I received a phone call from Dr Lee's office today and was told the results from the tests that were done on my prostate and some biopsy samples that were taken from the area. The results were the best that I could have hoped for. There were no signs of any cancer in the samples tested.
There were cancer cells in about 25% of my prostate and the cancer was limited to the surface area, I had what is called stage 1 cancer. This means that the cancer cells closely resemble normal cells and the prostate did not have any lumps or rough surfaces. As of September 21st, I am now cancer free. Of course for me there is no such thing as being completly cancer free. I will have to be tested for cancer every six months with a PSA test however I cannot ask for anything more.
Now I am focused on recovering from the surgery and again I could not ask for better results. I really feel almost 100% recovered and feel that I can do anything I want to do. The reality is that the internal healing will take at least two months to complete so I don't intend to push myself too hard for a while. I am not on any medication nor am I scheduled to take any medication.
I think I will sleep a bit better going forward!!!
Tuesday, October 4, 2011
Saturday, October 1, 2011
The catheter is removed
On Wednesday I had finally had my catheter taken out and boy was I glad to see that thing go. It wasn't that there was any pain associated with the catheter but I sure had to be careful whenever I was bending at the waist. The procedure for removing the catheter was pretty quick and it was over before I knew it.
We arrived at my urologist's office around 11:00 AM and were escorted into an examination room. A nurse came in and did the typical things like taking my blood pressure, asking me if I had any recent surgery, hello, what medications I was on and then she said ; "its time to remove the catheter. I looked around and asked, "where's Dr Tel Terzo?" She said "oh you won't be seeing Dr Del Terzo today" I of course said "well then who is going to take out my catheter?" I kind of expected the answer but was still somewhat surprised when she replied "I am".
She told me to lie on the examination table, pull down my pants, inhale and then quickly exhale and just like that it was all over. It kind of stung for about a minute after the catheter was taken out but then things felt pretty normal. I am now wearing a diaper, well actually it is more like a pad, and am getting along pretty well. I really don't have much leakage. I can sleep all night with out any leakage. I do have to get up once during the night to drain my bladder but other than that I have no problems. I get a very small amount of leakage when I run or ride the lawn tractor over bumpy terrain but every day things are getting better. I am hopeful that with a week or two I won't need the pad at all.
All of this has peaked my interest as to how exactly a catheter works. If you have an interest in things like this you may enjoy the following.
The formal name is the Foley catheter and in the hospital they referred to it as the Foley. The name comes from the designer, Fredrick Foley, a surgeon working in Boston in the 1930s. The Foley is a plastic tube about 12" long. Inside of the plastic tube there are two channels, one for the urine to drain through and the other is so air (or water) can be pumped into a balloon at the end of the catheter. The external part of the catheter has a splice in it that separates the two channels inside the tube.
One of the splices has a valve that can be hooked up to an air (or water) pump for inflating the balloon at the internal end of the tube. The other splice is for the urine to drain . This splice has a fitting that allows a friction fit to another tube that feeds into a plastic pouch for containing the urine. At the internal end of the tube one channel is open and allows the urine to drain from the bladder. The other channel is a flexible plastic balloon that can be inflated into a small balloon.
When the Foley is inserted into the urethra it goes all the way into the bladder. Once the end is inside the bladder the balloon is inflated This serves two purposes. It prevents the catheter from unintentionally sliding out of the urethra and it forms a gasket inside the bladder so the urine can only exit through the open channel preventing any leakage. When the catheter is removed the valve that keeps the pressure is opened and the balloon deflates. The catheter is then pulled out of the urethra and you are good to go, literally.
The following pictures may help you better understand my explanation
We arrived at my urologist's office around 11:00 AM and were escorted into an examination room. A nurse came in and did the typical things like taking my blood pressure, asking me if I had any recent surgery, hello, what medications I was on and then she said ; "its time to remove the catheter. I looked around and asked, "where's Dr Tel Terzo?" She said "oh you won't be seeing Dr Del Terzo today" I of course said "well then who is going to take out my catheter?" I kind of expected the answer but was still somewhat surprised when she replied "I am".
She told me to lie on the examination table, pull down my pants, inhale and then quickly exhale and just like that it was all over. It kind of stung for about a minute after the catheter was taken out but then things felt pretty normal. I am now wearing a diaper, well actually it is more like a pad, and am getting along pretty well. I really don't have much leakage. I can sleep all night with out any leakage. I do have to get up once during the night to drain my bladder but other than that I have no problems. I get a very small amount of leakage when I run or ride the lawn tractor over bumpy terrain but every day things are getting better. I am hopeful that with a week or two I won't need the pad at all.
All of this has peaked my interest as to how exactly a catheter works. If you have an interest in things like this you may enjoy the following.
