I'm only now just completing this post from May 2011. Seems rather glum, which probably explains why I stopped. Ironically I feel good at the moment even though the cancer and the treatments offered have moved to the next stage. I also now realize how lucky I've been to have had such good people helping me along the way in trying to keep me healthy. I didn't fully appreciate them at the time, and I could've been more generous in talking about them than I have been below. I had a depressive period, which is reflected in my diary. I think this is probably very common in people in my situation and has not been given enough recognition. On the other hand, most of the people in the health profession have treated me with much kindness and tolerance.
Before moving on to what's happened since, I shall finish this blog and finish recording my earlier handwritten diary. I stopped diarising in early 2011 so the story from then will be less structured, but that is for later. My last entries in this diary are chaotic and hard to follow.
What's going on? In March this year I felt increasingly tired so that by Sunday (27.03.2011) I did something I haven't done for years. I spent the day in bed. Then on Monday I ejaculated blood - a rich, red fluid. I have enough Christian guilt from my childhood about masturbation, but this puts the cap on it. I was told later that this was a side-effect of the brachytherapy back in 2007 (described below). The blood was enough for me to go to see the GP and email the Urologist.
After a week and a half the blood decreased and became almost black. My naturopath tells me this is a sign of old blood. I've also got over a lot of the tiredness. This has been greatly helped by a visit to my hypnotherapist and more regular hypnosis. Curiously I've started ejaculating a clear liquid with the blood. I haven't produced anything like semen since the brachytherapy in 2007. Also I had passed a clear liquid out my bottom, another by-product originally of the radiation.
The Urologist didn't respond to my email, but I made an earlier appointment. The GP couldn't throw much light on what was going on either, but he was reassuring. I haven't been (or wanted to go) to mass for a couple of weeks and I've not found latihan with Subud as rewarding as usual. However, I did have the strongest of experiences one morning I felt tired and not inclined to get out of bed - a big hand grabbed me by the neck and shook me in the air - like someone was trying to tell me to dust myself off and get on with it. Plus I was attending a weekly prayer group in the lead up to Easter - I saw this as my Lenten sacrifice. Nowadays I'm more likely to fast during Ramadan than Lent. Then I got the phone call from Michael.
Michael is my sister's partner. They live a long way away in Queensland. Among other problems he has been battling bladder cancer for years. After seeing the GP for extreme discomfort around his pelvic bone and then a CT scan, the GP was convinced the cancer had spread. Bad news kept coming and Michael was convinced he only had a couple of months of life left. This occurred less than two weeks he was due to head off to England for six months. To reassure Michael, I promised to pray for him at latihan, mass and the prayer group, which, if nothing else, led to my re-involvement in all three.
After visiting a local Uniting Church and asking the Minister to pray for him, Michael seemed to have a major recovery. Miracles can happen. I wonder. Michael also had a receiving that I needed to return to Lourdes twice more.
The following account of brachytherapy is the closest I've been to being on the stage. As I understand it, there are two types of brachytherapy. The first is low dose rate (LDR) brachytherapy where radioactive metal balls are injected into the prostate and these are ejected naturally by the body over time. The second is high dose rate (HDR) brachytherapy, which is described below, and involves the direct insertion of rods into the prostate through which radioactive material is then placed. Because of the extreme amounts of radiation involved there is only one place in Adelaide where this procedure can be safely performed - the basement of the Oncology wing of the Royal Adelaide Hospital.
Wednesday, 4 April 2007: I did the half hour walk to the chemist at Collinswood, a lovely walk across the Torrens River (really a creek) and the parklands on either side, to have my three monthly Zoladek prescription (hormone injection). They didn't have any. Only keep one in stock and someone else had come in earlier in the day and taken it. Could be in tomorrow by 10:30am, only an hour before the doctor's appointment to administer it.
Thursday, 5 April 2007: This time I borrowed my son's car to go to the chemist. As it was I had plenty of time - Dr B was way behind.He has a sense of humour. He escorted an old Italian guy to the surgery past the waiting room, saying "snap" to me as he passed by, and showed the box of Zoladek. Hurt a bit later as he injected me in the stomach. At least he bulk billed.
Dr B gave me another script for Nexium and told me to take one before going into hospital.
Friday, 6 April 2007: Have to get better from the external beam radiation, and ready for brachytherapy. Gradually feeling better. Not getting up so much to wee at night. Bowels becoming less of a worry, but still some urgency (and accidents). Apprehension as the day to go into hospital gets closer.
Monday, 16 April 2007: Phoned the Royal Adelaide Hospital (public) as instructed (between 1pm and 4pm). Given the bad news that I had to be at the hospital at 8am.
Fasted after 9pm. Took the anaemia, but some sensitivity - I couldn't hold onto for it for the recommended 20 minutes.
Tuesday, 17 April 2007: Never got around to getting slippers and forgot thongs.
Took 2 Microlax again.
Had to convince Elizabeth to take me in - dropped me off at the bus stop. She had work commitments and the original plan had been that I would get the bus in, but I couldn't see how I'd organise myself to be in at the hospital for an 8am start.
I took her black bag, but I didn't feel right using the wheels on my way up to the fourth floor. I was ten minutes early for admission but there were a lot of other people waiting already, although none of them had a case like me. The door outside did say "Surgical Admissions", but above it was the sign, "Day Surgery". More waiting.
Eventually got in. My name was taken and I was told to wait. Then called up and a clerk took my details. I signed in as a private patient - I felt obligated to Prof Y to do that.
I was then told to wait again until called. I was then interviewed by a pretty African nurse, hair in braids. She asked me a lot of questions, including whether I was pregnant: "Who knows might happen today? Then women won't be needed." She also said that I could keep my boots on, instead of slippers. (I had previously been told, and given a printout, saying that I'd be waiting around in my surgical gown, and that I should have a dressing gown and slippers.) I'm taken to an area to change. I'm moving through the system. I'm surprised that it's only 8:25am.
My bag is put on a wheeled rack and labelled after I have finished changing. I put on stockings, so I didn't need socks. When I came out of the cubicle I was told to take to take off my dressing gown and boots and get on a trolley. Dressing gown and boots were put in a plastic bag and placed under the trolley, not to be seen again until I was ready to leave. So much for the need for dressing gown and slippers.
More waiting.
