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Candid Confessions of a Cancer Survivor – Part One: Radical Prostatectomy – An Unnerving Experience
You consider your options very seriously when you’ve been told that you have cancer cells in that walnut sized organ, the prostate. To the average person, having prostate cancer is considered to be a matter of fact situation. “Oh, prostate cancer is one of the most easily treated cancers”, say the overly optimistic friends. With these expert’s encouraging words, it’s easy to go into self denial, but you soon realize that the medical experts don’t take it that lightly and think you should act, sooner rather than later. More serious now, you do research and learn of the ramifications that the conventional treatments may result in, including but not limited to incontinence and impotence. As scary as losing bladder control is, it’s nothing compared to the threat of impotence. So being aware that only a relatively small percent of prostate cancers will actually become aggressive (metastasize) and kill you, you feverishly start to Google for alternate, less invasive therapies. There is the holistic approach, laser treatments and HIFU, but in the end I opt for going with what I consider the most likely procedure to result in the eradication of the problem; a radical prostatectomy. My primal instincts have kicked in and survival has risen to the top, superseding even the need for sex. After having weighed the pros and cons for some time, one achieves a certain amount of peace, having finally made up one’s mind. Still there is a considerable amount of apprehension as the day approaches. Not only are they removing something situated in the lower regions, perched below the bladder and next to the large intestine (almost close enough to the back door to see daylight), but they are extricating the very essence of ones manhood.
Prior to this stage you’ve already been exposed to some fairly inhumane treatment. The urologist suspects that you have cancer due to an elevated PSA value, but he has to confirm his suspicions with a biopsy. All men over 50 have had the fun of the famed finger exam. Well that’s nothing compared to a prostate biopsy. First an ultrasound probe is inserted into the rectum to determine the size of the culprit. This is followed by a gun that shoots darts into the prostate to take samples. So when the time comes that you hear the dreaded “C” word, you kind of think, “How much worse can it be”? If you only knew what surprises lay ahead!
The first step is an appointment with a nurse navigator. I always thought this was a term pertaining to guiding a vessel through a dangerous waterway. Come to think of it, there are some analogies that could be made to the matter now under consideration. Anyway, the navigator is there to lay out the alternatives that are available to deal with the cancer cells. First there is plain old radiation therapy. Radiation is fired externally in the general region of your prostate. They’ll kill the cancer cells all right. They also kill any healthy cells surrounding the prostate. In fact, the oncologist said the area would look like a “bomb site”. Not in my opinion, a strong recommendation for the procedure. Then there is a specialized radiation treatment called Brachytherapy. Here, radiated pellets are shot through your perineum into your prostate. But this procedure only works with a small prostate. If one’s prostate is too large it must be shrunk with hormone therapy, which removes all testosterone from your system. You have to wonder if shrinking your prostate will cause collateral damage to other areas also involved in sexual function. Shrinkage notwithstanding, some other nasty side effects are obesity, lack of energy (including but not limited to lack of desire), an increase in vocal pitch and the development of the mammary glands which I believe are non functional. After hearing all this one begins to think, “How soon can I go under the knife”? But the surprises are just starting. First there’s the little problem of incontinence. Most men, you are assured, given enough time become more or less continent. The navigator moves right on, wanting to save time for a more glamorous subject; the delicate matter of impotence. Delicate for me of course, but not to the navigator who has done this a hundred times before. She, smiling radiantly, describes the procedures, should the need arise (bad choice of words) for external forces to be applied to the member in question to achieve adequate results. One is presented with two options, neither of which seems particularly appealing.
First there is the unsettling suggestion that one inject, yes, the penis, with a chemical substance that will cause an immediate response. Now that’s a titillating twist to foreplay! I doubt even sadomasochists have thought of that one. If one is too squeamish about needles in places that weren’t meant for needles you might try a vacuum pump. This involves placing the member into a chamber with a pump to create a vacuum that will draw in sufficient blood to cause an erection. I assume there will be a warning on the box that over pumping may cause permanent injury, seek medical attention immediately if… Once the desired state has been achieved a rubber ring is placed at the base to trap the blood in the engorged member. This procedure is reminiscent of that used to castrate calves on the farm by mechanically stretching a rubber ring over the testicles to cut off blood supply. Eventually the testicles shrivel up and fall off. One assumes there will also be a warning on how long it is safe to keep the rubber band on the penis. However you are given a “faint hope clause”. If the surgeon in his wisdom deems it safe to spare one, or if lucky, both nerves that run on the outside of the prostate, normal erections may occur over the course of time. This is fine for someone with the faith of an evolutionist who believes that given enough time anything can happen. Red-faced, hot and bothered, I leave. The still cheerful navigator awaits her next victim.
