Cystoscopy #8 through #10

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It’s now August 2015. Three cystoscopies have come and gone, each with no sign of returning tumors inside my bladder. Surgeon wants to do one more Cystoscopy before he considers me out of the woods.

Even then, he’ll still schedule me for three exams the following year, then two exams the year after, ending with an annual Cystoscopy for life.

Which is not bad.

Better a living cancer survivor than a dead cancer victim.

Post Prostate Removal #2

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Well, it’s now November, two weeks before Thanksgiving. It’s been roughly two years since this entire process started rolling.

I had my prostate removed during the last week in August. Two months and two weeks have passed. In my last post, (Post Prostate Removal), I said that the Foley catheter was removed on Day Nine post-op and my return to driving occurred just four days later. Which is all true.

However, allow me to pick up from there.

The pain had not really stopped. The prescribed narcotics were still in my system. Only when the narcotics had fully worn off, did my true state display itself.

Man, oh man, what a sad state it was. The pain returned, big time. It seemed determined to recapture all of the time masked by the narcotics. I would be sitting in the recliner, relaxed, and doing absolutely nothing. Then, out of nowhere, the lower abdominal muscles would cramp up. I don’t mean the kind of cramping when you defecate. I mean CRAMPING! Like an out-of-this-world charley-horse contraction—tall, wide, and deep! It was like a band of concrete, rock-solid to my pressing fingers, which seemed to help alleviate some of the hurt. (Very little, actually.) On the other hand, try to imagine a band of hard, rolled steel right below the lower belly skin. That’s how tight the muscles felt.

This tight-fisted kink would last for fifteen to twenty minutes. All I could do would be to grab the area in both hands and press against it. If I was standing, all I could do was stay standing. The same for sitting. Forget about walking—all motion stopped! Sweat would break out on my forehead. I did my best to keep breathing—small, shallow breaths was all I could manage.

Being male, I tried to man my way through it. You know: Stand Tall! Man Up! Power Your Way Through All Adversity!

After that first episode, I went looking for drugs.

Surgeon had said to use over-the-counter meds for any follow-on pain management. Okay, I found some Alleve in the medicine cabinet. The information on the bottle said to take one pill/caplet/capsule every twelve hours for proper pain control. Good, I popped a pill. After allowing for plenty of time for it to dissolve—about thirty minutes—I experienced another episode just as painful as before. I took another pill.

I soon worked my way up to three of the things every four hours. That dosage lasted for the next seven weeks. I know, I know, that’s a very large amount, yet it was the only way I found to control the pain and function normally. I went back to work four weeks after the surgery and kept up the regimen for another three weeks. Had to, there was no other way to do it. Even then, sometimes the pain would still power through the meds. Quite often, I found myself clenching my abdomen, pills or no pills, with sweat pouring from my forehead, scalp, and neck. It was exhausting.

Ladies, if this is anything like giving birth, I salute you!

Eventually though, I did notice a day when I did not have an attack. Curious, I backed off to two pills every four hours the next day. Then to one pill every four hours the following day. I went to one pill every six hours and then to the package insert recommendation of one pill every twelve hours. Amazing! One week before Halloween, I was pain and pill free! As I write this, another two weeks have passed with no reoccurrences.

About two weeks ago, I had another KUB (kidney/urethra/bladder) X-ray to check on the status of the shattered kidney stone fragments still residing inside my left kidney. Nothing new here, as the pieces are right where they were since last time. My Urinary doctor was satisfied with this. Since I was in no pain at all, no vomiting, no nausea, no sharp and hard spasms; the fragments could stay where they were. That fact that I had no pain at all was amazing to him. Here it was, near the end of October, and he and Surgeon had fully expected the muscle pain to last until the end of November.

Before the prostate surgery, I remember viewing a YouTube website where some guy was bragging about the lack of pain from the same robotic laparoscopic procedure I’d had. He claimed he was three days post-op and in no pain at all! Of course, the character failed to mention that the narcotic painkillers had not worn off!

Final Result: Pain and pill free! Prostate gland and its internal cancerous growth removed. Bladder tumors appear under control. I will find out more after the next Cystoscopy exam in January 2015.

Post Prostate Removal

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Oww! Oh, the pain!