An unshaven man chewing gum and smelling of cigarettes and maybe alcohol comes to collect me. The nurses seem reluctant to let him take me , but he insists that I have to go to the radiology area. (The anaesthetist, Dave, who later takes over says the hospital doesn't have orderlies any more, just people contracted to move patients between wards. I said, "Like sacking the tea lady to save money." He said a hesitant "Yes". He was pushing me in a trolley at the time and we turned a corner and there was a woman with a tea trolley. I'll bet she was a volunteer, but I didn't say anything. He said, "See we still have tea ladies".)
The guy pushing me didn't say much and the ride lasted forever. It reminded me of Redruth Trail (a long, tunnel-like passage with so many turns that totally disorient) in the Remand Centre. Sinister: no one around, never ending, and no windows to the outside world.
We ended up on the second floor of Radiology, really a level below ground, no windows here either. Someone once told me that the plan for the Radiology Building had been reversed by mistake so that there are no views of the adjacent Botanic Gardens on any of the floors, as had been in the original plan.
I'm handed over to a friendly nurse named Glen. I think: Maybe they give you a male nurse to make you feel more comfortable. Glen wheels me into a store room. It's 8:50am. Glen leaves me. Do I want something to read? I say "No".
I might be wrong about being on the 2nd floor at this stage because it all looked a lot like where I went for external beam radiation. I remember people looking at me curiously as I used to look at the other people on stretchers.
Glen comes back and wheels me through a door marked "Brachytherapy". This is the outer room. There are a lot of people in white gowns doing inexplicable tasks, plus, I guess, the inevitable observers. They don't use masks.
A man with an East European accent, named Zack, asks me if I want a spinal or a general anaesthetic. He recommends a general. I don't care much. How can I decide? So we settle on a general. Then another white coated man, a bit smaller, comes from the inner room, another anaesthetist. He doesn't introduce with his first name, just Dr xxxx, but later mentions his first name, Dave. He talks a lot. Anyway he informs us that Dr S, the urologist performing the procedure, wants me to have a spinal. He explains to Zack that he doesn't want me moving around after the procedure because the needles are left in.
Prof Y visits me. He asks what Dr W (my Urologist) had said about the hormone treatment. I said five and a half months before and after brachytherapy. Dr W had said that makes the brachytherapy most effective. Why is he asking me about Dr W? I haven't seen him for ages. Prof Y wants me to stay on the hormone treatment for three years. He knows I'm not happy about that idea, and repeats his joke about how American men refuse to stay on hormone treatment because of the side effects, whereas Europeans do what they're told. He indicates he's finished with me and I'm wheeled into the inner room. White coated people are busy with many tasks I don't comprehend.
Three technicians are working on instruments in front of computer screens. Professor Y said there's been problems with the software. This biggish man is also called doctor, but obviously not a medical one. He says it's more than the software.
A couple (boy/girl) in white frocks look on. I guess they're students. They're quiet. There are 3 to 4 nursing type people, including Glen. There is the Indian nurse I always see with Prof Y. We chat. She says I look familiar.
I'm moved over onto the operating table. Then I have to sit up while Zack does the spinal - a bit of pain. Dave gets me to hunch right over - makes inserting the needle easier.
Once I'm lying down they hitch my legs up. Zack asks for ice. The nurses find some and put it in a rubber glove. He uses this to feel my sensations. It can't be much after 9am.
A nurse, a middle-aged woman, is assigned to sit at my head and talk to me, but she doesn't have much to say. Glen asks if I'd like anything. I say I'm surprised there is no music - Bach'd be good. He comes back with a radio player, like the one my daughter had, but they're not playing Bach. Someone asks if it is "The Messiah" - I say it's Wagner (I'd heard them announce it on the radio). It may be because of my medication. Zack had put a drip in a vein in the back of my hand while we were in the other room, and he's been pumping something good into me. I feel relaxed and a bit disinhibited. I feel clever.
Dave takes over from Zack. (I really only need one anaesthetist.) He tells Zack he can go, but Zack comes back later. He's not needed elsewhere. Zack says he's interested that I'd come from Queensland. He said that he wanted to move up there next year.
I have a strong feeling of pressure on my pelvis on the right side. Dave says there is nothing there - that your brain remembers your last sensation once anaesthetised.
At times they put a tube up the penis to takes a video, as well as who knows what. With Glen's help I get to see the screen. I also get to see the screen for scanning the prostate, inserted via my bottom. Denby (the operating Urologist) doesn't say much. I now feel familiar enough with him, not to call him Dr S. He's preoccupied with inserting the pins. Prof Y comes and goes, and has an opinion on a lot - uses terms like "baseline".
Hollow pins are being inserted into my prostate via the area between my penis and anus. There's lots of problems with the prostate moving. They have to get the calculations so precise. Dave tells me not to cough as that can shift the prostate. After a long time Denby leaves when he decides the pins are properly inserted, and probably a lot of other things I don't know about.
I'm in that room 'til after 2:30pm and Dave talks most of the time, about his interest in cross country skiing, and skiing tragedies. He's employed full-time in the hosptial. I struggle to come up with subjects to talk about, for example, the dangers of being an anaesthetist. He goes on at great length about how it is safe.
My back hurts. Dave gives me more pain killers via the drip, but they're not as strong as what Zack had given me. I ask for more about every half hour. He says it would be my shoulders, but I insist it is my lower back.
People go off to lunch, but the work doesn't stop. It's getting near the end. I'm connected to the da Vinic robot. All the people leave the room for the radiation. I'm suddenly alone.
A nurse enters the room to check if the radiation levels are within safe limits. She has a little detector.
There are other people that I only vaguely remember, for example, Jill, who was very talkative. Later she was one of three otheres in the adjoining room working on a console.
I told Glen the story of how an Adelaide builder had provided the money for the robot in Adelaide so that men woould not have to go onto a waiting list for treatment in Melbourne. Then I complained of my having to wait so long to get an opportunity for the brachytherapy treatment. (They only do one a month.) Glen was defensive citing ongoing costs. Denby was amused, looked up and smiled. The only time we really engaged.
Dave wheeled me back to Recovery in the other building. We were accompanied by my assigned nurse. I saw Joe from my time with external beam radiation - he hadn't been at the show today.
Dave wasn't going to be with me tomorrow. Zack said goodbye as well. I went from two anaesthetists to none. One of them asked about my preference for leaving medication. During the late afternoon feeling came back to my legs but they were tied to a pillow to stop me moving. The pins were still in place. The transfer to the trolley had not been easy.
