Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the tag “Prostatectomy”

ProPep Surgical – da Vinci Prostatectomy | da Vinci Robotic Surgery | Nerve Monitoring Prostate Surgery

I found this interesting. I wish I had known about this technique so I could have discussed it with my surgeon prior to my prostatectomy. Being informed allows one to  advocate for oneself.

ProPep Surgical – da Vinci Prostatectomy | da Vinci Robotic Surgery | Nerve Monitoring Prostate Surgery.

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No More Roman Numerals

No More Roman Numerals

No More Roman Numerals

I can’t imagine what I was thinking when I started the “Thinking in Jewish” series of posts by numbering each post with a Roman numeral. This numbering system is antiquated and cumbersome and I am, quite frankly, tired of the whole mess. So from this day forward I will number the “Thinking in Jewish” posts using Arabic numbering system which means that the next post will be labeled 32.

There is a question I want to answer for the readers of this blog. It comes up from time to time in the comments which makes it a worthy topic to blog about. It centers on what on earth my atheism and the posts in the series “Thinking in Jewish” has to do with my prostate cancer diagnosis and treatment. Along the same lines I have seen a strange undertone that seems to be asking what is an atheist like myself doing commenting on Jewish thinking in the first place.  So here goes…my best effort at talking about these issues as I blog away.

Begin at the beginning. When I heard the words no one ever wants to hear, the words that may indeed harken the beginning of the end of life, the words “YOU HAVE CANCER” it has a sobering effect on the way one chooses to look at the world. In my professional life I was a Professor of Language and Literacy at a Midwestern state university. My professional interests gravitated toward the study of the teaching of writing so that middle school and secondary school teachers could better teach their students the skill of writing without effort. Blogging, then, seemed like the most natural thing I could do to both help me focus on the fact that I now have a disease that may contribute to my demise. Kubler-Ross was wrong in my case. I grieved over the possibility that my life was coming to an end but I quickly accepted that as a fact that may or may not be true. My job now was to come to grips with how I intended to live the remaining years (or months whatever the case may be) of my life.

As an atheist, I rejected the idea that there is a creator God that is omnipotent, omniscient, and benevolent. My own observations of the world and my deepening understanding of Jewish religious texts, however, caused me not to reject my own Jewish roots. I am a Jew, I have a Jewish understanding of the world, of time and space, of ethics and morality. I simply don’t attribute any of this to a creator God. one that is angry, demanding and punishing. As a post-Shoah (or post Holocaust although Shoah is a better word choice) Jew, where 6 million of my nation perished at the hands of Germans in an unspeakably horrible genocide (perhaps religicide is a more apt descriptor) for no other reason than they were Jews in Europe, made the very concept of a benevolent and omniscient God improbable and the very idea than an omnipotent God would not put a stop to the horrors of the camps, gas-chambers and crematory ovens would make this God either a sadist or rather than omnipotent, simply impotent and unworthy of worship. The other possibility to consider is that there is no God to be omnipotent, omniscient or benevolent, a possibility I find more convincing than any that includes God or religion at the center of the a discourse.

While sick and waiting for testing to be completed to determine what course of treatment for my prostate cancer would be recommended, I decided that learning how to ‘think in Jewish’ would be a good way to think about the potential end of life. It was a clear choice. The Christian story makes absolutely no sense to me. The same can be said for the story of Islam although that one is easier to swallow perhaps because it was formed in the same region as the Jewish story while the Christian story, while originating in Palestine, is essentially a European take on the very idea of monotheism. That being said, I thought it best to stick with what I know and simply become better at understanding where and how the religion of my people developed. The story, especially when told in the light of the ultimate schism of Jewish and Christian thinking and the response of both to the Roman destruction of the Second Temple in Jerusalem in 70 CE, is fascinating. I do not intend to go into that schism here but the response of the triumphal Christians and the defeated Jews of the first three centuries CE paints a picture of quite different approaches to the self-same problem.