The formal name is the Foley catheter and in the hospital they referred to it as the Foley. The name comes from the designer, Fredrick Foley, a surgeon working in Boston in the 1930s. The Foley is a plastic tube about 12" long. Inside of the plastic tube there are two channels, one for the urine to drain through and the other is so air (or water) can be pumped into a balloon at the end of the catheter. The external part of the catheter has a splice in it that separates the two channels inside the tube.
One of the splices has a valve that can be hooked up to an air (or water) pump for inflating the balloon at the internal end of the tube. The other splice is for the urine to drain . This splice has a fitting that allows a friction fit to another tube that feeds into a plastic pouch for containing the urine. At the internal end of the tube one channel is open and allows the urine to drain from the bladder. The other channel is a flexible plastic balloon that can be inflated into a small balloon.
When the Foley is inserted into the urethra it goes all the way into the bladder. Once the end is inside the bladder the balloon is inflated This serves two purposes. It prevents the catheter from unintentionally sliding out of the urethra and it forms a gasket inside the bladder so the urine can only exit through the open channel preventing any leakage. When the catheter is removed the valve that keeps the pressure is opened and the balloon deflates. The catheter is then pulled out of the urethra and you are good to go, literally.
The following pictures may help you better understand my explanation
Sunday, September 25, 2011
The Surgery
Well, now that I am feeling almost "normal" I thought I should take a few minutes and review everything that has happened since this past Wednesday.
Ginny and I drove to Philadelphia on Tuesday afternoon and arrived at our hotel in center city around 7:30. The hospital is about 3 miles from the hotel we were staying at and Ginny did not feel comfortable driving in the city on her own so after registering at the hotel I drove out to the hospital and parked the car in the hospital's garage. I spent about a half hour finding my way around the hospital so I wouldn't be lost the next morning getting admitted. Fortunately it was a very easy subway ride from the hospital to the hotel and I was back in the hotel by 10:00 PM.
I had a relatively restful sleep and we were up at 4:00 AM and on our way to the subway by 5:00 AM. We arrived at admitting at 5:30 AM and had all of the paperwork done by 6:00 AM. Things happened rather quickly after that. Around 6:15 AM I was taken to the prep area where I stripped, donned a hospital garment and placed on a hospital gurney. I was then wheeled into curtained stall where I was asked a lot of questions. I would have to tell the staff my name and date of birth at least ten times that morning. I guess they had too many instances where they took the prostate out of the wrong person and are going overboard to make sure that mistake doesn't happen again.
A nurse came into my stall and informed me that she was going to give me a shave around my belly button. When she looked at my abdomen she said; "Ooh, I'm going to like working on you" I said; "what are you talking about" she said "your not one of those big nasty hairy guys, your shave will be a snap".
After that I was wheeled into the operating room. The DaVinci machine is pretty impressive. The surgeon sits at a consul off to the side that looks like the cockpit of the space shuttle. I was placed on a platform in the middle of the room and all I could see were robotic arms directly above me. After that it was lights out.
I remember coming to and being very cold and shivering. I was wheeled into my room where Ginny was waiting and I slept most of that day. I was given some broth later in the day and remember feeling a bit nauseous. I had no appetite and was fed intravenously. I was given pain killers the first day and did not feel any pain at all. I slept quite comfortably and did manage a short walk that evening.
When I awoke the next morning I was famished. I ate a healthy breakfast of scrambled eggs, turkey sausage, a muffin and orange juice. I was starting to feel almost human. I was taken off the painkillers that morning and can honestly say that I have never felt any real pain. Certainly my abdomen is sore and I do sit and stand carefully but I have no problem sleeping. Dr Lee came to visit in the morning and he told me that the procedure went extremely well. He said that my prostate showed no visible signs of cancer and that he expected me to have a relatively quick recovery. I was allowed to take a shower at the hospital that morning and after receiving some instructions on how to deal with the catheter we were discharged from the hospital and on our way home by 10:30 AM on September 22, 2011..
My time at home has been uneventful. I am regaining my strength every day and have no problem sleeping. One of my biggest concerns was having my first bowel movements. They did give me some stool softeners to take and I must say that it turned out to be a non-issue, a piece of cake. I am walking 2 miles each day with no discomfort but I do tire easily. My appetite is pretty much back to normal and I can see that the wounds are starting to heal.
I can't tell you how much I am looking forward to getting the catheter removed on Wednesday morning. While I really haven't had any discomfort from the catheter its just a pain in the ass carrying a bag of piss around with you all the time. I've been told that it isn't too painful when they remove the catheter. We'll see!
Well its off for my 2 mile walk and then an afternoon of watching football.
