Back To...... Normal???

Back to work for two weeks already.  Having a great time being back on the patient side of pharmaceutical marketing -- trying to help so many in our country suffering from diabetes.  Man, does time just whip by me these days.  Luckily I had lots of entertainment while I was recouperating.  

Received a clean bill of health and my PSA is zero.  Great combination of prayers and the unparalleled skill of Dr Peter Scardino.  All is well.  Need to return for check ups every six months.

It's enlightening to reflect on the yin/yang of some and potential of others....

While the collapse of the Mets was tough and watching the Phillies win the World Series even tougher there is a certain subtle pride that grows as the Jets - who weren't expected to do much this year sit atop the AFC East...and the much heralded Eagles plummet to the depths of the NFC East - making Giants fans such as my wife happy...

By far the most engaging entertainment while recovering was the devolution of the"high-road, issue-based" presidential campaign.  Oh how even the promise of power and the resulting desperation debase even the most proud of our national heroes.  After decades of "maverick" positions and leadership, we got to watch as John McCain folded to Fundamentalist pressure and abandon his ideals and positions and even signed up for a shallow Rosencrantz-like VP.  At least Sarah Palin seems to have achieved the goal of escaping a state within eye sight of Russia.  Everybody seems to want to perpetuate her entertaining skills.  Luckily she had that great international diplomacy experience.  To bad she didn't realize that Africa is a continent...

On the home front there was lots going on.  I began to pick up my walking and even expanded out from our area to the Capital.  Right before going back to work, the family spent three days in Washington DC and enjoyed seeing so many of venerable, stoic memorials:  The Washington Monument, Lincoln Memorial, World War II Memorial, Korean War Memorial and Vietnam Memorial.  So many war memorials, good thing the Republicans are sitting out at least the next four years - don't know if there's room for any more war memorials.

At the foot of the Lincoln Memorial the entire family had a chance to write note and sign an oversized card being delivered to president-elect Barak Obama.  It really moved Cathy.  The kids just thought it was cool...

Halloween was great too. I was out there with the kids in a costume that exposed the darkest recesses of my personality.  It was great to play dress up and scare the crap out of local kids...

Have a great Holiday Season and thanks so much for stopping by..

STILL.......More Great News

A little over a month since Dr Scardino blessed me with his amazing skills.  Since that time I've shared some great news as well as some of the challenges and cautions associated with my condition with so many folks.  In the last month I confirmed I have a heart and it beats just like everyones'.  I also learned that the operation, which under normal circumstances is very challenging, presented extraordinary complications for a man considered to be the best in the world because I am not put together like most people in the pelvic area.  Learned about the dangers of post op sedentary living and that hangin out with my kids in the morning and going to the bus and picking them up in the afternoon is a joy.  Oh, and after living in this neighborhood for almost a decade, I now know the name of just about all the streets in the neighborhood - not so hard considering they all originate from Homer.

NOW...I've gotten the best possible news.  On Tuesday, I went over to MSKCC to provide samples to determine the status on the two urinary track infections and get a update on the PSA levels.  On Wednesday, Dr Scardino's office called to let me know that the two urinary tract infections are clear, and most importantly my PSA LEVEL IS NOW ZERO.  That means that I don't have to worry about anything else for a long time.  No radiation treatments!  Only additional action is the PSA test every six months.  Not so bad...

So thanks to everyone for their prayers, calls and thoughts.  I owe so much to you!  I also need to thank Dr Scardino, his fellow Dr O'Brien (who actually got some of my jokes - and replied with a few of his own), all the staff at MSKCC and a special thanks to Mike Davenport who directed me to the amazing lady, Karen Stein, who helped direct my search for medical help and refine my thinking at the very beginning of this journey.  Finally, I would be nowhere without the help of my wife Cathy who has empathized with the various emotions along the way and my amazing family from Helen, Michael and Jack to my brother Bob and sister Jeanne Marie and Jack and Terry Reynolds and the network of family and friends who have supported me through this interesting time.  I appreciate all the help!

One closing thought for today.  While it is a tragedy that 1-in-6 women will contract breast cancer (and I by no means wish to minimize the horror of this disease), 1-in-4 me will contract prostate cancer.  Do you think the public warning signs and awareness levels of signs is equivalent for each?

