So, for now, I get to continue on my 4 month Eligard injections and my daily Bicalutamide pills… Testing every couple of months…

I will be posting an article by a ‘guest bloggist’ shortly… this is an article about Seasonal Affective Disorder or S A D.  Not quite on topic of prostate cancer, but it is something that affects a lot of people… I will comment more on the article when I post it.

Until next time…

April gave me permission to post it here:

**************************

Hi John, its a little out of the blue for me to email you, but I have
to tell you what an impact you have had on the lives of the loved-ones
in my family. Back in I believe it was 2006 when you cycled through a
little town called Claresholm, AB, I was the new-to-the-job reporter
for the Claresholm Local Press. In an interview conducted at the
Claresholm Fire Hall, you told me your story, and well it stuck with
me. The next year I was married, my husband was then in his early 30’s
and I remember recalling the information you had shared with me to
him. Later that year we had sat around his uncle’s living room and
once again this topic seemed to come to the table. And my husband
encouraged his uncle (who was in his early 40’s) to get things checked
out. He did, and turned out he had a type of prostate cancer. He
battled it like a champion and after almost two years and multiple
surgeries, Uncle D is cancer free.
I wanted to say thank you for sharing your story, thank you for the
inspiration, and we are grateful for the awareness you helped to create.

Sincerely,
April

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It is always good to hear from those I met on my ride...it is even better when I hear news that my efforts during the ride made a difference in someones life!  Thanks April!  I am so happy for uncle D and the entire family…

Until next time....

The New Year has been good to us so far....  Cindy and I met with my new oncologist at the Tom Baker Cancer Centre… We both really liked him and his thoughts on where we are headed and plans for the future… Have to like a doc who is willing to plan for a future!!

I had a PSA test done on December 23rd… got the results when we met the oncologist… a little mix up at first (expected when your care is transferred from one doctor to another and then on to a third even without seeing the second...Not sure what happened to the second one!) but the results are good… My PSA levels actually fell slightly… so the Bicalutamide is still working… Great news to get going into the New Year… We discussed what the future probably holds and talked about new medications (not yet available here) and current Clinical Trials… so far I still qualify for a couple of trials...but hopefully we won’t have to worry about those for a little while yet… I will now be getting PSA tests every 2 months...previously it’s been every 3-4 months… The doctor is also willing to do as much as possible without me having to travel to Calgary and back… so testing will be done here, and we will connect through phone calls...if/when my PSA levels warrant further treatment then I will travel to Calgary to meet the doc and discuss the current options.

Hopefully the New Year brings great things to everyone! 

Happiness and Good Health!

Until next time....

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Questioning The Benefits of Exercise for Cancer Patients

Cancer treatments have changed a lot over the decades, and another change is now recommended for all cancer treatment centers. Based off recent studies, cancer specialists have called for physical therapists, trained in creating safe exercise programs for cancer patients, be included in treatment teams. As a result, growing number of personal trainers are receiving certification, and patients are demanding that their doctors and insurance companies make personal fitness part of standard, treatment protocol.

Is Exercise Appropriate During Every Stage of Cancer Treatment?

The simple answer is yes. Every cancer patient should be getting the same amount of exercise suggested for the general public, which is about 150 minutes of moderate-intensity aerobics a week. Of course, some people with cancer are not fit enough to handle this even when well, and some forms of cancer and treatment may leave the patient unable to move around much. This is where a personal trainer can help out the most. Just as they help design and monitor cardiovascular workouts for heart attack patients, a fitness expert can help ensure even severely ill mesothelioma patients receive the benefits of exercise.

What are the Benefits of Aerobic Exercise for Patients?

The primary benefit to be identified for all patients is increased quality of life. Many of the symptoms of cancer, such as weight change, pain, appetite loss and fatigue, can be moderated or relieved through regular exercise. Following a surgery, exercise is recommended for returning proper blood flow to the effected area and speeding recovery. One of the benefits, discovered directly through clinical trials, is that breast and colon cancer patients increased survival rates and reduced recurrence through the use of exercise.

When is the Best Time to Start a Fitness Program?

As numerous studies and recommendations from national cancer organizations have shown, the best time to start an exercise program is before diagnosis. Lack of exercise is a major risk factor for most types of cancer, and being physically fit makes successful treatment far more possible. In other words, whether you have been just diagnosed, are currently in treatment, or are a cancer survivor, the best time to begin moving toward the 150 minutes of aerobic exercise a week is now.

