Sunday, January 14, 2018

January 14, 2018 – Happy New Year

Since my last post much has happened, but not too much on the health score.  I had my next checkup on December 6th which was accompanied by another Lupron shot.  I actually had a scare with my PSA, which, when I looked at the results I saw 0.06, which is double that of my previous 0.03.  When my oncologist said that I was doing very well with an “unmeasurable” PSA I asked how that was, since it was 0.06??  He said, “Didn’t you see the < sign before the 0.06?”  So the result was <0.06 or less than 0.06, not 0.06.  Whew!

So why was this test termed unmeasurable at less than 0.06 when they were able to measure 0.03 before?  The obvious explanation is that the lab used a less sensitive assay.  This is annoying to an engineer.  Don’t mess with the tests!  I would hope to have the same test assay as I had before the next time so I have the best measure.

My testosterone was 58, which is higher than my oncologist would like it to be.  It may be because I was two weeks overdue for the Lupron shot, but now the he wants to see me in two weeks to check testosterone in the middle of the 3-month cycle.  Lord knows I don’t want my testosterone to be lower from a side effects standpoint, but I also want to starve the cancer!

My trip to Washington D.C.  On December 14th I went to Reston, VA to be on a panel for one of the Congressionally Directed Medical Research Programs under the auspices of the Department of Defense.  The program in which I was chosen to contribute was the Prostate Cancer Research Program. Through a very rigorous two-tier process, this program chooses which research facilities, from of a large number of proposals, will get funding toward finding a cure for prostate cancer. My panel was comprised of leading scientists, clinicians and fellow consumer reviewers (prostate cancer survivors).  The consumer reviewers were asked to assess proposals in the light of potential patient impact and also provide a sense of reality to the scientists, many of whom had never met a real prostate cancer survivor.  The experience was very tedious, with several weeks of proposal reading and review preparation, but it was also fascinating.  It is incredible what we do know about the stages of prostate cancer and equally incredible what we don’t know. 

I learned a few little tidbits that were eye-openers for me.  For example, I knew that prostate cancer tends to be a slow-growing disease (with exceptions of course).  Because of this, unlike other faster-growing diseases, prostate cancer mouse studies are difficult because the life span of lab mice is around 2 years and lab rats 3 or so years.  In other words, unlike studies of fast-growing viruses the “patients” most often die before advanced stages of prostate cancer can develop naturally.  This means that scientists have to resort to all kinds of unnatural methods to speed up or slow down processes.  This also means that with prostate cancer one of the last steps before human trials can be problematic.

I also learned that in practice the typical PET scans are less effective after androgen deprivation treatment (Lupron) because the uptake of glucose is less and can lead to missed tumors.

Most important to me personally was that some patients with certain genetic markers have responded well to specific genetic therapies.  Since I have a family history of prostate cancer that goes back several generations, it is time for me to get some genetic testing.  The possibility that I may have favorable genetic markers that could lead to successful treatment alone makes my trip to D.C. worthwhile.

As for my contribution to the panel, I hope I did help to ensure that our tax dollars go to very worthwhile research projects that will ultimately lead to a cure for prostate cancer.

If you are interested, this is a brochure on the program:   CDMRP DoD Brochure.pdf

Next steps.  I am hoping to get my genome sequenced to see if there is any other treatment that might be better than the Lupron.  The “problem” with this is that it does appear that my cancer is responding to the Lupron, so the doctors may not want to okay any other treatment.  This brings up the subject of Protocol.  Apparently every disease has a treatment protocol that doctors follow (often somewhat blindly) and insurance companies expect to pay for.  For prostate cancer at my stage the protocol is to treat with Lupron or similar androgen deprivation drug and if that shows a drop in the PSA, continue.  If the PSA drop is sluggish or there are painful side effects of the cancer in the bones, chemo is called for.  After chemo when the cancer stops responding to the androgen deprivation therapy Lupron or similar drug (Castrate Resistant Prostate Cancer), then there are some drugs that are called for.  These deal mainly with the side effects since at this point there is no cure.  Fortunately in my case I am not there yet.  I believe this is (1) because we broke protocol and went with chemo and Lupron out of the gate, (2) my general health was pretty good going into it, (3) I made dietary and supplement changes, (3) I’ve maintained a positive attitude, thanks in large part to a wonderful support network of family, friends, doctors, fellow church members, and God’s help.

