1 – Mike Riordan, Charlie Rinehart MD, and Paul Roach MD embark on a full discussion of Bladder Cancer: what it is, how it happens, how it behaves, and how it’s treated.
2 – Guest: Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego. Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois
3 – Timestamps relevant to points within the episode, in this format:
[00:24] – Intro & Charlie Rinehart, MD
B. Dr. Rinehart background & training.
[06:22] Overview of Bladder Cancer:
A. Incidence and Epidemiology
B. Clinical Presentation
C. Urinary system
[14:10] Hematuria and how is bladder cancer causing me problems?
A. Hematuria & its workup
B. Male / Female incidence & etiology.
i. Smoking Factors
ii. Occupational factors
iii. Low, Medium, High Risk
[21:06] Initial Workup of Bladder Cancer
A. Cystoscopy & Biopsy
B. CT Scan
[26:45] Tumor Grades and Depth of Invasion
A. Tumor Grades
B. Tumor Depth: Muscle Invasive and Non-Muscle Invasive
[36:00] Treatment & Surveillance of Non-Muscle Invasive Disease
C. Why not bladder screening for everyone?
[40:50] Local Invasion & Metastasis
A. Pelvic organs
B. Lymph Nodes
C. Metastatic Behavior
D. Bladder removal (Cystectomy) and reconstruction
[50:00] Preventing progression from Non- to Muscle-invasive disease
B. Chemotherapies and Radiotherapy
[54:00] Bladder Cancer Endemic to East Africa & Middle East
Welcome to Fixing Chicago: the podcast focused on “what right looks like,” and, how to achieve peace, educate the kids, restore vitality, and reinvent Chicago for success moving into and through the 21st century
I. Today’s guest is Peter Wagner, from Oak Park, Illinois, and the topic is “Connecting with the City on a personal level.”
A. Growing up & Education
B. Work Experience
II. Work as a tour guide throughout Chicago: Getting the job? What did it entail? Who would you take around? What were their impressions of Chicago, and their favorite places?
A. Personal interest and commitment to Photography
B. Photographing Chicago, Chicagoans, Aviation, Car show, tell us about the Chicago Photography scene…
IV. Volunteering at Children’s Memorial Hospital: What has been your involvement with the hospital? What was it like? What do you feel you brought to it? What did it give to you? Tell us about the kids…
V. Closing: Thanks again for listening and if you have a topic you would like to have us discuss, or comments or feedback please either log on to http://www.paulbryanroach.com and click on the “about & contact” page, or send them directly to “email@example.com”
4 – [17:45] Dr. Steven’s decision to go to Ukraine
[19:00] Getting there and getting started
[24:45] Ukrainian medical system & fitting Into it during wartime
[33:20]Joys & Sorrows of Volunteering
[41:24] Who is helping them?
[46:05] What kind of help is best?
[50:00] Closing and Slava Ukraini
5 – Key Takeaways:
Ukrainian defense an existential situation for the country of Ukraine, and for democracy in Europe
Medical system there improving from Soviet times, but still challenged even before Covid, and the stress (and the intentional targeting of it by Russian bombs) of the war
Volunteering as a Medical staff is rewarding and needed but to be effective, some command of the language is essential; and, issues such as medical supply and medical logistics may be as or more important than physicians lending a hand.
6 – Signout: Please “like” us on social media and follow us on your favorite podcast platform. Comments and feedback, as well as suggestions for topics and guests: https://paulbryanroach.com/contact/.
“What a gorgeous Spring day,” I said to my colleagues as we began our 30-hour shift at a downtown Level 1 Trauma Center.
“Ugh!” they groaned in unison. “We’ll be crazy-busy tonight.”
Chicago and Suburbs have a security problem that’s determining the area’s fate: Murder, crime, violence, intimidation, lawlessness, unaccountability, and administrative paralysis are without question ascendant and widespread here. These terrible forces characterize us both internally (within city/suburban areas) and externally (how the world sees us). The security problem we have in Chicago dominates the collective landscape. It holds the populace hostage. It destroys our peace and prosperity. It is taking the city down.
The problem impacts every aspect of our society, and every social stratum. Most acutely it degrades the life, liberty, and pursuit of happiness of our lower-income populations. The pain and misery of loved ones, friends, and neighbors lost to the violence and/or crippled by its whims; the daily accounting of neighborhood, work, and school shootings, robberies, and run-ins with outlaws; the consequent neighborhood blight and disinvestment; the functional loss of public spaces and parks; the surrender of public transportation; the stress, fear, emptiness, and bitterness creeping into each corner of one’s life; the generational effect upon children —pervasively traumatized— whose worlds and world-views are influenced and defined by the lawless environment around them, and who adapt to and accommodate the reality they’re presented with making it normal and oftentimes, permanent.
