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The Balancing Act® E-Newsletter: October 2005 Special Edition

This special edition is about a medical problem. It has a happy ending, but it can be somewhat disturbing, especially if you or loved ones have experienced serious illness. You may wish to delete this article and not read it, which is why I've made it a special edition.

I don't normally divulge many aspects of my personal life, but many of you have confided in me some serious challenges you are facing. I thought sharing this might be of help. I've included a humorous edge, not because I treat the topic lightly, but because I don't face life on any day, good or bad, without a strong barrage of humor.

Having made those disclaimers, I advise you to read on if you so choose. --Alan Weiss


It all started when I decided to grow beets. Every year I turn out a pretty respectable small garden near the pond: white radishes, string beans, broccoli, snow peas, and the like. Beets looked easy, and I managed a bumper crop.

My wife, who is a world-class cook, does not cook except on occasions so special that one would have to consult a Mayan calendar to find the propitious dates. One such date emerged on July 1 with Neptune rising, and she had to consult dusty cookbooks to determine just what one does with beets.

And so it came to pass that not long thereafter I consumed a truly vast quantity of saut�ed beets.

The next day, my urine turned red. "It's just the beets," theorized my wife who, through generations of soap operas, has diagnosed most of the major illnesses (once having accurately identified myacenia gravis well before the actor who played the doctor on TV).

"I guess so," I said dubiously, since I had consumed beets in my past without this result, and males are taught that blood in the urine is a very serious thing. Thus, when it was still red after 48 hours, I figured I'd make a precautionary appointment with my primary care physician, someone who makes Ebenezer Scrooge, prior to Christmas past, seem optimistic. I will call him Dr. S.

Dr. S asked me some questions and promptly told me that beets cannot change the color of urine. He went on to say that he wanted me to immediately have a colonoscopy, endoscopy, and cystoscopy, which pretty much covers the waterfront, or so I thought at the time.

He wrote scrip so fast that my head spun and then he told me, "Although there are other causes, the most common cause of blood in male urine is bladder cancer. Fortunately, it is a slow growing cancer."

I walked in a trance to the car where my wife was waiting (the last time she would not be at my side through every discussion and procedure) and I broke the news. We drove home stunned. I actually looked up bladder cancer on the Internet and found that one type has an 80% survival rate and another type only 5%. It's also one of the most recurring of all cancers.

Funny thoughts began. I cancelled a dental appointment for cleaning which suddenly seemed irrelevant. I wondered if I should stop flossing.

Why bother now? Every formerly minor bump, bruise, discoloration, ache, and pain suddenly caused questions. Were people looking at me differently?

I made an appointment with the gastroenterologist, Dr. A, whom I have known for almost 20 years.

When we visited Dr. A, who would be responsible for the colonoscopy and endoscopy, he was not prone to do anything, yet. "You are slightly anemic," he pointed out, "but we knew that last October at your annual physical. Let's see what the urologist has to say."

The urologist, Dr. C, would be doing the cystoscopy. He is a calm, totally likeable guy, and he did his usual workup when we met for the first time. After the history, blood pressure, review of records, and so on, he said, "All right, first thing you should know: There is a variety of ways to turn the urine different colors, including consuming various foods, such as beets."

My wife and I were speechless for three seconds, then began laughing uncontrollably. When I relayed Dr. S's assurance that beets cannot change urine color, Dr. C remarked, "Well, he must have missed that day in medical school. I don't think a cystoscopy is called for unless you absolutely demand it. If you see any more change of color, capture it and bring it to me. But there is no blood in your urine at this time, so I'm just going to tell you to have a good day." (That was a tad late, since I already had had my third digital prostate examination within one week by three different doctors.)

Dr. S, duly chastised, apologized to me but insisted that at this point the cause of the anemia had to be found and that the probability of a tumor in the internal organs or intestinal track was high. He called for more blood tests and then a cat scan, and asked me to call for the results in a few days. He told me it was likely that a tumor was either causing bleeding or directly causing the anemia.

I called him from the beach the next week and he said, "Alan, you'd better come in, there's something there." I turned to my wife and said, "I'm glad it's a good day at the beach." Once again, my wife and I steeled our nerves and went to see him. "There is no mass," he said, "but I'd like to do another cat scan with dye. We've ruled out kidney stones, but not everything."

"You said there was something there," I reminded him. "Yes," he said, "the anemia is still there and tumors often create anemia." I wanted to strangle him.

The second cat scan, with dye, was also negative. Now Dr. S demanded the colonoscopy and Dr. A complied. However, we were scheduled to vacation in Cape May. Dr. S said sooner was better than later. Dr. A said go on vacation and drink plenty of tequila. So, for several days, I abandoned my usual martinis to follow doctor's orders on the beach in southern New Jersey.

