A Week Of Bad News

Last week started off positive and quickly went over the cliff. In my last post I mentioned that there is a treatment for hip tendonitis that could be a game changer for me. The technology is called extracorporeal shockwave therapy (EST). I won’t go into the details but to say that the doctor who can offer EST required an MRI of the pelvis to confirm compatibility with the EST. He is especially sensitive to my cancer history, as doctors don’t like to disrupt anything cancerous on the theory that disrupting a tumor may cause cancer cells to break off and travel to other locations where they can take root. I had the MRI on Monday and the results showed a lesion on the femur and another on the pelvis. These new lesions put the kibosh on the EST. The concern is that the lesions may be more metastatic prostate cancer (PC), which often spreads to lymph nodes and bones. As noted in earlier posts, PC was already identified in one lymph node and treated back in July.

 

On Friday I went for my six month CT scan and a visit with the doctor who performed surgery on my chest in 2018 for pleural mesothelioma. The scan showed that an existing small and stable lesion on my spleen has grown significantly. He wants to know what it is. He wants an MRI and a biopsy. I explained the bone lesions and the possible relationship to PC. In fact, I was scheduled for a blood draw that same day to monitor PSA levels associated with PC. He decided to delay the MRI until more PC data is available. I had the blood draw and my PSA level is now higher than it was before the July treatment. This likely means that the PC is spreading in spite of all treatments so far, but we don’t know where it is. I already have an appointment next week with the doctor who has been treating the PC. I expect he’ll want to do an imaging study called PSMA PET/CT. This should identify the already detected lesions as PC or something else. It may also find PC in other locations. The spleen lesion, if not identified as PC, could indicate a recurrence of mesothelioma. The worst case here is that I have two recurring cancers. I don’t know if it’s possible to treat them simultaneously.

 

In a perfect world, the Monday MRI would have been normal and I’d be starting EST to improve hip tendonitis. The Friday CT would have been clear, and the PSA test would show reduced PSA compared to six months ago. No such luck.  

 

How I Use Conceptual Boxes

I’ve been using the word “box” in two different ways. When I think about physical mobility and exercise, I’m thinking about the things that I can and cannot do. If I can do it, then it’s in my box. If I can’t do it, then it’s outside of my box. I care about this because movement and exercise are important for just staying alive. Anything that comes out of my box is a negative. It means I’m forced to abandon an activity and my box just got smaller. Anything that comes into my box is a positive. When I started riding e-bikes my box expanded significantly. When I had shoulder surgery in January my box got smaller. It gradually expanded as the shoulder healed. I want the biggest possible box. When your box is pushing against you from all sides, your next box will be a coffin.

I have also used “box” to refer to compartmentalization. This is a technique I described in my book. When you have a lot of things going on in your life it can be overwhelming, but you can break those things down and focus on one at a time. All of the other things go into the box (a compartment) until it’s necessary to retrieve them. You can have as many compartments as you need. It’s a super-useful technique. I don't want to be pedantic about my dual meanings for "box," so I'll continue to use words interchangeably and let you sort it out.

I’ve got some things compartmentalized that I have to retrieve this week. There is my “six month lease renewal” CT scan to look for anything changing in the chest or abdomen. If there are no changes I put it back in a compartment and walk away, returning in six months. There is also the first follow up on July’s prostate cancer treatment. This will come in the form of a PSA test and I will see the results of that test the same day. There is a specific number that determines my immediate future. Above that number is bad. Below that number is good. The CT scan and the PSA test both come on the same day, this Friday.

On the flipside, I’ve got something going on that could expand my box. If all goes well, it will increase the distance I can walk before my hips get sore. This could be a big win. I’ll get into it a little more in a week or two.