Read the Post Before this First. This One is About Prostate Cancer

A cautionary note. What follows is something that I wrote several years ago. I have tried to tone it down a bit to be less offensive. It may not have worked as well as I would have liked. If you are easily offended skip this one.

Is It Really True that in Some Cases It Gets Shorter?

On April 20, 2006 I turned fifty years of age. This birthday is frequently referred to as the half century mark by those who revel in celebration. On a more ominous note this celebration marks the onset of a period of life known as being "over the hill". All sorts of paraphernalia bear this imprint. The over the hill thing must be on a sliding scale, for they trot that banner out at 30, 40 and 50 years of age. "Over the Hill" is very simply a matter of perspective, having made it 11/12ths of the way through my fiftieth year I can say clearly I am not over the hill, but if I rest for a moment I will see it from here. Most of the humor tied to this specific mark of the sun's passages is tied to medical and sexual issues. Had I only known the truth that lay within such comments I would have partied a little bit more at my birthday bash. I think that I once read a piece that implied the harsh punch lines contained in the most humorous of jokes usually house more than just a little truth.

Now having experienced the celebration of the big five-oh and having endured the reality of the year subsequent I am of the considered opinion that turning 50 sucks. At least for me it did. Being old sucks in the most maximum of ways; I think the Latin term is suckimus extremus maximus. This annum (and I am being generous time wise for birthday 51 is still six weeks away) while it has had its moments, has apparently been the boundary between life's ascent and descent (decent?) for me. WHY CAN'T I GO BACK AND BE 49 FOR EVER? PLEASE? I PROMISE I WILL NEVER ….er, uh well at least one of those things may have been taken care of against my will. Read on intrepid soul. You too, if you have luck with you, will survive and cross these hurdles that age sets in place.

Oh don't worry I am not despondent, at least not yet. Most of what has occurred this year is rather funny in the cosmic sense. If I were a believer in reincarnation the assumption for me would be that I was a miserable bastard in the last life cycle. Let's see…where do I begin this narrative?

First there was the big party. That was a real plus. It was held at a bar with a sophisticated attitude and I got rocked. Using some basic logical syllogisms I note old guys drink scotch. I am an old guy and thus I drink single malt scotch. 50 year old guys drink too much scotch. Oh yeah, it was tie around my head and shouting "We're burning down the house…" time that night.

The thing about my birthday party was that it was a good time. It wasn't huge but it was meaningful. I saw people I hadn't seen in years. People from all the ages of my life (except the 18 years I lived before coming to Michigan) were there. I had my current good friends around me along and my old good time buddies. Sometimes that mix presents problems. But sometimes drinking scotch presents even greater problems.

Celebratory table toppers were on the high top bar stands. Prepared by my wife one caption on the tri-folds was "Time will make me grow old, but you can't make me grow up!" Beneath this maxim was a blue tinted photograph of me taken in the atrium of my law school. Rail thin those 25 years ago, I was wearing a white t-shirt that had been pulled down to expose my left nipple. Long hair dangling I was leaning backwards away from the camera for the greatest impact. Ugh, hairy nipple. It might have seemed that this shot could only have occurred because I was intoxicated. Still, I can say that on that date there was no alcohol involved, I was just crazy. Still, the photo sitting astride a number of tables at the bar looked kind of cool.

Anyway I digress. The mixture of friends and the occasion led to the buying of drinks. The buying of drinks led to the telling of tales. The telling of tales found me talking in conversation with some of the old, old friends about my winning the dorm championship backgammon match. My win was based on my ability to consume prodigious amounts of pot. In essence as match play progressed it became clear that last person conscious would be the winner, and I was the winner. So it went, it was the seventies you know.

The above tale's being told was primarily instigated by my old roommate urging me on and by a shot of Lagavulin. My old roommate Rooke and I go way back. There was the near tornado in Detroit. There was the Kiss pantomime at the talent show that ruded everyone out, too much crotch rubbing was involved as we lip synced and played our mops and buckets in our faux Kiss regalia. Rookie was the guy we snuck up on in the shower and unleashed a bicycle inner tube packed with ice and water on. Doing this surreptitiously, the shower stalls ran five in a row and we did this from an adjoining stall, we didn't realize what the muffled and choked whimper meant when the hose let loose. It meant well, uh that the hose was let loose. Apparently the Rook at that moment was deep into autoeroticism and was nearing the point of no return when the ice floes of Niagara came gushing. From the conversation these 30 years later, it appears that incident stopped his further use of the showers as a refuge for his Willie wanker jive.

