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Rx for Marriage

By Dwan Reed   Dwan Reed’s Blog and Professional Web Site

I circled the carousel of self-help books. Improve your marriage…better health… become closer to God… Each looked interesting. “Should I choose one?” I wondered. “Who am I kidding? I need them all.”

I waved at Olive, my elderly friend, at the back of the grocery line and smiled, amazed at how fast she shopped. I had only been waiting twenty minutes.

Just then my phone rang. I trembled when my husband’s number flashed on the screen, took a deep breath and answered. “Did your results come in?”

He sighed, “Yes, and you’re not going to believe this.”

I waited for the good news. Thomas’s doctor, who obviously didn’t know how well my husband took care of himself, had referred him to an urologist for cancer screening. “Dwan, I have prostate cancer.”

I pulled the phone away from my ear and glared at it. Surely I was imagining this conversation. Thomas wasn’t really on the other end of the line. Yes, that’s it. Maybe one of those self-help titles took up residence in my mind. But the telltale number blinking on my cell’s screen told me otherwise. I pulled the phone back to my ear. “Did you just say what I thought you said? Are you sure the doctor was reading from your chart?”

“I’m sure, Dwan. And it’s not a slow growing cancer; it’s aggressive. The doctor wants to begin treatment right away. He says I don’t have much time to play around with this.

“Thomas, I don’t understand. How does a healthy forty-nine-year-old man have prostate cancer?”

“I don’t know, but I’ve got it.”

“This makes no sense. Shouldn’t there have been more warning signs?”

I don’t remember what Thomas said after that. My mind drifted, searching for “normal,” our way of life before this devastating diagnosis. I watched grocery items slide their way slowly down conveyer belts. Smiling clerks greeted customers, and baggers loaded plastic sacks and placed them in carts. I noticed another woman surveying the same carousel of books I had just circled. “I wouldn’t read those if I were you, “ I mentally challenged her. “You may receive a phone call with unexpected news.”

And “normal” was nowhere to be found.

One phone conversation, and fear had barged into my world, trampling the carefree expectancy of long life. Suddenly, I felt like a very old forty-one-year-old woman who had gained an undesirable understanding of, “tomorrow isn’t promised to any of us.”

I dropped off my friend, Olive, at the senior center and headed home thinking about the blessings I had always taken for granted. In spite of my husband’s spirituality, strength, and hard-working nature, I sometimes joked that I was trapped in a “ground hog day” of a marriage, complete with the repeat of humdrum every twenty-four hours.

My heart ached as I yearned for another eighteen years. I wondered, “What made me think it would last forever?”

Grasping the steering wheel with one hand and wiping back tears with the other, I petitioned God. “Lord, I love this man, but I know I don’t always act like it. What a fool I’ve been.” And as I pulled into our driveway, I continued, “God, Thomas is one of the best husbands and fathers in the world. Please forgive me for not being a better wife. What do I do now, Lord? Please save him.”

I slowly opened the front door, hoping my husband would meet me and announce, “The doctor called and it’s all a mistake. He confused my test results with someone else’s.” Instead, he pulled me to his chest and whispered, “Dwan, I love you… I don’t know what to say.“ As Thomas leaned down burying his head in my neck, I knew we couldn’t escape the reality of this illness that had invaded his body—and our marriage.

The coming months were difficult. We searched for a doctor who would address the lifestyle issues of a young man with an older man’s disease. With each serving of bad news, we cried and held one another, uncertain if we would be able to make love again the same way, uncertain whether my husband would have permanent incontinence issues, or worse.

Faced with the brevity of health, I wasn’t ready to let go. I longed for the simplicity of what I assumed would always be, yet helplessly yielded to a different course for our future.

For weeks, we awaited Thomas’s test results to determine if the cancer had spread. The ever-present malignancy in our lives began to melt my fierce independence and Thomas’s façade of indifference. As layers of buried emotions surfaced, I realized we’d lived together without truly knowing one another. I discovered that my husband was kinder, more loving, and enjoyable than I had ever imagined. And I hoped he discovered the same things in me.

The results came back. The cancer appeared to be contained in the prostate. The next step was to decide upon a course of treatment—surgery, radiation, proton therapy, naturopathic medicine, etc. Each therapy presented its own unique ramifications. For four months, we prayerfully studied each option and finally elected proton therapy and hormonal treatment.

