I'm going to use the frequently used PCA abbreviation to denote Prostate Cancer at times in this post.
One in 6 US men will be diagnosed with PCA in his lifetime. Approximately 1 in 36 will die from the disease. The cancer tends to strike late enough in life and there are enough medical techniques to slow the progression of the disease that men frequently die from another cause. Many estimates claim that by age 85, 50% of all men have some level of prostate cancer, but this has never, to my knowledge, been unequivocally determined. Most of the data is derived not from diagnosed cases, but from autopsies on older men.
I remember when Runner's World columnist George Sheehan was struck by prostate cancer. After it became obvious that he could not be cured, he decided that he was going to make the disease kill him. He was going to take such good care of himself that nothing else would get him. And, in November of 1993, he died from the cancer.
According to the CDC, prostate cancer was the most common cancer (non-melanoma skin cancers excluded) in the US in 2010, with 126.1 out of every 100K men being diagnosed that year. Female breast cancer was the second most common (male breast cancer exists but is uncommon and was not included in the charts I used).
When looking at death rates, lung cancer jumps to the top and then breast and prostate cancer are nearly tied at number 2. But, lung cancer kills at more than twice the rate of either breast or prostate cancer.
Funding for cancer research provided by the NCI shows some very interesting disparities in how research money is spent. Per case, among the more prominent cancers, (this data is from 2006, not 2010 as above), prostate cancer received $1318 in funding, while breast cancer led the pack at $2596. Lung, colon and pancreatic cancer were in between these other two in terms of funding, but lung cancer was the only other cancer to receive less than $2000 per new case - closer to $1500 actually.
In terms of deaths, the number of dollars spent are even more intriguing. Breast cancer still leads the pack, but the relatively low death rate from PCA pushes PCA to second in funding per death. In some ways this is confusing because 2010 data showed rates of prostate and breast cancer deaths to be nearly identical per 100K people, while the 2006 data shows that there were 1/3 more deaths from breast cancer than prostate cancer (absolute numbers vs. rates per 100K people). Lung cancer drops way to the bottom, at only 12% or so of the funding per death that breast cancer receives. I'm curious if lung cancer seems to lag because it's seen as a self-induced cancer, with most cases tied to smoking. Or perhaps it lags because it's also quite deadly.
So, those are some interesting statistics. I'm not going to comment much more on this, but I do think some things seem a bit skewed here. For men, prostate cancer is very much the equivalent of breast cancer in women. PCA is less deadly overall, but both cancers profoundly affect how people see themselves as sexual beings, and the treatments for both can involve the loss of a lot of dignity. Let's just say that I've become quite used to the command to "drop my pants" in the past few months. I don't even look around the room any more to see who is there. I just drop my pants. This morning, it was two nurses at Dartmouth. I dropped my pants on command and didn't think twice about it. I'm sure that breast cancer carries similar indignities for women and I'm sure if this post gets read, someone will tell me they are worse. At that point, the second half of this post might be informative, in terms of the indignities that men go through.
So, why is it that men seem to have done nothing like what women have done to raise awareness, raise money for research, or turn this into a cause? Is it just a difference in the sexes? Why the federal funding discrepancies between the two diseases?
Now, onto a second set of numbers. These are my personal numbers from my experience.
Late last summer, I had a series of PSA readings around 5, with 4 being the top of the normal range. A digital rectal exam (and there were many of these) showed no real issues. It was noted that one side of my prostate seemed larger than the other side, but this discrepancy is not statistically important when looking at actual cancers found. So, my blood test was out of range and my DREs were nearly normal, with one slight anomaly noted by one (of many) providers.
At this point, a biopsy was suggested. I did my homework, and I realized that the chance that a biopsy would show cancer was about 25%. The odds were in my favor, but I lost that round.
After talking to lots of docs, I picked a treatment technique and I'm now on the other side of that treatment. I chose surgery without any adjuvant therapies - radiation or androgen deprivation. The surgeon said that nomograms showed the chance that I'd have an affected lymph node to be about 1%, and he never removes lymph nodes at that low a chance. This shortened my surgery by 30 minutes.
I got my post-op pathology report and it essentially matched the pre-op estimates. Using some nomograms from Sloan Kettering, I have a 99% chance of being cancer free at two years with no more treatment at all. At 5 years and 7 years, it's 97%, and at 10 years, 96%. That says it's very likely that I'll be defined as "cured" at the five year mark. Unless I'm unlucky again. Yes, even in my low risk category, there are recurrences, and I'll spend the rest of my life getting blood tests to monitor for that possibility.
The three major goals of the treatment are, in order, to cure the cancer, maintain urinary control (continence) and maintain sexual function (potency). I've already covered some cure statistics above. Next, I'll talk a bit about the latter two of these.
For most men, full return to continence (and the definition of this is often debated) has a median time of just under four months. For certain patients, primarily younger patients who had nerve sparing surgery with a highly experienced surgeon, mean time to return to continence is closer to two months. I'm at one month right now, and I'm almost there. I am guessing that by two months, three at the outside, I will be considered fully continent. But, I am a younger than average patient, I had nerve sparing surgery, and my surgeon was very experienced, so I fit into the second category.
(This next section might be TMI - Read at your own risk).
Almost all patients are impotent immediately after this surgery. Due to a catheter for the first 1-2 weeks after surgery, sex is not possible at all (OK, I'm sure someone, somewhere has done it, but it wasn't me). For four weeks, at a minimum, there are internal stitches in the urethra and bladder that are healing, and doctors tend to steer patients away from sex during this period of time, even if possible.
But, after four weeks, most doctors begin a period of treatments frequently known as "penile rehabilitation". The rehab has two purposes. First, it's hopeful that this will speed the patient back to potency by drawing blood into the penis and helping the tissues to stay active. Secondly, if the rehab isn't done, the penis tends to permanently shrink during this inactive period. I'm just not going to say anything more about that.
