Sunday, April 10, 2016

Last Day as a Normal Person Before RP Surgery

YESTERDAY was my last normal day before radical prostatectomy tomorrow.
To celebrate the last day of an era... and remember/honor the kind of full normal life it was before, we decided to go first to the DC arboretum and fully soak in the vibes, before going to DC Costco for some final shopping. As it was, we also put in a quick early trip to Target to fill two more prescriptions, as I will explain. Life was 100% normal even today... until I got out of bed, and new orders went into effect.

By the way, I recently discussed this with a guy who ran all of DOD’s health programs around the world. He said: “Every man gets prostate cancer sooner or later, if he lives long enough.” So I will discuss a few lessons learned below.

These pictures were from the arboretum. The first is self-explanatory, and had an amusing resonance with my situation. I very much remember Luda’s laugh when she suddenly noticed the parallel. But the second was actually taken earlier. We would have wanted to say hello to the eagles at a high point we have often visited, which has a dramatic view of Capitol Hill through the trees, but the area was closed off with very strict warnings. As we stood on the azalea trail looking at the new fence and signs warning us to go no further, someone friendly came up from behind and quietly pointed. There, just behind us, was the male of the eagle family coming out to visit US.

Luda says that people call the nesting eagle couple “Mr. President” and “Mrs. President.” Should I add a caption to the picture, saying here is the new Mr. President... or just the new eagle father?

Beyond that, doctor’s orders are to do nothing really heavy today, just relax and amuse myself... and stick to the very specific preoperative regime. “Clear liquid diet.” Luda and I have debated just what that means. I even did a bit of web search, for example leading to an important technical paper:  

Luda I need to figure out better what this really tells us... but I get the impression that “clear liquid diet” is a kind of ancient mantra, that different operations call for different restrictions, and we don’t really know. For example, is dark grape juice OK or not? What about...? Until I reread the instructions for a third time, I will just assume the worst, and limit to water and broth. Yeshua ben David suggested I experiment more with water, and maybe this would be a good time. Even one of my more mundane physicist/brain university friends says he lived OK for a month on nothing but water in the Sinai, so why worry? But would more nutrients help in a serious way with healing?

No caffeine, no alcohol, no aspirin, not even vitamins – just for one day now. No problem, really.

I was very happy at the preoperative visit last week, with a nurse practitioner, to learn that 5-year survival rate for patients in my situation having this kind of operation (radical prostatectomy, RP, by robotic surgery) is over 99%. I had learned lots of stuff on the web (including journal articles) and read three books, but still learned new things from what she gave me last week, and from material my ex-wife was kind enough to give me yesterday. I learned the importance of exercising the WHOLE strip of kegel muscles all the way from the far back to the very tip, and learned that some papers saying it is only the “larger of two muscles, in back” to exercise was flat out wrong. (It is fortunate that our recent cruise encouraged exercise of both.) I learned that “natural fertility is now almost impossible in any case,” but that in all other respects the lilacs could fully come back in about a year. Also that I should not pay any mundane attention to that aspect for about four weeks now, because it is premature, and I need to focus almost entirely on the more immediate risk factors which need to be taken care of. Also, as the nurse practitioner advised, I visited, and downloaded the book.

For the next month ... it seems that the two most life-threatening risks are, in order: (1) blood clots in the leg, due to general immobility; and (2) infection. These are important for most major surgeries.

Luda says: “follow instructions, but don’t worry too much about (1). You didn’t even really know what a ‘charley horse’ is until a couple of years ago, and you certainly have exercised your legs a lot this month.” Sounds right to me. I remember ancient Red Cross lifeguard classes, where they said a lot about how to handle charley horse in the water, but it never meant much to me... until one night a few years ago, I felt... one day a lockup in my leg, and another day in a foot. I was worried, but Luda laughed and explained what to do. Massage some, gently put weight on it, get fluid, and then exercise it a bit to clear everything. It sounds as if the risk here is basically from more of the same, from more immobility and not enough water. Drinking lots of water should be no problem, or following the prescribed regime of 5 to 10 minutes walking every hour. “No prolonged sitting either on hard surfaces, or with legs dangling down. If you sit, sit in bed, or in that soft leather easy chair in your living room.” That sounds doable.

Infection... ex-wife (about to get her PhD finally in a medical area, after decades of experience) suggests they should have done more to emphasize what to do to prevent that, above and beyond the showers tonight, tomorrow morning at 5AM, and sometime on the day (Wednesday) after I return from the hospital (Tuesday).  The importance of keeping more parts of the catheter absolutely germ-free. The difficulty of properly instructing someone on narcotic painkillers just before discharge on all the important details. "Make sure they show you that injection system, and make sure they actually have you do it in the hospital." 

Lots of emphasis from everyone that in the first ten days (before the catheter is removed) that I really should take three medications every day and not wait for things to impel them: (1) dulcolax twice a day; (2) a prescription blood-thinning shot; (3) percocet, a narcotic pain killer. I chose not to fill the percocet prescription at first, because I have a real, deep horror of narcotic drugs, and mistrust of how they are being used. But after lots of pressure, reassurance, and arguments that my healing will be slower and more problematic if I don’t, I gave in, and we ran to Target/CVS to fill the prescription.  I am also a bit puzzled about the blood-thinner injection, since simple aspirin is also a blood thinner, but I suppose my liver may be working overtime with the other medicstions, and I will follow instructions in any case; no real problem. I also need to control my diet very firmly for a week, and less firmly for a month, and my level of exercise. (Essentially... none except walking, complex liquids management, and rare walking up stairs carrying nothing over 10 pounds.) They say people can go back to work in 4 weeks, usually, on average, but it varies from person to person. Even kegel is out until catheter is out.


And that’s all. I do begin to see interesting things in the cortical electrode data (from Jennie’s rats) I was starting to look at... but I may have troubles following up in a timely way with all these distractions...

Also, it hits me how my blood test (PSA) was not so scary, only 4, just a year ago, but spiked up suddenly not long after our trip to India last year, which certainly was hard on my digestive system both at the time and at a kind of time of revisit a couple of weeks later... I wonder.


  1. Paul, you're very brave to write about this procedure so directly, openly, and honestly. Best of luck with the surgery, and I look forward to your next post. -- Lucy McD

  2. Paul, you're very brave to write about this procedure so directly, openly, and honestly. Best of luck with the surgery, and I look forward to your next post. -- Lucy McD

  3. Thanks much, Lucy! Luda says I am a little bit too brave sometimes... but then she is braver than me for things like climbing up cliffs....