Prostate Cancer Diagnosis: No Health Insurance but I'm Still a Survivor!

According to the Census Bureau, the number of Americans without health insurance coverage is at its highest level on record. In percentage terms, 15.6 percent of Americans - almost one in every six people - were uninsured in 2003, an increase from 15.2 percent in 2002. This is not just news to report; this is becoming an epidemic in one of the richest countries in the world. Many of us scratch our heads and wonder how this could be.

Meet Haskell Smith, a 50-something working class man, in pretty good health by all accounts - with the exception of managing asthma over the years. Mr. Smith worked hard, paid his taxes and was by most standards, an upstanding citizen. As a hardworking American citizen, even with a full-time job, he was without healthinsurance.

Haskell Smith had only been hospitalized for severe illness once, maybe twice in his lifetime. In fact, the last time he was sick was in the late 80's when he had a bout with pneumonia. Although he didn't have healthcare coverage, he was in pretty good health, or so he thought, and managed to control his asthma with over-the-counter medication. It wasn't until he was in need of his asthma inhaler and went to a local pharmacy to get his over-the-counter med (as he'd done for years) that he ran into the issues of not being insured. "It was kind of unusual how this all came about." says Mr. Smith. While at the neighborhood pharmacy to pick up his routine asthma medication, he was given the shocking news that his over-the-counter medication had been pulled from the shelf due to government regulations. "I had been getting Primatene Mist asthma inhaler over-the-counter for years." Confused, upset and concerned about his health status, Mr. Smith began pondering how he would get the money to afford a doctor's visit to treat his asthma. The grim reality of not having health care insurance had finally come home to roost.

I Don't Have Health Insurance, Now What?

April 2007 - Mr. Smith was only making enough to live - no savings, just his regular paycheck that seemed to serve him well enough until now. He began his search for a low-cost clinic and it became quite an intense search as his asthma symptoms began to worsen. He explored county and social service referrals but since he was employed, he would have to pay market price to be seen by a specialist. The thoughts of the financial burden only made matters worse, but destiny began to work and Mr. Smith was referred to a non-profit clinic in his city, The Charlotte Volunteers in Medicine Clinic (CVIM) because of his financial constraints and his dire need for medical attention. Mr. Smith was relieved to find a low-cost clinic that wouldn't burden his finances and one that would attend to his medical needs. Unfortunately, it would be a couple of weeks before he could be seen at the clinic. This was yet another hurdle as he was really struggling to breathe without his asthma inhaler. He was even using a friend's used inhaler to carry him over until a doctor could see him. Mr. Smith recounts, "It was bad. I mean, I was having terrible trouble breathing and to add on a couple more weeks of waiting, man I was praying that I'd make it."

Mr. Smith's wait finally came to an end; however, it would also be a defining moment in his life that would change things permanently. He met CVIM's provider and Executive Director, Donna Murray Lacey and shared his story of how he found her. She was sympathetic about his dire need for an asthma inhaler - in fact, he needed one that very day. Lacey, a Physician Assistant, was touched by his need and took care of him right away, but before she released him, she asked him about his regular medical check-ups. Just as she'd suspected, since he was uninsured, he wasn't attending to regular check-ups. Donna gave Mr. Smith a routine health questionnaire to explore his familial health status and uncovered that his mother died of cancer, his grandfather died of cancer, and an uncle had also died of cancer. Donna informed Mr. Smith, that although he seemed to be in good health, it was imperative for him to be tested for prostate cancer as he was in the "high-risk" category. "He fit the profile. He was over 50 years old, African-American male and cancer existed on both sides of his family." She explained. Mr. Smith nervously went along with her recommendation for a PSA test. Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood. A blood sample is taken and the amount of PSA is measured in a laboratory. Because PSA is produced by the body and can be used to detect disease, it is sometimes called a biological marker or tumor marker. benign (not cancerous) conditions can increase PSA levels. As men age, benign prostate conditions and prostate cancer become more prevalent. Normal levels of PSA in the blood register between 0 and 4 on the scale for a male in his mid 50's. However, for Mr. Smith, his test revealed results in the double-digits - 33 to be exact, "It was about two days after my visit with" Dr. Lacey" and I was going to call her and thank her for having such a caring heart and writing me up a prescription for my asthma medication, but before I had a chance to call her, she was calling me." recalls Mr. Smith. Donna had some grim news to share with her new patient, Haskell Smith - his PSA levels, were off the charts - the prognosis was in question. Donna would have to recommend that he begin a series of tests to determine whether or not he had prostate cancer and how advanced it was. Haskell Smith was facing one of his greatest fears - he had tested positive for prostate cancer.

The Darkest Hour and the Greatest Light

September/October 2007 - Mr. Smith immediately began a series of tests to further explore if his diagnosis for prostate cancer was indeed, positive. Twelve of twelve tests confirmed Mr. Smith tested positive for advanced stages of prostate cancer. Devastated, confused and afraid, Mr. Smith asked Donna, "How long do I have to live?" She encouraged Mr. Smith and shared that his cancer, although advanced, was treatable and helped him to focus on his options. Although all twelve tests confirmed a cancer diagnosis, it had not spread to any other parts of his body which was miraculous, given the severity of the stage he was in. He immediately began a normal treatment, which is an injection similar to radiation inserted in his blood stream to counteract the cancer cells. He was advised to return to the doctor after three (3) months to check his prognosis. After three (3) months, he returned to the doctor and was given even more shocking news - his PSA levels had decreased from 33 to 0.4! There were almost no PSA levels in his blood anymore, however, it didn't rid him of cancer, it just meant, things were manageable. The only way to be sure was to have surgery to remove the affected prostate tissue. Mr. Smith decided to choose the sure way and opted for surgery. On October 24, 2007, Haskell Smith had surgery to remove his prostate.

December 2007 - As of December, Mr. Smith's PSA level is now completely at zero! He is in remission and has to see a Urologist to monitor things twice a year for the next six (6) years. However, if things stay just as they are, for the most part, he'll have a clean bill of health and declared cured. "Dr. Lacey saved my life. If it wasn't for her having a caring heart and being concerned about my lack of health insurance and how I was not taking care of my health, I wouldn't be here today. Technically, she wasn't supposed to see me because I live outside of her district for accepting new patients, but she took me on as a patient anyway and I'm forever grateful." Mr. Smith is now recovering from his surgery with high spirits and great expectation for living, "I tell you, if it wasn't for the Lord and "Dr. Lacey", I just wouldn't be here. I'm here for a reason, I have a purpose. It's like destiny intervened through an inconvenience that saved my life. The asthma medication is now back on shelves - isn't that something else!"

Mr. Smith urges African-American men over age 50 to get the simple test that could save their lives, "I urge men to please go out and have the PSA blood test done - it's just a simple test that can set them on the road to good prostate health. No one should have to die from this disease because it's 100% treatable if caught in time.

Risk Factors

There are certain risk factors for determining your need to have a PSA test which include:

§ Age - 50 years and older

§ Race - Prostate cancer occurs more often in African-American men than in men of other races

§ Nationality - Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands

§ Family History - Prostate cancer seems to run in some families, which suggest than in some cases there may be an inherited or genetic factor

§ Diet - The exact role of diet is still unclear, however men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer.

Donna Murray Lacey, PA-C and her staff at The Charlotte Volunteers in Medicine Clinic are grateful to patients like Haskell Smith who entrust their health care to them. They are also grateful to the supporters and philanthropists who make it possible through donations for them to serve the underserved community and those who cannot afford health coverage. To learn more or to see how you can make a difference, please visit www.projecthealthshare.org.