Well, if nothing else, it means I continue to have great sympathy with women going through menopause. Strange as that may seem, I continue to have hot flashes. From what various women have said about their hot flashes, mine have apparently been relatively mild. That symptom will continue for some time after the end of the hormone therapy. The reason is that it may take between six to twelve months for my testosterone level to return to a normal level.

The purpose of the Lupron® hormone was to eliminate the testosterone that feeds cancerous prostate cells. I was surprised when I learned that I would have only two Lupron injections, each lasting for three months. The reason is that it was simply a pellet injected subcutaneously – into the fatty tissue under my skin. The first one was into the abdomen, several inches from the navel. The second – and last – was into the upper, outer-thigh under loose skin. Those pellets dissolve slowly over three months, so the six months of hormone therapy, which started at the same time as the radiation therapy, expires at the end of the current month.

So the two symptoms that I will continue to experience for a few months will be the hot flashes and the lower level of energy. As far as my daily life, it has been back to normal, though with a tendency to take short naps a bit more often.

This is likely my last post solely about my therapy. I've been thinking about shifting to weekly posts about what I'm reading, watching, and thinking about these days.

Feel free to unsubscribe if you'd rather not get those posts emailed to you as well.

Life goes on – until it doesn't.

Therefore, the fact that two days ago I had my first cup of coffee – with no negative impact in the past forty-eight hours – strongly suggests I'm getting back to normal as had been projected by the therapy experts.

The other thing that supports that suggestion is that for the past several days I have not had to eat a lot of extra things — like cookies, ice cream, potato chips, etc — just to keep my weight constant as required. That is because the therapists want the pelvic mold to fit correctly. Today I'm actually a bit more than a pound above my desired weight – without eating all the extras.

What that means is that the balance of my recovery will remain slow. The second hormone tablet inside me won't be done slowly dissolving until the end of October. That means the low energy level – and the urge to nap throughout the day – will not disappear for some time yet.

Therefore, this is likely the last post on my therapy update – at least for the next several months.

It also means that, as my level of energy slowly returns, I may return to what was my original goal for rwhitney.com – a weekly or biweekly blog, perhaps about the books I'm reading, what's happening in my neighborhood during this extension of the pandemic and even, possibly, commenting on interesting YouTube videos I often watch, usually heterodox analysts talking about current social and political issues.

Basically last week the main thing I accomplished was the last three radiation therapy sessions. Now at least I am recovered enough to do simple things like write this update – but the projection I got from my radiation oncologist was not to expect much recovery for the next several weeks because the body will still be dealing with the impact of radiation on the targeted tissues in my pelvis. After that, only after the a hormone expires in October will the body slowly start to get me back to a normal testosterone level – which is key to having the level of energy one is used to for daily life. It could between six to twelve months – from April to October 2022 – before I get back to what feels like I was before it all started. Also there is a low risk of permanent effects due to the therapy, which could take up to four months from the end of therapy to show up.

At the moment, I seem to be having a hot flash – I now seem to get those at least several times every day – and that won't stop till my testosterone starts to recover. Oh well.

At least now I don't have to spend a half day going and coming from Memorial Sloan Kettering – a nice change even though the therapy staff were all very affable as well as extremely professional.

So, life goes on, just rather slowly for a while now....

If I manage to stay on schedule, Wednesday will be the day Kate finally comes with me so she can photograph me ringing the bell used to celebrate the completion of one's therapy sessions. Although I considered four weeks of daily sessions a long time, when I checked Cancer.Net I learned that these sessions range between 3 and 9 weeks, five sessions during each week. I now have a deep appreciate for patients who have to put up more than twice the radiation therapy sessions I'm nearly done with.

I also learned that my hormone therapy, Lupron, is often twenty-four to thirty-six months long. Again, I'm glad I'm only putting up with six months of hormone therapy, especially given the cumulative side-effects I already experience – hot flashes, tiredness, occasional joint aches, upset stomach – all relatively mild for now, but I really sympathize with those who have to deal with the strength of such effects after several years of hormone therapy.

