On Getting Prostate Cancer and Liver Cancer, Too

It is mid-July, 2007. I figure I’d better write about this now so I do not forget what happened. On the other hand, how could I ever forget what is happening every day!

Earlier this year, at winter’s end, I got a call from my urologist of 25 years.

UROLOGICAL ASSOCIATES, PC Jay J. Handler, M. D., F. A. C. S., Urology and Urologic Surgery located in the Calvanese Building Suite 2D 2137 Welsh Road Philadelphia, PA 19115 phone 215-698-7333 (fax 215-673-9492).

“I have your test results back. They are not normal,” he said.

He told me I have prostate cancer, something that affects one in six men. It is fatal for one man in every 34 with the disease.

My urologist said the PSA (Prostate-Specific Antigen) readings were borderline, but he was especially concerned because they had doubled in the past year. He scheduled an in-office visit. In his office, he told me the conclusion was unmistakable: I needed a program to get rid of the cancer.

He said he wanted me to attend a meeting involving other men also recently diagnosed with cancer of the prostate. I did. During the meeting, I asked the oncologist “how fast does the cancer grow”. The reply: “very slowly”. But the key is to attack it at your earliest time.

MNAP Oncology Center Department of Radiation Oncology Steven J. DiBiase,M. D. 9908 East Roosevelt Boulevard, Philadelphia, PA 19115 www.mnaponcology.com phone 215-673-9260 fax 215-673-9254.

At that meeting, it seemed to me that the suggestion of side effects from the radiation centered on NOT TO WORRY about them. Some men have problems during the treatments, many do not. That may well be true, but not in my case. If I have any criticism of the program, it is that the full measure of possible side effects was not conveyed.

I started the radiation treatments May 29th, the day after Memorial Day. This was about two months after that meeting in the urologist’s office.

I was given the appointment time of 9:20 a.m. each day. I was to be scheduled between a breast cancer patient and another man. The daily nods of “Hello” soon became routine, but I must admit my friendly demeanor, if perceived, was orchestrated.

This is because after a week of treatments, the side effects started. Pain during urination. Frequency of urination. Dizziness. Nausea. Exhaustion. Loss of appetite.

I was told the pain during urination could be controlled. After my experience these past six weeks, I need to tell you there has been, at least in my case, almost no control of the pain.

It has been vicious. And ongoing. Every 10 to 15 minutes. And more often than that. Urgency to go. And then, just a trickle, but terrible pain.

I told the doctor of the pain. I told him I usually could not make it to the bathroom before I started going. By the time I got to the toilet, the only thing left was the excruciating pain of the last trickle. He gave me a prescription (Phenazopyridine) designed to increase the flow, and he also gave me a prescription for Flomax, the recently-heavily-advertised pill for those with a “going problem”.

Still, pain.

I asked the second doctor (on duty that day) if there was any other relief. She said another possible remedy would be ibuprofen along with the Phenazopyridine and Flomax. This could be in the form of Advil or Motrin. I bought both. So, in addition to the two prescriptions, I was now taking ibuprofen. At first I was taking 600 mg four times a day. Doctor Number One at the oncology center a week later suggested I cut down from three capsules four times a day to two. This is because I also take Plavix, a well-known prescription for heart patients. However, so long as your urine and stool do not become bloody, the Plavix may continue. That’s the way it is with me, with the Plavix continuing to protect my heart and blood lines.

It should be noted here that ibuprofen is NOT recommended if your kidneys are not working well. I only can conclude that the oncology doctor was not aware that my kidneys were starting to emerge as new problems amidst everything else. (See below for more on this.)

Through these weeks, the pain continued. A urinalysis was ordered, and my family doctor also tested me.

Family Doctor: Frankford Avenue Family Practice, P. C. 8846 Frankford Avenue Philadelphia, PA 19136 215-332-8221 fax 215-332-2979 Paul H. Miller, D. O.

Earlier this week, my family doctor (Dr. Miller) said I have developed a kidney disease of some sort, and I will need to get an ultrasound (next Thursday), and see a specialist, a nephrologist, a week or two later in July. A nephrologist is a physician who has been educated and trained in kidney diseases, kidney transplantation and dialysis therapy.

Before you draw any conclusions, I need to explain: all four doctors are top-notch. They all attended college classes the days the professors discussed bedside manner. They learned well. They are good.

And I was told that most men do not encounter the side effects that have hit me. (One evening, in my office, I threw up so much and so long, I would have to say it was the home run of vomits in my life.)

I am sorry for the graphic descriptions here but I need to be totally forthcoming for you. Prostate cancer is curable, and has a high success rate. But it is not an easy road. I have heard about patients getting chemotherapy who have suffered far more than I. Just today, in the Philadelphia Daily News, there was an item about Gary Papa, sportscaster for Channel 6 here in Philadelphia. His prostate cancer has returned. He thought he had licked it more than two years ago. He now has another fight on his hands. I do not know what stage of prostate cancer he had three years ago. But according to the Daily News item, “an emotional Gary Papa announced” during yesterday’s 6 p.m. newscast that he is undergoing a second round of chemotherapy. I believe chemo is used most often when the radiation clock already is at midnight.