Aside from ruining individuals’ lives and ruining children’s futures, it is also driving away small business (ref: looting and theft), and big industry, both of which find other cities more safe and hospitable to its employees. Also lost is “opportunity cost:” things which could be built and which could evolve in the future, but don’t. These are harder to measure but in a fast-paced world they’re critical to maintain –otherwise we withdraw ourselves from the front tier, and we are left behind.
Criminality, organized and unorganized, has been prominent in Chicago and Suburbs for over a century. Al Capone, for example, did not invent this; he was part of a network already in place, and merely rose to its leadership. The city’s Security problem existed before him and has been a constant feature ever since. So you may ask, “How is it a ‘crisis’ then, when it’s been going on for over a century? What makes things different, now?”
I believe two things make it a crisis and make it different now:
(1) The national political apparatus no longer functions. Like a pair of addicted parents, both national political parties have become self-obsessed, self-destructive, and more captivated by the resonance of their own bloviations, and by the piques of their private grudge-matches, than by fixing the real-world problems the rest of us face. The far-right is fascist, the far left is socialist, and the supreme court has gone rogue. They cooperate on just one single thing: creating a new, worse, USA. And they’re succeeding.
We the people are subject to pure and ceaseless chaos. No help is going to reach us from above. In fact, only anti-help has been coming from above; and if we are going to survive, we as a city, as a region, perhaps as a state, are going to have to save ourselves. It’s a hard reality and a damning one, but the sooner we understand and accept this, the sooner we can begin.
(2) Civic and community support for police, policing, and the criminal justice system have eroded to a highly consequential degree, rendering the city functionally defenseless (or “immunocompromised” in Medical parlance). The security structures (Police, Policing, and Criminal Justice) are critically degraded. That’s where we need to put all our efforts, right now! Because that’s the immediate threat to life. If the security situation is allowed to persist or even worsen, well, we’ve all seen what happens next: peace and prosperity leave the city for dead. It doesn’t take long.
What do we do about it?
After a gunshot to the chest or neck or abdomen, for example, Step 1 in the management process is to first, stop the hemorrhage. Nothing else gets done ahead of that. Nothing else matters ahead of that. The patient is bleeding to death. It sounds simple, but it’s powerful: stop the bleeding. It gives you a little bit of time, enough to plan and execute your next moves. Similarly, for the city which is quite literally being attacked in an analogous way, I submit that the first step in the management is to reclaim order and control of our neighborhoods, schools, highways, parks, and trains.
Ultimately the best solution for that will be to address and remedy the root causes of bad behaviors such as creating better neighborhoods, schools, cultures, climates, and opportunities for our children, so they never join a gang or become a criminal in the first place. But that is a slow-build. It will take many years, many decades. And regardless –and here is the crux of it– none of that can begin until the place is made safe, anyway. It’s not the other way around. Step 1 in this crisis –the first solution– is that we must reassert control. We must create safety. Peace is achieved. We must stop the hemorrhage before it’s too late.
How is it to be done? Prelude: if it were easy, it would have happened already.
Culture of Violence. We must accept that Chicago is our problem to fix. Nobody is going to do it for us; in fact, we’ll need to tune out the rest of the national dialogue, as both sides have gone lost touch with reality. The overall remedy begins with fixing our culture of violence. Like an evil spirit genie conjured up over a century ago and sustained ever since (a malicious “egregore”), this violent culture that belongs to nobody and to everybody at once, that has no shape or form but exerts a sustained, profound influence upon our present and our future, it must be confronted and it must be overcome.
Land of the Free. We cannot adopt the complete and autocratic state-domination approach that China has taken: We have a culture of Freedom. We have a Bill of Rights. We respect the value of the individual. Liberty is at the very center of our Democracy. Whatever we do, we cannot create the invisible cage that China has created. We must do better than that.
Police, policing, and criminal justice. We must develop the best police force and criminal justice system in the country; perhaps in the world. Somebody already has that; weneed it(!), and we need it now. That should be our “moon shot.” Not the opposite. Not the antagonistic approach to policing we hear from city hall. Not the porous approach to dispensing justice we experience when those who commit crimes are released to keep doing so. We can no longer afford to elect people into positions of authority who are reluctant or unable to do their duty to protect us. We as a population need to set this as our collective goal, rank it above other goals, and we must work together to make it a reality.
