I was outside on our gravel driveway by 6:45 this morning, well before the daylight savings time adjusted sunrise. Most of the snow from yesterday’s winter weather event still lay upon the ground, mostly ice crusted from the overnight freeze. I could see the waning moon overhead in the western sky as I began my tai chi play.
Having studied and practiced martial arts since 1983, tai chi has been an important part of my coping strategy for dealing with prostate cancer. Balance, focus, and a measure of inner calm that have been cultivated with regular tai chi play have helped keep me centered as I deal with worries and anxieties that chronic illness brings, and have given me a way to maintain a level of physical fitness after surgery, a course of radiation treatment, and androgen deprivation treatment (a hormone therapy to retard the growth and spread of prostate cancer).
When reflecting on my journey with prostate cancer and why it is important to take care of myself physically and mentally, there are certain points in time and place that stand out.
I was only a high school-aged teenager when the first prostate infection occurred. Typically this kind of infection is called prostatitis, and this event was a signal that there was still plenty to learn about the human body. In particular, I had to learn about the little gland deep inside me that was mostly overlooked during the cursory sex education we had received during those years in the 1970s. It seemed like once a year or so I would develop a painful case of prostatitis and end up seeing a doctor to be put on a course of antibiotics. After the fourth such incidence during my junior year in college, I was referred to a specialist known as a urologist. After reviewing the medical records and giving a thorough physical which included yet another digital rectal exam, the specialist said words to the effect that my history of infections indicated that I was vulnerable to problems in this part of my body, and that there was a significantly increased risk for cancer. The specialist probably said “in the future,” however what I heard was “CANCER”. Oh no.
After spending a couple of days going in and out of the college library trying to learn about prostate cancer before I suddenly died, I settled down and allowed the rest of the urologist’s message to sink in. Everything was under control at that time, and the infection was being dealt with. However, I had to make some changes in my diet, such as restricting caffeine and the consumption of dark fluids like coffee. So, no more Coke and Dr. Pepper, and only decaf coffee in smaller and less frequent amounts. It was also important to maintain a generally healthy diet and exercise. The exercise part was easy, I had done that all my life. Walking, running, lifting weights, and as noted earlier, martial arts, have all been part of the exercise regimen. It also meant regular physicals to monitor for signs and symptoms, because although there wasn’t any prostate cancer then, this disease was sneaky.
Actively taking care of myself physically worked well for the most part. The frequency of infections dropped dramatically, and when prostatitis did occur, it wasn’t as painful. Even though I didn’t learn to like leafy green vegetables, better food entered my diet.
Years of health awareness went by, which included visits to local libraries to read the latest updates on prostate and cancer treatment. The years turned into a few decades.
Because of the regular monitoring of PSA levels and DREs, when the digital rectal exam showed another incidence of inflammation and the PSA doubled to over 4 in early 2013, the urologist advised a biopsy was in order. That February afternoon, only a week or so after my 54th birthday, stands out in my memory. What a strange and unpleasant experience a prostate biopsy is, and how nervous I was for the next couple of days. When the doctor called, it was with good news though. None of the samples showed cancer.
Nonetheless, given my early history and the doubling of PSA, the urologist wanted to increase the monitoring. That summer the PSA increased again, and in early 2014, it increased further to over 9. In four years the PSA had gone 1, 2, over 4, and over 9. The urologist, who was also trained as an oncologist, was concerned, and strongly urged me to have another biopsy, which we did. The results of the second test were alarming. Instead of no cancer, four of the 12 samples showed cancer. The biopsy suggested, and the biopsy of the tissue taken during the radical prostatectomy surgery confirmed, it was an aggressive kind of cancer. The good doctor informed me that without surgery or some kind of treatment, I would have been dead in two years.
The date of those results was March 3, 2014. Four years have elapsed, and there have been some highs and lows. The surgery took place in April 2014, and looked to be a success. However, the December blood work indicated the PSA had increased, and the PSA in January 2015 showed another doubling. The cancer had evaded the surgery. In early April 2015, a course of 37 radiation treatments took place. I tolerated the treatments fairly well, and again the intervention looked successful. However, the PSA doubled from November to December, and again in late January 2016. Again, that sneaky and resilient prostate cancer had survived medical intervention. After consulting with several specialists at Duke University Oncology, it was decided the best course to pursue was androgen deprivation treatment. The first shot of Lupron, the common choice for ADT, was in April 2016. The Lupron had a very positive effect, with the lack of overt symptoms and the bloodwork indicating a remarkably healthy profile after a year of treatments. Therefore, we are trying an extended holiday from the treatment and it’s side effects.
Dealing with cancer requires the patient, the individual and their support system, to be just as tough and resilient as the cancer. I am blessed with a loving and supportive wife and son, caring extended family, and a network of friends. What I can do, my responsibility if you will, is to take care of myself as fully as possible. For me, that takes the shape of learning to like eating spinach and kale, getting other fresh vegetables and fruits, eating lean meats, and reducing fatty foods. Regular daily exercise is vital, whether it is riding a stationary bike, walking, or playing tai chi. Getting rest is also important also, because the daily efforts to stay alive when faced with a life threatening illness take their toll.
So this morning, like the mornings before, I went outside to perform tai chi, and feel a deep gratitude for the many blessings given. Today, like most days, as I slowly move and breathe in the cold, late winter air, I am aware of the aches and pains in my aging body. Today, like some days, I wonder when the cancer will overtake my health, and confine me to bed. When I find myself thinking this, I focus on my breathing, return awareness to my ability to move, to the birds chirping around me, and the trees silently growing around me. Today, I am able to move well enough, see the sky changing to dawn, and hear the Nature around me. I cannot help but give thanks.
In coping with chronic illness, just as they say in addiction treatment, it is one day at a time.