The Results are In

Entry 79
January 23 

Sharing our letter to family and friends 

Greetings,

For some of you this will be the first time hearing from me directly and I would like to say that we are appreciative of your interest and care as we've moved through the various stages of my Dad's diagnosis. If you are receiving this email, it's important for you to know this is a message of information and appreciation. 

This past week our family met with Oncologist, Dr. Joel Gingrich, our beloved friend and retired doctor Dr. Graham Fuchs and, dear family friend and Radiologist, Dr. Jeff Mottola all whom have played key roles in navigating our care plan (with the two latter being exceptional beyond measure). 

We have moved into a new phase in our journey, one which has presented us with some difficult choices. As you were probably already aware, the cancer that began in the prostate has traveled, most notably, to the surface area of the bones. Up until this week, we were under the impression this was the extent of that spread. This week's revelation was that the cancer appears to have entered the liver in a manner consistent with aggressive disease. At this point, we have discussed our options as a family, cautiously weighing both the positives and negatives of further treatment as well as the option to pursue palliative care at home. Our family has had no shortage of difficult conversations over the last year and so our mantra has and always will be, we do this together. This has given us lots of strength to draw on and has led us to find comfort and peace in the decision to move forward with palliative care at home.

It is important for you to know that my Dad LOVES to hear from you. This is a time where reaching out is valued and appreciated. Rest has been prioritized so the phone may not get picked up for days at a time but, know that any communication, email and text included, provide a great deal of comfort and strength as we go forward. My Mom or I may be the ones to respond and that will likely vary with how my Dad is feeling on any given day. We talk often about how much my Dad appreciates your friendship and concern and I know he'll look forward to having more personal communication In the coming days. You have made a difference in our lives.

I know this may come as a shock to some, we were certainly in that boat and likely still are. In sending this email I hope to mitigate some of the effort required in having my Dad find the right words. There are still many things to be grateful for and laughs to be had (you may wish to ask him about our family phone call to the bank, where he was treated like a Somali pirate), so don't let him off the hook. He'd have it no other way.

With great regard and lots of love,

Tom

Harry can be contacted by email : harry.stimson at gmail.com

Chemo Completed but....

Entry 78

January 3, 2023

It really began to unravel on Christmas Day.  I woke up feeling quite sick. I tried to get out of bed to stand up but my left hip/leg would not support my weight and I fell. Fortunately I was facing the bed so no injury. Within 24 hours, on Boxing Day, I was unable to walk unassisted even to get to the bathroom. A wheelchair was pretty much the only option outside of the house.

What to do? It was Christmas and everything closed including Cancer Care.

On Thursday the 29th of December,  we finally got through to CancerCare - Urgent Care. They took me right away. I went through an all-day battery of tests including an X-ray. A lesion on the femur was deemed worrisome and required a CT Scan on Friday, the 30th, to determine the direction for a round of radiation on Monday, January 2. Yikes! 

In quick succession the following happened on Tuesday, January 3:

An ‘extensive’ CT Scan followed by ‘full’ Bone Scan, (their quotation marks not mine)followed by Zolmeta (bone strengthening) IV and finally blood test. So you know when they are talking that kind of hammering in a day and a half you know they are looking for something significant. The interview with the HSC Radiologist last Friday suggested as much.  

We won’t know results probably until mid next week after all scans and tests analyzed. 

Also, we will not know if I will begin to feel better.  The radiation is specific to the femur and pelvis, primarily to reduce pain. 

 

That’s where it currently sits. The radiation has helped my ability to shuffle around the house but anything other than that would require a wheelchair.

We have just passed the 12th year anniversary since my prostatectomy.

Reached the Chemo Halfway Mark

Entry 77 

Good morning everyone.

I’m currently in the 5th chemotherapy treatment at Grace Hospital. We are at the halfway mark for the 10 treatments over 30 weeks. 

The clinic is not busy this morning. I was in and hooked up to IV quickly. I barely got into my stand up comedy routine for the other victims in the waiting room. I thought I heard an audible sigh of relief when my name was called and I was ushered out to the chemo chairs. Something about don’t quit your day job. So it sounds as if someone thinks I still look young enough to work. That’s surprising to me because I’m down >15 lbs and my skin is all wrinkled. Looks like I could use a good ironing. 

