Hi, I am Mark Schlossberg and I've had a long career at IBM. Now I help startups and other companies who need help going to market and building their business or trying to flip their business, and I developed a passion for healthcare having moved my mom 350 miles from Montreal to Toronto via ambulance. She came with pictures. I looked after her for seven and a half years, and now I'm in my 15th year of, through digital health and other means, trying to help deliver better primary and long-term care that's patient centered. So that's a passion of mine and a life purpose. But I'm not healthcare person. I'm not a medical professional of any kind, business person with a bent or passion for healthcare.
What brings me here today? I think I was walking out for lunch or something with a buddy at IBM. I was about 45 at the time, I'm 66 now. And he mentioned, "You know, you should start looking at getting a PSA test around the age of 45 to 50." Around 50 is the guideline, I believe, and that's what he was suggesting. And I was 45 at the time and I thought, "Good thing to just add on to my standard blood requisition that I do every year for my annual physical." My doctor tells me, "Don't wait for your blood work to tell you you're in good health. We practice that all year and let the blood work be the marker to validate it, but don't fool yourself into just thinking that blood work is going to do it for you."
And anyway, I was about 65 at the time, the last several few years, my PSA had been going up beyond the guideline of 4, being the maximum cutoff range for what's considered the normal PSA. And I had put on some weight too, which may have been a factor. I don't know. In any case, it had gone up to about 6.3. And by that point, I had been monitoring my PSA instead of once a year, because it was going up gradually, we decided to monitor it quarterly. And then when it hit the 6.3 range, I said, "Geez, that's a 50% change. I wonder what's going on." And I sat with my GP, my family physician and said, "What else can we do?" And he said, "It's a free ratio test, and that I've become..." That's my thing, since I believe that saved my life in a way. I'm not sure I'd be here having this conversation had I not known about it, that another passion became informing people as best as they can to know about this test as an extra monitor.
I think the PSA test should be done. It's up to you how often, how frequently, everyone's life circumstance is different. That's a discussion between you and your family physician. Not doing it I think is problematic. The PSA test has been controversial the last few years, but as far as I can tell, there's a lot of new research coming, but not a lot of research that's standard practice for everybody. So it's one of the best games in town and better than not doing anything at all.
The free ratio and why I feel so strongly and I'm advocating for that is because what it is... On my blood requisition that we use, it's just another tick mark on the blood work requisition. And what it does is it gives you a number and the number corresponds to percentile, a range of confidence saying what is the risk of having... You may or may not have prostate cancer present and it's just giving you another indicator. So it's to complement the PSA test in a way.
In my case, the test came back, and the number was low, and the lower the number, the higher the risk. So I sat with my physician and he said, "I would've expected it to be higher." And that's when he said, "All right, what would you do if it were you?" What would I do if it were me? I was asymptomatic. So I was quite surprised at all this, and he said, "Go and have a biopsy done." Now some of the controversy over PSA is that the other tests are anxiety provoking and so on and so forth. Yeah, they are to a point. But I went for the biopsy and I went for a walk after. I'm not a professional athlete, I just went for a walk after. So yes, it's stressful because it's the unknown and you don't know what you're getting into and you're a little worried about what's going to come out of it. That's called being human. But nevertheless, it's a good thing to do if that's needed.
So in my case, because the free ratio was at a number that said that risk was higher, I could sit down and look at options. So for everyone else, you look at the combination of your PSA and the free ratio and you have a conversation with your doctor about options. And those options include things like, do your PSA more than once a year just to keep track of what's going on. And you decide with your physician and your life circumstance what that frequency is. Other options are to do a biopsy or to do an ultrasound. And there are different levels of ultrasound, some of which claim they can actually target and see where prostate cancer exists if it exists. But that test, you have to ask for that specifically. And in a lot of cases, they'll use the standard tests instead because it's not necessary unless there's some real cause for concern.
So they're options is the point and there's more than I've described, but those are the main ones to start with. So the free ratio is what basically led me to find the presence of cancer. Given where my PSA ratio was, it was at 6.3, I was on one of these weight loss app programs. I dropped a lot of weight. It went down to not quite the maximum of the normal range, but close. Instead of 4, it was 4.8. So you could think or imply that there was less cause for concern. And the free ratio, because I chose to take tests because of that thing, that's where I strongly believe it probably helped save my life because I'm not sure how long or if the prostate cancer would've been detected and in what timeframe. So I count my blessings for that.
And I ended up getting multiple tests, couple of biopsies because they do... Once you have the cancer, it's part of the protocol that was under the medical care that I was on that they did an ultrasound and then they did... Sorry, maybe it was an MRI. One of the two. And then they did another biopsy. And that biopsy was more specific because the biopsy targets, it gives you a sense of what's in the area, but it depends if they happen to catch that area. So it's not always found in some cases.
