The Walking Man and His Friend Spring Ahead

It is spring, but the Walking Man barely seems to notice. His tri-colored down jacket is still tightly zipped up to his chin, the North Face watch cap pulled snugly down around his ears. No scarf or gloves, and Nikes instead of boots, but he still shivers as the wind from the north cuts into him. Most of the snow has melted, but in shady areas, a thin layer of permafrost remains.

An “I Voted Today” sticker is pasted onto the Walking Man’s jacket. Although the temperature is still Chicago Bear Weather cold, the calendar says it is mid-March. It is the first day of the coming spring season, and the last day of the bitterly fought, overly-spent, primary season.

The little dog is once trotting at his side. The pup seems keenly aware of the impending spring. He sniffs along the ground than raises his snout to the sky, inhaling all the scents that are just beginning to awake from hibernation. He arrived here in the dull drab winter, but now, despite the cold, the sun is shining and his terrier instincts tell him better times are ahead.

If the dog is more sprightly, he also seems better behaved. He responds to simple commands, sitting at intersections, then resuming at heel. He no longer barks or lunges at the other dogs out for their afternoon jaunts. Perhaps he has been to the neighborhood obedience school, hour-long sessions in a dingy gymnasium, following in line behind retrievers and doodles and Dobermans, as they learn their basic manners, learn how to socialize with other dogs.

The Walking Man and his little companion pause for a moment at the pond, settling on the bench as the Canadian Geese strut and honk around them. He notices that the feeder and nesting dock have been returned to the waterfront. Soon the swans will be delivered to their summer home, doing their limited best to keep the geese from feeling too much at ease. With the swans will come cygnets, and the Walking Man wonders if this year more than one or two baby swans will survive.

Man and pup step inside as the last dawdling dog walkers in the neighborhood yield the streets to the commuters driving home at the end of their workday. It has been a cold walk, but in their bones they know, spring is here.
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Ten Things I Didn’t Do Last Night, and One or Two I Did

I was home alone last night. Barb was at a Homeowner’s Board Meeting, presenting a great new landscape design. So I did something I haven’t done in a long time. I grabbed the book I had been reading for the last two weeks–“Mrs. Fletcher”, a sort of creepy Tom Perrotta novel– headed for the kitchen and plopped down in the stool next to the island.

The lighting in the center of the kitchen is just right. I spread out my opened book on the countertop and I read. No diversions, no distractions. By the time Barb got home, I had sped through 110 pages. A few minutes later my reading was complete.

I don’t remember the last time I sat down and read like that. It is something I used to be able to do with ease. Now, not so much. But there is a cost. All those alternative activities I passed up. A list of things I didn’t do while perusing Perrotta.

THINGS I DIDN’T DO (AND MOSTLY DIDN’T MISS)

Take any turns in my 6 never-ending games of online Scrabble. Legalization of “qi” and “za” have changed the game, but give me a versatile “x” any day.
Watch this season’s final episode of “This is Us,” the most annoyingly introspective TV show since “30 Something.” Barb and I did watch the finale later in the evening. Why was I not surprised by that bizarre wedding toast?
Struggle through “March Madness” bracket. Not in any contests this year and I don’t miss it. But I am pulling for Loyola to win a game or two. I remember 1963. Vaguely.
Write a blog. I had the beginnings of one in the pipeline, but meh, it just wasn’t clicking. I may work on it some more, or more likely, just delete it.
Learn more about the Bear’s free agent signings. March’s excitement will invariably be December’s disappointments.
Send out Happy Birthdays, Likes or other Thumbs Up on Facebook. Dear friends, if I missed anything important, I beg forgiveness, but I escaped Mr. Zuckerberg’s mind trap. For at least one night.
Mourn Rex Tillerson. I also banished Donald Trump, Mike Pompeo, and Gina Haspel from my thoughts. There will be plenty of time for learning about waterboarding when I read this morning’s New York Times.
Take Milo for a walk. It was too cold, too dark. But I did take him out briefly for a call of nature. Between chapters, of course.
Play with my Fitbit. 10,000 steps a day? Child’s play. If I don’t hit 100,000 in 7 days, it has been a lazy week.

