Wednesday, December 20, 2006

Year-end Prostate Cancer Blog Summary

The last posting, May 18, reported on the sixth and final chemo treatment on May 8. In that post I stated that there would be irregular future postings. That never happened. Many of you have encouraged me to write a year-end report. Thanks for that suggestion. It makes so much sense. I need to bring closure to this year of treatment. It will be a lengthy report covering what has happened in these past six months.

I’ve been recovering rather well and haven’t felt the need to write what I was experiencing. I wasn’t feeling normal, but I wasn’t feeling too abnormal either. I was just slowly moving away from the chaotic/static feelings I had experienced during chemotherapy.

Some of you do not care to know about my personal sexual aspects experienced during treatment. But because a prostatectomy followed by chemo and hormone treatments have such a major impact on sexual behavior, it would be like talking to you with an elephant in the room and not acknowledging it. How honest and realistic is that? Besides, how else are men going to know and learn from one another if they do not share their experiences? So, if sexual behavior is of no interest to you, skip a couple of paragraphs.

On Monday evening, May 29, during my sleep, I had a quasi-erection and a nocturnal climax. While dreaming this event, I found it even surprising that it was possible, and I “chose” to climax. Of course there is no evidence that such an event happened since the seminal vesicles were removed during the radical prostatectomy. Was this a phantom dream? The experience was on my mind for days wondering how this was possible after being on chemo AND androgen deprivation therapy for five months. Do nocturnal climaxes occur independently of testosterone levels? A resistance exercise program can increase testosterone levels, but my last workout at the fitness centre before the dream was on May 23—six days prior to the event.

While I was delighted about the event, I was also concerned that there must have been enough testosterone in my body to have triggered or supported the ability to climax (or have a dream that would support it). Perhaps that was not a good thing. I wondered if the deprivation therapy (the total androgen block) wasn’t working. If there was testosterone, there might be cancer cells feeding on it. This began to worry me.

In the meantime, life went on. Dr. West had said that the effectiveness of the sixth and last chemo treatment would wane by the end of the month. So, Elly and I went out for dinner on May 31 at the Wild Saffron Restaurant (Victoria), and celebrated with our first glass of wine since the end of December. We felt it was important to mark this date to celebrate what we had accomplished thus far (fairing well with the chemo and contending with the emotional baggage that goes with this condition) and to mark it as a new phase in the treatment/healing process.

The nocturnal events were still dominating my thinking as to why they happened. I called Dr. West (oncologist) to inquire about this. He was out of town at a conference. I emailed Dr. Lin (surgeon) with my query and he emailed back the following:
Regarding your nocturnal event and if it has any bearing on testosterone levels or impact on any prostate cells, the bottom line is that I would not worry. We know that erections are somewhat dependent on normal testosterone levels, but clearly men can have erections with low levels of testosterone. There are men that can have erections even with androgen deprivation therapy, but I will admit that it falls into the more rare situation. I would suspect that Dr. West has already checked your testosterone levels, and if not, he likely will check them just to make sure that you have what we would consider to be "castrate levels" of testosterone.
Obviously, I felt pleased and relieved.

Myles arrived in Victoria June 14, and the following Sunday we participated in the Prostate Cancer run/walk fundraiser here. It was a glorious day and I felt very gratified being a part of such a strong turnout for Father’s Day. How appropriate.

On June 21, enroute to Portland via Seattle to visit with Blaine and Cindy, I stopped at Swedish and had blood work to check my testosterone level. Dr. West called me at Blaine’s the following day to say the level was low as it should be. He reiterated Dr. Lin’s advise, “not to worry.”

Elly and I spent a week at Camp Sherman on the Metolius River in Central Oregon. We love this place even though it was at this place exactly a year ago that I got the call from Dr. Lin telling me that the prostate biopsy showed cancer cells. Afterward, we flew to New York City to attend a wedding and spend time with friends. We returned to Seattle July 13, and I had the third hormone shot and a scan to measure bone mineral density. Chemo and hormones tax bone density. I had had a Dexascan done on January 3, 2006, to establish a benchmark for my bone density. That scan classified me as having moderate osteopenia. Dr. West was on vacation July 13. I faxed him on July 17 as a follow-up to Nurse Ruth’s notes for that visit. (I had had two more nocturnal climaxes—still perplexed but pleased). He called immediately after receiving the fax and we talked a good while. He reported that the 7/13 scan showed no loss in bone density. I am very fortunate to have such incredibly responsive doctors.

Even though I was feeling good and told people I felt about 90% of my normal self, I had quite a few different physical reactions after coming off the chemo. I began having hot flashes at night, tossing and turning and feeling very hot, throwing off the covers, then searching to pull them on again. Somehow, I never felt like I lost much sleep from this. For some reason, these hot flashes happened at night with very few during the day. My sister-in-law Irene, who lives in Holland, suggested I take soy supplements. She is on hormones after breast cancer surgery and chemotherapy, and finds soy gives her relief from the flashes. I asked Dr. West about soy, and he sent me instead a prescription for venlafaxine to address the hot flashes in case I wanted to try it. The Physicians Desk Reference says that venlafaxine is “ indicated for the treatment of depression.” (It says nothing about hot flashes.) While it may be effective in eliminating hot flashes, I’d rather endure the flashes than to chance any change in my thoughts and behavior. I was engaged in some deep philosophical thinking about my life, and didn’t want to take anything that might alter the authenticity of what I was thinking. The discomfort level from the hot flashes was not high enough to merit such drug taking.

Here are other physical conditions I began experiencing at the end of May after having completed the chemo treatments.
· Muscle stiffness settled in my legs and continues even today. Each morning, before getting out of bed, I must stretch my legs and make the muscles limber before standing. If I don’t do this, I can only stand with knees bent, and in some mild muscle pain, while feeling too uncertain to stand upright in fear of losing my balance. If I stretch before getting up, the stiffness is still mildly present, but there is no balance problem.
· I had a bone ache that ran across the chest and terminated in both shoulder joints. I don’t know how else to describe this. The pain felt like it was in the bones. At the onset of this, I would awaken often with mild pain in both rotator cuffs. I had to reposition my arm in a comfortable resting place before the pain subsided. Lately, the pain is only in the right rotator cuff and it is always whenever I challenge the range of motion of that arm. I often sleep on my side, with my arm stretched above my head, with the ear on my bicep. At first, I couldn’t lie in that position with either arm, but now I can do so with the left arm only. Neither the leg muscle stiffness nor the rotator cuff pain disrupts my sleeping much. I wake up each morning feeling rested. I am wondering if the hormone treatment is depleting the testosterone by taking it from the muscles and bones, and thus making my body weak overall.
· The back of my ankles swelled at times and became thick. This has not been the case for a while.
· My chest is developing slight breasts.
· I’ve gained 10+ pounds.
· All of my fingernails and toenails were affected by the chemo. Some turned black. The fingernails of the second finger of both hands came off. All the fingernails have grown in nicely. The toenails are slower growing but doing fine.
· My skin appears to be aging quickly. When I look at my arms and thighs, the skin looks craggy and dry, and in some areas puffy or dented, as if it lacks some cellular substance that gives the skin a full and firm surface.
· My head hair is back and silver but much thinner on top. While my beard is growing back reasonably well, the moustache is sparse.

