It's not an EZ road to recovery.

I've joined a support group for prostate cancer victims on Facebook. I also attend a live support group that meets once a month. Here is a description of my experience that I have shared with those groups.

I'm 65 yo, reasonably healthy but about 10% over ideal weight. I had the DaVinci radical prostatectomy on 3 December 15. 12 of 14 biopsy cores had been positive, Gleason of 7 (4+3 with "excursions" to 5) and some evidence of extra-capsule malignancy. Both the radiation oncologist and the surgical oncologist (and second opinion) agreed surgery was the best first choice for me, as it can be followed by radiation if not fully successful but, for some reason, it's less desirable to do surgery if the radiation doesn't fully work. I spent two nights in hospital, had next to no pain, painkillers for only two days post-discharge. I took the month of December off (slept  and went back to work 1st workday of January. Will go back for F/U with first post-surgery PSA early February. The surgeon was able to do "nerve sparing" surgery on one, but not both sides, of the prostate area. They took the seminal vesicles and samples of the lymph nodes as well. Pathology after surgery was good with all "clean edges" but it did show some extra-capsular malignancy which was removed. At this point, I'm finding that I still have excess fatigue and tire VERY easily. The incontinence is my big gripe, very demoralizing, and I've not seen any improvement, yet. I had a catheter for one week. Since it's removal, if I'm standing or walking, I'm leaking. I can hold it no problem sitting or laying down. Coughing, sneezing, laughing no problem unless standing. I'm using "prompted toileting" using the timer on my iPhone to remind me to void every hour while awake. I am receiving rehabilitative care once a week with biofeedback on the Kegels and electrostimulation for the pelvic floor muscle. I find I do better on holding the urine when I'm fresh than when I'm tired. I've been prescribed daily Viagra and issued an expensive pump, but there's no sign of life there yet. My wife is demonstrating the meaning of patience. A deciding factor for me: every Dr. I consulted said side effects are initially worse with surgery but they get better -- with radiation, side effects are minimal up front but a significant number of men so treated have onset of incontinence and impotence later on and the side effects then get worse over time and never get better.

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Positively EZ or easily positive?

October 20, 2015

My biopsy was collected on the afternoon of September 24, 2015, by Dr. Duffey in the urology clinic at the Brooke Army Medical Center (BAMC) within the San Antonio Military Medical Center (SAMMC). As I dressed afterward, Dr. Duffey said, "Make an appointment to come back in two weeks. I don't share results over the telephone -- good or bad, I do it face to face."

My appointment for receiving the results was made for the afternoon of October 8th. It was a convenient time, as I already had an appointment scheduled at the ophthalmology clinic on the morning of that same day. For at least 10 days prior to my appointment I found that I was unable to accomplish anything and could not concentrate for 10 minutes. I couldn't read, I couldn't write, I couldn't watch TV or a movie. I did not know why until I realized that at some level I was frightened. Upon that realization, I went and talked to a friend, really opening up. That helped.

I checked into the urology clinic after lunch on the 8th and was directed to the waiting area to see Dr. Duffey. As I sat on the slippery vinyl I tried to anticipate my appointment and receiving the feedback that the biopsy was negative. I mean, after all, I'm not sick, I have no pain, must be no problem, right? What, exactly, would I tell my family? Would I write about it in my blog? Would the doctor ask me to repeat the biopsy at some future date? With these thoughts in my head, I drifted into a light sleep.

"MR. MOYES!" Oh. My name. My appointment. Shaking my head to awaken, I stood and received my direction to Dr. Duffey's office, where I was greeted and seated.

Dr. Duffey did not mince words: "Your biopsy was positive."

There was more; a lot more, and I think I actually recall most of it, but I don't need to write about it here. The summary: of fourteen needle biopsy samples two were negative for cancer, four were questionable, and eight were positive. Of the eight positive samples, some had as much as 60% of the cells cancerous. This cancer, prostate cancer, is rated for risk using something called the Gleason Scale rated from 2 - 10. I recall that Dr. Duffey was professional, positive, and kind. He had earlier, before the biopsy, explained carefully that prostate cancer is not a death sentence -- it is generally not aggressive and most men of my advanced years that are diagnosed with prostate cancer die with the disease, not of the disease. And it is common: nearly half of the men who reach their mid-60s will have prostate cancer. With a Gleason score of 7, I am a patient of "Intermediate Risk." Dr. Duffey outlined my options: (1) Watchful waiting; (2) Prostatectomy by surgery; (3) External radiation therapy; (4) Implanted radiation "seeds." I, the patient, must decide which course to follow.

• Option 1, watchful waiting is not a good choice for a Gleason 7, Dr. Duffey says.
• Option 2, surgery is Dr. Duffey's choice, but he is a surgeon and admits to prejudice here.
• Option 3, external radiation is, he says, also a good choice and tells me I'll consult with a radiation oncologist before I make my decision.
• Option 4 is not done at BAMC.