I was wheeled into Ward 6B on the 6th floor of the Radiology Building. My room was an open shared space adjacent to the nurses station. My bed was against the wall. There were two old men in the beds opposite - one made odd loud noises and the other had dementia. The one with dementia thought he knew me. He was mobile and would come and stand over me and ask questions: "Are you up or down?" He kept telling his dog to be quiet - I think this was related to the bizarre sounds coming form the other man.
Because of all the attachments coming out of my bottom they had a lot of trouble placing me in the bed, even though a hole was cut out of the middle so they (the attachments) could dangle freely. My bum did not seem to fit right. I still had the catheter so it was okay to wee, but I was not allowed to poo. I was given some tablets to stop me. I kept worrying. I didn't want to move so there'd be minimal adjustments needed with the rods the next day.
I managed to phone Elizabeth at work, but she was not for a long conversation. She said the dog had caused a mess and she needed to go home early to clean up, and that would make her late to visit. That German Shepherd was bad news.
Dinner arrived and very different from my normal healthy diet. Much like I'd expect hospital food - roast lamb, but everything tasted like it'd been stewed to excess.
Elizabeth and adult daughter, Clare, visited around 8pm. Nice.
I didn't get a phone or TV (the only benefit I could see for going private from the form at admission), but I did get a laugh from the nurse when I asked about why I didn't get them.
I took pain killers throughout the night - didn't sleep.
Wednesday, 18 April 2007: Around 8:30am I was wheeled back to the brachytherapy rooms. The drip had been reinserted through the night - more fasting.
They gave me a couple of anaesthetic lolloypops to suck - not good - sickly and not very effective. Real pain this time as Denby and associates repositioned the pins according to to Xrays taken from the previous day. It hurt, like hitting a nerve at the dentist, only this time there were 17 of them to be positioned one at a time, and into my prostate. After it was over Denby seemed to remove them all at once.
The procedure this time only took a couple of hours. Denby left and Prof Y put on the padding where the needles had been to stop the bleeding.
When they shifted me back onto the trolley the giddyness started. I was farewelled through the outer room like a departing hero, including applause.
Some of the nurses were excellent and dedicated to their job, unfortunately more were not so good. An overweight one hurt her knee getting up from a couch, and was taken away in a wheelchair for observation. She returned at the end of the shift, seemingly improved. A number of other large nurses sat all of the shift on easy chairs in the nurses stations. The main discussion was around the need to assert their rights.
I vomited twice - the giddyness didn't go away. I could still taste those anaesthetic lollypops. I was told by the ward doctor that I had to pee and poo before I cold leave. In the end he prescribed an anaema - given by a male nurse.
Peed blood. Phoned elizabeth to pick me up. Daughter Clare and boyfriend (hers, not mine) collected me - still thinking I'd vomit all the way home.
Thursday, 19 April 2007: Gradually recovering. Slept well Wednesday night. Awoke not feeling giddy. Some numbness in right calf and thigh. Nicks all over me.
Now! Am I cured of cancer?
I'm reminded of an incident where, at Glen's request, Denby turned the video screen showing moving pictures within my bladder, and I could see my prostate pressing in against the bladder wall, as it was pushed from the other side by the needles.
Saturday, 28 April 2007: There are a lot of sore bits - scabs and cuts. Peeing gets harder and a little painful. Peeing also reacts on my bowels. I have to check that I haven't pooed. The numbness in my right thigh is still there and my left foot still gives me pain when I bend it near the toes. I ejaculated on Thursday - a dark brown, runny goo, I guess blood. It'll be good when I can wee without pooing at the same time.
I've been through the gambit. Had to listen to an old man with dementia shouting at his imaginary dog. I had to fight for the treatment I've had. People have prayed for me.
I've clung to the advice of a nurse who helped me when I first tried to get an appointment with a doctor at the Royal Adelaide Hospital. She summarised what would happen - the brachytherapy and then I could get back on with my life, return to work. It's not been that simple, but I've clung to that promise, plus the registrar Dr W's practical advice: keep still during the external radiation and you won't have other problems, for example, bowel damage. That with brachytherapy gave me 70% chance of full recovery.
Wednesday, 23 May 2007: Hospital check-up with a different doctor. He warned me about giving up the hormone treatment - clearly on my head if anything goes wrong. Denby had said that it didn't matter. I can't see how I can return to work with all the problems associated with the hormone treatment, especially the tiredness, plus pursue my writing and contribute to the family and household.
Next hospital appointment 6 months time, 3 months to Dr Richard W (my Urologist).
Friday, 15 June 2007: I started the process of recording my treatment at friend Marilyn's suggestion. She has now died of her cancer. I feel destined to keep updating it, if only to keep faith with her.
Monday, 25 June 2007: I'm conflicted about the hormone treatment. I've had enough. I email Richard about what I should do. He replied that there was no clear answer, and gave me a good summary of the medical debate.
August 2007: Appointment with Dr Richard W. PSA down to 0.09. Gave me samples of three different drugs (Viagra, Cialis and Levitra) to stimulate erectile function. Told to decide what suited me best and then take it intensively. He joked that it doesn't happen automatically as other patients have complalined - actually have to initiate sex. Cruise coming up, maybe a good time. But some of these pills cause pain. Ciallis best.
December 2007: Another visit to the RAH, another doctor. PSA has risen to 0.17. A bit of a worry. The doctor was not reassuring. He again raised the issue of whether or not I was on hrmone treatment. Have I made a mistake?
Friday, 7 March 2008: Confiusion about appointment with Richard. His office sent an appointment for earlier. I had worried that this was within the three months we were supposed to meet, although he said this was not a big issue, of course.
PSA now up to 0.41. Not looking good. Richard said to wait and see. I asked him for the okay not to go back to the RAH - they keep reminding me of my refusal to continue with the hormone treatment. I feel guilty and obliged to them because of the treatment they provided me. Richard said it was okay if I not go back, and that he would report my progress to them. He added that I would probably never get Prof Y seeing me there anyway.
Rang RAH and cancelled my next appointment, but this must not have been recorded. I still got a later call from the doctor I was to see to check if I was okay after I missed the appointment.
Thursday, 22 May 2008: Meeting with my GP, Dr B, to find advance result of blood test. Rate of PSA increase improved.
Thursday, 29 May 2008: Appointment with Dr Richard W. I had made it earlier than three months because of anxiety over the previous increase in PSA. Reading was 0.5. Richard said this was good - PSA could be stabilising and not an indication that the cancer was coming back. Asked him to check out my boobs because of pains and imagined lumps. Elizabeth accompanied me.
