Histology (Pathology) Results in Great Result 98% Certain its all gone

After 6 anxious months, sleepless nights, tests, biopsies , major abdominal surgery for prostate removal the news we have been waiting for arrived.

Went and saw Alan Doherty at the Birmingham Prostate Clinic, The Priory. He described the grading of the surgery he does as 1 - 5 with 5 being the best. He put my operation in the context of A Levels - basically the A*. If he could have a * grading , my operation would have been graded 5*. Everything went perfect apart from the blood loss - he has advised me to take iron tablets as I am still anemic . ( Anemia is a condition in which the body does not have enough healthy red blood cells. ). He would also still like me to take some rest in the afternoon - recovery wise I am well ahead of the curve.

The big results though is the histology that has come back from the labs. It totally justifies having had the operation. The cancer was not just on the right side of the prostate but also on the left and it was concentrated also at the Apex. Margins are all clear so he gives this a 98% Cureative factor.

ADENOCARCINOMA, GLEASON 3

+ 3 = 6 PRESENT BILATERALLY;

THE BULK OF THE TUMOUR BEING IN THE RIGHT APEX.

Tumour volume: Approximately 0.7 eu em (about

1.4%).

Apical margin: Negative.

Bladder margin: Negative.

Circumferential margin: Negative.

Perineural invasion: Present.

Vascular/lymphatic invasion: Negative.

Extraprostatic extension: Negative.

Involvement of seminal vesicle(s): Negative.

Premalignant change: Multifocal high-grade prostatic intraepithelial neoplasia.

Other pathology: Nodular hyperplasia, chronic active inflammation.

Pathologic stage (TNM 2010): pT2cNx

Tumour map attached.

Radical Prostatoseminovesiculectomy:

Specimen and organ confined ADENOCARCINOMA,

GLEASON 3 + 3 = 6, pT2cNx. Local excision appears complete.IsabeIle

The above tumour map was given to me by Mr Doherty, it was done by the labs. Basically they carved up the prostate into six slices including the seminal vesicles. The cancer is shown in red. Nice record to have.

PROSTATE:

Radical Prostatectomy specimen weighing 50.9 gms and measuring 37 (Length) x 42 (Width) x 40 (Height) mm, with seminal vesicles up to 21 mm in length. The specimen was cut into six parallel slices and all embedded into seven large blocks.

Mr Doherty wants me to go back in January when I will have a high sensitivity PSA blood test - this is not the same test that is done at the doctors or under the NHS hospitals. The BPC do this test and I will then see him a few days later to go through the results.  I will be tested like this in the future, but its all looking really good.

The only slight concern that I have re this histology report is " Perineural invasion: Present." - looking on the net and on the prostate cancer forums this indicates that the cancer got into the nerve system in the prostate and there may be a chance in the future of a re-occurance of cancer elsewhere in my body as a result. This is a slim chance that would be picked up by regular PSA screening. Its something called PNI. Apparently most doctors ignore it. I dont have to worry about it for now.

Another interesting aspect of this pathology report - I had BPH and had ignored it. All that going to the loo quite often and stinging ... yep I had ignored it - problem with always workign and no time to go to doctors as I was always working away from home ( Other pathology: Nodular hyperplasia, chronic active inflammation. )

One thing this cancer has taught me - I am now going to take a closer look at my health and looking after it.

Now the cancer is  sorted out, the side effects of the oepration have to be sorted. My incontince is being brought under control and he is happy with what I am doing. Things can only get better and the exercise I am doing will help.  My fitness has counted a lot for this, especially the fact that I was doing pelvic exercises before the operation.

The bladder diary that I have kept for the past 5 days shows the improvement.

From an erectile dysfunction point of view he wants me to go on 5mg Cialis per day. This will get the blood flowing and will aid penile recovery. My GP will prescribe these and he will drop him a note.

So, am really chuffed as punch today  - can now see many years ahead.

Told him that I will be climbing Snowdon in December. Must get the fitness going.

Am now signed off from work until near the end of November to recouperate. Will see how I get on by then to judge my return to the hectic work life I had before ther cancer.

So lucky as there are so many who are not as fortunate

The day started as normal, bit boring, emails, radio, TV - but this afternoon I took a walk around the field and was looking back at the house, land and the trees.

Made me think how lucky i have been to have caught this cancer early. Also made me reflect on my life and where it is now. There are so many people in this world who have not been as fortunate, I should be thankful that I am where I am today.

Was lovely looking at the countryside and the leaves falling from the trees and settling on the ground. Walking around and seeing the tracks made by the badgers. The horses came up to say hello and have some bread I had with me.

I would so miss all of this if I wasnt here.

Bladder Diary

Trying Google docs to see if its any good as an electonic record of the bladder diary. Its interesting as you can now sync your laptop, pc and smartphone using Google Drive so i can access the documents no matter where i am.  Therefore I can update the spreadsheet if i am out ... question now is if it will work or do I stay with paper. Below is a snapshot from the diary.