What I found as I studied and read more deeply was that the ethics of Judaism played a great role in the way I had been living my life for years. There was embedded in the literature constant reminders of obligations to care for the widow, the orphan and the stranger, for those less fortunate than we might be and there is always someone less fortunate than yourself no matter what your current situation might be. I don’t recall who said this but it is appropriate here. It goes something like this, “I cried out because I had no shoes until I saw a man who had no feet.” Sure I had cancer, but I still had hope and that hope lay in the hands of skilled physicians, men of science, who would do everything possible to make the remainder of my life one filled with the absolute joy of living. In the end, the men of science told me that surgery would cure my cancer and while there are some unpleasant side effects of the surgery, my life will not be disrupted to any great extent. I am now writing as a cancer survivor, one experiencing the unpleasant side effects and it is truly a small price to pay for many more years of life.

That being said, I decided to continue this blog because my personal struggle with ethics and evil in this world has become an important part of my life. Sure, it didn’t begin when I was diagnosed with cancer but that diagnosis brought it to the forefront of my being-in-the-world. That is why I continue to blog about my encounter with life in general and sometimes about health related issues that seems to arise as a result of my experience with cancer.

So no more Roman numerals and I’ll continue to make my thinking visible to me (and to you) on this blog.

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?

 

It is Raining Outside Chicago In January

It is Raining Outside Chicago In January

It is Raining Outside Chicago In January

It is raining, well not quite rain, rather a mixture of rain and sleet, freezing rain I suppose. This means that the electrical grid will be stressed to its limits this evening as temperatures drop into the mid-twenties. Tomorrow, however, the forecast calls for temperatures in the mid to high forties and it is still January. Something is awfully wrong with the weather. Of course, I live in the United States, the land of denial (that’s right the Untied States not Egypt). Global climate change is only a mythological story told by liberals in order that they might spend more money and grow the size of our government or so goes the tale told by the denial group. But temperatures in the high forties and low fifties in January in Northern Illinois are simply not normal. Perhaps it is time to wake up and smell the roses (that may bloom in February if this keeps up) before the world my grandchildren inherit from us is destroyed.

That being said, after all it is good to rant once in a while, I spent an interesting weekend at the Chabad of Elgin, where the Rabbi and his wife hosted a Friday night dinner. The evening included both a Shabbat service, a dinner and Shabbat games played by a raucous group of folks attending this event. The food served featured the seven native fruits of Israel including: dates, figs, pomegranates, sesame seeds, olives, apples and oranges (if memory serves me correctly). The food was simply outstanding, rich in tradition with a modern presentation that left everyone there satisfied. The hit of the evening for me was a potato kuggel, a baked potato pudding, that swept me back nearly 60 years to my grandmother’s table and her outstanding potato kuggel. I even asked for the recipe it was that good.

Part of the evening was spent talking to one of the regular attendes at our weekly torah study group. We see each other on a week to week basis but never really get a chance to talk much. Spending time building this relationship was both interesting and enjoyable. It turns out that he is a “Jew by Choice” having converted to the religion I was born to. Because we come to the table with such different perspectives our conversation explored nuanced belief; how, for example, I could be so interested in religious texts while I simply do not believe in a God (or gods for that matter) and while no conclusion was reached, I found myself thinking more clearly than ever about the differences between belief and non-belief, between faith and rationality. I suppose that is a good thing but I cannot yet draw any conclusions about the conversation we engaged in.

At one point in the evening Rabbi Mendel told us an interesting tidbit of information. We were celebrating the holiday of Tu Bish’Vat, the festival of trees, a holiday in which Jews traditionally eat fruit. The holiday that celebrates the harvest and, by implication, fruit, Sukkot, doesn’t have a tradition of eating fruit at all. Curious. But, needless to say, he found a lesson in all that. Eating of fruit on Tu Bish’Vat symbolizes the potential in the fruit tree, the very reason for the existence of the trees in the first place. Celebrating by eating fruit on this holiday reminds us of all of the work to nurture the trees, to pull the weeds, water the orchard and so on. It reminds us of the purpose of nature harnessed. The harvest, on the other hand, the picking of the fruit, represents a period of dormancy that doesn’t require a special food to remind us that the seasons turn in order. Now these are stories I can understand. They are simple, almost folksy, reminders of an ethical life lived encapsulated by infinity. The stories lend purpose to an otherwise absurd life, a life in which purpose often eludes us.

