Tag Archives: wellness

The Bidens must have known about his cancer for years

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First, my sympathies for the Biden family. I’ve been there.

Now, here’s my puzzlement. Prostate cancer is notoriously slow-growing. Although prostate cancer is the second-leading cause of cancer deaths among men (second to only lung cancer), that’s not because it’s so deadly, but because it’s so common. It’s a fact that more men die with prostate cancer than of it.

Of those who die, the typical mechanism of death is by the cancer cells metastasizing to other organs and/or to the bones. It takes years for that to happen – typically something like 5-10 years even without treatment, and even longer with treatment.

Even after the metastasizing occurs, death is usually half a dozen years away or more. After all, the cancer cells are still slow-growing prostate cancer cells, even though they’re now in a new home in another organ or in the bones.

The usual treatment for prostate cancer is to remove the prostate gland, a walnut-sized gland “down there” whose main function is to provide the ejaculate that is the vehicle for sperm cells produced in the testicles. After a prostatectomy, a man can still have an orgasm, and it’s a much tidier affair. The surgery is usually done with what’s often called a “robot” but, in reality, is a human-operated arthroscopic system that utilizes fine motor controls and a viewing system.  

An alternative treatment that is often elected is radiation treatment. The prostate is irradiated five times a week for about six weeks. In one of nature’s happy coincidences, prostate cancer cells are more vulnerable to radiation than normal cells. The intended result is for the prostate cancer cells to die (or, more accurately, be sufficiently damaged that they cannot reproduce) while the other cells survive.

In practice, the radiation damages other cells to some extent, which sometimes inconveniences the patient with regard to, for example, urinary and sexual functions.

Neither approach is thought to directly impact a man’s cognitive function. But it should be mentioned that prostate cancer is a disease of older men. Radiation five times a week for six weeks has an effect on older men, even when the radiation is all below the waist. And being under anesthetic for four hours for a prostatectomy is not trivial trauma for a 75-year-old man.

Both treatments are effective, but recurrences are common. A prostatectomy tends to leave at least a few viable cancer cells behind in the prostate “bed” from which the prostate gland is removed. Radiation treatment, too, is known not to kill all the prostate cancer cells. The hope is that it kills enough of them that the man dies of something else before the remaining ones regroup and reproduce.

If the cancer has spread beyond the prostate – i.e., it has metastasized – then all bets are off. Neither a prostatectomy nor radiation treatment are directed toward anything other than the prostate gland.

The announcement from the Bidens is that he has “an aggressive form” of prostate cancer which has metastasized to his bones. The particular bones are not specified, but the hips and pelvis are the most likely. Nor is it specified to what extent the bone metastasis has taken place.

In advanced stages, metastasizing will spread to many bones. The common symptom is worsening bone pain, a deep, achy, persistent and ultimately agonizing sensation.  

Prostate cancer is usually detected long before any symptoms are noticeable. A routine blood test, which is part of every older man’s annual physical, measures a compound called “prostate specific antigen” or PSA.

Elevated levels of PSA suggest, but do not prove, prostate cancer. The doctor typically orders up further tests to confirm the suspicions. The ultimate confirming test is a biopsy.

Here’s my puzzlement. How is it that Biden’s first inkling that he has prostate cancer is when it has metastasized to his bones, given that metastasizing takes years and he presumably has been getting PSA tests at least annually?

My guess is that the Bidens have known of his cancer for a long time. It’s quite possible – nay, it’s likely – that he has undergone radiation treatment for it. (Prostatectomy treatment appears out of the question, because reports are that a nodule was discovered on his prostate; so it’s still there.)

The radiation treatment appears to have ultimately failed, as it not infrequently does. When the cancer became detectable again, it would have produced elevated PSA levels. By the time it was metastasizing, those levels would be very high.

Again, this does not happen in a matter of weeks or months, but years. It’s inconceivable that the Bidens were unaware of this cancer last November.

Put this on your bucket list: open heart surgery

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“I can hardly wait to see your nine-incher, Glenn!” Those were the words of a dear hiking buddy with whom I’ve had a long platonic friendship.

But I’m getting ahead of myself.

Beginning last summer, I felt less than my usual acerbic, aerobic self, especially when hiking at altitude with my group around Aspen. I finally awoke one morning feeling downright crappy, and a little light-headed. I’m not prone to illness. I haven’t vomited for at least 30 years, and my last cold was over ten years ago. I figured something was wrong.

I drove myself to the local emergency room. Cleverly, or so I thought, I skipped breakfast because I figured they’d want to draw blood for tests.

They did draw blood, and did lots of imaging. They found nothing wrong.

Except I passed out. That alarmed me and everyone else until we figured out it was due to plummeting glucose levels. That’s what happens in early afternoon if you haven’t eaten a thing for 20 hours. So much for my cleverness in skipping breakfast.

Over the next two months, I became a regular in the ER and in the medical offices. Each time was with the same symptoms: Intense fatigue, light-headedness, and now some cognitive and memory issues. Each time, they found nothing wrong.

