Finishing the week with Session #4

It's been a good week, the treatments are going very well and the oncology practice, since it specializes in prostate cancer, is very efficient.  I have usually been in and out in less than 20 minutes.  At least one of those minutes involves showing the staff my picture of the day that I have chosen for them and they seem to actually enjoy that little break in their normal day.  I think they are a little taken aback that there is a patient out there that tries to bring them joy rather than just showing up for what could otherwise turn into routine drudgery.  By the time treatment #45 is over, everyone will know who Dave is!  I hope we're not wearing masks anymore at that point.  In fact, I told the staff today that I would bet that they are more familiar right now with my belly than with my face and I got a pretty good laugh out of them.  I also said I hoped that we would be done with masks before they were done seeing me.  I will have a different radiation technician and nurse next week, they are alternating work schedules during the Covid-19 situation.  The good news is nobody has been laid off, but like every other business or medical practice, they have had to scale back some for the time being.  I'm just blessed they were able to get me into the rotation.  Have a great weekend everybody!

I call this image Buck in Flight.  It's a one in a million shot.  I got it last December at Berry Springs Park in Georgetown at dawn as I was shooting a Hawk in a tree.  My friend yelled out that the deer were on the run, I spun around and caught this just as this buck was leaping.  There is actually tall grass on either side of this frame, talk about good fortune that this happened at the precise moment he hit the gap!  I may repeat the images from this week in the week ahead to make it fair to the other folks.  Stay tuned to see what I decide!

Session number three, my first "Doctor Day"

As usual, I arrived 15 minutes before my assigned time in the hopes that I would shoot in and out more quickly from the actual radiation treatment.  Today was a special day, my first "Doctor Day".  Each Thursday for the next 8 weeks, I will meet with the radiation oncologist after receiving my daily dose to ask any questions I may have, discuss any side effects and what to expect next and to hear what he has to say each step of the way.  This week I got a Green mark, which means I did everything they wanted me to do to make the treatment as effective as possible.  Number one on the list is coming in with a very full bladder, it presses the surrounding organs out of the way and the water in the bladder helps to protect it from radiation damage too.

I can't say enough good things about him and everyone on the team.  It truly is a team that put together the plan for my individualized therapy.  The radiation oncologist is the quarterback, if you will, but each and every team member plays a vital role in getting things right during both the planning phase and as treatments are dispensed.   There are also a physicist and a dosimetrist that perform precise calculations to determine the best angles for the radiation and the amounts.  They work with the 3D model of the body created during the CT and MRI scans and setup the computer programs that control the process.  The actual treatment is delivered by a radiation therapist and other staff that help during each visit.  So you see, it really is a team effort and I am blessed to have a Dream Team.  My urologist strongly recommended that I read a large book called Surviving Prostate Cancer by Dr. Patrick Walsh, so that I would be an informed patient and have the right questions for my personal situation.  I have it in Kindle format and it is on my phone as a pocket reference. That book has guidelines for choosing a radiation oncologist which include having treated more than 100 patients annually as well as working with the best technology.  My quarterback has done literally thousands of treatment regimens in the past 20 years and his practice uses IMRT and IGRT machines, considered the gold standard for what I need.  I couldn't be happier with the experience and technical prowess of my whole team.  

But wait, there's more!  Each and every person I have worked with over the past few months has been incredibly friendly and has the wonderful gift of making sure you feel like you are the most important person in the world as they give instructions and field questions they have undoubtedly heard numerous times before.   They do it with a grace and sense of humor that immediately allays any fears or misgivings I might have.  I thank God for each and every one of them and wish them and their loved ones well.

Finally, here is the picture I shared with the therapy staff today.  It's from Berry Springs Park this year and the beautiful hue in the water is the reflection of redbuds on the far shore accenting this Pied-Billed Grebe.

Radiation session number two is under my belt

I arrived at the radiation oncology lab at 1:15, fifteen minutes before assigned time of 1:30 for this week as instructed.  They ask you to do this because sometimes they are running ahead or another patient is running late.  It worked out great for me.  I was in and out before 1:35!  I will finish the rest of this week with 1:30 pm appointments, will be there at 1:40 pm next week and will get my permanent appointment time of 1:50 pm for the remainder of my nine weeks of daily treatments.  Even if traffic returns to any semblance of normal soon (normal is bad!), I will be able to get to and from the lab with ease.

As I had promised the staff, I brought them their daily picture to bring them a smile or a laugh.  The picture is below, one that I call Mama and Junior get a drink. More to follow after my daily routine tomorrow!

1 down, 44 to go! The treatments begin!

