{"id":23733,"date":"2020-11-17T17:09:55","date_gmt":"2020-11-17T22:09:55","guid":{"rendered":"http:\/\/ianchadwick.com\/blog\/?p=23733"},"modified":"2020-11-17T17:09:55","modified_gmt":"2020-11-17T22:09:55","slug":"the-cancer-diaries-part-15","status":"publish","type":"post","link":"https:\/\/ianchadwick.com\/blog\/the-cancer-diaries-part-15\/","title":{"rendered":"The Cancer Diaries, Part 15"},"content":{"rendered":"<div class=\"pvc_clear\"><\/div>\n<p id=\"pvc_stats_23733\" class=\"pvc_stats all  \" data-element-id=\"23733\" style=\"\"><i class=\"pvc-stats-icon medium\" aria-hidden=\"true\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" version=\"1.0\" viewBox=\"0 0 502 315\" preserveAspectRatio=\"xMidYMid meet\"><g transform=\"translate(0,332) scale(0.1,-0.1)\" fill=\"\" stroke=\"none\"><path d=\"M2394 3279 l-29 -30 -3 -207 c-2 -182 0 -211 15 -242 39 -76 157 -76 196 0 15 31 17 60 15 243 l-3 209 -33 29 c-26 23 -41 29 -80 29 -41 0 -53 -5 -78 -31z\"\/><path d=\"M3085 3251 c-45 -19 -58 -50 -96 -229 -47 -217 -49 -260 -13 -295 52 -53 146 -42 177 20 16 31 87 366 87 410 0 70 -86 122 -155 94z\"\/><path d=\"M1751 3234 c-13 -9 -29 -31 -37 -50 -12 -29 -10 -49 21 -204 19 -94 39 -189 45 -210 14 -50 54 -80 110 -80 34 0 48 6 76 34 21 21 34 44 34 59 0 14 -18 113 -40 219 -37 178 -43 195 -70 221 -36 32 -101 37 -139 11z\"\/><path d=\"M1163 3073 c-36 -7 -73 -59 -73 -102 0 -56 133 -378 171 -413 34 -32 83 -37 129 -13 70 36 67 87 -16 290 -86 209 -89 214 -129 231 -35 14 -42 15 -82 7z\"\/><path d=\"M3689 3066 c-15 -9 -33 -30 -42 -48 -48 -103 -147 -355 -147 -375 0 -98 131 -148 192 -74 13 15 57 108 97 206 80 196 84 226 37 273 -30 30 -99 39 -137 18z\"\/><path d=\"M583 2784 c-38 -19 -67 -74 -58 -113 9 -42 211 -354 242 -373 16 -10 45 -18 66 -18 51 0 107 52 107 100 0 39 -1 41 -124 234 -80 126 -108 162 -133 173 -41 17 -61 16 -100 -3z\"\/><path d=\"M4250 2784 c-14 -9 -74 -91 -133 -183 -95 -150 -107 -173 -107 -213 0 -55 33 -94 87 -104 67 -13 90 8 211 198 130 202 137 225 78 284 -27 27 -42 34 -72 34 -22 0 -50 -8 -64 -16z\"\/><path d=\"M2275 2693 c-553 -48 -1095 -270 -1585 -649 -135 -104 -459 -423 -483 -476 -23 -49 -22 -139 2 -186 73 -142 361 -457 571 -626 285 -228 642 -407 990 -497 242 -63 336 -73 660 -74 310 0 370 5 595 52 535 111 1045 392 1455 803 122 121 250 273 275 326 19 41 19 137 0 174 -41 79 -309 363 -465 492 -447 370 -946 591 -1479 653 -113 14 -422 18 -536 8z m395 -428 c171 -34 330 -124 456 -258 112 -119 167 -219 211 -378 27 -96 24 -300 -5 -401 -72 -255 -236 -447 -474 -557 -132 -62 -201 -76 -368 -76 -167 0 -236 14 -368 76 -213 98 -373 271 -451 485 -162 444 86 934 547 1084 153 49 292 57 452 25z m909 -232 c222 -123 408 -262 593 -441 76 -74 138 -139 138 -144 0 -16 -233 -242 -330 -319 -155 -123 -309 -223 -461 -299 l-81 -41 32 46 c18 26 49 83 70 128 143 306 141 649 -6 957 -25 52 -61 116 -79 142 l-34 47 45 -20 c26 -10 76 -36 113 -56z m-2057 25 c-40 -58 -105 -190 -130 -263 -110 -324 -59 -707 132 -981 25 -35 42 -64 37 -64 -19 0 -241 119 -326 174 -188 122 -406 314 -532 468 l-58 71 108 103 c185 178 428 349 672 473 66 33 121 60 123 61 2 0 -10 -19 -26 -42z\"\/><path d=\"M2375 1950 c-198 -44 -350 -190 -395 -379 -18 -76 -8 -221 19 -290 114 -284 457 -406 731 -260 98 52 188 154 231 260 27 69 37 214 19 290 -38 163 -166 304 -326 360 -67 23 -215 33 -279 19z\"\/><\/g><\/svg><\/i> <img loading=\"lazy\" decoding=\"async\" width=\"16\" height=\"16\" alt=\"Loading\" src=\"https:\/\/ianchadwick.com\/blog\/wp-content\/plugins\/page-views-count\/ajax-loader-2x.gif\" border=0 \/><\/p>\n<div class=\"pvc_clear\"><\/div>\n<blockquote><p>&#8220;&#8230; my only object was that all the world should enjoy itself and live in peace and quiet, without quarrels or troubles; but my good intentions were unavailing to save me from going where I never expect to come back from, with this weight of years upon me and a urinary ailment that never gives me a moment&#8217;s ease&#8230;&#8221;<br \/>\nMiguel de Cervantes: <strong>Don Quixote of La Mancha<\/strong>, chap. 22<\/p><\/blockquote>\n<p>I was listening to an audiobook of Don Quixote while driving to the hospital recently, and heard that bit. It just seemed appropriate. And a bit funny.