Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the tag “Urology”

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.

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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.

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.

Overlapping Circles of Community

The impossibility of approaching the other (autrui) without speaking to him signifies that here thought is inseparable from expression . . . consist[ing] in the intuition of sociality by a relation that is consequently irreducible to comprehension.
Emmanuel Levinas, Basic Philosophical Writings, p.7

Overlapping Circles of Community

As the new year approaches, less than two weeks away, I think it is important to reflect on the past year, the ups and downs, the natural fluctuation of the randomness of time, in order to digest the traces left behind that continue to affect me. As I age I find that life presents new, often unique, challenges that simply come with getting older. I also find that concurrent with those challenges is a desire to connect with friends and family through increased social contact. Additionally, while I have always been struck by nature, I find myself increasingly being in awe of the beauty and violence of the natural world. Both of these connections require one to approach the other (in the case of social contacts) and the Other (in the case of natural phenomenon) with a speaking, a conversation or perhaps as Levinas equates this use of language, with a (non-theistic) prayer (more like a polite but insistent asking or imploring) said without reservation or expectation.

Two major medical issues seemingly exploded, disrupting my life since May. The first of these required a total replacement of my left knee, a procedure from which I am still recovering. I am no stranger to orthopedic surgery having had two hips replaced and a L3-S1 laminectomy fusing my lower spine with titanium rods and screws but I had no idea how difficult it would be to recover from knee replacement surgery. After three and a half months of physical therapy I regained nearly full extension of the knee but I remain plagued with a stiffness that seems to haunt me during the day.

As if that were not enough, I was diagnosed in September with prostate cancer. Considering that the biopsy of the prostate found an aggressive strain (Gleason score of 4+4) and a spike in my PSA to 23 (a range from 21 to 26 over three samples) there was every reason to believe that the cancer was metastatic. This proved not to be the case on bone and CAT scans but the CAT scan was inconclusive because of the amount of metal surrounding my groin. In consultation with my urologist and internist and long talks with my wife, we decided to undergo a robotic radical prostatectomy, a procedure performed on November 28th, nearly one month ago. Once again I dodged a metastatic bullet when the biopsy of the prostate found the tumor completely contained within the organ and the lymph nodes free of disease. At this very moment I can look forward to many more disease free years.

As a result of the prostatectomy, I am left with two side-effects. I am currently required to wear diapers due to incontinence and I am unable to become aroused. I don’t know if these are permanent or temporary and I am not certain I want to undergo additional surgery to correct them. I meet with my urologist on the 27th of December and expect to have a frank discussion with him to see what he thinks. While he will be handing me off to a new urologist, one of his partners, as he moves to a new position out of town, I believe he will be more than straight forward with me about these two side effects.

So the point of retelling these two medical tales is simply this, for me, most of 2012 was consumed with medical issues. It was also met with family tragedy as my youngest cousin, Steven, passed away from multiple myeloma, a particularly virulent cancer that simply consumed his body but never his spirit. About a month before he died I was in Los Angeles to celebrate a 60th wedding anniversary of my wife’s closest friend’s parents. While there I had breakfast with Steven, my sister and several other cousins. Steven, I believe, knew the end was near but he never let on. We talked, laughed, shared stories of our younger days and, without knowing it, said our good-byes. A month later I was back in LA to attend his funeral.

When I let my family know that I was diagnosed with prostate cancer the outpouring of love and support was absolutely overwhelming. What I learned from my cousin Steven was to never ever give up on life, to live life on life’s terms, to experience every moment of existence as unique and filled with the joy of breath; there will be time enough for whatever the antithesis of celebration might be in the grave so there is no need to feel sorry for oneself for a life well lived.

None of my lived-experience of the past year comes close to my being able to comprehend the consequences of these events. There being no intentionality causing the events to occur (I see the universe we share as a gigantic random number generator where probability trumps intentionality) I find that I take great solace in the long and sometimes quite brief conversations I have had with those closest to me. I am learning to extend myself to others in powerful ways and even find myself making new friends along the way. I am buoyed by a fresh look at the natural world in which I exist and the awe inspiring power ranging from the smallest micro-organism to the power of a tiny river’s capacity to carve a Grand Canyon, to the ravages of a blizzard in winter. Taken together, these events, these conversations, my ability to see the absolute beauty in nature and to be awed by the universe itself make this life a life worth living.

With Apologies to Martin Luther King, Jr. — Free at Last!

Free At Last

Free At Last (photo credit: Roger Passman)

The first words I heard on the news this morning as I was getting ready to take a shower was that the area was seeing a bit of light rain and that it would last at least through rush hour and maybe beyond. “Oh no,” I thought, “this will make our drive into the city miserable!” There I go, projecting again. When will I ever learn? What really might make the drive miserable is traffic for whatever reason that traffic builds, be it time, weather or early holiday shoppers and I never even thought about other reasons.

This morning I had an appointment to remove the catheter that has been my constant companion since surgery last Wednesday. While mostly going unnoticed, there were times when the catheter was a royal pain, mostly when it came to doing the necessary upkeep to make the whole thing run smoothly. Then I had a day bag and a night bag, each one requiring a different skill set to manage. But this would all end this morning when the catheter would be ripped from my insides to bother me no longer.

Driving into the city was nothing like I imagined. There was no rain, only a bit of holiday traffic but it was still early. We left the house at 5:50 AM to make an 8:45 AM appointment. While I didn’t think it would take that long to drive into the city, I knew if we left much later our 1 hour drive could easily turn into 2 hours and then who knows. My mother taught me that if you aren’t at least ten minutes early for an appointment, you are definitely late. We arrived, dry, at 7:10 AM and sat down to a healthy hospital food breakfast. Yummy?

Being conscious of the time, we arrived at the urology clinic at 8:30 AM for my 8:45 AM appointment. Good, I was on time. Once checked in, I received a pager and a set of instructions for where to go when the pager went off. I expected rapid treatment because I booked the first appointment of the morning. So I sat patiently, waiting, waiting, waiting…until 9:30 AM when I went to the receptionist’s desk to ask if the pager was working or not. After many questions, the nice young lady behind the counter paged the nurse practitioner with whom I had the appointment. In a few moments a nurse appeared and led me to the procedure room. She was quite apologetic, perhaps because she was not the nurse practitioner with whom I scheduled the appointment, but she was efficient and pleasant; before long I was sans catheter. Oh happy days…

I came to the procedure armed with two pair of Depends for men. I expect to leak a bit as my body becomes used to working without help. There are exercises I am supposed to do and because they are so easily accomplished I do them frequently. I expect to not need these male diapers for too long but I am prepared for several days worth of leaking. I can always buy more if I miscalculated.

The whole point of this post is that progress is being made. Not only am I cancer free as of this very moment, I am also catheter free. We’ll see about erections and incontinence as time goes by.

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.

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