Living Well

April 30, 2010

The Challenge of Moral Courage

I was so struck by the quotation I lost concentration during the meeting at hand.  My attention was arrested by an elegantly refined calligraphy quotation of Dante Alighieri seated in a beautiful frame.  The quotation pierced me in a way not many quotations have in some time.  While many quotes focus my mind on a topic, this bold statement by Dante forced a deeply personal inquiry, “Have I been or am I now morally neutral on issues in this world that truly matter?”  The quote simply stated, “The hottest places in hell are reserved for those who in times of great moral crisis maintain their neutrality.”

The question that ran across my mind is a frightening introspection among a host of possible beliefs about oneself.  We may believe we are honest, just, respectful, and kind when it comes to others.  These are traits we can exhibit at any moment and in various ways.  I can show kindness by taking a plate of cookies to my neighbor or I can be honest by not cheating on my income taxes.  These acts may cost me time, energy, a bit of inconvenience or money in demonstrating personal character ingredients I believe about myself.

But moral courage is at the highest level of our willingness to demonstrate our character.  Moral courage asks us to pay a price with our reputation, friendships, or even our lives.  A striking aspect of moral courage is that it calls us to be other centered.  While some of the “others” might be friends or family members, it is quite likely they would be strangers, people who are normally just faces in the crowd.  It may also be that these strangers live in another time zone of the globe, whose skin and culture are very different from our own.  It was moral courage displayed when fire fighters, police, emergency personal and ordinary co-workers and selfless airplane passengers gave their lives to save others that fateful 9/11 morning.

So what might be ideals calling for our moral courage?  When we look around our globe, it is easy to find any number of stages for demonstrating moral courage.  The environment, unjust labor markets, war, human rights violations, abortion, racism and genocide are just a few that come to mind, but there are many others that we could name.  In considering these moral and ethical issues, the haunting question remains, “Would I be willing to pay a personal price for the well-being of strangers or future generations by confronting and overcoming these issues?”  It may be one of the most deeply personal and spiritual questions we will ever answer during our existence.

This is not new landscape to navigate.  Across the horizon of moral courage are signposts bearing people’s names that have paid a personal price for standing boldly against the flaming arrows of the issues they confronted.  Mahatma Gandhi, Martin Luther King, Jr., Mother Teresa, Nelson Mandela, and Abraham Lincoln are just a few individuals most recognized for wagering their lives in moral courage.  There are, however, countless others with moral courage, nameless and unheralded by historians, who have sacrificed their lives to become voices for reason and justice.  We may not know them, but we are eternally in their debt for attacking the severest issues that face humankind.  In recent years, filmmaker Steven Spielberg has shaped our concept of moral courage by delivering dramas of unknown heroes; simple women and men who gave their lives for causes set before them.

In reality, we are being summoned to moral courage whether we acknowledge it or not.  It may be our voices of reason are needed for stamping out human rights violations in some remote region of the globe or maybe our courage is needed in “downtown anywhere” where racism and hatred are choking sanity.  We are in reality indelibly connected to each other, no matter what corner of this planet we occupy.  By looking away, we grant permission for oppressions to continue and loud voices to prevail.  Our answers to these human cries must be our willingness to carve our names on the signposts peppered across the landscape along with those that have responded with their sacrifices, even if it was their own life.

It is a choice to live isolated or to “make our business that of humankind.”  I am not naïve in believing this is a decision made lightly or that our actions will stamp out the moral perplexities of our world.  But these decisions and personal choices to act with moral courage may carry eternal significance like no other.

So ask yourself, “Would I be willing to put my reputation, possessions or life ‘one the line’ so that injustices may be made right?  Why or why not?  Would I be willing to join a picket line or demonstration that would require my taking a public stand on some moral issue?  Would I be willing to boycott products or services that perpetuate human rights violations?  Do I value my personal safety and well being above that of others?  Why do I make this stance?

Moral courage.  It may be the highest test of living well.  Blessings, grace and peace for every day of your life.

David Neidert

February 17, 2010

Behaviors Good Anywhere in the World

Filed under: Personal Leadership,personal mission — dlneidert @ 11:43 am
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There are a gargantuan number of behaviors that are illegal.  It is easy to create a list of illegal behaviors, such as murder, rape, kidnapping, or theft.  If you were pressed, you could add to this list a host of additional violations, like espionage, fraud, abuse, or trafficking.  We might have a list of hundreds we could pen if we were given enough time.  But were you aware that the legal canon of the United States has over 260 volumes?  Additionally, there are over 16 volumes of IRS codes and 168 volumes of Supreme Court decisions.  Can it be any wonder there are so many lawyers (625,000 at my last check) for defending or litigating regulations?  Now, add to this international law and the laws of other lands.  And if you think those international laws don’t matter, read the fine print of your Passport which in essence says you are bound by the laws of the country you are traveling in.

