Dr David Lee

I finally met the doctor who will be performing my prostate surgery yesterday at his office in Radnor PA.  Dr Lee has performed over 4,000 Robotic-Assisted Laparoscopic Radial Prostatectomies and is one of the most renowned specialists in this area.  I was most impressed with Dr Lee and feel very comfortable that I will be in very good hands.  Tentatively the surgery is scheduled for September 30 at Penn Presbyterian Medical Center in downtown Philadelphia.  I have asked that I be moved up in his schedule if an opening should occur. We'll see!

The meeting with Dr Lee and his Assistant was very enlightening and I couldn't have asked for them to be more forthcoming and straight forward.  Some of the things I learned:

I thought that I would have to have a catheter for between 3 and 4 weeks.  Turns out I will probably have the catheter removed after one week.

I will spend one night in the hospital and will be discharged the next day.  I will be expected to begin walking up to two miles per day as soon as I get home.  If all goes well I should be able to return to all of my physical activities (tennis, running, pickleball) three months after the surgery.

I will not be able to drive a car for one week after the surgery.  This will probably drive me nuts but I'm sure I'll survive,

I will be wearing a diaper for a while, how long will depend on my progress.  I was given instructions on how to do the Kegel Exercise.  Since my prostate is being removed I will no longer have the muscles in the prostrate that control urine flow.  After surgery I will be relying on my pelvic floor muscles to control urine flow.  The Kegel Exercise improves the urethral sphincter strength by developing the bladder neck muscle and the muscle around the urethra.  The Kegel Exercise essentially is like trying to hold in a fart.  I need to squeeze my ass throughout the day and this will develop the necessary muscles.

It is interesting to note that since women do not have a prostate, they are always relying on these muscles to control urine flow.  Men with a prostate have not developed these muscles effectively.  I need to get on a crash course to get this muscles developed so I can get off the diapers ASAP.  Any woman who has had a caesarean section is well aware of the Kegel Exercise,  right Ginny, Sarah and Diane???

The really fascinating area involves sex and what to expect with all of that.  Since I will be losing my prostate I will no longer be able to ejaculate.  However, I will still be able to have an orgasam.  The interesting thing that I learned s that it is not required to have an erection to have an orgasam.  Who'd a thunk??  I probably won't be capable of having an erection for at least a year and then I may need some help in the form of Viagra.  All of this was very enlightening to me and I am sure that I will learn a lot more about all of this as I go through the process. 

Like the old saying goes; "use it or lose it" this is truly the case with sex after the removal of the prostate.  They told me that if I wanted to continue to have sex I will need to do something called self stimulation.  This is all unchartered waters for me and I will probably need to rent some X-rated movies to guide me through the procedure.  The key is to continue to exercise those muscles that are used during sex or I will lose them.

They will send my prostate and some lymph nodes to pathology after my surgery.  Hopefully they will not find any cancer outside of the prostrate.  I will need to have my PSA checked every three months for the first year after surgery and then every six months thereafter.

Well, now the wait begins!

The Decision

Well I have essentially made my decision as to which procedure I will have performed on me to remove my cancer.  I have decided to go with the robotic surgery that will remove my cancer.  In this blog I will go into some detail as to what the procedure involves, the risks and the recovery phase.  If you are a bit queasy about learning about the gory details you may not want to read this blog but if you are a male over the age of thirty these are things you should probably know about.  As for you Caron, you will probably be shocked to learn that your mother was not a virgin when you were born and yes we have actually had sex during our marriage.

The Surgery Itself:

During the surgery I will be totally sedated and will have no idea as to what is going on.  There will be five holes about the size of your small finger about six inches below my waist.  These holes will be used to insert cameras and surgical knives into my pelvic area.  The camera will have about 12 X magnification so the surgeon will have an excellent view as to what he is cutting.  The computer will guide the movement of the camera and knives but the surgeon will always have ultimate control over the procedure.

The entire prostate will be removed as well as some lymph nodes in the area next to the prostate.  The lymph nodes will all be analyzed to determine if the cancer cells have migrated beyond the prostate.  Hopefully these results will come back clean.  Since the entire prostate is being removed that means that a section of my urethra will also be removed since it runs through the middle of the prostate. 

 The urethra is a tube that transports urine from the bladder to exit the body.
In males, sperm also exit the body via the urethra but not at the same time!  The urethra is vitally important if you want to be able to pee normally and have sex.  Once the urethra is removed (about 2 inches) it will have to be sewed back together.  The entire procedure should take less than three hours.  I will hopefully only have to spend one night in the hospital and will be home in my own bed the following night. 

Recovery:

Sine the urethra has been severed and sewn back together I will have a catheter in my penis for about two weeks to allow the urethra to heal.  I will probably not have total control of my bladder for a while and will have to wear a diaper for a while.  Hopefully this inconvenience will last for weeks and not months.  During this time you cannot tell any jokes about your father peeing in his pants.  When its time to remove the catheter I will have it done in my urologists office.

As you girls know from both your mother’s and your experiences with a C-section I will not be able to do any strenuous work for about two months but will be able to do light activities within a few days.  After two months I will hopefully be able to return to my normal physical activities, tennis, running, pickleball etc.  I will also not be able to have any sexual activity for about two months.  If things really go well, all will return to normal in about three months.  If things don’t go too will I will probably have a year or two before things get back to normal.   If things go terrible, well, I’ll be wearing a diaper the rest of my life and I can forget about sex.