The biggest problem I think I have is remembering that before I stand up or sit down I must do a strong pelvic contraction. This closes the bladder and ensures no fluid escapes as its only gonna go one way and thats out!  Its early days so this is somethign I must drum into myself.

I suspect coughing and sneezing - as well as the painful effect on the internal surgery - which now seems to be not as bad, will result in accidents. One of the guys on my US support forum reported only this week, a year after his Open RP, that he still wets himself if he laughs too hard, has a head cold or coughs and sneezes - so its something I am gonna have to get used to.  They call this 'Stress Incontinence' so I think I am doing quite well.

What I now need to do is to start to increase my bladder intake and also increase the length of time between toilet visits. The Physio discussed this with me in hospital and the District nurse has given me a leaflet about it. Essentially he described it as going to see a good film at the cinema - say the Godfather. As he said, i dont want to be getting up every hour to use the loo, I need to be able to last the whole length of the movie. So I need to start pushing loo visits to 2 hour, then 2 and half then three hour intervals. This will also help with the evening as I need to be able to reduce the times I get up during the night so I can get a longer time sleeping.

All of this will also help with work, as I drive a lot - 4 to 5 hours somedays travelling south and the same back. Stuck in major traffic jams is a fact of life for me so I need to be able to hold it.  The pelvic exercises are helping with this - so I do them all the time.

Example of bladder sheet:

Sunday - a week since i left hospital - good day

Feeling really up beat today. kept a bladder log for the district nurse saturday and overnightand hardly any problems at all. Managed to wake up during the night twice so there were no accidents.

Also was up early did my exercises and felt good. Exercises to Madonna  on YouTube.
Still lots of internal soreness and a burning underneath berween legs, district nurse said thats where the surgery took place internally , where the prostate was removed. Most men report a burnong sensation there.

Dan said he would drive me to the shops so we went to Sainsburys so I could buy some boxes of Tena for Men pads. They are on special offer 2.49 per box. bargain if they give me confidence to leave the safety of the house.

Went to shops and walked across car park. really slow. chap from work stopped his car to let me cross. didnt see him a i was walking at snails pace.

glad to get back home.

excitement over for the day.

ED and Bilateral Nerve Sparing

Well , one of the side efects of prostate cancer and surgery is erectile dysfunction. Lots have been written about this subject and its one of the prime reasons for getting one of the best surgeons you can who understands and specializes in the techniques to save the nerves.

There is a good article at http://urology.jhu.edu/prostate/erectyle_dyssfunction.php which explains the ins a out and also gives a good picture from the Amercian Medical Association that shows where the nerves are that control erections and you can see these in relation to the prostate that is to be removed. I have included this picture below:

A. Lateral view of the male pelvis illustrating the course and distribution of the left cavernous nerve fiber, as part of the left neurovascular bundle within intrapelvic fascia coverings. The cavernous nerve travels from the pelvicplexus proximally to the penis distally, in close anatomical relationship to the seminal vesicle, prostate, striated urethral sphincter, bladder, and rectum.

B. Anterosuperior oblique view of the same anatomical structures.

C. Anterosuperior oblique view illustrating preservation of the cavernous nervesafter bilateral nerve-sparing prostatectomy and bladder neck anastomosis to theurethral stump. The cavernous nerve fibers are preserved by division and clip-ping of small prostatic nerves alongside the prostate. When non-nerve-sparingsurgery is required for cancer eradication either unilaterally or bilaterally, wide excision of periprostatic soft tissue includes the cavernous nerves en block withthe removed surgical specimen.

Today was a massive day for me as during showering there was definate movement down under - so much so that I encouraged it ( on the basis of research that has said you need to exercise it so that you dont suffer from cell death - cells in the penis do not regenerate as cells in the rest of the body do ).  The result of this encouragement was definate growth - showing that blood was circulating again and also those nerves are starting to work. Often the bruising and battering the nerves take during surgery mean a long recouperation time. You do hear of no life , even after nerve sparing, for up to two years. This exercise resulted in my first ever 'dry orgasm' weird sensation for a bloke - but things are looking up! 

Will be reporting in these results as well as the continence progress to Mr Donerty and his team when I see them next week.

Getting to grips with Incontinence - day 3 since catheter removal

It has been three days since I had my catheter removed. Its been a learning curve. When you have the catheter in you drink loads and dont worry about urinating, in fact , you consciously relax all your muscles because you want to expel the fluid to help with the healing process. Also you dont want to squeeze as you feel it may damage the internal stitches that the surgeon has done reconnecting your bladder to your uretha.

Tuesday evening when I got back from the hospital I wet myself getting out of the car. I had forgotten something the physio in the hospital had told me that will become so important in my life. When getting up or down out of seats, bending or stretching, I must remember to do a big pelvic muscle contraction to prevent leakage. This may well have stopped the leakage I had coming home from hospital.

