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Thread: PSA for PSA (and Beyond)

  1. #1
    Barracuda
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    PSA for PSA (and Beyond)

    *** Warning ***
    This is an account of my journey through Prostate Cancer. It might get a bit graphic at times.
    *** Warning ***

    Gentlemen, (and this is mainly for the gentlemen in the crowd, although the ladies are welcome to read along and urge their gentlemen to get tested),

    I have just started what will probably be a 4 month surface interval after surgery for Prostate Cancer. On the other hand, we have a vacation booked for late January and I WILL be diving.

    For the last 9 years, as part of my yearly physical, there was a PSA test – Prostate Specific Antigen test, used to detect signs of prostate cancer. About 3 years ago the numbers started to go up and both the rise and the rate of rise concerned my doctor. Even though a “digital exam” (the doctor’s finger up there checking for enlargement) did not find any excessive enlargement (almost all men will experience some enlargement as the years progress – one of the things that make it harder to pee) my doctor wanted to make the next check. Earlier this year we decided it was time to do a biopsy of my prostate to look for problems. It was a relatively simple procedure – some numbing cream for my butt, a small ultrasonic probe to let the doctor see inside me, and a grabber to pinch off 12 tissue samples to be examined under a microscope. And, you guessed it, the results came back positive in 3 of the samples. I had early stages of Prostate Cancer.

    Let me tell you about my state of mind. We hear so many horror stories about cancer that I was terrified. How long did I have to live? Would I have time to go on my dive trip in May? Did I even need to put more money in the parking meter? My doctor reassured me that as cancers went prostate cancer is hitting the jackpot. We had identified it early and, even untreated, probably would not effect me for years. And the nature of the prostate is such that it usually takes a long time for any cancer to metastasize beyond the prostate gland and spread to other tissue. That same contained nature makes it relatively easy to remove it all. As he put it “Many men die WITH prostate cancer; few die OF it. You will go into the treatment with cancer, you will come out cancer free.”

    Over 2 or 3 appointments with my GP and Urologist and lots of independent study with Dr Google by both my wife and I, we explored my options. Because of my age (54) we agreed that “watchful waiting” was not the best. Unless I get hit by the proverbial bus, I should have many years of life left and there was no sense in giving the cancer that time to grow, metastasize, and make any future treatment more difficult.

    Hormone treatment was the second option we discussed and set aside for me, even though it was the route chosen for my father last year. Again, I am young, healthy, active and don’t need the ongoing side effects of the hormonal treatment for years to come.

    This leaves radiation and surgery as treatment options. It was explained to me that radiation is a “one-way gate” – once we start on radiation treatment, it is very difficult to switch to another treatment path if the radiation doesn’t get all the cancer. We can opt to go to radiation later but starting with it locks us to that option.

    Which left us with surgery, the route we selected. Until recently prostate surgery meant a fairly large open incision so the Urologist could get his hands inside and muck around. But, as my wife pointed out, lately the preferred route has been robotic surgery. “Robotic-assisted laparoscopic radical prostatectomy” to give it its full name. The doctor makes 6 small stab wounds and inserts the arms of a robot that he controls from a console. Lights, camera, tiny waldos to manipulate the tools, computer dampening of any trembles in the surgen’s hands, and very fine motor control. The process is less invasive, more precise, leaves smaller incisions, and has less healing time. This is the route I wanted. (Go check You Tube for some live action clips!)

    The only problem is that robotic surgery is not offered in Ottawa! Canada’s 4th largest city, home to our federal government, my home, and we don’t have the equipment. They are in the process of raising the funds to bring it here but the machine is still a year to 18 months away. And do I really want to be the inageral patient? Or even number 10? Back to consult Dr Google and it turns out the “Centre of Excellence” for Canada is in London, Ontario. I don’t care that it is 6+ driving hours away: if someone is rumaging around my insides, I want the best! A quick referal from my Urologist and I am off for a consult with the Urologist who has done about 400 procedures using the robot, then a pre-admission screening and surgery.

    Prior to the surgery was some fairly extensive bowel preparation. The less said about that the better – lets just say the only things left in my digestive tract were teeth and tonsils and those only because they ar firmly attached. Surgery was scheduled for 6 Sept (a Tuesday) at 8am. My wife and I got to the admissions desk at 6am, and I was all gowned up and ready by 7:30. “A small needle pinch”; “Count backwards from 100”; “Welcome back, Mr Yaskowich. The operation was textbook perfect”; and we are off to the recovery room by 1pm.

    The in-hospital recovery process is mainly a matter of incision healing, pain control, and making sure all your internal systems come back on-line after being put to sleep with you. A couple of sleepless nights while you try to find a semi-comfortable position, getting up to walk a number of times, and having your blood pressure taken endless times.

    A quick tip: if you want the best care, be married to a nurse who spent more than 12 years caring for patients on a surgical floor. But be warned that the superior care comes at a price: You will get what you need, not what you want. You want to lay in bed, seeking the least uncomfortable position; you need to get up and walk. You want to baby your incisions; you need to take deep breaths and cough to keep your lungs clear. You want to be active; you need to take it easy and have frequent naps. Thank you, Charlene, for being there for me.

