What about future Toronto

March 28th, 2014

Rob Ford is spouting a new soundbite, “saved a billion dollars”.  Anyone who bothers to look at the numbers will quickly see that isn’t true, and even if it was true he’s selling Toronto’s future short.  I could tell Torontonians, “Elect me and you will not pay another cent of tax!”  and then watch as the city crumbles. “Sorry the Gardener is gravy”. ” Sorry community housing is gravy”. “Sorry transit is gravy”. Which is essentially what Ford is doing.

It works because the suburbanites don’t think of Toronto as their home even though they commute in every day.  The asphalt in their neighbourhood isn’t crumbing because their development is only 10 years old, where as the neighbourhood in Toronto is 110.  So it is easy to say “why should I pay?”

I could easily say the same thing.  Sell off the TTC, make all the highways toll based.  Charge people more money for Go train and let them pay for the renovations at Union station.  I don’t use it, why should I pay?

The answer is simple, because like it or not, you are part of this city.  It behooves you to elect a leader with vision.  Toronto needs to stop thinking about the next 4 years and begin thinking about the next 40.  We need a leader who can think about how can we connect different parts of the city easily and efficiently. How we can improve the lives of everyone in the city.

This election shouldn’t be about saving money, it should be about saving Toronto.  The future Toronto, the Toronto that could be.  If Rob Ford gets elected, that future will die…

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PC Plus gets email marketing right

March 7th, 2014

I have written about effective email marketing and what I would do if I was in charge of an organization’s email campaigns.  A bad email can hurt the customer experience,while a good email can totally make it.

I have started receiving a great example of a group that does it very well,  President’s choice.  I shop there several times a month and they email me offers every week.

PCplus

 

What makes this email so effect is

  1. It is tailored to me.  They know what I purchase on a regular basis and so they market to me!
    As Seth Godin once said, “I don’t want email, I want me-mail!”  In this case they are using my own purchasing habits to get me to come back to the store.  They know I have a cat, so they offer me cat litter.  They know I always buy bananas so they offer me bananas.  They know I occasionally buy cookies, so they offer me cookies.
  2. They are testing products I have not purchased before.  The “Bonus Offer” might just be a mass effort or it might be actual individualized testing, either way it is an effective test.  Personally I will not buy canned soup.  It doesn’t interest me.  However they will be able to judge how many of their customers are interested or whether or not to make me the same offer.
  3. I have to do something.  I have to load the offers to my card.  Yes, it is just a click, however it is still engagement and measurable.  By loading the card they can measure how many of their email work, otherwise what are they going to measure if they automatically loaded my card?  I am not going to click through to see the product page on zucchini.

 

 

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The luckiest unlucky man

February 28th, 2014

Mark tells me, “Control is an illusion.  The best you can do is improve your odds.

Odds…

I am a lucky, unlucky man.

I was diagnosed with prostate cancer two days ago.  That would be bad luck.

However, I would not even know about it if it weren’t for some incredibly good luck.  My husband bought me a watch freeing up the money I was saving to buy myself the watch for something else.  I decided that I wanted a comprehensive physical to get a baseline.  The accident last year made me much more aware of my health and I decided it was a good idea to get a baseline. As part of that physical I received a PSA test.   That PSA test showed a potential issue which was then confirmed with a second PSA test.  This in turn lead to a biopsy which lead to the diagnosis.

Where the luck comes in is the government doesn’t want doctors to test anyone under 50 with the PSA test (let alone do a biopsy).  Which means I would not have been tested for another 10 years. In 10 years who knows where that cancer could go? Metastasized into the bone, spread to the lymph nodes, who knows. I was lucky enough to have a urologist who as he puts it, “casts a wide net to catch them while their still minnows”.

On the other-hand, it might have done nothing.  Prostate cancer is funny that way.  So now I am on active surveillance and beginning to change my lifestyle.  I might not be in control, but goddammit I am going to improve my odds.