Chemotherapy takes about 2 hours and as usual the staff are professional and courteous. I feel fine and happily there is no pain in my left leg and hip. 

Through persistent experimenting I have the morphine down to 2 doses, one for the day and one for the night. It’s a very low dosage but nevertheless it’s an opioid. One of the knock-on side effects of a potent pain killer is constipation. I have learned to use Senokot-S in tandem with the morphine and have worked out a compatible combination. Feeling a lot better. 

My Oncologist was away this week so I had a telephone appointment with his Nurse Practitioner. That’s the first time I have spoken with one. We were very impressed. Tamara helped us work out a new plan to deal with the issues I was having that knocked me for a loop in the previous treatment. Hopefully it will add to the tool kit to get around the next tough stretch. The only way out is through. 

Finally and once again my sincerest thanks to Margaret and Tom for their non stop help. I simply can’t imagine what it would be like to try to navigate this if a person were on their own. I hope this does not sound like whining. It’s not and I’m sure it’s no different than anyone who has experienced chemotherapy. It’s a very humbling experience. 

I sold my Chestnut Cruiser wood canvas canoe last week. I was surprised by the amount of interest it generated. It gave me the option to pick and choose the buyer. Paramount was that it had a good home. Shed a few tears. I had some outstanding solo trips (some as long as 2 weeks) and I just loved the way it handled. It just got too heavy for me to carry as I aged. Closed another chapter.

Written from a Chemotherapy Clinic

Entry 76

I am currently at the Grace Hospital receiving my second chemotherapy treatment with 8 more to go between now and mid September (every 3 weeks), so it’s too early to pass judgement on the success of this treatment one way or the other. 

I had my third app’t with my Oncologist Dr. Joel Gingerich and the news was not great. Scans revealed “some new spots” with migration of cancer into the back and ribs. I hasten to add that while disappointing this is not unexpected. That’s just the way cancer in the bones works. 

On the plus side, there was nothing out of the ordinary in the bloodwork. The PSA number went up but not markedly, otherwise the bloodwork looked good. Additionally I was able to answer all of his other non blood related medical questions positively. 

Perhaps I whined a bit too much about the chemo side effects of fatigue, joint achiness, tingly tongue, and reduced sense of taste. Dr Gingerich offered the option of reducing the docetaxel chemotherapy dosage to lessen the side effects but after discussion we opted to stay the course.

Hair loss has been another side effect. It helps to have a lint roller nearby.

As usual we thought of questions we should have asked after we hung up. It involves timing. 

When Margaret and I were looking back on her notes from the appointment (she was on the phone call) we remembered the bone scan at the Victoria Hospital was only 2 days after the first chemotherapy treatment. So I guess another question is would the first chemotherapy treatment have had any chance to impact the results of the bone scan? 

The bone scan results are irrefutable - no question there. The question I have is can those results be tempered with the 3 weeks the second dose will have to work on the bone metastases? We will see.

As a brief aside it’s important to point out that the first appointment with Dr Gingerich was in person, but the appointments 2 and 3 were over the phone. I expect this to continue. It is a policy of Cancer Care Manitoba in order to reduce the risk to immune compromised patients in a time of Covid. While this can be tough I completely agree. 

As it turns out, it is very valuable for us. It permits Margaret to be part of the conversation on speaker phone. She takes detailed notes of the conversation allowing us to revisit them at a later date of our convenience. As a good friend who has been through it advised us, ‘You simply cannot remember it all’. 

Just finished the 2 hour chemotherapy treatment at the Grace. The dexamethasone anti nausea drug has removed that side effect for which I am very grateful. As in the first chemo treatment, the staff were professional and courteous. 

I am feeling fine and could readily have driven myself home, but Margaret is on her way to pick me up, one of the perks of being a trophy husband.

                           ————————————————-

Sorry for this being a bit of a downer first thing in the morning but the chemo side effects will announce themselves in the next ~48 hours and the energy level will probably drop.

 

Day 1 of Chemotherapy

Entry 75

Starting the thirty week regimen of chemotherapy

Giddyup !