In this case, originally the doctor had said, "Yes, you have prostate cancer, your PSA," even though it was up as high as 6.3 and down to 4.8, he said it was normal for my age. So from their perspective, business as usual, it wasn't a big deal. From mine, it was. And then when we did the second biopsy, they said, "Oh, there's a particular area that is of higher concern." The cancer was a little more... like one, they said, "You can live with it," thank God for that, "and we can just monitor progress over time because it's slow growth." This other part was more aggressive and I had to look at options, and my options were basically surgery or radiation. And within the context of surgery, it was either robotic or opening me up.
And I talked to a few surgeons, talked to some family doctors, talked to a radiologist, I talked to people who'd been through it. And some tried experimental work which maybe wasn't ready for prime time because they got many more complications that were near life-threatening, and talked to others who said, "Yeah, go this way. It's great. You're feeling better," and all the rest. So I had the gamut of people, and I chose robotic surgery because it's less invasive and less loss of blood in the surgery itself.
So I went for it. That was the choice I made, and I had to grapple with a lot of issues. Some were just dealing with the fact that I had cancer myself. So I started to do a lot of homework. Like I said, I talked to a lot of people and physicians and healthcare providers and I did my own research. I strongly suggest a free ratio discussion with your physician because it's something incremental to the standard. The only one I know who had it was someone who... I knew of one person of anyone I spoke to who even knew what it was, and he only knew it, I think he had a family history. So his private clinic had it as a mandatory test on his particular thing. He's the only one, no one else knew. People still call me to this day because I'm on my soapbox pushing this free ratio because I think it can save lives. But hopefully you won't have that issue in the first place and hopefully you won't even have the cancer.
But what I wanted to share was what happens if you do. You have to grapple with it in your own head what are you going to do about it. There is some shock, there is some fear, there's a lot of different feelings you go through: life expectancy, all that. In my case, I went through some of that and I tried to push hard to go through it quickly because I went into a combination of survival and how do I thrive in this case. And one issue was deciding how long to wait before continuing any further testing or treatment. I was getting this during covid, the hospital and surgical waits were much longer, even screening rates were longer. People were getting, not just with prostate but other issues, were getting seriously ill because they weren't able to be tested or screened for whatever their health issue was because of the long wait times because hospitals were limiting access.
So that was that. And my comfort level in not knowing how rapidly the cancer was changing or spreading, if at all. Prostate cancers... Hopefully, God forbid you get the cancer, but if you get it's one of the better ones to get. They say that in thyroid because it's less effect and it's less progressive and so forth. In my case, I want to remind you why my urgency for free ratio because I was asymptomatic. I didn't have any symptoms, so this was a shock to my being. So the comfort level of not knowing how rapid, not knowing what the risk is of waiting, and even discussions about having the biopsies, you get a picture of an area, it's not a sense of what is the whole situation. And a lot of times, they won't know until they look inside. That's just the way it is. There's only so much imaging and blood work and biopsies can do. It depends on what you're dealing with, and then this was just my experience.
I also thought about what other tests could give a more accurate picture of where the cancer is. So one, you want to know it for yourself, two, maybe the physician wants to know it so he knows what he's getting into when he looks inside. Then I started to think of all the treatment options. So it was, "Do I want radiation? Do I want surgery?" I chose the surgery knowing some of the side effects and so forth because I felt, for me, it was a better choice. Some of the feedback I got was, "Yes, the radiation can work, it's targeted and all that," but there's always a risk of something coming back because all you need is to miss one cell. Let's face it. So what that means, if you have the radiation, it makes surgery if you're eligible for it, depending upon what the surgery did to you, it makes it much more complex.
So I chose surgery first because they said, "Okay, if you have the surgery, if you need the radiation or something, either immediately or 10 years from now, if there's a recurrence, God forbid, then it might hopefully make life easier for you." But again, that's conditions of how physically you are, your age, all that.
I also looked at the trade-off for the different options of what the short and long-term side effects are, what the recovery rate is, what to expect in recovery, what the ongoing post-treatment monitoring will be. In my case, I'm two years into it. For the first two years after the surgery, the protocol I'm under is the doctor of one of his surgical team, he trains a lot of people, will see me every quarterly. And then it goes to annual and then it goes to... Over five years, it's going to be monitored.
And the last question I asked was when I talked to a lot of people, "Who are the recommended specialists?" And I went and tried to talk to them to see who I could get into. And there's a lineup and they're not waiting for your call. So you have to negotiate to try to get, in some cases, you do your best and they try to be really good.