One last thing, I am actually feeling quite giddy today. I spent the last two nights sleeping through the night, the first time since my prostatectomy. Not only that, but in the morning the only thing in my Depends for Men was the baby powder I put in before I went to bed. I take this as a sign that things are actually improving. I am pleased to report this progress as it gives me something to look forward to. Yea!!!

To the Pain…

To the Pain...

To the Pain…

At the end of June, 2012, I had a total knee replacement performed on my left knee. For three months I was in so much pain, a pain that simply didn’t seem to be getting any better, that I regretted having undergone this surgery. I was shocked and, frankly, surprised that the pain was so intense. After all, I have two total hip replacements and a titanium back from a laminectomy to deal with a stenosis caused by my severe osteoarthritis. I expected recovery to mirror my prior orthopedic surgeries. Then, one day about three months after surgery, the pain simply disappeared; while I was left with some discomfort, it was getting better from my commitment to physical therapy. But my healthcare nightmare of 2012 was not quite over. In October I was diagnosed with prostate cancer and, because of the biopsy, the bone and CAT scans, it was decided that surgery was the most appropriate option. So in late November I underwent a radical prostatectomy. So far, this is nothing new for those following this blog. Here is where it gets a bit dicy. Because of the surgery and the post-operative restriction on lifting, I was unable to continue the exercise program that my PT laid out for me. Three weeks ago I was granted a lifting of all restrictions on lifting and exercise. Ten days later I was in my orthopedic surgeon’s office for my six month evaluation. I was complaining about a stiffness developing in my left knee. He suggested that I go to physical therapy just to make sure that I didn’t do any serious damage to the knee as I worked my way back into some kind of shape.

Yesterday was my first serious day in physical therapy and man do I hurt today. There isn’t a muscle in my lower body that is not feeling the effects of having been sedentary for the past two months. Things that I did with ease prior to the prostate surgery were not only difficult, they were painful as well. When I rolled out of bed this morning I could feel the pain everywhere. I have a whole regimin of exercises to do at home and I will not return to PT until Tuesday. With enough effort on my part, perhaps I will rejoin the ranks of the reasonably fit but right at this very moment that doesn’t seem like a reasonable outcome. What I’ll have to do is shelve my pessimism and visualize the end result as I go down to my basement to push myself harder but within the limits laid out by my PT.

Okay, I know this is a short post, but I am out of the house to meet with the orthopod about another issue, nothing I am terribly worried about, and then to see Zero Dark Thirty. Exercise will wait until I return.

Reflections on Life and Death or Living with Prostate Cancer

I do not fear death. I had been dead for billions and billions of years before I was born, and had not suffered the slightest inconvenience from it.
Mark Twain

Reflections on Life and Death or Living with Prostate Cancer

Reflections on Life and Death or Living with Prostate Cancer

I agree with Mark Twain’s assessment with one exception, that he was dead before he was born, but I understand the inference quite well. One cannot be ‘dead’ prior to birth; one can merely be said to not exist. The transition to death is only a function of having been alive in the first place. But this is a minor quibble and doesn’t take anything away from the idea that life itself is a transitory journey that exists between the bookends of infinity. If I could only remember the infinity prior to birth, the non-existence of nothingness, I could accurately predict what the transition to death might be. In truth, however, as an existing sentient being, imagining that transition is impossible albeit many have tried to do just that. From reincarnation to heaven and hell, and all things in between, images of the ‘afterlife’ abound both culturally and in religious dogma. I choose to deny all of these mythological answers to the question of “What is next,” and concentrate on this very moment of existence.

There is no reason to believe that there is something other than the material world in which I reside at this very moment. In the past several months I have been placed in a situation in which I had to contemplate my own mortality, a fragile and precious thing. Given the choice between life and death I choose life. But that is not unlike the choice between good and evil, to chose anything but good is outrageous. What I came to realize was that, in the final analysis, at some time in the future, later than sooner I hope, I will be presented with no choice at all; that the only choice is the intimacy of the transition from life to death, a journey only I can take, there are no substitutes, no proxies from which to choose. Just as there are no substitutes, there are no coaches, no guides; the transition from life to death, from finite existence to infinity, is mine and mine alone.