Though the primary goal is aerobic exercise, this says little about the type. Type of exercise should be determined by your preferences and the suggestions of a trainer working with the treatment team.

David Haas
*************************************************************

I do believe in exercise...at every stage… of course, it has to be appropriate for each individual.  I exercise every week… sometimes 2 or 3 times a week… sometimes only once...and sometimes only a part of my regular workout.  It all depends on how I am feeling.  Over doing it only makes me feel more tired and makes me less functional for the rest of my day or week… So I adjust to how I’m feeling or what I’m capable of… But regardless, exercise is great for everyone who can do some.

Thanks David for taking the time to write this and allow me to post it here…

Until next time....

David has written an article commenting on the Benefits of Exercise for Cancer Patients… It is only a short article, but a great read… I hope you come back soon to check it out....

Until next time....

We’ll start with the latest test results… which are over a month old now… just too busy/tired to update....  Anyway, I was tested on October 3rd… and found out on October 21st that my PSA levels have dropped slightly.  They were at 14.6 in March… then down to 11.4… now down to 6.9… It seems the addition of Bicalutamide to my regular treatment of Eligard is still helping!  Great news!  Unfortunately, at the same time I heard the good news about my PSA levels, I heard the bad news that my oncologist is leaving his position at the Tom Baker Cancer Centre to take a position elsewhere.  He has assured me that one of the other 3 oncologists that he works with will be taking over my care.  I have an appointment with the new doc in January of 2012, at which time I will get the results of my next PSA test. 

Also in October, Cindy and I took a long over due vacation… It was fantastic… 11 days on Maui… While we only did a few excursions, we really enjoyed the sunshine and warmth.  The great part is that we came back relaxed and renewed rather than exhausted! 

So far this month, not a lot is happening… The colder weather is not helping my energy levels… I continue to try to get out every day for a walk, although some days it is pretty tough. Also I am trying to get in one or two workouts a week… one seems to be ok… two drains me… but I try to get the second (lighter) one in anyway. Hopefully, once I become more used to the weather, my energy levels will fluctuate less.

Time to prepare for Christmas too… already have some shopping done… I’m looking forward to the holiday season...I always do… Just a BIG kid at heart!!

Until next time…

*****************

Twenty-eight months of hormone therapy does not sound like much considering the benefits –your life. But nobody tells you how many functions of the male body can go awry without an assist from your macho hormones that turn 120 pound weaklings into Charles Atlas and Plain John into Casanova.

Three months find you fanning your brow as you swelter in mid-winter. At six months you could be wondering how you might have failed to notice Julia Roberts pass under your nose.  And yes, you are always hungry – not for healthy victuals but the carbs, ice cream, and chocolate your wife and friends crave. It’s quite possible to add a quick 20 lbs while not being able to find the motivation to hit the gym… not to mention the strength or endurance once you get your sorry butt there.

By nine months you are cursing this slow drip chemo. ‘Lupron Brain’ lowers you into the constant fog of a San Francisco July; it’s hard to concentrate for more than 120 seconds since you lose track of the first sixty. The wretched combination of fatigue, depression and anemia, the same three musketeers that duel with brain cells in chemotherapy patients, all result from a lack of testosterone.  Surprisingly and contrary to expectations, a fuller mane above is covertly offset by loss of cover elsewhere on our pre-pubescent body.

Yet, so many well-meaning folks tell you look so healthy, producing emotional twinges of guilt for feeling as crappy as you do.

After 12 months, we know the systems are all awry; the liver may be inflamed, cholesterol rockets, the heart beats to its own testosterone-less drum; and one task per day can lay us flat. Our medical gurus never mentioned all the issues we might well have noted by carefully perusing the pharmaceutical disclaimer.

It’s fair to say, every man reacts differently to hormone therapy. Few hit the jackpot of every side effect with a 5% or less incidence. My bogeymen were liver and anemia; Dan’s his arrhythmic heart, fatigue and momentary brain fogs. In the worst cases, some poor souls who have never received a visit from what I call the emotional ‘black dog’ spiral further into depression. For many men the simplest and safest antidote is daily exercise – perhaps the subject of a future post.

