Early maturity

Issues with health

The first part of January, 1998 Jane became very ill.  She had trouble breathing.  We took her to the emergency room at Medical City and her blood oxygen saturation was very low.  Her chest x-ray looked terrible.  The young doctor who was on call mentioned the possibility of her having pulmonary hypertension.  She was admitted to the hospital and we were scared.  I thought Jane might die!  I spent much time in prayer over the next few days.  After being on antibiotics and undergoing many tests, she was put on steroids and improved quickly.

She left the hospital after a few days and gradually improved.  After she had been home for a week or so, she began having breathing trouble again and was readmitted to the hospital.  A pulmonary specialist saw her in consultation but we were not given a firm diagnosis.  We learned several years later he had made the correct diagnosis; he just failed to inform us and did nothing about it!  Jane continued to complain to him and was ignored.

In the fall of 1997, Jane spent many days cleaning up after the carpenters.  In the remodel of the older house we bought, almost every ceiling and many walls were taken down.  There was a huge amount of dust and debris and she swept and bagged it for disposal.  We thought this was probably the cause of her lung problem.  She gradually improved over the next six months while she was on systemic steroids.  She was unable to sing, a great distress for both of us.  She had sung all of her life, and not being able to perform was bad.  If she tried to sing, it would make her bring up phlegm and cough.  She gave up any attempts to sing solos and left the church choir.

Problems at work

This was a chaotic time in our lives.  Jane’s health gradually improved.  Life at Prudential was changing every day.  We were under constant surveillance by our corporate office, as we were no longer a profitable unit.  Dr. Tony who was going to "help us" visited us frequently.  It became clear to me that he did not like my management style or me.  He was very upset when we did not implement every suggestion he made.  One suggestion was to contract with a new specialty in medicine called “hospitalists.”  I had read about them, but was unable to find any group in our market that would likely be a candidate for a contract.  There were a few individual doctors we identified, but no organized group.  The next time Tony came to town, I was called to task over this issue.  My boss, Dr. Alan Chernov, sent me an E-mail he had gotten from Tony indicating how displeased he was with me and questioned my ability to continue in a leading position.

Soon after this, we learned that Aetna had made a deal with Prudential to "join" with our healthcare unit.  This took the heat immediately away from me, but put it in another office.  I had meetings with the new bosses locally in the Dallas office.  I did not like the tone of the meetings.  It seemed to me that the only thing that mattered to Aetna was that we must be profitable at any cost and by any methods.

First retirement

In the early spring of 2001, I had a conversation with Dr. Chernov.  I asked him that I would be willing to “retire” if I could get a “package” as several of my Prudential associates had received.  He said he would see what he could do.  I soon learned that I would receive a “package” that would give me six months pay, but no health insurance in retirement.  I had fully vested in the pension and 401k plans, but needed 10 years of active service to be eligible to receive the health benefits in retirement.  I took the package as offered, as I did not think I could tolerate the job for another two years.  I left my job in May 2001 and began my “retirement.”

I then began trying to figure out what I would do.  I played golf, but my ankle and knee pain had become so bad I did not enjoy the few days after playing.  I spent time reading and on the computer, but that soon became tiresome.  I developed a reminder system for the myriad of people who serve in volunteer positions at my church to help them remember when they were to serve as ushers, greeters, communion preparers, choir members, worship team members, etc.  They kept me busy for a few hours a week.

I decided to go to our place in Cloudcroft and see what need to be done there.  Jane was busy with activates, and did not feel able to go for an extended time.  The main barrier was the health of her mother, who was in a nursing home with advanced Alzheimer’s.

I spent about two months in Cloudcroft alone.  I read many books and was bored silly.  Jane finally was able to come for a short while later in the summer.  This was when we learned she was having trouble tolerating the altitude.  Our cabin was at 8400 feet.  She felt badly and was having trouble sleeping at night.  After a couple of weeks, we decided to return to Dallas.

