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somebody wants in

The Real Prostate Cancer Second Opinion-Illustrated “Factors to consider” in your  treatment decision-making process.

I had my biopsy done by a partner during lunch. I took an antibiotic and  nothing for pain. My partner did attempt a prostate block but  it did not work. He took about 16 samples and it lasted about 20 minutes. It was very uncomfortable. My biopsy experience. I am trying to think if I under tell patients about the pain involved.

I give each patient a sedative and a pain pill prescription (such as an ativan and a percocet) that they take an hour before the procedure and I also perform the prostate block which is guided by the ultrasound. (For any of you that are interested, that is a space easily identified on ultrasound just lateral to the seminal vesicles at the posterio-superior aspect of the prostate. That’s where the nerves that enervate the prostate run and responsible for the pain.)

There are about three kinds of pain associated with the biopsy and my little protocol, and I would be surprised if most urologists don’t do something similar, limits all of them. First there is the pressure pain associated with the ultrasound probe itself, this is like a rectal exam done by large thumb and is five inches long-a generalized pressure pain. Then there is the irritation the rigid instrument has on the prostate and the prostatic urethra. (Any one reading this and trying to determine what type of treatment you are planning to pursue needs to understand the prostatic urethra and how it is affected by all the treatments. This is about a good a tip I could ever give you. I’ll put something today into the ” Decision Process” section of this blog.) The pressure on prostate gives you an intense sensation that you need to urinate, so be sure to empty your bladder before the procedure. And then of course, there is the actual biopsy itself. We all use a spring-loaded biopsy gun now, so you’ll hear a clicking sound before each biopsy and it feels like a bee sting. (A patient told me one time, ” Hell doc, that ain’t no bee sting, that’s a Texas wasp.) By the way, I went up to the river yesterday and while I was looking for a stick to throw into the river for Penelope, I got stung by two or three wasps on my ear….right on the lobe of it. Man oh man… I hate those things.

The blood that is referred to in the piece below is hematospermia and this does get your attention but is harmless. It doesn’t hurt anyone and usually goes away in a week or so, but not always. When there becomes a brownish tint to the fluid, you are almost done with it. It can last for weeks however.  After the biopsy-from ” The Decision.”

As urologists we worry most about a fever or difficulty voiding after a biopsy. This type of stuff occurs about 3% of the time and is why  we give an antibiotic before and after, usually Cipro, and tell the patient and family to call if any voiding issues.  If you are already on a drug to help you urinate or are having difficulties now, you are more at risk for problems voiding and this is something you should make known to your urologist. I do about 100 biopsies a year and in my 24 year career I have had to admit someone for a biopsy complication probably about 5 times.

I feel that I am fairly discerning about the pain. I ask my nurse to watch the patient’s expression and that will often tell you if there is undue discomfort. If we sense it, we stop and do something else… redo the block or consider giving something I.V. This is a recent post of a patient that did impersonations during his biopsy, if that tells you how he did pain wise during the procedure.

The other component to the piece that follows has to do about men and how much they will talk about pain and their medical condition.  I think its fine and appropriate to say to the urologist at the time of the scheduling, like I do with a Dentist, ” I don’t like pain. Can you give me something?” If the urologist says no and you want medicine…get another urologist.  It is really that simple, I doubt many will say no however.

More about men and what they will disclose. If you know someone who had robotic removal, most likely they will almost brag about having had it removed that way. It is almost as if they think they were cutting edge or ” informed.” But… if you ask them how are they doing, particularly with continence and potency, then that’s different story. I mention this to be careful to separate out from the conversation ” the procedure ” and the ” aftermath.” That’s a world of difference and you’ll have to really dig and persist to find out how they are ” really doing.” You might ask, ” Why would persist into something that is personal?” Well, my friend you are trying to make a decision about what to do and if you make it based on how the procedure went but not how things ended up ” functionally” then you have made a decision in error. Robotic and Brachytherapy are similar in this aspect. Patients often make the decision based on the procedure attributes  and not on a full understanding on how they will ” end up.”

As my mother said, ” Don’t value short-term gratification over long-term gain.”

From Chuck Gallagher’s Blog

Urologists Take Note – The Real Truth About A Prostate Biopsy!

At first I thought I was just a “wimp.” At the urging of my family doctor I went to a urologist for a prostate check. She (my family doctor) said my PSA was a bit high for my age – 4.58 PSA and I was 47 years old.

