The Nuking Has Begun

I'll begin by laying out some recent events. As I have mentioned, my PSA (prostate-specific antigen) has been on the rise, albeit slowly, for most of 2025. The main reason it's going slowly is because I remain on hormone blocking drugs since this cancer thrives on testosterone. I get the PSA checked every 3 months, though, and it was at least tripling every time we checked. It went from 0.2 in January to 0.65 in April to 2.14 in July. For most people, even that last number would still be considered in the "normal" range of 4.0 or less. However, given my history with this disease, it was only going to continue to rise ... exponentially. It's probably at least 6.0 right now, although I not scheduled to have it checked again until the end of October. 

Anyway, that recent timeline... 

• July 28 - Labs revealed the PSA of 2.14 and my oncologist decided that we need to take action.
• August 13 - I had an expensive PET-PSMA scan done to locate the active cancer. 
• August 20 - We met with my oncologist to go over the scan, at which point it was decided that it was localized enough that we would hit it with radiation instead of trying more rounds of chemo.
• September 5 - Surgical procedure to have a gel put in to protect "other things down there" from radiation.
• September 8 - Went in for something called a CT simulation, where they map things out in order to be able to target the cancerous area and minimize the effect on nearby parts that aren't cancerous.

Then came several weeks of nothing, with us waiting on word that I could begin radiation. They told us it would be "a couple weeks" before radiation started and claimed that this was primarily to wait for insurance approval. However, being proactive, we noticed that my insurance had approved 20 treatments within days of the request. We called to get radiation scheduled sooner than later, but were told that it was still going to be "a couple weeks" without any concrete explanation. At one point, someone actually said, "That's just the way it always goes."

This waiting period came with a somewhat unexpected truckload of anxiety and depression. I was concerned, with the cancer continuing to grow, that it might start to spread again before we started any radiation treatments. Mid-September marked 8 weeks since the PSA indicated we needed to take action, and 6 weeks since my PET-PSMA scan located where it was active. In my previous post, I wrote that the PET-PSMA report indicated I had "nonactive foci throughout [my] skeletal system." Would that make it easier for the cancer to spread? I asked, at least twice, but no one was willing to give me an answer to this question. The silence just added to my anxiety.

I feel like most of September was this anxiety-filled, depression-riddled waiting game. I realize now that I have a tendency to circle the wagons when I get down about something. September saw me pulling back from social media, not writing letters, ceasing participation in many things, as I fell into a funk of depression. The medical professionals were in such a hurry to have me do the various procedures necessary to start radiation and then... nothing. Even though I have now (just) started radiation treatments, I still have no idea if this stuff has metastacized. If it has, radiation to one spot isn't going to knock it out. 

On Wednesday, September 24, I was finally scheduled to go in for my first visit with radiation, where they did another kind of "mapping" session to see how well things lined up with the results of the CT simulation on the 8th. The following day, September 25, I had my first actual radiation treatment. This was just under two months after my oncologist said we should take action. "Taking action" means something very different in the medical field than it does to me. 

My previous post mentioned that my radiologist prescribed 45 treatments. It turns out that my insurance would only approve 20 treatments. This didn't do anything to change my view of insurance companies as gatekeepers who eschew genuine medical needs in favor of monetary decisions. (How did these for-profit corporations become such pivotal linchpins in everyone's health care?) One might see cutting the number of treatments in half as a good thing, and it will mean I am finished with radiation sooner, but my radiologist plans to give me the same amount of radiation in 20 treatments as I would have gotten in the 45. This means that my side-effects are likely to be more intense. 

Time will tell how hard this will be. I'm feeling a bit more fatigued now than before radiation started, which is noteworthy because I was already tired and weak then. Flashbacks to barely able to take showers during chemo have loomed prominently in my mind. I'm hoping for the best but anxious about it being just the opposite. Throughout this nightmare, I feel like the "possible side effects" have been soft-pedaled to me. As I say, though, time will tell. 

