Following a new PSMA (PET) scan
in March showing my prostate cancer had now metastasized to the lymph nodes and
intensified it was time for a new urology and oncology visit.
To briefly review, the PSMA uses a
more sensitive radionuclide than earlier (axumin) scans, in this case something
called F-18 Pilarify which: "Binds to prostate cancer cells to
help localize prostate cancer cells."
It is therefore the property of the agent's binding to
specific prostate cancer cells that validates and empowers its diagnostic use
in scans. The cancer cells then will "light up" i.e. experience measurable uptake of the
radionuclide - which helps to identify them and the level of malignancy- and show up brightly on scans.
The intensity of uptake by
those cells is defined by the SUV or standardized uptake
value. Where: SUV =
C(T)/[injection dose (MBq)/patient's weight (kg)]
In my case it was enhanced in the lymph nodes by a factor of nearly 2
from an earlier axumin scan in 2020 and a PSMA scan in 2022, e.g.
Both my urologist and oncologist delivered a wake up call in
terms of what could happen if the cancer migrated from the lymph nodes to the
bones, especially the spine. That is, such bone mets could easily cause a
fracture of the spine and have me laid up in a wheelchair. A scan (not PSMA)
showing a patient’s spine ‘threaded’ with bone mets is shown below:
If I didn’t want to risk
such an outcome I had to choose a treatment option: i) SBRT (Stereotactic
Body Radiotherapy) plus ADT (androgen deprivation therapy), ii) SBRT alone,
iii) ADT alone.
I declined options (i)
and (ii) in the course of my June 10th oncology (UC Health) visit because one of the primary potential complications recited by the P.A. was “severe bowel obstruction” – with 20 %
probability. This arose because I’d already had previous high dose
radiation therapy 12 years earlier at UCSF e.g.
And the tissues in the vicinity of the pelvic region would be susceptible to
damage from more radiation. Further, a bowel obstruction would likely require wearing an ostomy bag the rest of my days.I said ‘no
thanks’. So the sole remaining option was to go on ADT which consequences
I've elaborated in ancillary links from previous blog posts, e.g.
I had hoped to start
Orgovyx, the newest (and ‘greatest’) ADT medication which has the benefit of:
a) being taken in pill form as opposed to regular injections, and b) fewer
myocardial infarctions ( by about 43% ) . But the path to support was
scuttled because the company terminated its lower cost “bridge support”.
So I was left with either paying the full monthly tab ( copay) $2,500, or
opting for the lower cost ($ 523/ mo.)Firmagon E.g.
Well, seeing as I
didn’t wish to see our nest egg cratered I chose the Firmagon, and had my
initial double injection June 24th .
What I forgot to mention
was that the urologist suggested – because of my already low testosterone (156 ng/ml) –
adding another ADT drug: Abiraterone acetate
(Zytiga) which you can read more about at this
link (the least technical one I could find):
But I
wasn’t too gung ho- after reading more about it, the fact is could cause bone
fractures (the last thing I need) as well as other unwanted effects including
(from the link):
However, abiraterone plus
prednisone was associated with higher increases in weight, body mass index,
visceral fat, and glycated hemoglobin, as well as the highest incidence of type
2 diabetes,
In any case the SEs from the Firmagon are enough to tolerate for now and include night sweats, back pain, and nasopharynx congestion, some difficulty breathing. On the good side I learned the results of a blood test twenty minutes after the Firmagon injections showed a testosterone value of 82 ng/ml or nearly half what it was just before the injection. Both Firmagon and Orgovyx work by blocking
the pituitary gland from making hormones called luteinizing hormone and follicle-stimulating hormone, thereby
reducing the amount of testosterone the testicles are able to make.
With testosterone reduction the cancer's fuel intake is also lowered and
hence there is less havoc caused by tumor growth - including metastasis.
The need now is to see the PSA also go down, hopefully in another blood test Jul 22nd. (In general the PSA doesn't get lowered much until 2 weeks after the first injection.)
So for now my
choice is just to keep the ADT at the Firmagon level and no more meds. Another
paper – from The New England Journal of Medicine- actually referenced a test
trial using the Abiraterone and found the average added length of
lifespan for patients on regular ADT (e.g. Firmagon only) to be 33 months. But
when Abiraterone plus prednisone was added it meant 14 months more. But
really, to me, I can do without 14 more months of added life if it means 14
more months of misery including fatigue, brain fog, worse back pain and possible bone fractures.