When we returned, Dr. A explained that he would remove anything minor he found during the procedure, but if he saw what looked like a cancerous tumor, he might recommend I be immediately admitted to the hospital, since I was already "prepped." He discussed the difference between regular surgery and laparoscopic surgery, and even recommended a surgeon whose schedule he had checked.

But we were scheduled to vacation in Nantucket the next week. I told my wife that, unless my life was in imminent danger, she was not to consent to my being admitted (I'd be sedated). We would go on vacation, and then I'd have the surgery. When she agreed, I agreed to the procedure. Colonoscopies (I'd had one several years ago) have an uncomfortable preparatory sequence, but the drugs they administer are wonderful. I've solved the mysteries of the universe under those drugs but, unfortunately, forget them upon awakening.

The colonoscopy was clean, the hospital provided toast and coffee, and we left. Slightly thereafter, Dr. S demanded an endoscopy, which does for the upper tract what the colonoscopy does for the lower. Dr. A performed this a week later, and it, too, was clean. As a precaution, a chest X-ray was ordered, and it was also clean. Another blood test showed that my anemia had marginally improved. Undeterred, Dr. S now wanted a barium X-ray of the upper tract "because it's hard to see." I asked if tumors were common there. "No," he said, "but they are not unknown either."

Now, about two entire months after the 48 hours of beet-urine, I spend most of a morning submitting to barium X-rays, again as an outpatient. These, too, were negative. Dr. S, still somber upon getting the results the next week, told me, "Well, these tests aren't perfect, there could still be something there."

At this point I had ascertained that I was not bleeding internally according to every single test; no masses were detected anywhere; my energy level had not diminished and, in fact, I was shockingly healthy. Dr. S told me there was one more test, administered only at the largest hospital in the area. It consisted of swallowing a pellet which contained a camera. The camera recorded its trip through my entire system. The device had to be "captured" at the end of its journey, so that the images could be developed.

"And what might this find?" I asked. Dr. S told me there are tiny growths that can occur in the blood stream (I forget the term but he likened them to "hairballs") which can cause bleeding. The camera could detect them.

"Are they fatal?" I asked. "No," he said, "in fact, they rarely cause serious problems, but if we find them at least we'll know what's causing the anemia."

"Is my present level of anemia debilitating or putting my health at risk?"


"If you find these hairballs, how would you treat them?"

"The only course of action that we think has an effect is hormone therapy."

"So, let me summarize: You want to pass a camera through my system, to find hairballs that may not be there, to perhaps not treat them if they are there, or to use a treatment that would be worse than the disease?"

"Well, yes."

"What's the alternative?"

"Watchful waiting. I could live with that."

"Then that's what we are going to do. And by the way, I assume you don't need to see me in October for my annual physical, right?"

"No, we both have better things to do. Here's a prescription for some iron pills. Let's see if they help."

Thus, over two months after eating beets (without which I never would have gone through all this), and after a colonoscopy, endoscopy, two cat-scans, a chest X-ray, a barium X-ray series, three prostate exams, and a urologist's examination, I'm back to a life without hospital visits. Here is what I've learned:

  1. My health care was excellent. I had few waits, all health care professionals were extremely cordial, there was no pain, and I was dealt with honestly. My insurance, which costs $1,200 per month, paid for everything. I never even incurred a co-pay. I felt confident and comfortable in the hands of the doctors, nurses, and technicians. This is truly a great country.
  2. You live your life to the fullest extent. I wasn't about to sacrifice vacations, nor did I take "time off" from my normal working hours, brief as they may be. During this time, a woman in my Mentor Program told me her doctor had found something that could be quite serious. She asked if she should, ethically, stop accepting business. I told her that she could get hit by a beer truck crossing the street tomorrow, but that eventuality should not prohibit her from accepting business. You go forward until an actual obstacle might demand a detour. (She later thanked me for the advice, since her condition turned out to be benign.)
  3. You need a support system. My wife was there for me at all times. We told no one else, because we believed that no one else should be worried about what remained only a potentiality. (If my kids are reading this, it's the first time they've heard of the entire episode.) We went to the beach several times on day trips, took two major vacations, went to the movies, and dined out every night (there was now an excuse not to cook even on rare occasions). I could not have remained so calm and so controlled without her.
  4. Some of you are already thinking the obvious: He had the means. It's different if you don't have the means, and that's absolutely true. But that's why I advise all of you to help yourself first, because then you can help others. I've made a major contribution to the hospital's annual fund campaign, which I'm requesting be used for indigent patients.
Not everyone is as fortunate as I've been. Perhaps this really wasn't a close call but just a strange anemia that I've developed. The experience forced me to take stock, to be thankful that I have enjoyed life so much, and to resolve to enjoy it still more, and contribute still more, in the future.

I'm happy that I've chosen to live in the fast lane, signaling my turns, but seldom using the brakes.

And next year, I'm planting corn.