Recovering from surgery

Entry for 14 September 2010:

Last January, I was diagnosed with prostate cancer, apparently early stage. I did not record here my experiences during this process; I chose not to circulate them in this forum. Why? There were many reasons, but the principal were the uncertainty; my own discomfort and embarrassment (it somehow felt like a personal failing); and because I didn't want this to turn into a cancer blog. Thus, I chose not to reveal this information here. However, because this has been the major process going on in my life throughout this time, it has had the unwanted effect of pushing this blog to the side. In this entry I attempt to remedy this situation by offering a summary of my process over this time.

In the USA, men are routinely screened for elevated PSA from age 50 onwards, and I'd been tracked for slightly elevated PSA scores for the 6 years before we moved here. PSA screening isn't done routinely here, because of its high false positive rate and the resulting risk of over-diagnosis and unnecessary treatment. Now my elevated PSA (7.8) had been followed by two biopsies, the second of which identified early stage prostate cancer in a small part of my prostate. What was I to do?

There is currently a controversy -- on both sides of the Atlantic -- about what if anything to do about early stage prostate cancer. Here in the UK, NICE guidelines advocate Active Surveillance, essentially continued testing until it progresses to a more advanced stage, while some in the US are beginning to question indiscriminate prostatectomies for this stage of prostate cancer, because a large majority of men diagnosed with it die of something else first ("die with it, not of it").

What I did was to read a lot studies. It turns out the prostate cancer outcome literature is far messier than the psychotherapy outcome literature, because the cancer generally grows so slowly that 15-20 year follow-up studies are needed. Also, it turns out that most early stage prostate cancer is diagnosed in men 75+ or older, only 5% of whom will die of it. Eventually, I found a study of a European study tracking men of my age with my stage of prostate cancer for 8 years: I could see that death from prostate cancer leveled off a year or two after surgery, but with Active Surveillance the death rate kept trending upward in a shallow but straight line. Extrapolating from these data and given my life expectancy (I was 59, otherwise healthy, and could expect to live at least another 20 years), there was a better than even chance that this would kill me before something else did. Furthermore, I was more likely to be able to make a full recovery, with less chance of recurrence, if I had the surgery now rather later. I decided to go for it, in defiance of the NICE guidelines.

The issue of what kind of treatment was also problematic, and has odd parallels to the psychotherapy outcome literature: There are several competing treatments, with no compelling arguments or evidence to support any particular one, but a lot of strong opinions. Paralleling psychotherapy research, however, the crucial variable appears to be skill of the surgeon, indexed in this case by their having carried out whatever procedure it was hundreds of times previously. The person of the surgeon is more important than the procedure itself. On this basis, I decided to stay in Scotland and to receive an older form of the surgery at the hands of a highly skilled surgeon, rather than attempt to fly back to the North America for a more modern laproscopic-robotic surgery.

More importantly, as I delved into all this, I learned (a) that prostate cancer is now considered by key researchers like Neil Fleshner and his team at the University of Toronto to be primarily a nutritional/lifestyle illness, and (b) that there is a pretty good chance that the cancer had already spread to other parts of my body micro-metastically. This meant that surgery, of whatever kind, wasn't going to be enough; I would have to change my lifestyle: I switched to a mostly vegetarian diet (the exceptions being fish like salmon and free range, organically grown chicken); began making sure I got at least 7 hours of sleep each night; went on about 10 micro-nutrients with research evidence supporting their anti-cancer properties; and substantially increased my level of exercise. I also starting drinking alkalinizing water (at the encouragement of my friend Leigh McCullough), and tried in general to reduce the level of stress in my life.

I'd like to say that these measures reversed my prostate cancer and removed the need for surgery, but unfortunately that turned out not to be the case, although further PSA testing clearly indicated that its steady progression was halted and remained steady for the past year after years of steady increase. They did, however, ensure that I was in peak physical condition going into the surgery.