So that leaves options 2, surgery, or 3, external radiation. Dr. Duffey assures me that I don't need to make the decision right away but again stresses that I will have to make the decision. He explained that I (and my wife) would be enrolled in their comprehensive prostate cancer clinic whereby we would receive broad counseling from every medical and helping specialty known to man. I was introduced to Janet, who runs the comprehensive cancer clinic and she enrolled me (us) and gave me a verbal overview. In addition to the counseling, we will meet with survivors and current patients and have group sessions. Our first appointment for the comprehensive clinic is scheduled for the 28th of this month. Only after meeting with and being briefed by surgeons, radiation oncologists, nutritionists, psychologists, financial counselors, and the kitchen sink will I have to decide on a course of treatment. I left the clinic on the eighth of October with a bagful of reading assignments: books, leaflets, pamphlets, sheets, and a long list of internet links.

So, I have cancer. Cancer that is common and is not normally considered to be aggressive, not normally considered to be fatal. But my particular cancer is on the more aggressive side of the scale for prostate cancer, hence the Gleason score of 7. I have cancer. It does not have me.

I will have to make a treatment choice. Right now I'm leaning toward the surgery, but I won't make a final decision until after I speak to the range of counselors. Modern surgery is much less invasive than in recent past years. They use an orthoscopic technique with robotic assistance. The doctor says convalescence is normally comparatively short and most men are back to full function within about three months. Some men experience a loss of sexual function with the prostatectomy. Some don't. There will be other side effects with surgery and with radiation therapy. We will deal with those as needed. This is so new to me, because, you see, at age 65, I've never had any invasive surgery; never been hospitalized, and rarely ill beyond a head cold, so I've been blessed up until now. I did have a small skin cancer removed from my upper back a couple years ago, but that was outpatient, quick, and painless.

Now I'm reading the book, "What helped me get through" written by and about cancer survivors. I have shared the news with close friends and family. I don't see any reason for this to be a secret, but I don't think the world needs to know, either. But I need to clarify my thoughts, and writing is one way I do that, so I'm writing. I'm working. I'm scheduling and attending events with my family. I'm enjoying things that I want to enjoy.  I've also told my three sons that they are at increased risk of prostate cancer (their uncle, my eldest brother, is a prostate cancer survivor, so the tendency is definitely in the family) and advised them to ensure they talk to their doctors and get their checkups.

Over the next weeks (months?) we will be busy with appointments and procedures. We will deal with it and do what needs to be done. I thank our Father in Heaven for the good years I have had and for the good days I am having now. My last two blog posts are about family and friends time. It seems sweeter now than ever before and I am thankful. Friends and I are working on an idea for founding a nonprofit organization that should do a lot of good. I am thankful for the opportunity to contribute in a small way. I think I'll take the initiative to do my home teaching, visiting the few families in our ward congregation that I've been called to minister to. I am thankful for that opportunity.

And with this, and for now, I wish you all well. Guys: Talk to your doctor. Have your exam!!

EZ weight loss procedure not so EZ.

Have I mentioned that I love military medical care?

About six months ago, my dear wife of 45+ years was referred by her primary care physician at our nearby Army Hospital for evaluation for bariatric surgery. She is not grossly overweight but has always weighed more than she should and, sadly, thinks of herself as "fat."  She is also a Type II diabetic (which she currently controls without insulin) and some acquaintances have told us their diabetes "went away" after bariatric surgery or other significant weight loss. So, Glenda was anxious for the surgery, as she wants to be more fit and more proud of her body, and would love to see the diabetes go away. So long, I guess, as dieting and exercise are not involved. That's always been my position on the subject, too.

During the evaluation for the surgery she was subjected to nearly every medical test known to mankind, EKG, ECG, MRI, Upper- and Lower-GI series, blood, stool, and urine tests. She had to meet with a psychiatrist and attend group support sessions. All of this took months and hundreds of miles of driving. She passed all the tests and checked all the blocks and was told in late January that she would be called in "two to six weeks." We waited. Then we called. Then we waited some more. Today, she called the bariatrics clinic again, and was told that the bariatric surgery would not be available to her as the surgeon had been deployed. Army doctors must first support Army troops. No question, no argument there.

But I wonder what the paying party thinks of having spent a LOT of money on her surgery evaluation and preparation only to see the anticipated benefits not being delivered? After all, Humana, the insurance company that pays the vast bulk of our Tri-Care Prime military medical care, must have counted on lower life-time care costs due to the better health likely a result of the weight loss the surgery promised to deliver. Otherwise, why would they have approved this elective surgery. No surgery, no related weight loss, no resulting improved health, no reduction in life-time care costs.

I don't know how much all of the exams and preparatory work she underwent cost Humana. I know what our co-pay was and I could guess at the cost of all these exams. I shake my head at the waste of medical resources in this situation.

Glenda is going to speak with her primary care physician to see if it is possible to be referred to a local civilian hospital that has a good reputation in bariatric surgery, but I don't know if that's within his powers. If that fails, we may try to meet with the ombudsman at the military hospital. I'll be back when I know more.

Have I mentioned that I love military medical care?