Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the tag “health”

Finally, Good News on the Medical Front

Finally, Good News on the Medical Front

Finally, Good News on the Medical Front

I finally have good news to report. I feel as though I have done nothing for the past four or five weeks but sit in doctors’ waiting rooms but now I have good news. My failing kidneys are no longer failing. The last blood work that measured kidney function showed numbers that were essentially normal. While still a bit below the norm, there is no statistical significance between my numbers and the norm so that makes me quite happy (not that I wasn’t happy before because being happy is really a choice) but happier would be the better term here. The down side of all this is that I can no longer take hard working anti-inflammatory drugs for my arthritic pain because they beat up my kidneys making them undesirable. Tylenol, which will only beat on my liver or narcotics like Norco are the only drug related choices. Since I won’t take the narcotics and Tylenol, while it provides some relief, is not really up to the task, I think I’ll look into alternative therapies and lose some weight to see if that doesn’t help reduce the pain I am experiencing. That being said, all is good. I am going out now to enjoy this beautiful day.

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What a Week

What a week this has been and it is only Wednesday. It feels like I have been in and out of doctors’ offices every day for the past two weeks but this past seven days has been quite a trip. Since I had that urinary tract infection, which appears to be resolved, I have had some crazy numbers related to kidney function, so much so that I saw a kidney specialist a few days ago. He told me straight up that, while my kidney function appeared to be improving, I still have chronic kidney disease. When I tried to pin him down about what that broad description actually meant he simply said, “Let’s wait for the test results.” so I had to pee in a very large cup and had blood drawn. It is now a waiting game to find out what needs to be done to make this better…if anything.

To top that, I woke up on Saturday with a huge pain in my abdomen, a sharp, knife-like, stabbing pain that began in the center of my guts just below the diaphragm radiating out to the left and right. The pain persists, sometimes intense, sometimes mild and even sometimes gone; it is almost like the pain comes and goes in waves. Once again, I have to wait and see what the blood work looks like before my primary care doc will even think about what to do next. Medicine is a waiting game, meanwhile, I still am in pain. The good news there is that the pain is not getting any worse.

So I am engaged in a great waiting game, a game in which I am literally out of control. All I can do is wait. For me, this means that I have to think about the worst possible diagnosis, accept that diagnosis and then take whatever actions are needed to help with the cure. Once I accept the worst possible outcome, I am freed from the anxiety of that very possibility allowing me to effectively weigh my options once they are presented to me. In this particular case, I am thinking that the worst possible outcome is death stemming from a massive breakdown of my internal organs. While I do not know the specifics of the breakdown, I know that there is a reasonable possibility that things inside don’t look so good. I accept that possibility while I wait for the doctors to offer me options for treatment. Whatever speculations I make now are fear based and not based on evidence. Because they are fear based, there is no rational reason to pay any attention to my own speculations other than to accept the worst possible outcome. Now I am ready to move on.

In the next seven to ten days I should know more and know what my treatment options are. Then I have some decisions to make. Until then, I think I’ll head out to Starbucks and enjoy a cup of really good coffee.

Infusions, Doctors and Life Generally

Infusions, Doctors and Life Generally

Infusions, Doctors and Life Generally

As I was sitting in the very comfortable reclining chair getting hooked up for my sixth infusion of antibiotics to deal with the  resistant echoli strain that has seen fit to invade my body, I was struck by the idea that since my cancer diagnosis, surgery, and recovery period, I have slowed down. Now slowing down is a good thing. It began when I took off my watch forcing me to be less concerned with time in general. While the act of refusal to recognize time as a constraint was difficult at first, it has become a blessing. To not feel the urgency of time makes the time I have more precious; something akin to a gift from myself to myself. At the same time, I have not lost my appetite for punctuality. This may seem a contradiction but I think it is not. When everything is run by the clock then punctuality is an obsession but when I take the time to just take in what is there, punctuality becomes an ethical act; an act of respect for the other whether the other is driven by the clock or not.

