Sunday, March 25, 2007

Bringing You Up To Date...

In the last short while since I wrote, some issues are notable and some are just laughable. I’ll do my best to be serious about some and work at not guffawing myself off the page. You be the judge…

My doctor appointments were, at best, barely satisfying. I saw my primary guy early this month and he continued to admonish me for my weight gain and my elevated blood pressure. The weight gain is astonishing as I changed my diet to salads, vegetables and small amounts of chicken. Okay, maybe I do have a toasted bagel smeared with cream cheese every morning accompanied by mostly black coffee but, that can’t be creating this weight change. I think it started when I began the diabetic insulin shots which did improve the digestive process somewhat. My doctor agreed. So, I began a different tack.

I needed to start exercising and so, I did. I began walking in the mornings. The first week was seven to eight minutes a day but, it was every day. I hadn’t so much as put my running shoes on since before this cancer “unpleasantness” descended in October of 2006. I came back not winded but, certainly tired. The next week I resolved I would double my exercise time and I did—to 15 minutes per day. By now, not exercising daily meant I felt I was missing something in my day, like missing a meeting with a close friend. By the third week, I doubled my walking time to 30 minutes and added an incentive. I walked from my house, along the highway until I reached the local supermarket, “Sack ‘N Save.” I would usually arrive about 7:15am just in time to find day-old bagels at sale prices.

I’ve kept up the walking for these last three weeks and the expected and unexpected benefits showed up. A second doctor’s appointment three weeks into my program showed me at a weight loss of six pounds, a huge change. I was also sleeping better in that I would go for up to four hours a night without waking to make a liquid donation to the toilet. The walking was just tiring me out enough to create a pleasant slumber for the first time in many months.

Surely, the weight loss and the better rest were satisfying to my body and spirit. I proved to myself that my decisions were right, that improving my diet was a good thing, additional powdered fiber intake was moving that food through me more rapidly and getting my heart rate up through the walking was providing rewards in weight change and restful sleep. A surprise benefit was relief from a consistent, deep pain centered in my left hip.

The pain was unendurable at times, keeping me awake at night and preventing me from sitting at my PC during the day. It was right in the pelvic joint and while I couldn’t figure out if yoga-like stretching helped or made the pain worse, occasionally my entire left leg throbbed with pain. I started taking Tylenol regularly and that helped though I didn’t want to rely on that for life-time relief. I drank more water, thinking that would help as water intake helped with neuropathy, a painful muscle cramping associated with diabetes. It helped some. I even told my primary care doctor about it and he ordered an x-ray to see if my cancer had spread into that hip. (He called back later to say that the x-ray “lit-up” in that hip indicating a possible cancer spread. My oncologist told me in another appointment that if the cancer had indeed spread then he would see a hollow space in that ball joint and he didn’t. So, just what was causing this pain, arthritis?)

In any case, the more I exercised, the more the pain went away. I was amazed! There might be a few twinges from time to time but, in the main I was pain-free. My Tylenol intake dropped to maybe one pill every three or four days instead of two a day. My sleep was uninterrupted by pain. Life was good, indeed. My shorts were already getting loose and I had to tighten the wrist band on my watch. Watch this space for the continuing improvements… Tomorrow, I start trekking one hour a day, everyday.

A second medical appointment was with another oncologist or cancer doctor. My interest in connecting with him was because he was the head of a “clinical trial” researching the effects of a new prostate cancer (PC) treatment. This regimen involved twelve injections a week for about 12 weeks. It was a vaccine that triggered the immune system to chew up the cancer cells. Typically, the immune system won’t attack its own human body cells only foreign bodies, like viruses. This stuff makes the cancer cells look like foreign invaders so the immune system goes to work. He reported some success although there is a time limit of sorts. It only works for a little while in terms of the immune system eating up the cancer cells. The good thing though is that once diminished, the cancer stays diminished. My only disappointment was he wouldn’t admit me into the program because I’m not far enough into my current hormone treatment to qualify me. He did prescribe some medicine commonly used to reduce my PSA count (a measurement of how bad is the PC.)