Okay, I’m carrying on a bit. Surgery was nine days ago. Checked in with the hospital at 5:15 am and prepped for surgery by 7 am (booties, hairnet, and airy hospital gown). Met all the nurses, anesthesiologists, and finally Surgeon before anything really happened. Had one IV flowing into the back of my left hand (the nurse even shaved off the hair there), an oxygen monitor on a left hand finger, pressure cuffs on both ankles (a comfortable, warm weight), and heart monitors stuck across my chest and around my left side. The heart sits off kilter in the chest’s left side, so the monitors wrap around it, so to speak. Carle has my wedding ring and wallet.

This time, I’m wheeled back into the bowls of Surgery, not out into the hallway and down to a specialty room. The air is cold. I’m cold. My bed is maneuvered through hallways until I’m thoroughly lost and all turned around. Of course, my friendly neighborhood anesthetist has given me a shot of goody juice through the IV and I’m loopier than I realize. I vaguely remember the bed stopping in a room with all kinds of neutral looking gear sitting around. However, nothing beyond that.

I wake up in Post-Op. Carle’s there. Once I’m awake enough to tell Nurse my name, birthdate, and what hospital I’m in, they wheel me up stairs to my room. Mr. Transporter leaves me out in the hallway while he moves things around in my side of the room before the bed is maneuvered into it. I’m awake enough to move over into the room’s B bed. About this time, I notice I have two IVs flowing into me! When did I get the second one in the back of my right hand? Before I have time to dwell on this, I feel a familiar tug at my center. Oh, yeah, the Foley catheter. Jolly good fun, that. Pressure cuffs again wrap around both ankles. I’m awake enough to remember these are to help keep blood moving in my lower extremities, since I’m tied to the bed five different ways and not likely to go anywhere soon.

“Hello, Mr. New,” says a pleasant woman to my right. “I’m your Nurse for this evening. Dinner will be around soon. I’ve heard the rattling of the cart down the hall.”

Dinner? What happened to breakfast and lunch? “Oh, okay,” I say, bright as ever. “I do feel a bit hollow, I guess.” Honestly, I’m not sure of anything at his point.

“Later this evening, Mr. New, we want to get you up out of the bed. For a little walk, is all. If you need anything, just press the button, here. I’ll talk to you a little later.” She bustles off to attend to other, more needful patients.

Carle and I engage in small talk. She finds the phone and positions it so I can reach it if needed. She also finds the TV remote and shows me how to work it. She has a lot more hospital-patient experience than I do. Nevertheless, I’m learning. Joy of joys, dinner is served. I have to admit, it smells good. But after all of the moisture in each mouthful is sucked away, what’s left tastes like powdered cardboard. Yuck. This is when I notice I’m extremely interested in anything liquid. Carle’s had a long day, so she heads for home.

“Hi, Mr. New, I’m your Anesthetist, how do you feel?”

I want to say I feel with my hands, but I don’t. “Okay, I guess. How do you feel?” I think I smile at her.

Anesthetist laughs. “Oh, I’m fine. I need to check your drain.”

“My what?”

“Your body cavity drain we installed during surgery. It helps remove any excess fluid from the surgery site.” All business like, she pulls the hospital gown out from under my right side. “Oh, dear, it’s leaking.”

A foot-and-a-half length of bloody, plastic tube leads from my side to a clear plastic, bloody bulb laying on the bed.

“I’m applying some deadening ointment to your skin, Mr. New, so I can sew the skin tighter around the drain.” She does so and waits for a few minutes before prodding around the drain with her gloved fingers. “Feel anything?”

“Um, no.” I’m very big on conversation.

“Good. Now, a little bit of sterilization,” she wipes something on the site, “and some sterile sutures.” She takes out a sterile pack from her white lab-coat pocket and peels back the cover. In no time, she makes two stitches in my side. I feel nothing. “There, that should do it.” She squeezes the plastic bulb, lays it back on the bed, and tucks my gown back around me. “Have a good evening, Mr. New.”

I consume the ice water in the bedside canister and all three fruit drinks in the little cup dispensers they come in. Apple, Orange, and Grape. Later that evening, Nurse tells me the “cotton mouth” feeling is a leftover effect from the anesthetic. It will wear off.