Penile rehab can include the use of PDE5 inhibitors (they tend to not work well, if at all, early on), vacuum erection devices, and injected drugs that result in erections (and yes, they are injected into the penis. Did you just wince?) Insurance companies, for the most part, cover absolutely none of the costs for this "rehab".
Younger, healthier patients often start to see some recovery by 3 months. For many, it takes at least six months for a partial recovery. Many patients take up to two years, and improvements out to four years is possible.
In the end though, even with nerve sparing surgery, for a younger patient who was potent at the time of the surgery, approximately 30% of patients will remain permanently impotent. Everyone going into the surgery knows these odds, and everyone hopes to beat them. But, some people simply never recover.
So, I had a 75% chance of a negative biopsy. I lost. I have a 96% chance of a long term cure. Only time will tell. I should be fully continent in another month or two and even where I am today really isn't bad compared to many. On the other issue, just like recurrence, I simply need to wait and hope.
A friend recently told me that he didn't think he could have dealt with all I've gone through the past six months. I disagreed with him. While no one wants to go through it, when things happen, you have to deal with them. You might not be happy about it, but you have to move on.
And, on that note, I skied twice last weekend, took a rest day, and then went to CrossFit on Tuesday. Today, I'm going to work out again after work, before I take another rest day to get ready for a weekend of skiing. I'm getting better and life does go on.
Thursday, February 6, 2014
Monday, February 3, 2014
And, I Think I Passed the Test
Ski conditions in the northeast are less than optimal given where we are in the winter. Sugarbush has only about 100 inches of snow so far this winter, vs. an average annual snowfall close to 300 inches. Plus, there have been a few rain events that have melted a lot of the snow we have received.
So, I knew that by returning to work this past weekend, I wouldn't be skiing in the trees and I wouldn't be skiing tough moguls, but I would get tested on steep terrain. It was great to be back at the mountain, hanging out with friends and my students again. As I left the locker room on Saturday morning to take some warm-up runs, I told a friend that I just hoped I wouldn't take a fall during the weekend.
I opted to warm up on a very easy run (for me at least) - an intermediate trail that was well groomed. I was skiing by myself, in my ski school uniform, and I somehow managed to cross my ski tips and take a fall. One of my skis popped off (bindings doing their job!), and I stood up unscathed. Emboldened by that, I went to a steep double-black diamond run next. The snow was a bit funky due to a few hours of snowmaking over an icy surface, but I survived the run just fine. I even returned there later with my students.
For the first time all season, all 9 girls in my group showed up on the same day. And, after being gone for three weeks, I spent a lot of Saturday regaining control of the group. Apparently, they didn't behave well at all for the instructors who covered for me. One of those instructors went to my boss on Friday and allegedly said "Please tell me that Damon is returning tomorrow as scheduled." One of the parents later told me that he thinks the kids can "smell fear" in a substitute coach, and they had been kind of rough on the substitutes. Multiple parents told me that the girls were very happy to have me back, which always makes me feel good. One of the toughest parts of the job as an older coach is to truly engage with young students and make sure that not only are they safe and learning, but they are also having fun on a daily basis.
If I take the group for a day, no one gets hurt, and everyone wants to return to ski again the next day, I'm doing a good job. If the kids learn some new skills during the day, it's even better.
I did notice early on Saturday that the group had regressed in a few skill areas since I'd last seen them. I wanted to keep the first day back light and fun, so we had a simple focus for the day, and and tried to apply that focus to both racing and steep terrain.
On Sunday, I spent most of the morning doing some more formal teaching - much more than I do in a typical day. The girls weren't crazy about that strong a teaching focus, but I saw improvements through the morning, and some afternoon racing confirmed that some things had changed.
By Saturday afternoon, I was tired. By Sunday afternoon, I was exhausted. But, I had a great time, we are expecting some snow this week, and I have five days to recover before I do it all again.
It is nice to be getting back to my normal activities, even though I am far from 100% healed. But, it's better every day.
So, I knew that by returning to work this past weekend, I wouldn't be skiing in the trees and I wouldn't be skiing tough moguls, but I would get tested on steep terrain. It was great to be back at the mountain, hanging out with friends and my students again. As I left the locker room on Saturday morning to take some warm-up runs, I told a friend that I just hoped I wouldn't take a fall during the weekend.
I opted to warm up on a very easy run (for me at least) - an intermediate trail that was well groomed. I was skiing by myself, in my ski school uniform, and I somehow managed to cross my ski tips and take a fall. One of my skis popped off (bindings doing their job!), and I stood up unscathed. Emboldened by that, I went to a steep double-black diamond run next. The snow was a bit funky due to a few hours of snowmaking over an icy surface, but I survived the run just fine. I even returned there later with my students.
For the first time all season, all 9 girls in my group showed up on the same day. And, after being gone for three weeks, I spent a lot of Saturday regaining control of the group. Apparently, they didn't behave well at all for the instructors who covered for me. One of those instructors went to my boss on Friday and allegedly said "Please tell me that Damon is returning tomorrow as scheduled." One of the parents later told me that he thinks the kids can "smell fear" in a substitute coach, and they had been kind of rough on the substitutes. Multiple parents told me that the girls were very happy to have me back, which always makes me feel good. One of the toughest parts of the job as an older coach is to truly engage with young students and make sure that not only are they safe and learning, but they are also having fun on a daily basis.
If I take the group for a day, no one gets hurt, and everyone wants to return to ski again the next day, I'm doing a good job. If the kids learn some new skills during the day, it's even better.
I did notice early on Saturday that the group had regressed in a few skill areas since I'd last seen them. I wanted to keep the first day back light and fun, so we had a simple focus for the day, and and tried to apply that focus to both racing and steep terrain.
On Sunday, I spent most of the morning doing some more formal teaching - much more than I do in a typical day. The girls weren't crazy about that strong a teaching focus, but I saw improvements through the morning, and some afternoon racing confirmed that some things had changed.
By Saturday afternoon, I was tired. By Sunday afternoon, I was exhausted. But, I had a great time, we are expecting some snow this week, and I have five days to recover before I do it all again.