So I am ready to go the more conservative route, unless they find bone
mets in a new scan.
Bill Maher: Clueless as ever about Presidential elections
"It should go without saying that Biden in any condition is preferable to Trump, especially after the sinister Supreme Court ruling on Monday granting presidents immunity for their official acts, an act of civic desecration all but ensuring that a second-term Trump would rule as a vengeful dictator. The stakes of this election are existential; it’s a referendum on whether America will continue to be a liberal democracy." - Michelle Goldberg, NY Times, Monday
"If anyone were to doubt the menace of Donald Trump, they had only to watch his performance last Thursday night. He was worse than ever. His bullying lies were not just lies — they were frighteningopposites of the truth, uttered with the vigor and certainty of someone who has now mastered the dark art of demagoguery. It is difficult to summarize his lies because they suffused every sentence. "- Robert Reich, Substack, What Do Democrats and Sane People Do Now?
Bill Maher just keeps the 'hits' coming, in cluelessness, this time about American presidential elections. His fantasy - ideational NY Times op-ed:
Now has him arguing mindlessly for an open convention, writing such tommyrot as:
"Democrats could not buy, with all of George Soros’s money, the enthusiasm, engagement and interest they would get from having an open convention — and in Chicago no less, famous for Democratic convention drama. Suddenly, instead of rehashing the debate from hell — worst episode of “The Golden Bachelor” ever — they would be hosting a competition, something Americans love. Who will get the rose this August in Chicago? Gavin or Gretchen? ...
My pick would be Gavin Newsom. Watching him make the case against Mr. Trump in the pre-debate interviews and defend Mr. Biden post-debate reminded me: This guy is good at this."
One would have at least thought this smug character would have had enough on-air education from political maven Chris Matthews on Friday night's Real Time. You know, to get his head straight and clear out the wishful thinking nonsense. But not so. Maher is as committed to remaining a Political Pollyanna as ever. In an effort at a wake up call, Matthews reminded him of a little thing called the 12th amendment. To wit:
The Twelfth Amendment
made a series of adjustments to the Electoral College system. For the electors,
it was now mandated that a distinct vote had to
be taken for the president and the vice president. Further, one of the selected candidates must be someone who
is not from the same state as the elector.
In other words, it basically chucks the current ( first woman and minority) VP - Kamala Harris - overboard. It also violates the 12th amendment, and as Chris Matthews added: 'What do you think Harris' team is going to say, not to mention her voters?' Well, they wouldn't be too enthused and I'd dismiss right now Maher's half-assed rejoinder "It wouldn't be as bad as people think." Oh yes it would, my friend.
The other aspect overlooked by Maher and his cheerleaders for changing horses is that in the event Biden did drop out his entire accumulated war chest, as well as operations structure, then reverts entirely to VP Harris. What's left for Newsom, Whitmer, Shapiro and any other 'dream' candidates? Bupkis. As one NY Times commenter noted:
Maher has no idea the amount of resources that go into a presidential campaign - polling, message testing, ad reservations, legal ballot access, staffing: all take time and money to build out, both of which will be in short supply if the nominee is picked on the convention floor. The RNC and Trump campaign have nearly $170 million on hand right now. They will report a higher number on the 15th.
Because of FEC regulations, Harris is the only candidate who can access what team Biden has raised. Newsom (or Beshear, or Whitmer) would be starting from ZERO, ten weeks before election day. They cannot transfer any of the money from gubernatorial campaigns to the presidential level. Soros cannot write a check covering the difference. Republicans will have millions at their disposal to highlight Newsom's "California baggage", while Dems are frantically trying to catch up on the money front. A younger governor may be able to do more press hits on TV, but our media landscape is far too fragmented now for any one candidate to spread a concise message.
That is why it would be difficult if not impossible to 'change horses' this late in the campaign and especially to have an "open convention." (As Michelle Goldberg put it this is a fantasy out of Aaron Sorkin's Dem political soap, 'The West Wing'.) Btw, even Maher in his op-ed did touch reality at one point about Newsom, noting:
"Yes, he has too much California baggage — some of which I don’t love."