So, since I am doing well, there will be a desire on the part of the doctors to stick to protocol and not try anything new.  I don’t agree.  I think at the least I have to prepare for the next phase.  Hence I will be pushing to get my genome sequenced to see if I might be a candidate for other treatment.  That’s my next step.

In the meantime, I thank all who read this for your support.


Les, Supplement Eater Extraordinaire

Tuesday, October 24, 2017

October 23, 2017 – What’s Happening Inside Me?

I did see my oncologist on 8/31 as promised.  I also had my Lupron (androgen deprivation or hormone blocker) shot right after the appointment.  My oncologist said I looked good and my labs were also generally good.  My PSA is still at 0.03 but my testosterone was higher than he would have liked.  [That just shows that you can’t keep the old boy down, even with hormone-blockers.] 

My oncologist is operating under the theory that testosterone feeds prostate cancer.  Hence he would like to see it below 25.  On 8/29 mine was 53.  This could have been because I had chosen to get the Lupron shot two weeks after the 90 day mark.  It could also be that some of the supplements have had the effect of raising my testosterone level.  BTW 53 is pretty low, since men my age usually have around 278 ng/dl.  I used to have 450+.  Those were the good old days.

I have gotten back into my exercise program, doing push-ups at night and going to the gym to do strength exercises.  I think this is helping my stamina and posture.  I don’t go overboard because I am afraid to end up like Arnold Schwarzenegger.

I have become more active in UsToo, an online organization of men fighting prostate cancer.  I have learned quite a bit just by hearing other stories.  I also learned about a doctor at the Mayo Clinic in Rochester who is going for the cure in patients with Advanced Stage IV Metastatic Prostate Cancer like me.  More on Dr. Kwon later.

Palliative vs. Curative.  Let me explain that my treatment and the treatment of practically all patients at my stage of the disease is palliative, which means that the doctors try to keep it at bay with the expectation that it can’t be beaten in the long run.  Curative is treatment designed to rid the body of the cancer once and for all.  The problem is that curative treatment still has relatively low win odds and the patients often go through more aggressive, invasive treatments while the doctors attempt to kill all of the cancer.

Do metastases replicate the same cancer throughout the body?  In the past it was thought that this was the case.  If so, if one is able to kill one cancer, it would be possible to kill them all.  Unfortunately perfect replication is not the case.  As cancers spread, they tend to mutate into different forms.  As a result, either draconian treatments have to be given to kill everything that grows (chemotherapy), or multiple different treatments are called for to get rid of all of the now different cancers.

Dr. Kwon.  Going with a curative approach Dr. Eugene Kwon at Mayo uses a different type of PET scan to find tumors.  It is a C11 Choline Pet scan.  My hospital doesn’t do C11 PET scans.  Dr. Kwon says C11 scans are more accurate in finding small tumors.  As I understand his process, once he sees that there aren’t too many tumors, he then tries to gather information about each tumor, either by biopsies or other means.  He then develops treatment plans for every tumor.  The treatment may be radiation, chemo, or anything else.  He has had some real successes with this multi-treatment approach, but he admits to having failures as well.

The question is whether I should subject myself to Mayo.  At one point I was ready to jump on a plane, but I’m a little reluctant now, in small part because of Kathe’s and our schedule and in greater part because I am doing pretty well now.  Of course catching this early as possible would be best.  At the same time I don’t particularly want to find out that I am not a candidate.  In any case I have ordered copies of my reports and scans to be ready to go.

My schedule.  I have been fortunate enough to have been nominated and then chosen to be on a team that will be evaluating research proposals applying for grants from the Department of Defense in the area of prostate cancer.  It is called the DoD Prostate Cancer Research Panel - Cell Biology.  I am the lay consumer on the panel.  I will be going to Reston, VA in the end of December.  It will be interesting being a lay panel member surrounded by renowned medical scientists.  I have been included because the DoD wants to make sure that the grant choices take into account the patients who might be recipients of the research.  I’ll have to write my critique of each of the applications.

Sugar feed cancer?  While I was corresponding with several others with the same cancer as I have, I mentioned my avoidance of sugar and carbs as part of my dealing with my disease.  I was pointed to an article on the Memorial Sloan Kettering website that said that it is not true that sugar feeds cancer.  The article said that people have falsely concluded that because cancer attracts the glucose in the radioactive cocktail taken for PET scans, glucose must be what cancer thrives on.  Well, needless to say, I would like to believe this and eat some cookies that I have craved for a solid year, but based on all of my other reading I can’t accept this anywhere near 100%.  What MSK does say is that sugar and carbs lead to obesity and obesity in turn does seem to increase cancer growth.  I’m not gaining weight but I do think a low sugar, low carb diet is good for me, no matter what.

