Prostate Diary: The Docs Weigh In

One of out every seven men will get prostate cancer, and it's thought that all of us would if we didn't die of something else first. Prostate cancer kills about 25-30,000 men every year -- the most cancer deaths among men who don't smoke. For whatever reason, is a scourge among African-American men.

For what it's worth, I was not at risk: No family history of the disease, I'm in good physical condition, and I eat and drink in moderation. Sometimes, you just get it.

The diagnosing urologist presented me with two treatment options -- surgery and radiation -- and recommended that I read up on the subject and consult a radiation oncologist before deciding on treatment. He thought that at my relatively young age I would want surgery, and then added "but then I'm a surgeon." He recommended two books in particular, both of which proved problematic.

In the event, I read from the books, talked with survivors, and consulted with three urologists, a radiation oncologist, and a medical oncologist. The urologists included a robotics surgeon, a standard cut surgeon, and a brachytherapy (seed implants) surgeon. The collective advice was emblematic of the frustration and difficulty of dealing with this disease:

Urologist #1: Don't do radiation. Get it out and get on with your life. (The problem is that this is easier said than done.)

Urologist #2: You should probably get surgery, but radiation is a defensible option.

Urologist #3: You can do whatever you want. You're going to do well no matter what.

Oncologist #1: Your chances of a cure are the same (roughly 75% for localized Gleason 7 prostate cancer), so it comes down to a choice of side effects. But you have to do something.

Oncologist #2: Don't get surgery: You'll regret it. The outcomes are the same, so why court impotence and incontinence?

I wound up believing that there are good reasons to go either route, depending on who you are. I chose external beam radiation -- I'll get into why -- but I wouldn't presume to tell any man that that's what he should do. This time, it really is all about you.

Prostate Diary: Finding Out

Last May, while walking across the corporate campus where I work, the physician's assistant at my doctor's office called to tell me that I had an elevated PSA count of 6.7. The prostate-specific antigen is a protein produced by both normal and malignant prostate cells. Roughly speaking, as long the PSA count remains below 4.0 (and there's nothing palpable), men can assume that the antigen is being produced by normal cells. When the count goes above 4.0, a physician will usually recommend a consultation with a urologist. In my case, the PA had already scheduled an appointment. She said that the urologist would likely want to perform a biopsy.

My appointment was in two weeks. Honestly, I didn't think much about it. I knew that PSA readings were often false and that there were reasons other than prostate cancer for an elevated count. The urologist said as much -- he didn't want to recommend a biopsy on the basis of a single reading, and confirmed that there was no palpable evidence of a tumor. Moreover, none of the symptoms of prostate cancer were present. He recommended a second PSA test and -- in the event -- performed a third.

The results were not encouraging: The count for the second test was 7.1, and dropped slightly to 6.9 for the third check. The urologist recommended a biopsy and told me that there was a 50-50 chance that I had prostate cancer.

Two weeks later, I underwent a prostate biopsy, an invasive, depressing procedure that left me shaken. Three weeks after that, the urologist informed me that I had prostate cancer. The tumor, he explained, looked to be localized, which was to the good: This meant that the goal of treatment was a cure.

A biopsy on a normal-sized prostate involves taking six samples from the left and right sides of the prostate. A pathologist reads the samples and -- after the findings are confirmed by a second pathologist -- issues a report. My report showed that three of the samples from one side of my prostate tested positive for cancer -- two of them were classified as <50% cancerous and one as <30% cancerous. The other side was cancer free.

The pathologist also issued a finding on the aggressiveness of the cancer -- its Gleason score. The higher the Gleason score, the more likely the cancer is to spread. The average Gleason score for a man diagnosed with prostate cancer is 6; mine is 7. A Gleason of 7 is significant because it eliminates the option of active surveillance, in which the cancer is monitored but not treated.

The urologist advised me to have a CT scan, which he thought would confirm that the tumor had not spread beyond the prostate. He seemed confident that it had not, which the CT in fact confirmed. He did not think that an MRI was necessary, a conclusion that I later came to question.

So, I had been staged. My prostate cancer identity was and is: T2aN0M0, Gleason 7 (<50% 3+4, <50% 3+4, <30% 4+3). T2a signifies an early stage tumor; N0M0 indicates that the tumor has not metastasized into pelvic lymph nodes (N0) or beyond (M0).