So sitting in that chair, talking to Cynthia, the nurse administering the antibiotic, I noticed all of the surroundings, the pictures on the wall, the clock with the broken second hand, the smell and taste of the antibiotic as it drips into my veins. In the moment of that half hour of dripping solutions I was at one with the universe.

Since taking off the watch six or so months ago the world seems to spin at a slower pace. Of course it isn’t the case but the fact that I take the time to notice things I didn’t have the time to notice before is a bonus that was totally unexpected. I hear the voices of doctors as they try to figure out what is going on with me and find the urgency of one doc countered by the patience of another as they look at the results of the data. One doc looks at a number and nearly panics while the other looking at the same numbers takes the approach of waiting to see how the whole picture develops before striking out with a treatment plan. I think that one should never treat a number, rather one should look at the whole picture and treat the cause of the abnormal data that emerges over time. Jumping in without all the facts is as dangerous as denial of the emerging data. While one cannot be absolutely certain when incomplete data is present, one cannot allow oneself to be driven by the presence of a single abnormal number either. That too is an insight I learned after taking off my watch and allowed myself the luxury of observation.

As an aside, I found it interesting that even with the PICC line inserted I had to be stuck to draw blood in my internist’s office. What a waste of a good PICC line. When in the infusion center blood was also drawn and the same blood numbers will be analyzed. Why twice? Could it be profits are involved?

 

Yes, A Week for Medical Concerns: Dealing with the Aftermath of Cancer and More

Yes, A Week for Medical Concerns: Dealing with the Aftermath of Cancer and More

Yes, A Week for Medical Concerns: Dealing with the Aftermath of Cancer and More

In the next ten days, starting today when I visit my internist and oncologist back to back, I begin a ten-day period of rather intense medical review. While I expect to find things right on schedule, one never knows. My internist drew blood last week in preparation for this morning’s visit. Leaving his office, right around the corner from Starbucks, I went to read and enjoy a cup of coffee. While sitting in Starbucks, I began to notice some significant back pain along with gripping groin pain. It took a few moments, but it soon became clear that I was passing a kidney stone. As if I didn’t have enough urological problems, I then noticed that I was running a fever of around 101 degrees. Yikes, now I am getting sick as well. Just what I needed. Since the symptoms weren’t getting any better, last Friday I went to my internist complaining of cloudy urine and this on again off again fever. He prescribed an antibiotic, one I had never taken before and said I should keep the Monday appointment as a follow-up as well as one in which we would address any number of issues. By Saturday, I couldn’t stay away from the bathroom and I had developed a bright red, blotchy rash all over my body. I stopped taking the antibiotic on Sunday. It is now Monday morning and I still have bowel trouble but at least it is not constant and urgent.

Soon after I post this I will be on my way to Starbucks once again in preparation for my trip to the internist’s office. As soon as I finish with him I must go to the oncologist for an infusion of iron as my system simply refuses to ingest iron from any source whatsoever. This means a bag of the dirtiest looking rust water (I know it is not but that is exactly what it looks like) will be introduced into my veins and allowed to course through my system adding iron to my blood stream.

Finally, I get to see the urologist who replaces the urologist who treated me for the past fifteen years. He took a new position and so I am left to see if I like his understudy or not. I am actually feeling a bit uncomfortable about this change but my old urologist swears that this new doc is even more affable than he is and that he would send his own brother to him which, I suppose, is a strong recommendation. Time will tell whether I like this new guy and whether he will become my urologist of choice or will I have to shop for someone else? Tick tock tick tock!

Other than that, not much is new on my medical front. The kidney stone pain has subsided which may only mean that the stone is not moving about or it could be that the stone has passed. My fever is gone but there again, on only two days of antibiotic it may return. I think I’ll suggest to my internest that he stick with antibiotics that we know I have absolutely no allergic response to and take it from there. I nervously await the PSA results of my blood test, he also tested for testosterone levels but I don’t know why. I think I’ll ask. May post later with some news about the test results. If not, I’ll surely post tomorrow.