Entry 74

This is a note to let you know there has been a change in the current status of my prostate cancer. 

The PC has upped its game and the challenge now is to adjust my treatment regimen to address  it. As a result, my Urologist for the past 11 years, Dr Jeff Saranchuk has handed me over to the Medical Oncology department at Health Sciences Centre in Winnipeg to develop a new course of action.

That has happened and I am now totally in the care of Dr. Joel Gingerich. Margaret and I had >1 hour consultation with him which went very well and left us totally impressed. My other health care workers speak very highly of him and reference how smart, caring and professional he is. I think I am in good hands for the next 40 miles. 

I have been up to my ass in tests to confirm the treatment regimen Dr. Gingerich described to us. Two tests this week with a bunch more to come including redoing the CT and Bone Scans to see if the PC has made further incursions. At this point the lesions on the pelvis remain sclerotic and not lytic - the lesser of two evils.

At this point I am experiencing no pain and feel fine. 

My PSA went down yet again. Dr. Gingerich cautioned me not to get excited about the drop because it was likely caused by the December radiation treatment on my hip.  The unexpected decrease was fortunate in that it will give us time to plot the treatment schedule instead of rushing it.

That treatment will include chemotherapy- docotaxel. Not surprising.  Every 3 weeks for 30 weeks. Depending on when it starts that will last into mid to late summer. Clearly travel is not an option for me.

I’m also registered for a clinical trial and did the tests for it yesterday. Interestingly they take blood samples as well as tissue samples from your prostate gland. What? But I no longer have a prostate gland! He reminded me that I had agreed to put my prostate gland in a tumour bank at Health Sciences Centre after it was removed 11 years ago - research purposes. Completely forgot.

I am wait listed for the clinical trial of Radium 223 and probably won’t get in, but now that I am registered and tested, all my DNA information is on file for future immunotherapy treatment. Assuming I need it.

Additionally, last week I underwent a bone building/strengthening process that is administered by IV drip over 30 minutes every three months (for the foreseeable future). It will help mitigate the bone loss due to the cancer. The drug is called Zoledronic Acid or trade name Zometa.

That’s about as much as I know at this point. None of it is overly surprising to me. We knew the cancer was making its break for freedom and now we know it has been successful. We will see if medical science can slow it down. 

My new mantra comes courtesy of the poet Robert Frost when he said, " The only way out is through".   Giddyup!

Time to Transition

Entry 73

Greetings! Just wanted to give you an update on a change in the direction of my prostate cancer treatment.

As you may recall back in July of last summer a CT Scan and Bone Scan detected the prostate cancer had migrated into the pelvic bone of my left hip. Shortly after, the spot was radiated at Health Sciences Centre and it seemed to address the problem. 

Unfortunately, another CT Scan and Bone Scan in mid November found that the cancer had returned. Once again, cancer showed in the left hip and once again it was immediately radiated at the Health Sciences Centre. 

The second set of scans also picked up additional small lesions in the pelvic bone structure. Early stages, but nevertheless, it calls into question the continued efficacy of the medication I am on. 

Statue of the angel polar bear looking in the window toward the Hematology Lab of Cancer Care

So where do we go from here?

As of this week Dr Saranchuk, my urologist for the past 11 years has handed me over to the Medical Oncology department at Cancer Care. That just occurred a couple of days ago so nothing has happened as yet. That Oncologist, when appointed will take over my treatment in its entirety, both medication and radiology. 

With that in mind and in discussions with Margaret, Dana and Tom, we thought it prudent to scale back our Christmas interactions to immediate family only. This is a shame but in light of the potential impact of the Omicron variant of Covid, probably for the best.

I have been reminded that my immune system is under stress and I should be careful. Several times a week, I've been keeping fit with walks in the ~4 km range along with stretching and weight bearing exercises for about 50 minutes at a time.

I'd like to take this opportunity to thank Dr. Saranchuk and all the staff at the Prostate Centre in Cancer Care who have been instrumental in maintaining my health since prostate cancer was diagnosed eleven years ago. Dr. Saranchuk has been a very caring and skillful professional in this part of my experience from the original prostatectomy in 2010 until I transition to the Oncology team in January, 2022.