It's Day 25 and I can't get enough sleep

Welcome to my Cancer journey (Updated version)

(NOTE: This article has been updated since it originally appeared. If you’ve already read the original, my update is at the bottom)

I’ve started this newsletter for two reasons, the first being that I have stage three non-metastatic prostate cancer. About 12% of men get it, and for some of us it’s fatal if it spreads to other parts of the body. The earlier it’s caught, the better. In my case, for a variety of reasons, it was caught a bit late, but not too late. I started Androgen Depressant Therapy (ADT) with two powerful drugs on June 1st, and I’ll start radiation therapy sometime in July. The radiation therapy will be five days a week for six to eight weeks and the ADT therapy could last for up to three years, followed by active monitoring.

What I’ve learned even during this short period has shown me that early detection is key and doing research on treatment options as well as physicians is a necessity. If you believe that you can simply trust your care to others, you will regret it. I was fortunate in that my profession as a cybersecurity author and researcher has taught me to trust no one and research everything so for me it was a matter of habit. I’ve found the Peter Attia MD podcast immensely helpful in that respect.

The second reason is that writing is both my therapy and my source of income. Cancer treatment is one of those catastrophic diseases that drives families into economic distress. That includes families with financial means (and that is not mine). The term “financial toxicity” was coined because of the devastating financial impact of the costs of treating cancer patients, especially lung cancer patients, and evidence suggests that there’s a link between extreme financial distress and worse mortality rates.

I intend to make this a real-time record of my treatments, the side effects I encounter, any ways that I discover to mitigate them, the various treatment options, the research that I find to help me make my treatment decisions, and anything else that I think will help someone else who’s living with prostate cancer or knows someone who is.

To be frank, I hope that if you find my work useful, that you’ll support it with a donation.

And maybe purchase a copy of my book once it’s out in October. :-)

Today, I want to focus on the most immediate problem that I’m facing - my inability to sleep more than 90 minutes at a time, which has become pretty debilitating.

JUNE 26, 2024 | 06:15 PDT

Last night I went to bed at around 10:30pm and was up at Midnight because of an iintense urge to urinate. Afterwards, I went back to sleep and was up at 1:30am - same issue. Every 90 minutes, it was the same.

This was the third night in a row, and my brain and body were shutting down. I had a video call with my editor at 7am to go over the final details of my book prior to it being handed off to production. I was so exhausted that I think I frightened her.

Part of the reason why people with prostate problems have to urinate so often is that we cannot empty our bladders. My urologist prescribed Flomax but that didn’t help, so I started to examine what other factors might be contributing to frequent urination that I could control. One was water consumption in the evening and the other was my caffeine intake.

Once you start ADT, you have to exercise vigorously, both cardio and strength training because a side effect is the loss of muscle mass and bone density, plus an increase in body fat. The only way to mitigate those effects is through high intensity workouts.

To that end, I was drinking one to two cups of coffee in the morning to help me wake up and take my online Pilates class, and then I’d take a caffeine pill (200 mg caffeine) in the afternoon to help me power through a strength-training regime using TRX. Afterwards, I’d drink a protein shake with greens and creatine.

Creatine and caffeine combined have been shown to promote many positive benefits as performance enhancers, and regular intense workouts are critical for people on ADT therapy to retain muscle mass because we’re losing testosterone.

HOWEVER, I discovered that the combination of the two also contributes to dehydration.

So starting today, I’ve quit taking creatine and the caffeine supplement, and I’m limiting myself to one cup of coffee in the morning.

I’m also stopping my water consumption at 5pm. When I start to get thirsty, I’ll put an ice cube in my mouth.

I’m going to work this protocol for three days and see how it goes. I’ll report the results here on Friday, June 28. Wish me luck!

UPDATE JUNE 30, 2024 07:27 PDT

It’s been five days now and I’ve had two nights where I only needed to get up twice, and one night (last night) where I only needed to get up once. I feel SO much better having had some decent sleep. I tweaked my protocol slightly during that period so here’s the most current version.

One cup of coffee when I wake up

I make a pitcher of Clearly Filtered water, and drink 48 oz by 12:00 and another 12 oz by 16:00.

I drink a 12 oz shake consisting of water, JOCKO MOLK Whey Protein Powder, and LAIRD SUPERFOOD’s Probiotic Daily Greens between 17:00 and 18:00, right after my workout.

No more water after 18:00.

I eat dinner around 19:30 and then will have about 8oz of a probiotic fizzy pop. I’m still experimenting with different brands so I won’t say which ones yet. The other products that I mentioned above are ones that I’m very happy with and want to give the companies the credit that they deserve.

If I need some liquid after 20:00, I’ll put an ice cube in my mouth.

My water consumption is unique to me. You may need more or less. The way to tell if you’ve had enough water is by the color of your urine. If your stream is clear, you’re probably drinking too much water. If it’s dark yellow, you’re not drinking enough. If it’s pale yellow, you’re golden (forgive the pun).

DISCLAIMER: I’m not a licensed medical professional and none of the above is to be considered medical advice.