I'll check back in after a couple/few weeks to update how it's going.

A beautiful 2-3 foot long eastern fox snake that was hunting in our garden.

Into Battle Once More

This is an update on some of the unknowns I wrote about in my previous entry. The results of my second PET-PSMA scan have come back and we met with my oncologist on August 20. 

My first PET-PSMA scan occurred on March 27, 2024, prior to receiving any form of treatments to battle the cancer. The scan showed a concentration of cancer in my prostate, plus metastasis (spreading cancer cells) in my hips, a spot on my ribcage, a spot on my shoulder, and a spot on my spine. 

I'm bringing this back up because I was shocked to find that this disease spread like wildfire throughout my skeletal system after that scan until the chemotherapy and hormone suppressants started to take effect. The written report from my second scan (8/14/25) states the following: "Widespread, nonactive foci of osteoblastic metastasis now noted throughout the skeletal system which has significantly progressed since previous study." Of course, the word "nonactive" is the imperative there, referring to the state of the cancer. I sure hope it stays that way because, apparently, my entire skeleton is riddled with "nonactive" cancer cells. If those ever become active again, I believe that will be the end of this story. 

I'm trying, very hard, not to think about that. 

If there was "good" news from the latest scan, its that the cancer that's currently active was found only in my prostate. My oncologist feels that we can avoid more chemotherapy (for now) and hit the focus of activity with radiation treatments. I was glad to hear that, but was taken aback when my radiologist said that we would need 45 radiation treatments, one each day of the week (Monday through Friday) for nine weeks. It's not like there aren't any side-effects from radiation, so this is going to take me down several notches. I keep reminding myself that at least they're not recommending chemo, but that thought only helps a little. 

At of the time of this post, we have yet to schedule those radiation treatments. There are a couple things that need to happen first. On September 5, I'm scheduled to have a procedure where they inject a kind of gel that's supposed to protect certain vital functions "down there" from being irradiated. Then, on September 8, we have an appointment for a CT Simulation, which is where they make a map of the area to focus in on specifically where they want the radiation to hit. Shortly after that, I assume, I'll begin the treatments.

Emotionally, I'm not nearly as relieved to set chemo aside as I thought I would be. To be clear, I am relieved, but I have this sinking feeling that nine weeks of daily radiation treatments is going to take its own kind of toll on my health, such as it currently is. I suppose it boils down to the fact that I was only just starting to feel partially recovered from last year's intense chemo and now I have to somehow mentally prepare to take several steps backward. 

One could argue that, hey, at least I'm still alive, but the quality of my life pales in comparison to where I was in 2023 and earlier. I can only hope that, by the time the radiation treatments have ended some time in November, I can finally start taking steps toward living a more normal life. That's the hope I'm clinging to, anyway. 

A ruby-throated hummingbird foraging for nectar in our garden

Here we go again?

(What you can't really see here are the dozens of pollinators flitting around those flowers.)

 

Since I ended chemotherapy, late last year, I have "check-up" appointments with my oncologist every three months, with bloodwork done a few days before. I mentioned in my last post that my April bloodwork revealed my PSA (Prostate-Specific Antigen, the blood marker for prostate cancer) had gone from 0.2 at the start of this year to 0.65. While that is still well within the "normal" range for PSA (4.0 or less) it worried me because it had tripled in three months. My oncologist told me not to panic, and that we'd only start talking about more treatments if it got up past 2.0.

Three months after that, my PSA registered 2.14, meaning that it had (more than) tripled again, Cancer was clearly still growing, somewhere, and we should start to investigate where and how much. My oncologist put in an order for an expensive PET-PSMA scan, something my insurance balked a bit about when one was requested at the start of this nightmare in the spring of 2024. I expected more balking this time, but the scan was approved right away and we were able to schedule it within a week. I just had that scan on Wednesday (8/13) but won't know the results until we meet with my oncologist next Wednesday (8/20).

One thing is clear: I will need more treatments.

