Investing In Our Relationship

Taking time to celebrate us and our “woness” is something we live to do. So yesterday, we had an opportunity for an outing and we took advantage of it.

We really didn’t make any plans and neither of us were feeling something extravagant, so we just went on an impromptu lunch date.

Great company, fun conversation and time in each other’s gaze was all we needed to invest in our relationship bank.

My beautiful lunch date ❤️

Out With The Old, In With The New

It is common to think about resolutions as we celebrate a new year. Whether it’s a new diet, a work out program, an organization plan for our hones or a goal for work, we often usher in the new year with such promises. Some people also purge old clothes from their closets.

However, as 2020 ended, resolutions were probably not on high list of priorities as much as just a simple wish for a better year!

Nevertheless, in light of a new year, I wondered whether married couples use this concept to improve their “woness.” And honestly, if we really think hard, we can all work on throwing away some things that don’t really serve to strengthen a marriage. Things like pride, sarcasm and anger. And as we turn our backs on different degrees of these old ways, let’s ring in a new year by allowing our interactions with our loved one be characterized by grace, humbleness, gentleness and patience.

Spend intentional time together discussing how to make your “woness” better.

What are some new things that you could do to improve and strengthen your marriage?

A Celebration Of Life

As I recently celebrated another birthday, I’ve contemplated a lot on what the day actually meant to me. This is because I was celebrating more than just the day of my birth. I was also celebrating the one year anniversary of my prostatectomy procedure and the fact that my dear wife made me go get a physical, which led to my #prostatecancer diagnosis. I celebrated not only my birth but also my wife’s commitment to #insicknessandhealth. Her commitment to “woness.”

This month is also #prostatecancerawarenessmonth, which reminds me that I am now part of a brotherhood of men who fight and have fought this highly treatable yet terrible disease.

Yes, this birthday was like no other. It was definitely a celebration of life in more ways than one. Probably my most important birthday!

Staying Close During Social Distancing

People who know us well, know that I’m an extrovert and my wife is an introvert. I require longer periods of socializing whereas my dear wife, contrary to popular belief, does like social interaction, but has to have it in spurts and needs time to decompress after long periods of socializing.
So how do we, as polar opposites on the socializing scale, make our marriage work during this time of quarantine? This also applies to couples who don’t normally spend a great part of their day together. I offer a few suggestions:

Love our walks together!
  1. Respect Each Other’s Differences

Respecting one another’s differences is important at any time but when you’re in lockdown mode it’s extremely important. I have to be aware of not “suffocating” my spouse and she in turn connects with me after she’s had her alone times. 

  1. Be Willing To Communicate 

In times of a quarantine when social interaction is limited, it’s important not to isolate yourselves further.  It’s vitally important for us to communicate with one another if we need hugs, space, kisses or conversation.   

  1. Be Attentive To Your Spouse

No matter how much “alone time” a person enjoys, we all need some amount of socializing. When this is not possible, feelings of isolation, anxiety and fear can squeeze like a vice grip.  So it’s up to each spouse to be attentive to each other’s needs.

  1. Be Patient With Each Other 

Being around each other more can feel like your spouse is in front of you every turn you take.  This can feel a little like deja vu.  It’s important to be patient with one another and try to somehow have fun with these situations.

  1. Say I Love You

The most important way to survive a time of social distancing is to tell each other “I love you” often. These three words can never be said enough and are the foundation to Twobecomingwon!

What are other ways for a marriage to survive an increased time together?

HOPE SPRINGS AGAIN

For those who have followed our journey, I apologize for the long hiatus. So now, I bring my story current and to a close. 

Although I was troubled, dazed and confused, I was able to get composed again through prayer and the support of my wife and family.  Sometimes there’s a fine line between hope and despair.

I first listed my options: No treatment, radiation and surgery.  Because prostate cancer is a slow growing cancer, I thought I could roll the dice and take my chances.  How many years would this buy me?  No way of telling.  However, I was already at an intermediate risk stage.  How long would it take to reach the high risk?  No way to tell.  Maybe a year.  Maybe 10 years.  What then?  Then I’d be facing the other two alternatives.

Well after all the consultations, prayers for guidance and research, we decided on robotic prostatectomy, as our option.  An option that I had written off initially.  In terms of life expectancy, both surgery and radiation were in the 90% range.  These treatments were also characterized by low recurrence rates.  In addition to research, I also had the opportunity to speak to two men who had undergone this procedure and were doing well.

Although minimally invasive, a robotic surgery is still major surgery and requires at least six weeks rest from major activity or physically demanding work.  For us, this was the best option in terms of removing cancer, preventing recurrence and was also less disruptive to schedules.  

