The COVID-19 pandemic is the greatest health related disaster of the last century. This worldwide phenomenon has lifted our consciousness. We are all now acutely aware of the importance of maintaining good health. Fortunately, “ living per minute,” has been my mantra for the last three decades. For this reason, I publish my blogs to provide knowledge to enhance health and wellness for all my readers.
Try living life per minute
My father and five siblings were afflicted with cancer. This experience led to a life changing decision – I began to live with the mindset of living life by the minute. Every moment must be lived to the fullest. I lost three of my family members to cancer; that is, my father to prostate cancer, my brother to pancreatic cancer and my sister to breast cancer. The experience was heart-wrenching and devastating for my family. I experienced the pain, suffering and death associated with cancer in real-time, as I watched my loved ones succumb to this plague. Unfortunately, three of my living siblings were also attacked and fighting prostate, kidney, uterus and breast cancers. Though I am positive, I have been concerned since their diagnosis.
Family traits and disease patterns are manifested from generation to generation. We all need to be proactive in addressing the impact of this reality.
I have been totally paranoid about the possibility that I will be afflicted by prostate cancer. My previous article entitled, “Mek We Talk Bout Prostate: Men’s Health” highlights that I was delivered to parents over the ages of forty (mother) and fifty (father) who were afflicted by diabetes, heart disease, hypertension and prostate diseases. As my family aged, a number of my siblings were afflicted with ill health, this caused a surge in my paranoia to new levels, as I questioned my own morbidity and mortality.
Living to die is one of those sure realities that we all will have to contemplate. The last three months have been humbling and scary for me as my siblings discovered that prostate diseases were their new reality. Faced with this type of information, we all search for answers to the unknown and we all hope for the best. It is a time when we read every and anything we can to help with our self-diagnosis. Yes, it is a time when we engage with multiple medical practitioners and even ‘bush doctors’ to prescribe ‘something’ to protect and sustain us. As males, our lifestyle practices determine our health and wellness, and the stigma associated with prostate cancer further influences our ill health.
Prostate Stigma
Machirori et al, 2017, argue that cultural, societal, personal beliefs and structural factors prevent black men from taking part in prostate cancer-related health practices. Black men are disproportionally impacted by prostate cancer more than other ethnic groups. The highest incidence of prostate cancer occurs in Africa and the Caribbean. Cancer.org highlighted the following about prostate cancer:
one (1) man in eight (8) will be diagnosed with prostate cancer during his lifetime;
six (6) cases in ten (10) are diagnosed in men who are sixty-five (65) or older, and it is rare in men under forty (40);
the average age of men at diagnosis is about sixty-six (66) and
one (1) man in 41 will die of prostate cancer.
The most prevalent type of cancer of Jamaica is prostate cancer. It is also responsible for the largest number of cancer deaths. Jamaica has the highest incidence of prostate cancer in the world – with an incidence rate of 304/100,000 per year in 1998. In 2020 World Cancer Research Fund International listed Jamaica as the fifth highest in the world in global prostate cancer mortality. The Caribbean has the highest mortality rate of prostate cancer worldwide (www.ncbi.nlm.nih.gov).
The standard requirement is that men should have an annual digital rectal examination and Prostate-Specific Antigen (PSA) test. Unfortunately, there is a lack of compliance in taking these tests by Jamaican men. There are anecdotal reasons why the incidence of prostate cancer is so high in Jamaica, including Jamaican men engaging in promiscuous lifestyles, being exposed to damaging chemicals in the bauxite regions, and the high consumption of alcohol, milk and red meat.
While stigma is not a cause of prostate diseases, it is one reason for black men not seeking treatment intervention to combat the impact of prostate diseases. Many black men do not get screened and to a greater extent diagnosed early for prostate cancer, because they are afraid of the prostate examination. It is clear that screening does not directly decrease mortality, it is the best way to ensure early detection of prostate cancer (www.ncbi.nlm.nih.gov). Early detection activities are common for persons like myself who are from a high-risk family with a first-degree relative (father and brothers) who have had prostate cancer.
