Three Gleaming Rings, One Shining Marriage

When I was young I believed a wedding ring was forever. After you put one on, you never took it off. That same ring remained on your left ring finger till death do you part, or even beyond. It is a direct line to the heart and all that. But over the last 38 years I have learned that one ring doesn’t necessarily fit all. Rings can change, just as the nature of a marriage can.

My first wedding ring, the ring the rabbi told me to place on Barb’s finger as we said our vows, was a gold band. It had a groove in it, but was otherwise a pretty simple affair. Our lives were pretty simple too. We were 22. I was in medical school, Barb’s was in her first OT job. Gefilte the gold fish and Riff-Raff the parakeet made easy pets. No kids, no mortgage, and not that many responsibilities. An easy time to travel, even if the budget allowed only a bare bones European tour of 10 countries in 20 days. The motor coach was overheated and the tour guide sported a lousy attitude.

But the free and easy life didn’t last and neither did that first ring. I don’t remember if it became too tight, or if Barb just decided to surprise me with a new wedding band. This one was a more eye catching number. Four small diamonds, perhaps indicating we were checking off a new station in life. A good hospital position with lots of extra duties for me? Check. Extra training and certification in hand therapy for Barb? Check. Nice suburban homes? Check. Dogs and cats replacing fish and birds? Check. Two kids, days loaded with school, sports, b’nai mitzvahs, graduation? Check. So a little sparkle on my finger, and better accommodations on the next European tour.

Glitz has its attraction, but it can sometimes fade. The children go away to college for lives and families of their own, jobs change and so do goals and ambitions. My third wedding band, the one I now wear, does away with the diamonds and their twinkle. It is gold and platinum. Bimetallic, similar to the mechanism in old fashioned thermostats, it sets the perfect temperature balance. Just as our marriage does.

I have been having a little trouble with the ring lately. On many days, it is too tight for my finger. I suppose I should get it sized up. Or is it time for a new ring and a new stage of life? After all, we are in the new home, we are grandparents twice over, and our youngest child is soon to be married. Maybe it is a new phase of our marriage. I wonder what a new ring, or Marriage Phase Four, will be.

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Let’s Talk About PSA

The U.S. Preventive Services Task Force. Whew, that’s a lot to say. Hard to have a conversation when your mouth is that full. But the Task Force, or USPTF, is worth talking about and is asking us physicians to do some talking too. In a draft recommendation, the USPTF is telling men between the ages of 55 and 70 to have a discussion with their physician. The conversation is all about the risks and benefits of having a Prostate Specific Antigen (PSA) blood test to screen for the possibility of prostate cancer. This recommendation is a change from the USPTF’s 2012 recommendation that PSA testing should NOT be done in this age group. Why the change in the recommendation? Basically two reasons:

Some newer studies suggest that PSA screening can save lives. These studies are a little muddy, but anecdotally, I can attest that since the fall off in PSA testing following the 2012 USPTF recommendation, I am seeing more prostate cancers presenting with aggressive features.
There are changes in treatment options for men with low grade, low stage prostate cancer. These options can decrease the frequency of side effects (impotence, incontinence) in men being treated for prostate cancer. These men may now be eligible for protocols that involve “active surveillance,” in which a urologist carefully monitors the patient, with no treatment unless and until there is evidence of cancer progression.

To me, these points confirm that the risk/reward consideration is in favor of testing. If you find yourself (or a loved one) involved in the PSA or No PSA discussion with your health care provider, I hope the conversation goes something like this:

You: I think I might want to have a PSA test.
Provider: There are risk and benefits. Having the test may let us give earlier treatment to a prostate cancer, but you may become incontinent or impotent.
You: I understand and I think it might help me to have the PSA test.
Provider: The test will not diagnose all cancers.
You: But it might diagnose mine. I think the PSA test is right for me.
Provider: You may wind up getting treated for a prostate cancer that would not have killed you.
You: But if I am diagnosed, I will have lots of options. That is better than not being diagnosed until it is too late.
Provider: There is no guarantee this will save your life.
You: I WANT MY PSA.

So have the conversation. Weigh the positives and negatives against your personal beliefs. I hope you choose to test, but no matter what your decision, or your PSA results, I hope your life is a long and healthy one. And if you think this is an important discussion for someone else you love, please forward this blog, share it on Facebook, or give it a retweet.

