Home from the hospital

My purpose in writing about my prostate cancer is to encourage men to get tested. The PSA test caught mine very early, and despite it's moderately aggressive nature, I'm probably 100% cured. If anyone you know has to go through this, please don't hesitate to recommend me as a resource. The truly scary part is not knowing what to expect.

On a local web forum, one of the frequent posters said that he had to renew his blood pressure meds just as I had, and his doctor requires a checkup. The problem lies in the fact that he doesn't have insurance. I checked on the county health department web site, and while they offer some blood tests for free or reduced costs, they apparently don't do PSA screening. If anyone knows of a no-cost/low-cost PSA test service, please let me know about it.

I had surgery on Monday and came home yesterday. I snoozed on the couch most of the afternoon. It's kind of nice to wander around the house in a bathrobe, PJs, and slippers all day.

The pre-operative preparation was a chore. I couldn't have any solid food on Sunday, not even a glass of milk, so I was a cranky old man. Thankfully, the surgery was scheduled at 7AM. The anesthetic killed my appetite, so I wasn't really hungry Monday afternoon and evening. Lyndsay and Mary ordered cheeseburgers from the dietary department, something they actually encourage at the hospital, and they were very good. Oklahoma Surgical Hospital is plush!

The surgery went well. The after effects mostly involve some abdominal pain and what feels like gas pain, but is more likely bladder spasms. Part of it was removed, and since the bladder is a muscle, it's letting me know. I'll have a catheter until Monday and by then there's no doubt I'll be thoroughly sick of the thing. Normally I sleep on one side or the other, but with the catheter and bag I can sleep only on my back or – with difficulty – my left side.

It's almost impossible to get a good nights sleep in a hospital, and this one was no exception. I probably didn't sleep longer than an hour at a time. Since I was awake so often, I developed a nearly obsessive fascination with the breakfast menu. I hadn't had solid food since Saturday, so the prospect of breakfast was very appealing. Still, I behaved myself, limiting it to a blueberry muffin, a banana, orange juice, and the obligatory coffee. Dietary opened at 7AM. I called at 7:01.

Late night television is truly weird. Besides the noise of chat shows, reruns, and news, I found a Spanish language infomercial that went on for at least an hour touting a penis enlargement device. The ad featured a bevy of women smiling hugely.

Last night I had cling peaches for dinner and a granola bar for breakfast early today. I made some oatmeal around mid-morning. The post-surgery instructions advise against getting constipated, and believe me, if simple coughing hurts this much I don't want to think about straining.

As I write this, it's late afternoon on Wednesday. Duchess the Wonder Dog stares at me longingly, wagging her tail in the hope that I'll take her for a walk. It's not to be. Maybe we can get back to our regular routine next week, though she won't be going to the park because I'm not allowed to drive for two weeks. Still, I'm seeing rapid improvement. I had great difficulty getting up and down yesterday, and walking upright was painful. Today, I'm still feeling it when I get up and down, but straightening up is much easier. I don't bend easily, though, and reaching the floor is nearly impossible. Putting a bowl of cat food down for Tiggr required some ingenuity and an old Sierra cup.

Inspected, detected, neglected, and selected

20NOV2012

On Friday morning, I had another ultrasound with Dr. Milsten. He said the estimated size of my prostate given by Dr. Miller was very close. Milsten measured it at 71mm while Miller said 70. He's ready for surgery on Monday.

In the afternoon I went to the Oklahoma Surgery Hospital to be “inspected, detected, neglected, and selected” in the words of Arlo Guthrie. I was poked and prodded, filled out reams of paperwork, and chatted up every nurse in sight. Yeah, I'm gonna be one of those old guys who talks to every young woman within ear shot. But they took my blood and a chest x-ray, and after a while they let me go home.

Let me tell you about the hospital, though. For those unacquainted with Tulsa and ORU, the campus is truly a sight to behold. If you have even a modicum of taste, it's just not a good sight to behold. The architecture is comparable to something found on the cover of a pulp science fiction novel from the 1950s. I'll be charitable and only call it garish. I wanted to throw in lurid, too, but it's a Christian university and they don't do lurid. They're big on authoritarianism, though, as they have a policy that forbids single students from living off campus, they can't drink, and they not allowed to dance – ever. Why do to college, then? The place has a real Stepford Wives feel.