    One of the signs that your insides are working again is the ability to “pass gas”. I was having trouble getting things to release properly. Lots of gurgling and pain as gas moved around but no “exhaust”. On Thursday morning the head of the Urology department, the chief Resident and my Urologist are making rounds. Just as they entered my room I let go with a Concert in D Minor for French Horns and Wood-Winds. I was mortified! Until all three turned to me with big grins and thumbs-up. And the pressure relief was wonderful.

    I was released to go home at 1pm on Thurs, just 53 hours after the start of the surgery. Between being fortified with pain pills and a willing wife, she drove us straight home, making frequent stops so I could walk around to keep the blood moving. We arrived home at about 9pm and said Hi to the cat.

    Now it is just a matter of healing, with the occasional trip to the doctor for things like catheter removal, more blood work, general follow-up, etc. Luckily much of that can be done by my family doctor or Urologist here instead of making the long trip back to London.. I think the hardest thing is going to be giving my body time to heal.. Much of the pain is gone, so I want to be more active. But if I overdo things I get light-headed and pale. Slow and easy with frequent naps is the way to go. And not straining my insides by lifting anything heavy for a month. Do you know how many everyday things weigh more than 10 lbs? I am very thankful I have a job with full benefits that will let me take a month to 6 weeks off to heal.

    There are currently 2 body systems which still need to come back on-line: bladder control and sexual function. Part of removing the prostate involves cutting the outlet from the bladder that goes through the prostate and then reattaching it. While it heals I am wearing a Foley Catheter, which comes out 2 weeks after surgery (I am counting the hours!). Afterwards I will be doing Kegel exercises to strengthen the muscles responsible for bladder control (I started doing them in the weeks leading up to surgery, so recovery time should be less.) As for sexual function, the nerves that govern erectile function form a net around the prostate. Robotic surgery allows for very precise differentiation of the tissues so almost all of the net was saved. But nerves don’t react well to being stretched and abused as they were during the surgery so they take a while to recover. With this type of surgery over 95% of men recover full function (vs. numbers in the 60% range for traditional surgery), and my Urologist has numbers in the 98% range. I am young, healthy, active, and following doctor’s orders – I am VERY optimistic. As for right now – go look up “Foley Catheter” and you tell me how well you would function with one of those in place.

    So, what is the “take away” from all of this? Gentlemen, once you reach age 45, get tested for PSA levels as part of your annual physical (you DO get an annual physical, don’t you?). Ladies, drag your man, kicking and screaming if necessary, to the doctor to get tested. If you fall into the 7% of men who develop prostate cancer, talk to your doctor and Urologist: there are lots of options and the technology and techniques are getting better every day. And support the research initiatives that are looking into cancers “down there”. You can guess where some of my charitable donation money will be going in the years to come.

    Please note: I am not a doctor. I don’t even play one on TV. This is just an account of my experiences. Consult your own doctor about your body, your health, your options.
    And on the eighth day, God said, "OK, Murphy, you take over"

  2. #2
    Long Tailed Thresher Shark
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    John, I'm glad you have been properly diagnosed and treated. All will be well in time. I know how traumatic unexpected health issues can be. And how difficult and lengthy recovery can be. Take care of yourself in all ways and hope to see stories of your diving soon. Hugs.

    L


  3. #3
    Shark snagel's Avatar
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    Hate to hear what you went through, but great information...thanks.

    Snagel

  4. #4
    Shark
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    excellent accurate rendition of a very difficult time!!! fellas....listen up you have gotten the info that you need. now take action!!!!! Hubby gets checked because his Dad had it and also because he loves me..... nuff said...
    God is good, no matter what!!

  5. #5
    Grouper
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    And I thought my boss was a pain in the a**. Good luck on a full recovery and thank you for the information.
    What, me worry?

  6. #6
    Grouper bfmorgan's Avatar
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    Get well soon. A very well written narrative. I am sorry that you have first hand knowledge, but the narrative should motivate anyone who does not get a physical and PSA test annually.

  7. #7
    Grouper
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    I am a huge HUGE believer in the healing power of positive thinking. So thank you for sharing and get well soon! You'll be back in the swim of things in no time!
    jet

    sealion.jpg
    "The sea is not out to get you. It does not even know you exist."

  8. #8
    Shark
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    Thanks, John!
    Glad you're on the road to healing.

  9. #9
    Barracuda
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    *** WARNING - This will get a bit graphic - WARNING ***

    A quick update. The Folley came out at 10:15 on Monday. Today, Friday, I have much of my bladder control back (about 85-90%). I still occasionally have the "dribbles" but I am clenching like mad with Kegel exercises to get the rest back. For saftey I sleep in Depends and use a pad during the day. I just make sure I don't drink anything within about an hour of bedtime and sometimes get up in the middle of the night to relieve hydrolic pressure.

    As for the last system mentioned, it is also back on-line!!!! Some men take months to regain sexual function - I had it back in 15 days!!!! It is a bit different in that the prostate provides the "push" to the ejaculatant, so I have a "dry fire" orgasam. But, hey, who am I to complain - the equipment WORKS!
    And on the eighth day, God said, "OK, Murphy, you take over"

  10. #10
    Barracuda Founding Member
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    Glad your recovery is going well sounds like Diving in Jan is on target.
    'in media stat virtus'
    Virtue's in the middle

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