The thought of this depresses me. Although I've been trying to exercise and stay as active as I am able, I'm still nowhere near what anyone could call "recovered" from the cancer-and-chemo induced trauma from last year. The exercise has been helping, and I do feel like I've been getting stronger, but I still have numerous maladies and physical limitations. For example, on any given day when I have some sort of event on the calendar, that one thing is about all I can do that day. I haven't had a day when I've felt up to doing two or three activities (okay, maybe super low energy level activities like doctor's appointments) since before my diagnosis. Also, when I do have the energy to participate in something more enjoyable than a medical appointment, I'm only good for a couple hours before I wear out.

I've been tolerating this because, well, because I don't have much of a choice. Beyond that, though, the thought that has been keeping me feeling positive (most of the time) is that I am s-l-o-w-l-y getting better. In my mind, better days were ahead, I just needed to help bring them on by exercising and staying positive. Throughout most of June and July, I've been feeling like I could see the "old me" on the horizon, and it was a welcome sight to see. The regrowth of some of the cancer and subsequent discussion of more treatments has pretty much drained me of any such positive outlook. 

In the past few weeks, my energy level has gone way down. I find more difficulty in getting out of bed and, much more often than in the preceding months, I have trouble motivating myself to do exercise on my little home gym. I feel so tired, most of the time, that I don't even feel like trying to do things. At first, I was writing this off as the fault of cancer regrowth, but the more my wife and I talk about it the more I realize at least some of it is rooted in depression.

Whether or not I have to go through chemo again (an absolute nightmare last time) will be determined by my oncologist's take on the scan I just had. We've already talked about this, pre-scan, and we're all hoping that the growth is happening in a single location (or two) that can be irradiated. I'm also somewhat encouraged that this oncologist -- a different doctor than the one with whom I started this nightmare journey -- is up on current research and willing to discuss a variety of treatment options. 

Still, I think I spent the first half of this year thinking that I was on a slow road to recovery. I could see it and I could feel it. If I needed more treatments of any sort, it would be a couple years away. 

Not, as it turns out, right now. 

The Good, the Bad, and the Ugly

I haven't updated this blog/journal since the 1st of February so, now that I'm six months out from chemotherapy, it seemed like a good time for an update. I've had just as many ups as downs since my last update, which is what prompted me to steal my title here from that old spaghetti western starring Clint Eastwood.

The Good:

• My physical therapy sessions lasted from January through March, and our main focus was on balance, lower body strength, and mobility. I was a good boy about this, attending nearly every scheduled session (usually twice a week) and being fairly diligent about my homework exercises. It helped a lot. I won't claim to have the balance that I did before cancer but I feel a lot better about all aspects here.
  

• Some time during my PT sessions, I started incorporating some upper body exercise with a Total Gym that we bought just before my diagnosis. It can be easy to let an entire day pass without actually doing any of my TG exercises, but I continue to try to get in at least 2-3 per week. 
  

• My wife and I (and sometimes daughter and I, when she has the time to visit) have taken a number of nature walks/hikes this year, including several during the spring to check out ephemeral wildflowers growing in the area.
  

• I've been able to cautiously participate and/or volunteer for more events with local nature organizations. It's not nearly at the same level as before I got sick, but it feels good to be part of the world again after spending so long stuck at home.

• After two failed attempts (due to weather conditions, mainly) I was finally able to go downstate to visit my daughter for a weekend in early May. She had several day trips planned for us at natural areas down there, and I had enough energy to participate in everything she had planned. 

• This past Tuesday, May 13, my wife and I went on our first bike ride in two years! It was a short one, only a little over 5 miles in total, but we did it and had no adverse effects from it. It sure was nice to get out on our bikes again. We're already starting to plan a 7-mile ride to see how that goes.

Among the Virginia Bluebells display at Deer Run Forest Preserve

Kinnickinnick Creek Nature Preserve with our friend Lisa (and Rocky!)

