About Ed Mahoney

I work in the computer security industry and live in Colorado. I also write fiction. My novels Cyber War I and Full Spectrum Cyberwar can be found on Amazon.

Happy New Years

prostate-cancerLet me wrap this up with an end of year summary of my experience with prostate cancer.  I could have written more after that last blog but really, I don’t think about this much anymore.  That might sound odd but it’s true.  Eight months after my prostatectomy, my recovery is complete enough that I am no longer preoccupied with thoughts of cancer or measuring my recovery progress.  Only one relative asked me about it over the holidays and I was fine with that.  I’m done bringing it up.

I should relate my experience with the penis pump.  I asked my Urologist for one because I wasn’t satisfied with my erections.  I began to obtain erections fairly quickly after surgery.  They grew more robust with each passing month.  I only took the 30 day sample of 5 mg Cialis and never asked for refills because I believe my extreme running has my blood flowing strong.  My issue with erections has been two-fold.  I had not been able to obtain a boner without a helping hand.  And it would not remain hard during intercourse.  Talk about frustrating.  I got over my initial immature concerns with the pump and determined to try it in an effort to avoid prescription medication.  I’m not totally against meds but I do feel they should be a last resort.  Also, I never noticed any benefit from the 5 mg sample of Cialis.

I found the pump to be a bit of a process.  It’s fairly simple if only using the vacuum to create an erection.  But much more complicated if you apply the ring to clamp the blood flow.  And good God is that ring ever uncomfortable.  I could never imagine actually having sex with that rubber band around my shaft.  Maybe if I was into S&M, but I’m not.  It works fine though to spring a stiffy.  My Urologist suggested therapy to me during our last visit when I related my requirement for physical stimulation.  I declined.  I can’t see myself in therapy.  And I really do improve measurably each month.  In fact, I woke up with a boner on Christmas Day.  Talk about a Merry Christmas.  This was a first since surgery and a very welcome gift.

I wouldn’t say I’m 100%.  I’ll never be 100% again.  I aged from this, both physically and emotionally.  It still bugs me not to ejaculate during orgasm.  That takes some getting used to.  But I do orgasm.  There are worse things.  Overall, my quality of life is fully back and probably better than most men my age.  In my first race after the surgery, I ran a PR 3:31 marathon.  One minute shy of qualifying for Boston.  After ten years sporting a buzz cut, I’ve purposely grown my hair long.  My bangs are down to my nose.  I’m not stupid, I know I’m compensating for having lost my prostate to cancer.  But after all this, it feels good to know that at 52 my hair still grows like a weed.

At the end of the day, I feel very fortunate.  I am 100% cancer free.  I don’t consider myself at all unlucky to have prostate cancer fifteen years below the average age.  My youth made surgery an option and enabled me to recover much quicker than average.  I won’t have to worry about prostate maladies when I’m 65.  I’m good.  I’ve been able to advise a couple of men after they read my blog, and several more have thanked me for chronicling my story.  Happy to share.

Climax

iStock climaxMy story is nearing the end.  I doubt I’ll have much more meaningful content to share with you regarding my experience with prostate cancer. I completed my final physical therapy followup this afternoon with Jenn. I would consider continuing to see her for running-related injuries and whatnot. She’s good. And after our initial encounter, I feel sort of close to Jenn now. Her specialty though is pelvic floor related health issues, not aging runners.  I know because I asked.

Turns out Jenn has quite extensive experience in a number of PT disciplines including spinal hip abductioninjuries and head trauma.  She spent some time reviewing my leg muscles and determined – big surprise – my left side is weaker than my right.  Either from or as a result of that, my right leg is shorter due to a maladjusted hip.  She recommended some hip exercises: the hip abductor, hip adductor and clam shell.  All seem relatively simple.  I plan to try them out to strengthen my left side in an attempt to mitigate future running injuries.

With my urinary continence now under control, I intend to speak to my urologist about where I am with ED on our next visit. I forget when that is exactly but we are to meet quarterly for the next two years. Essentially, I’m fine with erections. Well, marginally functional. I’m less fine on the topic of climax. I actually can’t tell you if I’ve had one or not. I believe I have but the experience is that slight.  My penis experiences contractions, but they generate only a fractional sensation of what I remember an orgasm feeling like. It makes perfect sense to me that my nerves need to fully regenerate throughout my pelvic floor, which I am told will take a full year. But I still would like to understand more details on this topic. The one thing I have learned is my Urologist tends to share information with me as he thinks I need it. That’s probably fair because if he told me stuff too far in advance, I would not be focused on it and would forget half of it. Considering I have erections though, working toward a climax seems like the logical next step.

In fact, I’m in the mood now for a thorough understanding of the post-prostatectomy experience. And I’d rather the information come from my doctor because googling this topic is polluting my computer with nefarious URLs in my browser history. I bet you didn’t know about prostate massages. I do now. Seems like the sort of thing that would have maybe been useful to know about before I had my prostate removed. Nurses advertise online to provide this milking service. Well, at least I think they are nurses. They say they are nurses and that a prostate massage promotes good prostate health. That and Saw Palmetto should keep your prostate cancer free. Seriously, click on that link above and look into it.  Become an expert on the topic.

I bought a book two weeks ago on erectile dysfunction and post-prostatectomy orgasms from Harvard Health Publications.  Ironically it just arrived in the mail today.  One might think you could only read about such topics on the Internet but Harvard is bold enough to write on these topics in hard copy.  Not so sure I’m comfortable letting the book sit out on the coffee table.  I’d prefer to download a copy to my Kindle so I could read it more privately.  Looking very forward though to the content in order to become more informed on the topic.

If this does in fact turn out to be my final story to this blog, I hope you do well.  And I hope you found some of my stories useful.  I will know when I have comments and will of course reply back.  You can remain anonymous.    Don’t hesitate to reach out.

Turning Japanese

Godzilla“No sex, no drugs, no wine, no women.  No fun, no sin, no you, no wonder it’s dark…I think I’m turning Japanese…I really think so.”  Great ’80s tune about turning out surprisingly different from your own expectations.  Mostly I think to myself that my prostate cancer is not so dramatic.  I always believed it curable and not especially worrisome.  But that’s a lie.  It changed me.  It continues to change me.  I really think so.

Whether coincidentally or purposefully, my lifestyle has turned decidedly more healthy.  I’m exercising less for enjoyment and more from a disciplined regimen to promote healing.  Did I just use the word “discipline”?  See.  That’s not me.  My spouse recently decided to abstain from alcohol.  At least temporarily.  Add that to menopausal hot flashes.  Being a team player, she expects me to join in her abstention.  She needs to work on her timing.  No erections, no weed, no beer, no wonder I’m stressed.  I think I’m turning Japanese, I really think so.

I’m planning an 80 mile backpacking trip with two best friends from high school the last week of June along the Continental Divide.  I committed to it before I even had my catheter removed.  It was hugely important to me emotionally at the time and remains so.  But I’ve been way over the top in my distraction with it.  All my web browser searches are for REI-this and trailhead-that.  And my email correspondence to my trail mates is increasingly aggressive and psychotic.  “Everyone around me is a total stranger.  Everyone avoids me like a cyclone ranger.  That’s why I’m turning Japanese…I really think so.”  The question of whether or not I’ll be medically fit for this hike increases in validity as the date draws near.  I know I’m physically fit.  And emotionally, I need the release it will provide.  No doubt I’m going.  If all I can do is drive to each trailhead and camp out waiting for my buddies to conclude each segment of their hike, I’ll do it.

I wrapped up my regular physical therapy sessions with Jenn today.  I will still have a follow-up session in another month.  She trained me on some great exercise routines.  Jenn also filled in the information gaps for questions I neglected to ask of my Urologist.  And of course the scar tissue treatment was bonus.  My mission is to integrate some of my exercises into my everyday activities.  Part of my muscle weakness is directly due to the trauma of surgery, but part of it is from the absence of my prostate.  I will constantly need to be vigilant about practicing muscle control with my pelvic floor and abdominals.  I’ll never piss the same again.  I really think so.

