After Movember

Posted on December 5, 2015 by Davd

Men’s Health Still Matters…
,,, and We Can Promote Men’s Health with Intentional Brotherhood.
(c) 2015, Davd

Movember ended before Radiation Treatment did, but barely: My last session with the narrow slippery table and the elaborate attack-X-ray machine was December 3. My days are no longer dominated by Radiation Treatment, the times when others chose to schedule it, and the Special Toilet Training it required.

I celebrated the end of those constraints by lunching on pirogies, a Ukrainian folk meal which might be uh, anti-laxative. For those who live well east of Winnipeg, or outside Canada and Ukraine, they are made from wheat pastry, stuffed with flavoured mashed potato, and usually boiled or fried rather than baked. The standard dressings for them are chopped onion fried in bacon fat, and sour cream; with those dressings, especially if the potato be flavoured with cheddar cheese, they’re delicious.

Pirogies eaten—with an apple to help sequester cholesterol and saturated fat—i rested a lot during the rest of that Thursday. I rejoiced in having more days when my support dog Fritz and i can enjoy one another’s company all day, when i need not leave him locked up in a basement apartment wondering what i’m doing that he cannot join, locked up homeless as he and i have been homeless these past four and a half months. Friday afternoon, he smiled as he slept… we were together all day

Reflection time, “windup” time; Movember is over and now, so is my Radiation Treatment. My next scheduled time to be at Cross Cancer Institute, they told me as i left, will be for a check-up in March. Until then, and probably all of 2016, i will remain a pharmacological eunuch. Between now and then, i should expect my body to gradually recover from the radiation damage, while the tumor, with luck, will remain devastated. Odds are, i was told, i will not need to return to Cross Cancer Institute for further treatment, just for one or more follow-up examinations.

An appropriate setting, this first week of December, for a tentative assessment of the diagnosis process, the treatment, the likely consequences.1 It seems much more likely than not, that i’ve gained 3-15 years of lifespan from getting into treatment this year. This fall has not been fun, for me or Fritz; we’ve been going through the unpleasant part and next year, we should gradually get back into the pleasures of retirement and being wise old characters.

It does seem clear that changing physicians in 2014, got my prostate cancer diagnosed and into treatment before it spread; and men over 55 should insist on PSA and those uncomfortable finger examinations. That points to a dangerous flaw in the system: Physicians who don’t do basic prostate cancer screening shouldn’t be in primary charge of older men patients2.

Cross Cancer Institute and the Alberta Cancer Society have treated me well. I’m not planning to complain about my provincial taxes next spring, probably not for years. I can’t drive for others as others have helped me get to treatments, not with these old eyes in the state they’re in; but maybe i can do something toward providing lodging during treatment for men who need it, especially men who have support dogs. The many PTSD sufferers who served Canada in Croatia, Rwanda, and Afghanistan are getting older; and more prostate cancer patients will need dog-friendly lodging as time goes on.

Men’s health—in my experience and opinion—deserves more attention than it gets; and mimicking women’s health initiatives won’t always, maybe not usually work. For instance, men are more likely to work long hours, more likely to work in remote or shifting locations, and thus, less likely to have regular connections to the medical care system.

Movember Clinics providing PSA tests [and finger examinations, perhaps other men’s health examinations and advice] look to me like a good use of Movember donations—and for that matter, of public health spending generally3. They shouldn’t be restricted to Movember, but it’s a good month in the sense that most farming and fishing and a lot of forestry work is wound up, daylight is short and so construction overtime tends to be less, and the snow’s not deep yet in most of Canada—most men have time to go to clinics, and decent driving or bus riding conditions in which to get there, in November. The Movember emphasis is appropriate… but Movember clinics are not all there is to improvement.

Health promotion for men (like education for boys) should take into account our greater need to be physically active. Sports for fun (especially fishing and hunting), commuting by bicycle, even pushing lawn mowers and getting in the firewood, are more valuable to us than to women.

Health promotion for men should confront misandry, and especially the lie that men are privileged. Living a lie is mighty unhealthy, and the notion that men in general are privileged, is a whopper. That “if the genders were reversed” test is one good way to estimate misandry, and social programs that flunk it should be revised. Self respect is not pride, and if my Ph.D. in sociology serves me well, much of the depression among men is a symptom of oppression.

It’s bad advice—it’s misdirection—to send men to women for support if other men can provide it, in a social milieu where so many women feel entitled to privilege. Men with good marriages will get support from their wives without being told to; men with bad marriages shouldn’t be asked to rely on them; and the same goes for relationships other than marriage. There are good women, millions of them—and there are other millions of women whose effect on men close to them, in today’s biased legal and bureaucratic system, is too frequently toxic. If in doubt, i recommend, choose buddies—the word is based on brother, and we Christians are supposed to treat our fellow Christian men as brothers (as likewise with Muslim men4).

It’s not only monks who can benefit from intentional brotherhood. Monks provide us with examples of men living, successfully, as brothers not born to the same mother nor father, and successful for centuries. Their examples can be adapted for men who have other main interests than religious ritual5. Indeed, students in “fraternities” at universities and colleges are basically adapting the monastery model. Millions of men of all ages, who have been abused by misandry or have seen others abused and become wary of marriage, can benefit from the social efficiency of intentional brotherhood

Developing intentional brotherhood has had to wait this autumn, while i camped in an apartment and went every weekday to Radiation Treatment. I was willing to proceed but my first attention had to go to treatment and its special requirements. Now that treatment is done, my healthiest choice is not a solitary apartment but the fellowship of intentional brotherhood—and it’s not mine only. Fellowship is healthier, it’s more efficient, it’s more fun. The most challenging part, especially as we begin making intentional brotherhood a common choice and a respected alternative to marriage, is probably to identify sets of buddies who can group up into successful households. As intentional brotherhood becomes commoner and more respected, ways of identifying will develop; and the pioneers will make the going easier for those who follow.

My grandfather was a pioneer, and my favorite relative. The development of the PSA test that got my diagnosis started, was a different kind of pioneering than Grandfather’s. It’s the wrong time in history for me to walk halfway across the continent like Grandfather did; i don’t have the biochemical and physiological training to devise blood tests; but maybe i can contribute to the development of intentional brotherhood. It’s an appealing idea; i have experienced intentional brotherhood among monks and enjoyed it; now it seems i have been given a few more years in which to spread and live that way of life.

I’ve got work to do. Care to join me? Brotherly fellowship is good for men’s health.

Some References:

Brown, Grant A., 2013. Ideology And Dysfunction In Family Law: How Courts Disenfranchise Fathers. Calgary and Winnipeg: Canadian Constitution Foundation and Frontier Centre For Public Policy

Nathanson, Paul, and Katherine K. Young, 2006. Legalizing Misandry: From Public Shame to Systemic Discrimination against Men Montreal: McGill-Queen’s University Press.

Wells, H. G. 1920: The Outline of History: The Whole Story of Man. New York: Macmillan. Cited in the Project Gutenberg Ebook edition, 2014.

Notes:

1. “Tentative” is not meant as any affront. The March assessment should produce the first prognosis; and even then, it’s all estimate. As an Arthur Hailey novel pointed out, the final diagnosis is made post mortem.

2. To keep the details clear—the physician who didn’t do basic screening wasn’t practicing in Alberta; i came to Alberta for treatment, on the advice of clergy, because i have close relatives here and not there… and i’m much more likely to stay here than return.

3. Perhaps there are some already, just not where i’ve been this past decade or two.

4. The classic Islamic reference seems to be to Muhammad’s last speech at Mecca (e.g. Wells, 1920: ch. XXXII Muhammad And Islam, § 4); the Christian references are many (e.g. Matt 12: 46-50, Matt 23:8, Matt 25:40,45, Mark 3:32-35, Luke 8:21, 11:28 … plus Jesus’ tendency to refer to his disciples and followers generally as “brothers”.)

5. Religious ritual is a better use of time than many, but it’s not for everyone, not even for half or a quarter of all men. To those who are called to religious ritual, i say, enjoy. To those who are not, i say, let’s learn the distinct virtues of a co-operative household.

