Andrew's View of the Week

I am currently in that place between having a treatment plan and waiting for it to start so while I wait I’ll continue my story.  Last time I threatened you with the details of my biopsy.

You don’t want to know but in case this is going to be read by a man needing to have a biopsy I shall share some of the details.  The only way to know for sure you have prostate cancer is to take a sample of the prostate tissue and put it under a microscope.  A pathologist can then determine if any of the cells are cancerous and what is the stage of the cancer.

The question is how to get a few cells to check out.  The prostate isn’t that easy to get to.  It is located roughly in the center of the pelvis just below the bladder.  In a wiring diagram it would be on the same wire between the bladder and the outside world.

and no they don’t stick tubes and needles up the penis to get to it.

The doctor approaches from the rear using an ultra sound probe and a spring-loaded needle.  The probe goes up the rectum and using the ultra sound to locate the prostate they fire the needle about 12 times to get enough tissue from various parts to ensure that they have a complete picture.

Yes, it is every bit as, annoying, embarrassing, uncomfortable and undignified as it sounds.  Then there are the after effects and the dire warnings of what you need to watch out for.  Yes you do feel the needle when it hits – a little bit like getting punched from the inside out. And that was after the local anesthetic.

They started drilling me on the side effects of the procedure a few days before with an information sheet and a helpful call from the medical assistant.  Turns out that infection is the thing they worry the most about – after all they’re firing a needle through one of the least clean parts of the body.  And then there is the bleeding.  After the procedure you bleed from every opening below the waist and you’re told you’ll have blood in your urine, stool and semen (the last word is not a typo) for a few days, weeks and/or months in the case of that last thing.

To fight off a possible infection they give you cipro before the procedure and a three-day supply to take home along with this instruction, “take your temperature three times a day for three days.  Go to the emergency room if you have a reading over 101.” They also spend a lot of time trying to reassure you that everything will be all right and that most men have no problems – except for the bleeding and the fact that for two weeks you’ll be wondering if you need to call the doctor every time you pee.

Now I did just fine.  The trick is to have an out-of-body experience while they’re shoving things up your back side and afterwards pretend to be a strong brave, manly man and just ‘suck it up’ and quit your complaining.  Or afterwards you can pretend to be a scientist and be observant, “I wonder what the blood to urine ratio was in that last sample?”  Or you can embrace your inner wimp and complain a lot.  Your choice.

Of course it’s kind of easy to be the strong silent type about the whole thing because you’ll find very few people outside the hospital who will want to have conversations with you about which bodily fluid has the most blood in it.  Almost no one will want to sit with you over coffee and discuss how much water you should drink to flush out the prostate.

Perhaps the most difficult part of prostate cancer is the isolation you can feel.  Cancer is a loaded word and even with modern treatments there still is the smell of death about the word – I’ve noticed that my co-workers have stopped asking how I feel or complain about their health in my presence.  The prostate is still hard for most men to talk about – even in this enlightened and open age.  I grew up in a time and a family when these things weren’t openly talked about and I have to admit to being a bit shy about talking about my – stuff.

I am fortunate to have a very supportive wife, family, friends and church community.  There are many people who are supportive and I know that no matter what there are people who will listen to me and help me get through all this.  It is that support that makes it possible for me to even consider going ahead with the treatment – which is likely to be more annoying than the biopsy.

I have had the chance to talk to a few fellow biopsy survivors and trade horror stories.  You can instantly tell if a man has had a prostate biopsy by merely mentioning the word “biopsy” and  observing the pain that flashes over his face – there is the grimace and the instinctive bending over in pain.

Still while I like to complain it wasn’t that bad.  I’ve had much more painful medical procedures and injuries but I am hoping that I’ll never have to do that again.

Next time – “The call”

I’m a sitting staring at a blank screen trying to write a follow-up post to that last one.

I wrote this really cool and detailed outline for these posts to bring everyone up to date – the whys, whens, wherefores and all that good stuff.  Yeah, blew past that 12 paragraphs ago and haven’t been anywhere near it since.  And these posts were supposed to be humorous.  You should read some of the emails I’ve written to friends about what is happening – some of those emails are drop dead funny.  Um,  we won’t use that phrase anymore…

I’m still here figuring out what to write.  Just reread that last post – failed at the humor thing and I have a strong desire to apologize for it.  Now I feel the need to explain somethings and since this is MY blog I get to do just  that.  So there!

The feeling that something was wrong started several months before the PSA test.  It was a vague feeling of being unwell.  It’s hard to explain but I just felt something was wrong with my body. I was having more aches, pains, going to the toilet more often, not feeling as energetic, and feeling just plain old.  Something was wrong so when it was time for my physical I decided that I’d get everything I could checked out.  I even took a long list of things to the doctor to talk about.

But the only thing my doctor could find wrong was an elevated PSA test – everything else was normal for “a man of my age.” grrrr.

Then when the second PSA test results came in I was reminded of my father. About being his caregiver and having to deal with all his medical problems as the strokes slowly destroyed his brain and took his life.  Every call from the doctor, every visit to the hospital meant that he had lost another bit of health and vigor and had moved one step closer to dying.  The progression was continuous, long and filled with loss.

That is when the fear first hit me hard – what will I lose after seeing the urologist?

And I knew it had to be cancer – I just knew but routinely denied it, to myself and everyone around me.  After all it’s just silly to assume the worst based on little information. But I just knew.