There are behaviors, though, against which there are no laws, as the Apostle Paul writes in his letter to the Galatians.  Personally adhering to these attitudes of the heart could actually make life more fulfilling and transforming.  Living with integrity, honesty, sound speech, gentleness, self control and others keeps us within boundaries that seek the best for all involved.  These attitudes, when lived out, do not intend to harm but rejoice in the good we can experience as human beings.  These behaviors not only enrich us, but they also invite others to measure themselves against universal principles of excellence.

I know we live in a social structure that tells us we have personal rights and no one can tell us how to live or act.  We make life relative to our own situation….our behaviors are determined by our decisions and what feels right to us.  But as a student of ancient wisdom, I know that some of the greatest literature in the world for 3,000 years tells us that personal character is not a license to freely live, but to live free.  These ancient voices beckon us to live nobly, civilly, and with self-control.  Living well means incorporating these universal principles of attitude and character against which there are no laws.  Living with a high sense of character not only has benefit now in how we live, but is replicated in the lives of our children, grandchildren, great grandchildren and the communities in which we live.

I am not naïve to believe there should not be laws.  They are essential for bringing some balance of justice in the world, as well as protection when necessary.  However, I do believe that the plea of ancient writers to live with universal principles of excellence could change most, if not all, of our personal, corporate, community, and societal relationships.  I have personally been told while traveling internationally by my hosts that I have a “heart for their land and people.”  While I do read extensively about cultures, customs, and history of the lands I visit before I travel, I also just try to live universal principles that command the highest good from me.  The combination of these two behaviors allow me to have a heart for all those I will encounter during my travel.  Wouldn’t it be interesting to see what would unfold if we personally—and collectively—began living to the cadence of these ancient voices of civility and nobility?

In the blogs ahead, I will explore a number of character attitudes and behaviors that I believe can change us and infuse our relationships with hope, peace, grace, and living well.  Blessings for this day.  Grace and peace.

David Neidert

February 12, 2010

Patience and Endurance in a Microwave Society

I am home write now.  Recovering.  The recovery is from a very badly broken femur (thigh bone) that required surgery for the placement of a rod in my leg (from about hip to knee), screws, and metal bands to keep it all together.  It has also taken six weeks of sitting and not putting any weight on my leg.  A metal, “nursing-home-like” walker—fixed with a big basket on the front for carrying items around the house—has been my constant companion.

I have learned (actually relearned) an important lesson during this time.  It has been about patience and endurance. There have been a number of episodes during this time that I will call panic.  They came in weeks three and four of recovery.  These were times when I could not see the possibility of being anywhere else except in a chair looking out the window on the world.  The healing process for a bone is long for a person my age.  So, anxiety and distress came during a number of occasions.  It was then that I was reminded of my mission, my life purpose, and goals, especially by those who love me and give me daily support.  All of these pointed to the fact that this recovery would take patience and endurance, even into the many months yet to come.

I am reminded that we want things to happen so quickly in our society—in the West. We want microwave everything.  Speedy weight loss without effort, success without very hard work, a lifetime of love because I smell good or drive the right car, or healing without many hours of waiting for one’s body to regenerate itself.  We have been blinded by an illusion of instant success—like putting 30 seconds on the microwave and then being frustrated because it is taking too long!  If you don’t believe me take as much time as I have to watch the plethora of commercials that hit us on the TV during a ½ hour episode of anything.

I am reminded not only about this during my recovery which is taking time, but also because I am reading Malcolm Gladwell’s “Outliers” (which by the way I highly recommend).  Gladwell convincingly puts forward through a lot of data and studies (which I like) that success comes through hours of work, patience, and endurance.  It comes with putting in a lot of time and effort—at least 10,000 hours of hard work. 

I love words.  I have a 10 pound, 5.4 ounce Funk & Wagnall Comprehensive International Dictionary that is really important to me.  I bought it for $3 at a rummage sale.  Over those 1,466 pages I find the meaning of words that help me really make sense of what we sometimes so flippantly think about or express.  One of those words is endurance.  My F & W says that endurance is “to bear with strain and resistance, but with conscious power, suggesting a contest to win and conquer; patient fortitude.”  Looking further, ‘fortitude’ says “to be strong, a strength of mind to meet and endure unfalteringly—determination; patient and constant courage, enduring courage that steadily confronts threats and barriers.”

In what Gladwell researches and I have found in my own life and work with thousands of people is that success comes through all the ingredients of competence, very hard work, support and networks, and patient endurance; standing courageously and steadily as we confront the threats, barriers, and mishaps of life.  Success doesn’t come instantly; it comes because of well established goals, focus, mission, having a purpose in life, a hopeful vision for the future, and very hard work.  Euripides, the 5th Century BC Greek playwright penned, “To preserve, trusting in what hopes one has, is courage for that person.”  Patience and endurance through hard work brings courage.

