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Operation day= here we go…

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Fun Facts about my Robotic Prostatectomy tomorrow:

Question: will this surgery have ‘bilateral nerve spare’? To the extent I understand this question, it means will you avoid cutting into nerves surrounding the prostate that will aid in my optimal regaining of continence.

Answer: Yes bilateral nerve sparing.

Question: Will there be ‘pelvic lymph node dissection’?: As I understand it, this means will you be taking samples from the pelvic lymph node to see if there has been any micro-metastasis

Answer: Yes.

Question: Will I be prescribed Cialis (5mg) or its equivalent? As I understand it, this drug helps with penile rehabilitation, and can be used in conjunction with or instead of some type of penile tube device.

Answer: Yes, cialis 5mg daily starting a few days after surgery.

Question How long will I need to do daily Clexane subcutaneous injections?: As I understand it, these injections will help prevent clotting.

Answer: Since you are up and walking around the day after surgery, self injections are not necessary at home.

Question: How long before you recommend, I get on a plane to return home? I’m told air travel after this type of surgery can be risky, for reasons having to do w/possible clotting.

Answer: I would avoid that long air travel for 4 weeks.

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Man, I got the bill for my upcoming surgery today: 110,000 dollars!!! No kidding! The sorta good news is that I think I have to pay only 3k. Yuddah.

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Back in DC for Round Two - this time w/friend!

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Jan 27: heading to US tomorrow w Anita for a robotic prostatectomy, which is a fancy way of saying getting my prostate removed. Overnight stay at hospital, then start the work of recovery

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First Weekend Back in Jordan

It is Friday morning.  I got back a little after midnight Wednesday morning.  I got up around 7 or so Wednesday morning and went for a run.  Unfortunately I tripped over something while running and fell, and now my ribs are really sore/tender, which makes a lot of movement problematic.  I don’t think I broke/cracked anything, and when I went to the Embassy medical unit the guy said he didn’t think I needed an X-ray.  I’ll wait a couple of days to see if it gets any better.

In any case, it is wonderful to be back.  I think I will make an appointment with my urologist here to help explain my test results to me to ensure I know what is going on, given that I really didn’t spend too much time in discussion with my US urologist.

I just read a book Steve gave me: “A Gentleman in Moscow.” It was a lovely story, with striking characters.  Now I am reading a new, comprehensive translation of Marcus Aurelius’s Meditations, with really good explanatory notes.

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Back in Jordan!

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Got to Dulles at 530 PM for a 1020 PM flight. No lines, no hassle! 7 hours to Heathrow, 6 hour layover, 5 hours to Amman. Fingers crossed!

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All in all, a great vacation!

I’m heading back to Amman tomorrow, and all in all it has been a great ‘vacation’ here.  I got to see Edwina often, and also Tory, Melanie and Stephen!  And four museums!  And Silver Diner & Shake Shack all in one day!  It was all wonderful.  Added bonus: the medical news was pretty much as I expected, i.e. no unpleasant surprises, which was reassuring.  And now I get to go back to Anita & Edith!  (and yes, Percy, Penny and Gus...).

Next step in this adventure is December 20th, when the Dr. tells me the results of the genomic testing...

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Brunch!

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Amman-bound! (from Nov 9th)

I talked to the State Department Med unit today (Nov 9th).  It is willing to fly me back to Jordan, then back here if necessary for further treatment after my December 20 telehealth discussion re the results of the genomic testing.  So I’m looking to head back to Jordan Nov 14th.

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Today’s Telehealth Conference re Biopsy Results & Next Steps

BOTTOM LINE UP FRONT:  On the whole good news, as it could have been a lot worse, and I’m glad I caught this when I did.  There is no imminent threat, and the cancer hasn’t spread outside the prostrate.  Except for one small exception the cancer that is there is low-risk, slow-growing and non-aggressive.  Next step is a type of genomic testing called ‘decipher testing’ on the cancer they found, and based on the results of this testing, it is likely I will either just have to keep an eye on it for the time being (”Active Monitoring’), or have my prostrate removed (prostatectomy).  My next telehealth conference with him is likely to be on December 20 after the results of the genomic testing, at which point we will know more about next steps.