<\/p>\n<p>Last week I got my first hormone injection \u2014 <a href=\"https:\/\/www.medicalnewstoday.com\/articles\/324480\" target=\"_blank\" rel=\"noopener noreferrer\">lupron<\/a>: the brand name for <em>leuprolide acetate<\/em>. &#8220;Lupron belongs to a class of drugs called luteinizing hormone-releasing hormone (LHRH) agonists. These medications block the production of LHRH in the body, which results in the testicles producing less testosterone.&#8221;<\/p>\n<p>At 70, I&#8217;m not terribly worried about my testosterone levels dropping. Sure, in the near future I may not buy a pickup truck, drink a case of beer, and wear a backward baseball cap while driving with my stereo playing annoying rap at ear-aching volume, but I&#8217;ll live with that. I&#8217;ll just have to content myself with reading, gardening, playing my ukulele, having a glass of wine with my wife, baking bread, a bit of online computer gaming, and walking the dog. And if it means my facial hair grows in less, well that just means I won&#8217;t need to shave as often.<\/p>\n<p>Lupron is delivered via an intramuscular injection, which I got in my left buttock. Although the syringe looked like something a veterinarian might use to threaten a cow, it actually didn&#8217;t hurt at all to get it. Later the buttock muscles and got a bit stiff and sore, but it wore off after a couple of days during which we walked a lot. I have another injection scheduled for early February. I expect to get them every three months for some time.<\/p>\n<p>Possible side effects of lupron can include:<\/p>\n<ul>\n<li>loss of muscle mass<\/li>\n<li>hot flashes<\/li>\n<li>fatigue<\/li>\n<li>skin irritation at the site of injection<\/li>\n<li>erectile dysfunction or loss of sex drive<\/li>\n<li>shrunken testicles and penis<\/li>\n<li>changes in blood lipids<\/li>\n<li>depression<\/li>\n<li>osteoporosis<\/li>\n<li>mood swings<\/li>\n<li>breast tenderness<\/li>\n<li>weight gain<\/li>\n<li>the growth of breast tissue<\/li>\n<li>anemia<\/li>\n<\/ul>\n<p>Seems I might be able to share some of these effects with Susan, who still has menopausal hot flashes. She laughed at the thought of me throwing off the duvet in the middle of the night and sitting up to cool off, as she sometimes does. The weight gain I can do without: since the operation, I&#8217;ve been less active than in the past. But will I grow breasts? <!--more--><\/p>\n<p>As for a shrunken penis, well, the prostate operation last July pretty much set that stage. The nerve cabling that made Mr. Happy stand up and dance back when I was younger were shorn away during the surgery, leaving me to take comfort in memories and my imagination, while Mr. Happy slumbers.<\/p>\n<p>Coincidentally, I recently read<a href=\"https:\/\/narratively.com\/the-distinguished-medieval-penis-investigators\/\" target=\"_blank\" rel=\"noopener noreferrer\"> an amusing article about impotence in the past<\/a> that noted that in medieval times,<\/p>\n<blockquote><p>&#8230; men weren\u2019t afraid to discuss their impotence with their doctors and friends. This is in sharp contrast to the modern era, when the subject is verboten for so many men. Take contemporary advertisements for erectile dysfunction (ED) drugs, such as Bob Dole\u2019s iconic 1999 Viagra commercial, in which he encouraged men to discuss their impotence with their doctors. Speaking seriously and wearing a navy suit with an American flag in the background, Dole said, \u201cYou know, it\u2019s a little embarrassing to talk about ED, but it\u2019s so important to millions of men and their partners that I decided to talk about it publicly.