The Iaido Journal Dec 2004

Kicking Cancer's Ugly Gray Ass

Bill Schuster has been training in Aikikai Aikido since 2000 and is involved with the Aikido-L listserve. This essay grew out of posts he originally shared with the members of Aikido-L after he was diagnosed with prostate cancer. We are pleased and thrilled to know that he is healthy again, and we are honored that he shared his battle with us. -The Editor

Dear Sensei, Sempai, and Friends

"I've been one poor correspondent, and I've been too, too hard to find.
But it doesn't mean you ain't been on my mind"...   Sister Golden Hair, The Eagles

It would be hard to overstate how much your support and understanding has meant to me during this struggle. I have a wonderful family and the people I work with have been great, but there is something special about my "Dojo Family". I have discussed my treatments with some of you, but not in any organized way. So I've laid it all down here.

The Bad News
In December my wife, Cecelia, and I took our first trip to the Cancer Treatment Center of America (CTCA) in Tulsa OK. The doctor told me that prostate cancer is almost always slow growing and rarely life-threatening. He went on to say that my cancer was the exception. It went from undetectable to very serious in two years. That sort of growth usually takes five to eight years. This was indeed aggressive and life-threatening.   That is when I started to see the cancer as an invading army, and developed a martial mind-set. I turned to Tsun Tzu and The Art of War. He advises the general of an invading force to forage for food and supplies. I thought about Napoleon's invasion of Russia. The Russian people made sure that there was nothing for the invading force to use; no food, no shelter, no fuel for fires. The invaders returned to France sick, starved, frozen and defeated. I realized that I could make my body a hostile environment for cancer cells.

Hormones
The growth of prostate cancer is triggered by testosterone and by growth hormones. In the absence of these hormones, the tumor (and the entire gland) shrinks. But even more importantly, the cancer is unable to spread when deprived of these hormones. So I started hormone therapy in December. In fact, as the Dr. was giving me the injection, he announced that as of that moment, I was treating my cancer. I took that as the beginning of my "Active Engagement" of this invading army. The hormone treatments have several side effects. Although none of them are very serious, hot flashes, chills, diminished strength, night sweats, loss of muscle mass, wild emotional swings, and sudden loss of energy are all inconvenient. The hormone treatment went on with 3 injections (each good for three months and 9 months of pills. I completed this treatment on 7/20 and will need another 3 to 6 months for the side effects to fade away.

The injections and pills took care of the testosterone, but growth hormones are another story. This is somewhat controversial. You can find research to prove that growth hormones in our food contribute directly to the growth of cancer, and research proving the opposite. I have decided to go with the recommendations of the team from CTCA, and avoid meat with growth hormones. That is nearly all of the meat at grocery stores. It just makes economic sense to inject steers with hormones that make them grow faster. Buying meat without growth hormones is expensive and requires more shopping. Cecelia has risen to the occasion with creative and interesting meals from turkey, chicken, and fish. My son-in-law's father has donated some venison, and I've deepened my interest in fishing. Milk is naturally full of growth hormones. It is, after all, breast milk for the calf. So I've switched to soy milk, and am not eating cheese.

Sugar
This, like the growth hormones in meat is controversial. But the CTCA team tells me that Prostate Cancer feeds on sugar, so I have eliminated almost all of the sugar and simple carbohydrates (digest quickly to sugar) like white rice and white flour. This is part of the no foraging strategy. A diet rich in complex carbohydrates is a good thing, but whole grains are difficult to find on restaurant menus. Just go into your favorite Italian place and ask for lasagna with whole wheat noodles! Again, Cecelia has adjusted to the extra shopping and learned the idiosyncrasies of preparing whole-grains. Alcohol digests quickly to sugar, but I have not completely stopped drinking. I figure with all of the other changes, the amount of sugar from moderate drinking is a small risk. While the avoidance of sugar and growth hormones in meat are not universally accepted as necessary for preventing future cancer invasions, the CTCA approach has a 10+ year history of way above average success.

Toxins, Protein, and Illness
I have to keep my immune system in top shape, and focused on the cancer. It is the primary defense against a recurrence of the cancer. Toward that end, I'm taking a fistful of supplements daily, and I have eliminated lots of toxins from my diet. The health professionals call this the "Toxin Load", and the less of it there is, the more available my immune system will be. The immune system rides on the lymphatic system, which is mostly made of protein. So my diet includes a little more protein than before. According to the team at Cancer Treatment Centers of America, pork is loaded with toxins. Most preservatives are bad, so I'm avoiding pork and reading food labels with new interest. They also told me that coffee is grown in countries with very lax controls of pesticides, so it's organic coffee or tea for me. To allow the immune system to focus on cancer cells, I have to minimize the "distractions". So I have been very careful about infections, colds and such. I don't want my immune system to be fighting an infected cut when it should be focusing on any stray cancer cells. More on the ruthless pursuit and destruction of escaping cancer cells later (see healing with imagery below).