The Risks:

The biggest risk is that the knife cuts into the colon or bladder and results in internal bleeding.  This would not be good and a serious infection would probably result.  If the urethra does not heal properly I will have problems peeing and likely have to wear a diaper the rest of my life.  The biggest risk is the possibility that the surgery does not remove all of the cancer and I will have to deal with it through radiation or hormone surgery.  I will have to have PSA tests done every six months for the rest of my life to make sure that the cancer was totally removed.  All of the above risks are really pretty small but they are a possibility.

What Am I Hoping For?

The prostate has two important functions: one is to help control urination and the other is to help sexual activity.

The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.

The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion, which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the mobility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.

Since I will be losing some of the muscles that help control urination I will have to go through therapy to effectively control my urine.  This therapy is called penal rehabilitation.  Think of it as a penal colony for prostate cancer survivors.  I hope to gain full control of this function within six months. 

Since I will be losing the gland that produces the fluid that helps carry the sperm through the urethra I will no longer have an ejaculation during sex.  I am told that I will have a climax but that’s it, nothing else.  I am hopeful that I will have a somewhat normal sex life (whatever that means for a 66 year old man) within six months.  There is a possibility that I will need the help of Viagra to put lead in my pencil.

Overall, the odds of things returning to normal are better than I thought.  We’ll see!

The Consultations

After our return from China I had consultations with a number of specialists with expertise in dealing with the various options I had for treating my prostate cancer.  I had meetings with the following specialists:

Doctor Eshelman – Radiologist for both seed implantation and external radiology

Doctor Russinko – Specializing in laparoscopic surgery for removal of the prostate

Doctor Oyer – Oncology and internal medicine

Doctor Sieber – urology and urological surgery, cryotherapy

Doctor Del Terzo - urology and urological surgery

Dr Eshelman advised me that I am not a good candidate for seed implantation due to the fact that my Gleason scores are 7 and due to the location of my cancer, which may make it difficult to accurately, place the seeds.  He did say that if I really wanted seed implantation he recommended a combination of both seed implantation and a shorter period of external radiation.  Five weeks instead of the normal seven week external radiation treatment.

Dr Russinko went through the laparoscopic procedure.  The advantage of the lapraroscopic surgery over the open surgery is that the recovery time is quicker, significantly less loss of blood and the robot used is extremely accurate when used in the hands of a trained expert (read this to mean someone who is really good at video games).

Dr Oyer is more of a generalists and he highly recommended that I go with the laparoscopic surgey.  He had the best bedside manners of all the specialists I talked to and we had a very open and frank discussion.

Dr Sieber did more to confuse me than any of the other specialists.  He felt that I may be a good candidate for seed implantation and he recommended that my records be sent to Johns Hopkins in Baltimore for them to review and give their recommendation.  I should have their comments by July 5.

Dr Del Terzo is my urologists and he specializes in open surgery for removal of the prostate.

After all of these consultations I have made the following decisions:

I have eliminated cyrotherapy because this is a relatively new procedure and there is not enough data available to determine long-range effects.

I have eliminated open prostate surgery.  Why go through a major operation that will leave major scars and have a longer recovery time when laparoscopic surgery will accomplish that same thing with more accuracy and less collateral damage.

I really do not want to go through the external radiation process.  The risk of collateral damage is higher and it is a seven-week agenda with treatments every weekday.

That leaves me with laparoscopic surgery and seed implantation.  I am strongly leaning towards the surgery but we will see what Johns Hopkins has to say about me.

There was one last wrinkle thrown into my alternatives.  My wife has a good friend on the west coast, Judy Copanas, who is good friends with the head urologist at the University of California Irvine and she asked me if I would like to talk to him to get his views on my options.  Of course I said yes and last week I had an excellent phone conversation with Doctor Clayman.  Dr Clayman was very straightforward.  He told me that if it were his decision he would go with the laparoscopic surgery and he recommended that I contact Doctor David Lee at the University of Pennsylvania School of Medicine in Philadelphia.  I have since contacted Dr Lee and have a meeting set up with him the first week of August.

That’s were things stand as of today.  The one thing I do know is that I want to get this cancer taken out of my body ASAP.

Can You Speed Write in Chinese?

I don’t know about you but to me Chinese appears to be a very difficult language to write.  A number of people that I have spoken to tell me that while Chinese is a difficult language to learn it is almost impossible for a westerner to learn how to write in Chinese.  The problem is that Chinese does not have an alphabet, as we know it.  Chinese characters are based on drawings of real objects.  Therefore, the Chinese word for man looks like a stick man and the Chinese word for house kind of looks like a house (but not really). 

This leads to the question, “is there a Chinese dictionary and how in the hell does it work?”  This of course leads to the next question that once you see the Chinese character for man how do you learn how to pronounce it?  This project was quickly becoming much bigger than I anticipated and I think I will but this research on my “to do” list for a later date. 

Anyway to demonstrate just how complicated the Chinese language is, consider this;  The extended Chinese character set (including ancient, seldom-used glyphs) includes upwards of 100,000 characters. A modern and well-educated Chinese person may know 20,000 characters at best, but this is still a staggering number.  To be able to read a newspaper comprehensively you need to know about 6,000 characters.  Most Chinese agree that you need to know about 3,000 characters to be considered fully literate.  This is mind blowing when you consider we only need to learn 26 letters.  I’m beginning to think that you need to have an IQ of 150 just to learn the Chinese language. 