Ginny and I drove to Philadelphia on Tuesday afternoon and arrived at our hotel in center city around 7:30. The hospital is about 3 miles from the hotel we were staying at and Ginny did not feel comfortable driving in the city on her own so after registering at the hotel I drove out to the hospital and parked the car in the hospital's garage. I spent about a half hour finding my way around the hospital so I wouldn't be lost the next morning getting admitted. Fortunately it was a very easy subway ride from the hospital to the hotel and I was back in the hotel by 10:00 PM.
I had a relatively restful sleep and we were up at 4:00 AM and on our way to the subway by 5:00 AM. We arrived at admitting at 5:30 AM and had all of the paperwork done by 6:00 AM. Things happened rather quickly after that. Around 6:15 AM I was taken to the prep area where I stripped, donned a hospital garment and placed on a hospital gurney. I was then wheeled into curtained stall where I was asked a lot of questions. I would have to tell the staff my name and date of birth at least ten times that morning. I guess they had too many instances where they took the prostate out of the wrong person and are going overboard to make sure that mistake doesn't happen again.
A nurse came into my stall and informed me that she was going to give me a shave around my belly button. When she looked at my abdomen she said; "Ooh, I'm going to like working on you" I said; "what are you talking about" she said "your not one of those big nasty hairy guys, your shave will be a snap".
After that I was wheeled into the operating room. The DaVinci machine is pretty impressive. The surgeon sits at a consul off to the side that looks like the cockpit of the space shuttle. I was placed on a platform in the middle of the room and all I could see were robotic arms directly above me. After that it was lights out.
I remember coming to and being very cold and shivering. I was wheeled into my room where Ginny was waiting and I slept most of that day. I was given some broth later in the day and remember feeling a bit nauseous. I had no appetite and was fed intravenously. I was given pain killers the first day and did not feel any pain at all. I slept quite comfortably and did manage a short walk that evening.
When I awoke the next morning I was famished. I ate a healthy breakfast of scrambled eggs, turkey sausage, a muffin and orange juice. I was starting to feel almost human. I was taken off the painkillers that morning and can honestly say that I have never felt any real pain. Certainly my abdomen is sore and I do sit and stand carefully but I have no problem sleeping. Dr Lee came to visit in the morning and he told me that the procedure went extremely well. He said that my prostate showed no visible signs of cancer and that he expected me to have a relatively quick recovery. I was allowed to take a shower at the hospital that morning and after receiving some instructions on how to deal with the catheter we were discharged from the hospital and on our way home by 10:30 AM on September 22, 2011..
My time at home has been uneventful. I am regaining my strength every day and have no problem sleeping. One of my biggest concerns was having my first bowel movements. They did give me some stool softeners to take and I must say that it turned out to be a non-issue, a piece of cake. I am walking 2 miles each day with no discomfort but I do tire easily. My appetite is pretty much back to normal and I can see that the wounds are starting to heal.
I can't tell you how much I am looking forward to getting the catheter removed on Wednesday morning. While I really haven't had any discomfort from the catheter its just a pain in the ass carrying a bag of piss around with you all the time. I've been told that it isn't too painful when they remove the catheter. We'll see!
Well its off for my 2 mile walk and then an afternoon of watching football.
Thursday, September 22, 2011
After the Surgery
Ginny and I made it back to Lancaster around noon today. I am glad to be home but I can tell that it will be a few days before I really feel like doing much. I don't have any pain to speak of but I am really tired. I suppose this is the side effects of the anesthetics and the trauma of the surgery. My appetite is so so but thank goodness I do not have the nausea I felt the day of the surgery. I did have a very restful sleep last night and only woke up when the nurse wanted to check my vital signs.
I can see that I am going to need a lot of practice with changing the bag on my catheter. The first time I did it on my own was at the hospital this morning. I managed to spray piss all over the bathroom before I got the bag changed. It is amazing how quickly my bag fills up (about 1 liter). My urine was pretty pink yesterday but it is a lot clearer today.
I have nothing but positive things to say about Dr Lee and his staff. I have about seven holes around my abdomen and they plugged them with some pretty amazing super glue. I don't think they will ever bleed. My next session with Dr Lee will be in 10 days when they should have the results of the lymph nodes they removed during the surgery to see if the cancer has spread. I am saying more than a few prayers that the results are clean. Dr Lee did say that my prostate looked very healthy and there were no visible signs of the cancer we all know is there.
I can't tell you how anxious I am to have the catheter removed which should take place next Wednesday in the office of my urologist here in Lancaster, Dr Del Terzo. Now the healing begins!