Sometime later, Surgeon appears at my bedside. “Mr. New, how are you feeling?”

“Fine, best I can tell. What are you still doing here?” The wall clock displayed seven in the evening. “Shouldn’t you be home?”

Surgeon grins at me. He’s still wearing scrubs. “Since you are my healthiest patient, I saved you for last. I’m on my way home after I check on you.”

“An anesthetist was recently in here. She was very concerned about the drain leaking.”

Surgeon sighed. “I told them not to worry about that. Yeah, it will leak a little. That’s why I have this towel here underneath it.” He pulls up the gown to show me. “Nice stitches, though. I expect it to leak, but it’s no big deal. It’s only to pull excessive fluid buildup from the surgical site and will be removed tomorrow before you get discharged.” He squeezes the plastic bulb. “This provides suction to pull out the fluid.” He tucks the gown back underneath me. “Okay, Mr. New. You are doing fine. You’ll be sent home sometime tomorrow—with the Foley catheter installed. Because this coming Monday is a holiday, I will see you in Clinic on Thursday, instead. The Foley will be removed then.” He grabs my hand. “See you then.”

“Okay, Surgeon. Go home. Get some sleep.”

Later that evening, both the nurse and her aide assist me out of the bed. “We’re going for our little walk, Mr. New.”

“Oh, okay.” Nurse has an arm on my back, keeping the gown closed (a thoughtful person, is this nurse), while I concentrate on using the walker they’ve thoughtfully brought to me. Both ankle cuffs are missing. Either Nurse or the aide is handling the IV tree and the Foley catheter bag. I shuffle out to the hallway and turn to the left, like I’m told. The Foley catheter tugs at my middle. We mosey along the hallway until Nurse tells me to enter another room.

“We’re placing you into another room, Mr. New.”

“Okay. Why?” She told me but I don’t remember the answer. For that matter, I don’t remember much of anything else from that night. They get me into the bed (this one had an overhead trapeze thingy, which came in handy for shifting my position, as everything at my middle hurt). They arrange everything, and the ankle pressure cuffs reappear.

“Call us if you need anything, Mr. New.”

“Okay.” I down the ice water in the canister.

Someone is screaming. Oh, it’s the silly IV machine. The bag has run dry. I press the call button. It is late into the night.

“Yes, Mr. New?”

That was quick. “The IV machine is hollering. It needs another bag, I think.”

“Be right there.” Click.

A male nurse popped into the room right quick with another IV bag full of whatever they were flowing into me. “There, Mr. New, can I get you anything else? Water, fruit juice?”

“Actually, both, if you don’t mind,” I say. “I’ve still got that cotton-mouth feel.”

“No problem.”

Immediately, he iced and filled the water canister and poured me a cup. Darned if the cold water didn’t taste heavenly. Within minutes, he had three fruit-juice cups sitting on the bedside table.

“While you’re awake, Mr. New, let me take your vitals (blood pressure, temperature, and pulse) and I’ll measure your Foley output.”

The next thing I remember was the smell of breakfast. It’s morning. Carle walks in as I’m eating my scrambled eggs and toast. Later on in the morning, a few of my co-workers drop in to see how I’m doing. One of them is amazed to see I’d had breakfast. He’d had the same procedure about a year before and felt too nauseated to eat anything. Mr. Cast-Iron Stomach, he called me. I guess everybody’s different.

The ankle pressure cuffs disappeared sometime during the night. The oxygen monitor clipped to my finger went away this morning. The IV in the back of my right hand came out this morning also. Never used after surgery and filled with heparin, it was kept as an emergency fluid route, in case I went downhill.

Before lunch arrives, Nurse comes in, removes the last IV and gently pulls out the drain in my right, lower abdomen side. She tapes a sterile gauze over it. She moves around to the other side of my bed and pulls a ten by four inch baggy from a coat pocket. She moves the gown off my left thigh and attaches the baggy thing to my Foley line. “There, Mr. New. We are discharging you. Have a nice day.”

I’m sent home with an extra Foley night bag and some extra day bags.

“How does Burger King sound? Char-broiled burgers, French Fries?” Carle’s driving and I can’t resist.

