“I Know I’m Dying, Children, But I Ain’t Dead Yet…”

I want to give a shout-out  to a remarkable blog I came across while reading about the Blagojevich scandals in the Chicago Sun Times a few weeks ago.  It is called: 

”  Conquering cancer and heart failure…with Jesus, doctors and common sense”

http://blogs.suntimes.com/banks/2009/02/i_know_im_dying_children_but_i.html

This blog is written by a man named Lacy Banks, 65, who has been a columnist and sports writer for the Sun Times for 36 years.  He was their first African-American reporter.  Banks has  also been a Baptist preacher since he was 10 years old and  served in Vietnam for three years as a naval officer.  It’s definitely worth reading Rev. Banks’ bio in its entirety.

This past March, Rev. Banks went to the doctor and was simultaneously diagnosed with congestive heart failure, prostate cancer and brain cancer.  He needed a heart transplant, but because of his other illnesses, that was ruled out.  Fortunately, the brain tumor is benign.  Rev. Banks received brachytherapy (seed implants) for the PC, and fortunately, his PSA is down and holding steady.

Rev. Banks’ blog is the first I’ve seen that speaks earnestly of dying.  It is thoughtful, beautifully written and covers a lot of territory.  There are a lot of scriptures and hymns, but you don’t have to be religious to enjoy reading it.

Rev. Banks is fighting for his life, and so it would be really nice if you could say a prayer for him or stop by his blog and leave a nice comment. 

Here are some excerpts from Rev. Banks’ most recent post (Feb. 8).  He emphasizes the importance of work in his life — and death. 

“I am exercising regularly and I am pacing myself in my return to work as a Sun-Times reporter and I thank God that I have an understanding and kind boss in sports editor Stu Courtney and an outstanding employer in the Sun-Times. It has put me on the honor system and is allowing me to do the work that I feel I am capable of doing. The paper is not trying to play God or doctor. And I am not trying to play martyr or hero.

“I will share this painful memory with you, however. Three years ago, a superior of mine, perhaps in a fit of anger, told me I should retire because he felt I had slowed down physically and he knew I had undergone a triple-bypass in 2001 and still had a weak heart. ”Why don’t you retire and enjoy life?’, ‘ he said. ‘You ought to be able to do so.’ 

“Obviously, he knew nothing about my financial obligations, my need for the best health insurance and medical care available and what I could financially afford to do.

 “When other people dare to speculate and count your money, they always end up with a whole lot more than you KNOW YOU HAVE.

“Those words hurt me more than anything I had ever heard in my 36 years of working for the paper. It is true that I am no longer young. At 65, I am the oldest writer in the Sun-Times sports department and also the second longest in tenure. But I am still healthy enough to do my job. I’ve never had a heart attack. Dick Cheney has had several, as well as bypass surgery, and he was the vice president of the United States for eight years!

“Millions of Americans with congestive heart failure still work and live productive and enjoyable lives. Yes, I’m 65 years old and now officially drawing social security and I’m proud of my age. I thank God that I have lived this long.

“But even before I had a talk with the Lord and my lawyers, I knew that as long as I was healthy enough to work and, even more important, was doing my job properly, I could achieve something no black writer has yet achieved at this paper: and that is a normal retirement, not a forced one.”

Gleason Grade 7 or Above: Why You Should Consider Open Surgery

I want to pass on some information that newly diagnosed men absolutely should consider. It is from the excellent blog “Palpable Prostate” by A. Black.  The gist of this is that for intermediate- and higher-grade PC pts (GL 7+, PSA 10+), *open* surgery for PC is considered preferable to laparascopic (which includes robotic) surgery by a number of notable surgeons. One reason is that it allows for more extensive dissection of the lymph nodes, which is very important in this situation.

I am NOT saying that if you are in an intermediate or high-risk category you should not have minimally invasive RP.  What I am strongly suggesting is that you consult at least one open (traditional) surgeon to get a different point of view.  Do some research and find the most qualified doctor in your area.  Don’t settle for just anybody.

Dr. Alan Partin (of the famous “Partin Tables”), head of Urology at Johns Hopkins (top-rated urology faculty and top-ranked hospital in US by usnews.com), will not do a laparascopic RP on any patient with a Gleason grade over 7. This is also what I was told by Dr. Bertrand Guilloneau when I called about making an appointmentt for my husband a few years ago. Dr. Guilloneau pioneered the use of laparoscopic RP in France and was practicing it long before it was approved in the U.S.   He is also head of minimally invasive PC surgery at Sloan-Kettering, the #2-ranked cancer hospital in the US . (I understand that Dr. G. has since changed the rules, but I’m not sure why.)