With my daughter at Henry A. Gleason Nature Preserve

Stopping for lunch at Hononegah Forest Preserve with our friend Rodger.

 

 The Bad:

• At some point this year, I was excited that I was able to hike a mile to a mile and a half on unpaved paths. I tried a 2-mile hike with my wife once, and I could do it, but started dragging about 2/3 of the way. (Literally dragging. My wife says she can see me dragging my feet when my stamina runs out.) The "bad" part about this is that, irrespective of any other exercises that I'm getting, I'm still at that same exhaustion point. My stamina has not improved much at all.

• At my 6-month oncology appointment, my PSA had gone up slightly. It was 0.2 and has gone up to 0.65. My oncologist doesn't feel this is cause for alarm, and said that many PSAs fluctuate. The range considered "normal" is 0-4, and my wife keeps reminding me that 0.65 is still under 1. I can't help but worry that it went back up, though. In purely mathematical terms, it more than tripled. I'm trying to find consolation in what my oncologist and my wife are telling me, but the rise still makes me nervous.

 

The Ugly:

• Toward the end of April, I noticed that my right ankle had swelled up. There was no pain or bruising associated with it, it was just noticeably swollen. After looking for some answers online, we realized that this may have been some form of edema. I was already rather casually monitoring my salt intake because I have (for years now) high blood pressure, but we started scrutinizing that even more carefully. We also bought some compression socks, which helped quite a bit, and I started elevating my foot and leg whenever we were just sitting in the living room together. I haven't gotten rid of it yet, but it's down to "barely noticeable".

• In the evening of May 9 (one week prior to my writing this) I started feeling my heart not beating normally. It wasn't racing or skipping beats because I've had experience with both of those. It's hard to describe, but I kept saying that it felt like my heart was tired, as though it was struggling to beat normally. When it happened again the next evening, I mentioned it to my wife and she decided to keep a record of it happening. Unfortunately, it happened every day since then, and has started earlier in the day each time.

• On Wednesday, May 14 (the day after our bike ride mentioned above) I woke up completely exhausted -- drugged-like exhausted -- and my aforementioned heart issue had started even before I got out of bed. We decided to call my "regular" doctor in hopes that maybe we could make an appointment. He advised us to go to Immediate Care, which we did. We spend four hours there that day, with them subjecting me to bloodwork, chest x-rays, EKG, and a CT scan. None of the results raised any red flags so the parting advice we were given was to make an appointment with a cardiologist.

• That afternoon, we asked my GP for a referral for a cardiologist. He gave us two names. The earliest we can get in with either of them is early September! It's as though the cardiologists feel we just want a casual social visit. By September, this issue will either go away on its own or get so bad that we'll need to go to the Emergency Room because it got much worse. As I type this, my heart is not beating regularly, I don't know what's causing it, and the medical professionals are just shrugging their shoulders.

 

Sorry to end with the ugly. I want to emphasize that I'm very glad to still be alive and I am well aware that I'm doing better now than I was last year at this time. I'm just frustrated, first that my recovery is generally so glacially slow, and second that the edema and heart trouble have presented genuine setbacks. I was taking baby steps on a ramp that was almost horizontal, then somehow fell off the ramp with these new issues in May. 

 

I'd like to think that moving my body and eating better food are helping me, even in light of the setbacks, but I definitely struggle with motivation right now. I've been a very good boy since ending chemo, so why am I now taking several steps backwards? Has moving and eating better helped me? Right now, it doesn't feel like it.

Post Chemo Check-in

It has been four months since my last chemo infusion on October 1 and three months since we've checked any of my bloodwork. This update comes courtesy of a busy week, though, with labs and physical therapy on Tuesday, meeting with my oncologist on Wednesday, then an appointment with my GP as well as PT on Thursday. 

Anxiety ruled the days leading up to this. It would be the first time since starting chemo that my PSA (prostate specific antigen, the cancer "gauge" for me) wasn't monitored monthly. All sorts of thoughts of this aggressive cancer rearing its ugly head in the last three months was starting to weight heavily on my mind. If that PSA was back up, it would probably mean a 2025 that mirrored my 2024, which was the worst year of my 62 years on this planet.

