Climacturia

I started to experience Climacturia and Arousal Leakage a few months after my prostatectomy.  I first noticed it when I was still working on controlling urine leakage and thus quite conscious of anything which would trigger a spurt. On occasion when I would hug my wife, I felt the start of a little leakage!  We would be having a full-body, prolonged squeeze and out would come a bit of pee. It was NOT due to pressure on the bladder, but rather associated with a warm feeling of love. Then I noticed it when trying to masturbate to orgasm, which I had begun as part of my penile rehabilitation. Simultaneously, I heard about climacturia on “The Penis Project”, a podcast from Australia about recovering bladder and sexual function from radical prostatectomy. Here are a couple of links I found:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705983/ (Their literature review showed an estimated 30% prevalence after RP.)

Six months ago, I bought a Firm Tech, the more expensive model with an internal sensor designed to detect nocturnal erections. I was interested in whether my penile rehab was working to help me regain the natural blood flow which they provide. (I’m happy to say they have returned.) The key point here is that the Firm Tech is NOT like other cock rings in that it can be worn for extended periods of time, e.g., all night. It is softer, more pliable than other rings.

Now, why might the Firm Tech help with climacturia? What follows is my own speculation – I have no data or scientific studies to verify this theory. Why does climacturia happen? And why doesn’t it happen with the prostate in place? During orgasm, the sperm are ejected through the tubes which carry them from the testes eventually to the urethra and out of the penis, along with the prostatic and seminal fluid in which they are suspended. That happens because of smooth muscle contractions in vessels like the urethra, seminal vesicles, vas deferens, and prostate. With a prostate, urine as kept nicely in the bladder, and only the urethra might have a few drops in it, which would not be noticeable along with semen. But after RP, the bladder can more easily leak urine into the urethra, and with the automatic orgasmic contractions still occurring, out it comes. The Firm Tech is “firm” enough to squeeze off the urethra (which runs on the underside of the penis), so it theoretically can stop *most* of the orgasmic urine loss. 

I’ve found that not only emptying the bladder, but milking the penis afterwards to get out those last few drops, helps greatly reduce or even eliminate the climacturia.

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Sea of Tranquility

Emily St. John Mandel’s Sea of Tranquility is a compact, complex romp through time and space. Beginning in England, 1912, she sends Edwin St. John St. Andrew (no relation!) to Canada after he embarrasses his parents at a dinner party for being colonialists in south Asia. (He was born a century too early.) His status as third son means he inherits no property from them, so he willingly takes their remittance, and proceeds to languish in the new world, eventually alighting on Vancouver Island, where he witnesses a strange phenomenon in a primeval forest. He sees a vast a train station-like interior superimposed on the majestic maple in front of him, accompanied by a low whooshing noise. This odd encounter, lasting only a second, serves as the core of Mandel’s story.

Stretching forward to the present day, then on to a moon colony in the 23rd and 25th centuries, she weaves in a pair of childhood friends who have lost their husbands to a Ponzi scheme, a wildly successful novelist on a book tour, and another aimless young man who finds a purpose in life at the Time Institute in 2401.

At that point, these stories, disparate in time and place, begin to coalesce as Gaspery-Jacques seeks out his sister Zoey and insinuates himself into her work. At the Institute, she is trying to disprove that all of human existence is merely a simulation in some massive cosmic computer. Gaspery trains for years to travel through time so he can investigate the origin of this theory.

The essence of Sea of Tranquility lies not in the speculative fiction bed in which she’s planted her tale. Rather, the people, their very human plans and foibles, are her interest. We learn nothing about the mechanics of time travel, except that an iPhone-like device and a large, undescribed machine are involved. The computer simulation question is another MacGuffin she uses to set the plot in motion, and then leaves suspended, unanswered.

Mandel’s writing reminds me of Kurt Vonnegut, who sometimes used the trappings of science fiction in service of his plots. His prose is equally succinct and readable. They both pare down their writing so the plot never stalls, without the use of artificial twists to pique a reader’s interest. Mandel goes him one further by expertly weaving her several stories neatly together, offering just enough information at key points to keep us informed and engaged.

A quick, immersive read.

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Birnam Wood

In Eleanor Catton’s Birnam Wood, three young New Zealanders and a middle-aged American billionaire have interwoven plans for a vacant ranch on the South Island, at the base of the (fictional) Korowai National Park.