But, back to the original question; “can you speed write in Chinese?”  In order to answer this question I devised a little test.  I wrote down the sentence. “the red rabbit jumped over the high fence” and asked our tour guide, Shanshan, to write it in Chinese.  While she was writing it I timed her.  It took her 15 seconds to write this sentence in Chinese.  I then asked her to time me as I wrote the same sentence in English. 

When I got to the word “rabbit” I internally calculated that I had already used up about 7 seconds and I started sweating bullets.  I thought’ “ can this really be, can a Chinese person write the same sentence faster than me?”  I needed to step things up.  No way was I going to come in second in this race.  I started writing faster and by the time I got to the second “the” I felt I had only used up about ten seconds.  Feeling confident I cruised through the last two words.  I felt I had crushed her when I yelled, “stop”.  I was floored to hear Shanshan yell “14 seconds” right back at me.  I only beat her by 1 second, how could this happen?

I then looked down at what I had written and it appeared to be; “the ned rabit yuped oer the nuh feces”.  I wasn’t about to tell Shanshan  that I had left out about 30% of the letters in the sentence.  For all I know, Shanshan left out 30% percent of the characters or maybe she had really written, “Gerry is an idiot” 

I feel pretty confident that I can beat any Oriental in speed-writing as long as no one checks my work!

Chop Chop

Wherever you go in China you will find merchants who are selling seals that can be crafted to your personal identity.  These seals can be made from wood, plastic, metal or even jade.  These personal seals are an important part of Chinese history and are still being used today.   Today these personalized seals are known as chops.

The emperors of China were the first to use seals to identify official documents that were issued by the ruling family.  These seals were originally known as xǐ, later renamed bǎo.  The word chop is a westernization of the Chinese word and is now in common use throughout China.  When the emperor sent out an official decree his representatives would take the document out to the provinces with the official chop on the document.  The local official would stamp the decree with his official seal to verify that he had received it.   The Emperors representative was often anxious to have the decree stamped with the chop so he could be on his way.  He would tell the local representative “chop chop” and that is where the western term “chop chop” to mean hurry up originated.

The chop is still in wide use throughout China.  Most Chinese will have a personal chop designed when they are born and this chop will be used on official documents as a form of identity.  Since the Chinese language is character based they do not have signatures, as we know them in the west.  The chop serves the same purpose as your official signature. 

Planking on the Great Wall of China

The Great Wall of China

Ginny on the Great Wall

Gerry Planking on the Great Wall

It is often cited that the Great Wall of China is the only man made object that can be seen from space.  The reality is that many man-made objects including cities and dams can be seen from low earth orbit without the aid of binoculars.  The Great Wall is barely visible from low (120 miles above sea level) earth orbit under perfect conditions.   Based on my experience in China, “perfect” conditions never exist.  In fact if the air pollution were to be just a bit worse than it was on the day I was there I would not be able to see the Great Wall if I were standing right on top of it. 

The Great Wall is indeed a massive structure and it is all the more impressive when you see the terrain it is built on.  While not as high as the Rocky Mountains the hills the wall is built on are comparable to the Great Smokey Mountains.  I can’t imagine the manpower required to carry these massive stones to the top of these mountains.  It is almost unbelievable.

When we arrived at the tourist stop that was the access point to the wall the first thing many tourists do is buy a tee shirt that says, “I climbed the Great Wall of China and Survived”.  Since I’m not into buying touristy kind of stuff (see my blog “hey mister can I shine your tennis shoes”) I decided it would be sufficient to climb the wall and have my picture taken on it.

While climbing the wall is not like climbing Half Dome in Yosemite it can be challenging for people who are not in the best shape.  Most people climb a few hundred yards up the wall and call it quits.  The top of the wall is pretty smooth and there are parts where the incline is very steep and other parts where there are steep steps.  I climbed about 1.5 miles up the wall and felt that I had a pretty good work out.  I reached a section where workers were tuck-pointing the wall and they had barricades up blocking any further advancement.  Even at this remote location there were merchants selling tee shirts that said, “I climbed the Great Wall of China and Survived”.  Again I didn’t buy one.

A couple from Australia and another couple from Las Vegas were some of the few people that made it this far up the wall.  The Aussies decided that we should do something to commemorate this accomplishment and they came up with the idea of planking on the wall.  I was a bit leery about extending my body vertically over the wall when the ground was over 50 feet below us.  In fact none of us were anxious to trust the others to hold our legs while we extended our upper bodies over the wall. 

We decided that lying on our backs atop the parapet would qualify as planking the Great Wall of China.  So that’s what we did as the picture below shows.  I know some purists who read this would say, “what a wimp”.  Well, it’s the best we could do under the circumstances.  I must say that I did feel a bit queasy lying there and it is about as much planking as I ever want to do.

Are There Any Orientals Left in China?

A few weeks before we were scheduled to leave for our China trip my wife was talking to our 30-year-old daughter about the trip and during the conversation my wife used the term “Oriental” when referring to the Chinese. Our daughter was quick to chastise my wife for using such a derogatory term when referring to people from China.  My wife was taken aback by our daughters comment and said she had no idea that the word “Orientals” was so offensive.

Later that day my wife asked me if I realized the word “Orientals” was considered an ethnic slur.  My response was; “you’ve got to be kidding me, I had no idea”.   After due consideration I thought, wait a minute have I been living in a different universe?  When did I miss the decree that the word “Oriental” can no longer be used?  What else have I missed?  Have I been offending people when I call the English Brits, Canadians Canucks and Australians Aussies? 