I can see that I am going to need a lot of practice with changing the bag on my catheter. The first time I did it on my own was at the hospital this morning. I managed to spray piss all over the bathroom before I got the bag changed. It is amazing how quickly my bag fills up (about 1 liter). My urine was pretty pink yesterday but it is a lot clearer today.
I have nothing but positive things to say about Dr Lee and his staff. I have about seven holes around my abdomen and they plugged them with some pretty amazing super glue. I don't think they will ever bleed. My next session with Dr Lee will be in 10 days when they should have the results of the lymph nodes they removed during the surgery to see if the cancer has spread. I am saying more than a few prayers that the results are clean. Dr Lee did say that my prostate looked very healthy and there were no visible signs of the cancer we all know is there.
I can't tell you how anxious I am to have the catheter removed which should take place next Wednesday in the office of my urologist here in Lancaster, Dr Del Terzo. Now the healing begins!
Wednesday, September 21, 2011
Go to the Head of the Class, Gerry Claes!!!
We reported to the Penn Presbyterian Hospital at 5:45 a.m., Gerry went up for surgery at 7:37 a.m. and was taken to his room by 11:00 a.m. He received HIGH marks from the doctor who reported that the prostate was successfully removed with very little bleeding or nerve involvement. They really were delighted that he was in such excellent condition and believe that aided the surgery process and his chance for a speedy, efficient recovery. Clearly, at this point, this is the best possible outcome. The pathology report will take several days, but we are optimistic that the cancer is contained within the prostate.
Gerry was parched after the surgery and the minute he opened his eyes he was imploring the nurse to give him water. She cautioned him to only sip slowly. Not quite able to adhere to her admonition, he experienced a little nausea. The rest of the day he slept, only waking briefly. By late afternoon, he walked around the nurses station on two occasions and felt better each time. The nursing staff is not quite sure what to make of his "Don't help me! I want to do it myself." comments. Other than being gaseous and feeling like he did too many setup, he says that he is not in pain.
Thanks to all who have been so supportive. It means so much to both of us.
We expect to leave the hospital by midday tomorrow......and then the fun begins! Managing the catheter will no doubt be the biggest challenge. That is expected be removed next Tuesday.
Exhausted but happy to have the surgery completed, I now hope to get more than two hours of sleep tonight. Stay well everyone!
Gerry was parched after the surgery and the minute he opened his eyes he was imploring the nurse to give him water. She cautioned him to only sip slowly. Not quite able to adhere to her admonition, he experienced a little nausea. The rest of the day he slept, only waking briefly. By late afternoon, he walked around the nurses station on two occasions and felt better each time. The nursing staff is not quite sure what to make of his "Don't help me! I want to do it myself." comments. Other than being gaseous and feeling like he did too many setup, he says that he is not in pain.
Thanks to all who have been so supportive. It means so much to both of us.
We expect to leave the hospital by midday tomorrow......and then the fun begins! Managing the catheter will no doubt be the biggest challenge. That is expected be removed next Tuesday.
Exhausted but happy to have the surgery completed, I now hope to get more than two hours of sleep tonight. Stay well everyone!
Tuesday, September 20, 2011
Tomorrow's the Big Day
I am scheduled to have my surgery to remove my prostate tomorrow. Currently I am scheduled to be the first patient to be operated on by Dr. Lee. I need to be at the hospital by 5:30 AM to go through admitting and preparation for the surgery. If everything goes well I should be out of surgery and in recovery before noon. I will have to spend tomorrow night (9/21/11) in the hospital but should be discharged on Thursday morning.
Ginny and I plan to drive to Philadelphia today and spend the night in a hotel near the hospital. Ginny will also spend tomorrow night in the hotel and then will drive me home on Thursday. Ginny plans on posting to this blog tomorrow as soon as I am out of surgery to let everyone know how things went.
Reflecting on the procedure for tomorrow I really don't have any anxiety about the actual surgery. Dr Lee has done over 4,000 of these operations and his success rate is extremely high. Also based on everything I have read, I don't anticipate that I will have much pain. I expect there will be some discomfort and I am sure that I certainly won't be the fastest 66 year old in Pennsylvania for a couple of months but the recovery should be pretty smooth.
My greatest anxiety is about how all of this will change my life style:
Will I have to wear a diaper the rest of my life?
What kind of sex life will I have?
Will they get all of the cancer, my future PSA scores will monitor this.
I am optimistic about all of these things but they still are lurking in the background.
One of the big bummers I had about my prostate was the assumption that I would not be able to donate blood in the future. I have always been a donor and looked upon it as my civic duty so I was not happy to see an end to my donating. Fortunately my friend Rob Beeson's wife, Laurie, did some research on this and found that if my tests show no signs of cancer a year after my surgery I will once again be able to donate blood.