It is nice to be getting back to my normal activities, even though I am far from 100% healed. But, it's better every day.
Friday, January 31, 2014
Big Test This Weekend
I have been cleared by my doc to resume activities at a level that feels comfortable to me. So, first thing tomorrow morning, I will be driving to Sugarbush and putting on my ski equipment. I'll take a few training runs with my friends, and if all goes well, I will spend the day teaching skiing. If that goes well, I'll teach again on Sunday, assuming I can get to the mountain on Sunday. We are supposed to have snow and freezing rain overnight on Saturday night, so travel could be dicey on Sunday morning.
Since my surgery, I've been to CrossFit twice. In both cases, I worked out at a very light level - some arm presses, knee push-ups, super-light deadlifts (about 1/6 of my max), box step ups, and some rowing. Plus some mobility and stretching work. Each time, I've felt beat up for a couple days afterward.
So, trying to teach skiing all day tomorrow could be a challenge. But, it beats sitting at home for another weekend, wishing I was skiing.
And, if it's too much for me, I'll have my phone with me and I'll call my boss and tell her I can't pull it off. Hopefully that won't happen.
Given Sunday's forecast and the Super Bowl on Sunday, I'm not sure how many kids will show up. When the Patriots are in the Super Bowl, attendance tends to be very light. With two western teams in the game this year, people may be in the mood to ski all day on Sunday.
I hope my body is ready to ski all day. Twice.
Since my surgery, I've been to CrossFit twice. In both cases, I worked out at a very light level - some arm presses, knee push-ups, super-light deadlifts (about 1/6 of my max), box step ups, and some rowing. Plus some mobility and stretching work. Each time, I've felt beat up for a couple days afterward.
So, trying to teach skiing all day tomorrow could be a challenge. But, it beats sitting at home for another weekend, wishing I was skiing.
And, if it's too much for me, I'll have my phone with me and I'll call my boss and tell her I can't pull it off. Hopefully that won't happen.
Given Sunday's forecast and the Super Bowl on Sunday, I'm not sure how many kids will show up. When the Patriots are in the Super Bowl, attendance tends to be very light. With two western teams in the game this year, people may be in the mood to ski all day on Sunday.
I hope my body is ready to ski all day. Twice.
Wednesday, January 29, 2014
So, How Long is this Road Back to Some Sense of Normalcy?
In the last week or so, it seems like my recovery from surgery has simply stalled. I've had a few recent days where I've been completely exhausted, especially this past Monday. I quit work at 1:00 on Monday and went home and took a long nap.
I feel like I've been fairly prudent at slowly returning to activities, but perhaps it's still too much. Certainly, some physical side effects will take months to resolve. I'm not happy about that, but at least I went into this process armed with that knowledge.
The two things that have been toughest are the amount of time for my body to start to feel like it wants to do anything at all other than sleep, along with some mental issues. I did some research on-line and found a discussion between people who had the same surgery that I just had. They estimated that it took 4-6 months to feel physically normal again. It took at least four months for people to regain any sense of "stamina". And, I don't mean the stamina to do a hard workout or a week of hard workouts. I mean the ability to just make it through a tough week at work without needing some naps along the way.
Things are going well at work. It looks like my company is on the verge of getting some new venture capital that we need to continue through this year. Despite the issues I've gone through recently, I feel flattered that I've been promoted to Chief Technology Officer of my small company. My role isn't really changing, but it's a promotion on paper. And, I want to be sure that I prove worthy of the title. This means I need to be at my best, both physically and mentally, in the months ahead.
The week of my surgery, I didn't work at all, other than some e-mails and one phone call. The next week, I had hoped to work close to full time from home, but only managed 25 hours. Last week, I got over 30 hours and this week will be about 35. So, I'm getting there.
I'd also like to return to teaching skiing this weekend, but I have to admit that I'm afraid working both jobs might be too much.
Above, I mentioned that the second aspect of all of this has been mental issues. I have to admit to feeling a certain mental tiredness, like I need to nap for a month so my brain can recover. It seems that ever since I got my high PSA lab result in August, the world has been spinning way too fast. More blood tests. Visits to my primary care doc and then a urologist. A biopsy. A diagnosis. The need to talk to urologists, surgeons, and radiation oncologists at multiple hospitals. Fighting incessantly with my insurance company over treatment options. Scheduling surgery. The surgery itself. Living with a catheter for a week. And then, I was suddenly on my own until my next medical appointment in April. And, it seemed like the reality of the previous five months just crashed down on me.
With the surgery and the worst of the recovery behind me, I'm allegedly better. I need to take care of my family, take care of my responsibilities in the world. I work for a tiny company that can't let me simply disappear for 3 months to recover.
And, it's been a lot.
The past two days have been better, so that's good. I hope to ski this weekend. My company doesn't seem worried about my performance, given my new job title. I just have to find a way to both heal and live up to the world's expectations for me.
Wish me luck.
I feel like I've been fairly prudent at slowly returning to activities, but perhaps it's still too much. Certainly, some physical side effects will take months to resolve. I'm not happy about that, but at least I went into this process armed with that knowledge.
The two things that have been toughest are the amount of time for my body to start to feel like it wants to do anything at all other than sleep, along with some mental issues. I did some research on-line and found a discussion between people who had the same surgery that I just had. They estimated that it took 4-6 months to feel physically normal again. It took at least four months for people to regain any sense of "stamina". And, I don't mean the stamina to do a hard workout or a week of hard workouts. I mean the ability to just make it through a tough week at work without needing some naps along the way.
Things are going well at work. It looks like my company is on the verge of getting some new venture capital that we need to continue through this year. Despite the issues I've gone through recently, I feel flattered that I've been promoted to Chief Technology Officer of my small company. My role isn't really changing, but it's a promotion on paper. And, I want to be sure that I prove worthy of the title. This means I need to be at my best, both physically and mentally, in the months ahead.