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If you missed our remembrance of Max last week here it is http://www.chicagonow.com/downsize-maybe/2017/04/the-biggest-and-the-best-says-goodbye/

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photo credit: Lori Greig <a href=”http://www.flickr.com/photos/39585662@N00/4663902070″></a> via <a href=”http://photopin.com”>photopin</a> <a href=”https://creativecommons.org/licenses/by-nc-nd/2.0/”>(license)</a>

The Biggest and the Best Says Goodbye

April 20, 2017
It has been rough. When I saw the vet last month he thought I might have a good six months to a year ahead of me. He sent home some pills for the pain in my hips. It has helped, but I still haven’t been myself. Thirteen years is a long time for a big fellow like me, and I am feeling every hour, every minute, every second. Last night was the worst. I spent the night panting, and this morning I just couldn’t move. Not to take a walk, not to eat, not to take my pills.

She called him home from work, and then they called their son. They carried me to the car, and drove me to the clinic where people carried me in and laid me on a blanket in this room. I can hear soft crying, and feel hands stroke my back and chin. But my mind is blurred and thoughts jumbled. I feel a little jab on my hind leg, and the vet is murmuring to me. Now there is no pain. Now there is nothing. Now the kitty princess will be queen. But I will always be with you.

February 1, 2017
Getting my bearings in the new house. A little disorienting, but is nice that they have their bedroom on the first floor now. My hips were making it hard for me to climb stairs in the old house, and I would have hated not spending my nights with them.

All these wood floors are trouble though. My legs just splay out when I try to get up off floor. Sometimes they have to put their hands under my belly and lift me. But I enjoy my short walks with them. So many dogs in this new neighborhood. And a big pond nearby. I bet there will be lots of birds in the spring! Just have to remember to rest these bones.

March 15, 2011
They brought a new kitten home. I hadn’t seen the old one around for awhile, the one who could be mean. Don’t know what happened to him. This new one thinks she is a princess. Very cute and haughty. They give her lots of attention, got to be sure they don’t forget about me in all the excitement.

June 12, 2008
A perfect day. We went with the neighbors and their dog on a long walk, all the way to the railroad tracks and the grocery store. The sun felt so good on my deep black coat. And on the way home we walked by my girlfriends house. We romped in her front yard. A little play nipping too. But I would never, ever, ever hurt anyone or anything. It is just not in my nature. At bedtime he gave me my nightly chin rub, and then I lay down on the floor beside her side of the bed. A day we will always remember.

October 22, 2007
They got that DNA test on me, and guess what? No matter how much I look like an Irish Wolfhound, there’s not a drop of Irish in me. My genes say I am a labrador/sheepdog/chow/retriever. That’s quite a mix. But she still says I am the biggest and the best. That’s all that matters to me!

May 16, 2005
It’s two weeks since they took me from the shelter. She said she didn’t want a puppy, or any dog that was going to grow big. The daughter helped him talk her into it. They seem like a nice family. Today we are on a road trip to visit their son at college. We met a woman in a parking lot who said she adopted a dog just like me from the same shelter last year. She says their dog is an Irish Wolfhound and she bets I am too! My lady almost fainted, but I can see lots of fun times ahead. It’s going to be a wonderful life.

The First 100 Days: 10 Ways Raff Trumps Trump

Yes, we are approaching that milestone. While Barb and I join with the rest of the country in our countdown of President Trump’s first three months in office, we are almost at that 100-day point in our own transition to new down-sizers. Has the “honeymoon” period been a success? Let’s check in with how our initiatives have been doing.

Boosting the Local Economy: Grocery stores, big box retailers, restaurants, and furniture stores are all feeling the Raff impact in the neighborhood. No trickle down economics here, this is all cash on the barrel. Or should I say plastic in the chip reader. Got to keep earning my credit card points.
Improving the Job Market: We are keeping lots of local tradesmen busy with adjustments, fixes, and final touches. And sources report that Comcast has added an extra shift of technicians just to deal with the daily problems of our Xfinity TV connections.
Better Homeland Security: The number of false alarms, sensor failures, and forgotten codes has taken a tumble as a little Wi-Fi boost has solved our problem of spotty coverage in the house. OK, I admit the forgotten codes weren’t a Wi-Fi failure, they were a personal brain failure.
Reboot Health Care: As reported previously, health care (mine) has been a major issue of our last month. I am pleased to report much progress has been made as my difficulties have been repealed and replaced.
Immigration Reform: Based on the number of non-native, non-criminal, tradespeople and landscapers who have worked on the house before and after our move-in, I declare it a sanctuary zone. I plan on meeting with Rahm Emanuel soon to discuss the ramifications.
Voting Rights: After almost 3 months of procrastination, Barb and I spent a long morning at the Secretary of State’s office having our driver’s licenses updated to our new addresses. Much to Barb’s consternation, my new license continues to list my high school weight. It is a fiction I enjoy perpetuating. As solace for sitting on hard plastic chairs looking at pictures of Jesse White for 2 or 3 hours, we were also registered to vote at our new address. Got that done with 4 years minus 100 days to spare.
LGBTQ Recognition: No one has called me a homophobe since we moved in. And we are well into the third season of “Transparent.” We will finish it when the cable comes back.
Environmental Impact: It is our swan song.
Tax returns: Done and filed. Well, at least the extension request is.
Infrastructure Improvements: We just built a ?!#% house! I think I get a pass on this for the next few years.

