Dr. John McInroy is a psychologist practicing in Aurora, Colorado. Dr. McInroy specializes in the treatment of mental health problems and helps people to cope with their mental illnesses. As a psychologist, Dr. McInroy evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk... more
A Personal Account of Prostate Cancer
(And my fight with John Wayne's Voice)
John "Jack" McInroy, Ed.D.
October 15, 2013
Prologue: Most people, especially men, growing up in the 40s, 50s and so on are very familiar with the movie star John Wayne. He was always fighting in Cowboy movies as the good guy, but never ever showed emotion when his best friend or wife died. We boys growing up thought he was the person to model after. We don’t show emotion because we are tough! You will see how this hidden attitude complicated my treatment of cancer, but it was a wonderful relationship with the physicians who also emanated John Wayne.
As a Clinical Psychologist for over 30 years who was diagnosed with Prostate Cancer in August, 2012, one would expect I would be an active, educated, questioning patient who would know what to expect and when to expect it.
I expected this to occur also, but I was wrong for the most part because of John Wayne's voice in me.
First, the biopsy of the prostate was an office procedure. No big deal? Maybe not, normally, but in this case, I immediately was infected with e-coli poisoning (Sepsis). One physician indicated, "Two of every 100 men biopsied will develop Sepsis, a potentially lethal blood infection." Another study showed that "Nine of 10,000 men who tested negative for cancer died within a month of their biopsies."
In my case, I was admitted to the hospital immediately and put on antibiotics for a week, running a very high fever and becoming semi-delirious. My wife Barbara was at my side wiping the perspiration off my face, but I have no memory of this due to the high fever. Fortunately, I responded well physically, but I was angry that I had to go through with this illness.
After a week in the hospital, a family consultation with the Urologist was conducted, and a treatment plan was agreed upon which would consist of 45 radiation treatments followed by two years of Testosterone Suppression Therapy (Depot Injections to suppress the testosterone levels which is responsible for the spread of cancer). Since my Gleason Score was 8 out of 10, the cancer was aggressive.
The John Wayne personality took over my personality at this point. "I don't need to ask about the side effects of the radiation or the testosterone shots. I heard something about hot flashes and insomnia but that should be no big deal. “We men are tough!"
Consequently, night after night, I'd sleep for 2-4 hours, get up and drink water, go back to sleep and swim in my sweat, get up wrestling with the temperature for a couple hours, and finally just when I'm comfortable, it would be time to get up and go to work. Where's the humor?
A month goes by with no improvement. Two months. Out of desperation the doctor is consulted and a medication is provided that minimizes these side effects after suffering for months.
Why didn't the doctor volunteer? Why didn't the John Wayne personality in me ask for help?
Did anybody mention about complete loss of interest in sex or the ability to get and maintain an erection, or that there is no ejaculation fluid? A minor problem if you are over 95 years old, but isn’t this important enough to be mentioned?
I went to the outpatient radiation center specializing in prostate cancer for 45 radiation treatments. The routine was simple: Change clothes, and lie on a surgical table for about 12 minutes while the radiation machine zapped the prostate. It was painless, and the doctor and technicians were very friendly and helpful. This procedure was administered five days a week for nine weeks. No big deal, but just an inconvenience to take that much time out of the day.
I began to suffer from incontinence, an inability to control my bladder. This is very embarrassing. Diarrhea two to three days a week for a few months is very debilitating in general, and especially when you still are working. I wore and continue to wear pads in my underwear but refused to wear diapers just because of the name. Pretty dumb on my part!
It’s now been 18 months since the last radiation treatment and the symptoms are much better but the unpleasant side effects are still there almost every day.
These side effects are less important compared to the mental and psychological ones to be described at this point.
Fatigue/excessive daytime sleepiness: Not a big deal if you are retired and spend a lot of time watching television.
As a therapist, falling asleep on a patient talking to me reinforces the patient’s low self esteem. “Even my therapist thinks I’m boring.” But, of course, sleeping while riding his horse is commonplace for John Wayne and the horse doesn’t even mind he isn’t listening.
Changes in metabolism: I don't want to exercise and eat right when I can't sleep and have no energy. I gained weight. Not just a little, but a lot. Since I have no interest in sex, or even women in general, why take care of myself?