W.H. Auden, an American poet, challenges our microwave society and impatience when he wrote, “Perhaps there is only one cardinal sin: impatience. Because of impatience we were driven out of Paradise, because of impatience, we cannot return.”  Living well is not a sprint….it is a courageous, competent, hard working marathon.  That relearned lesson over these many weeks has helped me through these days of sitting, of wondering, of my own anxiety and impatience.  It is a lesson I am glad I found again; it brings courage for the many days yet to unfold.

Blessings as you live well.  Grace and peace.

David Neidert

February 11, 2010

Move Toward Your Goals: Use Your Time Wisely

I regularly hear people talk about not having enough time to do everything they want.  While I listen to this patiently, I also know that time usage is a matter of choices.  We know this intuitively, but we don’t apply what we know to our daily lives.  We delude ourselves into thinking that by some magic we can control time, save a few hours of today for tomorrow, or squeeze 25 hours out of a day for all we want out of life.  Nicolas Hayek, co-founder and CEO of Swatch Watch Group says it like this, “You cannot keep time.  You cannot catch it.  You cannot stop it.  You cannot possess it.  It’s always present, but if you try to hold it, it disappears.  So never try to manage it.  It will beat you at every turn.” 

Hundreds of books on time management can be found with a quick internet search.  In a nutshell, they would all say time management concerns giving priority to what is important in your private life, leisure, and work.  While they all have their variation on the theme, they would agree that one of the issues of time management are time bandits; those areas of life that rob us of productivity.  Time bandits can be classified as those items that keep us from reaping the opportunities for personal growth and living well.  Some time bandits are excessive television viewing, procrastination, moving from project-to-project without purpose, or even those many hours spent on the internet for a variety of reasons (surfing, social network without direction, games, etc., etc.)

A lament I often hear is how “I want to do “so and so” (you can fill in the blank) but never have enough time to actually get this done.”  One of the most wonderful experiences of my life that set the stage for my own future came during a breakfast I had in 1994 with Zig Ziglar.  I asked him, “How do you get the time to write so many books?”  His response, “I write one page a day.  In 365 days, I have a book.”  Now that isn’t rocket science.  That is just making a decision about using time every day for something that is purposeful, a part of your mission.  I have used this discipline myself since that conversation.  I have now written three books, nationally published nearly 50 articles, and researched for other books and projects by spending about 7 to 10 hours every week focused on this craft.  That simple use of time gives me between 300 and 500 hours of writing every year.

My advice, don’t get sucked into believing that time is infinite.  My time—your time—is finite; it has an end on this earth.  If no one has told you or if you are living a fantasy or in denial, let me remind you…you are going to die.  Your time WILL come to an end.  And it may be sooner (or later) than you think or want.  So what is your mission? How will this help you make decisions about your use of time? Will you get control of time bandits or let them use up discretionary moments of your life?  You can manage your time by courageously making some decisions. 

Johann Goethe, the 18th century writer, observed, “One always has time enough, if only one applies it well.”  Make some decisions today.  And one of the first is to read “First Things First,” by Stephen Covey.  I use this book with students to help them wed purpose and mission by how they use of their time.  If you take time to read this book, you will be taking the primary step in managing your finite time for the things what will help you live well.

Blessings as you live well in the time you have available.  Grace and Peace.

David Neidert

February 7, 2010

Prostate Cancer: Ongoing Followup to Cancer treatment

Filed under: personal mission,prostate cancer — dlneidert @ 1:11 pm
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A blogger that helped me originally in my own prostate cancer journey wrote, “Prostate cancer is a life long journey.”  I know this is the case as I continue going to my post prostatectomy consultations.  After my initial post operative work, the appointments began being set every three months for the first year.  The main objective of these consultations is to answer three ongoing questions:  What is the return of potency, How are you healing related to incontinence, and cancer management.  These are three ongoing questions I continue to answer as I am now in year 2 of my post surgery consultations.

Ongoing consultations are essential, especially in the area of cancer management.  The routine PSA report helps the doctor to know that no cancer has returned.  I always wait for the response, “Your PSA shows non-detectable.”  That means there is nothing to detect in the area of prostate cancer.  However, as I am aware, the PSA test can detect the return of prostate cancer well before it may in fact appear in the body in some location.  Thus, the ongoing consultations are essential.

My consultations started at 4 times a year for the first year.  These carried over into year two as well.  Now heading into year three, my consultations will move to every 4 or 6 months, yet to be determined by my surgeon.  In all years following, it will be at least once a year.  These consultations are essential, as my surgeon reminds me.  He tells me from his own experience that many men stop the annual PSA and thus short circuit the cancer management part of the equation.  Because of this, he finds at times men return to him in more advanced stages of prostate cancer by not managing it over time—being aware of your body and your own situation.

Cancer is a disease bent on your demise.  It will silently do what it does if men do not pay attention and manage it to a CURE.  Without paying attention, cancer can accomplish what it intends….the overtaking of your body.

