Okay. Now I’ve seen everything.
This ad for prostate stress balls popped up on one of my social media feeds, and I laughed out loud in disbelief that someone would come up with this idea.
Then I thought that maybe this isn’t such a bad idea after all. We can squeeze the crap outta the thing that’s caused us so much difficulty.
Perhaps I should come up with a logo to put on them and sell them here. 😂🤣😂 Or not.
If you read to the end of my last post, you already know that a wildfire was threatening my neighborhood and I promised an update.
While the Border 2 fire has grown to 6,500 acres / 2,650 hectares since then and continues to burn, it no longer threatens my neighborhood thanks to the heroic efforts of our firefighters and a change in wind direction.
Of course, Mother Nature and wildfires are fickle things, and there’s always a possibility it could head back in this direction.
Here’s a photo grabbed off of social media that shows the fire from about 18 miles / 29 km away. (He misspoke when he said that fire was southwest of San Diego; it’s southeast.)
My neighborhood was under an “evacuation advisory,” and it definitely was an interesting but unpleasant exercise to walk through my home and figure out what was coming with me if I had to evacuate and what was staying behind.
Fortunately from a property loss perspective, the fire has been contained to a wilderness area with few structures on its outskirts.
We’re expecting our first rain in months over the weekend, and that should help with the firefighting efforts as well.
I’m safe, but let’s not do this again anytime soon.
I’ve been debating whether to write this post but figured that I’ve never shied away from sharing the gory details of the total prostate cancer experience. So if you don’t want to read about my latest adventure with incontinence, you can check out the trip report of my trip to Death Valley last week.
In fact, the issue began as a result of my trip to Death Valley.
After four days of standing in the middle of the desert pretty much solo the entire time, I returned home Wednesday evening. Thursday morning, I can off to the clinic for my PSA test (it took 7 minutes and 38 seconds from check-in to walking out the door). But by Thursday afternoon, I was feeling a bit wonky.
By Thursday night, I was down for the count with a full-blown head cold/flu. I was both baffled by how I contracted it, and annoyed that I had. It had been several years since I’ve had a cold or flu.
Unfortunately, one of the symptoms that hit me hard and caused the incontinence issues was a nagging tickle in the back of my throat that had me coughing pretty consistently and, in many cases, pretty intensely. It sucked.
It sucked because coughing is perhaps the greatest trigger for my stress incontinence. The harder I cough, the more I leak.
I wear Depend Shields in my daily life, and I can get by with one or two pads a day. But by the weekend, the coughing and resultant leaking exceeded their capacity. I had one coughing fit that had me fill the pad, overflow, and soak my jeans. Not fun. Through the weekend and into early this week, I was going through multiple pads a day and doing several loads of laundry.
I toyed with the idea of running to the store to get Depend Guards, the pads with more absorbency and capacity, but I didn’t want to risk embarrassing myself in the middle of Aisle 12 at the grocery store. Plus, I was probably as contagious as Typhoid Mary, so that wouldn’t have been a good thing, either.
I was taking some cold/flu medicine that helped reduce the cough—the root cause of my issue—and I just rode out the storm for a few more days. Today, a week after this all kicked in, I’m back to my good ol’ self getting by with the occasional drip and dribble.
The lessons learned for me are to keep the cough medicine on hand to help reduce the root cause, and to keep a supply of Depend Guards on hand to do a better job of controlling the mess.
Now you know why I may have been hesitant to share this. But, hey, it’s for educational purposes, right?
On a related note, I was successful in getting my appointment to review my PSA results moved to an earlier date. It’s now 18 February 2025 (four weeks is better than four months). I’m okay with that.
Unless you’ve been living under a rock the last two weeks, you already know that southern California has been ablaze with wildfires. Luckily, up until this point, they have stayed clear of San Diego for the most part. Until today.
This little gem popped up about 6 miles / 10 km from my house this afternoon:
It’s grown to about 600 acres / 240 hectares in about six hours, and we’re expecting high Santa Ana winds this evening. It’s in a very mountainous area, and air crews have been working the scene all afternoon. Luckily, it’s adjacent to a large reservoir, so there’s plenty of water for the helicopters to access. We also have rain in the forecast for the weekend for the first time in months (San Diego has had the driest start to the wet season since they began keeping records in 1850. We’ve had only 0.14 inch / 3 mm of rain since 1 July 2024.)