Now let me state…I didn’t even know what a PSA was until she forced the test when I was having routine blood work done. Something I hated as I had a fear of needles.

The urologist did the “bend over boy” routine finding nothing with his “DRE” – Digital Rectal Exam. Now I have to be honest, that wasn’t the most exciting exam, but all in all it didn’t cause me any great pain. But, as the urologist said, “Better to be safe than sorry. Let’s schedule you for a biopsy.”

Now let me be frank…I had no clue what to expect other than what my doctor told me. He said there wouldistock_000002146611small be some minor discomfort but mostly I would be annoyed by the sound of the instrument when the sample was taken. “Other than that,” he commented, “most men don’t really feel much.” I do recall asking if there was pain, and again, my urologist stated, “Most men feel very little. Nothing to be concerned with.”

I have been interviewing men from all around the English speaking world who have been diagnosed with prostate cancer. With few exceptions everyone reports the same thing. The damn biopsy hurts! When they report this, I ask a follow up question: “Did you tell you doctor this?” Their response – “Well, no, I just took it like a man.”

GUYS…WHAT A CROCK!

In Dr. Sheldon Marks book, “Prostate and Cancer” he describes the biopsy as follows:

In a biopsy of the prostate, multiple tiny sliver-like ppeces of tissue are obtained for microscopic analysis to see if cancer is present. These pieces are obtained through a long but very thin needle, specially designed to open inside the prostate, take the sample and then close.

For most men, biopsies can be done as an outpatient office procedure without anesthesia and with usually only temporary discomfort. Now we can get a good representative sampling of the entire gland with minimal trauma to the gland.

He is right…it is done outpatient most of the time. Where I beg to differ is on the pain issue. Thus far, well over 70% of the men I have talked with have reported that their urologist misled them when it came to what to expect and the pain. All but two men interviewed would, in retrospect, have desired pain medication before the biopsy. One man reported that had he known it would have hurt as bad as it did…he would never had submitted to the test. (Although the test might have saved his life).

Several men stated that they felt that ALL UROLOGISTS should have a biopsy on their prostate so that they would know exactly what their patient was going through. In that way, the urologist might be willing to volunteer provide some local anesthesia to reduce the pain and trauma.

Urologists…do you get the picture. What is reported to you is inaccurate (men don’t want to admit to their pain) and it (the biopsy) freekin…hurts – SO GIVE US SOMETHING TO TAKE THE EDGE OFF.

WHAT ABOUT AFTER THE BIOPSY? For most men normal functions – exercise, work, activity will all resume as normal either the next day or day after that. Now, when I say normal functions…that also includes sex.

I’ve scoured the Internet and seldom do I see PRACTICAL ADVICE that men need to know – so here’s some. A few days after your biopsy you may engage in sexual activity. Be prepared! When you achieve orgasm your ejaculation will be bloody. Guys I don’t mean a trace of blood, but bright red bloody. And, gentlemen, if you are unprepared for that, it can cause alarm. That alarm may be to you and/or to your partner. Nothing can change the mood of an intimate evening of sexual play than to achieve an orgasm and find that you look like you just hemorrhaged.

GUYS… The biopsy is necessary so in no way take this entry as anything other than solid information. Have it done, and more than once if necessary. My personal advice is – request pain medication.

Chuck Gallagher is a business ethics and fraud prevention speaker and author. Having been diagnosed with Prostate Cancer, he spends time working to help educate men and their families about the practical aspects of Prostate Cancer and how to survive.

This entry was posted on Monday, November 10th, 2008 at 5:12 am

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you will never get ahead if you spend your time trying to get even....lou holtz

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

Featured image

About 3 million people visit the Taj Mahal every year. This blog was viewed about 42,000 times in 2010. If it were the Taj Mahal, it would take about 5 days for that many people to see it.

In 2010, there were 242 new posts, not bad for the first year! There were 251 pictures uploaded, taking up a total of 251mb. That’s about 5 pictures per week.

The busiest day of the year was October 8th with 319 views. The most popular post that day was How I as a urologist made my “Decision.”.

Where did they come from?

The top referring sites in 2010 were yananow.net, mail.yahoo.com, theprostatedecision.com, twitter.com, and search.aol.com.