I now deal with these consultations with resolve.  At first, it was pretty mental to work through the possibility that the cancer was not dealt with in the surgery.  But now the cancer management is about my ongoing life and taking responsibility for living well.  I have a choice about that, and you do also.

Prostate cancer consultations and cancer management are a part of living well.  Make them a priority.  Blessings, grace and peace.

David Neidert

February 4, 2010

Prostate Cancer: My Experience with Sex and Potency following a Prostatectomy

Here is where most men want to know the effects of a prostatectomy.  It is in the area of sexual performance following this surgical procedure for prostate cancer.  What follows is my experience.  I am not trying to speak for all men because the range is huge related to sexual performance following this procedure.  I want to honestly respond to my situation related to the mechanics, but I also want to give some insights related to my emotional response to these things.

Sexual potency, as I understand it, will be affected to some degree in the treatment of prostate cancer, no matter the treatment method you choose.  Whether you choose hormone therapy, radiation, or other means including surgery for the treatment of your prostate cancer, there will be some decrease of potency; the ability to get and maintain an erection during intercourse.  Again, I can only speak of my experience following a prostatectomy.  You will have to have a candid conversation with your doctor about this issue if you choose another form of treatment for prostate cancer.

Because of the male anatomy and the nerves that operate the prostate and seminal vesicles, there is no way not to damage some of them in a surgical procedure.  Surgeons will use nerve sparing surgical procedures, but reality must also be understood here:  some nerves will have to be cut and you will lose some potency following this procedure. The goal is to return your potency to the best it can be following surgery.  This may take as much as 18 months to become restored or to reach the peak of your potency.  It is a time for patience and focusing on what matters in life.  That is why I spent time in an earlier blog writing about one’s personal attitude toward sexuality and the sexual act.  If this subject is not considered when you have prostate cancer, it can become a stumbling block for you in seeking medical attention and in your attitude during recovery. 

Again, there is a range of potency following a prostatectomy.  It can be less than 65% up to 70% or so with the help of ED drugs like Viagra, Cialis or others.  The ability to have an erection at 100% the strength pre-surgery is not a reality.   But, my experience is that I can have good sex and maintain an erection during intercourse that makes lovemaking enjoyable.

One of the first things that struck me about potency is that I can still have an orgasm.  It is different, but it still feels very good.  What is also interesting is that because I no longer have a prostate (which mixes the semen and sperm) or seminal vesicles (which produce semen or ejaculate) there is no longer an ejaculate.  Because there is no ejaculate, sexual intercourse is actually clean—no body fluids to deal with after intercourse.

An erection does not happen as quickly following this surgery.  While I am still stimulated visually, it takes manual stimulation to help achieve an erection.  I can maintain an erection for a period of time, but it is not as long in duration as it used to be.  Without an ED drug, I have a more difficult time getting and maintaining an erection.

The use of ED drugs is helpful.  I use Viagra.  But there is a loss of spontaneity with these drugs.  Most of them require you take them at least 1 hour before intercourse so that they are in your system.  Also, you cannot eat a meal in the 45 minutes before you take the drugs if they are to have their full effect.  Thus, you have to time you opportunity.  I chuckle to myself when I see the ED drug commercials and they say, “When the time is right.”  That is exactly the point.  You have to plan to use these ED drugs.  This changes the communication about sexual activity with your spouse.  You do have to plan and communicate that the ‘time is right’ for you to engage in sexual activity.  It will take energy, planning, and communication.  My advice is not to allow this to become a barrier, but to talk frankly with your spouse about this timing and the use of ED drugs.

 You can take ED drugs in various dosages.  I use either 100 mg or 50 mg.  I find that with the 100 mg, I am able to have an erection for up to one day.  So, if I take it on a Friday evening, I can still have the ability to get and maintain and erection the following day.  The 50 mg allows me to have an erection for about 4 to 6 hours.  Finding the right dose will be trial and error with your doctor.

The side effects are also as they describe in advertisements.  I begin to get a stuffy nose as the medication is taking its full strength; so I know when it is fully in my system.  I also get flushed and warm in my face.  I do have a slight back ache after the drug begins to wear off.  And, for me, the most pronounced side effect is that I do get a headache.  With the higher doses, my headache is more intense than with the smaller doses.  I am fortunate not to have experienced nausea, which is a potential side effect.

One thing to keep in mind about ED drugs is they will not help you have an erection, but will help you maintain one once you do have it.  What this means is that if you are not able to have an erection, the ED drugs will not provide one.  The drugs, as I understand, work to seal off the blood that flows into the vessels (soft tissue) of the penis, making the blood engorge the penile tissue and “sealing” it so that the tissue stays erect for a longer period of time.