I.                 DIAGNOSIS

- He confirmed I have early stage, localized (confined) prostate cancer. It is highly unlikely it has spread outside the prostate (= no imminent threat)

- He confirmed I’ve also got Benign Prostate Hyperplasia (BHP – just a fancy way of saying enlarged prostate), but this is common for men my age and the recommended treatment is continuing to take Tamsulosin.

- the majority of the biopsy samples that showed cancer were of the low-risk, slow growing, non-aggressive type (Gleason score of 3+3).

- Only one sample – and only 10 percent of that sample - showing aggressive growth (Gleason score of 3+4)

[NOTE: A Gleason score of 3+3 is Grade Group 1 and is low risk, indicating low-grade cancer, where the cancer is less aggressive and likely to grow and spread very slowly.  If the cancer is small, many years may pass before it becomes a problem.  Low-grade cancer may never need treatment.

 A Gleason score of 3+4 is Grade Group 2 and is Low-to-Intermediate Risk, with a prognosis of intermediate grade cancer, i.e. moderately aggressive and likely to grow and spread at a modest pace. If the cancer is small, several years may pass before it becomes a problem  To prevent problems, treatment may be needed)  END NOTE].

My Risk Group is Favorable Intermediate Risk (on the scale of: very low – low – favorable intermediate – unfavorable intermediate – high – very high)

My TNM score is T1C, which means cancer found in one or both sides of the prostate. My cancer is bilateral, on both sides of the prostate, which is the case in over 80 percent of prostate cancer, which rules out focal therapy

II.               NEXT STEPS

The doctor said the next step is a type of genomic testing called ‘decipher biopsy,’ which measures/tests the gene expression of the tissue (which tells how aggressive it is). The results should be available in 4-6 weeks.  

Based on the results of the genomic testing, the treatment options would likely range from active monitoring to surgery to remove the prostate (prostatectomy):

- Active monitoring entails taking PSA tests every six months, MRI every year or two, and biopsy every two to four years.

- Surgery is more effective than radiation for those with an expected long life (long in the context of people w/prostate cancer, who tend to be old.  So in this case ‘expected long life’ means over 10 - 20 years I think), and surgery has a higher rate of cure than radiation.  Surgery first also leaves the option for future radiation, but radiation first causes scar tissue which makes subsequent surgery more problematic.  As such, surgery is preferred over radiation in cases like these.

So, next step is my talking to the State Department Medical Team to see what my options are in terms of staying here or returning imminently to Jordan.  My preferred option is to go back to Jordan and do the next telehealth conference in 4-6 weeks from there, then fly back here for treatment if needed, but I don’t know if State Department will allow a subsequent flight back and pay for a hotel stay.  If not, I guess I will have to do it out of pocket.  We’ll see.

 I love you all!

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Natural History Museum!

I had a nice Sunday: went to the Smithsonian Natural History Museum and wandered for a bit in the sections on oceans, mammal history and earth history.  Then I walked to the Politics & Prose on the wharf but didn’t get a book, which is good self-control because I’ve got about 5 unread books already here in my hotel room.

Tomorrow morning at 0830 I have my telehealth conference with doctor to discuss the biopsy results.  I confess I’ve got some low-level recurring ambient fear, but I’m fine with that, it is to be expected after all. I’m just trying to pay attention to what I’m feeling and not let my thoughts take over my mind for a wild ride.  I’m hoping for the best but preparing for the worst, or as the Stoics say:  “Premeditatio Malorum.”  The appointment is for (only) 30 minutes so I want to use the time effectively.  

OK, bedtime!  Goodnight all!

Museum outing!