Yet, my personal mark on this material world does not die when I die. Throughout my life I have listened to the platitude voiced at services of mourning that, “The good men do lives after them,” a stunning sentiment indeed since it fails to mention evil in the same sentence. Designed to placate that profound sadness attached to the loss of a friend or loved one, it is, I suppose, a compromise for the sake of those in mourning. That platitude, however, never rang true until I was forced to contemplate my own death. Then I began to assess my contributions to this world, the only world I know. To my surprise, those contributions were many. As a teacher I touched lives, and through my students that became teachers themselves, my influence continues to be felt a hundred fold every single day. I raised two interesting children, so different from each other it is surprising that they were products of the same parents, and they now have children of their own, and that is a continuing presence on this earth that cannot be denied by death.

The fact of the matter is simply this; I am very much alive and doing well. My cancer is in remission with a 15% probability of recurrence. The side effect of incontinence shows signs of being under control most of the time. Life is adjusting back to a sense of normalcy that I have not known for the past six or seven months. Clearly, however, cancer is a life altering experience; one that forces one to assess the quality of one’s lived-experience while adjusting one’s approach to future events not yet anticipated. Cancer forded me to face my own mortality, lifted the threat with early detection and radical treatment, yet, even with the threat lifted I have come to understand that life itself is a terminal disease so I should make the most of the only one I will ever know.

Showing Improvement

Showing Improvement

Showing Improvement

I am old enough to realize that every single new day, in fact every single moment of existential time, brings with it something new. New challenges abound while carefully balanced by new things for which to be grateful. Being-in-existential-time, experiencing first hand the lived-experience, is something to be savored, enjoyed and embraced. This all works when one looks outside of oneself, finds ways to serve, to engage with others in a face-to-face encounter. It does not work when, in the depths of emotional or physical pain one turns to the interiority of the self because all there seems to be is pain or loss that triggers the desire to turn inward. When in pain it is difficult to think of anything else. When I had my left knee replaced six months ago the pain was so severe that I wanted no part of any other human being including my closest family. I saw absolutely no hope for relief. Drugs like toradol provided some immediate relief but that relief lasted but a short period of time. Then, about 3 months post knee surgery, the pain simply disappeared; presto, it was gone. The prostate surgery four months post knee surgery brought a different kind of pain, one that settled into my upper torso, especially around the shoulders and chest. This came from the settling of the CO2 pumped into my guts during surgery. While it was happening I was beside myself but then it left me only it was two days not three months.

The point of this is simply that there is no pain so great as not to resolve itself over time. I am in the middle of such a resolution as I write this. The incontinence suffered as a side effect of the radical prostatectomy I had is beginning to diminish, so much so that I have changed from Depends for Men to Depends Pads for Men during the day. It feels so good to wear cotton underwear and not the rubber pants that are part of the Depends for Men. I feel like I can breathe once again, that the underwear doesn’t stick to my buttocks, feel cold, chafe or bind. The thing that prompted the change was the simple fact that I was using fewer Depends three weeks after the catheter was removed. Leakage is slowing, not stopped. But the simple fact is that things are improving, getting better day by day.

This is, of course, an important lesson to remember. No matter how difficult something may seem at the moment, there is always a bright side to the picture. That old saying, this too shall pass, is quite true so long as one is willing to do the work to extract oneself from the interior of the self. It all comes back to the idea embedded in Levinas’s fundamental ethical obligation, to be of service for the benefit of others, to think of others before you think of yourself, to be ready to answer the call of the other without reservation or expectation of reciprocation. It is this basic idea of getting outside of the self in order to be present in existential time, in the material world, that makes all the difference in living in the world or contained as a hermit within the self.

Being of service to others is a decision made without reservation. It is a decision that rips a tear in the fabric of interiority allowing the self to escape itself in order to live in the world. This tear in the fabric of one’s internal self, once made, becomes the guiding model for one’s lived-experience. This is not to say that the tear cannot be overlooked, especially in the time of great pain, physical or emotional, but once there it becomes the window that allows light to render the darkness moot. The tear in the fabric of interiority is permanent, it cannot be repaired. It remains open even in the darkest of moments, in the times of greatest difficulty. It provides a way back to the material world and the ability to be of service for others.