“Sounds great, babe. Just get me home. I’ll eat anything.”

Carle buys lunch and whisks me home. I’m stiff and sore and hang on to the overhead hand grab the Trailblazer is equipped with whenever the pavement changes, which is most of the way home. Slowly but surely, I make it to my recliner. Using my arm muscles, I lower myself as gently as possible to the seat. Man, oh man, I never realized how comfortable this recliner was. For the next eight days, I pretty much stay there. If I can make it from the recliner, to the kitchen or the bathroom and back to the recliner, I’m doing fine!

The recliner has become my new best friend.

Over the next eight days, I position two foldup dinner tables next to the recliner. These hold my laptop, tablet, cable remote, and cell phone for easy reach. Carle has stacked my favorite movies near the player (the Harry Potter series, Star Trek, Star Wars, The Lord of the Rings, Duck Dynasty, Dirty Jobs, and various others. Over the next four weeks, I find several of these on cable, also.)

On the ninth day past surgery, Carle drives me to the Urology Clinic. The Foley catheter comes out today. This is something I’ve been looking forward to—and dreading. Last time I had a Foley, it’s removal was painful. After the usual niceties, Tech gets down to business. Carle leaves the room.

“Okay, Mr. New, drop your pants and lie back on the table.”

I do so. I’m really dreading this. I don’t tolerate pain too well.

“Deflating the internal balloon and disconnecting the walk around baggy ….” Tech fiddles around with things down between my legs. “Now, I’m pouring some sterile water into your bladder, Mr. New. Hold it as long as you can, but let me know when you really have to go.”

I lie there, complacent as a pig in it’s mud puddle.

“Um, gotta go, I think.”

“Okay, Mr. New. Here’s the urinal.” She puts the urinal between my legs. “Grab hold, Mr. New.” I grab the urinal with both hands and feel some pressure inside my middle as Tech slowly withdraws the catheter. “Pee, Mr. New.”

I do. Gladly. Geez, it feels good to pee like a man.

“Okay, Mr. New. You’re doing fine,” says Tech. “You can get dressed now and I’ll send in Surgeon.”

She leaves the exam room and Surgeon pops in.

“Okay, Mr. New. You are doing exceptionally well. You’ll be glad to hear that pathology reported the margins of your prostate were negative, meaning the cancer had not grown beyond the organ, and now it is out and gone. One problem done away with.” He hands me a printout. “These are some instructions for the rest of your recuperation. Remember, no heavy lifting. You can lift food from the table to your mouth, but nothing else. No mowing the yard on your rider mower. With the Foley out, I expect you to start feeling immensely better. But don’t push it.”

“How soon can I start driving?”

“As soon as you can come off those narcotic pain killers I prescribed, you can resume driving. Take over-the-counter painkillers instead. Things you normally use for headaches or general muscle aches. Also, I’ve already sent to your pharmacy the antibiotics you wanted to head off any urinary tract infection. See? I do remember some things. You thought I’d forgotten, didn’t you?”

“Yeah, guess I did.”

Surgeon chuckles. “Okay, then. One important item: make sure you do these exercises three times a day.” He taps the printout. “More, if you’re so inclined. They are called Kegel exercises and they will firm up the pelvic floor muscles. The muscles that help you control urination. Wear Depends until you are back in full urinary control. I expect you’ll have little trouble during the day when you’re awake and conscious. However, you’ll definitely need them when you’re sleeping for a while. Possibly, even by the time you go back to work and resume your normal activities, you’ll want to wear the Depends. Now, I don’t want to see you until three months have passed. Okay? That will be early December when I’ll expect to see you again, Mr. New.”

By the following Monday, I’m driving. I’m still stiff and sore, but the pain is easing off on an almost daily basis. All the bruising along my right side has disappeared. I’m able to bend at the waist more and more. I can actually bend forward to stand up, without the assistance of my arms. I still sleep in the recliner, as I’m not quite able to stretch out flat on the bed, nor can I lie on my side, just yet. However, I expect that to come along later. Hair is growing back from where it was shaved off. Shaggy rug, here I come!

Final Report: Prostate excised (cancer removed). Bladder tumors (cancer) appear under control due to BCG treatments. Return to Surgeon for another Cystoscopy exam in three months.