I mean I know I shouldn’t use the term Krauts when referring to Germans, or Frogs for the French and Polack when referring to the Polish but where did the ban on calling Chinese Orientals come from?  Could I really be an old fogie who has become a bigot in my old age?  Wait a minute; did I just use a senior ethnic slur against myself?   This is becoming way too complicated.   I can assure you the last thing I want to do is offend any ethnic group but this seems to me to be political correctness run a muck!

Once we arrived in China I decided to do a little investigating on this thorny issue.  I donned my Inspector Closeau disguise and began my investigation.  My first “suspect” was an Oriental Asian woman on our tour who was born in Hong Kong and now lived in Canada.  I asked Ava if she would be offended if I called her an Oriental.  She looked at me rather dumbfounded and said; “what are you smoking?  Of course I don’t take offense with that term.  Orient means the east, China is in the east, I am from China, and therefore I am oriental”.

I thanked her for her directness and as I was leaving she said; “by the way Gerry take off that Inspector Closeau disguise.  You look stupid, everyone knows its really you and it makes you look uncomfortable”.  I again thanked her for her honesty but as I was leaving I had a feeling that since she really was now a Canadian maybe she really didn’t know the proper answer to my question.  I continued to pursue my investigation sans the Inspector Closeau disguise. 

At dinner over the next several nights I asked a number of people from our tour group, none of them were Oriental Asian, if they thought the term “Oriental” was derogatory.  Every person said “of course not”.   A few people did say it may be a dated term but there is certainly no malicious intent associated with the use of the word.  I was starting to feel pretty good that my wife and I are correct to use the word “Oriental” but my investigation was not yet complete.

As a final test to determine the appropriateness of the term “Oriental” I interviewed a number of the guides for our tour.  All of our tour guides were born and raised in China; all that I talked to have visited America and they all speak English as well as I do.  When I asked them if it was OK to refer to them as Orientals to a person they all said “yes”.  I finally felt vindicated that I can still call people from the far east Orientals but if a person does take offense I will offer my apology and refer to them as Asians in the future.

So, the answer to my initial question is; “yes, China is loaded with Orientals”.

As a final bit of investigative work I did google the phrase; “use of the word Oriental” and found the results to be a muddled mess.  I did find one article of interest which I include as part of my report.

Why is the word "Oriental" considered derogatory?

My father does a lot of business in a place that I call "Asia", but which he refers to as "The Orient". And he's friends and colleagues with many people that I call "Asians" but he sometimes calls "Orientals".

A lot of people consider the word "Oriental"---which simply means "Eastern"---to be out-dated and/or derogatory. But is it? And if so, why? I found an interesting answer on Wikipedia, a website which never contains inaccuracies:

"Some people think the term 'Oriental' is derogatory, largely because of its connection to imperial 19th century Europeans and Americans who are thought to have held a patronising attitude towards the region. ... Major objections to the use of 'Oriental' are chiefly limited to North America. Its use is much less controversial in Europe and Hawaii, as well as in Asia where, especially in Southeast Asian countries, the word is in comparatively widespread usage. In Europe the term is used to describe such things as the East's cuisine and goods, ancient culture, and religions, at times to denote an exotic quality with upmarket or mildly positive connotations."

So, North Americans are still upset because of attitudes that prevailed in the 19th century. Huh?

My dad is either very worldly, or just far and above philistine American backwardness and isolation. And damn, he's so down with his brothas and sistas from China, Thailand, Korea and Indonesia, that he's even allowed to call them 'Orientals'. My dad is The Shit, people.

Or maybe it's because in the 60s he occasionally played bass for Katherine & the Firebyrds 

If it’s 10:00 AM in Shanghai, what time is it in Xian?

China is a vast country with an area almost the same size as the USA (3.8 million square miles) and a population of almost 1.4 billion people.  In theory China spans 5 time zones.  The most eastern part of China is in Manchuria and the most western part is Xinjiang province, which is almost as far west as Kabul Afghanistan.  Therefore, if it is 10:00 AM in Manchuria it should be 5:00 AM in Xinjiang province.  But alas, as you will quickly learn once you visit China, nothing is what it should be.

Before 1949 there were 5 times zones in China but Chairman Mao in his infinite wisdom decided that it would be best if all of China had only one time zone.  So, on September 27 1949 all of China went on Beijing time, which is 8 hours ahead of Greenwich Mean Time.  Well that’s not quite true.  Xinjiang province decided that there was too big of a difference between Beijing time and what the sun was telling them for their province so they created Urmuqi time, which is 6 hours ahead of Greenwich Mean Time.  The only problem is that the Central Government does not recognize Urmuqi.  So the locals in Xinjiang use one time and the central government uses another time.  Who’s on first?  I don’t know!

Daylight Savings Time was observed in China from 1986 until 1991.  Daylight Savings time is no longer observed in China.

The answer to the original question; “if it’s 10:00 AM in Shanghai, what time is it in Xian?”   10:00 AM even though it is in a different time zone according to international standards!

P.S. please don’t ask me what time it is in Hong Kong and Macao.

Hey Mister Can I Shine Your Tennis Shoes?

One of the challenges one faces when touring China is “running the gauntlet”.  This refers to the horde of merchants who are always hanging around when a tour bus or cruise ship arrives at a tourist destination with a load of westerners.  These merchants are some of the most aggressive sales people you will ever encounter.  They are hawking all kind of merchandise.  You can buy a genuine imitation Rolex watch for as little as $5.00 any kind of tee shirt for $5.00 or almost any kind of trinket or book imaginable of one of China’s tourist attractions. 