Another party guest who was a former client I had worked with for many years. It was clear from the tilt of his head and the look in his eye he was listening to these tales. He worked in real estate generally aggressive and boundary pushing in business practices but conservative in other matters. For him I had constructed a more sanitized history of my life and he had never heard either of these particular tales before. I don't believe that previously he had heard one iota of my personal history in such realms. He was absolutely stunned at what at party monster I had been when I was young. Uh, I guess the fiftieth birthday party kind of ruled out any return to private practice for me... Open, drink, spew, I think such a tagline would look good on a t-shirt, don't you? At least I didn’t start asking for deviant sexual favors from people I didn’t know, in the past I might have. Oh wait in the past I did.

When I woke up from the party I had to face the required self evaluation. Nayh, it wasn't motivated by the people who had heard that I was a wild child. Nor was it motivated by any great remorse at the life I had lived so far. It was motivated by the fact that I just knew I couldn't live an unexamined life anymore. I looked in the mirror and I decided I had to make some changes.

The next day at our local mega bookstore I picked up a book by a guy named Jorge who claimed 8 minutes a day of exercise could pare the pounds off you and up your overall health. It wasn't 8 minutes a day, it was 22 minutes. I think the cover of that book should have explained old Jorge wasn't adding in the entire warm up, cool down and shifting periods between exercise times. This was a minor quibble for me because I found the weight loss and body tone claims were true. I lost 18 pounds in about two months and I was feeling good. It was a little hard to get up at 5:59 a.m. to do those exercises but I did it. Sometimes the exercises seemed too easy; but they weren't really because I was soooooo out of shape. In fact I don't think I had ever been in shape. But the stretching and the repetition that caused some pain ultimately felt real good.

I also began to think and read. In fact I picked up a book called Think by Blackburn. It was a philosophy text and it really gave my mind some new areas to stretch out in. Thinking about life, death and the universe felt really good. Things were going great, I was mentally aware and physically feeling as good as I had in many years. What was happening was really positive. Otto Neurath described what I felt I was doing, "We are like sailors who on the open sea must reconstruct their ship, but are never able to start afresh from the bottom" Tough task but the building project seemed to be progressing.

But then …..Memorial Day came. My cousin , one of my favorites in that he is an Ivy League graduate, a playwright and a landlord who does his own maintenance work on row homes in Princeton, opted to use this holiday weekend to get married. Given the high cost of flying last summer (gas @$3.00 + a gallon) a whirlwind trip to NJ via my Prius Air was made. While I got to see friends and family, and I got to go to church where I attended as I grew up, I felt poorly the entire time. Stomach cramps, miserable lower GI stuff rocked my body one way and then another. I kind of blamed it on the long road trip. My wife blamed it on the chemicals in the air out there.

Well it was neither. Turned out I had appendicitis. I had an appendectomy about 3 a.m., the following Saturday morning. So it goes. Turn 50, and your body go to hell. While I was in the hospital I was on morphine for a full day. As I departed the hospital I got Darvocet for the pain. And it did hurt, the pain was a motherfucker.

While this was occurring, my wife was in the belle province of Quebec. Based on our conversation as I awaited the surgery she stayed there. It just didn't make sense for her to fly back early. I would only be in the hospital two days and we would lose lots and lots of money. What could she have done had she been here? Amazing I turned 50 and got all economically responsible. Yeah, old that is what I am. Oh and to finish up on what Francie might have done, her parting comments next time might be a bit more tempered. Next occasion when she flies away and I am writhing in pain her parting words probably won't be the same as this time, those being more particularly, "Buck up bunky, you'll feel better tomorrow." I will never let her forget that one. Just because I matured a little economically doesn't mean I can't hold a grudge.

