The U.S. Preventive Services Task Force. Whew, that’s a lot to say. Hard to have a conversation when your mouth is that full. But the Task Force, or USPTF, is worth talking about and is asking us physicians to do some talking too. In a draft recommendation, the USPTF is telling men between the ages of 55 and 70 to have a discussion with their physician. The conversation is all about the risks and benefits of having a Prostate Specific Antigen (PSA) blood test to screen for the possibility of prostate cancer. This recommendation is a change from the USPTF’s 2012 recommendation that PSA testing should NOT be done in this age group. Why the change in the recommendation? Basically two reasons:

1.  Some newer studies suggest that PSA screening can save lives. These studies are a little muddy, but anecdotally, I can attest that since the fall off in PSA testing following the 2012 USPTF recommendation, I am seeing more prostate cancers presenting with aggressive features.
2. There are changes in treatment options for men with low grade, low stage prostate cancer. These options can decrease the frequency of side effects (impotence, incontinence) in men being treated for prostate cancer. These men may now be eligible for protocols that involve “active surveillance,” in which a urologist carefully monitors the patient, with no treatment unless and until there is evidence of cancer progression.

To me, these points confirm that the risk/reward consideration is in favor of testing. If you find yourself (or a loved one) involved in the PSA or No PSA discussion with your health care provider, I hope the conversation goes something like this:

You: I think I might want to have a PSA test.
Provider: There are risk and benefits. Having the test may let us give earlier treatment to a prostate cancer, but you may become incontinent or impotent.
You: I understand and I think it might help me to have the PSA test.
Provider: The test will not diagnose all cancers.
You: But it might diagnose mine. I think the PSA test is right for me.
Provider: You may wind up getting treated for a prostate cancer that would not have killed you.
You: But if I am diagnosed, I will have lots of options. That is better than not being diagnosed until it is too late.
Provider: There is no guarantee this will save your life.
You: I WANT MY PSA.

So have the conversation. Weigh the positives and negatives against your personal beliefs. I hope you choose to test, but no matter what your decision, or your PSA results, I hope your life is a long and healthy one. And if you think this is an important discussion for someone else you love, please forward this blog, share it on Facebook, or give it a retweet.

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If you missed our remembrance of Max last week  here it is http://www.chicagonow.com/downsize-maybe/2017/04/the-biggest-and-the-best-says-goodbye/

 

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April 20, 2017
It has been rough. When I saw the vet last month he thought I might have a good six months to a year ahead of me. He sent home some pills for the pain in my hips. It has helped, but I still haven’t been myself. Thirteen years is a long time for a big fellow like me, and I am feeling every hour, every minute, every second. Last night was the worst. I spent the night panting, and this morning I just couldn’t move. Not to take a walk, not to eat, not to take my pills.

She called him home from work, and then they called their son. They carried me to the car, and drove me to the clinic where people carried me in and laid me on a blanket in this room. I can hear soft crying, and feel hands stroke my back and chin. But my mind is blurred and thoughts jumbled. I feel a little jab on my hind leg, and the vet is murmuring to me.  Now there is no pain. Now there is nothing. Now the kitty princess will be queen. But I will always be with you.

February 1, 2017
Getting my bearings in the new house. A little disorienting, but is nice that they have their bedroom on the first floor now. My hips were making it hard for me to climb stairs in the old house, and I would have hated not spending my nights with them.

All these wood floors are trouble though. My legs just splay out when I try to get up off floor. Sometimes they have to put their hands under my belly and lift me. But I enjoy my short walks with them. So many dogs in this new neighborhood. And a big pond nearby. I bet there will be lots of birds in the spring! Just have to remember to rest these bones.

March 15, 2011
They brought a new kitten home. I hadn’t seen the old one around for awhile, the one who could be mean. Don’t know what happened to him. This new one thinks she is a princess.  Very cute and haughty. They give her lots of attention, got to be sure they don’t forget about me in all the excitement.