I would also say one other thing about ED drugs and my use of them.  They do not always guarantee that I will be able to keep an erection during intercourse.  I have been pretty lucky most of the time, but there have been occasions when my erection begins to fade way during intercourse.  This is disheartening for me and I feel badly for my wife in this moment as well.  But it is a part of the relationship change and enhancement.  It means that you and your spouse will have to discuss this potential and to support each other during your lovemaking and the times beyond.  Lovemaking will not be simply about performance, as it may have been in one’s youth.  It will really be about intimacy and pleasure with your spouse that can take on new meaning and new adventures in the bedroom.

I have been candid here related to my experience with sexual potency following a prostatectomy.  I did not find as much information as I would have liked in my own journey, so I share my experience in the hope that it will give encouragement in your own journey.  No part of my experience is meant to dishearten you, but to help men know there is potential for a satisfying sex life after this procedure.  It will just be different and will open new discussions and intimacy with your spouse.  And in the end, I believe this is what love is really about—sharing ALL the moments and commitments of life with the person who is your spouse.

Blessing, grace and peace.

David Neidert

February 3, 2010

Prostate Cancer: My Experience with a Prostatectomy

A prostatectomy was my decision for curing my prostate cancer.  At 53 when diagnosed, this was the best option for me.  I went into this surgery well informed concerning all the positives and negatives of this radical surgical procedure.  My goal for it was the cure of my cancer and the opportunity to live well in the aftermath of this diagnosis.

During the consultation with my urologist, he explained the procedure very well and in detail, which included many drawings.  Right at the top of the page was a list of risk factors which he wrote in doctor-prescription type penmanship.  The risk factors of this surgery are: bleeding during surgery, infection following surgery, incontinence, impotence, anesthesia related risks (including death), damage to adjacent nerves and structures, a pathology report during the surgery that shows the cancer has spread to the bladder or other tissue surrounding the prostate.  While most of these are rare, it is important to know that these things still happen in the best of situations.

At this point, we began discussing the surgical procedure, whether it would be done by the surgeon actually cutting me open or through a mechanical process called Di Vinci.  The Di Vinci is very successful and is widely used.  There are pros and cons to it.  Since I did not choose this method, it is important to have a detailed conversation with your doctor about it.  I chose being cut open by my surgeon for one reason:  he had trained to do this procedure in this manner and had performed over 600 surgeries like this.  I had confidence in him to actually use the scalpel as trained as well as having honed this skill over many years.  Additionally, this visual procedure allows the surgeon to see all of me at once, not only areas of me through a monitor, as with the Di Vinci process. 

As a side there is one item to ask your surgeon.  How many of these procedures have they performed?  This is very important because of the male anatomy in the groin area.  This surgical procedure, whether Di Vinci or manually, has potential to cut a number of nerves.  Nerves will be cut related to the prostate which effect the eventual potency issues faced in the future.  The surgeon is really trying to perform “nerve sparing” procedures, that is cutting as few of these nerves as possible.  Also, nerves that operate your bladder and also operate your legs run through this area of your groin.  One of the first orders of business is for the surgeon to locate and protect the nerves that go into your legs.  If this is not done properly, any disturbance or nick of them will cause you problems in walking.  I share all of this so that you see why you should ask the surgeon or listen for how many of these surgeries they have performed.  If your urologist has not performed at least 100 of these surgeries, ask for a second opinion or locate a surgeon who has a successful record with this procedure.  Remember YOU are responsible for your own health care and YOU have the right to get the best care, particularly with a procedure that will affect you for the rest of your life.  

Your surgeon will be removing your prostate and seminal vesicles during this procedure.  These two glands attach to your urethra (the tube that takes urine from your bladder down your penis to be expelled).  This “component” will be removed in one piece.  It is attached by nerves that come into play during sexual activity and give you the ability to have an erection.  This is where the surgeon will use nerve sparing procedures—attempting not to damage the nerves that will give you the ability to have an erection in the future.  This prostate/ seminal vesicle component is also attached to the vas deferens, which is how sperm get from your testicles.  These tubes will also be detached.  Finally, because this component is connected to your urethra, this tube going to your bladder will be cut on each side where the semen enters your urethra during sexual activity, the component removed, and your urethra sown back together again.  This part of the process will require that you have a catheter during the first 12 days or so after surgery.  This is because this internal stitching and section must heal.  The catheter will help keep the urethra open during the healing process.  You will wear this catheter home; it will likely be removed by your surgeon at your first follow up visit (but your surgeon will explain all of this as well as the maintenance of this catheter).

Following the surgery is the time of healing.  The healing process for me went like this: surgery was about 2 or so hours, I spent 3 days in the hospital, 12 days at home recovering with the catheter, office visit to remove the catheter (I used men’s urine pads after this for a while because there may still be some leaking as the bladder heals and becomes stronger), 2 weeks without driving (in that same period as the catheter), 2 weeks of lifting nothing more than a milk jug, 2 weeks more of nothing over 20 pounds, after 4 weeks as advised by your surgeon.