The week of my surgery, I didn't work at all, other than some e-mails and one phone call. The next week, I had hoped to work close to full time from home, but only managed 25 hours. Last week, I got over 30 hours and this week will be about 35. So, I'm getting there.
I'd also like to return to teaching skiing this weekend, but I have to admit that I'm afraid working both jobs might be too much.
Above, I mentioned that the second aspect of all of this has been mental issues. I have to admit to feeling a certain mental tiredness, like I need to nap for a month so my brain can recover. It seems that ever since I got my high PSA lab result in August, the world has been spinning way too fast. More blood tests. Visits to my primary care doc and then a urologist. A biopsy. A diagnosis. The need to talk to urologists, surgeons, and radiation oncologists at multiple hospitals. Fighting incessantly with my insurance company over treatment options. Scheduling surgery. The surgery itself. Living with a catheter for a week. And then, I was suddenly on my own until my next medical appointment in April. And, it seemed like the reality of the previous five months just crashed down on me.
With the surgery and the worst of the recovery behind me, I'm allegedly better. I need to take care of my family, take care of my responsibilities in the world. I work for a tiny company that can't let me simply disappear for 3 months to recover.
And, it's been a lot.
The past two days have been better, so that's good. I hope to ski this weekend. My company doesn't seem worried about my performance, given my new job title. I just have to find a way to both heal and live up to the world's expectations for me.
Wish me luck.
Wednesday, January 22, 2014
The Long Road Back
Bit by bit, my life is returning to normal, or at least, my new normal.
I've stopped taking post-surgical pain medications, although I'll probably be taking Alleve for inflammation for another week or two.
I started working again last week, on a part-time basis, but it was a bit too much. In particular, coming to the office on Friday was more than I was ready for. So, I spent the weekend resting a fair amount. On Monday, I worked 7 hours from a coffee-shop close to home. Tuesday, I worked for 6.5 hours. Today, I came to the office again.
The healing is proceeding at its own pace. The six holes that were punched in my gut for the laparoscopic robot are healing, but not one of them is fully healed 16 days after the surgery. The incision by the navel will probably require a couple more weeks to heal completely.
Other than walking when the weather is agreeable, I haven't really done anything physical. Even if I get firewood for our wood stove, I carry one log per hand and make multiple trips to the garage. Normally, I'd bring in 8-10 logs at a time in a carrying sling.
Tonight, my wife is going to go to CrossFit after work. I'm going to go along, but I won't do the workout. I think I'll probably put on my gym clothes, but spend some time stretching, foam rolling, and doing other mobility work. Maybe I'll play with some very light dumbbells. My target for even a very easy CrossFit workout is sometime next week or the week after. And, some movements, like squats, deadlifts, box jumps, rowing, rope jumping, etc., are simply off the table until I feel a bit more healed.
This weekend, I'm hoping to ski for a little bit. My goal is perhaps two hours on groomed intermediate runs. Nothing challenging at all. I am hoping to return to teaching skiing on 2/1. However, if the snow conditions improve dramatically, and the conditions allow for off-piste skiing, I'm likely to wait one extra week before returning to teaching.
I wish I was here telling a story about deadlifting 400 pounds months before the doc said it would happen. Or, that I'd been bump skiing on steep terrain, or doing some snowshoe running at a 6:00 minute per mile pace. I know that 10 years ago, I would have tried to do stuff like that. Hopefully, at this point in my life, I'm smart enough to avoid doing reckless things that might impede my recovery.
The fitness will return. I will return to skiing. I am still easing my way back into work.
This time around, I'm really trying to let my body tell me what it's ready for, rather than pushing my body too far, too soon.
There are still some side effects from the surgery that will take months to resolve. While I'm impatient, I know this is the case. So, if some parts of my body can't recover in less than a few months, I'm not going to try to force myself to return to normal activities in just a few weeks.
I've stopped taking post-surgical pain medications, although I'll probably be taking Alleve for inflammation for another week or two.
I started working again last week, on a part-time basis, but it was a bit too much. In particular, coming to the office on Friday was more than I was ready for. So, I spent the weekend resting a fair amount. On Monday, I worked 7 hours from a coffee-shop close to home. Tuesday, I worked for 6.5 hours. Today, I came to the office again.
The healing is proceeding at its own pace. The six holes that were punched in my gut for the laparoscopic robot are healing, but not one of them is fully healed 16 days after the surgery. The incision by the navel will probably require a couple more weeks to heal completely.
Other than walking when the weather is agreeable, I haven't really done anything physical. Even if I get firewood for our wood stove, I carry one log per hand and make multiple trips to the garage. Normally, I'd bring in 8-10 logs at a time in a carrying sling.
Tonight, my wife is going to go to CrossFit after work. I'm going to go along, but I won't do the workout. I think I'll probably put on my gym clothes, but spend some time stretching, foam rolling, and doing other mobility work. Maybe I'll play with some very light dumbbells. My target for even a very easy CrossFit workout is sometime next week or the week after. And, some movements, like squats, deadlifts, box jumps, rowing, rope jumping, etc., are simply off the table until I feel a bit more healed.
This weekend, I'm hoping to ski for a little bit. My goal is perhaps two hours on groomed intermediate runs. Nothing challenging at all. I am hoping to return to teaching skiing on 2/1. However, if the snow conditions improve dramatically, and the conditions allow for off-piste skiing, I'm likely to wait one extra week before returning to teaching.
I wish I was here telling a story about deadlifting 400 pounds months before the doc said it would happen. Or, that I'd been bump skiing on steep terrain, or doing some snowshoe running at a 6:00 minute per mile pace. I know that 10 years ago, I would have tried to do stuff like that. Hopefully, at this point in my life, I'm smart enough to avoid doing reckless things that might impede my recovery.
The fitness will return. I will return to skiing. I am still easing my way back into work.
This time around, I'm really trying to let my body tell me what it's ready for, rather than pushing my body too far, too soon.
There are still some side effects from the surgery that will take months to resolve. While I'm impatient, I know this is the case. So, if some parts of my body can't recover in less than a few months, I'm not going to try to force myself to return to normal activities in just a few weeks.