June 12, 2008
A perfect day. We went with the neighbors and their dog on a long walk, all the way to the railroad tracks and the grocery store. The sun felt so good on my deep black coat. And on the way home we walked by my girlfriends house. We romped in her front yard.  A little play nipping too. But I would never, ever, ever hurt anyone or anything. It is just not in my nature. At bedtime he gave me my nightly chin rub, and then I lay down on the floor beside her side of the bed. A day we will always remember.

October 22, 2007
They got that DNA test on me, and guess what? No matter how much I look like an Irish Wolfhound, there’s not a drop of Irish in me. My genes say I am a labrador/sheepdog/chow/retriever. That’s quite a mix. But she still says I am the biggest and the best. That’s all that matters to me!

May 16, 2005
It’s two weeks since they took me from the shelter. She said she didn’t want a puppy, or any dog that was going to grow big. The daughter helped him talk her into it. They seem like a nice family. Today we are on a road trip to visit their son at college. We met a woman in a parking lot who said she adopted a dog just like me from the same shelter last year. She says their dog is an Irish Wolfhound and she bets I am too! My lady almost fainted, but I can see lots of fun times ahead. It’s going to be a wonderful life.

 

Yes, we are approaching that milestone. While Barb and I join with the rest of the country in our countdown of President Trump’s first three months in office, we are almost at that 100-day point in our own transition to new down-sizers. Has the “honeymoon” period been a success? Let’s check in with how our initiatives have been doing.

1. Boosting the Local Economy: Grocery stores, big box retailers, restaurants, and furniture stores are all feeling the Raff impact in the neighborhood. No trickle down economics here, this is all cash on the barrel. Or should I say plastic in the chip reader. Got to keep earning my credit card points.
2. Improving the Job Market: We are keeping lots of local tradesmen busy with adjustments, fixes, and final touches. And sources report that Comcast has added an extra shift of technicians just to deal with the daily problems of our Xfinity TV connections.
3. Better Homeland Security: The number of false alarms, sensor failures, and forgotten codes has taken a tumble as a little Wi-Fi boost has solved our problem of spotty coverage in the house. OK, I admit the forgotten codes weren’t a Wi-Fi failure, they were a personal brain failure.
4. Reboot Health Care: As reported previously, health care (mine)  has been a major issue of our last month. I am pleased to report much progress has been made as my difficulties have been repealed and replaced.
5. Immigration Reform: Based on the number of non-native, non-criminal, tradespeople and landscapers who have worked on the house before and after our move-in, I declare it a sanctuary zone. I plan on meeting with Rahm Emanuel soon to discuss the ramifications.
6. Voting Rights: After almost 3 months of procrastination, Barb and I spent a long morning at the Secretary of State’s office having our driver’s licenses updated to our new addresses. Much to Barb’s consternation, my new license continues to list my high school weight. It is a fiction I enjoy perpetuating. As solace for sitting on hard plastic chairs looking at pictures of Jesse White for 2 or 3 hours, we were also registered to vote at our new address. Got that done with 4 years minus 100 days to spare.
7. LGBTQ Recognition: No one has called me a homophobe since we moved in. And we are well into the third season of “Transparent.” We will finish it when the cable comes back.
8. Environmental Impact: It is our swan song.
9. Tax returns: Done and filed. Well, at least the extension request is.
10. Infrastructure Improvements: We just built a ?!#% house!  I think I get a pass on this for the next few years.

I’ll match our record up to any administration. With successes like this, maybe we should plan for our next move to be to the White House. And we promise to release those tax returns too!

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We love our “down-sized” new home, our walking friendly neighborhood, and the serene pond next door. That is, we love it all except for the Canada Geese that come with it. Waddling, honking, and pooping, these big birds are a nuisance and a mess. According to Wikipedia, there are 4 to 5 million of these dung dumpers in the United States. Since we moved in, approximately three million of them have dive bombed within a 200 yard radius of our home. I can show you the droppings to prove it. Let President Trump build his wall to keep out the immigrants that he is afraid of, I want some defense against these foreigners.

In fact, we do have our secret weapon–swans!