Scar Tissue

scarsI completed a second session with Jenn, my Physical Therapist this week.  The exercises are becoming more complex.  I’ve added abdominal muscle activities to my routine of pelvic floor exercises and breathing.  You might think breathing seems redundant but trust me, it’s not as intuitive as one might think.  There’s a strong tendency to hold your breath while coordinating exercises between various muscle groups.  Oh, and I’ve added some leg motion.  It’s a regular hokey pokey.

PTs never fail to impress and Jenn is a master at making scar tissue disappear.  During our first visit, Jenn taught me to rub the scar tissue that has formed around my surgical incisions to hasten their recovery.  Today, she spent a good deal of time rubbing my incisions and demonstrated to me how the scar tissue has quite literally vanished.  And it doesn’t return.  Simply rub your finger tip, with some lotion, in a circular motion on top of the scar.  Do this for several minutes on a regular basis.  It’s like flattening out air bubbles.  The tissue simply melts away.  Brilliant.

This pic is two days after my surgery.  Honestly, that bloating is from gas used during surgery to expand my abdomen.  My tummy is normally fairly flat.  Seriously.  My flesh is this butt white though.  There are five incisions.  The one in the lower left of the photo is hard to see for some reason.  Five weeks later the color has faded from all the incisions.  I think they will be difficult to spot quite soon.  Especially once my hair grows back.  You should expect similar markings.  The ugly incision on the top right was for the JP Drain.  My prostate was removed via the incision across my belly button.  These wounds remained tight feeling even after my stomach pain eased three weeks later.  This rubbing Jenn taught me is dispersing that tightness.  Good progress.

Fitness & Health

Cialis film-coated tab 5 mgI met with my Urologist today for a post-surgical progress report. My PSA levels are fine. At .3 ng/mL, they could be lower.  It will probably never be zero because of how these tests work. I’ll have these reviewed quarterly for the next two years. I’m good on urinary continence, and of course have started my physical therapy for that. I have three more PT visits over the next two weeks on that topic.

My incisions are also healing well.  In fact, I escaped my prostatectomy without any infections period.  Feeling good about that.  The next focus area is erectile dysfunction.  Sonofagun, if I’m not ahead of the curve in that area too.  I am having erections already.  They have not been sustainable for actual sex, but they are a start.  Dr. Webster offered me a choice of Cialis or the erectile vacuum pump, or both.  I declined the vacuum pump.  I’d rather my kids find my collection of vibrators in the house than that.  I did research the pump online and am just not comfortable with it.  At least, I’d rather try the Cialis first.  Remind me to clear my browser search history.  He gave me a 30-day supply of low-dose, 5 mg samples.

We talked further about my running and his belief that even for my age, Dr. Webster believes I am recovering stronger than his typical patient.  I think the standard idiom is “health & fitness” but I reversed it for my blog title because Dr. Webster made the point that he credits my fitness being largely responsible for my rate of recovery – for my health.  He described how the effect of good blood flow and other healthy body conditions lead to a stronger recovery.  This made me feel pretty good.

He then tempered my enthusiasm to ensure I didn’t push myself too hard.  He suggested I keep my runs at 3 miles for the next month.  That was actually my game plan so we’re on the same page.  I’m not in a hurry to get back into racing shape.  I just want to show progress.  And I have some events I hope to be ready for.  I’m confident I will be without over doing anything.  I expect to report next on how this Cialis works out.

Milestone

This is such a major milestone, it belongs in two blogs. My recovery improves so dramatically each week. I would not have expected to be running this time last week.

A Runner's Story

Mesa Trail Running has never felt so good.  After over five weeks of convalescing and walking, I ran three miles today.  My expectations were set for July, but my Urologist did tell me I might be back within a month.  I ran the same trail along Left Hand Creek that I’ve been walking everyday.  I don’t know if I can express how much reaching this milestone means to me emotionally.  I had a silly grin on my face the entire run.  Running means more to me for my mental health than physical.  I feel like this could be the end of the health-related distractions and lack of focus.  I’m back.

My groin began to hurt half way through the run.  That was less than ideal, and a bit of a surprise.  I was monitoring my abdominal pain, breathing and dizziness.  My stomach didn’t hurt until after I stopped running.  While walking a…

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Physical Therapy

Pelvic FloorIn retrospect, I’m not sure I should have expressed such enthusiasm over my first PT visit.  I envisioned learning some useful exercises to control abdominal muscles.  I was told to expect kegel exercises.  While I wasn’t experiencing huge issues with incontinence, I was in fact starting to have more incidences of unintended dribbles after coughing, sneezing and flatulence.  And based on my experience, PTs just know lots of cool muscle information.  To my surprise however, this turned out to be the most exhaustive rectal exam of my life.  Part of my consolation from surrendering an organ to prostate cancer was in the misguided belief that I would never again require a rectal exam.  Ignorance is bliss.

I will say, my rectum seems less sensitive these days.  Not that it’s any more receptive.  Perhaps there is more room sans prostate.  Or could be the deadened nerves.  Beyond the waning physical sensation, any pride I once had is now increasingly desensitized as well.  I wore sweat pants with an elastic waistband.  On a certain level, I probably knew what to expect.  I’m telling you though, because no one told me.

My PT, Jennifer Davia, was highly professional and knowledgeable; and despite the circumstances I enjoyed talking with her.  Jen is CAPP-pelvic certified and specializes in pelvic dysfunction.  My Urologist sends all his patients to see her.  She explained the pelvic floor muscles to me.  A group of 3 muscles actually, puboco-this and ilioco-that.  I didn’t take notes but she showed me a model of the pelvic floor muscles as she talked.  She had me lay on my side and perform a series of kegel-like exercises for 10 or 15 minutes while she probed my pelvic floor muscles.  She determined my left side is a bit weaker than my right.  Big surprise.  Every running injury I ever incur is to my left side.  The series of exercises I performed, quick contractions and long contractions, are what I now have as a twice daily routine.  Should be more pleasant at home without half of Jen’s digits up my arse.  Jen emailed me the exercises from a site she subscribes to – PhysioTools.  I’ll return weekly three more times to check my progress and learn more advanced exercises.

After having my catheter removed on April 10th, my only other medical visit was Tuesday for a blood draw to record my PSA score for next Monday’s Urology consultation.  A full month on my own.  I did nearly call my Urologist several times about my burning meatus.  I expected my penis pain to subside much sooner and wondered if I didn’t have an infection.  But I was conflicted.  I also didn’t want my doctor scolding me for being a hypochondriac, saying, “Of course your penis hurts, it was recently impaled by a catheter for 8 days!”  So I took advantage of my blood draw to also have a urinalysis performed.  That’s the sort of thing a medical assistant can do in any office.  I learned from this that I don’t have an infection.  I do have blood in my urine still.  However, at a level that is to be expected after my surgery.  So all is good and I was able to stealthily learn this without bothering my Urologist.

Last point is I’m starting to really feel recovered.  I intend to try running tomorrow, which would be a full six weeks ahead of schedule.  Probably just 3 miles since that is what I currently walk.  Not sure if I’ll share that story in my running blog or here.  Maybe both sites.

Clean Sex

iStock pickleTwenty-two days after my prostatectomy, I had an erection.  Really.  On my 52nd birthday, I might add.  It wasn’t brought about completely by impure thoughts.  It had a helping hand.  But that’s fair.  There was no happy ending but then my orgasm would lack ejaculate anyway since I lack a prostate.  I’m all about clean sex now.  My testicles still produce sperm but those fishes have nowhere to swim and are simply absorbed into my body.  Who cares though, I had a bonafide boner within a month of my surgery.  Booya!

I’m putting a positive spin on this now although honestly I was a bit frustrated last night.  I couldn’t sustain my erection for anything meaningful.  And this morning I pissed a fair amount of blood.  Two steps forward and one step back.  Still, the fact I had naturally induced wood indicates my nerves have a functioning pathway.  Not being educated on exactly how erections work, I would think that’s all I need.  A signal from my brain to flood my penis with blood.  Apparently the neurons have to keep firing though to maintain the blood flow.  I would like a deeper understanding of this in order to know just how positive a sign it was for me to have an initial natural erection.