Great Stuff All Over

Rehab is still going great.  Only four days of multiple meds for the urinary infection left.  Taking a pill every six hour is a pain in the neck, but if it cures what ills ya -- guess that what matters.  At least I have nap time.

Today is an amazing day in the suburban northeast!  (Check out some of that foliage.)  Out for my 1.5 mile walk just suckin up the beauty that is autumn is New Jersey.  Crimson, gold and green on the clear blue sky, a solitary leaf drifting on a breeze and a senior raking a small pile of freshly fallen debris just make me appreciate the simplest things in life.  Wish that I would have the presence to pause and consider these things don the typical rollercoaster day.

Some other great stuff in the last week:

My brother Bob and his family came out to visit (that's Connor with the Mike and Jack.

Helen's havin a great time cheering.  We all went out to enjoy the game - or at least the cheering since Parsippany was crushed 27-0.  That's Cath relaxing and Mike with me.

The images on the political scene are a very sharp contrast.  Twists of truth and outright lies from both sides just disgust me.  The hubris and arrogance of the last eight years, topped with an economic collapse unlike I can recall  surely make it seem like the blue tide will rise.  But in America you can never count out the ignorance of the masses and racism.  Some folks think Barrack is muslim (not that it should matter), some printed voting ballots are actually spelling "Obama" as "Osama"    It's a confusing time for sure.

Thanks again for all the the prayers, calls, cards and emails.  I'm humbled by so much love....

Amazing Blessings....

So many things happening so quickly.  The incontinence is almost completely under control.  I am so blessed and thankful for the skill of Dr Scardino, the support of Cathy, my family, friends and all the prayers and positive thoughts.  I want to weep when I think of how undeserving I am of all the kindness coming my way.

The jargon of medicine is so peculiar.  When "positive" is bad news and "negative" is a great thing.  I had the opportunity to hear both and if I had to match one word with one situation in a set, I could not have done better.  Speaking with one of the most sympathetic  individuals who truly personifies all the best in nursing - Christine (Dr Scardino's nurse) - today, I learned my pathology report was completely negative!  The cancer was completely encapsulated within the prostate.  Twenty-three lymph nodes and the bladder neck all negative! In Christine's words, "the pathology report was perfect, A+, couldn't be better!"

Since every little thing can't be perfect, there had to be a tinge of "positive" in the conversation.  The test on the urine taken Friday was positive for a urinary tract infection.  There was also some abnormal pockets of fluid on the shaft of the penis.  So back into MSKCC on Wednesday.  Hopefully the additional Cipro taken on Friday evening and Saturday eliminated the infection.

But hey, if you had to choose either the pathology of infection to be "positive" wouldn't you choose this outcome!

The man who is well wears a crown that only the sick can see.

Wish I could take credit for this one, but it comes to me from Sir William Osler via Dr Patrick Walsh's Guide.

The last twenty-four hours have seen the passing of one emotional challenge (the catheter) and the rise of a new one (the incontinence).  Neither has been that tough physically with which to deal.  Emotionaly, it's a whole other story.  You know how it is.  We all have challenges and the first few times are most difficult, but after a while, we develop a system or compartment in which to deal with them most effectively for us.  I'm just at a point where once I git it figured out -- brand new challenges with their own unique requirements for addressing them.  Sort of like a psychological fun house ride where new stuff keeps popping up, providing a shock and dropping down - take a breath and ere comes the next.  Just gotta stay level.

The incontinence is doing better not every day, but every minute (so far).  Made it through the night -- no problems!  The confidence is building and I'm doin better all the time.  Heading out to see Helen play soccer and the b0ys play too.  Of course both games are at the same time in different places...that's just a parental thing.

Helen had to make a big decision soccer or cheerleading.  Chose soccer and played great!  Not only shutting out the competition, but also scoring the game winning goal!

At the boys game I showed up just in time to see Michael get kicked in the eye. But heard that he and Jack were scoring machines!

The boys came from karate Friday night in their new Karate uniform -- black robes and white belt.  Looked amazing -- for a minute I thought I might be seeing their Halloween costumes.  Our tables, chairs and oh yeah daughter are all still in tact as are the boys hands!  No emergency room visits yet.

The Tampa Rays starting former Met farm hand Scott Kazmir, the pitcher the wise sage Tom Glavine said would have no future, you know one of the most-feared left-hand pitchers in all of baseball did a pretty good job last night.  Combine that with the LA Dodgers, behind the leadership of American League East cast offs Joe Torre and Many Ramirez, are getting ready to extinguish the dreams of second city north-siders. LA to the Bay a nice ring -- not so hot for ratings.