Wednesday, January 15, 2014
Post-surgery update (long)
The surgery to remove my prostate was last Monday - 9 days ago now. The surgical technique used was Robot-Assisted Laparoscopic Prostatectomy (RALP). There were a few delays before the surgery, primarily when an examination of one of the robotic arms before the surgery revealed some contamination of some sort. That required them to re-clean the robot (I was the second patient getting that surgery that day), and I was finally wheeled off to the OR about 3:00 p.m.
Before I headed to the OR, I'd been given a sedative in my IV. On the way to the OR, I was receiving oxygen. Despite all of my fears about the surgery, I was fairly calm as this all happened, thanks to the sedative, and maybe the oxygen. I remember arriving in the OR and I saw the robot and asked a question about it. I got an answer. Then, I started to feel dizzy. If they mentioned that they were about to administer the propofol, I never heard it. Then there was darkness. Knowing that I was intubated, had a catheter inserted, was placed in a bizarre position for the surgery and then cut open and probed by the robot arms is easier to deal with because I have zero recollection of it all.
The next thing I remember is being extremely cold. I was in the PACU (post-anesthesia care unit), coming out of the anesthesia. It was about 6:30. My surgery was shorter than it is for some people because my surgeon elected not to remove any lymph nodes. As he had reviewed some nomograms pre-surgery, he determined that the chance that the lymph nodes were affected was about 1%. He said his cut-off to remove some lymph nodes for biopsy is about 2%, so he didn't remove any, which subtracted 30 minutes or so from the surgery.
People in PACU found me some blankets and the shivering subsided. My wife showed up for a while. The surgeon checked in with me. But, to be honest, this is all just a blur. I do remember asking my wife if the surgery had all gone as expected and getting an affirmative response. One of the funnier things I'd read about this surgery is men reaching for the catheter as they come out of anesthesia. If the surgeon finds that the cancer has spread, they abort the removal of the prostate because other treatments will be required. This eliminates the need for the catheter. So, if you wake up and there is no catheter, it's bad news. I had read this beforehand, but I honestly don't remember if I checked for this or not.
About 9:00 or so, I was sent to a room to recover more. I was dealing with a lot of pain at this point in time, and the nurses where helpful, giving me oxycodone and morphine. I used the morphine off and on until the next morning. It was extremely effective, but it did make me nauseous. I used way less morphine than I was allowed to have (I was allowed 2 mg/hour, and used either 1 or 2 mg every other hour). I really didn't sleep much that first night, as the pain and the regular visits by staff kept me awake.
The doctors doing rounds visited me around 8:00 in the morning, and they seemed concerned about my affect. I was still in a lot of pain, fairly unhappy with that, and the morphine was messing with my ability to think clearly. The surgeon visited me that morning as well, and he reiterated that it was my choice to stay or go home. I told him that I'd try to go home, but we would have to see how I felt. By noon, my affect was markedly improved (I had stopped the morphine, which may have been why), and people started talking about discharge. As I fought nausea and struggled to walk even the smallest amount, I really doubted that I was ready to go home that night.
I met the patient who had gone first the previous day in surgery - a retired VT state trooper. He was up and walking around with his wife, in great spirits, and reported no pain at all. He also told me he was staying a second night. Part of his reasoning was that he lived 2.5 hours away, in the middle of nowhere, near the Canadian border. If he had any complications, he wanted to be at the hospital rather than at home. By mid-afternoon, I'd made it clear to the nurse and the resident that I thought I should stay another night. The nurse seemed to agree, but the resident seemed determined to send me home.
I checked in with my wife. To be honest, I really wish she had been there with me, but she was at work. She works for a human resources benefits management company, so the end of one year and start of the next is always really busy for them. The implementation of the PPACA had further complicated her company's work, so she needed to be at work after missing all of the previous day.
My wife said she could get to the hospital about 6:30 or so, either to take me home or just visit.
At some point, I found myself very nauseous. I realized that the pain would be excruciating if I actually vomited. I got very close to that point, but not quite. The nurse gave me an antiemetic and the nausea faded away for a while.
I was expecting to see my surgeon near the end of the work day, but he never made it. Instead, the resident on the floor, a urology resident, claiming to represent the surgeon, and a third resident came to the room. They made it very clear that there was nothing they could do for me at the hospital that couldn't be done at home. They said my discharge instructions were done and I should really go home. I was less than 24 hours out of the OR and it felt like they were going to physically throw me out of the place. I was really unhappy but I seemed to have no choice.
My wife stopped by the hospital pharmacy to get some pain medication for me and then came to my room. By then, I was physically ready to leave. I was nauseous, in pain, and I did not want to leave, but I felt like there was no other option. This turned out not to be true, but in that moment, I didn't know that I still had a choice. The room rate at this hospital is $1650/day, and I was ready to pay it myself. Instead, I was put in a wheelchair and sent on my way.
Every bump on the ride home hurt a lot. As soon as I got home, I headed to the couch to lie down. I asked my wife for some water and the pain meds. And for the next 48 hours, I didn't move very much. I would get up to empty the catheter bag. I was not going to ask my family to do that for me. I sipped some ginger ale. By Thursday night, 72 hours after surgery, and more than 96 hours after my last meal, I was finally ready to eat some food. I had a bit of soup and a grilled cheese sandwich. A grilled cheese has never tasted so good.
By Friday, things really started to turn around. I was vertical for most of the day. I spent some time at my fly-tying vise, tying some olive woolly buggers for April's opening of trout season. I ate some more. And, I got into another disagreement with people at the hospital. I was still taking oxycodone for pain, although I'd cut the dose by then.