We come into this life alone, we go out of it alone. We even have semi minor/semi major surgery alone. Actually not, Terry my good friend stayed with me. He has known me for about 25 years. Much like my behavior in the bar at the time of my party, when I get loaded on painkillers I cannot keep my mouth shut. Per Terry, related to me with much snickering I was quite talkative in the pre-op area. Waiting for the operation room they gave me some pre-anesthesia drug. My response once it hit me was to holler to Terry, "This feels a lot like when you smoke opium." Apparently the anesthesia nurse starting cracking up just then. Rack that one up as an "oops" moment that my 50 years of maturity did not avoid.

In the dimly lit night of my post appendectomy stay, with those weird hospital LED lights providing a washed out blue tint to the dark hours, there arrived Nurse Todd. I would not be far off the mark to say that Todd, affable gent that he was, came right out of the casting of Doctor Strangelove. Todd ultimately is a good nurse with the bedside manner that is cross between Igor the mad scientist's assistant and that of a Zen master. Here is our initial conversation:

Todd: I am Todd your nurse for tonight.
Me: Usssdgh.
Todd: Are you in pain?
Me: Uh-huh.
Todd: Well, I know something about pain, and how they will treat your pain, but I can't tell you about that, but think carefully about how bad the pain is and maybe I can do something to help you.
Me: Owwwwwwwhhhh, owwwwww.
Todd: Can you rate your pain, and in doing this think about where your pain might be in two hours.
Me: Ahhhhhh, owwh
Todd: Okay, I will put some pain meds here on you table. Gosh I don't have my watch. So, I will just have to trust you when I come back as to when you took these. Remember you are allowed only two every four hours.

Todd was a saint. He was compassionate and played the system. It is good to know there are still people like him out there. He gave me meds to control my pain and told me that if I lied he would give me extras. With his help I made through that tough night.

And in the morning there was Nurse Joan. Nurse Joan was married to a Wookie. No I am wrong she is actually wed to Darth Vader. Well, in a way she is. Nurse Joan it turns out met her husband at a Star Wars convention and apparently he always goes as Darth Vader standing six foot five or so. Nurse Joan was the anti-Todd. She too had consummate skill and was compassionate also, but she very straightforward and by the book Nurse Joan managed my last few hours at the hospital and gave me some great tips on pain management for when I got home.

Who would have guessed that I would get to know a Star Wars nerd and the son of Dr. Strangelove in the course of one tormented weekend? Not me. My thought is that I would have been sent home with penicillin and a get well wish with no hospital stay. I was thinking it was just a generalized gut issue. Life at 50 has its turns and twists.

Following the appendix removal came a slow return to exercise; the net weight loss of this second go round was about 6-8 pounds from my initial start. Lying around for the time after the appendix came out gave me lots of time to eat. As I began this round of revisited exercise routines, nothing horrible, just those 23 or so minutes a day with 2 pound weights, my body just did not seem to snap back and into shape as it did the first time. Each exercise seemed harder, the soreness lasted longer and the result seemed diminished. Boy did that suck. I was going great guns and then this.

As the summer wore on I never got back to par. Aches and pains came and went, but I just wasn't on the mark. One evening I was feeling particularly bad. My suspicion for a long while had been that my esophagus was acting up. The problems with this organ were the result of too many years of tense deadlines and confrontation, the life of a lawyer. While my exercise didn't seem to make a difference in the pain it was clear something other than a muscle issue had arisen. During the course of that particular evening strong pain had developed on the right hand side of my body that grew more intense as the evening wore on. The call was made to the primary care doc's coverage to see what I should do. What happened next was that a trip to the ER was ordered. It was a very long night. Did I mention that about this time I was growing really, really suspicious that life after fifty wasn't going to be as good as life before fifty?

The ER at the Ingham Medical Center was a scene out of Dante'; it was wounds and blood; agony and screaming. After I was triaged I was set into a holding area of about nine beds. Next to me was an older gentleman who was in dementia. He apparently had blood loss so severe that his doctor had ordered him into the hospital ER to get stabilized. It was horrible to observe; he was ranting incoherently and he didn't know why he was there. His children who were present, both adult males, didn't want to be there and were trying out a game of how much better is my excuse to leave than yours on each other. The kid's are home alone. There have been break ins in the neighborhood. There is a nasty front coming through and I should help Mom up at the house. Their father with his dementia just kept screaming all night long.