\u201d Twenty years later, impotence is largely still a taboo topic, and advertisements for ED-focused startups like Roman and Hims emphasize that their products can be delivered discreetly.<\/p><\/blockquote>\n<p>Well, for me those modern products would be a waste, since there are no longer the nerves to send the signals to stand at attention, regardless of what the medication signals. I don&#8217;t feel embarrassed about it, just wistful: it&#8217;s not like something I did to myself. And it&#8217;s not like I&#8217;m 25; at 70 impotence doesn&#8217;t have quite the same sting. One of my favourite authors, <a href=\"https:\/\/reasonandmeaning.com\/2017\/08\/28\/summary-of-cicero-on-aging\/\" target=\"_blank\" rel=\"noopener noreferrer\">Cicero, wrote about the loss of sexual passions in old age:<\/a><\/p>\n<blockquote><p>\u2026 granting that youth enjoys pleasures of that kind with a keener relish \u2026 although old age does not possess these pleasures in abundance, yet it is by no means wanting in them. Just as (a great actor) gives greater delight to the spectators in the front row at the theatre, and yet gives some delight even to those in the last row, so youth, looking on pleasures at closer range, perhaps enjoys them more, while old age, on the other hand, finds delight enough in a more distant view.<\/p><\/blockquote>\n<p>Sounds like he would have appreciated watching Pornhub had he lived today, although perhaps he was a bit too modestly straightlaced for modern pornography (although many Romans had a far more liberal attitude towards sex than we do). Even if the flesh is weak, he tells readers, the mind is still active and can imagine all sorts of physical things and recall the delights of the past. Imagination may be all I have left, but it&#8217;s still active enough.<\/p>\n<p>I enjoy reading Cicero and many of the other classical philosophers and thinkers today because they wrote about and wrestled with the same issues and problems we deal with today. I wish I had read them more when I was younger, much younger, but I paid little heed to most philosophy until the last decade or so. I did read a lot of Buddhist philosophy that has helped me build my worldview, but in my youth, I should have paid more attention to the classical Western authors like Montaigne. I digress&#8230;<\/p>\n<p>Some of the other effects can be mitigated (osteoporosis through calcium and vitamin D, for example). Mood swings? I&#8217;m already a cranky old bugger, so how do I tell? It&#8217;s hard to get depressed with Susan to give me strength, plus we have a delightful dog and three cats to boost my spirits. And I like to read, play the ukulele, and some computer games, which always lift my spirits.<\/p>\n<p>As worrying as some of these side effects might be, they are certainly more attractive than some of the more radical alternative therapies to reduce testosterone, which include:<\/p>\n<blockquote><p><strong>Orchiectomy<\/strong>. Also known as surgical castration, this is a surgical procedure to remove a person\u2019s testicles. The testicles produce most of the body\u2019s testosterone.<\/p><\/blockquote>\n<p>Yipes. I&#8217;ll risk the hormones, thank you. Not that I need my testicles for anything aside from ornaments these days, but still, I am reluctant to remove any organs except where absolutely required for survival, especially those external ones I&#8217;ve grown accustomed to seeing (and feeling). Besides, I&#8217;m not all that keen on surgery.