Bad Logic

   I use to be immortal. Life insurance was for an older and much wiser genre. I got sick. Now it is too late. They don't sell life insurance to people who need it. I was kind of like this guy.

  Okay so I wasn't the brightest crayon in the box. Few faux-immortals are. It wasn't a problem prior to Diagnosis.

         I kind of felt like this guy.

So, I am going to die really young they said. How do I provide for my family? "Simple" said my financial guy. "Go heavily into debt on high dollar minimally depreciating items and take out life insurance on the loans." Wow... Great idea. I die, the loans are paid off and Mandy can sell the Items for profit.

   As mentioned above, I am not the brightest crayon in the box. Further more I am not the sharpest tool in the shed. I am a brick short of a load. My elevator doesn't reach the "Top floor", and if brains were gasoline, I couldn't power a sugar ants motorcycle around the inside of A cheerio! I neglected to factor in one possible scenario. What if I don't die?

   For the last ten+ years I have remained heavily in debt hoping to buck the system. Over the course of ten years, I have managed to piurchase and pay off quality firearms, expensive guitars, a very nice boat and several other toys and vehicles. While in doing so I have managed to fill our toy box, it is clear that 10 years later I would have served my family far better by putting that money into short term bonds and long term investments. I am not complaining. It has been a lot of fun. Mandy will benefit financially and we have all benefitted in the enjoyment of our lifestyle but hindsight is 20/20. 

   My plan would have worked quite well had I followed my original prognosis but I guess life really is a crap shoot. 

In summation: "It is time to go boat shopping!!"

   

   

Adjusting to a new chapter

   Writing has been slow as of late. Perhaps it is on a parallel course with life.

Last year it seemed as though we were running somewhere every evening after work. Our daughter kept us busy. It was her senior year in high school. It seemed as though we were attending a different function every other night just trying to keep up with her. The last few weeks of high school we had multiple activities almost daily. And then it ended!

   Life is still. Michaela began her first job and is starting college in a week. Many evenings it is just Mandy and I at home. It is a quiet time but it has its own special beauty. Michaela is transitioning into adulthood and adjustioning quite well to the new responsibilities. She opened her first checking account and religiously saves for the third of tuition we require her to pay herself. It is not that we cannot afford to pay all her tuition but rather we want her to have a vested interest in her future. We took her to our insurance agent and allowed her to choose her insurance options. I was pleased that after speaking to the agent, she chose wisely. I think we did a good job. We are pleased. As Mandy and I adjust to a semi-empty nest we struggle to fill the empty hours. Thank goodness the walking dead starts in 6 weeks!!!

   Summer is over. We washed the boat and cleaned up the interior and hung all the lifejackets and wetsuits up until next year. 

Last weekend I rolled the snowmobile trailer into the garage and started getting the sleds ready for winter. Hunting season starts in a few weeks. I'm looking forward to my 10 days in the wilderness chasing elk up and down the mountains of the Pacific Northwest. With all of our free time, we have been working on projects around the house that previously we never had time to complete. 

We have decided that we won't be taking any vacations for the next two years. Our home was built in 1979 and although it has had significant upgrades it is beginning to show its age. In the next two years we hope to paint, re-roof, install new carpet and flooring, and finish the landscaping. It will be a huge undertaking. In some ways I feel I don't exercise a lot of common sense. I've always been too stubborn to pay somebody to do something I know I can do myself. If the car breaks down I fix it. I do all of my own home repairs. The list is extensive. I am fairly competent at drywall, electrical, plumbing and general carpentry. Sometimes I wonder if I will ever reach the age where I decide to take the car to oil can Henry's for an oil change instead of getting down on a creeper and doing it myself.

   It is a quiet time. I think I'm going to like this new chapter.

   On the cancer front, nothing has changed. My last PSA came back as undetectable. Life is very good.

  We found the boat we hope to buy in the spring. It will be hard selling our current boat. We have had five years of wonderful memories of fun in the sun. The family however, is getting bigger. I have six granddaughters and another grandchild on the way. Michaela has been dating the same boy for a year and a half now. I think they are starting to get serious. Soon there will be more grandchildren to teach how to water ski. That's all I have for now I will be writing more soon.

   

Zytiga 3 years and counting.

  I have now been on Zytiga for

3 years. My most recent PSA came back at an undetectable level. It has been at that level for 30 months. It has been a good ride. I began writing this post over a month ago so currently I have been on Zytiga 38 months. I guess the reason it has taken me so long to finish this post is because my emotional state is a little mixed at the moment. Don't get me wrong, I am elated that I have had such an amazing response to my treatment. What concerns me however is the length of time I have been on treatment. Every day it seems there is some ambulance chasing law firm on the television filing a class action lawsuit against a pharmaceutical company because of side effects from long term drug use. 