Off to the Doctor

Off to the Doctor

Off to the Doctor

Today I have my post-surgical check and I say goodbye to my urologist (he is moving on and will hook me up with one of his partners) but the day is bittersweet. I have so many questions about this recovery and the two side effects that leave me helpless and I will have to break in a new urologist along the way. While my urologist will answer my questions he will not be the one to treat the issues; he will be gone, replaced by a doctor I don’t know who potentially will treat the issues and side effects that present themselves.

Trust is the issue here. Over the years I have built up a trust with my doctor that is hard to set aside. His advice has always been sound and it has always been provided with a smile and care. Unlike most surgeons, his first course of action is to treat medically leaving the knife as a last resort. He always took the time to explain the options, the pros and cons of each, make suggestions but he left the final decision to me. His demeanor always took on the posture of a caring physician first and a surgeon second. Not only that, I genuinely like him. So where does that leave me?

A new urologist, no matter how well trained or capable he might be, will present himself to me without the advantage of trust. He will have to build that trust a visit at a time. That is no easy task, especially after so good a relationship as I have with the present one.

My task in all this is to remain open. In this case I am the other calling to the new urologist to take charge, to be available, to care for my welfare without reservation (I cannot say without reciprocation because he is paid a handsome fee to care for me). It is funny how roles switch from self to other depending on circumstances. While my call is a call for care, a call that says I trust you, it is also a call of caution because, while I want to trust, I cannot until it is earned.

This day I confront the disquiet of change. What I do know is that life will go on because the crux of this very moment is change.

Getting Festive . . . Making Decisions

Getting Festive

Getting Festive (photo credit: Roger Passman)

It is Saturday afternoon as I sit down to write. The day began with a trip to the Vet’s office with our two dogs, Mazel and Simin. They were due for their heartworm injections, in fact, they were it turns out, six months overdue. They should have been injected in June but that month was taken up with my knee replacement surgery. Who ever said that growing old was going to be easy? Now, with the relief of being declared cancer free, we can pay more attention to the mundane tasks of everyday living.

While at the vet’s office I watched these two dogs, sniffing and exploring, at least that is what I think they are doing. I thought about their actions, how they were absolutely engaged in this very moment, concerned about nothing but their well chosen activity. There I sat, thinking also that I was peeing into a diaper which made me a bit self-conscious, while the Vet was getting ready to inject them with the serum to keep the dogs safe from heartworms for the next six months.

In the car, on the way home, it hit me. What am I feeling sorry for myself for? Look, I still don’t know if the incontinence caused by the Radical Prostatectomy is permanent. In fact, there have been some signals that it may be only temporary. But so what, let’s take the worst case, that the condition is permanent and I will be wearing adult diapers for the remainder of my life. What if instead of diapers I would be tied to a colostomy bag? Would I be complaining loudly or accepting the condition as a fact of life that I would simply learn to live with. Things became quite calm at that very moment of decision. It is now unlikely that prostate cancer will be the cause of my demise. The latest mortality rates for disease specific mortality is a mere 10% (a survival rate of 90%) so it is clear that I am not facing death from this disease. If I have to face the consequences of incontinence so be it. At least I may actually, possibly, maybe see the Chicago Cubs win a World Series…I can always hope!

I am also getting ready for the holiday season. Chanukah begins at sundown and the first candle is to be lit tonight. We are planning to attend a Chanukah party at the Elgin-Hoffman Estates Chabad tomorrow afternoon and on the last full day of Chanukah we will drive to Madison to join our Grandson Eddie, his parents and a number of other families for a festive Chanukah party with potato latkes, lox and bagels and a whole lot more. While I don’t much care for religious celebrations, Chanukah is one of those times when kids have a whale of a good time, families get together to share and we can get ready to be rid of the cold weather and look forward to Spring. The fact that one must recite a few blessings interjects a pallor of myth that must somehow be deconstructed in order to make any sense at all of the underlying irrationality of the holiday itself makes the whole thing somehow tarnished.