So, what is happening inside me?  This I truly want to know.  The doctors say that the only indicator of growth is PSA.  This makes me want to get a PSA test every few weeks, but my doctor and my insurance provider have something to say about this.  The other possible indicators are secondary effects of cancer in my bones.  As a result I am concerned with every ache and pain that it is the result of growing cancer.  My aches and pains don’t seem to be getting worse in general.  I do feel dull pain in my chest when I first lay down on my side, but this goes away.  This could be due to my exercise to some extent.  I also feel sharp pains different places in my legs from time to time, but this may be Lupron side effects.  Recently I was feeling a little dizzy and had a slight headache.  The headache could possibly be the cancer in my cranium, but the pain seems to have subsided.  The dizziness is likely due to the Lupron.  I’d like to get more PET scans, but I heard that the doctors are reluctant to do this because of that glucose attraction mentioned above.  Of course the cost might be the real reason.  It may just be true that there isn’t much of a change, but I want feedback to help me know if the diet, supplements, and exercise is helping stem the disease.  This lack of data is quite frustrating!

Les, Chemo Man



Thursday, August 17, 2017

August 17, 2017 - What Am I Taking After Chemo to Fight This Cancer?

I am taking a step back and rethinking all of what I am putting into my body to continue this fight against my cancer.  Whatever I am doing seems to be working.  I won't know for sure for another two weeks when I get my next PSA test, but I can't complain about my current health.

I'm using a three-prong strategy:

SUPPLEMENTS

1.      Vitamin D – There is a school of thought that says that deficiency of vitamin D is a major contributor to the spread of cancer.  Another says that many holistic therapies require the combination of vitamin D and the therapies to be effective.  Several sources say that the ideal preventative is to be sure that you have 4000 IU/day of D.  A very well balanced meal will provide 1,250 IU so I am sure to take 4000 IU in a D3 capsule every day.  It is possible to overdose in D but the amount would be much higher than this.
2.      Modified Citrus Pectin – This has been shown to improve outcomes of chemotherapy.  Its active mechanism is blocking cancer cell aggregation, adhesion, and metastasis because of its effect on galectin-3.  It can also have an effect in chelating toxic heavy metals.  I am taking 1/3 the dosage I was taking during chemo.
3.      AHCC – One study showed that AHCC could enhance the activity of natural killer cells in test tubes and animal studies suggest that AHCC has antioxidant effects and can improve the response of the immune system in chemotherapy-weakened immune systems.  This has not been proven in human studies but is used with chemotherapy in Japan.  It was shown to lessen the effects of chemo on the immune system.  I took it mainly for this reason. 
4.      Turkey Tail - When I was researching this article I ran across Turkey Tail (AKA Cordyceps or CS) mushrooms, taken in liquid, liquid capsule, or powdered form.  The ongoing studies have shown Turkey Tail to have many anticancer effects, such as attacking cancer stem cells, inhibiting metastasis, and it has even shown to protect against bone loss.  I am going to switch from AHCC to Turkey Tail.  .
5.      Saw Palmetto and Stinging Nettle Root – Taken together, the chemical theory is that this attacks free cancer cells.  All I know is that it reduced my PSA by 20% in only two weeks.  It is said to have similar effects to Finasteride without side effects.
6.      Broccoli sprouts – Although broccoli itself is definitely good in an anti-cancer diet, the benefits of broccoli sprouts have been shown to be much greater than mature broccoli.  This is because sprouts contain an abundance of myrosinase, which is an enzyme needed for the formation of sulforaphane, the cancer-fighting, anti-inflammatory component in broccoli. Broccoli has myrosinase, but cooking can destroy it.  Anecdotally, a friend who has had recurring bladder polyps is taking broccoli sprouts and after taking the sprouts for a month, experienced his first polyp-free exam.
7.      Multivitamin – I take one Costco senior multivitamin tablet every day.  I am hoping that this will make up for some of the vitamins and minerals I don’t get in my diet.  This is my main source of vitamin C.  I could probably stand to take more vitamin C.
8.      Omega 3 – I take one fish oil capsule per day with the intent to deal with cholesterol.
9.      Magnesium – I take this to deal with swelling in my feet, thanks to the hormone-blockers that my doctor has me taking.
10.  Potassium – I take this to deal with neuropathy and tremors.  At first I had these symptoms by now I have practically none of these symptoms.
11.  Rhodiola Rosea – This is a Russian herb that is an adaptogen that helps the body heal from physical and emotional stress.  The Russians have used this with Olympic athletes because it improves their performance in strenuous exercise.  It has also been shown to increase mental performance and last, it has killed bladder cancer cells and leukemia cells  lab experiments.  Last, it does increase the lifespan of fruit flies by 25% in repeated experiments.  I have noticed that in taking it I feel more energy, regaining some of the energy I have lost due to the hormone-blockers.  Note:  There are some possible drug interactions, so no caffeine, no anti-depressants, no P-glycoproteins and no substrates of Cytochrome P450 3A4 (Biaxin, Cardizem, Sporanox, Nizoral, Ketek, grapefruit juice erythromycin, etc.).

