What I did during my summer vacation part 1

by liberal japonicus

Below the fold, a medical story that may be of interest to:

-men of a certain age (over 50)
-people interested in national health comparisons
-people interested in how Japan may be refracted thru their health care

If you are not interested in hearing details about my health, I encourage you to skip this. Ret's go...

 A common notion in describing the prostate is comparing it to a walnut in size. I'm not sure why a walnut was chosen, and the only other thing I remember being compared to a walnut in size was the brain of a dinosaur, though google tells me this was the result of a journalistic mistake. If I were to personify the prostate, I might think that it felt diminished by being compared to a walnut, and take exception.

Which is what my prostate, absent the personification (I think, I'm wondering about all those educational medical films "Bill's Liver", "Sally's Heart". Is there an "LJ's Prostate" out there?), chose to do. However, in another reminder that no man is an island, when the prostate decides that walnut comparisons diminish it, this decision impacts the neighborhood, whose main residents are the bladder and the urethea. This makes urination a random and repetitive activity.

I just watched Paul Sorrentino's movie 'Youth' which has this dialogue between the composer, Fred Ballinger, played by Michael Caine and the film director, Mick Boyle, played by Harvey Keitel:

• Fred Ballinger: Did you take a piss today?
• Mick Boyle: [nods in affirmation] Twice. Four drops. You?
• Fred Ballinger: The same. More or less.
• Mick Boyle: More? Or less?
• Fred Ballinger: Less.

I had seen my urologist and moved to drugs. I had, in my late 40's, a prostate infection which did the same thing, but antibiotics from my US family doctor had me back to normal. This time, I went to a Japanese doctor's office. I wasn't really prepared for the fact that the waiting room was full of old people. In fact, I think a lot of the Japanese medical system is set up to give old people something to occupy their time.

The doctor, used to dealing with older people, had a voice 5 or 10 decibels above normal, which I assume is a result of dealing with the age demographic he does. 'So, you are having trouble peeing' in a voice that I assumed was heard throughout the building.

After some non-invasive tests, and marvelling at the size of my foreign prostate "Kannari ooki", which is Japanese for 'that is as big as a Buick', he gave me some medicine. 'how long will I be taking these pills?' 'oh, forever' was the answer.

So things settled back to quasi-normal. I was helped by the fact that for this condition, Japan is probably the best place in the world to live. Every place has a public bathroom, usually clean and well-lit. Often they have a washlet, one of the greatest inventions of man. The only reason a convenience store wouldn't have a public bathroom is that if, to use it, you'd have to go thru their stock room. While in the US, they might be concerned you would make off with a case of drinks, I feel like in Japan, they don't have a bathroom because they don't want you to see their messy stockroom.

Because of this, things were never too bad. I became the Jason Bourne of toilet location. Enter a building and immediately know where the toliet(s) are and be able to get to them in flash for a slash. But the world is not Japan, and it was getting to the point where I didn't feel I could travel, which was getting me down.

My doctor said that surgery was an option and so was going to have it done in March. I met with the surgeon, who suggested I try an additional drug and give it some more time. This made a lot of sense because the school year starts here in April, and I couldn't imagine dealing with a new cohort after having that surgery two weeks before.

It improved a little, but in the meantime, I had the chance to go to Korea for a year in 2019. Not wanting my go to phrase in Korean to be Hwa-jang-shil o-di-ye-yo (where's the bathroom), I thought that I should get the surgery.

And in preparation for that, an elevated PSA had the doctor recommend a CAT scan. The CAT scan revealed that I had something in my prostate. The surgery was scheduled for the beginning of Sept, but it's not surgery one wants to do with prostate cancer. So, an MRI guided biopsy (because the site was so small, a regular biopsy wouldn't guarantee they got it) was done just to make sure it wasn't cancer.

Whoops, it was. Then CAT and bone scans to make sure it wasn't Stage 2. Which it wasn't, which is very good news. This all took place from the end of August, so it's not really been fun.