 

 

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Biopsy

February 12th, 2014

I had my biopsy today.  It took all about 15 minutes.  I arrived at the clinic and handed the receptionist my health card.  She took it and then wrote down some information and then asked me to have a seat.  I look at the other man in the room.  ”Did I look as grim-faced as this guy?” I thought to myself.  ”Yes,” I realized, “I am just as morose.”

It’s not like there is any laughing in a normal Doctor’s office, but when you’re looking at twelve little jars that are about to hold 12 cores from your prostate isn’t exactly joyous.  One man was ahead of me and then the technician, I learned his name was Michael, asked me to come in.  He showed me into a little closet and told me to undress and put in one of the paper robes stacked on the shelf.

I complied and then used the washroom before entering the exam room.  Michael asked me to lie on my back and he then lifted up my robe and scanned my abdomen.  This made me question I have the silly paper robe in the first place.  I had done one of these before at Medcan so it was no big deal.  He then told me to roll on my side.  With a deep breath he inserted the scanner in my rectum.  It was smaller than the one used at Medcan so it went in easier but he was more aggressive in moving it around.  Once he’d taken some images of my prostate, Dr. Singal came in.  After greeting each other he said he was going to give me a local.  I must have visibly changed on the table because he noted my relief by reiterating how he doesn’t normally do this.

The wand went back into my rectum and it was followed by two needle pricks.  One on the right side, and one, much harder to reach  on the left.  In fact I could feel the poor doctor maneuvering the wand with one hand and try to spread my ass cheeks wider with the other so he could get it to the proper angle.  After a minute, when the freezing took effect we began.

“I will count down the first ones so you know it is coming.  Three…two…one…” Snap, went the needle gun followed by a dull pain.  ”That wasn’t so bad was it? The freezing worked?”  I sounded my consent.  Snap, Snap, Snap the subsequent cores were collected in short order.  Most were painless, only one or two caused any sort of pain.

I did hear him mention something about blood after the first core but it wasn’t until afterwards when he pulled out the wand and told me to hold a tissue against my ass that I got it.  ”Michael thought he saw an area on the ultrasound that looked suspicious, and your prostate is larger than it was.” Dr. Singal informed me, “We may have results for you as early as next Friday.”

So this chapter in my prostate saga is done.  Now we wait for the results…and hope.

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I should stay off the internet

February 9th, 2014

I know for a fact that all medical professionals lie.

Ever heard a nurse or doctor say, “this won’t hurt a bit” or “you might feel a slight pinch”, they’re lying.  They do this for two reasons one, studies have shown that patients who hear this actually report less pain. Two, no one wants to hear “this is going to hurt like a mother-fucker.”   I also know from experience that it is better you breathe as well,rather than hold your breath when they are going to do something that might be painful like give you a needle or remove staples.

So I wanted to know more about what to expect with the upcoming biopsy. I wanted to know how the procedure is performed, how long it takes and first hand accounts of the experience.  So I went to the internet.  Interestingly studies have been done on whether or not the internet is a problem for physicians. Turns out that patients look up illnesses online to become better informed, not because they don’t trust their doctors.

And now I think I have made a faux-pas. I came across so many accounts of how horribly painful this procedure is that I got myself worked into a state. Some guys were like, “no big deal” others were like,” I will never do it without a local anesthetic again!” Anyway I called the doctors office and strongly recommended the use of a local anesthetic, to which they said, they’d see.

I sort of feel bad, it shows a lack of faith on my part.  The doctor said it would be okay, I should trust him.

 

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The adventure continues

February 4th, 2014

So I finally got to see the urologist,  Dr. Singal, at his clinic this afternoon and the visit went more or less the way I had anticipated.  His performed a DRE for his own edification, as he put it: “I’m sure you been poked there before but the only finger that counts is mine.”  Now that I read that it seems creepier than it did at the time.  Basically he wanted to see for himself if the other doctor was correct.  To be honest I don’t know what the big deal is about DREs.

I had posted to an internet forum about going to see the urologist and wanting to know what to ask. I got a lot of responses and from that formulated a list of questions,

What about the PCA-3 test? He felt that it’s use was limited since I would need the biopsy anyway, and that it is more useful for men who have to undergo repeated biopsies after negative results.  He also mentioned that as a bio-marker it wasn’t the best.