I tried to console myself by reminding myself that I was still on the hormone drugs designed to keep my testosterone down, and that Ground Zero for the cancer (my prostate gland) had been nullified through the cryotherapy that happened at the start of all this. Still, especially in the days leading up to my oncologist appointment, I was pretty nervous and couldn't stop thinking about the worst case scenario. My wife admits to feeling similarly.

I am very pleased to report that my PSA is now down to 0.20, which is 0.06 lower than it was at the end of October! I'm under no illusion that my cancer is now somehow "cured", especially since they reminded me all last year that my cancer is incurable. However, if what we're doing is working so well that my PSA continues to go down, meaning that the cancer is mostly dormant, I'll take it!

One of my big concerns was that, in the past month, I not only started physical therapy but also supplemented that with some low-level upper body exercises at home. My understanding is that exercise increases testosterone, which was adding to the anxiety before my check-up. I need the exercise, but will it trigger cancer growth and spread? Apparently and very thankfully, the answer to that question is "no".

Speaking of PT, it really wears me out sometimes but I can tell that it's working. My balance (which had fallen into the "absolutely sucks" range) has improved. Likewise my lower body strength. I've still got a long way to go, but anything that makes me healthier than I was last year is welcomed with open arms. 

My wife and I found ourselves out at a frozen lake in a local state park on Wednesday, after the oncology appointment. The outside temps had warmed up that day, but there was still at least 6" of ice on the surface of the lake. After spotting a couple ice fisherman out much farther than I would choose to go, I decided to venture out on the ice for the fun of it... and ice photos! I didn't realize it when I stepped out, but this turned out to be a pretty intense test of both balance and leg strength. I had no ice cleats with me, so I was literally walking around on the ice with street shoes. I'm still surprised that I never ended up with my butt on the ice!

 

 

The next day, between trying to keep myself upright on the ice and a new and strenuous PT exercise, my legs we're just killing me. As I write this three days later, my legs are still sore. As much as that might sound like a complaint, it's also so nice to know that I'm building strength, gaining more balance, and I'm able to do stuff like walk around on a frozen lake. I don't think I would have been able to do that through most of 2024.

Bottom line? This recovery is remarkably slow but it's nice to feel sooo much better than I did most of last year, and it's just a nice to know that my PSA is staying down for now. 

Zen and the Art of Battling Cancer

✦ ✧ ✦ ✧  WARNING: Music Nerd Post  ✧ ✦ ✧ ✦

Not long ago, I was having a conversation about music with a good friend of mine. My friend and I have enjoyed numerous great conversations about music over the 30 years that we've known each other. In this instance, we found ourselves talking about how some music gets past us and, on the other side of that coin, the ups and downs of only recently discovering "older" music. This led to a brief discussion of some other self-imposed frustrations we put on ourselves.

It got me thinking about how my listening habits have changed, influenced by my battle with cancer for the past year. It's safe to say that this battle has changed me in several ways, both physical and mental/emotional, and our conversation made me want to try to articulate how the past year has changed my listening habits. 

Since I’ve been sick, I’ve really embraced spontaneity in my listening habits like never before. If a post about a record or a band makes me curious (or nostalgic) I give it a listen. If something trips a trigger and invites me down into a deep musical rabbit hole, I willingly follow it in. Life is short, and none of us will ever hear all the music. Listen as you please.

I realize that the ability to stream music makes the aforementioned easy to do. I would never have been unable to listen so spontaneously even a decade or so ago. I'm a big fan of streaming music for all the investigating and experimenting you can do with such ease. (To anyone reading this who might also be sensitive to the ways in which many streaming services pay so little to the artists whose work they stream, rest assured that I often support artists I really like financially.)