Finally after much agonizing and soul searching while clinging to the false, I mean faint hope that the surgeon will be able to use the nerve sparing procedure, the decision is made to opt for surgery. There is one more matter to deal with before surgery. When it comes down to the nitty gritty there is only one nasty outcome of a prostatectomy that really counts, and that’s loss of bladder control. Yes, that’s right, sex finally plays second fiddle. The cure all for this problem is becoming proficient with the Kegel exercise. Past experience has alerted the team to be proactive and not assume that all men are doing this exercise properly. Therefore they have trained a physiotherapist that you see before surgery, who is now the expert in the field of exploring the internal parts in the nether regions of the male anatomy, to determine the efficacy of the Kegel exercise you have been practicing. Most professional positions these days come with an impressive official title”; this one is ‘Certified Pelvic Floor Therapist’. Finally the fateful day of the pre-op arrives. You go through a series of tests and then you’re ready for the meet and greet with the therapist. To my surprise, it’s a woman. Why aren’t there more men in the medical profession these days? What would inspire a young, pretty woman to decide on a career specializing in this field is beyond my comprehension. It must have something to do with getting in on the ground floor. But everything is done with proper decorum. You are instructed to remove your clothing (nothing is said about keeping your underwear on), put on the gown and lie down on the bed on your back with your knees raised. Immediately a warning flag goes up (bad choice of words again). This in not the position one has become accustomed to during the routine digital exam that your GP uses, when you’re instructed to face the wall and get into a fetal position. How I yearn for the comfort of the fetal state right now. However, you muster up your courage and lie in a prone position adequately exposed, waiting for the Kegel expert. She comes in friendly and smiling enthusiastically. Again, she had done this a hundred times, but not me! This is a little tougher than with the GP who you can happily moon without having to look at him. She faces you as she puts her head next to your knee (on the outside, that is) and goes about her business. At this point eye contact is strongly not recommended. She instructs you to breathe deeply. When you’re off guard, zip, she’s in. That wasn’t too painful. One begins to wonder at this point if this really would be any easier if it were a man doing this procedure, strictly due to finger size of course. She begins to give instructions on what to do as she explores all those muscles on the pelvic floor to see if they are being activated adequately. Finally her examination is complete and she announces my rating of 4 out of 5. I’m not sure if that’s the Kegel’s score or the rating of my acting performance, feigning that this was routine for me too. Again she follows proper protocol and leaves the room while I am instructed to take my time in putting myself back together.
Take my time, no way. I’m up and dressed in no time flat. When I’m ready she comes back in cheerful as ever to give me last minute instructions and the possibility of future liaisons. She again stresses the importance of doing these exercises and doing them properly. Since I only got 4 out of 5, I guess she felt there was room for improvement. As an illustration she gave me a graphic concept the she hoped would stay with me; “When you’re doing your Kegel’s pretend that you are inhaling a pea through the end of your penis.” Well, you don’t forget that helpful hint immediately. It quickly becomes firmly embedded in… your mind. Then on my way out she hands me her business card, “Just in case you want to see me again”. Not likely. I’m out of there in a flash!
Finally the ominous day arrives, Friday December 13th 2013. I’m not superstitious but yet, one wonders. In China I don’t think this day would have been chosen as one particularly auspicious for such a delicate procedure. Before the surgery, I was led to a cubicle like a calf to the slaughter. There I was met by what appeared to be a reliable anaesthetist who went over his part of the routine. Then the surgeon who was to perform the radical prostatectomy came in – to settle my nerves I guess. He asked if I wanted him to contact my wife with the outcome. I thought the outcome of this surgery was a foregone conclusion, but I agreed he should do that. Then as an after thought I inquired about the nerve sparing technique and if he thought he would save one or two nerves. He informed me that he had decided he would remove both nerves. I was taken aback because I thought the plan was to do the nerve-sparing procedure. I guess he didn’t want to take any chances since I had, he explained, intermediate stage cancer. The exchange was quite unnerving. Maybe this Friday the 13th thing wasn’t such a good idea after all. Finally I was led to the theatre where I guess I was to be the star attraction. The first task was to get hooked up to all the IVs and other paraphernalia that would put me under. The anaesthetist had an assistant who was working on one arm while he was working on the other. The assistant was having all kinds of troubles so the anaesthetist went to help him out. Finally that arm was ready and he went back to my other arm and fiddled around for a while. Finally the head nurse said to him, “Shouldn’t you turn that on?” (What was that date again?) Thank goodness they waited till I was out cold before inserting the catheter. Talk about inhaling a pea! She didn’t say anything about the pee shooter.