DIET

The main premise that I operate on is that sugar feeds cancer.  Carbohydrates are converted to sugars in the body.  Hence carbs are bad.  Secondarily, it is said that processed foods with all of their chemicals also has a causal relationship with cancer.  Also, consuming an overabundance of certain foods can indirectly or directly cause cancer to grow.

On the plus side, we all have been indoctrinated to think that leafy dark green vegetables are good for fighting cancer.

Other than these “truths” there is a lot of noise around the best diet for people fighting cancer. 

1.      The Budwig Protocol – This is built around flaxseed or linseed oil and cottage cheese as well as vegetables, fruits and juices.  Processed foods, sugar, and most other dairy are no- nos.
2.      The Ketogenic Diet – This is a high-fat, adequate protein, low carbohydrate diet.  The idea is that the fat replaces the carbs, putting the body into a metabolic state called ketosis.  The body is then living on ketones instead of glucose, that has many health benefits, not the least of which is a treatment for epilepsy.  This diet has lots of chicken, fish, beef, pork, cream, butter, mayonnaise, low-carb fruits and vegetables.
3.      The Atkins Diet – This is close to the Ketogenic diet.  The modified version of this diet places no limit on calories or protein.
4.      The Paleo Diet – This is a diet based on what cave men and women ate, so there is no dairy, grains, or processed foods.  It includes vegetables, fruits, nuts, roots, meat, seafood, and coconut oil.  It doesn’t include the farm-grown vegetables like corn 

All of these diets have one thing in common:  limit sugar/carb intake.  But which one?  Many doctors prescribe the Ketogenic diet to patients that have cancer—especially brain cancer.  This may be a good choice, but it does have its side effects and is not all that appetizing.

The real problem is that the medical profession has not collected the data and therefore doesn’t have the evidence to correlate particular food intake and particular forms of cancer.  The only thing that is known is that certain foods provide certain benefits.

So, Kathe and I have formed the Les & Kathe Cancer-Fighting Diet, consisting of the following:

1.      Trying to eat only organic foods and avoiding all processed foods.
2.      Drastic reduction of sugar and carb intake.
a.       As a treat, the limited use of natural sweeteners such as coconut sugar, monk fruit sugar and some stevia
b.      Avoidance of manufactured sugar substitutes such as saccharin and aspartame
3.      No cow milk and reduction of all milk products
a.       Use of coconut oil and almond milk
b.      Limited intake of hard cheese and plain yogurt
4.      Increase of leafy dark green vegetables
5.      Limited intake of low sugar, antioxidant fruits such as blueberries and strawberries
6.      No high sugar fruits like mangos, oranges, cherries
7.      Smoothie every breakfast - The smoothie consists of one solid cup of spinach and kale (little frozen pieces), pea protein powder, turmeric powder, unsweetened almond milk, potassium/magnesium supplement, chia seeds, blueberries or strawberries, broccoli sprouts, and walnuts.
8.      We eat chicken, tuna, other fish, some beef, and (I eat) some ham  
9.      Snacks consist mainly of walnuts, pecans, macadamia nuts, almonds, almond butter, and occasional fruits such as apples or white peaches
10.  Kathe has picked up a Paleo Sweets recipe book, so we have had some cookies with a little maple syrup or honey as sweetener.

11.  Lots and lots of water. 

We will both admit that the diet gets boring.