Ida

Ida (2013) D: Pawel Pawlikowski. Agata Kulesza, Agata Trzebuchowska, Dawid Ogrodnik. A noviate (Trzebuchowska) comes to grips with her Jewish past and Catholic future in post-War Poland with the help of a disillusioned aunt (Kulesza) and a Coltrane-loving musician (Ogrodnik). The subtext of this somber but inescapably compelling movie is about the immense capacity of moviemaking to convey truths in a highly personal manner. Many of the square-framed shots begin as still photographs that stir to life with almost imperceptible movements. This one will stay with you.

Trailer here.

Chris Smither

Chris Smither at Ashland Coffee & Tea, 6/26/14:

The Republican War on Everyone Else

The following comment appeared in the New York Times in response to a Paul Krugman column criticizing Republican Rep. Paul Ryan's budget proposal:

Congressman Ryan is from one of the wealthiest Wisconsin districts, just across border from Illinois and a favored bedroom area for wealthy commuters from Chicago. He's representing the wealthy voters to whom everyone not one of them is invisible. 

Congressman Ryan proposed earlier budgets in which he would have eliminated the health care for children (CHIPS.) His constituents didn't protest. As far as they're concerned, Americans working for a living are lucky to be employed and should have worked harder and studied harder. 

His constituents pay to keep him in office because he'll carry their water: make it possible for the strong to prey on those who lack their wealth and connections. It's something the working people in this nation fiercely fought to overcome in the 1930s, 1940s, and even into the 1950s. 

I still recall when my father was a petroleum company executive during a refinery strike during my younger years and him telling how he had to low-crawl to his car after his month of working to keep the refinery operating. I remember the wives of the workers in that strike coming to our rural home with their children, and asking for food and toilet paper. I recall my mother answering the door with a revolver in one hand hidden behind her back. I recall us setting up a a pantry in the garage and my mother telling them she couldn't feed them all but would help in emergencies. I recall my father expressing amazement that after low-crawling to the car, the union workers opened the gate and waved him out. I remember his consternation when my mother showed him the garage pantry and explained why they'd waved him out. She said the strike was between the men, and union or not, she'd always share her food with mothers and children. I remember our house being shot at and seeing the bullet holes in the living room window. 

I recall one of my father's friends over one evening talking to him about a railroad strike. He told of how union workers had been found along the rail bed beaten black and blue. About that moment he looked up and remarked to my father that "little ears were nearby" and he'd better stop or there'd be nightmares. I was sent to bed. 

I recall the news stories on WGN radio about acid being thrown into truckers' faces during trucking strikes. 

I recall the death threats sent to my parents about kidnapping and killing me. I recall at age 7 people in Halloween masks attacking the windows on my bedroom and I then recall being taken to St. Louis where a large black German Shepherd named Windy and I were trained together for my protection. I recall the annual re-training through my eleventh year. That probably had a lot to do with my father regularly took me overseas with him. 

That is the era back to which Congressman Ryan and his bought, phony, grass-root supporters want to take us: the era of real class warfare. It's sick. They're morally corrupt. 

From President Truman forward, every Democratic President has reduced the national debt as a percentage of the nation's GDP. Since Truman forward, ONLY TWO Republican Presidents have reduced the nation's debt as a percentage of GDP: President Eisenhower in both terms and President Nixon in his first term. That's it. Since then, Republican Presidents have always increased the national debt as a percentage of GDP. 

Congressman Ryan's budget isn't the least bit serious. It's not a budget to build a great nation. It's a delusion concocted by his vanity egged on by the thought of accolades and personal riches from this nation's wealthiest. Congressman Ryan's budget has all the scope, insight, and foresight one might find in the Christmas wish list of a sheltered, spoiled child.

Exile

night
after night

I walk

the smouldering
dark streets

Sevastapol
Crimea

Inkerman
Odessa

Balkan
Lucknow

Belfast
is many

places then
as now

all lie
in ruins

and
it is

as much
as I can do

to save
even one

from oblivion

-Ciaran Carson, 2003

Juan Cole's Open Letter to the Left on Libya

Juan Cole was an early, articulate, and prescient opponent of the Iraq War. His blog, Informed Comment, became the go-to place for those of us seeking to construct a knowledgeable case against the war. Professor Cole supports the intervention in Libya, and explains why here.