From the Frying Pan to the Fire...

Got the catheter out today and was not psychologically ready for this.

Got the "maxi-pads" and have gone through four in the last two hours.  That a least minimizes the number of pairs of pants I've soiled.  Can't control timing or direction and can easily see how this might make a lion roar a little louder... at least he controls that.  And it's better than crying in an empty house.

Every time I stand, sit or take a drink -- out goes any illusion of control.  They say this could last up to two years!  I cannot have that. Some guys get to some form of control in three months... sure hope that is me.

Gotta really remember the saying I developed for me and those like me:  Nothing is ever as bad, or as good, as it seems.  Maybe a tattoo on the forehead and back of the hands???

One door closing...

The last couple of days were great!  Waking, showering, medicating and taking a nice mile and a quarter walk to our local park with the three kids.  Getting a chance to chat with them about their lives and quizzing them on big things at school and the world around them.  Great question from my daughter Helen, "Daddy, which of us is the most like you when you were little?"

Great question.  I explained that there were different parts of me in each of the three of them from the physical - the size of Jack's head - to the mental - Michael's temper and Helen's self-criticism.

I am so humbled by the gifts from so many friends.  Thanks to everyone!  My family and I are enjoying everything like the wine, fruit, candies and cookies!  This has got to be the best part of having you prostate removed.

On the other end is the Foley catheter and bladders.  This is becoming more and more difficult.  With the nearly constant bladder pressure whenever I am not lying flat on my back and periodic leaks.  Not little drip, drop leaks, but like a garden hose has sprung a leak out of nowhere.  Going through lotsa towels!

Tomorrow the catheter is removed at 10:00 AM at MSKCC.  I also get the Pathology report at that time.  This is the next major bridge.  All touch and go on using diapers, pads and plans.  Heard this is the hardest part -- amy be sleeping in a new room -- think Cathy is purchasing a mobile to entertain me while I a in the bed!

The End of a Stadium

Well, Shea Stadium will soon be gone.  There will be no more games, no more concerts and no more memories born in the home of the Mets and Jets.  I know the ammenities at Shea were no longer comparable to those offered at the new breed of retro stadiums around the country.  I even suffered stadium envy as I went to newer stadiums in Baltimore, San Francisco, San Diego, Seattle, etc.  But this was the first stadium I ever attended.

A young kid siting in the Upper Deck looking down on the (often empty) orange seats below wondering, imagining what it would be like to hear the players, or the snap of the fast balls instead of the fat guy with the accent yelling about the ineptitude of Joel Youngblood.  I loved watching baseball and only baseball until there was an Islander team in 1972.  I was alone in my family when it came to sports.  But my father would take me once a year to see the Mets play the Yankees in the annual Mayor's Trophy game.  Other times, I sat alone in the typical Long Island finished basement watching Mets games.  Back then the fans were more integrated into the team.  There were banners in the stadium, and even special scheduled double headers when between games the fans were welcome, no invited to parade onto the field to display their home made proclamations of loyalty to their home team.

I remember watching Mets games when my friends were watching football and hockey.  My maternal grandfather taught me to play baseball and shared his love of the Mets and any team playing the Yankees..  Until I was ten, there was no other team but the Mets.

From the dim memories of 1969 and receiving the pen/ink portraits of each of the miracle workers sold by the Daily News from my fraternal grand mother.  (They remain in my Mets binder today.)  To listening to the radio call driving home from working Saturday construction at the Executive Towers on the Grand Concourse in the Bronx as the bully Pete Rose throttled our Buddy Harrelson at second base.  The Mets were scrappers who never backed down.

The magic of '86 when the Mets beat every comer and excuses that other teams played harder against us were never whispered as we destroyed every team and city in the National league and the mid-summer replacement of the Mayor's Trophy game where my friends and I accompanied the Mets to Boston to watch them beat the Red Sox in the precursor to the World Series.

Entering an evening class at Farmingdale College on October 6 after work as the Mets were playing the Astros, I was bummed that I would miss the outcome, only to emerge hours later to learn the Mets were in the 13th inning and holding on. Prolonging the game so I could watch the end at Aspens in Wantagh.  I was there with friends in the 16th inning as the Mets shut down the team whose fans they had thrown a beating in some bar earlier in the season.

