Windsurfing with metastatic prostate cancer, a message, and periodic progress updates. . .

June 22nd, 2022

My life was blessed for 81+ years. Nothing that physically serious or threatening ever got in the way of a self-perceived somewhat athletic lifestyle. As a youngster my life was filled with play. Baseball, year round street/cosom hockey, soccer, skating, water-skiing, swimming, body surfing, hiking, camping, biking, and all the many other youthful passions that filled my recreational, childhood days.

As an adult, life included a serious commitment to skiing, running, hiking, cycling, racquetball, surfing, windsurfing, and now a serious attentive resolution in learning to wind foil.

Working out at a gym and home, plus walking daily, became a resolution and commitment over the past few decades as my body aged and needed help in continuing physical pursuits.

As with many of my friends a few accidents occurred along the way. A mangled left hand and a whiplash injury, were two of the more serious challenges needing to be overcome. With a skilled surgeon and a poster boy attitude in whatever the physiotherapy required for a successful recovery (for those two) and and several other rehabilitation were easy. Perhaps a positive attitude and a love of whatever the sport was the input that helped in the healing success. Then too, as now, I feared that windsurfing might be compromised. (2004 early fall) - The very talented hand surgeon, Dr. Huc, who met me at the hospital to which I was directed suggested that my first finger would likely become a problem. Circulation, winter cold, and lack of control (like putting my left hand in my pocket) could be a lasting problem. He suggested removing the finger. My response was to leave it for a year to see whatever the outcome. It did take a second surgical repair and followup plus additional hand specific physiotherapy but within a year grip strength of 120 pounds in the injured hand/finger exceeded that in the right hand. Windsurfing was in fact the light at the end of my tunnel. If it’s going to be it’s up to me was/is the personal mantra that continues to echo in my mind…

If it’s going to be, it’s up to me…

About a year ago, a strongly requested PSA test showed an elevated likelihood of prostate cancer. At 75 years I was told that PSA tests for me were to be discontinued. I was told that prostate cancer was a slow moving disease and the likelihood of dying from another cause was more likely the expected outcome than dying from prostate cancer.

At 81 years of age and still going strong life was good. I was referred to a specialized team of Urologists in St. Catharines for treatment.

A prescribed needle biopsy missed targeting the tumor. I was told that a tumour (if any) was small and to simply wait and watch, but a follow up second PSA test a few months later (42.7 mg/ml) resulted in an “oops, we missed something” and an MRI was scheduled. The PSA level in blood is measured in units called nanograms per milliliter (ng/mL)

My ultimate prognosis was diagnosed as advanced metastatic prostate cancer. The malignancy had spread into the pelvic lymph nodes. Fortunately, prostate cancer is one of the better cancers to treat or cure when caught in time. Pancreatic, lung, blood, and brain cancer, to name a few, are considerably more lethal diseases.

The current recommended standard treatment in Ontario for my condition involves hormone therapy along with radiation all within a period of about 5 - 6 months. There is likelihood that there might be a continuance of hormone treatment for another year or two depending on the outcome of testing. My prognosis for whatever degree of recovery is good according to the urologiosts involved in my procedure.

Treatments can differ around the world and here in Canada as well. Everything from electric needles in Germany and at currently North Toronto Prostate Centre (NanoKnife) to stem cell therapy in Mexico, Panama, and India.

My hormone treatment first involved 30 daily pills (Bicalutamide) and continued 3 month injections of a slow release medication (Leuprolide) for a duration to be decided by the medical team. Hormone therapy for males simply gets rid of the testosterone in the body. The hormones are designed to starve the malignancies which feed on testosterone. The hope is the malignancies will shrink or starve in the absence of testosterone. In any event the malignant tumours remaining will hopefully be eliminated when radiation is eventually included in the treatment.

The side effects are a bit of a challenge both physically and emotionally. From mood swings, sweats, to hot flashes, AKA male PMS, the long list goes on. I continue to walk, stretch, windsurf, foil, and work out. Prayer, QiGong, Yoga, and Reiki are personal inclusions in my daily/weekly time management. Research and reading anything involving healing is also essential. As would be expected a healthy and sensible daily diet is also included.

Reduction in strength and endurance have been noted and will likely continue to increase. That said walks and gym workouts are nearby to the numbers before treatment but with discomfort as expected. Windsurf and foil activities will continue on windy days whenever treatment scheduling, and prudent safety limits permit..

