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.