Thursday 18th was the day I started my physio exercises and I did them well. However, I did hurt. I stopped taking any pain relief when I got up in the morning as I wanted to be able to feel any tweek or twinge so that I didnt push myself to hard. I didnt want drugs masking any pain as this might cause more damage.

After the exercises in the morning I went for a walk from my house to the road , about 1/4 a mile - this was hard as the ground was potholed and bumpy. I could feel lots of soreness inside me, also the bumpyness of walking made me stop a few times and it also gave me a urinary urge.

Am suffering from annoying dribbles. Its ok being at home and also if I wear a pad, but need to combat this.

Tried to drink more Thursday  but my mind is consciously telling me not to in-case I wet myself. Must stop this and get back to a fluid regime.

A lady from the Office of National Statistics called in the afternoon on thursday and interviewed me for nearly 2 hours. This length of time talking got me really tired and I was glad for her to go. 

The internal soreness got worse into the evening and also I developed a headache. i never get headaches. Decided I needed some paracetamol. Took some at dinner time and then at bedtime ( midnight ). Bit of an accident before bedtime, snoozed on the settee .. major error .. woke up wetting myself !! Dam ! 

Time for bed.

Restless nights sleep - up three times to go to the toilet - in the end I was up early again. Did pelvic exercises in bed to kill some time. Must keep doing them to cure this wetting problem.

Big day in Birmingham TWOC - Do not Fart in Public !!

TWOC - Trial Without Catheter.

When I went into theatre for the Open Radical Prostatectomy the operation didnt just involve removing a prostate, but also involved the removal of a section of the uretha. The uretha has to be re-attached to the bladder so to help with the healing and to ensure you can pass water they put a catheter into your bladder through your penis.  This has to be removed at some point so you can urinate again and learn to do it under control. The start of potty training for adult men -:) . Today was the big day.

Went to the Priory and checked into the ward - this time Bournville room 3 . Was looked after during the day by some great staff nurses.

Stage 1 - anti-biotics so I dont get any infection when the catheter is removed. An hour later , lie down on the bed and the removal takes place. Trick they dont tell you that I found out on the internet, take a deep breath and when she starts pulling it out , breath out - it relaxes you and you dont feel a thing.

The next three to four hours involved me drinking fluid, weeing  and after each wee pushing a buzzer, nurse would come in , take the bottle away for measuring and they would then scan my bladder to see what was left in. After three scans they were totally happy that I was voiding my bladder. In fact they would have been happy with less than 200ml left in, but I was managing to expel urine and only leave 21 ml in there.

Brilliant - everyone happy  so I could go home.
They redressed my surgery wound for me. Also I was given a bag of bottles, some incontinence pads and some aweful paper panties !! Plus a seat pad that I could use at home. Time to leave - got my discharge papers .. then a quick trip to the loo ... and into the car for trip home.

Got back to Telford and I had no accidents. Trip into Tesco to buy some more Mens Tens Pads, a waterproof sheet for my side of the bed .. incase of evening accidents .. then to the KFC for a celebration take home meal.

Still everything ok .. drive home.

We pulled into the driveway, now our drive is down a long bumpy private lane .. obviously this must have caught me by suprise. We pulled in to the drive and it happened ... car stopped , I swung out of the car and straightened up ( a Golf TDI GT is low to the ground ), when I straightened up I couldnt stop it -- I farted !!!! Woops - never fart without control or never fart unless you are in the loo ... I pissed my self !!!!!

It wouldnt stop, I couldnt stop it.  I was out of control !! The pad I had put on to leave hospital wasnt in the right position - pants wet . OMG!! 

Thank god this did not happen in Tesco - I would have been mortified.

I suppose this is going to happen again until I am potty trained -:)

Sunday 14thOct - Longest drive home in my life

Sunday afternoon, 14th Oct 2012 was when I was discharged from The Priory with instructions to come back on tuesday 16th at 10am for TWOC where they will trial me without the catheter , measuring bladder, slow rates etc .

Walking around the hospital and eveen lifting my laptop had not prepared me for a drive from Birmingham to North Shropshire. Even though Helen drove well, every touch of the brakes and sudden movement I felt inside me. Not on the outside scar, but inside. I spent most of the time, pressing my insides trying to ensure they didnt 'wobble'.

By the time we had gotton from one motorway to another (M54) I was so tired.
We then realised that I needed a shower seat for home and pain killers!! Decided we would stop at Tesco on the way home. This was a mistake but also a bonus - my catheter seemed to block in the car, so I didnt just have the pain of the journey, I now had urine backing up the catheter into my bladder - and this hurt.

So into Tesco we went - Helen to pharmacy, me to the loos - thankgoodness for clean disabled toilets - which i availed myself of. Sorted myself out.

Then I spent 30 mins leaning against a trolley - not pushing it - while we picked up goodies for me to eat at home.

Home time!  ( Really not looking forward to Tuesdays TWOC )

Constipation takes time - dont force it!!