Sometimes things don't trip any triggers with me. In the past I might "try" to like it with further listens, especially if it's getting good reviews. Now, if something doesn’t hit me, I might just try it again later... or I might not. Sometimes it works “later” and sometimes not, but that’s okay too. It's all okay. There are no rules.

My friend and I share a common frustration (or would "sense of wonder" be more accurate?) about certain music slipping past our radar and then "discovering" that music much later on. Here's an example: One of my sweet spots in the world of jazz is small group sessions from the late 50s and early 60s. Most of this came out before I was born. Sometimes when I listen to it, I’m both overwhelmed at how great some of that music is but also frustrated that I didn’t even know it was out there until decades later!

It was a low key frustration, to be sure, but I've never liked missing out on things musical. These days, I’m convinced that such late discoveries only enhance my daily listening experiences. New musical surprises… only of older music. I realize that my previous frustrations were entirely self-induced, but it's still nice to be free of them.

There's a Zen-like, go-with-the-flow theme emerging here. Music has been incredibly therapeutic for me since I got sick. It helped bring me out of some very dark places. I value it now more than ever ... and I already valued it a great deal! I’m not going to give a second thought to how timely I discovered something, whether or not I "should" like it, how much I know about it, or even whether I'm streaming or listening to physical media sources to hear it. 

Life is too short for all of that, except music itself.

100 Days

It has now been 100 days since my last chemo infusion on October 1, 2024. That seems like a good excuse for an update. 

I've alluded to this in previous entries, but I'm astounded at how long recovery from chemo takes. Over three months from my last infusion and I'm still weak, feeble, and my balance is terrible. I've only just recently stopped using my cane around the house for stability, but I still get around like an old man and make frequent use of countertops and door jams to maintain stability.

I just turned 62 but I feel much more like 72+ these days. Seriously.

My hair is taking an incredibly long time to grow back. I think I mentioned this in the previous post but my glacially slow hair regrowth has turned into a gauge for my healing in general. I've been very frustrated that I'm not getting better any faster than this, and my wife reminds me that my hair regrowth is a visual indicator of how long it's taking my body to recover from the chemo. That has helped me be more patient, at least to an extent. 

Matters of fact: At 100 days after my last infusion, I have 1/4" to 1/2" hairs growing on most of my head, eyebrows, mustache, cheeks, arms, and chest. (I was no gorilla before I got sick but I was a kind of hairy guy, making the loss of hair very apparent.) At a distance, I still look mostly hairless. Only my chin hair seems to be growing enough to be obvious.

Somewhere in the middle of my chemotherapy, at the end of some of those rounds, I felt well enough to go for short hikes now and then. I expected that to happen during the last week of round five and six, but the accumulation of Docetaxel in my system had built up enough that I never saw "better" days during those rounds. Little did I expect, though, that I had so much in me it would take many more months to recover once chemo was over. It will be interesting (in a somewhat perverse way) to find how long it will actually take before I feel like my old self again. At times I wonder if I will ever feel like my old self again.

In better news, I started physical therapy, and I've been working on some things that definitely seem to be making a difference in terms of strength and balance. In addition, just in the past week or so, I've started to do a few upper body exercises on the Total Gym that I bought about a year ago. (At the time I bought it, I thought I was really run down and out of shape, and it was winter. I didn't realize cancer was spreading through my body and making me feel that way.)

My physical therapy exercises are focused on hip and balance issues right now. All lower body work. My upper body was always the stronger half of me but I still want to get back some of what I lost through last year's ordeal. That's the Total Gym's job right now. I'm also happy to report that, even though I'm only doing about a dozen repetitions of a handful of exercises, it's not wiping me out. The smallest amount of exercise was wiping me out from February 2024 onward. It's nice to feel that I'm finally at least well enough to handle some minor exercises. It's been a while!

One last thing. I'm still on my anti-testosterone hormone drugs. I will likely remain on those drugs. I really have to wonder how big a role those are playing in my overall lack of strength and stamina. They've got to be playing some role!