It almost seems anti climatic. I have just passed 5 years cancer free. No hint of my prostate cancer. No serious effects of the surgery.

In light of current reports suggesting that no one be screened via PSA, I must say, " I'm glad I was screening and I am thrilled to have made the choice I made." I can't imagine living everyday knowing that there is a cancer eating away at me at and unknown rate. A veritable sword of Damocles, threatening to break loose at some unknown time, for some unknown reason and falling upon me.

That would make me something that I have never felt that I am, a victim. I feel like a heart attack survivor and now a Cancer survivor. But I have never felt like a victim.

Would I Do It Again?

It is hard to believe that three years have passed since my prostatectomy. I am still cancer free. I am less fit physically; but in better health. My Diabetes is under fantastic control with an A1C of 6. My LDL is 67 my HDL is 58 and Triglyceride is 75! PSA is .004 (negligible). BP is 120/70.

Additionally, I am enjoying my family and friends. My spirit is positive. The side effects I have are impossible for me to pin on a cause. It could be cardio meds, diabetes meds, BP meds, or surgery. I honestly don't know.

I do know that although I cannot do what I did eight years ago, before a heart attack, before diabetes, and before cancer, I can pretty well function as a man in his early sixties. I can't labor all day with the best of them, as I once did, but I can take care of myself and family.

My long bout with idiosyncratic constipation has finally ended. Without clinical proof, I believe it was started with very strong antibiotics and hydrocodone 7.50/750. It was finally ended with a month long course of pro-biotics. My intestinal flora are back in balance and moving.

There has been a lot of talk lately about the efficacy of screening for cancer of the prostate or other organs. I wonder who is behind the studies and analysis of old study data. Is it possible that they are funded by insurance companies? Are the doctors compensated now or have they ever been compensated by insurance companies? What are their political philosophies?

Another Six Months and ...

August 23, 2009 I checked the bicycles for a Labor Day trip to Michigan. I checked Sally's bike, inflated the tires and lubricated the chain, adjusted the brakes and rode it around the block. It worked good. Then I did the same for mine and rode it around the block. I got the bike rack out and mounted it on the truck and got the tie downs out. I am ready for Grand Haven!

Monday morning I had blood in my urine and a couple of clots floating in the bowl. I didn't have any pain of note. Just some mile 'awareness'. It became less each time I voided during the day. Tuesday onward I didn't see any and assumed it must be from the bike ride. I wasn't too alarmed other than to remember to mention it on my next visit with the doctor.

I have been in a diabetes study group for the insurance company. I don't know what that is for; but it has required closer monitoring. The insurance company has not paid me. They have required me to visit the doctor every three months for blood test and check up. So it has actually cost me more. But this time I was going to the doctor on Friday, August 28, and would mention the blood then.

The doctor ordered a urinalysis and PSA; it did show microscopic hematuria. If you see it with the naked eye it is gross hematuria. If it is detectable but not visible it is microscopic. He said a lot of people have that and it is probably nothing. He didn't think it was from the bike ride. He wanted to see me again in a week and we would check again.

So it was back to the doctor again on Friday, September 4. Another urinalysis, another positive for microscopic hematuria. The PSA was .004 (zero) so it isn't a return of adenocarcinoma of the prostate. Better go to the urologist to see what the continuing bleeding is from. Referral was ordered and I made an appointment for September 23, Wednesday.

They too found blood in the urine and asked for an abdominal and pelvic CT with and without contrast and a cystoscopy. Since I have BCBSIL HMO my urologist can't order tests. That means another trip to the Primary Care Physician. He ordered the tests and I waited for the referrals. Nothing by Friday so I called IPA and she said, "They are working on it right now. It will be ready by Tuesday, September 8, because of the holiday.

Wednesday, September 30, the imaging lab called to make an appointment. They had the referral and we are all set for the week after I return from my trip. We are going to my reunion and to visit family. (The trip was a blast)

The Scans were done. I got the cystoscopy. My urologist said I healed great. Except for the absence of the prostate you couldn't tell I had any work done in there. The scans were good. The old granulomas are unchanged, the one lymph node is unchanged and the Abdominal Aortic Aneurysm has not grown beyond 3.6 cm. I am cancer free and good for another six months. The bleeding was probably from riding the bicycle for the first time since the surgery. Adjust the seat to provide relief for the urethra and take it easy.

Keep up with your checkups. Live well and stay tuned.

Only One In Fifty

Here is an article in MSNBC on Prostate screening efficacy.

http://www.msnbc.msn.com/id/29745004/

If you read it, or if you have heard in the news lately, there is a circulating tale about screening. The story is that: the PSA blood test is of no benefit and may be a negative. DRE (digital rectal examination) is not a benefit, is embarrassing. Screening for Prostate cancer is not worth the cost, the embarrassment nor the harm.

Now a larger European study indicates a 20% improved survival. So the American studies release early to counter.

Read it for yourself and make-up your own mind. For my part, I am certain that I made the right choice. I am glad my doctor screened . I went to the doctor for my health. I didn't like having blood drawn. I didn't like getting poked in the bum. When the PSA was positive I was very apprehensive about the biopsy. I was thrilled the first time the biopsy was negative.