So I underwent robotic surgery 15 weeks ago and although I only took 10 days off from work, I did have a good bit of energy loss and fatigue from the stress of surgery.  However, I’m back to full activities as of 7 weeks post surgery.  I continue to thank God for so many texts or social media messages from friends, my church family and especially my wife and family for their love and support!  

This has been a long and unexpected journey for us.  A journey that has changed my perspective on life and definitely deepened our “woness.”  

THE TREATMENT PLAN

Now that we are well versed on the Gleason system, I’ll continue my story.

So with all the pieces of the puzzle together, now came time to break out the National Comprehensive Cancer Guidelines (NCCN) to develop a treatment plan. The NCCN is a comprehensive set of guidelines developed through extensive review of clinical trials and existing treatment protocol along with expert medical judgment and recommendations by physician panels made up from Member Institutions. These guidelines cover 97 percent of all cancers affecting patients in the United States and are updated on a continual basis.

According to the NCCN flowchart, interventions or treatment protocols are based on age and life expectancy. This means that the younger the patient, the more aggressive the intervention. Conversely, the older the patient, the more conservative the approach. For example, a 75 year old male diagnosed with a Gleason 7 prostate cancer would more than likely undergo radiation rather than surgery.

Well, from what I remembered, my Gleason score was 6. According to the NCCN Guidelines, the recommendation was prostatectomy (removal of the prostate), brachytherapy (radioactive pellets placed into the prostate gland) or external beam radiation. And with the radiation, I would have to decide if I wanted to have androgen deprivation therapy (ADT), which are basically injections to decrease testosterone, which is known to promote prostate cancer growth.

So, again, my Gleason score was repeated as a 6. And now I had to decide on which type of radiation I wanted as treatment and if I wanted to go through with ADT. Well, nothing sounded extremely attractive about pellets being inserted into my prostate or ADT. So I decided against those and surgery and opted for external beam radiation, which I know from others who had it or were having it, that it was 40 treatments.

Of course, as with any discussion of a surgical procedure or medical treatment, came the discussion or “informed consent.” “Everyone is different and not everyone has these effects, but some of the side effects of radiation are urinary incontinence, blood in the urine, painful urination, diarrhea and erectile dysfunction. These are mostly temporary and medications can be given for erectile problems.” (Sorry, I have to keep it real). Just what I wanted to hear- feasible ways in which I could help keep the prescription drug industry viable! (insert sarcasm face). Well, this was starting to sound less attractive

I left that appointment determined to do more research in terms of pros and cons of radiation therapy. I knew I need to find people who had been through this type of treatment and glean from their experiences. To be continued…

As we continue to raise awareness for prostate cancer, please remember: Although there may not be a hard rule for screening, talk to your doctor about a PSA test if you’re between 45 and 55 years old. Screening should be done at 40-45 years of age for African Americans, Latinos or if there’s a strong family history.

THE GLEASON GRADING SYSTEM

Remember the numbers associated with my biopsy specimens? Let’s get back to those. During my phone conversation with the urologist before my vacation, I was told I had a “Gleason 6” staging. Or maybe I understood that in my mind. Remember this, it will be important later in the journey.

Normally the pathology report will list each specimen or “core” (named such because it’s a “core needle biopsy”) separately by a number assigned to it by the pathologist, with each core, having its own diagnosis. The cores are listed separately because If cancer is found, it’s often not in every core, so the each core has to be examined separately to accurately make a diagnosis.

Pathologists grade prostate cancers using numbers 3 or higher based on how much the cells in the specimens look like normal prostate tissue under the microscope. Grades 1 and 2 are not used. Instead, if the core sample present with cells that look normal, it is designated as “benign.” This is called the Gleason System. Most biopsy samples are grade 3 or higher.

Since prostate cancer specimens can often have areas with different grades, a grade is assigned to the two areas that make up most of the cancer. These two grades are then added together to give the Gleason Score. In this system the higher the number, the more likely the probability of spread and thus the higher stage the cancer. The highest a Gleason sum can be is 10. Recall that the numbers are designated as a sum: 3+3, 3+4 or 4+3. The first number assigned is the grade that is most common in the specimen. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less of it is grade 4, and they are added for a Gleason score of 7. This sum can also be designated as 4+3=7. Although this is the same Gleason score, most of the cancer is grade 4, which is obviously higher. If a tumor is all the same grade (for example, grade 3), then the Gleason score is reported as 3+3=6.

Although most often the Gleason score is based on the two areas that make up most of the specimen, when a core sample has either a lot of high-grade cancer or there are three different grades including high-grade cancer, a higher score is determined to reflect the aggressive nature of the cancer.