They did notice my bicuspid aortic valve – a defect that I was born with and have been aware of for many years. The aortic valve is the exit from the heart to the aortic artery. All the blood pumped to your body goes through it. It’s supposed to be three-leafed, but about one percent of the population gets short-changed in the aortic valve line at birth and gets only a two-leafed version.

A bicuspid aortic valve is usually not fatal. Many people never realize they have it. But it’s not as efficient, and it can deteriorate over time.

They saw my bicuspid aortic valve through a routine echocardiogram. They apply an echo transducer to the chest, something like the transducers applied to a woman’s belly to generate an image of a baby in the womb.

The echocardiogram showed that I had “mild regurgitation” through my bicuspid aortic valve, and would need to have it replaced sometime in the next few years. But it was not an emergency and did not account for my symptoms.

I was starting to think my symptoms were imagined, and the docs probably were too.

Almost on a lark, I saw yet another cardiologist. This one was suspicious about the echocardiogram images showing only mild regurgitation at my defective aortic valve. He ordered up a different sort of echocardiogram. For this one, they put me under an anesthetic and put the transducer down my trachea to get a view of the valve from a different angle.  

That angle showed the regurgitation at the bicuspid aortic valve was not mild, but “severe.” The valve had deteriorated to the point that blood was backflowing from the aorta back into the heart. They checked me into the hospital that very day and performed open heart surgery to replace the valve as soon as they could round up a surgical team.

The lead surgeon happened to be a petite blond woman. Her blondness was of no consequence, medically speaking, but I noticed her small, strong fingers that would soon be fishing around in my chest. I thought, “That makes sense – all surgeons should be petite women.”

For the replacement valve, they can use a mechanical prosthesis or a biological one. We chose the biological one. It’s fabricated from natural bovine heart tissue. So, I have a bit of Bessy in me. At least it wasn’t porcine tissue.

Surgery entails a nine-inch incision lengthwise over the sternum (hence the remark by my friend which I quoted above). Then they cut through the sternum, still lengthwise, and pry open the split sternum and chest cavity with a steel prying cage that looks like something from a tire store.

That exposes the beating heart. A vein and an artery are accessed with catheters connected to a heart-lung bypass machine to maintain the oxygenation of the blood. The heart is then stopped with drugs, and remains stopped for an hour or two during the next steps.

The surgeon cuts into the heart to expose the aortic valve, carves it out, takes measurements, and sews in the prosthetic valve of the right size. Then the heart is closed with stiches, the bypass machine is disconnected from its arterial and venous access points, the heart is restarted, the prying cage is closed and removed, the sternum is stapled or wired together, and the skin incision is stitched up. The whole operation usually takes 4-6 hours.

I once had simple knee surgery where they used an epidural to numb me from the hip down. I elected to stay conscious the whole time and observed the surgery on a video monitor.

That was not an option for the heart surgery.

I awoke that evening with a tube down my throat. My first assigned task was to convince them that I was well enough for them to remove it. I succeeded, and they did.

I spent another four nights in the hospital. With encouragement, I was able to walk to the bathroom right away, and each day I walked a bit farther down the hallway. By the last day, I was walking a single flight of the stairwell. It wasn’t exactly the Matterhorn, but you have to start somewhere.

At home, it was tricky to get around without feeling pain in the sternum and thereabouts. After about three months, the direct pain was pretty much gone, except there would be odd bouts of intense pain or cramps in the intercostals between the ribs.

Heart arrhythmias are common after open heart surgery because the surgical incisions cut through established electrical pathways. The body finds alternative pathways that are incorrect and mistimed.

I got the full measure of arrhythmias. Atrial fibrillation was first, where the heart races and flutters. My heart rate would be 64, then 42, then 163, then 81, all in the span of a few seconds.

For that, I underwent the usual treatment of “cardioversion” where the patient is anaesthetized and the heart is shocked with a high-voltage current to reset the proper electrical synchronization. The burn marks left on the chest are usually small and heal quickly.

Then there were the premature ventricular contractions, or PVCs, where the sensation is that the heart is skipping a beat. All people get a few PVCs now and then, and they tend not to be dangerous, but mine would go on for hours or days. They were typically loud enough to keep me awake all night. Eventually, they subsided (I think).

The whole experience is disruptive to one’s metabolism, one’s head, and one’s emotions. I sincerely believe I’m a different person now.

That person is not yet as mentally acute. There’s a name for the symptom of brain fog after heart surgery involving a heart-lung bypass pump. They call it “pump head.” I confess to having a bit of pump head. It often improves over time.

I’m also not as aerobically strong. That, too, may improve – especially now that I have a proper and efficient aortic valve for the first time in my life. I’m not ready to hang up my hiking boots quite yet, or my spurs.

And I’m different in my personality. I’m relearning things, relearning people, and relearning myself. I choose to see it as a blessing. How many people get the chance to reinvent themselves, free of the baggage of who they were?