My doctor screened again and the PSA was elevated further. The DRE indicated that my prostate was smooth and still small. But the PSA warranted another visit to the urologist. We did another biopsy. It was positive.

I made the treatment choice. That is as it should be. My choice for surgery saved me from later treatment. The American proponents put forth the idea that my cancer may have been slow growing. They think I may not have needed to do anything. If I died at 73 I would only have suffered a short spell of symptoms. They may be okay with that; but I'm NOT.

My personal opinion is that the Insurance industry is behind the claim that screening does not save lives. For years it was touted that early detection made cures possible. Catch cancer before it metastasizes and before it gets out of hand, while it can be effectively treated.

Now they claim that is not true. That defies logic for me. I urge you to ask your doctor for screening. If they refuse then find a new doctor. I can assure you that having screened when I had no symptoms found cancer while still contained in the interior of my prostate. Removal of the prostate left me cancer free. Da Vinci robotic assisted surgery spared nerves and retained full function. I have no negative impact, save a small scar a bit over one inch below my umbilicus.

And when I see those advertisements on television for Flomax or Avodart, I know that I will NEVER have BPH or a need for those drugs. I won't be getting up multiple times per night to go. I won't be stopping my activities when out with friends to find a toilet. I don't see the negative.

If It Wasn't For Insurance ...

Well, it's been six months since my last follow-up. I've had no urinary issues at all. The plumbing is all working fine. All those things the urologist asks you about, good stream, good control, no issues with starting or stopping, etc. are great. PSA is 0.001! They apparently took all of my prostate and with it ALL of the cancer.

We will check again in six months. I couldn't be more satisfied with the outcome. There is no worry about a recurrence, metastatic cancer or as a bonus no future BPH (Benign Prostatic Hyperplasia). I am not going to have a need for Avodart or Flomax. I won't have a need for any of those uncomfortable prostate procedures. I have met some very skilled people who are a pleasure to talk with.

If you wonder why you have any issues with your insurance, remember they view themselves as financial companies. And we all know how well they are run. Get your checkups! It isn't embarrassing; it is science! And it's good for you! Contact me if you have any questions or just want to share your woes.

It Really Is Important

You shouldn't play George in Capra's "It's A Wonderful Life" thinking the world would be better off without you or that you don't matter. Do it for yourself, do it for a friend; Find a reason and get screened.

There is discussion now that PSA tests should not be done on men younger than fifty. And should not be done on men over fifty who are not for some reason in a high risk category. I don't understand that logic. It's as if 'they' are willing to lose one family member, of YOUR family, before the remainder of the family should be tested.

The argument is that the test does more harm than benefit. That isn't obvious to me. The claim is that a false positive result causes further testing with a TRUS or even a biopsy. The biopsy is slightly invasive and carries some risk in rare cases. But I don't understand not giving men a choice to test or to treat. If caught early you can be CURED. If not treated you MAY live fifteen years. Or it may be an aggressive form that will not give you fifteen years. But the final years will be hell.

Some argue that it is not imperative to treat immediately. In their argument, treatment may improve in several years to cure it later with far safer methods. They seem willing to make the bet with YOUR life that you will be treatable later or in fact may DIE of some other cause before you die of cancer. How BRAVE and generous of them.

Stay watchful and aware of the politics as well as the science of medicine. Especially your health.
Talk to your doctor about being screened soon.

August 6, 2008 Fifteen Months and Counting

Well, it's always something. I wanted to make an appointment with my primary care provider to get a blood draw for my PSA and A1C. Should be a snap after six years with her. But nooooo.

My doctor, whom I loved, left the group and they just said it was her choice. But, they have two doctors there to replace her and ... Oh wait a minute, they don't take your insurance "administrator". Yes they take my insurance but not through that admin group. But I can just call BCBSIL Customer Service.

No, you can't switch. The BCBSIL offers two HMO plans. They are both the same coverage, the same co-pay, the same drugs. One is about sixty dollars a month less. So of course I chose the one cheaper. OH, I see said the blind man. The difference is that the cheaper one has fewer doctors. All on HMO Illinois did not sign up on BLUE Advantage. And the Administrative group the new doctors are on don't accept BLUE Advantage. So I cannot switch.

I searched the Internet and found my original doctor very near. When I called the office the receptionist said, "Sure, just come in." Not so fast Maria. I didn't see my insurance on the web site and need to verify that first. Well she can't do that. She will have the office manager call me back.

Two days later I get the call. They do take BCBSIL but not with Tri-country (sic) claim administrator group. They only work through Advocate. (same as the 'new' doctors at the old medical group) And I can't switch to Advocate. In the Fall during open enrollment, I could select HMO Illinois and select Advocate. Just pay the extra sixty dollars, if it is still just sixty dollars. Or who knows if the offer will be the same companies.

The hoops you have to jump through are worse that the illness and treatment. Hopefully the insurance and doctor selection will work out as well as the health issues.

I went to another doctor in the medical group I've been with and had the blood tests. It went well. The referral is done and I was all set for my visit to the urologist.

That visit was easy and without issues. The PSA is perfect. There is no sign of cancer from the prostate. I have no issues to speak of. I am totally continent and without urinary problems. Good enough that I don't need to follow-up for six months.

It's Official ...

I've made one more year. The results are in and my PSA is officially pronounced, "Undetectable! Perfect!" And a DRE confirms that healing has gone well.