But you can bet your sweet bippy Trump and the Reeps will make hay with it, especially the escalation of 'smash and grab' gangs in LA, San Fran etc., and also the "exploding homeless population." (Now over 400.000).
Maher also doesn't seem to process that none of his fantasy candidates to take Biden's place - whether Gavin Newsom, Gretchen Whitmer, Josh Shapiro, Andy Beshear or any others- have approval ratings that break 20%. Getting national name recognition alone would likely take more months than we have left before Nov. 5th. As NY Times' columnist Jamelle Bouie noted last night (All In) the only serious and logical option other than Joe Biden is Kamala Harris, the first in line of succession as Biden's VP. No one else would have access to the campaign operations and resources, war chest, so it's useless and stupid picking fantasy names out of thin air for an "open convention" and trying to get people to believe it's a plan. In the meantime there is a memetic resurgence in social media (KHive) for Harris:
Matthews last point may also have been lost on Maher: that democracy "is not some abstract concept". Indeed, one for whom it is more ought to recognize instantly its violations, as when Trump begged Brad Raffensberger for 12,000 votes in Georgia in the 2020 election or set then acting AG Jeffrey Clarke to find ways to nullify Biden's election.
As Chris fairly screeched at the still lame -faced Maher:
"Every other president has acknowledged losing an election when he did. Not Trump. Trump does not respect democracy. He should not even be a candidate."
Which means it is up to we the voters to ensure he's neutered again by leaving him out of our voting choices, as well as making other non-choices (e.g. no vote at top of ticket, voting 3rd party) that would still squeeze him into unearned power.
That means ultimately, we the voters are charged with being the last bastion to protect our democracy. No court, verdict, grand jury, special prosecutor or other agent can do it for us. And it is on us to do the work (of voting) not Biden. As Atlantic
columnist David Frum aptly puts it,
"The job of saving democracy from
Trump will done not by an old man on a gaudy stage, but by those of us who care
that their democracy be saved. Biden's evident frailties have aggravated
that job, but they have also clarified whose job it is. Not his, YOURS."
So this is how liberty dies—in the void of an Atlanta TV sound stage plastered with more CNN logos than a NASCAR Camaro, where the relentless march on Washington by an American Mussolini, fueled by lies about everything from national greatness to his sleazy sex life, could not be stopped either by the muzzled moderators or the coughing and occasionally confused 81-year-old who was the last thing standing between the United States and dictatorship.
Everything you need to know about the critical, on-a-ventilator condition of American democracy can be explained by this:
Two-time Donald Trump voters who’ve since soured on the former president still don’t plan to back him after his debate with President Joe Biden, according to a focus group spearheaded by conservative strategist Sarah Longwell.
Longwell, publisher of the Bulwark and prominent “Never Trumper,” joined CNN on Friday to discuss the fallout from Biden’s much-maligned performance at the first presidential debate held on Thursday.
Longwell said she hosted a focus group Friday morning with “two-time Trump voters who are out on Trump — people who did not want to vote for him again.”
Noting “some of them had been leaning Biden prior to last night's debate,” Longwell said, “this morning, they told us that they just didn't think they could get there on Biden.”
“I will say, though, they were very clear about Trump still,” the Republican strategist said. “One of the things you heard from all the voters in the focus group is that Trump is a liar. Trump is a bad person. They don't want to vote for Trump. There was nothing about last night in Trump's performance that brought these voters who don't like Trump back to him.”
Rogue's Gallery:Trump's hacks who demolished the rule of law
“Today’s decision to grant former Presidents criminal immunity reshapes the institution of the presidency. It makes a mockery of the principle, foundational to our Constitution and system of Government, that no man is above the law. ”- Justice Sonia Sotomayor in dissent
“A
former aide has claimed that Trump frequently called for the “execution” of
people he didn’t like. The Supreme Court’s ruling this week would grant Trump
immunity if this conversation had led to actual executions, because it was
“official”. Many Americans found it difficult to celebrate July 4 this
week given its commemoration of our founding democratic principles, and were
left recalling John Adams’s ambition of creating “a government of laws, and not
of men”.
