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. 

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.

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.

Overall, the odds of things returning to normal are better than I thought.  We’ll see!

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.

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” 

I feel pretty confident that I can beat any Oriental in speed-writing as long as no one checks my work!