A few thoughts. . . Be careful searching the web with Doctor Google if you ever face my challenge. YouTube, advertisements, Samurais with solutions, books, diets, pills, whatever, lurk about the world wide web. Unproven treatments abound. Fake news exists “out there” at its best. The incentive to make money (at your expense) are plentiful. Take care. Find peer reviewed factual information and recommendations from proven places & qualified people like your doctor(s), your oncologist(s), and leading medical university studies and publications.

Insist on a PSA test whatever your age. The potential dilemma I currently face is a result of my lack of insistence on a PSA test for a few too many years. The ultimate decision should be ours. We should for the most part be in control of our own health care. Life is good.

July 2nd

An appointment on June 30th advised that hormone treatment was working well and will continue for another 3 months (and maybe up to 21 more months). PSA level was down to 0.58 mg/ml, a huge difference from the 42.7mg/ml showing a few months ago. The malignant tumours are shrinking.

Radiation treatments begin this coming Wednesday, July 6th and will continue 5 times weekly, Monday - Friday, for 8 weeks, a total of 40 sessions ending September 1st.

Expecting to be able to continue to walk, work out, windsurf, and do most everything within my accustomed lifestyle for the most part. Strength and endurance will continue to decrease as testosterone levels continue to lessen or maybe better expressed as peter out …ha! And those distracting side effects from hormone therapy will continue for another three months or more, along with whatever the future side effects from radiation will eventually present. . .

Wind-foiled twice in the past two weeks. Shorter sessions prevailed mostly due to timelines or wind but was able to easily up-haul and fly. Still have to keep the board on the water to complete the turns. In flight jibes by the fall are a definite possibility.

July 9th

Finally, made a full foiling jibe, not very pretty, and yes, a wee bit of luck was involved. . .

Foiling involves less strength/endurance and for next few years it will be my go to wind involvement for the most part. Much of my higher wind windsurfing gear will be sold or stored.

And maybe, start driving some golf balls, with serious intention.

July 24th

As all of the many uncomfortable physical side effects included in the hormone/radiation treatments continue it seems that making plans and considering acquisitions are not the clear focus it once was. Life is becoming a wait and see experience.

To add to the moment both Nancie and I have health concerns. The what if considerations now become a cautionary traffic light. Once, a time ago, dwelling in possibilities and confidence defined our lifestyle. Now, dwelling in uncertainties we live with apprehension and pause for the most part.

As a self defined windsurfer of 42 years I can currently accept/expect lacklustre turns, jumps, and a loss of strength/endurance. As physical side effects and treatment continue it seems that making plans and considering any acquisitions become somewhat more challenging. A simple return to remembered lifestyle and living is most often the main agenda in my mind. Daily routines are often on hold. Making any travel or gear changes to accommodate any new normal and uncertainty become impulsive thoughts that are and need to be recognized quickly, and simply put on hold.

All in all, I simply want the old reality back.

So it’s a waiting game. And, one for which I am honestly thankful in knowing, and will have to endure whatever the prescribed treatment. Once radiation and hormone therapy are eventually over both cardiovascular and strength training will continue anew. Together these two significant activities will help with the return to whatever the new normal will be. If it’s going to be, it’s up to me. Any journey begins to unfold with a single step.

Hope is not a strategy. Having a plan, intention, and inspiration to begin again is.

And lastly - whatever gear needed will then find its way into a quiver stowed carefully in whatever the surfmobile needs to become. Cheers

August 4th

Passed the half way point for radiation treatment a few days ago. Only 18 more sessions left till September 1st. Hormone therapy will likely continue for another 5 more months, and maybe more depending on how treatment results unfold. I understand that the metastasized tumour contained in my pelvic lymph glands/nodes will also be given a higher dose of more intense and focused radiation in the next while.

Windsurfing/foiling is still a part of my life along with all of the household responsibilities & etc. on my at home agenda and elsewhere list.

Physical strength and endurance has noticeably decreased on the water due to a large drop in testosterone production affecting my current muscle mass. Increased fatigue is evident throughout the day. Hot flashes/hot flushes and sweating are common daily occurrences. Occasional bouts of mild nausea, distraction, and dizziness still occur but have noticeably lessened for me over the months since April. (All of the side effects from radiation and hormone therapy can be easily found with the help of Dr. Google.) They are common to males with prostate cancer and once recognized can be/have been easily handled and accepted in my opinion. That said I haven’t met anyone in the waiting room waiting for radiation who likes the hormone therapy side effects, other than it works helping treat the disease.