As of this day, Saturday, July 14, I have had 31 radiation treatments. The usual series is 39 or 40. Before I started, I was asked to add four more for purposes of a survey. Total 44. I agreed. Last week, I asked out of the final four, but the doctor urged me to hang in there. So far, I still have 13 to go, not nine. Despite the pain, I suppose I will try to hang in there.

I should point out what you probably already have concluded: my experience may be unique, and very well may be unusual among the many patients at my oncology center. However, I think I know why the doctors did not “announce” at that original session with more than a half-dozen men that the side effects are brutal. If they described the pain, the urgency and so on, probably they would see some of their patients seek another opinion. I want to hasten to add that I do not criticize the doctors because nobody at that original session asked, in effect, how bad can it get?

In between the urgencies, I am OK but always exhausted. I am writing this on a Saturday evening when I have had to stop periodically to run to the bathroom. And most of the time today, it has been very painful when I urinate. Oh, and I forgot to mention the diarrhea: yeah, I get that, too. Sometimes it consumes my morning. And maybe most embarrassing of all of it: I am wearing diapers on the basis of a recommendation from the woman doctor at the oncology center. But it helps. Before diapers, I was soiling five and six underwear jockeys each day.

I cannot walk from my car into my house without becoming out of breath. I hardly can walk from my office to the bank, less than a block away.

The woman doctor at the oncology center suggested I contact my family doctor to check whether I should continue to take the ibuprofen since a kidney disease was suggested by the one urinalysis. My family doctor said the ibuprofen does adversely attack the kidneys; he suggested Tylenol. No offense to Tylenol, but the pain came back today stronger than during the past week.

But I trust my family doctor and will stay with the Tylenol. Maybe its good days are ahead of me.

If you are diagnosed with prostate cancer, prepare to fight it as you would any anomaly. The doctors deal with the several treatments and patient care on a daily basis. You should not shy away from the necessity of treatment.

Maybe my comments above will help you to ask more direct questions about the side effects of radiation. My business partner’s husband was treated earlier this year at the same treatment center as I. He finished his 40th treatment May 1. Yet, in mid-June, he still had some of the agonies described above. So radiation lingers.

I never sought a “second opinion” partly because of the experiences of my partner’s husband. We both have the same urologist, who impresses me as no less than an expert in his field. A nice guy, too. And, as noted above, all four doctors treating me are superb. And nice people. Bedside manner, so to speak, is needed for those patients undergoing chemo and/or radiation.

Since reading about Gary Papa, another nice guy, I have been preoccupied thinking about the recurrence of prostate cancer. Gary first disclosed his cancer in May, 2004, actually. So his came back and the article did not explain why.

Thus, despite an apparent high success cure rate, chemo or radiation may not be enough. It demonstrates the need for men to be tested at least once a year, if not more. My “not normal” readings were part of a four-times-a-year blood test in the office of my family doctor. As apparently happens in most cases, once you are known to have prostate cancer, your friends are quick to give you reassurances, based on other cases with which they are familiar.

Earlier in these remarks, I mentioned that the treatments started about two months after my urologist reported the findings. The two-month period apparently is inevitable, due to the several steps that must be taken prior to radiation. Of course, it had been a biopsy which revealed the cancer. That was first after the blood test. And while nobody said so, and I didn’t ask, apparently it takes a while just to prepare the paper work involving a patient’s hospitalization plan. But as far as I could tell, this did not “delay” treatment.

An early procedure, with advance preparations similar to a biopsy (fasting, etc.) was to insert three “markers” on my lower stomach. These markers are not visible to the naked eye, but are evident on a machine. Each treatment requires the drinking of 1 1/2 cups of water just before the treatment. This serves to lift the prostate into better position for radiation.

There are three treatments (i.e., three patients) each hour, 20 minutes apart, at my oncology center. The actual radiation procedure takes about 12 minutes for one person, and only starts when the technicians are satisfied they have lined up the radiation machinery according to those three markers. This assures them that the radiation is going directly to the prostate gland, regardless of its position, which changes from day to day.

And about those technicians. They do a great job. The crew for each patient almost always involves two women, sometimes three. They even have to place my legs in a cast, which was created prior to the radiation treatment program. There are scores of those casts on the shelves of the radiation room. A lot of men are under treatment for prostate cancer. Likewise, the women patients who are battling breast cancer go through essentially the same procedures. The women technicians are friendly where the situation desperately calls for “friendly”. The same goes for the rest of the small staff, including three women at the front desk (at least two are nurses who once a week take my blood pressure, weigh me and ask me howzit goin’ now, and so on; let’s call one of them Heidi, who is warmly friendly each day and who has her own pleasing bedside manner, so to speak). The others are professionals, too. And the young woman in the “Interview Room” (she does the leg casts) gives you a heartwarming smile every time she walks by. Where is she going all the time?