Investing in the police and making our criminal justice system the most effective in the country, these two improvements are fundamentally necessary to stop our city from cascading into chaos; they are preconditions to the emergence of a better culture. They must be in place before we can drive a new narrative for Chicago; one that evolves out of the century-old legacy of crime and murder for which we are unfortunately known across the world.
We must attract the highest talent to our police force and to our courts of law, and we must learn and adopt the most modern and effective techniques for both. We must make the Chicago Police Academy the envy of every other police department there is, and develop our officers professionally and continuously throughout their career. We must do the same for our attorneys and courts. We must promote the ablest leaders and demote those who are not. We must define valid, reliable, practical standards for policing and adjudicating this complex, international, 21st-century city, and then meet them. Then we must all support our force in what is the most difficult, hazardous, and essential job the city has, and be grateful for and take pride in the peace and prosperity they enable with their work and modern professionalism. And we must care for our police who are injured or traumatized in the line of duty because theirs is a tough and dangerous and never-ending task, and we honor it by caring for them.
I am an ordinary citizen. I very much believe we in Chicago are at an inflection point. Many others do as well. The Chicago streets and trains and schools and shopping centers must get safer or we will soon lose this amazing city. It’s happened to other cities; it will happen to ours. The loss may not happen overnight but by the time we realize that things are beginning to crash we will be too late in the process to reverse it. I believe there is no “war on crime” for us or “war on drugs” or “war against terrorism” that makes any sense, here; there is only the necessary realization that our first priority must be the day-in, day-out safety and security of our citizens, businesses, and institutions and that in the 21st century / digital age / global village in which we all now live, how that is done will be a mix of classic wisdom and common sense (as a primary basis), with a variety of new technologies, ideas, values, and techniques added on top.
Yes, there is much, very much to do on so many other fronts, but we must stop the hemorrhage, first, or there will be no patient left to save.
1 – Intro: Interview with History Teacher John Turek on the importance of teaching and learning History to children, the practical value of knowing your local history, the joys of teaching junior high students, and how we can understand and improve our city by knowing the history of other cities.
2– Guest bio: John Turek is a recently retired History teacher (30+ years) within Chicago and Oak Park areas.
[00:30] Intro to John Turek, History Teacher, and his background
[03:30] What draw into Education
[07:30] Why study History?
[10:30] 4 key ideas on History
[14:30] Teaching Junior High Students
[17:15] What historical examples apply to Chicago today? For example, the Chicago Machine.
[24:00] Is this the first time this has ever happened?
[30:00] Sit, Think, Read, Analyze
[32:00] What does one city have to learn from the history of another city?
[36:35] You should have seen that coming. Do your research.
4– Key Takeaways:
—Need to study History to understand context of your life, generate meaning, and understand the others around you. Also, Biological perspective: H. sapiens the only species so minimally instinctual, and History learned from elders, others, imparts survival value.
—4 key ideas on History: customs (learned ideas), values (what a certain culture considers to be important), Institutions (families, schools, hospitals), and Beliefs (what a certain culture believes to be true). Most of what we now think we know comes from a “cultural” perspective. These help us understand “why I do the things I do.”
—The reward taken from student growth, and from your own growth and adaptation as a teacher
—Chicago’s 77 different cultural enclaves & have their own sense of place : if you know the history of your enclave you can see things that you didn’t understand about your present.
—Know your history, but be careful of the history you do read. Understand where your history is coming from. Do your Research.
So doc, it’s Cancer? is a podcast dedicated to being a “how-to” manual for cancer patients and their friends and families.Each month we will work through different elements of the overall problem, “from soup to nuts” as they say, beginning at the beginning such as the the basics of what cancer is, who may be at risk, who is involved in the treatments, why treatments differ so much from one cancer to another, or even within the same type of cancer?The podcast will work through to the various possible outcomes, and quality of life.
Why? Need for physician-led podcast series that is patient centric.It helps to have a chat with your physician, only, that chat is usually short, emotional, hard to remember, and often only a beginning.
Hosts: Paul Roach – Surgical Oncology; Courtney Coke – Radiation Oncology; Pete Schlegel – Medical Oncology; Mike Riordan – Graphic Designer
It’s Memorial Day in the USA and I just had the extreme pleasure of being on the sidewalk waving and clapping at our annual neighborhood Memorial Day Parade with close friends of ours and their neighbors and everyone’s pet dogs. Fire trucks from the surrounding six suburbs, Police cars as well, local politicians, marching bands, boy scouts, martial arts clubs, tumbling clubs, grade schools… you know the drill. It was fabulous.
Turns out, that’s one of life’s most generous and rarest pleasures.