In discussing all the physical changes, Dr. West said men have varying reactions to hormone treatment. Most men are not apt to observe and/or articulate their changes. In my case, the first five months of hormone treatment were accompanied by chemotherapy. This is an unusual protocol. There are no data on how men respond to this treatment. Maybe this blog will contribute to the anecdotal evidence of what men experience.

It was in this 7/17 fax to Dr. West that I reiterated the supplements I was taking. Dr. West doesn’t have much faith in the effectiveness of so-called alternative pharmachemicals. They are not tested or regulated, and he thinks they can do as much harm as good. The combination of all the supplements I was taking might be harmful. More is not always good. Based on his concerns, and mine too, I pared down the list of supplements. I cut out the Vitamin E, Selenium, Flavonoid (green tea extract), and Greens Plus drink, but kept the daily Calcium (600 mg) with Vitamin D (200 IU), Multivitamin (Centrum Silver), and Vitamin C (1000 mg) along with the prescribed 50 mg of Casodex (hormone).

My diet includes plenty of the following: tomatoes (lycopene), nuts (vitamin E). flax seed (omega 3 oil) ground on cereal every morning along with soymilk and quark, fish, vegetables of all colors--both leaf, fruit, and root; fruits, especially berries; ginger; and turmeric (curcumin).

Dr. Lin is involved in research on broccoli. In my November 6 meeting with him (I am getting ahead of my story here), I asked about the broccoli experiments. He explained that the lab team is learning that the enzyme myrosinase transforms glucoraphanin, found in broccoli sprouts, turns into sulforaphane upon damage, such as from chewing. In the lab, sulforaphane is destroying cancer cells. Isothiocyanate, found in mature broccoli, is also destroying cancer cells. Both compounds look very promising as a cancer prevention—especially against prostate cancer, Dr. Lin’s specialty. Of course, I am eating lots of broccoli—sprouts and mature clusters.

On September 27, I had blood work and the fourth quarter hormone shot. My blood condition was good. Dr. West called me the next day to report that the PSA was undetectable, less that 0.01.

On October 2, Elly and I flew to Santiago, Spain, and met Judson friends for two weeks of touring western Spain and celebrating our 35th wedding anniversaries together. We were all married within several months of each other at Judson Memorial Church. After our friends returned home, we drove to northern Portugal for another week’s visit. Then we flew to Holland for a week to be with Elly’s family. We did fine with so much traveling and learned to take it easy and allow each day to unfold as we felt like it. Some days we just sat around and read. Some days we took short walks and long naps (the Spanish and Portuguese cultures strongly support both). We always ate well and had some excellent wines. I managed to get in a couple of afternoons of drawing.

We were back in Seattle, Portland, and then again in Seattle on November 6 to meet with Dr. Lin. This was a one-year follow-up after surgery (September 14, 2005). I was pleased to report that my urine control is very good. I sleep through the night. The flow is steady and strong, and there is no leakage except on rare occasions with the release of a droplet resulting from involuntary actions like a belch or hiccup. Although the libido is active (I still have sexual stirrings and desires), I have not had any more sexual climaxes since mid-September. I think they are out of the picture for the time being and maybe forever. Dr. Lin said he has another patient with a medical profile similar to my own. Since I am “breaking ground,” he said he would inform him of this blog.

The question of “What Next?” still looms large. I am just taking one day at a time and enjoying it. I am grateful for my family who is very supportive and normal in dealing with me. We don’t have our heads in the sand, yet on the other hand we are not intimidated by adversities. We deal with whatever comes, and get on with our lives. I have good friends who affirm that I am valued and loved, and I participate in a reading group that challenges my thinking about spiritual matters. I am blessed in so many ways. Blaine and Cindy are expecting their first child in February, and we will all be blessed even more.

If any of you readers are interested in talking about prostate cancer, I am available at dickasonj@shaw.ca and 1-250-382-4530. Happy holidays to you, and may we all encourage and nurture prospects of hope and peace for the entire world in the coming year.
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Thursday, May 18, 2006

Sixth Chemo Treatment
Monday, May 8, 2006

On Monday morning, May 8, I had an appointment with Dr. Lin, my surgeon at UWMC, for the nine-month check up after the radical prostatectomy. It is always a pleasure to see Dr. Lin. My PSA was 0.03 and is considered non-detectable, which is what we all expected. No surprises here. We had a nice chat. I am to schedule quarterly PSA testing, at least for a while, to monitor any possible changes.

At 11:00, I saw Dr. West, my oncologist, at Swedish, for the sixth and last chemo infusion. Before each infusion, we always discuss my condition. He thinks I am doing great, but of course, I am always loaded with questions. My primary concern this time was to learn at what point the effectiveness of the sixth infusion would wane, and at what time it would be appropriate to start a program of supplements.

Then I had the actual chemo infusion. Twenty-four hours later, I had a Neulasta shot (white blood cell booster). That night I began feeling bad, real bad. We were in Victoria by Wednesday evening, and I immediately went to bed. This sixth infusion hit me hard—the worst of any of the previous five infusions. By Thursday, I was taking an Ativan every six hours.

Chaos was what felt. I was in a zinger-like malaise—feeling totally zapped. Kinesthetically, it was like what you might think radio static would "feel.” I had made prior arrangements to have a Reiki session Thursday after the infusion. I knew that I would be feeling at my lowest at that time and wanted to experience the energy alignment competing against the chemical toxins. When David, the therapist, arrived at 9:00AM, my mind was abuzz. We sat and talked a bit and he began the laying of hands from head to foot. Visually, the chaos I was experiencing appeared as static, and David was taming it to be at-ease. Blaine and Cindy have a sweet and demure Siamese cat, Mona. As David was working on me I was visualizing stroking Mona to smooth the chaos out of her frayed fur. After an hour, the buzz and zinging-malaise feeling had dissipated, and I felt relaxed and yet vacuous. The chaos was no longer dominant.