Anyhow, now, I am about to head into my last 13 treatments. I know it will continue to be a struggle; I more or less figure I will continue to go through the agony until weeks after the treatments end August 1. But let me hasten to add: I have thought not infrequently about the alternative. What if there were no treatment? Many patients die of cancer yearly because the cancer maybe was diagnosed too late to avoid its becoming an eventual killer. So while I am concerned about the remaining treatments, and the aftermath, which may not ebb until mid-September, I am even more concerned for Gary Papa.

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After the above summary was posted, there was a visit three days later (Tuesday, July 17th) with the oncologist doctor right after Radiation Treatment 33.

I told the doctor I was spent in more ways than one. He replied that he thought I was depressed. Inasmuch as I rarely become depressed, I told him it could not be depression: it was the hot poker pain and the other maladies described in the summary above. I suggested that he READ it to understand my dilemma better. He said he preferred just to continue with the interview. I know he’s busy, but I rather think he was not fully grasping the severity of my many discomforts.

At some point on this day (Tuesday, July 17th) or before, the doctor had suggested I might be suffering from a urinary tract infection.

In any case, the next day (Wednesday), I received Treatment Number 34, after which the doctor met with me again (normally, he meets with each patient once a week). Heidi took my blood pressure and reported it to the oncologist. It was 88 over 50. It demonstrated I was in poor shape with low blood pressure.

The doctor suggested that I was dehydrated and needed to go for hydration somewhere.
The conclusion was to go to the Emergency Room at Frankford-Torresdale Hospital, about seven minutes’ drive, “for an hour or two”, the oncologist speculated. He asked whether I was able to drive myself. I replied that I could drive throughout the radiation period, despite fatigue and shortness of breath, if I took a few minutes to recover. So I got in my car just minutes before Heidi would have been calling for an ambulance. Getting to Frankford-Torresdale was not a problem, and the ER was just as the doctor had suggested: few patients waiting at that time, about 10:20 a.m., unlike the scene most nights, when you may not get “seen” for hours, due to the many people ahead of you (if you are not an emergency-emergency case, which would mean you would be taken much sooner).

Thus, last Wednesday (July 18th), I started what turned into an eight-day hospital stay.
Within minutes, I was being interviewed by Nurse Linda Nowak, who also doubled as my ER nurse. She was the first of a zillion top-shelf nurses to treat me both in the ER and in the Telemetry Unit and thirdly in one of the regular wards. I was placed in the Telemetry Unit Wednesday night due to my heart attack two years ago when I spent three days at the same hospital. In the ER I had been put on a heart monitor. By the way, they are “wireless”. Pretty snazzy.

When I was in what became my ER room for about 10 hours, Linda Nowak told a male nurse “UTI” was suspected. UTI is hospital lingo for Urinary Tract Infection.

The doctors and nurses in the ER had plenty to do and having been there in the past, I know the activity often is big time hectic. However, the hospital personnel proceed with high professionalism, and take pains to make sure they get my medical history and names of my doctors. As noted in the summary above, I had quite a bit to report. Soon after arrival, the male nurse inserted a “line” for IV and I was told I would be getting “fluid” that would hydrate me.

But as for the pain during and after urination, I was told it was likely I had an infection in the urinary tract which in large measure was the main culprit for the pain.

After I was in the Telemetry Unit, doctors and nurses combined to diagnose the ills and try to alleviate my situations. Included were the periodic runs to the bathroom to urinate. I made it on time about half the time. Because of the urgencies described above, in no time I was spreading the “orange” on the bed sheets, all over the floor and on and near the toilet, the orange being the result of the medication I was taking.

The easing of pain throughout my stay could not be sustained.

More often than not the nurses changed day to day. “Mari Pat” and her Nurse’s Aide, Terry, were on duty two days in a row last Thursday/Friday. But the schedule changes, and this is highly significant, did not result in any reduction in the level of care or caregiver knowledge.

As you would see on another summary on this site, I do not regard lawyers as the Number One saviors of our society. I recognize some of them perform outstanding service, but we have far too many of them in this country (read “LAWYERS ARE RUINING OUR SOCIETY”) and far too many of them literally or figuratively chase too many ambulances.

It may be that the Oath of Lawyers says to first do harm, as they often do. (Some judges and the judicial system also aren’t squeaky clean; we need also to remember that.)

You would think that doctors are the scourge of lawyers, and of course some physicians seem not to operate by the Hippocratic Oath (irrespective of which Oath form you consider). The original, it generally is concluded, goes back to good ole Hippocrates, the father of medicine in the fourth century BC.

The doctors I have encountered over the years for the most part have been professional, hard-working and dedicated to my care.

I have not followed the medical procedures in recent years, but apparently my family doctor, your family doctor, cannot come into a hospital to see his/her patients. At Frankford Torresdale during the past week, I was seen by, I think, two hospital doctors and a half-dozen specialists.