Thursday, 28 August 2008: Appointment with Dr Richard W. A good PSA result again - 0.48. Richard said we could now extend out appointments to six months. He also offered me various sexual aids - injections, pumps et cetera - these all seemed appalling - said that I'd wait and see. Desire has somewhat reduced, as well as ability.
Thursday, 26 February 2009: Appointment with Dr Richard W with Elizabeth. Depressing news. PSA up to 0.9. Richard talked of my going onto hormone treatment. He said that this medication (Zoladex) could be done intermittently and could wait until my PSA rose up to 4 or 6.
Friday, 6 March 2009: Visit to my Naturopath. She made the point that exercise and fish oil can send up the PSA count. I felt much better.
Monday, 25 May 2009: Appointment with Dr Richard W. Good news. PSA down to 0.6. Appointments back to 6 months.
Wednesday, 23 September 2009: Appointment with Dr Richard W. Bad news. Not just bad news - shattering! PSA now up to 1.7. Richard still saying wait until the next test.
What caused a long period of hayfever and did this affect PSA / stress with work. Work contract finally finishing.
Went to GP for mental health referral to psychologist Dr Sue S for hypnotherapy on basis of depression.
Monday, 15 February 2010: Appointment with Dr Richard W. PSA further increased. I think I blocked out the last number - 2.3 or 3.4? Discussion about options. Richard said that it could still stabilize. My PSA reading is 4.3 - not much to hang on to show that this could be slowing. Richard wants to wait for the next test to determine if hormone treatment is needed.
I raised the possibility of an operation to remove the prostate. Richard said that he'd need to be sure the cancer is limited to the prostate. He thought there'd only be 25% chance of success and even if successful I could have urinary incontinence. He expressed further reservations about surgery. He said that he would discuss this with his Urologist colleagues and get back to me, or I could phone him if I did not hear from him - of course, I phoned him.
Richard's secretary gave me a referral for CT and bone scans. The first appointment I could get with him to follow-up would be delayed three weeks because of our planned holiday in the Northern Territory.
Monday, 15 March 2010: Appointment with Dr Richard W. CT and bone results clear. Next his secretary arranged appointments for biopsy and MRI.
Wednesday, 17 March 2010: Phoned Richard. All on track. Also discussed insurance. QBE were hopeless. Their dismissive attitude was very disappointing, especially given all the money I've paid them over the years through my Credit Union for household and car insurance. They make no allowance for people with cancer, whereas I found Covermore on the Internet did make reasonable allowance for prostate cancer. My PSA count was under 16 and the cancer had to still be located within the prostate. I needed to confirm with Richard that he would support this, preferably before he carried out any further investigation. All good.
Monday, 29 March 2010: Prostate biopsy by Richard at his surgery. This was not painful like the first time he did this to establish I had cancer.
Tuesday, 30 March 2010: Transrectal Ultrasound (MRI) at St Andrews Hospital.
Thursday, 1 April 2010: Appointment with Richard to discuss the results of all my tests. Elizabeth attended all these appointments I had with Richard.
The biopsy showed cancer in the right portion of the prostate. The CT and bone scan were clear but the transrectal ultrasound (MRI) showed growth in a right lymph node. On the basis of the MRI result Richard did not think that there was any point in continuing towards operating. Interesting that the MRI is far less intrusive (no chemical injections required) than CT scans, and also gives far better pictures.
Richard gave me a new self-help book and a prescription for hormone treatment, a final recognition that the brachytherapy did not eliiminate all the cancer. He explained that the tablets were to soak up testosterone from glands and the injection works on the prostate (and presumably the testes).
Thursday, 15 April 2010: Visited GP, Dr B, for Zoladex injection in stomach.
A lot of other things are happening in my life to help me deal with this cancer. Ongoing naturopathic treatments with Tanya. Hypnotherapy sessions with Sue. I used up my first 6 psychology interviews (Mental Health Plan) and so went back to Dr B to approve a further 6.
Wednesday, 9 June 2010: Appointment with Dr Sue S (Clinical Psychologist). Discussed my current negative thoughts and Sue's suggestion that I write these down and examine rationally. Also discussed imagery I could use, for example, me in a small capsule travelling through my body and zapping cancer, in a healing fountain, and good prostate - damaged prostate - good prostate. Also discussion about what I can do in the fight against cancer during my three month trip to Europe, including checking out what the treatment options are there.
Tuesday, 13 July 2010: Jonathan, my son, told me about a new treatment (PROVENG), which works on boosting the immune system. Nice of him. I need to check on its development.
Also went to Dr Richard W today. PSA down to 0.31 from 4 (four months ago) attributed to the hormone treatment. Richard said that I could have a break - take tablets to end of August and then wait and see what my PSA is when I get back from Europe. Richard told me that he was going to an overseas conference on the debate over intermittent versus continuous use of hormone treatment.
Thursday, 11 November 2010: Appointment with Dr Richard W. I was nervous. Needn't have been - PSA dropped to 0.13 despite break from hormone treatment. Amazing. I attributed this to a miracle from my visit to Lourdes (refer first post). Richard attributed my PSA drop to continuing effects of the hormone treatment. He first thought I didn't need to return for 6 months with no further hormone treatment, eventually settled for 3 months. Wait and see!
Monday, 7 February 2011: On Friday (4 February 2011) had PSA blood test. Confusion about requiring a referral letter from GP to see the psychologist, but already done. Still useful to have appointment so he could look up PSA result - had gone up to 1.05.
Thursday, 3 March 2011: Very tired. Had day in bed.
Monday, 28 March 2011: Blood in ejaculation, normally nothing. Emailed Dr Richard W about this. Also made appointment with GP Dr B.
Tuesday, 29 March 2011: Appointment with GP, Dr B. A small amount of blood appeared in a urine sample. Dr B said ejaculating blood may not be linked to prostate cancer or its treatment, although if it persisted I should see Dr W. Dr B said it could just be a cyst that bursts - this happens even in young men.
Wednesday, 30 march 2011: Blood in ejaculation, less than Monday.
Friday, 1 April 2011: Quite a lot of fluid. No more semen since the radiation treatment, now replaced by blood - rich, red.
Wednesday, 6 April 2011: Blood (ejaculation) almost black, but not nearly as much. Still farting mucous, another after-effect of the radiation treatment.