 

Posted in Davd, Male Lifestyle, Men's Health, Movember | Leave a comment

Less Common Prostate Cancer Treatments

Posted on November 28, 2015 by Davd

… that I Myself Didn’t Experience
(draft*) 2015, Davd

“I got the usual.” What you’ve read about this Movember, in the previous 4-5 blogs, is what you’re most likely to face if you have prostate cancer and it’s detected relatively early: A biopsy, followed by either “watchful waiting”, if the tumor is benign, or androgen suppression and then daily radiation beams (except weekends) for 6-8 weeks.

Radiation Beams seem to be the commonest prostate cancer treatment, with androgen suppression “before and after” in a supporting role. This is the treatment pattern i’m in as of Movember 28, with the radiation about 90% complete. After the last radiation session next week, i can expect some follow-up examinations, and to remain a pharmacological eunuch through 2016 and partway into 2017. I don’t have a real prognosis yet, and probably won’t until the first or second follow-up.

I did not get “chemotherapy”: which is probably the kind of cancer treatment that has most visibly increased in variety and hopefulness over the past few decades, and yet remains quite scary. The scans and chest X-ray found no indication that the cancer had spread. Chemotherapy is rare for prostate cancer that has not spread; usually a tumor local to the prostate is treated by radiation, perhaps combined with or preceded by androgen suppression, or else by surgery. If i hadn’t changed general practitioners last year, and my cancer had been detected only after spreading, i might likely have got chemotherapy—which from all i’ve heard, is a much harsher kind of treatment than radiation, with poorer average results, at least in the case of prostate cancer.

The scuttlebutt i’ve heard, says that when people get chemotherapy, they nearly always vomit and are nauseous for days. Even the American Cancer Society website seems vague about chemotherapy, probably because there are so many different chemicals used, each with a different profile of effects and risks. I’m glad not to be in it.

Radiation by Surgery is called brachytherapy. It’s a half-day procedure, from what i’ve read, and if radiation leaves you fatigued, the restrictions demanded after brachytherapy imply weakness well beyond mere fatigue: One rule i’ve heard said, lift nothing heavier than a 10 kg sack of flour or sugar, for 8 weeks after surgery.. maybe 25 pounds [11 kg] might be allowed.

There are two varieties of brachytherapy, and if you are considered for either, you’ll probably read and hear about both. Not having been through either, i’ll just say that they don’t seem as drastic as chemotherapy; but how the oncologists decide who gets one or the other of them, is beyond what i know.

Direct prostate surgery didn’t seem to be available to me; and most of the men i’ve talked with didn’t seem to have it as an option, either. One man had had it, and suffered incontinence [inability to hold the urine in his bladder] until a second surgery installed—this is not a joke, he told me—a valve he can turn on and off. When he goes to piss, he reaches down into his underwear and opens the valve; when he’s done, he shuts it again. I have no information on how common such secondary surgery is, but it is impressive that it exists. In my father’s friend Bill’s day, that would have been either impossibly precise or impossibly expensive.

The Canadian and American Cancer Societies have websites which can give you some further information about those treatments and what to expect—but neither told me the sort of detail that i described about the radiation beam experience. It would be good to find writers who can tell their stories of “Chemo”, brachytherapy, and direct surgery ,… but i’m not one of them; androgen suppression and radiation beams are what i’ve been prescribed, what i’ve been through, and so, what i can write about from experience.

Movember’s near its end for 2015, and radiation treatment is near its end for me. Next Movember, i’ll probably have a good idea how well my treatment succeeded, and roughly how long my remaining lifespan will be if i don’t get killed in a road accident.

It does seem clear that changing physicians in 2014, got my prostate cancer diagnosed and into treatment before it spread; and men over 55 should insist on PSA and those uncomfortable finger examinations. Without them, my father’s friend Bill died not that long after diagnosis; without them, i might not know yet that i have prostate cancer. I might have found out too late, like Bill did; while with those diagnostic tools, i might be cured of cancer by the time i would have known of it, without.

Note:

* I label this blog “draft” at first posting, to allow for possible technical improvements and corrections by readers. .

 

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Special Toilet Training:

Posted on November 26, 2015 by Davd

… It’s Not as Easy as What You Got at Age Two:
(draft) 2015, Davd

Did anybody yet warn you, that if you get radiation to the pelvic region—as most prostate cancer patients do—you have to go through Special Toilet Training? That “not going in your underwear”, which has been “good enough” ever since you were two years old, is no longer good enough?

Nobody told me, when i was first told to expect pelvic radiation beam therapy, that it would include an exacting, difficult bowel and bladder discipline. Perhaps someone should have, and perhaps there should be a “toilet training course” for men scheduled to receive radiation beams to the pelvic area1. We’re better able to learn than we were at age two; but this special toilet training is more difficult than the toddler version.

Basic toilet training has one principal purpose: Don’t mess your underwear (or any other clothing). That’s not good enough for pelvic radiation therapy. When you’re flat on your back on that strange plastic table, getting zapped—you won’t be wearing underpants (and no, they don’t welcome soiling the table!)—but the important new purpose of Special Toilet Training, is to put you on that table every appointment, with empty bowels and a full bladder.

The radiation beams [X-rays] can damage any tissue, though i read somewhere that they damage cancer cells more than normal cells. If the bladder is full it “stands up away” from the prostate; if the bowels are empty they sag down away from the prostate. Less radiation hits a full bladder or an empty bowel; that’s why the protocol demands you arrive with empty bowels and a full bladder—which combination, unfortunately, is unnatural.

Basic Toilet Training taught you (and other little boys) to go ahead and empty the both of them, every time you sat on the toilet—and to sit rather than stand, if in doubt, so you could empty them both. If you’ve ever tried to do only one while “holding” the other, you probably found it was very difficult—maybe impossible.

So while Basic Toilet Training works with nature to that extent, and amounts to knowing when you “have to go” and getting to a toilet to “go in”; Special Toilet Training works somewhat against nature: Empty bowels, full bladder, at the same time (but not, unless you are lucky, the same time of day each day2) goes against the natural tendency to empty both at once. Empty your bowels, and the bladder will naturally empty also; don’t empty your bladder, and the bowels might be too full and at risk of more radiation damage.

Being told to arrive at every appointment, with empty bowels and a full bladder, then, is not enough—no more than telling you to start doing it only in the potty, would have been enough for most two year olds. Toddlers don’t naturally take their excretory urges to the nearest potty: Toddler toilet training amounts to showing the child how to “do it only in the potty” (but accepts that if both bladder and bowels are ready to be emptied, it’s completely O.K. to empty both at one sitting.) You are being told to do something unnatural for radiation treatment, but unlike when you were two, not really shown how… and the directions arrive later than some fellow patients and their next of kin, believed they should.

One woman sitting in one of those waiting rooms, said quite sincerely that she believes you should begin practicing bladder control at least a month before your first radiation treatment. I don’t know if she was referring to her own experience or that of a male patient she knew, but that “month before” is consistent with technicians finding many patients arriving for treatments early in the series with bladders not full enough, (and a significant number with bowels not empty enough.)

The blue half page handout i received gives some general directions which are helpful but not enough to guarantee “empty bowels and a comfortably full bladder” every time:
‣ Take a laxative [“Milk of Magnesia”] every night at bedtime;
‣ Sit down and “have a bowel movement” at least one hour before the scheduled treatment;
‣ empty your bladder exactly one hour before the scheduled treatment;
‣ Quickly drink one half litre of water immediately after emptying your bladder.
‣ Do not empty your bladder again until treatment is over (and there may be times when treatment begins late.)

Easier said than done: Taking the laxative is easy enough, but as the handout itself admits, the amount to take isn’t the same for everyone. “Having a bowel movement” 1-3 hours before appointments that aren’t even the same time each day2, can be difficult or impossible. Exercise before sitting on the toilet can help, but it’s not certain to work for every man. The tendency, from limited comments i heard and my own experience, is to aim for “softer movements” than one would want otherwise. Maybe there’s a better way—but how many men will find it in a few weeks of 5-daily radiation treatments?

Emptying your bladder exactly one hour before treatment is not that difficult to do—unless perhaps you go to treatment by bus and have to head to the bus stop more than an hour before that treatment time. (Go ahead, have a laugh—imagine emptying your bladder on a bus—but i doubt many readers will actually do that.)

