Tattoos

I don't have any tattoos, even after eight years in the Navy and traveling around most of the world, I managed to avoid them. Not that some aren't interesting. A good friend in the Navy, Chuck Soper and I, used to visit the tattoo parlors on Broadway in San Diego and watch the sailors and Marines getting inked there. None of the available tattoos were really appealing though and we never got drunk enough to just get one for the hell of it.

A few years later when my ship pulled into Pearl Harbor I went to the sub base to visit Chuck who had been stationed there after our various fire control schools. At lunch, he showed me his new tattoo. Seems he had gotten involved with a local woman who knew this old Chinese tattoo artist in Honolulu. The man was a traditionalist and made his own tattoo needles from bamboo. He laboriously pricked the ink into the skin by hand, working from his own designs. Chuck had a marvelously done dragon entertwined among bamboo. I loved it. But, learning that it had taken a couple of months to complete, and me having only a few days in port, it was not to be.

My wife got a tattoo in California when our children were young. A nice bracelet with two pendants engraved with the initials of our kids.

Now, on Monday next, it appears I'll be getting my first tattoo. I'll undergo a "dry run" for the beam radiation treatments that will locate the exact area to be zapped during the upcoming real treatments. To mark the spots, small tattooed dots will be place into my skin. Not exactly what I had in mind, but you have to go with what works.

I have been considering getting an actual artistic tattoo to commemorate this part of my life and to remind me of what is important and inevitable for all of us. I'm leaning toward a colorful representation of The Day of the Dead sugar skull. We celebrate The Day of the Dead here in the southwest USA because it is a time of remembrance and respect for those who have gone from us. It's a journey we all must make and the life we lead toward that end is important. This has become increasingly obvious to me of late.

Something we all should consider when we are sidetracked by life's clamor and craziness that is really irrelevant to living a good life as we can.

Treatment Begins, and what's happened over the last year...

It has taken over a year to get to the point that I found two critical things: doctors I can trust, and enough information, reliable information, to make informed decision for myself.

The most important thing to say here is that you must take charge of your own care. I'm going to be blunt. There are physicians, specialists mainly, who will not provide you with the full picture and guide you to the alternatives available you so that you can make your own, well-informed decisions about what treatments are appropriate for you. Some are operating from their own agendas which may not be in your best interests.

The majority of the time between my initial diagnosis and deciding on doctors and treatment was consumed in finding relevant information then in locating and seeing an oncologist who specialized in prostate cancer (PC) and was not allied to any particular field or specialty practice. My worst experiences were with urologists. Picking up where I left off with my previous posts, the short version is this:

I went to a respected doctor, recommended by one of PCRI support people who had heard this guy talk on PC for a second opinion. When I walked into the place, I discovered it was a urology clinic. My first impulse, which I should have followed, was to immediately cancel the appointment and leave. I stayed. The urologist, who will remain unnamed here, met with me. I had taken care to ensure that all of my medical records, biopsy report, etc. had been sent to him weeks ahead of my appointment. It was immediately obvious, watching him scan through the computer in the exam room, and from the elementary questions he asked me, that he was familiar with none of the material I had provided to him before my visit.

Worse, I had been assured that I would be meeting with a team of different specialists and getting a good review from different medical perspectives. This didn't happen, or if it did before (or after this ill-fated visit), I am not assured how it was conducted or what was actually said.

At one point, early in my visit, he told me that although he recommended treatment, I really had nothing to worry about for the next five to seven years. Plenty of time to decide what I wanted to do. Then, later, he said I should have treatment within the next six months. What treatment? His, of course. He then launched into what I can only term as a sales pitch for himself and the kind of surgery he was skilled in – old-school hands-on surgery, not this new-fangled robotic surgery. (That was the favorite of my first urologist, even though he was not old or experienced enough to have been good at it, as I later discovered. He was also a rude jerk whom I quickly fired.) This urologist then commenced to denigrate not only robotic surgery, but most other kinds of recognized treatments: radiology, hormone, bracheotherapy (seed implants), etc. He assured me he had done hundreds of hands-on surgical procedures and, for him, it was like cruise control.  I would be happy, he assured me, and suffer virtually no side effects.