I feel like people my age are on the trailing edge of Cancer as Voldemort, the invocation of the name was enough to stop discussion. Yet when you start asking, the number of people who have had, or who know someone close to them with cancer, it's really a lot more common than I thought. I don't know if this is true for others, but getting told I had cancer was a lot like grief, it occupies all your thoughts, making it difficult to move or think, and slowly, you have lengths of time where you don't think about it. As time goes on, those periods become longer and longer.

Anyway, that's part 1. While good wishes and advice are appreciated, I'm in pretty good shape emotionally/mentally at the moment. I'll be writing about the procedures and how things are done in Japan in the next post, maybe next week.

Comments

[McKinneyTexas]

Early detection is key. If you are interested in talking to some people who've been through it and have a lot of knowledge about the process and treatment options, I'm happy to try to help. If you're considering removal of the prostate, picking the right surgeon is key. Most urologists can remove the prostate, but doing so and not leaving the patient incontinent and impotent is a different story. There is nothing wrong with asking pointed questions of your putative surgeon. Hope things work out well. You're right, when the C word gets dropped by a doctor, it changes everything.

[hairshirthedonist]

The only thing I can add here is that my father had prostate cancer - long enough ago that I'm not even sure how long ago it was. I can at least say it was more than 10 years. He's still alive at 76. He's not in the greatest of health (not in the worst of health, either), but cancer is not among his health problems, FWIW.

[Girl from the North Country]

but doing so and not leaving the patient incontinent and impotent is a different story

So very true. There are certain surgeons famed for their success in retaining these functions - when I read an article about one of them in the UK some years ago I noted the name, in case Mr GftNC ever needed this surgery. The next I heard of the guy, he had prostate cancer. I wonder who he got to do his surgery. The encouraging news about prostate cancers, as I understand it, is that most are so slow-growing that it is considered moot whether in these cases removing the prostate is always necessary. And the second piece of encouraging news I believe is that in the last year or so enormous strides have been made in the treatment of aggressive prostate cancer, such that survival rates are seriously on the rise.

In any case, long may your being in pretty good shape emotionally/mentally at the moment last, and may your treatment be as painless and as successful as possible.

[Nigel]

Best wishes with this.

As McKinney suggests, ask LOTS of questions. There are multiple different treatment options (including no treatment), all with advantages and disadvantages - surgery is not necessarily the right one in every case.

[McKinneyTexas]

Nigel is right, although generally, the younger one is, the more aggressive the treatment modality. LJ, you're in your late 50's IIRC. That's young for prostate cancer. Like HSH, my dad had prostate cancer but it came late in life. It never was an issue.

[Michael Cain]

Best wishes on having a good outcome, lj. Prostate cancer is always a complicated set of choices -- particularly surgery, since it's technically challenging with a significant risk of serious side effects -- unless it's absolutely clear that you have one of the aggressive varieties.

[Countme-a-Demon]

lj, I'll be thinking of you and knowing things will turn out fine.

Also brave of you to share this news. Thank you.

I understand only a little, because I've never had cancer, the idea that the thought of it once diagnosed can paralyze a person. I just had some moles removed the other week ... something I do every few years because I had a couple removed as a kid that appeared to be very funky and quickly changing ones ... and the four-day wait for the test results last week, negative, had me in a state.

I never know (I do know, but not when I first read or hear them) how to translate medical test results. Negative, you say? How can that be good news? But if it's positive, which is negative in the medical testing world, everyone around you tells you to stay positive.

No, don't do that. Strive for negative and stay that way.

It helps nothing to look up this stuff on the internet, because then you make your own horror movie without an editor.

I suspect if and when I'm ever diagnosed with the C, my D certificate will read that I died of a sudden case of fright.

I've noticed my doctor doesn't prescribe the PSA test any longer .... though I can request it ... because it's reliability has been called into question. Mine have always been OK, but at my age, I have a few urination problems, and now I'm going to be talking out loud to myself in my crummy Michael Caine impersonation when they occur.