I am currently reading David R. Hawkins, M.D., Ph.D., Power vs. Force: The Hidden Determinants of Human Behavior. Dr. Hawkins, through his years of research in particle physics and nonlinear dynamics, has developed an anatomy of consciousness that profiles the entire human condition. We have made incredible strides in science, yet, our limitations on knowledge result from a lack of knowledge about the characteristics of consciousness itself. Hawkins explains that his calibrated scale, a stratification of levels of power in human affairs, is based on “current discoveries in advanced theoretical physics and the nonlinear dynamics of chaos theory” (p. 31).
Ah, chaos. Maybe there is reason this word permeates my consciousness. The essence of chaos theory is that chaos is a process wherein complex systems have the capacity to simultaneously give rise to both turbulence and coherence. From a “big picture perspective,” there are recognizable patterns intrinsic within systems (coherence) that are not predicable (chaotic and turbulent)) at a lower level of consciousness.

“Man thinks he lives by virtue of the forces he can control, but in fact, he’s governed by power from unrevealed sources, power over which he has no control” (p. 37). Hawkins equates degrees of wellness with levels of consciousness. It is his intent that, as we read his research findings, we will come to know our level of consciousness and how we may increase that level, thus increasing our health and well-being.

So what’s this got to do with chemo infusion number six? Damn if I know for sure, but on one level, I feel that having prostate cancer has greatly enhanced my level of consciousness. I have gone from the unknown to the known, not just in acquiring information about my illness but also in gaining awareness about a level of consciousness within myself. It is not full-blown knowledge, but rather a budding process. I am different, and as trite as it may sound, I am better for it. I know and understand that lots of people, perhaps the majority of people with infirmities, do not feel they are better off having gone through their “infirmed” experience. But nonetheless, we read plenty of accounts of people that do.

Tuesdays with Morrie is precisely about raising levels of consciousness. Everyday, Morrie learns more about himself through his illness. Such lucidness could not be acquired otherwise. How fortunate Mitch Albom was to be the recipient of those insights, and how fortunate we are that Mitch passed them along to us as examples by which we can compare and critique our own experiences. When you look at Morrie or Reynolds Price or Lance Armstrong, their conditions were totally chaotic, yet the chaos exposed them to a higher level of consciousness that provided coherence and a level of wellness in spite of the menacing illness. Call it effective coping devices, or whatever. The fact is the experience was a change agent that increased insight and consciousness. Hawkins says, “Facts are accumulated by efforts, but truth reveals itself effortlessly.” Amen. This isn’t even the essence of what Hawkins’s book is about. Go for it if you are interested in more—at a risk of a higher level of consciousness.

So, where am I now? When I talked with Dr. West on May 8, I asked him what I should do as a follow-up to the chemo treatment. My sense was that I should start taking extra nutrients (vitamins, minerals, enzymes, and electrolytes). Also, I thought I should do a regimen of fasting, cleansing, and/or detoxification to assist my body in recovering from the taxing toxins received during treatment. I am on a promising path of health and wellness now, and I do not want any time to lapse before moving into the activities that will build on all that has been gained to date. This supplement program is part of an answer to the question posed in the last blog posting “What Next”?

Dr. West said June 1 would be the date I could start living normally, even though I will still be on hormones for the next 18 months. I shared with him the supplements I wanted to take, and he thought they would be fine.

Continue to take daily:
Multivitamin (Centrum Silver, 1 tablet daily)
Calcium (600 mg) with Vitamin D (200 IU).

Start anew:
Vitamin E (400 IU)
Selenium (200 mcg)
Flavonoid Supplement (300 mg) in the form of green tea extract at 80% polyphenols.
Green liquid such as Greens Plus (8 oz)
Vitamin C (1000 mg). This also works synergistically with flavonoids and calcium.
High protein smoothies (whey drinks, 8 oz. This may be repetitive with Greens Plus. I need to check it our further and be sure to maintain an acid-base balance in my body)

Deliberate foods
Tomatoes (lycopene)
Nuts (vitamin E)
Flax seed ground on cereal and salads (Omega 3 oil)
Fish
Vegetables of all colors, of both leaf, fruit, and root
Fruit of all sorts
Soy milk
Ginger and turmeric (curcumin)

I was seeking a recommendation from Dr. West for a detoxification, cleansing, and/or fasting plan to cleanse and give my organs, particularly the liver, a rest after the chemo treatments. He felt that any cleansing/fasting/ and/or detoxifying would not be of benefit, and that it could do more harm than good. His premise is that when you stop eating or flush out nutrient intake, the liver has to make up any deficits it experiences from other parts of the body. This would be taxing and not restorative. It would be more supportive, for all body functions, to simply monitor intake so there is a balance of sufficient nutrients to assist the body in its healing endeavors. I asked about working with a naturopath to help sort out “sufficient nutrients,” and Dr. West said he had no problem with that. I may be consulting a naturopath in Victoria.

Yesterday when I was at the bank, I noticed a brochure for the 8th Annual Father’s Day Prostate Cancer Awareness 8K run+walk. “Eighth annual,” I thought, “my word.” This is the first time I’ve seen a fundraiser for prostate cancer and it has been going on for seven years! This was certainly a consciousness level raising experience. You can be assured that I am going to participate in this one.

So what’s going to happen to the blog now that the chemo is over? I’ll continue posting, primarily for my own record, but it will not be on a regular basis. I know that engaging a naturopath will be of interest to some readers. Taking supplements has already stimulated my research into things like the USDA’s dietary supplement labeling guide, the FDA’s daily values (DV), and the international unit (IU) in pharmacology. Here’s a question for you: Do you know all the information on the side of a cereal box and can interpret (this is key) the value it has for you?

There is a huge gap in the “What Next” question that still has not been answered and that relates to my soul. I haven’t avoided this. I continue to read and spend time in in-depth discussions with two close friends, Peter and Bill, and I will continue reading in a Rudolph Steiner study group. These things feed my soul. They nurture me, and they aid my awareness of consciousness. Also, Elly, in her encyclopedic knowledge and understanding, continues to challenge me, as well as encourage me, in my endeavors to make sense of things. Her strength is an enormous support to me.

As I have “awakenings” or “ah ha” experiences, I’ll record them on the blog. I am not talking about religious experiences, for I am an atheist. That means I do not believe in the God-concept that I was raised with or one that I have come upon since. I know I have a soul, the essence of my very being, but it does not need to be saved. It needs to be nurtured and enriched with experiences that affirm the grounding of my being. Paul Tillich is an influence here. This is as close as I can get to a description right now of my emotional/mental/spiritual state--that huge gap in the “What Next” question. Who knows what will come of it or where it will lead.

