Pain Test

It never fails. Throughout my life, whenever I've gone to see a doctor, I usually feel fine if not good, but the day after seeing the doctor tends to be misery.

This has been an interesting week. Starting with Monday, Labor Day, a national holiday in the US. I decided to try an experiment and stop taking my vicodin. My as-needed pain regmin currently consists of taking Ibuprofen every 6 hours and Vicodin every 4. I had noticed that for some time I was taking both at the same time, every 6 hours, on the same schedule and that I was not taking the Vicodin every 4 as allowed, and I wondered if it was still actuallly even needed. So I decided to stop taking it starting Monday afternoon and all the way through Thursday afternoon. 

At first it seemed to work just fine. The Ibuprofen alone seemed to be enough to keep the pain at bay. The first 48 hours went smoothly without any complications. The next 24 were not as smooth. Wednesday afternoon I had pain that persisted even after taking the Ibuprofen. It was rellatively mild, but it was pain nonetheless. It was enough that I left work early in order to beat the traffic home so that I could try to find more comfort at home to finish my work for the day. I was in a fair amount of pain by the time I got home, but was due for another dose shortly after I arrived and it seemed to bring it down to tolerable levels. Thursday, I had the pain throughout most of the morning and by mid afternoon, decided to go ahead and take the Vicodin again. It took a while, but my pain did subside once again.

I don't yet know what that means as there have been a lot of variables in play this week, any of which could have affected my pain levels. I have now been back on the Vicodin for about 36 hours and at the moment, I am up late writing this in a fair amount of pain just waiting until I can take another dose of both. Perhaps I'll try the experiment again if I get things back under control again.

Tuesday I had my monthly check in with my oncologist. There was nothing new to report on that front as everything has been going pretty well of late and my last blood test had not shown anything of concern other than my PSA had gone up a little over the previous month to 3.57. He decided to do another blood test, presumably because my PSA has been going up. When I went back to get the blood draw and my monthly Adamantium shot, as I like to call the Xgeva shot, the person who admninstered the shot gave me the most painless one that I've had so far, I barely felt it at all, but then she overshot my vein when trying to draw blood and was unable to get any. I became dizzy as a result and had to sit back for a little while before they could try again. They brought me ginger ale and chocolates, as well as a damp cloth to put on my neck, to help the situation..

I haven't had that happen in a long time. In the past, I could pretty much count on getting light headed after a blood draw every time. There have been several occasions in my life where I have passed out after blood was taken. It had been a whle since that had happened. With alll of the IVs and blood draws that I've had since I was diagnosed, I've been surprised that it hadn't happened yet so I guess that I was due. Anyway, after a few minutes rest and refreshment I was feeling OK and ready for them to try again. This time they called over the phlebotomist to do it and it went without a hitch other than my flinching when he said "1, 2, 3, now" as he stuck me. Because of the whole potential for passing out, I don't watch the procedure, ever, and I prefer not to get the play by play. Just let me know when you are finished and I can turn my head back.

With a bandage wrapped around each arm, I then headed down to NIH to get more blood drawn. That went pretty painlessly except that phlebotomy didn't have an order in the system for my blood draw and they had to track down my study nurse to get one. After that, I went home and caught up on work. A long day, but mostly painless running on Ibuprofen alone.

Wednesday was just a day at work with nothing exceptional happening other than the pain started creeping back in by the end of the day and I left early to mnimize the amout of time I had to be in the car, but after I got home, things went back closer to normal.

Thursday was another doctor day which started with my radiation oncologist's office calling and waking me up at 7:00AM to inform me that the doctor had a conflict at 3;00 and couldn't make my appointment with him. They offered me an 8:00AM slot so I took it and raced to take all of my morning medication and get ready to go. My meeting wth the radiation oncologist was uneventful. He said thta the MRI had not shown any change worth noting and asked me to wait 6 months this time before checking in with him again. Then I want home to work for a while until my next appointment for the day. Since I had already reserved 3:00PM on my calendar for my original appointment time with him, I called my accupuncturist to see if they had that time open. I had had to cancel my appointment with him for Friday becasue we were going out of town with the kids and I didn't want to skip the whole week without seeing him. Fortunately they had 3:00PM open and I went to get poked following my first Vicodin in 3 days.