Walking to and from the gym workouts have been somewhat irregular but at present will be a daily ritual on non windy days. Workout weights and reps are much the same as always maybe lessened by about 10 - 20 pounds for the most part as determined by a kind of common sense at the moment. The van is pressed into service on hot, high in the sky sun and higher outside temperatures as needed. The tread mill helps complete the daily steps that have become a priority.

Muscle ache after working out is common and an occasional Tylenol helps deal with that.

Nightly bathroom trips number 4 to 6 times, with no alarm clock necessary. Water is always nearby to help stay hydrated+ for for both radiation and cleansing throughout the day and night.

Becoming better organized reduces stress by knowing where keys, wallet, glasses, and cell phone etc. are placed and kept. Having one place in the car/van and/or at home has become a high priority as memory loss and distraction seems to be a side effect that needed to be mindfully handled in my case.

On windy days I head for Long Beach after radiation sometimes making 2 to 3 washroom stops along the way with a packed lunch, hot coffee and a breakfast snack.

All in all my lifestyle hasn’t fundamentally changed that much at this time.

Seated and waiting to be called in, I see many other patients around me each day currently in treatment and in different stages of their different cancers. Many patients sit like me, waiting for radiation, whatever, before and after after surgery. They talk. We sometimes talk. Many of their lives have fundamentally changed, not only for them but also for their loved ones as well. Their courage is admirable. My thoughts, words, and prayers are extended to each one of them as possible in conversation. Often, I simply count my blessings and sit silently with gratitude.

Another thought worth mentioning - the thoughtful, caring staff at the Walker Cancer Centre are extraordinary. Their patience and attitude is both appreciated and openly expressed by others in waiting room conversations.

Over the next few weeks here at home we will all be together as a family. Nancie’s summer birthday will once again be celebrated with our children and grandchildren. Life is good.

If my prognosis is as good as my oncologist and team have suggested it definitely helps in looking ahead. I have a great deal for which to be thankful. Pretty sure that my wait time over the next few months will be an easy one, with no complaints.

Que sera, sera. . .

Prepping a water start on fin, Pamlico Sound, OBX, N.C.

August, 24th, 2022. Am counting down the days and sincerely looking forward to a last radiation treatment at 9:00 a.m., on Thursday, September 1st, 2022.

For these past few weeks the increasing (side) effects of both radiation and hormone treatments are best described as challenging and uncomfortable. Intestinal discomfort including Montezuma's revenge, constipation, gas, irregularity, fatigue and the like have been common. Recommended over the counter medications to balance and ease these symptoms have been helpful but not always in step coinciding with the moment. Thank goodness for the likes of Imodium, Gas-X, metamucil, etc etc. I am also taking Vanlafaxine to help ease some of the the side effects of the hormone therapy that produce hot flashes and heavy sweating. Hopefully the possible side effects which that prescription includes will not occur. There have been a number of occasions in which I was instructed to make corrective adjustments before before proceeding with treatment. (A mini MRI scan is performed at the beginning of each radiation session to check for a correct bladder level, no gas bubbles, etc. etc. within before radiation begins.)

As previously mentioned this is not a complaint. Prostate cancer is both more treatable and generally much easier to tolerate than the many other, more serious cancers. That said, it’s also important to mention that prostate cancer is currently the second leading cause of death in American males and the 3rd leading cause of death In Canadian males.

This journal entry is simply a journey of sorts related to aging with cancer and readjusting to a windsurfing lifestyle that’s being threatened with hormone and radiation treatment for my metastatic prostate cancer.

As previously mentioned, one of the issues with hormone therapy facing a windsurfer or any male athlete is a reduction of energy, strength, and endurance which all depend on testosterone to help build and maintain muscle. Testosterone is the food on which prostrate cancer cells need to consume to thrive. Hormone therapy over a period of time kills testosterone produced by the body and in so doing starves, shrinks, and kills the cancerous cells causing prostate cancer.