I’ll match our record up to any administration. With successes like this, maybe we should plan for our next move to be to the White House. And we promise to release those tax returns too!

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The Mother of All Swans

harvey-and-sheila-2 — Harvey and Sheila on patrol.

We love our “down-sized” new home, our walking friendly neighborhood, and the serene pond next door. That is, we love it all except for the Canada Geese that come with it. Waddling, honking, and pooping, these big birds are a nuisance and a mess. According to Wikipedia, there are 4 to 5 million of these dung dumpers in the United States. Since we moved in, approximately three million of them have dive bombed within a 200 yard radius of our home. I can show you the droppings to prove it. Let President Trump build his wall to keep out the immigrants that he is afraid of, I want some defense against these foreigners.

In fact, we do have our secret weapon–swans!

Last year, as the house was being built, we noticed two lovely white swans had appeared on our pond, with two more on the adjacent inlet across the street. We admired these graceful creatures, Barb naming our pair Harvey and Sheila. Our many, many trips to the construction site were never complete without a few minutes watching the couple, who seemed to be as content on rainy days as they were on the sunny ones. Eight cygnets hatched, and the little armada would swim in single file across the pond, interweaving with the many ducks also floating by. By the end of the summer, only a few of the cygnets remained, and in the fall, Harvey, Sheila, and John and Yoko across the way, disappeared. This spring, four swans were back.

Now that we are living in the house, we are able to unlock the secret of our waterfowl. The ducks and geese arrive under their own wing power, but the swans are imported by our subdivision from a Wisconsin company, Knox Swan and Dog. I spoke with Bob Knox, the owner of the company for the last 23 years, and learned that his company winters 300 swans on a farm in Wisconsin, and delivers breeding pairs to various locations every spring. Each pond or lake gets the same couple each year. We got back our Harvey and Sheila!

The subdivision imports the swans with two goals in mind. First, their beauty adds to the aesthetics of the neighborhood. Second, their other useful trait is an intolerance for the Canada Geese–especially geese that might disturb their tranquil summer home on our pond. Spending a few days at home last week I had the opportunity to watch the swans on the attack. Gliding across the water, they set their sights on any goose that lands on the pond. As quick as a PT boat, and with barely a ripple of swan feathers, there is a sudden acceleration, the gap between the goose and the swan closes, until the quaking, quacking, goose flaps its enormous wings and flies off, safely out of reach of the swan’s beak. Score one for the good guys. Harvey, Sheila, John, and Yoko haven’t totally eliminated the neighborhood intruders, but the size of the fouling fowl flock has definitely dropped since our white knights returned two weeks ago.

We are ready to spend our summer in the screened porch watching our flock. We can look forward to a new brood of cygnets, though I learned from Mr. Knox that the tiny swans are easy prey for snapping turtles in the pond, explaining why the number of babies dwindled as the summer wore on last year.

I guess its all just a part of the circle of life, suburban style.

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Learning to Be (a) Patient

It runs like a river runs to the sea-U2 , 1987

Let the river run-Carly Simon, 1988

As anticipated in my last blog, I had my urinary tract plumbing procedure on rainy Wednesday. Most patients are sent home immediately after the procedure, but because of a few kinks (kinks in my history, not kinks in my urethra,) I had an overnight stay. I am now resting semi-comfortably at home. A catheter is in place to ensure that things keep streaming along. The big test will come Monday when the UroPartners team pops out the catheter. At that point, it will be all up to me to pee. By Monday evening’s Passover Seder I plan to be flowing like the mighty Nile did when Moses led the Jews out of bondage in Egypt.

And how did this doctor do as a patient? I spent the first twenty some years of my career as a pathologist in a community hospital, so the sights, sounds, rhythm and routine were somewhat familiar, but it is certainly different from a patient point of view. The good people at Advocate Lutheran General Hospital did a great job of helping me feel comfortable, and treating me with kindness and respect, whether or not they knew I was a physician. The staff was uniformly polite and every member, from housekeepers to nurses, assistants, volunteers and administrators was sure to identify themselves and make it clear just what they were doing in my room at 4 in the morning. And as my wheelchair was pushed out the door on Thursday morning, there was even a woman cheering me on with a hearty “You’re going home-Yeay!” I am not sure she is a hospital employee, but if she isn’t, I suggest that LGH give her some pom-pons, a cheerleaders outfit, and offer her a job!