Thomas took a two-month leave from work and rose before dawn each morning to drive across town for therapy. Day-by-day, his energy diminished while his slender frame surged to stocky proportions. I witnessed my well-tempered, reserved husband become emotional, reflective, and at times, irritable. A reluctant onlooker, I observed the passion in our marriage reduced to a kiss on the cheek as Thomas’s testosterone level dropped to near zero.

Even though Thomas was the one with cancer and undergoing treatment, I realized we were a team—partners in this battle; and I was willing to do anything to ensure my husband would live. To aid in his treatment, I mastered the art of cooking cancer-fighting foods. I took over many of his responsibilities, and learned not to complain when I was tired from carrying his load—and mine. I encouraged him daily, even when I felt uncertain of the future.

In spite of the changes in our marriage, we grew in intimacy beyond the physical. As we connected with each other’s hearts, minds, and souls, our home became a place of peace and hope—a safe house from the troubles of life. The shroud of disease lifted as we learned to laugh amidst trials and savor each new day.

A little over a year after my husband’s diagnosis, Thomas is now cancer-free with minimum side effects—praise God! His illness turned our world upside down, yet brought us closer. I don’t know if our marriage would have ever come alive, if it hadn’t been for prostate cancer. Prescriptions come in all strengths and forms, yet ironically, one of the most ravaging diseases in the world was the prescription we needed for a stronger marriage.

I never want my family to be affected by disease again, but thank God for the blessings that resulted from our journey.

Bio for Dwan Reed

Dwan Reed, Realtor and Broker’s Associate, resides in Houston, TX. She is a professional public speaker, freelance writer, and prison evangelist.  Visit her blog at www.dwanreed.com.

August 2010 Beam News – An Information Program Coordinated by Carolyn Allsen Nurse Manager

Date

Beam News For August … every Wednesday

Time
Aug 4

Chuck Merrifield RTT
Therapy Supervisor for PTC
Excellent information on your treatment and photos of behind the scenes at PTC

1 – 2 PM
Aug 11

Fellow Proton GU patients returning to answer your many questions….what to expect during and after treatment with and without Lupron!
  Will have 2, ProtonPals, 3 year veteran Peter Taaffe and 2 year veteran Thomas Reed

10 – 11 AM
Aug 18

Amy Stahl MS CNSD, LD, RD
Sr. Clinical Dietician
Maintaining a Healthy Diet

1 – 2 PM
Aug 25

Curtiss Beinhorn, LMT, NCTMB
Massage Therapy
Please don’t miss this meeting.

10 – 11 PM

How Aggressive Is That Tumor?

Scientists may soon be able to answer the agonizing question facing men with prostate cancer: Does their cancer need immediate treatment or can it be left alone?

Some 218,000 American men will be diagnosed with prostate cancer this year. An estimated 85% of those tumors will grow so slowly that they will never cause problems. But the rest are aggressive and lethal. As of now, there’s no way to tell early on which cancers are which, so tens of thousands of men undergo surgery or radiation each year for cancers that never needed treatment, risking impotence or incontinence in the process.

.[healthcolfront]

 

Read more about these new results  Prostate Cancer Quandary

As a Token of Appreciation

Mr. Harvey House, one of the ProtonPals has donated a song just for you. Mr. House owns House Productions and represents several artists. He’s donated a song by one of his artists is Jerome Jackson as a token of his appreciation.  You can download the song below for your personal use. A Song for You  If it doesn’t start playing automatically in QuickTime you may have to down load it. It’s an MP3 file - download it and play it in iTunes or other media player.

Every decade or two the entertainment industry surprisingly discover the abilities and vocal superiority of a musical genius. That musical genius has materialized in the form of Jerome Jackson. Mr. Jackson always had the showmanship, dedication and range to become a leading vocalist but his talents were always shadowed  or ignored. His early experiences began with gospel music at age 12, performing with James Cleveland and Shirley Caesar, gaining confidence and showmanship.

Jerome officially began his professional career in 1971 with the group Richmond Extension in Richmond, Virginia under the direction of Disco artist Van McCoy who recorded the legendary hit “The Hustle”. Jerome went on to release a single entitled “Everything’s Coming Up Love”.

Which PCa Treatment has less sexual side effects?

Reader question:

Which prostate cancer treatment produces less side effects, especially sexually: Proton beam therapy or external beam radiation? I have heard conflicting reports on the value of one over another.