They also offer all kinds of services ranging from “freshly” prepared fruits to offers to carry your bags.  One of the most innovative merchants I encountered on our trip to China was the shoeshine lady.  I first met her as we were debarking from our river cruise ship in Chongqing.  She offered to shine my shoes but since I was wearing tennis shoes I didn’t see the point.  She followed me for about a quarter mile and I thought I had finally lost her when I reached the promenade above the river.  

There was a very nice view of the opposite side of the river and I stopped to take a few pictures.  While I was taking a picture I felt something brushing against my shoes and when I looked down, there was the shoeshine lady “cleaning” my tennis shoes.  I started hopping around as if someone had given me a hotfoot and began yelling; “what in the hell are you doing?”   The more I hopped, the more she tried to “clean” my tennis shoes. 

Fortunately I was only about 50 feet away from our tour bus and I made a mad dash for the door.   I managed to reach the safety of the tour bus and when I got in, everyone was having a good laugh at my expense.  A few people in our group said that my encounter with the shoeshine lady was one of the more entertaining events of the entire tour. 

When I looked outside the bus I saw the shoeshine lady with a big smile waving at me.  I decided that she earned a nice little tip for bringing some grins to our tour.  I made a mad dash out of the bus and threw $2.00 to her and retreated back into the bus before she had a chance to “clean” my tennis shoes.

GERRY CLAES’ TIPS FOR RUNNING THE GAUNTLET IN CHINA

1. Never look a merchant directly in the eye.
2. Keep moving; once you stop they will be all over you like flies on cow manure.
3. If you express any interest in their wares you will have a tar baby stuck to you for the duration.
4. If you are really interested in an item ask the price and then offer 25% of the asking price.  After that the best negotiator wins. 
5. You are not buying quality.   
6. The merchants do not have a return policy.   
7. If your watch works for more than 2 months you got a “good” deal.

Joe Torre on Prostate Cancer

On Baseball

Torre’s Gift to All Fathers: Frank Talk About Prostate Cancer

By GEORGE VECSEY

Published: May 28, 2011

When Joe Torre was managing, he used to receive suggestions from fans about lineups and rotations and, most helpful of all, how to handle the Boss. As if.

Enlarge This Image

Elise Amendola/ Associated Press

Joe Torre learned he had prostate cancer in 1999, one year after leading the Yankees to a total of 125 victories.

Now that he is working for Major League Baseball, Torre occasionally receives news from strangers that they have something in common: they have survived prostate cancer.
“All of a sudden, we’re in the same club,” he said.
Torre has been out front in fighting this surreptitious disease since his bout with it early in 1999. One hundred twenty-five victories the year before meant nothing at that moment. The only number that counted was that his P.S.A., the marker for cancer, had nearly doubled in one year.
Instead of choosing between the lefty and the righty in the bullpen, Torre had to choose between conservative and aggressive treatment. He opted for surgery. Now he is 70 years old and working in the commissioner’s office and enjoying his family, and spreading the news about prostate cancer, which strikes one in six men, in the gland between the bladder and the rectum.
Torre is putting himself in public, serving as a judge in a Father’s Day contest, MVP Dad, held by Major League Baseball. Through Wednesday, fans may nominate their fathers on a Web site, MLB.com/mvpdad. Thirty fathers, one per franchise, will be honored around June 19; Torre will visit four ballparks in the preceding days — Coors Field, Yankee Stadium, Nationals Park and Wrigley Field. Current stars will also publicize the cause, and a charity home run challenge will be held in June.
“My father wasn’t the best role model to me,” Torre said, alluding to the abuse his father directed at his family, the motivation for the Safe at Home Foundation, which combats domestic violence.
Father’s Day is the perfect time to remember the love and guidance fathers can give — but it works both ways. Children can also urge their fathers to seek annual checkups for prostate cancer, the way many of them lecture their parents about smoking or bad diets.
“Kids are much more intuitive these days,” Torre said in a telephone interview. “Not that I’m crazy about what’s on TV, but they know so much these days.”
Torre was 58 when a routine checkup revealed he had prostate cancer. His daughter, Andrea Rae, was 3. “I wanted to be around for her,” he said.
His wife, Ali, was part of the process, which Torre says is vital, to have somebody close sharing the details and the fears. He often refers to his wife in conversation, as if her counsel was helping him hold a news conference, say the right thing, and maybe it is.
Then there is the army out there, the men who have faced the chilling diagnosis, the options for treatment. Some men cannot talk about it; others share their experience.
Just like checking the batteries on a smoke detector when moving the clocks two times a year, Father’s Day is a good time to remind men of a certain age. Torre praises Michael Milken, the founder of the Prostate Cancer Foundation, for taking some of the mystery from this common disease.
After a few months off for surgery in 1999, Torre helped the Yankees win two more World Series, then moved to Los Angeles after 2007, when the Yankees let him know it was time. Last September, he turned the job over to Don Mattingly.
“The price for losing wasn’t worth it,” Torre said. He recalled going to spring training this year and saying to Mattingly, “How do you feel about this managing stuff now?” Mattingly, still on the learning curve, is engrossed. Torre said he was sad to watch M.L.B. take over the strapped team.
“It’s a shame,” Torre said. “I go back with that club to growing up in Brooklyn.”
He was a Giants fan, but he understands the history. He also watches his previous club, the Yankees, in their first full season since the death of George Steinbrenner last July.
“Let’s admit it, George cast a very large shadow,” Torre said. He gets a kick when fans say this event or that event would not have happened if the Boss had been running the club, as if things always ran smoothly back in George’s day.
Torre’s main responsibility is overseeing the umpires. He says he feels for them, when modern technology suggests they have made a mistake. He says he can see technology deciding fair from foul one of these seasons, adding to the current use of cameras to determine whether a ball went over a home run line. But he does not see the day when technology decides balls and strikes, or plays at the bases.
“It’s an imperfect sport,” he said, adding quickly that umpires were very, very good.
Ultimately, it is a sport, however combative and expensive — not to be confused with real life, which is children urging their fathers to get a checkup.