   Long term Lupron use causes several nasty little side effects. I get to look forward to ostioperosis, increased risk of heart disease, and now it appears I have a 50% higher risk of developing dementia. I am sort of a glass half full kind of guy so on a positive note, I may live long enough to forget I am sick.

   Zytiga is an unknown. In the short term I have noticed very few side effects other than higher blood pressure due to the prednisone and a tendency to bruise easier. Not much is known yet about long term exposure to the drug. I, and a million or so other guys, are essentially Guinea pigs. It is necessary. It is the only way science can advance cancer treatments. If my prognosis was not terminal, it might be unsettling but the truth is, were it not for these new treatments, I would already be in the grave. I suppose that as long as I don't grow a third eye or something equally bizarre, I can handle any side effect that comes down the road. 

   It has been 124 months since my stage IV diagnosis. I feel good most of the time. I seem to need more sleep lately but I am getting older. I think part of that is normal. 

  When first diagnosed, I would ponder all of the things I would miss out on because of cancer. I felt ripped off that I would not celebrate my 50th birthday like all of my friends and family. In 6 weeks I will be 53! All of the things I thought cancer was going to steal away from me continue to happen. I am grateful. 

   

   

  

  

I still have cancer

   I have been on the drug Zytiga for 3 years now. At times I have felt like this disease might never come back. I have even toyed with the word "cured"! A pipe dream perhaps. Isn't that what all cancer patients want? To be cured! I do want to be cured. I want it with all my heart. I want to hold my wife in my arms and feel the rush of passion she so much deserves. I want to believe in a future that is without the asterisk of cancer. I know however that I have been living in denial. 

   Last Monday I went in to have blood drawn for monthly labs. I was not suppose to have a PSA test and they did not draw blood for one but my Doctor must have insisted on having one drawn because the next day I received an email stating that I had new test results. 

   For the last several months, my PSA has come back as less than 0.02. Prior to that it came back at less than 0.05 for almost 2 years. On this last PSA test it came back at less than 0.05. What does that mean? Absolutely nothing. My PSA still falls below the lowest parameter that can be detected by the test that was used. They simply used a different machine this time. I am still undetectable. Yay!!

   When I get these online test results, I have a difficult time reading them. The font is very small on my phone and my eyes are not as good as they once were. At first I did not see the "Less Than" symbol. All I saw was 0.05. For a moment my heart sank. All I could think was "well here we go again" That is when reality set in. I still have stage IV prostate cancer. At this time in history nothing can change that. 

   I am doing well. We are on vacation and I have water skied every day like I am still a punk kid. Life is a wonderful gift and I will do my best to choke the life out of every day. Maybe the cancer will stay in remission forever. Maybe I am not cured but I am the next best thing. My blessings are too many to count. Vacation is not over yet and we have had Todd and Amanda time 4 times this week. No blue pill or injection required. I will write soon. Todd

   

Oh What A Difference!

   I met my new doctor yesterday and I couldn't be happier. What a difference.

Here is how I will make a comparison. 

   Last Monday, July 18, I had an appointment with my Oncologist at Kaiser Permanente. It went something like this.

   Hello Mr. Seals, how are you today. Is your PSA ever going to go up? Your lungs sound good. See you in 2 months and I will sign the orders for your prescription. 

   The entire time with my doctor was 5 minutes. There was never any discussion of what is next or the future or anything. 

   On Monday, July 25, Mandy and I drove south to Providence Cancer Center in Portland Oregon, to meet my new Oncologist. 

               Dr. Brendan Curti.

   My new oncologist sees patients one day a week. The balance of the week is spent in the lab. Dr. Curti heads a research team at Providence Cancer Center in the field of immunology. His team developed OX-40, an immunotherapy headed for a Nation Wide Clinical Trial in the coming months.

   To be fair, I cannot complain about the quality of care I have received at Kaiser Permamente. I can however state that they have never once went over and above any normal standard of care and have put my family through hell by forcing me to fight to obtain medication while this disease was progressing.

   The moment Dr. Curti walked into the exam room, we knew we had found our new doctor. His demeanor was both professional and compassionate. We exchanged pleasantries and then discussed why I was there. To my surprize, he listened to me. I explained to him that I have a minimum 30 year plan and when I stated that failure was not an option he didn't smirk. I told him that my current physician never discusses current or future treatment plans. I mentioned that I am not the type to get caught watching the paint dry and that I need to be included in the process. He listened to it all. 