Cystoscopy #7

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Today is Monday. Last Thursday, I had another cystoscopy exam. Surprisingly, Surgeon found nothing! I thought sure something would be growing again. I just knew it, you know.

Which is good! This is what we have been shooting for since a year and three-fourths ago. This coming Thanksgiving will be two years into the project and I am happy to say that everything bladder-wise is working out great! Because of this, I sincerely feel that prayer is a positive effort. Especially if you are a child of God. He does listen to our concerns. Moreover, following your doctor’s directions are helpful. (Take all of your medications, don’t skip procedures, and think that a problem will go away. Left alone, problems only grow into bigger problems. Pay attention to your body. It will tell you things.)

With that said, on Tuesday, August 26th, I will go under the knife again for my prostate removal. I talked about this in my last post (Prostate Biopsy Results). Again, Surgeon is confident the procedure will go off without a hitch. I’m counting on his confidence.

Again, I would appreciate any and all prayers concerning the procedure. Surgery should start around 7 a.m. I’m first in the chute. I know my Christian brothers and sisters will come through for me. As will God in His Almightiness and Omniscience.

Final Result: Robotic Assisted Laparoscopic Radical Prostatectomy is up at bat. Hit me a homerun, Surgeon!

Prostate Biopsy Results

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“Morning, Surgeon. What’s the news?” I am trying to remain chipper and upbeat. At today’s appointment, I am to find out about the biopsy results.

“Your results came back positive for cancer of the prostate, Mr. New. However, let me re-emphasize, at fifty-nine years, you are still a young man. You are in excellent health otherwise. The BCG treatments appear to have the cancer tumors–that have been growing from the interior bladder surface–under control, although, as you know, that rating could change with the next cystoscopic examination.

“Now, I need to explain some things, Mr. New,” continued Surgeon. “When I say that your results were positive, here’s what I mean. Before I performed the biopsy, I did a DRG, which means Digital Rectal Exam. I placed my gloved finger into your rectum and pressed it against the front wall of your rectum. I was feeling for a bulge on the backside surface of your prostate, which is right next door, so to peak. I felt nothing, meaning if there is a tumor, it is not big enough to feel. This is a good thing.

“Remember, we took twelve pickings of the prostate tissue?”

“Yes.” I nod my head.

“Okay. The tissue rating came back as a T1c. T1 means the DRG test was negative. I could not feel any tumor growth. A T1a or T1b result is usually found by accident, during surgery for relief of BPH, which stands for benign prostatic hyperplasia, an overgrowth of normal prostate tissue. Over time, this problem blocks the urethra from discharging urine from the bladder and you, Mr. New, do not have that problem. However, your PSA level, the prostate specific antigen level, has been trending high for the last two years.”

Surgeon held up a hand, as if to ward off my interruption.

“Yes, I know that you and your GP have been monitoring the PSA for some time now. And, yes, all of the manipulation of the prostate from the BCG catheterizations could be causing the PSA increase. At this point, because your PSA is running on the high side of normal, you are rated at a T1c, the most commonly diagnosed stage for early prostate cancer. With me so far?”

“Yes. No tumor felt via the DRG, yet the PSA is running high. T1c or early prostate cancer.”

Surgeon nodded. “Correct. Now, about the twelve tissue samples—”

“Yes, the biopsy samples.” I nod in turn.

“The samples are run through a preservation procedure, then sliced and diced into small fragments so thin that light can pass through them with ease. Placed on a microscopic slide, a pathologist examines them. She can detect whether cells look normal or not. She will ‘grade’ the cells on how abnormal they appear. If they are barely abnormal, they get a grade of two (2). If they are the most abnormal possible, they get a grade of ten (10). Based on how abnormal they appear, they could also get grades of three (3) through nine (9). These are called Gleason grades, for the pathologist that developed the system. Yours, Mr. New, came back as grades three and four. These are added together for a total of seven, or, a Gleason seven, which is classed as a medium-aggressive case of prostate cancer.”

“Okay. So, what can we do about it?”