My main doctor was a turban-attired Medical Doctor by the name of Bakhshish S. Sandhu. I had the feeling he had 1,000 patients there. He also has a private practice. He would visit me each morning; it was somewhat tornadic. But I mean that in a nice way. He was terse and at first I wasn’t prepared for his quick exit. He usually came into my room so early in the morning that I was still more than half-asleep as he spoke with me. What I realized soon enough is that I had to ask a question quickly, as he was so much on point, I almost wished I had a tape recording of his visits. Soon, however, I realized there was plenty going on in his brain at its own cyclonic speed. This was evident not only in his quick analyses and decisions but in what the nurses were able to tell me, and do. It was impressive.

It was the conclusion at ER the first evening, before transfer to my room, that I needed two “units” of blood. The transfusions (two pints, I suppose) took from midnight till 6:00 a.m. Thursday. My dizziness and shortness of breath abruptly stopped with the blood.

On Friday morning, a lab technician took 10, yes, 10 vials of blood from me. At first, I tried to joke with a nurse that the hospital was trying to get its blood back from the day before. Yeah, it wasn’t funny. Dr. Sandhu was throwing the book at my problems but with total focus.

During my stay, the various nurses were superbly efficient in following up on my complaints. It did not take long for me to realize that the Frankford Torresdale nurses are well educated and highly trained to perform under constant daily pressures. I was asked for my name and date of birth 1,643 times during the week. The checks on my identity probably could have been reduced to 1,521, but each caregiver is carecarecareful, and I am grateful they are such.

After the blood transfusions, an antibiotic (Levofloxacin) was administered daily via IV. This was to attack the UTI. Do I seem to be picking up the medical lingo??? They also ran a fluid IV at almost every available time period. Saline? Electrolytes? Looked like water.

Pain during urination and frequency and urgency continued throughout the week, but Doctor Sandhu et al attacked my problems. Through the blood tests, it was learned that maladies discovered by my family doctor became re-exposed in the hospital. A “mass” on my adrenal gland. A “nodule” on my liver. My family doctor also was concerned about my kidneys.

Monday night, still in the hospital, I encountered pain between near midnight and 3:00 a.m. Tuesday that exceeded all that I had endured since early June. If there was a chance of depression creeping in, it had to be early Tuesday. But it could be boiled down to the other activities involving me. There were times when the medications could not be administered when they would do their best. On Monday, I had a CatScan on my adrenal gland.

Late Monday night, I asked the nurse, Jaime, to give me medication for the pain. A bit later, she asked, on a scale of 1 to 10, how bad was the pain. During the six-week period, including pre-hospital, I often had answered 9 or 10. It had been that way for 10 or 15 seconds. Early Tuesday, my reply was “11″. It was the worst pain of all.

Within two hours, Jaime had me on the way to being pain free, at least until the next recurrence.

What I have come to discover is that each medication designed to handle the pain during urination, the urgency and the frequency must be administered at the right hour to be effective. And I suppose it is impossible for both nurse and patient to be forecasters who are timely and right every time.

And there are the interruptions, such as the CatScan. On Tuesday, I was given an MRI to look at my liver. That was the test that showed the “nodule”. Yesterday (Wednesday), I had a followup on the liver: a biopsy. Results to be available shortly.

Dr. Sandhu is comprehensive, thorough. He may be terse, but he is reporting the medical facts to scores of patients daily at Frankford Torresdale, he is getting alot done in a short time and he clearly is an asset to the hospital. You see such doctors on TV drama shows; I got to watch a “show” with even better examples of the service of the medical profession. They involved me! And I repeat: just about all of my up-close experiences with doctors this year have been favorable and impressive.

A hospital is a powerful place. What goes on there impresses me far more than the rich oak walls amidst the book cases and legal cases in a law firm. I guess some lawyers save people’s lives, in a matter of speaking. The people at a hospital save people’s lives, period.

In listing and thanking some of the people who worked so hard for me this past week, it always is a possibility that I will overlook someone, such as those two male nurses in the ER, and the doctor who explained at length what the blood transfusions would be, and why I had to have them. I don’t know the names of the men who pushed me around in my bed or wheelchair, or the fellow who pushed my wheelchair to the ER entrance last night so I could go home. I don’t remember the names of technicians in radiology. They have to be super efficient and accurate all day long. They were terrific.

And then, how about the nurses? They are so smart. Each patient has an RN (Registered Nurse) and a Nurse’s Aide. The nurses and their aides must be mini-lawyers in their own right, and investigative reporters. There was Rachael (yes, that’s the way it’s spelled) who took my blood pressure, my diabetic blood count, my temperature and my pulse rate. And the RN’s did the same things from time to time.

One day, my IV “line” had to be changed (after four days with the first line). My nurse on duty tried to find a vein twice. Tracey knows how to do it, but some days a patient’s blood lines go to Upper Darby. Or maybe I don’t have any veins??? Tracey sought help from Jess, Nurse Number Two, who tried an additional three times without success. I was a bit confused on her identity but I think “Lidia” was the third nurse to try. The third time’s a charm. Lidia found the lifeline. She should be a contestant on one of those TV shows where they ask for a lifeline. The “line” was used yesterday as part of the liver biopsy.