"I'm bloody dribbling again, not many people know that."

https://www.youtube.com/watch?v=rX0F3kY3uxU

Perhaps this is the wrong time to suggest an article to read, but it so happens that the New Yorker has a recent very interesting one:

https://www.newyorker.com/magazine/2017/09/11/cancers-invasion-equation

Think of it as reading about the mollusk infestation in the Great Lakes, because that's where it starts.

In the article, a study is mentioned which observed, regarding prostate cancer, that 30 to 100 men, diagnosed but not in mortal danger, would have to go undergo unnecessary treatment, typically surgery or radiation, for every life saved.

I hope to find out I have it during my autopsy after I keel over by other means at age 97.

The article poses the question, what is it that causes some human bodies to resist various cancers and others to serve as fertile hosts for C?

Lean on McKinney. But make sure you do it before 8:00 pm Houston time, because otherwise he might fall over. ;)

Red wine is very therapeutic.

Stay negative.

[sapient]

Very best wishes, lj. I went through some nightmarish worries with a friend of mine, and all is going well.

[CaseyL]

May you be able to pee plentifully, and need to less often; and may your staff continue to rise.

(IOW, Best wishes for successful treatment with no bad side effects.)

[JanieM]

Good luck, lj. Getting entangled with the medical system (apparently, *any* medical system?) is no fun even without the headline "Cancer diagnosis."

I'm with you about the effect of the word; I've had a couple of (what in my fears were) close calls over the years, but they turned out to be nothing much...and my fears went back into hiding.

On the other hand, by this time I know or know of a long list of people who have had cancer and have been declared clear of it, and who -- after some number of years -- have still had no recurrence. Some of these people have been quite young (my great-niece was three, now she's thirteen), so it still makes me a little edgy wondering whether it's not too late for a recurrence. (I've only skimmed the Count's long New Yorker link, but it sheds fascinating if murky light on that question.)

I'll be looking forward to your further posts. If a great cheering section could be dispositive, here we are!

[Evan]

"I feel like people my age are on the trailing edge of Cancer as Voldemort, the invocation of the name was enough to stop discussion."

A few years back I had a thing that turned out after a biopsy not to be skin cancer, but looked like it... and hoo boy, do I vividly remember my doctor casually suggesting that it might be while he peered at it with a magnifying glass.

Then he saw my face and said "oh, not cancer cancer. You just cut it out and forget about it."

I've thought ever since that we need a different word for cancer-but-don't-worry-about-it. "I'm afraid you have skin capricorn, Mr. Smith."

Anyway, here's hoping what you have is prostate capricorn. Best of luck.

[joel hanes]

it wasn't Stage 2

Thank FSM.

[JanieM]

prostate capricorn

That's great. :-)

[bobbyp]

best wishes, lj (fellow prostate issue sufferer).

[DaveC]

lj no matter what they do with your prostate, you will always be the big swinging dick around here.
in a good way.

[liberal japonicus]

DaveC! Nice to see you! I was looking for your last comment (moved to Florida with your daughter I think?) but I'm not sure that was it. If you are in Florida, how was dealing with Irma? Hope everything is ok.

[Countme-a-Demon]

DaveC: long time, no see.

I'm repeating myself, but since we're telling doctor stories, I had a doctor years ago who upon looking at one of my moles, pointed at it from across the examining room and exclaimed in what I thought was an inappropriatley gleeful voice, "Oh, I bet that's a melanoma!!!"

As if she was picturing herself presenting my case at the International Skin Cancer Symposium in Vienna accompanied by slides of cross sections of me.

The biopsy came back negative, the good negative not the bad positive. So there.

The very next year, just before Christmas, during my physical as I was bent over the examining table, and as she finished coating her finger in jelly in preparation for the digital examination of my nether regions, she asked me brightly just prior to, you know, insertion, "What do you hope Santa brings you for Christmas?!".

HA ha, old medical school joke. My answer was garbled. Not a pony!