Some visitors came searching, mostly for prostate cancer diaries, prostate diaries, frank zappa prostate cancer, bill clinton cancer, and alberto sabatino.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

How I as a urologist made my “Decision.” September 2010
2 comments

2

“Decision” Process February 2010

3

Prostate Diaries January 2010
4 comments

4

McHugh Decision Worksheet February 2010
1 comment

5

McHugh Decision Cheat Sheet-It is imperative that you understand and have considered each of the questions in order to make the “Right Decision” for you. February 2010

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somebody wants in

I had my biopsy done by a partner during lunch. I took an antibiotic and  nothing for pain. My partner did attempt a prostate block but  it did not work. He took about 16 samples and it lasted about 20 minutes. It was very uncomfortable. My biopsy experience. I am trying to think if I under tell patients about the pain involved.

I give each patient a sedative and a pain pill prescription (such as an ativan and a percocet) that they take an hour before the procedure and I also perform the prostate block which is guided by the ultrasound. (For any of you that are interested, that is a space easily identified on ultrasound just lateral to the seminal vesicles at the posterio-superior aspect of the prostate. That’s where the nerves that enervate the prostate run and responsible for the pain.)

There are about three kinds of pain associated with the biopsy and my little protocol, and I would be surprised if most urologists don’t do something similar, limits all of them. First there is the pressure pain associated with the ultrasound probe itself, this is like a rectal exam done by large thumb and is five inches long-a generalized pressure pain. Then there is the irritation the rigid instrument has on the prostate and the prostatic urethra. (Any one reading this and trying to determine what type of treatment you are planning to pursue needs to understand the prostatic urethra and how it is affected by all the treatments. This is about a good a tip I could ever give you. I’ll put something today into the ” Decision Process” section of this blog.) The pressure on prostate gives you an intense sensation that you need to urinate, so be sure to empty your bladder before the procedure. And then of course, there is the actual biopsy itself. We all use a spring-loaded biopsy gun now, so you’ll hear a clicking sound before each biopsy and it feels like a bee sting. (A patient told me one time, ” Hell doc, that ain’t no bee sting, that’s a Texas wasp.) By the way, I went up to the river yesterday and while I was looking for a stick to throw into the river for Penelope, I got stung by two or three wasps on my ear….right on the lobe of it. Man oh man… I hate those things.

The blood that is referred to in the piece below is hematospermia and this does get your attention but is harmless. It doesn’t hurt anyone and usually goes away in a week or so, but not always. When there becomes a brownish tint to the fluid, you are almost done with it. It can last for weeks however.  After the biopsy-from ” The Decision.”

As urologists we worry most about a fever or difficulty voiding after a biopsy. This type of stuff occurs about 3% of the time and is why  we give an antibiotic before and after, usually Cipro, and tell the patient and family to call if any voiding issues.  If you are already on a drug to help you urinate or are having difficulties now, you are more at risk for problems voiding and this is something you should make known to your urologist. I do about 100 biopsies a year and in my 24 year career I have had to admit someone for a biopsy complication probably about 5 times.

I feel that I am fairly discerning about the pain. I ask my nurse to watch the patient’s expression and that will often tell you if there is undue discomfort. If we sense it, we stop and do something else… redo the block or consider giving something I.V. This is a recent post of a patient that did impersonations during his biopsy, if that tells you how he did pain wise during the procedure.

The other component to the piece that follows has to do about men and how much they will talk about pain and their medical condition.  I think its fine and appropriate to say to the urologist at the time of the scheduling, like I do with a Dentist, ” I don’t like pain. Can you give me something?” If the urologist says no and you want medicine…get another urologist.  It is really that simple, I doubt many will say no however.

More about men and what they will disclose. If you know someone who had robotic removal, most likely they will almost brag about having had it removed that way. It is almost as if they think they were cutting edge or ” informed.” But… if you ask them how are they doing, particularly with continence and potency, then that’s different story. I mention this to be careful to separate out from the conversation ” the procedure ” and the ” aftermath.” That’s a world of difference and you’ll have to really dig and persist to find out how they are ” really doing.” You might ask, ” Why would persist into something that is personal?” Well, my friend you are trying to make a decision about what to do and if you make it based on how the procedure went but not how things ended up ” functionally” then you have made a decision in error. Robotic and Brachytherapy are similar in this aspect. Patients often make the decision based on the procedure attributes  and not on a full understanding on how they will ” end up.”

As my mother said, ” Don’t value short-term gratification over long-term gain.”

From Chuck Gallagher’s Blog

Urologists Take Note – The Real Truth About A Prostate Biopsy!

