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 Tales from real life |
| Well, if they're not true, they oughta be! |
| Part 1 - Diagnosis My blue ribbon story begins with a routine yearly physical in September of 2024. My blood pressure and cholesterol numbers landed in the normal range for a 67 year-old male, but my A1C had risen just high enough to qualify for diabetes. That was a bit disappointing, but not unexpected. My family has a history of type II diabetes and I’ve always had a sweet tooth. My doctor and I agreed that I would modify my diet, get more exercise, and recheck my A1C in six months. A bigger concern was that my PSA had jumped from 4 to 18. I hadn’t experienced any physical symptoms, but an elevated PSA is usually an indication of prostate cancer. My GP told me not to be overly concerned, though. He said that there are other conditions that can cause a high PSA and he ordered another blood draw to confirm the result. The second test came back at 16. Diagnosis confirmed? Not quite. Doctor Chan wasn’t ready to use the C word just yet. “There’s no reason to panic,” he told me. “I sometimes see patients with a PSA in the hundreds. But l do want you to see a urologist and get checked out more thoroughly. Next week.” The urologist’s office confirmed my appointment immediately and the quick response seemed ominous. I’m used to waiting weeks to get a non-emergency appointment at our primary health clinic. But only four days later, I gave up a urine sample to be tested while I was being poked and prodded in the exam room. I faced a battery of questions from the urologist about my personal habits. Questions that no one even wants to hear, let alone answer. My urine test didn’t reveal anything unusual, but there was a possible abnormality found during the ‘digital’ exam. “No reason to panic,” Doctor Dai told me. “It may be nothing serious. But l do want you to have an MRI. Next week.” The MRI appointment was confirmed immediately. Again, the urgency seemed ominous, and again, the doctors all said it was premature to use the C word. Nevertheless, my anxiety level ratcheted up. A few days later, I was lying on my back in the claustrophobic tunnel of the MRI machine. I kept my eyes tightly closed, partly because I don’t like tight spaces and partly because I was dreading what they might find. Still, I needed to know if the outlook would be good or bad. And I got bad. The MRI images showed lesions on my prostate gland. The MRI also revealed a prostate gland volume of 63 cc, a significant enlargement over normal. “There’s no cause for panic,” Doctor Dai said. “It probably isn’t serious yet. But we’ll have to do a biopsy to see exactly what we’re dealing with. Let’s schedule it for next week.” Despite all assurances, the trajectory of my diagnosis seemed to be headed downhill. I’d gone from not serious to not serious yet. And the sense of urgency remained. I tried to stay calm and keep a positive attitude for my wife, Debbie, but I had a bad feeling and I did a poor job of concealing my anxiety. The biopsy was performed by Dr. Dai on September 30th, less than three weeks after my GP first noted the elevated PSA level. Prostate biopsy is a relatively minor outpatient procedure, similar to a colonoscopy, with the patient under a light general anesthesia. A hollow needle takes tissue samples from suspicious areas of the prostate as identified by the MRI scan. The doctor is guided by an ultrasound probe and also does a more thorough physical exam of the gland while they’re ‘in the neighborhood’. The side effects are mild, and recovery requires only a few days of restricted physical activity. The emotional impact was far more severe. I didn’t want to think about a negative outcome, but simply having the procedure forced it on me. Debbie and I met with Dr. Dai the following week to discuss the results. This was the meeting where we finally used the dreaded C word. Ten of fourteen cores taken from my prostate were positive for cancer. It had already spread throughout most of my prostate gland. Dr. Dai explained the surgical treatment option, total removal of the prostate, and she described the probable side effects. Incontinence, impotence, infertility, there wasn’t any good news. My initial reaction was a panicky impulse to get the tumor cut out immediately, today if possible. I wanted the damned thing gone. But there’s a mandatory six-week recovery period between biopsy and prostate surgery. That meant waiting until mid-November at the earliest. And Dr. Dai recommended that I get a second opinion from a radiation oncologist before making a final decision about treatment. She also scheduled a bone scan to determine whether the cancer had spread beyond my prostate. There weren’t any more comforting assurances, the cancer diagnosis was serious. The only question left was how serious. I spent the next two weeks in tense apprehension before getting back to the hospital for my next scan. The urgency felt very real now, and time dragged slowly as I waited for the next piece of bad news. In my mind, the bone scan would reveal whether my case was treatable or terminal. I could almost feel those insidious cancer cells breaking away and spreading through my body. What if today is that day? What if next week is too late? A bone scan is done to look for cancer cells that have migrated to other parts of the body. A radioactive marker that binds to cancer cells is injected into the patient’s bloodstream and the scanner creates a full-body image of where the marker accumulates. For some odd reason, cancer cells show up in the bones first, so that’s where the doctors look. If there’s no cancer in the bones, then it hasn’t spread. It’s important to look beyond the initial tumor site because metastatic cancer is much more serious. The treatment options are more invasive, the side effects of treatment are worse, and the long-term outcome is less likely to be positive. Thankfully, my bone scan was negative (although it did show significant wear in my arthritic knees). I felt considerable relief at this bit of good news. Maybe there is light at the end of the tunnel. At least, I wouldn’t have to start out with chemotherapy. But I still needed to decide on surgery versus radiation. So, the next step was to schedule an appointment with Dr. Taylor at Evergreen hospital for November 12th. It was at this point that I ‘came out’ to my friends and family. I hadn’t wanted to frighten them until I had a firm diagnosis. Their outpouring of support was encouraging. My daughter Megan immediately brought me a T-shirt emblazoned with a cat giving the double bird and a caption that reads simply Hey, Cancer. Debbie gave me a St. Peregrine medal to wear. He’s the patron saint of cancer patients. I’m not sure if I believe in the intercession of the saints, but I haven’t taken it off either. When I’m feeling down, I can reach up and touch it. It’s comforting to know that Deb is praying for me. My daughter-in-law Mary gave me a ball cap with a row of colored ribbons that represent different types of cancer. It says Cancer Sucks in Every Color. I knew about the pink ribbon for breast cancer, but I had to search online to find out that there are actually many colors for many cancers. My ribbon, for prostate cancer, is light blue.  |
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