Of course, I’m concerned and I’ve made preparations to leave if need be. But given the location, the fact that the reservoir is between me and the fire, and the prevailing winds are keeping the smoke south of me, I’m hopeful that my neighborhood will be unaffected.
I’ll keep everyone updated over the next day or two.
Be well.
Header image: Courtyard at The Ranch at Death Valley National Park, California
I jumped the gun a couple of days and went for my PSA lab work Thursday morning on 16 January. (The three month date since the last PSA test would have been 22 January.)
As a refresher, my PSA in October was 0.69 ng/mL; it’s now 0.94 ng/mL.
I’m going to have to get a little aggressive with the medical team in terms of appointment scheduling. In October, we agreed to retest in three months and go over the results, but the schedulers didn’t have any open appointments until May 2025. Needless to say, that’s too far out so I’ll have to cajole my way into a canceled appointment or ask for a virtual / telehealth appointment sooner.
With my PSA as high as it is, I suspect that another PSMA PET scan would finally reveal some useful information that we can use to plan treatment options.
Header image: Devil’s Golf Course, Death Valley National Park, California
Okay. I originally planned this to be last month’s post when I stumbled across the linked article in early December, but I had second doubts about the topic during the holiday season, so here it is this month. I hope you had a great holiday season and that 2025 is off to a great start for you and your families.
No one likes to talk about dying. It’s a topic most people try to avoid at all costs, but it’s eventually going to happen to all of us no matter how hard we try to avoid it. Sadly, because we don’t want to talk about it, we’re also less likely to plan for end-of-life decisions and that certain eventuality.
In this very poignant article, the author wrote about her conversations with her father about his end-of-life desires after he appointed her with medical power of attorney. These conversations went on for over twenty years, and one of the key takeaways for me was that his desires evolved over time. Those changes made having ongoing conversations even more important.
I Had To Choose Whether To End My Dad’s Life. Here’s How I Made That Unthinkable Decision.
It’s never too early to have these conversations. Last summer, a friend lost his 47-year-old brother and another friend lost his 44-year-old brother-in-law. Both passed quickly so no one in their family had to make a similar end-of-life decision, but no one was expecting either to happen. Two of my elementary and high school classmates also passed away last year, one from prostate cancer.
Following my mother’s lead, I’ve created a binder with the nuts-and-bolts information needed to manage and dispose of my estate when the time comes (important when you’re single), and I review it quarterly to make sure it’s current. But I haven’t reviewed my medical power of attorney since it was written in 2006. It’s time to do that to make sure it’s aligned with my current thoughts and desires. Of course, determining my current desires is an important first step, and I’m guessing they may evolve over time and circumstances, just as they did in the article.
Yes, talking about our own demise isn’t fun and isn’t comfortable. But clearly expressing our desires now could lessen the burden on family members and eliminate guesswork when the time comes, especially when they’re in a heightened emotional state.
That’s a win for all of us.
Header Image: Torrey Pines State Natural Reserve, San Diego, California
I’ve used the prostate cancer forums on the website HealthUnlocked to help gain other patient experiences as I move deeper into the world of advanced prostate cancer.
Recently, one of the forum moderators posted a link to this article:
The danger of doing your own research (or using AI)
It’s a rather blunt—perhaps even controversial—look at how patients research their diseases and treatments, but it does make you think about your own approach to becoming an educated patient and perhaps some of the pitfalls in doing so.
You may find it interesting. Or not.
Header Image: San Diego skyline from Coronado, California
This headline on the AP News feed caught my attention this morning:
China bans exports to US of gallium, germanium, antimony in response to chip sanctions
When you read the article, it omits any reference to gallium being used in medical diagnostics, so I have to wonder if this ban will adversely impact the ability to do 68Ga PSMA PET scans.
That question led me to a quick Google search on the production of 68Ga that yielded:
I’m no nuclear physicist or radiopharmaceutical guy but, given that process outlined above, it sounds to this layperson that PSMA PET scans could possibly be impacted.
Or I could be completely out to lunch, reading far too much into the story.
It’s definitely something to keep and eye on going forward, as I’m guessing another PSMA PET scan is in my future in January or February.
Just a quick update to report that the two polyps removed from my colon during the colonoscopy came back as “tubular adenoma” polyps, which are the pretty normal, precancerous polyps that are found in most patients. Less than 9% of tubular adenomas become cancerous.
The doctor recommends doing a follow-up colonoscopy in three years.