Finally, on the 3rd of September, I had a radical prostatectomy, that is the complete removal of my prostate gland. This is a delicate, painful, major operation: I was under anaesthetic for about 5 hours and hospitalised for 4 days; the catheter will have to be in for 3 weeks, and I won't know for some time after that how much incontinence and impotence I will be left with long term. In addition, although I've been assured that the surgery was successful and appears to have removed all of the cancer, I don't have the pathology results yet. Ultimately, I'm not likely to know for years whether the combination of surgery and life style changes will have prevented a recurrence of this cancer. But in any event, I will have done my best.

So that's the story. I will be off work for at least 4 weeks through the end of September and possibly for much of October. It's my hope to be able to continue regularly to write this blog during this time, but at this point, in the meantime, really my only job is to heal as best I can: Drink a LOT of fluids, to prevent blood clots and to keep my catheter open; to take daily walks around my neighbourhood (for the same reasons); to sleep a lot (8 - 9 hrs / night); and to be at peace. Mostly, I take my days slowly, and listen a lot to my body. This makes it a special, almost holy time, like being on extended spiritual retreat, communing and listening to what my body and spirit are saying. In fact, it is a marvelous gift to be given this time for healing and reflection.

Rubidium Wedding Anniversary Adventure

Entry for 28 August 2010:

Although actual date was more than a week ago, things were a little busy in the US before we left, so we decided to celebrate our Rubidium Wedding Anniversary (ie, number according the Periodic Table of Elements).

According to Wikipedia, “Rubidium is a soft, silvery-white metallic element of the alkali metal group.” It is “soft and highly reactive.” Rubidium is not biologically active, but is metabolized like Potassium, which is above it in the Periodic Table, which means it can be used as a marker in brain scans. It is highly stable in its more common isotopes. More recently, it was been used to form Bose-Einstein condensate, an exotic form of matter that displays quantum effects.

I suppose we could make something of the “highly stable but reactive” nature of this element, but I’m more struck by the fact that it means that we have started a whole new row of the Periodic Table.

We celebrated by taking a Saturday Adventure to the National Museum of Rural Life, a farm museum not far from Glasgow. We had been a bit leery about this locate National Trust property, but in the end we were delighted by the working dairy adjoining the farmhouse with all its original fittings. We spent a lovely few hours there talking with the volunteer in the house, the farm manager and dairyman as he milked and fed the cows, and with the docent, who proudly showed us their prize baby bull calf and pigs. We’ll have to take a closer look at the actual museum, gift shop, formal garden etc next time…

On our return, we walked down Great Western Road to a new restaurant, Persia, where we had a very nice meal. We finished our day by Skyping with our son Kenneth. It was a lovely finish to a great day!

Murray Creek Impressions 2010

Entry for 19 August 2010:

The haiku form seems to work well for writing about Murray Creek, especially now, when it is so quiet and peaceful.

1.

Late summer stillness

Deer eat brush just below house

Nature fills our space.

2.

Leave all that behind

Labyrinth knows what matters

Arrive at center.

3.

Old trail above creek

First time cleared in many years

Heart must follow now.

4.

Unpicked all summer

Wild blackberries that yield easiest

To hand taste so sweet.

5.

Before he left, my

Brother removed dam from creek

Water finds new place

Tree branch reflects in still water.

6.

Dusk: we wait for owls

Their low cries come up from creek

Suddenly fill the trees.

California Spotted Owl Visitation

Entry for 19 August 2010:

For the past 3 nights, my mom has been receiving nightly visitations from an owl, which on each occasion landed on the rail of her deck. The first two nights there was a cry and a silent visitation while on the previous night my mom had interacted with the owl for several minutes, as they mirrored each other’s head movements, and the owl emitted its haunting cry. What did this mean? It seemed worth further investigation.