The
Declaration of Independence includes a long list of indictments against King
George — the justifications for the first American Revolution. These include:
“He has made Judges dependent on his Will alone, for the tenure of their
offices, and the amount and payment of their salaries”, and “He has excited
domestic insurrections amongst us.”
The case for the prosecution against Mad King George looks a great deal like
that against Trump. Instead, the Supreme Court decided to hear a case with the
chilling name Donald J Trump vs United States — and ruled in favour of Donald J
Trump.”
Sarah Churchwell,
“Amidst Trump-Biden ChaosAmericans Should Not Forget Their History’, Financial Times
The
Supreme court finally ruled on presidential immunity Monday, issuing a 6-3
decision that agreed former presidents have immunity from criminal prosecution
for official acts but not for unofficial acts. The decision, basically, is a judicial atrocity amounting to “inventing immunity for corrupt acts” in the words of Justice Sonya
Sotomayor in her dissent.By way of
example, the ruling de facto grants absolute immunity for Trump when he
pressed Mike Pence not to certify Biden’s election on January 6th,
2021.The reason? That came under the court’s
designation of an “official act.”
Justice Sotomayor,
adopting a scathing tone, said the court’s 5 conservatives (Amy Coney Barret actually backed out of the ‘presumptive
immunity with official acts’ BS) would effectively allow presidents to commit clear crimes without
punishment. This marked an expansion of presidential powers that put democracy at risk.
She and fellow liberal justice Ketanji Brown Jackson laid out the hypothetical ways
the court’s ruling could create crises in the U.S. Including a power hungry autocrat (like Trump) dispatching Seal Team 6 to assassinate political rivals. Or dispatching a covert team of allies to instigate a coup, say to overthrow a free and fair election - perhaps by employing military. Sotamayor wrote in her powerful dissent:
“The President of the United States is
the most powerful person in the country, and possibly the world. When he uses
his official powers in any way, under the majority’s reasoning, he now will be
insulated from criminal prosecution,”
“Orders the Navy’s Seal Team 6 to
assassinate a political rival? Immune. Organizes a military coup to hold onto
power? Immune. Takes a bribe in exchange for a pardon? Immune. Immune, immune,
immune.
“Let the President violate the law, let
him exploit the trappings of his office for personal gain, let him use his
official power for evil ends. Because if he knew that he may one day face
liability for breaking the law, he might not be as bold and fearless as we
would like him to be. That is the majority’s message today.
“Even if these nightmare scenarios never
play out, and I pray they never do, the damage has been done. The relationship
between the President and the people he serves has shifted irrevocably. In
every use of official power, the President is now a king above the law.”
All of which is resoundingly valid and indicates
how far the court’s Trump renegades have gone down the rabbit hole of
ruthless abandonment of the rule of law and the Constitution. Indeed, this single ruling of ‘presumptive
immunity for official acts’ is similar in many ways to the changes made to the Weimar justice system
after Hitler ascended to the Chancellorship in 1933. There followed the
mutation to the Reich courts and the multifold ways the Nazis perverted state
power – just as Trump plans to do with an agenda for a 2nd term based on sheer retribution, e.g.
Now thanks to these SC imps, Trump will have a speedway to wrecking what’s left of our laws and any respect for their adherence.
Nina Totenberg, legal specialist appearing on
Rachel Maddow’s show last night, commented on how mind- boggling the ruling was
for those of us who recall how Nixon’s use of the DOJ was taken down in the 1973 SC rulings. As she put it, “he’d love to have a re-do of those Watergate rulings based on this
new Supreme Court”. Why not? Hell, he’d
never have had to hand over the Watergate tapes since that evidence would be
disallowed given he’d have “presumptive immunity” for “official acts.” Just like Trump now has presumptive immunity
for his efforts to use the DOJ to install fake electors and impede
certification of Biden’s electoral votes on January 6th.
Naturally,
the sane realm of anti-Trump voters are in a state of rage at the prospect that
this orange swine will now escape all major federal accountability for his
actions.He will skate basically through
the November 5th general election- and if
indeed elected- can finish the justice system off as an autocrat with his own decrees
and stacking the DOJ with toadies and hacks. So no wonder this traitor was cheering as the news broke. His pet toadies on the court had done his bidding and made his picks of the final three clowns worthwhile.