I had two choices. One: attend medical school and study gynecology. Find out what medical practice that doctor patronized, and get a job there. Meet her at the front door for her next check up, gurney in tow, both hands in rubber gloves and face masked and a fake arrow sticking out of both sides of my head, making ambulance siren sounds with my mouth, introduce myself as Dr. Howard Fine Howard Quackenbush and rush her into surgery cackling like a fiend.

Or 2: Sit on it for a few days, so to speak, call my medical practice up, and request a new primary physician.

I chose Number 2.

I appreciate a proactive physician. But I like a little romance in their bedside manners.

[JanieM]

in what I thought was an inappropriatley gleeful voice, "Oh, I bet that's a melanoma!!!"

When my son was a little guy he got an increasingly bad circular rash on his leg, and the docs were just delighted that they might get to see their actual first live case of Lyme disease. I was not so full of glee.

[wj]

I confess I was not unhappy when my doctor informed me that the manual prostate exam was no longer on the recommended list. Apparently better tests have come along. Yeh!

[Michael Cain]

When my son was a little guy he got an increasingly bad circular rash on his leg, and the docs were just delighted that they might get to see their actual first live case of Lyme disease.

This always drives me crazy. Friends have a daughter with a very rare developmental syndrome. When they moved to a different state their daughter became the second current resident with the syndrome. When they were looking for an appropriate specialist, they told me that most of the ones they talked to were like "Two! Differential studies! I can publish!"

Now that I have reached that certain age, I live in a bit of fear that my body will fail in some way that makes the specialists salivate.

[wonkie]

Best wishes, LJ and thank you for sharing with us so we can be part of your journey. FWIW everyone I know--which is quite a few since I'm an old lady--who has had prostate cancer has bee basically Ok afterwards.

I think it is the sudden hyperawareness of mortality that scares the crap out of people.

[Pro Bono]

My late wife was an oncologist specializing in advanced prostate cancer. After her diagnosis with a rare sarcoma she tried to go back to work, but she found it too difficult to listen to the concerns of patients whose prognosis was much better than hers.

Which is to say that as intimations of mortality go, stage 1 prostate cancer is a good one to have.

[bob mcmanus]

Okay help me out here, I am not getting this on the symptom. I was primary caretaker for several years for a whole failure of a body (for instance she had terminal osteoporosis in that all her bones were disappearing, including ribcage and skull) and she couldn't pee. Kidney failure and dialysis three times a week. Her blood pressure would spike leading to heart failure and strokes.

So you are telling me you couldn't pee? 3-5 drops a day?

[liberal japonicus]

Sorry, didn't mean to imply it was that bad. (If it were that bad, here in Japan, I'd probably be in the hospital. In the states, I'd probably order a self-catheterization kit from Amazon). It's just that I liked that dialogue (liked the movie too)

I'm peeing more often and getting overwhelmed. Was in a rehearsal with the regional orchestra I play with and the conductor (a young woman who, when she joined us, had me realize that I had never been conducted by a woman) said that she wanted the section we were rehearsing to have the feeling like you needed to pee. Whoops, I'll be back in a minute.

McT, at the top, is right, the questions of incontinence and impotence are looming large. Maybe one of the future installments is going to be how this made me think about getting old.

[hairshirthedonist]

On the odd-timing front, good friends of ours - a married couple - just found out, on the same day, that both of their fathers were diagnosed with prostate cancer.

(Probably not particularly helpful news, but just weird to enough to bother mentioning.)

[sanbikinoraion]

Oh man, I hated "Youth". Typical wanky old guys ruminating on life fare, with a spectacularly infuriating ending. We only watched it for the scenery - and because it was a baby screening!

[Kaleberg]

The good news seems to be that Japanese doctors now tell their patients when they do have cancer. This was an important point in Kurosawa's 'Ikuru'. Here's to good clinical luck and good, competent medical are.

P.S. Has anyone described the prostate as being the size of dinosaur's brain?