Therefore, last night after dinner, we went out and sat on the deck about 8:30. It was dusk and the colors were fading into darkness as we looked out over the valley. We talked and waited and listened as the darkness deepened. After awhile I could barely hear, at the edge of my ability, a long, low cry in the distance, sometimes punctuated by a chattering sound. Since I was a small boy, I’ve loved strange noises (which might have something to do with why my musical tastes are so broad); so I tried imitating the cry with a breathy sort of whistle. After ten or fifteen minutes of this, we noticed that the cries were getting louder, and as they got closer, it began to sound like more than one.

Then suddenly there were cries from the top of the tall tree just below my mom’s house, then from the next tree to the left of it, opposite the deck where we were sitting. There were soft flutterings and a couple of times I saw a shadowy form flitting from one tree to the next. Finally, a third set of cries emanated from the tree above the house. The three owls continued to cry back and forth to each other, and I joined in. Entranced, I’d been sitting on the chaise lounge, out under the stars in order to see better, but I was now struck by a powerful sense of uncanniness, and began to feel terribly exposed sitting out in the open. I felt as though at any moment these three mysterious beings might descend on me, and I was filled with a mixture of exhilaration and terror. I got up and moved under the shelter of table’s umbrella.

My mom and I now really wanted to know who our mysterious visitors were, that is, what kind of owls they might be. I went inside and got my new iPad and brought back it out again. I found www.owling.com and began looking up likely species and listening to their calls. After trying about 20 or these, we finally came to the California Spotted Owl, whose recorded cry closely matched what we’d been listening to. The annotation to the matching cry characterized it an “agitated contact call" which “may be associated with territorial disputes”; it noted that this type of cry is mainly used by females. At some point during the process of trying to explain what we were experiencing, the object of our interest got bored and moved away back down the hill toward the creek. As often happens in life, reflection had replaced direct experience.

Because the two outlined shapes we had glimpsed looked smaller than what my mom had seen the previous nights, she concluded that we had been visited by a mother owl and her two young owlets, whom she was instructing while at the same time checking out the humans who live in their valley. This narrative seems as good as any other, and my mom vowed to continue her Owl Vigil in order to see what might come next.

Birthday Haiku Poem for Gladys

A linked set of stanzas, roughly in haiku form, in honor of Diane’s mother’s 80^th birthday. The first stanza plays with the mathematical factors of 80 (not counting 1 and 80). We celebrated her birthday in great style, with 40 people, including family, friends and friends of family. Gloria, Diane's exchange student sister also came from Chile along with her husband Juan & eldest granddaughter Daniela.

1.

Eighty years, many factors:

Two, four, five;

Eight, ten;

Sixteen, twenty, forty.

2.

Who knew?

Such a petite person

Could actually be

A very large tree?

3.

Roots sink deep

Through valley's sandy loam,

Ground tree to grow

Strong secure base.

4.

Branches spread:

Children, grand-, great-,

Adopted by marriage or exchange.

5.

Friends flock, many-colored birds,

Summer and winter,

In your sheltering shade.

6.

There is a stillness:

You listen without judgement

Reveal indwelling treasure.

7.

Time passes: Four generations.

Spreading wave of love.

Everything connects.

-15 August 2010

Fifty to Sixty

Poem written for family celebration of my 60th birthday a week ago. Kenneth has been reading Greek poetry and had been critical on the lack of poetic structure in my poetry, which I took as a challenge to try to work on a more formally structured way. The poem is in pentameter, although the individual lines vary between iambic, trochaic and alexandrine (trochaic but with a final foot consisting of a single stressed syllable.

At fifty years, I faced my fear of death:
And found it based on greed, a need to live
Forever, grasping after endlessness.

And so I made a prayer, a thing to say,
Recited as I run, approaching home:
Lady of the Universe, I know not
Where I came from first, before my birth;
I don’t know where I’ll go after my death.
The limits of my knowing are: I come
From nothing, and therefore, to nothing go.

This means, every moment is a gift:
Every day a gift, and every month;
Every year a gift, and all my life.