Drinking half a litre of water may take more than a minute or two, but within ten minutes you can probably comply with that demand. Trouble is, an hour may be too long, especially if you drink a lot of water, juice, tea … if you are normally “well hydrated.” For years, maybe decades, i’ve normally had 2-4 litres each day mostly of mild tea with Vitamin C and orange peel, but also including water, coffee, juice, sometimes even beer,. That meant that my bladder would fill in more like a half hour than a whole hour, if i drank that half litre of water. 3

The fact that i like coffee with my breakfast might also have been an influence. Coffee probably did make it easier for me to arrive at treatment “with empty bowels.”

I’m only one man, and i don’t know how men generally “feel the fullness of their bladders.” The feeling and the words used for it—among those few men who even talk about the fullness of their bladders before being told they must pay special attention—probably vary from man to man, and plausibly, even more between men and women4. (I found that in the early weeks, if my bladder was uncomfortably full, the technicians were happier with its condition, than if i had only a slight “urge to go.”) That woman who said we should allow a month to learn to perform, not merely into the potty but so as to arrive with empty bowels and a full bladder, might have been right about how long it takes, or might take.

I’m not so proud as to think i can design and describe a good Special Toilet Training course in a day or even in a month. What i’ll do here, is list some things that might help you without that course, to help your bladder and bowels flee to safety before the X-rays come; and might even be parts of the Special Toilet Training course that is designed too late for this Movember:
‣ Starting 3-4 weeks before your “CT Simulation appointment”, practice holding your bladder, full, until you’re getting worried you’ll wet your pants. Notice how that feels (and with luck, learn how to hold that “urethral sphincter” shut longer and more easily. I don’t know what to tell you to expect, and i don’t need to; you get to figure it out yourself because it may not be the same as the next man’s.
‣ Drink 2-3 litres of water or weak tea each day “so your body is normally well hydrated”.
‣ Starting a week or so before the “CT Simulation appointment”, practice emptying your bladder , quickly drinking one half litre of water immediately after, and setting a timer for one hour5. Note how full your bladder feels and how easily you can “hold it” as the hour passes.
‣ Note when you have had coffee, and how much, relative to these practice sessions.

Yes, this does take a lot of time and attention. .. and i have only given you some general ideas how to proceed, not a course outline.

Back when i was in my late teens, as i mentioned in two earlier posts, a friend of my father’s was diagnosed with prostate cancer—and castrated. He died not long afterward despite the castration. In his time, there was no “Prostate Specific Antigen” test to detect prostate cancer early; no testosterone suppression drugs to substitute for castration, and radiation treatments were cruder. In my case, those recently developed techniques give me a serious chance to die of something else, and years later than if the cancer were diagnosed as late as in his time, and treated in those ways.

One of the next steps forward might be, not another sophisticated new technology, but a superior way to learn Special Toilet Training. Being zapped with empty bowels and a full bladder, means less damage to those vital organs, and less risk that they will get secondary cancer from the radiation. All i can provide here is a general indication of the Special Toilet Training you should have, to make pelvic radiation safer, and a little advice that might help you prepare while it isn’t available as a short course. It ought to be possible to make that training more complete and more specific to specific patients’ natures and needs, than the blue handout; but one man can’t do that alone.

Finally, my apologies to any men who find the language of this blog “prissy.” The Webmaster specifies “PG-13” limits to rude words, and using the ruder words i would normally use talking among men, probably wouldn’t read well either… given that it’s a public site and the subject is hospital treatment. As many of you may have noticed, hospitals expect us to use very nice, polite language, to the point that it can be a chore for some men to translate from “the way the guys say it.”

Maybe that’s why some guys found M.A.S.H. such a fun read.

Notes:

1. Any women reading this, please remember it was published on a men’s website during Movember. The principal focus is on prostate cancer, which is exclusively male and normally treated by radiation beamed into the pelvic area. (Tumors which are managed by “watchful waiting” are “benign” and usually not called “cancers.”) Women do get radiation beam treatments to the pelvic area, but the prostate is not what’s involved, your anatomy is [duuuuuuuhhh] different from ours, and plausibly your Special Toilet Training should be somewhat different also.

2. My treatment times ranged from 8:15 AM to 3:36 PM.

3. One technician said that an hour is too long an interval for many patients, and that the bladder of a well hydrated man can refill well enough for safe treatment in 30-40 minutes.

4. i’m writing that “in the analysis of variance sense”, in case you reader are schooled in probability and statistics.

5. Most relatively new mobile phones have timer software, and provide a convenient way to time this business. Only a little subtraction arithmetic is required.

 

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External Beam Radiation Therapy

Posted on November 20, 2015 by Davd

“Normal Treatment,” Part II
(draft) 2015, Davd*

It’s November, the trees are bare, and there’s ice on the streets outside, but you’re looking up at a deep blue late spring sky with apple blossoms and green leaves around the edges. You’re flat on your back, on a slippery high-tech carbon fibre table, with your knees and lower legs supported by plastic frames to make it easier to lie stock still. The room you’re in has a door about as thick as the doors on bank vaults, but the lock is a lot simpler, and what it’s keeping inside is radiation, not money.

Your pants, underwear, and shoes are back in a locker maybe 100 feet from the vault where that slippery table and you are about to get zapped. Two technicians [techs for short] have positioned you on the table, laid a cloth over your belly and pelvic region, hurried out, closed and locked the door, and are now steering a very elaborate machine around your otherwise naked pelvic regions, by remote control. First it will take X-ray pictures, then figure the trajectory of the high-powered1 beam, and give the table a little jerk to make it line up with the figuring. I don’t know how much of the figuring is done by the machine and how much by the techs—who are on the other side of the vault walls so they don’t get zapped when the table and you do.

After the table jerks, usually in a minute or less, the machine begins to whine: That’s the attack intensity X-ray, and as the machine rotates around your pelvic regions, the ray shoots at the tumor from an ever-changing angle. The tumor always gets zapped while it’s whining; but other parts of your body, only briefly.

The whine lasts perhaps a minute—that’s the actual treatment. This whole big fuss and bother, hours of work for you and among the 2-3 techs and the various desk jockeys, a total of another hour or more, is “all about” that minute or so when it whines. But don’t move when the whine stops! Sometimes, not every time, the techs will want to measure something with you still in that same exact position. If they do measure, the’ll do so before they tell you that you may pull up those funny hospital pants—or move at all.

Then the table lowers to a little higher off the floor than the top of a coffee table, and they will want you to take a metal ring in one hand while you get off. You go back to that change room, get your own pants and shoes out of the locker, dress, and move on with your day… somewhat wearily, which leads to the warnings.

The first warning, methinks, should be that Fatigue is the commonest and usually worst “side effect.” Expect fatigue. If you’re not yet retired—a rather large fraction of prostate cancer patients are retired, compared with other cancer patients and even more, with the general population—you might not be up to doing a normal week’s work along with treatment. Plan to be slower and weaker than normal, even slower and weaker than “eunuch normal”, from some time in the second week of treatments, to a month or so, perhaps six weeks, after they end.

Why? Because radiation treatment is destructive, that’s why. The big elaborate machine is so big and elaborate, so that it can rather precisely aim attack-power X-rays at the tumor from a whole lot of different angles. The tumor always gets damaged; surrounding body tissues, much less—but some damage is done. Your body will give priority to repairing the damage2, and it will take a lot of energy, protein, and other nutrition. In other words, you are being selectively injured and healing the injuries will tire you badly. In still other words, you are taking a selective beating and getting over it involves several weeks of weakness.

Second warning: Expect austerity. A very common austerity is being forbidden to enjoy alcoholic drinks. Repairing the selective damage, puts some strain on your liver. Alcohol would add to the strain. So even if you’ve been able to have a few beers with your friends or your burgers, without it hurting you; even if you’ve been able to have a half bottle of wine with a good meal, no harm; that might not be the case while you’re in radiation treatment and for the fatigue weeks that follow its end.

(I don’t know nearly as much about chemotherapy as about radiation, because prostate cancer is less often treated with chemotherapy, than with radiation… plus, my treatments were in a radiation zone and those who got chemotherapy went to another part of the building. In the waiting areas, i talked with other radiation patients. What i heard and read, seems to say that a ban on alcoholic drink is more likely, and likely to last longer, if you get chemotherapy. What i’ve seen, away from the cancer hospital, is that the ban is not always obeyed.)

You will almost certainly be told to quit smoking if you do; and may also be banned from coffee. (Remember the neighbour who died of lung cancer this year? He was a regular cigarette smoker.)