Assuming I am on track, I should give credit to my surgeon whom is also my urologist.  I know I was hard on him in a couple of blog posts.  In my defense, I was an emotional train wreck the first week after surgery.  Dr. Webster no doubt will credit the robotic surgery method.  That’s an important point because many men do select it based on its record of supposedly faster recovery time.  But the robot didn’t stitch up my incisions, my surgeon did.  If you were to look at my minimal scars, you’d be impressed with the skill of my surgeon.  It’s perhaps fair to point out my age too.  I read recovery averages this and that, but most men don’t get prostate cancer until they are in their mid 60s.  My younger age likely accounts for a quicker recovery.  I actually took this into consideration as part of my decision to have surgery.

I’m looking forward to physical therapy now more than ever.  I read somewhere on the Internet that atrophy is a concern.  I think this was part of a read on the use of vacuum pumps.  This device doesn’t require impure thoughts.  It relies on physics to induce an erection. If atrophy really is a potential issue, I might ask my urologist for a prescription to present to my wife for regular hand jobs.  Ideally, without an expiration date.  I don’t mean to celebrate here or be insensitive to anyone whom might still have issues with ED a full year later.  My expectations are for anywhere between 3 and 12 months to deal with this issue.  I suspect I’m off to a healthy start though.  My first PT visit is in two weeks, along with a visit to my urologist to review my status.

The Walking Man

Eagle TrailMy recreational pastime is running.  I’ve been a runner my entire life.  It’s so much more than working out to me.  It’s a lifestyle.  I’ve been writing a running blog for the last five years with weekly updates.  You no doubt have a hobby of your own.  Question is, did your prostatectomy impact your hobby?

Clearly, my running is taking a breather.  I can live with this but it’s not ideal.  Today, Easter Sunday, was absolutely gorgeous and I wish I could have gone for a run.  I did however get in a record distance walk – nearly four miles – on Eagle Trail with my wife and daughter.  I’ve been walking three miles per day over the last week or so since my catheter was removed.  I like walking, but it’s not running.  I also enjoy running the occasional road race.  I get a little competitive.  Sometimes I finish in the top three, but that’s not what I’m after.  It’s racing against other runners.  It’s feeling my body as it pushes the limits without going into oxygen debt.  It’s hard to explain unless you’re also a serious weekend warrior.  For me, training and racing are extremely enjoyable.

I cancelled my registration for next month’s Boulder Half Marathon.  Actually, I gave my race bib to another runner – a friend of a friend.  Hope she enjoys it.  My consolation is that I will now be a race volunteer.  I don’t know that I’ve ever volunteered before.  I’ve always been a participant.  I’m actually looking forward to this and consider it a constructive consolation.  I fully expect to be running again by July.  That won’t give me much time to prepare but I am registered for the Boulder Marathon in the fall.  Plans are good.

I’ve been following this exercise chart to ensure I don’t do anything stupid.  I suspect I’m not following it correctly though.  It says I can walk up to 90 minutes per day, but I think it means in 5 or 6 shorter walks.  I pushed it too much on my fifth walk by doing two 60 minute, 3 mile walks.  I pissed a good deal of blood for the next two days.  I also get a little light headed near the end.  My breathing is much better now but I still get winded.  For me to get winded walking is a bit shocking.  I run several marathons a year.  I’m improving though.  My next target is the Bolder Boulder 10K on Memorial Day.  I plan to walk that with my daughter Ellie and wife Karen.  I’m confident I’ll be able to do that without hurting myself.  It’s a full month out.  Heavy lifting still fatigues me rapidly but I plan to start with weights after that 10K.  Then start running again by the start of July.  I need some content to fire my running blog back up.

So those are my plans.  Keeping things positive and constructive.  I also spent time today writing thank you cards for all my friends and family who went out of their way to make me feel good.  A couple of my sisters started to call me regularly.  Others brought food over to the house.  This was my first surgery ever and I was caught off guard a bit by the strong emotions.  Friends and family have made the difference.

Vibrator Replacement Strategy

shortsProbably the biggest surprise to me after my prostatectomy was the emotional roller coaster.  I think of myself as a fairly even keeled person.  I was euphoric the afternoon after the surgery and didn’t sleep until about 1am.  The next several days consisted of extreme mood swings.  Hope nobody noticed, I was trying to appear positive.  I suspect some of this was a result of starvation from my clear liquid diet.  I wasn’t drinking alcohol so there were no mood depressants involved.  I know some of it was also related to having a catheter tethered to my bladder.  I’ve been much more normal since returning to real food after five days and having my catheter removed after eight days.  But define normal.

If you’re a fan of the TV show Breaking Bad, perhaps you recall the episodes of Hank when he was bed-ridden after being shot.  He began buying rocks online.  Well, minerals actually but totally irrational purchases nonetheless.  I went through a period of buying vibrators.  I’ve been married almost 27 years and have never included vibrators in the bedroom.  Suddenly I felt I needed some.  At least five.  I even bought a vibrating cock ring which makes absolutely no sense.  A boy can dream.  I think in my mind I was doing something nice for my wife.  If your partner happens to be another guy, maybe you’ll find yourself buying something else equally stupid.  Or maybe it’ll be vibrators.  Just know that if you find yourself doing something super irrational, you’re not alone.

Knowing my wife, she’ll have me throw them all away.  I haven’t got around to even thinking about sex, because three weeks post surgery – I’m just not there yet.  The throbbing pain in my penis I associate with the catheter is finally subsiding but I still have some soreness.  I also still have burning in my meatus which I suspect could be an infection.  I might call my urologist later today.  I tried doubling my exercise earlier in the week from one three mile walk to two three mile walks.  I ended up pissing blood for the next two days.  For the most part I have not been pushing myself but that was apparently too much.

I will tell you that I am having feelings of an erection already.  I’m a bit concerned this might simply be in my mind.  I swear though I can feel the signals from my brain’s impure thoughts pinging my penis, and my penis return that ping.  I’ll go as far as to say I think I’m getting about 5% of an erection.  The problem is, this could be an optimist’s dilemma.  I might be making this up.  I think I feel something but it could easily be all in my head.  Regardless, it makes me optimistic.  When I toss out all my new vibrators, maybe I’ll hold on to that vibrating cock ring.

Incontinence

Depend ShieldNow that I’ve been decatheterized, I can focus on recovery for the two most impactful side effects of a prostatectomy – incontinence and erectile dysfunction.  I won’t begin to even discuss E.D. with my urologist for another month.  Dealing with incontinence comes first.

This maps well to how I personally rate the two.  I find incontinence a thousand times more distressing than E.D.  It’s an awkward condition to ask questions of my urologist.  Not that there is anything between us anymore.  I’m considering making him my kids’ godfather and sharing my bank pin code with him.  When I ask what to expect, I get responses in terms of, “well 75% of men are 100% recovered by 3 months and 90% of men fully recover by 12 months.”  And I’m advised to wear pads.  This is good to know but not the level of detail that satisfies me.

As for the causes, my urologist generalizes that the entire urinary ecosystem has been severely traumatized, leading to leakage.  My radiologist told me my bladder would have spasms for perhaps a couple of days, causing leakage.  I would like to know the exact cause.  My bladder having spasms.  The elasticity of my urethra recovering from the catheter.  Muscle control.  I imagine my urologist has the bases covered because the answer could be any or all of the above.

I could have used more detail on the need for protection too.  Pads?  Diapers?  My urologist suggested I would be fine with a single pad for the full day so I didn’t bother buying diapers.  He was right and that was an easy call because I couldn’t bring myself to take a box of men’s diapers to the checkout line.  But not having a better idea of what constitutes leakage made this questionable.  While I read nothing that implied this would be needed, I went as far as to dress my bed with a waterproof mattress pad.  That was dispiriting too but I couldn’t take the risk of soiling my mattress.  This might have been smart preparedness for the seven nights I slept at home with a catheter.  I removed the waterproof mattress pad today.

Turns out, I don’t need the pads either.  Three days ago when my catheter was removed, I leaked a couple of drops the first time I coughed, and the first time I sneezed, and with my first flatulence.  Apparently I have an autonomic bladder and sphincter because I haven’t leaked a drop since.  It may be too early to call, but I feel like I have this issue under control.  Anyone need a box of fifty Depend Men’s Shields?  To be fair, this actually does not make me all that exceptional.  If you read this incontinence link, most men do not have ongoing issues with urinary function.

