The Walnut
Walnuts in woman hand, Hunan holding two walnuts

The Walnut

Rough waters for me of late dear reader; medical “stuff” going on. I’ve been on the path of this particular “thing” for a while, but it was fairly easy walking, shallow and perhaps even somewhat comfortable. It has, suddenly, turned steep… and uncomfortable. And not being able to see a thing up ahead, I have no idea what lies ahead.

Truthfully, it turned out to be two things really unrelated yet connected in a bizarre way. So get to it then, here is the gist of it. I have suffered hypertension for year and years; high blood pressure. Not terrible, but above what “they” want to see. So I take a medication that does a great job of moderating it.

For a lot of reasons, I have not had a physical in over two years; I missed 2018 due to all the millions of details I needed to tend to in order to have a successful retirement in April of 2019. I mean there was health insurance options, pension choices, social security, 401(k) decisions, and a litany of other financial things to work through. And of course all that I needed to get squared away at work so I could walk out after 44+ years confident I had dotted all the i’s and crossed all the t’s. And there were performance issues with at least one vital operation at work that required my full focus for most of the months leading up to my retirement. So I missed my physical.

I planned on 2019, but somehow that never happened – not sure why. But through this all, there was nothing pressing medically so I was not too concerned about missing a check-up here or there. Eventually though, my prescription expired and required a renewal. They renewed it but only on the condition that I schedule an appointment – that’s how they get you in: withhold your meds!!

So I booked one but then the pandemic hit and I opted not to go into a walk-in care clinic in the midst of a active pandemic. And they understood and I snuck another renewal out of them in trade for a new appointment in the fall. They cancelled my appointment a few weeks prior, and we rescheduled for late December. Of course by December we were back into a renewed outbreak with new cases skyrocketing so I cancelled. But then I found out why they had cancelled: he had to surrender his license due to substance abuse. Sad, such a nice guy but somehow, he got himself tangled up in that stuff.

I had no more renewals and began sort of rationing my remaining pills, sometimes skipping a day here or there. Secretly I had hoped that all the exercise I had been getting, along with the elimination of all the responsibility and stress of work, coupled with getting a real full night’s sleep every night may have resulted in my not needing the medication any longer. I was wrong.

I signed up with a new primary care physician and asked her, in an email, if perhaps she would renew my prescription. Bear in mind, I had yet to meet her let alone have an examination. She politely declined and asked me to make an appointment for an initial check-up, which I did, That visit was yesterday. More on that in a moment.

Men have a walnut-sized body part inside them that it extremely critical to take care of, and no, I do not mean the brain! Rather, it is a gland – the prostrate. It is purely there for reproduction, or more precisely, the means of reproduction. It takes sperm from the testes, fluids from other glands, adds in its own fluid, and sends the soon-to-be ejaculate along its way with push. If you want to ejaculate, you need a functioning prostate. Unfortunately, it is prone to a few things: inflammation, swelling, enlargement, and cancer. For men, prostate cancer is the most common form of cancer (excluding skin cancer). An enlarged prostate can cause issues with urination and erection and can be a harbinger of future cancer.

The general health of a prostate is primarily determined by a blood test called PSA: protein specific antigen. Your score can range from 0 to 2.5 and be considered normal; above that it warrants additional attention, usually a digital exam by a doctor where they will feel the shape and size of the gland to determine if there is evidence of an abnormality. Test results can vary with age and a 4.0 may be perfectly normal for men above 60.

My score sat quietly in the normal range for a long time, but one annual physical I learned it had gone up above three – so time for a urologist. And thus began the twice yearly blood test, and silent anguish waiting for the results. On the off cycle test the results come by phone while the other one is revealed by the doctor in the office during the annual. Over time it has crept up, now at, or a little above, five. Until yesterday.

I sat in my new doctor’s office while we felt each other out trying to establish a balance in the doctor-patient relationship. She asked about previous history and I did not have a lot of good info, so she jumped on some statewide shared medical records website and found me in it and began going over previous lab results, casually reading off numbers as she scrolled through the records. She then rattled off a PSA score of eleven from February of this year and I damned near fell out of the chair. She had found my results that were scheduled to be revealed to me the next day at the annual urologist’s visit. And they were off the chart.