Cole analyzes differences in the left over the intervention as a matter of cognitive dissonance: On the one, the left supports the efforts of ordinary people to free themselves from tyranny; on the other, it opposes as imperialism military intervention in their lives. In the case of Libya, Cole believes that the opportunity to rid the Libyan people (and the world, for that matter) of the sociopathic predations of Muammar Qaddafi is paramount and must be exploited.

The responses opposing Cole's position are depressingly predictable, illustrating a doctrinaire intellectual vacuity that substitutes sloganeering for critical thinking. To be fair, the left is hardly alone on that score...

In Defense of Dithering

Where Citizen K. rants, the New York Times' Timothy Egan -- who lives here in Seattle's Seward Park neighborhood -- offers a cool defense of President Obama's style. I have wondered that the same "progressives" who rightly despised President Bush's strutting and preening continuously gripe that Obama doesn't act in the same way. (The Nation doesn't publish an issue without someone blasting the president for not rearing up on his hind legs and blaring like a rogue elephant.) Apparently, bluster and certitude are just fine so long as it is the bluster and certitude of the left.

R.I.P., Elizabeth Taylor

The New York Times calls her "the last movie star," and they're probably right. Born in 1932 in London to American parents, Elizabeth Taylor became an international star at age 12 with her winning turn in 1944's, National Velvet. As seemed to happen often, Taylor's presence inspired her leading man -- in this case, Mickey Rooney -- to do some of his best work. Rock Hudson was never better than as Bick Benedict in Giant, and Montgomery Clift was at his considerable best in A Place in the Sun.


The tabloid headlines and legendary marital brawls obscured Taylor's impressive range: She played and played well characters created by Tennessee Williams, John O'Hara, Edward Albee, Dylan Thomas, and William Shakespeare. She made her mark in family movies and smoldered in sprawling epics and soap operas. She played it for laughs in Father of the Bride as naturally as she evoked pity and disgust in Who's Afraid of Virginia Woolf. 


To me, though, Elizabeth Taylor is first and foremost Leslie Benedict, the brash Maryland debutante who over the course of 201 minutes becomes the seasoned partner of a Texas rancher. (I grew up a mile from the main gate of the King Ranch, upon which Giant is based.) Over the course of the movie, the outsider becomes an insider while her principles and wit remain intact, a combination that causes her husband Bick Benedict (Hudson) to conclude that he won't understand her if he lives to be 90 (or a 100 or 150, one suspects). Taylor takes advantage of Giant's to show her character as arch, sardonic, wondering, overwhelmed, determined, warm, sympathetic, feminine, and maternal. She shifts moods as easily and naturally as you or I might change shirts. It's a bravura performance, all the more so as their isn't a trace forced or self-conscious.

Whatever the misfortunes of your personal life, Liz, you were not only one of the greats, you just may be the last of them...

Don't miss this 1949 Times profile of 16-year old "soft-spoken, rather quiet, almost shy" Elizabeth Taylor...

The savage fight scene from Giant, followed by the closing:

All Over

At 6'8", Gene Conley was big enough to be that rare athlete to play two professional sports. From 1952-63, the three-time All Star took the mound for the Boston and Milwaukee Braves, the Philadelphia Phillies, and the Boston Red Sox. For good measure, he put in six years with the Knicks and Celtics of the NBA (spaced out between 1952 and 1964), where he was a capable rebounder off the bench.

By 1964, Conley's strong right arm had given out. As he stared bleakly at the end of his sports career, he determineded to give it one more shot. Conley called Cleveland Indians executive Gabe Paul, who agreed to let Conley pitch for an Indians minor league club in order to see if there was anything left.

There wasn't.

In this memorable passage from Donald Honig's Baseball Between the Lines, Conley recounts his final realization that he was through:

So I started a game. We were playing Greensboro, North Carolina. Those kids came up to the plate and started knocking line drives all over the place. I tried flooring a few of them but they weren't impressed; I didn't have enough on the ball to scare anybody. After four or five innings they had to take me out.

I called Gabe Paul the next day.

"Gabe," I said, "I tried but I can't do it."

