Radiation

The year of 2014 was tough on me as a cyclist. I rode fewer rides, and covered fewer miles, than ever before since I began logging my rides as a newly avid cyclist in 2005, at the age of 65. I rode only 1550 miles, and logged only 68 rides, roughly half the totals of my best years. In 2014 I was plagued by bad weather (lots of rain), bad schedules, too much post-retirement teaching, and inopportune travel times. These, in retrospect, were partly excuses. Truth is, I was finding it more tempting not to ride during extremes of weather, be it precipitation or temperature, and less inclined to “squeeze a ride” into a busy schedule, lest I have a mishap without time to be rescued before a key appointment. Yet I had the same good gear I have always had for weather extremes, and I have had few emergencies during my years of riding because I don’t abuse my equipment and I do keep it maintained.

Perhaps the truth is simply that, despite my generally good health, time and age were creeping up on me.

But the last weeks of 2014 brought a whole new factor into the equation. During a simple trip to the doctor’s for a flu shot, it turned out that it had been a little over a year since my last annual exam. So he gave me one on the spot, pronounced me generally healthy, and gave me a list of blood test items to take to the diagnostic lab. One of those items was for Prostate-Specific Antibodies, the PSA exam. The presence of too many such antibodies in the blood indicates that there may be a problem with the prostate gland. The normal range varies a bit, but is generally 2 to 5. The test’s indication is so general, and it produces so many false positives, that there is widespread discussion in the medical community about whether the PSA should be given at all, especially to old codgers. The argument is that false positives can do more harm than true positives do good. Many men over 70 have prostate cancer, but it is generally so slow-growing that they die of something else long before the cancer gets serious.

Be that as it may, my PSA reading was 14, enough to raise the eyebrows of my physician and garner a reference to a urologist (turned out to be the same guy who gave me a vasectomy years ago!). There rapidly followed a biopsy, a cancer diagnosis, a bone scan and CT scan (both clear, thank the Lord!), a consult on treatment, a reference to a radiation oncologist, a consult on radiation treatments, and the beginning of a several-month period of treatments, of which I am still in the midst.

The treatments sounded like a piece of cake. Nine weeks of radiation 5 days of 7. But the entire process, door-to-door, takes just a little over an hour, 50 minutes on good days.  Six months of hormone therapy. But that amounts to 6 15-minute appointments to get a quick, nearly painless injection. I envisioned an easy skate through the months, never missing a class, a good meal, or a bike ride.

But then reality set in. Turns out that radiation has one set of diet issues, and prostate radiation a totally different set. Radiation’s issues are sufficient nutrition. Radiation takes a lot out of the body, and patients tend to lose weight unless they really toke up on protein, carbs, and other essential nutrients. Prostate radiation’s issues address the criteria necessary to make the lower intestinal region ideal for radiating the prostate: full bladder and empty rectum. The nurses’ advisory sheet is soothing: no big crisis; it’s not like preparing for a colonoscopy; don’t worry too much, but we’d prefer an empty rectum. Take a little gentle laxative in the evening (“most of our radiation gentlemen do”) and don’t eat food that gives you gas, which includes all forms of beans, including peanuts, all members of the cabbage family, leafy greens including fresh lettuce and spinach, onion, scallions, and garlic, high-fiber anything, berry fruits with seeds, apples in any form, and beer, sparkling water, and sparkling wine. Meats, most starches, squashes and bananas are fine. And beware, because the technicians look at any imperfection in your preparation—each tiny gas bubble—as a medical emergency and a lackadaisical failure by the patient. “We can’t treat you because you’re full of gas.” So no matter what’s on the plate at dinner I begin with Beano, and I try to stay wholly off the “verboten” list.

I prepare at length each morning, and on the way over to get the treatment I chug 16 to 20 oz. of water—not the happiest way for my stomach to start the day. Yet I’ve had a small handful of failures and some near-misses. The failures require re-preparing, including drinking 20 more ounces of water, and then waiting for the next vacant slot in the schedule. Usually they can squeeze me back in after 15 minutes.

The other energy-sapping element in the therapy is the lack of testosterone. The purpose of my shots—which has already succeeded and is now being maintained—is to get my testosterone level down to zero (“castration level” as it is colorfully called). As my urologist points out, testosterone is the principal driving force of prostate cancer.  Without it, the prostate shrinks to become a better radiation target.  But testosterone is also the single largest instigator of muscle-mass development in the human body. Without it, my muscles are weaker, and from a cycling perspective my shape is totally shot. And yet I still can’t sing soprano!

It is as if I can’t get my car out of second gear, or as if I only have a single small gear on my bike’s chainring. Riding the bike, I am exhausted after a short time, and the signs of real strain are evident: an ache in my neck and shoulders, and no breath. Within the first two weeks of radiation, I took 2 rides of over twenty-miles. They went well, if a little more slowly, and there was some ache in my shoulders and quads. The third time, after the second week, I could not get comfortably past Vienna. I ill-advisedly rode “all the way” to Hunter Mill Road, not even a quarter of the length of the usual ride, and had to return slowly and with aching muscles. That was it. I can still manage my exercise bike all right, but with much-reduced intensity.

And so it will be until my treatment ends this Friday. I hope to dedicate the rest of the cycling year to rebuilding strength and stamina. At my age it is going to be a long, slow process. Right now I have ridden outside exactly seven times since January 1. But if I can regain at least the basic level for a solid year in 2016 I will be happy.  Not what I expected this year to be like.  But life happens.

©Arnold J. Bradford, 2015

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