I have written before of the many safety precautions we take in our lab to ensure the right result goes to the right patient. We bar code, color code, do manual double checks, and with patient consent do DNA identification verification. I was glad to see similar safety precautions in place at Lutheran General. I recited my name and birth date at least 5 times an hour. The 2D and 3D bar codes on my wrist band were scanned with virtually every contact with staff, and certainly every time any medication was being administered. I know that if my visit had been for an orthopedic procedure, the staff would have marked either my right or left knee to identify which side should be cut on. I don’t think that was necessary for my particular case–only one place for that cystoscope to go! By the way, if any of you are looking for an investment opportunity, alcohol based hand wash would be a good bet. To prevent spread of infection, there is a lot of hand washing going on.

Sorry, but I have absolutely nothing to tell you about what it felt like to be in the O.R. I have zero recollection from the time I was rolled out of Pre-Op until the moment I saw Barb beside me a few hours later.The intravenous sedative followed by general anesthesia was so relaxing that I think I will ask for it on my next trans-continental airline flight. It sure beats a Diet Coke and a bag of peanuts at 30,000 feet.

Kudos to my good friends and associates at UroPartners and my new friends at Advocate Lutheran General. I just hope that in my case, when it rains, it pours!

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photo credit: Onasill ~ Bill Badzo <a href=”http://www.flickr.com/photos/7156765@N05/32632872480″>Iceland ~ Landmannalaugar Route ~ Ultramarathon is held on the route each July ~ Water Falls ~ HDR</a> via <a href=”http://photopin.com”>photopin</a> <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>(license)</a>

Taking the Doctor Under the Knife

It is just a bit ironic. This coming week I will be undergoing my first ever surgical procedure. True, I am not a surgeon, so there is no irony in that. The irony I see is that as the Medical Director for the laboratory of the biggest urology group in Chicago I deal with about 60 urologists on a regular basis, and yet have delayed this necessary urologic procedure for about, oh, 6 or 8 years!

As is common for men of a certain age, my prostate gland has been slowly encroaching upon and compressing the prostatic urethra, the tube that runs through the gland and carries urine from the bladder to “out there.” In laymen’s terms, it was getting pretty hard to pee. I had seen a few different urologists at about 5 year intervals, and all had told me that some day, probably sooner rather than later, I would need a procedure to get things moving again. Not seeing any benefit in doing today what I could put off until tomorrow, I ignored their warnings and just accepted the fact that I would be spending a few extra minutes each day standing in front of toilet, thinking of waterfalls and bubbling brooks, hoping that positive biofeedback would get things flowing.

And then about three weeks the flow stopped as permanently as if it had hit the Hoover Dam. Inconveniently enough, my internist was on leave, but I knew which of my 60 urologist buddies he sent most of his patients to, so I gave that doc a call and we arranged a way to give me some relief. Urologists can do a magical job opening the floodgates with catheter tubes and balloons. With a little training, I have learned to do the magic myself–something I do not recommend for the squeamish or for easy fainters. And it is only a temporary remedy.

So a permanent solution needed to be found. My urologist and I discussed a variety of options, from newfangled metal splints that shove the offending part of the prostate aside, to old fashioned scrape and burn treatments. In the end, we have settled on a newer type of procedure that vaporizes the obstructing tissue but does relatively little damage to the prostate that is left behind. I am set for Wednesday at Advocate Lutheran General Hospital. LGH is the birthplace of Michael and Laury, so I will have happy memories to focus on while the anesthetic scrambles my brain. Recovery should be quick–no worries about being ready to dance at Laury’s wedding two months down the road. You may remember Barb had major surgery a few months before Michael’s wedding. It makes us glad we don’t have a another kid to deal with. Who knows what medical emergency would proceed a third wedding?

On a related note, my regular readers know of my interest and involvement with the diagnosis of prostate cancer. Fortunately, the area of the prostate that grows in my current condition is not the part of the gland that is the common site of malignancy. Although I have had a small spike in PSA, it is probably related to some inflammation. Nevertheless, I will keep a close eye on the values, and as always, I recommend that you, your spouse, or your partner have at least an initial PSA screen.

I can’t say whether there will be another blog before my big day, but if not, keep me in your thoughts and I will catch you on the flip-flop. We gone.

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photo credit: MashrikFaiyaz <a href=”http://www.flickr.com/photos/144410977@N03/32861108973″>Tiny Waterfall</a> via <a href=”http://photopin.com”>photopin</a> <a href=”https://creativecommons.org/licenses/by-nd/2.0/”>(license)</a>