Hismones 12/30/24

"not the way you thought it would be" We're spending a couple of days in my wife's small-town hometown in eastern Kentucky, renewing family contacts and getting the latest updates. Like most families, there's a lot of love and usually a bit of drama. I've mentioned to my wife a few times during our 30 years of marriage the possibility of moving back here in retirement. She always responds, "You'd miss me!" There are reasons kids grow up and find new things to do and new places to do them. This season of diagnosis and treatment reminds me of a time that began almost 35 years ago when my first wife, two tiny daughters, and moving van drove out of town, landing 250+ miles away. At a church conference lunch, an area pastor quoted Henry Ford as saying, "Life is just one damned thing after another." Regardless sunshine, it was an extraordinarily dark day. That night, I was kneeling in front of the hearth talking by phone to a friend who reassured me with these words: "You've walked with God long enough to know that it's going to be ok; it's just not going to be ok the way you thought it would be." Back in the winter of '89-'90, I was about to start a two-year series of family court appearances, living alone, and jogging daily to stay busy. One morning rain started during part of my route, soaked me pretty thoroughly, but ended before I was through. I believe God impressed me that the season I was beginning was like a short-lived shower and the sunshine would return. I've now started a two-year series of treatments and I believe the same: this is a little shower, no matter how severe temporarily, that will pass and the sunshine will return. As God is my witness. P.S. I discovered today that the Biologics pharmacy able to fill my new medication has only two locations in the U.S.: North Carolina and Fort Worth. Maybe not a coincidence?

Hismones 12/28/24

Starting Day 5 of hormone therapy We are enjoying a great visit with Tammy's software engineer nephew and his wife in Lexington, KY and have already seen friends/former fellow church members who moved here in retirement. Today, we'll see a niece, great/grand niece and nephews, and a couple of great-great nieces. I've developed a bit of a winter cold (runny nose/cough, no fever) and fatigue, so of course I'm blaming everything on the new hormone therapy. From what I read, however, it takes about two weeks for the full effect to begin taking place. I'm grateful to have made a lot of progress in treatment communication: I now have the necessary surgical procedure (gory details, below...I was going to write "details after the 'assterisk' but I decided otherwise) scheduled for January 21, with radiation beginning a week or so later. After maybe 8 phone calls, I have located an area pharmacy that can provide Orgovyx as a 90-day supply: not a neighborhood pharmacy or even their area specialty pharmacies but another they referred that is accepted by insurance, "Biologics." It specializes in cancer and other specialty medications. If this works as planned, it will save us $1000 out of pocket during the course of treatment. Apparently, insurance reimbursements to standalone pharmacies make 90-day supplies financially impractical. Both Walgreen's and CVS' pharmacists were very helpful, admitting they couldn't help but referring to their specialty locations, and the CVS specialty pharmacist staying on the line with me to confirm Biologics' ability to fill the need. I'm grateful that our Medicare Advantage PPO accepts this pharmacy. *Now for the gory details: the prostate can take lots of radiation but the rectum none, and they are adjacent. I will be under brief general anesthia for the surgical oncologist to inject a gel material between the two that will solidify to create space between them. The gel "pillow" will last three months; radiation, two. Bowel prep is less than for a colonoscopy, I'll have NPO after midnight, and I show up at the surgery center 5:45 A.M. for the fifteen minute procedure that happens at 7:15 A.M., then go home soon afterward. I'll have a CT scan sometime soon afterward to determine positioning, then be placed daily in the same position for radiation treatments. Now to get on with my easygoing Saturday!

Hismones 12/23/24

Last week was a flurry of activity, with appointments among urologist 12/16, radiation oncologist 12/17, and surgeon 12/19. We are so grateful that openings appeared in their schedules in such short order. The PSMA PET scan showed the issues to be abnormally complex, especially for 6.4 PSA and 7 Gleason score for the first two tumors found by the biopsy (3+4, 4+3). Statistically, only 30% of us "70'ers" have a more aggressive cancer and only 4% with these biopsy results have activity beyond the prostate. Had cancer been limited to the prostate, surgery could have been one-and-done. Evidence of activity in the right and left iliac lymph nodes pointed toward androgen deprivation therapy and radiation. Surgery would only have successful results if the lymph node reactions were false and they were clear of disease, and access to those could be complicated by scarring and material from previous hernia surgery. So I begin Orgovyx 120mg tomorrow (about $3K my cost for 24 months unless I can find a 90-day supplier). I can look forward to a little fatigue along with hot flashes, mood swings, and bedtime "headaches," along with always keeping an eye out for nearby restrooms. Radiation weekdays for 5-8 weeks will start after about a month of prep protocol that includes a surgical procedure to help isolate the prostate for treatment, which will be in daily 45-second gentle bursts. No tan line! It's far too late to say "long story, short," but the radiation oncologist is optimistic that this cancer will either be cured or managed well. For the rest of my life, PSA tests will reveal whether the cancer is dead, dormant, or active. Treatment anticipates that PSA will drop to 0. It took twice for me to allow the Lord to let me see one, but I'll say that nothing compares to having a strong believing wife alongside during this process. She accompanies me to appointments, takes notes and asks great questions, and prays for and with me as well as accommodating any inconveniences that arise; I'm sure there will be more. My radiation oncologist is Dr. Jerry Barker who grew up in an oncological environment while his dad served M. D. Anderson in Houston. In addition to medical training, he has a degree in Bible from Abilene Christian and a hospice certification. He asked and then led us in prayer at the end of our consultation, including expressing his trust that God will heal. It's a different Christmas season, but I feel remarkably blessed and grateful.

Hismones Post 1, 12/12/24

Friends! A rising PSA level this year led to my beginning work with a urologist who monitored the level for a few months, then ordered an MRI. Unfortunately, its results were inconclusive and he chose to move forward with a prostate biopsy and bladder ultrasound. The 11/21 biopsy and 12/9 PET scan confirmed that I have prostate cancer: three spots in the prostate and highly likely two adjacent lymph nodes. The urologist initially called this treatable and curable, but not a slow "wait and see" strain. I have a urology follow-up next Tuesday (12/17) and will have a much better idea of treatment options. I am experiencing no symptoms, so am deeply grateful that the urologist moved forward with the biopsy after the questionable PSA results. Thank you for your prayers and friendship! Blessings for Christmas and beyond, Jim