Month: January 2005

I finally finished reading Prostate and Cancer by Sheldon Marks, M.D. as my physician requested. It’s a relatively easy read and answers many of the questions I had about my prostate cancer.

The book begins with some rather scary statistics:
More than 189,000 men have been diagnosed with prostate cancer in 2002, and more than 30,200 men previously diagnosed will die as a result of it.

Dr. Mark suggests that if a cancer is large enough to show up in a PSA test or during a routine exam it’s significant:

We know that many men have prostate cancer and are never affected during their lifetime. Most don’t even know they have prostate cancer. But it is believed by urologists who specialize in prostate cancer that if we detect prostate cancer because of an abnormality on exam or because the PSA level is elevated, there is most likely a significant cancer present.

That strongly suggests to me that it’s not a good idea to sit back and observe how fast the cancer’s growing unless you’re pretty sure you have less than seven years to live.

Naturally, though, the book doesn’t really answer the question that has been bothering me the most, which the author readily admits:

How can I know what treatment is right or wrong for me?

I find it interesting that with prostate cancer, everyone expects that we will have all the answers and know for an individual what the “right” course of treatment will be. Yet with every other aspect of health, men and women are accustomed to not knowing these answers.
“
There is no right or wrong. Rather, the question should be “What is best for me at this time.”

In many ways prostate cancer has been the most difficult cancer for me to deal with precisely because experts seem to differ on the best possible treatment.

Of course, it’s probably not entirely irrelevant that the physician who recommended the book is a surgeon and that the author is also a surgeon. If one were really looking for the “best” answer, it might be wise to also read a book written by a radiologist or a physician who specializes in alternative treatments.

In essence, though, by choosing to have surgery rather than radioactive treatment I’m rolling the dice that I’ll live longer than seven years, the time when cancer commonly returns with older radioactive techniques. Naturally, there’s no data on newer radioactive techniques, so it seems nearly impossible to accurately compare the two.

By having surgery, I’m also giving myself a second chance, as I did with my throat, you can have radioactive treatment after surgery but they generally don’t want to do surgery after radioactive treatment because of its effects on tissue.

It’s rather drastic surgery, but I guess you bet the cards you’ve been dealt, not the ones you wish you’d been dealt.

So many facts
so many statistics —
hope outweighs them all.

My second encounter with cancer, which took place three years ago, was terrifyingly different from my first encounter. I saw a doctor for nearly a year because of throat pain and difficulty swallowing before I was correctly diagnosed, apparently not an uncommon experience. Unfortunately, my regular doctor was on leave and I had to see another doctor in the clinic. When I explained that I was having trouble swallowing and coughing a lot, she took a summary look at my throat, suggested it was probably “acid reflux” and prescribed medication.

When I returned later still complaining, she sent me for a standard x-ray, which came back negative. She prescribed another round of the same medication and told me to come back after that was gone. When I returned, she told me that I would just have to learn to “live with the pain” and that it was “nothing serious.”

Finally, my regular physician returned and I went back because by this time it was incredibly painful just to drink water. He immediately referred me to a throat specialist, who took one look down my throat and scheduled me for a biopsy the same week. Within days I was having a CAT Scan to determine the extent of the cancer.

Unfortunately, the cancer had advanced to the stage where the throat surgeon was afraid they might have to remove my tongue to remove it. I told him, given that option, I guess I would just have to die. He referred me to a chemotherapist and radiologist. The radiologist was anything but optimistic, suggesting that I might have to have all of my teeth pulled before therapy, that I would most likely lose my saliva glands, and, to top it all off, that it was probably one of the most painful forms of radiation treatment. He insisted I see a surgeon at Oregon Health Sciences University before beginning treatment.

Leslie and I didn’t have much to say on the way home. After the consultation, I went home, went to bed, curled up in a fetal position and prepared to die. I had never felt so vulnerable and so helpless. At least in Vietnam I had the ability to fight back. There seemed to be nothing to do but submit to treatment and prepare for the worst.