At first I thought I was just a “wimp.” At the urging of my family doctor I went to a urologist for a prostate check. She (my family doctor) said my PSA was a bit high for my age – 4.58 PSA and I was 47 years old.

Now let me state…I didn’t even know what a PSA was until she forced the test when I was having routine blood work done. Something I hated as I had a fear of needles.

The urologist did the “bend over boy” routine finding nothing with his “DRE” – Digital Rectal Exam. Now I have to be honest, that wasn’t the most exciting exam, but all in all it didn’t cause me any great pain. But, as the urologist said, “Better to be safe than sorry. Let’s schedule you for a biopsy.”

Now let me be frank…I had no clue what to expect other than what my doctor told me. He said there wouldistock_000002146611small be some minor discomfort but mostly I would be annoyed by the sound of the instrument when the sample was taken. “Other than that,” he commented, “most men don’t really feel much.” I do recall asking if there was pain, and again, my urologist stated, “Most men feel very little. Nothing to be concerned with.”

I have been interviewing men from all around the English speaking world who have been diagnosed with prostate cancer. With few exceptions everyone reports the same thing. The damn biopsy hurts! When they report this, I ask a follow up question: “Did you tell you doctor this?” Their response – “Well, no, I just took it like a man.”

GUYS…WHAT A CROCK!

In Dr. Sheldon Marks book, “Prostate and Cancer” he describes the biopsy as follows:

In a biopsy of the prostate, multiple tiny sliver-like ppeces of tissue are obtained for microscopic analysis to see if cancer is present. These pieces are obtained through a long but very thin needle, specially designed to open inside the prostate, take the sample and then close.

For most men, biopsies can be done as an outpatient office procedure without anesthesia and with usually only temporary discomfort. Now we can get a good representative sampling of the entire gland with minimal trauma to the gland.

He is right…it is done outpatient most of the time. Where I beg to differ is on the pain issue. Thus far, well over 70% of the men I have talked with have reported that their urologist misled them when it came to what to expect and the pain. All but two men interviewed would, in retrospect, have desired pain medication before the biopsy. One man reported that had he known it would have hurt as bad as it did…he would never had submitted to the test. (Although the test might have saved his life).

Several men stated that they felt that ALL UROLOGISTS should have a biopsy on their prostate so that they would know exactly what their patient was going through. In that way, the urologist might be willing to volunteer provide some local anesthesia to reduce the pain and trauma.

Urologists…do you get the picture. What is reported to you is inaccurate (men don’t want to admit to their pain) and it (the biopsy) freekin…hurts – SO GIVE US SOMETHING TO TAKE THE EDGE OFF.

WHAT ABOUT AFTER THE BIOPSY? For most men normal functions – exercise, work, activity will all resume as normal either the next day or day after that. Now, when I say normal functions…that also includes sex.

I’ve scoured the Internet and seldom do I see PRACTICAL ADVICE that men need to know – so here’s some. A few days after your biopsy you may engage in sexual activity. Be prepared! When you achieve orgasm your ejaculation will be bloody. Guys I don’t mean a trace of blood, but bright red bloody. And, gentlemen, if you are unprepared for that, it can cause alarm. That alarm may be to you and/or to your partner. Nothing can change the mood of an intimate evening of sexual play than to achieve an orgasm and find that you look like you just hemorrhaged.

GUYS… The biopsy is necessary so in no way take this entry as anything other than solid information. Have it done, and more than once if necessary. My personal advice is – request pain medication.

Chuck Gallagher is a business ethics and fraud prevention speaker and author. Having been diagnosed with Prostate Cancer, he spends time working to help educate men and their families about the practical aspects of Prostate Cancer and how to survive.

This entry was posted on Monday, November 10th, 2008 at 5:12 am

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did you google priapus and priaprism? this is good….. do it .. over— mythology is the bomb my friend.. the womd.. what? …. the weapon of mass destruction……a tangential analogy to the ” the bomb” .. i.e.. the womd… jm

penis vest/anthurium post       The mythology of Priapus and it’s relationship to the condition of priaprism is probably my favorite urologic historical tidbit.

