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 have 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.

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.

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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