Mira Bunting, a 29-year-old horticultural student, founded a guerilla collective, Birnam Wood, which plants veggies on otherwise unused parcels of land. Her sidekick, Shelley Noakes, provides organizational nous and stability to Mira’s headstrong activism. Tony Gallo, who left soon after the group began has returned, hoping to rekindle an imagined romance with Mira and kick-start a journalism career.

After learning that the ranch in question, belonging to the recently knighted Owen Darvish and his wife Judy, has been effectively abandoned while Darvish pursues his pest control business on the North Island, Mira investigates the planting possibilities on the Darvish property. There she accidently meets Robert Lemoine, who has made a fortune in various tech companies, most recently a drone business. He, too, has plans for the land, but they don’t involve seedlings or fertilizer.

Mira and Lemoine quickly form a partnership. Lemoine offers money to the group, hoping to use them as a cover for his mysterious activities. Mira sees the funding as a kickstarter towards respectability and a sustainable proposition.

At the hui – a leaderless meeting of the collective, held in a circle – to announce Lemoine’s offer, Tony re-appears and proceeds to burn his bridges with the gang through a multi-page rant against capitalism, environmental depredation, intersectionality, and neoliberalism. In other words, he’s an angry young Marxist without a compass.

Each of these protagonists changes as their individual agendas collide and they evolve into fully drawn complex personalities. Each of the heroes also has at least one foot of clay. Mira is a scheming, ambitious idealist. Shelley is a frustrated second banana who benefits from the loyalty she has shown to Mira and her project. Lemoine appears at first to be in the game for fun, but his lack of transparency and unlimited resources foreshadow a darker side.

Tony may be the most complex character. He is introduced as a shy romantic, reveals a dissatisfaction with most aspects of modern society, then proceeds to show remarkable resilience and ingenuity as he tracks Lemoine’s plans to their deadly end.

Catton’s writing is fluid, easily digested most of the time. But every so often, she crams multiple ideas into one sentence, comma after comma stretching for 100 words or more through the depth of an almost undecipherable paragraph. And, two-thirds of the way through the book, Mira and Shelley, after speaking with intelligence and maturity up till then, begin to throw “like” into every other sentence. This tic comes and goes for a while, and then disappears.

The tale is well-constructed. Catton is economical in the way she provides new information and action which drives the narrative to its racing conclusion. What starts out as a gentle exploration of flower children trying to change the world one planting at a time becomes a page-turning thriller when the truth of Lemoine’s activities is discovered by Tony.

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Visitation

CyberViewX v5.16.80 Model Code=89 F/W Version=1.07

[Final Draft]

“He likes to argue, doesn’t he?” Julana asked.

“He was on the debate team in high school. It’s hard sometimes…” Cheryl responded.

“Hard?”

“He always has to have the last word.”

Julana looked over at Michael. We were having a farewell dinner, September 2019, before they left for another six months in Spain with their daughter, granddaughter, and son-in-law. Each time we saw them, we didn’t know if it would be the last.

Michael stroked his beard, his smile lighting up the dark-paneled restaurant. “Why’d you join the debate team?” he prodded. “Trying to pick up girls?”

“Funny you should mention it…” I replied. Strobes of long buried scenes flashed up through my past, burbling out to be told. “I did meet my first girlfriend, my first real girlfriend because of that.”

His eyebrows shot up. “Really?” He looked over at Cheryl. “Did you know about this?”

She laughed. “That’s what he tells me.”

Michael turned back to me. “I bet there’s a story there…”

One I hadn’t thought about, much less told, in years – decades, maybe. I felt the embers re-appearing from underneath the ash pile of my history.

Two girls, Carol Downs and Susie Wise, appeared one night while the team practiced for our up-coming regional tournament. Our advisor, Miss Flory, let them in to her little apartment.           

“They wanted to be our cheerleaders,” I told Michael. “They made these timecards, paisley fabric glued onto small white cardboard. They thought the football, the basketball teams were getting so much attention. But since our school was college prep, they thought the intellectual competition of debate deserved equal treatment. So they wanted to be our timekeepers.”

“And where did that go?”

“Once I finally figured out that Susie was interested in me, we started going out, and kept it up throughout college, until I went to USC for medical school. Susie had one more year at Radcliffe. I stayed in LA, she stayed back east.”