Friday12th Oct 2012 -  afternoon in hospital I was gearing myself up for discharge on saturday. 

Physio - Kizzie was really happy with everything and he had briefed me on what I should and shouldnt be doing. My biggest problem was trying to get what had gone into my body from the top out from the bottom without straining as this could damage the fantastic work done inside by the surgeons.

My method to help this - and because I was a lot fitter being a hillwalker, was to take a walk outside. I devised my route , circular around the hospital with an uphill and downhill section by the Consulting block.

Two laps of this friday had me shattered.
Didnt seem to work.
Back in the ward I was given double Laxido's - its like drinking wallpaper paste. Also given double glycerin suppositories still didnt work. However I assumed all would happen - it didnt. I had to eat, so had my evening meal - when was all this gonna come out!!

Saturday 13th October ... its been 5 days since the operation - wind - no problem now, but nothing being discharged below - this is all getting too stressful.

Helen arrived and spent most of the day with me. We went for a walk together outside, but still nothing.

Andrea and her Assistant from the Colmore Ward, where Mr Doherty's patients are normally housed was on. First thiing she did was to correct how I had my catheter strapped to my leg - that made things more comfortable - typical techie in my  - I dont read the manual. Also they got me to read the health and instruction booklet with the catheter - stressing the importance of cleanliness and maintenance  - to ensure I dont given myself infection.

Andrea said she would sort out the bowels:

Jug of hot orange juice ordered
Large glass of pure prune juice ordered
Two Laxido's taken

Andrea told Helen that I could not be discharged as I had not emptied my bowels, but it would happen and i would be home sunday.

17:00 hrs I drank the hot orange juice.
at 17:30 hrs Andrea inserted both glycerin suppositories into my rectum and got me to sqeeze my buttocks and lie on my left side. At 17:45 hours I could sense something was happening .. as I was getting up catering came in with my meal - I sent them away to put it on the hot plate ... I just managed to get into the bathroom and sit down when it happened - WOW what a relief !!!!!!!!!!!!!!

15 mins later I was showered and telling the nursing staff what had happened - then meal time and visitors .. dam I felt good. Home time sunday.

Jonathan, Emma and Chris

Visitors left just before 9pm and I had some more Laxido and drank the pure prune juice  - ewwww - but it had to be done. 22:00 and hour later I was sat again on the loo and filling the bowl.  So sad this to think that having a crap could excite you so much.

Went to bed and was up again at 02:21 hrs sunday morning - again on the loo. Night staff were really pleased. Went back to bed and was up at 6am , packed my bag and laptop and tidied up and was ready to go!!

Helen arrived later in morning and after I was shown how to dress my wound, given diet instructions, given a bag full of medication to take home - again to help keep my insides clear ..  I was on my way out of this fabulous hospital .. for a few days. ( Got to go back tuesday for TWOC ... trial without Catheter ).

Wind - unbelievable pain and nausia

It was thursday late afternoon and Natalie ( Daughter ) and her friend Lorna were due in later. The big thing that needed sorting out was bowel movements. Aparently I wont get to go home unless this is cracked. Decided with the staff nurse that we would try and start it all - or at least get the stool softeners in early so I would be ok for my visitors.

Brilliant Staff Nurse - Elisa was looking after me. She has suffered herself from the type of pain I was going through and about to go through. Without her help I wouldnt have got through the next few hours.

Really didnt quite work out. I had a couple if glycerin suppositories that were meant to iritate the bowel and might help movement. That didnt work. Held them in for an hour and then sat for ages on loo - no result. Also I took and oral Laxido to help soften the stool. The active ingredient, Macrogol 3350, is a laxative that makes stools softer and easier to pass .  This didnt work. The nurse then contacted Mr D. to see if I could have a stronger enema - injected up the rectum to kick start things. This was done, but still no joy. Wow - seems the use of the pain drugs like codeine etc had really buggered me up. At this time I also received another injection of an anti clotting agent.

A concern here is that I havent voided since a small one on tuesday morning and now it was thursday - day three post op. Mr D doesnt like his patients straining to void as it can impact the internals he has done. Big point this as during my research online and talking with other people who have been through the procedure this was a big bug bear.

Whilst all this happened the wonderful dinner I had ordered arrived. Managed half a cup of coffee and some soup, but the fish and veg went back to the hotplate to be saved and the jelly and double cream would have to wait on the tray.

I was still sat on the loo praying to the toilet gods when my daughter arrived. Lorna and Natalie stopped for about an hour but the longer they were there and I was talking the more sick I was  feeling. Maybe it was all the talking, maybe it was the drugs - I dont know , but what I did know was i needed space and to be on my own with the nursing staff to sort me. Felt so guilty asking the girls to leave after  they had journeyed here. They understood though.

After they went, Nursing team came back in. They got authority for some anti nausea medication, wind medication and my normal paracetamol.  I asked them to take the food try away  - which they did. Even looking at a glass of water was making me feel ill. It wasnt even 9pm and I turned all the lights out.

