Good news! Colonoscopy was fine, no cancer, no polyps.  Nada. Good for 10 years.

Iron is back to normal levels. That's after being off iron supplements for a month. So probably the low iron was just a glitch, bowel issues just diet and getting older.

 Well...crap (potty humor for a potty post)

I saw the physician's assistant for the gastroenterologist I've chosen. She was kind, and not rushed, and agrees I need a colonoscopy for diagnostic, rather than screening, reasons. I'm booked. For July 7. That's nearly two months from now.

She didn't talk about cancer, but she did say that there were different flavors of colitis that could cause mild iron deficiency. Okay. I know. Let's not put the cart before the horse, etc.  But still.

Here are the symptoms of colon cancer, according to "Colon & Rectal Cancer: From Diagnosis to Treatment, 3rd ed., by Paul Ruggieri, M.D., and Arti Lakhani, M.D.

1. Fatigue caused by iron deficiency anemia.  CHECK. 

2. Change in bowel habits. CHECK.

3. Rectal bleeding. NO.

4. Chronic abdominal pain, bloating, or fullness. CHECK (bloating & fullness)

5. Painful urge to have a bowel movement. NO.

6. Decreased appetite or unintended weight loss. NO--BUT--I started a new weight loss regime, just cutting calories a little, and was shocked by the rapid change on the scale.

Here are the symptoms of colitis, according to MayoClinic.org

1. Diarrhea, often with blood or pus. (yes to diarrhea, no to blood/pus)

2. Abdominal pain and cramping. NO.

3. Rectal pain. NO.

4. Rectal bleeding. NO.

5. Urgency to defecate. Maybe.

6. Inability to defecate despite urgency (no, at least not until the iron pills!)

7. Weight loss. (Maybe--see above)

8. Fatigue. CHECK.

Now colitis is no walk in the park, it seems, and in severe cases, people do end up with colostomies.  I really, really want to avoid a colostomy, so I'm not "hoping for colitis" or the misery that illness portends. But another way to end up with a colostomy is to have your colon cancer spread undetected for a while. 

The physician's assistant suggested Benefiber, because Metamucil gave me diarrhea. Okay, I tried it. First day, I tried the normal dose. 18 hours later, diarrhea. So I waited until that afternoon, and took a half dose. 18 hours later, the worst diarrhea of my life. So I guess I'll just have to suffer constipation on the iron supplements until oh, sometime late this summer when the medical system can spare the time to do a colonoscopy and figure out if I have a terminal disease or not.

Ever have a dream where you call 911 and you get put on hold forever? Or some disaster is unfolding and your feet move like you're in deep sand?

Fine. I'm just going to wait while all these people who were too frightened to get their 10 year colonoscopy done during 2020 get in front of me.

 Nothing has materialized so far from that one ultrasensitive PSA reading. I had a PSA test in February, the standard assay, and it was still less than 0.1. So I'm not worried about that.

But. (or Butt--ha ha!)

Sometime around the early part of this year, I noticed a change in bowel habits. Nothing too dramatic, just things were a little looser and faster than normal. Like diarrhea, but without the cramping and endless returns to the bathroom. Where before I'd go once or twice a day, now it was several. And it now included the night--sometimes I'd have to get up in the middle of the night to have a bowel movement. 

I was also feeling a lot of fatigue, and needed to take a nap after work for the first time.

I didn't do anything at that point.

Then I tried to donate blood later in the spring. For the first time in my life, I failed that iron test where they poke your finger (always the worst part of donating for me).  I didn't fail it big time, just one digit low.

So I arranged a televisit with my primary care doc. I explained the failure on the iron test, the fatigue, and the change in bowel habits. I mentioned that it was nearly 10 years since my first screening colonoscopy (that I passed with flying colors, aside from a bit of diverticulosis). I think for my own ease of mind, he agreed to refer me for a colonoscopy now, rather than waiting until next year. He also ordered a slew of blood tests, some of which I had never had before.

I was a little low on testosterone (he recommended more exercise), Vitamin D (get more sunshine, although I live in the Sun Belt and already get a lot), and I was still slightly prediabetic ("cut down on carbs").  My red cells, cholesterol, etc all were in normal range. So was the test that the blood bank had administered (hematocrit, I think).

But a couple of tests came in late, and his office called me.  My ferritin (a measure of iron in the tissues) was low. Iron saturation was slightly low. And something called RDW, a measure of how wide the variation is in the size of red blood cells, was high. All of those point to iron deficiency.  He recommended 65 mg of iron supplements daily, and a retest in a month or two.

I naturally checked Google, WebMD, Mayo Clinic's site, PubMed, etc. Turns out that men should really never have iron deficiency, and the number one cause of iron deficiency in men (and menopausal women) is blood loss somewhere in the digestive tract. And the big monster under the bed here is colorectal cancer, especially right-sided colon cancer (far enough away from the exit that small amounts of blood get absorbed into stool, so patients don't see blood right away). 

In women who are not menstruating and in men, “anemia is colon cancer until proven otherwise,” said one expert, Dr. Thomas Weber, who serves on the steering committee of the National Colorectal Cancer Roundtable.