On a related note, the blood in my stools has virtually disappeared since the procedure. There have been only two incidents where there was even a faint hint of blood, so that’s a good thing.
Hard to believe that December starts tomorrow. How’d that happen?!?
Be well.
No one can say I do things half-assed. I got a perfect 9/9 score on the Boston Bowel Preparation Scale. Clean as a whistle! 🙂 (I didn’t even know that there was such a scale.)
Yesterday’s colonoscopy went well, although it was a little different from the last one I had six years ago. The last one, I was knocked out with anesthesia and don’t remember the procedure at all. This one, I had “moderate (conscious) sedation” and was able to have conversations with the team and watch the procedure on a monitor, although my mind was drifting in and out of focus throughout.
Before we started, I had a good conversation with the doctor about my salvage radiation therapy and the possibility of radiation proctitis given the occasional blood in my stools. She was appreciative of the detailed information to help her in doing the procedure. I really stressed that I didn’t want the scope or the inflation of my colon to do more damage than what may already be there.
There were two polyps that were removed during the procedure and will be sent off for pathology. The first was in the transverse colon, and the second in the sigmoid colon, not far from the rectum. (I didn’t think to ask how long it will take for the pathology to come back, but I’m assuming it will be about two weeks.)
The sigmoid polyp was described as, “erythematous and friable.” Erythematous means the mucosa is red and inflamed due to a buildup of blood in dilated capillaries; friable describes how easily the mucosa can be damaged by a biopsy instrument or endoscope.
Because I didn’t read her printed report—with 13 color photos and map of my colon—until I got home, I didn’t get to ask if she thought that could have been caused or aggravated by the radiation therapy being closer to the rectum.
She also found “a few non-bleeding small angioectasias in the rectum, consistent with chronic radiation proctitis,” which are dilated, thin-walled blood vessels (think spider veins) that can occur anywhere in the gastrointestinal (GI) tract. I watched her zap those with “argon plasma coagulation (APC).” She described that as cauterizing the vessels to stop them from possibly bleeding into the GI tract.
Pending the outcome of the pathology on the polyps, she recommended a follow-up colonoscopy in three years. Yippee!
Time will tell if the sigmoid colon polyp removal and APC did the trick to stop the blood in my stools (hopefully, there are no new side effects from the APC). I guess time will tell on both counts.
Next up: Get through the holidays and PSA test sometime in late January.
Happy Thanksgiving! (I’ll get a 0/9 score after Thanksgiving dinner. 🤣)
Header Image: San Diego, California skyline at dusk.
I met with the urologist this afternoon to go over my most recent PSA test results and the plan going forward. In a nutshell, we agreed to remain in limbo for another three months and retest the PSA in January and consider a PSMA PET scan if warranted at that point. (She was a bit skeptical that the PSMA PET scan would be conclusive even at my current PSA of 0.69 ng/mL.)
The urologist thought it was a little premature to start talking about androgen deprivation therapy, but recognized that that’s the next likely step down this path. I mentioned that, when I met with the urologist and medical oncologist in February, one suggested ADT at metastases and the other suggested starting at a PSA of 2.0 ng/mL. She said she could understand both positions.
Bottom line is that I continue to be in this sort of “no man’s land” of prostate cancer. We know it’s there; we just don’t know where, and we don’t want to pull the trigger on ADT prematurely. So more waiting.
One other thing that we discussed was radiation proctitis.
Graphic Biology Ahead
I’ve been sitting on this little tidbit for a while now, but I’ve been noticing blood in my stools. It initially appeared as spots a little smaller than a dime coin (~ 1 cm) but, over time, it has subsided to a small streak or a hint of blood. You know me: I had to create a spreadsheet to track it, and it’s been occurring in about ten percent of my bowel movements. That makes me feel better that it isn’t happening each and every time—that might indicate a larger problem if it were happening every time.
Fortunately, I haven’t had the diarrhea or mucus discharge that can come with more severe cases of radiation proctitis.
I mentioned this to my primary care physician during my appointment on 4 November, too. Both he and the urologist recommended a colonoscopy to check out what’s really going on. That joyful experience is scheduled for Friday, 22 November. Yippee!
I did come across this continuing education paper that gives a good overview if you’re really interested in learning more:
So the journey continues. Stay tuned for the next installment.
Header image: San Diego skyline and Mission Bay from Kate Sessions Memorial Park
Dan's Journey through Prostate Cancer 