Synergy - The whole is greater than the sum of the parts
One more thing on the subject of supplements. My treatment team told me about some new research on the effects of vitamin C on the lethality of radiation. It seems that when a prostate cancer cell is deprived of sugar, it can be tricked into ingesting vitamin C. The two share similar nuclear structure, so I've been told. Cancer cells which have been thus "seeded" with vitamin C are many more times as likely to die from a given dose of radiation than cells which have merely been deprived of sugar. Cells which have been deprived of sugar are themselves many, many more times as likely to die from that same dose of radiation. An excellent web cast on nutrition and cancer is at: https://www.cancercenter.com/web-casts/register.cfm?Video=4

Attack with Fire - Tsun Tzu
Tsun Tzu devotes a chapter to attacking with fire. One lesson is to start your fires where they will do the most good. Cecelia and I went back to Tulsa in early March, to escalate the "Active Engagement" of this invading army. This first of two radiation treatments used a delivery system called High Dose Rate (HDR) Brachy Therapy. It would be a three day trip. On the first day we met with numerous members of the treatment team to assure that we knew what to expect, what to do if things deviated from the plan, and who to contact for anything we might need. The goal of this phase of my treatment was to kill the cancer cells inside the tumor. So we used HDR, the "smart bomb" of radiation treatment: http://www.cancercenter.com/prostate-cancer/hdr-brachytherapy.cfm

Imagine an enemy encampment built on/in a hill. The top of the hill has a troop concentration manning defenses, but this is a small fragment of the enemy forces. The entire hill is honeycombed with narrow passages leading to thousands of small pockets of varying sizes. Each pocket contains a number of enemy proportional to its size. Now use advanced three-dimensional imaging technology to precisely locate each and every pocket. With this information at hand, carefully calculate exactly how much napalm it will take to incinerate the exact number of enemy in each pocket. Using too little will leave the enemy wounded - and you plan to take no prisoners. Too much will destroy the hill, which you need. Now comes the new smart bomb. It can penetrate the hill and separate into exactly the right number and size of bombletts. These are dispersed from within to every pocket delivering the carefully calculated "dose" of napalm.

OK, my prostate is the "hill", a point source of radiation is the napalm, and the location and dosage are guided by 3-D imagery. The actual delivery is through a set of 24 small diameter tubes that have been thrust into my prostate (think very narrow, hollow knitting needle) by a surgeon. This starts with "put your feet in the stirrups" just before the anesthesia takes effect. Like almost everything else that is hollow and goes into the body, these are called catheters. At this point the science becomes blurred with the art, and the treatment team's instincts, training, and hard-earned experience make the difference. Deciding which dosage to deliver to each spot in 3-dimensional space is not just a simple calculation, nor is selecting the optimal isotope. Placing the catheters so that they go through or near as many pockets as possible is the work of a skilled surgeon, guided by live high tech imaging. With a new set of images to show where the catheters have actually been placed, a computer calculates the speed at which the point source should move as it travels up and down each of the 24 catheters. With all this in place, the point source is sent down the first catheters, pausing here, going slowly there, speeding up to pass a cancer-free area all based on the above speed/dosage calculations. The patent is blissfully asleep from the time they start placing the first catheters through the first treatment. The catheters would stay in place for a second treatment later that day and a third the next morning. This day started at something like 4:30 AM, it was early afternoon when I came out of the anesthesia. Cecelia was there like the Angel she has always been, and I knew I was OK. After the warm glow of waking up to Cecelia's beautiful face, I realized that I was cold. NO, I was FREEZING!!! Apparently this is very common and the nurse had a little hat for me along with heated blankets. They actually have a small oven for that purpose. She just finished bundling me up when I got a hot flash and threw it all off. It seems that the hormone treatment combined with the radiation really screws up the body's temperature sensing and regulating. The hot part of this brought on heavy sweating, and the cold part teeth chattering shivers. This was to continue throughout my stay. My treatment team started visiting me soon after I woke up. My case manager, the radiation technicians, my radiation oncologist, my dietitian, a priest, a psychiatrist, the director of pain management, and others all came by. I was on a liquid diet. The only discomfort was during the ride from the hospital room back and forth to the treatment room. The bumps at the elevator doors were killing me. I soon had a standing order for morphine before every trip. I was awake for the second treatment and did not even feel the source moving through the catheters. The ride was painless too!!! Cecelia spent a great deal of time in waiting rooms and made friends with the wife of another patient having exactly the same treatment as me. Pat and Frank soon became friends. I passed a night of short naps, sweats and chills, but only the mildest of discomfort. In the morning, they took me down for my last treatment, preceded by new imaging which showed that 4 of the catheters had moved slightly in the night. These were repositioned with live imaging and moderate to high discomfort. The last treatment was soon over; the catheters and the template that had been stitched to my crotch to guide their placement were removed without any additional pain or medication. I spent the rest of the day recovering and converting to a solid diet.