I elected to do external beam radiation and now am experiencing sexual side effects. Later on, after I had finished my radiation, I heard of another patient who went to Loma Linda in California for proton radiation, and he says he has experienced no loss of sexuality.

If I had known this beforehand I would have investigated proton radiation a lot more aggressively. I did see a video clip on the internet from a Boston doctor, who said there was no advantage in doing proton beam therapy over external beam radiation. This really influenced my decision-process so I did not look into it further. And of course, my doctor favored the external beam radiation approach since he is associated with a radiation center.

I know I cannot do anything about my situation, but I wish there was more information out there on both radiation approaches for men could make the right decision for them. And it would be kind of a therapeutic for me to hopefully help other men get the right information to make the right decision. —B. A. (Houston, Texas)

Rabbi Ed’s Answer:

I’m sorry you’ve come to the point where ED has become a part of your life as it has for most patients after radiotherapy (external beam and seeding) as well as after surgical removal of the prostate, - a prostatectomy.  

To answer your question, most proton radiation patients who have prostate cancer treatment (about 6,000 a year in six U.S. locations thus far) seem to complain of fewer sexual side effects, compared to patients who have undergone other treatments.   However to my knowledge, most proton therapy patients, like those who choose other treatment options, will exhibit some degree sexual dysfunction, especially in terms of eventually being incapable of ejaculation.

So, while it’s true that using a proton beam enables doctors to destroy a prostate tumor with pinpoint accuracy, a substantial number of proton beam patients (though perhaps the minority) will also eventually lose their prostate’s capacity to produce semen (1/3 is from the prostate and 2/3 from the seminal vesicles.).   

It’s also true that up to half of external beam patients will eventually get ED within 5 years of their treatment, and the other half won’t!  How that breaks down for proton therapy patients has not been determined to my knowledge, though it wouldn’t surprise me if at least ¼ of proton therapy patients eventually ended up with ED as they get older. 

It’s true that unlike most proton beam therapy efforts, external beam radiotherapy – even IMRT, can affect some surrounding tissue, although less so than the original external beam radiotherapy.   However, a couple of years ago a Johns Hopkins report indicated that while proton therapy might cause less sexual dysfunction, it can lead to the loss of bone density in the hip area and hip fractures; so it may be a bit of a trade-off for some men, who may end up with better sexual function, but could be worse off in terms of their bone health.

Another report indicates that “Lateral overshoot in the region of the neurovascular (=nerve) bundles is …necessary to avoid the risk of under-dosage. In the future, this potential disadvantage will likely be mitigated by the use of intensity-modulated proton therapy, although at present only one center in the world is using this.” (http://jco.ascopubs.org/cgi/content/full/25/24/3565).

In simpler terms, proton therapy has a greater chance of destroying nerve bundles that allow for erection, situated on either side of the prostate as the tumor is eradicated. That will happen until further technological developments have helped lessen this possibility.

Finally you have to ask yourself if your ED would have transpired anyway, regardless of your type of treatment. ED is also a function of aging, diabetes, neuropathy, depression, or plaque in your arteries, not to mention “losing it (sexual function) because of not using it.”  In addition it’s the consequence of certain medications such as cholesterol drugs like Lipitor or anti-depressions like Cymbalta.

Besides, if you had any symptoms of ED before your treatment, you’re likely to be worse off sexually than those who were in good shape before treatment; on the contrary you are less likely to be fully functional sexually after the treatment ends. That applies as well to surgical patients who had a tough time before surgery and then had a prostatectomy – and that includes me! 

How can you and the rest of us get around ED and a lower libido? Explore with your doctor if you are a candidate for supplemental testosterone two  years after the treatment if not earlier. Also try to reframe “having sex” and seek to “make love”, which is a broader goal that can enhance intimacy. Involving yourself in sensate focus with your wife or partner with "whole body sex." In other words put greater emphasis on touching each other physically apart from intercourse, as that can reduce frustration, increase pleasure, and therefore make a big difference in enhancing intimacy.  

I hope that answers your question even though others might bring more medical details to this discussion. For an even more definitive response consult some urologists who do proton therapy to see what the outcomes of proton beam therapy have been in their experience. Still, be aware that like most patients, doctors, - regardless of the treatment option they favor,  tend to “root for the home team," so some proton beam specialists might understate proton beam therapy’s potential hazards.   

