I knew it was coming. My PSA (a blood marker that monitors the progress of my 18 year survival of prostate cancer) has been slowly creeping upward over several months. When I hit 8.5 (this number is quite a bit above “normal”) this past month my oncologist decided it may be time to do something other than keep an eye on things.

I need to apologize up front because this next part is going to contain a lot of medical detail which will be very confusing (and probably TMI-boring). I tend to slip into my old nurse instructional mode when talking of such things because I believe you need to understand things in plain English to appreciate the depth of what is to follow.

My oncologist Dr. Seghal felt it was time to order another scan, this one specific to locating microscopic level prostate cancer cells. The good news was it found no cells anywhere but in what remained of my prostate. Unfortunately, the tumor that’s still there had apparently “cloned” itself and was now resistant to the abiraterone (a medication given specifically for advance prostate cancer that had spread to other places) which I had taken first thing every morning (depending on circumstances, usually about 5:OO or 6:00 am) for the past 2-3 years.

Surgery was ruled out as an option: I lost that when it wasn’t done at my initial diagnosis 18 years ago. Radiation was no longer an option, either. I have been extensively radiated on two different occasions, and can’t have any more (not that there’s much of anything left to radiate; my “prostate” is a bunch of scar tissue with just enough left to cause problems.

So the only treatment option left was chemotherapy. I wasn’t really surprised by it; in fact, I had been expecting it would one day become necessary. My treatment will consistent of six “cycles”, or doses. of a rather nasty chemo agent given one dose every three weeks, depending on several other factors which might delay a dose.

If it were only a matter of going to the clinic in Corpus Christi every three weeks for my infusion it might be a little simpler. I suspect when most people hear the word chemotherapy that’s what comes to mind. That and horrible side effects, which we’ll get to in a moment. But there are other matters which are essential to making this work.

Next week I have to return to the clinic to receive injections to boost my red and white blood cells, which will also fall victim to the chemo agent. They are given on two subsequent days, which means two additional trips. Being a retired nurse, my hope is they will give me the second dose to take home and administer myself. With any luck, they might even just give them both to me, let me do it at home, and save me two trips.

Two weeks later, and then a week after that, they draw blood to see if the blood counts and the rest of my organs are in decent enough shape to get my next ‘cycle’. I also see the doctor on the day of the second lab draw to get the all-clear to proceed. Then we rinse and repeat until we get to six.

Before they administer the actual chemo agent, you receive an IV infusion of steroids and an anti-nausea medication to stem any immediate bad reactions. So yesterday I walked out feeling pretty good, all while knowing in about 4 or 5 days the bad stuff was going to start. For the next three days I take an oral steroid pill twice a day, which should help stave off the bad stuff until next week. Again, rinse and repeat until you count six.

Now we get to the part that everyone always dreads: the side/adverse effects. One of the most common is nausea; fortunately I have an arsenal of a high-powered pharmaceutical drug as well as some homeopathic interventions (thanks to my brother and sister-in-law) to treat that. Next is constipation or diarrhea (take your pick and treat appropriately). This drug doesn’t play well with ANY fast-growing cells in your body (think mouth and cheek tissues, including your gut) so mouth sores and sore mouth will probably be there as well. The other fast growing cell that are affected are hair follicles, so guess what. One additional consideration with this drug is the hair loss may be permanent. With my head, that wouldn’t amount to much, but I would miss my beard (although not shaving is a plus). So you can just call me Hairless Joe or Uncle Fester, whichever you prefer. I previously mentioned blood cell counts; if they get zapped too badly you develop anemia and leukopenia (seriously low red and white cell blood levels). With anemia you get weakness, probably shortness of breath, and generally feeling like crap. Leukopenia takes out your immune system, so stay away from sick people, wear a mask if you have to go into crowded areas (ugh!). and wash your hands about 150 times a day after you touch anything. Oh, and it also messes with your platelets, which control blood clotting, which means you’ll bleed much easier if you hit or cut yourself-so be careful.

This all sounds so hopeless and depressing, I’m sure. But I have a God who has promised to never leave me or forsake me, who is always there, Who works all things, good and not so good, to my benefit and His glory. Whose strength is seen through my weakness, Who tells me that these “light and momentary afflictions are bringing about a greater weight of glory”, because this stuff that’s seen is temporary, but the things that aren’t seen are eternal. He is a God who gives me strength to stand firm, and blesses me with another day to spend with Him, my wife, my Christian brothers and sisters, and to maybe have an opportunity to give someone else hope.

I am thankful that God guided us to Rockport, Texas. Among the several good reasons for me to be grateful, certainly important are my doctor Dr. Ajay Seghal, as well as the wonderful nurses, assistants, pharmacist (oh, how much I appreciate all that Valerie has done for me!) and other staff at Coastal Bend Cancer Center. They have been a Godsend, one that I didn’t know I needed. I am also profoundly thankful for our church family here in Rockport who have taken us in, surrounded us with love, and adopted us into our family. It’s a privilege to serve them in what ways I can.

My goal and my prayer for this experience is that I will get through it with grace, be an encouragement to those around me or who might cross my path, and that God will be honored and glorified in it all. Jesus told in in John 16:67 that we were going to have hard times in this world. But then He told us, “Be of good cheer! I have overcome the world“. That’s all I need to know to make it through what’s coming.