POSITIVE ATTITUDE and LOW STRESS

This is the woo woo part.  We both feel it is essential for the immune system and for healing that we maintain a positive attitude.  This is not always easy if the patient is in pain or suffering in other ways, but maintaining a positive attitude is much easier with the support of my loving wife, friends, relatives, and a strong faith that God will help in helping maintain a positive attitude and in giving us wisdom to make the right choices.

It is really important to minimize stress.  This is not easy in today’s environment.  Avoiding the news is nearly impossible.  We try our best, realizing that there is so little we can do anyway.  There is political, social, business and, last but not least, financial stress.  This last one is not easy when we know how much these drugs and treatments cost and may cost in the future.  To our benefit, Kathe is a Medicare guru, so I have the best supplement insurance available.  So far we have had to pay very little out of pocket (I won't mention the supplements and organic foods).  I therefore thank Kathe and MedicareQuick.com for this major stress-reliever.


Next appointment:  August 31st with the oncologist and labs 

Thursday, June 22, 2017

June 22, 2017 Maintaining Diet and Supplements

Not much has changed since my last post.  The only major thing is that the PSA results came back at .03, which is half of what it was at the end of chemo.  For this I give credit the Lupron and my regimen, plus lots of positive thinking and continuing great support.

I am still having some swelling in my ankles and legs that I am able to control with compression socks.  I am avoiding diuretics, largely because they really don't help.  I suspect that the swelling is a side effect of the Lupron, but I can't test this since the Lupron lasts for three months.  I'm starting to eliminate a supplements one by one to see if I find one that is contributing to the swelling.

On the diet front I am constantly fighting the desire to eat sweets and am constantly exploring the world of "no sugar added" and "sugar free" foods.  Practically all have just as many carbohydrate grams as the sugar items and as we know, our bodies convert carbs to sugar.  So these sugar free and no sugar added foods are not the answer, but a few bites here and there help.

I also started first taking a carb blocker and now a sugar blocker.  I don't know if this is having the right effect, but I do notice if I take these I am more regular, which is a desirable side effect.

I have been having minor stomach aches.  I suspect that it is because I am not religious in taking broccoli sprouts pills right after meals.  I'm trying to control this better.

As for my general comfort level, I am still feeling pretty good.  In spite of the doctor's predictions that I would be fatigued as a result of the Lupron, I am feeling pretty close to normal, able to operate for full days with a minimum of fatigue.  The only thing that I notice most is the stiffness when I get up from sitting.  Much of this is in my legs and I attribute it to the water retention and also to the lack of exercise.  Exercise is one area that I really need to work on.  I walk 45 minutes per day, but I need to do more.

I'm taking the following:  (1) Magnesium, (2) Potassium, (3) baby aspirin, (4) Saw Palmetto, (5) Stinging Nettle Root, (6) Broccoli Sprouts, (7) Sugar Blocker, (8) AHCC+ for immune building, (9) Modified Citrus Pectin (1/3 dose per day), (10) Multivitamin, (11) Omega 3.  I also have a loaded smoothie with protein powder, lots of frozen kale and spinach, frozen fruit, and almond milk every morning for breakfast.  I am consuming prodigious amount of walnuts, pecans, almonds, and macadamia nuts as snacks.  Then there is the low carb/low sugar diet, although I do have some fruit and a small piece of hard cheddar and some yogert from time to time.

So far, so good...

Until next time,

Ex-Chemo Man, Les

P.S. The hair is slowly returning to my head and face!







Thursday, May 25, 2017

May 23, 2017 - Post-treatment Follow-up - Great results

I last left the blog a month ago with a problem of swelling ankles and lower legs.  Since then I went to my primary care doctor, Dr. Vaccari, for a general exam and advice on my swelling.  She is very thorough, having asked me 100 questions and prescribing an EKG and Ultrasound scan of my legs.  I had both of these done and no problems were shown.  The end result is that Dr. Vaccari thought the swelling might be from my other treatments and suggested we watch to make sure the swelling doesn’t get worse.  Since then the swelling has actually subsided considerably.  I am wearing mild compression sox, am watching salt intake, and am taking magnesium.  From my wonderful church nurse I borrowed a compression machine that will reduce the swelling mechanically.  In any case I foresee that the swelling will soon disappear.   