“Based on your young age of fifty-nine, a T1c for early prostate cancer, and a Gleason Score of seven, I can recommend two procedures. The first is prostate brachytherapy, where radioactive seeds get implanted directly into the prostate. This low-dose radioactivity kills the cancer in place. This may or may not be permanent, as a cancer cell far enough away from the seeds may survive and start growing again, some years down the road.

“The second option is surgery to remove the prostate entirely. I am a surgeon and I think this is best all around.”

“Get it out and gone before it has a chance to spread.”

“Exactly. With it removed from your body, a better slicing and dicing can be done to determine precisely how close to the prostate boundaries the cancer had grown. That way, by knowing accurately how far it had gone, we can give you a more concrete understanding of what you did have. In addition, of course, ‘out-and-gone’ means, it is no longer a problem for you.”

“What is involved, actually?”

“For the radioactive seeds, a little discomfort at the time of insertion. Nevertheless, it may return. For the surgery, I do a procedure called Robotic Assisted Laparoscopic Radical Prostatectomy, where I control the cutting and cauterizing via a robotic system. This uses minimally invasive surgery and computer technology. Several one to two-inch incisions are made in your lower front abdomen. Sterile robotic surgical instruments—at least one gripper and one blade (both can cauterize as they work, reducing blood loss)—and a laparoscopic camera, are inserted into the sterile operating field. With these tools, I can tease away connective tissue from around the prostate (which produces a lubricating fluid for sperm), tease free the seminal vesicles (which produce additional lubricating fluid), and cut the Vas deferens (the tube the sperm travel through from the testicles to where it joins the urethra inside the prostate. This officially makes you sterile). The urethra runs through the middle of the prostate. This is cut just above and below the prostate, and the prostate and attached seminal vesicles are removed for pathological testing. Any nearby lymph nodes are removed at the same time. Then I sew the ends of the urethra back together. You will spend at least one night—maybe two—in the hospital and go home with a Foley catheter and attached urine bag. This is similar to what you went home with after the first bladder tumor was removed.”

“Yeah,” I say. “I remember it well.”

“After you get home from the hospital, I recommend four weeks rest for proper recovery. No lifting, exercising, mower riding, or anything really, for the first two weeks. Believe me, you won’t feel like doing anything, anyway. By the third week, you will feel more mobile. This is okay, but still, no heavy anything. I’ll see you sometime around the fourth week to release you back to normal activities.

“The two minor problems you will have for a temporary time are erectile dysfunction and urinary incontinence. The degree of erectile dysfunction depends on your age and overall health, sexual function before surgery, the stage of the cancer, and my abilities to save the erection control nerves. Younger men—those under sixty, like yourself, Mr. New—are less likely to have problems with their erections than are older men. If it does occur, erections usually return to normal over time, say one to two years. These days, there are medications to help with that, if needed.

“Short-term incontinence is a common side effect. Many men require a protective pad for several weeks to months after surgery. Most men do recover urinary control. Besides, there are exercises that can help build up the urinary bladder control muscle.

“That is pretty much it, Mr. New.”

“All right, then.” I’m busy processing all of this information. Surgeon has given me a handout that explains in black ink on white paper everything he’s said. “Guess I need to discuss this with my wife, Carle, and get her take on it. I know she had something similar done with her thyroid some years ago. She didn’t like the idea of having a dead anything left within her from radioactive seeds, so she opted for surgical removal. And to be honest, I’m kind of leaning that way already.”

“Well, think it over, Mr. New. Call my cancer-scheduling assistant when you decide which route to take. Here is her number.”

 

Final Results: Radioactive seeds or complete prostate removal via surgery? Personally (and it is personal), I like the complete removal idea. Out-and-gone!

 

Prostate Biopsy

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The alarm just sounded, telling me it is only 4:40 AM. I remember it’s Thursday, my day off. Why am I awake this confounded early? Oh, yeah, I have an appointment with Surgeon at 8 AM.

Yawn.

Carle bustles about getting ready to go to her employer. She works at a Daycare teaching VPK to four-year olds. Woops, maybe it’s called a Preschool, not a Daycare. They teach things to kids fresh out of the backyard. You know things like the kid’s name, shapes, colors, numbers, and the alphabet. Carle enjoys showing them bugs. Mostly pictures. Sometimes, the real thing.

