875 NGUOUY Part 39 WHAT! WILL CAN'T HAVE SURGERY TILL—WHEN???

Dr. B's response to Will's last question hits us like a stun gun, no kidding.  I mean, here we are, hoping he'll find an open slot of surgical time sometime next week or the week after at the latest, when instead, our sense of logic is thrown for a loop upon being told that surgery can't take place for six weeks!

Upon hearing that Will will have to wait for a month and a half, I'm sure you can understand our minds feeling stung.  I mean, who's to say whether or not this cancer, which has been growing for years, may be metastasizing as we speak!  Needless to say, all Jerry sees on our faces is surprise.  Then, while listening to Larry explain why six weeks must pass, the natural rise of our internal unrest calms down for this reason:  Though Jerry's logical response does not reduce frustration with the waiting game, his explanation swings the stung state of our metronome's needle from emotional reaction toward neutral by offering up a puzzle piece that clarifies the bigger picture ... And clarity proves calming.

Then, Jerry offers us yet another piece of information that makes six weeks easier to swallow when compared with this fact:  Had we chosen to travel to Rochester for prostate surgery, urologists at Mayo Clinic would have postponed surgery for eight weeks.  Why?

Well if you remember, I've already penned the logical reason as to why Will's surgery must be postponed in a previous post; however that piece of information may have slipped your mind, so I'll refresh your memory, anew:

After extracting 24 biopsy tissues, it will take a minimum of six weeks for this diseased gland, which is now riddled with inflammation, to heal.  And allowing time for inflamed tissue to heal is essential in order to provide any surgeon with an exquisitely clear view of the delicate boundaries separating healthy tissue from disease.  Again, the delicacy of this surgery demands that Dr. B's hand-eye coordination be meticulous when the focus of his goal is two fold:  Extracating diseased tissue, while preserving as many nerves as possible.

Though urology residents at Mayo are trained to wait eight weeks after performing biopsies, Dr. B, who has performed this surgery, daily, for many years, reassures us that he's never encountered a problem with going in after six … and as he has experienced the challenge of this nerve-wracking waiting game, himself, he chooses not to stretch six weeks to eight.

As you can see, our minds feel relieved to hear that this next chapter in the waiting game, which, naturally, drives nerves of steel up the wall, will not stretch out over fourteen additional days … until Jerry, consulting his appointment book, suggests a date that causes our spirits—which have been holding on to this lengthy roller coaster ride, blindly—to plunge straight down, again, for this reason … the date is Wednesday, Sept. 10th …

874 NGUOUY Part 38 WE DISCUSS WILL'S CHOICES FOR PLANS OF ATTACK ….

While discussing options with Will, I'm gratified to see my husband's think tank flip its switch from emotional human being to experienced surgical mode, for this reason:  While Will considers each choice knowledgeably and thus methodically, my intuition has sound reason to line up with his professional line of reasoning, spontaneously.

Thank goodness, I don't have to play twenty questions while listening to the precise nature of my husband's surgical mindset eliminate options, beginning with …

Russian Roulette, which means do nothing:
As is true when engaging in any war, one's choice of attack when battling cancer proves a gamble at best.  Even so, none of Will's options gives me the shivers as much as closing our eyes to the fact that diseased cells, which have been freely invading healthy tissue for years, will continue to march, here and there, without restraint, thus allowing this dread disease to grow ever more widespread, year in and year out.  Though one cousin had chosen this option, I was relieved when Will did not even write this choice on his pad.

Traditional methods of radiating the gland are dismissed for this reason:  If, with the passage of time, it is determined that radiation has not eradicated the disease, surgery is no longer possible, because scarred tissue, surrounding radiated tissue, fails to heal.

A new approach to radiating diseased tissue injects pellets containing seeds of radiation into the gland; however, Will does not consider this a viable choice for this reason:  It's impossible to direct these pellets to radiate the most cancer ridden portions of the gland.  And, once again, if there is a resurgence of disease, tissue adjacent to radiated areas scars down, suggesting that surgical intervention is no longer an option.