My main concern at the moment is the cold I think I caught from Kate. Her cold symptoms have been very strong, strong enough that she checked with an urgent care unit where she also was tested for covid (negative) even though we've both been vaccinated. So far, my symptoms have been mild enough that they wouldn't interfere with radiation therapy. Obviously, I hope that remains the case for the next five days.

In this week's consultation with my radiation oncologist, I learned that side effects will peak during the two weeks or so following the last radiation session. Since the last session is scheduled for Wednesday, August 11, I take that to mean the last half of August will be my lowest period, with slow recovery in September and October. The hormone pellet lasts through October, so I should probably not expect anything like a complete return to normal until the year's end.

Based on my conversation with Dr. Shasha on Wednesday, I now consider that returning to normal will be when I can drink a cup of coffee with no digestive impact. Dr. Shasha recommended not trying any coffee for two to three weeks; his assistant has actually previously recommended holding off for a month. It's not that I'm a big coffee drinker – usually only one cup a day and not even every day – but coffee was the one thing I was told to absolutely avoid. Apparently the digestive impact of coffee during radiation therapy is not just the caffeine, as I am able to drink a small diet Pepsi, for example, with no impact even though it does have some caffeine.

I'll also be pleased when I can safely return to eating fresh vegetables and fruits. As of now, only bananas are allowed – all the rest are apparently a bit too difficult for my radiation-irritated digestive system. Also, at some point, I hope to return to being able to make it through a day without needing a nap.

Despite all the effects I just mentioned, daily life is still well worth living – I'm still able to eat many of my favorite foods, eat out occasionally at a restaurant, walk through the park and, often, even able to read or watch TV without falling to sleep. So life does go one, just a bit more slowly than usual...

So far, the side effects remain manageable for me. My digestion has been fairly normal, due as advised to avoiding a large number of items normally part of my daily diet – fresh fruit, fresh vegetables, coffee and alcohol, among others. It will probably be at least two more months before I can slowly return to my normal diet.

I also received the results of a detailed genetic test, which found none of the variants known at present to be associated with cancer. When I got the report I was amazed at the number of genes that had been tested -26! One variant was found to be an uncertain finding, meaning that three labs thought there might be a relationship to cancer and four labs rejected that evaluation. I was advised that result will likely be shifted to 'negative' as more research is completed. I was also given a bit of advice to pass on to direct relatives, which would be principally my son, Paul, but also potentially my brother and sister.

The treatments I am receiving at Memorial Sloan Kettering are very standard treatments that could be provided most good medical centers across the county. However, when I am at MSK, I know that all the patients I see there are dealing with cancer of some type. When in the waiting room, any men who have been asked to drink a cup of water are other men undergoing the same treatment as myself. I see many of the same guys every day.

What happens nearly ever day is one or two patients ringing the bell that signifies their completion of radiation therapy – always greeted by clapping from all the rest of us & good wishes for their final departure. In less than three weeks, that will include me!

In this week's conversation with radiation oncologist Dr. Shasha, I learned that the radiation would be more limited for the final fifteen sessions, focused just on the immediate area around the prostate location rather than the entire pelvis. That means, according to the doctor, that the laxative impact of radiation will be reduced.

Though my cells producing PSA were to limited to be found with MRI scans, the high probability is that they're located in one or more of the many lymph nodes near the prostate gland. Of course, when removed, it appeared that the tumor had not gotten close to the prostate exterior, which means the chance of recurrence is low. Surprisingly, there is a small chance that biopsy's cell extraction can result in cells spreading. Obviously the biopsy benefit outweighs that risk – but it's reminder that virtually no medical procedure is truly free of risk.

In any case I was one of the 30% of guys who have some level of recurrence after their prostatectomy. Obviously I now hope I'm going to join the 70% of guys who never need any further therapy!