In addition check out  my book or other parts of this blog – Conquer Prostate Cancer (.com), or consult a couple of books on prostate cancer and proton therapy at Amazon.com. One book, called “You Can Beat Prostate Cancer” by Bob Marckini, describes proton therapy and its impact at length.  

If you learn anything more definitive, please let me know.  Meantime I wish you all the best for improved health. 

–Rabbi Ed Weinsberg

Choosing the Right Treatment for Prostate Cancer by Dr. A. K. Lee

Joseph Landry

Joseph Landry Five minutes of fame has finally come to me but may go swiftly if you don’t listen to the podcast. Just kidding. I went into one of the professional studios at the M.D. Anderson Cancer Center and got to do a podcast with my world class doctor. Dr. Andrew K. Lee director of the Proton Therapy Center. I was excited to be there and you’ll be able to tell if you listen to the recording. Being a geek, I may have been more impressed with the technology, the microphones, the recording engineer and as well as seeing Lisa Garvin, a radio announcer from a few years back at KPRC, do her work.

 

Dr. Lee’s blog for MD Anderson Cancer Newsline with link to the podcast.

 

Choosing the Right Treatment for Prostate Cancer

By Andrew Lee, M.D. on May 24, 2010 9:22 AM | Comments (0) | Trackbacks (0)

Lee_PTC.jpgNo man wants to hear the sentence, “You have prostate cancer,” but more than 190,000 men in the United States will be told that this year.
Prostate cancer is the second-leading cause of cancer deaths in this country, but the good news is that the death rate is decreasing. In fact, when prostate cancer is detected early and treated properly, men have a five-year survival rate of nearly 99%. But choosing the right therapy remains a daunting task for men facing this disease and their families.
Trying to learn about the diagnosis and the treatment options can be difficult. Choosing between external beam radiation therapy (proton therapy and IMRT), surgery (open vs. robotic-assisted) and brachytherapy (radioactive seed implant) can create anxiety for even the most informed patient. 
One size does not fit all
As a prostate cancer specialist, I would say that there is no one perfect therapy for every single patient, but I do try to give each patient all the information he needs to make the right decision for his case. While I want to effectively treat my patient’s cancer, I also want to preserve his quality of life - during and after treatment - as much as possible. 
All definitive treatments for prostate cancer carry the chance of side effects, which vary depending on the actual therapy and the patient. But we are always striving to minimize these effects by selecting the appropriate treatment for each patient. 
External beam radiation therapy is one of the most effective and flexible treatments for a wide range of prostate cancers. It can effectively treat localized disease, as well as more locally-advanced tumors, with good results.
Proton therapy a good option
Technologic advances also have improved our ability to deliver higher radiation doses to the prostate, while decreasing the risk of normal tissue damage. Proton therapy is one example of how advanced technology can be used to help treat patients, since the unique physical properties of protons allow higher radiation doses to be deposited at the tumor while minimizing unnecessary exposure to surrounding normal organs. This may result in improved cure rates with fewer side effects and can be done using just a few beams (one right-sided and one left-sided beam), which is something that cannot be done with even the most advanced X-ray techniques.
MD Anderson is fortunate to be one of a few centers in the world with proton therapy available for our patients.
Proton treatments typically take only 15 to 20 minutes each day and are delivered five days a week for approximately seven to eight weeks. Most patients tolerate the treatments extremely well and are able to continue to work and exercise during their treatment course and immediately after treatment is complete.
Proton therapy is one of the most flexible treatment options available for prostate cancer. At MD Anderson Proton Therapy Center, we’ve treated a wide range of tumor stages of prostate cancer as well as a variety of patients with proton therapy. So, it may indeed be an excellent option for many men, depending on their unique situation.
No matter what you decide to do, begin by talking with your oncologist. And don’t be afraid to ask and get in-depth details about all of your options.

M.D. Anderson Cancer Newslline - for PodCast

Stay in Touch with your Pals! Read the May newsletter.

The May newsletter assembled by the ProtonPals leaders went out this week end.  It’s full of links to new and summary information. You can view it by selecting the View our ARCHIVE  link to the right of the screen.  Here you’ll find the last 12 issues plus some meeting notices. Check it out and subscribe if you like it.

And let us know how you’re doing.

In this issue is Dr. Lee’s second blog and a podcast from the M.D. Anderson site. In that podcast you’ll hear how by the very slimmest of chances, I met an old friend;  how that led me away from surgery and to the Proton Center including the formation of the ProtonPals. 