I made a career out of solving problems, really big and really bad problems. And I learned to deal with them without getting excited or overwhelmed or otherwise reacting with any emotion. That was not me yesterday – I was absolutely floored by the news. And that… that is when she decided to take my blood pressure. And there came the second near out of chair experience for me – the BP monitor displayed numbers totally foreign to me, numbers I have never seen associated with my blood pressure. It was absolutely through the roof and off the charts. She actually became very concerned, taking it twice by automated cuff and twice manually; no matter, it was real. The shock of hearing my PSA blew my BP completely out of control.

Of course, I had probably only had two of my pills in the previous five days, which no doubt had sort of destabilized my pressures. And my BP always goes up in the doctor’s office; white coat syndrome they call it. But all the excuses in the world can’t explain away the numbers my body was putting out. Later, after I got home, (and after I picked up and took my new BP prescription) I read that pressures such as I was exhibiting typically call for immediate hospitalization. Happily we didn’t do that. We decided to move on with the check-up and I left promising her I would take my pressure at home and let her know that my pressure had returned to some semblance of normalcy, which it did. In fact it was near perfect by bedtime. But it just shows how overwhelmingly my new elevated PSA value affected me.

So today I did go to the urologist, but this time already knowing the results. We discussed it and the doctor was great about it, telling me to not get too excited. It turns out there are great number of things that can cause a PSA value to spike unexpectedly, things such as riding a bicycle, taking a fall, an infection or irritation, or even having sex with a couple of days of the blood test can cause a spike. Of course, so can a change in your physiology. So while it can be explained it away, it should not be explained away.

She went through the full examination including the digital exam and nothing new or alarming was noted. The end result of the visit was that we would simply repeat the blood test and regroup based upon the results. If it comes right back into the fours or fives, maybe we’ll then go a few months and try again. If it comes back equally as high, there will be really no choice but to have a biopsy performed to determine if cancer is present. There is a third, in between option which entails a different blood test call the prostate 4K test, which is a new test recently rolled out that somehow helps the doctor decide if a biopsy is warranted or is not. My take on it is if the PSA is suspicious and the digital exam reveals nothing alarming, this blood test is sort of a coin flip; one score will result in advising for a biopsy and the other resulting in a wait and see strategy.

The biopsy is invasive, hence the need to really be certain it is warranted. It is, however, not all that terribly invasive; it is performed in the office and the anesthesia is merely a local. There is risk of infection so antibiotics are administered, but beyond that, it is a somewhat innocuous procedure. The instrument extracts core tissue samples that are sent off for assessment and analysis. Heads you win, tails you lose so to speak. A quick search reveals that three out of four biopsies come back negative. (There are times I really love math and statistics!)

So next Monday I will go have another blood test performed and will then cross my fingers while waiting for the phone call with the results, hopefully by Tuesday, the next day. If the result is even a small amount above where it has been for the last year or so, I am fairly certain I will ask to have the biopsy done. This is something you just really don’t want to mess around with; you want to know and you want to be sure.

Sadly, with a positive biopsy, the trail falls apart thereafter into a rocky scramble with no clear direction. You can have the gland removed or you can try radiation. Neither holds any appeal for me because while either choice will remove the cancer, both will forever change you as a man. I greatly enjoy my manliness, my machismo, even at this age I am still an alpha male and will go toe to toe with anyone should I need to do so. Losing that walnut sized gland causes me great concern that I will lose that; probably more mentally than physically. But that aside, should we reach that juncture, we’ll figure it out and make it work; the alternative is simply unacceptable.

So a wild couple of days for me dear reader! And the ride is not over by a long shot; I have the COVID vaccination Friday, the repeat PSA blood test Monday, and still need an ultrasound of (I think) my aorta, something the doctor thought worthwhile now that I am 65. The fun never ends. But it is not all bad; if I can do something now to help preserve my health and prolong my time on this earth, I will absolutely do it.

And another positive from this will be some changes in lifestyle of the last several months: I will be exercising more, getting out to walk and hopefully hike again, and plan to make some modest changes in my diet. I am increasingly reminded that I am not 17 anymore, no matter how much I think or feel that I am. The body, and its systems, are older and they require more TLC now than ever before.

If you are reading this, and you are a male older than 45, please take the time to ensure your PSA is being checked by your doctor and learn what your personal number is. There are no immediate outward signs of prostate trouble for many men; the blood test is the critical indicator. Don’t take a chance! More to come dear reader, no doubt! Stay well!!

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