Well they did finally put me out and the next thing I remember was being wheeled down a hallway. I was kind of going in and out of consciousness. My wife was waiting for me in my room and she says the first thing I muttered mournfully was, “They took my nerves.”
The rest of the hospital stay was rather uneventful. The nurses were very kind and always tried to maintain my dignity, which was difficult, and next to impossible under the circumstances. One concern after surgery is getting your bowels working again. This is one of the few times when it is acceptable, in fact encouraged, to fart (that’s what the young nurses said). I should explain, and my wife will verify this, that I’m anal when it comes to regularity. This has been aggravated by my oldest brother’s experiences with serious constipation when he couldn’t go, sometime for up to two or three weeks. He underwent numerous tests and it was finally determined that his bowel impaction was not due to a blockage but simply to a lack of roughage in his diet. There was no way I was going to succumb to such a condition, so as I aged I did everything in my power to avoid a blockage. Normally a home made mixture of various types of bran and ground flax seemed to be sufficient, but now with the my homemade remedy I also smuggled in some lactulose to ensure that I would be able to go with ease and without the slightest bit of straining so as not to aggravate what ever had been compromised down below. When things decided to break lose, with all the precautions taken and the encouragement to try to fart, and my determination to perform, I over did it, losing more than my dignity on that occasion. Nobody had told me that maybe I should be wearing diapers even before the catheter was removed.
Another concern was the possibility of getting a urinary tract infection (UTI in hospitaleze). To ensure this wouldn’t happen I took to guzzling copious quantities of juice, including a high proportion of prune juice to further avoid the earlier mentioned condition. I think I must hold the hospital record for the shortest time it takes a patient to fill his pee bag.
Wearing the pee bag felt like a ball and chain, and getting home was a bit of a challenge. Draining the bag was routine; just lift up your leg, open the valve and voila, you’re drained in no time. Going to the washroom was never so efficient. It should be noted that in a public washroom, to avoid undue attention, it is best to use a stall instead of the urinal. However in the comfort of my home, this was the one time I could offer to let people watch me pee, but no one took me up on it. Changing from the daytime leg bag to the night time bag was a little more challenging. There were too many valves to turn off and on so this didn’t always happen in the right sequence, resulting in messes on the bathroom floor. It was convenient though not to have to get up at night to go to the washroom. The only problem was I didn’t have a nurse making the rounds to see if my bag was about to overflow. I definitely didn’t want back wash to occur, which could possibly lead to a UTI.
Finally the much-anticipated day arrived, day 7 and catheter removal time. The instructions given suggest that it is best to remove the catheter in the morning, in case there are complications, such as an inability to void. This is apparently not likely to happen, but in case it does and you haven’t been able to empty your bladder after 8 hours, you should seek medical attention. Well, as I have mentioned earlier my operation was on Friday the 13th, and you guessed it, I was not getting so much as a dribble. Just my luck that I was in the 5% of patients who, when the catheter is removed, have a swelling where the urethra meets the bladder and the result is no flow. When I first had it removed I hopped off the bed waiting in anticipation for the expected flow; nada, zilch. But I wasn’t too concerned because I could apparently wait for 8 hours for something to happen. After 6 hours I was feeling desperately full. I had my urologist paged.” Yes,” the doctor said, go to the hospital,” we’ll have to reinsert a catheter. If you haven’t peed after 4 hours you never will.” I thought, you mean I waited two hours longer than I would have had to, with my bladder bursting, begging for relief? When I was discharged from the hospital initially, I was given a card for my wallet with some pertinent information. There were dire warnings that until eight weeks after my surgery date (Friday Dec. 13th, 2013, or did I mention that already) no one other than the urologist should insert a catheter. This was now a delicate procedure that required great care with the assistance of a scope to navigate the impaired waterway to ensure no damage was done. When I got to the hospital and settled into a bed, the urologist walked in. Boy was I relieved to see that it was a male on call tonight and not the female that saw me during my hospital stay on the weekend. I had had enough experiences with females that were experts in the field to last me for quite some time. After all I believed that this procedure involved entry through the front portal, not the rear. This definitely wasn’t the time for a female specialist. As the doctor outlined the solution to the problem, I began to feel a lump in the pit of my stomach, and not because of the bulging bladder. Not only was I to deal with the pee shooter now, but also a scope and he didn’t even mention the trouble light that would surely be needed. Not to worry, they would deposit some anaesthetic gel into the urethra to deaden things somewhat. Deaden somewhat, my eye. Bring on that anaesthetist again. I was willing to risk just about anything to be put under for this procedure. But this wasn’t to be. With my mind racing wildly, some words from a Seinfeld episode were retrieved from memory, and all I could do in a barely audible whisper was mouth the mantra “serenity now, serenity now.” I was jolted back to reality when I saw the doctor approaching with his gadgetry. I didn’t have to wait for his instructions. I already knew the routine. I took a deep breath until my lungs were bursting and my eyeballs popping. He caught me off guard, and zip it was in. That wasn’t too bad. What was I fussing about anyway?