I remembered the Christmas before my mother died.  One day she announced that she had breast cancer.  No, she hadn’t been to see a doctor but she just “knew.”  She had a pain and knew it had to be cancer.  Now, I am more rational than my mother, and after talking to her I was convinced that she was having heart problems and got her to agree to let me take her to the cardiologist.  Between that decision and seeing the cardiologist she had a side trip to the urgent care clinic where a scan detected a tumor on her liver.  In the end it turned out to be pancreatic cancer. We never saw the cardiologist. My mother died of cancer three months after her first declaration.

I remembered standing in a hospital hallway talking to a doctor about whether or not they should operate on my father.  I started to second guess myself – what if I chose wrong?  What if?  How can I make those kind of decisions?  That hallway at the VA still haunts me and troubles my mind in time of darkness and doubt.

And now a simple test, a prudent request of by my doctor and all those old memories, fears, and pain flood back.  I recall. I remember.  Then project into the future – how can I make those decisions for myself?

I wanted to scream at God and say, “Damn you, I’ve done this for two people.  Don’t make me walk this path again.”

I didn’t scream it but I did say it, quietly, privately, with the lights out.  Don’t worry, God has a sense of humor even when you don’t and knows when I am being melodramatic.  Yes the lightning bolts were my fault, sorry.

So, there I was with bad memories, fears and an appointment to see a urologist.  I’ll now admit to not being smart enough to, “not go to google and do a few searches.” After filtering though the wackos it was clear that the doctor would/should recommend a prostate biopsy to which there are a few realistic possible results:

• nothing is wrong – that is your normal PSA level
• prostatitis – an infection that a few drugs will cure
• cancer that doesn’t need to be treated at this time
• cancer that needs some treatment
• cancer that requires we rip out your prostate out as soon as possible.

Okay, the last one is just me being melodramatic and engaging in unfounded and unreasonable fears but still it will wake me at three in the morning and require a lot of beating down to get back to sleep.

My first visit to the urologist included answering an embarrassing questionnaire (I mean talk about deeply private and personal) and a “digital rectal exam.” (yes he sticks that there) The doctor found nothing obviously wrong.  My prostate was normal size and performing all its functions properly.

Of course the biopsy was recommended and scheduled.  It is the only way to rule out cancer but the doctor reassured me that there was a 75% chance that it wasn’t cancer and it was likely that I just have a normally higher PSA number than average.

Then I was given the patient preparation instructions for the procedure and a date for the procedure – December 7th. A day that will…

No I won’t do that line.

Next post – everything you never wanted to know about a prostate biopsy.

Last time I told you where I am – prostate cancer about to under go treatment.  Now for a little background.  Well maybe a lot of background.  Today I’ll just focus on the facts in the case.  I’ve had a million different emotional reactions to this which I’ll cover in other posts. I have put some little thought in how I’ll present the information (emphasis on little) and I’ve decided that what I really want to do is to give you a day by day description of what is happening to me.

Yeah, like that’s going to happen.

More likely you’ll only hear from me every two or three days.

And here are a couple of tips for reading my blog:

• The longer and better edited the posts the better I feel.
• Short posts mean I am not feeling well.
• Bad jokes in the post mean I am in pain.
• No posts mean I am totally depressed and have likely run out of chocolate.

Hum – where did these three pieces of chocolate come from – er two pieces of chocolate…

Moving on.

This whole thing started because I am far too conscious of my health.  I get all the health screenings I am supposed to, try to eat right, take my meds, treat what is wrong and exercise – some, a little, okay I don’t get enough exercise.  On the whole I am in good but not great health.

A year ago I watched as a blood relative of mine went through prostate cancer.  He had to have his removed and I’ll tell you that wasn’t easy.  He’s recovered well but still I know the problems he went through.

Fast forward to August and my annual physical.  I turned 51 last year and the doctor was going over the list of screening tests I needed.  She ask if I had any concerns and I mentioned the things I usually stress over – my gout, blood pressure, hemorrhoids and the fear that I’ll suddenly have a massive stroke and be rendered a complete vegetable.  Then I mentioned about my mother having cancer and this prostate cancer thing came up.

So my doctor told me I could get a PSA test done but she suggested that I have two – one now and one in three months.  After all there are a number of things that can cause a hight PSA reading and we don’t want to take action on just one test.  It felt like the right thing to do so off to the blood lab I go.

So November rolls around (I am sure it means something when I start many paragraphs with ‘so’ but I haven’t figured out what) and my tendonitis was flaring up so I went to see my doc hoping for some good drugs to cure my elbow.  Turns out the cure for tendonitis is rest, no drugs.  I also got the results of my PSA test – high, it was a little on the high side.

Then I got a reminder that I need to get another test to confirm. Okay.  Blood tests I can do.  After all I looked it up on the internet and the PSA test is known to be problematic.  There are a million things that can raise the PSA level and it’s prone to false positives.  Right?  I mean the test was wrong, I knew that, so a second test would just prove it.

It’s never a good thing when your doctor calls and says, “can you come by the hospital today?”  Your brain kind of takes a left turn and you drive into a parked car.  Well I wasn’t driving at the time she called but I did almost walk into a wall.

Turns out that the PSA test was higher and she wanted to refer me to a urologist – the prostate doctor.  There were instructions I needed to get because the next step was a prostate exam.

That is when I cried.

That is when I knew that I had something.

That is when my fears started.

That is when denial failed to protect me.

That is when I told my wife, “I don’t want to do this.  I don’t want my life to go this way.”

This is where I end the story for tonight.

Before the tears prevent me from writing further.