Well, I am going out for my last run for at least two months and need to start packing. I look forward to talking to all of you on the other side.........................Gerry
Ginny and I plan to drive to Philadelphia today and spend the night in a hotel near the hospital. Ginny will also spend tomorrow night in the hotel and then will drive me home on Thursday. Ginny plans on posting to this blog tomorrow as soon as I am out of surgery to let everyone know how things went.
Reflecting on the procedure for tomorrow I really don't have any anxiety about the actual surgery. Dr Lee has done over 4,000 of these operations and his success rate is extremely high. Also based on everything I have read, I don't anticipate that I will have much pain. I expect there will be some discomfort and I am sure that I certainly won't be the fastest 66 year old in Pennsylvania for a couple of months but the recovery should be pretty smooth.
My greatest anxiety is about how all of this will change my life style:
Will I have to wear a diaper the rest of my life?
What kind of sex life will I have?
Will they get all of the cancer, my future PSA scores will monitor this.
I am optimistic about all of these things but they still are lurking in the background.
One of the big bummers I had about my prostate was the assumption that I would not be able to donate blood in the future. I have always been a donor and looked upon it as my civic duty so I was not happy to see an end to my donating. Fortunately my friend Rob Beeson's wife, Laurie, did some research on this and found that if my tests show no signs of cancer a year after my surgery I will once again be able to donate blood.
Well, I am going out for my last run for at least two months and need to start packing. I look forward to talking to all of you on the other side.........................Gerry
Monday, September 5, 2011
New Date for My Surgery
This past week I received a call from Dr Lee's office informing me that one of his scheduled operations for September 21st had been postponed and they wanted to know if I would be interested in moving my operation up from the 30th to the 21st. I of course said "yes", the sooner I get this cancer out of me the better. So I am now scheduled for September 21st.
Like everything else in life this is not as easy as just changing the date. Before Dr Lee will operate on me he needs to have my family doctor, Dr Warren, sign off on my fitness to be operated on. I also have to have some blood work done that will act as a baseline for my future blood tests. All of this has to be completed within 30 days of my operation and the paperwork must be in Dr Lee's office two weeks before the operation. The blood work will not be a problem since I can go down to the health campus and have this done this week. Getting Dr Warren's sign off is a bit more complicated. I did have an appointment with Dr Warren on September 9th but this is less than 2 weeks before the scheduled operation. I could not get my appointment with Dr Warren moved up however Dr Lee's office has agreed to waive the 2 week requirement for Dr Warren's approval.
Hopefully everything will go as scheduled and I will be back home, sans my prostate, on September 22nd.
Like everything else in life this is not as easy as just changing the date. Before Dr Lee will operate on me he needs to have my family doctor, Dr Warren, sign off on my fitness to be operated on. I also have to have some blood work done that will act as a baseline for my future blood tests. All of this has to be completed within 30 days of my operation and the paperwork must be in Dr Lee's office two weeks before the operation. The blood work will not be a problem since I can go down to the health campus and have this done this week. Getting Dr Warren's sign off is a bit more complicated. I did have an appointment with Dr Warren on September 9th but this is less than 2 weeks before the scheduled operation. I could not get my appointment with Dr Warren moved up however Dr Lee's office has agreed to waive the 2 week requirement for Dr Warren's approval.
Hopefully everything will go as scheduled and I will be back home, sans my prostate, on September 22nd.
Saturday, August 13, 2011
Dr David Lee
I finally met the doctor who will be performing my prostate surgery yesterday at his office in Radnor PA. Dr Lee has performed over 4,000 Robotic-Assisted Laparoscopic Radial Prostatectomies and is one of the most renowned specialists in this area. I was most impressed with Dr Lee and feel very comfortable that I will be in very good hands. Tentatively the surgery is scheduled for September 30 at Penn Presbyterian Medical Center in downtown Philadelphia. I have asked that I be moved up in his schedule if an opening should occur. We'll see!
The meeting with Dr Lee and his Assistant was very enlightening and I couldn't have asked for them to be more forthcoming and straight forward. Some of the things I learned:
I thought that I would have to have a catheter for between 3 and 4 weeks. Turns out I will probably have the catheter removed after one week.
I will spend one night in the hospital and will be discharged the next day. I will be expected to begin walking up to two miles per day as soon as I get home. If all goes well I should be able to return to all of my physical activities (tennis, running, pickleball) three months after the surgery.
I will not be able to drive a car for one week after the surgery. This will probably drive me nuts but I'm sure I'll survive,
I will be wearing a diaper for a while, how long will depend on my progress. I was given instructions on how to do the Kegel Exercise. Since my prostate is being removed I will no longer have the muscles in the prostrate that control urine flow. After surgery I will be relying on my pelvic floor muscles to control urine flow. The Kegel Exercise improves the urethral sphincter strength by developing the bladder neck muscle and the muscle around the urethra. The Kegel Exercise essentially is like trying to hold in a fart. I need to squeeze my ass throughout the day and this will develop the necessary muscles.