Though robotic surgery, which being less invasive than open surgery provides an easier recovery, statistics continue to prove that the results of this option, in terms of longevity, match results following open surgery.  However, this caveat tips Will's intuition toward favoring open surgery:  Will agrees with Dr. B's stance, which I'll paraphrase here:  Though I was trained to perform both surgeries, here is why I've chosen not to do robotic surgery:  During robotic surgery, the patient and surgeon are in separate rooms.  (This fact surprises me, immensely.)  Then, continuing to paraphrase Dr B:  While performing surgery, which proves this delicate, I feel the need to see living tissue close up.  I need to actually feel the tissue between my fingers while determining precisely where to cut in hopes of separating disease from healthy tissue, thus saving as many nerves, which enervate erectile function and urinary continence, as possible.  (I have no doubt that during his six weeks wait, preceding his surgery for prostate cancer, his surgeon's precision must have felt as vital to Dr. B as Dr. B's precision is vital to Will—and me.)

Will, who'd scoped countless knees over the past forty years, concurs that he'd prefer a sharp eyed, steadied, hands on approach  when cancer is the enemy.  (As for me, common sense suggests that my comfort zone lines up with that of both physicians, who have earned sterling reputations within the medical community.)  Therefore, when gambling with longevity and sparing the nerve bundle which services erectile function and urinary continence, I can clearly see why Will and Dr. B suggest that recovering from open surgery seems a small price to pay for greater peace of mind in years to come …w

Thus, it seems likely that open surgery is the option pointing toward resolution for Will.  On the other hand, Will's surgical mind opts for thoroughness, and as Dr. B agrees that seeking second and third opinions proves wise, he provides Will with contact information for two robotic surgeons, whose reputations are as sterling Jerry's, and in addition to that fact, both are Jerry's friends, as in—birds of a feather etc. etc. 

As our appointment, which had extended over an hour and a half, is winding down, my head swells with knowledge that had been absent when I'd first sat down.  In fact I don't think it's possible for my mind to absorb one more fact until Will asks how quickly surgery can be scheduled after second opinions settle his mind, and just that fast, my attitude of weariness switches to eagerness to listen up and absorb Dr. B's response—I mean, slow growing or not, thoughts of cancer invading healthy tissue catalyzes anxiety's pressing need to put this rainy day behind us in hopes that a sunny result will provide all three of us with smiling sighs of relief—tomorrow, tomorrow— it's only a day away …

If asked why worry about the waiting game when prostate cancer is slow to grow, I'd reply:  We've learned that several biopsies, which had proved positive, are bulging against the margin of the gland, and this bulge at the edge does not protend well for peace of mind, because this cancer has been growing in Will's body for years, and none can tell which day one of those bulging cancer cells will cross the line, meaning that—shudder the thought—metestatic disease may already be on the march. …

In tomorrow's post, I'll explain why Dr. B's response to 'how soon' shocks our socks off as we learn that the waiting game has barely begun …

PS
Today marks the fifty-second anniversary of the day when a tall, wiry, athletic, nineteen year old, pre med student, sporting a crew cut and a twinkle in his eye rang my front doorbell and then waited on my front stoop while a seventeen year old, blue eyed, brunette, high school senior stole one last glance in her dresser mirror before running down the stairs, eager to open her front door and meet her blind date, who'd sounded like lots of fun on the phone.  I mean, guess what he'd suggested they do, tonight?  Go to a movie?  Bowling?  No way.

As Annie introduces this young man to her mom and then grabs her hat, coat and gloves, her blind date cautions his soon-to-be girlfriend to dress warmly, because it will be cold on the pond, where he plans to spin her around the ice until, feeling dizzied, she has to hold on to him ever more tightly in hopes of not falling down.  Then while smiling delightedly at Annie, who is hugging her mom good night, her blind date holds out his hand to carry her ice skates to the car.  While the young pair walk out of the foyer into the crisp, star studded night air, Annie's mom reminds her elder daughter to be home no later than midnight, which, if you remember, proves to be the bewitching hour.

While walking carefully over patches of ice on her way to Will's car, Annie has no clue that she is destined to hold hands with this smart young man for better and worse while they raise a family of three rollicking, little boys, who will, over the years, have been given sound reason to grow up to be a trio of strong, compassionate, emotionally intelligent human beings, who will have learned to make good use of five simple tools, thus injecting their minds and spirits with the ability to balance work with play (couldn't resist that plug :)

Next thing we know, Annie and Will make their way toward the pond before moving on to whatever lies beyond, concerning that which fate has in store for two unique individuals, who are about to skate and smile and laugh and, over time, develop into fast friends—until they break up … and one story follows another until two thirds of their future has flown into the past as fast as both can blink twice …