What I say about Rachael can be said about Terry, or Kim….and so on. Let me try to acknowledge professionals such as Lisa, Sheena, I mentioned Mari Pat (who seemed to have the Merck Manual in her brain, who told me plenty about a UTI), there was Tracey who was my RN three days’ straight, also Lidia (as noted above, I think she was third time’s a charm), Theresa Fitz who was my first night nurse, Alex, Janet, Jaime, and when they moved me out of Telemetry there were Peter and Nadia, and yesterday there was Maureen during the day and Jennifer after 3 p.m. Jennifer put up with me enough to arrange for my release from the hospital about 8:30 last night. And Jill. Nurse’s Aide. She is on the verge of passing the tests to be an RN. She worked 16 hours yesterday. She was a prime example of all of them who had to try to endure the urination spots I distributed all over the floor and in the bathroom. And all over my body. And on the bed sheets.

Both in the hospital and at home, my nights were continually disrupted by the problems noted above. I don’t know why but I seemed to pass the idle times overnight in idle singing of songs (just in my head). So, get a load of this for craziness: “Pop Goes The Weasel”, “Don’t Fence Me In”, “One” (from “A Chorus Line” LOL), “Raindrops Keep Falling on my Head”, here’s one for your real oldies: “I’m Always Chasing Rainbows” !!! Yes, I know: Bizarre !! And how about going to the Brown’s Hotel on the “Atcheson, Topeka and Sante Fe” (“all the way from Philadel-FIGH-A”) and the last one I can remember: “Three Blind Mice”. Amateur psychiatrists, have your field day on this!!!

Speaking of those almost hourly hospital messes, as I was above, there was Janet Deshields (I think that is her name), one of the three housekeepers who had to find the special solution that cleaned up the orange urine, orange due to the medication I was taking. One day, I half-joked a question to Janet: “How does it feel to have the toughest job in the entire hospital?”

What she was going through reminded me of one of the toughest jobs involved with my business: cleaning buses. It can be a demeaning job, disgusting, etc. You know what I mean. To make a bus presentable for the next trip, after the last group unfortunately had practically ruined its interior, the bus cleaner had to dig in with all the methods of trash cleaning. The hospital housekeeper has a daily similar challenge. In fact, Janet faces more trash in the course of a week than a bus cleaner.

After I asked the question, she replied, with a sort of “Thank you”, so to speak, “Nobody’s ever said that to me before!”

She takes pride in her work.

Janet is a hard hospital worker. A hospital is a building we treasure far more than a law office. (I should make clear that those in law offices spend not a small amount of time making life miserable for many in the medical profession. Some cases have justification; many are the result of ambulance chasing.)

Twelve hours after my arrival home from the hospital last night, I was back on the radiation table this morning. And Treatment Number 36 is coming up tomorrow.

And, oh yes, I have to check on that biopsy report, too.

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The next morning, Friday, July 27th, I was feeling dizzy one hour after wake-up. I headed for the Oncology treatment, and was given Number 36.

My blood pressure was 108 over 48. It was going lower again. The woman oncologist suggested that I contact my primary physician so he knows what is happening. I went to the Family Physician office and signed in (I had no appointment). Through a receptionist’s error, I had to wait more than an hour, but I sat in the waiting room allowing the dizziness to ebb.

My doctor listened to my story, and told me he had just spoken with Dr. Sandhu at Frankford Torresdale. My doctor said I needed to go right back to the ER there.

I was taken to Room 16 quickly and an IV was running shortly thereafter. I needed once again to be hydrated. During the afternoon, I also was taken for another chest X-ray of my lungs and heart. This is a good hospital.

After a five-hour stay, the ER doctor, Amy Witkin, told me I had to drink more fluids if I am to avoid the intense pain during urination. Yeah, I know that. I was avoiding the fluids to avoid the pain. But I was on a trip to nowhere good. If I don’t force the fluids, the dehydration and light-headedness return.

Dr. Witkin, who said she once worked at (the now-closed) Graduate Hospital in downtown Philadelphia, gave me a discharge sheet that summed up my situation. It noted that 55% of the human body is water. Here is some of the commentary:

The average healthy adult consumes about two quarts of water a day in the form of milk, juice, soda, etc. Each day, about one quart of water is lost in the urine. About one quart is lost through evaporation. If, for some reason, the amount of water consumed is less than the water lost, the total amount of water in the body will decrease.

This is called dehydration.

It can result from any disease that produces nausea, vomiting, diarrhea or simply a decreased appetite.

It concludes: Diseases that frequently result in dehydration include the common cold, the stomach flu, pneumonia and urinary tract infections.

HOLY BATMAN!! It almost sounded as though the ER doctor had read the above commentaries on this blog! Just kidding, of course. But I was reading about myself.

The statement from Frankford Torresdale also said the most common symptoms of dehydration are a “run down” feeling, a dry mouth, decreased urination and a dizzy feeling when standing up.