I realized I was going to run out of oxycodone over the weekend and I wasn't sure if I was ready to stop the pain meds completely (I'm still using some pain meds today, so the answer was no). On my first call, I was only able to leave a message and I was told I'd get a call back. After three hours with no response, I called back. I didn't want people to go home for the weekend with this item still pending. I was told that they were short-staffed but they would get to it. About 3:00 or so, I got a call back. They really questioned my need for the medication. Was I doing everything else I was supposed to be doing? They seemed alarmed that I was taking Alleve instead of ibuprofen for inflammation. In reality, the discharge resident had told me that would be fine, but he didn't want to re-print the discharge instructions. I told this to the nurse. She told me they could write a script for more pain medicine, but I would need to pick it up myself. I understand the laws governing prescribing of opiates. However, on discharge, they'd sent a script to the hospital pharmacy for me, and my wife had picked it up. I asked if they could deliver it to the hospital pharmacy for me and I could pick it up on Saturday. "No" was the terse response. I reminded them that I was on opiates and I had a catheter and I couldn't drive. I think they knew that I would say this, and this was their "checkmate" position to deny my request. My wife couldn't get there in time to get the paper script. They said they could leave it with the on-call resident for Saturday pick-up, but there was no guarantee that we'd be able to find him on Saturday. One roadblock after another. Finally, I reminded them that they could legally send a less powerful pain medicine - Vicodin - by phone to my local pharmacy. At that point, they relented and did that. I was drained at this point in time. Why did I need to fight so hard for a medication my surgeon said would be available as long as I truly needed it? Yes, we have a state level and national level problem with the over-prescription of opiates. They are often abused or diverted. But, I'd just had major surgery and I was dealing with real pain. Was my request that out of line? Essentially, I felt like I was being treated like a criminal for requesting the medication.
On Saturday, I was even more vertical. I cooked dinner. Sunday, I left the house (my wife drove) to go grocery shopping and cooked dinner again. Monday, I left the house for a few hours and worked for part of the day at a local coffee shop.
On Tuesday, I returned to the hospital. I had the catheter removed. I was afraid this would hurt, but while it was an extremely odd feeling, it wasn't pain. I had very good urinary control as soon as the catheter was out. I had to prove I could drink water and urinate on my own before I could go home. This went fine. My control isn't perfect, but it's way better than the average patient after this surgery. Full urinary control should return very quickly.
I met with the surgeon. The biopsy was exactly as expected - identical results to the pre-surgery biopsy. The cancer was low/intermediate in grade and it had not gotten close to the edge of the prostate. These are the biggest predictors of recurrence, so he is very sure that I'm completely cured. We will check blood PSA levels for five years before the medical community will truly consider me cured. But, just one year of no PSA in the bloodstream will be very convincing evidence.
I also voiced my concerns about the discharge and the pain medication refill to the surgeon. He told me neither should have happened and he didn't think I was ready to go home when he saw me. But, he got busy and had to send a resident to check on me. He said he would talk to all the parties involved in the two incidents.
(On another note, I have voiced two complaints here. The reality is that my surgeon was amazing, the nurses on the floor were beyond amazing, and I benefited from technology and compassion at many steps in this process. Many parts of this process were full of care and compassion - people truly concerned about my well-being throughout the entire ordeal.)
Today, I'm still using a small amount of pain medication. Most of the pain is centered around the incision points, and moving is still a bit slow. If the weather holds, I'm hoping to get out for a walk this afternoon. I'm working right now, although I'm not yet back in my office.
I still have a lot of healing to go, but right now, everything looks good. Hopefully, any incontinence issues will be short lived. And then, I need to watch and wait for sexual function to return, but that's a completely different issue. It should resolve, but it could be weeks, months, or even a year or more.
I will return to my office next Monday. I may get out for some easy skiing on the 25th. I hope to return to teaching skiing by 2/1, maybe 2/8 at the latest. I hope to be lifting light weights by early February and increasing those weights over the next couple months. But, my body needs to heal completely. In some ways, I need to heal mentally as well. I will take the time I need to allow this healing to occur.
Before I headed to the OR, I'd been given a sedative in my IV. On the way to the OR, I was receiving oxygen. Despite all of my fears about the surgery, I was fairly calm as this all happened, thanks to the sedative, and maybe the oxygen. I remember arriving in the OR and I saw the robot and asked a question about it. I got an answer. Then, I started to feel dizzy. If they mentioned that they were about to administer the propofol, I never heard it. Then there was darkness. Knowing that I was intubated, had a catheter inserted, was placed in a bizarre position for the surgery and then cut open and probed by the robot arms is easier to deal with because I have zero recollection of it all.
The next thing I remember is being extremely cold. I was in the PACU (post-anesthesia care unit), coming out of the anesthesia. It was about 6:30. My surgery was shorter than it is for some people because my surgeon elected not to remove any lymph nodes. As he had reviewed some nomograms pre-surgery, he determined that the chance that the lymph nodes were affected was about 1%. He said his cut-off to remove some lymph nodes for biopsy is about 2%, so he didn't remove any, which subtracted 30 minutes or so from the surgery.
People in PACU found me some blankets and the shivering subsided. My wife showed up for a while. The surgeon checked in with me. But, to be honest, this is all just a blur. I do remember asking my wife if the surgery had all gone as expected and getting an affirmative response. One of the funnier things I'd read about this surgery is men reaching for the catheter as they come out of anesthesia. If the surgeon finds that the cancer has spread, they abort the removal of the prostate because other treatments will be required. This eliminates the need for the catheter. So, if you wake up and there is no catheter, it's bad news. I had read this beforehand, but I honestly don't remember if I checked for this or not.
About 9:00 or so, I was sent to a room to recover more. I was dealing with a lot of pain at this point in time, and the nurses where helpful, giving me oxycodone and morphine. I used the morphine off and on until the next morning. It was extremely effective, but it did make me nauseous. I used way less morphine than I was allowed to have (I was allowed 2 mg/hour, and used either 1 or 2 mg every other hour). I really didn't sleep much that first night, as the pain and the regular visits by staff kept me awake.