Hormone therapy, like chemotherapy, is systemic. Contrary to many chemo treatments it does not assault the system; it creeps up like too many birthdays. Men facing just 4-8 months of adjuvant therapy in combination with radiation are frequently off the ‘juice’ before much more than the sweats. Those facing longer treatments find an exponential deterioration in their quality of life beyond 12 months. Several doctors have disclosed, NOT upfront mind you, that some men cannot endure more than 12 months before coming off the LHRH (luteinizing hormone-releasing hormone) drugs.

Intermittent therapy, going on and off hormone therapy, balances Quality of Life factors with controlling the prostate cancer; but this is more in line with recurrent disease. It must be managed for a lifetime stretching the period hormone therapy is still effective. For men receiving neo-adjuvant or adjuvant hormone therapy in the hope of finding the elusive C-word grail – CURE, different studies suggest continuous therapy for 18-36 months. In line with Dan’s recent post, there is a developing school of thought that the LHRH drugs do the bulk of their work in the first 12 months; thereafter the benefits are marginal and easily outweighed by QoL and medical co-morbidities.

Either way, those of us who have lasted the longer course as well as several enlightened practitioners, are in agreement that treating doctors do a poor job preparing men for their rough ride along the hormone therapy journey. Over the past 18 months I have provided a catalytic function to produce a comprehensive UCSF ‘Your Health Matters’ pamphlet for men considering hormone therapy, long or short. While still in draft, I am happy to share with any of you that follow this blog. And for those of you well along the Lupron highway – keep the faith …. onwards & upwards!

–Rick Davis

You can contact Rick at “medafit@gmail.com” .

*****************

Rick is currently (in his words) “trying to identify a connection to a national health club chain to initiate an exercise program for folks living with serious and chronic illness; we have set up a couple of successful pilots here in the bay area.  I have many of the other building blocks in place and hope to get something up and running asap.”

I’ll comment on some of Ricks thoughts in an upcoming post… but for now, he has told it like it REALLY is… at least for a lot of us!

Until next time....

My PSA levels have gone down a little since starting the Casodex… so for now, we are going to just continue on it and watch closely for any rise… once that happens, I will enter a clinical trial for MDV3100… the oncologist has a few patients that have been on it for 3 years or more with PSA levels below 1.0 for the entire time. There is just no guarantee that I will get the drug on the trial...could get a placebo...so he feels it’s best to stay on the Casodex while it’s working… Abiraterone isn’t available for use at this time… If / when it is approved for use in Canada, he says he will put me on it right away.

Right now things seem to be going quite well… I am getting used to the new lower levels of energy… managing to get in a workout or two a week, with added rest… a lot of stress has been lifted since meeting the oncologist… Life is Good!

Until next time....

Shortly after my last posting, I finally got in to see my Urologist… He seemed a little distant (just returning from a ‘family emergency’) and was not yet aware of what had been happening with me. After telling him everything, he figured I should start on Casodex (Bicalutamide) to see if the combination of that and the Eligard will bring things under control again for a while.  He also decided that it is time to see a medical oncologist to take over treatment… He sent the prescription over to the cancer centre pharmacy and a referral to the local medical oncologist… I went directly from his office over to the pharmacy to pick up the new meds…

The Casodex does pretty much the same thing as the Eligard, only in a different way… The side effects are pretty much the same...and the doctor warned me that they might be intensified being on both meds… Seems he was right about that… The ‘hot flashes’ have definitely intensified… they don’t seem to last as long, but WOW do I get HOT!..  and I’ve been a lot more tired since starting the Casodex, although I seem to be getting used to that, as it doesn’t feel as bad for the past few weeks as long as I don’t over do it. 

It was another week before I heard that I had an appointment with the medical oncologist… August 4th… set up by the radiation oncologist… then a few days later, I heard that I had an appointment with the medical oncologist...on August 2nd...set up by the urologist… I cancelled the Aug. 2nd one and kept the one on the 4th...reason being, Cindy had already arranged for the time off to attend with me… A week or so later I decided that I really didn’t want to wait that long, and really didn’t want to see the local guy… I went to my family physician and asked for a referral to a medical oncologist in Calgary at the Tom Baker Cancer Centre.  A few days later I heard from them… I had an appointment on July 13th...only a few days away. The 13th was also the day we were heading up to Edmonton for our eldest sons wedding… Travel plans were slightly revised, and onward we went.