Basic bullshit.

I left as soon as possible.

After more research and confusion, I contacted Dr. Mark Sholz in California and he agreed to see me. This was fated not to be. When my wife and I left on our trip from Colorado to California, we had serious car trouble and spent five days in Albuquerque, NM, while the car was repaired. I missed my appointment and burned through our cash and credit reserves in the process. Back to California. Further mis-adventures occurred in attempting to talk with Dr. Sholz, so we decided to find an experienced oncologist specializing in PC closer to home.

We were successful, and, strangely enough, found our man practicing now out of Albuquerque. After a few visits with him, I have begun hormone therapy and am scheduled to start external beam radiation for five weeks as a follow on. Afterwards, I will travel to Seattle for radioactive seed implants by a doctor I like and trust.

During this period, in Seattle, I had a thorough MRI to get a good look at the extent of the PC. This is a painless, though somewhat obnoxiously noise procedure and provides immensely better results and less risk than the needle biopsy.

If I have one thing to say about the needle biopsy to other men it is: don't do it.

There are much better and more accurate assessment methods than having your prostate punctured with needles and running the risk of infection. Besides, it's barbaric.

This is my status at the moment. I feel fine and optimistic about my future and the professionals I have finally found are good, caring and treat me like they would like to be treated as well. If your health care workers and doctors don't treat you like that, I'd say, move on and find those that will.

Beginning the search for a good oncologist

It's been a month. I've had conversations with my primary care doc and his assistant. I've looked at the lab results. I've been doing some reading. Now, I'm getting back on the trail of a good oncologist who is not committed to any one treatment and can act as my medical reality checker in this journey.

My basic policy now is to avoid treatment as long as possible for these reasons:

1. Most of the current treatments have a high probability of leaving one with unacceptable and irreversible consequences - at least for me.
2. Medical science progresses and new treatments and medicines are being developed as I write this. Not hoping for miracles, but putting some trust on the advance of medicine in this field.
3. I'm seventy years old. Being subject to serious surgery or radiation treatments has their own inherent dangers. I recall the urologist in New York who said the only way he would operate on a man over seventy was if both that man's parents were also in the OR.
4. A recent study published in the AMA Journal showed that of men with high risk cases, there was only a 5% difference in mortality between the ones who underwent treatment and those who did not.
5. Something else is probably going to get me first.
6. I value the quality of my life over the quantity of it.

Follow Up Visit, Breathing Room, and Buy the Book

Had a good follow up visit with my primary health PA today. The most pressing issue is these damn allergies that are keeping my nose stopped up and my cough going. I am now armed with information and medicine, along with a routine to finally get rid of the little buggers for good.

We talked about my desires and approach to PC. My PA put my wife at ease with the information that I have on spread outside the gland. I'd tried to support this notion before, but it's good that she got the "official" word. I didn't mind hearing it again either.

Given my age and the percentage and grade of cells found by the biopsy, I have plenty of time to monitor this thing and make some considered decisions.

In this case, time is on my side. More advances in medicine and technology will be made in the next few years, all to my advantage I believe. And, while that time goes on, I might get caught by the grim reaper in entirely some other fashion.

I must repeat. Don't get rushed into anything you may regret.

Whenever the subject of prostate cancer comes up around men, and women too, the cancer word kind of takes over the conversation and perceptions of most people. As the authors of The Invasion of the Prostate Snatchers point out, for most of us, this should be considered as a condition rather than a disease with the reputation that cancer enjoys. But, I've seen this happen, the attitude and perceptions of those involved in the conversation always move toward doing something. Treatment. Cure.

I've not met many men who had PC, or have it, that were not moved toward some kind of treatment pretty early in the diagnosis stage. And, most did not fully understand the consequences of treatment.

Don't let that be you. Buy that book and learn about what we are dealing with - the condition, and the industry that has developed around it. The Invasion of the Prostate Snatchers. A most significant and important book.

The Depression Group

Yesterday I drove for an hour to attend a prostate cancer support group. Once I found the place, I couldn't find the group meeting place. Each room I was referred to was vacant. I then saw five men sitting around a table in an open area and walked over. Yes, this was the place. They had decided to move, but had not left a notice of that anywhere. Not an auspicious beginning. It soon got worse.

