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.  As in physical stimulation.  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.

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.