SIUSLAW NEWS | WEDNESDAY, JUNE 20, 2018 | 7A
Siuslaw News
Community Voices
Natural Perspective —
By Emily J. Uhrig, Ph.D
Special to Siuslaw News
W
ith Father’s Day in June, it’s
time to celebrate dads of
all sorts. For many animals,
males have no active role in rais-
ing offspring; in many cases, the
young never even set eyes on
their father. However, paternal
care is not limited to humans. If
asked to name an attentive ani-
mal father, most folks would
likely suggest bird species in
which both parents tend the nest
and feed the growing young.
However, fatherly care can be
seen in some unexpected indi-
viduals, including certain insects.
In general, insects are not
Us TOO Florence —
Bob Horney
Special to Siuslaw News
A
s we sat down with Dr.
Mehlhaff at our May 8 Us
TOO Florence meeting, we had
the opportunity to review the
final version of the 2018 U.S.
Preventive Services Task Force
(USPSTF) recommendation on
prostate cancer screening. The
new recommendation supports
an individualized approach to
screening, based on physi-
cian-patient discussions about
the potential harms and bene-
Go bug your father
often associated with care by
either parent. For many species,
eggs are laid and the parents sim-
ply move on with their lives, but
a number of insects do provide
continuing care for their off-
spring. For the giant water bug,
these parental duties fall exclu-
sively to the male.
As their name implies, giant
water bugs are quite large, some-
times over 2 inches in length.
They live in freshwater ponds
and lakes where they are preda-
tors of other insects and even
By Barry Sommer
“S
tar light, star bright /
The first star I see
fits of screening and letting the
patient make the final decision
based on his values and prefer-
ences.
It only applies to men ages 55
to 69 without symptoms or a
previous diagnosis of prostate
cancer. It has no special guide-
lines for men at increased risk
due to race or family history of
prostate cancer.
The USPSTF continues to
recommend against PSA-based
screening for prostate cancer in
men age 70 years and older.
You may recall that in 2012,
the USPSTF recommendation
relieved men of any deci-
sion-making. The USPSTF sim-
ply eliminated routine PSA
screening for all men, regard-
less of age. And, since the
American Academy of Family
Physicians (AAFP) adopted
that recommendation, the elim-
ination of most PSA screening
happened overnight.
All of a sudden, I had men
tonight / I wish I may, I wish I
might / Have the wish I wish
tonight.”
Where were you when you
first heard or said that sing-
song wish?
It may seem silly, it’s just a
childhood thing to keep the
young’uns’ attention and give
them another rhyme to mem-
orize. Yet after we grow out of
youth, there are few of us who
can look skyward at night and
not hear it in our heads.
Too old to indulge in childish
rhymes? Naw, you’re never too
old as long as you can remem-
ber what it’s like to be a child.
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are attached to aquatic vegeta-
tion, but for others they are
deposited directly onto the back
of the male who will carry them
until they hatch. Males defend
their eggs from predators,
including female giant water
bugs. They also carry out various
behaviors, such as underwater
push-ups, to ensure the eggs are
well-aerated and may assist off-
spring with hatching. Without
the males’ efforts, the eggs will
not survive.
The males’ parental invest-
ments also come with costs. Egg
masses are heavy, perhaps twice
the weight of the male, which
slows him down — decreasing
his hunting efficiency and mak-
ing him more vulnerable to
predators. These are risks the
male must take, however, if he is
to see his offspring succeed.
So, if you’re enjoying freshwa-
ter activities for Father’s Day,
keep an eye out for the giant
water bug. His bite can be ago-
nizing, but it may be just another
father looking out for his kids.
Behind the headlines
telling me their doctor told
them, “We don’t do that test
anymore.”
With the new guidelines,
men who want the test should
get it. That will be one step in
the right direction.
The USPSTF’s intent was to
prevent men from being diag-
nosed, treated and harmed
from an indolent prostate can-
cer that would never have
threatened their lives. The Task
Force determined the substan-
tial harms of treatment, such as
incontinence and/or impo-
tence, far outweighed the limit-
ed benefits of lives saved from
early detection.
As the USPSTF released its
2012 recommendation, dire
warnings were sounded by
urology experts and others that
eliminating routine PSA screen-
ing would lead to a reversal of
the advancements in prostate
cancer detection, treatment and
survival rates made in the last
Notes from the Siltcoos —
Special to Siuslaw News
small fish and frogs, which they
catch using their strong forelegs
as pincers. They stab their prey
with a sharp beak-like structure
to inject digestive chemicals that
dissolve the victim from the
inside. The bugs’ venom is not
lethal for humans, but results in
an excruciatingly painful bite.
When it comes to reproduc-
tion, the male carries much of
the burden, often quite literally.
After mating, the female depos-
its fertilized eggs onto a solid
surface. For some species, eggs
several decades.
So, what actually happened
following the 2012 recommen-
dation? As predicted, there was
a significant reduction in men
being screening. More men (at
the time of their diagnosis) had
higher-grade, more invasive
prostate cancer with increases
in positive surgical margin
rates, tumor volume, and lymph
node involvement. Also, at time
of diagnosis, we have these fol-
lowing findings, each being sta-
tistically significant:
1. The median PSA level
increased from 5.1 ng/ml to 5.8
ng/ml;
2. Mean age also increased
from 60.8 years to 62 years;
3. As feared, the proportion
of low-risk 3+3 Gleason cancers
decreased from 30.2 percent to
17.1 percent;
4. In contrast, the incidence
of high-grade Gleason 8+ pros-
tate cancers increased from 8.4
percent prior to the recommen-
dations to 13.5 percent follow-
ing the recommendations;
5. One-year biochemical
recurrence (BCR) rose from 6.2
percent to 17.5 percent.
