“I’m calling to close my account.”

It took some doing. After being transfered to a specialist in such matters, who tried to tempt me with such things as a six-month discount, a new TiVo box when they [...]]]> “Thank you for calling DirecTV, and thank you for being a loyal customer since 2004! How may I assist you today?”

“I’m calling to close my account.”

It took some doing. After being transfered to a specialist in such matters, who tried to tempt me with such things as a six-month discount, a new TiVo box when they become available, a free premium channel or two, and so on, they finally did disconnect the account.

When asked why, I was armed with:

• Their migrating all HD services away from my HR10-250 TiVo DirecTV receiver
• Their continuing inability to deliver a new TiVo model years after the first offered “release date”
• Being forced to pay for hundreds of channels when I only ever rarely watch half a dozen

Call me a TiVo fanboy if you like; I won’t dispute it. I’ve just never been entirely happy with the user experience of the DirecTV models and DirecTV’s insistence on lobotomizing the TiVo software to get rid of streaming and sharing features.

Nearly everything Jane and I watch (Jeopardy, Glee, The Mentalist, House, The Late Late Show with Craig Ferguson) is available free over the air. Our home is spittin’ distance from the transmitters on Mt. Wilson — I could get the signals with a paper clip stuck in the antenna port, but I have an antenna in the attic.

So my DirecTV bill of some $90/month would get me an occasional glimpse at the Daily Show, the Weather Channel, Conan on TBS, rarely CNN, and NASA-TV. DirecTV pulled ESPN and the local Fox sports channels from the HR10-250 in HD, so I never even bothered with the games there.

Three months ago I put a Roku box in my system, and we’ve been loving streaming from Netflix, Amazon, even Radio Paradise HD. (Current favorites in our queue: Dr. Who, Have Gun – Will Travel.)

Everything else we might want to watch (Entourage, Saving Grace, Big Love) is either available on disks or streaming. I’ve long since lost the need to see a show the night it’s broadcast.

Now in place of my DirecTV receivers, I have a pair of TiVo Premiere models. I put an XL model in the living room home theater and the standard model in the bedroom. I’ve had enough experience with TiVo to know that I should go ahead and buy the lifetime service subscriptions for both boxes. The total bill was roughly equivalent to 13 months of DirecTV.

I’m tickled with the new TiVos. I love how they work to download a rented (or purchased!) movie from Amazon. The RSS feed support is going to be fun — Jane’s What’s Up podcast will just appear in the Now Showing queue. I love being able to share recorded shows between the two boxes. (But not downloads, why TiVo?)

It’s also fun to see what the local broadcasters are doing to make use of their digital bandwidth. KTLA is using sub-channel 5.2 to market their library of classic TV using the moniker Antenna TV. It’s like having a free version of Nickelodeon on hand (Mad About You, Gidget).

Just before I wrote this, I did a Google search, “life without cable,” yielding 11,600,000 results. Interestingly, the first page of results all seemed to imply that giving up cable meant giving up network programming as well. Not one of them mentioned the bounty that was available in free over-the-air broadcasting.

I have every reason to believe that our deprivation will be barely noticed and short-lived, and I’m happy to do my part to disrupt the MVPD business model. Give me a la carte programming choices and I could change my mind.

And of course if Verizon were to install FiOS in my neighborhood ….

I felt fine, always did. I wasn’t running to the bathroom two or three times a night. My doctor never felt anything. I have no family history of prostate cancer. [...]]]> Here’s the deal: All along, this whole “prostate cancer” thing seemed to me like a gigantic fraud. Well not fraud, but maybe “surreal.” That all changed yesterday.

I felt fine, always did. I wasn’t running to the bathroom two or three times a night. My doctor never felt anything. I have no family history of prostate cancer. It was just a blood test, an imprecise secondary indicator, that suggested a biopsy.

Okay, I believed the biopsy, but still it all seemed abstract.

So I had the surgery. Sure, take it out. I don’t really need it. But I want to know.

This is why I picked surgery over radiation. The radiation therapy is known to be effective, but it’s still all abstract, not real.