Next week, when I do a status check with the radiation oncologist, Dr. Shasha, it will be a halfway mark. Though Dr. Shasha is excellent, I actually spend more time talking with his support nurses. His status checks are generally very brief, simply because one of his nurses has already gathered my answers for him to review before we talk. I have no issue with that procedure at all; in fact, I think it's a good way to make the best use of his and my time, as the nurses are all quite excellent themselves.

So far, I have no new symptoms and the ones I do have are relatively modest and manageable. Over the past several days, I've been experiencing digestive issues and mild fatigue – and have learned how to deal with those issues so that I don't also become depressed about the whole process.

It is always a pleasure to see a patient ring the bell that signals they've completed their therapy – to which all of us in the waiting room clap our hands vigorously and then wave good-bye as the patient departs, hopefully for the last time ever.

The only thing I have missed these past few days has been the ability to walk comfortably back home from MSK. What has kept me from doing that has not been therapy symptoms – it has simply been bad weather, mostly very hot and, when not hot, too much rain. I'm hoping I can get back to that post-therapy walk next week.

Meantime, life goes on relatively calmly.

It's relief because I am now experiencing at least some of the symptoms commonly associated with radiation therapy. When I reported several more days of either very loose stool or up to half a day of minor diarrhea, the doctor said symptoms often started around two or three weeks of sessions – exactly where I am. The nurse I talked with first explained what to do for managing diarrhea caused by therapy. While talking with her, I realized I might be also be experiencing minor heat flashes, triggered by the combination of the Lupin hormone and the very hot weather of the past week.

Most sessions are now very routine, but there were two a bit different last week. Tuesday in the midst of the actual therapy, the radiation machine froze. With me still in position, engineers entered the room and tried to fix the problem. After about ten minutes, the decision was made to move me to another machine. What impressed me was the second machine was able to start up where the other machine stopped. The other thing that impressed me was that I was able to hold my full bladder for the length of the delay.

Yesterday, after the initial x-ray that starts every session, the senior technician came back in an said I had a bubble of gas in my bowel. She asked if I could pass it; I said I didn't feel anything that could be passed. She then suggested I just wiggle around – as much as possible while locked in by the cast of my pelvis – and she would take another image in two minutes. That worked – I suppose my wiggling caused the gas to temporarily break up and disperse throughout my guts. I complemented her for the advice on the way out.

Finally, I believe I am just beginning to feel a bit of the predicted fatigue associated with therapy – so, hopefully, I'll just be sleeping a bit more and briefly napping during the day.

The sessions themselves are now very routine and short. I have to check in 45 minutes early, just to drink a cup of water when asked. I spend the waiting time reading either a book on my Kindle or emails and news on my iPhone. When notified to go to the men's dressing room, it takes me 3-5 minutes to take off pants and underwear, put on the robe, and stash everything in the bag I take with me. There's usually a 5-10 minute wait before a technician calls me into the radiation room. It takes the technicians several minutes to position me and lock down the cast of my pelvis that keeps me in place. When they leave the room, the therapy machine starts moving around me for about five minutes, and then the technicians return, unlock the cast and say goodbye.

Yesterday I saw something I hadn't seen before. It looked like a daughter asking her mom to wait a minute until she was ready to do an iPhone video of her mother. When I heard the bell I realized her mom was standing just below a small bell on the hallway corner next to the check-in desk – and the video was her mother pulling to bell to announce she had finished her therapy. When folks in the waiting room heard the bell, they all clapped loudly for her as she waved goodbye and headed to the elevator for her (hopefully) final departure.

As a result, I now realize that Kate should come with me to my last session so that she can do the same for me! That will be about seven weeks from now.

Yesterday was another nice day to get exercise by walking back from MSK. On the way back, Kate and I texted each other, both unsure about whether we wanted to eat out again. After a while Kate called, and by the time we decided we'd both like to eat out I was at Central Park West and 69th street. We agreed to meet at French Roast and both managed to show up at the same time. After looking at the outdoor options, we decided to eat inside, where there was less noise and fewer people. I had a Steak Frite, of which half I brought home to finish. The delicious fries were finished by Kate and me.

Despite the daily therapy sessions, life goes on fairly well these days....