I was about to go to sleep and noticed a message to me on ProstateCancerUK Forums from Tony. He had an RP under Mr D at the Priory. He stressed to me to lie on my left side and this would help clear the wind. I tell you honestly, I had never felt pain like this before. All lights out and I got myself as comfortable on the bed and started to try and sleep. Around 10 pm the over night nurse came in and gave me pain killers and a wind tablet. If you can imagine your body full of gassy water gurling away and nowhere for that gas to go - thats the feeling and thats the noise you hear. Even Lorna had heard it before she left. I must have nodded of but about 11 pm I started to actually pass wind - big style. It obviously had found its way through to the exit -:) This went on for sometime , probably a couple of hours off and on and then I slept.

5am I woke up and felt quite good so got up for a walk around the room. Had a wash, did teeth and had a shave.. what else to do .. nothing. Started to feel pain from the abdomin , not wind pain this time.Nurse came in and gave me paracetamol x 2 and a Tramadol - I wasnt aware at the time that Mr D doesnt like his patients to have this really as its like codeine - not to worry - the combination helped me sleep and I woke at 7.30am to the gentle knock of Mr D on his morning round to say hello.

Again he was quite pleased with my progress and he gave me the good news that I should be able to go home saturday. I would however have to come back on tuesday to have the catheter out. To be honest, if I could be at home it would be great.

After Mr D left I saw the nurses, Staff Nurse Nicky - brilliant, talked me through the drugs - we have everything at home that I need to get me through the weekend. I only need Paracetamol and Ibuprofen. If I dont take my Amlodipine then I should be ok. I havent had any Amlodipine all week and the hospital have been fine monitoring my heart. I also have my own heart monitor at home so can check this.

Only problem might be saturday's drive home if we get stuck in traffic for a few hours. Nicky said she could give me a suppository pain killer - one Mr D recommends - Voltarol - as it doesnt cause constipation. Via suppository it will be quick acting. They might also be able to give me an oramorph dose before I leave.

Had my breakfast and then decided to get really mobile. Tidied my ward room. Picked clothes for the day - socks, shorts and pink i-scout tee shirt. Bathroom and then had a shower - well, the nurses showered me yesterday, this was interesting doing it on my own. Now I have a problem at home. I need a shower stool to sit on, also I will need a handle to pull up on. Havent got any. Dam. Gonna have to see if son of mine can fit them when I get home.

Below ... fridays breakfast ... prunes .. my god ... never thought I would welcome these .. but needs must!

Wowa .. How much fluid can you fit in your bladder!!

Well its wednesday, checked into my ward room , great team of nurses sorting me out. Still buzzing a bit after the ITU experience. In ITU I could drink small amount of fluid. Now being out the priotity is to get enough fluid through me , through my bladder to help the healing process.

Lots of what I have read talks around clearing out clots, bits of blood and getting the urine to a lighter colour. Also, I suppose with the drugs I am on its important to hydrate well.



My baby cup


In the room I am given a glass to drink from, however I have become attached to my baby cup -:) The cup enables me to drink but not spill anything on me, the bed or my laptop as I am lying down. Got used to it in ITU as you can only drink small amounts. Now i am out i can drink more. I was given a soup, more like hot flavoured water. Interesting that when I drank this, suddenly the fluid from the catheter was red and I mean dark red. Lots of it. Maybe the soup did this?

Sort of frightened me - especially when I knew I had lost blood in the op. So decided to drink lots of fluid and get it clear again.

I think I was still slightly disorientated on wed in the room as I was not saying the right things to people. Also I felt nervous about buzzing for a nurse. Family visited again, but to be honest, I was so tired my eyes were closing all the time.When the family went I was ready for sleep - me - at 9pm - wow. Had medication from nurses and they told me they would see me again at 2am. Yep, saw them then and they said I would see them again about 6am. They emptied my catheter bag. During the night between sleeps I kept drinking. Didnt realize how much I had drunk but i woke with pains. Started to do some work on my laptop but the pain got worse. Eventually about 7am I buzzed a nurse. She was really shocked when she saw my bag full. To cut a long story short, they emptied 4 litres of fluid out of me ... wooops ...  I was blowing my bladder up with all the fluid as the catheter bag was full. Wont do that again.!! You learn !!

Working on my laptop in hospital

Thursday, Mr Doherty arrived again, brilliant pick me up for a morning. The epi was coming out, was going on light meals and later in day we would work on the bowels - great thing was I farted for England about midnight - that was important as they needed to know that I could pass wind.

Lots of people, men, get embarassed about these things, but when you are in the middle of this kind of treatment, get a  life and get on with it. What I have learnt is medical people deal with the human body all the time, nurses are nurses, doctors are doctors. Like I am a proffessional IT person, they are medical proffessionals, dont be embarrassed about anything.

So, thursday, the epidural came out, suppository put in for anti inflamation to help with abdomin.
More pain releif, this time just paracetamol, as I had para and codeine at 6am. Codein cut out now.