At this point in today's post, I'll offer up one last train of thought in hopes that this insight may linger in your minds till tomorrow:  As life zooms by with the speed of light, let's imagine Annie and Will laying eyes on each other and exchanging smiles on that cold winter's night, with no clue that the time will come when they'll skate on thin ice—then, let's take a leap of faith across the timeline of their lives until we land upon today, where we'll imagine your friend, Annie taking you by the hand while she zooms back and forth across the short duration of years that make up the decades of her life in hopes of coloring in the ways that a positively focused attitude chooses to take sadness in stride, so that step by step, story by story, you too may find reason to consider yourself to be one of the lucky ducks, who fly high in the sky with that fortunate flock of birds of a feather whose memories are made up of many more reasons to smile than frown … And then, no matter how many miles separate your flock from mine, we'll feel free to close the gap by sipping from the very same cup, which overflows with gratitude for two lives, well lived, much more often than not :)

You see, at every stage of life, our spirits have sound reason to fly at half mast whether this be due to our minds feeling naturally conflicted, anxious, angry or sad.  On the other hand, each human mind is capable of seeking solutions with silver linings that place the blues in perspective, and here is why today's last insight is true:  Each time we dive into our memory banks in hopes of retrieving beautiful moments in time, blue is just one color within the spectrum of that wondrous rainbow of natural emotional reactions, which follow in the sunny aftermath of each person's decision-making storms—and here is why I know this last insight to offer the truth, the whole truth and nothing but the truth:  Your brain is a wondrously complex machine as is mine.  And as with all machines, which go on ticking like a Timex that's taken a licking, every brain finds itself in need of an oil, lube and tune up, from time to time.  And a clear shot of positive focus tunes up our brains in record time—because—attitude is everything :)

Tomorrow, we'll turn the page to find out why the waiting game between Will's biopsies and his surgery is about to extend for longer than six weeks time—

873 NGUOUY Part 37 DR. B OUTLINES PLANS OF ATTACK …

While Dr. B outlines a variety of battle plans, Will's pen, which he'll holster at the end of this appointment, shoots back and forth across the lines of his yellow legal pad of paper.  In weeks to come, my husband will take pen in hand, pointedly again, while broadening his plan of attack by marching from office to office, seeking second and third opinions from renown urologists, suggesting that when on the front line, it pays to be ranked with physicians in terms of knowing whom to call concerning—whom to call.  As Will's second in command, I take comfort in watching my husband's courageous think tank soldier forward toward strategizing the best way to obliterate this invasive enemy, which proves a serious threat to his life … and our peace of mind.

Will has five options:
Play Russian Roulette
Traditional radiation
Seeds of radiation in which pellets are injected into the gland
Robotic surgery

Open surgery

(I have an appointment, shortly, so I'll go into detail concerning each option when next we meet.)

As our appointment with Dr. B winds down (after an hour and a half), Will holsters his pen and rises from his chair as do I.  At this point, we're eager to be alone to discuss details, concerning each option (the first of which makes shivers run down my spine).

When I turn toward my chair to pick up my contoured pillow, which allows me to sit more comfortably, the sharp eyes of this caring urologist, who has gathered up Will's chart after rising from his chair, asks:
Bad back?
While nodding, I smile and make light of this chronic ailment by replying: My pillow is like Linus's blankee, I go nowhere without it.
That bad, huh?
That bad.  For many years.
With an empathetic nod, Jerry comiserates:  I struggled with back pain for years, as well.  Of all the doctors I've seen only one has been of help.  Would you like her name?

Since Jerry has already won my vote of confidence, I welcome his recommendation.  He disappears for a moment and upon returning, hands me a paper with the doctor's contact information.  And guess what?  My time to write is short, today, for this reason:
My first appointment with this miracle worker is this afternoon!  So—wish me luck :)

872 NGUOUY Part 36 CONTINUING TO SUMMARIZE DR. B'S RESPONSES TO WILL'S LIST OF QUESTIONS

I wonder if most guys are as unconcerned about prostate cancer as Will had been—I'll bet that's true of most guys in their thirties and forties.  As prostate cancer has become a topic of conversation in our home, we continue to learn much more than we'd ever thought necessary when this disease had not been of personal concern.