Appointment with Dr Richard W. PSA now 12. Back onto hormone treatment.
I'm feeling negative about the progress of my prostate cancer. I feel like I'm walking in the footsteps of hordes of vanished men. The RAH wanted to keep my scans for teaching purposes. I imagine them still being used by students.
Before moving on to what's happened since, I shall finish this blog and finish recording my earlier handwritten diary. I stopped diarising in early 2011 so the story from then will be less structured, but that is for later. My last entries in this diary are chaotic and hard to follow.
What's going on? In March this year I felt increasingly tired so that by Sunday (27.03.2011) I did something I haven't done for years. I spent the day in bed. Then on Monday I ejaculated blood - a rich, red fluid. I have enough Christian guilt from my childhood about masturbation, but this puts the cap on it. I was told later that this was a side-effect of the brachytherapy back in 2007 (described below). The blood was enough for me to go to see the GP and email the Urologist.
After a week and a half the blood decreased and became almost black. My naturopath tells me this is a sign of old blood. I've also got over a lot of the tiredness. This has been greatly helped by a visit to my hypnotherapist and more regular hypnosis. Curiously I've started ejaculating a clear liquid with the blood. I haven't produced anything like semen since the brachytherapy in 2007. Also I had passed a clear liquid out my bottom, another by-product originally of the radiation.
The Urologist didn't respond to my email, but I made an earlier appointment. The GP couldn't throw much light on what was going on either, but he was reassuring. I haven't been (or wanted to go) to mass for a couple of weeks and I've not found latihan with Subud as rewarding as usual. However, I did have the strongest of experiences one morning I felt tired and not inclined to get out of bed - a big hand grabbed me by the neck and shook me in the air - like someone was trying to tell me to dust myself off and get on with it. Plus I was attending a weekly prayer group in the lead up to Easter - I saw this as my Lenten sacrifice. Nowadays I'm more likely to fast during Ramadan than Lent. Then I got the phone call from Michael.
Michael is my sister's partner. They live a long way away in Queensland. Among other problems he has been battling bladder cancer for years. After seeing the GP for extreme discomfort around his pelvic bone and then a CT scan, the GP was convinced the cancer had spread. Bad news kept coming and Michael was convinced he only had a couple of months of life left. This occurred less than two weeks he was due to head off to England for six months. To reassure Michael, I promised to pray for him at latihan, mass and the prayer group, which, if nothing else, led to my re-involvement in all three.
After visiting a local Uniting Church and asking the Minister to pray for him, Michael seemed to have a major recovery. Miracles can happen. I wonder. Michael also had a receiving that I needed to return to Lourdes twice more.
The following account of brachytherapy is the closest I've been to being on the stage. As I understand it, there are two types of brachytherapy. The first is low dose rate (LDR) brachytherapy where radioactive metal balls are injected into the prostate and these are ejected naturally by the body over time. The second is high dose rate (HDR) brachytherapy, which is described below, and involves the direct insertion of rods into the prostate through which radioactive material is then placed. Because of the extreme amounts of radiation involved there is only one place in Adelaide where this procedure can be safely performed - the basement of the Oncology wing of the Royal Adelaide Hospital.
Wednesday, 4 April 2007: I did the half hour walk to the chemist at Collinswood, a lovely walk across the Torrens River (really a creek) and the parklands on either side, to have my three monthly Zoladek prescription (hormone injection). They didn't have any. Only keep one in stock and someone else had come in earlier in the day and taken it. Could be in tomorrow by 10:30am, only an hour before the doctor's appointment to administer it.
Thursday, 5 April 2007: This time I borrowed my son's car to go to the chemist. As it was I had plenty of time - Dr B was way behind.He has a sense of humour. He escorted an old Italian guy to the surgery past the waiting room, saying "snap" to me as he passed by, and showed the box of Zoladek. Hurt a bit later as he injected me in the stomach. At least he bulk billed.
Dr B gave me another script for Nexium and told me to take one before going into hospital.
Friday, 6 April 2007: Have to get better from the external beam radiation, and ready for brachytherapy. Gradually feeling better. Not getting up so much to wee at night. Bowels becoming less of a worry, but still some urgency (and accidents). Apprehension as the day to go into hospital gets closer.
Monday, 16 April 2007: Phoned the Royal Adelaide Hospital (public) as instructed (between 1pm and 4pm). Given the bad news that I had to be at the hospital at 8am.
Fasted after 9pm. Took the anaemia, but some sensitivity - I couldn't hold onto for it for the recommended 20 minutes.
Tuesday, 17 April 2007: Never got around to getting slippers and forgot thongs.
Took 2 Microlax again.
Had to convince Elizabeth to take me in - dropped me off at the bus stop. She had work commitments and the original plan had been that I would get the bus in, but I couldn't see how I'd organise myself to be in at the hospital for an 8am start.
I took her black bag, but I didn't feel right using the wheels on my way up to the fourth floor. I was ten minutes early for admission but there were a lot of other people waiting already, although none of them had a case like me. The door outside did say "Surgical Admissions", but above it was the sign, "Day Surgery". More waiting.
Eventually got in. My name was taken and I was told to wait. Then called up and a clerk took my details. I signed in as a private patient - I felt obligated to Prof Y to do that.
I was then told to wait again until called. I was then interviewed by a pretty African nurse, hair in braids. She asked me a lot of questions, including whether I was pregnant: "Who knows might happen today? Then women won't be needed." She also said that I could keep my boots on, instead of slippers. (I had previously been told, and given a printout, saying that I'd be waiting around in my surgical gown, and that I should have a dressing gown and slippers.) I'm taken to an area to change. I'm moving through the system. I'm surprised that it's only 8:25am.
My bag is put on a wheeled rack and labelled after I have finished changing. I put on stockings, so I didn't need socks. When I came out of the cubicle I was told to take to take off my dressing gown and boots and get on a trolley. Dressing gown and boots were put in a plastic bag and placed under the trolley, not to be seen again until I was ready to leave. So much for the need for dressing gown and slippers.
More waiting.
An unshaven man chewing gum and smelling of cigarettes and maybe alcohol comes to collect me. The nurses seem reluctant to let him take me , but he insists that I have to go to the radiology area. (The anaesthetist, Dave, who later takes over says the hospital doesn't have orderlies any more, just people contracted to move patients between wards. I said, "Like sacking the tea lady to save money." He said a hesitant "Yes". He was pushing me in a trolley at the time and we turned a corner and there was a woman with a tea trolley. I'll bet she was a volunteer, but I didn't say anything. He said, "See we still have tea ladies".)