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My wife and daughter went to the beach recently and as my usual custom I stayed to work to pay for my many ill-advised investments. So…what to do with the pepster,(our most wonderful chocolate lab, have you by chance seen any of her pictures?). I ask one a member of my staff if she would mind going to my home mid-morning to let her out of our bedroom to go out in the backyard to run around, do her thing, and maybe throw tennis balls in the pool for her to fetch. So one my employee volunteers goes and dutifully does as I ask and lets the pompsie out and throws balls for about twenty minutes, puts her back into the bedroom, and comes back to work. ” How did the pepsi do?” I asked when she returned. ” I saw the bathroom where you filmed the legbag movie!” she said. I thought, ” That wallpaper is distinctive and dated.” I then debated telling my wife about any of it.

I had moderate obstructive voiding symptoms at the time of my diagnosis of prostate cancer. I was 52 and noticing a slower flow to my urinary stream and a little more frequency in feeling the urge to void. This was exacerbated by certain foods or drink, particularly beer.
This is key: obstructive voiding symptoms (diminished force and caliber of stream) is a sign of benign prostate enlargement. (See the diagram of the previous post). It can be a symptom of prostate cancer but only if the cancer is revealed very late. HELLO…THERE ARE NO SYMPTOMS RELATED TO PROSTATE CANCER IF IT IS DIAGNOSED EARLY. SYMPTOMS RELATED TO PROSTATE CANCER OCCUR IF THE DISEASE IS FOUND OUT LATE. IT IS USUALLY A SYMPTOM THAT GETS THE PATIENT TO THE DOCTOR BUT THAT IS WAYYYYYYYYYY TO LATE. SEE MY LETTER TO THE NYT REGARDING ABLIN’S FATHER. WE DON’T WANT THAT SCENARIO…. WE WANT EARLY AND WE WANT TO ADVOCATE AND SUPPORT EARLY DIAGNOSIS, AND AWARENESS. I SAW THIS SOMEWHERE ON THE NET…. A MAN DESERVES THE RIGHT TO KNOW IF HE HAS PROSTATE CANCER OR NOT AND HE IS GIVEN THE OPPORTUNITY TO DECIDE WHAT TO DO AND HOW AGGRESSIVE OR PROACTIVE HE WOULD WANT TO BE. FOR SOMEONE TO DECIDE NOT TO DO A PSA OR A BIOPSY BECAUSE A ” THIRD PARTY THINKS IT’S THE RIGHT THING AND MOST COST EFFECTIVE THING TO DO” IS WELL…. WELL…. WHAT IS IT….ORWELLIAN?
Anyway back to me.
I had obstructive voiding symptoms at the time of my diagnosis. Removal of the prostate would fix that but would risk stress incontinence common to surgery. Radiation would worsen my obstructive symptoms (by virtue of the inflammation of the prostatic urethra).
So here is the deal today and the poignant point of the blog ……
You absolutely need to know your current voiding pattern and the affect each of the treatments has on that baseline.
For me one of the biggest factors favoring removal was ” how I voided.”
If you are reading this and don’t have a feel for where you are now, how each treatment affects how you void… you have more work to do.
Voiding issues and patient’s difficulty in understanding them was a very large impetus for writing ” The Decision.” Most of one chapter is devoted to the males abnormal voiding patterns and how each is influenced by each treatment.
Why? It was the urologist in me…. you know…. I’m a penis machinist, a pecker checker and of course a verified member of the ” stream team.”
Tomorrow… irritative voiding symptoms and why that is important…. tease…. radiation therapy… no matter which one… think irritative. Do your homework on this and more next post….
Oh yeah… the youtube…. I had surgery so immediately post op I had total incontinence which progressed over three months to stress incontinence which progressed to continence. Do you understand continence and it’s relationship to the treatments? No? It’s in the book my friend.
The whistling is supposed to the carefree sound of one of the seven dwarfs from Snow White….carefree, happy, not a care in the world….not!

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New Zealand is a favorite post-urologic residency destination. They have a very good urologic medical community and I have two  friends that did a fellowship there. That Mr. Tucker speaks of being sexually active  after a prostatectomy bespeaks of the folks over there performing a prostatectomy the right way ( I also noted the length of his incision on his last blog and the size of it tells me something about of his surgeon’s acumen). One of my friends that did a year over there, and by the way both told me they were treated very well by the community there and that their experience enhanced their understanding urology. The way one of my friends told it, and he was there circa 1986, they had a dinner in his honor to celebrate his time there and as appreciative send-off. At the conclusion of the ceremonies they asked him to speak and he took the opportunity to tell a joke. Now, I love jokes and have quite the repertoire myself and in a situation like this half way around the world and the likelihood that he’d never be back, one would not take the choice of “the joke ” lightly. It would have to be one that was not only thought out, but one taking into consideration the audience and one that he knew would have a positive response. A “ringer of  a joke” so to speak. This is the joke he told me he told to all the urologists in New Zealand, possibly one in the audience performed Mr.Tucker’s surgery, a budding urologist at the time so to speak. Hey, you never know. Ps… if you are a urologist in New Zealand and were in training or practice when a urologist from Georgia with the initials D.D. was visiting please let me know. Anyway without further a Dieu (apologize for spelling, I have never seen this word spelled.)