I thank all those readers who have responded on the blog, and I thank all those readers who chose to respond to me via email rather than post. Some of you did both. It has been a great comfort hearing from you all. You’ve been a very supportive audience.

Like my friend David Johnson says, “Life is Good!” Indeed, it is.
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Friday, April 28, 2006


Fifth Chemo Treatment
Monday, April 17, 2006


Each time before seeing Dr. West, the oncologist, I have blood work done right across the lobby from his office. It takes the lab about 20 minutes to run the blood pathologies and email him the results. As soon as he receives the lab report, Nurse Ruth calls me in for the “vitals,” and then Dr. West sits with me to discuss my condition. It is a very efficient routine.

This time, before the fifth treatment, Dr. West announced that I was anemic—the red cell count was low: “It won’t be a problem; we’ll give you a shot of Aranesp. It stimulates the bone marrow to produce more red blood cells.” But he also said, “I am concerned about how your liver is doing. The lab work shows that it is vulnerable. You may not be getting the sixth chemo infusion. We’ll make that call after we see your blood results ten to twelve days after this treatment.”

Dr. West explained that four cycles of Taxotere infusion are generally sufficient to kill all the cancer cells. Infusions five and six are icing on the cake. I was having some of that icing with the fifth infusion, and he did not want to risk compromising the liver for whatever benefit might be gained from the sixth infusion.

Obviously I did not want to risk damaging the liver, but psychologically I had prepared myself for six infusions. Not only had I prepared myself, I had begun to believe that the chemotherapy would be effective only if I had all six treatments. In fact, I had become fixated on that, and I was upset that it might not happen.

This fifth treatment hit me the worst. The day after the infusion, Elly and I took the train to Portland to be with Blaine and Cindy for a few days. The fatigue that normally hits me three or four days after the infusion was there when we got off the train. The weather was awesome and on Wednesday we went walking in Portland’s Arboretum. By Thursday afternoon, I was feeling more fatigued than I had felt before, and the general malaise was prevalent. My fingernails were all discolored and sore. I hadn’t taken Ativan on the day of the treatment because it was part of the chemo infusion orders. I didn’t take Ativan Tuesday or Wednesday. But Thursday night, Elly suggested I take an Ativan to assure a good night’s rest. I think I was so spaced-out that it required a “suggestion” to move me out of my inertia. It worked.

On Friday we took the train back to Portland. We checked into the Silver Cloud Inn, and I walked to the infusion department for a shot of Neulasta to boost the white blood count. You gotta wonder what’s going on with the bone marrow as it deals with boosters for both red blood cells (Aranesp) and white blood cells. These two drugs are pumping me up while the Taxotere is killing all the fast growing cells and while the Lupron (hormone--I got the second three-month shot right before the fifth infusion) is suppressing testosterone. The body is truly amazing to be accommodating all these active ingredients at the same time.

We were back in Victoria by noon on Saturday, April 22. I felt so weak that I knew I could not drive. One of our neighbors took me to the supermarket for a few groceries. At the nearby video store, I also picked up three DVDs with all 24 episodes of the first year of “West Wing,” and that’s how we spent the rest of the weekend. What a wonderful respite.

On Wednesday, April 25, I did the mid-cycle blood work at a local lab, and got the results on Thursday. Immediately I faxed the report to Dr. West and followed up with a phone call. Nurse Ruth said the lab results looked good. Dr. West called me shortly thereafter to say that my blood count and liver are of such conditions that he will prescribe the sixth and last infusion for Monday, May 8. I am pleased by that. No, I am elated! So, all is on schedule, and I am amazed at how fast it has gone. Everyday I am so grateful that I was able to do this treatment regimen.

So,“What next”? This is the question proffered at the end of fourth treatment blog, and it is what I have been trying to figure out since writing it. At the moment I am researching naturopathic writings to develop a follow-up care plan to enhance the immune system—a plan that is compatible with the quarterly hormone treatments through December 2007.

I have stayed clear of all antioxidants during the chemo treatments, but now, with an eye on prevention, I want to start supplementing, some would say complementing, my diet with a rational assortment of minerals, nutrients, and vitamins. Prior to the radical prostatectomy I took a daily 500 mg vitamin C tablet and was drinking daily whey-and-fruit smoothies. That was it. As soon as I get a plan, I will share it with the readers.

There are other aspects to the What Next question, and that is how I am going to engage myself. Instead of thinking “supplementary” or “complementary,” the word “integrative” seems to be a more complete and encompassing term. I honestly believe that the cause of cancer is multifaceted. To eradicate it from my body, I have focused on medical treatment, diet, and supplements, but I must also pay attention to the emotional, soulfulness, and spiritual aspect of my being. Will there be any changes in what I am doing now that will contribute to a new integrated being? At the moment, I cannot respond to these parts of the equation. Obviously, I am working on it (or, it is working on me) or I wouldn’t have mentioned it.
To be continued. . . .
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Saturday, April 08, 2006

Fourth Chemo Treatment
Monday March 20, 2006

The medical staff had told me that the third treatment is generally the worst and that the severity of the side effects stays at that level for the remaining infusions. But as King Lear says, “The worst is not, so long as we can say, “This is the worst” (IV.i.27). After this fourth treatment the eeriness, sense of malaise, and outright fatigue were much stronger than before. However, the period between the fourth and the fifth infusion is four rather than three weeks (Dr. West is off Easter week with his family), so I have a longer time to recuperate and feel strong again. Who knows if the worst is yet to come.

The intensity of the side effects is usually strongest from the fourth to the tenth day after the infusion. This was again the case. After this period I slowly become stronger, but certain side effects continue erratically throughout the entire period between treatments. Here are some examples.

Taste: Almost immediately after the infusion, a strong metallic taste pervades my conscience. On some days it truly dominates. This affects my food interest. I get these crazy cravings: celery and peanut butter, tomatoes and tomato juice, ice cream with chocolate syrup, curry of any kind, and moussaka, if you can believe that. Sometimes I find these same foods nauseating, and they would make me sick if I ate them. Why moussaka came to mind, I don’t know. Luckily there are several Greek restaurants in town; so on the day of that craving we went to dinner at Periklis.