Yesterday I went in to have my staples and catheter removed. (Yay!) (Anyone who is facing this procedure and wants to know more about it, I’m happy to share in a private exchange.) Meanwhile my nurse practitioner delivered the pathology report, and I asked her for a printed copy.

I’ll post all of the relevant parts below, followed by a few word interpretations.

Here is the pathology report:

Collected: 1/19/2010
Received: 1/20/2010
Signed Out: 1/21/2010

————————————————————————–

FINAL PATHOLOGIC DIAGNOSIS

PROSTATE, ROBOT-ASSISTED LAPAROSCOPIOC[sic] PROSTATECTOMY:

1. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 6 (3+3).
2. MAXIMUM TUMOR DIMENSION IS ESTIMATED AT 1 CM.
3. THE TUMOR INVOLVES THE GLAND IN A BILATERAL FASHION AND EXTENDS FROM THE APEX TO THE PROXIMAL PORTION OF THE GLAND.
4. VASCULAR INVASION IS NOT IDENTIFIED.
5. PERINEURAL INVASION IS NOT IDENTIFIED.
6. THE TUMOR IS CONFINED TO THE PROSTATE.
7. THE SEMINAL VESICALS ARE NOT INVOLVED BY TUMOR.
8. SURGICAL MARGINS OF RESECTION ARE FREE OF TUMOR.
9. HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA IS PRESENT.
10. THE NON-NEOPLASTIC PROSTATE SHOWS HYPERTROPHIC CHANGES.
11. TNM STAGE: II (PT2C NX MX).

Report Electronically Signed by
STEVEN R. MCLAREN D.O.
Date Signed out: 01/21/10

————————————————————————–

MICROSCOPIC DESCRIPTION
A microscopic examination is performed.

CLINICAL HISTORY

CLINICAL HISTORY (REQUIRED): Prostate Cancer

GROSS DESCRIPTION
The specimen consists of a radial prostatectomy specimen weighing 42 grams. The prostate itself measures 3 x 4.5 x 4 cm. Attached to the specimen is the left seminal fesicle, which measures 3 x 1.5 x 1.2 cm with the contiguous vas deferens measuring 0.7 cm in length and 0.3 cm in diameter. The right seminal vesicle measures 4 x 1.5 x 1 cm with the contiguous right vas deferens measuring 0.6 cm in length and 0.3 in cm in diameter.[sic] The outer surface of the specimen is inked and the gland is serially sectioned. Sectioning of the gland reveals nodular tan-gray cut surfaces.

CASSETTE SUMMARY:.
[Inventory of slices omitted]
[End of meaningful report]

Item 9 is interesting, “High Grade Prostatic Intraepithelial Neoplasia” is also referred to in the industry by its shorthand HGPIN.

I believe this is shorthand for a common cell formation detected under microscope. Neoplasia is literally “new growth.” And intraepithelial means “within the layer of cells that forms the surface or lining of an organ.” It’s an abnormal mass of cells that are known to sometimes morph into cancer.

Finding HGPIN, aside from the tumor, is significant in that it adds to the diagnosis, and provides another data point in the statistical link between HGPIN and a cancerous tumor. Nice for me is that it’s fully contained within the gland, “intraepithelial.”

Following on with item 10, non-neoplastic would then refer to everything that isn’t “new growth,” all the non-tumor parts of the prostate. Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It’s just evidence that my prostate was getting bigger. That’s what they do.

Item 11 is meaningful too, and puts the cancer into a statistical class. TNM is short for “Tumor, Node, Metastasis.” Stage II says the tumor has not spread outside the prostate. The overall stage is then followed by T, N, and M numbers. T2C means the tumor is found in both lobes. (I suspect the qualifier PT2C means this is a prostate cancer specific designation.) NX and MX mean the lymph node and metastasis stages could not be determined. That makes sense, since the lab is handling a disconnected prostate gland in vitro.

I’m sure that an industry professional might correct some of my interpretation to be more specific, but I think I have the gist of the report.

And I like what I see.