Fortunately Dr. Andersen at OHSU was convinced that he could perform the surgery without having to remove the tongue. The surgery was radical and required removing my epiglottis but, considering the alternatives, seemed the best choice. It took me about five minutes to schedule the surgery which, mercifully, took place within a few days.

As noted in a rather infamous Christmas blog entry, recovery, was slow and frustrating, but was manageable with persistence and a sense of humor. Although I had to relearn how to eat and how to swallow with my vocal chords, I’ve managed to recover and learn how to eat all but a few of my favorite foods. I’m also more prone to bronchitis and pneumonia, but so far there’s no sign the cancer is returning and I seem to get a little stronger each year.

When dealing with a cancer as aggressive as the one I had, there are no guarantees of success. The doctor gave me, at best, a 50% chance of remaining free from cancer. The surgery contained its own risks and required strong lungs and relatively good health. Still, because the procedure I had is apparently not widely available, I feel lucky to have found someone who could perform it.

How welcome,
sunshine
between winter storms.

I was first diagnosed with cancer nearly thirty-five years ago. I had a tumor removed from my neck and, while it wasn’t cancerous, there was a small piece of thyroid attached to it that was cancerous.

My first reaction to the diagnosis was, predictably, panic. I was too young to die. My children needed me. My wife seemed even more distraught than I, and the fact that I just plain wasn’t willing to talk about dying seemed more disturbing to her than the fact that I was about to die.

My doctors said I should have my thyroid removed immediately. Despite my protests I had to finish the yearbook before surgery, friends urged me to have surgery immediately. I finally scheduled the surgery for that week, but when I went to get an x-ray to determine the extent of the cancer they couldn’t find any sign of it, and I had second thoughts.

After considerable research, my surgeon finally recommended I take synthroid to shut off my thyroid and delay the surgery until there were further signs that the cancer was spreading. Though I understand that that probably wouldn’t be the current recommendation, I’ve lived with it quite well since. Now I seldom think about it. Current research even seems to indicate some older people have relatively benign forms of thyroid cancer that go undetected throughout life and end up having no real effect on their lives or lifestyles.

I’ve been diagnosed with three different forms of cancer and there’s always something shattering about the diagnosis. Still, sometimes it’s CANCER — and sometimes it’s just cancer. There are many different forms of cancer and some are much more treatable than others.

In other words, don’t panic if you’ve been diagnosed with cancer; it’s not an automatic death sentence. Get the best possible advice you can. Get a second opinion if you feel you need one. Consider options carefully. Don’t let fear paralyze you or drive you to irrational decisions.

Death comes too soon.
No reason to let fear
rob you of today.

I nearly canceled my birthday Thursday because I’ve decided I’d prefer to become younger, not older.

If I’d done that, though, then Dawn, Rich, Gavin and Lael wouldn’t have had an excuse to visit. So I decided to pretend one more time that I would really, really try to grow up.

To celebrate my resolution, Gavin and I spent the evening playing with the new Playmobile castle that Gavin was sure that Santa was going to give me this year. (You do need a castle for each side, after all.) Strangely, Gavin ended up with Pahtah’s new castle, but reassured me we would take turns and I could have the new castle next time.

Lael’s idea of playing is to crawl up the stairs as fast as she can (damn fast, considering she’s only 9 months old), crawl directly to where Gavin is playing, and try to play with exactly the same toys Gavin is playing with, all the time ignoring Gavin’s increasingly loud and hysterical cries of “Lael, Lael, Lael” until Pahtah has to pick her up because she tries to swallow all the swords, helmets, and crowns. I think the name of this game is “Torture Older Brother,” and, being a younger brother, I have some vague memory of just how much fun it can be. She certainly seems perfectly happy playing the game again and again.

No one grows younger —
hanging on, hoping to live
as if each day were born anew.