The first 10 or so days at home were difficult.  Because of the incision running from just under my navel to about the middle of my pubic bone, I could not get around very well.  I spent a good deal of time lying in bed.  The catheter also kept me from getting around much.  But, after the first week, I did find that just walking around in my house began giving me the stamina I needed to get stronger.  After the catheter was out (as well as the staples holding the incision together), I began walking outside (it was April of the year).  I walked a little every day and increased it over the weeks of my recovery until I was finally walking five miles every day.  I would highly recommend walking as a way to increase your stamina and energy during this time of recovery.

It was during this point that the waiting begins.  The honest surgeon will tell you that it will take roughly one year to 18 months to heal fully from this surgery.  It is during this time that one has to be patient with the issues of incontinence and impotency.   Here is where your confidence and communication with your surgeon are critical.  Constantly talk about each; be honest with how your body is responding during this time of healing.  It is no time to be macho in this healing process.  Playing that form of pride may hinder your complete recovery or not allow you to take appropriate steps if other medical measures are needed.

For me, this time of recovery was filled with prayer, reading, reflection on life, listening to music that gave me strength, being with family, relying on family, and considering the good that could come out of this moment in my life.  Prostate cancer IS a life long journey.  This time of recovery can give you the opportunity to consider it, plan for it, and focus on living well in the midst of your journey.

Blessings, grace and peace.

David Neidert

February 1, 2010

Prostate Cancer: Mission Guided Consultation

My sister is a health sciences educator at a Midwestern university.  On an early test in one course, she asks, “Who is responsible for your health care?’  It is a multiple choice question with answers like the insurance companies, doctors, etc.  The correct answer is YOU.  You are personally responsible for your health care and understanding what is happening.  This may not have been the case in an earlier time (and still is for many senior adults because they do not understand nor question authority), but you are responsible for what happens in a prostate cancer journey and consultation.  If prostate cancer is your journey, you will have to make some decisions along the way.

My own consultation took three hours.  Since I had already chosen a very good surgeon, this was a highly informative time together with me and my wife.  From the start, my advice is go prepared to ask many questions AND to stop the surgeon along the way and ask more questions.  If you want to live well, you have to ask the right questions in the process.

As I write this blog, I am looking at five yellow legal size pages of notes given to me by my doctor after the consultation.  It contains very rough drawings, types of treatments, side effects, and many other items to help me make a good decision about my treatment.  These are the history of that three hour consultation and the reminder of the choices I would have to make along the way.

I was 53 when diagnosed with prostate cancer at Gleason 7.  This age and Gleason Score changes the options often available for younger men that older men have available to them.  After we discussed the biopsy results, we began examining the options for treatment.  At 53, the goal was cure.  At 83, the goal may be to retard the growth of the cancer.  But for a young man, the goal is cure by the types of procedures.  If the cancer is slow growing, early stage, then one option might be the best.  But if fast growing with a high Gleason Score, many options might be taken off the table.  A good article concerning this appeared in the New England Journal of Medicine (Winter 2008).

Drawing a hierarchy of treatments, my surgeon explained six of them to my wife and me.  There may be more that you read about, but these are the typical treatments to choose from.  In the hierarchy, “watchful waiting” was at the bottom because of the Gleason Score and my age.  Both were against me.  Next was a series of chemical injections.  Again, this put time against me as this takes a number of injections to see results.  Fourth on the list was hormone therapy.  This can be a good option for older men with slow growing prostate cancer or early stage.  Hormone therapy retards the growth of the cancer.   These were treatments 6 through 4.  These treatments are not cures.  They are means to control prostate cancer.   Here I say emphatically:  You MUST consider your age in treatment AND you must ASK your doctor all the risks and side effects of each of these treatments.  EVERY treatment does have a side effect from impotence to incontinence to breast tissue enlargement (hormone therapy) that you must be aware of before you make a final decision.

 For me the goal was cure.  Cure treatments would allow me to live well.  Cure treatments also have their side effects, but would allow me to still life a full life.  In a previous blog, I talked about my personal mission and how it guided me in this particular choice.  Additionally, I had a trip planned for Egypt.  I had tried for 8 years to get to this country that I taught about every year at my University.  But because of so many circumstances, I could not get there.  I wanted a cure—one that would give me life and allow me to live this dream of touring archaeological sites in Egypt.

