Welcome


Welcome.

When I wrote that banner above, I was just days into this adventure. I'm a pretty analytical guy, and the simple act of writing every day helped me wrap my head around the fact that I had just introduced the word "cancer" into my vocabulary, and it helped me rationalize my treatment options. It also helped keep friends and family informed on my status.

Those daily updates tapered off to weekly updates and eventually to monthly updates (which I continue to do on the 11th of every month, the anniversary date of being told I have cancer).

I've kept this blog going because I remember how helpful it was for me to hear first-hand experiences of other prostate cancer patients. I wanted to return the favor by sharing my own journey in order to educate others and increase prostate cancer awareness.

But I wanted it to be a truthful sharing of details, so you will quickly see that I didn't sugar-coat much of anything. That means that you'll find some pretty graphic descriptions of the male anatomy and biological functions in this blog.

Finally, if you're reading this as a fellow prostate cancer patient, please understand that I am not a medical professional, and you should not construe any of the content of this blog as medical advice. Each case is unique, so please solicit the advice of your own medical team.

I wish you all the best as you go through your own journey.

-- Dan

Thursday, April 11, 2013

Month 29 - Blogging About Cancer

I stumbled across the article below a few weeks ago and found it to be quite interesting, considering that I've been blogging about my prostate cancer for over two and a half years and 8,000+ page reads now.

Blogging about cancer certainly isn't for everyone, and there are concerns in this electronic age.  For example, how much do you want your employer to know about what you're going through?  How do you protect your own privacy and the privacy of others in your blog?  All things to consider.

I haven't looked at some of the sites mentioned in any detail, but the one that offers up a calendar to coordinate visits, meals, snow shoveling, etc., is something that could come in quite handy. 

During my recuperation, I had very generous friends and neighbors who would help me out, but there was no coordination, and I'd end up with three meals on one night, and go for four or five days without seeing someone.  Would have been nice to have that calendar and the ability to coordinate better.

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BIOLOGY AHEAD
 
Well, last month I reported having had an erection good enough for penetration, and I'm sad to report that, for now, it appears to have been a one-time event.  Still, my erections are certainly better than a year ago, and it's something I'll discuss with my urologist when I go for my next PSA test in May.
 
Other than that, things are pretty good...  I can sleep 7-8 hours through the night without having to use the bathroom, and I think I'm stuck with some very minor stress incontinence (a drop or two when I cough, sneeze, or squat) from here on out.
 
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Why More Patients Should Blog About Illness and Death



I entered the world of illness blogs for the first time when I learned through Facebook that a friend from middle school passed away last Friday from acute myeloid leukemia. In the three months between his diagnosis and his death, the friend, whom I'll call Tom, blogged beautifully and intimately on CaringBridge, a Web tool designed to help the seriously ill tell their stories and manage communication with friends and family.

Tom was 34. In his Web journal, he wrote about the trauma of bone marrow exams and chemotherapy and his anxiety about finding a bone marrow transplant donor. He supplemented his dispatches from the cancer ward with funny and raw Instagram photos, defiant tweets and YouTube videos and lyrics of the songs he was listening to.

Altogether, it was a window, painful but so rarely accessible, into the exquisite horror of a harrowing prognosis and the burden of the toll of illness on his friends and family. Tom was desperately worried about his wife, his young son and his daughter on the way. Yet his love for them rang out so clearly through his writings that the blog itself may one day be a treasured memento of the ways Tom held them close in his final days.

We share so many milestones now through social media. And that includes health: A 2010 survey by Pew Research found that 23 percent of the users of social networking sites have followed their friends' personal health experiences on Facebook. So is it any surprise that the outer reaches of our social networks now also deliver us intimate stories of dying?

Palliative care experts, who specialize in improving the quality of life for people with a life-threatening illness, say all this blogging and sharing about illness is helping to open up the conversation about death that we so often avoid.