The ubiquitous nature of the season is also a cause for stress. No matter where one turns there are reminders that simply won’t let go. I cannot drive down my street without being attacked by houses lit up with commercially available lights made in China (or some other third-world sweat shop) which seems to me to debase the message the house decorators are trying so desperately to send. Wouldn’t it be a better choice to sit this one out, to pledge to purchase only domestically manufactured goods as presents? Perhaps one should also look to the idea of gifting as something one does, not to impress, but to give unconditionally without expectations of a gift in return. The gift of love, of caring, of hope, of embracing the differences we share with our neighbors ought to be enough to capture the spirit without breaking the bank or supporting the practices of shipping jobs overseas to save a corporate dollar (which goes to feed the greed of the corporate executives at a rate of nearly 500 times the annual salary of their average company salary). Okay, then, I have ranted enough. Time to sit back and watch some sports on tv and get ready for dinner with friends tonight.

Bittersweet News For Sure

Bittersweet

Bittersweet

Finally, I spoke to my urologist yesterday. Here’s the scoop. At the time of surgery the cancer had invaded 35% of my prostate and a small percentage had nearly reached the margins of the gland. The Gleason Score for the tumor was an overall 4+4 (or in simpler terms an 8) meaning that this was an aggressive tumor. The biopsy of the lymph nodes was clear of any indications of disease. It seems that surgery was the right choice…hooray! Sadly, however, my urologist, a man who has cared for my prostate and other urological problems for years, is leaving his current position to accept a huge promotion around 200 miles from Chicago. Good news for him and I’m sure I’ll get over the shock of a new urologist.

So once again, life throws a curveball. One reason I never advanced as a baseball player is the simple fact that I couldn’t hit a curveball no matter how hard I tried. Catching up to a fastball, no problem but that damned curveball would never hold still long enough or be in the expected place when I took a swing at the pitch. Once I gave up playing kids games, however, I learned that life’s curveballs, difficult as they might be, are always subject to a period of adjustment. It is almost like Kübler-Ross’s stages of grief with acceptance being the ultimate goal. I found that coming to acceptance is a matter of deciding what the worst possible outcome is, accept that outcome and work hard to see that that outcome is avoided if at all humanly possible. Acceptance is, in this sense, an active step; one that requires a positive approach to any difficult situation.

Look, I know that grieving over the loss of one’s urologist is maybe a bit crazy, but the end of any relationship is always difficult, especially one that is long-standing. It is, however, just one more example of how I can use the ethical tools I am developing to remain on an even keel during times of hardship, great or small. In this case, I turn outward and, rather than feeling sorry for my loss, I feel a sense of joy for this extraordinary physician and care-giver. I wish him well and I am absolutely certain that he will hook me up with one of his partners who will afford me the best of care, albeit, most likely without the smiling bedside manner that separates him from the crowd.

Here I Am!

Abstract

Abstract

Sometimes I wonder just how many significant opportunities to escape the mundane, day to day activities of life are offered up in a single lifetime. A group I belong to, one that relies on platitudes to make a point, drills into its membership that one must live life on life’s terms. For the most part, that means accepting the humdrum of a random life, one that offers up both challenges and boredom, and mostly boredom. So perhaps the question of escaping the day to day absurdity of the lived experience is not the goal, rather the challenge is to learn to live with the chores of existence while being open to the challenges that sometimes come along.

Challenges appear without notice. There is no announcement that a challenge will present itself on Wednesday at 7:47 AM so be ready. No, challenges strike randomly from apparently nowhere in particular. They are random occurrences that follow the mathematical laws of probability.  Most challenges sort of creep up on you. Once noticed, they don’t seem to have a point of origin. They are suddenly just there, presenting themselves in a way that causes one to remark, “Where did that come from?” Others present themselves suddenly, without any real warning even when a point of origin can be readily identified. The evening after my bone scan and CAT scan, sitting at the dinner table, when my urologist called and said, “You have prostate cancer,” proved to be one of the latter challenges. Those words were like a glass of cold water being thrown in my face, a wake-up call that, while perhaps anticipated, came as a shock.