The guy pushing me didn't say much and the ride lasted forever. It reminded me of Redruth Trail (a long, tunnel-like passage with so many turns that totally disorient) in the Remand Centre. Sinister: no one around, never ending, and no windows to the outside world.
We ended up on the second floor of Radiology, really a level below ground, no windows here either. Someone once told me that the plan for the Radiology Building had been reversed by mistake so that there are no views of the adjacent Botanic Gardens on any of the floors, as had been in the original plan.
I'm handed over to a friendly nurse named Glen. I think: Maybe they give you a male nurse to make you feel more comfortable. Glen wheels me into a store room. It's 8:50am. Glen leaves me. Do I want something to read? I say "No".
I might be wrong about being on the 2nd floor at this stage because it all looked a lot like where I went for external beam radiation. I remember people looking at me curiously as I used to look at the other people on stretchers.
Glen comes back and wheels me through a door marked "Brachytherapy". This is the outer room. There are a lot of people in white gowns doing inexplicable tasks, plus, I guess, the inevitable observers. They don't use masks.
A man with an East European accent, named Zack, asks me if I want a spinal or a general anaesthetic. He recommends a general. I don't care much. How can I decide? So we settle on a general. Then another white coated man, a bit smaller, comes from the inner room, another anaesthetist. He doesn't introduce with his first name, just Dr xxxx, but later mentions his first name, Dave. He talks a lot. Anyway he informs us that Dr S, the urologist performing the procedure, wants me to have a spinal. He explains to Zack that he doesn't want me moving around after the procedure because the needles are left in.
Prof Y visits me. He asks what Dr W (my Urologist) had said about the hormone treatment. I said five and a half months before and after brachytherapy. Dr W had said that makes the brachytherapy most effective. Why is he asking me about Dr W? I haven't seen him for ages. Prof Y wants me to stay on the hormone treatment for three years. He knows I'm not happy about that idea, and repeats his joke about how American men refuse to stay on hormone treatment because of the side effects, whereas Europeans do what they're told. He indicates he's finished with me and I'm wheeled into the inner room. White coated people are busy with many tasks I don't comprehend.
Three technicians are working on instruments in front of computer screens. Professor Y said there's been problems with the software. This biggish man is also called doctor, but obviously not a medical one. He says it's more than the software.
A couple (boy/girl) in white frocks look on. I guess they're students. They're quiet. There are 3 to 4 nursing type people, including Glen. There is the Indian nurse I always see with Prof Y. We chat. She says I look familiar.
I'm moved over onto the operating table. Then I have to sit up while Zack does the spinal - a bit of pain. Dave gets me to hunch right over - makes inserting the needle easier.
Once I'm lying down they hitch my legs up. Zack asks for ice. The nurses find some and put it in a rubber glove. He uses this to feel my sensations. It can't be much after 9am.
A nurse, a middle-aged woman, is assigned to sit at my head and talk to me, but she doesn't have much to say. Glen asks if I'd like anything. I say I'm surprised there is no music - Bach'd be good. He comes back with a radio player, like the one my daughter had, but they're not playing Bach. Someone asks if it is "The Messiah" - I say it's Wagner (I'd heard them announce it on the radio). It may be because of my medication. Zack had put a drip in a vein in the back of my hand while we were in the other room, and he's been pumping something good into me. I feel relaxed and a bit disinhibited. I feel clever.
Dave takes over from Zack. (I really only need one anaesthetist.) He tells Zack he can go, but Zack comes back later. He's not needed elsewhere. Zack says he's interested that I'd come from Queensland. He said that he wanted to move up there next year.
I have a strong feeling of pressure on my pelvis on the right side. Dave says there is nothing there - that your brain remembers your last sensation once anaesthetised.
At times they put a tube up the penis to takes a video, as well as who knows what. With Glen's help I get to see the screen. I also get to see the screen for scanning the prostate, inserted via my bottom. Denby (the operating Urologist) doesn't say much. I now feel familiar enough with him, not to call him Dr S. He's preoccupied with inserting the pins. Prof Y comes and goes, and has an opinion on a lot - uses terms like "baseline".
Hollow pins are being inserted into my prostate via the area between my penis and anus. There's lots of problems with the prostate moving. They have to get the calculations so precise. Dave tells me not to cough as that can shift the prostate. After a long time Denby leaves when he decides the pins are properly inserted, and probably a lot of other things I don't know about.
I'm in that room 'til after 2:30pm and Dave talks most of the time, about his interest in cross country skiing, and skiing tragedies. He's employed full-time in the hosptial. I struggle to come up with subjects to talk about, for example, the dangers of being an anaesthetist. He goes on at great length about how it is safe.
My back hurts. Dave gives me more pain killers via the drip, but they're not as strong as what Zack had given me. I ask for more about every half hour. He says it would be my shoulders, but I insist it is my lower back.
People go off to lunch, but the work doesn't stop. It's getting near the end. I'm connected to the da Vinic robot. All the people leave the room for the radiation. I'm suddenly alone.
A nurse enters the room to check if the radiation levels are within safe limits. She has a little detector.
There are other people that I only vaguely remember, for example, Jill, who was very talkative. Later she was one of three otheres in the adjoining room working on a console.
I told Glen the story of how an Adelaide builder had provided the money for the robot in Adelaide so that men woould not have to go onto a waiting list for treatment in Melbourne. Then I complained of my having to wait so long to get an opportunity for the brachytherapy treatment. (They only do one a month.) Glen was defensive citing ongoing costs. Denby was amused, looked up and smiled. The only time we really engaged.
Dave wheeled me back to Recovery in the other building. We were accompanied by my assigned nurse. I saw Joe from my time with external beam radiation - he hadn't been at the show today.
Dave wasn't going to be with me tomorrow. Zack said goodbye as well. I went from two anaesthetists to none. One of them asked about my preference for leaving medication. During the late afternoon feeling came back to my legs but they were tied to a pillow to stop me moving. The pins were still in place. The transfer to the trolley had not been easy.
I was wheeled into Ward 6B on the 6th floor of the Radiology Building. My room was an open shared space adjacent to the nurses station. My bed was against the wall. There were two old men in the beds opposite - one made odd loud noises and the other had dementia. The one with dementia thought he knew me. He was mobile and would come and stand over me and ask questions: "Are you up or down?" He kept telling his dog to be quiet - I think this was related to the bizarre sounds coming form the other man.