What are the risks? the statement asked. Dehydration usually gets better over one to two days and does not ordinarily produce any serious medical problems. There are, however, some risks: Very severe dehydration can damage the kidneys or produce a serious chemical imbalance in the blood, and occasionally dehydration is the result of a serious medical problem such as diabetes or blood poisoning.

The INSTRUCTIONS include the advisory that “as long as you do not have any heart or kidney disease, you should DRINK LOTS OF FLUIDS. Adults should drink at least two to three quarts a day. Avoid diet soda or caffeinated drinks such as coffee, tea or colas”.

The hospital statement also described at length all about dizziness.

The hospital says some of the more common causes include anxiety, hyperventilation, dehydration and minor viral infections. Then, some of the more SERIOUS causes of dizziness include severe dehydration, serious infections, stroke, irregular heart beats, blood clots in the lungs, dangerously low blood pressure or even a heart attack.

Sometimes, the hospital reports, careful examination reveals the cause of the dizziness, but often it does not. In a private office or emergency department, it may not be possible to find the exact cause of a particular episode of dizziness. As for symptoms, there also may be a false sense of motion, as if the room were spinning in circles. This is called “vertigo”, which could mean a loss of balance and occasionally nausea and/or vomiting.

Most cases of dizziness, says the hospital, get better within a few hours and cause no serious medical problems. However, there always is a small chance the dizziness may be an early sign of a potentially serious medical problem, such as a serious infection, blood clots or even a heart attack. Serious problems are more likely to occur in people who have had previous heart or lung problems, smoke, have high blood pressure, high cholesterol or diabetes, or are persons more than 50 years of age.

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An update on a Sunday afternoon in mid-August August 19, 2007 . . . . . . . . . .

The weekend of July 28-29 was unpleasant. There was more of the same: urgencies, then intense pain and often then: a trickle. Nausea. Dizziness. I had two instances of the dry heaves at home that Sunday. Nonetheless, I went in for Treatment Number 37. I know I wasn’t their favorite patient; I was arriving at the Oncology building daily without enthusiasm, even though it was refreshing to see Heidi give me a warm “Good Morning”. During this visit, I threw up in the doctor’s office (the exam room) and on another occasion. You want to know what happened, don’t you, or you wouldn’t have read this far.

Admittedly, it was very discouraging because I had spent a week in the hospital, had been treated for a urinary tract infection and still was feeling the same pain as ever. I didn’t know it that Monday, but some relief, ironically, was a day away, but in bizarre fashion.

During the day Monday, however, I had two more instances of throwing up.

Around midnight Monday (going into Tuesday, July 31), I started getting even more frequent pain, if that were possible. It was worse than any time in the prior two months. There simply was no letup despite my quick pacing in the bedroom.

At 2:00 a.m. I HAD to go to the ER. My wife drove me.

Even though the ER had only two other patients, and I was interviewed by the intake nurse almost immediately, I could not get into an ER bed for nearly two hours, during which the pain had eased.

One of the nurses was Linda, my friend from my first visit July 18th.

One of the doctors concluded the situation called for a catheter. I had had one for a short while after my October, 2004, heart attack, but I could not recall much about that experience. At 7:00 a.m. Tuesday, the catheter was inserted (you know where) and I was discharged from the ER at 7:45 a.m.

But after arriving home, the greater pain returned, and things seemed to be just as they were after midnight prior to the trip to the ER. Agony was thy name. We called the ER because we didn’t know what to do, and were told to either come back to the ER or see my family doctor.

Shortly thereafter, the catheter was getting bloody. We called 911. And the ambulance from the Philadelphia Fire Department “911″ arrived in six or seven minutes and took me back to the ER.

After further examination, I was given pain medication and advised that the catheter, in fact, was my best course to be able to urinate with less discomfort. And actually, that was true. It apparently was that the combination of further pain and blood scared me to Upper Darby.

At times during that second ER visit that day, I could not believe how bad the pain could get right there in the hospital!!!

In late morning, I asked a doctor (nice fellow) if it would be possible to find out about the biopsy report. I said it was supposed to be ready on Friday (July 27) and now it was four days after that. The doctor returned in a half-hour to say that the report was not finished and I could find out the results, when available, by contacting my family doctor.

I was discharged from the ER for the second time that day about 2:20 p.m. The conclusion: the catheter was properly in place, and it would ease the flow during urination, and eliminate the need for frantic dashes to the bathroom, only (often) arriving there 10 seconds too late.

It was decided to postpone radiation treatments until the next week. As it happened, I had three more, ending Wednesday, August 8th. The pain was too much to proceed further. My urologist had given me his home telephone number, which I called that Wednesday night. He agreed the treatments should be stopped at 40. Even after that, of course, I expected no sudden cure.

I continued to pace and pace to walk off the periodic pain. The catheter definitely reduced the times, so despite that call to 911, it proved to be an improvement. But it wasn’t taking care of all the instances. And amongst the new difficulties came the return of diarrhea.