Death by A chee chee.

Three men were in a plane crash over a far-away land and captured by the natives. They were each given two options; to be boiled in the fat of dead animals and then for their skin to be used for the covering of the native’s canoes, or death by a chee chee. The first man chose “death by a chee chee.” At the announcement by the tribal leader, the natives went into a frenzy and encircled the unfortunate survivor. They then stripped him and then tortured him both to the horror of the man himself as well as the two other men watching. The next man considering his options decided that the lesser of two evils was death by a chee chee as well. The thought of frying in a vat of boiling fat far out-weighed what he had just witnessed albeit each was detestable. So again the tribal leader declares, ” He has chosen death by a chee chee!” Again, the natives go wild and the second man is encircled , striped of his clothes and tortured. When this ended, the third man was asked his decision. (Tough decisions,… a plug for the book and the prostate decision process was purely accidental.) Having witnessed the two previous men and what had been done to them, not only was he now very angry at what he had observed, he could not bring himself to ” death by a chee chee.”  The tribal leader then asks him how he would want his fate to proceed. “I want to be boiled in fat,” he says indignantly. The tribal leader states loudly, ” He no want death by a chee chee.” All of the natives are dejected and surround the last man with shoulders slumped, as the fire is stoked and the flames begin to boil the fat in a very large “human size” pot looming over the condemned man. The last man says to the tribal leader, “My I have a last wish?” Somewhat surprised but relenting the leader says, “Yes, you may.” The last of the three men says, ” I want two forks.” “Forks,” the tribal leader asks somewhat confused? ” Yes , a fork,” the man ascertains. ” Get  forks.” A member of the tribe runs off and returns with a fork, which he gives the remaining man. The whole tribe is now crowding around him smelling blood and the anticipation of his eminent death and the subsequent procurement of his skin. The last survivor takes the forks and begins to violently and repeatedly  stabbing himself all over his body as deeply and quickly as he could as the natives begin to clutch at him to stop and to get him to the pot of boiling fat.

The man then yelled, “To hell with all of you and to hell with your damned canoes!”

I am not saying it was the best of jokes, I am not saying I would have chosen it,  just that it was one he decided to tell in New Zealand when he could have told any number of jokes. He was an excellent joke teller.     I guess you had to be there.

The prostatblog by Jim Tucker

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coast guard flag and chloe

my wife and i at the beach after prostate surgery

Something I give to all my patients who are leaning for the surgical removal of the prostate is a part of a chapter from Patrick Walsh’s book on prostate cancer. It has to do with post-prostatectomy incontinence. The beauty of the piece is that Dr. Walsh thoroughly vets the unpredictable nature of this issue. I have said to patients, “I have done hundreds of these, I do them the exact same way with every precaution regarding continence, but I cannot tell you you will be dry or if you are when that will happen.” The excerpt of this particular chapter makes this point and I feel that giving the couple the article enhances and reinforces this concept. Walsh quotes Osler, “The well wear a crown seen only by the sick.” I love that saying. I get it. You have to be sick once to truly feel it. I have been trying to now put myself in other’s shoes, particularly my patients, to try to feel what they are going through. In this sense, my experience with prostate cancer has helped me as a doctor. (I said helped me…I ain’t there yet.)

So after my surgery my wife gives me a little, “lift you up card” with two penguins holding hands walking on the beach. Essentially it said, “I know that you are now damaged goods but I don’t intend on leaving you anytime soon.” Or something like that. Anyway, we decide to go to the beach the week after my surgery to “recuperate in private.” The thinking was we could go down to Orange Beach, Alabama, a six hour drive, and do all the catheter stuff and transition to diapers down there in anonymity. The thought of someone coming to my home to visit and me having all the urinary paraphernalia draped about my body was a bit much for my ego, I’m sorry. (See “Diaper Diaries – The screenplay- my first diaper buying incident occurred at a Rite Aid on Perdido Beach Blvd.)