I'll try to go down there this coming weekend and get some photos. Or at least I'll take photos until the campus security folks get an alert from their Unbeliever Detector. Honestly, if this is Oral's vision of heaven, I don't wanna go. My personal vision of the hereafter is more on the order of a cathedral-like grove of trees. The virgin timber at Heart's Content wilderness area in Pennsylvania comes to mind as does the Great Smokey Mountain National Forest or the Grand Tetons – the latter named by some love-starved Frenchmen.

21NOV2012

One of my co-workers returned to work today. S had prostate surgery five weeks ago. Naturally, I had questions. I asked about the surgical drain and catheter. He said the drain was removed the day after surgery, but the incision hurt for a time. The catheter was another story. It made his bladder feel as if it was always full. It was in for a week, but when Dr. Milsten removed it, S had problems urinating. He fell asleep as soon as he got home, and that was a mistake. He should have had his wife wake him every hour so he could go to the bathroom.

He told me about Kegel exercises as a means of preventing leaks. I read about it earlier. Many prostate patients have bladder problems if they try to lift something heavy, experience pressure on the abdomen, or even laugh heartily. It's one of my concerns, of course, but at this point I'm simply looking forward to getting this done.

In yet another example of bureaucratic idiocy, S was called to the administration building for fingerprinting since he's been off work for a month. He has 25 years of seniority here and only now they want finger prints? To make it even more ludicrous, he's retiring next week.

I took photos at work today, concentrating on those co-workers who will be retiring. They'll be gone before I get back to work. For those few who read this, the photos will be in a private album on my Google+ page, and I'll see that Richard and Nick have the URL. Without it, you cannot see the photos or the album.

I've had a lot on my mind...

"All twelve samples are positive for prostate cancer."  Dr. Miller was matter-of-fact and calm.  He'd done this many times.

I was remarkably calm too...for the moment.  Unlike the movies, there had been no ominous music building in the background as Dr. Miller entered the room.  In an odd way, finally knowing that I had cancer was a relief.  The doubt that began back in August was finally resolved.  It was a problem that could be overcome.  The doctors caught it very early, so there's an excellent chance of a full recovery.

Let's start at the beginning.





September.

When I visited my doctor for a checkup back in August, blood tests indicated that my PSA was over 4.  Normal should be under 2.  He scheduled me for a meeting with a urologist, Dr. Miller, who did another exam and more thorough blood work.

My PSA increased more than a point in one month.  It's now over 5.  When the nurse called with the results, she immediately scheduled a prostate biopsy.  In the meantime, I'm not supposed to have any aspirin or other blood thinner.  I have to report an hour early for the biopsy so they can give me an antibiotic, and of course, I have to use a fleet enema to clear the way.

Fun, fun.

Sure, there's a slim chance that I can develop a serious cancer or a complication from the procedure.  That's a remote possibility, but one that exists nonetheless.  I'm a little nervous about this.

17OCT2012

I had the biopsy on Tuesday last week.  On Monday, Dr. Miller told me that 12 of 12 samples were positive for prostate cancer.  I've been reading more about it since then, and I've learned that by the time we reach 80, half of all men will have it.  That's a 50/50 chance over a lifetime.  Even so, most men will die of something else before the cancer gets them.  When it's detected early, the success rate is nearly 100%. 

Treatment options include: surgery, chemotherapy, cryotherapy, hormone therapy, radiation, and surveillance.  Each treatment has several approaches, so treatment can be tailored to the individual depending on his age, general heath, and type of cancer.  I'm presently reading the National Cancer Institute's "Treatment Choices for Men with Early-Stage Prostate Cancer" (NIH pub. no. 11-4659) and it's riveting stuff...if you're an insomniac.  It's informative, though, and some of the material could be fodder for immature and slightly off-color satire.  Not that I'd yield to that nefarious temptation, of course.  Not me.

Here's something weird, though.  Some of the people around me have been far more freaked out over this diagnosis than I am.  Honestly, Monday afternoon I walked around thinking, "I have cancer."  But there was almost no emotional impact to that thought.  I didn't get depressed or angry.  It was like being told that a bad tooth would have to be extracted.  It's just something to get through. 

A few people reacted as if I were about to keel over any minute.  Maybe that comes from seeing others decline and die of cancer, or maybe it comes from a simple lack of knowledge.  Then there's fear of the unknown.  Put them all together and you get shocked people.  As I already know a couple of men who have been through treatment or are entering it, I asked questions and read about it, knowing that by acquiring information I can overcome my own fear.