My only disappointments today were first that insurance made a simple follow-up an exercise in frustration, aggravation and mediation. Secondly, the fact that I have to go back every three months for another year. Then every six months for the following three years. Of course that puts me on the path to a quarterly encounter with the insurance.

Back in December I went through a bit of a hassle getting a referral for a follow-up in January. They questioned, "why would you need to go back now? You were just there two months ago."

I had to explain that the doctor wanted three month follow-up visits and PSA tests to watch for the possible appearance of metastasized cancer. They sent the doctor a referral for two visits. Sounds like a good deal to me. When I went to get the blood test I was denied because it had not been THREE months since the last one. So I rescheduled my appointment with the urologist and my blood draw at the primary care physician. When I went back in January the blood test went well and I had no issue at the urologist.

My good fortune in that matter was an illusion. When I went to my primary care physician for the blood work again, they were questioning why we were doing it in April when we just did it in January. They checked and it was OK since it was April 30, the anniversary of my surgery.

Now it's May 7 and I went to the urologist for my 8:15 am appointment. I should have been in and out in fifteen minutes, because it was early, before they could get behind. No, there was a problem with my referral. It had one more visit open on it; but, it expired on April 30. (The date I needed to wait until to get my labs done.) The urologist's office had requested an extension on the thirtieth but had not received a response yet. The receptionist called the insurance and the doctor's group.

They weren't open. The voice mail said the they would "open promptly at eight-thirty a.m."
Of course they didn't. In fact at nine o'clock they weren't open, at least not answering the phones. I called my doctor about five after nine and Renee, there receptionist, was going to call a direct number and see if she could get it faxed to the urologist right away. So we waited.

I was just headed to the public men's room when my cell phone rang. Renee was explaining to me that she spoke to Violet and they were not able to fax the referral at this moment, but they would do it TODAY. I asked if she would mind explaining that to the office staff here because I didn't think they would believe me. She agreed and I handed my cell phone to the receptionist. They finished their conversation with the receptionist asking for a number where she could reach Renee and handed me my phone. I was all set. She would get me in to see the doctor as soon as possible. Of course this is one hour, forty-five minutes after I arrived and one and one half hours after my appointment.

"Pee in the cup, put your name on it and place it in the cabinet, please. You'll be in room one when you finish." Or words to that effect.

Wow! Peeing never transported me to another room before. I know she didn't misspeak. Syntax and alternative interpretations amuse me. I came out and went to room one and sat down. About five minutes later the same little girl, about five feet tall if she stands straight and petite, come's to the room and says, "Oh! There you are. How did you get here without being seen? I was right there."

I said, "I don't know; I'm pretty hard to miss." (being six feet two inches and and two-hundred seventy-seven pounds I don't usually slip by) She took the usual history, asked if I had my PSA tested and a list of my medicines and said the doctor would be in soon.

He was and said I was perfect. He wanted to do a DRE (I thought I had the last of those when they took my prostate out). He wanted to check on the healing, if the ureter healed well, with little scaring. He said it was great! I'm not sure how he meant that. I didn't think it was special.

Then he tells me he'll see me in three months. "THREE MONTHS?", I said. "I'll have to fight for that then."

He asked, "Why would you have to fight for that?"

So we had the discussion about referrals and about the hard time they gave me for seeing him every three months for the past year. He said, "You had cancer, for Christ sake you need to follow-up to monitor your health. It will be every three months for two years, then every six months for three years. Then annually. You want to be sure you're over it."

I tell you this NOT just to bitch. I'm telling this partly to let you know I too have my hassles with insurance. But, also in hopes you will do as I am doing and contact your insurance. We need to inform them that their process is BROKEN. Common sense should tell them that there is a linear sequence of events. Blood draw, lab work, result to doctor, referral to doctor, patient to doctor. It should not require the patient to call for each step and schedule the insurance office processes. We should not have to get approval for every step of the protocol individually. If they are covering treatment, in my case prostatecomy, then they should write a referral for the protocol.

Most people are aware that it is five years before doctors will talk about "cured". As process oriented as insurers are today, I would think they have a protocol for every treatment plan that they agree to pay for and the medical professionals agree is a 'standard' protocol. Having been diagnosed and verified by multiple tests the course of treatment being chosen and approved, the insurer should write the referral for the five year plan. The only caveat should be that I show up ALIVE and still insured by them.

The insurer has the trump cards. If I should die or be terminated by my employer or change insurance, or other wise lose coverage they can deny the claim submitted by the physician. If he was fraudulently filing claims and they deny it the doctor is not harmed because he didn't perform a service for which he is not paid.

Like the movie line, "I'm mad as Hell and I'm not gonna take it anymore!"
Call your insurer. Write your insurer. write to your state's Department of Insurance. Contact your legislators.

Be healthy and enjoy life. It's up to us to respond positively to stimuli. Keep smiling.

Twenty Percent Down!

It has been a year since my surgery. I didn't even have a twinge as my anniversary passed. Although I did think of it. As the medical transcriptions would say, "After recognition of the day the remainder was unremarkable."

The insurance got very particular about the precise day they would authorize lab tests. I must be at least ninety days since the last draw. And the same with the office visit. So I have had the blood test. I have an appointment for the seventh of May for the results.