After accupuncture, I went to see my pain management doc and told him everything that had happened including the Vicodin experiment. He took it as a positive sign and said to continue trying to cut back here and there where it felt appropriate. He said that he felt really good about my progress. Also, because he's part of the same hospital system as my oncologist, he had access to my blood results from Monday and reported that my latest PSA was back down to 0.99. I don't know if that's due to being on the Abiraterone for this study or if it's just normal unreliable fluctuations of PSA, but I'll take it eiher way. I've been seeing the pain doc once per month, but since things are going so well, he didn't see a need to continue that and asked me to come back in two months.

Here's where that whole thing about feeling miserable the day after seeing the doctor comes in. First, I was feelling fine on Tuesday when I saw the oncologist after having dropped the VIcodin. The next day, I had to leave work early due to pain that was ignoring the Ibuprofen. Thursday I was in some pain most of the morning, but then went ahead and took a Vicodin before going to see the pain doc and felt fine when I saw him, then Friday was a day of pain.

Friday was my oldest daughter's birthday. She turned 6, or 6 fingers as she responds to anyone who asks.  So I woke up Friday morning, took my medications and waited for the usual morning pain to subside. It took a little longer than normal to the chagrin of my new 6 year old who we had promised to take to IHop for her birthday breakfast. I finally felt good enough to go after a couple of hours so we went for breakfast. I wasn't 100% but I made it ok. We had agreed to take her down to Great Wolf Lodge for her birthday so when we got back from breakfast, we quickly packed up for the overnight trip down to Williamsburg. My lower back hurt for the entire trip down there. It wasn't excruciating, but it was just enough to be uncomfortable all the way down. 

After we got there 4 hours later, I felt a little better once we got out of the car and I had an opportunity to walk around a bit. The girls were eager to get down to the water park, so we checked in, changed clothes and went down to the water park. I had noted as we were changing that it was time that I could take another Vicodin if I wished but in all of the chaos of getting 2 adults and 3 girls ready I forgot to take it. I was OK for the first two hours in the water, but the last one was coming up on time for another dose of Ibuprofen and the pain started setting in. By the time that we got back to the room, it was bothering me pretty good. We changed, I medicated, and we went to dinner. We were halfway through our meal before I felt the medication do its job. I felt better, but not all the way. There was still some pain that was ignoriing the medication. I was sleepy and started feeling like nodding off by the time we got back to the room.

After we got everyone into bed, I attempted to do the same. I think that I had just gotten to sleep when the baby cried out. I woke up only to realize that I was feeling pain and it was too much to go back to sleep. Since we were all in the same room, my options were limited for sitting up and dealing with the pain. I had brought my heat wrap, which often helps in this situation, and the room had a microwavve that I could heat it in, but I didn't want to figure out an unfamiliar microwave in the dark and potentiallly wake everyone up with the noise, so I sat in the corner by the door, basking in the glow of my iPad and started writing this. The pain at that point was pretty strong in my lower back and thighs. I found that if I applied pressure to my thighs that it felt momentarily better, but it was little comfort. I tried laying on my back on the floor and that seemed to help some. I'm not sure how long I laid there but I started to nod off and took that as a sign to go back to bed.

The baby woke us up at her usual 4:00AM request for feeding which meant that I woke up and was suddenly aware that I was in too much pain to go back to sleep, but that it was also a couple of hours past time for me to take my medication.  So I'm up, waiting for them to do their thing. Hopefully I'll get to go back to sleep for a couple more hours. I'm not sure what's going on with this pain today. There are a lot of variables involved. I'm wondering if some of this is from exerting mysel in the water park. There are a LOT of stairs up to the top of the various slides, maybe that explains the pain in my thighs. 

Hopefully Saturday will be a better day on the pain front. We've got a full day in the water park followed by the return trip home. I hope it goes a little better than yesterday.

Breakdown

"Daddy, I hope you get better soon and aren't sick any more!" A statement that pierces  my heart.

I had a breakdown today, the first one I've had in months. As I've been feeling better overall it's been easy to leave all of the emotional baggage in the past. Being back in the daily grind has left me without much time for reflection or even cause to reflect, but I guess that I was due as today it hit me pretty hard.