Lot more drinking and now food - wow, breakfast...lunch ... huge ..
Shower. This was an experience. Two nurses had to help me. When I got out of the bed for the first time I leant against the wall as I took my first few steps. I used the wall and a nurse to support myself into the bathroom. Then another humbling experience beign showered by the nurses, but its a job for them and I was more focused on not falling over or passing out in the shower. But the wash felt good.

The shower meant I could get rid of the hospital gown - got dressed into shorts and T, am starting to feel normal. Interesting as it was the first time I had walked since tuesday morning. Coped well, though nearly fainted a bit in shower so sat down. After the shower I felt brilliant.

New dressing and a chance to see my scar... it looks so neat and tidy

Physio called to see me - Kizzie - had seen him yesterday - makes me laugh. We went for a walk up and down the corridoor - he thinks I am doing great. He is going to take me up the stairs tomorrow. Wants me to walk the corridoor twice more today.

Now more suppositories - glycerin - this time we need to start working on the bowels  - got lots of stuffy pain. Must not forget that I had a roast dinner monday, big lunch today .. not been for a void since tuesday and that wasnt much. ....

Will have to see how this goes.

Am feeling good, but I dont know if I am overdoing things.

I do know these suppositories as I am typing this up are creasing me up !!!!

Its 4.45 ... wednesday 11/10/2012 .. might need the little boys room !! - Nope.

Post Op - ITU Experience

Apparently the operation took about 3 hours and I was returned to intensive care unit at 11.30am still fast asleep. I remember waking up after 12 midday, could have been slightly later. My recollection was trying to take a mask of my face and being asked to put it back on.  All very nice, a feeling of airiness but no pain, just dreamy.  Gradually as I came around I started to notice the business inside the Intensive Care Unit. Saw a sheet next to my bed which said I was a Critical Care Level 2. They have level 1, 2 and 3.  The nurse, Amy, kept asking if I was in pain but I couldn’t say I was really.  

After a while the oxygen mask was taken away and replaced with a tube thing that attaches to your nose and sends the oxygen up your nose. I then started to notice all the stuff attached to me, oxygen, tube draining blood from my stomach, catheter coming out of penis, tube into arm putting fluid and pain killer in, epidural into back, ECG leads attached to my chest.. Wow, it puts things into perspective what’s just happened and why this hospital is so good at what it does.

Even more impressive and something that helped me was the ability for me to have my smartphone in ITU so I could listen to calming music and also send texts and talk to friends via messaging . I was also able to liaise with my family. When my wife and daughter arrived later in the day I was so chilled out she took a photo for me .. on the blog here - my niece who works in ITU in London reckons I look too healthy..

I look a lot cheery in this picture

The great thing about being able to use the technology in ITU was my ability to tell all my friends I was OK. It gave me a real lift.

You don’t really notice things but gradually during the day you become accustomed to everything and everyone.  I must make a special mention here to the team in the Priory ITU, to  Amy, the nurse who suffered me coming around, Emma who fused after me on both days I was in there, to Elaine who ensured I was given the post op medication including the clotting agent also Elaine had to re-adjust my position when we found that the epidural which was giving me a block from above wound down to thighs only worked on one side, to Niera who looked after me day 2 and took me to my ward, but the massive thank you goes to the overnight team and Jaira who monitored me all night, topping up medications when required ; being naturally nosey, but wanting to understand what was happening she was able to explain things which for me put me at so much ease. It also helped as I really couldn’t sleep. With machines on the go and monitors taking readings every hour I just didn’t sleep .. Until that is 06.05 .. I know that as I didn’t hear or feel the heart rate squeezing my arm, Jaira also changed my IV paracetamol at that time and she told me later I was nicely asleep .. Until just before 7 am, so I got some sleep!

Lying in ITU being monitored



Didnt realize I looked this crap

When I woke up I had my first humbling experience - the bed bath. Having never been ill or having to go into hospital before in my whole life this was a new to me and as a man was quite humbling. But the staff who did this were so proffessional and considerate it was all over in no time and any embarrasment I may have had was gone.

Just before 8 am I was joined in ITU by Mr Doherty; he confirmed what he had said to my wife that the operation had gone well. He did say there had been a slight problem with heavy bleeding ( notes said I had lost 1.2 litres ), but they would check my levels to see if I needed a transfusion or whether I would be slightly anaemic . Surgical margins were fine but we wouldn’t know for definite until the results come back from pathology and of course the PSA testing (as normal post op follow-up). Felt really great after his visit. Our priorities had been cure, continence, ED .. so well on the way to Number 1, and I know I can do Number 2 as I have been practising my Kegels before the Op.

Ah, well , so Op now over .. Neira took blood samples – the results would be ready in 30 mins, this was to check levels , especially as a result of that heavy blood loss  -turns out am ok anyway. Lunchtime I was fit and well enough to move out of ITU and go to a ward room. Really do need to sleep .. am so glad that bits over .. now lets see how fast I can recover. If I can climb mountains , surely I can get up and about ….