Curing prostate cancer is never 100%.  As I know intellectually and my doctor reminds me in the ongoing blood tests, “It only takes one cell to get away and multiply again; so we work at cure and ongoing monitoring.”  THIS is the life long journey started with prostate cancer, as with any cancer.  For me the options for ‘cure’ were freezing the prostate with liquid nitrogen, radiation, or prostatectomy.   Freezing may be a good option, but does have some dangers associated with it.  While there are significant safeguards, if an area unintentionally gets frozen, it is destroyed; no turning back.  Radiation is a good cure, but again, age is a factor.  The return rate of cancer following radiation may be as much as 15% over 15 or so years.  Thus if you are 80, that is not a problem.  But if you are 50, that is a problem.  And if radiation is used, it burns up the prostate and the tissue around it.  In essence, as my surgeon said, your prostate is like a charbroiled brisket.  If the cancer would return, there is nothing to surgically remove or radiate again.  You may be faced with chemotherapy as the only option.  The final option for me was surgery, a prostatectomy.  The cure rate is approximately 93%; remember nothing is 100%.  This is the cure treatment I chose, again because I want to live long and well.  There was a good deal of life remaining for one seeing the future from age 53.  I will explain this procedure in the next blog and the options related to it.      

So now, questions to know in the consultation or ask of yourself in the process:

  • What is my Gleason Score?  Is my cancer slow growing, early stage or fast growing?
  • What factor does my age play in the treatments for prostate cancer?
  • What are the side effects of each treatment offered to me?
  • What is the cure rate for each of the treatments offered me or are these treatments meant only to retard the cancer’s growth?
  • What is my goal in prostate cancer treatment related to my age and circumstances?
  • What is the percentage of reoccurrence of prostate cancer if I use this treatment option?
  • What does my wife need to know about these treatments or options?  What is she feeling about these cancer issues?
  • Finally, remember to ask questions, ask questions, and ask questions…..

 

 My personal mission and desire to live and live well helped me choose that option of a prostatectomy.  It allows me the best option for living a long life and growing old with my lovely wife.  While nothing guarantees anything, choosing this option from a place of being fully informed allows me the greatest potential to live as it is intended.

Blessings to all you men in the prostate cancer club who are currently faced with many decisions.  Make them well and with focus on life!  Grace and peace.

David Neidert

January 30, 2010

Prostate Cancer: My Story Guided by Personal Mission

Life is about choices.  My personal mission guides me all the time.  It guides my thoughts and how I make decisions.  Because I want to “invite people to abundant life by choosing God’s best” I am writing this particular blog on the area of my prostate cancer surgery and future.  This is my experience.  I want to weave through it how my personal mission helped me (and continues to help me) make decisions 1 ½ years after my cancer surgery.  I write it as an encouragement to men who are facing the reality of prostate cancer and potential surgery or other treatments.

I am writing, too, because when it was determined that I had prostate cancer; I joined a ‘secret club.’  I use this phrase because of encounters I have had with men concerning their own potential of cancer.  I have often had men come and talk close up to me about ‘their situation.’  This is a private matter for men, but I want to break that silence and talk frankly and authentically about prostate cancer, its treatment, and the life journey.  In the end, it is my hope by sharing my story; other men will find abundant life by how they make choices in their own prostate cancer situation.

After I was diagnosed with prostate cancer, I began researching about this disease.  While I found a lot of good medical advice, I didn’t always find how men actually worked through this emotionally.  As I stated in a previous blog, the outcome of prostate cancer always revolves around three ongoing concerns: impotence (the inability to have an erection or sustain an erection during intercourse); incontinence (the inability to hold one’s urine and thus a man leaks, often forcing them to wear absorbent underwear), and; cancer management.   I have this discussion every time I see my surgeon.  But I did not find any reflection about these topics in my internet search.

I don’t take these lightly because for men they are important issues.  Plus I think it important not to just deal with these three areas of concern, but with the emotions that go with them.  I will deal specifically with impotency in another blog, because it is the one that I did not find a good deal of information on.  Since this deals with sexuality, I will deal with that later.

There is a billboard near our house that says, “You wouldn’t tell a person with cancer to just get over it.”  The billboard is about how we sometimes respond to people about depression.  It is an apropos statement because a person getting a diagnosis of cancer does not get over it, but this diagnosis also can lead to depression.  In my own case, I realized that I was a victim of a drama not of my own creation.  There were ‘actors’ coming in and out of my life that I did not create, but had to acknowledge and work with in this journey.  For me, I would have moments of heavy sighing….just a ‘soul sigh’ because I had cancer in me that I could not control.  It was growing and I couldn’t do anything about it.  I was moving to the instructions of a lot of people simply following their directions and making decisions on the advice they gave me. 

This is where my personal mission came into play.  In these moments, I kept asking myself what was important in life. What had I determined was important for living well?  How would I honor God in how I lived my life and made choices about this cancer journey?  How would I set an example for my children and other men I came in contact with?  My personal mission served as a foundation for the choices I would have to make.

The first choice was to accept that I had prostate cancer and would have to do something about it.  At 53, there are not a lot of options.  Older men have more options related to prostate cancer, but younger men have to be intentional in seeking consultation that will help them win over this disease; to find a cure.  If one is in their 70s, wait and see can be an option; but at 53 waiting is not in one’s favor.  So the first choice was, “Who should I listen to?”