JELandry 5/30/2010

Don’t Compromise if You’re Going to Have Surgery

If you are still considering what kind of treatment to have for prostate cancer and your urologist has you fast tracked to have robotic surgery using the Da Vinci system you need to read this.Almost 3 years ago we posted articles about how the radical prostatectomy is a blind operation and one even a surgeon would not have and preferred proton radiation. A Surgeon’s StoryWe also posted an article by the Oct. 2007 Wall Street Journal (WSJ), about how the outcomes of prostate surgery completely depends on the skill and experience of the surgeons. You might think this is a “given” but so many men like myself look upon the doctor or surgeon with unwarranted respect and so we will be reticent to question his judgment and reluctant about getting an second opinion. Or we will compromise not seek the very best surgeon he can find in the United States. Over the past 3 years I’ve met and learned from men in our ProtonPals group who will travel extensively to the best centers in the U.S. to get a second opinion and eventually to get treated even if it means leaving home for a couple of months.  See My JourneyOf course there are circumstances that will limit the choice you make, e.g. the time and expense of travelling out of town, the need for having family and friends around, and insurance coverage for the surgeon.  However you should be very picky and selective. Remember “Knowledge can be the best medicine of all”.  So here’s a bit of knowledge.Some urologists in the NY State study performed 2 –3 surgeries a year while a top urologist in Houston performs more than 250 a year. That means if he’s completing more than one operation a day, could very well be going from suite to suite to handle multiple operations in a day..  Average Prostate Surgeon in New York State Performs Fewer Than 4 a Year    Original WSJ Article by Peter B. Bach October 27, 2007  You probably won’t get a good outcome out of the surgeon who only does a few a year.Now last week Larry Hock sent us this article from the Wall Street Journal and the same thing applies to highly technical robotic surgery, maybe even more so.  Small regional centers with low surgery loads are adopting the Da Vinci robotic system. They may have for example a 100 cases a year for 4 –5 surgeons. In this WSJ story, a 178 bed non profit center in New Hampshire had the bad luck of making the news.  Surgical Robot Examined for Injuries  Here’s an outline

  • Some small centers don’t perform enough surgeries
  • Surgeons usually will not take the time off to get the requisite training.
  • It can take 250 – 700 cases to master the use of the Da Vinci system.
  • If used with inadequate training it can do more harm than good.
  • In one example surgeons got only 2 days of hands on training on pigs and cadavers.
  • Think of your child’s or grandchild’s X box game and see how difficult this is to control the elements in there. I can’t keep the cars on the track.

I’m not making a medical recommendation but giving you an encouragement to get more knowledge and use it to set your course.

After Surviving Cancer, a Focus on True Manhood

Surgical Robot Examined for InjuriesI wrote about Dana Jennings, a very good writer at N.Y. Times about 2 years ago. Dana who had Stage 3 prostate cancer and surgery at age 50 has been writing a blog.  That article I referred to was about performing Kegel exercises while being a Sunday couch potato watching football. Not typically a “manly” topic.  In my younger, single days in the 70s, I had learned how women used Kegel exercises for two or three reasons. Little did I know I would revisit the topic again 30 years later when I relearned about how they could be used to prevent incontinence in men who had urinary problems after prostate surgery and/or radiation.

In a February column this year, Dana wrote about his battle with the issues and side effects from prostate cancer surgery and radiation.  Please read this moving and well written article by Dana Jennings Blog @ NYTimes

If after your prostate cancer treatment, you’re dealing with erectile dysfunction here’s a take way line for you from his blog. “There’s no percentage in being erect and dead”.  As all things in life it’s not black and white but it was a decision you faced when you chose your form of treatment, and also like all things in life, there’s no free lunch. Even with the best treatment in the world with the lowest incidence of side effects there is still a chance that proton radiation will affect you and is a consideration when you make the choice, for example to have hormone therapy or not.

JEL 4/8/2010

Cancerwise OnLine – Is Proton Therapy Right for You?

Dr. Lee has an article in M. D. Anderson’s on line newsletter describing proton therapy.  This is notable in that the ProtonPals are acknowledged as a support and outreach group.  And of course we are. It’s just very nice that a Pal wrote me that he remembers 3 years ago when we were just a mailing list on a clip board in the “gown room” of the proton therapy center.

Joe Landry