Insurance of every type tries to run every one's life to avoid disbursement for claims. They live by premiums and die by claims. So understandably they don't want people to use them to frequently. They have to walk a fine line between 'practicing medicine' and managing claims.

To that end, my health insurance company changed their listing of several drugs in January. I had been on Lipitor and Zetia and Tricor for blood lipid level control for five years. My results were excellent. LDL <70,>45 and Triglycerides ~ 120. My nuclear stress tests had indicated no new cardiac blockage. My carotid artery ultrasound was very good.

The insurance sent a mailing out that Lipitor would go from $30 co-pay to $100 co-pay. There is no generic equivalent for Lipitor but they "suggested" Vytorin or another statin-family drug. The doctor wrote me a prescription for Vytorin and Fenofibrate, to replace the Lipitor, Zetia and Tricor. Thus I needed to test again in ninety days.

I made an appointment for April to combine all the blood tests for liver and kidney function and lipid levels and PSA for my Prostate follow-up. That week news broke about the ineffectiveness of Vytorin and of Zetia. They do lower the cholesterol level but don't stop blockage and in studies blockage increased. That pissed me off! In the interest of profit the insurance decided what drugs I could take; not my doctor.

Then I realized they decided what they would pay for which products. I decided what I would pay for which product TOO! But not to white wash the insurance company, they didn't lower my premium. They kept the profit and I had to give up more money or possible health advantage.

The test results came back and the doctor called with the news. LDL=64, HDL=48, EXCELLENT!! Liver function great! Kidney function good! PSA, undetectable!! I still have to go to the urologist for follow-up. Possibly as much for his edification as for my benefit, since I know there is no adenocarcinoma from my prostate. I should be good for another year. One down and four to go.

I looked into the Vermont thing. I thank you for thinking of me. I might consider it later. I am focusing very hard on wrapping up my career this year. I want to retire with benefits for me and my bride. At least for my bride. And I'm not sure what to expect from organizations for support.

Whether for heart, diabetes or cancer; I don't really feel worthy of a support group. I think of my self as much like I was; but MORE worthless. I don't feel like I survived a major heart attack that kills 43% of victims. Or that I have, knock on wood, gotten apparent control of my diabetes. Am I a cancer survivor? People in those support organizations seem to all have a story so much more worthy than I do.

I didn't have OPEN HEART SURGERY! I didn't have the anguish of being diagnosed with cardiovascular disease and FINALLY deciding to have my five arteries with 85% to 90% blockage bypassed. I didn't have to suffer the worst pain in my life. I didn't face death. I didn't almost die multiple times.
I only had one dominant right artery blocked 100%. I watched them push the dye. I saw the blockage. I saw the doctor place the stent. And it was so easy! I got the best drugs in the world for pain as I lay flat of my back under a sandbag while a tube ran in my groin to a balloon in my heart that inflated and deflated to pump my blood through my heart. I never felt like a victim. My nurses and doctors treated me with respect. Their touch felt so sincere. Their words were comforting when they told me how tough I was and how I could ask for anything we needed. And Sally sat there in the mind numbing boredom from the Wednesday night I went in to the Saturday morning I got out.

MY cancer was without manifestation of symptoms. It was discovered via my annual check-up blood tests. It was only moderate grade, the Gleason was 3+3, contained within the envelop of the prostate and unremarkable (one of my favorites of doctor descriptive words). I had a good bladder neck left and nerve sparing went well. I worked very diligently at bladder control and regained total continence in five weeks. What could I offer in support?

Every one there would have gone through so much more than I that I could not offer understanding, encouragement nor hope. The other day I received in the mail an invitation to Cancer Survivors, to attend a celebration of the hospital's award winning Cancer Center. Sally looked at the mail and said, "Huh! I never thought of you as a cancer survivor before."

But thanks for listening. I am just a very blessed old fart.

February 7, 2008

Results are what counts I suppose. Mine are excellent. Now nine months cancer-free. Had my blood drawn last week on Wednesday and got my results this Wednesday.

I have occasional pains from one or another of my hernias but I can now hold my water even shoveling the fourteen inches of snow we got on Wednesday. Doc says I'm doing fine! This is how it's supposed to be. No urinary problems and undetectable PSA.

I am set for the end of April for my next follow-up. That will be one year. Then I can go to annual check-ups on my PSA. If that is clear for years two through five they will consider me cured. I pretty much consider me cured now. At least from Prostate cancer that is. Who know what else will attack me.

November 19, 2007: Time for a Physical

Experience isn't always the best teacher. I went for my labs and was given a fellow named Tom. He was new to me and seemed about 30. He got his set up and I didn't bother to give him directions. He looked at both arms and said, "I'll try this one, okay?"

I agreed and he started slowly and methodically to put the band on my arm. I pumped my fist a couple times and he put on his gloves. He took the butterfly needle and laid it beside where I could see the vein and at a low angle. I was sure he wouldn't get blood that way.

He put a finger on the other side of the vein and slowly slid the needle into my arm. At the first flush of blood he stopped and put a vial in the tube. It slowly filled with blood. He popped it off and pushed in another vial. Slowly it filled. WOW!

I said, "You did that well. I usually get stuck three or four times."