The website I referred to, Palpable Prostate, has a 4-part survey of the relative merits ot the different kinds of PC surgery. http://palpable-prostate.blogspot.com/2007/03/rp-vs-lrp-vs-rlrp-part-1-open-surgery.html. Then there is a wrap-up of “what surgeons and others say”. The information here is comprehensive and well-sourced, with links to all cited references. Here is a pertinent excerpt of doctors’ opinions:

Dr. Kevin Slawin of Baylor College of Medicine:

“Dr. Slawin recommends that [patients with] Gleason 6 and less extensive Gleason 7 [3 + 4] can have laparascopic surgery, while patients with more extensive Gleason 7 [4+3] disease and Gleason 8-10 patients have open surgery and are most effectively treated when a careful, extended lymph node dissection, that includes the removal of all lymph nodes situated in the iliac, hypogastric, and obturator regions, is performed as part of the prostatectomy procedure. This type of lymph node dissection can only be best performed using an open, rather than robotic-assisted, approach.”

“Patients with larger Gleason 7 – 10 tumors, situated primarily at the base of the prostate, who have a high risk of seminal vesicle invasion, can achieve a lower positive margin rate and higher cure rates than those with similar tumors treated with standard techniques, either open or robotic, when treated with “en bloc” resection of the prostate, SVs and bladder neck.”

David F. Penson 

“An Evidence-Based Analysis (Feb 7, 2007) concludes that for low risk patients (all of: GS 6, PSA < 10, cT1 or cT2a) either open or robotic is reasonable, but for high risk patients (any one of: GS 8 or higher, PSA > 10, cT2b or higher) open surgery is preferred. For intermediate risk patients (GS 7) the proper approach is unclear.”

BTW, the results achieved of by minimally invasive surgeons (such as short recovery time), can often be equalled by an experienced open surgeon. Also, there is no evidence that the rate of ED is lower in patients who’ve had laparascopic PC surgery.   Finally, I believe there are fewer urinary problems with open surgerey.

In any case, read the information for yourself. Always remember that the most important thing in choosing a treatment is saving your life, i.e., *cancer control*.

Saving Your Sex Life: A Guide for Men with Prostate Cancer

I occasionally do book reviews, and am really excited about this one. I recommend it sight unseen because the author is one of the foremost experts in the world on prostate cancer and sexuality. The book is titled:

Saving Your Sex Life: A Guide for Men with Prostate Cancer”

by Dr. John Mulhall

(Hilton Publishing Company, 2008. Avalable at Amazon.com for $18.95)

I haven’t had a chance to read this book yet, but I wanted to get the news out. So I am providing excerpts from a review written by the Canadian Prostate Cancer Network (cpcn.org)

*I am also including a link to an article which appeared today in a medical journal. It features a full-length interview with Dr. Mulhall.* I suggest you read it as well. (The following is all one URL, you must cut and paste.) Here is a sample:

‘The most important thing is to convey realistic expectations. I tell all the patients who come to see me the same thing: Don’t base your decision [on which treatment to opt for] on sexual function. After three years, the outcomes from all the procedures are the same. Patients need to make an informed decision. If they don’t know what questions to ask and the physician doesn’t bring up sexual function, they’re going to make an ill-informed decision. Every day I have a man sit in front of me with tremendous regret—with tears in his eyes—who tells me, ‘If I had known it was going to be like this, I would have never opted for that treatment.’ Such patients weren’t given realistic expectations’.

http://www.renalandurologynews.com/
Prostate-Cancer-and-Sexual-Function/article/125900/

——————————————————————–
Book Review from cpcn.org:

“Saving Your Sex Life: A Guide for Men with Prostate Cancer”

“Dr. John Mulhall has devoted much of his working life to studying and treating the sexual difficulties associated with prostate cancer and its therapy. He is currently Director of the Sexual and Reproductive Medicine Program in the Division of Urology at the Memorial Sloan-Kettering Cancer Center of New York. . . .

He reports that, in his practice at Memorial Sloan-Kettering, he sees more than 600 radical prostatectomy patients, approximately 150 radiation patients, and about 100 hormone therapy patients each year. They are all interested in pursuing improved sexual health following a prostate cancer diagnosis and treatment.