I intend to keep my physical therapy appointment, but it’s nearly a month out in May.  If I were to need help, I would think I’d need it now.  I’m keeping the appointment mostly because I figure I’ll be able to discuss remedies for E.D.  I don’t even care to turn my attention to erections this early.  One of my remaining areas of extant pain is my penis.  And anything near it.  I feel as if 500 boots have stomped across my johnson.  Fairly certain this throbbing pain is due to the catheter.  It’s a huge distraction.  I stopped taking the prescription-strength AZO but am considering taking them again because they numb the penis quite effectively.  I’m sure this will subside soon.  Hopefully before I return to work so I can think straight.

De-Catheterized

Foley CatheterMy urologist removed my foley catheter today.  This is a huge milestone.  This thing has been a prison sentence.  Like being tethered to myself with a ball and chain.  My urethra has only been penetrated by this catheter for eight days, but during that time this device has been responsible for a great deal of my discomfort and emotional state.  I probably don’t remember all my experiences, but I’ll relate what comes to mind.

Starting Monday when I had my first BM, that event also caused me to urinate outside of the catheter.  That burned my meatus (pronounced “me 8 us”).  A lot.  I learned I could mitigate the pain by physically coaxing the urine out of my penis with a pinching action.  Also, a vacuum is often created in the bag, which acts as a plug to stop the flow via the tube.  I have to blow air into it as a remedy.  To do that, I have to carefully place my lips on a recently sterilized section of tubing.  There’s a certain similarity to siphoning gas, not that I’ve ever siphoned gas.  Another hint, I learned that it’s better to string the tubing for the large foley bag down through my pant leg, like I do for the smaller bag, rather than have the tubing come out through the top of my waist when I sleep at night.  The tubing is long enough that I can still carry the bag in my hand.

I have to switch to the larger bag every night, which means cleaning the smaller bag, because the smaller bag can’t go more than two hours without the need for draining.  I drain the larger bag a couple of times in the middle of the night anyway, because it’s not really possible to sleep well wearing a foley catheter to bed.  Likewise, more cleaning when I switch back to the smaller bag in the morning.  It’s a fifteen minute routine I didn’t use to have – twice a day.  Double that to include the time it takes to clean my wounds.  I use a spray bottle of bleach and rinse with warm water.  This is the same procedure I use on my Camelbak reservoirs.

My abdomen suddenly improved dramatically Tuesday.  Apparently much of the gas filling my intestines cleared.  With this pain now largely gone, the discomfort from my catheter gained focus.  I think the pain was there all along, but the feeling was lost in all the noise from other body parts.  The shaft and meatus of my penis have been constantly sore.  This makes sleeping at night difficult.  Then there is an emotional impact from wearing a catheter.  I don’t know what could be more disheartening.  Adapting the smaller bag that straps onto my leg helped dry my damp mood significantly.  I went to a gathering Monday with my friends to watch the NCAA basketball final.  This was my first real social experience wearing my catheter.  I have such good friends, and old enough that they’ve experienced their fair share of medical history, that the evening was good.  It felt great to be out with friends.  I talked too much which made me short of breath and fatigued, to where I needed a drive home.  Otherwise, I was happy to get out.  I had to use the restroom once to drain my foley catheter.  Socially awkward.

cystogrpahyI arrived at Out Patient Services in the Longmont United Hospital Wednesday morning at 8:30am to receive a cystogram.  My tech’s name was Dave and the radiologist was Dr. Wall.  They were both personable and good about setting my expectations.  They had me lay supine on a table.  They filled my bladder with contrast, the term they use for a liquid that registers on the fuoroscope.  They leveraged my catheter for this with a reverse flow from the tube into my bladder.  They said I would feel discomfort.  I felt like I had a full bladder and needed to urinate, but this was not a painful procedure.  It took less than 30 minutes.

I learned from this procedure that in order to try peeing outside of the catheter, I need to push on my tubing to lift the balloon off the bottom of my bladder.  It’s normal position blocks the flow of urine other than through the catheter.  I was able to see this visually on the fluoroscope monitor and I was able to do this technique later at home when I felt the need to.  Dr. Wall told me it appeared my bladder was not leaking and I could expect for the catheter to be removed on Thursday.

Bard CatheterMy catheter is manufactured by Bard Medical.  The component pictured here with the balloon and small opening is the length of the catheter that sits inside my bladder.  The other end is taped to my thigh.  The Y-split to the little red endpoint is used to inflate the balloon for installation and deflate it for removal.  I was sent home from the hospital with multiple pairs of both the small and larger bags, straps and various parts.  With my expertise cleaning and caring for Camelbaks, I never needed to replace my originals.  I am disappointed with the constant vacuum problem that would trap urine in the tube before draining into the bag.  I emailed their support site for advice and received a response from someone with a PhD in their title the same day.  The response described the patch feature in the larger bag intended to mitigate vapor traps, or at least provide material to pull on in order to break the trap.  Unfortunately the smaller bag does not have this feature.

AZOKaren visited the Urologist with me this morning for the foley catheter removal.  I didn’t know 100% that it would be removed, although the radiologist did set my expectations for this the previous day.  Dr. Webster first reviewed the biopsies from my surgery.  The three prostate carcinomas were Gleason score 6.  Nothing was found on my lymph nodes.  I was able to ask for a prescription of AZO – or at least I think that’s what I’m getting – to address the extreme burning in my meatus that is expected for the next couple of days.  Dr. Webster further reviewed my next steps to address urinary issues and erectile dysfunction.  I’ll meet with a physical therapist as soon as I can schedule a meeting, to address urinary function.  I won’t begin to work on ED for another month.  Karen left me alone for the actual procedure.  Unexpectedly, so did my urologist.

Nurse Brittany and her new intern Abigail performed the necessary steps to remove my foley catheter.  She had me lay back on a table with my upper body propped erect by pillows.  Intern Abigail observed and took notes as Nurse Brittany explained each task.  She first placed a tray between my legs to catch urine.  Then she removed my leg bag and its section of tubing, and discarded it in the trash.  Next she deflated the balloon that anchors the catheter in my bladder.  Nurse Brittany then injected three or four syringes of water into my bladder via the catheter.  She kept going until I told her to stop.  Last step was to pull the catheter out.  From the effort Nurse Brittany expended prior to the big tug, advising me to relax, I was braced for some pain.  I also expected this to be too quick to hurt for long.  In the time it took her to reel in that line, I could have read Moby Dick.  A tougher guy might describe this as discomfort.  I’m categorizing it as epic prolonged pain.  The final task was mine to expel all the water from my bladder into the toilet, which I was allowed to perform without an audience.  Lastly, Nurse Brittany scanned my bladder with some ultrasound device to confirm I did indeed empty my bladder.

We arrived home to a shipment on the front porch of Amanas smoked ham and assorted sausages and cheeses dispatched by my older sister Sandy in Marion, Iowa.  I made a ham and cheese sandwich from it, on Rudi’s Spelt Ancient Grain bread, and am eating some again now as I write this blog.  Before I ate lunch, I went for a walk.  A real walk.  Previously, with my catheter, my longest walk was only a half mile.  Typically divided in two segments by a short rest period at the mailboxes or coffee shop.  Shoot, until Tuesday, I couldn’t even actually walk.  It was more of a shuffle.  Understand, there is not much more you can do with a catheter tethered to your bladder.  It would only take a quarter mile for blood to start streaming through my catheter.  Not enough to be concerned, but certainly enough to make me pause.

Today, I wore my Garmin to record a three mile walk.  I averaged a 17:30 pace alongside the Left Hand Creek.  Considering my typical walking pace is 15 minute miles, and the average walking pace is closer to 20 minute miles, I’m happy with today’s pace.  The weather was full sun, mild breeze and 51°.  I wore walking shorts.  You have no idea how proud I was to be wearing shorts.  Make no mistake, wearing a catheter is completely demoralizing.  Not the best scenario at a time when maintaining a positive outlook is paramount.  I felt good about my shorts.  I felt good about my pace.  I wasn’t very dizzy or breathless afterward, and I burned 300 calories – my daily average intake on that clear liquid diet.  What a difference two days and catheter removal can make.