The metallic taste becomes very evident about a third of the way into my exercise routine. I think the exertion must cause the chemo toxins to flood through my system looking for ways to exit.
I can’t do much about this. Occasionally I’ll have a mint, or do a quick tooth brushing. What I find works best is a drink of water. Victoria has good water, but it is treated. Therefore we now have bottled spring water in the apartment. I’ve been drinking a lot of it, which is also recommended for chemo recipients.

Fatigue: A walk or a workout energizes me, yet they also tire me. This too differs from day to day. One day I walked to the gym to do the exercise routine. The walk felt great, invigorating, but when I completed the stretches, I was depleted of all energy and worried about being able to walk home again. I stopped, rested a bit, walked home, and was fine when I got there—tired but fine. When I sit on one leg or move both legs under the chair, I feel muscle strain that quickly dissipates. The slightest muscle stress is apparent from a mild burning sensation.

Hot Flashes: This is new for me. They started when I stopped taking Ativan, ten days after the infusion. I have them only at night and I wake in perspiration and throw off the covers. Soon I am pulling the covers on again. This goes back and forth about three of four times during the night. Of course, the hot flashes may also be the result of the cumulative hormone treatments. I take a daily Casodex and I have been shot with a three-month supply of Lupron. The next Lupron shot is April 17.

Over Halfway Done
Now that I am past the halfway mark, I want to shout “SHORT”! Shouting short was ingrained in all of us who served in Vietnam. Everyone had a calendar with his or her halfway mark conspicuously decorated. Psychologically, you were on your way home when you passed this point. Your tour of duty was about over. What a motivating factor that was. It kept you upbeat and productive. (Such a factor is sorely missing for the National Guard soldiers in Iraq where there is no end-date of duty for anyone.) Everyone should have points in their future to mark accomplishments and launch new departures. The latter is what occupies my thinking at the moment. What next?

This week Elly remembered that she had a book by Reynolds Price, A Whole New Life: An Illness and a Healing (1994), that deals with this author’s struggle with cancer. What an incredible writer! I had never read Price before and this book grabbed my attention immediately, not only because of the subject matter (as you know, I am intoxicated by this illness) but also because of the writing style.

Price tells his story as a “temporarily able-bodied” (quoting Chuck Close) who has a malignant tumor in his spine that he refers to as “the eel.” After two years of catastrophic conditions, he found salvation in the return to writing. Concentration on something other than himself got him through mountains of chronic pain.

It wasn’t until six years after he became somewhat stabilized that he wrote A Whole New Life. He wrote it because he couldn’t find a personal account that he could learn from and/or use to size up his own situation. In writing such an account, you can’t just leave the reader without some lessons learned. Price gives three “facts” he would “risk conveying to a friend confronted with grave illness or other physical and psychic trauma.” I might add that these three facts are equally instructive for any life-altering event.

The first two deal with putting the self back together again. In whatever way that happens, you can never be the previous self. As to the third fact, Price says, “You’re not that person now. Who’ll you be tomorrow? And who do you propose to be from here to the grave, which may be hours or decades down the road?” In other words, what is next?

In the early throes of painful recovery, Price cites another piece of wisdom. He asked daily “for life as long as I have work to do, and work as long as I have life.” That thought, coupled with “what’s next?,” is where my focus is now. Stay tuned.

Links to the Blog
Several sources have been very helpful throughout my research on prostate cancer. I list five of those sources. They are hot-linked to websites. Here is a brief note about each.

Sloan-Kettering Prostate Nomograms. This gives probabilities for projected years of being progression-free based on a variety of variables a person is dealing with. A combination of disease factors, including stage of the cancer, prostate specific antigen (PSA) level, biopsy pathology, use of hormone therapy, and radiation dosage, are incorporated into the nomograms. Select the variables of your condition and calculate the probability for mortality. For example, before my radical prostatectomy, the surgeon estimated that the cancer could very well be contained within the prostate. Based on the PSA, biopsy, and radical prostatectomy variables, I had a 5-year progression-free probability of 66 %. After the surgery when they found that the seminal vesicles were involved, the 5-year progression-free probability went to 58%. Then, after Sloan-Kettering found lymph node involvement in their biopsy study, the 5-year progression-free dropped to 25%!
Sloan-Kettering offers nomograms for other cancers as well.

MedlinePlus. This is a service of the U.S. National Library of Medicine and the National Institutes of Health. It indexes more than 700 topics on conditions, diseases, wellness, drugs, and supplements. It provides a medical encyclopedia, dictionary and current health news. It offers directories to find doctors and hospitals, and provides links to libraries, organizations, and international sites.

Discovery Health Channel. This is an amazingly entertaining, interactive site that can easily distract you from your focus. It offers resources for every sort of health issue.

Townsend Letter. The Letter originally started as a magazine publication ten times a year and continues to do so. On the web it is a forum for the entire alternative medicine community. It presents scientific information (pro and con), and provides an index on a wide variety of alternative medicine topics. Anything pertaining to integrative and supplemental medicine you will find here as well.

Kimball’s Biology Text. This is an online biology text, a search engine, and a news broadcast. My learning about blood came from this text.

After this posting, I am changing the frequency of my posts. We now know generally what is going on between infusions. So rather than wait a length of time to observe side effects, I am going to post more often on what’s next in my thinking as well as my condition at the time. This will include thoughts about follow-up procedures I want to adopt after the chemo infusions are completed on May 8. Such thoughts will be about how to put together an arsenal of disease-fighting habits for prevention. Also, I may wax philosophical on conceptual changes in living.

Elly and I leave Sunday April 16 for Seattle. I have the fifth infusion on Monday. On Tuesday we are going to Portland again to be with Blaine and Cindy. We return to Victoria on Saturday, April 22. I’ll post again after the 22nd.
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Monday, March 13, 2006

Third Chemo Treatment
Monday, February 27, 2006

Over the past few months, it has slowly become evident that we are living with two additional “people” in our lives—Mr. C (Cancer) and Ms. MS (Multiple Sclerosis). We hadn’t consciously realized that we had been living with Ms. MS until we were introduced to Mr. C and began dealing with him on a daily basis. Now they both shadow our lives. We can’t seem to do anything without first taking each into account. It’s almost as if our lives are lived in reference to them. Our social life is definitely defined by their sense of things. If Mr. C’s blood count is low, I can’t go to populated public places in fear of contracting some infectious disease. If Ms. MS is seeing double and not maintaining good balance, Elly must restrict her activities as well.

We hold council each morning and consult with Mr. C and Ms. MS before we can make decisions about the activities of the day: activities such as when do we get up, how much reading can we do, what do we want for lunch, do we take a nap, can we email, do we work out, take a walk, return calls, write the bills, accept an invitation of any sort, and decide when to go to bed and with what medications? We are constantly conferring among the four of us.