The other significant part of the pathology report, besides the Gleason score is the volume of each specimen. This basically refers to the percentage involvement that each specimen is affected by cancer. For instance, one of my specimens, the one graded at 3+4, had 50% volume. And one of the 3 + 3 specimens had 40% volume. These are consistent with a possible greater involvement of the prostate gland and a greater possibility of spread.

This certainly was a cause for concern. However, I already knew from the scans that there was no spread. Next stop: Treatment Plan.

As we continue to raise awareness for prostate cancer, please remember men: Although there may not be a hard rule for screening, talk to your doctor about a PSA test if you’re between 45 and 55 years old. Screening should be done at 40-45 years of age for African Americans, Latinos or if there’s a strong family history.

THE SCANS

So what’s it like to hear you have cancer right before a vacation? Well, let’s just say that it wasn’t in my bucket list.

After our vacation, came the follow up visit. As it had already been related to me, I would need some diagnostic studies to rule out any spread. Oh yeah, I guess this is a good time to say that I’m a doctor and I was very familiar with all these steps. Familiarity, however, didn’t add any level of comfort. It did however, allow me to cut out the middle man and schedule my own tests! In my sense of losing control I needed to feel like I still had some, even if it was in my own head.

As I laid motionless on the hard, cool table for the bone scans, I could see my images on the screen and immediately knew there was no spread. I guess my knowledge was helpful in this case. But I also knew that the next step involved a discussion of treatments. And I knew that I was facing radiation or surgery. However, I thought for a moment how someone in my shoes would feel if they didn’t have the medical knowledge that I did. Would they feel lost, out of control and helpless? I think they would. Because in a way, so did I.

I guess I also have to share at this point the fact that my darling bride of 23 years was with me during these visits. It was very reassuring to know that I had her support. I told her she didn’t have to go with me but in a very assertive way, with a not so nice look she said, “shut up!” That made me happy.

To be continued…

THE BIOPSY

“Next stop, Biopsy,” said the conductor as the train pushed forward. Then the Tran came to an abrupt stop. As I de board, I enter into the urologist’s office for my biopsy appointment. This would be what’s called a core needle biopsy. For this procedure, the doctor uses a probe with a somewhat of a spring-loaded, thin, hollow needle to obtain specimens from the prostate gland. (I won’t go into all details).

When the trigger is pulled, the needle retrieves a small cylinder of prostate tissue called a core. This is repeated about 12 times to get several samples from different areas of the prostate. Yes, there’s local anesthesia involved. Besides some discomfort, it wasn’t horrible. I wouldn’t sign up for it again though!

Well, we were all set to go on vacation in three days and here I am, waiting on biopsy results! I didn’t really know if I wanted my results before or after our vacation. But in a way, I wanted to know what I was up against so that I could have some time away from the hustle and bustle to gather myself and get mentally prepared for what was coming up. After moments of contemplation, I decided to bite the bullet and call for my results two days before our trip. Well, when I called, I was transferred to the doctor’s assistant. “Hi Mr Araujo,” said the nice assistant. Her voice was friendly and chipper. This could only be good news, right? Could this be a sign for optimism? I didn’t find out because I was told the doctor would have to call me in the morning. Ugh!!!!

So I get a call in the morning. Not only was I told the results, but I was also e-mailed the report. In a matter of seconds I felt like had just entered the twilight zone! I don’t remember anything else that was said but I could probably reel off what the pathology report read. What I remember most vividly, was the word “adenocarcinoma.” Adenocarcinoma is the type of cancer that develops in gland cells and is the most common type of cancer found in the prostate gland.

50% of the biopsy specimens were positive for adenocarcinoma. There were numbers

associated with each biopsy specimen that appeared in the following manner: 3+3=6 which were most of the core specimens. One however, had the numbers 3+4=7. The others were labeled with what became my favorite word, “benign.” I was also told, as I would’ve expected, that I would need to have a bone scan and MRI to check for possible spread. Yes, I had now entered into the cancer world. The only question was, how deep?

Wow! This was a lot to take in right before a vacation! But I just needed to know so that I could at least use a few days off to process this information.

To be continued…

Why I Love My Wife

She’s beautiful. The kind of beauty that radiates from the inside.

She loves life and loves speaking life to others!

She’s analytical. She’s often deep in thought about a lot of things.

She’s an introvert but she loves that even though I’m an extrovert, I respect her need to withdraw at times.

She loves family and would do anything for her family.

She’s a motivator and deeply enjoys helping others reach their personal and fitness goals one on one.

She has the loudest, cutest laugh in any room! But it’s a joy to see her enjoying herself.

She always has a sacrificial kind of love.

She always believes in me and makes me feel strong.

In short, I love her because she means everything to me!