Hospital Procedures
I was amazed at how much work it was to be a patient! Someone from Physical Therapy came to see me and told me that the lovely white stockings someone had put on me were not a fashion statement. It seems that while lying around with no activity, patients all too often develop blood clots in their legs. To prevent this, the compression hose (not stockings) are used to force the leg muscles to do some work. But that was not all; I was to rotate my ankles every hour in support of this effort. Then a respiration therapist came in with a strange little meter thing. He told me that patients who are bed-ridden tend to use only a small part of their lung capacity and this somehow increases the risk of pneumonia. To combat this, I had to breathe in through the meter. During the entire intake of air, I was to keep the indicator on the meter above a particular level. The inhale was to last at least 10 seconds and I was to do this several times an hour. My Cecelia was there to take the blankets off and put them back on and to help me remember to move my ankles and to breathe through the meter. I did not develop blood clots nor did I get pneumonia so I guess it all worked.

HDR Brachy Results
The treatment went exactly as planned. I had minimal side effects. Mostly temperature swings, fatigue and a little soreness. Lots of good meds for any pain. Overall, it was a good week. We killed a couple of trillion cancer cells!!!

Quote of the week: "You're the warrior, I'm the worrier" - Cecelia, wife of 33 years. She handles the stress, leaving me to deal with the battle.

NO PRISONERS
Another lesson from Tsn Zu is to position your troops where they can kill the enemy as they escape the fire. The next phase of my "Active Engagement" was Intensity Modulated Radiation Therapy (IMRT). This delivers a very precisely measured dose of radiation to a non-uniform section of 3-dimensional space. In this case, the exact shape of my prostate gland, but just a little bit larger. More on the technology later. It involved a 4 week stay in Tulsa from late March to late April. It was timed to start a week and a half after the HDR, and consisted of a one hour treatment Monday through Friday for 4 weeks or a total of 20 doses. Although the CTCA provides chauffeured town cars for patients, I wanted my own wheels. So Cecelia and I drove out there. We took our time and saw the Kent State memorial and the Indy Speedway on the way. She flew home on the following Tuesday and flew back a few days before my stay ended and we drove home together. Four weeks is a long time to be away from family and friends, so our youngest daughter, Laurie, came to see me for my second weekend away. I visited our new friends Frank and Pat from the shared experience and the waiting rooms. They even had me over for Easter dinner. I spoke with Cecelia every day and did little else than heal. This phase of the treatment plan was intended to get any cancer cells that escaped the HDR. These were still in the vicinity of the HDR target area, (by virtue of the timing) but less densely concentrated. So we used a different delivery system called Intensity Modulated Radiation Therapy (IMRT): http://www.cancercenter.com/prostate-cancer/imrt.cfm.

This is a fascinating technology. I was laid down on a table, with my body positioned in exactly the right spot. On my previous visit, an imaging technician precisely located my prostate and marked me with 3 tattooed dots. The IMRT table has laser sights which were lined up on my tattoos, and then the technicians did an ultrasound to verify the position of the prostate. This seemed redundant until they explained that the gland is not attached to the skeleton. It sort of floats with the rest of the internal organs. Very small adjustments were needed to fine tune my positioning. The radiation source (like an X-ray "head") moved in a half circle around me. As it moved, the radiation beam was constantly re-shaped to match the cross section of the target area as viewed from the radiation source's ever-changing position. Again the skill and judgment of the treatment team plays a major role. The idea is to deliver a near-lethal dose to the entire area. Cancer cells can not recover from this much radiation, while healthy cells can. By the next morning, the healthy cells have repaired themselves and the cancer cells are that much closer to death. The wounded and dead cancer cells are enveloped and removed by the immune system. Determining the precise size and 3-dimensional shape of the target area, and radiation dosage are as much art as science. There was no burning sensation, and the major side effect was more fatigue.