"As more people tell their story of dying with a terminal illness, we're seeing a change in how we look at illness and mortality," says Christian Sinclair, national hospice medical director at Gentiva Health Services, a large home health care company. "Illness and death are still so technically driven, or medicalized. So getting a safe space, like a blog or social media, to talk about it can be very empowering."

Blogging empowers patients to talk about illness outside the typical frame of "the battle," Sinclair says, and reading the stories helps family members, too. "They don't have to dodge the hard questions, because the patient is able to tell their story openly and frankly," says Sinclair, who also edits the blog Pallimed.

The most prestigious medical institutions, including Johns Hopkins and the University of Michigan, now encourage patients to blog their illness through sites like CaringBridge and CarePages. In the hospice community, a longtime volunteer and software engineer started What Matters Now to offer similar services.

Other institutions, like the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., run writing workshops. Nancy Morgan, who directs the center's arts and humanities program, says she never instructs people to write directly about cancer. "There is a potential for wounding," she says, especially if the patients are depressed or otherwise feeling too vulnerable. "Most of the time they do [choose to write about the cancer], but it's their choice."

While many illness blogs are read only by friends and family, some patients go more public with their stories. Right here on NPR.org, Leroy Sievers and his wife, Laurie Singer Sievers, blogged their way through Leroy's cancer, which took his life in 2008. And David Oliver, a retired professor of gerontology at the University of Missouri, and his wife, Debbie, a palliative care and hospice expert at the same university, have kept a video blog of David's illness on YouTube and this site.

Still, some bloggers keep their blogs private from certain people close to them during their illness. A 2011 survey of 41 illness bloggers by researchers at Tufts University School of Medicine found that only 1 in 4 of the writers shared their blogs with their health providers.

Holding back from doctors and nurses like that could be a missed opportunity — and not just for the patient, according to Sinclair. "I think these blogs help physicians and nurses see their patients as [people]," he says. "But there are boundaries, and some health care professionals are looking for opportunities to get closer while others want to shield themselves."

Sinclair says that when patients have shared their blogs with him, he's enjoyed them. "I think it helps us check up on our own mortality. Am I doing the things I want to do? Am I making a difference? These are positive questions that can get lost in the shuffle of the day."

Monday, March 11, 2013

Month 28 - Surprises

So this month I had two surprises related to my surgery and its outcome...

The first came in the mail.

Remember that my surgery was on 4 January 2011...  This week I received a bill for the anesthesiologist, which I thought was odd.  I dug through my financial records and found that I paid them back in March of 2011, so I called my insurance provider to see if they had any insight.

It appears that I had more than one person assisting and this was the bill for the second person (that apparently had gotten mired up in some administrative red tape).  I also called the anesthesiologist's office, and they're digging into what happened, too.

Lesson learned:  Keep good records of all your health insurance transactions and be ready to question anything.

The second surprise...  Well, it requires my standard "Biology Ahead" warning:

BIOLOGY AHEAD


With only one nerve bundle remaining, my return to full sexual function has been slow.  Still, it's been steadily getting better over the last two years. 
 
This week, I achieved what I would consider to be a full erection good enough for penetrative sex.  And that was without any chemical assistance--no Cialis or Viagara!
 
Once does not a trend make, but it was encouraging to see that the progress continues.  Needless to say, I was pleasantly surprised.
 
So that's about it for this update.  Best of luck to one of my readers as he nears his treatment option decision point.  I'm sure he'll select what's best for him and his circumstances after doing his research.

Monday, February 11, 2013

Month 27 - Another Study

New Page & New Helpful Link
 
You may have noticed that I've added a new page (link to the right)--"Life After Radical Prostatectomy - 24 Months Later" for those with inquiring minds...

Under the Helpful Links section to the right, I've added a link to the American Cancer Society's list of questions you should ask your doctor during your diagnosis and treatment.

Another Study
 
So there's yet another study published in the New England Journal of Medicine (link to original article and text below) talking about the side-effects of prostate cancer treatment, supporting the notion that prostate cancer is overtreated with significant consequences.
 