For the rest of this blog post I hope you don’t mind a duplication of my post on Facebook:

We just returned from the oncologist.  This was the follow-up after my PET scan on the 22nd.  This is the appointment that most cancer patients dread because it is the report card on the chemo and hormone-blocking treatments for the past 4 months.  I’ll admit that I went into the examination room with some trepidation.

Dr. Bhangoo came in and handed me the results of the PET scan and with a smile he said, “’Looks very good.”  In other words it looks like I got an A in the test.  The words on the scan report are “Stable to slight improvement in osseous metastatic disease.” In other words the treatment appears to have stopped the spread and even reduced the signs of cancer in several areas.

I should explain that back at the beginning of all of this, the doctors told me that the PET scans are unlikely to show shrinkage of cancer because cancer in bones leaves scar tissue even when it is no longer growing.  This explains the somewhat understated results.  The bottom line is that we appear to have kept the cancer at bay.  As Dr. Bhangoo said, “We now just have to keep it this way for the years to come.”

The next step in a few days is to check the PSA numbers to make sure they are down around the 0.06 that was the case the end of March. I will also get another hormone-blocking shot that will last for another three months.  Then we another PSA and testosterone test.  The PSA will be the marker we will continue to watch.

In the meantime I will continue to limit sugar and carb intake, have Kathe’s wonderful smoothies every morning and continue to take Modified Citrus Pectin, Saw Palmetto, Stinging Nettle Root, AHCC, and Broccoli Sprouts.  I also need to get back on an exercise routine.

I am feeling very good, all things considered.  Kathe and I will celebrate our good fortune tonight by having a Brazilian dinner. 

I don’t have the words to convey how thankful I am for God’s and your support throughout this ordeal.

Les



Saturday, April 15, 2017

April 15, 2017 - Last Chemo Treatment Subsiding - New Problem

In my last post I was saying that I was at a physical low, due to the accumulative effects of 6 treatments of chemo.  Well, I am getting back to normal with one exception.  One day last week I looked down and my ankles had disappeared!  They had swollen, as had my legs to some extent.  I've never had this so I started research and discovered that this could be due to a blockage (not in my case since both lower legs were swollen), to a heart problem, due to some vitamin deficiency, or (last) something in the diet.    I took magnesium pills and raised my legs above my heart and by morning the swelling had gone down about 90%.  Then it came back within hours.  I called my doctor and he said he would prescribe a diuretic.  He was less concerned because the swelling was in both feet and legs and I had no redness.  Kathe wondered if it might be a new protein powder that we started around the time of the swelling.  She convinced me not to take the diuretic while we went back to the old protein powder.  So far the swelling is much less, although it hasn't gone away completely.  Like most of the other things that have hit me, this one is not debilitating at all--just annoying.  I like seeing my ankles.

With chemo and hormone blocking it is a lot of little symptoms.  The good news is that they are little symptoms, not big ones.

Now, I'd like to see some hair growth!

Les

Friday, March 31, 2017

March 31, 2017 - Two days after last chemo treatment

I am in that period that is the low point from a stamina standpoint and this time I feel the most fatigued.  However, I am still hanging in there.  We saw palliative doctors on Thursday.  The purpose of palliative care is to deal with patient problems post heavy treatment or surgery.  Palliative doctors are therefore very sensitive to patient needs.  The doctors we met at Scripps in Hillcrest had me give a rundown on my status.  Without bragging, I think they were impressed by how well I was handling the chemo.  They congratulated me on this and how good I looked.  I don't know that they would credit the natural supplements, but they did credit the diet.

I had hoped palliative care would be sharing with me some natural approaches to ensure that my outcome is the best.  Unfortunately they do come from the medical profession that has little training on these approaches.  I will have to go to a naturepath.  The bottom line is that I don't think I will need palliative care help for now.

In my last post I didn't mention a few side effects.  One is watery eyes and nose, which apparently does happen along with hiccups when taking steroids.  The other are these small muscle twitches at random places on the body, which may be the Lupron.  They are just somewhat annoying, but not debilitating.

I'm starting to go out without hats, just to get some sun on the top of my head.  That way when I do start growing hair (I hope), I won't come across as a light head. :-)

After our appointment we went to have poke bowls, which is one of Kathe's favorites.  It was a beautiful day.  So was today.

Next step is to have a PET scan in two months to see if things have changed in my bones.  In the meantime we will be watching my PSA closely.  The Lupron shot will last another three months. After that I am planning to go the naturepath route without the Lupron hormone blocker, monitoring PSA very closely.

Les