OK, on to the third treatment. On Sunday evening, February 26, Elly and I took the Clipper ferry from Victoria to Seattle. It was a blistery day; the hydroplanes were not flying and it was the end of a weekend. The Clipper was filled to capacity (300+ people), all sitting tightly as if on a bus. I had anticipated this crowd and wore a health mask (N95 respirator made popular by SARS) to protect against germs from being in such tight quarters with so many people for a long period time (2 ½ hrs). The sail was longer than expected because of the weather, and we felt like we were traveling in steerage. I felt conspicuous with the mask but all the while was glad I had it on.

The next day, the day of treatment, the routine was as follows. First, I saw Dr. Zucker, a physiatrist, and then a physical therapist to check my physical state and review my prescribed exercise plan. The plan is designed for muscle maintenance throughout the entire treatment process. I am not to exert beyond the feeling of “burn” in any of the exercises. The objective is to keep muscles flexible and working for endurance and not strength building. If I feel the stress of “burn,” I am to stop immediately. “Burn” means the muscle tissues are stressed and are breaking down, which I do not want to happen. Now that the Taxotere has thoroughly saturated by body, I must continuously reassess how much (weight, repetitions, and sets) I am able to exercise for each of the selected muscles areas (calves, thighs, arms, and chest).

During the previous three weeks (February 6-27), there were times that I did not feel physically up to doing the prescribed exercise. Consequently, on this visit, the therapist reduced the weight considerably for the next three weeks, but she increased the number of repetitions and sets in my home program to enhance the muscle endurance factor.

I do the home program at a local fitness center, a 20-minute walk from home, and as I complete each exercise, I assess and assign a rate of perceived exertion (RPE). This RPE index is from 1 to 10, 10 being “can’t do anymore.” To be internally consistent with myself, I decided that the moment I felt the “burn” that would be an RPE of 8. So as I approach a “burn” feeling I stop the exercise and rate it a 7 and record the repetitions. For example, I have a bicep curl with a 10 lb. free weight to do 15 repetitions for 3 sets. As I count each curl toward the 15, I focus on the exertion on my arm. If I begin to get a burn feeling, I stop and record how many reps before the burn started. Then I rest for a minute and do a second set until the burn starts again, stop, record, rest a minute, and do the third set as far as I can before the burn starts.

When I started this bicep curl at the beginning of treatment, I was doing 15 lbs. and never had an RPE above 5. It was a piece of cake—no challenge at all. Last week, when I worked out with the 10 lb. weight, I was just able to do 14/15 curls at an RPE of 7 on the first set. Second and third sets had an RPE of 6 and 8. I am not sure why the second set was less than the third set. Fifteen to ten pounds are quite a drop in muscle endurance capacity since I started the infusion. The week before, I was even weaker.

Every other day I am at the gym attempting the whole routine. There are days that I get to the gym, start the routine but am not able to complete the sets. I feel no energy. Usually this is accompanied by a feeling of malaise hovering about my mind and body. I just feel strange. When I am in this state, I am instructed to go with the flow and not exert beyond a level of comfort. My purpose is maintenance, not building.

After seeing the physical therapist, I had blood drawn in preparation for seeing Dr. West. The blood results were electronically transferred to Dr. West within a half hour of the take. As you may recall, I had blood work done two weeks after the second infusion and my white blood cell (WBC) count was very low (2.7). Based on that vulnerable level, Dr. West this time prescribed 6mg of Neulasta, a white blood cell booster, to be given 24 hours after the Taxotere. Since we already had our train tickets to leave the next morning to visit Blaine and Cindy in Portland, we scheduled the Neulasta shot for Friday at 6:00 PM on our return from Portland.

I then sat in a comfortable chair for three hours to receive the infusion. Dr. West again prescribed 140 mg of Taxotere, the strength of the second treatment. There always is a residue of eeriness that lingers about ever since having the second infusion. Other than this, I felt nothing out of the ordinary during the infusion. Afterward, I walked back to the hotel and relaxed for 45 minutes. Elly and I ate at a neighborhood restaurant. That night I took an Ativan to assure sleep. The next day we caught the train to Portland, where we spent several enjoyable days with Blaine and Cindy. Michael Kelly was able to join us for dinner one evening. That was a nice treat for us all.

By Friday, I began to feel eerie and out-of-sorts. As with the previous two treatments, the side effects kicked in four days after the infusion. On the train back to Seattle, I focused on what I was physically experiencing and just sat and pondered. My mind was active and I felt coherent, but the body was of another substance that my mental energies hovered in and around. I did not like these spacey feelings, even though, paradoxically, they had a calming effect. I just sat. Time had no meaning. Perhaps because I was in a holding pattern riding the train, all goal-oriented thinking ceased to exist. There was no past or future, just the present. You learn to accept that, say “OK,” and eventually your mind moves on to something else. There is never any rush.

When I am at home I can read during these times. I am not sure how much I retain, although my memory seems to be no different than before the treatment began. Most of my reading is about cancer. That may be why most of my pondering is tied up with an obsession with the illness. It’s my whole state of existence, for crying out loud. As Anatole Broyard put it, I am “intoxicated by my illness.”

We are back in Seattle in time for my 6 p.m. appointment. Swedish Cancer Institute’s Infusion Center is open long hours to accommodate a variety of schedules. Friday at 6 the place was hoppin’--lots of family members, some with children, hanging out. Nurse Marie called me from the waiting area and escorted me to a curtain-enclosed area to give the shot. She had a great disposition, focused completely on my situation, and wanted to know what I knew about Neulasta and why I was receiving this drug. Marie was prepared to give me a pharmaceutical presentation on the virtues of Neulasta or any other drug, for that matter.

Marie did say that Neulasta had revolutionized the application of chemotherapy treatment. Before, when patients’ WBC were too low, the chemo would have to wait until the WBC was at a safe level. Neulasta keeps the WBC at a safe level, enabling the chemo to be administered on schedule without interruptions. The one side effect that is most often reported is bone ache. Thus far, I have not experienced that. I will be getting a Neulasta shot from here on out 24 hours after each the remaining three infusions. Nurse Marie engaged me in talk a bit longer--I think to make sure I was not having a reaction--before letting me go. I walked back to the hotel, and Elly and I went out for dinner at another neighborhood restaurant.