We headed out early on Wednesday morning and managed to make it to the oncologist appointment on time… Filled out the questionnaire and waited for a short while before being taken in… Cindy and I met with the doctors assistant, and gave her my history and answered some questions… she explained a few things, then went to get the doc.  He came in, introduced himself and explained what he does… he briefly went over my history again, just to double check a few things, and then told us about 3 clinical trials he is involved in… he gave me some literature about two of them. He told us about new meds that are in the works, and what is currently being used as well.  We talked about a lot of things, then he set up another appointment for a week later so that we could make plans for the future… I was to read over the literature and decide whether I wanted to use the current treatments being used, or enter a clinical trial…

From there we headed to Edmonton...arriving a few days early to give me some time to relax and recharge before the wedding… Saturday arrived, and things went very well… it was a beautiful day and the Wedding was great… So proud of our son and his beautiful bride!  The rest of the day went well, but I didn’t get much of a chance to rest, so I was pretty tired by the time the reception was over… and even more tired by the time we made it to bed… It took a few days to recover, but all is well… We returned home on the following Wednesday.

On Thursday morning we headed back up to Calgary to see the oncologist again… We once again talked about the options available...I signed an application form for a clinical trial ( oral MDV3100 ).  Next I headed to the lab to have my PSA levels checked… if they are down, then I will cancel the application for the trial...if they are up, then I will stop the Casodex, and approximately six weeks later I will start the trial… There is a lot involved with it...lots of testing before, during and after...but the doctor has had some great results with it… the only major drawback is that it is a Double-Blind, Placebo-Controlled study… meaning I may not get the MDV3100… I guess only time will tell…

The other major thing that has been happening is that I have been working with the WCB and we are in the process of switching me from the insurance company over to WCB coverage… it’s going well, and they have been incredible… No problems at all...in fact, they are doing everything possible to make the process as easy as possible and offering all kinds of help… such a HUGE change from the insurance company!

PSA results this week some time… so I will let you know what is going on when I hear…

Until next time…

Radiation treatments have been going well… today will be my 5th and final treatment… Things have changed slightly since having radiation in 2005… The new machines are pretty incredible… After climbing up on the bed and being tossed around until the tattoos are lined up properly the radiation techs leave the room… an Xray is taken...compared to the original positioning of the CT scan and then the bed moved so that the two images are aligned… once that is done, the treatment begins… first from the top...then from the bottom… it takes a minute or less in total… then the techs return and I am free to go.  There is no pain...in fact, other than the slight hum from the machines, you would never know anything was happening.  I have also not had any of the ‘flare’ that I was told might happen.  The treatments sometimes cause inflammation around the site which increases the pain in the area… I have had no increase in pain...in fact only a very slight ‘ache’ and mostly only when I lay on that side… so very lucky!

The only thing that originally bothered me about the whole thing was that the first day they had me remove my t-shirt, wanted me to remove my gym shorts and leave on my underwear (sorry, they are actually sewn together...so left them on with permission) and then put on a hospital gown and housecoat… I complied and went through the first treatment… seemed like such a waste of time and added cleaning costs for the hospital.  I mentioned that I NEVER had to put on a gown during my 7 plus weeks of radiation in Calgary...that I wore a t-shirt and gym shorts for every session… They seemed shocked as it is hospital policy that patients gown up… but they said I could do the same here, so now I just go to the waiting area and then go in for treatment… No changing involved.  In my opinion, it is much easier… and I think leaves the patient feeling less stressed and more dignified… So hopefully they will allow others the same!  Time to change the policy.

The only real stress this week has come from trying to get my PSA and Testosterone results… I had an appointment booked with my urologist on Monday morning… but a family emergency caused him to cancel all his appointments this week… My family doc is out of town this week...on holidays I was told.  So I tried to get in to see other docs or find another way to get the results… Road Blocks at every attempt… Finally, yesterday, after my treatment, I talked to one of the nurses at the radiation unit… we talked about how the treatments were going (great!) and she asked if I had any questions… My only question was if she could get my results… she quickly checked with the radiation oncologist and grabbed them… the oncologist came to see me and we talked about the treatments and then she told me the results…