It struck me, watching the happy parade in our suburb that borders Chicago as an urban war of its own rages just inside the city limits and in other neighborhoods around ours, how Peace and Prosperity are always achieved. They are not the baseline from which matters deviate. Rather, they are theheights to which we as individuals and we as communities and we as societies may aspire. And it struck me right between the eyes this mistaken assumption (that Peace on Earth is a baseline state) is a root cause for many of our societal troubles. The baseline state is actually chaos and misery; that’s what everything descends into, if we’re not careful.
Yes, that is it! The wild-eyed folks on the side of the guns bloviate that arming ourselves to the teeth (“harden the grade schools!”) is going to somehow make us safer and more prosperous (they’ve never been in Afghanistan, obviously, where John Q Public owns an AK and frequently a rocket propelled grenade launcher), and the wild-eyed folks on the side of the oppressed and disenfranchised bloviate that it’s wrong to arrest or prosecute crime when it happens because the person was obviously oppressed and disenfranchised (which fact only makes the other side angrier and more convinced about the need for personal weaponry), and they’re all feeding off this grand assumption that the peace and prosperity which we do have, that this Memorial Day Parade in front of us, happens and continues to happen no matter how much they alter and degrade the system that produced it. Wrong. This peace and prosperity can be broken quite easily. And they’re both breaking it, each in their own ways.
I’ve no idea how to counter such notions other than to encourage everyone to look not to me –who am I, I am nobody– but to History for lessons. Let us learn the right lessons from those who’ve experimented with all of this before us. But what are the right lessons? Here are my thoughts:
I recently took a fascinating and extraordinarily disturbing trip through modern history in the version of a couple of biographies (listed below), a history on the Soviets’ daily lives (The Whisperers) and then capped it off with a three hour podcast on the unspeakably evil horrors of the post WWII Soviet state (Martyrmade podcast: episode 19 the Anti-humans –if you dive into anything I’m suggesting to dive into in this article, dive into this podcast episode).
Why did I go down this path? I needed to better understand the history we Westerners collectively lived through one generation ago (how quickly we forget), and, I suppose I needed to better understand the design and construction of the US government –particularly were the framers of our Constitution expressly intent on creating a nation where dictators in whatever form could not emerge or if they did, could not remain for long? Was avoiding a dictatorship the sine qua non for the framers of our Constitution? (I believe the answer to that is “yes.”)
The reason for this focus on that period of Western history should be obvious right now: Vladimir Putin, Xi Jinping, and an assortment of lesser dictators all focused on disrupting the primacy of the Western-led world order. It’s relatively peaceful here in the USA, for now, but agents are afoot….
My learning excursion began with Vladimir Ilyich Ulyanov (22 April 1870 – 21 January 1924), who is better known by one of his pseudonyms, “Lenin,” founder of the Russian Communist Party (the Bolsheviks), inspirer and leader of the Bolshevik Revolution (1917), and the architect, builder, and first head (1917–24) of the Soviet State. It lead me from there to Ioseb Besarionis dze Jughashvili otherwise known as “Josef Stalin” one of the most notorious killers in the history of the world.
Why them? Because as I mentioned I was wondering about our politics these days: the left-right polarization, the lack of a middle ground, the hysterics, the fascination with the sound of one’s own voice and of staking out one’s theoretical stance combined with the complete lack of interest in listening to anybody else’s… and I wanted to learn about the history of such polarized arguments. What are those who have learned the hardest, bitterest, brutalest of lessons, what are they –from the tomb– trying to tell us now?
As JFK put it so well, “Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought [Commencement Address at Yale University, June 11 1962].” Or as my Mom used to tell me, “Two ears, one mouth;” in other words, listen first. We’re not listening.
Lenin was the perfect example of someone with an extreme political opinion (his happened to be on the Left; the Nazi’s next door would form an equal and opposite position on the Right) who absolutized the worldview of his chosen sect of society (“The worker,” although some say he’d hardly ever met one) and he doggedly used that new ideology as a lever, exploiting all to catapult himself into power, establish his agenda, and when that agenda failed (it was an untenable concept all along), he altered his ideas to set in place a reign of terror to at least maintain the power; he forced the ideology into functioning in reality and who paid the price for that? You guessed it: the worker! The very individual he had professed to support.
He was Godless and Communism is Godless, and why that is important hearkens back to the original issue I brought up of Peace on Earth: unless you put love and human values in the center of your ideology (notice I didn’t say “religion,” as those suffering under the Iranian Republican Guard Corps can likely attest), you will get a society that doesn’t care about individuals. And that’s exactly what the Communists got, and it’s what they still have. The lack of concern showed then in the way they murdered and destroyed tens and hundreds of millions of their own not to mention others; and it shows now, in the way the Tibetans have been wiped off the map and in the way the Uyghurs are being wiped off the map, and in the way civil rights in Hong Kong are wiped away…
After Lenin came Stalin, who many historians say was worse. Stalin needed Lenin, of course, to get the thing started. But he took off from there. Read this biography! Read “The Whisperers!!” Books / histories like these are essential to understanding where we’ve been, to understanding why we celebrate Memorial Day in the USA today! We MUST learn and understand what has gone on in the past, if the present is to make any sense at all.