If treatment is successful so too will be an on going plan focusing on strength and cardio including distance walking, working out, windsurfing, and adjusting my diet and board gear accordingly. My windsurfing plan is to continue to be there and not give up windsurfing & foiling and to persist doing whatever it takes to advance and achieve my personal best. Or more simply put - Just Keep On Keepin’ On…

It will late November when the lingering radiation in my body is finally gone and a diagnosis can be better made as to how successful the outcome of my whole treatment has been in getting rid of the malignant tumours. A cure would be the best result, or a continued treatment for an extended time would be the next best hope. With a metastatic cancer there’s a chance of a spread or (re)growth of cancerous cells elsewhere in the body that might not have been killed. It’s a wait and see at this point. One patient with whom I talked believed that he was cured but in fact a recent PET Scan showed cancerous cells were found in lymph nodes elsewhere in his body. A disappointing setback.

I feel too that we need to be mindful in helping our immune system improve with whatever diet, exercise, new or old therapy (i.e. stem cells), or medical advisement becomes available. I am confident that a cure for the many cancers will be discovered and will become not only available but also hopefully affordable at some time in the near future.

In the meantime it’s a waiting game. We ponder whatever the outcome of our disease and hope for the best. We live on. We question and become more thankful not only in our existence but also our purpose.

We are not built to last forever and something will eventually happen to each one of us to cause our end of life.

Are we spirits on a human journey or humans on a spiritual journey? The universe is a huge playing field. Our imagination and faith can either limit or extend our possibilities.

On a lighter note, a short verse…

When God has closed my coffin lid,

I’ll do no more the things I did,

Thank God I did them when i did.

Oct. 6th, 2022 It’s been about 4 weeks since radiation ended. Things are pretty much back on track. Bananas and Rice Krispies are finally in the past! The fatigue and daily naps have thankfully ended. Bowel movements and intestinal discomfort have returned to mostly near normal. Daily one hour walks (including squats and lunges) are back on track, workouts at the gym number 3 - 4 times weekly including 2 sets of 10 - 15 reps on 13 machines being tolerable. Have had a few good days on the water making progress on the foil but windsurfing is currently on the back burner until strength, stamina, endurance and courage return.

The telling numbers (PSA 0.02 and testotorone .5) are somewhat as expected and will likely change over the course of continued hormone treatment which may go on for a full 27 - 36 months. Am getting used to the gnarly hormone treatment which will continue to starve and shrink any remaining malignant cells that remain or somehow get created.

Two more review appointments in December will better indicate whatever progress has been made.

A new foil board (pic below on top of the heap) has been introduced into the quiver that will be pressed into service wind/weather permitting, hopefully this coming Thursday.

Thursday, December 1st, 2022 Dr. Ishkanian, my radiation oncologist from the Walker Family Cancer Centre called with good news today. The beam radiation focus and duration he prescribed plus his accurate numbers in the treatment were all spot on! Recent blood-work came back with the best of numbers at this half way point in my treatment. Zero Zero. These are the numbers for PSA and testostorone. In other words, my cancer isn’t showing any sign of activity at this time. If these numbers reoccur 6 months from now it would strongly indicate that my cancer is (cured/in remmision) or at least under the best control possible. Hormone Therapy would be discontinued shortly thereafter to see if in fact the cancer is gone. So with fingers crossed and hope (neither of which is a realistic strategy) in remission may well be in my future.

Workouts at the gym are currently the same numbers as a year ago before the diagnosis. Strength is good, stamina is questionable, but yes - windsurfing/foiling will definitely be a part of my immediate future. Santa Nancie has approved a new winter wetsuit to accompany my new foil board and windsurf gear. Hatteras (OBX) is booked for the spring and fall 2023 and colder water periods through to November and after returning from Hatteras in April will be a doable reality.

Walking and hiking daily for at least an hour is a continuing routine. A good diet, stretching, QiGong, a few old favourite yoga poses are included in all this just in case, plus on going Reiki with Diava.

More important at this point is also an expression of gratitude and thanks to the doctors, nursing staff, and radiologists at Walker Cancer Centre in St. Catharines and Niagara Urology Associates Inc., St. Catharines. The timing following Covid and the other stressful pressures our Health Care System currently faces has not been easy for them. A sincere thank you to all.

This story will continue to unfold over the next year and as long as Hormone Therapy injections are deemed necessary to help control and continue to kill any and all cancer cells that may be lingering. . .

Pamlico Sound, (OBX) N.C. Shortest foil mast for the many shallow runs. Hopefully next Spring 2023…