Being in the Upper Deck of Shea for game 2 with girlfriend Valerie as Glenn Close sang (still wince whenever she sings at Shea) the Star Spangled Banner to open the first World Series game I ever attended.  We lost that game, but ..... well you know.

The last nine years, my wife Cathy and I were lucky enough to have Saturday package tickets.  It made me feel so accomplished.  Taking my daughter Helen to the frigid games in April before she was one year old.  Sharing post-season tickets with my brother Bob as we watched the Mets' Bobby Jones pitch a one-hit shut out to clinch a spot in the Championship Series against the hated Cards. 

Cath and I have had the privilege of taking our sons (Michael and Jack) to games as well.  As a matter of fact, taking turns attending games with me (we only had two seats) was one of the first things Michael and Jack did without each other.  I cherish those times of one-on-one with each of my children.

Shea even provided a stage for a great guys weekend with my in-laws a few years back.  My brother in-law Tommy hooked up the entire male crew - father in-law Jack Reynolds, his son Kevin, in (or out)-laws Scott, Chris, cousin John Donahue and I had a ball going from a parking lot where handicap players in wheelchairs played baseball to the best seats I ever placed my bottom in at a professional sports event.  You know -- the ones right behind home plate that are on TV.  They were so good - my sister in-law Maureen even called us on the cell from Minnesota 'cause she saw us.  Yeah - we were the goofy guys waving back at the camera. 

Even the disappointments of the last few years and the spectre of a new stadium rising in left field didn't tarnish some great times.  Cath and I were there when Endy Chavez made one of the greatest catches either of us ever saw against the Cards two years ago - only to then watch Carlos Beltran rest the bat on his shoulder as a called strike three ended another season of hope. Given the Mets history, it was great just having hope that late in the season.  

And this year, while my operation prevented me from attending the last Saturday at Shea, the memories kept coming.  I was able to take by oldest friend Terry and his son Brendan to a game allowing five month old Brendan to one day stake a claim to having been at Shea, just as Terry had been to the Polo Grounds as a child.

The first football game I ever attended was a Jet game at Shea in 1980.  (That would be the only football game I ever attended for almost a decade - unless you count the Generals.  

Shea was also the home for some great concerts.  During the early '80s when sports was taking a bit of a back seat to music in my life, Shea was still there.  I saw the Who and the Clash with some questionable characters no longer in my life. My brother Bob,best friend Terry and Bob's buddy Alder and I sat in the upper deck behind home plate to watch what we were told was the Rolling Stones.  Can you believe some guy a row behind us asked us to sit during Sympathy For the Devil.  The usher did not attempt to enforce the request.  Was lucky to be given priority seating for the Bruce Springsteen Band 'cause of the Mets package seats.  (One very sweet part that night was knowing my boss Randy Sloane was in the upper deck as I sat in the ninth row.)  But the high point had to be this year, with all the challenges I had been facing, my amazing wife Cathy got fifth row tickets to allow me to witness the icon of Long Island - Billy Joel - perform an amazing show at Shea.  Some guests included Don Henley, Tony Bennett and John Mellancamp.  Yeah I had to yell "Yankees Suck" to Paul O'Neill as he walked by. Not a very proud moment.

Don't know if I will be given an opportunity to buy Saturday package tickets to the Citifield.  The Wilpons have not decided if us package holders deserve any special treatment.  We'll have a brick with our names and a quick saying at the new field.  

So the closing of Shea marks the closing of a major chapter in my life.  Maybe this is truly the end of the innocence - at least for me...

The Aftermath

Well, its the Monday after another heartbreaking Mets season.  EVen the great Johan Santana could not save the collapse of this team.  Playing the hapless Marlins again, the could not generate as much offense as a local high school team.  The pall of another team missing passion, persistency and spark fell over the closing of Shea Stadium like so many missed opportunities before.

Maybe it's good that the Wilpons have chosen to cast aside people like me who have held ticket packages for so many years.  (I had Saturday ticket packages for eight years.) Maybe this treatment as income streams no longer needed instead of as fans who bonded with and supported the team through (the rare) thick and (never-ending) thin lead to some of the east acceptance of yet another disappointment.  Most of the folks who sat by me in section 18 of the Mezzanine didn't buy the post-season option this year because they knew they were not valued by the Wilpons of Brooklyn. Wonder when I'll get my post-season ticket money back?