What about MRI guided biopsies? They are not common yet, so I could do one in the U.S. if I really wanted to but that tumors and lesions are not always visible in MRIs and that the “blind biopsy” isn’t exactly blind that it is guided and he can see what he’s doing.

Who would do the biopsy?  He would. That was important to me since I didn’t want to get schluffed off to some resident or nurse.

What about local anesthetic?  This was one of my bigger questions.  I have read some accounts which make the biopsy sound worse than paper-cut between your toes (you cringed just a little didn’t you?) and other accounts which were totally dismissive. He said that there was a concern regarding injecting something into the prostate, which at the time seemed to make sense but now I’m having second thoughts since the biopsy needle is pushing something into the prostate. However a quick internet search confirmed this was actually true.  Poor Dr. Singal is going to have his hands full with me.

He mentioned that most men complain about the ultrasound wand going in.  I cut him short and informed him I was gay and that wasn’t going to be an issue that I was much more concerned about the needle.  He then mentioned he had done over 3,000 biopsies to which I pointedly asked how many he himself had received? In the end he gave me a prescription for a sedative to take the edge off and calm my nerves.  I figure I can also take a Tylenol before hand as well.  I did the same thing when I got some of my later tattoos and it seemed to help.

So I said we should go ahead with the biopsy, which is scheduled for next Tuesday. As I was leaving he said something to the effect of, “Trust me, I’m going to take care of you.”  Which I thought was probably the perfect thing to say.

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The waiting is the hardest part

January 22nd, 2014

So I am still waiting to see a urologist.  It’s my own fault.

Medcan offered an appointment with one of their urologists but I wanted Dr. Singal.  He reviewed my men’s health chart and is a recognized leader in the field.  Plus he tweets.

However I greatly over-estimated my resilience and patience.  Part of that is my fault too.  I started reading forums and articles on the internet.  Shit I even bought a book on programming “R” so I could run my own stats on datasets that accompany medical research.  I am strong believer in informing yourself.  Or at least I was.  I only ended up in scaring myself stupid and now I think I am a firm believer in stick your head in the sand and cry.

I know I have made my coworkers lives difficult, I have been truly miserable to be around but I am going through some pretty stressful shit at the moment.  So in a moment of panic, I shit you not – a panic attack, I called the nurse and pressed her into booking an appointment at Sunnybrook since they have a rapid biopsy lab.  Dr. Singal would take another two weeks to do a biopsy and then 10 days to get the results.  I don’t think I can last that long.

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Adventures with my prostate

January 4th, 2014

I started to write this because if this whole thing should head south and takes a turn for the worst, I want to document it.

This journey has started because I turned 40 as one usually does if they spin around the sun enough.  For my birthday I gave myself complete “executive” physical at Medcan.  I wanted to give myself a Rolex but Zuimei gave me one and so I used the money for this instead. As part of my physical I got a PSA blood test. On October 25, my total PSA came back 3.24, which isn’t especially high except that most men 40 years of age have a PSA  less than 2.  The more alarming issue is the free PSA  at 0.367 and a FPSA/TPSA ratio of 0.11.

The report back from the clinic reads:

FPSA / TPSA ratio 0.11  

>0.20 Probabiltiy of prostate cancer less than 10%
less than 0.10 Probability of cancer greater than 90%

PSASo I am somewhere between 10% and 90% sure I have cancer…

As this was cause for concern my physician recommended I get another PSA test.  On December 10th I went back to Medcan for the follow up to another exam and as part of it had lab work done. My PSA had risen to 3.81 and the FPSA/TPSA ratio went down to .1.

This is not good.

Being the analytically inclined fellow I am, I quickly did some math in my head.  In 47 days my PSA rose 0.57. At this rate it would double in 6 months.  When I got home I made a chart to see if my math was correct and I was just a little off. Yay for me.

Keep in mind I still haven’t seen a urologist. In fact, I haven’t even “officially” gotten back the results from the doctor (he’s still on vacation). I just pestered the poor nurse into giving me the results to get me off her back. Rather than wait for the doctor to return I decided to start doing some research on my own.

