State Of The Bill Address, 2011
Despite the ongoing ravages of age, the incessant dermal snippings of cancers basal and melanomic, lower back problems exacerbated by exercises aerobic and anaerobic, the appropriate corrective measures have been taken and The State Of Our Bill Is Good!
One of the reasons for this happy result is that Bill, as should you, has extensive physical examinations every year. These are conducted by Dr. James DeStephens, a progressive Gainesville M.D. (also a cardiologist) who keeps abreast of the latest health revelations and incorporates them into his treatment of patients. Dr. DeStephens is a little bit of a maverick in a conservative world, but, then again, so is Bill, so this works out fine. Both are open to new ideas and new ways of attacking problems.
Each year, Bill visits Quest Labs to have blood drawn (nine tubes this year) for a long list of areas DeStephens wants to keep tabs on. There are the routine checks such as the lipid profile (cholesterol, 170; HDL high, LDL low) and a few others like Homocysteine and CRP (a protein found in the blood, the levels of which rise in response to inflammation). High levels of Homocysteine, a non-protein amino acid, can predict heart attacks. Of all the blood results, this was the only one “out of range” and it was a very modest overage (12.0 where the ceiling number is supposed to be 11.4). DeStephens prescribed a Vitamin-B compound mainly consisting of Folic Acid. He also upped Bill’s Vitamin D intake to 4000 IUs a day, in accordance with the new government standards. No great discoveries, no important measures to be taken. Probably could have skipped this exam with no negative consequences. The trouble is, you’re never sure which exam you can afford to skip.
Oh-oh….
The most widely used measure of determining potential prostate problems is the Prostate Specific Antigen (PSA) test, which measures the PSA level in the blood. Mine has always been very low (.4 to 1.1), which is good. If the level rises past 4.0 or if it rises suddenly even to a lower number, doctors are wary. Because PSA tests are not entirely reliable, however, doctors usually perform a digital test as part of an annual physical exam. In 2005, I was surprised to discover there was a “hard spot” on my prostate. Dr. DeStephens sent me to Dr. Jack Paulk, the longest-practicing urologist in Ocala.
“I think we need to do a biopsy,” Dr. Paulk told me after confirming DeStephens’ findings. Oh, that should be a barrel of laughs I thought. Nonetheless, we set it up. If you have never had a prostate biopsy, I could best describe it as feeling like someone was using a stapler on your insides….even extending to the stapler noise as (in my case) a dozen tiny pieces of your prostate are removed for analysis. It is not horribly painful but it is much less fun than a walk on the beach at sunset.
“You don’t have prostate cancer yet,” said Dr. Paulk (the word “yet” seemed to boom through the room). “But you do have PIN.” That turned out to be Prostatic Intraepithelial Neoplasia, which meant you may not have prostate cancer now but you will soon enough. As William Bendix famously remarked on The Life Of Riley, “What a revoltin’ development THIS is!”
“So what do I do to try to stop the cancer from happening?” I asked Paulk.
“Well, there’s not much you can do,” he said. “We just have to wait and see if it turns into cancer and, if it does, we take it out.”
This didn’t sound like a very good option to me, so I got on the internet and started looking for information. They have drug trials for everything, don’t they? Somebody, somewhere, must have a drug trial for a prostate cancer retardant. And they did. Researchers at the University of Tennessee were testing Toremephene Citrate, a breast cancer drug, to determine its effectiveness against prostate cancer. And, wonder of wonders, they had an office set up at The Cascades in central Ocala where I could go to apply for inclusion in their drug trial. I was accepted and seemed to be making progress….a biopsy a year later showed no advancement of the cancer. I congratulated myself on my great wisdom in locating and joining in this trial. I never concerned myself with the little advisory that “taking toremephene can lead to (a raft of horrible possibilities) including blood clots.” If as much as one person included in these studies experiences any kind of adversity, that has to be included in the List Of Horrible Possibilities, right? Blood Clot indeed! Harrumph and double harrumph. No blood clots for me, thank you!
There’s Always That Ten Percent
So, several months later, despite what my cardio doctor from Interventional Cardiologists called “pristine arteries,” I got a blood clot. To make it worse, the clot was in the left anterior descending artery, the absolute worst place for it to show up. I almost died. You can relive this exciting episode in last year’s Birthday Blog (just scroll back to last November if you can stand more medical crises), but, to make a long story short, I was off the toremephene. Doctor Gregory Imperi, supervising my post-stent procedure, said “There’s no reason in the world that someone with as healthy a heart as you and no arterial problems should have any heart issues.” Well, Doc, maybe one reason. Anyway, with no drug to ward off the inevitable, my third—and last (you can only have three)—biopsy confirmed the arrival of prostate cancer in 2008. Dr. Paulk, a gruff old cattle-rancher with little bedside manner, tried his best to be consoling.
“We caught this as soon as it turned,” he told me. “You’ll be fine. If you were 75 and not in such good shape I’d tell you not to worry about it. But you look like you’ll be around awhile so we’ve got to address it. Basically, you’ve got two choices—surgery or radiation. Some people like to have those radioactive beads inserted but they almost always come back to me complaining about the pain. And cryosurgery—freezing—don’t like that. Body parts sloughing off and all.” Gulp.