Julana looked at Cheryl. “That’s where he met you, right?” The subject changed, and we shared our origin stories as couples. Cheryl and I flirting on the night shift on the LA County Hospital labor and delivery unit, Michael chasing Julana to Kentucky after getting a fleeting glimpse of her at his brother’s house.

I’d seriously reminisced of Susie only once in the previous 35 years, ever since I learned of her death at age 35 from leukemia. Memories of her drifted far below my conscious thoughts until I went to Boston in 2005 to race the marathon. I visited her grave, had a good cry, wrote a story about it, then heard no more from her memories. Until Michael asked that question. Over the next five months, she pounded on the door I had closed over her, insisting I pay attention to her story, get it out of me and into the world.

********

The next month, I prepared for the Hawaii Ironman, mid-October. Following that, back to the triathlon grind for Ironman Arizona, mid-November. My brain had no bandwidth for the past, only the immediate future of finishing my triathlon career on a high note. I won my age group in Tempe for the 4th time, securing a ticket back to Kona for what I planned as my absolute last and final Ironman.

Returning from Arizona, I plopped in front of the TV, and watched the latest Jack Ryan series on Amazon Prime. In it, John Kasinski and Wendell Pierce traveled to Venezuela, CIA agents trying to reinvigorate the democracy there by ensuring a female candidate for President would stay alive and win. Midway through the seventh episode, as she leaves her house the night of her victory, the candidate, Gloria Bonalde stares in wonder as her driveway fills up with supporters, cheering the overthrow of the defeated autocrat. Her two children trail behind, shepherded by her chief aide Valentina, played by Columbian actress Paula Castaño. They are seen out of focus in the background several times for a split second as the camera shifts from Bonalde to what she sees. Then, another quick take features Valentina and the kids, in full focus, smiling and nodding in wonder. Castaño appears ready to cry with joy. She is wearing a simple white top, covered by a gray pants suit. Her dark, wavy hair is parted on the left. At the instant of her mouth opening, I caught a sudden rush of Susie’s image careening back into view. The eyebrows, the shape of her cheeks, the set of her hair, the smile of wonderment and knowledge – she was there once again in my mind.

And she wouldn’t go away this time. As days went on, I kept remembering who she was, how accomplished she had been, how lucky I was to have known her, to have her teach me. I didn’t know it right away, but she began demanding more and more of my attention.

********

In the winter, Cheryl and I spend many evenings in front of our Vermont Castings Reliant stove, warmed by a fire from logs I have split the year before. In early December, we began discussing love, how it happens, why it leaves. I remembered a poem I had written about that, five decades before. I searched for the folders which preserved the writing I had done in in my late teens and early twenties. 

First, I checked under the sink in the mud room – I had not stored them there. Next, down in the basement, on metal shelves next to my collection of old skis and discarded Christmas decorations, I found the yellow cardboard container, and brought it back upstairs.

Sifting through the box in front of the fire, I found it filled with forgotten memories. Not only poems, but papers I had written in college, sporadic attempts at journaling, a few newspaper clippings, and other detritus of my past I refused to discard.

I had burned the letters Susie had written before we parted, but discovered several I’d saved from after we split up, along with one or two which escaped the fire. And a letter from her mother to mine, after Susie’s death, sketching her last few years. These along with the journal entries ripped off the encrustations my brain had placed over Susie, and she escaped fully into my consciousness.

I began to think about her, unbidden, at all hours of day or night. I began to see bits of her in any woman with long dark hair. I began to wonder, What am I supposed to do with this, these poems I wrote to and about her, these letters she sent after we ended our love, these messages I scribed to my future self about what happened and how I felt back then, November 1965 to September 1970.

I found a birthday card she had created, a sheet of colored construction paper. She sent it from spring break in Cincinnati, 1970, after visiting me while I spent that winter skiing in Snowmass. Her tiny writing filled every inch not covered by a collage of pictures cut from ski magazines. She listed every secret phrase or joke we’d shared, every place we’d shared. She acknowledged her love for me, even though we both knew we were already separating.

I’d saved other little tidbits from her. Four poems she wrote to me when we first got together. Comments on a clipped “Ask Ann Landers” column. A ticket stub or two from plays we’d seen. It was all too much, and I started crying, not knowing I still had those feelings left in me. It was not nostalgia; it was the actual return of her into my life.