“Yet, according to Mulhall, ‘The simple fact of the matter is that most physicians and patients do not talk about sexual health in a routine medical interview.’ Sometimes, he suggests, doctors treating men who have prostate cancer shy away from discussing in detail various of the possible side effects or complications of particular treatments. Their main initial focus is to save their patients’ lives, of course. But an information gap is often the result.

“Consequently, Mulhall sees a need for solid, credible information, communicated in plain English, about the possible impact of prostate cancer on sexual function and on what options are available to treat sexual dysfunction and help men and their partners overcome the sexual problems associated with this disease and its treatment.

“His book, ‘Saving Your Sex Life: A Guide for Men with Prostate Cancer’, fits the bill. It is ‘aimed at giving you state-of-the-art, up-to-date, comprehensive information on the impact of prostate cancer treatments on your sexual function and what options are available to you for the treatment of such sexual problems,’ writes Mulhall.

“Chapters describe the basics of male sexual function, the connection between prostate enlargement and sexual dysfunction, the impact of a prostate cancer diagnosis on sexual function, and the possible effects of radical prostatectomy, prostate radiation, and hormone therapy on sexual function. Mulhall continues by examining various options available to avoid or treat sexual dysfunction, including penile rehabilitation and preservation, drugs such as Viagra, intra-urethral suppositories, penile injections, vacuum devices, penile implants, and other emerging therapies.

“His book is comprehensive and has obviously been written to answer the many questions patients have asked him in the course of his practice. ”Why am I experiencing urine leakage during sex?’ ‘Can I still father children?’ ‘My penis seems shorter now. Is that normal?” ‘ What are the risks of testosterone supplementation? Mulhall’s direct, open, and intelligible answers are obviously the result of considerable experience and research, and they convey the doctor’s concern for his patients as well as his very effective “bedside manner.” Here is a sample:

“It is surprising to me how many men come in to see me after radical prostatectomy who are not aware that they will not ejaculate again. While some physicians may not tell their patients about this, there are patients who are so stressed before surgery that they simply forget what was told to them. . . If a man who remains interested in future fertility, it is important that he banks sperm prior to the procedure. Banking sperm is a process by which a man masturbates into a cup and the semen is then examined and frozen (cryo-preserved) for future thawing and use down the road (p. 121-122)”.

“As you can see, the prose is easy to understand, and there is no dithering or avoidance of the facts. . . Dr. Mulhall’s book is an excellent resource for men with prostate cancer and their partners. It answers all those questions about sexual function after prostate cancer diagnosis and treatment that men and their loved ones may not have asked.” . . .

Viagra May Protect Heart from Damage Caused by High Blood Pressure

“First evidence that the Impotence Aid Helps a Signaling Protein Protect the Heart”

Written by J. Strax, psarising.com.

“The first direct evidence in lab animals that the erectile dysfunction drug Viagra (sildenafil) amplifies the effects of a heart-protective protein has been reported today by a team of researchers at three leading US medical centers, Johns Hopkins in Baltimore, Tufts Medical Center in Boston and University of North Carolina.

“Published in the Journal of Clinical Investigation online, the findings help explain why sildenafil has already been shown to improve heart function and may one day have value in either treating or preventing heart damage due to chronic high blood pressure.

“The key, investigators say, is sildenafil’s effects on a single protein, RGS2, newly identified in the latest study as an essential link in the chain reactions that initially protect the body’s main blood-pumping organ from spiraling into heart failure.

“Experimenting in mice, the team of heart experts first established that after a week of induced high blood pressure, the hearts of animals engineered to lack RGS2, or regulator of G-protein signaling 2, quickly expanded in weight by 90 percent. Almost half the mice died of heart failure. In mice with RGS2, by contrast, the dangerous muscle expansion, known as hypertrophy, was delayed, growing only 30 percent, and no mice died.

“Subsequent tests treating hypertensive mice that had RGS2 with sildenafil showed enhanced buffering, with less hypertrophy, stronger heart muscle contraction and relaxation, and as much as 10 times lower stress-related enzyme activity compared to their untreated counterparts. In mice lacking RGS2, sildenafil had no effect.

“Sildenafil clearly prolongs the protective effects of RGS2 in mouse hearts,” says study senior investigator and cardiologist David Kass, M.D.”