The Doctor said that sensors in the bladder start to send some fairly strong messages to the brain that maybe it’s time to be looking for a facility, when it has about .6 of a litre of fluid in it. Well, let me tell you this was peeing time. The bag began to fill up, half a litre, then .8 of a litre. The urologist noticed the volume rising rapidly and said, “Wow, you were getting quite full weren’t you?” This was no surprise to me. When all was said and done, I topped her off at just over a litre. One has to wonder what would have happened if I had waited the suggested 8 hours before seeking medical attention. Then I was given the bad news; another 10 days with the ball and chain.
In a way it was a blessing. We had just barely gotten the procedure of draining and changing down pat without flooding the bathroom floor, so it would have been a shame to not be able to put that expertise to good use. I even had a chance to hone my skills showering with my attachment. Actually, I should say without it, since I finally realized that it was easier to remove the connection to the bag, and what the heck, let it drain into the bathtub. A side benefit is that I shouldn’t get athlete’s foot for quite some time.
Finally day 10 arrived and I was off to the hospital to get the catheter removed. I had mixed feelings actually, because I was getting quite attached to it. This time I was back to see the navigator. Oh well, I thought, another chance to get caught up on things. After all it had been sometime since we first met. A real opportunity to get better acquainted, and there was always the possibility that there had been medical advances made in torture devices that she could share with me. I had been instructed this time that I wouldn’t be released from the hospital until I was peeing adequately. I was completely relaxed as the navigator approached. By now I could do this in my sleep. I breathed in deeply, and zip it was out. As the navigator discreetly left the room, I lay there for a while, just contemplating life. There was no hurry I thought, judging from the previous experience. I had even brought a book along, anticipating an extended stay. You can imagine my surprise when I got off the bed, and low and behold there was a steady stream flowing onto the floor. Luckily there were some extra towels around to mop up the mess. I regained my composure, got a hold of myself, reached for, and yes, put on my first diaper in almost 65 years. I was elated. I actually peed! And I had the security of my Depends. Momentarily I was transported back to that fetal state. With peace flooding my soul, in a barely audible whisper, I sighed, ah… serenity now, serenity now. I thought naively, what more can life hold in store? Surprisingly, as I would soon discover, a whole lot more.
With the catheter out I had a whole new set of problems. Now the spigot was flowing freely, but without a shut off valve. Unfortunately there were accidents not only in the bathroom but also in the bedroom. Thankfully we hadn’t replaced that carpet yet. With all the urinary accidents going on I felt a bit like a male cat leaving its mark in the house. The analogy does break down though because a cat is neutered to cure this problem whereas mine was caused by being basically neutered.
Now one begins to revert to childhood. Diapers are worn at first because there is virtually no control. Baby powder and zinc oxide are required to prevent diaper rash. As a young adult it’s quite likely that you are buying these products for a new baby. Now, so as not to raise suspicions, I explain it’s for my grandson. After several days when some control is happening you graduate to pads, maximum absorbency of course. Later you can get by with medium and eventually minimum absorbency pads for low flow days. Baby steps you know. Of course it is more politically correct to refer to such products as Depends and Guards so we can sound more masculine; after all our egos have recently taken quite a beating. What’s beyond me though, is why we should be concerned about these ridiculous euphemisms when here we are, grown men, going around peeing our pants in public like babies.
