A Date With Surgery 29 comments

25 Mar 2004 @ 03:59, by Richard Carlson ...and he was almighty because he had wrenched from chaos the secret of its nothingness. ---Jean-Paul Sartre When you get there, there isn't any there there. ---Gertrude Stein God never appears to you in person but always in action. ---Mohandas K. Gandhi Bernard Safran: A Surgeon Working 1982, 37" x 48", oil on masonite In some ways this article will not be typical of my writing. In the first place I shall begin with a caution about reading it at all. The main information about what I'm doing and what is happening to me---hopefully in some kind of equal balance---is simple and I can tell you that right away. As a routine procedure for prostate cancer, which we have reason to believe I have in a very early stage, I received a total body bone scan last Friday. The results were shared yesterday and they were excellent. We see cancer has not moved into the bones...and there are not other marked abnormalities. It's time to take the next step and that is selection of treatment, and I have done that. We have a date for surgery to remove the entire prostate gland on May 3rd. My urologist, with whom I have been working for a year, will perform the operation. Some may want or need to read no further. This situation is all about male anatomy of the most personal kind. Surgery is not the stuff for a morning read over your first coffee either...at least for most of us. I'm going to talk about the operation and why we selected this option. I'm going to write about the risks and what may happen to me. You may not be interested in knowing any of that. I certainly never wanted to...until my time came, as I guess in one way or another it comes to us all. I shall not be insulted in the slightest if you simply X out this item from your screen and move on to something you like better. You're now aware that from here until the operation I shall be preparing, and afterwards I'm going to be laid up for a few weeks. That may be enough of an alert. I would appreciate if someone would volunteer to Ming to, or if Ming himself would, edit the Logs for Front Page placement for a couple of months, beginning in May. Many people have gone beyond filing away these pieces of info about me, and have replied with amazing advice and heartfelt support. All kinds of stories have been shared, sometimes publicly on the Web. We're still pioneers in very significant ways with this computer communication. I don't know if writing about my personal life to significant people in my life and to complete strangers all at the same time is a smart thing to do. However, all of us live in communities, and people want to know what is happening with the other members...and what has happened when someone comes up missing. It turns out a couple of the communities I live in are electronic and virtual, "where" I have certain responsibilities to take care of, just as I do at home and in my workworld. So it seems important to try to write. A number of people have cautioned me about this surgery and the whole medical scene in the United States particularly. I welcome this controversy and hope the dialogue will go on with those who continue to read. The most important influence in my decision is my wife. We chose each other for a life journey, and it's at a time like this that a marriage means the most. Fortunately we seem to be agreeing about almost everything---although she always is able to find a few more things I can do to become a better man. After that come my doctors. I have chosen them carefully and nurtured our relationships. I feel that they know me and like me---which simple involvement I find important in being healthy and in healing. Maybe they have faults, but I do not think either has been brainwashed by the pharmaceutical companies or is ignorant of new research and alternative therapies. Both see me anytime I call and give me all the time I need during appointments. As usual I am not entirely happy with clerical communication between the offices, and I find I have to ride herd on that process much more than I'd like. But these physicians are understanding about those problems, and not overly defensive or frightened I'm going to sue them. In the past 10 years I'd had to get rid of a couple of doctors with whom I was not comfortable. Next in influence come friends and family, church and colleagues, and the mountain of reading material you've recommended. I know some of you have disagreed with me about this option of treatment. Some of you have been through this yourselves and selected other methods. This is where this essay may start to get more sensitive. I have 5 1/2 weeks to change my mind, and if anybody wants to move me in another direction please try. Having the prostate out is not like removing the tonsils or appendix. This is major surgery and in a minute I'll review with you why. Some of you selected radiation instead when you were in my shoes, and it's still an option for me. Others have heard about chemo and hormone therapy. The importance of diet is undeniable...and I believe there is ample evidence to show that what I've eaten and drunk throughout my 64 years has contributed to my diagnosis. Many alternative therapies sound wonderful and I want to try them, but we've decided they should complement rather than replace our selection. Much of what I'll say now is my understanding of things the urologist has told me and from a book he gave me entitled Prostate & Cancer by Dr. Sheldon Marks. My copy was revised in July 1999, and I've tried to supplement with more recent evidence and opinion; but I believe essentially the treatments have not changed since then although procedures hopefully have gotten better. It seems prostate cancer is particularly nasty because of how lethal is the spreading. The gland is nestled at the base