My PSA levels are up slightly from March… from 12.4 to 14.6....  My testosterone levels are down… from 9.7 to 0.7… She suggests getting another PSA in a month or so to see which direction the PSA levels are going, and then adjusting treatment if needed… I see my urologist next week, so that will be the topic of discussion… what is next??  Is Treatment still working?? or is it time to add something new??  So, I’ll post an update next week after that visit…

Until next time…

Cindy and I arrived on time and made our way to the Jack Ady Cancer Centre… This was Cindy’s first visit to the cancer centre in Lethbridge… It is a great facility that is state of the art when it comes to the equipment… and so far the doctors aren’t too bad either.  After filling in some forms, we were escorted to the examination room… answered some more questions, got weighed and measured, then waited just a few more minutes for the oncologist, Dr. Sandra Wajstaub. She took an in depth history (which continually got updated as I remembered things throughout the visit...) and then did an exam...checking lymph nodes, reflexes, strength and movement of my extremities, and looking for any painful spots in my pelvis and spine (none).  She then explained what was found in the bone scan...and after I explained all the problems during my initial pc diagnosis, she went to double check the bone scan herself.

She explained that the only spot found was in my pelvis...and that it was still small… She explained the options available… Do nothing… 1 radiation treatment or 5 treatments… She talked about side effects and what may happen if I chose not to have the radiation.  She seems to think that I do not currently have ‘castrate resistant prostate cancer’ (hormone resistant or hormone refractory are other terms for it)...and that the current treatment is still working… I explained that I had not had a PSA test recently, so she ordered one to be sure one way or the other… here’s hoping that the current treatment is still working!!  After that we talked a little about other therapies and about a medical oncologist taking over my care from my urologist… only because the urologist does not do chemo therapy...so if it is needed, I will need to see a good medical oncologist.  I suggested getting a second medical oncologist opinion from outside the city and she agreed it would be a good idea… but in the meantime she is referring me to the local one. She then answered a few more of our questions...and asked a few more of her own as the history taking continued as I remembered more things to add.  We then agreed on doing 5 radiation treatments to really kick the cancers ass!!

After all of that we were escorted down to the radiology floor...where the CT’s and radiation are done… We were given a quick tour of the facility and after a short wait we met one of the radiation technicians. He explained about the side effects (minimal) and how things would run… since I’ve had radiation he explained that it would be pretty much the same...and that since my previous ‘tattoos’ were still visible, they would use those as markers and the next step would go pretty fast.... So we headed in to the next room and I hopped on the CT table… down went the pants and then I was moved in to position using my ‘tattoos’ as the guides… once i had been jostled into place everyone else left the room and I was slid into place… a few minutes later I was moved out of the scanner… got dressed and we were on our way.  Next stop the scheduling desk… booked an appointment for Monday and we were ready to head out…

Everyone at the cancer centre were great… they treated us with respect and even had a few laughs with us…

From the cancer centre we headed over to the lab for my PSA and Testosterone blood draws… that done, we were on our way home… Cindy was feeling just a little less (and I mean very little less) stressed… but now we are back to waiting for test results...and more doctors appointments…

Next up is a sigmoidoscopy on Friday… then a weekend off… then back to the urologists...hopefully they will have the PSA and T results by the time I get there.

Until next time....

Tomorrows oncologist visit is basically an hour long, one on one (or two as Cindy will be there with me)… I imagine we’ll be discussing the severity of the metastasis, options for treatment (or lack there of) and what we want to do....  I get to ask questions, so I’ll be writing down all the ones I can think of today… I’m sure more will come up after hearing what the oncologist has to say.

I’ll update again after the appointment…

Until next time…

After all the good news we have received over the past couple of weeks… the legislated WCB coverage for prostate cancer and the results of my physical… the bad news came.

After my physical last week I went for a bone scan.  I had been having some left hip pain for a while...I thought it was something I had done and hoped that with rest it would go away.  It didn’t.  So after some discussion with my family doctor, he set me up to have a bone scan.  He didn’t think it would be anything related to the prostate cancer...since I had started back on hormone deprivation again in March, if it was the cancer, it should have settled down with the treatment.