Your modesty is going to be rather well ignored in the vault, much as it was in the biopsy. You get a change room about the size of a two-holer privy with a curtain instead of a door, to get out of your pants, underwear, and shoes, and a locker to put them in3. You get a pair of pale green or maybe bluish (they look sort ot like splash pants but i don’t think they’d last long in the woods) to cover your nakedness while you wait to be called into the vault. But once in the vault, you lie down on that table, pull down the splash pants, pull up your shirt and whatever’s under it, and they line you up using those tiny tattoo marks they made a few weeks ago.

You probably won’t suffer claustrophobia—the vault is pretty large, larger than most bedrooms, and the big machine doesn’t crowd you like CAT and MRI scanners can. You can see, not daylight but at least some kind of light, and ceiling and walls, past gaps in the parts of the machine. I suppose some psychologist figured that the late spring sky graphic—not all treatment vaults have them—will help you relax; at least, it is what you might see if you were lying on your back under a skylight, at that time of year. But the vault doesn’t have a skylight, it has another level of the cancer hospital above it… and probably, radiation shielding between its ceiling and the floor upstairs.

You might suffer a more common discomfort—“having to go.” The directions for pelvic radiation treatment include “A full bladder and an empty bowel.” If you do what’s natural, plus the toilet training you had when you were two, you’ll empty both at once if the bowel has something to empty. SO—part of the whole treatment scheme, will be Advanced Toilet Training, and that’s a big enough business that just to tell you what it’s about—not actually doing the training—will take a separate post.

Notes:

* I label this blog “draft” at posting, to allow for possible technical improvements and corrections by readers. It is written less personally than the previous two, but as posted, is based more on my experience of Radiation Therapy than on technical knowledge—so to be prudent, i allow for the possibility of a mistake.

1. “High-powered” is relative; the machine is capable of at least two levels of tumor-attacking intensity. At the highest intensity, both doors of the vault are closed. At the lowest “attack intensity”, only the outer door is closed. In between, i don’t know the details, and anyway, you can’t see the doors from flat on your back on the table.

2. Tumor cells, i read in one of those many handouts, cannot repair themselves as readily or as well as normal cells, so in addition to getting more damage than surrounding body parts, the tumor has a disadvantage in its repair efforts.

3. I suggest you carry a small lock. During the time i’ve been receiving treatment, at least three patients had their clothing stolen—and if they’d left wallets in their pants, the clothing was found later somewhat messed up, but the wallets were gone. The techs were saying “lock up your clothes, and to be really careful, carry your wallet and keys into the vault with you.” There was an old chair off to the side of the vault to put personal effects on; i carried mine in a cloth bag a little smaller than most shopping bags.

 

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The “Normal” Treatment I Received:

Posted on November 12, 2015 by Davd

.. Part. I: Androgen Suppression
(c) 2015, Davd

That first prostate cancer story i ever heard personally, from my father’s friend Bill, happened before 19751. He wrote that treatment included “the operation that makes a steer out of a bull.” That surgery made sense, though today they use drugs much more often than surgery. Castration stopped Bill’s testosterone production; and most prostate tumors need testosterone to grow.

If Bill died a year or two after diagnosis, the reason was probably that the cancer had spread before the diagnosis was made. He never told me specifically. As a guess, some two generations of time ago, he had had a prostate tumor for years before it was diagnosed.

Prostate cancer grows slowly, compared to most other kinds. If you have finger examinations of your prostate and PSA blood tests, regularly, there is a good chance—a far better chance than Bill had in his day—that you will be diagnosed with a prostate tumor whose biopsy results, or other “further tests” indicate that it is benign—not spreading, not about to spread.

The usual treatment for such prostate tumors is called “Watchful Waiting”: More tests, perhaps ultrasound or another biopsy—but no heavy drugs, no radiation, no surgery to remove the tumor. Prostate tumors grow slowly enough that you might well die of something else before your tumor becomes something that could kill you within a few years… and as you’ve already read about prostate biopsy, and will see again below and in the Radiation Therapy posting to follow, treatment is uncomfortable, makes life less to much less pleasant while it goes on, and requires hospital facilities. If the disease is a benign, slow growing tumor, it seems fair to predict the cure would be worse than the disease.

I wasn’t so lucky; my Gleason sum score was above the line between benign tumor and cancer. The diagnosis, and diagnoses are estimates, was that the tumor might “metastasize”, or spread around the body, if not treated quickly—indeed, the bone and CAT scans and the chest X-ray were to see if it had spread. They came back negative, so i fell into the category “no sign yet of spreading, but might be about to spread”. That got me the modern equivalent of what Bill got: Pharmacological castration. Instead of removing my “balls”, they drugged them out of action.

This is also called hormone therapy and androgen suppression therapy. As the American Cancer Society website puts it, “Androgens [male hormones] stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time.” For localized cancer with a Gleason sum score high enough to be dangerous, androgen suppression disrupts cancer growth and “buys some safe time” to plan and schedule radiation treatment (or perhaps surgery).

Immediately the bone scan, CT scan, and chest x-ray came back negative (no sign the cancer had spread), i was given a large injection under the skin of my upper abdomen, and a prescription for pills to be taken daily. (I won’t name the medications, because they each seem to have alternatives, and i’m not medically trained. I don’t understand the subtleties of how specific medications are chosen, and i don’t want readers to think they ought to have something else than what they were prescribed, just because some blogger got it.)

Over the next few days, living in the same house with the same woodstove, i noticed i felt colder. My diary entry for two days later than the first injection reads in part, “Comfortable temperature … 2-3 C above what i found comfortable as a man.” Two comments: First, i was well aware that the medications were intended to suppress my male hormones, and had started calling myself “a pharmacological eunuch”. Second, if you are reading this from the US or UK, 2-3 degrees Celsius is about 4 degrees on the Fahrenheit scale you use. I needed that house, at least the part where i sat still, heated 4 Fahrenheit or 2-3 Celsius warmer than i had needed three days earlier… and for years before that.

It was 7-10 days after the injection (meaning i had also taken 7-10 of the pills) when i felt the first flush of heat. It lasted a few minutes and then i felt cooler than before the medications, again. I’d been warned about “hot flashes”, and told that women entering menopause have the same experience. Not having been a woman, i didn’t get much help from that comparison.

In my case, “hot flashes” were fairly rare, but i did notice that i could start perspiring with exertion that hadn’t got up a sweat before. I also noticed that my strength and stamina were going down. Over the months that i was “on androgen suppression” before radiation began, i lost noticeable strength, stamina, and “drive” compared to the years before. My stride was nearly as long, but walking fast, which hadn’t been tiring before, now got me breathing a little harder.

I also gained weight, though i was cooking the same foods and eating the same amounts as ever. The reason—some of you may have guessed already—was connected to the loss of strength and drive, and the need for a warmer house. My metabolism had slowed down, as could be expected: Eunuchs’ metabolism is normally slower than men’s. My body was burning less food, but my habits hadn’t adjusted—and there was some good reason for me not to “diet.”

The androgen suppression was preparation for a direct attack on the tumor. In my case, as in most cases from what i’ve heard and read, that attack would be with radiation. The radiation would cause heavy to total destruction of the tumor, and also some damage to the surrounding tissues. My body, i was warned, would need more nutrition, including more energy, to heal the damage to normal tissues and clean up the debris from the tumor.

The preparation seemed to work: My testosterone and PSA levels fell to far below ldquo;normal.” Next treatment was to be radiation, as seems to be usual for dangerous but localized tumors.

It took me months to organize for the debilitating effects that might have. I was warned i could not expect to do the chores that were normal and required for that wood-heated house in a region with heavy winter snow. So as happens to rather many men, but far from all, i had to relocate and i don’t expect to be able to go back. I don’t know how common that experience is, though; so the next “post” will be about the radiation experience, which from what i’ve heard, a majority of men with dangerous looking, localized prostate cancer have shared or will share.

Notes:

1. This is from memory—i didn’t keep a diary in those days; and i didn’t plan on writing about prostate cancer at that time—so i cannot say just what years were involved. Indeed, the word “Movember” was first used at the very end of the last century, over 20 years after Bill died.

 

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Prostate Cancer Diagnosis:

Posted on November 6, 2015 by Davd

My Experience of the Process
(c) 2015, Davd

The first prostate cancer story i ever heard personally, came from a friend of my father’s, more than 40 years ago; and in a year or two, he died. I’m not sure how he was diagnosed; but a Cancer Society volunteer confirmed that it couldn’t have included the blood test that started me—and starts very many men—into the process today. It’s called PSA, for “Prostate specific antigen”.