"I thought that might be the case," he said. "I guess you just had to get it out of your system."

"Well," I said, "It's out."

When I walked away from that telephone I was really shocked. There was no more fooling myself. It was all over and I knew it. Not only that, I didn't have a job, nothing to go back to. The basketball was about over, too. So I was pretty depressed.

I wandered around for a while, a lost soul on the streets of this town in North Carolina. Then I walked into a church and sat down in the back, all by myself. There was a service going on. After the singing this Baptist minister started preaching. All of a sudden it hit me real hard and I caved in and started crying. I just sat there in that last row and cried and cried, trying to keep my head down so as not to upset anybody. Then I felt a hand on my shoulder and I looked up. An elderly Southern gentleman was standing there gazing down at me.

"What's the matter, son?" he asked. "Did you lose your mother?"

I shook my head, the tears still running. "No sir," I said. "I lost my fastball."

What is Preventive Heath Care?

These before and after pictures of the tsunami will stun you. Don't miss them (scroll down)...

Paul Krugman writes that GOP staffers recently jeered at the part of a Kaiser Permanente presentation that discussed the importance of preventive health care. (It's a "slush fund," apparently.) Claiming that there is no such thing as preventive health care is the medical equivalent of saying that the world is flat, yet I've seen this showing up more and more in the comments that I monitor. There are even cherry-picked references to a CBO study. (Funny how conservatives like the CBO just fine when they can distort it to in their own interests.)

The thing is, Americans have relatively ineffective preventive health because we practice it in the context of our commitment to heroic medicine. There's much more to the concept than a yearly physical and PSA (which may not do that much good, anyway). We don't really practice what is known as population health, which includes outcomes, determinants, interventions, and policies that impact the health of a group. A group can be as small as the total number of patients in a given practice and as large as the entire population of a country, and be based on condition, locale, demographics, or some combination of the three.

At the end of the first quarter of school, my team made a presentation based on steps that could be taken to reduce the number of pediatric asthma admissions to a rural emergency department in an area with a heavy migrant worker population. We set a goal (50% reduction, based on research) and designed a program based on ED clinical staff training, patient education, check-in and check-out procedures (wherein, for example, no one left without what's called an Asthma Action Plan), home mitigation strategies, and primary care followup. We minimized other possibilities because of budget limitations and likely behavioral restrictions on the families. This is the idea behind preventive care based on population, although it doesn't address public policies that might improve outcomes even further (such as improving air quality eroded by a high concentration of pesticides).

So, if someone tells you that preventive health care doesn't work, the chances are that they don't know what it is and that they're unaware that we really don't practice it here.

Utah Teabaggers Support Gay Sex

These people are nuts. But it has been fun watching Orrin Hatch humiliate himself by sucking up to them. I mean, I thought these people were all for family values and against gay sex. But here they are: Making old Orrin give them exactly what they tried to crucify Bill Clinton for.

Two Songs About Rivers

If there's a better American song than this one, I'd like to hear it. Here's a Brit performing an aching rendition. Away, I must away:



Kris Kristofferson looks like singing "i'm gonna sit right here until I die" with Johnny Cash fulfills a bucket wish list. It tore me up every time I heard her drawl that southern drawl:

The Dean Passeth

Journalist and commentator David Broder passed away today at the age of 81.

The Dean was the ultimate insider, a man with an almost childlike faith in the senior elected officials he courted and befriended. Although he often wrote in broad strokes about the stultifying ideological partisanship that has paralyzed Congress and especially the Senate, he rarely named names out of a seeming reluctance to offend. While Broder often criticized presidents, one had the feeling that it was because he saw them as DC blow-ins unworthy of the noble men and women of the legislative branch.

Broder was a throwback, an American innocent at home who never really understood the corruption of Congress by corporate lobbyists and money. To do so would have offended his sense of the politician's noble calling to represent the people. He never explored the gap, or even the possibility of a gap, between the calling and the reality: That might have made him unwelcome at the highest levels of the DC party circuit. No gap -- especially when it wasn't really real -- was worth missing out on martinis with Mitch McConnell and Chuck Schumer.

He valued compromise, even though compromises almost never hold. He cranked out column after column with an almost Talmudic weighing of issues, only to conclude that there was no conclusion other than to wait and see. Somewhere along the line, he mistook an absence of point of view for intellectual integrity, and too often settled for pabulum. Today, this passes for a balanced perspective.