Tom said, "That was only my second time."

November 3, 2007: Again?

I went to the doctor on October sixteenth for a blood draw. That is always an experience. This time it was lucky Kathleen. She is 46 years old and experienced.

As always, that doesn't matter to me. I destroy them all. I told her where it doesn't work and that we often resort to my hands. She started with my right hand. My veins just don't pop-up. We had the talk about drinking a lot of water for at least twenty-four hours before the draw (I did) and double tourniquet, baby needles, butterflies and all of that. I hang my hand , I pump my fist and still no veins. She finally sees one that she will try behind the third finger of my right hand.

Drat! She could see it "just go turtle". Blood started to flow, but then the vein contracts and draws back. Well I have others.

She would like to try my right arm at the inside of the elbow. I told her that rarely works in spite of how prominent it looks. Kathleen put double tourniquets on my upper arm and gets another butterfly setup while my vein backs up with blood. Rather it should have been. Still it did look pretty good.

Kathleen looks for the direction the vein runs and lines up the needle. Slowly she pushes the needle in and there is a little burst of blood that just reaches the tube on the butterfly and quits. No amount of coaxing, pumping or wishing can get blood out of this turnip! At least not at this junction of the humerus with the ulna and radius.

She apologizes for putting me through this; I'll just have to wait until the doctor comes in. With tears welling in her eyes she says she ALWAYS get it by the second stick.

I told her, " The doctor won't do any better, if even as well as you. How often does the doctor draw blood? Let's just get another setup and find another one. I'm used to getting stuck four or five times. You'll just have to change that 'always' to usually."

She was real reluctant to keep sticking me. I assured her that it was no big deal to me. It is obviously much more traumatic to her than to me. We agreed we would just keep going until we got it done. She got another setup and looked on the left hand. She gave it a try but it was another dry hole. I encourage her to just poke it again. It actually got some in the vial but just a bit. She said it was only about two ml and not enough for the testing.

I offered my left bicep. There is a large vein running up the bicep toward the chest. Whew! That creeped her out.

"Oh, no! I could do that." she said. She made a face and turned her head. I guess there are somethings that just aren't done.

We put a bandage on sticks number three and four and went to my right hand again. I pointed out a couple on my fingers that had been used before. They are right on the knuckle of my index finger. They weren't real prominent and she couldn't tell which direction they ran. So while she referenced the veins of her hands and arms and looked for the corresponding vein on me we talked about how I used to get weak kneed and green on the first stick. But over the last few years I have grown accustomed to being stuck a lot. She found one on my thumb. It was excellent! Two vials full. To the very top. Just in case there was some other test they wanted to add on. The probem using the knuckles is that it stings the entire time.

I assured her this was not the worst I had endured. I expressed my thanks for her patience and effort. It's nice to get a half hour of time from someone in the medical profession.

I only had to wait a week to go to the urologist/surgeon/oncologist for my follow-up. The second three months has passed already! I am still cancer free! It seems anti-climatic after the effort of the blood draw. He said I'm perfect! Much to Sally's chagrin.

We talked about continued continence and function. All is well and the doctor said really early. So I guess I am a poster child for prostatectomy. Personally I think it is remarkable that they can do what they do; but ... It is not without it's problems. I still have issues with constipation and hemorrhoids I never had before. I have various abdominal pain every day.

Then I put ALL my experiences on the scale. The pains and problems post surgery weighed against the pains and problems of undiscovered or untreated prostate cancer are pretty insignificant.

He said there are no long term detrimental effects. The recovery is permanent. Once I regained contienence it won't go away. Dysfunction won't return as a result of the prostatectomy. Not having a prostate won't produce ill effects over time.

Another visist in three months, January! Then again in April! Then every April for four years.
If the results are all negative i will be considered cured.

August 28, 2007: As time goes by ...

Here it is, another month gone. April seems so far away. I feel just as guilty as ever; but I am looking forward to retirement in several months. This continued good luck just makes me anxious about the future.

None of us have any promises of a tomorrow. We are all given the ability to dream and hope that what we believe will come to be. I wonder how it is that I am so very lucky to have not suffered.

I think perhaps it is partly due to my belief and faith. Part due to just the way I am. I would have expected that I would have been shocked, angry and fearful. Since my heart attack I have been more emotional. Why not now? It just never occurred to me. It was as if I were told, "you have a wart and we are going to remove it."

My life is surreal. Things are so very different since the MI that I sometimes wonder if I died and this is the afterlife. I often don't feel connected to events in my life. I don't get concerned or worry about little things like I did before. Not even big things like I did before.

I suppose a large part of this is that I feel that I can't effect any change in the outcome of any event. I can't 'be' healthy. I can't change the situation at work. I can't change my personal life. I can't change my children's lives. I am really just an observer.

I'm riding this 'train' and don't need to waste my energies worrying about where it is going or where to turn. I just sit back, relax, look out the window and take-in the scenery. I don't interact with the environment, I just observe.

I wonder where the next station is. What awaits me at the next stop. Is there a next stop? I suppose at any moment the conductor can kick me off the train. Or the engineer could screw up and wreck the train. I just wonder ...

August 1, 2007: First Follow-up Results

Wow!! Three months already. I got to go talk to a cute 30 something young lady about my test results and "sex life".