There are two meanings available for “digital prostate examination”. One involves pushing a finger [digit in semi-Latin] in a thin glove, up through your anus and feeling the prostate for size and lumps. Older men should get one of these uncomfortable examinations every year, at least every two years. (It is one good reason for men to prefer a same-sex physician1.)

The other involves computerized [“digital”] chemical analysis of blood samples, especially the fraction of PSA in that blood. I don’t believe either kind existed when my father’s friend Bill was diagnosed, nor when he was buried. Perhaps the finger version was known but because it was uncomfortable and embarrassing, seldom used until something else led to suspicion of prostate cancer. The biochemical version depends on technology that probably didn’t exist, certainly wasn’t widespread, in the 1960s.

My experience tells me, so i’ll tell you—if you’re an old man, even over 50, at least ask for both “exams” with every annual check-up. If you’re over 65, you should definitely have them.

In 2014, i was referred by a Salvation Army officer friend, to a “new” physician, Dr. K, whose practice the Major had left when he was transferred, as Salvation Army officers are every few years. There had been awkward aspects to consultations with the one that i had been sent to as “available”; and at least for now, i will not identify individuals: Few readers if any will be in either practice. I will say that while both physicians used laboratory tests, one seemed to be letting a computer software system interpret them, while Dr. K, a man whose appearance resembled my uncles when i was a boy, seemed to be interpreting them himself.

I will say that Dr. K. included the PSA test in the blood sample analysis he ordered as part of my first annual check-up within his practice. His finger exam found the prostate to be enlarged, the PSA score was higher than normal, so since i was less than 75 years old, he referred me to a urologist, Dr. V. Dr. V. repeated the finger examination and concluded that not only was my prostate larger than normal—something fairly common in old men—he felt a lump2. A biopsy was ordered for some 6-8 weeks later.

The biopsy was in fact, “day surgery”; and since the majority of readers likely have neither had such surgery nor will in the next year’s time; i’ll just report that it was messy, somewhat painful, and broke most of the rules of everyday modesty. If you or a friend get to this stage, expect it to take most of the day, leave the patient unfit to drive or appear in public, and thus, require either a taxi if you live in a city, or a driver if a taxi would be too expensive (as is usually true for rural people.) When it ends most patients will not feel like riding the bus or even standing around at a bus stop.

A few weeks later, i heard the results: The lump was a tumor with a “Gleason sum score” high enough to call it cancer. Next came a “CAT scan”, a chest X-ray, and a “bone scan”, to see if it had spread. Those tests came back negative: If there were rogue [cancer] cells outside the main tumor, they were solitary or in groups too small to detect.

I had been “diagnosed with” carcinoma of the prostate, not yet metastatic, and was immediately given two “androgen suppression” drugs to inactivate the tumor [make it stop growing, perhaps even shrink]. End diagnosis, begin treatment … and with the cancer still localized.

If i had continued in that other practice, where i don’t remember any PSA screening and know very well i never had a finger exam of my prostate, i might not know even today, that i have prostate cancer. Meanwhile, that cancer might have spread, over the months, if it hadn’t been suppressed and now is being zapped. It might have spread over more months past this Movember, months when i might still not know; to where radiation would not be enough and knocking the tumor out for longer than my remaining life expectancy, very unlikely.

I’m not “home free” yet. The radiation treatments are about half done. I will continue to be weakened by them for some weeks after they end, until Christmas or later. There is even some risk that the radiation will trigger cancerous changes in cells around the prostate and i will later have a different kind of cancer. But at 73, having a life threatening cancer changed to a dying cancer, or one knocked so far back that i’m very likely to die of something else instead, is a great improvement compared to finding out when it’s too late, like Bill did.

It’s important to know a tumor is present earlier rather than later, and to know as soon as it becomes serious enough to need treatment (if it ever does.) Older men should have regular PSA and gloved finger examinations. If you have a regular GP [General Practitioner, aka family doctor] and don’t get those two tests every year if you’re over 65, at least every other year if you’re 50-65, methinks it’s time for a change. For the men who don’t have a regular GP to go to, Movember Clinics providing those tests [and perhaps other men’s health examinations and advice] sound to me like a good use of Movember donations—and for that matter, of public health spending generally.

Notes:

1. My favorite example of an ideal medical “family practice”, was that of Drs. Guy and Elizabeth Richards, in Saskatoon. Their examination and waiting rooms were in their house; they had bought a big house and set aside part of it for their practice. They had as short a walk to work as possible; they were available to their children when not seeing patients (and could make patients wait a minute if the children needed something quickly). Guy could counsel men and boys as one who had the same kind of anatomy and physiology; and Elizabeth could do likewise for women and girls—maximum empathy and “i’m built like that too” understanding; minimum embarrassment…and family connections in health needs and care, could be easily determined between the two doctors because they shared most of their time. (I write “was” because i am now 73, and they were older than i—still are, if they are still walking the Earth.)

2. Dr. V, as a urologist, had more experience with prostate cancer than Dr. K, who is a general practitioner. Finger examination is somewhat subjective; he had a greater experience base from which to assess.

 

Posted in Davd, Men's Health | Leave a comment

It’s Movember:

Posted on November 1, 2015 by Davd

… and Prostate Cancer* is the Subject of the Month
(c) 2015, Davd

The CBC News website recently reminded us (as part of its biographical sketch of his son Justin, the new Prime Minister), that Pierre Trudeau died of prostate cancer in 2000. A Cancer Society volunteer filled out the story for me: The elder Trudeau had Parkinson’s disease, he said, and was facing a future of severe disability leading to eventual death, when prostate cancer was diagnosed. Aggressive treatment was offered to him, which the doctors believed was nearly certain to save him from the cancer—but not from Parkinson’s. Pierre Trudeau decided, the volunteer said, to accept an earlier natural death from cancer rather than a slower one from Parkinson’s.

Prostate cancer is the main subject of “Movember”*. Last Movember, i was going through the diagnostic process, and did not know if i did or did not have it; i wrote one blog about a new aspect of prevention. Early the next year, i learned that i not only had a prostate tumor, but that its “Gleason sum score” was just high enough to count it as cancer. as this Movember begins, i’m about halfway through a series of radiation treatments designed to destroy that cancer, which tests made months ago indicated has not spread yet1.

Over a year ago now, as the diagnostic process was beginning, a good physician told me, “More people die with cancer than from cancer.” That can be read as [1] “some people with cancer die of something else first,” or as {2} “more people with cancer die of something else first, than die of their cancer.” {2}, the more optimistic reading, seems to be true of prostate cancer: It is much less aggressive, much slower growing, than several other kinds—and it is easier to treat than lung, liver, pancreatic, esophageal, or several other cancers.

A neighbour and friend near where i used to live was diagnosed with lung cancer weeks, maybe two months after i was diagnosed with prostate cancer. He died late in September; i started radiation treatment not long after he died. (I had been on androgen suppression treatment since well before he was diagnosed… and my cancer was probably diagnosed at an earlier stage. Prostate cancer detection is much better than it was a generation ago.)

This Movember, i plan to summarize the usual treatments, not as an expert but as one of the victims. Then i plan to go into some detail about what it’s like, for me and a few men i have interviewed, to go through radiation treatment specifically; and what it will do to the part of your life when you’re not being treated. I haven’t yet talked to enough men who are six months or longer post-treatment, but if i do, i might write about that late in the month.

Other subjects that may be included are cancer prevention, hormone treatments, and some suggestions for the treatment system to consider, to make it easier for men to adjust to the demands treatment makes.

The volunteer’s story about Pierre Trudeau, reminds us of one fact people—men and women—tend to ignore or minimize: We are all mortal. Medicine gives our bodies longer life spans, at least usually. It does not give us endless spans. As best i can guess from what people have told me as physicians and nurses, as fellow patients in waiting rooms, and also “out and about”, prostate cancer treatment is usually successful—which means, it keeps you alive long enough to die of something else. Pierre Trudeau decided that his “something else”, Parkinson’s, was a worse way to leave this life.

