Reforming Old Behaviors

BY RALPH BLUM


Back into the mists of time, year after year, in our unending struggle to protect ourselves against sinister and deadly invaders, we expend our energies, our wealth and our physical strength to survive and maintain our health. One mysterious and potent ally is the Anger Response. The Anger Response system is not unique to our bodies. Parallel forms of this “homeland defense” can be identified at all societal levels: of the family, the community, of nations.


However, like any effective and powerful resource, over-reliance is a potential pitfall. Over dependency on the use of anger as a problem-solving-mechanism leads to an angry persona. “As a people thinketh” certainly applies.  So the loose bundle of platitudes and commonplace aphorisms pertaining to sending healing, loving messages, really needs to become SOP, “Standard operating procedure.”


What a daunting privilege! Swing high enough on that swing and you are led, inevitably, inexorably, to thoughts of Our Creator, to the God of our Understanding . . . in whose image we are said to be fashioned.  We have the free choice to send messages of hate and fear or messages of healing and love.  And so we communicate with the rest of the planet. Words come back to me, my mother frustrated and distressed, me about 25, her launching, “Your whole modus operandi is rotten to the core.”  Not even certain she could define modus operandi.  It was a phrase she picked up from my father.


As advice for Rageaholics, I remember various of my elders advising me to “stop and think” before I blasted off.  Well, here are five questions to teach small boys to ask themselves, to determine, or “profile” who they are at any given moment.  Five questions to answer when they can catch themselves in the act of feeling angry:


1) Is it true?
2) Is it helpful?
3) Does it inspire?
4) Is it necessary?

5) Is it kind?

A tremendous communication tool, serves as a referee for our impulses, and allows an opportunity for us to work through a kind of a checklist re. who we want to be—what compliment of qualities would we want present in this moment, qualities that will allow us to operate (and “cooperate” to match our destiny) in most positive and uplifting way.  I have a growing taste for acronyms. Well there’s a good one: The acronym (what a pleasant surprise) is THINK.

Let the Buyer Beware

BY MARK SCHOLZ, MD

It’s time to change our preconceptions about prostate cancer and “reboot” the way we think about what typically is a non-life-threatening disease. Ever since the FDA first approved PSA testing in 1987, prostate cancer has grown into an aggressive multibillion dollar industry. Marketing hype has created the impression that treatments like Proton therapy and robotic surgery are universally desirable, even though well-informed patients know this is hardly the case.  How did the prostate cancer world deviate so far off the originally intended tract of helping patients? And what can be done to set things straight?

Ten years ago the experts believed that immediate curative treatment was needed for every man with prostate cancer.  Today, after 20 years of vigorously detecting and treating every case of prostate cancer, it has become clear that almost half of the 230,000 men diagnosed every year are undergoing radical treatment for a cancer that is incapable of metastasizing.  Now it’s time for the medical community to come to grips with the fact that over a million men in the United States are living with impotence and incontinence for no justifiable reason. This is a disaster of gargantuan proportions.

Shockingly, even though we can now readily identify these harmless cancers, the problem of rampant overtreatment continues. In 2015 another 50,000 men will undergo unnecessary radical treatment. The medical industrial complex that has been gaining momentum for 25 years refuses to confess its tragic errors.  The huge investments in enormously expensive medical equipment need to be paid off.  No one is willing to accept responsibility, make apologies or confess wrongdoing for all the overtreatment.  The existing system is entrenched and the doctors are too comfortable with the status quo.

Reversing the momentum of twenty-five years of recommending unnecessary radical treatments is going to require the patients to protect themselves.  They need to become far more medically sophisticated consumers.  Five years ago, Ralph Blum and I fired the first salvo by writing Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency. In our book, we attempted to defang the poisonous and fear-inducing word cancer by renaming the low-risk type that does not metastasize “The UnCancer.”  Our book has been helpful at revamping the gross misconception that every prostate cancer is potentially deadly.  Invasion provides an excellent introduction to men with newly-diagnosed cancer by presenting the important concept that prostate cancer comes in three broad types: low, intermediate and high-risk.  

One of the important themes introduced by Invasion is a healthy mistrust of physician motives. For protection against patients receiving the wrong treatment, Invasion argues strongly for patient empowerment through education. The term, “prostate cancer” is merely an umbrella term for a broad spectrum of illnesses that behave very differently. The book simplifies the treatment decision making process by clearly identifying the three major subtypes of prostate cancer, low, intermediate and high-risk.  Once patients have gained an accurate understanding of where they fit into this individualized schema, an informed treatment decision can be made.  As a medical oncologist, rather than a surgeon, the information provided in the book is unbiased with clear presentation of all the risks and benefits associated with all the different treatments that are available.

In an era now past, physicians were trained to put their patient’s interests ahead of their own.  Today, patients need to adopt defensive tactics that are realistic about how prostate cancer care has become a highly lucrative business. The patient who assumes that their counseling physician represents his best interests, is on the cusp of making a dangerous mistake. Bluntly, the prostate cancer world has evolved into a sophisticated and well-oiled business and the buyer better be on guard.   

The Faces of Stress

RALPH BLUM

Whether you are newly diagnosed with prostate cancer, or coping with bone metastases, learning about chronic stress and its negative impact on your body is almost as critical to your healing as whatever treatment you choose.