The day has finally arrived.  No more poking, prodding, invasive instruments, biopsies or other indignities anymore.  Just 45 daily radiation treatments and I'll be done before the end of July.  I'm feeling truly blessed.  At first, it looked like I would get started at the end of June, then it got moved up to June 1st and now here we are commencing on May 26th.  I should have been leaving the country for a mission trip in Kenya this Thursday.  We all know that's not going to happen now, probably not until next year.  So what better way to spend my summer than to be ridding my body of cancer and making new friends in the process!

I arrived 15 minutes early for my first appointment to get instruction on what to do each day as I prepare for every treatment.  I still had a few questions that had crossed my mind like whether the dose of radiation would be the same for all of the treatments or would it vary? And how soon I might see side effects from it or from the Lupron injection?  I still haven't had my first hot flash and am hopeful it is on the milder side of what's possible.  The answers were that the dose and the target vary somewhat from treatment to treatment, but when everything is said and done, it all evens out.  And as far as side effects go, it varies wildly from one individual to another.  So I can only hope I am one that has mild or negligible problems.

I will be getting radiation every weekday for 9 weeks with the exception of a holiday or two, starting with the Memorial Day holiday we just celebrated which means I only go 4 times this week.  My last session will be on a Tuesday.  I will see the radiation oncologist every Thursday, that's my "doctor day".  I'll be able to discuss any questions and I'm sure he'll have a few for me as well.  

So far, for each appointment with this urology practice, whether for a biopsy, a day surgery or whatever, I have brought in a different one of my photos on my phone and have promised everyone that is interested at least one smile or laugh each time they see me.  They will know who Dave is before this is all over!  And how I share the glory of God's creation through these images.  It's a good conversation starter.  Here is the picture I brought in today which I call "Wink, wink" of 3 Screech Owlets this Saturday at Mills Pond.  More to follow as I have more to report.  Thanks again for all of your prayers and well wishes.  So far, so good!

The good news just keeps coming!

The radiation oncologist's office called today and I'm going to be able to start my treatments next Tuesday at 1:30.  I don't know what happened to the patient that originally had that time slot for next week, but I am thankful.  First, my treatment got moved up from the end of June to June 1st.  This is great.  I'll be done before the end of July now.  Woohoo!  More to follow after the treatment begins.

Prep is finally all done. Let the games begin!!!

I had my MRI Monday morning at 7 am.  I needed to be there at 6:30 in Round Rock to check in.  The nurses, who were in a tent outside the door, took my temperature with a touchless forehead thermometer and let me inside after answering Covid related questions.  I got my paperwork all filled out and turned in and then they sent me outside to sit in my truck until I was sent a text message to come in for my scan.

This was the hardest of the procedures for me to do because I had to lie on my back with my mask on, breathe shallowly through my nose and keep my belly extremely still.  A 2 minute test scan came back blurry and I was told I needed to be much more still and the actual MRI might take up to 20 minutes.  I told them that as a wildlife photographer, I also hate blurry pictures and would try to be a good subject.  The machine is extremely loud, so they gave me a pair of earplugs and I gave them the green light to start the machine back up again.  It seemed like an eternity trying to be perfectly still, barely breathing through my mask and hoping they wouldn't have to repeat the process.   Luckily, the MRI came out OK and I left, thanking everybody along the way.

That was not the high point of the day, however.  My Supercuts finally reopened and I made my way to an 8:30 appointment with my stylist, friend and psychotherapist Rita.  It was a joy to see her, we swapped stories of my recent past and of hers as well.  I told her my Covid Hair proved that I had been faithful to her.  She told me about several people that had taken the matter into their own hands and wanted her to fix the results.  Sometimes you just can't fix stupid!  At least it grows back eventually.  

Anyway, that's my story for now.  My next step will be my first radiation treatment on June 1st.  They will give me an orientation, showing where the mold of my lower body will be each time I come in and instructing me on what to do each time.  It will become routine very quickly I'm sure.  I'm blessed, I got a 1:50 pm time slot each day which will allow me to do my dawn nature photography and conduct my computer repair business each day before going in.  I should be out by about 2:15 pm each day and even if Austin traffic returns to normal this summer, I will be able to make my way home before rush hour.

I am going to start an online exercise program, mostly for my upper body, because the hormone therapy and the radiation will cause me to be fatigued, possibly gain weight and suffer muscle and bone loss.  I will be fighting back with exercise, diet and calcium and vitamin D pills.  I'm sure I'll be able to do it.  I'm a stubborn German Lutheran.  I just need for somebody to tell me I can't possibly do all that and I will prove them wrong!  Any volunteers? 

Blessings everybody until next time! 