With Apologies to Bob Wills–Time Changes Everything

Oh you can change the name of an old song
Rearrange it and make it swing
I thought nothing could stop me from loving you
But time changes everything

Bob Wills and the Texas Playboys, Time Changes Everything

With Apologies to Bob Wills--Time Changes Everything

With Apologies to Bob Wills–Time Changes Everything

I grew up on music called Western Swing and the king of Western Swing was a band called Bob Wills and the Texas Playboys. I loved the sound of the fiddle and as an adult, learned to play at playing the fiddle. Popular tunes that were trademarks of the Texas Playboys like Faded Love and tunes that only those who loved the idea of a swing band that included fiddles like Rolly Polly and San Antonio Rose filled my record (yes vinyl) collection. Right now I have been playing the tune Time Changes Everything as a reminder that I am but five weeks out of surgery and cannot expect everything to be as it was prior to my radical prostatectomy.

This morning I awoke with an almost dry pad. I don’t think this is anything to write home about yet but it is clear that given enough time, the incontinence I have suffered since the removal of the Foley catheter will resolve itself. Phew, that is a relief.

The severe itching that I experienced from the steri-strips used to close the five small wounds is also beginning to resolve. That is also a great relief.

As things begin to resolve and side effects from the surgery diminish, the title of the song Time Changes Everything has been running through my thoughts. Look, I have what is known in some circles as an addictive personality. This means that I want what I want and I want it right now and I’ll do anything to get what I want. It has taken a number of years (22.5 to be precise) to retrain myself to develop patience (although my wife still thinks I am the most impatient person she knows.) Immediate satisfaction is no longer a requirement in my life. The phrase “This Too Shall Pass” taught me that even the greatest emotional or physical pain is not a forever pain, it will pass because Time Changes Everything.

I also learned that living in the moment, in the immeasurably brief moment of time that is always already past, is a powerful way to release negativity and embrace the positive contained within the moment of life. Measuring one’s breath during meditation is a way to engage in the simulacrum of that instant of time, the existential moment of the lived-experience.

I believe it was Edgar Allen Poe that said that life is a dream wrapped up in a dream, or something like that. What remains of the existential moment is a trace, a memory engram that seems to lose much of the negativity of the moment as it fades into distant remembrance. It is impossible to remember what physical pain feels like, rather, we recall that pain was present but not what it felt like. Time Changes Everything. The trace is not the event, is not the moment, is not existential reality. It is merely a recall of time past re-presented in its most positive light. Our remembrance of time past is much like a dream wrapped up in a dream…it is what allows us to survive to face just one more existential moment.

Yes, Time Changes Everything. In the Bob Wills song there is a verse that begins, “The time has passed and I have forgotten you, Mother Nature does wonderful things…” The simple words of the song, one speaking about a lost love, captures the very idea of existential time in terms of both hope and how the trace fades into acceptance the further removed from the moment of lived-experience it gets.

Simple Reflections Before the New Year

Simple Reflections Before the New Year

Simple Reflections Before the New Year

It is always important to reflect on the events of the past year, the traces of memory that make a life remembered. This past year has been a doozy with ups and downs that shake one to the core. Some of these events were anticipated while others were not. Some caused great pain while others inspired great joy. To say the least the peaks and valleys of 2012 felt a bit like being on a never ending roller coaster. I want to share the highlights.

  • The birth of my second grandson on March 22nd, Eddie is an absolute joy to behold.
  • The nomadic wanderings of my son who moved in with Susan and me in June for five months, a terrific re-connection.
  • The news from my orthopedic surgeon that I required a total left knee replacement which was then performed in late June–OUCH!
  • The diagnosis of prostate cancer, a very aggressive strain, in October, a diagnosis that put my existence on hold, forced me to face my own mortality and reflect on my own value as a human being in this world.

I want to expand one by one.

The Birth of My Grandson Eddie

Eddie

Eddie (Photo Credit: Roger Passman)

In March I called my sister to inform her that while she was always a great aunt, she was once again a Great Aunt. Eddie was born on March 22 in Madison, Wisconsin sometime before dawn. Mark, my son-in-law couldn’t wait till the sun came up to call and tell us that we were once again grandparents. Both Susan and I jumped from bed to the showers, dressed, grabbed a bite to eat and brewed some coffee to take along for the 1.5 hour drive to Madison.