That was a mistake.

So I know PSA density, velocity and FPSA ratio are all important.

“PSA velocity only “somewhat” improved the prediction of prostate cancer, compared with a single measure, but PSA velocity is nonetheless valuable, especially for predicting aggressive disease, say the study authors.” That is not so good considering my PSA doubling in just over 6 months is pretty fast.

PSA density is the relative measure of your PSA compared to the size of your prostate. And as luck would have it, I happen to know that from the men’s health assessment I did in October.  According to the report my prostate volume is estimated to be 18.9cc and so my PSA density is 0.17. However, when comparing two patients who have the same elevated PSA and different prostate volumes, the patient who has the smaller prostate is more likely to have prostate cancer. Again not so good.

The Free PSA ratio I already mentioned with the whole 90% cancer thingy…

Here is what else I know from my research.  Lots of men gets prostate cancer at some point.  It usually grows so slowly though something else kills you before it does.  The government doesn’t want to do PSA tests for men under 50 years old because it is expensive ($50) and because it gives false positives (high PSA readings without cancer) and false negatives (cancer without a high PSA).  This leads to a lot of unnecessary anxiety and treatments which cost a lot of money.

Despite this, it is still the best marker we have.   Prior to this the doctor has to feel it during a DRE (Digital Rectal Exam) and often the treatment was palliative (you’re gonna die, but we’ll make you comfortable) rather than curative (you’re going to live!) The government also doesn’t want PSAs performed on older men because, “why bother they’re going to die and not vote anyway”.  Okay they didn’t actually put it that way but you can read between the lines.

So now, here I am with my elevated PSA reading about a prostate biopsy which sounds like it fucking hurts.  It involves a trans-rectal ultrasound (been there, done that, bought the t-shirt) with the added bonus of a sharp needle jabbing your most special place  a dozen times.  In case you didn’t know, the prostate is the male “g-spot”.  Google it, I’m not kidding.

The biopsy takes about 15-20 minutes and then you can go home.  But you have to be careful to make sure you don’t get a fever or have trouble eliminating because that could be a sign of infection, which can go septic and kill you.  I shit you not. It’s very rare, but it happens.

Here is the best part.  The biopsy is no better than a random test.  Each biopsy sample is 1/10,000 of your prostate just to give you an idea of size.  It is very easy to miss the cancer.  If you look at an image of a biopsy you can see the biopsy needle only gets to the back part of the prostate.   I read 70% of prostate cancers are located there but that still leaves almost 1 in 3 missed.

Now there are more precise ways of checking.  For example one could use diffusion weighted imaging from an MRI to determine where exactly the biopsy needle should go but again, those cost money and the government just isn’t ready to fork over that kind of money.  I could also shell out big bucks to check my genes to see if I have a BCRA mutation which makes men who have it get very aggressive cancers at a young age, but considering my father and his brother are in their late 70s with no signs of cancer I think I am safe there.

risk

So now my mind is churning over the blogs and sites I have read from support groups like the PCCNToronto, and from various hospital websites. So am I scared? Your damn right I am. None of the indicators bode well, and I haven’t been that lucky lately.

I suspect on Monday the doctor will call to set up an appointment with the urologist and he in turn will recommend a biopsy.  And if that is the case I will ask to have it at Sunnybrook since they have a rapid biopsy lab.  They can turn around a biopsy in 2 or 3 days instead of the 2 or 3 weeks.  Personally I don’t want to spend two weeks thinking about “what if it is positive”.  I would rather just know so I can deal with it.

 

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2013 – The good, the bad, and the ugly

December 28th, 2013

Every new year I get excited; maybe this year will be the year things really take off for me. I’m not totally sure what I think is going to happen.  I realized at 40 any dreams of being a rock star are moot, as are pro-cyclist and movie star. I have decided 2013 will be the last year for that nonsense.  Life is really just a series of high points and low points sandwiched in between days of boredom and routine.  The routine is the day the day stuff like going to work, picking up the kids, cooking dinner.  The highs and lows are what keep it interesting.