Last year, as the house was being built, we noticed two lovely white swans had appeared on our pond, with two more on the adjacent inlet across the street. We admired these graceful creatures, Barb naming our pair Harvey and Sheila. Our many, many trips to the construction site were never complete without a few minutes watching the couple, who seemed to be as content on rainy days as they were on the sunny ones. Eight cygnets hatched, and the little armada would swim in single file across the pond, interweaving with the many ducks also floating by. By the end of the summer, only a few of the cygnets remained, and in the fall, Harvey, Sheila, and John and Yoko across the way, disappeared. This spring, four swans were back.

Now that we are living in the house, we are able to unlock the secret of our waterfowl. The ducks and geese arrive under their own wing power, but the swans are imported by our subdivision from  a Wisconsin company, Knox Swan and Dog. I spoke with Bob Knox, the owner of the company for the last 23 years, and learned that his company winters 300 swans on a farm in Wisconsin, and delivers breeding pairs to various locations every spring. Each pond or lake gets the same couple each year. We got back our Harvey and Sheila!

The subdivision imports the swans with two goals in mind. First, their beauty adds to the aesthetics of the neighborhood. Second, their other useful trait is an intolerance for the Canada Geese–especially geese that might disturb their tranquil summer home on our pond. Spending a few days at home last week I had the opportunity to watch the swans on the attack. Gliding across the water, they set their sights on any goose that lands on the pond. As quick as a PT boat, and with barely a ripple of swan feathers, there is a sudden acceleration, the gap between the goose and the swan closes, until the quaking, quacking, goose flaps its enormous wings and flies off, safely out of reach of the swan’s beak. Score one for the good guys. Harvey, Sheila, John, and Yoko  haven’t totally eliminated the neighborhood intruders, but the size of the fouling fowl flock has definitely dropped since our white knights returned two weeks ago.

We are ready to  spend our summer in the screened porch watching our flock. We can look forward to a new brood of cygnets, though I learned from Mr. Knox that the tiny swans are easy prey for snapping turtles in the pond, explaining why the number of babies dwindled as the summer wore on last year.

I guess its all just a part of the circle of life, suburban style.

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It runs like a river runs to the sea-U2 , 1987

Let the river run-Carly Simon, 1988

As anticipated in my last blog, I had my urinary tract plumbing procedure on rainy Wednesday. Most patients are sent home immediately after the procedure, but because of a few kinks (kinks in my history, not kinks in my urethra,) I had an overnight stay. I am now resting semi-comfortably at home. A catheter is in place to ensure that things keep streaming along. The big test will come Monday when the UroPartners team pops out the catheter. At that point, it will be all up to me to pee. By Monday evening’s  Passover Seder I plan to be flowing like the mighty Nile did when Moses led the Jews out of bondage in Egypt.

And how did this doctor do as a patient? I spent the first twenty some years of my career as a pathologist in a community hospital, so the sights, sounds, rhythm and routine were somewhat familiar, but it is certainly different from a patient point of view. The good people at Advocate Lutheran General Hospital did a great job of helping me feel comfortable, and treating me with kindness and respect, whether or not they knew I was a physician. The staff was uniformly polite and every member, from housekeepers to nurses, assistants, volunteers and administrators was sure to identify themselves and make it clear just what they were doing in my room at 4 in the morning.  And as my wheelchair was pushed out the door on Thursday morning, there was even a woman cheering me on with a hearty “You’re going home-Yeay!”  I am not sure she is a hospital employee, but if she isn’t, I suggest that LGH give her some pom-pons, a cheerleaders outfit, and offer her a job!

I have written before of the many safety precautions we take in our lab to ensure the right result goes to the right patient. We bar code, color code, do manual double checks, and with patient consent do DNA identification verification. I was glad to see similar safety precautions in place at Lutheran General. I recited my name and birth date at least 5 times an hour. The 2D and 3D bar codes on my wrist band were scanned with virtually every contact with staff, and certainly every time any medication was being administered.  I know that if my visit had been for an orthopedic procedure, the staff would have marked either my right or left knee to identify which side should be cut on. I don’t think that was necessary for my particular case–only one place for that cystoscope to go! By the way, if any of you are looking for an investment opportunity, alcohol based hand wash would be a good bet. To prevent spread of infection, there is a lot of hand washing going on.