I allowed myself two good luck charms. I wore simple gold ring that our daughter found on the beach and gave me. It was on my finger for every treatment. I also carried a lucky quarter which a friend had pressed at the Star Trek Experience in Las Vegas. It had an image of the Enterprise stamped into it. After my last treatment, I gave it to the penguin. Penguin??? Tulsa has a fine zoo. When they needed money for a penguin exhibit, the zoo did a fund raising campaign by selling 8' tall penguin statues to businesses and individuals. The idea was to decorate the penguins, much like cows were done in NYC and Chicago. CTCA decorated one and it was located about 1/4 mile from the building. Every night I took a walk to clear my head and renew my fighting spirit. I'd walk over and exchange a high five with the "Cancer Fighter" penguin. Here is a photo of me with the penguin.

Healing With Imagery
While in Tulsa for the IMRT, I refined my technique for focusing my body's defenses. Through conscious relaxation and holding a vivid multi-sensory image in mind, one can influence the body's autonomic systems. I used two images. During the treatments, I envisioned a huge army, massed at the top of a hill with the battlefield below. The battlefield was under bombardment and my army waited for the bombardment to stop, then charged onto the field of battle like Galdalf at Helms Deep. After the radiation, many of the cancer cells were injured and I wanted my immune system to finish them of. The second image involved hunting down and eliminating stray cancer cells. For this, I used an image from the '70 film "The Fantastic Voyage". Antibodies, traveling through the blood stream in packs, find and envelop any cancer cells that they find. I envisioned packs of 3 to 4 dozen antibodies with half a dozen ranging ahead of the pack looking for cancer cells. You have to rent the movie to appreciate the scene when Raquel Welch gets caught by the antibodies.

Exercise
The best way to regain my stamina and my lost muscle mass is through exercise. While in Tulsa for IMRT, I had lots of time. I would walk for an hour outdoors and another hour on the indoor track. I did half an hour of floor exercises and another half on weight training. This was too much to maintain after my return to work, so I have had to cut back. I still put in an hour and a half to two every day. I use my Nordic Track and a weight set that Cecelia got for me, I still do floor exercises, and I've learned some Chi Kung from Tai Chi.

Results
This treatment plan and the life-style changes have paid off. The blood test for prostate cancer is called PSA. In December mine was 10.5 (above 4 and they send you for a more tests), last month it was "less than 0.01" which is the lowest result they report. Now, my body chemistry is still in flux and it is too soon to declare total victory. Another month will give definitive results. Someone once said that eternal vigilance is the price of freedom. All of these dietary and life-style changes are my eternal vigilance.

Well, that's it, the whole story. I'll see you on the mat as soon as my recovery allows.

The Final Chapter
Cecelia and I traveled to the Cancer Treatment Center last Sunday. They drew blood Sunday evening and had the results for our appointment with my doctor on Monday.

The previous set of results were suspect, as my body chemistry had not reached anything like a steady state. Monday's results are definitive.

*************************** This Uke is DEAD ***************************

And I want to thank all of you for your support throughout this battle. All the good thoughts, prayers, positive energy - whatever you call it has paid off. The strength to do this came from many sources and every one of you is among them.

I still have to follow a special diet and take supplements and keep up the exercise program, to stay cancer-free. So I have transitioned from an active running battle to "eternal vigilance".

Lessons:
What did I learn from this fight to the death? Well, a few things.

Controlling Ma Mi
This was a long drawn-out attack when the cancer was detected. I knew that I had to act, but I also knew that I had enough time to plan my defense and engage the enemy at a time and place of my choosing. This gave me the advantage of preparing the battlefield; much like the Seven Samurai lured the enemy into attacking at the chosen place. It also allowed me to form strategic alliances with the medical team and my network of friends and supporters.

Seize the moment:
There is nothing like surviving a deadly attack to make you appreciate life. A much loved Sempai reminded me to see every training opportunity as if it were my last chance to train with that partner. That applies to other encounters with all the people in my life, not just training partners.

Moral Support
It really, really, really helps to have family and friends to offer the moral support and encouragement that kept my spirit strong.

So I offer very big THANK YOU VERY MUCH from me to you.

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TIN Dec 2004