<\/p>\n<p>I&#8217;m also taking a daily tablet of ACH-Bicalutamide (50 mg) for a month (I&#8217;m in my second week) which,<a href=\"https:\/\/chealth.canoe.com\/drug\/getdrug\/ach-bicalutamide\" target=\"_blank\" rel=\"noopener noreferrer\"> I read,<\/a> is a class of nonsteroidal antiandrogens that &#8220;block the effect of the male hormone testosterone in the body.&#8221;<\/p>\n<blockquote><p>Bicalutamide is used in combination with another treatment that reduces the amount of testosterone in the body (either with medications called luteinizing hormone releasing hormone [LHRH] analogues or with surgery to remove the testicles) to treat late stage (metastatic) prostate cancer.<\/p><\/blockquote>\n<p>That last bit about &#8220;<a href=\"https:\/\/www.pcf.org\/about-prostate-cancer\/diagnosis-staging-prostate-cancer\/prostate-cancer-metastases\/\" target=\"_blank\" rel=\"noopener noreferrer\">metastatic prostate cancer<\/a>&#8221; is worrisome. I knew from my discussions with the urologist and oncologist that the cancer had spread outside my prostate, and the surgery was unable to collect it all. How much and how far, I don&#8217;t know yet. My recent radiation planning scan showed an enlarged lymph node, also troubling, but that might be caused by several things. I hope it <a href=\"https:\/\/www.pcf.org\/about-prostate-cancer\/diagnosis-staging-prostate-cancer\/prostate-cancer-metastases\/\" target=\"_blank\" rel=\"noopener noreferrer\">hasn&#8217;t gone too far<\/a>:<\/p>\n<blockquote><p>If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.<\/p><\/blockquote>\n<p>For which I have a second bone density scan coming up. But, like everything else going on with this cancer, there&#8217;s nothing I can do outside following through with the treatment, trust the doctors, and practice stoicism. I try not to dwell on the negative aspects. If the current treatments don&#8217;t work, I can still try <a href=\"https:\/\/www.cancer.ca\/en\/cancer-information\/cancer-type\/prostate\/treatment\/metastatic\/?region=on#:~:text=%20Treatments%20for%20metastatic%20prostate%20cancer%20%201,or%20without%20hormonal%20therapy.%20%20...%20More%20\" target=\"_blank\" rel=\"noopener noreferrer\">chemotherapy<\/a>.<\/p>\n<p>More to come&#8230;<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"pvc_clear\"><\/div>\n<p id=\"pvc_stats_23733\" class=\"pvc_stats all  \" data-element-id=\"23733\" style=\"\"><i class=\"pvc-stats-icon medium\" aria-hidden=\"true\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" version=\"1.0\" viewBox=\"0 0 502 315\" preserveAspectRatio=\"xMidYMid meet\"><g transform=\"translate(0,332) scale(0.1,-0.1)\" fill=\"\" stroke=\"none\"><path d=\"M2394 3279 l-29 -30 -3 -207 c-2 -182 0 -211 15 -242 39 -76 157 -76 196 0 15 31 17 60 15 243 l-3 209 -33 29 c-26 23 -41 29 -80 29 -41 0 -53 -5 -78 -31z\"\/><path d=\"M3085 3251 c-45 -19 -58 -50 -96 -229 -47 -217 -49 -260 -13 -295 52 -53 146 -42 177 20 16 31 87 366 87 410 0 70 -86 122 -155 94z\"\/><path d=\"M1751 3234 c-13 -9 -29 -31 -37 -50 -12 -29 -10 -49 21 -204 19 -94 39 -189 45 -210 14 -50 54 -80 110 -80 34 0 48 6 76 34 21 21 34 44 34 59 0 14 -18 113 -40 219 -37 178 -43 195 -70 221 -36 32 -101 37 -139 11z\"\/><path d=\"M1163 3073 c-36 -7 -73 -59 -73 -102 0 -56 133 -378 171 -413 34 -32 83 -37 129 -13 70 36 67 87 -16 290 -86 209 -89 214 -129 231 -35 14 -42 15 -82 7z\"\/><path d=\"M3689 3066 c-15 -9 -33 -30 -42 -48 -48 -103 -147 -355 -147 -375 0 -98 131 -148 192 -74 13 15 57 108 97 206 80 196 84 226 37 273 -30 30 -99 39 -137 