Excerpt Chapter 17

Chapter 17 Excerpt (Continued):

Like so many prostate patients, sales Lennox had no clue that he was about to deal with an insidious and surreptitious foe. He was then fifty-one. “One day I had a strange feeling in my abdomen. It was hard to describe. Not painful but ‘funny.’ Just a feeling that told me something in that area was not right. I pay very careful attention to my feelings and I decided to take action. I decided to go to my primary care physician and have it checked out. He indicated to me that it was probably inflammation of the prostate gland. And he gave me some antibiotics to take care of it. But the feeling came back. And I told my doctor, sales ’Something is amiss here.’ And because of my knowledge of prostate cancer, case I knew the only way you can know for sure if you have prostate cancer is to have a biopsy. That’s the true way to know and there is no other answer. He went along with my thinking and gave me a referral. I went to a urologist at the University of Maryland and the doctor performed a biopsy on me. It was a very embarrassing thing. Very embarrassing because I felt it would just be the doctor and me in the room. But you had nurses walking back and forth. It was very embarrassing to me. Your feet are in these stirrups, and you’re just spread open like that. And people I see everyday just walking in and looking at me. It was very, very embarrassing to me. Anyhow, the doctor numbed the prostate area and then went through the anus and he did his random clips of the prostate. Taking these samples of the prostate. There was a little blood in the urine as I tried to urinate. But all in all, it went well. But thanks to God I went home and the blood left my urine and everything seemed fine.”

“About three or four days after that I was in a video conference at work and I was called out of the room to take a phone call. It was the urologist on the phone. He said, ‘You have prostate cancer. What you need to do is come and let’s get this thing out.’ I said, ‘What! You know, I’m in a meeting right now, and you give me this type of information on the phone. You’re leading me on by myself. Where are the ethics here?’ He apologized, but I was shook up for the rest of the day. Lennox was angry.” There was no discussion. No options offered, just let’s do the surgery. I sat in my chair for a long while, just contemplating what I just heard. I thought about the people who don’t have the knowledge I do and who don’t know there are options? They depend on doctors to make decisions for them. Where would someone be who had to depend on a doctor and not be able to make his own determination? Where would that person be today? Some doctors aren’t caring enough to give you what you need and when you need it. And many African Americans go to the doctor too late, when the cancer has metastasized. That is a major problem! The irony of it all was here I am, someone who has been advocating about prostate cancer, and I find myself in the same situation. I am realizing, too, that I know of no one in my family who had died of prostate cancer. I never knew what my grandfather died of. Somewhere along the line, someone may have died of it but it wasn’t to my knowledge.

“Well, my wife and I made an appointment to visit this urologist who called me. He said he can do the operation. He has a neighbor he did the operation on. The man is doing well…on and on. Then he began to berate the doctors at Hopkins and said besides they only operate on the opulent. I would like to say that any time you meet a doctor who is putting down other doctors, that should be a red flag. His actions and remarks were not sitting well with me. He said set your appointment with me and I’ll do the operation. As we were driving home my wife said something very poignant to me—and it still sticks in my mind. She said, ‘I do not have a relationship with your prostate. I have a relationship with you!’ And I am thankful, and men ought to be thankful for wives who are caring and understanding of the situation. That was so touching to me. Then she went on, “I just want you to be here and that’s what’s important to me. Right there and then I decided I was going to do this operation—but this particular doctor would not do the operation.’

Results of the biopsy taken at the University of Maryland indicated that Lennox had fifteen percent cancer cells in only one of the twelve cores taken. “ I was having no symptoms and I decided to shop around for a doctor. My boss at the University of Maryland, a renowned doctor, advised me to get a second opinion at Johns Hopkins. So, I went to Hopkins, met with Dr. Burnett and immediately felt very comfortable. He was a very positive man and the first thing he said was that with for fifteen percent we don’t operate. We are going to do expectant management. My wife and I were very happy to hear that we don’t have to have the surgery. We were so happy, so pleased. Then, about a week later, I got a call from Dr. Burnett. He said the pathology lab at Hopkins reviewed the slide and that eighty-five percent of the cells were cancerous! And he said he had now decided to take a more aggressive approach than we had discussed. There was silence on the phone. Dead silence. I was in shock! To think that you had two pathologists—and that one could be so wrong! It just goes to show that this is not a perfect science. And so Dr. Burnett said I didn’t have to make a decision right then. We can talk about it a little later on. Right there I said to him, ‘Let’s get the operation done.’ And we fixed the date. ” The truth is that some pathologists have more experienced eyes and can see a different picture of the cells while others may not recognize the complex morphological differentiations of those same cells.

“I remember I went home and walked into my living room. I sat down and began looking around my house. I was actually coming face-to-face with my own mortality. I said, ’I can die!’ I’m looking around at my wife’s pictures and my children’s. I’m overwhelmed by how fleeting life can be. Everything took on a new meaning for me. Everything looked so special. The trees looked different to me. Their leaves looked different. It was just beautiful, beautiful. I saw things that I had passed on the road. Never paid any attention to them. Everything looked different and that day, And later when I was traveling down to Hopkins to do the operation, I just felt like shouting to everybody, ‘How are you? Hi ya doin’?’ I just wanted to talk to everybody!