“Have a good day, Rich” Kiss, kiss. “Remember, dear, I want to know everything! Bye! Oh, here’s your Fleets enema.”

Now I’m awake.

I sit up in the bed, bleary-eyed. I stretch, scratch, and rub my face with both hands. I put on my reading glasses lying on the bedside table and peruse the side of the box again. Hmm. Sounds simple enough.

Okay. I strip and position myself on the bed in one of the two recommended positions. Neither one is normal, but I get there. Inserting the tip wasn’t as horrendous as I suspected. Squeeze the bottle. Instructions said that not all of the saline material needed inserting, that some would be left over in the bottle, so, not to worry. I crumple the bottle as best I can, one-handed. I sit it aside. Wait ten to fifteen minutes.

Head for the john. I’m so glad it’s nearby. Believe me!

Time for a shower. Ah, nice hot water and soapy-suds. Afterwards, I feel clean all over. I’m probably cleaner on the outside than on the inside below, if you get my drift. However, that’s Surgeon’s problem. I dress and drive into the Urology Clinic.

*****

I’m in the Clinic, in another exam room, one I’ve never been in before. I’m butt naked from my waist down with one of those ‘privacy sheets’ laying on top of me. I’ve still got my socks on though—cold floor. I’m lying on my side, facing the wall, and peering at the non-active monitor.

“Okay, Mr. New, I need you to schooch on back towards me a bit,” says Surgeon. “I need your rear-end hanging off the table a little bit more.”

I schooch as best I can.

“Great! That’ll do. Okay, I’m preparing the ultra-sound device, which will provide me with some pictures on the monitor for guidance purposes. Applying some lubrication goop and in we go.”

I feel something. Kind of like pressure.

“See? On the monitor, Mr. New,” says Surgeon. “Yeah, I know, the picture is kind of grainy, but that’s the state of the art with ultra-sound. We learn to recognize what we’re looking at. Similar to how you learn to recognize white blood cells under the microscope. See the black looking area at the top of the screen? That’s your empty bladder. The large, round object on the lower left is your prostate, the thing we’re here to examine.

“Now, Tech showed you the ‘gun,’ correct?”

“Yes,” I say, trying to sound alert. “And she demonstrated the sound it makes when a ‘picking’ is grabbed.”

“Fine, fine. So you remember the loud POP it makes?”

“Oh, yes.”

“Great. So I’m loading the gun, inserting it into the ultra-sound’s cavity, and—”

POP!

“Number one is done, Mr. New. How did that feel?”

“Sort of like a pinch.”

“Yes, that is exactly what it is supposed to feel like. Good.”

Surgeon continues to collect “pickings.” Eleven POP-ping more of them. Actually, I caught a glimpse of the apparatus that collects the “pickings.” The “gun” consisted of a gray, plastic handle apparatus with a trigger. The business end was a transparent tube of plastic with a squared off, open window, angled to one side at the far end that presses up against the tissue in question. Inside this clear tube, goes a metal rod with four to three “fingers” that, when released by the cocked trigger of the gun, “grab” or “pick” whatever tissue the fingers are pressed against. In this case, my prostate, which is pressed up tight against the rectum wall.

“Okay, Mr. New, we are through. Remember, there might be some rectal bleeding for two-to-three days and the same from your ejaculate. This should clear up nicely, since you are in very good health otherwise. You said you took the antibiotic this morning, so take the last pill tomorrow morning. That way, any nastiness that got into the wrong tissue during this procedure will not cause any additional problems.”

Surgeon comes around to my side of the exam table—minus the now non-sterile gloves—and shakes my hand. “We good? You feel okay?” he asks.

I shake his hand. “Yeah, we’re good and I feel fine.”

“Great! My office will call you when the results come back and we’ll go from there. I expect it will take about one to two weeks before any answers come back. Have a good day!”

Final Results: Twelve “pickings” of prostate tissue were taken, all for an additional cancer screening. Amazingly, all the above took only thirty minutes from check-in to checkout. I head home.

Urology Consult #5 & Cystoscopy #6

1

“Afternoon, Doc. What’s up?” I try to sound upbeat. It is April 2014. It has been three months since I have seen either Doc or Surgeon. In the meantime, I’ve had three routine BCG treatments but no lithotripsy treatments.