The short version is that I was diagnosed with a small but clinically significant prostate cancer in September, and will have [...]]]> With Jane’s encouragement, I thought I would write this blog entry. I want to keep my friends and family up to date, and for the most part they are the only ones reading this blog anyway.

The short version is that I was diagnosed with a small but clinically significant prostate cancer in September, and will have RP surgery (Radical Prostatectomy) using robotics on January 19. I’ll be at Kaiser’s West L.A. Medical Center for one night, then recovering at home for about three weeks. Within a few months, the expectation is that I’ll be pretty much back to normal for the duration.

For those of you who really want all the details, how this came about, and what decisions were involved, I’ll go into it all below. For lots of people this comes under the category of “too much information,” and you are certainly excused without prejudice.

It all started with a routine physical back in June. A blood test then revealed an elevated PSA (Prostate Specific Antigen) level. 3.5 is considered significant, and mine was 3.6. My previous test 18 months earlier was around 1.something.

One positive test is not a result, so my doctor ordered a retest, which had a count of 4.1. That called for a referral to the urologist.

The urologist meeting came in September. Prostate cancer is so slow-growing that one has the luxury of dealing with it deliberately. After reviewing my chart, he scheduled a biopsy, which we did the following week or so.

(In discussing the process with other men who’ve been through it, the biopsy seems to be the most unpleasant part. I called Jane after mine and said, “I need a drink.” We met at Traxx Union Station shortly after.)

The biopsy took fourteen “cores” (yes think of core samples) which were examined visually under a microscope. One sample was 30% cancer cells, and one was 10%.

Interestingly there are absolutely no symptoms at this stage of the cancer. I feel great, have no urinary troubles, and no other symptoms of any kind.

In this instance, I must recommend my experience with Kaiser Permanente. They take advantage of having a vast and closely-tied medical staff, combined with the best Electronic Medical Record system in the business. The efficiency and accuracy is very confidence inspiring.

The question after diagnosis becomes the choice of treatment. Interestingly, because prostate cancer grows so slowly, new treatment studies can’t know their effectiveness for 15-20 years. The accepted treatment these days is either RP (surgical removal of the prostate) or radiation treatment.

My urologist scheduled me for a type of seminar session in which Jane and I would meet with specialists from each of the different treatment options to discuss the matter. In one morning we discussed the options with surgeons and radiation oncologists.

(For men closer to 70 than 50, another possibility is “no treatment.” Prostate cancer is really slow growing. Indeed most men will have prostate cancer when they die, but it will be something else that killed them.)

Which treatment to pursue was really a no-brainer. Surgery and radiation treatment are about equally effective. The big advantage of the surgery is that they get to actually examine and analyze the cancer in vivo. They get to take it out and send it to a lab for analysis or  research. The surgeon can see without any doubt if it has spread beyond the prostate and if any follow-up treatment is required. All of those advantages disappear with the somewhat blind radiation treatment.

The modern robotic surgery technique is fascinating. The doctor sits in a corner watching high-def video and manipulating the tiny robotic instruments. I’ll spend one night in the hospital and head home the next day.

I get to spend ten days at home with a catheter, and another couple of weeks recuperating. They taught me an exercise regimen to restore tone to the pelvic floor muscle, so I’ll be doing those.

I decided to do one other bit of preparation before going in. I had already joined Weight Watchers, and have been sticking with it to drop another five pounds of weight or so. I also hired a personal trainer to try and be in decent physical shape. I managed to make progress in both areas over the past three months. These are not part of the official protocol for surgery prep, but to me they just made a lot of sense.

This Friday, Jane and I are going to celebrate our 10th wedding anniversary in Las Vegas at the Venetian. We’re going to have a splendid vacation weekend. I’ll turn 53 on my birthday on Monday, January 18, but won’t get to eat any solid food that day. It’s okay, we’ll celebrate plenty the day before.

A lot of men are going through this now, or will be in the future. Prostate cancer is the most common cancer, but not the most common killer. Don’t put off the routine physicals; this thing has no symptoms until it starts to become a serious problem.