This completes my surgery phase.  I consider myself to be starting the real recovery phase.  The blog posts will decrease in volume, as they already have.  I suspect I’ll recount my medical professional visits.  First one should be with Physical Therapy.  Then a visit with my doctor, or at least his nurse, for PSA blood tests, followed by a urology visit in a month.  To sum up the last week, surgery was tougher than I expected.  Not much actual pain but extreme discomfort, fatigue, and an emotional roller coaster for the eight days I had to endure attachment to that dispiriting catheter.  I’m set now for Jen’s breakfast party Saturday.

Breaking Bad

MedicineI don’t expect my out-of-pocket health care costs to be overwhelming, but then I won’t be surprised to find anomalies either.  If I find my insurance costs to prompt decisions on downgrading my cable plan or internet speed, then I’ll consider breaking bad.  I have a full and unused bottle of Oxycontin that I could deal to high school kids.  There’s a bus stop right outside my front door.  I understand snorting opioids is currently in vogue.  And if I’m fortunate enough to recover well from erectile dysfunction, I could maintain my Cialis prescription for resale purposes; assuming the secondhand market is strong.  Of course I’m kidding, but it occurs to me I might blog on some of my insurance related info when the bills start to arrive.

My urologist surgeon called yesterday while I was napping and told my wife I could start eating regularly again.  This was my fifth day on a liquid diet so that’s in line with everything I’ve read, but I was surprised I would not be required to transition to soft foods first.  Still, I am transitioning somewhat.  My appetite is down along with my metabolism.  Plus my stomach is a bit delicate still so I’m not even tempted to over indulge.  I was cautious on my first real food and didn’t experience any nausea.  I did have some painful gas, but that’s probably a good thing.

Another good thing was my first bowel movement this morning.  Makes sense considering I ate real food yesterday, but extremely comforting feedback that my intestines are okay.  Oddly, I leaked a small amount of urine outside of my foley catheter while having my BM.  Which I might add, burned like bloody hell.  I don’t know if this is good or bad.  I’ll mention it to my urologist when I see him Thursday, but seems good to me.  It suggests that my urethra has reconnected to my bladder, or at least has some secure stitches.  Pee will not be contained.  Pee will find a way.

Ahuacatl

AvocadoLast night completed four full days on a clear liquid diet.  My urologist surgeon has neglected to provide me with detailed nutritional instructions.  Left to my own devices, and the Internet, I determined that I would eat a banana when I woke up this morning, and begin a transition into a full liquid diet.  So I did.

I took a full hour, slowly eating the banana, in order to monitor my stomach’s reaction.  This was between 5:30 and 6:30am.  I drank a glass of cranberry juice with it.  I felt full from it but did not have any nausea.  It wasn’t enough to regain my strength though.  I fell back asleep in my chair.  I took out the garbage upon waking and became extremely light-headed.  This isn’t anaesthesia anymore.  Clearly, I am malnourished.  I’ve consumed less calories in four days than I typically eat in a single half day.  I’ve logged everything I’ve eaten since returning home.

Emboldened by my stomach’s acceptance of the banana, I set my sights on an avocado.  My absolute favorite fruit.  There is nothing more satisfying than an avocado.  Just one could easily bring me back to the land of the living.  An avocado is God’s food.  I sent Brittany to the store to fetch me some.

Amazingly she returned with five perfectly ripe avocados.  Firm yet creamy.  Dark forest green skin.  I sliced one in half, the seed fell out on its own.  I applied coarse sea salt and scooped the flesh out into my mouth with a spoon.  Vitamins.  Magnesium.  And fat, real fat!  Ever see the film Barfly where Mickey Rourke eats a package of lunch meat and feels strong enough to return to the bar for a fist fight with the bartender?  That’s what I felt like immediately after eating this crocodile pear.  Reinvigorated.  Back from the dead.  I’m telling you that when you can eat something real after coming off your clear liquid diet – eat an avocado.

Walk

walk to coffeeI took my first walk outside today, down to the Brewing Market for a decaf coffee.  It’s about three blocks, a good quarter mile.  Took me 15 minutes each way.  So let’s call it a shuffle rather than a walk.  Actually had to stop on the return because I was light headed.  I hope that’s from my low calorie intake and not still side effects from the anaesthesia.  My throat and neck are still super sore from the assisted breathing tube.

This shuffle down the sidewalk was made possible due to changing my foley bag.  I finally switched out the large bag from the hospital to the smaller bag that attaches to my leg.  This then allows me to wear pants and go out in public.  I didn’t do this immediately because I was a bit overwhelmed.  I determined last night I would switch them this morning though.  I was embarrassed that my daughter had to see me with the foley catheter in the house.  And there was no way I would let anyone visit with that bag out in the open.  My difference in mood after dressing in Nike sweat pants and a race t-shirt was immediate.  Like full sunshine breaking through the clouds after a rain shower.  My spirits went from night to day.  I highly recommend switching to the leg foley catheter as quickly as possible.

I’ll need to sleep with the larger bag.  I don’t expect the small bag will go more than two hours without requiring to be drained.  Still feel like I’m one step further from the hospital though now that I can remove that monstrosity.  Another weird contraption I had to wear in the hospital was a pair of SCDs on my calves.  If you’re a runner, think of Synchronous Compression Devices as compression socks.  The difference is this automatically inflates at regular intervals to promote circulation and mitigate blood clots.  It feels like someone has just grabbed onto your leg each time they fire up.  This is why patients don’t sleep well in hospitals.

Karen snapped this photo of me and Jack after this morning’s walk.  I was going to publish a picture I took of my stomach to show my incisions.  I decided against it because it’s just too gross.  I’m not shy about this.  Shoot, I’ve linked a video of my cystoscopy.  That’s way more graphic, but also interesting and hopefully adds some value for anyone planning such a procedure.  Not much content value to pics of my abdomen right now.

I’ve scheduled radiology to review my healing progress next Wednesday.  Positive results will determine if I can remove the foley catheter Thursday.  That will be such a huge milestone.  Of course it will start another phase.  I’ll need to learn how to urinate again.  Looking forward to it.

Liquid Diet

Tea with cranberries in a glass cupYou’d think this would be a simple subject matter but it hasn’t been for me.  Having a constructive conversation with my surgeon on nutrition doesn’t appear likely.  Maybe it’s outside his area of expertise because discussing my liquid diet options seems to bruise his hyper-sensitive ego.

I’m to remain on a clear liquid diet for awhile.  How long exactly is related to the gas completely exiting my distended intestines, my ability to eat solids without vomiting, and the weather.  I can understand it’s an imprecise art, but more detailed guidelines would help considering I’m supposed to make the call myself.  Or maybe I’m supposed to consult with my surgeon.  I don’t know because as I said, our conversation was not very constructive.

My immediate concern is maintaining a decent calorie intake.  A 51 year old male should consume 2000 calories per day.  Probably more but I like to use round numbers when I’m going from memory and not referencing actual charts.  The broth I’m allowed to eat/drink contains 20 calories per cup – which is three servings.  My jello (considered a liquid if you ask a chemist) contains 10 calories.  My PowerIce frozen electrolyte pushups are 30 calories each.  So maybe if I drink 3 gallons of broth and fifty jellos each day, I could expect to maintain my weight, and more importantly, keep from jacking up my metabolism.

Then I read the calories for cranberry juice.  130 calories per 8 fluid ounces.  I could reach 2000 calories in fifteen glasses.  Still sounds ridiculous but the math is starting to add up.  This is as far as I’ve mapped this out to date.  Would have been nice to receive a chart or something detailing how to consume enough calories.  Or what my calorie intake should be.  I’m a little disappointed that the nutritional aspects of my recovery aren’t spelled out for me.  Not sure if I’m being unreasonable but it just happens to be important to me.  I’m dragging around and I can’t tell if I’m depressed or simply under-nourished.

The Next Day

bullThis picture captures how I feel after waking up today.  Strong as a bull.  I went on a 25 minute walk around the floor.  I finally quit when I noticed the flow in my foley catheter turn from urine to blood.  I probably should not have been left unattended.  Seriously wish I’d brought my Garmin though to record my distance and pace.