Surgery - Open Radical Prostatectomy with Bilateral Nerve Sparing

What a week so far.
I didn’t sleep at all on Monday evening as I was full of nerves - I have since found out that my wife described me to a relative as terrified. I had tried to conceal this but obviously I am not good at that type of thing. Anyway, back to Monday - went and did bits of shopping and had a roast chicken lunch with Helen. Also in the evening I was under hospital instruction not to eat after 2am. We decided to have a roast lamb ... like lamb to the slaughter comes to mind - lol fabulous meal cooked by my lady wife. Food over by 7.30 pm just enough time to go to a Shropshire Scouts meeting to help organise the county gala, then home by 10pm.

Glass of water before bed - couldn’t sleep anyway so I just lay there until 4am and then got up for my shower. Must have been in that shower for about 30 mins, just so much going through my head about what was happening to me. Got changed and downstairs to Helen who was enjoying a coffee – I had a sip of water with an Amlodipine (hypertension).  I was panicking about the time. We had to be at the hospital for 7am and after last week taking over two hours to get there I didn’t want to be late. Sat nav on and into the car we went - well, leaving at just after 5am we sailed through arriving at The Priory for 6am  - early for a change. At least it made me calmer, I think Helen may have been more nervous than me, bless. We hung around in the car until 6.50 and then went in.

I must say the staff at this hospital are fabulous. Lovely smiles when you arrive and the porter so friend and chatty. We were shown up to my room with a copy of the morning paper. There were only three of us booked in that morning, two for quick day procedures and me for what was described as something a bit bigger. Oh well. I unpacked and then was told that this ward may close and I may go back to a different ward – so packed again. All this helped to take my mind of things. Did paperwork with the Staff Nurse who joked away with me, she was the lady who was here last week. Got unchanged and into the fetching hospital gown .. backside covered by dressing gown.

Shortly before 8am, Alan Doherty arrived. He just oozes confidence – when I read the book, Dead Men Don’t Have Sex, the author described how you have to have confidence in your medical team and urologist – this is exactly what you have with Alan. Just talking about the operation and nerves didn’t come into play. When assessing the operational needs – risk etc. I even said ‘Heavy Bleeding’ without a quiver – I had read a lot about this from Dr Patrick Walsh when researching Prostate Cancer and its mentioned in his excellent book Surviving Prostate Cancer.  I joked with Alan about the possibility of a photo for my blog in the theatre -  not really when an open procedure is being done. Alan went away and a few moments later. Dr Singh came in ( replacement for Dr Farouqui ) – was to be my anesthetist. He described all the pain control that would be done. Again, something about the air of Dr Singh that puts your mind at rest. He left and I was joined by the nurse who would take me to theatre .. woops .. forgot to mention, I donned a lovely pair of long green stockings – combat DVT and clots post surgery.

It couldn’t be described as the long walk, more a walk and a lift . When we arrived at the ante room there was just enough time to give Helen a hug and in I went.  I think I must have said a whole Rosary ( The Roman Catholic in me ) on the way down . The nerves really did kick in and I am glad Helen didnt see me.

Nervously I took of my dressing gown and they undid the ties on the back. I climbed onto the operating table. Name and date of birth checked again, whilst one person put a blood pressure gizmo on one arm Dr Singh was slipping a needle or two into my other hand for the tubes . Something went in as I remember telling the nurse I felt weird. So many people had said that you go out in seconds, I can only guess that I had been given something to calm me down – excellent.

Then talking to the other chap without looking at Dr Singh, that was the last I remember .. until waking up in ITU ( Intensive care – the Priory has 6 dedicated critical care beds and all people who have major surgery end up there for monitoring ). … see next entry…

Its the big day. Nervous as Hell.

couldn't sleep all night. Up at just after 4am and now heading to Birmingham. I so need a coffee but can't have anything, not even water. Prayers said, almost said a whole Rosary.

Amazing Day - from Motorway Anxiety to calm in Hospital

What a day. Didn't sleep that well last night with the thought of going into hospital as 'day case' for the flexible cystoscopy and the unknown pre - op tests and samples.

Was up just after 5.30am and got myself ready - long shower to wake me up, coffee and checked all the paperwork. Finally left the house just before 7am - as I didnt need to get to the hospital until 9.30 am that would give me loads of time as its only about a 45 min drive away. Or so I thought.

M54, to M6 and then the traffic jam started. Stayed calm but slowly I watched the clock go to 8am, 8 15, 8.30, 8.45 and I still had 10 miles to do. At one point i drove 1 mile in 20 mins. Panic was starting to set in. Then all of a sudden all three lanes of the motorway started moving, 9am, I was off the motorway and heading through Birmingham. 9.10 am swung into the hospital carpark. Time to calm down for 5 mins.