While Cheryl and I spent those December evenings by the wood stove, cheering and warming ourselves through the dark, damp drizzerable season surrounding the holidays, she read her books, browsed the internet, and luxuriated in the heat. I pawed through that box, reading and re-reading the poems, letters, and journal jottings, creating cascading thoughts about the five years I spent with Susie. Inside my brain, those thoughts had no landing lights, no place to settle and attach to a story I thought was finished.

As the New Year came, and holiday excursions no longer saved me from the growing obsession, I frantically tried to stop the intrusion. I felt possessed by her, or at least the memory of her face, her laugh, her love. I wanted those thoughts gone back to wherever I had buried them, but I couldn’t find the cemetery they’d escaped from, no headstone or open grave to guide me back to sanity.

The first week of January, I tried writing her out of my thoughts, transferring what I remembered to document and preserve her spirit on the page, where it could live outside my mind. My plan: put it all down on “paper”, and I could return to it when I wanted, knowing it wouldn’t leave. I got two chapters in and lost the plot immediately. She consumed my thoughts in a way nothing ever has before.

Since the mid ‘90s, I had been documenting my daily physical “activities” – training exercise, workout, it’s all the same. First on an Aspen photo calendar and in a small reporter’s notebook, later on computer apps. Looking back on the first quarter of 2020, there’s a gap in the recording I did in a training diary, from January 16 to February 23rd. I know I kept the activity up, as my smart watch faithfully kept track and uploaded the data to Strava. But the training diary I wrote in every day – the only other gap since 2007 was after my bike accident in fall 2010, when I was physically unable to either do any training or write on a keyboard. This obsession with a long-dead girl had crowded out my other life, threatening my sanity.

On January 12th, I checked out a therapy site I’d heard advertised on NPR the day before – BetterHelp.com. I signed up and several days later I got the courage to request an online visit with a therapist for the following week.

A few days later, while Cheryl and I were preparing dinner, I got a mysterious urge to hear the Bob Dylan song, “Don’t Think Twice It’s All Right.” Susie and I had each brought a predilection for Dylan into our relationship. More than the contemporaneous Beatles, his combination of social justice anthems and oddly evocative love songs resonated with each of us. That evening in the kitchen I searched for it on Apple Music. After hearing Dylan’s version, I clicked on another which appeared in the list, by someone I’d never heard of, Kesha. She gave a dirge-like rendition accompanied only by a cello, her voice continually cracking as if she were on the verge of crying.

I heard the words for the first time from a woman’s perspective, specifically as if Susie were trying to explain to me what she was thinking and doing when she drove out with me to Los Angeles as I started medical school there. That she was willing to travel cross-country with me I see now had given me subliminal hope that we might be able to continue a long-distance relationship. In retrospect, that clearly was not on her mind. She literally got out of our bed and left me behind. “You’re the reason I’m traveling on. Don’t think twice it’s all right.” She had given me her heart, but I wanted her soul, Kesha was telling me.

That song appeared on an album called Chimes of Freedom: The Songs of Bob Dylan Honoring 50 Years of Amnesty International. Four discs holding 76 covers by artists as well known to me as Joan Baez and Jackson Browne, and as unknown as Kesha and Darren Criss. As varied as Ziggy Marley, Adele, and Johnny Cash. Dylan’s songs new and old flew past as I scrolled the list, and randomly lit on one I didn’t know, “I’ll Remember You”. I see now that choice was not random, the title was exactly what I was doing. Thea Gilmore, along with an acoustic guitar, stand-up bass, and lonely trumpet, started out, “I’ll remember you when I’ve forgotten all the rest”. From the end of life, looking back at all s/he’s known, she sings “Though I’d never say that I’d done it the way that you’d have liked me too, in the end, my dear sweet friend, I’ll remember you.”

I began to think my obsessive thoughts were not coming from within but brought in by some cosmic link reconnecting me to Susie. My hold on reality, on the belief that I controlled my thoughts, my actions, began to loosen. Over the next two months, while I skied in Colorado, baby-sat our granddaughter (who was born on Susie’s birthday), and kept busy training for the upcoming triathlon season, I continued to get messages from other songs, images from other people who resembled her which accelerated the disruption. I eventually decided to live with the mild insanity, cancelling the therapy appointment.