   After our chat he did a thorough exam and then it was his turn to speak. He told me that I must realize there is no need to do anything different at this point. After all, I am in a durable remission. He acknowledged the fact that one day the cancer will return. He told me that if my PSA reaches .5 he will give me a pet scan. He talked about using radiation to kill small cancer clusters. He talked about using chemo and Xtandi and other immunotherapy. He talked about things my former oncologist never brought up.  

   Having a medical team that has your best interests at heart is paramount. I have never had that luxury until now. Amanda and I no longer feel alone in this battle. We can look forward to the future with confidence. Today we feel thankful and grateful!

   

   

   

Survivors guilt

          REST IN PEACE JORDAN

   Sometimes I think survivors guilt is the wrong terminology. When a group of army buddies are caught in battle and only a couple survive, the guilt that those soldiers feel is real. They come home feeling like they should have died with their buddies on the battlefield. 
In my travels and especially due to the fact that I am a musician, I have been able to participate in many cancer benefits. The hardest ones are always the children. Seeing children dying of cancer when they haven't started living yet is hard. Seeing a young mother in her mid 30s with two small children and stage 4 breast cancer is hard. Telling her to stay positive sounds hollow as she endures treatment after failed treatment. She knows that her children will grow up and she won't be there to see it. Only the most jaded among us cannot be affected by her bravery! Watching our friends die because no treatment worked for them while we have reaped the benefits of multiple successful treatments is hard.
   Tony Crispino's motto is stay positive. Jordan's motto was live thrive survive and my motto " live it loud " are all really positive statements but the fact is that although we want to convey that message of hope and we pray the treatments are successful 50% will fall below the median life extension and 50% will exceed it. A small percentage will exceed it many times over. 
   I do not feel guilty for surviving. I feel righteous anger that others did not. I feel compassion fatigue each time a new guy comes aboard with late stage disease and a poor prognosis. I want to encourage and give hope. Sometimes the results are positive and sometimes not. The higher the Gleason score the harder it becomes to give encouragement. We make friends only to lose them. In the process, a hardening of our hearts occurs. It is a defense mechanism. It is natural. It is necessary.
   Yesterday, for me, was a very bad day. I lost a friend I had never met. I felt a kinship with Jordan. Our diagnosis was very similar. We shared the same positive outlook.  We exchanged a few emails. We talked a few times. I believed he would do well. He didn't and now he is gone. Why??? Why did he fulfill my original prognosis while I have exceeded all expectations? Not Guilt! Just heart wrenching sadness. He, I believe, is in a better place. My tears are for his family and for myself!

https://www.youtube.com/watch?v=c8AF6gx8CY0

  In society we must give everything a name. In the process we marginalize and cheapen what it really is. It is love and it goes beyond cancer and beyond the grave.

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What is Provenge

  Six years ago, after two phase 3 clinical trials the F.D.A. approved Provenge therapy for the treatment of castration resistant, (cancer that no longer responds to hormone therapy) metastatic, ( cancer that has spread to the bones or other organs) prostate cancer, for patients who are Asymptomatic or mildly symptomatic. ( my take on that is they are in little or no pain and healthy enough to do the treatment.) To this day, only 8% of men who are eligible for Provenge therapy actual receive the treatment.

NCCN guidelines recommend Provenge for first line treatment after a patient has failed hormone therapy. (Cancer is spreading despite the use af Androgen Deprivation Therapy). Many within the medical community believe that subsequent treatments work better and for a greater length of time if patients receive Provenge first. If this is true, and I believe it is, then why is it that over 90% of patients who are eligible to receive the treatment do not get it?

   I believe the short answer is 2-fold. Money and education. Money is obvious. Provenge is expensive. I have only two comments regarding money. The first is this. My dad use to say " good ain't cheap and cheap ain't good." The second is a joke Willy Nelson told in the Dukes of Hazard movie. "Why are divorces so expensive? Because they are worth it." Provenge is Good and it's worth it. Medicare and private insurance usually cover the cost of Provenge and there is a patient assistance program through Dendreon that also helps to cover the cost of treatment.

   The second part of the answer involves education within the medical community and within the patient advocate community. 