Kind of poetic that the primary stadium of my youth where I enjoyed Mayor's Trophy games with my dad and first saw baseball with my grandfather, where so may memories shared with friends and family were born, is being destroyed just as the organ of my youth and manhood, the organ which enabled my to help create my three amazing children has been removed.

Anyway, the Jets won and I am recovering quite well.  Was up and walking today.  Went outside for a walk around the neighborhood for about a half hour.  Great to move the limbs.  Starting to get better at managing the catheter rotation and had a nice chat with a neighbor about my docs.  He said next to lawyers, he trusted docs the least - sorry to my friends in the Legal community.

Had a chance to read more of Guide to Surviving Prostate Cancer, and am grateful for the ignorance I enjoyed before the operation.  On page 264 of the book, Dr Walsh says, "There's no getting around it, radical prostatectomy is a tricky operation, one of the most difficult in medicine.  There can be tremendous, at times life-threatening , blood loss."  Boy am I glad neither Cathy not I knew that before or during the operation!

The next hurdle is removal of the Foley catheter to see how much urinary control I have.  They say those who are continent immediately after the surgery are blessed.  I know my in-laws and friends are well-connected and praying hard, so hope the quality and volume of prayers is directly proportional to the blessings I have.  We'll know more Friday.

The Beginning

September 27, 2008

Thanks for stopping by to check out a few of my thoughts.  I'm starting this cause I need to vent about a bunch of things and think a great injustice is being perpetrated upon the men of this country by our "health care" system.  

On May 23, 2008 my PSA (prostate-specific antigen) test, which I'd requested since my uncle had been diagnosed with prostate cancer ten years ago, came back with a new high of 4.11.  This showed an increase from the 3.05 test level from 2006.  Now these numbers probably don't mean much to the average person since next to nothing is done to inform men of the importance of screening, the simplicity of testing (just another check mark on the same vial of blood that is typically tested at each year's physical), the values which are "normal" or the potentially devastating side effects.  The big joke about prostate cancer is that diagnosis isn't important because it grows so slowly something else will probably kill you first.  Not true when you have a history in your family.  I was diagnosed at 47.  

When I shared my case history with one of the best surgeons in the country, he let me know his staff at Memorial Sloan Kettering was "shocked" at the severity of the cancer, and pondered why my primary care physicians (PCPs) at Madison Internal Medicine in New Jersey took no action when the PSA of 3.05 was reported two years ago.  I guess they just fixated on the magic number of 4.00, but did not take into account that that level is a reference for men around 70 and the value should be significantly lower for a 45 year old man.

But I digress.....

After receiving no guidance from my PCPs on selecting a urologist with whom to follow up on  the readings of May 23, I wound up with a very reputable urologist in Denville, who digitally examined my prostate and told me there didn't seem to be any problem.  But, to be on the safe side, he was going to do a biopsy on the prostate.  Looking back, I'm amazed that this would not be done as a matter of course for someone with a PSA of 4.11 at age 47, but the deeper I descend into the labyrinth that is the American health care system, the more it appears that PCPs are nothing but gatekeepers for access to health insurance trying their best to minimize costs for those companies.

On July 11, 2008 the biopsy was done by taking 12 tissue samples from my prostate.  This is done by sticking a nice size probe up my ass and clipping off pieces of tissue from the prostate itself.  I am sure there is a sub-segment of the patient group that enjoys anal invasion, but it ain't me.  My urologist was going on vacation for the week, so I received the results on July 21st.  Ten days is a long time waiting with your head in a guillotine to hear if you have cancer or not.  It doesn't feel much better when you hear that ten of the twelve samples came back positive for cancer.  The fact that my in-network physician sent the samples to an out of network lab resulted in a $4,500 bill which I now have to fight just added more distractions.  (That's another whole tangent.)

Well, now I know I have cancer, so we next have to figure out how far it has spread.  That delay between 2006 and now is weighing heavily on me now.  After going for blood tests (CBC/Kidney) and going to St Clare's on July  25th for outpatient tests - CT of abdomen and pelvis with contrast and a whole body bone scan, I am told by the urologist that the cancer does not appear to have spread.  (When reading Guide To Surviving Prostate Cancer by Dr. Patrick Walsh from Johns Hopkins, I learn that the CT scans don't really indicate anything because of the nature of the test focused on large masses.  By the way, any man who has any questions about prostate cancer MUST get this book!)