I spent a few days alone in Snowmass skiing and listening to maudlin music. I started compiling those songs into a table of contents for a massive story I would tell, about winning and losing Susie and then finding Cheryl, how all that created the person I have become. I tried explaining this to Cheryl on the phone, but I kept leaving out anything related to the girl who came before. It was very important to me to not lose the most important person in my life, my wife of forty-some years, my best friend, and the mother of my children.

I was scared. Scared because I was not in control on my own thoughts. I had two choices: either I was going crazy, or I was being visited, haunted, by a ghost. I chose the latter, even though a part of me strongly suspects that is not possible. I made that choice because it was too scary to think I was losing control of my mind. 

Back home, being around Cheryl again brought stability. We spent a week in mid-February skiing with family, and I felt grounded once again. Returning home, as the drum beat of the novel coronavirus increased and people began to question the risk of their daily routines, I threw myself into a neglected project, compiling blog posts of my early triathlon journey into a book for sale on Amazon, I Really Wanna Go To Kona.

All this activity had failed to completely silence the external voice in my head. Not one I could hear as if it were speaking, but one that was trying to possess me, to insist that it had a story to tell, and needed to get it out in the world before I was no longer able to help. I could see the entirety of the tale, knew how it started (those paisley time cards), how it proceeded (Susie left me), and how it ended (she died.) The day after I clicked the button to publish my Kona tales, I started writing.

I began on March 8, not in my own voice, but in that of Susie’s, our relationship told from her point of view. I have no explanation for why that happened. But once I switched perspectives, once I let her tell the story, the words came easily.  Everyday, as the country began to shut down, I sat at my computer and wrote for 60 to 90 minutes, a thousand words or more, chronologically from November 1965 to May 1984. The last fifteen years I could not rely on my own memories, only on the few letters I’d saved, the brief note from her mother, and scientific articles on which she had been a co-author. Those fifteen years flowed as easily as the first five, and I was done in mid-August.

Along the way, I learned as I never had before who I was. I learned I was lovable. I was reminded about the foundation of a loving relationship, the ability to give up oneself in favor of a new duality. In April 2022, after editing, pruning, and refining, I publish Love Rhymes. I ended it with a poem, thanking Susie for what she brought me twice in this life.

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Visitation – II

[First Draft!]

The next month, I prepared for the Hawaii Ironman, mid-October. Following that, back to the triathlon grind for Ironman Arizona, mid-November. My brain had no bandwidth for the past, only the immediate future of finishing my Ironman career on a high note. I won my age group in Tempe for the 4th time, securing a ticket back to Kona for what I planned as my absolute last and final Ironman.

Returning from Arizona, I plopped in front of the TV, and watched the latest Jack Ryan series on Amazon Prime. In it, John Kasinski and Wendell Pierce traveled to Venezuela, CIA agents trying to return democracy by ensuring a female candidate for President would stay alive and win. As she leaves her house the night of her victory, Gloria Bonalde stares in wonder as her driveway fills up with supporters, cheering the overthrow of the defeated autocrat. Her two children trail behind, shepherded by her chief aide Valentina, played by Columbian actress Paula Castaño. They are seen out of focus in the background several times for a split second as the camera shifts from Bonalde to what she sees. Then, another quick take features Valentina and the kids, in full focus, smiling and nodding in wonder. Castaño appears ready to cry with joy. She is wearing a simple white top, covered by a gray pants suit. Her dark, wavy hair is parted on the left. At the instant of her mouth opening, I caught a sudden rush of Susie’s image careening back into view. The eyebrows, the shape of her cheeks, the set of her hair, the smile of wonderment and knowledge – she was there once again in my mind.

And she wouldn’t go away this time. As days went on, I kept remembering who she was, how accomplished she had been, how lucky I was to have known her, to have her teach me. I didn’t know it right away, but she began demanding more and more of my attention.

********

In the winter, Cheryl and I spend many evenings in front of our Vermont Castings Reliant stove, warmed by a fire from the logs I have split the year before. In early December, we began discussing love, how it happens, why it leaves. I remembered a poem I had written about that, five decades before. I searched for the box and folders which preserved the writing I had done in highs school, college, five years after. First, I checked under the sink in the mud room – I had not stored them there.

Next, down in the basement, on metal shelves next to my collection of old skis and discarded Christmas decorations, I found the yellow cardboard container, and brought it back upstairs.