In her words, "The PSA is perfect!" The continence is great! Really was early and has improved. The Viagra therapy is okay.

It can take months and months. Then she explained that the musculature heals pretty quickly. The Viagra will promote revascularization in a few months. Nerves can take a long time to recover. They suffered a pretty big insult. It is all attached to the prostate and had to be carefully separated before the prostate was removed. Even though they were very careful and had very good nerve sparing experience with me, nerves don't respond well to being disturbed. It was as if they really whacked my prostate 'funny bone' and it will take a lot of time for them to recover.

The good news was very outstanding, I thought. If this is my life, I can live with it. And what guy doesn't like the opportunity to talk to a cute 30 year old who really cares about his petty problems? And then I get to go home to my lovely lady who knows me like a book. Three great kids and their spouses and families all in the turmoil of busy, happy lives.

This is what makes the autumn bountiful! I am having a great harvest of what I sewed in the Spring of my youth and loved through the Summer of my life. I often wonder why I deserve such riches.

Another three months and I can do this again. Just to catch anything that might recur early.

July 30, 2007: First Follow-up

Well, we have been off-line for sometime now. We have been busy with the things of summer, family, vacation and of course friends.

Friends in need are friends in deed. Some have been having more than their share of problems, but we pray they see that they are healing and getting better everyday.

I took a trip for two weeks with my wife. We went 3,000 miles without a problem. The seed was a 50th Anniversary party for her uncle and aunt in South Carolina. The trip was planned for a week to get there and a week to come home. It had a few days of long drives and some sights we wanted to see along the trail.

We started with a long drive to southwest Missouri to see my sister and brother-in-law. It was just an over-night visit after a LONG drive. Next we went to Little Rock, Arkansas to see the William Jefferson Clinton Presidential Library and Museum. The building looks much better in life than I saw in the news. It has an amazing amount of information and is very well done.

We stayed the night and drove to Atlanta the next day. We toured the James Earl Carter, Jr. Center and Library. It covers his term and the center is dedicated to alleviating suffering, illness and oppression around the world after his presidency. He has done a lot of good works around the world. We also saw a lot of Atlanta. It is quite a metropolis in the south. Gray Line has a good tour option. We both can see the sights without traffic worries.

On to Savannah. We were told in Atlanta, "In Savannah, everything they talk about is the 'oldest' or the 'first'." They hit the nail on the head there. The citizens of Savannah are VERY proud of their city. Maybe more than they should be. I expected to see an OLD city of the south, one spared by Sherman, truly antebellum. It couldn't live up to the hype. It reminded me very much of Springfield, Illinois. Not in good repair and getting around was not easy. And it was 101 F but felt like 108F. Another Gray Line tour, in an open trolley, and on to Walterboro.

It too was a small southern town with most of the really nice places out of town in newer developments. The South Carolina Artisan and Craft Center is located in Walterboro. We just looked. There were some pieces I liked; but, I would have needed to buy the room, cases and surrounding works because they looked 'right in the context of the display'. They would not look right in my house. The party was very nice and it was fun to watch the folks interact.

Next stop Charleston or "Chalstun" as they say. Our tour guide was very entertaining. Will was a native who had left and been a bit of a way faring man before returning to settle in Charleston. We toured the city and out to Magnolia Plantation and Drayton Hall. This was not an antebellum plantation. It was destroyed , rebuilt , burned, rebuilt then expanded. The gardens were not as I expected but it was interesting to see the slave quarters the home and get a sense of the way of life there.

Next to Asheville, North Carolina to tour the Biltmore Estate. The sin of wealth! 125,000 acres! Forty some bedrooms! Thirty some bathrooms! Thirty staff when the Vanderbilts were NOT there. All built at the end of the 1800's. And still family owned! Not given or sold to the state. Just one of their homes. They had "The Breakers" in Connecticut and a "Cottage" on the Hudson. It took all day to tour and we only saw 60 rooms.

How much Tennessee looks like home after being in the Deep South. Just passing through to Kentucky. We were staying at Mammoth Cave lodge and had to drive from the Biltmore. The lodge is like stepping back in time to the sixties. The room had a real key with the green plastic fob with the room number stamped on it. The walls were paneled, there were swag lamps with painted glass cylinders for shades. The place was immaculate! It was a wonderful place to stay. The restaurant was in the same building and a short walk from the park's visitor center. We sat on our patio and watched the bats at sunset. The next morning we took a "old man" tour of the cavern. Not too many stairs and no narrow passages. It was hot and humid when we came out of the 54 degree cave.

Then a long day's drive home. The number of trucks on the highway is incredible! The economy must be flourishing. There is too much commerce for it not to be thriving. We went 3,000 miles with out an accident! Vehicular or biological. We saw a lot of rest areas across the country. Fortunately there was no Minnesota on this trip; every state had all the rest areas open.

When we arrived home I had an appointment to get blood work done for my first follow-up visit with my oncologist. As usual, it took two people and three needles and four sticks to get three little vials of blood. It's not easy, even for the pros, to draw blood from me. I was finally holding the vial on the end of the butterfly-needle while he used both hands to steady the needle and the vein. When he got a flush of blood I'd push the vial onto the outlet and watch it slowly fill. When it would stop he would have to pump the needle in and out to find the vein again. He apologized for blowing the vein but we got it. Now I wait until Wednesday to go get the results. I am hoping (and pretty confident) for a near zero PSA. That will be an 'all clear' for the first 90 days. Four years and nine months to go to a 'declaration' of cured.