Again, a stark reminder that elections have critical consequences and even if you are not entranced by a particular candidate, you better damned well vote for him if he is in opposition to Trump. And I am writing here of Joe Biden, no one else. Because no one else amongst all the wacko calls for him to bow out have the name cachet or campaign war chest, operations to compete against Trump. No more BS about "sitting this one out" or voting 3rd party as if one has real alternative choices. No you don't. It's either the hellfire doom of the Trump proto-Nazi landscape or a decent man in Joe Biden - who may be frail and slow of speech, but still knows right from wrong and what underpins our Constitution. But evidently, none of these 5 conservo Supremes do.
Indeed, Chief Justice John Roberts had the temerity and mental torpidity to downplay Justice Sotomayor's warning with this limp dick response that the liberal justices "strike a tone of chilling doom that is totally disproportionate to what the court actually did today."
Confirming Roberts is a foursquare fool like the four other Trump bots. So either Roberts hasn't been paying attention to the litany of Trump's threats and vows of vengeance, or thinks they are a joke. But in any case confirming again the takes of commentators from Chris Hayes to David Frum and Stuart Stevens, i.e. we cannot count on the justice system to save us from a mega criminal like Trump. We have to do it ourselves by voting this maggot gone once and for all.
The
decision came more than nine weeks, a travesty in itself, as I've already written about e.g.
The Supreme Court's MAGA faction of right wing imps have now confirmed they are in Trump's pocket to keep him out of harm's way before the November election. Their anodyne a certiorari ("cert") acceptance of his claim for absolute presidential immunity case yesterday confirms it. The reason is that such interference was totally unnecessary given the D.C. Appellate Court had already given an exhaustive ruling. Especially exposing the insanity of Trump's lawyer John Sauer claiming absolute immunity even for the use of assassination for a political opponent would be justified under certain circumstances.
Now we the voters are left to do what the Trump-owned Supremes would not: pass the final judgment on him in the November 5th election. By re-electing Joe Biden in a landslide. Before that day of reckoning, Judge Juan Merchan - in the New York hush money case - has a chance next week to hold Trump to account by sentencing the orange roach (now delayed until Sept. 18th). That ought to be to at least one year in Rikers Island, thereby delivering a hearty finger in the eye to the Trumper Supremes.
As for the Trump lawyers' plea that Judge Merchan now toss out the sentence and case based on the SC traitors ' ruling of "presumptive immunity", I say let them suck cow dung. Given the slimeball has shown zero remorse and violated dozens of gag orders he merits at least a year in the can. Thereby Judge Merchan can show the Supremes are not the only ones who can wield a mallet.
They did it. The U.S. Supreme Court handed a massive victory to former President Donald Trump in this so-called “immunity” case, and it will probably take a year or more before there’s even a chance he’ll be held to trial for trying to overthrow the 2020 election and, thus, the government of the United States.
As feared, the six Republicans on the court essentially threw Trump’s sedition case back to the lower court (with caveats) where there will be numerous decisions to make—which are all further appealable, resetting the case so Trump can drag things out for another year or more—about whether the crimes he’s committed are “official” or “private/personal” acts.
But that’s not the worst of it. They also turned Trump or any future fascist president into our first American king or führer.
Unless Congress acts quickly to overturn this obscene 6-3 decision—which won’t happen so long as Republicans control the House—democracy in America has been wounded, perhaps fatally, and the president has been made into a dictator, should he or she choose to behave that way.
Donald Trump was the luckiest man alive last Thursday. President Joe Biden's abysmal debate performance overshadowed what should have been the biggest story of the night: Trump, as he did in the 2020 presidential debate, winkingly encouraged his supporters to commit political violence. Biden correctly noted during the debate that Trump has promised to pardon the over 1,200 people charged with federal crimes for the January 6 insurrection. Trump responded by calling the rioters "innocent" and saying Biden "ought to be ashamed" because his Justice Department charged them with crimes. This echoes Trump's increasingly rabid defense of the insurrectionists on the campaign trail, where he often calls them "hostages" and "political prisoners" and holds ceremonies honoring those who are imprisoned.