I found it filled with forgotten memories. Not only poems, but papers I had written in college, sporadic attempts at journaling, a few newspaper clippings, and other detritus of my past I refused to discard.

I had burned the letters Susie had written before we parted, but discovered several I’d saved from we split up, along with one or two which escaped the fire. And a letter from her mother to mine, after Susie’s death, sketching her last few years. These, along with the journal entries, ripped off the encrustations my brain had placed over Susie, and she escaped fully into my consciousness.

I began to think about her, unbidden, at all hours of day or night. I began to see bits of her in any woman with long dark hair. I began to wonder, What am I supposed to do with this, these poems I wrote to and about her, these letters she sent after we ended our love, these message I scribed to my future self about what happened and how I felt back then, November 1965 to September 1970.

I found a birthday card she had created, a sheet of colored construction paper. She sent it from spring break in Cincinnati, 1970, after visiting me while I spent that winter skiing in Snowmass. He tiny writing filled every inch not covered by a collage of pictures cut from ski magazine. She seemed to list every secret phrase or joke we’d shared, seemed to still wonder about her love for me, even though I knew we were already separating.I’d saved other little tidbits from her. Four poems she wrote to me when we first got together. Comments on a clipped “Ask Ann Landers” column. A ticket stub or two from plays we’d seen. It was all too much, and I started crying, not knowing I still had those feelings left in me. It was not nostalgia, it was the actual return of her into my life.

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Visitation – I

“He likes to argue, doesn’t he?” Julana asked.

“He was on the debate team in high school. It’s hard sometimes…” Cheryl responded.

“Hard?”

“He always has to have the last word.”

Julana looked over at Michael. We were having a farewell dinner, September 2019, before they left for another six months in Spain with their daughter, granddaughter, and son-in-law. Each time we saw them, we didn’t know if it would be the last.

Michael stroked his beard, his smile lighting up the dark-paneled restaurant. “Why’d you join the debate team?” he prodded. “Trying to pick up girls?”

“Funny you should mention it…” I replied. Strobes of long buried scenes flashed up through my past, burbling out to be told. “I did meet my first girlfriend, my first real girlfriend because of that.”

His eyebrows shot up. “Really?” He looked over at Cheryl. “Did you know about this?”

She laughed. “That’s what he tells me.”

Michael turned back to me. “I bet there’s a story there, right.”

One I hadn’t thought about, much less told, in years – decades, maybe. I felt the embers re-appearing from underneath the ash pile of my history.

Two girls, Carol Downs and Susie Wise, appearing one night while the team practiced for our up-coming regional tournament. Our advisor, Miss Flory, let them in to her little apartment.         

“They wanted to be our cheerleaders,” I told Michael. “They made these timecards, paisley fabric glued on to small white cardboard. They thought the football, the basketball teams were getting so much attention. But our school was college prep, they thought the intellectual competition of debate deserve equal treatment. So they wanted to be our timekeepers.”

“And where did that go?”

“Once I finally figured out that Susie was interested in me, we started going out, and kept it up throughout college, until I went to USC for medical school. Susie had one more year at Radcliffe. I stayed in LA, she stayed back east.”

Julana looked at Cheryl. “That’s where he met you, right?” The subject changed, and we shared our origin stories as couples. Cheryl and I flirting on the night shift on the LA County Hospital labor and delivery unit, Michael chasing Julana to Kentucky after getting a fleeting glimpse of her at his brother’s house.

I’d seriously reminisced of Susie only once in the previous 35 years, ever since I learned of her death at age 35 from leukemia. Memories of her drifted far below my conscious thoughts until I went to Boston to race the marathon. I visited her grave, had a good cry, wrote a story about it, heard no more from her. Until Michael asked that question. Over the next five months, she pounded on the door I had closed over her, insisting I pay attention to her story, get it out of me and into the world.

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It’s Just Like Riding a Bike – IV

[First Draft!]

A year into medical school, I felt the need for two-wheeled transportation again. Another police auction in downtown LA, and for $60, I got another beater. My world opened up. I already had a car, of course – it was Los Angeles – but now I could explore the area on the weekends without having to fight freeways or parking. I rode a few miles south from our MacArthur Park house to the USC main campus and tootled around just like an undergrad. The place looked like a real university but felt like a Hollywood set. Students had a more polished look than the Ivy Leaguers I’d grown used to in New England. Appearances matter in LA.