One thing a diagnosis of cancer—or even the possibility of a diagnosis of cancer—can remind us if we let it; is that our time will eventually come to an end. While going through the waits and the adjustments that prostate cancer treatment requires of us, we might spend some time planning how to make the best of the life span we have left. We can’t know exactly how long it will be, though we might get a good estimate under the Latin name prognosis. By the time most men get prostate cancer, they are already over half way through a normal span.

If you have some dissatisfactions with the story you’ve lived in the years before you were diagnosed (or learned you don’t have cancer, at least not yet)—the disturbance that your life is having, can be occasion for you to make the next few years more worthwhile. Maybe you have started writing a novel you want to finish “sometime”, and then neglected it; or there’s some family history you lived through and your children didn’t, to write down. Maybe your grandchildren are ready to build a boat with you, or travel with you to places their parents don’t know as well as you do. Maybe you’ve thought of buying a few acres and planting an orchard and some gardens, building a summer-house or even a big enough house for ten or more people, for your family to have, or you’ve been talking with some other men at your church about setting up a household where fatherless boys can learn their way to manhood.

Being reminded that you are mortal—that we all are—can motivate you to get back doing those good works that somehow got sidelined. Acknowledging your mortality can help you see your life as a story and cancer treatment, even the process of deciding if you have cancer, as a pause, a chance to choose a new perspective, with which to design and then live the rest of it.

Live a good story.

____________________________

*. The Wikipedia Movember page, last modified on 21 September 2015 [as retrieved 27 October] indicates that prostate cancer was the principal focus of early Movember awareness and fund raising. Depression, exercise, and testicular cancer have been added, but the article indicates that prostate cancer is still the largest focus.

1. When those “has not spread” results came in, an “androgen suppression program” was begun which, not to be too nice about it, made me a pharmacological eunuch. My testosterone levels fell like a foot-diameter hailstone; and as consequences, my metabolism slowed down, my red blood cells became fewer, and thus, down went my energy and stamina. (Since i’m old, many people just attributed that slowdown to old age.) Prostate cancers, Dr. V told me, need testosterone to grow, and blood and other tests indicate it soon stopped growing … allowing me to wait fairly safely for treatment.

There could be more subtle aspects to the “androgen suppression program”. I can call myself an ecoforester without lying, but i’m not medically trained. These blogs are for non-medical readers, especially men who have or might have prostate cancer; and the “pharmacological eunuch” experience is something that might be easier to take if you are forewarned… more about that, perhaps, later in Movember.

 

Posted in Davd, Male Lifestyle, Men's Health | Leave a comment

The Beauty of Old Men

Posted on October 13, 2015 by Davd

No Cosmetics Required.
(c) 2015, Davd

This is written in appreciation and in honour of old men who “mentored” me, as well as in affirmation of what i can now contribute as they did then, and of the value of men who are past the strength of youth. So please keep in mind that i write in the plural, in appreciation of my Granps and several other teachers and mentors.

Let me begin this reflection, then, with a stock phrase, more general than an aphorism: Too old for that sort of thing. I do say it about “sex”, but its range is far larger than eros. To appreciate old age, and old men, we should keep old-age’s weaknesses in mind as important context.

Last March, looking out the window at the prayer-garden i had so enjoyed for six years1, i noticed a pruning task that was likely to be called-for about this time of autumn, when the branches have stopped growing, involving a man standing on an 8-foot-tall stepladder and reaching above his shoulder level, perhaps above his head, to use a pair of lopping-shears.

Lopping-shears are a two-handed tool, so this task will call for whoever does it to stand some seven feet above the ground, on a ladder rung, without a free hand to steady himself. Twenty years ago, i could have been that man. This year i realized, and accepted, that i am now too old for that sort of thing.

Twenty-five years ago next summer, i knelt on a half-steep roof, facing down over the edge toward a 20-foot drop to bedrock, and nailed on the outer courses of asphalt-“shingle” roofing because, of course, they go on first. Then i worked my way to the top. Today, i would be willing to do the same work starting from where i could face upslope rather than downslope—but not those bottom “courses”—and i couldn’t work kneeling for as long.

Traditional wisdom takes notice: The glory of young men is their strength; and the beauty of old men is their grey hair. [Proverbs 20:29]

More precisely, the beauty is not in our grey hair. It is under our grey hair—if we have hair left—and in the way we use our time. Old bald-headed men partake of it also—but not all old men “have the beauty,” however much or little hair they wear above their ears and of whatever colour. If we have put our earlier lives to good use, we have learned many, many things—more than our juniors have had time to learn. These things-learnt—most of them not memories in a personal sense, but of events and circumstances from our earlier days—provide us old men with abundant context, more abundant than middle-aged men have, far more abundant than young men have, in which to think about the tasks, problems, and events of the present.

I, for instance, have learned to read, speak, and write some Finnish, improved my German and Spanish, and lately learned a little French, in addition to my boyhood English and the basic Spanish i learned in secondary school. When i was half my present age, i could speak, read, and write English quite well and Spanish quite badly; now i can speak and read some Finnish, French and Spanish, can struggle to read and occasionally even speak some German; and these four languages inform my use of English as none of them did back then.

I can remember when many women, at marriage, promised to obey their husbands… and i can also recall observing that in those same years, about as many wives dominated their husbands, as vice-versa2. Today’s young men and big boys can perhaps remember US President Obama telling a random male voter, “Just do whatever she tells you to” while campaigning for re-election in 2012. Women, as part of the marriage ceremony, promising to obey their husbands?—“that’s history”, and they have no feel for how ancient or recent, no personal recollection of its context.

The first beauty of old men is in how much knowledge we can recall, in our personal context of that time, rather than having to look it up and read it in the unknown context of someone else’s recollection and work.

The second is in our appreciation of the strength and accomplishments of younger men, and of boys. This is far more important today than it was fifty and one hundred years ago, when men were more valued in culture (and specifically in law and bureaucratic administration.) The ecological predicament is best addressed—best resolved—using skilled, large muscle labour—the work young men do best. We old men can give the young men on whom our best response to the ecological predicament depends, some mentoring in those large muscle skills, some appreciation and respect for them3. We can affirm and mentor the boys who have a flair for skilled manual work, and with better effect because that flair was once ours..

The third beauty, which is in our willingness and disposition to bless and to tutor our juniors; overlaps the second but is distinct. When a man is between one and two generations old, his first concern usually is to do whatever he can do best, as best he can, with his own body. He won’t ignore nor neglect his children, but he is likely to take, rather often, a “Look at this and see if you can do it too” (or “… and see if you can learn to do it too”) approach. By the time he is of the age to become a grandfather, he begins to have a fuller appreciation of the diversity of humanity, and a greater ability to nurture the good qualities in people—boys and younger men especially— who aren’t much like him.

Old men also have more free time to “mentor”. Young and middle-aged men are called-for when the job involves heavy lifting and quick reflexes; and while the old men and boys might tag along if it isn’t a hireling job, our work is less demanding and less constant. We have time to tell and show the boys what’s going on, while the younger men have to give fuller attention to the task. (In industrial societies, younger men are usually employed at single-focus worksites in places where boys and old men are not even welcome … those worksites are less human than the multi-generation family farm, fishboat, or craft business.)

It was from my grandfather, not my father, that i received a rough map of the work possibilities to which my talents might lead, and introductions to electricity, gardening, science, and woodworking. Dad took me fishing and showed me some of “how to dress”; but he had many more demands on his time, and i think he was more concerned that i “represent him well”, somehow.

Our fourth beauty overlaps the first; it is in personal memories, that can inform boys and younger men beyond their own lifespans: We can recall “how things were” in times when younger men were not yet living, or were boys rather than grown men. It’s been many years since that once common prank, “The Stink Bomb”, was common. In retrospect, “The Stink Bomb” was a rather efficient form of civil disobedience—better than some more violent and disruptive forms we have seen more-often, lately. You’re not likely to learn that in school, nor on the evening news.

I can remember when misogyny and misandry were roughly balanced and neither was dominant. I can remember a change to strong net misandry during my lifetime. They can’t. But if i tell young men and adolescent boys my stories, stories i remember rather than have read, that can bring them closer to a sense of social change, and of the real possibility—and superiority—of balance rather than dominant misandry.

There is wisdom, and a fifth beauty is possible, in our acceptance of mortality… in our awareness that we have fewer, decades-fewer years left to live than we have lived already. Younger men are also mortal—but few of them feel it, once they are on their own and doing their man’s work. It’s all too easy for middle-aged men to take on projects and mortgages they will not have time to complete.