“Hello, Mr. New. How are you doing?”

We shake hands and Doc takes a seat, crosses his legs, and smiles at me.

“No pain from the stones?” he asks. “Your latest KUB (Kidney-Urethra-Bladder) images show no changes in the stone fragments. They’re right where we left them.”

I shrug my shoulders. “No pain. So, what do we do next?”

“Nothing, really. Since you are not having any problems from them, and we’ve cracked them twice, well, we’ll just leave them alone. However, we will monitor them every six months or so, just to keep an eye on them. How’s that sound?”

“Sounds great to me. X-rays don’t hurt. I like that idea.”

Doc chuckles. “Fine, then. Anything I need to know?”

I cock my head, thinking. “Well, last weekend, I did notice some blood in the urine again, but it didn’t show after the third day. I’m not sure if that means anything. It may not be another tumor. I may have just had my belt too tight.”

“Yeah, the dipstick report on the urine sample today did show a 2+ on the occult blood. However, that is Surgeon’s concern. I understand you have another Cystoscopy scheduled with him?”

“Yes,” I say, “Thursday, later this week.”

“Fine, then. I’ll schedule you for another KUB X-ray for six months out, in November. See you then.”

*****

“Okay, Mr. New, looking good. Coming out.” Surgeon slip-slides out the camera probe. I’ve been propped, prepped, and now probed for Cystoscopy #6. Surgeon glances over at me after handing the camera/probe to his assistant. “I can’t say what, or where, the bleeding came from. You saw on the monitor, just as I did, that there were no recent hematomas, clot formations, or new tumors on your bladder wall.” Surgeon shrugged, and then smiled. “Perhaps you did have your belt on too tight!”

“So no major problems?”

“Major nor minor, Mr. New. I saw nothing. The BCG treatments look like they’re doing they’re job. Great, hunh?”

“Yeah, great,” I echo. I wonder what he’s not telling me. I’m still lying on the examination table. He has not told me to sit up yet.

“However, Mr. New, I checked your last PSA (Prostate Specific Antigen) results for the past two years. Both it and your Creatinine are trending high.”

“Yeah, my GP and I have been watching that. He says the slight increase in both may be from all of the manipulations from the BCG treatments and the Cysto exams. All that movement back and forth through the urethra could be stimulating the increase.”

“True, that could be all it is,” Surgeon nods. “However, it’s my job to make certain.” He snaps on another set of sterile gloves. Snap-snap. “I’m going to do a rectal exam. Just relax and keep breathing.”

Great. How far in is he going to go?

“Sterile gloves and some lubricating goo. A little pressure, Mr. New.”

Ummm. I feel something from below. Not sure what I feel. However, I’ll call it pressure.

“Okay, Mr. New. I’m through for today. You can sit up now.” He turns away and does something at a counter for a few minutes. “Well, that’s good, too. The Occult Blood test is negative. No rectal bleeding, Mr. New. Your prostate felt normal, too.”

“Oh, goody. That’s lovely.”

“Yes, it is. So, since that didn’t tell me anything new, I going to schedule you for a Prostate Exam/Biopsy in two weeks.”

“Oh, joy. What does that involve?” Do I really want to know? Well, yes.

“Not much, really. It’ll take only thirty minutes or so. I’ll apply some numbing jelly into your rectum. After it numbs you up, I’ll insert another probe, and then slide in a tool that can take a ‘grab’ of tissue cells. It will feel like you’re being pinched. I’ll take ten-to-twelve of these ‘pickings,’ as we call them, and that will be it. Then you can go. Oh, there may be some blood in the stool and in your ejaculate for two or three days. This is normal. It will clear up, never fear.”

“Oh, good.”

“Two other things. I’ll prescribe you an antibiotic for this procedure. Take one pill the day before, the second the day of and the third pill the day after. You will need to buy an enema dose to take the morning of the procedure. Before you come in, that is. Your pharmacy will have one on the shelves. It’s an easy-peasy thing to do.”

Great! True Joy in the morning! “Thanks, Surgeon.”

Final Result: No tumors and no bleeding problems. However, there is the prostate gland to worry about—it’s always something, it seems.