My urologist says the decision to either go with traditional removal, laporascopic robotic removal, radioactive seed implants or radiation therapy is a personal choice that differs for all men.  When pushed, he says he would remove the prostate via laporascopic robotic surgery done by his associate.  My independent readings indicate this relatively new procedure could be a great way to go.  My readings also indicate that the severity of side effects is directly linked to the skill level and experience of the surgeon.  I am not going to simply trust the word of any single health care professional.

Oh yeah, side effects.  The major side effects associated with prostate cancer, assuming the cancer is removed, is potential loss of continence and/or loss of erection.  Also, if one opts to remove the prostate, there is one certainty.  One will never have ejaculate again!  So I am going to make sure I have the best possible people helping me decide on appropriate treatment and selection of the person to execute the treatment.

Luckily, I have friends who have access to key opinion leaders in the area of prostate oncology who identify a physician at Columbia Presbyterian - Dr Daniel Petrylak - who can review my tests and provide a second opinion.  On August 5th, I went to review my case with Dr Petrylak. After waiting to see him for five hours, he stopped in and said given my age, he would remove the prostate.  It was the most valuable five hour wait I ever endured!  I have now decided to remove the prostate, so I begin focusing on identifying the best person to do that.

After doing more research on my own supplemented by the help of some friends, I decided to attempt to set up a consultation with a gentleman who is supposed to be the best surgeon in the world for this type of operation.  Dr Peter Scardino, the Chairman of the Department of Surgery at Memorial Sloan Kettering Cancer Center (MSKCC), I am told has a wait list of three months.  However, I gather all required information and forward it to his office.   In no time I am contacted by Dr Scardino's office and given an appointment on August 27th.  Two weeks from initial contact, not three months.  The urgency of his office does raise a slight red flag in back of my mind.

Dr Scardino's office staff is extremely accommodating, polite and efficient.  I arrive at MSKCC at 7:30 in the morning for our 8:30 appointment.  By 11:00 I have completed the MRI and blood tests.  By 6 o'clock, I learn that Dr. Scardino and his team have accepted my case and recommend removing the prostate via traditional surgery.  While tests still indicate that the cancer is localized to the prostate.  The extent of cancer within the prostate indicates there is a possiblity that some of the cancer cells may have escaped the membrane of the prostate.  So feeling the cells to make sure all the cancer cells are removed is vital in ensuring removal of all the cancer cells.

When I ask how soon we can remove the prostate, I am given the choice of either waiting until September 23rd or going in on September 2 - just six days from the consultation!  My wife and I opt to wait until the 23rd so we can wrap up some things professionally and prepare ourselves and our family for this operation.

On the 23rd, I enter MSKCC at 5:45 AM, and am under anesthesia by 9:30.  The five hour operation then requires about four hours of recovery because of my habit of sleeping with my mouth open and my inability to prevent myself from using the button supplementing the pain medication.  However, when I awake, my wife is there to let me know Dr Scardino was able to remove all the cancer cells and spare the nerves controlling continence and sexual function.  This is the best of all possible outcomes.  The biggest issue now is recovery and the management of the catheter for the next ten days.

The next day I am up and walking around the hospital floor, eating solid food and doing my best to make sure I can leave the hospital on the 25th.  I am thrilled when I learn I can leave the hospital.

It is the afternoon of Sunday, September 28th as I write this.  Being home has been fantastic.  My wife and children game me breakfast in bed on Saturday.  I am weaning myself off the Percocet and walking around the house as much as possible.  

My Mets and Johan Santana sent my spirits soaring yesterday as they battled against the odds to defeat the Marlins inthe rain yesterday.  ensuring their sporting lives for another day. The Cubbies, while at times appearing to TRY to give away their game with the Brewers, held on against the Brewers leaving the Mets in a tie for the National League Wild Card.

So, with my wife and kids out shopping, my biggest challenge is bouncing between the Jets/Cardinal game and the Mets/Marlins game.

To wrap up this first installment.  I hope that anyone confronting prostate cancer reads this and takes the management of the disease or potential of having the disease into their own hands.  Don't trust in the first-line health care professionals who have so many other demands on their time and priorities. At a minimum, get Patrick Walsh's book and educate yourself enough to challenge the people who may not be putting your health first.