of the spine and surrounded by the lymph system. That's where it goes. If it moves into either there are desperate problems for the patient. Therefore recommended treatment is radical and needs to be more aggressive than the cancer itself. Surgery has the best recovery rate of all the therapies...and that is because the cancer is gone from my body and in a jar in a pathologist's storeroom. That isn't to say we might not get it all or that some bad cell floating around might not bloom into another problem. The PSA level reveals if that is happening, and I'll have to have that test now the rest of my life---but all us guys have to do that starting at some age. The point is that surgery is a window of opportunity available only now for me. Later I'll be too old to endure it. Radiation is my second choice, and if I'm bothered by this kind of cancer again (which is highly unlikely) that's what I'll do. I could take radiation now...and still elect surgery if the cancer reoccurs within 5 years. There is an uncomfortably high ratio of men who find the cancer back after 5 to 10 years following radiation. The problem I would face then is finding a surgeon willing to try it. The operation is called salvage prostatectomy. As Dr. Marks puts it, "Because all the tissues have been radiated, the normal layers between the tissues are usually gone, leaving the tissues all stuck together" (p. 271). The chances of error are enormous and a mistake in there is disastrous. People at Johns Hopkins are willing to try, but won't talk to you if you're over 70. So if I miss the boat of surgery now, it'll be gone for good. Another advantage of the surgery is that some lymph nodes can be examined during the procedure to see if the cancer has spread to the lymph system. Given my genetic situation it may be vital to have that done, and radiation as an option does not provide it. Chemo and hormone therapies are used for men with prostate cancer as control and containment. In these cases because of age or severity, therapy to remove and cure is not possible. Guys have to come to this kind of acceptance eventually in one way or another. I've also been advised toward radiation by friends because of the enormous risks and side effects of prostate surgery. Yes, I'm worried about all this. God in His Wisdom of Perfect Design and/or Nature in Her Sweet if Haphazard Evolution has set us up generally, male and female, so that stuff goes in at the top and comes out the bottom. Maybe gravity is to blame for this. I use the word "blame" because it always has been a bit awkward for me that sex and elimination are so close together. I'm sure we poets and artists could come up with some much better ideas for sexual pleasure and propagation than God did. I'll be careful about what I say since, if God is watching, I don't want to get Him mad at me right now. But I'm sorry, it's hard for me to consider semen and urine as equally sacred...although ultimately in some way I suppose they are. With removal of the prostate, it's good-bye to semen---and maybe hello to diapers. Here's the main reason men balk at the surgery...and why it is a major operation. The urethra carries my urine from my bladder. This vital pipeline goes straight through the prostate gland. You can't just slide the gland off the urethra---which would be a really cool improvement. You have to cut it. Then it's stitched back onto the bladder, and I wear a catheter for a while as it heals. Incontinence can be a side effect for men if all this doesn't go perfectly. Furthermore there are significant nerve endings that will be disturbed in the operation...and they're the darlings that provide the mystery of the male erection. There's no way to predict what a guy will be like in this area after the voyage of surgery. You may have spent over 50 years trying to train the darn thing...and now there's a 50/50 chance you have to start over---and may not be able to do it. No more Viagra jokes please. Well, if you've made it this far through the writing, you probably know more than you ever wanted to, both about me and about prostate cancer. But if you did, I'm sure you're one of those special people to whom I owe so much for your messages and your prayers. I know they will continue and they really mean a lot. I have been so surprised and encouraged at this important moment of my life with the thoughtfulness and caring of both friends and strangers. We live in such an amazing world---in which we are more isolated and yet more connected both at the same time. My father used to conclude his radio program every day with a quotation from Dickens...and I'd like to follow his example now. "And so, as Tiny Tim observed, God bless Us, Every One!"

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25 Mar 2004 @ 04:16 by jstarrs : In the tantric...
...inner offering, the ordinary appearance of semen & urine (and the other bodily liquids, such as blood) are transformed into nectar.
In the least, I hope that you'll be able to transform the shit you're going through into a positive experience - (thanks for your frankness, I guess looking at the situation frankly & openly is the first step in being able to transform it).

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I knew Jeff would top me in talk of the juices. Thanks man.
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My honor, Jazz...I'm thinking that I'm seeing a fine supportive example of what can be done on the net, between people sharing their experiences. (thanks Kay, for the honest example & Shawa for keeping the passionate flame alive)  

Here we see a father, just home from the hospital, giving to his family new commands of priority appropriate to the occasion.

(More later...when hopefully I can feel the tips of my fingers better~~~)  

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