I spent the better part of the day today working in the yard weeding, picking carrots, and finishing a small retaining wall project, not all that much work really. When I came in and cleaned up from doing all of that and sat down I realized that my lower back was hurting and it would be another 2 hours before I could take another round of pain medication. I laid down on the floor in an effort to get more comfortable and ended up nodding off for 20 or 30 minutes. When I awoke, I was feeling like crap. My back still hurt, I was drowsy, and just felt kind of icky overall. My wife suggested that I go to the bedroom and lay down for a while, that I had overextended myself again, and so I nodded and started shuffling off to the bedroom. Along the way, I passed my oldest two girls who were seated on the floor playing a game together. "Can. We go in the tub now?" the 5yr old asked. " not right now" I said. "I've got to go lay down for a while:"

I didn't have to look to see the disappointment on her face, nor did I even hear her response which was likely something like "Aw, we never get to go in the tub." Or "But you said we can go in the tub today!" It didn't matter, I knew how she felt. I had promised them both earlier in the day that we would get in the hot tub some time that afternoon. I had even used it to motivate them to do some work of their own in the yard, especially cleaning off their trampoline since being able to jump on it apparently wasnt sufficient motivation. They had done everything that I had asked of them and had been on fairly good behavior for the day.

Getting to get in the hot tub is a big deal to the girls. It's the closest thing tha we have to a pool and with everything we've had going on this summer, they didn't get many opportunities to go swimming. They also love the hot tub because its shallow depth gives them confidence and allows them to be a little more daring than they would feel comfortable doing in a large pool, plus, it's their special activity that they get to do with Daddy. My wife has had little occasion to get into the tub since shortly after we got it. Between surgeries, pregnancy and the baby, she's been either unable to get in or unable to gain the freedom required to be able to. Thus, the hot tub has become my thing that I do with the girls, but even those events have been few this summer as it was out of order for a couple of months and I've had few occasions where I've felt up for it on a day where both the weather and our schedule permitted it. The girls have begged on a number of occasions to get in and up until today, I've had to deny them every time, even a couple of times were I had otherwise promised that they could.

So as I walked past them into the bedroom and shut the door, feelings of guilt that I was somehow letting them down washed over me and as I laid down on the bed, I started to sob. It wasnt just about my promise to the girls that caused me to cry. As I lay there, I also my wife's comment that I keep pushing myself too hard doing things out in the yard. She's right, of course, but the problem is that the level of activity that I'm able to perform today with which I push myself too hard is but a fraction of the effort that I could have previously put in.

I am so tired of being limited in what I can do. Much like taking the motorcycle for a ride out in the country, doing DIY projects and tasks around the house is what I love doing, it's my hobby. If I were independently wealthy and didn't have to work, I would probably spend all of my time finding projects to do around the house and I doubt that I'd ever run out of things to do. It's one of the reasons that I bought this house with an acre outside of town so that I would have a place that could keep me busy as long as I had the time for it. Now I no longer have the time, and when I do, I don't have the energy or strengh to do everything that needs to be done and that frustrates me to no end. I'm tired of being unable to do the things that I need/want to do and I fear that's not going to change, that this is the best I'm going to feel even if I'm able to keep the cancer at bay for another 20 years, this is the best it's going to be. These thoughts fueled the sorrow that I already felt over disappointing the girls and I continued to sob uncontrollably. 

It didn't help that my wife left the TV on when she had been in the room earlier watching something on tha Apple TV. Now in standby mode, the screensaver had kicked in which meant a sideshow of family pictures streaming from the computer. I laid there and watched as random pictures of the girls from birth to present flowed across the screen bringing back memories of events and activities, some of witch I'm afraid are no longer possible. As pictures of my oldest as a baby scrolled past, I noticed how much my youngest, now 9 months old, resembles her older sister at the same age and I wonder if I will get to make similar memories with her as I did with her sister as there was so much more that I was able to do then.

At some point, I realized that I wasn't going to be going to sleep and somehow my pain was less noticible. Maybe just laying down for a while was all that was needed, so I got up, put on my swimsuit and directed the girls to do the same. They, of course, noticed that I'd been crying and asked me what was wrong. Trying to spit out an answer only made me start crying again at which point my 5 year old came over to console me and said those words "Daddy, I hope you get better soon and aren't sick any more."