I've had some pains. Occasional abdominal wall searing pains. And if I can't get to the toilet in time it gets real painful. I think I am sooo good at controlling the flow that the muscles start to spasm. When I do get to the bathroom I can barely get the flow going. Then I have to relax a few minutes and go again. It really is no big deal when one compares it to having cancer. I would bet if anyone who has cancer that is terminal were given the choice, they would take this in trade.

Well, I will be back with an update on the results soon.

June 23, 2007: Another Week Gone

This is how I get OLD; time just flies by. I have gotten much better health wise. I rarely have any leakage now and rarely have a twinge of pain. Even then it is not a sharp or searing pain; but more of a low grade achy pain.

The short term disability insurance company has finally received sufficient information to make a decision on my claim. I am covered through the 3rd of June and can return to work on the 4th. Since they made that decision, the FMLA unit of my company also decided that my time off is covered under FMLA. Any further incidents in the twelve month period will have to come out of the remaining 95 days of eligible time. Whoopee!

Now they just need to get the adjustment made to my earned time off. Lord knows how long it will take for them to give that back to me. That is just small stuff.

I am again getting used to the daily grind of working. The folks I work with are really very nice. They are also a lot of fun.

June 18, 2007: This seems to be whipped!

Boy do I feel too lucky. It seems that this thing is whipped already. I am afraid to think that.

IF IT IS, this has been one more lucky star, blessing, etc. It could be my personality flaw; but, I feel like this has not been a big deal. As bad as I felt from the start I feel good about it now. I'm almost guilt-ridden that I've had a result this good.

The continence has continued to improve. I don't 'weep' when I step to the side like getting out of the car or mow. I can sleep six hours now. I can hardly wait for my next PSA test. I am pretty confident that it will be a virtual '0'. But that is reinforcing evidence that I am cured. That will be August first.

Any man or for that matter any woman who knows a man should insist on an annual prostate exam as part of his physical. (She won't need one)

I have heard that there are tests for ovarian cancer very similar to the DRE that combined with a good history at her physical can detect it early. The history should include the following from the website, http://www.baymoon.com/~gyncancer/library/weekly/aa011001a.htm :

WARNING SYMPTOMS OF OVARIAN CANCER
Contact your MD if you develop one or more of these symptoms and they persist for 2-3 weeks:
-Abdominal Swelling/Bloating/Clothes Too Tight
-Abdominal/Pelvic Pain or Pressure or Feeling "Full"
-Gastrointestinal Symptoms (such as gas, indigestion, nausea, or changes in bowel movements)
-Vaginal Bleeding or Discharge
-Urinary Problems
-Urgency, Burning, or Spasms
-Fatigue and/or Fever
-Pain During Intercourse
-Back Pain
-Difficulty Breathing

Remember, the vast majority of the time, these will not be due to cancer, but you owe it to yourself to get them checked out.

What should you expect from your doctor at your appointment?
In addition to testing for other causes for your symptoms, your doctor should perform a pelvic examination, including the rectovaginal component. A prompt pelvic exam has been shown to be one of the best predictors of timely diagnosis. The other non-invasive tests used to detect ovarian cancer are the CA-125 blood test, and transvaginal ultrasound. These three tests together will alert the doctor to whether there is a danger of ovarian cancer.

I love all of you and hope you take care of yourselves.

June 07, 2007: End of Week One Back At Work

Well, I must say it has been pretty good this week. Monday was wading through over 1200 e-mail. That was a trip because I couldn't respond to any until I deleted or moved many of them. I was way over the 90K of storage I am allowed. I had 120K. The result is they don't allow you to send e-mail until you remedy the usage. That took most of the day.

Actually talking to folks took MOST of the day. I mean the e-mail work took most of my "work day". But then I came home to find a letter in my mail box from the FMLA Unit (Family Medical Leave Act) at my work. They stated that they sent me the forms on May 3rd and as of the May 28 they had not received them. I have 2 days after returning to work to submit the form or my time off may not be protected. That sounds pretty dire.

Of course the office is closed when I get home so I took the letter to work with me on Tuesday. The SECOND DAY I am back at work. I called the number listed and pressed option 7 as told to. "That don't work." They tell me I'm an idiot and to just stay on the line and a representative will be with me soon. It really was soon, only about two minutes. She asked for my identifying information like social security number and birth date and address and full name, etc. And then the pleasant, "How may I help you today?"

I explained that I had received the FMLA request form and the cover page stated that I can file it as soon as possible but no later than 15 days after returning to work. She said, "That's correct."

I proceeded to explain that Monday I received a letter from the FMLA Unit stating, correctly, that I had been sent the form on May 3rd and as of may 28 they had not been filed. That letter also stated that I must file within 2 DAYS of returning to work or I might not be protected. She said, "That's correct."

I started to get a little steamed and said I don't understand how both can be correct since they state two totally different times. Why do we have to always do illogical things? She said, "The government makes us say that."