I had to tell my story, of course, but I didn't get all that far before the group, exclusive of the leader who seemed to be up on the topic and very open minded but had to leave to attend to business, took over. The basic story was that each of the four men there had already undergone some form of treatment, and, as far as I could tell, were not thrilled with the outcome. Some talked as if they were "cured" while others worried about remission. All complained about some undesirable side effect. Incontinence was barely mentioned but alluded to of course. The focus of discussion quickly moved to the need to make a decision on treatment and get on with it. Just the opposite of my belief.

I mentioned that one good thing about waiting on any kind of treatment is the likelihood of new and better options as medicine learns more about PC. While most of the men agreed that this was true, they didn't want to linger here. Their main focus was telling stories about their treatments, their doctors, and a little about side effects. There was much discussion along the lines of "what's your PSA? What's your gleason?" Sort of like, "what's your sign."

However, running through the conversations was the fact that all of them had been rushed into a treatment decision by their doctors. One man recommended that I go to a local doctor who was an "expert" in PC. I knew of this doctor. He is a radiation oncologist, and guess what, he favors early treatment with radiation. There was also a recommendation to see this robotic surgeon. "He's really good." There was discussion about needing both seed implants and general radiation together. Some gruesome tales of treatments of various kind. Only one of the group mentioned that he wished he had waited before jumping into treatments.

I also learned that one of the urologists I had been referred to is the guy who slammed one of the group with a 6-month effective hormone shot very soon after his diagnosis. Looking back, the patient wished he had taken the time to understand his condition and options, and the possible side effects of various treatments. He would not have acted so swiftly.

In the end, these men validated what I have been learning. Most doctors will treat PC, regardless of it's severity, as something that needs treatment rather quickly. Their recommended course is whatever their specialty happens to be, naturally. Regardless of the fact that men with high risk factors are no more likely to die within ten years than are men with low risk factors. And, the likelihood is around 5%.

In addition to all this, little discussion was made of the risks of these radical treatments, especially surgery, on older men. One of the guys suffered a severe infection resulting from a biopsy, but this didn't raise any red flags. Probably because, other than him, the rest had escaped serious consequences, or didn't talk about them.

So, rather than support, I felt depressed. I need a group of men who are more understanding of PC and modern thinking on the subject and some who are refuseniks like me who prefer to keep their quality of life and wait.

I know this sounds harsh, but the general impression I left with is that these men are afraid to die. Now, I am fearful as well, but I also know that dying is the natural end of life and the manner in which we choose to live, and to die, matters. Undergoing long and difficult treatment processes, with life-altering after effects that seriously degrade those few years left does not seem worth it to me. If I was not seventy years old, I might think otherwise.

One of the men, the least educated of the group, but probably the most perceptive, said something to the effect that it really doesn't matter. You might get killed by a car tomorrow.

Exactly.

Support Group Meeting

Tomorrow I'm driving to Pueblo, Colorado to attend my first UsTOO support group meeting. I've never been strong on groups. All of the groups and clubs I've joined in the past have been duds, except for one, which isn't so much a club as a like-minded bunch who enjoy getting together each month and talking about their favorite hobby.

I suspect this PC support group will be different. Prostate cancer isn't a hobby. It's a reminder that life is short, we are all mortal and the journey will end sooner or later. I think having PC is a good thing in that it brings the doorway into view for the first time. We all know it's out there, the door to the undiscovered country, but I think most of us don't really believe it. Too far in the future (whatever that is), too abstract and mostly something other people have to experience. Not any more.

The more I think about this, the more I am convinced that as Lincoln was supposed to have said, "It's not the years in the life, but the life in the years." I am not signing up for a short segment of life lived with awful and undignified side effects. Personal quality of life and medical ethics should intersect in a doctor's office, although it has been my experience that it most often does not. And, from the source materials I read, especially the book, The Invasion of the Prostate Snatchers, that healing intersection does not exist for the majority of health professionals dealing with men with prostate cancer.