I don't have the heart to tell her that there won't be a time when I'm "not sick any more". I don't know if she'll be able to comprehend that fact or if I even want her to know yet, but it pains me every time I hear her say it. How do I tell her that in one way or another, I will be sick for the rest of my life, that there won't be a time when I'm fully recovered and cancer free unless some miracle cure is just around the corner? It's amazing how a simple statement of comfort and concern can have both it's intended effect and can tear at my heart at the same time.

Afterwards I did take the girls out to play in the hot tub for the short time that was left in the day. They were happy and so was I and even though I was out there past the time that I was due to take pain medication, I was pain free the whole time we were in the tub. Lately I know when it's time without even looking at the clock as I can feel the meds wearing off, but somehow while spending that time with my girls I didn't even notice. I'm glad that I was able to keep my promise.

The Big ?

The last few of weeks have been full of surprises. I found out that my company is being acquired which places a big question mark over everything. It's too early to know what that will mean for me and that's probably the most unsettling thing about it. This could turn out to be a good thing, it could be a great new opportunity, or it could be just the opposite, and only time will tell. It's the uncertainty that is the terrible oppressive fog that puts everything on hold and makes you feel frozen in place. Knowing what comes next, even if its the worst possible outcome, at least allows you to put together a plan for moving forward but planning for the unknown can be maddening.

Life is full of uncertainty and we usually deal with it by planning for the most likely outcome. Sometimes, if we're smart, we also plan for a less likely outcome at the same time. We call that insurance. Sometimes I feel like I've lived under the cloud of uncertainty for most of my life and though I've always managed to get through it ok, it doesn't get any easier whenever the cloud returns. About a year ago I thought that I was in the clear, things were going well for me and my family and I didn't see any clouds on the horizon. Then, just like a Texas summer thunderstorm, the cancer came up out of nowhere, a wall cloud promising heavy rain. Though I feel like the heavy stuff has passed, the cloud remains. The uncertainty of what is to come hangs over me making it difficult to plan for the future. Now this new cloud drifts in from another direction and I don't know whether it brings rain or just simple shade but it does seem to freeze things in place. 

I feel like I should preserve finances in preparation for the worst possible outcome and avoid any unnecessary spending. It's funny, but the weekend before the acquisition announcement I went out and looked at a Ural motorcycle as a possible solution to my motorcycle conundrum. The hearty Russian made bike comes with a side car that makes the possibility of falling over unlikely and would provide an option to take the girls along with me. After a test ride, I decided to think it over. Even though I could afford to buy it, it's still a lot to pay for the occasional joy ride. Would those opportunities come often enough to be worth it? With summer winding down, should I wait until next spring? I was weighing these questions the following Monday morning when it showed up in my inbox. Another cloud had rolled in out of the blue. Now I look at every expense as money that could be needed down the road.

The prospect of being unwillingly placed in the job market again is always a daunting proposition, one that has never really concerned me greatly, but I was single the last time that I found myself there and had less to be concerned about, and no one depending on me to land that next opportunity. I did not have this cloud hovering over me putting limits on the options that I may entertain. I hate uncertainty and everything that doesn't go with it. I'm a problem solver, it's what I do, but the first step to solving a problem is to evaluate your options and having all of this uncertainty floating above not only obscures the options, but it obscures the problem as well. For all I know, there could be no problem but I don't like operating without a contingency plan. I hope that at least one of these clouds burns off before madness begins to set in.

Speaking of uncertainty, I went to NIH again on Monday and am now enrolled in their study. After a long the day getting irradiated, poked several times, and scanned twice, they arrived at the conclusion that I qualified for the study, the one that is supposed to be for people whose treatment is no longer working. Though I'm not convinced that's the case, they had the data points that they needed to satisfy the entrance criteria. My PSA was up again since the last time I was there, at 3.2. Supposedly they only use that as an indicator and rely more on the scans and other factors to determine progress, but the radiologist's report wasn't complete at the time that I saw the doctor and he was fairly vague on the question of whether or not the scans showed any regression.

Acting on my oncologist's advice of "If I were you, I'd do it", I went ahead and signed up for the study. There seems to be little risk, falling under the category of "it may help, but it can't hurt", though it is also unclear to me how they will actually determine success since the goal of the study is increased life expectancy and considering that most, if not all, of the other participants are septuagenarians. There were two groups that I could be randomized into, the control group, and the experimental group. The study is to determine whether the drug abiraterone combined with another called amg386 is more effective than abiraterone alone. I wound up in the control group which means that I get just the abiraterone. This is in addition to all of the meds/treatment that I'm already taking. 