So that's sort of the thought process I went through. And I also thought because of my experience in healthcare, it's challenging for them, during covid and then just in general with the level of work of workload that these people are under, I thought, "How do I help them?" So do I do my blood work in a hospital and I get the test or there's also a clinic near me that could just do the blood work. The clinic in the hospital gets it quick, they can get it almost immediately. But it's downtown, a little bit of a hassle, going into a hospital where a lot of people are sick, maybe you want to go into a little clinic down the road that specifically does blood work and stuff. And that's what I did. And the tests are done and the results are generally made available that night.
So in actuality, my two-year, final three-month review is next week. I did my blood work this morning prior to this interview. Hopefully if all goes well, my results will be posted tonight, I can take the PDF and email them. What that does is, you got to look at it from a physician's point of view, they're looking at multiple systems trying to put together the information on you. It's not all necessarily in one record depending upon what hospital and system they're under. So that's search time that takes them away from care time. So if I could reduce their search time and give them more care time, I'm trying to help them do a better job, and then in turn they can serve me and their other patients better. So I would take that blood work and email the admin and say, "Here it is posted. Here's the number," and they know how to go on from there.
Another thing that helped me was I had dropped a lot of weight. I dropped about 45 pounds prior to surgery. I found some since, which is okay. Because I got a little concerned, I'm 66, and I think the last time the weight that I got to, I was probably 10. So I thought I was maybe a little too light and I dropped 20 pounds of muscle, so I wanted to put some of that back on. So that was that.
So now where am I at? One of the things they do, you're going to love this, when they prep you for surgery is they do a body scan. So they do multiple scans to get a sense of your body, and it's going to find every hair follicle you've had since you were in your mother's utero. Now the imaging isn't precise, so they can't always tell is it fat, a cyst or another cancer. So some people are terrified of those things. My position is it's an early warning system and a precautionary system. So I got, there were other issues everywhere. We're not sure what they are, but I said, "Let's get the specialist just to monitor me, should anything come arise from this." They may be absolutely nothing, but at least I'm being monitored by the right people. Hopefully we'll detect it with enough runway to fix it if they ever become something. And hopefully they won't.
So what do I do now? So now my priorities changed. When you go through something like this, you start looking at your life, you start looking at your family, you start looking at what you want to do and accomplish and all that stuff, and what bugs you. And what I try to do is not to be stressed over what a lot of other people find stressful. Just because of the experience. I had issues in my family taking care of a parent with Alzheimer's, mild cognitive impairment that became Alzheimer's. My wife has had health issues, my kids have had chronic issues. So I've been to all these clinics and I'm thankful. People used to ask me, "How do you take it all?" And I said, "I've seen the clinics and I've seen what could be, and I'm thankful for the problems I have." And so what I do now is try not to stress.
I remember sharing this with an executive at IBM where IBM where I used to work, and she said she worked with someone who was in the Vietnam War and he was in demolition, and one day he had a bad hair day and it took out a part of his shoulder. So he's got a metal plate, and she said that he said the same thing, after that kind of life experience, he doesn't get upset so easy over problems. And what it does is, one, it makes you feel better, two, it reduces your blood pressure, and you have a smile on your face. So that helps then, and this is something I'm still working on, deciding how to prioritize and use my life time. So what's important to me at this stage? What do I want to work on?
One of the reasons I'm here is because I want to improve the quality of life of people so that they hopefully don't have to go through what I went through or maybe sharing what I've gone through will help their experience be better. Because one of the things you got to deal with is... Well, you're confronting your own mortality for sure, but it's the stress of what you're going through, the wait times. I negotiated when I was doing tests that were lineup, wait times of six to eight weeks or more for tests, standard procedure for an MRI or something like that. And I just said, "Can I get on a waitlist? I can be there in 10 minutes, 15 minutes," maybe it took me 20. I got on a waitlist. I got to know the person in imaging, they liked me, they put me on the waitlist and I had moved my scan up six weeks. That helps my anxiety. And they only caution was I said to them, "I don't want to take someone's spot that might be in a worse position than me."
So I live in Canada, and this was during covid. So you book an appointment for the MRI and it's subject to whatever availability at that clinic or hospital. And in my case, I was able to move up. The wait time at the time was roughly two to three months. They weren't in a rush for me. Because you got to remember at the hospital level, they're doing triage, who needs it the most, who's most urgent. So in one way, it was a blessing that I wasn't most urgent that they could say, "Come in three months." But for my own peace of mind, if I could get in earlier, I wanted to move things along, as long as I didn't impact someone else in the queue that was in a more serious condition. I like to sleep at night, so I try not to do things like that.