Although Broder was once an undeniably fine reporter, the DC political and social whirl informed his views as a columnist, and he seemed more anxious to not offend his friends (and to parrot their opinions)  than to actually analyze. He too often dealt in stereotypes and believed in his own importance, never a good thing for a supposed observer. Nonetheless, he was a rare voice of civility. Even though that came with a paucity of actual insight, I suppose it will be missed...


Citizen K. wrote critically of Broder here and here...

The Art of the Poster: Sullivan's Travels (1941)

Sullivan's Travels, Preston Sturges' pre-war masterpiece, concerns a movie director (Joel McCrea) who has tired of making light comedies and wants to make a film about the downtrodden forgotten man. So, like William Powell in My Man Godfrey, he goes incognito as a hobo, but finds that no matter what he does, he winds up back in Hollywood. Several plot twists later with the help of The Girl (Veronica Lake), Sullivan succeeds in becoming a hobo only to wind up on a chain gang serving time for manslaughter. Here, he learns the value of laughter and decides that possibly he has been contributing after all. Like any Sturges film, Sullivan's Travels is satiric and sharply observed, though this time the satire informs a powerful social message. Many regard this as Sturges' best film.

In this famous scene, Jesse Lee Brooks leads a congregation in "Go Down, Moses" as the convicts arrive to see a Disney cartoon:

Vermont Moves Toward Single Payer

Dr William Hsaio, perhaps the world's foremost expert in the implementation of new health care systems, has delivered a report to the Vermont General Assembly recommending that the state adopt single payer health care based on a hybrid means of financing. Financing would stem from an employer-employee payroll deduction; benefits would be comprehensive and come with a low co-pay. It leaves Vermont Medicare and Medicaid intact, apparently because eliminating them would greatly complicate implementation. The General Assembly is expected to pass some version of Hsiao's proposal. The state would then request a waiver from the Affordable Care Act, which the Obama administration would almost certainly grant.

Implementation of a single payer program would be a health care reform development on the scale of Medicare and the Affordable Care Act. Hsiao estimates (conservatively, he says) that Vermont will save 25% of expected health care costs between 2015 and 2024. If the plan delivers as promised, pressure will grow on other states to reduce costs by expanding coverage and benefits. HealthMatters details the proposal here.

Youthful Idealists Need Not Apply

[The knight] had gone but a few paces into the wood, when he saw a mare tied to an oak, and tied to another, and stripped from the waist upwards, a youth of about fifteen years of age, from whom the cries came. Nor were they without cause, for a lusty farmer was flogging him with a belt and following up every blow with scoldings and commands, repeating, "Your mouth shut and your eyes open!" while the youth made answer, "I won't do it again, master mine; by God's passion I won't do it again...

Miguel de Cervantes, Don Quixote 

The right of citizens of the United States, who are eighteen years of age or older, to vote shall not be denied or abridged by the United States or by any State on account of age. 

Twenty-sixth Amendment to the Constitution of the United States

The Washington Post reports that New Hampshire Republicans have prepared legislation limiting the voting rights of college students on the grounds that students are "foolish" and "just vote their feelings," causing them to inevitably vote liberal. This, apparently, must be suppressed for the good of the state and the country. Another Republican cites "youthful idealism" as justification, complaining that young people  are inexplicably "...focused on remaking the world, with themselves in charge, of course, rather than with the mundane humdrum of local government."


Citizen K. sometimes can't resist shooting fish in a barrel and this is one of those times. One might forgiven for thinking that the the phrases "foolish," "just vote their feelings," and "focused on remaking the world, with themselves in charge" might, say, apply to the teabaggers behind all of this foolishness. One might also be forgiven that were the shoe on the other foot, conservatives would be screaming bloody murder and accusing liberals of eviscerating the Constitution.


Which brings me to another point: Once again, Republicanists mount a frontal assault on the document they profess to revere as much as the Bible. The Twenty-sixth Amendment is as clear on the matter of voting age as the Fourteenth is on citizenship birthright. It doesn't say, as New Hampshire Republicans would apparently prefer, that the voting rights of citizens eighteen are older "shall not be abridged unless they are college students." The meaning and intent is quite clear, and it's not "keep your mouth shut and your eyes wide open."