I have another catheter to carry around with me too.  It’s called a JP Drain and it collects bodily fluids, mostly blood, from inside my abdomen.  Hard to imagine anything more disgusting than my foley catheter, but this qualifies.  Hoping it will be removed before I return home but that’s iffy at this point in time.

I tried to sleep last night around 10pm.  The pain began increasing though and I didn’t doze off until after 1am, which is when they refreshed my Toradal anti-inflammation medicine in my IV.  I slept soundly until 4am when they came in to mess with me again to record my vitals.  I couldn’t go back to sleep because of my discomfort and finally called my mom when I saw her online presence appear on facebook.  You can’t wake up old people.  They always beat you out of bed.

Pain was a bit of an issue last night but I haven’t needed any pain medication.  Anti-inflammation drugs have been sufficient.  I was a bit disappointed with my nurse last night because she was so quick to offer the pain meds.  Don’t get me wrong, Sandy has been an outstanding nurse.  She’s been great to talk to, although I suspect she might have done her residency with the Marine Corps.  I really admired the way Nurse Paul and tech Lisa performed problem solving yesterday on my foley catheter.  Nurse Paul determined my tube was kinked and Lisa coached me to relax.  They asked me if I wanted pain meds but also performed this due diligence.  And it worked quickly enough to relieve my pain so that I was able to decline the pain meds.  I was trying to perform similar problem solving for my pain last night.  I discovered a kink in my tube but couldn’t fix it without assistance.  My nurse seemed more intent on having me take pain meds than look at other probable causes.  And then she seemed irritated with me when I declined the meds.  I wanted to wait to see if adjusting my foley catheter would show results.

It did relieve the discomfort from my meatus but unfortnately this pain was coming more from my abdomen.  I decided to wait until 1am when I expected the next round of Toradal rather than admit defeat to Nurse Sandy – who was by now in full commando mode.  This speaks to another reason I am avoiding pain meds.  I have half a dozen good reasons.  The first is it’s a game.  I treat a number of life’s mundane tasks as games.  Some people play words with friends; I make a game out of planning meals for the week.  Two or less I lose, three or more I win.  Five is a shutout.  Avoiding these pain meds is just another game and I feel good about beating Nurse Sandy last night.  This might point to my immaturity but it’s my way of maintaining a positive attitude.  Games help me keep score.

Another reason for avoiding the pain meds is that I don’t fully believe in them.  I’m not against medicine at all.  I think it’s great.  And I know I am not at all qualified to have an educated opinion.  But I do have personal opinions nonetheless.  I like the concept of anti-inflammation drugs because they reduce swelling that leads to pain.  That’s smart pain mitigation in my mind.  I believe most of the opioids, like the Demerol they gave me after surgery, only mask pain by fooling the brain.  I don’t like that approach, especially given the potential side effects of opioids.  I prefer the pain mitigation concept behind anti-inflammation drugs.  Besides, I’m just arrogant enough to believe I can fool my own brain.  There is no spoon.

I could go on but I don’t want to sound like some crackpot.  I will admit that part of my reluctance to opioids is playing tough guy.  But that’s part of my game to pretend I’m winning at something.  It’s easy to turn negative in these situations.  People die in hospitals.  It’s a good place to play the rebel.  I’m Paul Newman in Cool Hand Luke.  Steve McQueen in The Great Escape.  Might sound silly but I keep myself entertained. And I believe I do have a positive attitude.

I’ve discovered that people think I’m being negative when I relate my pragmatic views of recovery.  I don’t mean to sound negative but I can see how discussing my next 12 months of side effects can come across as defeating.  I got a kick out a friend trying to coach me last night on facebook to be positive.  I’ll tell you my plan.  I went from 51 years old to at least 81 years old yesterday, in terms of the loss of certain bodily functions.  I’ve never been depressed over this cancer because I have always understood it to be fully curable.  I do have occasional melancholy moments when I consider my next 12 months.  But I understand it’s temporal.  My plan is to drop twenty years over the next month.  That will bring me on par with a 61 year old.  Then I hope to drop a virtual year each month ongoing.  I think this is inline with the NYT story on setting expectations for recovery from a prostatectomy.  I’ve linked that story in an earlier bog post.  I advise reading it.

So my attitude is good.  Dr. Webster should show up in another hour and I fully expect to be released.  I’m a bit irritated with him for not advancing me from a clear liquid diet to the full liquid diet.  Less so for the marginal improvement in food but more to tick off some progress.  Everything is a game to me.  I did coax some coffee from the Nurse’s station.  Not because I’m too cheap to buy it from the kitchen but because I suspected it would be a better tasting brew on the floor.  I was right about that.  Another win.

Prostatectomy

hospital room 5005I woke up this morning to a 5am alarm set on my iPhone.  I always have my alarm clock ring tone play the same tune, Telluride, because I find it peaceful.  If this makes sense, I find it non-alarming.  I don’t care for abrupt wake-ups.  You can play a clip from the link above and tell me that’s not a smooth wake-up tune.  Per pre-surgery instructions, I showered.  I even shaved.  That was not an instruction but thought I’d over-achieve today.  I couldn’t drink coffee – brutal – but was able to read the WSJ before arriving to the surgery center at 6am.  Routine acts as a diversion for me.  Oddly enough, I even slept well.  Not something I’ve done in several months.

Karen sat with me during the hour-long prep.  Nurse Carol expertly inserted and taped off my IV.  And Carol did what I love; she fully set my expectations for everything that would come next.  I’m one of those people who need to know the why along with the what.  Gives me a chance to improve whatever instructions I am being given.  Doubtful I would have done well in the military.  My Urologist, Anesthesiologist, Pharmacist, and perhaps others, all stopped by at some point as part of their role in today’s big show.  At 7:15, Carol wheeled me into the operating room.

I recall shifting myself onto the operating table and chatting for a few minutes of light conversation.  Suddenly, I was talking to another nurse in the recovery center.  But I didn’t just wake up.  Apparently I’d been awake for awhile and talked to Dr. Webster, my Urologist.  To me, I felt like I just woke up.  Imagine though, waking up in the middle of a conversation.  Because that’s what I did.  I almost understand that, if my memory only goes back that far.  But I recall the sensation of waking up in the middle of speaking a sentence.  Very strange.

I went into full Q&A mode and stubbornly took several minutes to comprehend that not only did I complete my surgery in three and a half hours, but I’d been in the recovery room for a good hour as well.  I don’t remember much of this scene, other than the nurse’s name was Lisa.  Lisa had Shayne.  No Sean.  No Jamie.  Fuck.  Lisa had some guy transport me to my hospital room where I am now.  One of the odd thoughts I had going into surgery was wondering if people dream while under anaesthesia.  If I did, I don’t remember.

Just as well I don’t have even a thread of memory, because surgery really is just a transition to the next phase – recovery.  Surgery was Scottie beaming me up into this hospital room.  I probably shouldn’t get my hopes up but recovery is going quite well so far.  I expected abdominal pain but would list it more in the discomfort category.  I did have a fairly acute pain episode a few minutes before Karen and Ellie stopped by for a dinner visit.  Let me see if I can describe this without being overly crude.

My pain felt like it does when you’re watching a super long movie at the theater, and you don’t want to go to the restroom because you don’t want to miss anything.  The pain builds up to the point you can’t hold it anymore.  When you finally try to release a stream of urine, letting it go hurts almost as much as it did holding it in.  And instead of a smooth stream, the flow is spasmodic.  If you’re not an idiot like me, then this has never happened to you.  But if you have experienced this, it’s the closest description I can give to my pain episode.  Except this was more intense and rapidly accelerating to an intolerable level.

Understand that I can’t actually urinate right now.  Probably not for another week or two.  My urethra was sliced off from my bladder.  It was stitched back in place and until it heals I will be urinating through a foley catheter in my bladder.  Urinating might not be an accurate term since I won’t be controlling the flow.  It will just flow – unimpeded until it catches in the foley bag hanging to the side of my industrial bed.

This pain episode was perhaps from a combination of that catheter piped into my bladder via my urethra and some confused muscles not letting the stream flow.  I don’t really know.  Maybe I have a phantom prostate attempting to hold back the flow until I can get up to walk to the bathroom.  Muscle memory from a time I still had dignity and believed pissing in a urinal is what civilized men do.