It is often said that Jamaican men are homophobic, and they are especially fearful of doctors putting their fingers in their anus. The result is that many men have prostate diseases that are not being diagnosed and treated. The impact of prostate diseases related stigma on relationships is also major and significant. Men suffering from prostate diseases sometimes think of themselves as less attractive, they are belittled by both genders and they suffer from depression which leads to minimal communication with family and friends. Oncologynurseadisor.com highlights that men suffering from prostate diseases feel that they lack support from their physicians and the rest of the health team, they describe “prostate cancer as an emasculating journey."
The man I call Papa
Family Plague
My family’s journey with cancer has been scary, painful and even deadly. We are cursed with this ‘family plague – cancer’. This plague continues to lurk around waiting for an unpredictable time to possibly attack another member of the family. Like most people, my family’s healthcare needs and challenges have evolved with time and exposure. Our health challenges seem to be influenced by a lack of access to quality healthcare, our lifestyle practices and genetics. In our rural community, the lack of an accessible health system forced many residents to resort to self-treatment commonly referred to as “home remedies”. This seems to have legitimized the use of the ‘bush doctor and obeahman’ in treating health matters. In many rural communities, a cancer diagnosis is sometimes blamed on obeah. I recall a family member who was diagnosed with cancer of the throat, a tube was inserted in his throat, and he could not speak or eat from his mouth. The talk around the community was that, "sumbady obeah him because him chat tuh much.”
For years my Dad hid the fact that he suffered from prostate disease, only my mom knew that he had issues. She revealed to us that for over twenty years my dad displayed symptoms including the frequent urge to urinate, low urine stream and burning during urination. She revealed the first time he explained to her that it took over fifteen minutes to wait before the urine finally trickled out. Mom said they turned to the bush doctor for a remedy. She boiled soursop leaves and gave it to Dad, which helped somewhat. At the age of sixty-eight (68) my Dad had chronic ‘stoppage of water’, which resulted in no passing of urine, massive swelling of the bladder, and severe unbearable pain. Dad was rushed to the hospital and a catheter was inserted which provided temporary relief. The decision was taken to take him to Kingston to see a urologist. He was literally forced to go for further treatment. After testing, the doctor told him that he would have to do a biopsy, but he resisted, took the medications and went back home to the country.
This decision was a bad one, as the stoppage of water came back with a vengeance. The pain and discomfort were unbearable. He was taken back to Kingston where he allowed the biopsy and the results confirmed that he had stage two prostate cancer. The doctor proposed emergency surgery. Dad accepted and the doctor removed the areas of the prostate that had malignant cells. Unfortunately, eight years later, after this partial prostate removal, the stoppage of water came back as before. This was the darkest year of my life. My dad was rushed back to the operating theater to remove his prostate. My dad did not recover from this surgery. The surgery caused the cancer to aggressively spread through his body, and from there on he became weak, frail and fragile. this powerful man started withering away. I remember his brother passing away, in his weakened state the family gathered to tell him. My brother and I held his hands and walked him to the veranda where most of his children awaited him. While he sat there Dessie ( one of his sons) told him the sad news. This was heartbreaking for me as this was the first time I saw my dad cry.
In a couple of weeks, thereafter, the cancer metastasized into other parts of his body, including his bone marrow. His life was now like hell. His days and nights were now filled with horrendous pain; he lost weight precipitously from 215 pounds to about 130 pounds. I can see him now, like I saw him just last night, kneeing over a pail, coughing up blood for hours. I remember going into the darkness of his room to chat with him and his weak faint voice could only utter, “Don Don, pain pain pain.” His crying and moaning were endless dark chants. I heard him asking God to deliver him from the pain and misery he was experiencing. My own prayer asked that, “God’s will be done.” Then the time came when we knew he was about to leave us. His voice became faint, his crying became just moaning which became almost inaudible. One morning he woke up very weak and his eyes were glossy and he was rushed to the hospital. The doctor confirmed that his pulse was weak and asked that he be brought back home. On the way home, he seemed to pass out multiple times. Papa fought the good fight, he was determined to go home to see his family one more time from the comfort of his bed. He made it home that day and from his bed, he called out for “Claris”, his wife and my mom, his eyes lit up when he saw her. By this time, everyone was by his side. I was told he looked around at everyone and then squeezed my mom’s and brother’s hands, before he left us. He died in the praying arms of my mom. Sadly, I was not there to see him go.