At my stage of the game, I can treat it as an inconvenience. Throughout everything leading up to this, I’ve lost no sleep, had no serious worries. Bridge players learn to do the best they can with the cards they hold, and it doesn’t hurt to have a top-notch partner across the table from you.

Update: This lolcat went by today on ICanHasCheezburger:

Photos from our first three days with Jane’s family are here.

The cruise went non-stop from San Francisco to Ketchikan, which involved two days at sea. About 36 hours of the cruise were spent in [...]]]> Jane and I are in our first port of call on our first-ever vacation cruise. We’re in a coffee shop in Ketchikan, Alaska.

Photos from our first three days with Jane’s family are here.

The cruise went non-stop from San Francisco to Ketchikan, which involved two days at sea. About 36 hours of the cruise were spent in 15-foot swells, which made for quite a rolling shuddering ship and a lot of dramamine patches given out by the medical staff. Luckily Jane and I aren’t susceptible to motion sickness, and mostly just enjoyed being rocked to sleep in our stateroom.

I joined a bridge game for the first time since 2000, and dusted off a little of my bridge muscle memory. I played two games with a delightful 70-year-old lady from near Austin, TX.

Ketchikan is a scenic town, and I’ll have lots of pictures for Day 4 of the photo album. Right now there are at least four giant cruise ships berthed at the town, and the merchants are busy sucking every dime out of them they can manage.

Internet access is available on the ship. You can buy packages for as little as $0.35/minute if you buy $175 worth, or pay $0.75 per minute pay-as-you-go. I think I’ll be content to visit internet coffee houses on our shore stops.

Next stop is Juneau, AK, and hopefully new pictures from there.

Listen to the audio …

At 0:49 into the video, about 15 seconds into the launch, CAPCOM says “Bypass [...]]]> It’s been several weeks since NASA launched Atlantis to service the Hubble Space Telescope. Watching the launch, I heard several calls that made me sit up in my seat. You probably didn’t hear them. Watch it with me here:

Listen to the audio …

At 0:49 into the video, about 15 seconds into the launch, CAPCOM says “Bypass across the board Scooter, no action!”

Wow! I was just imagining what the flight controllers must have been seeing. This is what I heard in my mind as he said that, “Yes we see that you have multiple warning lights and alarms going off, but don’t do anything!” Holy crap!

Listen again at 1:20 into the video, “Atlantis, Houston, No action on the MPS H2 Out key.” In other words, “Yes, we see that additional warning, but don’t do anything about it.” Scooter called back, “Houston, we copy, no action.”

(I can’t believe at 3:20 in the video the public affairs guy (“Mission Control Houston”) says “No issues heading to orbit.”)

At 3:40 into the video, Houston calls up with some explanations for the earlier calls, “Atlantis, Houston, H2 out key is a ducer only, and the ASA-1 is a power only.”

“Copy ASA-1 is power only, and the H2 is ducer,” called back Scooter.

Later on in the post-launch press conference, we got to find out what was going on, and this article on nasaspaceflight.com had a lot more detail:

“A post launch review of the data showed that the failure seemed to have occurred two to four seconds prior to liftoff after main engine ignition and the resulting shake and bake. An EPD (Electrical Power Distribution) review of their BMU data of Main Bus A shows that Main A bus saw a 400 hz signal with a peak to peak of 100 amps. EPD is going to look at the Main B data next.

Wow! I had to wonder if that was a typo. 100 amps of current at 400 hz shorting into an avionics bus! No wonder several warnings and alarms went off.

Later the Flight Director had the commander turn off the power to ASA-1, which is one of four Aerosurface Servo Amplifiers on the orbiter. These are critical components that actually power the rudder and elevons during aerodynamic operations (flying in the atmosphere). With three remaining, they could continue the mission, but another failure would call for an immediate de-orbit.

The other interesting call was related to a transducer (“Ducer” in NASA-speak) that monitors the pressure of the hydrogen being fed to the main shuttle engines. That’s the “H2 out key.” If that warning lights, it could mean that one of the three engines is suddenly not getting enough fuel pressure.

So why did the controllers call “No action!”?