This pain attack had unfortunate timing because my dinner had arrived and I was famished.  Naturally I couldn’t eat in this condition.  Thankfully, Nurse Lisa walked in and helped me out.  Like Master Po imbuing wisdom upon young Grasshopper, Lisa told me to relax.  This analogy is not too far off – trust me.  Relaxing through gut wrenching pain is hardly intuitive.  I did though and it worked immediately.  My foley bag began to fill.  Monitoring my foley bag is one of my new tools for diagnosing pain over the next two weeks.

Surgery and Day One of recovery is winding down.  I haven’t needed any pain medication since arriving to my hospital room.  I’m happy with that because I have an irrational fear of any drugs that can be associated with Rush Limbaugh.  I am receiving Toradal every six hours.  This is an anti-inflammatory that I suspect is working well to keep down the pain.  I can tell you I am being treated by extremely outstanding professionals at the Longmont United Hospital.  My day-shift Registered Nurse Paul is unbelievable.  It’s like this married-with-no-kids, telemark skiier reads my mind.  He feeds my penchant for detailed explanations with copious morsels of explanatory information.  I got lucky with him.

busI just returned from my first walk and saw some high school photos my friend Cynthia facebooked to me.  Literally tons of pics I’ve never seen before.  Nearly cried.  Seriously, all the response I’ve had on facebook has meant so much to me.  I haven’t advertised this much and I’ve kept it out of my running blog.  Wrong genre, I started this new blog.  And I’ve only been publishing it to a small private facebook group rather than the half dozen social mediums I use to distribute my running exploits.  If you know me though, I’m not shy.  I’m just not posting content that my friends might not be asking to see.

Last detail.  Nurse Sandy says I did the biggest post-prostectomy walk she’s ever seen.  And the nurses can’t get over the fact that not only do I not need oxygen, but my oxygen rate is 99% for what they call in-room air.  I’m on the road to recovery.

In Harm’s Way

magnesium citrateI go in tomorrow morning for a radical retropubic prostatectomy.  Radical means full removal of my prostate rather than partial which is termed “simple”.  Retropubic refers to a surgical approach via my abdomen.  The procedure technically begins today with prep similar to what you would do for a colonoscopy.  Essentially drinking a couple bottles of lemon-flavored Magnesium Citrate.  I’ve been instructed to drink them all at once rather than the all day drink fest required of colonoscopy prep.  Not too concerned since this is only 20 ounces vs a gallon.

I also shaved the hair from my chest and abdomen.  I trimmed my chest because two weeks earlier the nurse shaved a dozen patches for her EKG probes.  I expect the same patchwork routine now on my stomach.  A surgery center is no spa and salon.  Actually I’ve only trimmed my hair off with clippers, but this gives them a cleaner launching pad for shaving.  I believe they should advise patients to shave.  It’s just one of those little details they don’t mention.

Karen and I will arrive promptly to the surgery center at 6am.  I don’t want to admit to being afraid, but to be honest the anxiety level has been increasing each day over the last week.  I’ve more than doubled my drinking.  I was having maybe four or five drinks a week.  I’m now having two drinks each evening.  Much more last Friday.  It’s hard to describe and I would rather not call it fear, but I think “dread” might be a fair descriptive for my emotions.  Not looking forward to the post-surgery side effects.  As in, I dread E.D.  I am ready to get this started though, so it can end.  Everyone I know has been very supportive.  My nearest family live 1000 miles away but they have been calling frequently.  A neighbor will bring over chicken noodle soup.  I expect to be fine.  I’ll see everyone on the other side.

A Slow Rape

drunkDuring early discovery, I looked into medicinal marijuana.  I’m all about silver linings.  You never want to miss a good opportunity.  Honestly, I was researching erectile dysfunction and the linkage to medical marijuana came up.  I can’t tell you how dirty my browser history is.  You go a couple of weeks googling “prostate this” and “prostate that”.  See if you don’t end up on an NSA watch list.

Interesting tangent.  One of my favorite activities related to my running blog is reviewing the search terms viewers use to reach my site.  The feature is intended to serve as a guide for suggesting good tags.  I find it interesting.  People search for some wildly specific shit.  Weirdos don’t search for “porn”.  Weirdos find themselves on my running blog after searching for “high school cross country runner porn”.  And I would find that entertaining.  The little joy I found in that exercise is gone now though.  Nearly 100% of search terms for my blog now show up as ” encrypted searches”.  I used to get some of those occasionally five years ago when I fired my blog up.  Now it’s more rare when a search is transparent.  Apparently everyone searches with their privacy settings enabled.

Back to point.  Regular smoking of cannabis, as in daily usage, leads to E.D.  THC impacts the function of cannabinoid proteins.  Messing with the cannabinoid proteins in your brain makes you stoned.  Messing with the cannabinoid proteins in your johnson can lead to either premature ejaculation or the inability to maintain an erection.  The point is, there is no silver lining.  I’m trying to stay positive here but it’s been nothing other than a slow fucking rape.  So far I count four digital rectal exams.  That loosened me up for a biopsy machine via my rectum.  And once I was thoroughly loosey goosey, they began penetrating my penis with probes.  Next, they intend to tunnel in through my belly button.

Cystoscopy

cystoscopeI was nervous over this procedure.  Much more so than over my pending surgery.  Because it’s just not right.  I think of the urethra as uni-directional.  Exit only.  I could go on but I shouldn’t have to.  No one reading this blog should be comfortable with this procedure.  Naturally I read the entire Internet searching for real stories.  And I talked to one person, my father-in-law, who underwent the cystoscopy.  But he had the rigid scope where they put you under like they do for a colonoscopy.  My cystoscopy would be the flexible type where they only apply local anesthesia, which I imagined would be a couple of needle shots to my penis.

I need this penis torture to prepare for my prostatectomy.  My surgeon will leverage this scope to view how my prostate attaches to my bladder.  The scope enters the bladder and then looks back on the wall connected to the prostate.  It’s important to understand if the shape is concave, convex, or flat in order to properly cut it out.  I don’t know of all the repercussions, but can imagine leaving in cancerous tissue or making too large a hole.  Apparently this tool is also used to remove gall stones and for other non-cancerous reasons.  This is performed on women as well but I think that procedure goes by another name.

I went in Tuesday afternoon, March 18th, for blood work and an EKG, related to my surgery.  The cystoscopy was Friday morning on the 21st.  My nurse’s name is Brittany and she looks amazingly similar to my niece Cari.  She’s the one who won’t let two minutes go by without requesting a urine sample.  Brittany had me lay down for this, with my head and shoulders propped up to view the video.  I was naked below the waist and she covered me with a sterile drape (paper blanket) with a hole around my penis.  She cleaned the area with some pink anti-septic.  Before I undressed, she gave me an antibiotic to take afterward.  She then used a needleless syringe to inject a fluid into my urethra that would numb it for the procedure.  I expected shots and was greatly comforted by this.  It was still uncomfortable.  It burned slightly and I felt like I was peeing, although I wasn’t.  She added a clip afterward to hold in the liquid.  She then left me to relax and become comfortably numb before Dr. Webster would join me.

Dr. Webster took only two minutes to perform the procedure.  He talked to me explaining everything and I was able to watch the visual on a monitor.  You can watch it at this link since I recorded it with my iPhone.  I didn’t feel the initial entry at all.  Pushing past my sphincter was extremely uncomfortable.  Doctors like to say you will feel some pressure as opposed to calling it pain.  Maybe that’s fair.  It certainly is not a sharp pain, but there is nothing that feels good about “some pressure”.  The visual though, with him explaining everything to me, was enough distraction to quickly get over the discomfort.

Dr. Webster met with me afterward to set my expectations for the prostatectomy.  Karen sat in with us to listen.  I will have four or five insertions through my abdomen.  The largest hole will be above my belly button through which the prostate will be extracted.  The other points of ingress will be for various tools.  I’ll stay overnight and can expect to be released the next morning.  Now that I am home, I’ve had to pee several times.  It stings and there is noticeable blood in my urine.  Otherwise I’m fine.  If I can get enough work done, I intend to go for a run later this afternoon.