On Friday, I see Dr. Miller to discuss treatment. I'll try very hard to keep from telling him my fears of radiation therapy leading to a 50 foot penis attacking Tokyo.  He's probably already considered it.

(I resisted for nearly three paragraphs!  That's a really long time!)

22OCT2012

We saw Dr. Miller on Friday, and by "we" I mean Mary, Lyndsay, and me.  Jordan wanted to go along too, but found his pillow far more attractive.

At the office, we were ushered into a conference room where Dr. Miller explained the various treatment options.  My Gleason score is a six, or as I understand it, a slightly aggressive form of cancer that can be treated in a number of ways.  They include: surgery, radiation therapy, chemotherapy, hormone therapy, or simply "watchful waiting."  Dr. Miller did not recommend the latter.  Several surgical options are available, but the most promising from my point of view is the laproscopic robot surgery.  The other option I'm considering is radioactive seeding.  Right now, I'm leaning more toward surgery because the radiation technique may allow the cancer to recur in 10 years or so.  I don't want to be 70 years old and facing surgery.

Besides having a 50 foot tall penis, the radioactive approach might cause fogging on my photographic film.  I hate that.  I'll probably have to do a couple of glow-in-the-dark jokes too.


24OCT2012

Mary and Lyndsay talked to me about the possible treatments.  Both were thinking that removing my prostate would be the best course, an option that I had already decided was best.  I called Dr. Miller's office today, telling his nurse that I wanted to do the laparoscopic surgery.  "Dr. Miller doesn't perform those", she said, "so I'll set up an appointment with Dr. Milsten."  Indeed, Dr. Miller told us on Friday that he did the traditional surgery, not laparoscopy, so this was not a problem.  I'm seeing Dr. Milsten on November first at 11 AM.
 
1NOV2012

Lyndsay accompanied me to meet Dr. Milsten.  He's younger than Dr. Miller, and at one point, said that he didn't do prostate surgery the "old-fashioned" way.  I can't decide if that was a dig or not.  But he was focused and professional, probably from doing this spiel hundreds of times. He said my prostate would be removed intact so the pathologist can study it.  I had the impression that finding widespread cancer cells in a prostate that hadn't started to enlarge was slightly unusual. 

He asked what I thought of the process so far, so I told him of my initial trepidation and how it was alleviated by experience and more knowledge.  I told him of my reasoning at reaching the decision to go the surgical route.  Radiation therapy may work, but if it doesn't, a later surgery is less effective, and in the case of radioactive seeding, it's simply not possible.  I don't want to be another 10 years older and facing surgery.

Meanwhile, I'll have another ultrasound so Dr. Milsten can plan his surgery, and sometime before the 26th, I'll have a meeting at the hospital, probably with the anesthesiologist.  I have a set of instructions to follow prior to surgery.  Mary and Lyndsay will be eagle-eyed seeing that I stick to it.

Here are the next steps.  On November 16th, Dr. Milsten will do another ultrasound to map out the position of my prostate.  The surgery is scheduled for November 26th.  I can have only clear fluids the day before the surgery, and I'm NPO after midnight.  All blood thinners are forbidden 14 days prior, and that includes aspirin, ibuprofen, vitamins and supplements.

Now for the icky stuff, and I forgive you if you want to skip this paragraph. Dr. Milsten said the outcomes are very good given my present good health and the progress of this cancer.  He said that there's a chance it can recur anyway if they miss any of the cells, but that radiation is a fall back position if that happens.  There's one aspect that is problematic.  In order to preserve erectile function, the usual approach is to peel back the nerves surrounding the prostate, yet that also may allow some cancer cells to remain.  Removing the nerves entirely is the nuclear option.  Eliminating the nerves greatly reduces the chance of recurrence.  This will require some careful thought. Mr. Happy and I have been together for a very long time.  The other concern is incontinence.  Eighty percent of all prostate surgery patients recover without problems.  Most of the other 20% have occasional problems, like if they strain to lift something, laugh, or sneeze, they may experience some leakage.  In a very small percentage, that problem is far worse if sphincter control is lost.  That's mainly a problem with the open prostate removal, or, as Dr. Milsten said, the "old fashioned" way.  Still, the surgery is preferable to radiation because the side effects of radiation therapy can include ED, incontinence, and loss of bowel control.  I don't want to go there.