This prayer weighed my life against the empty
Nothingness of death, dividing every
Separate moment of my life by zero:
Undefined, divine, they shoot toward
Infinity; each one showing, magnified,
In sharp detail, is luminous and glowing.

Since then, ten years have passed, a time of turning:
A broken job, a father’s death, and more:
Children graduate, house then empties out;
A move, across the sea, new place to be,
New work in Scotland next unfolds for me,
New daughter, and granddaughter now arrive,
And illness, brings re-thinking of my life.


Of course in saying something over and over
My prayer of every-day-a-gift evolves,
It does not stay the same; things happen to it:

So other parts appear, to say their piece:

Lady of the Universe, I also know that
All I am comes out of all that’s come
Before me: Galaxies and trilobites,
Etruscans, Galicians, parents, siblings: all.
Likewise, all I’ve been, am now flows out
Through all I’ve known and touched in sixty years,
And does so every moment, day and month:
Children, colleagues, students, grandchildren: all.


And then my mind runs far beyond its common
Orbit, and this image comes to me:

We are all there, in an endless place,
Beyond this life, beyond all dates, we wait;
And with us, people nine hundred years from now,
And from all times, they wait, these ecologues,
Star-dwellers, strange galactic citizens;
Even blue-green algae, waiting for the
Final flare, and all the company of
All conscious creatures, standing, swimming, floating
Assembled in the endless Hall of Being,
Watch in awe as universe completely
Cools, and time exists no more.

-Murray Creek, Aug 2010

Elliott & Farber (2010) Carl Rogers Research Leader Chapter Published

Entry for 14 Aug 2010:

A couple of years ago, Louis Castonguay and other colleagues in the North American Chapter of the Society for Psychotherapy Research decided to do a book on famous/important psychotherapy researchers, as a way of “bringing psychotherapy research to life”. I felt very pleased and honored when they asked Barry Farber (an old SPR friend and former fellow clinical psychology course director) and me to write the chapter in Carl Rogers.

In order to prepare myself, I got a hold of a pre-publication copy of Howard Kirschenbaum’s (2007) new Rogers biography, which I read on the plane while flying across the Atlantic back to Ohio, and then mostly drafted while on holiday. Barry added other bits, a broader perspective, and bits of poetic expression. In the process of writing the chapter, it became clear to me in a way that had I not fully grasped before that Carl Rogers really had invented most of contemporary psychotherapy research.

We were under fairly tight space constraints and had a lot of material, so writing the chapter ended up feeling a bit like write haiku, and indeed writing it did inspire a kind of lyric quality in both of us, I think the following passage, which opens the chapter illustrates what I mean:

In many ways, Carl Rogers was and continues to be a figure of contradictions. Dreamy idealist who was also a hard-headed pragmatist; humanist grounded in positivism; shy, somewhat stiff midwesterner who ended up advocating openness, disclosure, and intimacy; persuasive advocate for empathic and respectful listening raised in a judgmental, non-expressive home; founder of a major school of therapy who discouraged followers, training institutes, and professional organizations; academic who rebelled against almost all of the trappings of academia; and key figure in the origins and development of psychotherapy research who at a crucial moment gave it all up to move to California to pursue encounter groups, educational reform, and peace-making. What are we to make of these contradictions? Do they detract from his contributions? Or are they essential to what drove him and what continues to inspire his supporters more than twenty years after his death in 1987? (p. 17)

References:

Elliott, R., & Farber, B. (2010). Carl Rogers: Idealistic Pragmatist and Psychotherapy Research Pioneer. In L.G. Castonguay, J. C. Muran, L. Angus, J.A. Hayes, N. Ladany, & T. Anderson (Eds.), Bringing psychotherapy research to life: Understanding change through the work of leading clinical researchers (pp 17-27). Washington, DC: APA.

Kirschenbaum, H. (2007). The life and work of Carl Rogers. Ross-on-Wye, UK: PCCS Books.