Voter suppression to prevent youthful idealism? God knows that we wouldn't want too much youthful idealism. That will kill a country, every time.

By Two and Two with Fetters on Their Feet

From the newly published Atlas of the Transatlantic Slave Trade (Eltis and Richardson):

[The Africans are] so crowded, in such disgusting conditions, as the very ones who transport them assure me, that they come by six and six, with collars around their necks, and those same ones by two and two with fetters on their feet, in such a way that they come imprisoned from head to feet, below the deck, locked in from outside, where they see neither sun nor moon, [and] that there is no Spaniard who dares to stick his head in the hatch without becoming ill, nor to remain inside for an hour without the risk of great sickness. So great is the stench, the crowding and the misery of that place. And the [only] refuge and consolation that they have in it is [that] to each [is given] once a day no more than half a bowl of uncooked corn flour or millet, which is like our rice, and with it a small jug of water and nothing else, except for much beating, much lashing, and bad words. This is that which commonly happens with the men and I well think that some of the shippers treat them with more kindness and mildness, principally in these times...[Nevertheless, most] arrive turned into skeletons.

"Description of Africans on a Slave Ship (1627)," in W. D. Phillips, Jr. Slavery from Roman Times to the Early Transatlantic Trade (Minneapolis: University of Minnesota Press).

The Atlas is a remarkable volume, everything a reference book should be: Focused and detailed with informative and ideally designed graphics and maps that explicate its six parts: Nations Transporting Slaves from Africa, 1501-1867; Ports Outfitting Voyages in the Transatlantic Slave Trade; The African Coastal Origins of Slaves and the Links between Africa and the Atlantic World; The Experience of the Middle Passage; The Destinations of Slaves in the Americas and Their Links with the Atlantic World; and Abolition and Suppression of the Transatlantic Slave Trade.

One map shows that the direction of sea currents and prevailing winds caused slavers to take a longer but easier voyage from central Africa as opposed to points further north. Another details the flow of slaves from specific African ports (and the number of slaves from each) to their destination ports in the New World. Still another breaks down the demographics of age and gender of captives on typical voyages.

Each page is the turn of a screw, slowly revealing until undeniable the official complicity of European nations in the deliberate design and perpetration of a horror that lasted for over three-and-a-half centuries. For the captives who survived the Middle Passage to be sold into slavery, the horror had only begun, and would be passed down from generation to generation.

The slavers and their investors, though, pocketed their profits and began preparations for more voyages to the central African coast. This included taking out insurance that protected "The Insurers from any loss or damage from the Insurrection of Negroes" but that otherwise specified a precise value for human life "computed on the nett Amount of the Ship Outsett & Cargo -- Negroes valued at Thirty Pounds p Head." Of course, to the slavers and slaveowners, these were not human lives: They were nothing more than commodities of labor valued at 30 pounds per unit.

R.I.P., Suze Rotolo

They looked so domestic. Just a young couple crazy about each other, strolling a New York City street with the confidence that the world was their oyster. The near mundaneness of the image belied the brilliance of the music within, but once you heard the music within, you took a second look at the cover. Suddenly, it portrayed something else: A portrait of a young man as an artist who had just changed popular music forever and his (somewhat reluctant, it turned out) muse. She clings to him smiling and proud as he whispers something secret -- a private witticism, perhaps, a sweet nothing, or a tale of the Village night. The images of the cars behind them futilely attempt to freeze the image in late 1962 or early 1963, but the music had already demolished the mere temporal pretensions of a camera: It's already immortal. And Suze, you feel, knows it. The smile says, "This record? He couldn't have done it without me."

Suze Rotolo is gone, succumbing to lung cancer at age 67. She inspired Bob Dylan's interest in the political world and became the subject of some of his greatest songs. Here's, Dylan's friend Ramblin' Jack Elliot sings one of them (music begins around 3:30):

Those Union Members Will Get You Every Time

A unionized public employee, a member of the Tea Party, and a CEO are sitting at a table. In the middle of the table is a plate with a dozen cookies on it. The CEO reaches across and takes 11 cookies, looks at the tea partier and says, "Watch out for that union guy, he wants a piece of your cookie.