To the west, I discovered Hancock Park, a quiet oasis filled with wide yards and tree-lined streets with little traffic, as if Beverly Hills had been transplanted into the teeming concrete jungle surrounding LA’s downtown. A mile away, the hexagonal streetscape of Park La Brea provided another respite from the relentless grid of LA concrete.

Two miles east of our house, the Los Angeles River ran trapped in a concrete watercourse. Most of the year, a trickle flows along a recessed central channel, leaving the main river bed dry for twenty miles to San Pedro. I discovered a wide open storm drain at the end of 7th Avenue two miles from our house. Now, fifty years later, that entrance is blocked to prevent anyone from entering the river proper. Back then, no chains or barriers blocked the way, but I never encountered anyone else as I pedaled for miles with the Harbor Freeway grinding and pulsing above me.

The summer after my second year, I took advantage of the last extended free time I would have for six years, as I completed the clinical rotations of the final two years of med school, and then four years of residency. I drove my ’66 Dodge Charger up the Pacific coast, through the Rockies, back to Cincinnati and Chicago, returning ten weeks later to enter my medical apprenticeship.

I stayed with family or on my own in the back of the car (the rear seats folded down, providing a rather firm mattress). My sister lived in Ketchum, Idaho, and I spent a week or two with her. She and her fiancé Stephen lived in a trailer at the base of the Sun Valley ski mountain hard by the Warm Springs Creek. Stephen worked at Sturtevant’s Sports. A smooth-talking salesman, he easily convinced me to buy my first drop-bar “English” bike, otherwise called a “ten-speed”. Drop bars, pedal straps, shifters on the down tube, this Raleigh was sleek and elegant. We rode over Galena Summit, taking in the views to Redfish Lake and the Sawtooth peaks to the north. I managed to fit the Record (for that was it’s model name) into the back of the Charger, and continued my romance with cycling.

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Post-Op Activity Advice

I’ll focus on just one aspect of the post-op period, which I’ll define as the first three months…physical activity.

If you are someone who does routine, regular activity, be that golf, running, weight lifting, yoga, whatever, MAKE SURE you discuss with your surgeon after the surgery before you leave the hospital exactly what you usually do, and what they recommend doing/not doing. how to return, when, etc. “Physical activity” after surgery is not one-size-fits-all. E.g., you can walk right away, but you can’t ride a bike for 3 months. And everything in between depending on the motions involved, the weights involved. Also, because each surgery is slightly different, there may be some things which apply in your individual case which only the surgeon would know about after having been in there and knowing exactly what they did inside, so the generic advice online might not be right for you.

If you are not routinely physically active, at a bare minimum you should commit to walking as soon as possible after the surgery (like, the afternoon after!), and every day forward. Walking is critical to (a) get your bowels moving again, (b) keep air moving through your lungs to prevent pneumonia, and (c) enhance the body’s healing powers by increasing blood and oxygen flow.

Also, the less opioid medication you use (oxycontin, Vicodin, etc), the better as far as bowel function is concerned. Many/most of us after laparoscopic prostatectomy got by just fine on only Tylenol after leaving the hospital.

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The Country of the Blind

The Country of the Blind, by Andrew Leland, is the story of one man’s exploration for understanding as his vision slowly dwindles. Retinitis pigmentosa (RP) affects about 1 in 4,000 people. A genetic disorder, it results in the slow death of the individual elements which receive light at the back of the eyeball, the rods and cones. With first the rods, then the cones slowly degenerating, gradually unable to transmit signals to the optic nerve, a person with this condition will notice decreasing night vision and progressive loss of peripheral vision. Over decades, at a different pace for each individual, this incurable condition reduces vision to a small tunnel with loss of color until the light flickers out, and one is fully blind.

Leland, a writer and podcaster, decided in his mid-thirties to explore what the future held for him. He systematically explores various facets of blindness, learning about the organizations which advocate for the unsighted, and the government agencies which provide services to them. Along the way, he meets people with many different types of blindness, observing how they adapt the world to their condition. He provides a history of blindness activism and connects that to the larger world of discrimination and marginalized groups.