Believe it or not the year started with cycling.  The weather was crazy warm a year ago and so I was cycling in January. 2013 was looking to be a good year!  I had signed up for boot camp and decided to join the Lapdog race team.  I also started making my own ramen in anticipation. Zuimei had decided to move home and open a ramen restaurant, and so I wanted to see what was involved. February was dull.  It got too cold to cycle and Zuimei wasn’t home.  To be honest it is one of the most awful times of the year.  Toronto is cold and grey and dirty in February. Seriously, fuck February.

In March, I went to the Adobe Summit in Salt Lake City.  I got to go skiing again for the first time in fifteen years and stand in the front row for The Black Keys.

  20130306_081417   

April started out well.  I road in the first two O cup races before heading to Europe for Zuimei’s 40th birthday! Paris was beautiful and the food was good. Personally I much preferred Italy but that’s probably because on our first day in Paris we got robbed by gypsies!  I suppose they needed the money more than us.

However we loved Florence, and we will definitely be back.

Shortly after returning, Zuimei’s nephews moved in with us to go to school.  It’s been quite a change going from having a house to myself to not having my own room.  It’s also been trying to go from no children to two teenagers. They are good kids but very lazy, they are definitely getting better.  In Japan their mothers did everything, and I simply won’t put up with that nonsense.  They can now cook, clean and do their own laundry!

Three days after Zuimei left to take his mother back to Japan I was in a motor vehicle accident while cycling!

I struck the side of a Wheel-trans bus after the driver made an unsafe left turn.  I was training for a race at the time and was travelling around 40km/hr. I ended up with several broken bones including my ribs, left foot and left shoulder.  And I know I got off easy, it could have been much, much worse. The shoulder has required surgery to reconstruct, as well as months of physiotherapy and massage to get back to work.  Luckily CBC had a good medical plan and short term disability. Poor Zuimei had to fly back and look after me since I was physically incapable of doing so myself. I suppose that is what marriage is for!

        

I am still looking at another surgery to clean up the bone and repair the rotator cuff but at least I got to keep my own shoulder.  There was talk of an artificial one which would have needed replacing every 15 years.  The accident took me out for three months and then followed that up with 6 months of physio… whee!  Despite needing another surgery it could have been much worse.

Shortly after I was able to return to work I handed in my resignation to CBC to start a new job with my good friend Mark at the Bank of Montreal. I wear a suit everyday which is a bit of a change from the jeans and a t-shirt I wore at CBC!  However the work is very similar, and something I am comfortable with.

Zuimei meanwhile started a new business.  He now owns a restaurant called “Touhenboku” (www.touhenboku.ca) on busy Queen Street.  It’s a Ramen restaurant which is quite popular here.  He seems to be doing well but works long hours.  A normal day is at least 12 hours.  He worked very hard opening it, with little help from me.  I hope he does well.

Zuimei’s mother fell ill and he had to race back to Japan.  Luckily she recovered and moved in with us. With the boys and his mother there was five of us in a three bedroom one bathroom semi so we bought a new house!  We looked around Toronto but like most big cities it is stupid expensive.  We already had our foot in the real estate market so we thought we’d be able to find something for a million dollars but no luck.  As a result we started looking outside the city and found a great house in Newmarket.

And as luck would have it, it’s called “the Sutherland house”, which is sort of fitting since my grandfather was a Sutherland.  It is a beautiful brick century house with some modern updates to the kitchen and solarium but most of the house is the original woodwork.   We take possession in the spring.

So now we are patiently waiting for winter to pass so we can begin a new chapter of our lives.  Personally I am happy to close the book on 2013.  It’s been too much of a roller-coaster and I could use some normality!  Don’t get me wrong, I am not saying I want the tedium and boredom of routine, I just want a year that doesn’t tax me to the limit like this one did.

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233 Prospect – Sutherland House, Newmarket

December 23rd, 2013

 233 Prospect 233 Prospect  Solarium Bermuda Gate Garage Main Stairs Office Living Room Dining room

Kitchen

Solarium

Guest Bedroom

Master bedroom

Master ensuite

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