There is no good news in the
above data. There is nothing
there convincing me that elimi-
nating prostate cancer screen-
ing reduced the harms of
screening. Instead, the data
points to a far greater harm —
more men being diagnosed
with advanced, incurable pros-
tate cancer.
The question now is… How
long will it take to turn things
around in the primary care set-
ting now that men are supposed
to be the decision-makers?
Anita D. Misra-Hebert, MD,
MPH, and Michael W. Kattan,
PhD, of the Cleveland Clinic
note there are obstacles in doing
so.
“What the updated USPSTF
recommendations for prostate
cancer screening are asking of
physicians is to take time to
pause, explain what is currently
known, understand patient
preferences, and make the
screening decision together,”
they explained. “It is clear that
these types of conversations are
a necessity to deliver optimal
patient care even while there
does not appear to be enough
time, or any specific incentives
tied to engaging in these dis-
cussions.”
Looking at it that way, I have
a suggestion: Join us at an Us
TOO Florence meeting where
you can talk with prostate can-
cer survivors who have taken
different paths along their
prostate cancer journeys
(based on their personal values
and preferences) and the urol-
ogists who do engage in
time-consuming, patient-cen-
tered decision-making.
Call me at 541-999-4239 if
you need meeting times and
places.
a dome which surrounded the
earth. Remember, we used to
be the center of the universe
with all things revolving
around us, until that heretic
Galileo decided to look at the
sky with his telescope and
declare that we were not the
center of the universe.
With the advances in optics
and the computer we can now
look deep into the eyes of the
universe. What has been
revealed is nothing short of
mind-bending.
The Hubble Space Telescope
has opened up the universe to
such an extent that with the
naked eye we can now look at
all those pinpoints of light and
understand them as portals to
the past. The constellations
that we all know are more
than a bunch of stars that
form a pattern; they house
light-years worth of secrets as
well as the keys to unlock
those secrets. Billions and bil-
lions of galaxies, stars, novas,
white dwarfs, red giants, gas
clusters and dust clouds all
add to the totality of that
ambient glow we see each
night.
With the advent of the
Hubble we are able to see into
the farthest reaches of the
past, looking at what amounts
to the beginning of the uni-
verse. What were just spar-
kling lights in the night sky
with names like Orion, the Big
Dipper,
Ursa
Minor,
Andromeda, Vulpecula and
Cygnus are now space/time
gates, each one distanced by
our perception of time as well
as measured miles.
This nightly glory is more
intense if one allows for the
eye and brain to adapt to the
Purkinje Effect, named after
the
world
famous
Czechoslovakian anatomist
Jan Evangelista Purkyně (but
you knew that already, right?).
It describes how our eye shifts
toward blue as the light level
decreases.
This physiological response
has also been described as
dark adaptation, but the end
result is our ability to see
many more stars with greater
clarity than if we just walked
out of our well-lit house and
looked skyward.
I have experienced this
firsthand when I wake at 3:
a.m. and go outside for a
breath of air. Since I have been
in complete dark (asleep) for
hours, the stars and sky are
much brighter and more
detailed.
And one night, when I saw
the Milky Way as a band of
glowing cloudiness from hori-
zon to horizon, I really felt the
scale of my existence. Then I
went back to bed. No sense
wasting perfectly good sleep
time gazing at the stars for too
long, they’ll be there tomor-
row night.
Drifting off, I remembered
this ancient Arabic proverb:
“My lover asks me, ‘What is
the difference between me
and the sky?’ / The difference,
my love, is that when you
laugh, / I forget about the sky.”
Keep looking up. And
laughing. And loving.
Pinpoints
As I grew up in a large
urban jungle, I did not have
the opportunity to lay on my
back gazing up at the heavens
and marvel at the pinpoints of
light that filled the night sky.
My childlike wonder had been
stunted by all the light pollu-
tion emanating from millions
of cars, homes and billboards
that crowded my hometown’s
sky. To see the endless sky and
stars, one had to travel many
miles to the east, out to the
desert or up into the moun-
tains to the pristine heights
where skylight predominates.
Like our ancient ancestors
who have gazed at the night
sky since the beginning of
time, I too have wondered;
will the sun come back tomor-
row, and do I have to sacrifice
a goat to make it happen?
Night is scary with all sorts
of dangers hidden in shadow
and any manner of creature,
whether terrestrial or celestial,
abound in both our dreams
and just beyond our sight.
There are monsters in the
dark — but with the coming
of day they slink back to their
lairs and we sigh a breath of
relief.
The stars and their ambient
light may not be bright enough
to keep the monsters at bay,
but it is sufficient to allow us
to peer into the past.
We gaze skyward and see
what is unseeable. We can
watch the past unfold right
before our eyes because the
universe is a time machine.
Think about this for a
moment; when we see the
light of the sun we are seeing
it nine minutes after it was
created. Thus the sunlight we
bathe in is from the past. I
know, weird and wonderful
are the things that inhabit the
celestial world, the space/time
continuum being one of the
more unique “rabbit holes”
one can travel down.
Our ancestors believed the
stars in the sky were just
points of light on the inside of