Anticipation is an emotion I somehow learned to suppress simply because it makes for doing stupid things. I set the cruise control at precisely 5 mph over the posted speed limit and drove from our house to Madison, following Veronica’s (my gps) instructions to the hospital. We were the first of the grandparents to arrive.

There he was in all of his 4 to 5 hour glory all swaddled with a wool cap covering his head, eyes shut even while awake and cooing. He was smaller than I remembered babies to be but they say that memory is the first thing to go. His fingers and toes were intact, he squirmed and fidgeted, cried a little but mostly he slept. As the other two, yes two, sets of grandparents arrived (my ex and her husband and Mark’s parents) the hospital room got smaller and smaller. After about three hours with Becki (she sometimes goes by Leah but that is a very long story) Mark, Eddie and the rest of the family we decided to leave with a few pictures and a whole lot of joy. Pointing the car back to Gilberts, IL we made the return trip and were home for supper.

Watching Eddie grow and develop for the past nine months has been the joy of all joys. He responds, is getting his top two teeth (he already has his bottom two) and is generally in good health. Who could ask for more?

Re-Connecting with Ben

In December 2011, my firstborn decided to pick up stakes and move from Phoenix to Austin, TX. He is in the throes of a midlife crisis that is quite interesting to watch. The move to Austin was motivated by the fact that his girlfriend wanted to go there, his son Drew (my first grandson and a joy to watch grow into a young man; he is now 14 years old) moved to Albuquerque because his mother landed a terriffic new job and he felt that since he really had no ties to Phoenix, why not.

In late April or Early May his girlfriend moved out leaving him stranded in Austin without any close connections or ties to the city. Within a few weeks the girlfriend decided she wanted back in but by this time Ben decided that he would be best served if he moved back to Chicago, his home town. After some discussion, he and his girlfriend got back together and she agreed to accompany him to Chicago. This is the stuff of soap opera scripting, yes, and it only gets better.

Ben called and asked if they could stay with us. We have a spare room and so it was decided that this would be okay. Now the girlfriend had two kids and Ben had Drew for the summer so, literally five new human beings moved into our house just days prior to my knee replacement. Ouch. It was a madhouse for nearly two months when things calmed down a bit as the two girlfriend kids were shipped back to Phoenix. Then it was Ben, the girlfriend and Drew for a few more weeks. Drew went back to Albuquerque and the house settled down to Ben, his girlfriend, Susan and me. Phew!

In October Ben and his girlfriend moved into a small apartment in the city; Susan and I were finally back to some semblance of normal.

Then the hammer blow, the girlfriend decided she missed her kids too much to stay in Chicago with Ben and she up and moved back to Phoenix leaving much of her stuff in storage in my basement. Ben spent some time agonizing about his move to Austin and then to Chicago, over his relationship with the girlfriend which he finally decided was going nowhere, and the fact that his ex’s contract in Albuquerque was ending and she was moving back to Phoenix to her old job plus a plumb promotion so Drew would be back in Phoenix. Finally, he decided to move back to Phoenix (a place I think he never should have left in the first place) so he could be close to his son.

During all this time we had a chance to talk, share ideas, ask for and provide advice and generally have a powerfully good time. I will miss his leaving at the end of January but I am also quite pleased that he may have stopped his nomadic ways. I can’t wait to see what develops in the coming year.

Knee Replacement

Then there were the low points. In late April or early May I slipped and suddenly was unable to place any weight on my left knee. Susan was meeting me for lunch that very day; rather than lunch we went to the emergency room where they put me in a brace and told me to make an appointment with an orthopedic surgeon.

I met the orthopedist a couple of days later and he told me I had three choices: First, I could do nothing and suffer, second, I could try injecting the knee with a substitute cartilage that, if it works, will provide relief for six to nine months and could be repeated until it no longer worked, or third, I could opt for a total knee replacement.” I opted for the second choice. Unfortunately it didn’t work.