It is interesting to note that since women do not have a prostate, they are always relying on these muscles to control urine flow. Men with a prostate have not developed these muscles effectively. I need to get on a crash course to get this muscles developed so I can get off the diapers ASAP. Any woman who has had a caesarean section is well aware of the Kegel Exercise, right Ginny, Sarah and Diane???
The really fascinating area involves sex and what to expect with all of that. Since I will be losing my prostate I will no longer be able to ejaculate. However, I will still be able to have an orgasam. The interesting thing that I learned s that it is not required to have an erection to have an orgasam. Who'd a thunk?? I probably won't be capable of having an erection for at least a year and then I may need some help in the form of Viagra. All of this was very enlightening to me and I am sure that I will learn a lot more about all of this as I go through the process.
Like the old saying goes; "use it or lose it" this is truly the case with sex after the removal of the prostate. They told me that if I wanted to continue to have sex I will need to do something called self stimulation. This is all unchartered waters for me and I will probably need to rent some X-rated movies to guide me through the procedure. The key is to continue to exercise those muscles that are used during sex or I will lose them.
They will send my prostate and some lymph nodes to pathology after my surgery. Hopefully they will not find any cancer outside of the prostrate. I will need to have my PSA checked every three months for the first year after surgery and then every six months thereafter.
Well, now the wait begins!
The meeting with Dr Lee and his Assistant was very enlightening and I couldn't have asked for them to be more forthcoming and straight forward. Some of the things I learned:
I thought that I would have to have a catheter for between 3 and 4 weeks. Turns out I will probably have the catheter removed after one week.
I will spend one night in the hospital and will be discharged the next day. I will be expected to begin walking up to two miles per day as soon as I get home. If all goes well I should be able to return to all of my physical activities (tennis, running, pickleball) three months after the surgery.
I will not be able to drive a car for one week after the surgery. This will probably drive me nuts but I'm sure I'll survive,
I will be wearing a diaper for a while, how long will depend on my progress. I was given instructions on how to do the Kegel Exercise. Since my prostate is being removed I will no longer have the muscles in the prostrate that control urine flow. After surgery I will be relying on my pelvic floor muscles to control urine flow. The Kegel Exercise improves the urethral sphincter strength by developing the bladder neck muscle and the muscle around the urethra. The Kegel Exercise essentially is like trying to hold in a fart. I need to squeeze my ass throughout the day and this will develop the necessary muscles.
It is interesting to note that since women do not have a prostate, they are always relying on these muscles to control urine flow. Men with a prostate have not developed these muscles effectively. I need to get on a crash course to get this muscles developed so I can get off the diapers ASAP. Any woman who has had a caesarean section is well aware of the Kegel Exercise, right Ginny, Sarah and Diane???
The really fascinating area involves sex and what to expect with all of that. Since I will be losing my prostate I will no longer be able to ejaculate. However, I will still be able to have an orgasam. The interesting thing that I learned s that it is not required to have an erection to have an orgasam. Who'd a thunk?? I probably won't be capable of having an erection for at least a year and then I may need some help in the form of Viagra. All of this was very enlightening to me and I am sure that I will learn a lot more about all of this as I go through the process.
Like the old saying goes; "use it or lose it" this is truly the case with sex after the removal of the prostate. They told me that if I wanted to continue to have sex I will need to do something called self stimulation. This is all unchartered waters for me and I will probably need to rent some X-rated movies to guide me through the procedure. The key is to continue to exercise those muscles that are used during sex or I will lose them.
They will send my prostate and some lymph nodes to pathology after my surgery. Hopefully they will not find any cancer outside of the prostrate. I will need to have my PSA checked every three months for the first year after surgery and then every six months thereafter.
Well, now the wait begins!
Tuesday, July 5, 2011
The Decision
Well I have essentially made my decision as to which procedure I will have performed on me to remove my cancer. I have decided to go with the robotic surgery that will remove my cancer. In this blog I will go into some detail as to what the procedure involves, the risks and the recovery phase. If you are a bit queasy about learning about the gory details you may not want to read this blog but if you are a male over the age of thirty these are things you should probably know about. As for you Caron, you will probably be shocked to learn that your mother was not a virgin when you were born and yes we have actually had sex during our marriage.