(Roni Caryn Rabin, "What Young People Need to Know About Colon Cancer", New York Times, 16 March 2017. https://www.nytimes.com/2017/03/16/well/live/what-young-people-need-to-know-about-colon-cancer.html?searchResultPosition=1)

 

So I try to get that colonoscopy appointment. Guess what? So is everyone else, now that pandemic fears are lessening. The GI guy I was referred to was booked up for over 2 months. My previous gastroenterologist died years ago--from gastric cancer. And the telephone screeners don't care about your blood tests or your previous radiation treatments, or your fatigue--they all have set questions "family history? polyps? when was your last colonoscopy?".  Anyway, I managed to find someone highly rated that I can see for the initial consultation this week. Oh, wait--the doctor isn't available, but his PA is. Okay.  Maybe I can still get things going. 

I'm very worried, to say the least. I read a journal article that said in the UK, a man with iron deficiency gets fast-tracked to colonoscopy. Here in the US, I seem to be on the slow train.  

If it's cancer, could it be from my salvage radiation in 2007? Who knows? Maybe it's just too much processed food over a lifetime. One hot dog too many. My first colonoscopy didn't reveal any sign of radiation (it was five years later). Colon cancer is very common, anyway.

Stay tuned. It may be time to dance with the bear again. 

 Oh, hey--it's me again. I have a change to report.

In June I had a PSA done as part of a routine physical. I actually had a PSA reading this time:

0.02

I've never had an ultrasensitive test before. Every test before has been the standard assay, which always shows (and would have shown this time) <0.1.

So hopefully this is nothing. It's certainly a very low score. If my PSA is really rising, and if the velocity is the same as in 2006/2007, it will be evident by the time I get another test in June 2021.

I'm not worried, just mindful. I think it's pretty unlikely that I'm really having a recurrence 13 years later, but who knows.

Anyway, stay healthy, and I'll report back next year!

All done.

I'm going to wrap this blog project up now. Long story very short: at a relatively young age, I was diagnosed with prostate cancer. I had surgery, but it failed to cure me. I underwent salvage radiation just over a year later, and it--apparently--cured me. It has now been 10 years since my PSA became undetectable.
That's a major personal milestone, and even though there is a chance of recurrence, after 10 years it is pretty low. And after 15 years it will be practically zero.
So, good enough.  I'll keep getting an annual PSA for the foreseeable future, but there's no longer any anxiety about the tests.  And at some point I will be done with them. (My dad, who was successfully treated in his early 60's, has stopped testing after 20 years of undetectable results).

This blog got some attention in its early days (it used to be pretty high on the Google results list for "salvage radiation") but no longer. Technology and treatments have progressed, and my story isn't nearly as compelling as it once was. If you're stopping by after I hit the "publish" button on this post, you are basically seeing an archive.  I won't be updating it.

Here is the message I want to send you: if surgery didn't cure your prostate cancer, don't despair. There may still be a good chance of a cure.  If you are in that situation, don't sit back and wait. Explore your options now. Time is of the essence.

If you're in the battle at any stage, I send you greetings, best wishes, and with a bow and flourish, adieu.

Memento mori

Gustave Dore - Death on the Pale Horse (WikiCommon)

This week I saw the movie "Dr. Strange". If you haven't seen it, there are rather deep questions (for an action movie) about mortality. For example, the Ancient One tells Stephen Strange, "Death is what gives life meaning. To know your days are numbered and your time is short."

I'm 54. It seems to be about this age that the Reaper really starts mowing. Two weeks ago a childhood friend died after battling heart failure for 15 years. He was born just a few weeks before me. Last week my sister-in-law died of cancer. This week I learned that one of my favorite teachers (young at the time) from elementary school had died of Alzheimer's. 

I feel my age. This wasn't always the case. In my 40's I felt younger. In my 30's I could pass for 21--and I felt like it. At 21 I looked like 16--and acted like it. No longer.

I think I've beaten prostate cancer. I'm so happy that I got on top of it when I did, especially the salvage radiation after surgery failed to cure me.

But that means that something else will be my demise. Another cancer, maybe, or heart disease. Or maybe dementia. Right now I think I'd opt for door number 2.

I sometimes get an unpleasant squeeze in my chest. Nothing serious, the cardiologist says. A little valve leakage, a little rhythm disturbance. But just the fact that I'm seeing a cardiologist says a lot. Right now I'm the youngest person in the waiting room. But I know that, in a flash, that will change. In a heartbeat.

Anyway, just a reminder that death is a part of life, essential to the natural order of things, and that I will kick from something at some point, and I have far fewer days ahead of me than behind. So I should stop and smell the coffee, enjoy the pizza, the bike ride, the rising of the full moon.  And I should shift my focus to serving others.

As the Ancient One teaches Doctor Strange, the "simplest and most significant lesson of all": 

It's not about you.

Salvage Radiation Nomogram Updated

This is exciting stuff for people contemplating salvage radiation after prostatectomy.

https://consultqd.clevelandclinic.org/2015/10/updated-nomogram-predicts-modern-outcomes-after-salvage-radiotherapy-following-radical-prostatectomy/

"A contemporary update of a 2007 predictive nomogram for salvage radiotherapy after radical prostatectomy offers a modernized forecast of cure compared to its predecessor."

"The updated 2016 nomogram takes into account the more recent trend of treating patients at lower PSA levels than in the past (“early SRT”). Randomized trials published since the original nomogram was created have demonstrated the benefit of early SRT in high-risk patients."