Before Will's diagnosis, I knew of only one friend, who'd endured treatment for prostate cancer, a cardiologist, who has been our dear friend since college, when he and Will had participated in a Friday night study group, along with two other determined, pre med students.  After college, this dedicated quartet continued their Friday night ritual over the next four grueling years until we all celebrated the joyous occasion of their graduation from medical school.  Each stood up at each other's weddings.  All held their first child in their arms within a year of each other.  And we're in the midst of planning a trip to Napa, later this year.  (At this point in time, I'm the only woman left of the four who had originally been considered one of 'the guys'.)

At any rate, ever since Will's diagnosis we've listened, attentively, to one case of prostate cancer after another, kind of like when you buy a new car, and all of a sudden, you see your model everywhere you go.

Recently, a neighbor, whose three sons match ours in age, informed us that after his bout with the disease, his sons chose to be tested, annually, and thank goodness for taking preventative action, because much to the family's disconcerted astonishment, one son, in his early forties, had already developed the disease, and surgery proved necessary.  As to the youngest, who is still in his thirties, his PSA is on the rise.

Unfortunately, Will had known three colleagues who'd been amongst those who did not survive, very long.  Though their surgeries had seemed successful, their cancer had metastasized.  As you can imagine, these deaths weigh heavy on my husband's mind, especially since we learned that these three doctors, like Will, had been diagnosed at an age when the prognosis, concerning longevity, is more worrisome.

Being a surgeon, Will is a stickler for detail, which is why its surprising that he'd not been tested for five years (Guess this is another example of everyone being imperfectly human, if not here then there).  While listening to Dr. B outlining options, I watched my husband taking meticulous notes, and thus did my intuition note that Will's well being was most definitely in the safekeeping of two pairs of exceptionally capable hands … And though nothing else had changed, that fact give my anxiety reason to relax, at least somewhat … And relaxing somewhat is definitely preferable to anxiety spiking … which will come later …

PS ... Did I mention that our neighbor, whose three sons match ours in age, is an internist, who, having checked his PSA, annually, caught the disease at an early stage… 

Next up ... While Will takes notes and I listen, Dr B outlines medicine's most current options …

871 NGUOUY Part 35 SUMMARIZING DR. B'S RESPONSES TO WILL'S LIST OF QUESTIONS

Let's back up for a moment and review the findings of Will's biopsies:
After numbing Will with a local anesthetic,  Dr. B withdrew twenty four tissue samples throughout the prostate thus allowing him to surmise if and where the gland was diseased.  Then, depending upon how many tissue samples proved positive, Will's lab report would offer Dr. B an accurate accounting of whether or not the cancer was widespread or, hopefully, contained within a specific area of the gland.

Sixteen of the twenty-four biopsies were diseased, and these sixteen were widespread throughout Will's prostate, so Dr. B. surmised that the cancer, known to be a slow growing rather than aggressive, had been invasive for several years.  As this slice of information sunk into our minds, we felt like a lead weight had been dropped on our heads. 

After pausing to take in this unwelcome news, Will and Dr. B. began to discuss the significant fact that Will's PSA level had not been tested for five years.  When I asked what a normal PSA level would be, Dr. B responded: Normal is below 4.0.  Will's recent PSA was 5.4.  Upon placing those two numbers in the forefront of my mind, I listened to my husband express how it came to be that five years had passed between tests …

Will began with:  Several years ago, I had an EKG that proved irregular.  As I began to see my cardiologist on a regular basis, it didn't seem necessary to see my internist, as well.  Thankfully, my heart continues to check out as healthy as a horse.

Two years ago, I had a serious bout of pneumonia, which saw me hospitalized and in need of oxygen and IV antibiotics for a week.  Upon returning home, I'd felt exceptionally weakened for several months, so, in addition to seeing my cardiologist, I was followed by a pulmonary specialist, as well.

In retrospect, I'd no conscious concerns about my prostate, and professionally speaking, the PSA test is known for inaccuracy.  Since the real value of this test is to gauge whether the number is climbing, and as my last PSA test had registered at 2.8, I just didn't think about it until I decided to see my internist, Dr. A, this June.

After my physical, Dr. A called and said that he'd felt somewhat concerned but not alarmed to see my PSA rise from 2.8 to 5.4, over a five years period.  In order to assuage his concern, he asked me to return to his office, and though no nodules were felt during his examination, he suggested that I meet with you.

When I asked why he'd recommended you, Dr. A's response was two fold:  He said your reputation was sterling to the point that when doctors face this problem, you are the urologist of choice.  (At this, a humble smile stole across Dr. B.'s face.)  Then, Dr. A went on to explain that you'd experienced your own bout with this disease, a decade ago, and how, ever since then, your practice has specialized exclusively in prostate, suggesting that over the past ten years, your surgical expertise has focused solely upon resolving problems like mine, every day.  Being a surgeon, myself, that fact said a lot, and here we are.