Prostate Treatment Matrix

It has become abundantly clear to me that there is no "one size fits all" when it comes to deciding the best procedure for treating prostate cancer.  There are too many variables and too many ifs, ands and buts.  I found that I always placed the procedure that I read about last on the bottom of my preferred list because of all the disadvantages.  In order to place some logic in choosing the right procedure for me I decided to create a matrix.

The first thing I had to do was create a list of all the reasonable options I have available.  I am sure I could come up with a list of about twenty options because of all the choices I have within a specific procedure and even the possibility of combining different procedures.  I ended up listing six procedures.   The next thing I did was create a list of  concerns with each procedure and assign a weight for each of these concerns.  For me the most important concern was "what are the chances that this will eliminate all of the cancer cells".  Because this was the most important factor I assigned this a weight of 10.  At the other end I listed external scars as a concern.  Because this is not that important to me I assigned this a weight of 2.

The last thing I did was to rate each of the concerns against all of the options with an input number.  For instance, since a radical prostatatectomy will leave a fairly significant scar around my midsection I gave it an input number of 2.  Robotic surgery will leave small incisions around my midsection I gave it an input number of 6.  This is the most subjective part of this exercise.  I think ranking the concern for each procedure is pretty straightforward but whether an input number should be a 5 or a 6 can always be debated.

				Input
Weight	Concern
		A	B	C	D	E	F
10	Odds of 100% Cancer Removal	8	8	7	7	7	0
8	Minimum Collateral Damage	7	6	4	5	5	10
2	External Scars	6	2	8	8	10	10
7	Leaves other options open	7	7	3	4	7	10

Procedures

A	Robotic Surgery
B	Radical Prostatectomy
C	External Beam Radiation
D	Seed Implantation
E	Cryotherapy
F	Watchful Waiting

Once all of the input data has been entered I simply multiplied the input data by the weight to calculate a number for each concern for each procedure.  I then simply added these numbers together to arrive at a total score for each procedure.

As you can see from the table below the robotic surgery came out with the highest number which means it appears to be the best option for me.  I am sure that some of my input numbers will change as I learn more about each procedure.  I also suspect that I will add one or two concerns over time but I think this is a good starting point.  My sessions with the specialists in each of the procedures will certainly help me refine my matrix.  I am scheduled to have all of these consultations complete by the first week of July.  After that date the ball will be firmly in my court and I will have a big decision to make.

If anyone has any ideas on how to improve my analysis I would love to hear from you!

				Score
Weight	Concern	A	B	C	D	E	F
10	Odds of 100% Cancer Removal	80	80	70	70	70	0
8	Minimum Collateral Damage	56	48	32	40	40	80
2	External Scars	12	4	16	16	20	20
7	Leaves other options open	49	49	21	28	49	70
	Total	197	181	139	154	179	170

The Test Results

May 25, 2011


Today (5/24/2011) I had the results of all of my screening tests reviewed and to quote Ginny; "we couldn't have asked for better results.  All of the test results indicate that my prostate cancer has not spread to other parts of my body.  This means that my cancer can be treated by focusing only on the prostate.  I should point out as I have painfully learned that there are no "guarantees" in this business of dealing with cancer.  It is possible that some renegade cells are hiding inside of my body and only waiting for the opportunity to wreck havoc at some future date. 

Given these results the task now is to decide on the best option to fight the cancer.  My options are as follows:

1. Radical Prostatectomy:  This is an operation that essentially removes the entire prostate gland, both seminal vesticles (small glands behind the bladder that produce most of the semen) and a portion of both vas deferens (tubes that transport the sperm from the testicles to the urethra).  This is a major surgery and will require 2 to 3 nights in the hospital and full recovery will take anywhere from 4 to 8 weeks.

2. Radiation Therapy:  There are essentially two types of radiation treatment.  The first is external beam radiation where a machine delivers radiation in brief sessions to the cancer cells.  The treatment usually takes 40 sessions.  This means that you have to make a trip to the hospital for 5 days a week for about 8 weeks.  The second type is radioactive seed therapy.  With this procedure radioactive seeds are inserted into the cancerous area of the prostate and over a period of days or weeks the radiation is emitted from the seeds and attacks the cancer cells.

3.  Cryotherapy:  With this procedure a probe is inserted into the prostate and something like liquid nitrogen is used to freeze, thaw, refreeze and thaw the cancerous cells to kill them. This is one of the newer treatments for prostate cancer and the results have been promising with some patients but the long term effects of this procedure are still being developed.

4. Watchful Waiting:  This is exactly what the name implies.  I would essentially do nothing but watch my PSA scores and have periodic biopsies taken of the prostate to see if anything changes.   This may be an option if  I were 80 years old but at 65 it isn't an option that I am considering.

5. There are other options such as hormonal therapy, chemotherapy and investigational therapy (clinical trials)  that probably are not appropriate for me.