“What would you do, Dr. Paulk?”
“I’d have the surgery, but either one would work for you. Interview a surgeon and a radiologist. We’ve got two excellent men with our group. The University of Florida even called our man, Dr. Taub, to come up there and teach their people how to operate that new da Vinci machine, the robot they use now for most prostate surgeries. If you like, I can set up the appointments.” Be my guest, I told him. Despite trying everything I could think of to avoid prostate cancer, now that it was here I wasn’t all that worried. A little operation, maybe a night in the hospital. Nothing to it. Yeah, right.
Surgery Or Radiation?
The eternal question. Now, like most people, I’m not particularly enamoured of the idea of getting body parts chopped off (although, in retrospect, this seems to keep happening to me). I think I wanted to be convinced that radiation was the way to go. Siobhan, on the other hand, was for surgery from the word “go.” Easy for her to say, right? Anyway, the allegedly wonderful Dr. Taub was on vacation and not available for a meeting until August 14th. And if you know anything about me, you know August 14th is dangerously close to the beginning of football season. I would not be missing any football games, prostate cancer or not. So I thought, gee, maybe I ought to be having surgery (if surgery it was to be) not much later than two weeks before season started, say around mid-August. I pulled up the UF website to check on the backgrounds of Dr. Taub’s tutees and what to my wondering eyes should appear but the mention of a NEW surgeon, Dr. Li-Ming Su, previously of Johns-Hopkins, who had performed over 250 surgeries with the da Vinci robot. Was I a lucky guy or what? I called the Urology Department at UF and described my situation. After sending and receiving more information than anybody could possibly need, the University set up interview sessions with Dr. Su and, shortly thereafter, with a radiologist whose name escapes me and, for some reason, is not written down in my notebook for that period. I guess that might be an omen.
Siobhan came with me to these meetings, probably to bolster the surgeon and shoot holes in the radiologist, but nonetheless.
Dr. Su, despite his name, was the ultimate American, had even grown up in Gainesville. A very charismatic guy with little doubt in his abilities, which is certainly a prerequisite for me. I had a lawyer once who expressed concern over our chances of prevailing. I got a new lawyer next morning. You may not win but you damn sure better think you’re gonna win. Dr. Su started off with what he called the “bad news.”
“First thing you need to know,” he warned, heavily, “is that you will no longer be able to father children.”
“I thought he said this was the bad news,” I whispered to Siobhan. “I think the bad news is still coming,” she replied.
“Second thing—no matter how good sex is for you right now, it will be less so in the future. The intensity will be diminished. For some people not much, for others a lot.”
I wasn’t real thrilled with this part. I looked at him with trepidation. “But it’s still better than a poke in the eye with a sharp stick, right?”
“It will all depend on how many of the nerves we can save. Sometimes we do very well. The third thing you should know is that everybody who has this surgery has some degree of incontinence. It can last from a couple of months to a few years.”
“When do we get to the good part?” I asked Siobhan.
Dr. Su went on to say that operatee would need a catheter for a week or so. No heavy lifting was allowed. For some reason, they didn’t want you to drive while the catheter was in. Otherwise, you’re on your own. Have a blast. Oh, and you get the additional bonus of not having to worry about going to the men’s room at halftime. The men’s room would be strapped to your leg. Not to mention, they would be giving you a wonderful prescription for Viagra, without which you would be helpless. Not that sex would be allowed for a couple of months. Which is just as well considering the cost of Viagra.
The Rest Of The Story
Okay then, so maybe this radiation guy can tell me a better story, thought I. No such luck. This fellow also believed in getting right to the negative side.
“First,” he said. “The treatment will be daily, except for weekends, and it will last for 8 ½ weeks.”
“Holy shit!” I almost said out loud. By the time they were finishing up—and I would be feeling my worst—I would be fairly recovered from surgery.
“Next,” the radiologist said, “If you have the surgery and it doesn’t solve the problem, you can always come back and have radiation. But if you have radiation and it doesn’t work out, you cannot repeat it.”
“Why’s that?” I asked Siobhan.
“Because it fries your guts,” she said, helpfully.
“Oh.”
“Another thing, of course, is the possibility of intestinal perforation from the radiation,” the helpful doctor added.
“Siobhan, is this guy trying to sabotage the works? Is he getting paid off by the surgery department?”
“But here’s the good news!” the radiologist beamed, brightening considerably. Oh boy, there’s good news, I thought.
“To prevent damage to the intestines, when you come in we insert a balloon into your rectum. The balloon is inflated to provide separation from the intestines and better protect them!"
“AAARRRGGGHHH!!!” I screamed, running from the room in blind panic. Well, no, I didn’t, but I wanted to. How the hell do these radiologists ever get anybody to buy their product? Geez, Louise!
“I think I’m slightly leaning to having the surgery,” I told Siobhan, who never swears.
“No shit,” she replied.
Tune in next week for our next exciting episode as Bill navigates the maze of pre-op requirements and finally goes under the knife. Will the operation be a success? Will his sex life be ruined forever? Most important of all—will he miss any football?
That’s all, folks. But just for now.