I believe suffering is reserved for martyrs or saviors so I opted to undergo a total knee replacement. Being no stranger to orthopedic surgery (I have had two total hip replacements and a laminectomy) I thought that I was aware of the recovery period and what I could expect during recovery. The doc told me that knees are more difficult than hips or back surgery so in my mind I compensated for that as I prepared for surgery.

Oh man was I disappointed. Waking from surgery I was in the worst pain I could have ever imagined. Thoughts ran through my head that were as mild as “Why did I ever agree to this?” to “I want to die right now!” In the past I never needed heavy duty pain relief. I recognized the pain as bone trauma and that it would get better over the course of six to eight weeks. But with this knee surgery I was pushing the button on the morphine (or whatever drug was in there) machine as often as I could. The pain was unbearable most of the time.

The morning of the second day, the physical therapist walked into the room and said, “Time for your morning walk, ready?” I was in a fog, but I knew that if I did what I was told that I would get better faster. So with much help I got out of bed to begin my first walk post surgery. Offered a walker or crutches I chose the crutches but I couldn’t find balance that first time so a walker it was. I made it about twenty steps out of my room before I needed to stop. Finally, turning around I slowly walked back to the room where I was ready for bed. No such luck. It was time to learn how to sit in a chair, go to the bathroom and get back into bed with some help.

The afternoon walk was actually a bit easier and I pushed myself to walk to the nurses station. This time the crutches worked, I found balance and they made the walking easier. The next day I was walking up and down stairs, learning how to get in and out of a car and walking longer distances with the aid of crutches. But the constant pain was still there. We tried many drug combinations to help relieve the pain and finally decided that, in spite of my history, Norco in combination with Tramadol would be a reasonable choice. I went home with that cocktail the morning of the third day post-surgery.

I started out patient physical therapy two weeks post surgery (for the first two weeks a home-bound physical therapist visited me 3 times a week); for the next three months I dutifully went to PT and while I could see results in flexibility the pain would simply not go away. I couldn’t sleep well because the pain was agonizing. Drugs helped but couldn’t provide enough relief to make me happy I did this surgery.

One morning in mid-September, I woke up and noticed that my knee, while stiff and a bit swollen, didn’t hurt. It was as if some switch was turned off. I stopped taking the Norco which led to withdrawal symptoms for ten days but that was a small price to pay.

I continued with PT until mid-October and today, six months post surgery, all seems okay with the knee. While I think I have some fluid on my knee, it doesn’t bother me too much, other than making standing for long periods of time difficult. I see my orthopedic surgeon on January 4th so I’ll know more then.

Prostate Cancer

Then there was the kick in the head. In September I saw my internist for what amounted to an annual physical. He was quite concerned that I had a PSA of 23. Wow, so was I. He told me to see my urologist as soon as possible to track down the cause of this spike in PSA. Getting in to see the urologist has always been a difficult thing. Waiting two to three months was not unusual. When I called for an appointment I mentioned that my PSA spiked to 23 and the appointment person said, “Oh, then I can squeeze you in next week, would that be soon enough?” I responded in the affirmative and the appointment was made.

During the week prior to the appointment, I began to puzzle with my own mortality. What would be my contribution to this world? I didn’t much worry about what the transition to death might be like other than it is a deeply personal transition that only I could make, there are no substitutions possible.

When I saw my urologist he drew blood for another PSA (the result was 26) but when he did a prostate exam he felt nothing out of the ordinary. Several years ago I had a spike in PSA which required three needle biopsy procedures of my prostate, all of which were negative. BPH was the diagnosis which led to a procedure called a Trans Urethral Resection of the Prostate (TURP) and the biopsy of the tissue removed was negative for cancer. I vowed that I would never do another needle biopsy again, however, now I had to rescind that vow because of the unusual set of circumstances.

The biopsy was scheduled for the following week (in the past I had to wait two to three months to be inserted into the schedule). When the results came back he called me to tell me, “You have cancer of the prostate.” We set up an appointment for the following week to meet and discuss options. This diagnosis was like being kicked in the head by a mule.

We met and the facts were laid out in front of me. I had a cancer of the prostate with a Gleason score of 8 (4+4) with a PSA of 23 (my internist did a second PSA which came back with a score of 21) so the average of 23 appeared to be the best working number. This meant that I had a very aggressive cancer and that metastasis had to be ruled out or identified. This meant a bone scan and a CAT scan. Both of these turned out negative, but the CAT scan was inconclusive due to interference from my hip replacements and back surgery so the lymph nodes in the groin could not be clearly ruled out.

