Posts Tagged ‘erection’

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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Sexual Function Does Not Continuously Decline After Radiation Therapy Treatments For Prostate Cancer

07 Jan 2010

Sexual function in prostate cancer patients receiving external beam radiation therapy (EBRT) decreases within the first two years after treatment but then stabilizes and does not continuously decline as was previously thought, according to a study in the January 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).

Prostate cancer is the most common male cancer other than skin cancer. It can be effectively treated using multiple methods, including prostatectomy, brachytherapy and EBRT, so the long-term side effects are often used by patients and doctors as deciding factors when choosing a treatment.

Changes in sexual function are some of the more common side effects from prostate cancer treatments, but the degree to which EBRT affects function varies widely, depending on the study.

In a first of its kind study, researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital Department of Radiation Oncology in Philadelphia and the University of California, Davis, School of Medicine Department of Radiation Oncology in Sacramento, Calif., evaluated 143 prostate cancer patients receiving EBRT who completed baseline data on sexual function before treatment and at follow-up visits.

Patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years. The study authors found that the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment and then stabilized with no significant changes thereafter.

“Treatment-related side effects, especially sexual function, have a significant effect on a patient’s quality of life and satisfaction with their overall outcome,” Richard Valicenti, M.D., M.A., senior author on the study and professor and chair of radiation oncology at the University of California, Davis, School of Medicine. “The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT and what they can expect after treatment, which should aid in deciding on a treatment course.”

Beth Bukata
American Society for Radiation Oncology

My thoughts-

This is a good article but not for the reason that it was written. The deal is that patients are very much aware of the potential for sexual dysfunction as a result of surgery, but often don’t consider it an issue if they choose radiation. Brachytherapy (seeds) affects sexual function more than external beam and of course combination therapy of external and brachytherapy affect erections more than either alone. In the decision making process it is very important for the newly diagnosed patient to consider the ramifications of all treatments on erectile function.  As it pertains to the quality of your erections and how you void after the treatment of prostate cancer, there is “no free ride.” This issue is addressed in my book “The Decision: Your prostate biopsy shows cancer. Now what?”

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I remember the day as if it were yesterday. I had had my surgery on my wife’s brother’s birthday, May 10th, a Thursday. On June 6th, my wife’s birthday, I called home to see if she would like me to pick something up for her birthday dinner. “I’d like Thai Dish; I really miss eating there.” There used to be a Thai restaurant near our home that she loved, but it had moved to another location about 30 minutes from our house. The new location was inconvenient, and as a result we ate there infrequently. The round trip to this restaurant from my office and then to my home I figured would be about 40 minutes, and probably a good time to try taking a sex pill to see if I could “fire this baby up.” Most of the pills have about a 30-minute window before they take effect. So as I am finishing up seeing patients for that afternoon, I get a sample pack from the drug cabinet and take one. By the time I had placed the to-go order and was in the car to pick it up, about 30 minutes had passed. Since I was still wearing a condom catheter because of the incontinence, I decided to shake the tubing that connects the bag to the condom and see if, on the way to Thai Dish, anything “perked up.” There was a fair amount of anxiety associated with this test because of the chance that the surgery had messed up the nerves responsible for erections. It was a big deal to me as it is to all men treated for prostate cancer. I determined that there was life down there. It was not much, but the fact that I had any response at all indicated to me that, at a minimum, at least some of the nerves had been spared. I pranced into and out of  Thai Dish  and played the Beatles as loud as my CD player would allow with the windows down all the way home. (I love loud music in the car with the windows down.) When I got home with the food, my wife asked, “John, did you have a good day?” “Yes,” I said, “It turned out to be a very nice day.” June 6th is historically known as D-Day, but for me it’s E-Day. In time, as the degree of my incontinence decreased and I was able to go to back to a diaper, I was very content and actually felt lucky to be “dry with a diaper, potent with a pill.”

Excerpt from ” The Decision: Your prostate biopsy shows cancer. Now what?”

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