In some ways I was relieved not to get into the experimental group as that would have required me to drive down to Bethesda once per week to get the amg386 injection and would have made holiday travel plans a little tricky. Instead, I just take four horse pills every morning an hour before breakfast. Then I have to take a prednisone pill with breakfast, along with the calcium supplement and 4 different pain relievers that I was already taking. I am hopeful that this additional treatment will lead to a lessening of my need for the pain pills if not removing the need altogether, but then there's that uncertainty thing. Who knows how my system will respond to it?

Uncertainty has become my new status quo. I don't like it, but it's the hand I've drawn. I really don't need any more and could use a little less. Here's hoping the current clouds move on soon.

Catch Up

It's hard to believe that my last post was back at the end of May. It feels like it was only a few weeks ago. I haven't written anything since largely because I simply haven't felt like writing. Part of it has been because I'm getting more sleep these days. Most of my previous posts were written while I was up in the night dealing with one pain or another that kept me from sleeping but lately those moments of nocturnal solitude have been few and far between. These days I tend to get up only once or twice in the night and am often able to go back to bed rather quickly after taking medication or stretching or whatever is required to quell the discomfort that woke me in the first place. When I do get up in the night, I have a tendency to nod off where I sit only to wake up an hour or so later and return to bed.

A lot has happened since my last post that I wanted to write about but somehow just couldn't bring myself to actuallly sit down and do it. When I saw my oncologist at the beginning of June, I received some news that was pretty devastating to me personally. It probably seems pretty petty to someone looking at it from the outside and probably is in the grand scheme of things, but it still hit me pretty hard. At that appointment, my wife wanted me to ask the doctor if it was OK for me to continue to ride my motorocycle. She was concerned that perhaps the vibration of the motor could somehow cause problems for me with all that I have going on. Ever the skeptic, I was not prepared for the answer that he gave, that he would not be comfortable with me riding, not due to the vibrations, but due to the risk of complications from any injury that I may receive should I get into an accident on the bike. He explained that the cancer in my bones has left me in a similar condition as someone with osteoperosis, that my bones are brittle and weak and that any serious accident would only be complicated by this fact. The Xgeva that I take is to strengthen my bones, to make them harder. It is often given to older women who suffer from osteoperosis which I think I had read when I first started taking it, but somehow that information didn't sink in at the time. 

The news was a shock to me much like my original diagnosis as it was equallly unexpected and had a much bigger effect on me than I would have imagined. You see, riding my motorcycle is one of my few true passions, something that originally brought my wife and I together and something that we've been able to do much less of since the kids arrived. It's difficult to explain the freedom that one feels when riding up and down the hills and around the curves of backcountry roads, difficult at least to someone who hasn't experienced it. Hearing that I couldn't ride again filled me with helplessness, mostly because this is not a temporary condition, but a permanent prescription, a freedom taken from me, that would not return over time. The worst of it was that the doctor didn't outright tell me that I can't ride, just that he "would not be comfortable" with my riding my bike. He had put it all on me, given me the facts of the situation, and advised me that it's not in my best interest, then left it up to me to make the right decision. I thought of writing about it then, tried to come up witih the words to explain how I felt about it all, but just couldn't do it, but my wife did a better job at putting it into words than I ever could have in her own blog.

As I slowly recoverd from my angst over the motorcycle issue, I started having these pains in my legs. At first my pain doctor suggested applying heat to the areas in question for relief and for a while, that helped, but within a couple of weeks it had gotten to the point where the pain continued through my doses of medication without abatement. I reported this to the doc and he had me drop the Lodine from my regimin and switch it out with Ibuprofen. Surprisingly that worked. The Ibuprofen made the pain in my legs go away and I've mostly felt pretty good since then as long as I stay on schedule with my medication. The Ibuprofen is only supposed to be taken every 6 hours and I can usually tell when it's been 5½ hours without looking at a clock as the pain starts to slowly seep back in around then. In the last week or so, I've been able to stretch it out beyond 6 hours here and there and have been taking smaller doses of it. 