Sorry, but I have absolutely nothing to tell you about what it felt like to be in the O.R. I have zero recollection from the time I was rolled out of Pre-Op until the moment I saw Barb beside me a few hours later.The intravenous sedative followed by general anesthesia was so relaxing that I think I will ask for it on my next trans-continental airline flight. It sure beats a Diet Coke and a bag of peanuts at 30,000 feet.

Kudos to my good friends and associates at UroPartners and my new friends at Advocate Lutheran General. I just hope that in my case, when it rains, it pours!

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photo credit: Onasill ~ Bill Badzo <a href=”http://www.flickr.com/photos/7156765@N05/32632872480″>Iceland ~ Landmannalaugar Route ~ Ultramarathon is held on the route each July ~ Water Falls ~ HDR</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>(license)</a&gt;

It is just a bit ironic. This coming week I will be undergoing my first ever surgical procedure. True, I am not a surgeon, so there is no irony in that. The irony I see is that as the Medical Director for the laboratory of the biggest urology group in Chicago I deal with about 60 urologists on a regular basis, and yet have delayed this necessary urologic procedure for about, oh, 6 or 8 years!

As is common for men of a certain age, my prostate gland has been slowly encroaching upon and compressing the prostatic urethra, the tube that runs through the gland and carries urine from the bladder to “out there.” In laymen’s terms, it was getting pretty hard to pee. I had seen a few different urologists at about 5 year intervals, and all had told me that some day, probably sooner rather than later, I would need a procedure to get things moving again. Not seeing any benefit in doing today what I could put off until tomorrow, I ignored their warnings and just accepted the fact that I would be spending a few extra minutes each day standing in front of toilet, thinking of waterfalls and bubbling brooks, hoping that positive biofeedback would get things flowing.

And then about three weeks the flow stopped as permanently as if it had hit the Hoover Dam. Inconveniently enough, my internist was on leave, but I knew which of my 60 urologist buddies he sent most of his patients to, so I gave that doc a call and we arranged a way to give me some relief. Urologists can do a magical job opening the floodgates with catheter tubes and balloons. With a little training, I have learned to do the magic myself–something I do not recommend for the squeamish or for easy fainters. And it is only a temporary remedy.

So a permanent solution needed to be found. My urologist and I discussed a variety of options, from newfangled metal splints that shove the offending part of the prostate aside, to old fashioned scrape and burn treatments. In the end, we have settled on a newer type of procedure that vaporizes the obstructing tissue but does relatively little damage to the prostate that is left behind. I am set for Wednesday at Advocate Lutheran General Hospital. LGH is the birthplace of Michael and Laury, so I will have happy memories to focus on while the anesthetic scrambles my brain. Recovery should be quick–no worries about being ready to dance at Laury’s wedding two months down the road. You may remember Barb had major surgery a few months before Michael’s wedding. It makes us glad we don’t have a another kid to deal with. Who knows what medical emergency would proceed a third wedding?

On a related note, my regular readers know of my interest and involvement with the diagnosis of prostate cancer. Fortunately, the area of the prostate that grows in my current condition is not the part of the gland that is the common site of malignancy. Although I have had a small spike in PSA, it is probably related to some inflammation. Nevertheless, I will keep a close eye on the values, and as always, I recommend that you, your spouse, or your partner have at least an initial PSA screen.

I can’t say whether there will be another blog before my big day, but if not, keep me in your thoughts and I will catch you on the flip-flop. We gone.

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It has been a couple of months since move-in day and we are settling down. The house is beginning to feel like our home. It is taking time, but the neighborhood is beginning to feel like our neighborhood as well. The neighbors, all very friendly, have been stopping by, bearing gifts and eager for the house tour. With the arrival of warmer weather and the imminent delivery of our pond swans, we will feel even more in touch with our surroundings.