I get it.  But until researchers can isolate the really agressive cancers from the more slow-growing cancers, it's a crap shoot for any prostate cancer patient no matter how you slice it. Do the active surveillance and pray that the cancer doesn't metastasize and spread, or treat it with surgery or radiation and risk possible significant side effects when it could have been left alone.
 
More research is needed to get us to that point where we can make truly educated decisions about our treatment options based on whether we confirmed we have the aggressive or slow-growing cancer.
 
Would I have made a different treatment decsion two years ago if I had known this information?  Probably not.  I take comfort in knowing that my PSA levels have been undetectable for two years now.  I don't know how I would have handled living with cancer in my body under active surveillance, not knowing if and when it would have metastasized. 

Prostate cancer treatments have serious long-term side effects

Prostate cancer treatments have serious long-term side effects

New research strongly reinforces the notion that prostate cancer is vastly overtreated with often dire results.

A study out Wednesday in the New England Journal of Medicine focused on treatment side effects, following a group of 3,533 men for 15 years after they got either surgery (called prostatectomy) or radiation for cancer that had not spread beyond the prostate. Radiation produced fewer side effects -- especially in the first years after treatments-- but both groups experienced huge impacts.

“This paper tells you that if you get treatment there are a lot of side effects regardless of the therapy you chose,” the senior author Dr. David Penson, professor of urologic surgery at Vanderbilt University Medical Center, said in an interview.

Most men were in their sixties when they were first treated. Two years after treatment 60.8 percent of the men who had undergone radiation had erectile dysfunction, compared to 78.8 percent of those who chose surgery. By 15 years, the numbers became 87 percent and 93.9 percent. Many men also suffered urinary and bowel problems and those, too, grew worse with time.

A rational argument is that such side effects are acceptable if the treatment is saving lives. But the paper raises serious doubts.

“So many of these men have low-risk disease that probably doesn't need to be treated,” Penson said.
Men typically undergo needle biopsies because they have elevated levels of the blood test called prostate-specific antigen (PSA). If the needle finds cancer cells, a pathologist measures their severity, resulting in what is called a combined Gleason score that ranges from 1-- the least severe-- to 10.

Most prostate cancers score between 6-7. Several top urologists at university medical centers agreed that prostate cancer below a score of 6 should be watched, but not treated. Yet in this latest study, which is a reliable cross-section of how medicine is actually practiced, about 60 percent of the men who underwent treatment had scores of 2 to 4.

The findings prove that “a staggering percentage of men with totally inconsequential prostate cancer got treated and suffered the consequences,” says oncologist Dr. Marc Granick of Beth Israel Deaconess Medical Center and Harvard Medical School, who was not involved the study.

Undoubtedly, prostate cancer can be deadly. Estimates are that it will kill almost 30,000 men in the United States this year, second only to lung disease as the major cause of cancer deaths in men. But the problem is, there are at least two kinds of prostate cancer.

The common form appears in the majority of men over age 50, grows slowly, and never presents a health threat. The other form spreads rapidly and can lead to a horribly painful death, usually from malignant cells invading the bones. Doctors cannot tell the difference between the dangerous and harmless cancers. Researchers are looking for genetic markers that would make the critical distinction, but they have yet to find them.

Meanwhile, increasing numbers of prostate cancer specialists argue that the sensible path is for men with lower combined Gleason scores to undergo active surveillance (formerly called watchful waiting), come back for future tests and forgo treatment until it is indicated. Often they will never need treatment.

That doesn’t happen, however. Penson said recent surveys show that fewer than one in four men who are candidates gets active surveillance. The majority get surgery or radiation.

One reason for the intervention is “incentives for the facility and for the providers” -- in other words, money for hospitals and doctors. “Also,” he adds, “patients don't like to hear 'I have cancer and I'm just going to watch it.’” But patients should demand and doctors should educate that “just watching it” is perfectly safe in many cases.

Learning that lesson could spare an enormous amount of misery and money.