The Surgery Itself:
During the surgery I will be totally sedated and will have no idea as to what is going on. There will be five holes about the size of your small finger about six inches below my waist. These holes will be used to insert cameras and surgical knives into my pelvic area. The camera will have about 12 X magnification so the surgeon will have an excellent view as to what he is cutting. The computer will guide the movement of the camera and knives but the surgeon will always have ultimate control over the procedure.
The entire prostate will be removed as well as some lymph nodes in the area next to the prostate. The lymph nodes will all be analyzed to determine if the cancer cells have migrated beyond the prostate. Hopefully these results will come back clean. Since the entire prostate is being removed that means that a section of my urethra will also be removed since it runs through the middle of the prostate.
The urethra is a tube that transports urine from the bladder to exit the body.
In males, sperm also exit the body via the urethra but not at the same time! The urethra is vitally important if you want to be able to pee normally and have sex. Once the urethra is removed (about 2 inches) it will have to be sewed back together. The entire procedure should take less than three hours. I will hopefully only have to spend one night in the hospital and will be home in my own bed the following night.
In males, sperm also exit the body via the urethra but not at the same time! The urethra is vitally important if you want to be able to pee normally and have sex. Once the urethra is removed (about 2 inches) it will have to be sewed back together. The entire procedure should take less than three hours. I will hopefully only have to spend one night in the hospital and will be home in my own bed the following night.
Recovery:
Sine the urethra has been severed and sewn back together I will have a catheter in my penis for about two weeks to allow the urethra to heal. I will probably not have total control of my bladder for a while and will have to wear a diaper for a while. Hopefully this inconvenience will last for weeks and not months. During this time you cannot tell any jokes about your father peeing in his pants. When its time to remove the catheter I will have it done in my urologists office.
As you girls know from both your mother’s and your experiences with a C-section I will not be able to do any strenuous work for about two months but will be able to do light activities within a few days. After two months I will hopefully be able to return to my normal physical activities, tennis, running, pickleball etc. I will also not be able to have any sexual activity for about two months. If things really go well, all will return to normal in about three months. If things don’t go too will I will probably have a year or two before things get back to normal. If things go terrible, well, I’ll be wearing a diaper the rest of my life and I can forget about sex.
The Risks:
The biggest risk is that the knife cuts into the colon or bladder and results in internal bleeding. This would not be good and a serious infection would probably result. If the urethra does not heal properly I will have problems peeing and likely have to wear a diaper the rest of my life. The biggest risk is the possibility that the surgery does not remove all of the cancer and I will have to deal with it through radiation or hormone surgery. I will have to have PSA tests done every six months for the rest of my life to make sure that the cancer was totally removed. All of the above risks are really pretty small but they are a possibility.
What Am I Hoping For?
The prostate has two important functions: one is to help control urination and the other is to help sexual activity.
The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.
The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion, which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the mobility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.
The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.
The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion, which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the mobility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.
Since I will be losing some of the muscles that help control urination I will have to go through therapy to effectively control my urine. This therapy is called penal rehabilitation. Think of it as a penal colony for prostate cancer survivors. I hope to gain full control of this function within six months.
Since I will be losing the gland that produces the fluid that helps carry the sperm through the urethra I will no longer have an ejaculation during sex. I am told that I will have a climax but that’s it, nothing else. I am hopeful that I will have a somewhat normal sex life (whatever that means for a 66 year old man) within six months. There is a possibility that I will need the help of Viagra to put lead in my pencil.
Monday, July 4, 2011
The Consultations
After our return from China I had consultations with a number of specialists with expertise in dealing with the various options I had for treating my prostate cancer. I had meetings with the following specialists:
Doctor Eshelman – Radiologist for both seed implantation and external radiology
Doctor Russinko – Specializing in laparoscopic surgery for removal of the prostate
Doctor Oyer – Oncology and internal medicine
Doctor Sieber – urology and urological surgery, cryotherapy
Doctor Del Terzo - urology and urological surgery
Dr Eshelman advised me that I am not a good candidate for seed implantation due to the fact that my Gleason scores are 7 and due to the location of my cancer, which may make it difficult to accurately, place the seeds. He did say that if I really wanted seed implantation he recommended a combination of both seed implantation and a shorter period of external radiation. Five weeks instead of the normal seven week external radiation treatment.
Dr Russinko went through the laparoscopic procedure. The advantage of the lapraroscopic surgery over the open surgery is that the recovery time is quicker, significantly less loss of blood and the robot used is extremely accurate when used in the hands of a trained expert (read this to mean someone who is really good at video games).
Dr Oyer is more of a generalists and he highly recommended that I go with the laparoscopic surgey. He had the best bedside manners of all the specialists I talked to and we had a very open and frank discussion.
Dr Sieber did more to confuse me than any of the other specialists. He felt that I may be a good candidate for seed implantation and he recommended that my records be sent to Johns Hopkins in Baltimore for them to review and give their recommendation. I should have their comments by July 5.