Apparently the old man's conditions had rendered most of his veins and arteries useless. The first hour and a half I was there the nurses kept trying to sink the IV into this guy and could not find a usable vein. Eventually because of his high amount of blood loss they brought in an IV team. While the old man never became lucid the nurses with the family's aid were able to up the old man's blood level. But it took an hour and one half for them to put in the IV. The two sons never got to leave before I was discharged six hours later.

Eventually the best guess given by the doctors as to the genesis of my own writhing was a touchy gall bladder. Thus I was kicked to the curb and sent on my way. The old codger next to me however was in for the duration. I was so happy that I didn't have to spend another minute with this guy. It was everything I dreaded about getting old. Well, that and these repeated visits to hospitals.

As I have grown older I have accumulated some wisdom. One thing I comprehended is that it is often better to address a problem earlier as opposed to later. It is a hoary old maxim but it is true oft times in matters of physical health, that the sooner you fix a problem the smaller and the more fixable the problem is. A stitch in time saves nine, right? Figuring there must have been a reason for the trip to the ER (and the visit with the wailing demented) I decided it was time to get a physical

Per orders given in advance I had my blood work two weeks prior to the appointment with my physician. Then at the time and place appointed I showed up at my doctor's office. I had a mole on my neck that bothered me and I was worried about it. The short version on that is my doctor blew off the mole altogether.

It is something intangible, elusive, but I think most people get a sense when their doctor is acting strange, Tony, my doc, was acting strange. It turns out that Tony had gotten squirrelly results on my PSA and my lung x-ray but had decided we would get through the rest of the examination before we broached those topics. It wasn't until the very end he brought up the x-ray. My guess is that with the PSA elevated he figured I had prostate cancer in a couple of places inclusive of my lung.

The lung thing turned out to be the same spot we had first detected 10 years ago. I probably got it from working at the vegetable packing house in my home town. It comes from being exposed to pigeon guano and farm chemicals. It is non malignant and is basically calcified. Thus the possible issue and a very scary one at that of lung cancer was a false alarm.

The same cannot be said for the PSA (Prostate Specific Antigen). I am not out of the woods there and may never be. Luckily my doctor acted conservatively which means he took an active approach on the PSA. My PSA was low enough to be called normal, as was the annual increase in the PSA, but for my age and my health Tony was suspicious. Tony ordered a biopsy. I am glad my doctor likes me because many physicians would not have sought a biopsy at this stage. Probably helped that I aided him with some traffic problems a few years back (I was still in private practice and exactly how do you get so distracted that you run into a city bus?). This early focus on my prostate may make a difference over time in my chances for long term survival.

With the dark spectral images of the "C" word floating in my head, I agreed to undergo the first biopsy. PSA is a specific marker for prostate cancer. Cancer, it's a Jersey thing isn't it. I am cursed by where I grew up.

Up until about a week before the visit to the urologist I thought it was going to be a consult prior to the actual biopsy, but when I got the request for a medical history that focused on antibiotic use I knew it was something more. Prostate biopsy is a polite way of saying savage sodomization completed by a dildo with teeth. Sure after they get that rocket up the old chocolate channel the first knitting needle fired out fills the organ with lidocane or another local anesthetic. However even after this first pain reducing, but not eliminating, injection it still feels like someone is shooting a staple gun up my arse hole.

It is not pleasant. But what in medicine is? This particular procedure leaves blood in the seminal fluid. Pinto cum, if you would. If you think trying to solicit a blow job before the biopsy was difficult, think about the chances of getting a pass with the potential for mottled goo. Despite causing the overall reduction in the number of hummers available to me the test was Inconclusive but with a recommendation for a retest. More specifically the first biopsy had ambiguous results even though the slides were sent to Johns Hopkins for review. What Hopkins said was that I had non normal cells but not what they classified as technically cancerous cells. Thus the second biopsy was awaiting.