Went to the hospital reception and asked for outpatients, was directed to a seperate building. Went there - what an idiot I am  - I am an inpatient, not outpatient - sent back to the main hospital - more panic.Am late!

Main hospital - all calm, told everything ok no rush. Thank god.

Taken by a lovely porter to my room within 5 mins of being in reception. Settled in and shown how to operate the TV - get the priorities right -:)

Catering staff arrived and gave me a menu to order my 3 course lunch !! ( OK small courses ) I ordered fan of melon, chicken sandwiches and a fruit salad with a pot of coffee. Could have done with a coffee right then.

Staff nurse came in and went through all the questions and history and other stuff. Put a wristband on me.

Consultant came in, lovely smile and manner - what a great guy - put me at ease straight away. So we could speed things up he was ready for me now! No time to dwell on it. Into the gown I went , slippers and dressing gown donned and with a theatre nurse I walked . We chatted away on the way down - she was obviously getting me relaxed as she knew I had never been a patient in hospital. ( The staff nurse later on remarked that I had done well to get to 52 years and not have to go into a hospital ).

Into the anti room , pause - loads of machines - door opens to the theatre and anesthetist appears and shaked my hand and welcomes me. They are all so nice. Two more theatre nurses and I am onto the operating table. No modesty here as I am bared for all to see and prep'd for the procedure.

Mt D. comes in and again with a reassuring smile starts chatting to me and we start. He starts to inject what I think is the topical anesthetic . He says it might sting a bit, to be honest it didnt and I told him I had had worse . I was more focused looking at the nurses with saline bags and the large TV screen in front of me. Mr D then put the device in and started to thread it into me. Wow, amazing, he gave me a running commentary of what I was seeing on the screen. He went down the uretha and stopped before he went into the bladder. He then asked me to do my pelvic muscle contraction - wow  -saw the bladder close. He said my contractions are perfect and strong. He also thinks after the main operation this will really help be achieve continence quickly.

Camera then went into the bladder and he had a good look around. He did notice reddening and slight inflamation. He asked if i had a problem passing water , I said I didnt and I suppose I dont , I just get on with it , like most men. He thinks I may have had or have slight Prostatitis. This wont impact the operation next week.

Camera is then withdrawn and its all over. While Mr D writes up his notes the nurses look after me. Wow, I now know what its like for a woman whose water break on the operating table. The table is soaked with the fluids they were putting through me. The floor is and so am I.

Mr D gives me a cheery goodbye and says he will see me tuesday. I am all smiling and happy  - considering what I have read about the procedure I have just had, I cant understand what people were moaning about - spinal blocks, generals - maybe I just had a great guy doing mine for me.

Back to the ward.

Cleaned up and got dressed. Mistake  - ECG's needed. Never mind, sorted it all.

Drank loads of water and had a coffee - staff were great. Woops pee needed  - method in their kindness - they needed the urine sample - gave em loads lol.

Blood tests - pathology nurse was fabulous, chatting away about everything  and explained about every sample. I have a good vein so it was so easy for her to put the needle in. Vial and Vial filled.

MRSA swabs done.

Lunchtime and dressed - more coffee.

Was about to leave and then we had more laughter - forgot that you actually have to be discharged from hospital, you cant just walk out. WOOPS. Back to my room.

Staff nurse then went through the discharge with me. We also talked about next week. She was great; as I didnt know what was going to happen she explained it all . Day by day. The big one was tuesday morning I would have a pre-assessment and I would see both my surgeon and the anesthetist . She also expained that I would have the open radical prostatectomy on tuesday and would not come back to the ward until about 11 am on the wednesday. From theatre on tuesday I would be taken to Intensive Care and stay there overnight being monitored and brought back to ward wednesday.

She thinks I will be there 7 days due to the operation I am having and also as I live so far away they prefare me to be clinically ok to have the catheter removed in hospital before I leave.

Went through lots of other stuff and then we said goodbye . She said she would see me tuesday.

What a day, time to go home. Am tired.

My room for the day today.

Below  - fruit salad - real fruit - not tinned

Lack of sleep

Having real problems at the moment sleeping. There is just so much going through my mind. I get tired during the day but its a different tiredness almost a depressive one. Then I don't sleep at night and I lie there thinking of everything that is going to happen.

They do say the waiting is the worse part of this disease.

Spoke to my GP yesterday and she was quite nice. She confirmed it would be OK to take a prescription from the hospital into surgery after my release and they would change it for an NHS one. Must take hospital release forms in as well. She also gave me the number for the district nurse team .

Keep getting all emotional and have to hold it all in. Blurted it out yesterday and it wasn't a good start to the day. No repeats today. Have to write a short will as I haven't got one. Need to sort this before next monday , I assume I can download something or pick a paper one up from Smiths.

Last day doing work today though working from home. Time to sort any email backlogs and say my work goodbyes for a week or so. Also need to phone loss adjusters over repairs to the house. They should have done the work by now. Will be just my luck that they start building work when I get out of hospital.