“On November 23, 2003 I checked into the hospital. My pastor came. A strange feeling came over me. I can still remember. We were there together because I knew there was going to be a time in my life that I will not know. I will not ever be able recall. That’s the time when I will go under anesthesia. That’s the time when I will not be in control. And that’s the time when I realized what is man? There must be something higher. A higher power. In my case, as a Christian, I knew that God is control, and we are not in control. And so I prepared myself for going up to the operating room. We prayed there. Then I had to make a decision as to whether I wanted a lumbar injection (spinal anesthesia) or whether I wanted to go under with full anesthesia. I opted for the lumbar “punch” injection. And so I was taken into the operating room. The nurses were so kind to me, and the doctor indicated he was going to put something into my saline line. All I knew I was sitting up there talking to the nurses…and I knew nothing after that. Then, I remember, when I came around in the recovery room my wife was there and I couldn’t move my toes! I was scared as hell. I had the will, but I couldn’t move my toes! I’m someone who likes to be in control. With all the will power I had, I still couldn’t move my toes. I had to be patient because after a while I was able to wiggle my toes.

The next day I was up and out of bed. Walking down the hospital corridor with a lot of other men. We called it our little highway. It’s times like this you realize how little material things really mean, how much just being alive is what counts. The gentleman in the next bed told me he was just forty-two years old, and his PSA was over 24. We talked and developed a bond, and we shared, and I was wondering what was next…I was in so much pain. And he told me the next day I’d be walking without this pain. He was right. Magically, like clockwork, the next day I was walkin’ without the pain. Each day I became stronger. I started encouraging other men who had just come in. Because I was getting ready to leave, and I could see them doing their rounds. And I’d say, “You gonna do better each day, and I would encourage them and we would just have a ball. We had a bonding. The nurses were so kind to me and took care of me. It was just a wonderful, wonderful experience.”

Following his recovery from the prostatectomy Lennox turned his attention once again to helping less fortunate men in the black community who learned that they have prostate cancer. “My role is to help African American men understand how they must stand up to the disease. To help the black community understand how to apply science to improve the quality of their lives. We do this through workshops in the community that are health-related. We teach people in the community about blood pressure, about diabetes, and I specialize in the area of prostate cancer. Much of the work is through churches and community groups. My word to African American men is this: . You can’t expect people to give you everything. You must have a burning desire within yourself to want to know and to want to live. Opportunity comes clothed in everyday garments. It’s all around you. If you don’t have a focus, if you don’t have a goal, you’ll never realize the things around you.”

UPDATE: September, 2009:

In less than two month’s time, Lennox Graham says he was completely dry and “in the other department” ( sexual potentency) he is doing just fine. He currently teaches global health at Howard University in Washington, D.C.

THE DOCTOR’S NOTEBOOK

Quite obviously, Lennox Graham has a personal knowledge and passion regarding the condition of prostate cancer. He stresses the importance of early detection and diagnosis of this disease, which by his own experience translates into the best opportunity with treatment to achieve a successful outcome. Because of the early presentation of his disease, he was an optimal candidate to undergo a “nerve-sparing” modification of radical prostatectomy His case is a very good example of what can be achieved with early diagnosis—cure with preservation of pelvic functions. He effectively communicates how confronting the disease early can be both life-saving and quality of life-saving. He champions this concept for all men while keeping a very special focus for those with particularly high risk for the disease, African-American men.

A teaching point is worth discussing here. Lennox Graham had presented with what appeared to be low-profile disease on the basis of no suspicious findings for prostate cancer on digital rectal examination and a biopsy result that showed low- to intermediate-grade disease (Gleason score 6) in only fifteen percent of one of twelve biopsy cores. Only after his prostate biopsy material was reevaluated was it clear that more disease was apparent, because the biopsy core showing cancer actually contained eighty-five percent cancerous cells. The initial pathological interpretation revealed minimal enough and low-threat disease that presented a quandary. The initial findings suggested a presentation that might not ever progress. I had put forward the option of expectant management in this light initially. However, upon further review, the biopsy findings definitely directed a definitive reaction to his disease.

I think it is appropriate to communicate to patients truthfully about their disease state and inform them that we urologists struggle at times to know the exact risk of the disease presentation when only minimal findings are identified. The critical issue in this context is whether the risk of the intervention exceeds the threat of the disease. I ask patients to help me decide how they wish to proceed when this situation arises. This is not meant to suggest that I am avoid giving them proper direction or failing to help them with deciding what action they should take. Rather, it is an effort to treat patients as thinking individuals who should partner with me in providing their very best care. It is our practice at the Johns Hopkins Hospital to have outside pathology material re-reviewed in our pathology department. More important, we want to do our own”homework” when giving patients the very best of a second opinion. Upon re-review, it was apparent that a greater extent of disease was evident than what was initially reported. The re-review clearly indicated that his cancer presentation was not clinically insignificant. I did impress upon him under this circumstance that definitive management should be pursued without delay. After discussion of treatment alternatives, a decision was made jointly to proceed with radical prostatectomy.

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Hippocrates

~ Father of Medicine