At this, Dr. B glanced over Will's chart, because he'd run a PSA test, as well.  Within the few short weeks between Will's last PSA and this one, the number had—decreased from 5.4 to 4.4—exemplifying that which Will had stated about the inconsistencies of the test.  On the other hand, both Will and I strongly suggest that every man be tested every year for this reason:  Whether the test proves inconsistent or not, Will's situation indicates sound reason for noting how much the PSA level may be rising from one year to the next if one hopes to detect the presence of cancer, so common within the population of men, at an early stage… I mean, who wants to hear that cancer has been invading healthy tissue for years …

As our appointment with Dr. B lasted an hour and a half … this summary of twenty questions will pause for now and resume tomorrow …

870 NGUOUY Part 34 TWENTY QUESTIONS WITH DR. B

Once we've introduced ourselves to each other, the warmth emanating from Dr.B's eyes deepens upon hearing how calming I find every detail of his office environment, and after thanking me for expressing the postive nature of my reaction, his soothing smile turns to Will, to whom he says, I'm sure you have a list of questions, so ask away, and I'll do my best to answer as thoroughly as possible.

With that, Will holds up his yellow legal pad and shows Jerry the length of his list.  At a glance, Jerry smiles while reassuring my husband with these words:  You're my last appointment, for good reason … my staff will leave at the end of their day … so relax; take your time and fire away.

See what I mean about how naturally Jerry's empathetic attitude soothes anxiety away?  Having walked in Will's shoes, a decade ago, this surgeon is anything but emotionally removed—and nothing relaxes anxiety, concerning mortality, as a shot of empathy coupled with professional precision.

With a sigh of relief (though nothing has changed), Will asks question #1… and though I wish my memory bank could withdraw Will's list questions, followed by each of Jerry's detailed answers, the truth of the matter is this:  I was standing in the wrong line when photographic thought processors were handed out.  So though I paid close attention to every question and answer this pair of surgeons exchanged, the best I can do, five months later, is to cough up a summary of Dr. B's empathetic responses … and I emphasize empathetic for this reason:  Over the next several months, information imparted by more than one urologist will offer our anxious minds a mixed bag in that one response will prove as reassuring as the next makes us catch our breath … 

As mentioned in an earlier post, I'd mistakenly cued up in the talking line twice, thus missing my once-in-a-lifetime chance to receive a photographic memory, so when next we meet, I'll do my best to summarize Jerry's responses to Will's lengthy list of questions …

869 NGUOUY Part 33 THE SERIOUS NATURE OF YESTERDAY'S THOUGHTS ...

As one day is not like any other, my mind awoke too weary, today, to conjure up insights into human nature that prove as timeless, universal and classic to the well being of wo/mankind as those,which flowed naturally out of my think tank, yesterday.

I also feel too spent to withdraw twenty questions from my memory bank.  And as each post penned places as high a value upon self respect as mutual respect, I'll honor my weariness by sending a warm, heartfelt hug into cyberspace before placing my mind at rest, permitting myself to luxuriate at my leisure for the remainder of this lovely, sunny day … I mean, we chose desert dwelling because warm winter weather allows us to play in the snow when we choose to drive two hours north rather than gazing out of frosty windows, shivering at thoughts of scraping away at ice covered windshields while chattering teeth hope that the frigid air in our car warms up before we arrive at our destination—if the car starts at all—And with that said, I bid you adieu, until the desert sun comes out, as most commonly happens, tomorrow :)

PS
Hopefully, you did not think that I held the underlying meaning conveyed in yesterday's insights too lightly.  One of my defense mechanisms expresses the depths of that which I feel in a lighter vein thus denying the full weight of heartfelt heaviness, which would surely pull my spirit too far down …  In fact, after pondering over mindful insights expressed in yesterday's quotes, may I respectfully suggest that if you choose to review post 868 repetition will not prove redundant when our mutual goal is retention concerning the acknowledgment of both sides of human nature.  Seriously, it's impossible to improve upon imperfections within oneself if we remain blind to strengths that remain half baked :)

Hoping to see your humble, inquisitive, courageous, and sunny sides interacting with each other, more intuitively, tomorrow, than ever before …
:) Your friend, Annie