Because of all the attachments coming out of my bottom they had a lot of trouble placing me in the bed, even though a hole was cut out of the middle so they (the attachments) could dangle freely. My bum did not seem to fit right. I still had the catheter so it was okay to wee, but I was not allowed to poo. I was given some tablets to stop me. I kept worrying. I didn't want to move so there'd be minimal adjustments needed with the rods the next day.
I managed to phone Elizabeth at work, but she was not for a long conversation. She said the dog had caused a mess and she needed to go home early to clean up, and that would make her late to visit. That German Shepherd was bad news.
Dinner arrived and very different from my normal healthy diet. Much like I'd expect hospital food - roast lamb, but everything tasted like it'd been stewed to excess.
Elizabeth and adult daughter, Clare, visited around 8pm. Nice.
I didn't get a phone or TV (the only benefit I could see for going private from the form at admission), but I did get a laugh from the nurse when I asked about why I didn't get them.
I took pain killers throughout the night - didn't sleep.
Wednesday, 18 April 2007: Around 8:30am I was wheeled back to the brachytherapy rooms. The drip had been reinserted through the night - more fasting.
They gave me a couple of anaesthetic lolloypops to suck - not good - sickly and not very effective. Real pain this time as Denby and associates repositioned the pins according to to Xrays taken from the previous day. It hurt, like hitting a nerve at the dentist, only this time there were 17 of them to be positioned one at a time, and into my prostate. After it was over Denby seemed to remove them all at once.
The procedure this time only took a couple of hours. Denby left and Prof Y put on the padding where the needles had been to stop the bleeding.
When they shifted me back onto the trolley the giddyness started. I was farewelled through the outer room like a departing hero, including applause.
Some of the nurses were excellent and dedicated to their job, unfortunately more were not so good. An overweight one hurt her knee getting up from a couch, and was taken away in a wheelchair for observation. She returned at the end of the shift, seemingly improved. A number of other large nurses sat all of the shift on easy chairs in the nurses stations. The main discussion was around the need to assert their rights.
I vomited twice - the giddyness didn't go away. I could still taste those anaesthetic lollypops. I was told by the ward doctor that I had to pee and poo before I cold leave. In the end he prescribed an anaema - given by a male nurse.
Peed blood. Phoned elizabeth to pick me up. Daughter Clare and boyfriend (hers, not mine) collected me - still thinking I'd vomit all the way home.
Thursday, 19 April 2007: Gradually recovering. Slept well Wednesday night. Awoke not feeling giddy. Some numbness in right calf and thigh. Nicks all over me.
Now! Am I cured of cancer?
I'm reminded of an incident where, at Glen's request, Denby turned the video screen showing moving pictures within my bladder, and I could see my prostate pressing in against the bladder wall, as it was pushed from the other side by the needles.
Saturday, 28 April 2007: There are a lot of sore bits - scabs and cuts. Peeing gets harder and a little painful. Peeing also reacts on my bowels. I have to check that I haven't pooed. The numbness in my right thigh is still there and my left foot still gives me pain when I bend it near the toes. I ejaculated on Thursday - a dark brown, runny goo, I guess blood. It'll be good when I can wee without pooing at the same time.
I've been through the gambit. Had to listen to an old man with dementia shouting at his imaginary dog. I had to fight for the treatment I've had. People have prayed for me.
I've clung to the advice of a nurse who helped me when I first tried to get an appointment with a doctor at the Royal Adelaide Hospital. She summarised what would happen - the brachytherapy and then I could get back on with my life, return to work. It's not been that simple, but I've clung to that promise, plus the registrar Dr W's practical advice: keep still during the external radiation and you won't have other problems, for example, bowel damage. That with brachytherapy gave me 70% chance of full recovery.
Wednesday, 23 May 2007: Hospital check-up with a different doctor. He warned me about giving up the hormone treatment - clearly on my head if anything goes wrong. Denby had said that it didn't matter. I can't see how I can return to work with all the problems associated with the hormone treatment, especially the tiredness, plus pursue my writing and contribute to the family and household.
Next hospital appointment 6 months time, 3 months to Dr Richard W (my Urologist).
Friday, 15 June 2007: I started the process of recording my treatment at friend Marilyn's suggestion. She has now died of her cancer. I feel destined to keep updating it, if only to keep faith with her.
Monday, 25 June 2007: I'm conflicted about the hormone treatment. I've had enough. I email Richard about what I should do. He replied that there was no clear answer, and gave me a good summary of the medical debate.
August 2007: Appointment with Dr Richard W. PSA down to 0.09. Gave me samples of three different drugs (Viagra, Cialis and Levitra) to stimulate erectile function. Told to decide what suited me best and then take it intensively. He joked that it doesn't happen automatically as other patients have complalined - actually have to initiate sex. Cruise coming up, maybe a good time. But some of these pills cause pain. Ciallis best.
December 2007: Another visit to the RAH, another doctor. PSA has risen to 0.17. A bit of a worry. The doctor was not reassuring. He again raised the issue of whether or not I was on hrmone treatment. Have I made a mistake?
Friday, 7 March 2008: Confiusion about appointment with Richard. His office sent an appointment for earlier. I had worried that this was within the three months we were supposed to meet, although he said this was not a big issue, of course.
PSA now up to 0.41. Not looking good. Richard said to wait and see. I asked him for the okay not to go back to the RAH - they keep reminding me of my refusal to continue with the hormone treatment. I feel guilty and obliged to them because of the treatment they provided me. Richard said it was okay if I not go back, and that he would report my progress to them. He added that I would probably never get Prof Y seeing me there anyway.
Rang RAH and cancelled my next appointment, but this must not have been recorded. I still got a later call from the doctor I was to see to check if I was okay after I missed the appointment.
Thursday, 22 May 2008: Meeting with my GP, Dr B, to find advance result of blood test. Rate of PSA increase improved.
Thursday, 29 May 2008: Appointment with Dr Richard W. I had made it earlier than three months because of anxiety over the previous increase in PSA. Reading was 0.5. Richard said this was good - PSA could be stabilising and not an indication that the cancer was coming back. Asked him to check out my boobs because of pains and imagined lumps. Elizabeth accompanied me.
Thursday, 28 August 2008: Appointment with Dr Richard W. A good PSA result again - 0.48. Richard said we could now extend out appointments to six months. He also offered me various sexual aids - injections, pumps et cetera - these all seemed appalling - said that I'd wait and see. Desire has somewhat reduced, as well as ability.