Diagnosis

gloved handThis story begins with the blood work a gentleman is obliged to undertake when he reaches fifty years of age.  I pushed the boundary a tad by waiting until I was fifty-one.  I had been waiting for the general acceptance of a blood test that would replace the dreaded colonoscopy.  About the same time however the efficacy of a promising blood test was brought into question by the medical establishment.  I would soon learn there are far worse “oscopies” to fear.

I visited Dr. Tusek (he has an office in my neighborhood) on August 20th, 2013 for my first blood work, along with my first digital rectal exam.  Another thing I had been hoping to avoid with the advent of some new medical breakthrough.  I now understand the tactile benefits of the finger probe.  The surface of the prostate should be smooth to the touch.  A seasoned doctor can easily feel small bumps which indicate cancer.  I checked out fine and scheduled my colonoscopy.  I completed that procedure, with great results, before returning to Dr. Tusek to review my blood test results.  Drinking the prep solution the day before the colonoscopy truly is the worse component to that experience.  Especially considering they drug you with something that erases your memory of the event.

I walked away from my review of the two dozen or so serum and protein test results thinking my biggest concern was a vitamin D deficiency.  Dr. Tusek’s recommendation for 10,000 IUs seemed excessive considering you can’t buy Vitamin D over the counter in capsules larger than 5000 IUs.  He was also concerned about my PSA results.  I scored a 4.1.  The acceptable range is 0.0 to 4.0.  Dr. Tusek explained to me I could schedule a prostate biopsy, but that such biopsies aren’t trivial and this particular measure of proteins in my blood could be skewed by a long run I did the day before.  I scheduled a do-over for December and didn’t think much of it.  Oh, and my testosterone results were on the high end of the established range.  Booya!

I took the second test on December 20th, and reviewed the results with Dr. Tusek on January 7th, 2014.  This PSA reading was 4.4.  Not only is this higher than my initial score but it indicates an undesirable rate of change – PSA Velocity.  I scheduled a consultative visit with my Urologist for January 10th – Friday of the same week.  Dr. Webster, of Alpine Urology in Longmont, used this session to set my expectations for the biopsy.  Oh, and his nurse collected a urine sample.  You will never leave the office of a bonafide Urologist without also leaving behind a urine sample.  Even if you are only there to pay a bill.  Dr. Webster was thorough, meaning yet another digital rectal exam.  He also completely advised me of the potential side effects to biopsies and why some men don’t risk the procedure.  I scheduled my prostate biopsy for the following week on January 17th.

I’ve written on some of these earlier events in my running blog.  This link will filter those stories under the “medical files” category.  Suffice it to say, the biopsy is not painful, but it is extremely uncomfortable.  I couldn’t run the next day but did snowshoe on Sunday.  The blood in my urine cleared up by the next day.  As far as I know I might still have blood in my semen.  I’m told it takes about twenty ejaculations to fully clear.

I reviewed the biopsy results with Dr. Webster on January 23rd, wherein I learned I have an early-stage, slow-growth cancer.  Of the twelve biopsies, two show carcinoma and two are suspicious.  The two carcinomas are clinical stage T1c which implies early stage, and both have a Gleason score of 6 which indicates slow growth.  Dr. Webster reviewed my treatment options which include active monitoring, radiation and surgery.  Some sort of cryo-freezing procedure is technically an option too but he didn’t support it.

Active monitoring is an option with the Gleason score of 6.  But it would require quarterly digital rectal exams and annual biopsies.  I can’t live like that and did not consider it a viable course of action for myself.  There are two forms of radiation treatment.  They have formal names but I’m not a doctor.  One is internal with beads or seeds.  I’ve also heard the term pellets.  These radioactive seeds are inserted into the cancerous prostate tissue and left there to rot.  The other form of radiation treatment is external and administered with a death ray gun.  This requires five or six weeks of daily therapies.  Like I have that kind of time.  The final option is of course surgery to remove the prostate.  A prostatectomy.

Dr. Webster ended the session by suggesting I seek a second opinion.  He also made it clear, as a surgeon, he advises surgery.  We met again for another consultative visit on February 7th, after I had some time to think about my options.  This did not give me time though for a second opinion so I refrained from making a commitment to surgery.  He retaliated by giving me my 3rd digital rectal exam.  I got in some good questions though to further establish my expectations on post surgery recovery.  I was more knowledgeable after having talked to two others with prostate cancer, along with my father-in-law who is a retired medical doctor.

Talking to others made me considerably more informed.  I spoke to an older friend who had external radiation therapy.  The cancer disappeared for five years and then returned much more aggressive.  He now needs hormone therapy which is essentially chemo.  I learned from him, and also the doctor from whom I eventually get a second opinion, that certain initial treatments can rule out specific subsequent treatments.  I further learned of the experience of another friend, now deceased, who had the internal radiation.  He had good results but died soon after from a heart ailment.  The best discussion was from a total stranger, a friend of a friend, who underwent the prostatectomy.  He is my age and in similar health as a serious recreational, masters class athlete.  He was clearly disappointed that he still has Erectile Dysfunction a full year later – for which he is attending physical therapy.  He was able to return to exercise after three months.  I’m so very grateful to this guy, whom I totally cold-called, for sharing his experience with me.  If anyone has questions for me, this blog takes comments anonymously.

I finally received my second opinion on February 28th, 2014 by Dr. Ronald Rodriguez from the UT Health & Sciences Center in San Antonio, Texas.  I mentioned my father-in-law is a retired endocrinologist.  He suggested this urology oncology center.  I didn’t know what I needed exactly in terms of a second opinion.  I had no reason to doubt my original diagnosis and was fairly comfortable already with my decision to elect surgery.  This is due diligence though. Talking to Dr. Rodriguez was simply amazing.  He gave me so much more information than I’d learned to date from all the online discovery and interviews of previous cancer patients.  He told me of interesting correlations.  Most importantly, he re-evaluated my biopsies.  He ordered them from the lab that performed them – AmeriPath.  He determined one of my suspicious biopsies was in fact another T1c carcinoma with a Gleason score of 6.  And that one of my carcinomas was actually a Gleason score of 7.  Apparently cancer scoring is a subjective art.

Dr. Rodriguez explained how this changes my treatment options.  Active monitoring is no longer an option with Gleason 7.  And I forget why but he advised against external radiation.  Plus he advised against internal radiation suggesting certain techniques would not work well for one of my carcinomas based on its location.  Essentially he confirmed my choice for surgery.  He did downplay the apparent advantages of robotic surgery.  He explained how manual surgery provides a tactile edge over the robotic visual superiority in terms of completely removing hard to reach cancers that are growing into other areas.  In his words, robotics have a higher rate of positive margin.  But robotics lower the bar allowing more surgeons to perform more operations beyond the confines of the larger medical facilities.  He suggested my surgeon should have performed a minimum of 50 robotic surgeries, but also supported my preference to use my Urologist over some hired gun.  The benefit being able to maintain an ongoing dialog with my surgeon since he is also my Urologist.  As I got up to leave he conducted my fourth digital rectal exam, with a hernia inspection for good measure.

I then scheduled my prostatectomy for April 2nd.  I hate to admit this but I took my work schedule into consideration.  I have a project with a key date for deliverables due at the end of March.  My surgery will be proceeded by a cystoscopy (AKA medieval penis torture) on March 21.  Looking forward to that.

Prostate Biopsy

Reblogging this post at this site since it is really part of the story.

A Runner's Story

Michelangelo's David  with clipping path Forgive the title.  I want to be clear up front on the following content.  I held off blogging about this until I talked to my mom to give her a heads up.  Since she reads this blog, I have to be fucking careful about what I write.  A blood analysis last fall indicated an elevated PSA level .  I elected to take a second reading a few months later rather than proceed directly to a prostate biopsy.  Do-overs are standard policy in my book.  Unfortunately the second test didn’t work out in my favor.

In case you’re interested because you expect a prostate biopsy in the future, the following is my experience.  I can tell you this is not some cavalier test.  Without even taking medication, simply having the procedure has potential side effects.  I find the risks acceptable, major inconveniences though for sure.  I can see not every guy…

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