Tuesday, September 3, 2019

Prostate Cancer Part 2

Not so much, anymore
NOTE TO READERS: The subject of this blog is prostate cancer, written from recent personal experience. While still maintaining a humorous approach to the subject, this material is written in an honest manner. Some readers may find the subject and the manner in which the material is presented indelicate. If you might fall into that category, please do us both a favor and skip this blog.   

If you missed part 1 of this saga, click here.

Two weeks after the biopsy Mrs. Poynor and I reported back to the doc. After a short wait he stepped into the room wearing his best, official white doctor coat and wearing a very neutral professional expression. After brief salutations, he got down to business. The doctor apparently had given similar speeches before that were, perhaps, not well received. He approached the subject very gingerly and explained what the biopsy had shown – yup, there was cancer. He also mentioned something called the Gleason score. (In return, I mentioned I was never a big fan of ‘The Honeymooners,’ and wouldn’t do well with the quiz. Not even a pause. Tough crowd.)  Without going into too much detail, a Gleason score is assigned by the pathologist and runs from 2 to 10. The higher the number, the more aggressive the cancer. My number was in the “moderate” range.

I had always wondered what it would be like to hear you had cancer. To be frank, I definitely didn’t feel like breaking out into song with Tim McGraw’s “Live Like You Were Dying.” If I felt anything at all, it was lack of surprise.

The doctor presented three options. The first option was to take a wait and see approach. The second option was to treat with radiation. The third option was robotic surgery to remove the prostate.

The wait and see approach seemed like a good idea to me. (Personal motto: denial is always easier than action.) However, after the doc mentioned I’d be repeatedly experiencing the “Ride of Captain Nemo,” the glow of that option dimmed considerably. Besides, wait and see what? The cancer is there. It isn’t as if it’ll go away, and there’s a chance it could spread. Eventually there would likely be a decision between options two and three.

Radiation sounded simple enough, but the doctor said much of his work involved “fixing issues” resulting from radiation therapy. In the interest of full disclosure, however, I need to point out my doctor specializes in robotic surgery.

Replaces hands, but can it remove a prostate?

The robotic surgery option would, in all likelihood, eliminate the issue permanently. That is, providing there was no spread of cancer to the surrounding tissues. There would be side effects to be sure – incontinence and impotence – but they are normally temporary. That sounded like a good idea, and after a few days of thought it was the way we decided to go. I say “we” because such a decision affects the spouse, too. As it turns out, Mrs. Poynor had been secretly rooting for the surgery from day one.

A robotic prostatectomy is a lot like that old game “Operation,” only it’s done with more tweezers that are operated remotely. I also suspect there’s no buzzer, but I can’t swear to that because I slept through the whole deal. The instrument used is called a da Vinci System, and it looks much like a Star Wars medical droid – only not as cute. Of course, I just HAD to look it up online. What I saw provided no comfort.

Day of the surgery the doctor and his assistant showed up for a few encouraging words. “Right there,” he said, pointing just above my navel. “That’s where I’m going to put the camera.”

For the life of me, it took a few moments for that that statement to sink in. At first, I was baffled, thinking to myself, “He’s going to record the surgery? What’s he got, a GoPro Navel Model?” Then it hit me, “No, he needs to see what he’s doing.” Suddenly, his comment seemed rather ominous. The prospect of someone cutting near, by, or on my navel gave me a serious case of the willies (no pun intended). Unfortunately, before I could come to my senses and ask for a negotiation about the location the doc had walked off.

For those of you who had your tonsils removed as a kid, do you remember the promise of “all the ice cream you can eat?” Oh yeah, that con has been around since the dawn of tonsillectomies. And since the days of Hippocrates, the medical profession has made an art form out of downplaying discomfort. It has been no different with the prostatectomy.

There was brief mention of being catheterized during the procedure and having to keep the catheter in for a week after the surgery. It makes sense. The procedure involves disconnecting the urethra from the bladder to remove the prostate, then sewing things back together. Things would get messy in a hurry without a catheter. What the medicos didn’t mention is that a Foley catheter is used.

Eliza Doolittle meets Frederic Foley
Even if you’ve never had a catheter, if you watch late night television, or the Outdoor Channel, you’ve seen catheters; those slick, smooth, skinny little tubes. Yeah. Those are NOT Foley catheters. Foley catheters have two tubes, one inside the other. One allows the urine to drain. The other is, basically, a long-necked balloon. The balloon sits in the bladder and is inflated with sterile water to prevent the patient from doing what only seems natural: PULL THAT STUPID THING OUT! Of course, since the Foley is comprised of two tubes, it is roughly the size of a garden hose, perhaps larger. To make matters worse, to make sure the Foley stays put, a holder for it is glued to your thigh.

By week’s end, I had called Frederic Foley every name in the book and cast aspersions on his lineage at length. My joy at the prospect of having it removed was reflected on that glorious day.

“Are you humming?” my wife asked on the way to the clinic. “It sounds like ‘Get Me to the Church on Time’ from My Fair Lady. You hate musicals.”

“I’ve got my own lyrics. It’s a mantra of sorts.”

“I’m almost afraid to ask, but do you want to share?”
“I’m getting’ rid of this damn Foley!
Ding-dong the bells are going to chime!
They’re pulling out the stopper and freeing up my flopper.
Just get me to the doc’s on time!”

Yes, use LOTS of alcohol
The Foley came out, but they didn’t remove the holder stuck to my thigh; patient, heal thyself. The doctor also pulled most of the staples. I say most because when he started plucking the ones on the incision in my navel, which was the largest of the six, he had second thoughts.

“Hmm… looks like that one could use some more time to knit. We certainly wouldn’t want that incision to unzip.”

I would say not. An unzipped navel presented all sorts of macabre scenes in my mind. “Let’s leave them, doc. Heck, I could learn to live with them.”

“No, no, they have to come out, but we’ll wait three more days. That should do the trick.”

Once home, it was time to remove the last vestiges of the Foley by getting rid of the holder glued to my thigh. I don’t know what the heck they use to attach those things, but I’m guessing it’s the same adhesive used to attach the heat tiles to space shuttles. There’s even a warning printed on holder: REMOVE WITH ALCOHOL. They aren’t kidding! Bet I drank half a bottle of Jack Daniels before I had enough nerve to rip that puppy off.

At this point, all that’s needed is a follow up PSA test in a few more weeks. If the results are zero, things will be wonderful. To be honest, if one must get a form of cancer, and if it’s caught early enough, prostate cancer is a good form of cancer to be saddled with. The key to take away from that last sentence is early detection. Get checked guys.