The last month has seen the IQ of the house rise dramatically. Not the IQ of the inhabitants, our brains are no longer adding neural networks, but of the house itself. First I discovered that our garage door opener was more than a motor and lights switch.I can check my phone and find out if once again I have forgotten to close the garage door on my way to work in the morning. The opener also tells me for exactly how long the door has been closed, a feature whose necessity I have not yet fathomed. Maybe if we had teenage kids trying to sneak out of the house in the middle of the night…

Next I got tired of switching on five different lights switches scattered all around the house to turn on our outside evening lighting. Sure, I could have installed individual in-wall timers for each of those, but resetting each of those as the days become longer is more than my slightly past middle-aged eyes can handle. So while our low voltage/wireless/wi-fi/cable team was tweaking our alarm system we asked them to install a smart controller system for the outside lights, and then, in for a penny in for a pound,  added in controllers for the inside lights that Barb likes for ambiance. It has taken me a while to master the “scenes” and “schedules” the controllers provide for, but I am well on my way to becoming a smartphone lighting impresario.

Our wireless house sound system is doing just fine as a smart feature on our phones. It is the hard-wired stuff, the interface between Comcast and some of our TV’s that has been an issue. Some online research has revealed that we are not the only ones having problems with Xfinity boxes not behaving well with newer Sony sets. So far neither Abt Appliances, Comcast, or our cable team have a solution to this one. A swap out may be the answer. Any suggestions on the best brand to replace our Sony’s with?

Yesterday we had a long awaited walk-through with our HVAC contractor, a nice young man, rightfully proud of the job his company had done in the house. We reviewed furnaces, humidifiers, air balancing, and the new thermostats. Of course, the ‘stats are also much smarter than mere mortals, anticipating our needs and wants, calling for service whenever they feel the need, and changing colors to match our wall paint.  When starting this project two years ago we didn’t dare dream we would have chameleons on the wall with brains bigger than IBM’s Watson.

The crystal is shining, prismatically fracturing the rays of light into rainbows on the dining room walls. Shades and shutters are being installed,  and we are making plans for our first ever holiday celebration in the new house. The grass is growing greener, and every day we, and the house, grow a little bit smarter.

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We are in the Westchester Panera.  Barb has brought our granddaughters to the western ‘burbs for a rare treat, lunch out followed by a visit to Baba’s lab. The girls are entertaining the crowd as they always do, generous with their giggles and smiles and waves. An older couple, who tell us they have five grandkids of their own, seem particularly entranced.

Our food arrives and we begin the balancing act of eating our own lunch while keeping a one-year-old and a three-year-old fed, clean, and happy. Nana and Baba are quick with the wipes, not wanting the macaroni and cheese to fuse with the squeezable yogurt into an organic Gorilla Glue on the girls’ chins.

“hold my hand”–Hootie and the Blowfish

Barb nudges me. “Don’t look now, but they are holding hands.”

“Huh?”

“That older couple we were talking to. They are reaching across their table and holding hands. It is so cute!”

“holding hands and skimming stones”–Elton John

I casually look over my shoulder to witness the elderly couple as they hold hands and chat while waiting for the server to bring their order. They see us watching and smile.

“How long are you married?” Barb asks, gambling that this is a long-lived love affair and not a new infatuation.

“53 years,” they say in unison.

“I want to hold your hand”–The Beatles

Barb and I both do the math. That’s 15 years longer than the two of us have been married. Not such a long time. We will hit 53 years of marriage in our mid-70’s. Will we be sitting in the 2032 equivalent of Panera, holding hands and staring into each other’s eyes?

Barb still takes my hand when we walk across a parking lot. Sometimes we hold hands in the car, even as I barrel down the fast lane of the Tristate, cruise control set and just one hand on the steering wheel.  It’s not something we think about, just something that happens.

“hands, touching hands” –Neil Diamond

There are supposedly scientific reasons for hand holding. Yeah, that kind of science is air quotes “science.” For us, it is a connection, and more than that, a contentment. I think we can keep that up for another 15 years. Better yet, I think we will shoot for another 30! What do you think, Barb?

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Good things come to those who wait. Back when I was an underaged Northwestern undergrad, circa 1972, football and basketball, the “big” sports of the Big Ten, were an afterthought, or more truthfully, a non-thought for most of the student body. The last place football team had just graduated Mike Adamle, its only star, and the basketball team was  rooted even more deeply in the cellar. I got my education, my degree, my med school admission without once getting the nerve to scream out “Go Cats!” And no one cared.