During the month of June I will have consultations with doctors who are experts in the first three options.  My intent at this time is to make a decision either in late June or early July and have the procedure as soon as possible after I have made my decision.

I should point out that none of these options are to be taken lightly.  They all have potentially serious side effects and as I stated earlier there are no guarantees that any of the procedures will kill all of the cancer cells.  Also, some of the options preclude the use of other options should the cancer flare up again.  For instance if I elect external beam radiation I probably will not be able to have surgery to remove my prostate at some future date.  No simple solutions and no guarantees.  This is serious business.

At this point I feel it is appropriate to mention a few people who have been very important in helping me deal with my prostate cancer and  giving me guidance and comfort through this challenging journey.  The first is my urologist Dr Michael Del Terzo.  He has been very open, informative and supportive since the beginning.  I couldn't have asked for more.  I am very lucky to have him on my team.
 
Second is our neighbor and good friend Liz (Korman) Bond.  Liz is a dietitian with Lancaster General Hospital who works with cancer patients.  Liz knows a lot about my cancer and she is well connected with the key specialists who work with prostate cancer.  Liz was able to get me signed up with a couple of doctors who are among the best in treating prostate cancer in their specialities.

Finally of course there is my wife Ginny.  Always by my side and always looking out for my best interests.  Sometimes I ask myself; "how was I so lucky to find a mate like this?"  As you can imagine, I am not always the best of patients but Ginny is always there.  I hope I can give her the same kind of care should she ever need me.

Now its off to China and a wonderful trip with my wife!

China Trip

We leave on May 31, 2011

Currently it is 7:50 AM in Lancaster PA and the current time in Shanghai is 7:50 PM.  That means in order to determine the current time in Shanghai, add 12 hours to east coast time.  Or conversely if  we are giving the time in Shanghai, deduct 12 hours to determine the time on the east coast.

May 31, 2011   Depart Baltimore to Toronto, Toronto non Stop to Shanghai.
June 1 - Shanghai
June 2 - Shanghai
June 3 - Fly from Shanghai to Wuhan, board ship for river cruise
June 4 - Yangtze River
June 5 - Yangtze River
June 6 - Yangtze River
June 7 - Yangtze River
June 8 - Disembark ship in Chongqing fly to Xian
June 9 - Spend day in Xian and fly to Beijing
June 10 - Beijing
June 11 - Beijing
June 12 - Beijing and fly to Toronto and then to Baltimore
June 13 - arrive home

Gerry's Prostate Cancer Journey

I guess I always knew there was a high probability that some day I would hear the dreaded words; "you have prostate cancer".  After all my father had prostate cancer and there was a history of prostate cancer on my mothers side as well.  I do try to eat reasonably healthy foods, I have stayed physically fit and I thought maybe I could beat the odds.  But no such luck.  This week I received the results of the prostate biopsy I had last week and there it was:  "Cancer"!!

It wasn't as bad as it could have been, the cancer only showed up on two the the twelve samples taken from my prostate and based on the  Gleason Grading System ( see below) of measuring the cancer I had a score of 7 which placed me in the middle in terms of aggressiveness.  My scores were 4 - 3 from one sample and 3 - 4 from the other sample.

Gleason Grading System

Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular architecture as grade increases. Gleason score is calculated from grade as described in the text.

The Gleason Grading system is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, it is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy. A Gleason score is given to prostate cancer based upon its microscopic appearance.^[1] Cancers with a higher Gleason score are more aggressive and have a worse prognosis.

The pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason Score. For example, if the most common tumor pattern was grade 3, and the next most common tumor pattern was grade 4, the Gleason Score would be 3+4 = 7. The Gleason Grade is also known as the Gleason Pattern, and the Gleason Score is also known as the Gleason Sum. The Gleason Grade or Gleason Pattern ranges from 1 to 5, with 5 having the worst prognosis. The Gleason Score ranges from 2 to 10, with 10 having the worst prognosis. For Gleason Score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4. Also, there is not really any difference between the aggressiveness of a Gleason Score 9 or 10 tumor.

How do you know that you may have prostate cancer?

The realty is that if you are a man and you still have your prostate the odds are pretty high that if you live long enough you will get prostate cancer.   For most men the likely-hood of having prostate cancer before you are 40 is pretty low.  After you reach the age of 40 the odds of having prostate cancer increase with each passing year.  As for myself, I never had any problems with my prostate.  My MOJO is still working pretty well.  While I wouldn't rate myself as a Don Juan, I haven't had any complaints from my wife.  Like most men, for the past 5 to 10 years I do tend to get up once or twice during the night to urinate.  I think trying to find a 65 year old man who doesn't get up at least once during the night is like looking for the proverbial needle in a haystack.  My doctor would also perform a digital examination of my prostate (that's where the doctor sticks his finger up your ass and feels for an enlarged prostate or lumps).  Theses examinations have always been very good.  The bottom line is that I didn't have any physical issues that would cause me to believe that I may have prostate cancer.

About 15 years ago I began having blood tests done that would check my cholesterol, as well a a number of other factors.  One of the tests done was the PSA.  A PSA number between 1 and 4 is considered good and there is no need for concern.  My original PSA scores were between 1 and 2 so there was never any indication that I had a problem with my prostate.  In 2007 my PSA started to climb and by 2009 it was at 3.8.  In December of 2010 my PSA was at 7.0 and my doctor decided it was time to "take a closer look at the prostate".