Thursday, 26 February 2009: Appointment with Dr Richard W with Elizabeth. Depressing news. PSA up to 0.9. Richard talked of my going onto hormone treatment. He said that this medication (Zoladex) could be done intermittently and could wait until my PSA rose up to 4 or 6.
Friday, 6 March 2009: Visit to my Naturopath. She made the point that exercise and fish oil can send up the PSA count. I felt much better.
Monday, 25 May 2009: Appointment with Dr Richard W. Good news. PSA down to 0.6. Appointments back to 6 months.
Wednesday, 23 September 2009: Appointment with Dr Richard W. Bad news. Not just bad news - shattering! PSA now up to 1.7. Richard still saying wait until the next test.
What caused a long period of hayfever and did this affect PSA / stress with work. Work contract finally finishing.
Went to GP for mental health referral to psychologist Dr Sue S for hypnotherapy on basis of depression.
Monday, 15 February 2010: Appointment with Dr Richard W. PSA further increased. I think I blocked out the last number - 2.3 or 3.4? Discussion about options. Richard said that it could still stabilize. My PSA reading is 4.3 - not much to hang on to show that this could be slowing. Richard wants to wait for the next test to determine if hormone treatment is needed.
I raised the possibility of an operation to remove the prostate. Richard said that he'd need to be sure the cancer is limited to the prostate. He thought there'd only be 25% chance of success and even if successful I could have urinary incontinence. He expressed further reservations about surgery. He said that he would discuss this with his Urologist colleagues and get back to me, or I could phone him if I did not hear from him - of course, I phoned him.
Richard's secretary gave me a referral for CT and bone scans. The first appointment I could get with him to follow-up would be delayed three weeks because of our planned holiday in the Northern Territory.
Monday, 15 March 2010: Appointment with Dr Richard W. CT and bone results clear. Next his secretary arranged appointments for biopsy and MRI.
Wednesday, 17 March 2010: Phoned Richard. All on track. Also discussed insurance. QBE were hopeless. Their dismissive attitude was very disappointing, especially given all the money I've paid them over the years through my Credit Union for household and car insurance. They make no allowance for people with cancer, whereas I found Covermore on the Internet did make reasonable allowance for prostate cancer. My PSA count was under 16 and the cancer had to still be located within the prostate. I needed to confirm with Richard that he would support this, preferably before he carried out any further investigation. All good.
Monday, 29 March 2010: Prostate biopsy by Richard at his surgery. This was not painful like the first time he did this to establish I had cancer.
Tuesday, 30 March 2010: Transrectal Ultrasound (MRI) at St Andrews Hospital.
Thursday, 1 April 2010: Appointment with Richard to discuss the results of all my tests. Elizabeth attended all these appointments I had with Richard.
The biopsy showed cancer in the right portion of the prostate. The CT and bone scan were clear but the transrectal ultrasound (MRI) showed growth in a right lymph node. On the basis of the MRI result Richard did not think that there was any point in continuing towards operating. Interesting that the MRI is far less intrusive (no chemical injections required) than CT scans, and also gives far better pictures.
Richard gave me a new self-help book and a prescription for hormone treatment, a final recognition that the brachytherapy did not eliiminate all the cancer. He explained that the tablets were to soak up testosterone from glands and the injection works on the prostate (and presumably the testes).
Thursday, 15 April 2010: Visited GP, Dr B, for Zoladex injection in stomach.
A lot of other things are happening in my life to help me deal with this cancer. Ongoing naturopathic treatments with Tanya. Hypnotherapy sessions with Sue. I used up my first 6 psychology interviews (Mental Health Plan) and so went back to Dr B to approve a further 6.
Wednesday, 9 June 2010: Appointment with Dr Sue S (Clinical Psychologist). Discussed my current negative thoughts and Sue's suggestion that I write these down and examine rationally. Also discussed imagery I could use, for example, me in a small capsule travelling through my body and zapping cancer, in a healing fountain, and good prostate - damaged prostate - good prostate. Also discussion about what I can do in the fight against cancer during my three month trip to Europe, including checking out what the treatment options are there.
Tuesday, 13 July 2010: Jonathan, my son, told me about a new treatment (PROVENG), which works on boosting the immune system. Nice of him. I need to check on its development.
Also went to Dr Richard W today. PSA down to 0.31 from 4 (four months ago) attributed to the hormone treatment. Richard said that I could have a break - take tablets to end of August and then wait and see what my PSA is when I get back from Europe. Richard told me that he was going to an overseas conference on the debate over intermittent versus continuous use of hormone treatment.
Thursday, 11 November 2010: Appointment with Dr Richard W. I was nervous. Needn't have been - PSA dropped to 0.13 despite break from hormone treatment. Amazing. I attributed this to a miracle from my visit to Lourdes (refer first post). Richard attributed my PSA drop to continuing effects of the hormone treatment. He first thought I didn't need to return for 6 months with no further hormone treatment, eventually settled for 3 months. Wait and see!
Monday, 7 February 2011: On Friday (4 February 2011) had PSA blood test. Confusion about requiring a referral letter from GP to see the psychologist, but already done. Still useful to have appointment so he could look up PSA result - had gone up to 1.05.
Thursday, 3 March 2011: Very tired. Had day in bed.
Monday, 28 March 2011: Blood in ejaculation, normally nothing. Emailed Dr Richard W about this. Also made appointment with GP Dr B.
Tuesday, 29 March 2011: Appointment with GP, Dr B. A small amount of blood appeared in a urine sample. Dr B said ejaculating blood may not be linked to prostate cancer or its treatment, although if it persisted I should see Dr W. Dr B said it could just be a cyst that bursts - this happens even in young men.
Wednesday, 30 march 2011: Blood in ejaculation, less than Monday.
Friday, 1 April 2011: Quite a lot of fluid. No more semen since the radiation treatment, now replaced by blood - rich, red.
Wednesday, 6 April 2011: Blood (ejaculation) almost black, but not nearly as much. Still farting mucous, another after-effect of the radiation treatment.
Appointment with Dr Richard W. PSA now 12. Back onto hormone treatment.
I'm feeling negative about the progress of my prostate cancer. I feel like I'm walking in the footsteps of hordes of vanished men. The RAH wanted to keep my scans for teaching purposes. I imagine them still being used by students. 