   I received a call from a guy last week who's doctor told him that Provenge doesn't work. I couldn't believe it. My doctor refused to prescribe it to me 4 years ago for the very same reason. He told me it wouldn't work and it was a waste of resources. I would not take "No" for an answer and we fought it all the way to the State Insurance Commissioner where he ruled in our favor. It is needless to say but I no longer see that Doctor. He based his professional decision not to provide on an article written by a stock analyst. Personally I think she held stock in another company but that is purely speculation on my part. Physicians need to be educated on the benefits of Provenge. It amazes me that 6 years after FDA approval there is still so much controversy surrounding the treatment. In some ways I get it. Medical logic dictates that if PSA is rising then the cancer is growing. Likewise if PSA falls then the cancer is shrinking. Provenge is different. It does not usually exhibit a PSA response. Doctors have no standard way of gauging it's effectiveness. This puts Physicians in the precarious position of not knowing and I believe in general, that it is not comfortable place for them to be in. It is difficult to have faith in a treatment when one cannot see the results. Provenge does work however and there are mechanisms that show it working. In the week and a half between the first infusion of Provenge a patient receives and the second Lukapherisis, labs can already detect an immune response.

   We in the advocacy community, need to do a better job of educating patients as well. Men tend to be a silent crowd for the most part. Real men do not cry, complain, or talk about personal health issues. This must change. We must inform those who are forced to follow us on this journey of every treatment option available to them. It may very well save their lives.

    No real man cries

What is Provenge

   Provenge/Sipeulcel-T, is the first ever ( more will follow )cancer vaccine for prostate cancer. It is an immunotherapy that fights Prostate cancer wherever it is in the body. It is a treatment administered usually ( it can take longer ) over a period of 5 weeks in three seperate Lukapherisis appointments( the patients blood is circulated through a centrifuge spinning off the white blood cells and plasma. This process takes 3-4 hours and other than a needle stick is painless)and Infusions ( the patients own activated white cells are re-infused) four days later. On a normal schedule this process occures every other week. 

How it is made./How does it work!

  I am not a molecular biologist nor do I pretend to have an understanding of how T-cells, antigens, or other enzymes work and interact with each other. All of that being said, I will attempt to explain the process in blue collar terminology. I use to wonder why cancer cells are not stopped by our immune system. The answer is that the cancer cells are too similar to normal cells. Granted, they are mutated angry cells hell bent on killing us but the immune system cannot distinguish between them. Enter Dendreon. At the Dendreon labs, white cells are seperated to eliminate cells that are not useful to the process. Out of the 60 billion cells collected, aproximately 75% do not make the grade and are disposed of. The remaining cells are then introduced to an antigen. This is where it gets fuzzy to me and I may not be completely accurate in my explanation but I will be pretty close. I believe that the antigen is similar to an antigen produced by Prostate Cancer. The antigen causes the Dendreonic Cells ( those cells that make the grade ) to proliferate. (Reproduce) and are then incubated outside the body for a couple days. The reason the cells are incubated outside of the body is so the immune system will not attack the antigens that activate the cells. Once the cells have been activated and incubated, they are re-infused into the patient where they interact with normal white cells and attack the cancer at the source. Simply put, the Dendreonic cells grow up eating cancer and develope an appetite for it. After infusion they are hungry and lead the entire immune system to a prostate cancer buffet. There is an interesting video on the Provenge website that explained the process in greater detail. Simply go to Provenge.com and have a look around. While there, you might go to patient stories and check out my video. I am a Provenge patient and a 10 year survivor of stage IV prostate cancer.

Side Effects

  The label says there are side effects. Some men do experience them. Most side effects are mild flu-like symptoms that last a day or two. I for one experienced no side effects whatsoever. It was the easiest treatment I have ever received.

A cure.

  As of Thursday July, 14, 2016 there is no cure for advanced prostate cancer. I believe a cure will happen in my lifetime.  (thanks to Provenge I believe I will live to see it)

I believe that immunology holds the key that will one day unlock the door to a cure. I believe that biotech companies like Dendreon and others will soon crack the code that cures this disease once and for all. Provenge is not a cure. Provenge is a tool that helps your immune system to identify and destroy cancer cells. Provenge is you. It is your cells empowered to beat up cancer and take its lunch money. To me, nothing could be more natural. My doctors believe that Provenge is why I am doing so well in my battle against the beast. 

  If you have advanced prostate cancer that no longer responds to hormone therapy, talk to your doctor about Provenge. If he won't prescribe it then find a doctor who will. Don't take "No" for an answer. In this day and age, we must be our own advocate. We must insist on what is best for us and not allow others to decide for us. Insist on tomorrow. Insist on Provenge. YOLO ......Todd