Challenges offer one some choices. In the case of my diagnosis of prostate cancer, the choices were quite simple. I could turn inward, sit on the pity pot, sink into a depression or I could choose to become an advocate for life, to turn a theoretical ethics into a practical ethics, to become available for myself and for others. I chose the latter as being the only reasonable approach. I chose to live life on life’s terms. This is not to say that I didn’t make aggressive treatment choices, I did. A prostatectomy is major surgery even when done robotically. I chose this approach because it provided the best possibility for a long-term “cure,” although I don’t believe there is ever a “cure” for cancer, only a set of survival statistics, probabilities, percentages. If I understand my own mortality statistics, there is a 15% probability that I will die as a result of prostate cancer in the next ten years. Certainly nothing to go into a grand funk over. After all, I am 69 years old and I would think that I have around a 15% chance of dying from anything over the next ten years.

What this challenge has provided for me is something that I could not have anticipated, the ability to turn my humdrum lived-experience into an ethical one. This is not to say that daily living will not still be filled with routine, be commonplace, rather it means that I am always already present for the other. Here I Am! does not mean that sudden changes will occur in my life. To the contrary, I am creating proximate space that may or may not be addressed by the other (person) but the moment it is, the moment I hear the call of the other (person) I must act for the benefit of the other (person)…period. I see this ‘calling’ to be concentrated on benefiting prostate cancer patients but it is not limited to that sphere of influence. To be truly ethical it must not have walls to contain the effort. So, once again, Here I Am! I stand at the ready in proximity simply waiting to be called.

As I Sit Quietly and Listen

Northern Lights (photo credit) Camilla Hylleberg

Northern Lights (photo credit) Camilla Hylleberg

I make a habit of sitting quietly and listening to the infinite silence of the universe. I do this each and every day because it is calming. I engage in the quiet of the emptiness of all that surrounds me while I work on shutting out the objective world if only for a few minutes. When I emerge from a meditative state I feel refreshed, ready to resume my lived experience in the objective world around me with the clarity of this very moment, the instant of existence being more than a set of intentions, more than desires, more than problems, more than the unintended consequences of actions; in this very moment I am alive, an existent, a depositor of traces that are but flimsy recollections of a moment past.

This very moment of existence is vibrant, filled with the spark of life. It is the very root of the power to connect to the absolute Other through the intimate interaction with the existing other, the other person with whom a face-to-face encounter mirrors the potential encounter with the infinite. The very moment of existence is filled with the joy of living in the objective world, the power of proximity created by announcement, the patience of waiting for response. But it also provides one with the absolute knowledge that all is good; that even when news is bad, there is still the moment of existence that moves one forward to the ultimate transition, the clarity of engaging with the infinite from which one emerged.

Meditation is a learned experience. I have been practicing some form of meditation for a bit more than 22 years. It helped me overcome any number of difficulties along the way. In its current form, my meditation is quite simple. I stop activities, sit straight in a comfortable chair, fold my hands on my lap, close my eyes and listen to my breathing. Breathing is the metronome that transports me from this world into the absolute quiet of the universe. Some days the transition is quick while other days the transition takes some time. On rare occasions, but especially when there is physical pain, meditation does not transform. Yet even on those bad days, I emerge a quieter, more centered human being. That is the goal and the results make for a positive lived experience.

On Suffering

All that is past and that is future draws near to the present. Time shrinks, the line between the eternities disappears, only the moment lives and the moment is eternity.
Martin Buber,  Hasidim and Modern Man

Mask by Carl Milles (Photo credit: Wikipedia)

Suffering Mask by Carl Milles (Photo credit: Wikipedia)

Existentialists find life itself absurd, that suffering, that feeling of dread and woe, is the hook upon which absurdity hangs. Through suffering one comes to the very profound conclusion that even in an absurd life one must still live a life of responsibility; to behave in an ethical and moral manner toward one’s fellow man. Briefly, assuming responsibility for one’s actions toward the other.