Seriously, if you’re between say, 35 and 60 years old, and you’re thinking of something long-term you’d like to do or something expensive to buy with a mortgage—talk it over with your father, your uncle, an Elder in your church or your tribe. Form with that older man, a perspective on your remaining years on earth. Recognize that life is partly a matter of chance, and that it’s prudent—and healthy—to allow plenty of extra time and even money for bad luck, bad times—and good opportunities you can’t name right now.

Keeping track of your remaining life expectancy, and a sense of that expectancy as a random variable, can be valuable even to young men and adolescent boys. It should be part of the initiation of boys into the first stage of manhood, and such initiation, given by men of diverse adult ages, should be a normal puberty experience for boys.

I’ve been told, now and then since i finished Grade 12 and went on to university studies, that i act older than my years. Some of these “beauties of old age” may have been with me longer than with most other men in their seventies. I may have become middle-aged at 30, in my second year as Associate Professor, and old [but not yet weak] in my fifties. If so, i have an old man to thank, who nurtured my boyhood; an American Métis electrician, fiddler, storyteller, and inventor. Not him alone, but him especially. If you are past 50, or act old for your years, see what boys you can “mentor” as he did, me.

Gran-Père, je te souviens.

 

Notes:

1. It took three years at least, to make it even a semblance of a prayer garden, from its use before i bought the land.

2. One reason so many women dominated their households, was the separation of men’s workplaces from their homes. In those mid-20th-Century years, fairly few Canadian and “American” women worked away from home; theirs was the predominant presence in the house. As i commented above, separating men’s work from the presence of boys and older men, is less human than the multi-generation family farm, fishboat, or craft business.

3. Feminism and the bureaucracies it has influenced, whose main concern is the self-interests of higher-class women, haven’t the motivation, nor the background, to fully appreciate skilled manual labour. That is likely one major reason, why the governmental as well as profit motivated approaches to managing nature, are too mechanistic.

 

Posted in Commentary, Davd, Human Nature, Male Lifestyle, Working | Leave a comment

Steamed Pink Salmon with Carrots and Rice

Posted on October 6, 2015 by Davd

… or Barley if You Prefer:
(c) 2015, Davd

One reason i began this series under the name “Bachelor Cooking”, was that i cooked for only myself most times then, and still do now. Sausage soup, the first technique i published, is a good hearty meal that is cooked in one pot1, and keeps well in the ‘fridge: Cook once, enjoy twice, perhaps as many as five times. This steamed-fish technique, which i’m “posting” now because of the fall Pacific-salmon harvest, also cooks a meal in one pot; and much as sausage soup can be made with several kinds of sausage, this technique can be adapted to several kinds of fish, not just pink salmon.

I use the same basic technique with cod, haddock, rockfish (“red snapper” is often its name near Canada’s West Coast; but that name also applies to some different, warmer water fishes) and greenling. It might adapt well to freshwater fishes like pickerel [the one the Americans call “walleye” et les Québecois, doré], and perhaps whitefish, perch and [freshwater] bass. I tend not to use it with stronger flavoured fishes like wild Atlantic, chinook, coho, and sockeye salmon, nor with herring, mackerel or tuna… all of which fishes are better than pink salmon, cod, or haddock, when smoked. It seems there’s a distinction between medium-flavoured fishes that steam well, and stronger flavoured fishes, higher in fat content, that smoke better than they steam2.

The equipment you’ll need are a steaming basket, a cooking pot in which that steaming basket fits well, and “the usual utensils.” If you start with skin-on filets, a filet knife is best for slicing the meat off the skin. (The skin can be boiled a minute or two and given to your dog or cat. Most humans i know consider it to taste “rank.” I would not steam fish, skin-on,)

I usually steam carrots with fish: They taste good together, they cook well together, and the carrots improve the taste of the liquid under the steaming basket—in which, following this technique, you’ll be cooking rice or maybe barley. Your one-pot meal then consists of steamed fish, steamed carrots, and seasoned rice3. Cod and haddock each make a fine meal cooked this way; pink salmon is not so much my favourite, as equal to them4 and in season this month.

For the cooking liquid, i prefer vegetable stock to water. White wine, and beer, make fine cooking liquids, too5. I’d avoid stock that has a lot of beet or beet greens in it, for steaming fish. Broccoli, cabbage, carrot, celery, cauliflower, onion, and turnip are the basic stock vegetables; spinach, chard, beans and beet greens in small amounts can be fine. Beets are OK in sausage-soup and stew stock, but i’d avoid them with steamed seafood, partly because they’ll turn the grain pink.

I put 2½—3 times the volume of stock [or water] in the bottom of the pot, as i intend to add of rice. (If it’s more than three times as much, there’s a risk the rice will be more like a soup than a cooked grain you can put on a dinner plate. Fish varies in moisture content, stoves vary in how hard they boil water at any setting i can name in words; so it is not possible to state exactly what ratio of water to grain, to use.) A little oil or bacon drippings will help the flavour of the grain, and help keep it from sticking to the pot. If you have lots of chive, you can snip some into the water—or onto the grain after it has cooked.

I tend to cut the carrots lengthwise, into quarters. Very thick carrots might be cut into smaller fractions; the idea is to have 2-4 inch [5-10 cm] long pieces of carrot, about 1 cm [¼ -½ inch] thick. which you lay on the bottom of the steaming basket with spaces for the steam to rise between them. The salmon filet pieces are laid flat on top of them, so the carrots get just a little more cooking than the fish.

I sprinkle my pieces of pink salmon filet with dill weed, or tarragon, and cut chive (chopped onion will do6 but chive [even frozen chive], or in second place cut green onion, will be better.) Chive and onion should be fresh or fresh-frozen, not dried; dried dill weed and tarragon, if dried well, will do fine. (If you’re steaming cod or haddock, finely cut sage might also do.) Finally, sprinkle a little black pepper on top.

I put a volume of dry uncooked grain equal to, or less than, the volume of fish i’m cooking, into something over twice that volume of stock. Start with at least 2½ times to be sure.

You don’t need very high heat, on a gas or electric stove, to bring the stock to a boil. It’s fine, probably preferable, to put the grain in the stock before it’s heated; and moderate heat under the pot will make sticking less likely… as will that little bit of oil or bacon fat. Stir the grain when you put it in, and again a few minutes later. When the water comes to a boil, or just before—stir again. (A glass lid on your cooking pot will help you see how steamy the inside is, and how the pieces of fish are going whitish and opaque, and thus, estimate how the heating is going.)

I suggest having a metal plate to stand the steaming basket on, when you take it out of the pot to stir the rice. (A regular dinner plate will do—but you’re likely to stand that plate on a stove element some times; and if the element is hot, metal takes it better. I have an elongated stainless steel plate that i use, and have used for a few decades now.)

If the pot has a glass lid, you’ll be able to see the fish starting to cook… a good sign to stir the grain again, if you haven’t done so lately. Lower the heat to what will keep the water boiling but not wildly7. When the fish looks fully cooked, put a fork into a few of the carrot pieces; and feel if they’re cooked. (If in doubt, stir the grain, and that will indicate if it is cooked.) If in doubt, cook 2-3 minutes longer than your guess as to when it’s done, the first time you use this technique. With experience, there won’t be so much doubt.

The fish and carrots should be well cooked but not “to death”, the grain, fully soft and flavoured with the fish, carrots and stock. Sometimes i snip some chives onto the grain (and onto the fish, if i didn’t cut some on before cooking). Sometimes i put a little soy sauce on the grain, or some salsa picante if i have some in the ‘fridge. Garlic butter goes well with the fish, and rather well with the grain, especially if you’re not that fond of soy sauce.

If you cook this in a shallow pan, such as a stainless steel frying pan, you can eat it from that same pan if you’re eating alone. I prefer to use a plate. (I have a set of four French glass dinner plates and four “soup plates”, and prefer the soup plates [or my elongated stainless steel plate] to serve this meal.) With a large enough pot, i recommend you cook at least two portions (twice as much as you’ll eat alone, or more) even if you’re by yourself. Cold steamed salmon with dill and chive is delicious; the carrots and grain are also quite pleasant eaten cold.–and there’s no law against reheating them.