Five days out from the third chemo infusion I began having a repertoire of sensations, some old and some new, and not all at the same time. The physical ability factor I talked about earlier is a fairly accurate index of “how” I am feeling. If I feel weak, I am weak. The “how” begins to translate into the “what” I am feeling, and that is the part that’s hard to describe.

One new experience is that my fingernails are very tender and every now and then the ends of my fingers get a rush of sensitivity. As I touch things like jar lids or gym weights, I feel the need to be extra careful so as not to damage the fingernail. Sometimes touching things does hurt, like pressing my thumb and index finger together to zip up my pants. However, the tips of the fingers are not affected by typing, at least not at this time.

Food now often has a metallic taste. During the course of a day, my taste buds change and the desire for certain foods become insatiable. When grocery shopping I saw small watermelons sold in halves. I bought a half and could hardly wait to get home and eat it. It was delicious! Also I have a thing for celery and peanut butter right now. Elly has a theory about this. Pregnant women experience hormonal changes that cause some of them to crave certain foods. My hormone therapy may have the same effect. (No, there is no possibility of being pregnant.)

Lots of sensations happen sporadically. Sometimes my lips feel fat as if they were going to burst into blisters. Sometimes my teeth feel singular, and I am aware of the length of the tooth. When this happens, there is fear about biting into something.

The eyes often feel dry. There are times that I just want to rub the sockets into my head, but I am afraid to infect the eye if I do. Instead, I close my eyes, and through imagery visualize the irritating molecules marching to the outside corners of my eyes. Shortly, the itching stops. Every evening, Elly gives me Vizine drops.

I have developed a rash on top of my bald head. This may be caused by the skullcap I wear a lot to keep my head warm.

What has not happened this time is the burning sensation of my esophagus or the fever blisters around my mouth.

No telling what will yet evolve before the next infusion on March 20. Dr. West and Nurse Ruth both say one generally hits the lowest ebb after the third infusion and stays at that level until after the last treatment. If the side effects don’t get worse than they are now, they will be a nuisance through the end of May, but I gladly accept them in exchange for the hope of a cure.

P.S. Several readers have complimented me on how personal and readable the blog is. Elly gets the credit for making it read so well. As I told one friend, she easily turns my sow’s ear writing into silk purse prose. Elly goes over my draft with me to make sure her editing reflects what I am after in each paragraph. None of this would exist without her help. Truth be known, her hand can be found in most everything I’ve accomplished. I am grateful to her in many ways.

P.P.S. Regardless of your interest in cancer, there is one book in particular that I think is worthwhile reading because of its holistic approach to wellness: How to Prevent and Treat Cancer with Natural Medicine by Michael Murray et al. Dr. Murray is a naturopath and is interested in what helps the body heal itself, be it traditional or complimentary medicine. Dr. Murray is analytical about research findings. The text is very well documented.
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Friday, February 24, 2006

Second Chemo Treatment, Part II

Friday, February 24, 2006

I should have waited with the last installment of my blog, because almost immediately the picture changed. But then, a chemo patient’s condition is never predictable or static.

What changed the picture was the results of a blood test taken the day before via my Victoria doctor on orders of my oncologist in Seattle. Several categories on the lab report were flagged; the scores for the red blood count and platelets were just slightly below the lower end of range. However, the white blood count (WBC) dropped way down (2.7 for a range of 4.0-10.0). I faxed the results to Dr. West at Swedish, and I followed up with a call. Nurse Ruth said that Dr. West would be out of the office all week. She discussed the results with me and assured me that I was OK and that she would share the lab report with another oncologist and get back to me on Wednesday, which she did. Ruth said it was expected that my WBC would drop. That was the reason Dr. West had asked me to have the lab work done two weeks after the day of the second chemo infusion.

Here is an important note. During our telephone conversation, Ruth corrected a misconception I had about the reactions I would experience within each three-week cycle. In the February 6 posting, I stated that Taxotere “does not wane from the onset.” Ruth said the two-week mark is usually the low point in a WBC score. Literature about Taxotere says that the white blood cell count is lowest in 8-10 days and returns to normal in 15-21 days after treatment. In my case, 15 days after treatment my WBC was 2.7. It was probably lower than that at day 8 or 10. When it hits a low point, it doesn’t stay down as I had previously thought. There is some recovery. The body WANTS to heal itself. Yes, the Taxotere does not wane; it is as effective on the twenty-first day of the treatment cycle as on the first day. However, it is the reactions that toggle between worse and better that makes one think the Taxotere is wearing off.

When we were talking on Wednesday, Ruth said she thought the WBC was already climbing back up. Ruth reminded me to continue with all the neutropenic precautions (neutropenia is the condition of a low white cell count) such as frequent hand washing, avoiding crowds and sick people, and wearing a mask if I thought I might be in danger of something contagious.

Beginning Monday afternoon, I had begun to feel sluggish. Ruth said one cannot feel the drop in WBC. Such a drop does not manifest itself in a feeling the body detects. The sluggishness was probably from the just-below-normal counts in the red blood cells and platelets, and that it might have been caused by an oxygen deficiency. Tuesday morning I had a 45-minute brisk walk and Wednesday I had a 20-minute brisk walk to and from the fitness center plus a 40-minute workout routine. Even though I was not able to do the number of sets and repetitions I usually do, because of a lack of power or energy, I would think my oxygen level would have been somewhat normal or above.

My physiological feelings began to change for the worst. What I found interesting about this was that I couldn’t find words to describe the sensations. I have been searching for a new vocabulary to match the feelings. I feel light-headed, but I don’t feel as if I am going to faint (only done so once in my life) or lose control. I feel suspended, but don’t feel weightless. I am having irregular coughing fits, but it doesn’t feel as if it is coming from a place that a cough syrup would respond to. I am not short of breath but the cough catches me up short with a quick, sharp feeling in the back of my throat.

All these reactions I am attributing to the chemo, but I am also on hormones. Which is it? On January 3, I was given a 22.5 mg shot of Lupron. The Lupron is administered every three months. In addition, I take a 50 mg tablet of Casodex daily. Maybe some of these physical reactions result from the hormones or from the combination of both. For example, one of the general side effects of hormone treatment is “hot flashes.” Yet, I am experiencing “cold flashes.” I get cold and layer on the clothing. After a while I shed some of the clothing. This happens about three or four times a day yet the temperature is constant in our apartment.