I have three brothers who are presently dealing with the plague of prostate diseases. Recently, I went to Winchester Medical to conduct an Magnetic Resonance Imaging (MRI) of my prostate, the service provided by the radiographer and the administrative team was just amazing…prostate cancer series to be continued.
Dr. DF’s Prescriptions
The following are a number of prescriptions that you should implement to reduce the incidences of prostate cancer:
If you are from a family that has a history of cancer diseases; ask your doctor to provide a referral for you to conduct cancer genetic testing to identify the presence/absence and type of cancer at risk.
If you are over the age of 35, consult with your doctor about conducting an Executive Medical once per year. Always, ask your doctor to request all relevant tests you want to be done.
Compile a copy of ALL your medical files. It is in your best interest to compile an electronic “medical record footprint” to have at all times. Digitize this information so that it is very portable and can be shared with multiple doctors locally and abroad.
Be mindful of the environmental exposures that you select to live in (publichealth.uic.edu). Stay away from places where the land, built domain, food and water are contaminated with chemicals that could make you predisposed to prostate cancer.
From an early age develop a health and wellness plan that includes walking, running and weight lifting. This will ensure that your body burns away excess fat and other impurities in your body. Engage in dieting and food management; minimize or eliminate red meat, alcohol and sugar, they are known to be associated with increasing the risk of developing prostate cancer (healthline.com).
Your life is more important than the fear and stigma associated with doing a prostate examination. Identify a doctor that you are comfortable with as your general practitioner, and give him/her permission to holistically evaluate and care for your prostate.
Be proactive about assessing and treating the symptoms of prostate diseases. These include the frequent urge to urinate, getting up multiple times at night to urinate, blood in urine, pain and/or burning during urination and ejaculation, etc.
If symptomatic, secure a referral from your doctor to a consultant urologist. Ensure that the referral is occupied with all your medical history. This should include a graphical representation of your PSA results. If you are a black man be alarmed if your PSA level is about 2.
If your PSA increases dramatically and consistently over time, consult with your urologist about doing a transrectal ultrasound, MRI and biopsy. A biopsy is the main tool for diagnosing prostate cancer (cdc.gov).
If your prostate is enlarged and cancerous, and your doctor requires you to do prostate surgery. Discuss the different types of prostate surgeries and treatment methods, and their side effects (hopkinsmedicine.org/health). If you have completed your child-producing days; consider removing your prostate completely.
Conclusion
Men’s health is so important to ensure a better quality of life for all families. The tremendous stigma that is associated with prostate diagnosis and treatment, is driving the incidences of prostate cancer worldwide. The result is that 1 in every 41 men will die from prostate cancer. This reality has hit close to home for me. I know the trauma, pain and death that one can or may have experienced having dealt with my own family being plagued by prostate cancer.
Have a Holy Christmas and a Happy and Prosperous New Year When It Comes. Be Blessed and Be a Blessing to Someone!!!!!
We Only Live Once, Make Every Day Count…..Early Detection Save Lives!!!!!
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References
Glover FE, Jr et al (1998) The epidemiology of prostate cancer in Jamaica J Urol 159(6) 1984–6 discussion 6–7 DOI: 10.1016/S0022-5347(01)63220-8 PMID: 9598503 - https://pubmed.ncbi.nlm.nih.gov/19565947/