I can almost feel the heart pounding of a “steely-eyed missle man” monitoring all of the systems. One warning by itself is not a drastic call to action. They could see that all of the other systems were functioning correctly, and most importantly, the flight dynamics and performance of the craft as a whole were safe and correct. Doing something could have been a bigger disaster than doing nothing.

The H2 out key warning was a simple call. The controller can see immediately that all three engines are still producing their normal thrust. In the press conference someone pointed out that if there were a real problem, Scooter would have felt it in the seat of his pants, big time. The problem there wasn’t with the H2 pressure, it was with the transducer. “H2 out key is a ducer only.”

But that ASA-1 problem is still a concern, and even today, while Atlantis is in California being mated to a 747 for ferry operations back to Kennedy, technicians are crawling through the orbiter trying  to diagnose the problem. They suggest that a power wire shorted to ground, which fed all that current directly into the bus ground. That would make a lot of systems go a bit funny.

Hats off to the guys behind the screens in Houston. I know hardly anyone shared in those few moments of heart-pounding pressure, but a few of us heard what you were dealing with. Because of your heads-up attention, we can today look back and call it a nearly flawless mission.

If nothing else, for me it was an interesting foreshadow to a mission that would be as dramatic in its problems and solutions as any I’ve seen.

[Edit: The video I was linked to was made private by the uploader, so I found another copy and updated the time notes in the post.]

This past week, my wife and I spent four nights in a deluxe room at Caesar’s Palace in Las Vegas. I was attending TheServerSide Java Symposium, and she went along for three days of pampering and relaxing.

Caesar’s is a fine place, a grand old warhorse of the Vegas strip. [...]]]>

Registration lobby at Caesar's Palace Las Vegas

This past week, my wife and I spent four nights in a deluxe room at Caesar’s Palace in Las Vegas. I was attending TheServerSide Java Symposium, and she went along for three days of pampering and relaxing.

Caesar’s is a fine place, a grand old warhorse of the Vegas strip. It’s probably known good times on its own, but is now part of the Harrah’s conglomerate of gaming properties.

While the building seems tired, it’s clear that it has seen much refreshing and remodeling over the years.The gaming and shopping areas are opulent and clean, with very attractive eye-candy sight lines throughout the property. In the rooms, the marble bathrooms are luxurious, and the suite appointments are in good condition.

(It amazes me that they fill the suites with flat widescreen TVs, but can’t manage to feed them with any high-definition content. The delivered video quality is really bad. The same is true for the giant standard-def projectors in the sports book.)

So why do I feel uncomfortable at Caesar’s Palace?

Everywhere you go throughout the property, there are subtle signs that “we don’t want you here.  You’re not good enough.”

Start with the key-locked gilded private elevator in my elevator bank in the Augustus tower. In the casino, everywhere you look are private exclusive gaming areas where you aren’t welcome. There are the empty lines for “Platinum” casino guests only, closed doors marked “7-star Registration,” a gold rope around the sports book seating for “VIP reserved” customers only. My wife drove back to the hotel on Friday to find the valet parking limited to “Platinum and 7-star guests” only.

Sure every big Las Vegas casino has its exclusive services for the whales, and private luxury gaming areas and apartments. Certainly you want to encourage people to play more, and perhaps tease them with the promise of forbidden pleasures.

But nowhere else on the strip have I been to a place where the number of closed doors seemed so plentiful or so obvious. Not at Harrah’s other properties, including the Rio, and Harrah’s Las Vegas. (Harrah’s casino is really a festival of the everyman.) The subtle hidden message is that Caesar’s is mostly for the whales. We might let you walk through our halls and play at our slots, but we really don’t want you here.

Okay Caesar’s, I get the message!

P.S. This should not reflect at all on the fine employees at Caesar’s who made our stay very pleasant. Nor on the top-notch convention facilities and services provided for TheServerSide. Indeed Jane and I left a few personal items behind in our room, and I’m certainly grateful for the time taken by their staff to bundle up the package and forward them. I think the subtext I write about above is built into the very bones of the place. It’s just how it is. — Mojo