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“Attitude of Gratitude”

(I heard that phrase today - I like it).  Today i got alot done: went to a skin doctor appointment then worked a few hours at main state. Edwina is out in San Fran, but coming back tomorrow and I will see her this weekend.  I got a lot of walking done, and had my usual dinner of spinach and lentil soup!  Although I did also have a monstrous chocolate chip cookie earlier in the day.  I got my biopsy results back tonight - they are mostly gobbledygook to me, but from what I can tell they seem to be relatively good, i.e. most of the samples have a good “Gleason score,” which means the cancer is early or less harmful or something like that.  In any case, I’m not opening champagne on the one hand or saying goodbye to old friends on the other...I’ll just wait to see what the doctor says on November 7th.  But I will also reread my primer on early prostrate cancer, so I know what sort of questions to ask him.  The “telehealth conference” is only about 30 minutes long, so I want to be as prepared as possible!

It is funny walking around main state, I bump into a lot of people whom I’ve not seen for years....  In that regard, I was in a meeting today with somebody who remembers me from Afghanistan in 2001!  That is a good memory.  I am having coffee/tea with various people to ‘catch up,’ which is nice, especially since it is hard for me to find meaningful work to do!  I’m trying to put in four hours a day there.  

I’m watching too much TV though:  I watched most of “Twilight-Saga” tonight, followed by “Captain America.” I need to read more!

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Life Goes On Here in DC...

Had a nice time yesterday w/Edwina, who came over for take-out and Gin Rummy (she kicked my butt)

I got some test results back in my patient portal (see below), but I have no idea what they mean.  I will wait to find out on the 7th.  Yesterday I was out of breath alot, if it continues I’ll bring it up to my doctor.

Study Result

Narrative

Department of Pathology The George Washington University Hospital 900 23rd Street, NW Washington, DC 20037 Pathology Office Phone: 202-715-4665 Pathology Reports (by Component) ACCESSION: 55-CM-22-001351 COLLECTED DATE/TIME: 10/27/2022 15:42 EDT RESPONSIBLE PATHOLOGIST: M###  MD,  RECEIVED DATE/TIME: 10/28/2022 08:26 EDT Cytology Non-GYN Report - 10/31/2022 15:57 EDT - Auth (Verified) Diagnosis Urine: - Marked acute inflammation with reactive urothelial cells. - Hematuria. - Negative for high grade urothelial carcinoma. This report was electronically signed on 10/31/2022 15:57 PM I attest to the fact that I have personally reviewed the materials in this case and agree with the above interpretation. I##  M##  MD MD Specimen Source A. URINE CYT 1: URINE FOR CYTOLOGY CIT @ 1542 Clinical Information 64yo M with elevated PSA, microscopic hematuria and negative CT urogram. Gross Description Date specimen collected: 10/27/22 Date specimen processed: 10/28/22 Fluid received: Volume: 100ml (equally split) Color: golden Appearance: cloudy Number of Thinprep slides prepared: 1 pap Total number of slides per case: 1 Tech: as Microscopic Description A. Atypical urothelial cells seen as single cells and in groups with enlarged hyperchromatic nuclei, nucleoli and scant cytoplasm.

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Another nice day

Today Tory & Mel left around 9:30, and Edwina came in the early afternoon.  A nice relaxing day - to include Edwina and I walking to a nearby thrift shop.  And Eliza FT’ed in the afternoon.  I got a lot of walking done.  Not any real pain, although my head felt weird every now and then throughout the day, but I’m writing that off to post-operation recovery. We’ll see if it is there tomorrow. I watched some TV but don’t want to get into that habit, so I am going to read a bit before bed.  Tomorrow I’m going to try to get a haircut.  I bought some peanut butter and bread this afternoon and had a Peanut Butter sandwich for dinner w/a banana. Tomorrow is the Marine Corps Marathon here.

Walt Whitman

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Another great day today: morning with Tory and Melanie, afternoon with Edwina! AND special FT appearance by Eliza!