I would like to take a different approach to the very notion of suffering, one that centers around choice and action. Let me start with the very idea that suffering is nothing more that an overload of external (or internal) datum experienced as a turning inward to the exclusion of the rest of the world. An escape from the real into the depths of despair  In this sense, when faced with such an overload of phenomenological sensations one is, in reality, faced with a choice; turn inward, thereby derailing one’s ethical compass or embracing the sensations yet projecting those sensations outwardly as an empathy for the suffering of the other. Self pity or empathy are the choices when facing potential suffering in one’s life. Nothing lies in between.

Suffering is born of projection into the future emboldened by fear that is coupled with a profound regret of the past. When one complains of pain, real or imagined, or hurt, or loss, or any other thing one is truly embracing the experience of self-pity and seeking attention from others. “Oh woe is me,” is really a cry for sympathy, a cry for understanding of those fears and for the guilt of the past, whether deserved or not.

So, with this in mind, I could ask about my cancer, “Why me?” But I am savvy enough to understand that whenever one asks a “why” question the only reasonable response is. “Because!” As I understand the universe we live in , the only place we have direct knowledge of, pretty much everything is based on probabilities. Once born, for example, the only outcome of life is not life or death. When not life occurs, however, is a matter of probabilities (if this were not the case all life insurance companies would necessarily go broke because of the inability to create reasonable actuarial tables). I like, then, to think of the universe as a random number generator complying with the mathematical laws of probability. The simple fact is, that I got cancer because the probability meter pointed toward me. It is as simple as that. I cannot dwell in the past trying to think about why or what I could or should have done differently to prevent this disease. If I did, I would be suffering needlessly; needless suffering is self-defeating because it only turns one more deeply inward leaving little room for escape. I also cannot project into the future a myriad of possibilities that hinge on fear and lack of knowledge for that is also self-defeating. I must, therefore, choose to live in this very moment.

Learning to live in this very moment is a difficult journey. For me two things are required. First, I make time for sitting quietly every day to clear my mind of wandering thoughts and just sit comfortably listening to the silence of the universe. Sometimes I chant a repetitive OM sound over and over until my brain hears nothing but my own breathing, while other times, just sitting quietly will do. Secondly, learning to let go of those things I cannot control, to not think about those things where I have no dog in the fight, where I have no interest whatsoever in reasons for or outcomes of, to accept the absolute worst outcome of those things that absolutely effect me, of things for which I have some level of control and then work for a better outcome; one might call that acceptance; I prefer to think of it as living in this very moment.

I cannot control the absolute fact that I have prostate cancer nor can I control whether or not it is metastatic at this very moment. I can, however, control what I will do about it when presented with choices for treatment. As readers know, I have opted for surgical removal of the prostate two days from now. Surgery and, then, pathologists will then determine what the next options will be. I have no reason to project beyond the surgical procedure and all I can do about that is anticipate the operation itself. The closer I stay to living in this very moment, the less I think about the procedure.

At the same time, I have accepted the worst possible outcome of the consequences of this disease; death. By acceptance I mean to eschew denial, recognizing that this is only a possibility among an finite number of possibilities but I refuse to deny that it is a very real possibility. In terms of probability I currently have a 15% possibility of dying in the next ten years from this disease (a bit more than a 5 to 1 chance of death). Should the biopsy of my lymph nodes prove positive the probability will increase to around 2 to 1, a near coin flip.

Yet, what do I have to complain about? Absolutely nothing! I am grateful for all those little things that make life worth living to its fullest up to and including this disease. Why, in other words, should I spend my time in unproductive suffering? I think the answer to those questions is that I should not. Rather than suffer, I choose to continue to live, to live for rather than to live with this disease, to live for rather than live with others. In short, I choose to be present in the world at the very moment of eternity contained within the immeasurably brief time represented by this very moment rather than to sink into the unproductive world of suffering. It just isn’t worth it!

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