Surgery appeared to be the best course of treatment. A biopsy of the lymph nodes along with the prostate post surgery would find the lymph nodes clean and the prostate 35% involved with the tumor almost at the margins of the prostate but it does seem that the disease was entirely contained within the prostate.

So what does all this mean. For now, I am a prostate cancer survivor but even this is tentative. Some cells may have escaped prior to surgery or even during surgery and are just waiting to settle in to wreak havoc. For the next year I will have my PSA checked every three months and once a year thereafter for the remainder of my life. It is as if I have cancer rather than I am a cancer survivor and that cancer is just waiting around like a monkey on my back.

So there you have it. Some highs, a bit of drama, pain and suffering, and finally hope. What a year this has been!

Back Home After The Doctors Visit

Back Home After The Doctors Visit

Back Home After The Doctors Visit

Making an appointment with one’s urologist on his last day in this office was more interesting than I had ever imagined. For the first time in my memory I was buzzed back to the examining room on time. The efficiency of the staff was at its best. I first was visited by a resident who laid the groundwork for the ultimate visit from my urologist. Blood was drawn, fluid samples left and then some genuine time spent talking about how normal my recovery was up to this very moment. Absolutely nothing unexpected, unheard of, abnormal, or even slightly out of the ordinary. Good news once again. I’ll wait for the PSA results which are expected to be significantly lower than they were before this whole cancer thing began, maybe even undetectable but who knows. More than likely, given the time frame of four-weeks since surgery, a number slightly under 2 can be expected. Four weeks from now, however, a PSA of around 0.1 would be more like expectations. We’ll see. For the moment, however, everything looks quite positive.

As Guy Clark (a Texas singer-songwriter) once wrote,

Nothing lasts forever
Say the old men in the shipyards
Turning trees into shrimp-boats
Hell, I guess they ought to know.

Clark’s words have often been of great comfort to me. Change is a constant; randomness in this world is the grease that lubricates the entire machine. Accept that and the very idea of turning trees into shrimp-boats is something one must not only expect but accept as a rule of living in this world.

In my mind the universe is a very large random number generator, run by probabilities, predictable to a fault but not to the detail of any single individual actor in the play. If something can happen, if something is possible, no matter how small the probability, it will happen. You can absolutely count on that. It may not happen to you but if it is within the realm of possibility it will happen to someone or something. One cannot live in fear of the possible. That is a waste of one’s time and effort and gets you absolutely nowhere other than, just perhaps, causing significant stress, a factor which could actually trigger the unwanted. No, the only rational place to be emotionally is to be in this very moment, a time in which we deposit traces of an existential life and think about our own potential future by creating goals, hopes, and dreams.

Wasting time on the what could be, the what might be, the otherwise than what is wanted, the worst possible outcome without accepting what could be, what might be, the otherwise that what we want, or the worst possible outcome opens the door to negative energy and outcomes to occur. By accepting the worst, the otherwise, the could be, the door is open for us to work positively toward a more positive outcome.

Let me give you an example. After a radical resection of the prostate, even with nerve saving techniques and the steadiest of surgical hands, it is quite likely that one will suffer from some form of urinary incontinence. I know this for an absolute fact. The truth is that it is possible for this condition to be permanent, the worst possible outcome I can think of; the otherwise of desired outcomes. That being said, if this were true in my case, that the worst outcome possible were to occur I would not allow that to interfere with my zest for living. I have accepted that possibility. It would be something I would simply have to get used to. But I am doing everything humanly possible to assure that this outcome doesn’t occur. I do pelvic floor exercises on a regular basis. I left the urology clinic with a new, quite difficult, pelvic floor exercise that I do twice a day, morning and evening. This combination is expected to produce results sometime in the next 11 months, yes 11 months; I have already experienced some positive signs from just doing the pelvic exercises regularly.

So there you have it, accept the worst, work toward the best; it is a combination guaranteed to provide one with a serenity beyond one’s wildest dreams.

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