With his curious mind and investigative skills, he uncovers a broad tapestry of attitudes by and about the blind. For some, blindness is inconsequential until someone uses it to put barriers in front them. For others, their lives are totally upended by their inability to see what others take for granted. Along the way, he explores the implications of unsightedness to relations between men and women, speculating on what the “male gaze” means both to a woman who doesn’t feel the same as others if she can’t see it, and what a men might feel when judging women as prospective partners, if he can’t see them.

He provides a history of attempts at helping the blind access written communication, including the development by Louis Braille of the eponymous system for transcription words. He includes a fascinating anecdote about the author James Joyce, who had significant vision impairments when writing Finnegan’s Wake. The Irishman dictated the entire book to others, including his friend Samuel Beckett, the playwright. Leland then shows how Beckett’s Endgameprovides insight into the experience of blindness.

He dives into the potpourri of technological aids for the blind, most developed by the blind themselves. And Leland spends two weeks at a training school for the blind, mostly recent highs school graduates, to give them tools for navigating the physical world with confidence and humor. One of those students, Ahmed, tells him, “You have to be willing to get lost, and be confident in your ability to figure it out.”

Amongst these reports of his trips into the world of the blind, Leland weaves stories of how his small family reacts to his increasing blindness. His wife is a professor of comparative literature in “Western Massacheusetts” (institution unstated). They met in college, so she has made the journey of progressive vision loss with him. Together, they have a son, whose growing awareness of his father’s condition provides the unique unsentimental and accepting views of a child.

In the end, Leland has learned the deep mindfulness that navigating the world without vision requires. He adopts a technique from a Buddhist monk, Tran Nhat Hanh, who advises “half-smiling”, to meet “absolutely everything and everybody, always, with equanimity and friendliness.”

Concluding, he says he found “the experience of blindness encompasses both tragedy and beauty, the apocalyptic and the commonplace, terror and calm. This is true of most human experience: the same can be said of the process of aging, or of dying.” Leland has become not a hero, but another one of us, trying as best he can to get through life with the tools he’s been given.

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Second Thoughts?

From the Prostate Cancer Forum: 

I have a Gleason score of 3+3. PSA of 9
4 cores of twelve positive. Family history. Father hade prostate cancer and had seeds, lived till 90 with complications and Cather last few years. Surgeon tells me they never do surgery on 3+3, but probably need it in 1.5 yrs. Up here in Vermont options are removal or radiation. Based on history debating removal now than later. 64 yrs old, urologist and surgeon want me to wait. But waiting for what, to get worse? Appears contained to prostate but they don’t want to do anymore biopsy due to double infection. Anyone ever had removal at 3+3?

My response:

Here are some thoughts to consider. My own history was Gleason 4+3, CT and Bone scans negative, PSA 6>>8 in six months. I had nerve-sparing surgery.

Last year, the New England Journal published a 15 year follow up of a randomized trial of active surveillance (AS) vs surgery (RP) vs radiation, with over 500 men in each grouping (notably, very few Black men). https://www.nejm.org/doi/full/10.1056/NEJMoa2214122 While there was no statistical difference in death from prostate cancer among the groups after 15 years, the AS group had twice as many cases of metastatic cancer. And 50% of them went on to have treatment within 8 years, rising to 67% after 15.

The two key considerations to me would be complications and erectile dysfunction (ED) after surgery. Personally, I did not want to have radiation and (a) worry if all the cancer had been dealt with and (b) face the prospect of difficult surgery if the cancer “came back”.

Complications: Teachable moment – Defense Sect’y Lloyd Austin had an RP end of last year, then went back in with an unknown complication (rumour says it was a bowel obstruction) which put him in the ICU for a week or two. Also, people do die after surgery, probably less than 1/1000.

ED – 95+ % of us will get ED after RP for a minimum of 9-12 months, some never see spontaneous erections return. If spontaneous, penetrative sex with a partner is part of your life (average for those age 65 is 2 x per month), consider the loss of that for a significant period of time or forever. Note that orgasmic ability is not lost.

Those are the main reasons doctors will caution against jumping into treatment right away in a situation like yours – “First do no harm” is part of the Hippocratic oath. Don’t let the cure be worse than the disease.

On the other hand, I watched my father die from bone metastases from prostate cancer. That was very painful and difficult for him, and I want to avoid that at almost all costs. AS has a 50% higher rate of that over one’s lifetime (10% of the men in the study vs 5% for RP or radiation.)

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