I had an appointment Thursday (August 2) with my family doctor, one arranged in connection with the hospital discharge Wednesday, July 25. I told my doctor what had been going on, etc., and also mentioned, perhaps too casually, that I still did not have the biopsy results from eight days before. My doctor immediately left the exam room and called Frankford Torresdale. He returned and said he had just spoken with the radiologist who had been working on the liver biopsy. The “report” was not yet in written form but it was in shape to be conclusive.

There were cancer cells in my liver …. is how my family doctor advised me: I have liver cancer.

He arranged an appointment with the surgeon at Frankford Torresdale for 1:15 p.m. the next Tuesday (August 7).

(Dr.) Jeffrey Brodsky, M. D. Frankford Hospital-Torresdale Medical Office Building Suite 235 3998 Red Lion Road Philadelphia, PA 19114 phone 215-612-5630 fax 215-632-3544. Surgical Oncology General Surgery Laparosscopic Surgery. Frankford Hospitals Jefferson Health System (he also has an office in Langhorne, PA)

At that office visit, the surgeon explained what was ahead. He would need to remove 4.1 centimeters of a cancer mass from the smaller lobe of my liver.

I am to report to the hospital at 6 a.m. tomorrow (meaning Monday, August 20). The operation is expected to take two to three hours, I may need a blood transfusion in the midst of it and I likely will be hospitalized three to five days.

I haven’t seen a day since early June when I wasn’t pacing back and forth, seeking to ease the pain.

Dr. Brodsky, my life is in your hands.

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After the surgery, I was not in shape to update this summary for a month, either due to further hospitalization or time at home when I was too weak to think about typing on the computer. So ………………………………………..

It is now 31 days after the operation. Tomorrow will be Thursday, September 20th. To recap: it was on the 20th, in August, that I arrived at Frankford Torresdale Hospital at 5:45 a.m. I was due there at the Admissions Department at 6:00 a.m.

The operation, after appropriate check-ins, started shortly after 8:30 a.m., if I remember what the anesthetist told me. In a seeming moment, I was back awake, with somebody knowing I was returning to consciousness: “It’s all over.”

From what I could glean, the operation extended into mid-afternoon.

They say some surgeons are cocky and repulsive in their behavior in the medical field. I suspect, however, all of them are messengers from God. Putting an incision across my belly about 10 inches somehow has to include the deity; a miracle. My stomach resembles a sketch of a mountain, with a tall television antenna at the top.

This was because of one of His miracle workers, Dr. Brodsky. No cocky one, he. All business except that he’s also a big sports fan, as am I.

Thank God for Dr. Brodsky; a cancer mass measuring 4.1 centimeters was removed in the lengthy procedure.

Nearly all my contact with hospital professionals was favorable.

I reported above on the nurses. I regret to say there was a negative day involving a nurse. For this description, call her “Kathleen”. It was the day (Tuesday, August 21) after surgery. The time was seven minutes to 9:00 a.m. I felt a strange pressure in my nose. I pressed the call button, and a nurse who was in training, working with Kathleen, came into my room. She realized she needed to call Kathleen.

Kathleen said a tube in my nose had backed up. She said she would have to call a doctor. It turned out, unknown to me, that a nasogastric intubation tube had been inserted in my nose. It extended into my stomach where it was to perform a draining function. However, it had retracted and formed a coil in my nose. Kathleen casually told me she would have to contact the doctor on duty.

Fifteen minutes later, and the pressure in my nose remaining, I pressed the call button. When Kathleen entered the room, she told me she had not yet reached the doctor, but the main problem of the moment, as far as she was concerned, was that I should be prepared for a trip to Radiology. I needed another chest X-ray.

I told her the chest X-ray could wait; first I had to get the nose pain eased. She was not convincing as she discussed her attempts to reach the doctor. She had explained that, as nurse, she was not able to deal with the faulty tubing. I asked her several times whether she had talked with the doctor. Once, finally, she told me she had been unable to reach him, as all physicians were in the surgery rooms. I asked if the hospital had a fallback position when a problem develops, and there seemingly is no doctor to consult. I have to tell you, as I think about it weeks later, that my greatest concern was the rather casual way Kathleen felt she could deal with the problem. I had to insist that she do something, and more than a half-hour after the tubing retracted into my nose, a woman intern came in and withdrew the coiling.

Because I was not even 24 hours out of surgery, everything that I was feeling seemed to be a bother and an uncertainty, an unknown. It had me in fear, especially because Kathleen was more interested in scheduling my X-ray than in easing my pain.

What the intern was able to do alleviated the problem but I lay there for more than three hours before a doctor (“Chris”) showed up about one o’clock, with Kathleen. Chris reinserted the nasal tube while Kathleen’s nurse-in-training gave me water to drink, and orders to swallow. I tried to get Chris to stop the process momentarily as I could handle the swallowing alot better with cold water than warm water. He seemed unconcerned that cold water would have speeded the process, which he finally completed, I am happy to say. The nasogastric tube ultimately was back in place, ready to perform its function.

I suppose I was more bothered by the day’s events due to the apparent lack of a little Hippocrates on the part of both Kathleen and Chris. As I look back on it, it seems to me all they would have had to do was EXPLAIN what the hell was going on, and what they were doing and what they had to do.