This morning I got a call from the doctors office...he wanted to see me.  NEVER a good thing… Good news they generally tell you over the phone.  I went in to the office an hour later.  He came right in...he didn’t have a smile on his face...and I knew what he was going to say.  The prostate cancer had metastasized.  It is into the ischium and surrounding area.  He didn’t go into a great amount of detail on the amount seen… He did say that he had already contacted my urologist...and the local radiation oncologist (we, as of last year, have a radiation unit in our local hospital...) and the paperwork had been started for me to prepare for radiation.  He explained a little about the coming process and asked if I had any questions.  Since I have been through radiation, I am ok with that...but there are some new meds available for treatment of hormone resistant prostate cancer (which is what I now have).  So I asked him about those… He thought they were available in Canada...but I will have to wait to talk to my urologist and the oncologist to see if I can use them… I’ll be persistent…

So...what the %^$& happened??  From the way I understand it...the prostate cancer feeds off of the testosterone...because the hormone deprivation blocks the production of testosterone in my body, it had none to feed and grow on… This %^^&%^$ stuff, since it was being deprived...figure out how to produce it’s own food source...and in doing so was able to grow...resulting in the metastasis… It may have been there all along...or it could have moved there once it became active...it really doesn’t matter now… It’s there...and we are going to do everything possible to stop it!!  NOW!!

The toughest part of the day today...at least for me...was telling my family… I HATE having to spread the bad news… And I still have a lot of people to tell… Some family that is away...as well as some friends… Some unfortunately will find out here… I’m sorry you have to find out this way...but for now, it’s the best I can do…

The best part of this day… I met up with Tim and Ali… Tim is my riding buddy from the Cycle For Life rides...and more importantly, one of my very best friends… He had been away for a while and just returned back to this area...passing by on his way home.  So we both made the effort to meet up...I’m sure he wasn’t expecting the news I had to share...but we had a great visit… Far too short...but all time would allow for now.  THANKS Tim!!!  THANKS Ali for helping make it happen!

Well, for now, that is the news of the day… A lot more thoughts to share in the coming days… But for now....

Until next time....

I went for the usual blood tests that go along with a physical about 2 weeks ago… in plenty of time for the results to get to the doc.  Pretty straight forward… the only other test I would have liked to have had done is a PSA...but that should be getting done in the next month, so not a big deal...yet…

When the doc came in, we talked about past medical history… family medical history… and then he told me the results of the blood tests… Everything is well within normal limits.  We then talked about how things have been going recently… I told him I’ve been more tired than during the last two rounds of Eligard… but feel ok other than that… I also told him that I’ve been having some pain in my left hip for a few months… I was hoping it was just a strain and that it would get better with time… unfortunately it hasn’t been getting much better… We discussed the spread of the cancer and how this pain is more likely than not something other than related to the cancer… but to ease my mind and his I have a bone scan set up for Thursday morning...just two days away… WOW was that quick.  Heart and lungs sound good… BP is okay… the doc says that I am “extremely healthy other than having prostate cancer"… Then he said how sorry he was and how unfair it is that things are the way they are… I just shrugged and told him “it is the way it is… “ I’m doing everything I can right now and that’s the most we all can do… Hey, I’m healthy...(other than the cancer)… ;o)

So, the appointment went well… I’m staying healthy and managing with the side effects of the Eligard… LOTS of naps… limited physical output without paying for it.... eating well and enjoying life… oh yeah… also lost over 30 pounds since Jan. 2 this year… on purpose!!  Back to my pre cancer diagnosis weight.  Feeling great about that… it hasn’t helped my energy, but I feel much better at the lighter weight…

Until next time....

After 6 years of trying to convince the WCB that my prostate cancer is work related...and being denied at every hearing… it is finally official… Well, at least at this point, my claim has been re-opened and is moving in a positive direction.

It has been an incredibly emotional day...both for myself, and my wife… There is great happiness and sadness… The happiness stems from the fact that my claim will probably be approved fairly quickly...that after all of my failed efforts, our dreams of this happening have come true… The sadness comes from the fact that although I will probably be covered by WCB and that we will finally have piece of mind about having compensation in the future… I still have prostate cancer… and it is progressing… although hopefully still under control at this moment. The final outcome hasn’t changed.... Sadness…

As for my progress… I am still feeling tired...actually even more so… I am still trying to exercise, but recovery is slow… I am having a LOT of hot flashes and night sweats… although they don’t last long, they are extremely intense...at times feeling like I am about to burst into flame… I’m also having a lot of pain in my feet again...and now in my left hip… I have an appointment to see my family physician in a few weeks...so until then, I will just continue to enjoy the hot and cold...and keep moving to keep the joints moving. 

Until next time....