The doctors doing rounds visited me around 8:00 in the morning, and they seemed concerned about my affect. I was still in a lot of pain, fairly unhappy with that, and the morphine was messing with my ability to think clearly. The surgeon visited me that morning as well, and he reiterated that it was my choice to stay or go home. I told him that I'd try to go home, but we would have to see how I felt. By noon, my affect was markedly improved (I had stopped the morphine, which may have been why), and people started talking about discharge. As I fought nausea and struggled to walk even the smallest amount, I really doubted that I was ready to go home that night.
I met the patient who had gone first the previous day in surgery - a retired VT state trooper. He was up and walking around with his wife, in great spirits, and reported no pain at all. He also told me he was staying a second night. Part of his reasoning was that he lived 2.5 hours away, in the middle of nowhere, near the Canadian border. If he had any complications, he wanted to be at the hospital rather than at home. By mid-afternoon, I'd made it clear to the nurse and the resident that I thought I should stay another night. The nurse seemed to agree, but the resident seemed determined to send me home.
I checked in with my wife. To be honest, I really wish she had been there with me, but she was at work. She works for a human resources benefits management company, so the end of one year and start of the next is always really busy for them. The implementation of the PPACA had further complicated her company's work, so she needed to be at work after missing all of the previous day.
My wife said she could get to the hospital about 6:30 or so, either to take me home or just visit.
At some point, I found myself very nauseous. I realized that the pain would be excruciating if I actually vomited. I got very close to that point, but not quite. The nurse gave me an antiemetic and the nausea faded away for a while.
I was expecting to see my surgeon near the end of the work day, but he never made it. Instead, the resident on the floor, a urology resident, claiming to represent the surgeon, and a third resident came to the room. They made it very clear that there was nothing they could do for me at the hospital that couldn't be done at home. They said my discharge instructions were done and I should really go home. I was less than 24 hours out of the OR and it felt like they were going to physically throw me out of the place. I was really unhappy but I seemed to have no choice.
My wife stopped by the hospital pharmacy to get some pain medication for me and then came to my room. By then, I was physically ready to leave. I was nauseous, in pain, and I did not want to leave, but I felt like there was no other option. This turned out not to be true, but in that moment, I didn't know that I still had a choice. The room rate at this hospital is $1650/day, and I was ready to pay it myself. Instead, I was put in a wheelchair and sent on my way.
Every bump on the ride home hurt a lot. As soon as I got home, I headed to the couch to lie down. I asked my wife for some water and the pain meds. And for the next 48 hours, I didn't move very much. I would get up to empty the catheter bag. I was not going to ask my family to do that for me. I sipped some ginger ale. By Thursday night, 72 hours after surgery, and more than 96 hours after my last meal, I was finally ready to eat some food. I had a bit of soup and a grilled cheese sandwich. A grilled cheese has never tasted so good.
By Friday, things really started to turn around. I was vertical for most of the day. I spent some time at my fly-tying vise, tying some olive woolly buggers for April's opening of trout season. I ate some more. And, I got into another disagreement with people at the hospital. I was still taking oxycodone for pain, although I'd cut the dose by then.
I realized I was going to run out of oxycodone over the weekend and I wasn't sure if I was ready to stop the pain meds completely (I'm still using some pain meds today, so the answer was no). On my first call, I was only able to leave a message and I was told I'd get a call back. After three hours with no response, I called back. I didn't want people to go home for the weekend with this item still pending. I was told that they were short-staffed but they would get to it. About 3:00 or so, I got a call back. They really questioned my need for the medication. Was I doing everything else I was supposed to be doing? They seemed alarmed that I was taking Alleve instead of ibuprofen for inflammation. In reality, the discharge resident had told me that would be fine, but he didn't want to re-print the discharge instructions. I told this to the nurse. She told me they could write a script for more pain medicine, but I would need to pick it up myself. I understand the laws governing prescribing of opiates. However, on discharge, they'd sent a script to the hospital pharmacy for me, and my wife had picked it up. I asked if they could deliver it to the hospital pharmacy for me and I could pick it up on Saturday. "No" was the terse response. I reminded them that I was on opiates and I had a catheter and I couldn't drive. I think they knew that I would say this, and this was their "checkmate" position to deny my request. My wife couldn't get there in time to get the paper script. They said they could leave it with the on-call resident for Saturday pick-up, but there was no guarantee that we'd be able to find him on Saturday. One roadblock after another. Finally, I reminded them that they could legally send a less powerful pain medicine - Vicodin - by phone to my local pharmacy. At that point, they relented and did that. I was drained at this point in time. Why did I need to fight so hard for a medication my surgeon said would be available as long as I truly needed it? Yes, we have a state level and national level problem with the over-prescription of opiates. They are often abused or diverted. But, I'd just had major surgery and I was dealing with real pain. Was my request that out of line? Essentially, I felt like I was being treated like a criminal for requesting the medication.
On Saturday, I was even more vertical. I cooked dinner. Sunday, I left the house (my wife drove) to go grocery shopping and cooked dinner again. Monday, I left the house for a few hours and worked for part of the day at a local coffee shop.
On Tuesday, I returned to the hospital. I had the catheter removed. I was afraid this would hurt, but while it was an extremely odd feeling, it wasn't pain. I had very good urinary control as soon as the catheter was out. I had to prove I could drink water and urinate on my own before I could go home. This went fine. My control isn't perfect, but it's way better than the average patient after this surgery. Full urinary control should return very quickly.
I met with the surgeon. The biopsy was exactly as expected - identical results to the pre-surgery biopsy. The cancer was low/intermediate in grade and it had not gotten close to the edge of the prostate. These are the biggest predictors of recurrence, so he is very sure that I'm completely cured. We will check blood PSA levels for five years before the medical community will truly consider me cured. But, just one year of no PSA in the bloodstream will be very convincing evidence.
I also voiced my concerns about the discharge and the pain medication refill to the surgeon. He told me neither should have happened and he didn't think I was ready to go home when he saw me. But, he got busy and had to send a resident to check on me. He said he would talk to all the parties involved in the two incidents.