Short-term stress, a single episode of acute stress, generally doesn't cause problems. However, chronic emotional stress, caused by situations or events that last over a period of time, takes a significant toll on the body.  Furthermore, this kind of prolonged stress suppresses the immune system, profoundly affecting its ability to detect defective or cancerous cells and destroy them.

Persistent feelings of fear, anxiety and unrelieved stress trigger the fight-or-flight response system that our ancestors relied upon.  When a threat is recognized, heart rate and blood pressure skyrocket, sugar pours into the blood, muscles tense for quick action, and the whole metabolism goes into survival mode. This is great if you're on the African savannah and you hear a lion growling outside your tent.  However, Nature never intended this "On your mark! Get set! Go!" response to last more than a moment or two.  So when the brain sends a threat message for which there is no swift resolution, the fight-or-flight system stays stuck on "Get set!."  As a result, the immune system is locked into protection mode and is no longer capable of performing the remedial function that is our most powerful defense against cancer.

So when we feel unable to manage or control the changes in our lives caused by prostate cancer, it not only reduces our quality of life, but it is associated with poorer clinical outcomes.  In fact, studies in mice, and in tests in human cancer cells grown in the laboratory have found that prolonged psychological stress can enhance a tumor's ability to grow and spread.

There is always the temptation to alleviate the stress overload of a potentially life-threatening diagnosis with risky behaviors such as drinking alcohol in excess, taking drugs, and over-eating. But this kind of "stress management" only further inhibits immune function. However, maintaining a healthy lifestyle—which means eating well and staying physically active--supports the immune system.  As do coping strategies such as relaxation techniques, meditation, yoga, and visualization.  And don't forget laughter—the ultimate antioxidant.

Here's how the Discovery Health Web describes the impact of laughter on the immune system: "When we laugh, natural killer cells which destroy tumors and viruses increase, along with Gamma-interferon (a disease-fighting protein), T cells (important for our immune system) and B cells (which make disease-fighting antibodies).  As well as lowering blood pressure, laughter increases oxygen in the blood, which also encourages healing."

So find out what works for you so that stress does not get the best of you.  If you can’t seem to get a handle on it, laugh your way back to health!

A Midlife Crisis Avoided

BY MARK SCHOLZ, MD

Building up a medical practice and getting a late start with a family, my midlife crisis was delayed past the usual occurrence for men in their early 40s.  However, by the time I hit 50, self-questioning was starting to surface. My life had meaningful pursuits but it was time to take a deep breath and do the traditional life inventory of the “mid-years,” to reassess my goals for the last third of my existence here on planet earth.

After reflection, I realized that I really didn’t have any great ideas to reinvigorate my passion for the last lap. I couldn’t sell my wife on the idea of buying a Lamborghini (I already owned a small boat).  I didn’t have any specific desire to travel.  I had given up on golf due to a terrible and uncorrectable slice.  I have never been successful playing the stock market.  All these considerations were going through my head about ten years ago.  Now ten years later, I turned 60 and I feel revitalized and reinvigorated.  So what turned things around?  

Many of you have come to know Ralph, my coauthor in the Snatchers Blog. He is as a sensible dispenser of advice and knowledge about life and about prostate cancer.  I first met Ralph almost fifteen years ago, first as a patient, subsequently as a writing teacher and now as a writing partner. As I reflect back over the years that we have worked together I am convinced that its Ralph who spared me from my mid-life crisis.  Don’t get me wrong, I have a lovely family.  My wife Juliet is a bulwark of truth.  My children are delightfully sensible, talented and hard-working. I am also blessed with an amazing medical practice with wonderful coworkers and extra-special patients.

Even so, visiting with a dozen men a day, five days a week, year after year, decade after decade can wear you down.  Getting paid less and less every year while the work load steadily increases is hardly inspiring either.  A midlife crisis was in the wings and I had no idea how my passion for the medical profession could be restored.  So back in 2005, I was looking for a new challenge when Ralph first approached me to write a book . I even agreed after he told me the zany title, “Invasion of the Prostate Snatchers.”

Fortunately, when Ralph invited me to be a cowriter, he didn’t give a second thought to the paucity of writing skills.  (Ralph has so much confidence in his own writing skills he believes he could train a monkey to write). Over the next four years we clashed on many occasions. Considering that English was my worst subject in school I have to give myself some credit for having the courage to accept his proposal.

Back then I had little interest I had in developing the craft of writing.  Writing is hard to do.  In addition, with limited free time in a busy medical practice, it’s no surprise that developing writing skills was a low priority to me.  But I was also starting to get upset about the injustice of so many men’s sexual identities being robbed by unnecessary surgery.  The dawning realization, that men, rather than being helped by surgery are actually being tremendously harmed, is what motivated me to finally confront the painful task of developing some writing skills so I could convey my observations to the naïve and unsuspecting patients. Thank God I had Ralph to tutor me along through this long and arduous journey.

Learning to write about topics that matter to me (such as saving men from the loss their sexual identity) has saved me from the “meaningless” philosophical wandering that characterizes a midlife crisis.  And as I get older and further polish my writing skills, I have enjoyed even more satisfaction by helping men to avoid numerous medical pitfalls.  For example, in my next blog I’ll be exposing another incredibly repugnant policy—men on Active Surveillance who have 12 large needles plunged through their rectal wall into the prostate gland every year. Yikes!

In the meantime, let me express my genuine appreciation to Ralph for having the patience and skill to draw me down this totally unexpected pathway.  At this point I am happy to report that I see no hint of an existential crisis looming on the horizon.