With this new regimin in place, I took the family on vacation to Chincoteague Island, VA. Overall the trip was a success as I made it through the week, as well as the 4 hour drive down and back, without any complications. I even rented a bicycle one day, one of those with the kids tagalong bike attached to the back, and took my oldest for a ride around town that lasted a couple of hours. I was surprised that I not only was able to last that long without any pain or exhaustion, but also that I didn't have to pay for iit afterwards. I fully expected to have some kind of pain afterwards even if it was just muscle soreness from putting them through unfamiliar paces, but surprisingly there was none. Other than feeling a little tired and dehydrated, I felt fine afterwards. I took this as a sign that my pain doctor was correct, that my curent pain is largely musculoskeletal and that I need to start getting more exercise into my routine to keep the pain at bay. 

I have noticed that on weekends as I'm out working in the yard, I just don't notice the pain until I stop and sit down for a while. Sometimes while working outside I'll go beyond the time that I would normally need to take more medication and not even realize it until I stop, other times if I feel pain coming on before it's time to take more meds I've found that going for a walk helps to reduce the pain until it is time for medication. It's been difficult to find time to work some kind of exercise into my daily routine, but I now know that I need to find a way to do so.

Today I visited the folks down at NIH again. After my last visit to the oncologist, he gave his blessing for me to enter this study that they've been trying to get me into so now that I'm ready to go for it, they are desperately trying to fit me into the protocol. The study requires that in order for me to enroll there must be evidence that my current treatment is no longer working. The problem is that I am doing great and am continuing to improve. They need data that shows a negative trend which thus far there has been none. It sounds like the bar for proof is pretty low which is why they keep taking so many tests whenever I visit so today they took blood once again and depending on the results that come back, we'll determine next steps. It's a little amusing that they've been pressuring me for some time to enroll in the study and now that I'm wiling, they are now not so sure that I can qualify, but are doing eveything that they can to shoehorn me in somehow.

It feels good to finally get something written after all of this time. If you are one of those following this blog to keep up with my progress, I apologize for the long wait, but "no news is good news" as they say and other than my depression over the motorcycle situation, things have been going really well for me. I seem to have achieved some measure of normalcy and am able to maintain that for the time being. I've been going into the office pretty much every day for the last couple of months without any negative consequences. It's been busy at work which hasn't left me with a lot of time to worry about keeping a log of every ache, pain, or discomfort that I've had. Mostly when I do feel it lately, the level of discomfort has been pretty low with it being more annoyance than anything. Hopefully this current trend will continue for the time being. We'll see what the next few weeks and months bring.

Staycation Plague

I took last week off to have a staycation and get some things done around the house. I was thwarted the first couple of days by rain. Took care of a few things the next couple of days and then the plague set in. The girls each came down with a mild fever and some bowel issues. It eventually caught up with me and took me down for a several days. After the worst of it had passed, it seemed to linger a couple of days longer than seemed reasonable. After sleeping through most of Memorial Day it finally occurred to me that I had practically eaten nothing for four days while continuing to faithfully take all of my medications. With no food in my system, the medicines overcompensated with the pain killers knocking me out for most of the day while the prescription laxative kept me occupied in other ways. Once I realized this, I stopped taking the laxative to give my system a chance to catch up. The next day I felt much better and was finally able to eat something. This was perhaps the worst staycation ever.

Tuesday I went back to NIH to follow up on the last visit and get their take on all of the scans that they took during the last session. It was largely more of the same and they didn't really have anything new to offer that I hadn't already heard. The scans show that it has progressed a littl further when compared to the original scans taken back in December. My PSA for the day was back up to 1.41 which they were trying to claim was an upward trend when you took mother last three readings two of which were taken on the same day of my last visit. It almost feels like they are desperately trying to find an indicator that things are regressing. They are still advocating that I enter this study that they have been promoting all along only now the approach is more of an "it can't hurt" message. They are recommending that I get on Aberaterone either via their study or through my oncologist. The write up for the study says that it's for patients whose treatment has stopped working but now they are saying that it would be better to start it before things get to that point. When I tried to get from them what benefit I would expect to get from the treatment, they mentioned that it had been known to extend the life of patients by 4 or 5 months but that if I took it I may never really know what benefit, if any I recieved from it. It all seems a little thin to me. When I last saw my oncologist he said that Aberaterone would be the next treatment that he would go to when it became necessary but he didnt seem concerned that it was needed at this point. I asked them to write up their recommendations for my doctor and I'll discuss it with him further at my next appointment. The biggest frustration in all of this is the uncertainty of it all. Nobody can say anything with any certainty, they can only speak in potential outcomes.