I didn’t even think about NU athletics until the mid ’90s. Then came Fitz, Darnell Autry, Gary Barnett and an upset win at Notre Dame. Son Michael pushed me onto the bandwagon and with him I went to Evanston to watch NU play for the first time in over 20 years. Soon there was a Big Ten Football Championship and I almost won Rose Bowl tickets from Roy Leonard, my WGN radio favorite.

But then Barnett left for Colorado, Fitz and Autry graduated and after a few years Purple Fever lost its heat.

Despite the cooling, Mike and I  maintained a tradition of one NU football game a year. We cringed through critical broken bones (receiver D’wayne Bates), historic blown leads (against Michigan State 2006) and a scary road trip to Madison. We threw in a basketball game now and then, highlighted bywatching 6th year Senior Evan Eschmeyer and his  ‘Cats lose in the NIT to local rival DePaul.

This year, basketball hopes and hoops were of a higher caliber. Then Mike and I sat in the cheap seats for the Northwestern-Illinois game last month. As we left Welsh Ryan Arena with all the other disappointed fans, I thought the NCAA Tournament dream was ending again. But no–some big late season wins and here we are, dancing! The exciting first round win aided by bad Vanderbilt mistakes, clutch free throws, and lots of screen time for player-mom Julia Louis-Dreyfus.

Tomorrow we face number one seed Gonzaga, a school that was almost unheard of not that long ago. I’m afraid that game maybe a rough one, but as Michael told me, I need to just sit back and enjoy the ride. And always be proud to scream out “Go ‘Cats.”

Pass it on!

 

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Thanks to all for their kind thoughts on my previous post about Barb. She and I saw “Hedwig and the Angry Inch” last night. Among other things, it reminded us of the power of rock’n’roll. And political movements need a sound. After all, the French Revolution had La Marseillaise and people have been singing that number for more than 200 years. We have Trump. So turning to my rock’n’roll musical roots, here are my

Fifteen for Freedom:

1. Blowin’ in the Wind, Bob Dylan:

   Sure there were folk singing protesters before Bob, but his music changed the world. How many years can a people exist?

2. London Calling, The Clash:

   Punk rock of the ’70s, challenging police brutality and nuclear accidents with a great howl.

3. Sunday Bloody Sunday, U2:

   Bono says this is not a rebel song, but with that military beat, you you want to get to your feet and fight for what’s right.

4. For What It’s Worth, Buffalo Springfield:

   “There’s something happening here.” Say it Steven!

5. Where’s The Revolution, Depech Mode:

   The only current song on the list, it speaks directly to today. But that is something all of these songs do.

6. Dialogue Part I and II, Chicago:

   Maybe not the song that finally got Chicago into the Rock’n’Roll Hall of Fame, but “don’t you feel repression, just closing in around?”

7. Pompeii, Bastille:

   Of course natural disasters have always been around, but our new EPAChief shouldn’t be guiding us to avoidable calamities.

8. Shape of Things to Come, Max Frost and the Troopers:

   From the 1968 movie Wild in the Streets, “a cult classic of counterculture.”

9. Imagine, John Lennon:

   I don’t particularly care for this Lennon classic, but there is a requirement that it be included on any list of songs of the past 50 years.

10. Street Fighting Man, The Rolling Stones.

    Mick went to the London School of Economics. he gets it.

11. Revolution, The Beatles:

    Cause I love the great guitar intro, and you know, its the Beatles.

12. Volunteers, Jefferson Airplane:

    For Grace Slick, I “got a revolution”.

13. War, Edwin Starr:

    Be it trade war, currency war, or fighting war, do I even have to ask, what is it good for?

14. Holiday, Green Day:

    When Billie Joe Armstrong wrote “Sieg heil to the president gasman” in 2005 was he looking at the future through a crystal ball?

15. Won’t Get Fooled Again, The Who.

    The greatest album, the greatest song, the greatest scream. But this time around, the new boss just ain’t the same as the old boss.

It’s not an all inclusive list, feel free to add your own thoughts. Or better yet, write the new song of sanity. Maybe people will be singing it 200 years from now!

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