Time for the second biopsy came and I was again sodomized. This time it was by a tool that shot 12 needles into my prostate. The cells collected were be sent to a lab and analyzed for cancer. While Dr. M. had indicated it is one in four odds that they would find cancer cells this time they did in fact find cancer. Malignant is such an ominous word at 8:05 on a Monday morning in the dead of winter. I have prostate cancer at 50.

I note just a as a curiosity that as I was prepping for the second biopsy I got a phone call the day before the event that reminded me to take my enema and to cease using blood thinners a week prior to the mechanical violation. Wouldn't it have made sense to get that call a week before the procedure? I know it is an odd thought, but one worth considering.
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I will digress on purpose for a paragraph. Everyday I get an e-mail that contains an image and random thought attached. One day I got this particular message. It seems to sum up most of my thoughts on signs. Believe me I feel that I have had enough signs for a long time to come. I offer that random thought here for you.

I used to wait for a sign, she said, before I did anything. Then one night I had a dream & an angel in black tights came to me & said, you can start any time now, & then I asked is this a sign? & the angel started laughing & I woke up. Now, I think the whole world is filled with signs, but if there's no laughter, I know they're not for me.

~~Storypeople.

It was a month between discovery/confirmation of cancer and surgery. There were trips to the primary care doc, to the oncologist and to the urologist. And there was the reading up on all the techniques to address the issue. Radiation beam, cryogenic freezing or removal oh my! In all of my reading there was one fact that was most disturbing. Did I mention that in one article I read it implied that the person undergoing a removal of the prostate's penis might be shorter after the operation? When matched against the perils of impotence, incontinence and death (and trust me this is the ranking men assign to the risks of a complete prostate removal), the fact that my dick might be shorter kind of signaled the end of the first half of the journey.

But anyway, laparoscopic removal was the choice. All three doctors I talked to said that with prostate cancer appearing at 50, it couldn't be predicted how aggressive the malignancy was. Removal in such a case was stated by all three to be the best option. Did I mention that my appendix removal was laparoscopic? Did I mention that it really, really hurt?

With images of the pain filled days of my appendectomy floating in my head, and fears of a permanently limp member, I on March 1, 2007 appeared at the Hospital. I had been on a liquid diet for two days prior and had taken various laxatives to cleanse my system. On the day of the surgery I had antibiotic enemas to reduce the chance of infection. With the number of anal violations I have suffered in the past five months I ought to just turn bisexual.

I was under general anesthesia for four hours. If you want to you can watch a similar procedure here, http://www.brynmawrurology.com/Mcginisonline.html. I personally can't, not yet at least.

I came out of surgery at 8 p.m. into semi private room. My and my friend who had been with me through the appendectomy were waiting there as I was rolled into the room. So was some maniac fucker screaming about those doctors had better do something, that he hadn't taken a shit in four days since his appendectomy and that this had to be remedied! My roomie was cursing out the nurses, the techs and just about everyone on the floor. This tirade was only cut short because shortly after I was moved into our room he soiled himself. Soiled is an understatement he exploded. This was apparently due to the upped dosage of laxatives he had been give because of all his bitching.

My guests did not stay long. With a kiss and a wave they vanished into the mists. I was left with the cursing curmudgeon. Mr. Grumpyfuck who despite the fact I was just out of surgery decided he had to watch TV with his monitor turned up. The only saving grace of the moment was that the drugs, in particular self administered morphine, were very nice. La, la, las all around. And there was Vicoden, too. Uh maybe it was the combo of the residual general anesthesia and the morphine (or maybe the Vicoden) but there came a point when I was falling into a rose colored sky only to discover it was an ethereal Zen garden that I just flew through and landed in the soft warm darkness beyond. And of course there were miniature little spiders running all over the back of my eyelids leaving traces of there dark paths in complex Arabian patterns.

And then at 4 a.m. came my judgment for a profligate life came to call. And this is where it all starts to come together.