There are four main ways to cook salmon: Grilled, fried, steamed, and baked. Steaming is the easiest for a man eating alone, because he can cook fish, carrots, and grain in one pot. Grilling is partway to smoking, especially over a wood fire that is more coals than flames; it involves more work, grilled salmon is delicious cold, and you should plan to grill as much as your firebox will “do.” Frying is a fine way to cook stronger flavoured fishes, and is quite good for cod and pink salmon too; baking fish, i think of as belonging to the cooks who have several people at table, nearly every meal.

Also, more people, men and women, believe they know how to fry fish, than are comfortable steaming it. Steaming is if anything healthier than frying, though if you use canola oil to fry it, not much so8. I might get time to post a fried salmon or fried fish blog, later in the fall.

You’re best off being able to alternate among steaming, frying, and grilling—if you’re fortunate enough to have that much salmon. I’ve started with steaming because it’s new to more men; because you can cook a whole good meal with less work by steaming, than by frying, grilling, or baking; because pink salmon has been abundant this September and much less expensive than the other species; and because the technique adapts well to cod and haddock which are more available in the other seasons.

It’s the way i most often cook pink salmon—and cod, and haddock—myself.

Notes:

1. I recommend having an apple with sausage soup, because most sausage is fairly high in saturated fat, and i’ve read that apples help keep saturated fat from becoming cholesterol deposits in your blood vessels.

2. There are very mild flavoured fishes, like goberge [pollock] that are better cooked in salsa-picante than steamed or smoked. These mildest flavoured fishes will steam and be good, but to my taste, are better with a sauce.

Almost all kinds of fish are good fried; and better covered lightly with flour or breadcrumbs. Bacon fat seems to go well for frying almost any kind of fish—but not necessarily ham fat.

3. Good gardeners should have tomatoes either still in the garden, or picked greenish and ripening indoors in a cool room or the garage; and some chives left in good condition. Very good gardeners should have a fall planting of lettuce near its prime. Thus, i tend to make a lettuce and tomato salad with a sprinkling of chive, to go with this meal.

4. Like my Acadian friend Smitty, i prefer cod ahead of haddock because “it has more of a sea taste”. That’s a personal preference.

5. I’m usually too “cheap” to use wine, but if a bottle has been sitting in the fridge for several days since it was opened, i might well use it for steaming. If beer goes flat, saving it for cooking stock [in my humble opinion] is better than either drinking it flat or pouring it down the drain. And as a home beer and wine maker, i’ve saved the water from rinsing the bottles (which i do soon after i empty them, for easy sterilizing and refilling later on), and boiled vegetable trimmings in it to make stock.

6. It should be chopped very fine (or browned lightly in canola oil or bacon fat before it goes on the fish, in which case it can be added when the fish is already cooked.)

7. If you boil the stock very hard, you might boil away enough of it that too little remains to cook the grain to the softness it should have.

8. I prefer bacon—not ham—fat for frying fish, when i have some saved in the ‘fridge. It is possible, and OK, to put a little bacon fat in with as much or more canola oil. Don’t use olive oil; from my limited experience and what i hear from professional cooks, it doesn’t perform well at temperatures high enough to brown the surface of a piece of fish—or meat.

 

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Poor Br. Davd’s Salmon Soup

Posted on September 29, 2015 by Davd

If Salmon’s Expensive, Use This Technique.
If it’s Cheap, in this century, be pleasantly surprised!
(c) 2015, Davd

Salmon (to repeat) is wonderful food. Given its great merits, particularly as to protein and fatty acids, as the previous post detailed, it is worthwhile, in these times when salmon is no longer abundant as it was one and two centuries ago, to use every salmon you get, to the full.

“Poor Br. Davd’s Salmon Soup” is one way to use the bits and scraps from a whole salmon. Since salmon is usually scarce and costly, the happy and healthy cooks and “eaters”, if more nearly poor than rich, will make the most of those salmon they have. At this time of year, that often involves fileting many fish while the price is relatively low, and freezing most of the filets. The bones and fins aren’t so easily stored—but they can be put to use “at the time”. This is my usual way.

Not only is this soup very tasty, and differently so from grilled, steamed, [raw]salted, and fried salmon; it also raises the efficiency of your use of a whole fish—meaning the true price of the salmon you eat is a little lower. Only the wealthy can afford to ignore that.

I have watched the price of salmon, in comparison with those of beef, chicken, pork, and other fish, for a few decades at least. Not to go into confusing detail, the relative price of salmon [and of other fish] has been rising relative to other ‘meat’ prices1. Whole fish, drawn [gutted] are usually much less expensive than filets, steaks, or parts of filets: It’s worth while to buy a whole fish and make soup from the bones and fins, if you’re not wealthy.

This technique begins, then, with a whole salmon, gutted, with or without the head, and now that you’ve read about butchering cabbages, and had two years to try that, the previous post should guide you to get filets and-or steaks from the more complex anatomy of salmon.

Let’s figure that you have some salmon fins, bones after fileting, perhaps strips of belly meat and scraps left from fileting and skinning, perhaps also a head or two. The next step is to briefly boil them to make stock. It will take about as long as vegetable stock, and you can use the same vegetable trimmings, including onion. For herbs, sage, dill, liveche and-or celery, onion or chive, and tarragon are best. . The skin of the head and fin areas may be left on, but remove and discard the skin from scraps if they aren’t already skinned, and from belly meat if used. Skin can make the soup slightly rank (I’ll estimate that if you tried to make broth from salmon skin alone it would be very rank… but my dog enjoys lightly boiled salmon skin as soon as it cools. So treat your dog, or cat if you don’t have a dog.) Add salt to the bones and trimmings now, not too much but enough to help extract flavour from the bones.

Bring all these to boil with dill stems, celery or lovage stems or leafage, and sage stems or leafage if you have them; simmer 10-15 minutes. Leftover bits of onion, chive, garlic, thyme, savory, parsley, bay-leaf, and carrot trimmings, may also be simmered with the fish.

Allow the stockpot to cool, reserve2 the broth, pick the meat from the fish head, bones, and fins, collect other meat that was put to the boil, and put all that meat into the reserved broth. This is the salmon part of the soup. It can go back into the pot where you made stock, once the bones, plant scraps, and any scraps of skin have been removed.

Chop 1-2 small carrots into quite small bits, so the amount of carrot is a fifth to a quarter as much as the amount of salmon-meat; chop chives or onion, fairly fine, and perhaps parsley and celery bits (use at least dried celery leaf or seed if neither celery nor lovage was used in making the stock, and dried sage if no sage was), and add them. A pinch of black pepper or hot red pepper may be included. Bring these seasonings to boil with the fish bits and broth, and enough rice, barley, or potatoes in the broth3, to make a fairly full-bodied soup. When the grain or potatoes are cooked, the soup is ready.

The finished soup should contain enough broth to be sipped, but more body than liquid; and flecks of green [probably chive or onion tops, perhaps celery], and orange [carrot]. The broth should be rich and aromatic; the fish bits small but fairly plentiful.

This is a hearty soup comparable in menu positioning to minestrone, but far different in taste. It is made from cheap vegetables and meat [also herbage] that often gets thrown out; yet it is high in sustenance and enjoyment value. The chive, celery, and carrot can be frozen surplus from other seasons [dried lovage =liveche also substitutes for celery, and in my humble opinion is better in soups and stocks] so the soup is quite winter friendly.

You can add tomato in season, in which case hot red pepper might be preferable to black; and basil and oregano might be tried. As with many of these techniques, i’ve named several ways to vary the soup. and all the possible variations number a dozen or more. Most will be pleasant. Which you make most often, should depend on your likings and what’s in your garden.

Notes:

1. … though just lately, west of Saskatchewan, beef prices are even more inflated than those of pink and perhaps coho salmon, This is likely a matter of a good wild salmon “run” this year, and i would not expect such prices to persist into next year.

2. “Reserve” is a common verb in cooking; it means “set aside in a clean container, for future use”.

3. The grain can be added any time up to when the broth begins to boil; if you add it when the broth is cold, stir a few times while it is heating. Potatoes should be added well before the broth boils, unless you brown them in bacon fat at the same time the broth heats..

To my taste, rice goes best with salmon, barley and potatoes, next best. Imaginably, you could cook pasta instead, but i’m not convinced that pasta goes well with salmon. Tuna does go well with pasta, so perhaps mackerel would also— but they are both strong flavoured in a quite different way from salmon.

 

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