"Raise your legs for me", asks Radiation Therapist Claudia Huntley. She's preparing Ivan Cutler for a radiation treatment at Cone Health in Greensboro. "The Alpha Cradle's purpose is to make sure the turn of his hips and everything are completely the same level and even throughout his treatment each and every day of his treatment, which is very important."
Huntley helps Ivan settle onto a flat metal platform protruding from a Tomotherapy unit in the Cancer Center. It’s a large circular tube machine. The 63-year-old is about 5'6", curly salt and pepper hair, full mustache and beard and always wearing a smile. Behind his glasses, his eyes twinkle as he jokes with Huntley in-between humming along with a 70’s tune playing in the room.
It's July 2011 and Ivan is being treated for prostate cancer. It was discovered six months earlier in January as he and his wife Wendee attempted to change health insurance companies. Ivan's physical raised some red flags and almost two weeks after a biopsy, “The doctor swung around in his chair and said, you have prostate cancer in 7 of the 12 pathological samples," explains Ivan. "I was shocked. Speechless. My first question was about longevity. And after we dealt with that, I just pulled myself together and decided I’m going to fight it, possess a positive attitude.”
Chief Radiation Oncologist Dr. Robert Murray says having a positive goes a long way in a cancer patient's recovery. He's been treating cancer patients for almost 30 years at Cone Health. Nationally, prostate cancer is the second most frequently diagnosed disease in men. Determining if a man has prostate cancer is connected to his prostate specific antigen or PSA score, which is derived from a blood test. Dr. Murray says typically a score of 4 is considered healthy. Although, he cautions large, healthy prostate glands can result in a higher score. “What’s probably more important than the level is what the psa is doing year to year. If a typical male has a PSA of 1.5 to 2. The next year it’s 3.5 you’ve had a doubling of the PSA in a year. And if this is not related to infection, this man may have prostate cancer.”
Ivan’s cancer was categorized as an intermediate risk, with a PSA of 5.5. But his wife Wendee describes figuring out the best treatment as being worse than getting the diagnosis. “The delays in getting the appointments for those consultations are horrendous. When we received the diagnosis in January, it took us until May to get through all of the consultations and get on everybody’s calendars and get the treatment started. That’s a long time to walk around and dwell on this.”
Finally in May, Ivan began 40 days of IMRT-- Intensity Modulated Radiation Therapy. Which brings us back to the Tomotherapy unit at Cone Health. It’s the only Piedmont hospital using this advanced technology. In 2011, doctors here treated 407 prostate cancer patients. Dr. Murray attributes this to this machine's precise abilities. “We often have three gold seeds implanted in the patient so we can triangulate the prostate gland’s position. And IMRT allows us to deliver the radiation therapy where we want to deliver it. So we can give very high doses of radiation to the prostate gland and spare the rectum and spare the bladder.”
Pain and or impotence can be side effects to radiation therapy. Ivan says he had little pain and he and Wendee agreed sexual activity wasn’t important. But they felt like they were getting more than their share of distressing new. Ivan’s 2nd oldest brother Arthur was a prostate cancer survivor. Just as Ivan began his treatments, Arthur died of other health complicatioins. Joel was just a few years older than Ivan. As he battled prostate cancer, Joel was battling brain cancer. But Ivan describes the nights as being worse, when he was alone with his thoughts. “I woke up crying , I looked at my family, and I’d think about losing my wife…but I pulled myself together and said, I’m going to fight this.”
Wendee was also fighting, with their insurance company. Shortly after Ivan’s diagnosis, some forms were incorrectly filed, creating a potentially expensive problem for the Cutlers. “Everything is so automated now, you can’t get to one dedicated person until I finally stumbled on something by accident," explained Wendee. "So I marched down to the insurance company and one person took pity on me. They called someone in another city who was at supervisor level and they found me one dedicated person that I had calling me every day or every other day until we had the whole thing straightened out. And that took 3-4 weeks."
Through it all, Ivan found a unique way of staying positive--especially during his treatments. He carried a large, green stuffed toy frog named Leap to Remission. And every day, he wore a different costume. A grass skirt with lei and some swinging moves, a green boa draped around him, and a sumo wrestler dressed in a huge diaper. “I consider this to be an act of strength. Vulnerability is really another form of strength," says Ivan. "So I see this letting my hair down as strength and comfort. It brings a little happiness to all of us involved and that’s what’s good.”
Since day one, Ivan’s chronicled his cancer journey via costumes. And on this day, he’s dressed in a full tuxedo accented by a silver cummerbund and bow tie. Tied on his head is an arched pillow shaped like the tomo unit. It’s treatment #40, Ivan’s last one. Radiation Therapist Claudia Huntley steps outside of the Tomotherapy room and sits down at a desktop computer. Knobs, monitors and lights are on a panel near her. She pushes a button, and watches a monitor as radiation is targeted into Ivan's prostate gland. Five minutes later, he walks out grinning. But the emotional strain of living with her father’s prostate cancer overwhelms 12 year old Alexa. She says she was nervous because she wasn't sure her father would be okay. Through tears, Alexa describes the man she calls her best friend. "He’s fun to be around and he makes me happy.”
Dr. Murray describes Ivan as an unusual patient because of his willingness to talk openly about his fears and feelings during his cancer treatment. Not common for most of his patients. “Men look at themselves as being bullet proof. They’re the providers in the family. They’re supposed to be the tough person, not show any emotion," says Dr. Murray. "And I think many of them believe their friends don’t care what they’re going through, how they’re doing. But I would say the majority of men want to get their treatment, get it over with and get back to their daily routines.”
On December 30, Ivan will be 65. He’ll also celebrate 17 months as a cancer survivor, his PSA has hovered around 0.05 for most of this year. Now he says he has a new ministry, letting men know they can survive prostate cancer and that their greatest weapons are education, regular physicals and talk about their feelings. “Men over 35 certainly 40 years old need to bench mark their PSA. They need to stay in consultation with their physician and understand what this is. And they shouldn’t be afraid of anything," according to Ivan. He also encourages the women who are important in the lives of men, "make sure the men get a physical every year, stay in tuned with your body. It’s a different kind of Harley to ride." Meanwhile, Ivan is back to work, taking walks with his wife Wendee and shooting hoops with their daughter Alexa. He says now he spends more time embracing friends and being sensitive to what’s important to others. Going from strength to strength and living the ‘good life’.