Grumpy Motherfucker in the Next Bed: "Hey, hey buddy…aren't you my judge."
Me. "mumble, mrph, gurgle….huh…why yes, that is me"
Him (Mr. I have problems with my bowels) "So why didn't you give me my driver’s license back last summer when I saw you?"

Hanging between the conscious world and the blue soup of opiate oblivion in omnipresent pain, I was being questioned by a disgruntled litigant who I had denied a license six months earlier. What the fuck did I do in my last life to deserve this?

And he kept at it.

Him, "you know those rules you use are kind of tough."
Me. "We look at a lot of things….."
Him, "Must have been that useless lawyer I hired, Mr. Post."
Me. "I spoke to Mr. Post last week."
Him "So could you even guess how long it would take for me to get my license back.
Me. "I am taking my morphine now I will talk to you in the morning.

More eyelid movies. After I hit the pump I wasn't sure that this guy wasn't going to sneak over and snuff me with a pillow while I was out. As the morphine coursed through my veins my discomfort faded. No more discussion with grumpy Gus about why he is walking and not driving.

When I awoke the next day my doctor was at the foot of my bed. Dr. M. said I had my choice; I could go home either today or tomorrow. My first though given my roommate situation was to move on and go home. But then Mr. Grumpy over his lack of a license left. With him gone I could rest. Additionally I wouldn't have to face the stairs at home. When time came at five p.m. as to whether to stay or go, I stayed.

Funny thing though I did remember grumpypuss. My unhappy roommate had a job that was unique in this area and it was one a buddy of mine had had when I was in college. So he stuck in my memory. I denied him relief because of an undisclosed drug problem. So what follows is thus funny.

We I woke up and was somewhat more cogent my roomie and I talked about his appendectomy. I mentioned that my appendectomy was painful and took more out of me that I had anticipated. I was trying to calm him down because he seemed so overwhelmed by the whole situation. As we talked I told him he would probably be slow and not up to snuff for at least a month. And this is where I was just amazed. When he was checking out Mr. Grumpy was asking for the nurse to give him another two weeks of Vicoden based on my saying it would take six weeks to heal…. Hmmh? The guy has a drug problem, and I offer him advice to take it slow and he turns it into a ploy to hit the nurse up for more drugs. Do you think he should be on the road? Do you think he has addressed his problems?

And then it was silence for a couple of hours and I read a book of 15 minute gourmet dinner recipes.

And then the dementia guy from the other hospital appears in my room. As God is my witness it was the same guy from Ingham Medical with the pissed off kids. And again it takes them an hour to put in his IV, same complaint as last time, blood loss due to internal bleeding and it might be impacted by his cirrhosis. And the same adult children who were pissed off to be at the hospital are still pissed off. And then the adult children left and Nurse Todd, "I know something about pain", from my appendix surgery came in. I was never so happy to see anyone. Mr. IV pulls out three lines each taking an hour of moaning to reinsert and thus ends up being restrained with alarms. And at 2 am after numerous screams and alarms I ask for sleep meds and Todd complies, willingly, almost eagerly.

And then Nurse Joan appears and we talk about all of our connections, her son and mine go to school together and she lives about four blocks from the park. Nurse Joan says her husband still dresses up like Darth Vader.

Finally I get to come home with a tube hanging out the old snake with a promise that it will be removed "soon" The kicker is that the surgical inspection showed no cancer outside the prostate, and this is good. As to the length, the rigidity, the continence and well impending death, only time will tell.

It has been an interesting year this 50th. The year contained some wonderful ups and some very obvious downs. It seems surreal at this point as I sit at home healing. All and all I think I should have made that 50th birthday party last a little longer. But hey as far as I am concerned I don't want a birthday party this year.

Coda

Two years have passed now and I am still cancer free. I have sex and it is enjoyable. I worry about things like is that ache a sign of cancer or not but it is not always at the forefront of my mind. I try to live right, but I am not that good at it. People who helped me through the process were other survivors. I talked to them frankly and frequently. Some are doing okay, in fact most of them are. The one thing that seems to be key is early detection. Guys if you are peeing too frequently see a doctor. Pay attention to your PSA. If it is rising anywhere close to the limits that are out in the literature get your doctor to be your advocate and go get it checked out.