18z\"\/><path d=\"M583 2784 c-38 -19 -67 -74 -58 -113 9 -42 211 -354 242 -373 16 -10 45 -18 66 -18 51 0 107 52 107 100 0 39 -1 41 -124 234 -80 126 -108 162 -133 173 -41 17 -61 16 -100 -3z\"\/><path d=\"M4250 2784 c-14 -9 -74 -91 -133 -183 -95 -150 -107 -173 -107 -213 0 -55 33 -94 87 -104 67 -13 90 8 211 198 130 202 137 225 78 284 -27 27 -42 34 -72 34 -22 0 -50 -8 -64 -16z\"\/><path d=\"M2275 2693 c-553 -48 -1095 -270 -1585 -649 -135 -104 -459 -423 -483 -476 -23 -49 -22 -139 2 -186 73 -142 361 -457 571 -626 285 -228 642 -407 990 -497 242 -63 336 -73 660 -74 310 0 370 5 595 52 535 111 1045 392 1455 803 122 121 250 273 275 326 19 41 19 137 0 174 -41 79 -309 363 -465 492 -447 370 -946 591 -1479 653 -113 14 -422 18 -536 8z m395 -428 c171 -34 330 -124 456 -258 112 -119 167 -219 211 -378 27 -96 24 -300 -5 -401 -72 -255 -236 -447 -474 -557 -132 -62 -201 -76 -368 -76 -167 0 -236 14 -368 76 -213 98 -373 271 -451 485 -162 444 86 934 547 1084 153 49 292 57 452 25z m909 -232 c222 -123 408 -262 593 -441 76 -74 138 -139 138 -144 0 -16 -233 -242 -330 -319 -155 -123 -309 -223 -461 -299 l-81 -41 32 46 c18 26 49 83 70 128 143 306 141 649 -6 957 -25 52 -61 116 -79 142 l-34 47 45 -20 c26 -10 76 -36 113 -56z m-2057 25 c-40 -58 -105 -190 -130 -263 -110 -324 -59 -707 132 -981 25 -35 42 -64 37 -64 -19 0 -241 119 -326 174 -188 122 -406 314 -532 468 l-58 71 108 103 c185 178 428 349 672 473 66 33 121 60 123 61 2 0 -10 -19 -26 -42z\"\/><path d=\"M2375 1950 c-198 -44 -350 -190 -395 -379 -18 -76 -8 -221 19 -290 114 -284 457 -406 731 -260 98 52 188 154 231 260 27 69 37 214 19 290 -38 163 -166 304 -326 360 -67 23 -215 33 -279 19z\"\/><\/g><\/svg><\/i> <img loading=\"lazy\" decoding=\"async\" width=\"16\" height=\"16\" alt=\"Loading\" src=\"https:\/\/ianchadwick.com\/blog\/wp-content\/plugins\/page-views-count\/ajax-loader-2x.gif\" border=0 \/><\/p>\n<div class=\"pvc_clear\"><\/div>\n<p>&#8220;&#8230; my only object was that all the world should enjoy itself and live in peace and quiet, without quarrels or troubles; but my good intentions were unavailing to save me from going where I never expect to come back from, with this weight of years upon me and a urinary ailment that never gives me a moment&#8217;s ease&#8230;&#8221; Miguel de Cervantes: Don Quixote of La Mancha, chap. 22 I was listening to an audiobook of Don Quixote while driving to the hospital recently, and heard that bit. It just seemed appropriate. And a bit funny. Last week I got \u2026&#8230;&#8230; click below for more \u2193<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[1197,718,9],"tags":[961,1258,1259,1110,1260,1241],"class_list":["post-23733","post","type-post","status-publish","format-standard","hentry","category-cancer","category-daily-life","category-personal-reminiscences","tag-cancer","tag-hormone","tag-lupron","tag-prostate","tag-testosterone","tag-treatment"],"a3_pvc":{"activated":true,"total_views":311,"today_views":0},"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"jetpack-related-posts":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/posts\/23733","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/comments?post=23733"}],"version-history":[{"count":20,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/posts\/23733\/revisions"}],"predecessor-version":[{"id":23753,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/posts\/23733\/revisions\/23753"}],"wp:attachment":[{"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/media?parent=23733"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/categories?post=23733"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ianchadwick.com\/blog\/wp-json\/wp\/v2\/tags?post=23733"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}