It's just getting on with what's important in my life. I have this passion for helping tech companies develop their solutions, go to market, build market and so on. And with my passion for healthcare, I'm trying to blend the two together. So I'm looking at aging at home, digital health, what can we do in long-term care, all that stuff. One other key thought that I wanted to share was if you have a diagnosis, you got to come to grips with it yourself. But the other is hopefully your family is there to support you, friends and family, but you got to understand the stress that they're under too. And in some ways, you need to manage your state of mind and attitude towards what you're going through to support them. Your kids, your wife, partner, whatever, they want you around.
I did a lot of research. I understood this stuff better than my family did, better than some of the healthcare professionals I spoke to, but I'm not a healthcare professional. So you got to manage those feelings, both yours and theirs and take the support as you need it. Share whatever you're going through, let them share their feelings about it. In our case, we're thankfully a very tight-knit family and we try to shoot straight with each other. So feelings are on our sleeve, it's not on our face, in our eyes, in our tears. Whatever it is, we try to deal with it. And that makes it tough, but it also makes it good because there's a bond there and there's support there. And then there's a sense of maybe a deeper love or a different facet of love, I'm a hopeless romantic. But in some ways can bring you closer, and in some ways, hopefully it'll help you prioritize things about what's important in your life at whatever stage you're in. And some of the stuff that you thought was important, wasn't, other things come into things that are will be important.
Robotic surgery, thankfully it went well. A friend of mine was supposed to get it. After nine and a half years of monitoring, he was supposed to have his done months before mine, and he had other complications, they had to wait. So I was in a position to tell him how to prepare, and a few things helped. I spoke to someone who'd gone through the surgery before me and he said, "Do Kegels." It's an exercise to strengthen the muscles in the area, and that helps with your ability to control your urination and other things. And it's good for just building muscle. And he said, "You should do it before the surgery." It's always recommended after. I thought it was a great idea to do it before.
And the loss of weight and the Kegels I think made some of the recovery more comfortable. You do get a catheter for a couple of weeks, which is not the joy of life, but you'll get used to it. And can't wait till you get it out, but you'll get used to it. And in my case, I had it for about two weeks and that made celebration after the fact and navigation during the fact. And it was okay. It wasn't that big a deal, not the most comfortable position to be in, but it is what it is.
Then I like doing walkabouts. I used to walk about five miles, and I remember my neighbor came to me, a dear friend, and he said, "After surgery like that, you shouldn't be rushing to walk so far." I was shocked. I had some people at a study group I'm in who knew about the surgery, and to make them feel better, when I woke up the day after the surgery, I went on the Zoom call for the first half hour. And the guy looked at me and said, "What are you doing here? You're probably still feeling the anesthetic." And I wasn't a hundred percent there, but I was on my way and I wanted to do it for me, I stayed on for half an hour, and for them because they were concerned about me to help them feel better.
But yeah, hey, robotic surgery is challenging, but I felt that was my better choice. And I think I was in the hospital for, I think it was maybe two days at most, three max. And the nurse taught me how to manage with the catheter to do other things. She gave me, I got a loot bag to go home of medical stuff for treating me and all that, and band-aid or whatever I needed.
During the period, I just took it easy, just navigating yourself with the catheter. You're walking around with this bag, but that's fine. I actually looped it on a pair of shorts and just walked around the house with it. But you just have to be careful sitting down and getting up. And overall, the way the robotic surgery works, they put in a couple of minor small incisions that are pinholes and one larger incision, it's a couple of inches. And relatively speaking, they healed. There was some muscle just above the navel where they make the larger incision of maybe two inches. And because they're cutting through muscle, that takes longer to heal. So I didn't do sit-ups and some of my core exercises for a while. Or actually I was, and then I asked the surgeon, "Should I be doing this? Am I going to hurt myself?" And he said, "It's okay, but you could do a little less and then go back to it."
And then I devoted my time to that, to doing my own reading and other stuff, doing things, enjoying music, trying to get together with friends where possible, just to help with the recovery. And then I started walking again more and more to ease into it. And I was lucky that that worked for me. And the family was there. We had heart to hearts about what they were feeling and worked ourselves through each other and in support of each other through it. And I'm here to say that it's still going on.
My hope in this conversation is that I've given you some food for thought. Your life circumstance is different. All I'm asking you to do is think about this. If you think it's relevant to your life or someone you know, share it. And two, have that discussion with your family physician, what's right in your life circumstance. At least get that PSA test done and a free ratio every so often, just as a marker for your own set peace of mind. But that's your choice. I'm not a physician, I'm just someone who's been through the experience. So if there's someone who wants to chat about it, my email will be at the bottom of the video on the website. Good luck everybody, and stay healthy. Be well.