Meanwhile, I’ve got this nine-incher. Got that going for me.

Like everything else, the debate over alcohol is turning into a bar fight

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Jesus turned water into wine. Modern-day abolitionists want to turn that wine into poison, and modern-day drinkers want to chase them out of town. We’re come a long way baby.

Not.

Let’s start with some facts:

As a long-time drinker, I can say with some authority that alcohol is a toxin. Half a quart of hard liquor in half an hour will probably leave you unconscious. More than that can kill you.

However, people rarely drink that much, that fast. Those who do are probably engaging in many other reckless behaviors, too, that will kill them long before the alcohol does.

The big question is, what about the millions of people who do not drink themselves into oblivion, but just into a mild buzz? And what about people who don’t drink for the buzz at all, but despite it – they’re drinking because they simply like the taste of a beverage, especially with dinner, that happens to contain a small amount of a nuisance toxin?

Most wine drinkers fall into this category, myself included.

As you might expect, the matter has been studied. Most recent studies suggest a strong link between heavy drinking and many different diseases – no surprise – but also a tenuous link between even moderate drinking and some cancers and vascular disease.

(Please don’t rebut these studies with a story about your long-living great aunt who drank every day.)

This link between alcohol and illness is, however, difficult to get a real fix on, because it is confounded by many variables. For example, people who drink moderately tend to be moderate in many of their other habits as well. And moderation is usually a healthy thing.

As for people who don’t drink at all, they tend to be moderate in all things including moderation. That’s why their alcohol consumption is not moderate, but is highly immoderate – it’s zero. These immoderate individuals very often engage in immoderate activities like ultra-marathons and are immoderately ultra-fit.

Comparing the health of a teetotaling ultra-marathoner with a moderate-drinking three-times-a-week treadmill exerciser will produce skewed and misleading results tending to show better health in the former that appears to be, but is not, a result of his teetotalling. Correlation very often does not equal causation.

Here’s another example of a confounding factor. Heavy drinkers tend to die young. People who die young are never included in studies of populations that are not young. Therefore, studies of not-young people will tend to show that drinkers are healthier than they really are, since the unhealthiest drinkers are dead and unincluded in the study.

The Surgeon General last week re-ignited this controversy-for-the-millennia by suggested that warning labels be put on alcohol, much as we’ve done on cigarettes for many years and as we already do on alcohol as it pertains to pregnant women.

As a sign of our times, the reaction was along party lines, but not in the way you might have expected. Strait-laced conservatives were outraged that anyone would dare warn them of the health hazards of getting intoxicated (even if the warning is only a warning and not a ban) while libertine liberals applauded the suggestion.

In reading the commentary, you might think the SG’s suggestion drove conservatives to drink, while it sent liberals onto their wagons.

That partisan reaction seems odd until you realize that the SG is a Democrat. In today’s charged political climate, that means many Democrats will reflexively like whatever he says, while many Republicans will dislike it.

In the mostly-conservative Wall Street Journal, for example, a member of the Editorial Board (with a BA in American Studies – owwwhh!!!) wrote an editorial unburdened by any supporting data announcing that the Surgeon General (a graduate of Yale Medical School) was simply wrong.

Other conservative commentators with similar “qualifications” weighed in with similar sentiments. The common theme was that the SG’s suggestion was yet another example of governmental overreach. It was Democrats trying yet again to control your life by warning you about things that might hurt you.

Well, maybe. But it seems to me that a fine-print warning that alcohol can be unhealthy is not exactly in the same category of, say, a warning that coffee can burn you or water can drown you. This is particularly true in view of widely published studies some years ago suggesting that moderate alcohol consumption is actually good for you – studies that were later debunked as having been confounded by the sort of lifestyle factors mentioned above.

And even if alcohol warnings are indeed in the same category as coffee-can-burn-you warnings and water-can-drown-you warnings, what’s the harm? It seems the protesters doth protest too much. A wee bit defensive, are we?

But that’s the current political world we live in. Messages are judged not by their content or other objective standards, but by the identity of the messenger. In my lifetime, America has never been so tribal. That’s bad.

By the way, I wonder about the position of our current tribal chief, for whom I’ve voted thrice now and whose performance as de facto president is great. (I especially like the idea of annexing Greenland, where we’ve had an early warning Air Force base for many years.) He is a known and admitted teetotaler. (Thank goodness – can you imagine Donald Trump intoxicated?) Wouldn’t the world be turned upside down if he were to side with the Democrat SG?

Along the same lines, I wonder how politically conservative, teetotaling Mormons reacted to the liberal SG’s suggestion.

As for me, from time to time I consider reducing my alcohol consumption, and maybe even ending it. It’s probably not the healthiest of my habits, nor the least expensive. But I hope I’m already knowledgeable enough that a silly new warning label won’t persuade me to stop, and I hope I’m mature enough that it won’t persuade me not to.