I am seeking four (4) new 17 in rims for my Nissan Frontier for the purpose of dedicated snow tires. If you have a set taken off your new Frontier, and would like to sell them, please DM me. Pickup is easier so my interest is 100 miles from 06611
The attached video is of my compost heat. My goal is to develop top soil to repair parts of my lawn. I have a large lot which needs to be mowed. There are quite a few trees which drop huge quantities of browns every year. The video shows my heap about 3 years old. It is mostly unmanaged as I believe in the patron saint Santo Bago. I occasionally drop coffee grinds into the mix. I rarely bless the heap with uric acid as this would be pissing in the ocean.
What is the opinion of the experts? How soon before I see paydirt?
My chosen cure path is through the Isotope Mountains located on the MSK tectonic plate. I had already stopped at HDR Falls where I picked up 15 Grays of radioactive rocks. MSK calls these ‘Sloan Stones.’ My trip yesterday was to their Koch Center in NYC to prepare for my arduous descend to the Five Pools at SBRT. This was the simulation process where I received my tattoo freckles. I was in their lobby and two treatment floors. Each floor had an art studio look and feel that had to be from the Milan School of Design. The locals tell me the interior design is for the patients who are stressed from the cancer treatment.
The visit involved an MRI. MSK has a 3T large bore (1.5 feet dia.) machine that is clearly not as imposing as the normal machines. The MRI technicians needed my lower GI tract and bladder to be just right so they could create perfect MRI images. I was treated like a piñata: too much gas, not enough water. It took over 30 minutes to attain the perfect setup. The MRI imaging took 20 minutes.
It was past 6 pm when I left to go to Grand Central. NYC is a hopping place for young adults. There must be plenty of jobs for these kids. The street activity on 3^(rd) Avenue looked like a fraternity party for super seniors. But my position in life is akin to Grisabella from CATS fame. I had my time in the sun. Now is the time to focus on my Isotope Mountain trip.
This is my Decipher read out from February this year. It is at odds with Scotty whose Deciper score was 0.87 mapping into a 8.7 % of distant mets in ten years.
Yesterday. my journey through the Isotope Mountains stopped at the Hot Springs of HDR Creek. My prostate received 20 Grays of radiation via 20 needles. Further down the road at the Five Pools at SBRT, I will receive an additional 7 Grays of radiation to complete my radiation treatment. In the OR, were three large LED screens showing images of my prostate lesion. Most interesting was the sepia-colored PET PSMA scan that showed the illuminated tumor. Although it was the same tumor, the PSMA PET image was more dramatic in presentation. The docs used these images along with trans-rectal ultrasound to place the HDR needles. I asked the doc will he treat my small amount of cribriform/intraductal cancer pattern with a higher dose. He responded no, they will hit it just as hard as the rest of the lesion. Only if my tumor has invaded the seminal vesicles or bladder, would they increase the dosage. The anesthesia was injected and I went out like a light.
I was jarred awake by me moving on a gurney noisily moving me to Recovery. It felt like I was in an episode of MASH being moved from the evac helicopter to surgery. But I was going through the hallways in the main campus of MSK. My doc, who was wheeling me, said the procedure went off perfectly. In Recovery (3 hours after entering the OR), I was met by the nurse who made me comfortable and said I could leave once my urinary functions were demonstrated. First, is if I could pee at will and if not, a catheter would be inserted. The OR doc said this was a rare occurrence. I passed this test easily. The next test was to urinate 200 ml of pee into a jug. Although still groggy from the anesthesia, I knew if I drank enough fluids, I could easily pass this test.
After an hour and a half, no pee.
I’m stuck in Folsom prison, and time keeps draggin’ on.
…..Johnny Cash, 1968
By now the anesthesia has fully worn off and reasoning entered my mind. Water entering the body is a zero sum game. It leaves through pee and exhales. No pee means I was dehydrated coming out of OR. This was probably due to my bowel prep procedure the night before. I amped up my drinking and ultimately peed 200 ml and was released from Folsom prison at 2 pm.
Post op, I am pain free. No bleeding, pain, or swelling of the perineum. I had the Barigel installed next to my rectum, but I don’t feel it. My urinary function is still healing but it is not too far off from pre treatment. I can pee at will and hold it in. I am taking Pyridium to ease the burning sensation. It turns the pee’s color to a mix between Yukon Gold and Red Sunset. Otherwise, I think with time my plumbing will be restored.
In the lobby of MSK, I was placed in a special lounge for post anesthesia patients and was watched over by an attendant. Yesterday, MSK performed six brachytherapy procedures. The clinical staff at MSK was all disciplined and followed procedures with no shortcuts. My experience so far confirms the COE status of MSK in prostate cancer.
In 2 weeks I go back to MSK for my simulation test in advance of my visit to the Five Pools of SBRT.
This afternoon, I will travel to NYC for my HDR brachytherapy treatment at the main campus of MSK tomorrow. It will be followed up with 5 fractions SBRT in late June. This 1-2 punch is known as brachyboost. I am lucky because my doctor ordered a PSA test at 74 yo that induced the cascade of diagnostic events leading to my treatment. I am also lucky that I have access to MSK who is the best in my region and probably the entire US for PCa.
I am also fortunate that my ADT therapy (4 months) has yielded only mild side effects (see my graphic). I am at halftime with Orgovyx and am surviving well. The only science that hints at my positive experience is my low starting testosterone of 270 ng/dl. Surprisingly, MSK has not ordered a T test after the start of Orgovyx.
My staging is Gleason 4+3, unfavorable with 1 core having 5% cancer showing cribiform and intraductal.
President Biden is 83 yo and was diagnosed last year with metastatic PCa to the bones. He is now on the many drugs that halt the progression of this disease. How is it possible that a sitting President who has access to the best medical care be diagnosed with Gleason 9 cancer? The answer is simple: Biden stopped getting PSA tests. His doctors didn't have to do it because he was over 70 yo.
Men, if you don't want to be surprised by a doc saying to you, out of the blue, that you have metastatic cancer, keep up with the PSA test. This applies to your dad and brother. Some medical systems quietly drop the PSA from your annual blood panel. It is up to you to demand its inclusion.
I had a long talk with my HDR nurse at MSK concerning the prep leading up to my procedure next week.
A question concerning ADT as an adjuvant to radiation has been raised on this subreddit.
Some men start ADT concurrent or after definitive radiation treatment. MSK's treatment is radically different. They start ADT months before radiation. For me, it will be 2 months at time of HDR. Why? They believe low testosterone shrinks the prostate for better targeting. It stops the progression of the tumor. But the biggest factor is low testosterone makes the cancerous lesions more sensitive to the radiation.
The nurse said the relationship between PCa, low T, and radiosensitivity is well known.
I visited MSK in Westchester today to be screened for anaesthesia use during HDR. They go through great lengths to ensure no issues during the surgical procedure. Blood draws, EKG, and detailed examination of my meds. My procedure is considered low risk. But RALP is considered high risk. I can only imagine its screening procedure. Compare and contrast: Just a few months ago, I was under general anaesthesia for my perineal biopsy. Then, there was no elaborate screening for anaesthesia. What I saw today was the high attention to detail which sets a Center of Excellence apart from others.
The Westchester facility is large and modern. The waiting room was full of patients that I knew some were PCa patients. All of them knew the issues before them through the power of MyChart. The concerned look on their faces foretold the questions they had for their doc. "Can you spare the nerves?" "How many months of ADT?" "It's been 1 year why have my erections not come back?" So on and so forth.