It was a joy to just read, read, read. And the one other thing I did? There IS a hazard to reading in the kitchen. Cold pizza, and more. After the munchies, the 10th thing I didn’t want to do last night-

10. Get on the scale.

My suggestion to you for a great night? Turn off all the screens, grab a good book and a glass of wine, and keep turning those pages.

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In Prostate Cancer, 3 + 3 = 1. How Does That Add Up?

Prostate Cancer Gleason 3+3=6, Grade Group 1

You are looking at the headline and thinking, “Boy, this guy has lost it. He doesn’t even know that 3+3=6.” Well, that’s the way it used to be in prostate cancer. But in the last year or so, the assembled multitude of prostate pathologists have gotten a lot smarter, or at least more sensible. The benefit is to the patient, making the choices that have to be made in dealing with prostate cancer a little more straightforward.

You see, whenever we are looking at a slide in a case of cancer, one of the pathologist’s most important jobs is trying to estimate, based on the tumor’s microscopic appearance, how aggressive it might be. Often, we use generalized terms, identifying the cancer as “well-differentiated,” or “poorly-differentiated,” or for those somewhere in between, the highly nebulous term “moderately-differentiated.” Sometimes we use the phrases “low grade” and “high grade.” In breast cancer, we may use numeric scores for various microscopic features, add them all up and come up with a score to pass on to the oncologist and patient.

And then there is prostate cancer, home of the Gleason Grade and Score. The Gleason Grade is named for Donald Gleason, a pathologist whom back in the 1960’s examined tons of prostatectomy (removal of the prostate) specimens at the Minneapolis Veterans Administration Medical Center and recognized various microscopic patterns that he connected to different degrees of aggressiveness. He gave these patterns a numeric value of 1 through 5, creating the Gleason Grade. The Gleason Score was obtained by adding together the 2 most common grades, and thus could range from 2 (least aggressive) to 10 (most aggressive.) And there the matter stood, with minor adjustments by panels of renowned pathologists, for almost 50 years.

So what’s wrong with the Gleason system? The problem is twofold. First, Gleason Grades 1 and 2 were sort of wishy-washy tumors that might not have acted much like cancer at all. Second, Gleason’s studies were all done with the entire prostate available, while now, most patients are diagnosed with skinny needle biopsies that don’t even reach the center portion of the prostate gland where most of Gleason’s Grades 1 and 2’s could be found. Also, these skinny needles biopsies aren’t large enough to show the architectural patterns needed for the diagnosis of those 1’s and 2’s.

What’s the upshot, and why is any of this important? Based on the paragraph above, you can see that the least aggressive prostate cancer that we are going to diagnose on a needle biopsy is a Gleason Grade of 3+3 for a Gleason Score of 6. And we now know that for many men with a Gleason Score of 6, an approach called “active surveillance,” which means careful follow-up without definitive therapy, may now be the treatment of choice. Do you see where the problem is going to be?

Mr. Jones has a prostate biopsy for an elevated PSA and I diagnose prostate cancer Gleason Grade 3+3=6. Dr. Smith tells Mr. Jones “You have cancer, but I think that rather than surgery or radiation, we can try active surveillance.” But Mr. Jones has been doing his Googling and says “But Dr. Smith! My cancer is a 6 out of 10, and I think that is pretty bad! I want treatment.”

Thus the dilemma, a cancer that sounds much more aggressive than it may truly be. To resolve this discrepancy, we have a new approach. We still determine a Gleason Score, but we now additionally place the tumors in Groups 1 through 5. The higher the Gleason Score the higher the Group. Our old lackadaisical but scary Gleason Score 3+3=6 is all alone in Group 1. Gleason Score 3+4=7 earns a Group 2, 4+3=7 occupies Group 3, and the various higher Gleason Scores comprise Groups 4 and 5.

Now Dr. Smith can say, “Mr. Jones, you have prostate cancer Group 1 and I think we can hold off on any treatment for now.” And it is a whole lot easier for Mr. Smith to respond, “I think that is a fine idea.”

All it took was some modern math.

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The opinions above are those of the author and not of UroPartners LLC.

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