One of the authors of The Invasion of the Prostate Snatchers, diagnosed with PC and unwilling to be pushed into surgery, was told variations on, 'you are stupid', 'you'll be dead in a year', 'we'll schedule you for next Tuesday." Although during the diagnosis meeting, I got the signs that my urologist was harried, new to the profession, pushy and totally unfamiliar with doctor-patient relationships and the caution to 'do no harm' and fired him later than I should have, reading his notes later told the same sad tale. Even though my incidence is low-grade and low risk with no evidence of the cancer spreading anywhere else, he noted that he thought I shouldn't do watchful waiting because, "of the risks". He didn't bother to elaborate on what those risks are. Probably because they are low to non-existent, given my condition and age.

A 2008 study by the Mayo Clinic published in the Journal of Urology, April 2008 shows that only 2% of men with Intermediate-Risk and only 5% of men with High-risk PC die from it within ten years. So, given my Low-risk status, and age of seventy years, what kind of risk drove my urologist to state that I should undergo surgery because of the "risks"? I think one of the reasons might be that he wants to operate. That's what he does.

Right after the diagnosis in his office, accompanied by "facts" from my tests and biopsy fired at a machine gun rate, without benefit of consulting or explaining the actual findings themselves (he kept all of the paperwork to himself) he launched into a commercial for robotic surgery, which, it turned out, he was specializing in. He didn't spare the details, although all of his details were good. He didn't talk about the dark side, possible complications of the surgery itself, the extreme difficulty of doing the surgery right even for those who were vastly experienced and capable. Which he was not. He didn't mention that one of the most imminent urologists in the country stated that the would only operate on a man over seventy if both of the patient's parents were also in the OR. Like, never happen.

I subsequently learned that in order for a surgeon to be very good at robotic PC surgery, the average level of experience needed is 240 operations. Taking into account the number of years my guy had been in practice, multiplied by the standing of the medical school he'd graduated from, I figured he was going to need another ten or fifteen years before he would be at the level I'd trust to even seriously consider him doing such a procedure on me.

One of the big reasons I want to attend the support group meeting is that I need the reality-based opinions, knowledge and experience of others who have gone down this road before. It is too often the patient, hearing the words, "you've got cancer", is so vulnerable that he is too open to bad advice given by authority figures at the time. Good thing for me that I am stubborn, cynical and a born "refusenik", to use Ralph Blum's term, or I might have put myself in the hands of a doctor who was not so much concerned about the overall health and well being of his patient, but his own career and practice. If I sound harsh, well, it is a harsh reality.

It's a minefield out there and you have to choose your path carefully. Make sure it is your path, not someone else's. After all, it's your life to live how you choose.

Another Appointment Canceled

After reading "The Invasion of the Prostate Snatchers" (thanks to my lovely wife Barbara for the book) I have become more determined to take charge of my life and my PC. As the authors point out, most specialists see things from the viewpoint of their own specialty. It is no wonder, given the years of training and expense they have put into their professions. However, their biases are not necessarily good for me. Or for most men who have a low and medium risk case of PC. Treatments are, mostly, forever. You have to live with the consequences, some of which are quite frankly awful.

Urologists want to operate. That is what they do. And, from my research, most of them are not all that good at it anyway. Look at the statistics, and do the math. Radiologists want to apply radiation. Cryology specialists want to freeze the gland. All of these are fraught with serious and unpleasant risks and consequences, or side effects. None of which I care to risk.

So, the "old, conservative" urologist that my Doc recommended is, all things considered, a urologist and would view my situation from his perspective, which is to "cure" my PC. Right now, I am not looking for a cure, but a management strategy that will allow me plenty of time to access newer and better methods, medicines and processes that will do a much better job than what is available today. Remember, in the 1990's prostate cancer treatment was in what has been called the "iron lung" stage. Things change rapidly and I want to have time to wait on those changes.

So, I canceled yet another urology appointment. I am looking for a good oncologist and a medical team that works with me and my life preferences.

In the final analysis, something is eventually going to get me, whether it is PC or something else, so I am not overly concerned with the fact of my eventual death. I am grateful that I have gotten the support and information I need to deal with this like a real human being instead of a panic stricken male ego.
One fray at a time, as my father once said.

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