I still don't know which government, federal or state, makes her say 'that'. Nor do I know whether 'that' is '2 days' or '15 days'. But I realized that she too is ignorant and unable to do anything about it, even if I could convince her that they BOTH cannot be correct.

So, I printed out another copy of the form sent to me via e-mail several weeks ago and left work early to take the new form to the doctors office in Barrington. The receptionist checked and there were no forms waiting for action so they must have been sent. I left the new copy and requested it be sent again. No wonder doctors used to charge per form to fill out for insurance.

That done, I had it downhill from there. I am starting to catch up on my work and recall what it is I do and how I do it. I don't know what I will put on my time sheet this week. But I will put something down.

June 2, 2007: A Good Week

I am just amazed that I have progressed so much. It has been a stellar week!

I am dry with the exception of sudden moves that cause me to step or lean to the side without thinking about those kegel contractions. Most of the time I make the moves automatically.

If something is falling over and I jump to catch it, I can have a bit of a problem. They call these stress incontinence. It may require a few months to control these. They are not heavy leakage, but more of what I call 'weeping'. It is just some dampness usually.

There has been another kind of stress this week also. Liberty Mutual Insurance (read as hired thugs) administers the short term disability claims for my employer. I have yet to experience administration on their part. They call and write me requesting I get the information for them to evaluate 'my claim'.

It started on the 9th of May when they sent me a letter stating that they contacted my doctor on the 9th of May and had not received the requested information from him. They proceeded to inform me that it is my responsibility to get that information for them. Seems that they should do their job and get what they need from my doctor. Oh well!

I went to Virden, Illinois on Friday. My sister's mother-in-law died this week and I thought we had to go the wake or funeral since my brother-in-law has been such a great guy. he did a lot for my mother. Sally had to work Saturday, which precluded our attending the funeral so I drove us down for the wake on Friday. Had a good visit and saw my mother's brother.

Bruce is going through the prostate treatment too. He is having the external beam radiation and hormone treatments. That's a shot every couple months and radiation five days a week for eight weeks. He is handling this real well. Gets tired but other wise feels fine. He has already had a PSA test that was .04. That is equivalent to zero but a lab won't say 'zero'. He and I talk regularly now. It is good to have someone to share this with. I think this is a pretty big coincidence that my uncle and I are both being treated for prostate cancer at the same time.

Wow! I'm still angry at the insurance company! Better let that go. At worst it will cost me a weeks pay and all my vacation time this year. I can't do anything until Monday anyway.

May 30, 2007: A Qualified Success!!

This was a milestone day! I had an appointment with my urologist/oncologist/surgeon. I had news for him.

I have worked diligently on my exercises. As I said last time, I can see some progress each day. I had only a spot on my pad when I showered on Monday. I decided to try a day without pads. I always was able to work under pressure. You know the "write the report the night before it was due" syndrome. It is common to all us procrastinators. I thought the pressure would keep me cognizant of my requirements. It worked! I was dry all day!

Tuesday I decided to push my luck and go another day. I was astounded again. So Wednesday morning I took a pad with me; but, I didn't wear one. We sat in the reception area for about a half hour. Then Barb called my name and Sally and I went to room two. We waited there about fifteen minutes.

Becky came in to update my chart with the usual. Same medications, how you doing? stuff. I told her of my leg pains and some blood in my stool, but that this is the third day I have gone without a pad. Becky was pretty excited and said she was going to put an exclamation mark in her notes. She said the doctor would be in since I hadn't really seen him since surgery and left the room.

It was just a few minutes until the doctor came in asking, "How are you?"

I said, "Better!" I'm cancer free and this is my third day without a pad. He was pretty amazed too. He had a big smile on his face and said how great this surgery is. We talked about my leg pain and he thinks it is probably back related, not related to my surgery. I thought as much. The blood is hemorrhoids. They should resolve themselves. I told him I had worked pretty hard on the exercises and was amazed that I could see daily improvement.

He asked if I'd had an erection yet. I would call it one. Doctor Goldrath asked if I thought I was capable of intercourse. I said no it wasn't that good. Maybe 60%. He said it is just one month today. That is very early! It is encouraging and will improve. To have this much function this early is very encouraging. All the nerves and muscles are inter-related. They take time after surgery to heal and resume normal senses.

There are some studies that show improved results when treated with a regimen of Viagra. The sooner it is started the better the results. He prescribed a quarter tablet everyday for six days and a whole tablet once a week. This promotes revascularization and enhanced blood flow. The instructions were difficult for the pharmacy to translate to their system for insurance billing. They came up with 10 tablets as a seventy day supply which cost me two co pays.

I came home to figure out what they were doing and to call the insurance company. It seems that they thought it was a quarter tablet daily upto 1 tablet per week. So that would be 1 tablet every 7 days so 10 tablets equals 70 days. The pharmacy wouldn't call the insurance, but they called the doctor for explanation. They then under stood .25 tablets each day for six days. (1.5 tablets) and 1 tablet on the seventh day. (2.5 tablets per week) Repeat. That is ten tablets for 28 days or four weeks. That is one (1) copay. Half price to me. That took four trips to the pharmacy and we didn't finish until 4 pm.

But who cares! I have made three days without leaking. I'm set to return to work Monday the 4th of June 2007. Cancer FREE!! And almost as important to me, with dignity and dry!