Part-time job

While I was in Cloudcroft, a former colleague at Prudential called me to ask if I wanted to have a part time job as a medical director for PacifiCare.  I could do it from home or wherever, using the phone and computer.  This sounded good to me and it provided me something to do.  He was the medical director in their San Antonio office and was swamped with work.  He asked me to help with appeals.  It was what I had been doing for several years and worked OK for me.  After I returned to Dallas, they wanted me to come and work out of their office.  I did not think it would be a long time arrangement, but it worked for me.  I did not think PacifiCare would be a survivor in the Texas managed care market.  They were a California company and having trouble trying to manage Texas like they did in California.

Managed care in Texas was very different.  Most companies depended on contracting with large groups and clinics.  The model in Texas was individual practitioners and a few small groups.  It varied from city to city.  There were more groups in Houston than in the other big cities.

Jane's health

Jane’s health continued to be fragile, and she was not getting any care from her pulmonary doctor.  We began to look for another doctor.

I took her to see my long time friend Dr. Bill Sellars.  Bill had practiced allergy and immunology for many years.  After spending considerable time with her, he thought she had hypersensitivity pneumonitis.  We retrieved records from her hospitalization at Medical City.  To our great surprise, the pulmonary doctor had entertained this diagnosis, but did not inform us or make any attempt to find out the cause or causes.

She saw my internist, who was also our next-door neighbor.  He referred her to a pulmonary doctor who recommended a lung biopsy.  After considerable time, the diagnosis of pulmonary hypersensitivity was confirmed.  We learned through our pathologist friend that the Mayo Clinic pathology department had been consulted and made the diagnosis.  She was then referred to a young pulmonary specialist at the medical school.  He was not long out of training, and was the only doctor who specialized in occupational pulmonary disease in our area.  Hypersensitivity pneumonitis is not common in our area, or at least not diagnosed very often.  It is also called “farmer’s lung” and is thought to be caused by mold.

A survey of our house was recommended.  The doctor told us that most of the time, the offending agent or agents were found in your home.  After the survey, the only findings were the fact that a lot of organic pesticides had been used.  They brought several spent cans from under our house.  They found a leak in a return air duct under the house.

We had a major upgrade of our air conditioning equipment in an effort to make the air cleaner and free of chemicals.  We stopped having our house treated for insects.  As we thought more about it, we remembered that during our time in El Paso, we had our house treated once a month in an effort to control bugs, mostly scorpions.  We were convinced that pesticides were the offending agent. Pyrethrins were commonly used and others had similar problems.  We learned that some states had outlawed the use of pyrethrins.

Dr. G put Jane on Biaxin for its anti-inflammatory properties.  She also was to use Mucomist orally twice a day to help loosen secretions.  She seemed to gradually improve.  Her pulmonary function tests indicated she had lost about 20% of her lung function.  She was followed by CT scans of her lungs ever six months.  Her problem seemed to stabilize.

My health problems

As Jane’s illness seemed to get better, I learned that I had prostate cancer.  This was in the fall of 2001.  I had been seeing an urologist for many years.  The first PSA test I ever had was abnormal.  In the early days of the PSA test, any value less than 4 was thought to be within a normal range.  As I researched it, normal values were established by testing men and women of similar ages.  As women have no prostate gland, their values should always be 0.  I saw my urologist for a regular checkup, and my PSA had jumped since the previous test.  He said my prostate gland was normal size and he could feel no nodules.  He told me not to worry about it and that I would “never need prostate surgery.”

I sought a second opinion that led to needle biopsies that found cancer in several of the core biopsy specimens.  My doctor recommended I have brachytherapy or “seed implants.”  He said it was “easier on the body.”

I began to search the Internet for answers.  Prostate cancer is very common and very confusing, as there are so may approaches to treatment.  Watchful waiting was one option.  Most men do not die of prostate cancer, but of some other lethal illness.  As I was 64 years old when the diagnosis was made, I thought I was not a candidate for watchful waiting.  As a cancer surgeon, I knew you could not make good decisions on the basis of needle biopsies.  My friend who is a clinical pathologist confirmed this.  He told me that reading needle biopsies was an art more than a science.  I elected to have my prostate removed so the cancer could be adequately staged.  My pre-operative workup, which included CAT scans and bone scans, was negative for advanced disease.  My choice for surgery was made on the basis that if radiation treatment failed, there was little chance of salvage surgery or other treatment that was successful. 

Last edited April 27, 2017

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