Even though attempted murder is not one of his 34 felony convictions, Donald Trump has never been coy about his longing to kill people. During the 2016 campaign, Trump famously mused in a speech, "I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn't lose any voters." In 2020, he threatened to murder Black Lives Matter protesters by tweeting, "When the looting starts, the shooting starts." Throughout and after his presidency, there was a steady stream of stories from aides alarmed at how Trump would repeatedly ask if they would kill people for him. He requested bayonets and spikes on the southern border, hoping for grisly deaths of migrants crossing. He had Oval Office meetings in which he demanded the military "crack skulls" and "shoot" lefty protesters. Former Attorney General Bill Barr appeared to confirm reports that Trump regularly ordered him to "execute" government staff for speaking to the media. Barr did pretend Trump wasn't serious, despite how often he circled back to the topic of extra-legal executions.
Even before he got into politics, Trump's bloodthirstiness was on public display. In the 1980s, Trump demanded the death penalty for five young men falsely convicted of rape, a position he did not back down from, even after they were formally exonerated. (Trump himself was found liable for sexual assault last year by a jury, but does not feel he should face his own recommended punishment.) In 1990, Trump praised the Chinese government for killing peaceful protesters in Tiananmen Square. In the same interview, he lamented that the Soviet Union did not murder enough people, calling the Soviet government "out of control" for allowing more dissent than they had in the past.
The Supreme Court just decided, along party lines, that Trump will enjoy immunity in the federal election case in Washington from any allegation in the indictment concerning his “official acts” while president.
The court has remanded the case to the trial judge, Tanya Chutkan, to determine which of the allegations should be thrown out because they involve official acts.
The practical consequences of this ruling:
The case Donald Trump v. United States will almost certainly not be concluded before the election, meaning that a verdict against Trump could be rendered meaningless if Trump is elected and he orders the Justice Department to, in essence, throw the case out.
Allegations in the indictment concerning Trump’s dealings with the Justice Department, in which he sought to install a loyalist, Jeff Clark, as acting attorney general in order to claim there was fraud in the election, will probably be thrown out by Judge Chutkan.
Allegations that Trump tried to strong-arm his vice president, Mike Pence, into using his role overseeing the election certification proceeding on January 6, 2021, to throw him the election, will in all likelihood be thrown out as well.
The Supreme Court has ordered up a similar fact-finding process on most of the remaining allegations in the indictment — those concerning Trump’s attempts to pressure state officials into helping him win the election as well as his plot to gin up false slates of electors declaring that he won in states he actually lost. It’s doubtful that these will be found to be within his official duties.
Finally, the Republican-appointed justices have given a dangerous amount of discretion to presidents — broad enough, as Justice Sonia Sotomayor noted in her dissent, to protect presidents from prosecution for bribes and assassinations. A president already has the authority under the Insurrection Act to order troops into American streets. After today’s ruling, those troops would be under the command of a person who would almost certainly enjoy absolute immunity for the orders he gives them.
In other words, today’s ruling makes it even more important that Trump is trounced in November
At any
other time, and with any other president, Monday’s landmark decision by the US
Supreme Court vastly expanding presidential powers would generate little more
than scholarly hand-wringing. Indeed, the 6-3 majority’s ruling that a
sitting president should have “absolute immunity” from criminal prosecution
from actions he takes when exercising “his core constitutional powers” has a
certain pragmatic logic to it.
Since the
1990s, American political leaders have increasingly attempted to criminalise
policy differences, be it Democrats seeking to prosecute George W Bush for war
crimes in Iraq or Republicans launching impeachment proceedings against Joe
Biden’s homeland security secretary for a surge in illegal border crossings.
New Deal-era Supreme Court Justice Robert Jackson once said that the US
Constitution is not a suicide pact, and an American president should not fear
that an action sincerely taken to provide for the common defence, or to insure
domestic tranquility, or to promote the general welfare, will later be picked
over by federal prosecutors and land them in jail.
The
founding fathers built checks into the federal system, but having the justice
department setting up shop outside the Oval Office to adjudicate presidential
decision-making — even those that fail spectacularly — wasn’t one of them. The
problem is that Donald Trump is not any other president, and we are living in
an era that could see a man who has vowed to use the power of the US government
to take revenge against his political enemies, and rule as a dictator for at
least a day, returned to office in a little more than six months.