 through the treatment and can see the light at the end of the irradiated tunnel. My time was moved from 12:30 pm to 11:30 am so I could beat the lunch crowd and the other patients bused in from another site. The oncology facility in Sugarland is getting a new linear accelerator so until Doc Brown installs it, their patients come to my facility and had been bumping me from my 12:30 time.

The techs here do about 50 of these sessions a day. I think I saw a “ONE MILLION SERVED” sign at the drive-through. It is not unlike a drive-through. You show up at lunch time, give your birth date and wait to be “served.” Then you drive away. You have to repeat your birthday each time so they don’t give your “order” to someone else, or vice versa.

People ask me how I am doing. Before I selected this treatment, I was anxious.

I talked with several doctors and men who had undergone the surgery or the hormone therapy or the radiation or a combination of the latter two. Those who had hormone therapy wish they hadn’t. I read a couple of good books on prostate cancer and it seemed to suggest the same thing—avoid hormone therapy if you can. I parted ways with MD Anderson—perhaps the top cancer center in the world—because they would not allow me to decline hormone therapy (i.e. chemical castration) before radiation. Once I found an oncologist who supported my choice—radiation only—the anxiety dissipated. That’s why I am fine. I can always do hormone therapy down the road if the cancer returns. Once you decide on a treatment, stop reading. I shelved my cancer books and stopped Googling the subject. Embrace your choice and get ‘er done.

I chose the least invasive treatment option and thus far the only side effect other than frequent trips to the restroom is dry mouth from the prescription that I take to minimize trips to the bathroom. I have had cotton mouth after running a mile and occasionally a motor mouth, but never dry mouth. Eating solid foods with dry mouth is like putting spackling compound in your mouth. Makes you want do drywall work. It’s a catch-22. You drink a lot of water and that increases the trips to the bathroom. It reminds me of Mickey in the Sorcerer’s Apprentice but without the music. Your day and most of your night revolves around two things—going to pee and thinking about going to pee.

4/24

Today they kept me waiting 40 minutes with a full bladder. I can’t think of many more unpleasant feelings except maybe child birth or a PTA meeting. It seemed like the longest radiation session to date but I made it to the restroom before the Hoover Dam burst. I am not going to miss this daily routine. I failed to mention earlier that prior to each session in addition to drinking 16 oz. of water, I also take two tablets of Gas-X. I thought they were afraid the radiation would touch off a small explosion if too much gas accumulated below. Not likely, they told me. They just want to be able to see France without cloud cover (SEE: 3/15 explanation).

I have 9 or 10 sessions to go (out of 40). May 7 is the date I have circled on my calendar.

That will free up my days and, hopefully, my nights, too. Stay tuned.

xxxxxx

4/25

Today I met with the oncologist who informed me that I had 12 sessions to go. May 11 is now my end date. After that day, I am free to move about the country. I was also asked today—by the records’ nurse—if I wanted to be resuscitated should something go wrong. “Do you have a big finish planned for me?” I asked. No, she said she had neglected to ask me that question the first day. I told her to check with my wife if that becomes an issue. I just need to keep on Laura’s good side.

The oncologist also told me to continue taking the Oxybutynin to minimize trips to the bathroom even though it seems to have helped very little. He claims the brain cannot differentiate between the urgency to pee and a simple bladder irritation brought on by radiation. I explained that I spend more time in the bathroom than a plunger. I am like “Fish” from Barney Miller. I am told this too will pass—pardon the pun—once radiation ends.

The magic pill, I am informed, tricks the brain into thinking all is well but my tired brain is not easily fooled, (contrary to what I have been told). Still, I continue the pills hoping for an undisturbed sleep. The mind says no but the body says go. I am like one of those 1950s era cars still cruising Havana. We both have spacious trunks, aging exteriors and leaky water pumps. We don’t get the same mileage that we once enjoyed but with spare parts and a new radiator, we still get around.

4/27

Naked and Professional

Once the tech draped me with the loin cloth to expose the three pelvic tattoos to target the radiation, I drifted off into thought about how it is possible to be both naked and professional. I recall a time in the early 80s when I was in grad school and a female classmate received a photo assignment from Texas Monthly for a story about Texas’ first (and only) nudist night club. She was nervous about the assignment and that part of town and asked me if I would accompany her. I was working at KPFT at the time and figured I might get a story out of it, too. We both showed up one evening prepared to get the shot, record an actuality and leave quickly.

The owner told us that we were free to talk to anyone or shoot any photos inside the club with one stipulation—we had to be naked, too. Now, my classmate and I hardly knew each other but she was being paid $35 by Texas Monthly and I thought I might sell my story to NPR’s “All Things Considered. “

That was a lot of money to both us and, after acknowledging that fact we decided to be very professional and do as the Romans do, so to speak. We tried not to glance at each other as we undressed side by side in the cloak room. We then moved in to the club—she carrying her Nikon and flash in an almost defensive fencing stance, and me strapped to my Sony with the cassette recorder hanging strategically. What a sad sight. Not us. The club. Well, maybe us, too. About seven naked strangers—counting the bar tender and the entertainer—were present. Yes, some guy sitting in a chair on an elevated stage wearing only a guitar. I interviewed him and several guests—including a couple shooting pool—with all the double entendre jokes that conjures up. Then we left as quickly as we arrived, dressing faster than firefighters at the sound of a fire horn. My classmate got her photo in Texas Monthly and I sold my piece to “All Things Considered.” The next time I saw her in class she handed me an 8 x 10 black and white glossy of me sitting on the edge of a stage, mic cord and cassette recorder strategically placed interviewing the naked troubadour. Now you know why I never ran for president. After our class ended, I never saw the female classmate again.

I told my wife I never really “saw” her the first time. I kept that photo for years showing it only to my wife and a few friends but as my kids grew older I decided to deep-six the photo least someone up the family tree line might think the bark was a little off this branch. When my kids were adults, I told them the story. I think they are still in recovery. But I reminded them that It is possible to be naked and professional. But don’t try it at work. Except today. My session is over. Only 10 more to go. Stay tuned.