Today I returned to the office a little worse form the wear. After feeling no pain over the days I was sick and not eating, now that things have returned to normal, so have the normal aches and pains. They were a little elevated today, but that tends to be the norm the day after spending the day trekking down to NIH. I didn't sleep very well last night which probably contributed to it all today. Hopefully tomorrow will even out a little.

Nothing to see here.

My first two days of vacation have been rather unproductive. I've spent half of the last two days napping. I'm not sure what's going on, I haven't felt bad, I've just been tired and felt a little like a lump but otherwise things have been fine. The overcast and gloomy weather this weekend didn't help and I think I have a touch of the spring allergies. Hopefully tomorrow I'll be more productive.

Saw the radiation oncologist today to follow up on the hour long MRI that Inhad a couple of weeks ago. Even though the report showed an increase, he seemed unconcerned and said that while there may be more spots on the scan than the one back in December, it's possible that they were there before just not as visible. He said that it is "clinically insignificant" in the grand scheme of things and is not a cause for concern.

He did say that I looked a little pale and I mentioned that I've been extra tired the last couple of days. After reviewing my file he said that my hemoglobin is down a little since December, not enough to be concerned at this point, but something to keep an eye on, so I may be a little anemic.

Overall, he seemed to agree with everyone else that things are progressing well and that for now we just need to continue to keep an eye on things.

We Now Return to Our Regular Progress

The follow up at NIH proved to be a very log day full of various tests of one form or another. At the end of the day, the doctors came in and told me that my PSA that morning was 0.9 indicating that it had gone back down from the reading a couple of weeks prior that prompted this unplanned visit. I hope I was reading them wrong, but they almost seemed disappointed that it had gone down. They at least seemed puzzled by it and ordered yet another blood test before I left for the day to compare to the one from that morning. They also informed me that it would take some time for them to compare the scans of that day to the ones ordered by my doctors in the beginning. Apparently their system is different and incompatible with the system the local hospital uses, so they would need to do a manual comparison or something. After drawing my blood one more time, they sent me on my way saying that they would be in touch in a couple of days.

That following Friday, the doctor called me to ask how I was doing and to tell me that my PSA at the end of the day was 1.25, further proof of the erratic nature of the PSA readings. He said that they had not yet completed their analysis of the scans and would get back to me as soon as they had. That was a week ago and I haven't heard back from them yet. I have a follow up scheduled for the day after Memorial Day so we'll see what they have to say then.

I had visited my Oncologist the Thursday before all of this and he didn't seem overly concerned by all of it. He stated that the PSA trend was more important than any single value and that he medicine used in this trial is what he would probably put me on if my current treatment stopped working, but at this point there isn't any evidence of that. He ordered his own PSA test that day, but I haven't heard the results from him yet. I saw my pain management doctor that same day and he felt that I'm doing well overall. He asked if the Meloxicam was helping and I stated that I really couldn't tell, so he switched it out with Etodolac and asked me to let him know if that resulted in any change. He did take a quick look at the report from the long MRI that I had the previous Friday and was concerned that it seemed to indicate a spread but asked me to speak to the radiation oncologist about it. He said that it didn't make sense and seemed to run contra to all other signs and symptoms which have all indicated progress. I have an appointement with the radiation oncologist next week, so I'll hopefully know more then.

I don't know if the change to Etodolac made the difference or not, but I've felt pretty good this week. I've only had to take one or two Vocodin per day, usually first thing in the morning and maybe one on the way to bed. I managed to spend some time working in the yard all weekend and made it to the office 4 days this week, all without feeling any negative after affects. The only reason I didn't go in all 5 days was that Thursday I had a series of phone calls all day that started fairly early. Had I gone in, I would have been holed up in my office with the door shut most of the day on the phone anyway, so there wasn't much reason to drive in. Instead I holed myself up in the bedroom all day while I sat on those calls. Otherwise I would have made it a whole week in the office, a pretty significant milestone. I'm on vacation next week, taking a staycation. Assuming the weather cooperates and all goes well, I hope to clean out the garage, and perhaps my shop as well as get a number of tasks done in the yard. This week has made me optomistic about my chances for success in those endeavors. Hopefully the good feelings that I've had this week will carry over into next.