I had a plethora (dozens actually) of people ‘telling’ me how to proceed.  Everyone had their own story, their own advice.  I had a number of people point me to experimental drugs, herbs, new techniques, and a host of other ways to deal with prostate cancer.  But, each man has to deal with this journey how they view as the right path.  After a lot of reading, I intentionally chose a well respected surgeon (plus a dear friend put me in touch with him).  This was and has been a key for me.

As I close today, my mission guided me to choose a good doctor.  In today’s health environment, YOU are responsible for your own health care.  The Ad Council has a good commercial.  A person is asking all kinds of questions of a waiter about what is in a particular menu item at a restaurant before they order it.  But in the next scene, they are sitting on a table in a doctor’s office.  The doctor says, “Do you have any questions?” To which the patient says—“no.”  We would rather know how many calories are in a plate of food than what is happening in our bodies!  Men, in particular, are more likely not to ask questions. 

Thus the desire to live well allowed me to make a good choice—I have things that I believe I am to do in this world; a table of opportunity set before me.  So I chose a good doctor and took control of my health care at that moment.  I had some depression along the way as well, yet my personal mission, faith, and life of prayer helped me work through these moments of ‘soul sigh.’ 

A personal mission and future hopes guided me in this initial endeavor.  It can guide you, too.

Blessings, grace and peace.

David Neidert

January 29, 2010

You have the Tools: Now Write a Mission Statement

“Live in such a way that when you die the preacher doesn’t have to lie.”  That statement on a student tee-shirt has always been humorous to me and captures what I believe about personal mission.  It is unfortunate that people spend a lifetime working on “something” thinking that “someday I will do what I am supposed to do in life.”  Problem is it becomes like St. Augustine observed, “By and by never comes.”  Often we wait, but for what?  What are we waiting for to live out that we cannot start to live at this moment?  I love the comment by Tony Campolo, “When we get to the end of life, we ought to be about all used up!”

If you are following my blog, you are at the point of trying to write a personal mission statement.  Take the legacies you want to leave behind, the values you believe identify you, and write a sentence that will help you set before you those areas of life that are important.  Whatever you write at this moment does not have to be polished because it is a first attempt at writing a mission statement.  Mission statements are not at first an exact science, but a fleshing out of your thoughts, dreams, and what you believe about yourself and your future.

After you write out your personal mission statement, test it by asking, “Can I really affect my world and the people in it by living out my mission?” If your answer is yes, then how will you do this?  If no, how must your mission read in order to keep you actively working toward its fulfillment?

Your personal mission statement will guide you and give you focus related to your preferred future and legacy.  The statement you write should be challenging to you and something that you are passionate about.  It does not need to be a statement exciting to others, but must extract your best abilities, passions, use of time, and daily actions.  When you read your mission, it should give you an ache to live well in what it commands from you every day.

Here is also a way to test your personal mission.  It comes from Laurie Beth Jones, international bestselling author of Jesus, CEO.  As a side, it is an honor to also have her as one who endorses my book, “Four Seasons of Leadership.”  Jones believes your mission statement should be a single sentence (in standard English this is about 7-10 words); simple enough for a 12-year old to understand and recite, and; you should personally be able to recite it from memory at “gun point.”   Jones received criticism for this last element, but she is right….sometimes we have to make split second decisions that require us to know exactly who we are and what we will stand or not stand for.  Life sometimes forces us into its corner where we have to decide that quickly.

I originally wrote my own personal mission statement in 1989.  It was a few sentences.  It did not fit Jones’ criteria above.  So I worked on it over time.  I honed it over a few years until it now reads, “inviting people to abundant life by choosing God’s best.”

Now it is funny, but I actually have people say to me occasionally, “What is your mission statement?”  Some know I teach leadership courses and this concept; some just hear about this activity I believe deeply in.  These are my “gun point” moments.  And so I recite it to them from memory.  It is my agreement for how I will live in this world, both today but also in the days ahead.

In the end, here is the real point of having a personal mission statement.  The purpose is in not having a written statement to impress people, but to use it for goal setting, making decisions, determining what really matters in life, and “living your life in such a way that when you die, the preacher will not have to lie” but only recount what you did during the years you had on this planet.

I am convinced that if you ponder your life, figure out a personal mission, and set it into writing you will live well daily and you will influence those around you both now and into the next generation.  In the end, having a personal mission will influence the quality of your relationships, career, community service, and how you make potentially critical decisions should they come your way.

There is freedom in knowing your life’s purpose and in living your personal mission.  The Apostle Paul writing in the First Century challenged “Be not conformed to this world, but be transformed by the renewing of your minds” (Romans 12:1-2).  We can be transformed and live well—fully living what we were created to be IF we work out our personal mission.  It is a task worth agonizing over.  It is a choice that will lead to a life lived well.

Blessings, grace and peace.

David Neidert

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