One step closer to the radiation treatments

I had an appointment with the radiation oncologist and the radiation therapist today at 10 am.  As usual, the prep consisted of an enema the night before and one three hours before the appointment.  I have now had a grand total of 6 of them over the course of my last 3 appointments.  6 down, 2 to go next Monday and that will be it.  I also had to drink 16 ounces of water one hour prior to the appointment and then had to hold it until everything was over.  The purpose of having a full bladder was to make sure I was able to do that right because I will need to do it before each of the 45 radiation treatments.  It helps protect not only the bladder but other surrounding tissue from side effects caused by the radiation.  Once I was ready, I was placed on a table with a special material that formed to my lower body.  The radiation therapist told me to pretend I was a sack of potatoes and just let her move me around until I was in exactly the right position to do the CT scan that forms one of the baselines for my therapy.  I finally have found something that I am qualified to do, just call me Mr. Potato Head!  The impression of my body will become the mold that I will lie in for each treatment and will help to keep me perfectly still and in the exact same position each time.  The oncologist came in and was happy with the imaging.  The last step was to give me 3 tiny tattoos less than the size of a medium BIC pen dot, one on each hip and one on the front of one of my upper thighs.  These dots will also be used in targeting the radiation.  I thought I would make it through this life without tattoos, but I was wrong. The appointment was about 40 minutes and they let me use their restroom when we were done.  I was very thankful!

Next Monday will mark the last of the preparation.  I'll be getting an MRI at 7 am and that information will be added to the other data gathered today.  It will be used by my radiation team to create a custom treatment plan specific to my body.  There is a lot of behind the scenes work that goes into this planning that the patient never sees and I am thankful for the diligence that each of the folks I've met obviously possessed.  Great leaps have been made in the last 5 years or so in the accuracy with which they can deliver the radiation, so much so that the dosages are about a quarter more per treatment with less side effects than they once had, since they are pinpointing the cancer.  I'm blessed to live in this remarkable time.

More to follow after the grand finale MRI prior to starting the actual radiation on June 1st.  Thanks again for all of the prayers and well wishes.  It means a lot to me.  Thank you, Jesus!

Let the Games Begin!

This morning I took the first step towards the radiation treatment which is currently scheduled to begin June 1st.  My dear friend and mentor Rudy drove me to the 10 am appointment.  I was given a Zanax to relax me, an intramuscular antibiotic injection (butt shot) and then stripped from the waist down.  I was positioned face up on a table and stirrups were retracted for me to put my feet in and I laid on my back for about 20 minutes as the drugs kicked in.  Now I know how my lady friends feel when they get to use stirrups!  Speaking of that, so far, almost 3 weeks after the Lupron injection that will cut my testosterone to zero for about 6 months, I still haven't experienced my first hot flash.  With any luck, I avoid that, there are enough other side effects down the road to worry about.

The procedure itself probably didn't last more than 5 minutes.  3 gold "seeds" about the size of a grain of rice were implanted in the prostate in strategic locations for precise targeting of the radiation that is to come.  A SpaceOAR gel injection was the final step.  It is placed between the prostate and the rectal area to protect it from radiation and some serious side effects that used to take place before this innovation.  During conversation with the surgical assistant, I learned that my surgeon's elderly father had prostate cancer years ago before these spacers were invented and he was deeply moved by the suffering that he had gone through from the side effects.  I love the fact that my surgeon had such a personal connection to making life better for others.

As I did during my recent hip replacement and the prostate biopsy that led me down this path, I made friends with the medical team and was telling them some of my favorite stories from Kenya missions and recent hospital stays and actually had them laughing a bit.  It really is better than just laying there getting worked on and worrying about each pinch, poke and flash of pain.  It was over before I new it.

I was pretty wobbly getting dressed, the surgical assistant helped steady me and tied my shoes for me to keep me from falling over.  They got me out to Rudy's car in a wheelchair and helped me get in.  What was funny about the Zanax was that I had slurred speech but my mind was pretty clear.  Rudy and I had a nice conversation on the way home and he helped me get into the house.  I was told to eat a big meal if I could, that it would shorten the recovery from the sedative.  I had some leftovers of grilled salmon and steamed vegetables and then sat down in my lazy boy for a half hour nap that turned into a solid 4 hours of great sleep.  Wow.  I hope I can sleep tonight.

The next step is this Friday when I get CT scans of my pelvic area and then an MRI sometime next week.  A 3-D computer model will be generated from these scans and fed into the computers that will control the delivery of the radiation treatments.  The spacer that was inserted today plus more accurate targeting that has only become possible recently means that I will be given about a third more radiation per dose and it will act directly on the cancer rather than burning surrounding flesh and organs.  I'm not sure yet, but I am expecting 9 weeks of 5 day a week treatments, with some side effects beginning to appear after about week 7.  Several months after treatment, all of these should subside.

That's about it for now. I am very thankful and humbled for the large number of my Facebook photography followers and real world friends that are praying and sending positive thoughts my way.  I really appreciate it and just want to remind everyone that my chief purpose for writing this journal is to encourage everybody, men and women alike, to be faithful about getting annual checkups and catching conditions while they are still very treatable.  Thank you Jesus for the opportunity to have a positive effect in this regard.  See ya next time!