About a week after the surgery I take my catheter out, man that was nice, and switch to diapers. For some reason I had in my head that I’d have some control early on and that complete continence would come in a few weeks. That seemed to me the most common scenario in my patients or maybe that is how I perceived how they did (remember up until this point I was just a doctor not a doctor patient).  With the diapers and the bloody urine filling them up on an hourly basis, my wife and I agree that it would be good for me to take a walk on the beach. I put the diapers on under a bathing suit and away we go. The route we usually walk is to the left of our condominium and ends at a rock jetty just before Perdido Pass. It is a delightful walk, takes about 45 minutes round trip (one diaper’s worth I figured), and I enjoy having a defined stopping point before turning around. Its fun climbing up on the rocks and watching all the boats come back and forth through the pass. 

About half way there my diaper begins to sag. By the time we get to the jetty, they have bulged in a lopsided fashion with that glob absorbent stuff, which now was red, trying to find its way down one side of my bathing suit. I’ve developed an abraded area of skin from this and it is uncomfortable to walk. I had to walk like a cowboy or dare I say a penguin to keep the diaper from rubbing my inner thigh raw. I decided to ditch the diaper. It is the middle of May and it is cool and there are a fair number of beach walkers and folks lying around on the beach. In front of a hotel I saw a wooden enclosure that housed the lounges that are rented. I sneak up to the side of this, much to the chagrin of my wife who has walked ahead to distance herself from being associated with me. I kneel down as if I am looking for something, snatch the diaper out through one pant leg of the suit and in one motion, a maneuver that I will  come to prefect in the months to come, I have it out, compressed and  stuffed through the wooden slats of the container. (A nice little surprise for the attendant of the lounges. I am sorry, I was desperate.)  As I reach my wife, my bathing suit is now wet and has the pinkish tinge of blood in the front. It looked like I had been stabbed there.

I wasn’t embarrassed by all this. In a way it was an adventure. At times we were laughing. What I think helped me was that in my heart I felt that one day it would not be like this, that with time all the issues would resolve. That it would make for a good story to tell. I often time view things in real time as if I am telling a story about it later. (Can you imagine how you’d feel if there was no hope in this?  I am grateful for whatever spirit in me, it was not purposeful nor do I take any credit for it, which allowed me to feel that this was a temporary situation and remain optimistic.

It was too cold to jump in the water, although I did try to ease down into the water and let the waves “splash away any evidence of my predicament.” I resigned myself to just waddling back to the room wet, stained and raw. The adventure was not so neat now. I did not feel well. All the medicines I had taken for bladder spasms with the catheter, pain from the surgery were having their after-effect.  We were almost back to the room when something interesting happened.

It was if I were in a dream, or better yet superimposed into a movie and the sound effects were heightened and dramatic and so very real. The sound track of the movie was out of balance with the visual. The visual was there but the sounds were just spot on, loud, clear, natural, perfect and over emphasized. (My brother Bob says that the remastered Beatle C.D.’s that were just released have sounds in there like John walking a way from the mike, or someone coughing in the background. That kind of sound, something you hear beyond the obvious.)

I was surrounded by all the beach people and their children. Some are walking, some are throwing things, some are running, children are running and laughing. Imagine this, for yourself as if you are in my movie. Children running, the sounds of waves crashing and children are laughing. It was beautiful children laughing and waves in a soundtrack and in backdrop of all the beach people. The horizon of the ocean looms and completes the scene. But the sounds are what get you and feel.

And then out there on the beach the realization of it all came crashing down upon me, an intense sense of melancholy that I feel right now as I write. I was not well, my pathology report was unknown to me, I am leaking urine and probably would have some degree of impotence. Unseen, unknown to all of those around me, those “well people” the young children without a care in the world and a world where every thing works in their body without even thinking about it or trying to make it that way. “Youth is wasted on the young,” indeed I thought.  Why did this happen to me? I wanted it to be easy. Have I taken my previous life for granted? I have let my wife and family down. It was so easy then. The well do have a crown they don’t even know they have and they take for granted.

I can see their crown as plain as day.

When we got home, I found the penguin card, tore the edge of the envelope off and fashioned into the shape of a diaper and pasted it back on the card. Clever huh?

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