I wonder about our current turmoil within the USA. No one is overtly attacking us at present but we are certainly attacking ourselves. Where did these insane times originate? How did the USA become as ungovernable as Beirut? Was it the gerrymandering throughout every state’s electoral map? The 100+ Cable news stations that have to make up “news” even when there isn’t any? Internet search-engine bubbles? Social Media’s machinery amplifying the impact of fringe idiots? Economic disparities more drastic than pre-revolutionary France? The loss of focus on Humanities in American high school and collegiate education?
It’s moments like these I wish I had been a History major.
Back to Lenin: the context of Lenin’s rise was the lingering reign of the Tzarist Russian monarchy (the Romanovs and Tzar Nicholas II), and the faltering of that entire system of governance. The wealth gap in Russia at the time was astounding, the secret police (the Okhrana) highly intrusive and dangerous, the middle class was more or less nonexistent and categorically blocked from progress, anyway. Further context is Lenin’s father being laid off of work, and his brother being hung for being a revolutionary against the Tzar. The Industrial Revolution was raging through Europe, and Russia was behind them already, and getting further behind every day.
Lenin was a brilliant mind but he was a kook, an exiled wing-nut, a whack-job. We’ve seen it a thousand times how you can have a smart mind that is clever and effective but its fundamental assumptions are wrong, and therefore everything that the mind produces is wrong. And I’ll allege here, as I did a few paragraphs up, that what was wrong was Lenin ascribed no unique value to the individual and absolutized the state’s priorities alone. The Menshaviks were far more reasonable than the Bolsheviks, but somehow [read: ruthlessness] the Bolsheviks won out. Once again, how did an entire country fall for his bizarre ideology? And more to the point… will we in the USA fall prey to a similar kind of idiot, some day?
I tried to begin by looking at the beginning. Peter the Great in the 1600’s and Catherine the Great in the 1700’s… they tried to modernize Russia to be more like Europe. During the second half of the 19th century, a faction of so-called “Slavophiles” emerged in intellectual circles. These “Slavophiles” were convinced that Peter the Great made a mistake in trying to modernize / Westernize the country, and that Russia’s “salvation” lay in the rejection of Western ideas. The Slavophiles apparently believed that while the West polluted itself with science, atheism, materialism, and wealth, they should return to a simple peasant-based society centered on the Orthodox faith.
I went through the entirety of Napoleon’s attack of Russia a century earlier, Tolstoy’s “War and Peace,” prior to that. Fascinating book, by the way; I highly, highly, highly recommend it.
I tried to see what happened in the century between Napoleon’s invasion and the Bolshevik revolution. Best as I can tell, while Europe had its Agricultural and Industrial Revolutions, and had the Enlightenment as a social development Russia reinforced the Middle ages in its Serfdom rule and became farther, and farther, and farther behind its neighbors to the West.
Ultimately the strain was too great and the Communist cataclysm was the result.
I wish for a solemn and meaningful Memorial Day for everyone, and please remember that the peace and prosperity we enjoy at the moment is no accident: it is the result of generations, centuries, even of countrymen and individuals working together –imperfectly, yes; very imperfectly working together– and sacrificing and holding a particular ideal above all others. And remember that whenever tempted to tinker too much with the formula and cultural norms that have gotten us this far, to think about it some more and try to put the great ideas we have at the moment into historical context and see if anyone has tried them before, and see where that got them, then. Maybe your great idea needs to be implemented in order for us to move forward? But maybe with respect to your great idea the experiment has already been run (in Soviet Russia, or Iran, or Afghanistan…) and it’s worth a second look before widespread implementation?
Lastly, although above I’m primarily focused upon our fight against post WW-II Totalitarianism and the meaning behind all those who gave their lives opposing Communism whether in Korea, Viet Nam, or elsewhere, let us not fail to honor all those who have given the last full measure in the war against Terrorism whether Iraq, Afghanistan, Somalia or elsewhere. None of these conflicts have been unalloyed or perfect or beyond criticism but that’s not my point: today is the day to honor those who have given their lives in the intent to make a better peace for the rest of us. Today’s Memorial Day Parade is their gift to us, and what joy we feel in and through it, is for them.