Finally, Thursday, February 23, at noon, I was at my lowest. I was hungry but was not at all motivated to prepare lunch for Elly and me, which I do most days. Also, I did not want to do my 45-60 minute brisk walk Thursday morning. I took my temperature and it was 36.6C (Canadian thermometer), which is roughly 98.6F. I sat in a coherent stupor (oxymoron?) while taking the temperature. I thought my reasoning was sharp, I was clear and focused, but I lacked energy. I experienced an overall eeriness. Elly fixed lunch and I went to bed immediately afterward for a 3-hour nap.

The nap was restorative, and I started writing this update.

Elly and I will be back in Seattle on February 27 for the third chemo infusion. The next day we will take the Amtrak train to Portland to visit with Blaine and Cindy. We will return to Victoria on Saturday, March 4.

I won’t post on the blog again until after we are back from Portland. We’ll see how things are then . . . .
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Monday, February 20, 2006

Second Chemo Treatment

Second Chemo Treatment
Monday, February 6, 2006

It has taken me a while to sit down and record the second chemo treatment, and in hindsight it made sense to wait ten days or so before reporting any reactions.

I have learned from this second treatment that there is no way of knowing if or when or what reactions I would have. Taxotere is not a frontloaded drug. It does not wane from the onset. It is designed to be as effective on the twenty-first day as on the first day of infusion (three-week cycles in my case). There is a rule of thumb that chemo reactions usually do not begin to manifest themselves until the third or fourth day after an infusion. However, anytime during the cycle a reaction can occur.

The primary reason for the delay is that on the day after treatment, Elly and I flew to Puerto Vallarta for some relief of our winter blahs. Up to that time Victoria had had 40+ consecutive rainy, stormy, depressing days—very uncharacteristic for this region. On February 4, we said “Enough of this already!” and got on the web and phone and found that we could fly non-stop from Seattle and be in Mexico’s 80 degree, sunny climes in 4 hours.

Our main concern was how I would react to the chemo. My immediate thought was that whatever would happen, I could probably handle just as well, and maybe even better, under glorious weather conditions. So we made the reservations, and on Sunday, February 5, we both flew to Seattle. We were gone from February 5 to February 16, and I really didn’t feel like seeking an internet café to record my treatment.

Yet another reason is that once we returned to Victoria, we were inundated with lots of general things requiring our attention, and I just didn’t feel like trying to recapture past events. Maybe I was feeling lethargic. Maybe the chemo was slowing me down and sapping my motivation. Finally, I made myself do it out of an obligation to the blog, and now that I am doing it, I am feeling better already and remind myself that this was one of the reasons for starting the blog—to discipline and motivate myself during treatment.

Now to the actual treatment.

During the pre-infusion consultation with Dr. West, to discuss blood count and overall well-being, he was delighted to hear that we were going to Mexico and thought it was a great idea. That eliminated all doubt that we might have made a bad decision.

The second chemo infusion routine was similar to the first: 12mg of Decadron and 8 mg of Zofran before having the Taxotere. But, this time the Taxotere was increased from 120 mg to 140 mg. Dr. West said my blood count response to the first round was very strong. The hematocrit (red blood cells) was 40.0 (range is 39-44), and the white blood count (WBC) was 15.9 (range is 4-10.5). My WBC before the first chemo was 5.3. The Decadron (steroid) in the medication brought it above range. My platelets were 310 (range 150-400). These counts were the basis for increasing the Taxotere dosage to 140 mg.

The infusion procedure started about 2:30 and went to about 5:00 PM. I was in an open area with a picture window overlooking an ordinary cityscape and a curtain divider between my space and another person’s. The monitoring of my reactions was not as constant this time. The nurse checked on me about every 20 minutes or so. I didn’t report in the blog the first time that it takes two nurses to sign off on administering Taxotere. At the beginning of treatment, the primary nurse engaged me in small talk to establish a rapport and asked questions, i.e., name, birth date, etc., to verify that I am who I am. Before starting the Taxotere infusion, a second nurse was called in and she asked similar identity questions to confirm that I was the correct patient for the prescribed drug.

After the infusion I walked the 10 minutes back to the hotel, where Elly was waiting, and I rested until Carol Cellman and husband Bill Roach came and picked us up for dinner at 6:30. We had a wonderful evening, and I was feeling no different than before the infusion.

Our flight to Puerto Vallarta Tuesday morning left at 8:30 and we were on the beach by mid-afternoon. Regarding how we spent our time, everyday I would awake at about 7:30-8:00; I would take 2-3 hour naps, and be in bed by 10:00. The rest of the time we would read, walk the resort compound and beach, go to town, and go out for dinner. It was completely stress free. Of course I rested well because every evening I took an Ativan.

I felt fine and really didn’t have any reactions until two days after the infusion when cold sore-type blisters began forming on the exterior of my face, below the left corner of my mouth. It was a bother, but not the nuisance I had read about of blisters forming on the inside of one’s mouth.

Everyday, before going outside, Elly and I would lather up with 30 SPF sun block. We were never in the sun for too long. I had checked with Dr. West if the sun would affect the chemo or hormone medications. He said they would not as long as I used sun screen and he thought the natural vitamin D would be of great benefit. Thus I’ve ruled out the sun as the cause for the blisters and attribute them to the chemo itself.

I developed one blister on the gum of a lower molar. That interior blister lasted about two days whereas the exterior blisters, around the corner of the mouth, are still visible. Other than these blisters there were no other physical reactions per se. I always felt a little bit off but nothing I could really describe. There wasn’t the light-headedness I experienced after the first chemo, but that came during the first workout at the fitness center, and I didn’t do any workouts in Mexico. Since we’ve been back, I have had one workout at the center, but did not experience the light-headedness as before.

On Friday, February 17, I stopped taking Ativan, and that night I had a very active dream life but not as vivid as when I stopped after the first chemo. The dream this time was that I was not able to get to sleep and should get up and take an Ativan so I could get some rest. The whole sleep experience was a resistance to the notion that I should take an Ativan. It seems the Ativan has a suppression agent that blocks dream activity, maybe even rapid eye movement (REM) as well. I awoke much earlier than usual on Saturday, not exhausted, but not rested either. Saturday evening I didn’t take Ativan, the dreams were less, and I awoke early but felt somewhat rested. Sunday evening was without Ativan; the dreams were about the same as Saturday, and I awoke early not completed rested. I don’t anticipate taking any more Ativan until the third treatment. I may even wait and see how I do without it.

That’s it for the report on the second treatment. Last week a Judson friend, Paul Holzer, posted a thoughtful comment on the blog. He is curious about alternative medicine for treating cancer. I’ve wanted to address this issue, and Paul’s query prompts me to do so. In the next week or so, look in the blog for an entry, in the sidebar table of contents, entitled “Complementary Medicine.”
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