My next appointment that same day was with an MD dispensing what is called “integrative medicine.” He was a Western-trained doctor that was integrating Eastern medicine with contemporary medicine with some remarkable results. Even the local medical insurance company, HMSA, was impressed enough to include his clinic in their payment programs. He went through the normal questions asked of a new patient and then started applying the Eastern methods on me. He took my pulse in both wrists not so much to count my heartbeats against a clock but to read what their strength or weakness was telling him about my general condition. When he finished with that he started asking other questions of me. “What was I most proud of?” I said my daughter. “What did I do for fun?” I said my art was so engrossing that I hadn’t found anything else of such a level. “Why did you divorce?” I explained that I thought my wife had tired of my behavior and decided to lay down the marriage. When he asked what that behavior was, I started to choke up. He asked me what I wanted accomplish from here on out and I started to bawl. I don’t know why I started crying; perhaps because I had never been asked these questions in a medical setting. I felt as if a professional really cared about was important to me as a part of his determination of what was the right treatment for me. This interview was so different from the “Where does it hurt?” routines of previous medico’s. I felt at home in a way probably more because I felt as if someone was actually listening.

In the end, he prescribed acupuncture as a way to “balance” me as I handled the double diseases of diabetes and PC and my work to make my artistic talents pay off into a wealthy lifestyle.

My last appointment was with the oncologist who last saw me almost six months ago when I was in hospital. I thought he wanted to see me because my PSA count was of concern.

In October, my PSA count was 48.5, incredibly high. When I left the hospital it was down to 5, still high when a normal PSA reading is >.01. By February, it was t 7.4. In March, it had risen to 7.9. In PC, the rate of increase over a specified amount of time is the critical measurement. While mine was of some concern, it wasn’t too serious.

I arrived at his office about 20 minutes early for a 3:15pm appointment. My appointment time came and went and soon it was 4:00pm. A nurse called my name and hustled me into a lab to draw some blood. I went back into the waiting room and waited some more. By 4:45pm, I was in a deep nap when I was finally called in to get weighed, read my blood pressure and other vitals. It was close to 5 o’clock before my interview started.

Before he got going, I told the doctor about my days in the airline business. A physician’s conference ended in Hawaii and doctors, wives and families were aboard and ready to leave when some airplane part broke down. Departure time came and went and I was assuring the passengers of a time not far off when they would be on their way. When the delay extended to an hour and a half and the doors were ready to close for the last time, I took up the cabin microphone to speak to the sold-out airplane. I apologized for the delay and wished them an otherwise safe trip home. I then said, “And folks, we know you are doctors and specialists with us today. We thank you for choosing us to fly with but, we also hope you now know what is like to be stuck in your reception areas for hours on end waiting to be served. See you next time!” Whereupon the cabin’s occupants burst into laughter and applause as I clicked off the mike.

This doctor got the message and chuckled, as well. He apologized, saying that a just-prior patient didn’t want to leave and took loads more time than normally allocated. I asked him if my elevated PSA count had caused his office to make this appointment and he said, “What elevation?” He said he hadn’t seen my recent blood reports but he had set up this meet because he hadn’t heard from me these past six months.

It was my turn to pause and consider just what kind of care I was getting in terms of quality and quantity. I had assumed that the medico’s associated with my care were in contact with each other in some way, if not at least by sharing my reports, lab tests and x-rays with each other. They do that and they even sometimes read these things before this patient is at their doorsteps.

I then understood why it is critical to anyone in my position to keep, read and understand the medical reports issued. Once understood, it’s a lot easier to ask questions, even penetrating questions of what treatments should or should not be undertaken on one’s behalf. The internet helps immensely in this regard and I’ve begun to research more and more about what ails me. In time, I may know as much about these two “deadlies”--diabetes and PC--as my medico’s. It’s then I’ll feel confident enough to point out the direction my medical partners will take in my treatment.

Watch this space for more developments…