I didn’t have a clue. They should have informed me.

Since surgery day, Monday, August 20th, I continued to face a battle. I was discharged from the hospital on the eighth day (Monday, August 27th). But I knew I wasn’t a well person. Four days later, I was back in the hospital for a four-day stay. This was on the afternoon when my surgery “staples” were removed (31 of them !). In Dr. Brodsky’s office, I was again dizzy and exhausted, and Dr. Brodsky’s office quickly arranged for my re-admission. During the four days, the hospital concluded I once more was hit with a urinary tract infection. When I was discharged this time, I was of the same mind as my situation a week after liver cancer surgery. I walked out of the hospital partly based on hope.

So, as mentioned above, I was discharged on Labor Day, September 3.

The next week at home was frustrating. I still had the catheter and I still had the periodic pacings to ease pain, especially in the midst of normal sleep time. What was happening, I believe, is that I was avoiding the hospital/doctor/nurse entreaties to drink plenty of fluids because the more I drank, the more urination pain I encountered.

I was scheduled to have the catheter removed on Friday, September 7th, in Dr. Handler’s office. I showed up that day dizzy and still feeling sickly, and Dr. Handler told me he could not remove the catheter when I was still in sorry shape. So I went home with the catheter that day, Day Number 39 with it.

On Wednesday, September 12, my family doctor phoned to say that the most recent blood tests had revealed more kidney problems. Or to put it bluntly, as Dr. Miller did that morning, “Your kidneys have just about shut down.” He said I had no choice except to return to the hospital for further treatment. This was done in concert with Kidney and Hypertension Associates: One Woodhaven Mall (Andalusia ??? PA). Main office: Suite 152 825 Town Center Drive Langhorne, PA 19047 phone 215-741-3510 fax 215-741-3517.

A nephrologist by the name of Dr. Michael D. Shulman, M.D., visited me several times during my hospital stay.

During this period, I was facing an eight-day stay. Toward the weekend, it appeared I might be able to be discharged, although I know I had little strength and not much enthusiasm for anything, including the Phillies and Eagles. An associate of Dr. Handler’s, that Friday (September 14th), Dr. Coll, told me he felt the catheter had run its course; it was time to remove it. It was scheduled for Tuesday, September 18th. I must admit I was scared because I wondered if I would go back to the intense pain during the frequent urinations.

The weekend, however, turned things momentarily upside down. Saturday morning, the catheter bag showed red fluid. Blood. Blood in the urine. No doctor or nurse could provide a good guess as to what had happened to me between Friday night and Saturday morning. Blood in the urine. The red fluid continued throughout the weekend. I was scared.

On Monday morning, the bag was virtually clear. No blood in the urine. What happened? I happily asked. But no doctor or nurse had an answer. The only conclusion: be happy that the urine is clear again.

A hospital mystery, left virtually unsolved. And the plan to remove the catheter was still “on” for the next day.

And, removing the catheter (at 6:05 a.m. that Tuesday morning !!!) was a positive step. My body had to start working on its own, and did so. Although the first 24 hours were scary, I realized I had to keep at it, and lo and behold, the hospital doctor agreed to discharge me the next day, Wednesday.

Recovery was surprisingly and refreshingly rapid. I did have a hard time trying to eat the lunch that day. But within an hour, I was being discharged from the hospital, and I was feeling strengthened and wondering whether it was a cruel hoax being played on me.

At 2 p.m., I was heading out the front door of the hospital.

As I had vowed to myself to do, shortly after arriving home, I was in the backyard pitching to Kevin, my three-year-old great grandson. It had been more than three months since we last played together back there. In short order, Kevin smashed one of my pitches to beyond the doghouse and hollered “HOME RUN”. It was. Bases were loaded. Grand slam.

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During the three weeks since my last hospital stay, I was visited at home by a Visiting Nurse, first Kathy and then Heather. They also are experts in the field, and are able to give you extensive answers to your questions. I was fascinated by their knowledge. A Visiting Nurse definitely is an asset as part of the hospital discharge procedure.

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And now, on the second day of October, more than four months after I started the radiation, I have had two weeks of increasing recovery. I have my voice back, I am drinking the fluids and day by day my appetite is increasing. I am having three meals a day. I had worked from home during the last two weeks of September, and yesterday and today, I went into the office for a few hours.

I had a follow-up appointment with Dr. Brodsky this afternoon. Where liver cancer is concerned, nothing is for certain. He said he was able to remove all of the cancer August 20th, but there are no surgery guarantees. He wants to check me again the first week of January. My situation will continue to require watching.

Thank you for traveling these hectic weeks and months with me.

A SAD POST SCRIPT: There was reference in the above account to Gary Papa, sports director of 6ABC Philadelphia (Channel 6 in Philadelphia, formerly WPVI). Mr. Papa died of prostate cancer Friday, June 19, 2009. He had battled the cancer for nearly six years. He was 54. His last day on the air was May 13th.

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