Dr Del Terzo is my urologists and he specializes in open surgery for removal of the prostate.
After all of these consultations I have made the following decisions:
I have eliminated cyrotherapy because this is a relatively new procedure and there is not enough data available to determine long-range effects.
I have eliminated open prostate surgery. Why go through a major operation that will leave major scars and have a longer recovery time when laparoscopic surgery will accomplish that same thing with more accuracy and less collateral damage.
I really do not want to go through the external radiation process. The risk of collateral damage is higher and it is a seven-week agenda with treatments every weekday.
That leaves me with laparoscopic surgery and seed implantation. I am strongly leaning towards the surgery but we will see what Johns Hopkins has to say about me.
There was one last wrinkle thrown into my alternatives. My wife has a good friend on the west coast, Judy Copanas, who is good friends with the head urologist at the University of California Irvine and she asked me if I would like to talk to him to get his views on my options. Of course I said yes and last week I had an excellent phone conversation with Doctor Clayman. Dr Clayman was very straightforward. He told me that if it were his decision he would go with the laparoscopic surgery and he recommended that I contact Doctor David Lee at the University of Pennsylvania School of Medicine in Philadelphia. I have since contacted Dr Lee and have a meeting set up with him the first week of August.
That’s were things stand as of today. The one thing I do know is that I want to get this cancer taken out of my body ASAP.
Saturday, July 2, 2011
Can You Speed Write in Chinese?
I don’t know about you but to me Chinese appears to be a very difficult language to write. A number of people that I have spoken to tell me that while Chinese is a difficult language to learn it is almost impossible for a westerner to learn how to write in Chinese. The problem is that Chinese does not have an alphabet, as we know it. Chinese characters are based on drawings of real objects. Therefore, the Chinese word for man looks like a stick man and the Chinese word for house kind of looks like a house (but not really).
This leads to the question, “is there a Chinese dictionary and how in the hell does it work?” This of course leads to the next question that once you see the Chinese character for man how do you learn how to pronounce it? This project was quickly becoming much bigger than I anticipated and I think I will but this research on my “to do” list for a later date.
Anyway to demonstrate just how complicated the Chinese language is, consider this; The extended Chinese character set (including ancient, seldom-used glyphs) includes upwards of 100,000 characters. A modern and well-educated Chinese person may know 20,000 characters at best, but this is still a staggering number. To be able to read a newspaper comprehensively you need to know about 6,000 characters. Most Chinese agree that you need to know about 3,000 characters to be considered fully literate. This is mind blowing when you consider we only need to learn 26 letters. I’m beginning to think that you need to have an IQ of 150 just to learn the Chinese language.
But, back to the original question; “can you speed write in Chinese?” In order to answer this question I devised a little test. I wrote down the sentence. “the red rabbit jumped over the high fence” and asked our tour guide, Shanshan, to write it in Chinese. While she was writing it I timed her. It took her 15 seconds to write this sentence in Chinese. I then asked her to time me as I wrote the same sentence in English.
When I got to the word “rabbit” I internally calculated that I had already used up about 7 seconds and I started sweating bullets. I thought’ “ can this really be, can a Chinese person write the same sentence faster than me?” I needed to step things up. No way was I going to come in second in this race. I started writing faster and by the time I got to the second “the” I felt I had only used up about ten seconds. Feeling confident I cruised through the last two words. I felt I had crushed her when I yelled, “stop”. I was floored to hear Shanshan yell “14 seconds” right back at me. I only beat her by 1 second, how could this happen?
I then looked down at what I had written and it appeared to be; “the ned rabit yuped oer the nuh feces”. I wasn’t about to tell Shanshan that I had left out about 30% of the letters in the sentence. For all I know, Shanshan left out 30% percent of the characters or maybe she had really written, “Gerry is an idiot”
Thursday, June 23, 2011
Chop Chop
Wherever you go in China you will find merchants who are selling seals that can be crafted to your personal identity. These seals can be made from wood, plastic, metal or even jade. These personal seals are an important part of Chinese history and are still being used today. Today these personalized seals are known as chops.
The emperors of China were the first to use seals to identify official documents that were issued by the ruling family. These seals were originally known as xǐ, later renamed bǎo. The word chop is a westernization of the Chinese word and is now in common use throughout China. When the emperor sent out an official decree his representatives would take the document out to the provinces with the official chop on the document. The local official would stamp the decree with his official seal to verify that he had received it. The Emperors representative was often anxious to have the decree stamped with the chop so he could be on his way. He would tell the local representative “chop chop” and that is where the western term “chop chop” to mean hurry up originated.
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