(On another note, I have voiced two complaints here. The reality is that my surgeon was amazing, the nurses on the floor were beyond amazing, and I benefited from technology and compassion at many steps in this process. Many parts of this process were full of care and compassion - people truly concerned about my well-being throughout the entire ordeal.)
Today, I'm still using a small amount of pain medication. Most of the pain is centered around the incision points, and moving is still a bit slow. If the weather holds, I'm hoping to get out for a walk this afternoon. I'm working right now, although I'm not yet back in my office.
I still have a lot of healing to go, but right now, everything looks good. Hopefully, any incontinence issues will be short lived. And then, I need to watch and wait for sexual function to return, but that's a completely different issue. It should resolve, but it could be weeks, months, or even a year or more.
I will return to my office next Monday. I may get out for some easy skiing on the 25th. I hope to return to teaching skiing by 2/1, maybe 2/8 at the latest. I hope to be lifting light weights by early February and increasing those weights over the next couple months. But, my body needs to heal completely. In some ways, I need to heal mentally as well. I will take the time I need to allow this healing to occur.
Friday, January 3, 2014
End of last year and an anticipated slow start for the new year
I did fewer workouts in 2013 than I'd done in 1012 - about 20 fewer. I did CrossFit more often, I skied more often, but I ran and cycled less in 2013. As always, I ended the year wishing I weighed a little bit less than I weigh. My weight is lower than a year ago, but it's also 10 pounds higher than my low point in 2013, which happened at the end of July.
I'd like to say it was a good year. From a fitness perspective, it wasn't bad. I got new lifetime bests in all of the power lifts, including a 440 pound deadlift at age 51. I had a PRP treatment done for a nagging rotator cuff injury, and that healed reasonably well. I improved my mobility, and therefore my form, for a number of lifts - primarily the front and back squat and the Oly lifts.
On the flip side, I had some skin cancer removed from my arm early in the year. It wasn't a big deal, but it means I need to be more vigilant in the future. In September, I lost my mother unexpectedly. Shortly after that, my daughter's cat died unexpectedly. And, then I got hit by my biggest issue of the year - a diagnosis of prostate cancer.
It was caught early and I should have a complete recovery from the cancer. However, all of the treatment options truly suck. There is no other way to describe it. When you spend all your time with doctors talking about things like recurrence, impotence, incontinence, "penile shrinkage", androgen deprivation therapy, various forms of radiation, wearing a catheter for a week or more, robot assisted surgery, pain from CO2 gas stuck in your abdomen after surgery, etc., you realize that the solutions aren't optimal.
But, I supposed most of them beat dying a painful and premature depth.
So, I got to CrossFit yesterday for my first workout of the year. I'll go again today.
I'll teach skiing all weekend.
And then Monday morning, I'm heading to Dartmouth to have my prostate surgically removed. I'm not looking forward to this in any way, but I do want the stupid cancer out of my body.
The amazing thing is that I feel strong and fit right now. I have zero symptoms. But, if I wait too long to treat the cancer, that won't remain the case.
So, Monday afternoon, I'll be in surgery, completely knocked out. I haven't had general anesthesia since the late 1960's, when I had my tonsils removed.
If all goes well, I'll miss a week or so of work. I might work from home for another week. I will likely be out of skiing for a month or so. Lifting heavy could be 6-8 weeks. But, as I heal, I should be able to return to my normal activities. And, if the surgery goes well, the cancer should be completely cured. I will need to be monitored, but hopefully, a few years of blood tests will be all that I need to verify that it's gone.
It's not my favorite way to start the new year, but we don't always get things exactly as we'd like them to be. So, it's time to get this fixed and move on.
And after it's over, I'm looking forward to working hard in the gym, so I can duplicate or exceed my workout load from this past year.
I'd like to say it was a good year. From a fitness perspective, it wasn't bad. I got new lifetime bests in all of the power lifts, including a 440 pound deadlift at age 51. I had a PRP treatment done for a nagging rotator cuff injury, and that healed reasonably well. I improved my mobility, and therefore my form, for a number of lifts - primarily the front and back squat and the Oly lifts.
On the flip side, I had some skin cancer removed from my arm early in the year. It wasn't a big deal, but it means I need to be more vigilant in the future. In September, I lost my mother unexpectedly. Shortly after that, my daughter's cat died unexpectedly. And, then I got hit by my biggest issue of the year - a diagnosis of prostate cancer.
It was caught early and I should have a complete recovery from the cancer. However, all of the treatment options truly suck. There is no other way to describe it. When you spend all your time with doctors talking about things like recurrence, impotence, incontinence, "penile shrinkage", androgen deprivation therapy, various forms of radiation, wearing a catheter for a week or more, robot assisted surgery, pain from CO2 gas stuck in your abdomen after surgery, etc., you realize that the solutions aren't optimal.
But, I supposed most of them beat dying a painful and premature depth.
So, I got to CrossFit yesterday for my first workout of the year. I'll go again today.
I'll teach skiing all weekend.
And then Monday morning, I'm heading to Dartmouth to have my prostate surgically removed. I'm not looking forward to this in any way, but I do want the stupid cancer out of my body.
The amazing thing is that I feel strong and fit right now. I have zero symptoms. But, if I wait too long to treat the cancer, that won't remain the case.
So, Monday afternoon, I'll be in surgery, completely knocked out. I haven't had general anesthesia since the late 1960's, when I had my tonsils removed.
If all goes well, I'll miss a week or so of work. I might work from home for another week. I will likely be out of skiing for a month or so. Lifting heavy could be 6-8 weeks. But, as I heal, I should be able to return to my normal activities. And, if the surgery goes well, the cancer should be completely cured. I will need to be monitored, but hopefully, a few years of blood tests will be all that I need to verify that it's gone.
It's not my favorite way to start the new year, but we don't always get things exactly as we'd like them to be. So, it's time to get this fixed and move on.
And after it's over, I'm looking forward to working hard in the gym, so I can duplicate or exceed my workout load from this past year.
Subscribe to:
Posts (Atom)