I despise myself and say many derogatory things to myself about myself. "I am just lazy and have no control." While there may be some truth to this, it also is one of the side effects of the hormone shot. But a gain of 30 pounds or more in 6-12 months is a big deal--certainly important enough for a doctor to mention, and if not for John Wayne's personality to question the doctor. John Wayne’s horse complained bitterly of his weight gain.
Cognitive and memory decline: "What was I doing when I came into this room and what were you saying?" "What did I go to the store for this time?" "You never told me that your mother died." "Where am I driving to?”
Here all this time, I thought my memory problems were all age related. But according to the research, some may be related to age, and the rest to my prostate treatment (especially the hormone shots), but the doctor didn't think it was important enough to inform me. (That's assuming he knew.)
Depression and emotional conflict: Emotions become runaway trains, almost like when I was a teenager and some girl with braces smiled at me from across the room and I felt instant love!
I have always prided myself in my critical thinking ability and have always been "on my game," being able to anticipate consequences and faulty thinking. Rarely has my thinking and intuition failed me in 47 years of practice. Until now! Now, my thinking is completely dominated by emotion and my reactions are sometimes at least 10 times exaggerated more than normal. When my friend told me someone said she should be hit by lightening the other day, I exploded! I could be heard a long distance away. This is extremely atypical of my emotional reactions in the past.
Was it helpful? Not particularly, except to raise my blood pressure considerably.
My reaction was instant without thinking, other than to say to myself, "Nobody treats my friend that way." I was at least 75% overreacting, most likely due to the hormone shot. Did it cause damage? Only for my friend to think how weird I am again.
(Minor problem for John Wayne until he gets depressed, angry, and shoots his horse.)
If I were prone to depression, I may have curled up in a ball and not have left the bedroom for days, weeks, or months. Neither of these possibilities were discussed by my doctors, nor did they say these feelings are normal and predictable after taking the hormone shot.
Not that important?
Yes, it is very important because otherwise I felt like I was going insane and I was embarrassing myself with people in my life whom I respect: My best friends and those I love. If they aren’t extremely patient with me, it could result in the loss of a friendship, or even the loss of a marriage. How much of a bigger deal could it be? I worry about this all the time when I never was a worrier in the past.
The worst part of the story is not the prostate cancer, or even the treatments, or side effects; it’s the unawareness of what is going on in my brain and body. I thought it was “normal” and shouldn’t a psychologist know what is normal since that is my profession?
I was and am very fortunate to have a colleague, Dr. Shauna Casement, who was my good friend, an excellent psychologist, and someone I respect a great deal. Shauna took me aside and spoke to me in a kind, compassionate manner suggesting that maybe I was acting a little irrational due to the hormone shot.
(Not me! I’m John Wayne. And besides, I have been an expert on irrational behavior for over 30 years.)
But I trusted my friend Shauna more than I trusted myself, or my partner John Wayne, so I accepted her feedback and began to do my research. Of course she was correct and I was (and am) the weird one. Now my eyes are open and my brain is under control (most of the time), but I have to be aware every minute my brain’s engine is on fast idle ready to take off at lightning speed.
Shauna also suggested I get involved in a physical fitness program since I had been completely inactive since my back surgery and prostate cancer. She offered to be my fitness partner. It didn't work out, but I made a promise to myself to see how much I could gain of my physical self and contacted an excellent physical therapist, a massage therapist, and a trainer at the 24 hour Fitness Center. I started working out 2-3 times a week in September and now 8 weeks later I have improved my physical condition by 35 to 40%.
John Wayne is getting upset now, as he has to walk everywhere since he shot his horse.
I have an eviction notice for John Wayne posted on my heart and brain: “You were my idol in the 50s, but now it’s time for you to leave. In a few ways you have served me well in the past, but in this situation I could have been killed at the OK Corral if I had listened to you and if I hadn’t had such a good friend to talk some sense into me.”
Goodbye horse! (Actually, the horse can stay.)
How long does this treatment continue? Two years? Which is worse: The disease or the cure? Most men don't die from prostate cancer, but they could die from runaway emotions, like when a jilted spouse shows up with a hatchet, or the guy who tries to steal John Wayne's new horse!
And now a word from my wife, Barbara, who believes she has all of the same menopausal symptoms I have described.
“I just laugh and consider my husband my best friend after all these years! Sex isn’t the most important thing in a man’s life." (and how does she know?) "Move on. I love you anyway.”