Another surprising problem is shrinkage. I explain this later on but for the present discussion let me describe the extreme measures I’ve had to take to prevent diaper rash, or more accurately an inflamed scrotum; my sincere sympathies to all babies that go through this agonizing condition. After much consideration of the problem I devised an ingenious solution. I purchased some jock straps and cut a strategically placed hole, one inch in diameter (remember I mentioned shrinkage). Then my wife pinned on a perfectly shaped piece of a bedtime accident sheet around the hole and down over the scrotum on the outside of the jock strap so it wouldn’t get wet. Thankfully the safety pin opened only once (preparation for the shock of future needles?). It worked beautifully, until the hole would stretch a bit and I’d find myself on the wrong side of the jock strap! Being somewhat of an expert in this field now, I’m justified in weighing in on an age-old debate, definitively declaring that yes, size actually does matter. Not to be foiled, we cut guards similar to those you slip over your dog’s head after surgery, to prevent retraction through the hole in the jock strap. The “head” guard couldn’t be too tight or it would cut off the blood supply. Remember we’re not concerned about restricting blood flow just yet. It was quite effective, but what a sight! My wife said that no, a selfie was not appropriate. It would have gone viral! I missed my moment of fame, or rather infamy.
I did mention that they call it a “radical prostatectomy” because as I’ve stated they take more than the prostate and the nerves; to be on the safe side, they also take the seminal glands and the Cowper’s gland. I’d like to make another analogy, this time with male anatomy and a missile carrying a payload. Through sabotage, James Bond, that icon of virility, could thwart an enemy mission by either removing the payload or by disrupting communication with the warhead. In the radical prostatectomy the surgeon removed the carrier source and yanked the wires of communication but thankfully after having done all that he didn’t have the balls to remove the source of the payload. Had he done that, I’d really be testy. As usual, an analogy breaks down at some point. James Bond did his work leaving the women breathless. I have yet to notice a similar result of my surgeon’s handiwork, unless the asthma attack inducing odours emanating from the wet diapers in the garbage can qualify for “heavy breathing”.
A problem I was never told about, and perhaps this is unique to me (maybe I should discuss it with that cute physiotherapist) is that there seems to be shrinkage, not including the testicles. Perhaps it can be attributed to the use it or lose it concept. As already mentioned, this caused some problems once the catheter had been removed. Most of the constant dribbling ended up on my scrotum. Now, this problem may not have been solely due to shrinkage. You’ve no doubt heard the joke, “What do you find between an old man’s knees?” You guessed it, his testicles. So, one shrinks and one stretches. Too bad there couldn’t have been a role reversal. Before the jock strap invention, this incessant dribbling caused my scrotum to become irritated and inflamed. Once when I was airing out, (lying naked in bed) my wife walked in and exclaimed, “Great balls of fire!” When you cough, sneeze or laugh you should engage the pelvic muscles to thwart unwanted flows. I hadn’t practiced this enough and when she said that I burst out laughing and involuntarily attempted to put out the fire!
Through life one suffers many losses and has to deal with these in a variety of ways. There is a grieving process that includes several stages. One of these stages is denial. One day while airing out and listlessly bemoaning the situation, in a clear state of denial and desperately grasping at straws, so to speak, I suggested that possibly things could be brought to life by my wife. Talk about a faint hope. She took one look at my shrunken, flaccid condition and said, “Forget it! There’s no point in flogging a dead horse.” I extinguished the fire again. Then as emotions reeled within, I decided if I can pee like a baby, I can also cry like one and with tears streaming down my face, I felt the flickering flame of hope had fizzled out.
One should look on the bright side though and I do have things to be thankful for. The urologist told me that the lab report indicated the cancer was contained in the interior of the prostate and it was completely removed. I won’t need any follow up radiation or chemotherapy. I’ll be getting another PSA test soon to confirm that I’m clean. Another thing to be cheerful for is no more digital exams, and no more biopsies. All I’ve got to show for after this ordeal is five small scars from the laparoscopic surgery. And once I have this incontinence issue behind me, I can move on to other concerns. I’m confident that despite the difficulties facing me and the setbacks that are sure to come, I’ll rise to the occasion, one way or another.
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