  Ginny and I were spending February and March in Florida so there wasn't much that we were going to get accomplished before we got back.  I did have a meeting with a urologist in Lancaster in January and he suggested that I schedule another blood test when we returned from Florida to check the PSA.  On April 5, 2011 I had a blood test and the PSA number was 6.8.  My urologist determined that there was enough concern on his part that it was time to do a biopsy on the prostate .  So we scheduled to have the biopsy done on May 3.

My word of recommendation is that if you are a male over 40 years of age have your PSA checked at least once a year.  Many times the PSA will give a false positive but at the present time there really isn't a better test to monitor the health of the prostate.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and in other prostate disorders. A blood test to measure PSApositive predictive value of only about 35%.^[1][2][3]

Rising levels of PSA over time are associated with both localized and metastatic prostate cancer (CaP).

The Prostate Biopsy

The procedure for taking a prostate biopsy is very similar to a colonoscopy.  You can't eat after midnight the day before the procedure and you can't take any blood thinners or similar medication one week before the procedure.  You are also required to begin taking antibiotics the day before the procedure to fight any infection.  The procedure itself is pretty uneventful and only takes about 15 minutes.  I elected to be totally out during the actual procedure.  I did this for a number of reasons.  The obvious reason is that you don't feel any pain.  I also felt that if I were awake I may make some sudden movement which could cause some problems.  Lastly I didn't want to distract the surgeon by asking a lot of annoying questions.  The reality is that there wasn't much I could contribute to the whole thing so why not take a nice nap?  If you insist, you can be awake during the biopsy and I understand that there are some people that elect this option.

I must have been out for about a half hour and when I awoke in the recovery room I felt a little groggy at first but quickly recovered.  I felt no pain at all and was up and walking within 15 minutes.  I did feel a little discomfort the afternoon of the biopsy but never experienced any real pain.  My urine was a bit darker for about a week after the procedure and I assumed that it was from blood.  The only other side effect I had was some discomfort around my anus.  If the doctors intent was to give me a good case of  hemorrhoids he didn't succeed but he came awfully close.  Within two weeks everything was pretty much back to normal.

Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA blood test rise to a level that is associated with the possible presence of prostate cancer.

The procedure, usually an outpatient procedure, requires a local anesthetic, with fifty-five percent of men reporting discomfort during the biopsy.^[1] The most frequent complication of the procedure is bleeding in the urine for several days, some bleeding in the stool for several days, and blood in the ejaculate for several weeks afterwards.

The procedure may be performed transrectally, through the urethra or through the perineum. The most common procedure is transrectal, and may be done with tactile finger guidance,^[2] or, more commonly and precisely, with ultrasound guidance.^[3]

About a dozen samples are taken from the prostate gland through a thin needle - about six from each side. If the procedure is performed transrectally, antibiotics are prescribed to prevent infection. An enema may also be prescribed for the morning of the procedure. In both the transrectal and the transperineal procedure, the doctor inserts an ultrasound probe into the rectum to help guide the biopsy needles. A local anesthetic is then administered into the tissue around the prostate, similar to the local anesthetic administered for a dental procedure. A spring-loaded prostate tissue collection needle is then inserted into the prostate, through the rectum (or more rarely through the perineum), about a dozen times. It makes a clicking sound, and there may be considerable discomfort.^[3]

Okay, you have prostrate cancer now what?

Well, the first thing that needs to be determined is; "has the cancer spread to other parts of the body?"  In order to determine this I have been scheduled to undergo the following procedures:

Ultra sound of the kidneys and bladder
Additional blood work
Chest  x-ray
bone scan

I had the ultra sound on the kidneys and bladder yesterday (5/17/2011) and "no irregularities were observed".  I also had a blood sample taken yesterday and they will be looking for cancer markers.  I will have the results next week.  Both of these procedures were very easy and uneventful except for a little incident during the drawing of my blood.  I went to a blood clinic at the health center on Harrisburg Pike and it is a real blood sucking factory.  There must have been at least 20 people in chairs having their blood samples taken.  My phlebotomist whose name was Grey was getting ready to take my blood when I heard an announcement; "Grey we have an emergency at station 6".  With that Grey took off to station 6 leaving me in the lurch.  I happened to have a clear view of station 6 and I observed a teenage girl who was having her blood taken and she threw up all over the station.  They had a real mess to clean up. About 10 minutes later Grey came back to my station and I asked her; "did you wash your hands?"  She assured me that she had and she asked me if I was a puker.  I told her that depended totally on how well she did her job.  Fortunately Grey is a very proficient phlebotomist and the blood sucking proceeded without further incident.

Today, 5/18/2011, I am scheduled for a chest x-ray and bone scan.  The chest x-ray was pretty straight forward, one from the front and one from the side.  The bone scan is a bit more extensive.  The first thing they do is inject a very small amount of radioactive tracer into my blood stream.  This tracer has to circulate completely throughout my blood stream which takes about three hours.

I just got back from the bone scan.  Pretty uneventful.  I had to lay on a bed that went back and forth underneath a camera that  scans my entire body.  The entire procedure lasted about 30 minutes.  Some people say that they find it uncomfortable laying completely still for 30 minutes under this large camera but it did not bother me at all.  I just closed my eyes and took a short nap.  After I was done the technician told me to wait in the lounge while they reviewed my pictures to determine if more were needed.  After waiting for about 15 minutes he came out and told us that we were done and no more pictures were needed.  I asked him if anything showed up on the pictures.  He told me that he was not qualified to review the results with me but then he said with a wink in his eye; "when they don't ask for more pictures that is a good sign".  Now the wait begins until next Tuesday when we review the results with the experts and consider our options.