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Baileywick Sailboat Charters |
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John G. Bailey |
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A Prostate Cancer Survivor Story: da Vinci Robotic Surgery The following narrative is based on notes made during John’s progression from discovery of his high PSA score [6.8] to his recovery from removal of the prostate gland by Dr Jason Engel using the da Vinci robotic assisted procedure at George Washington University Hospital on July 22, 2008. This is a continuing story so if you want updates, check back periodically at this web page, email John at baileywickcoATcomcast.net, or call him at 410-326-3115.As you should know, males have prostates and as they age over 50 they become
candidates for cancer of the prostate. Most men who survive beyond 80 die of
some other disease but actually have been living with prostate cancer. I have
been having annual physical exams since my 50's. As part of the exam, the PSA
[prostate specific antigen] blood test is done. When it climbs above 5 it is a
warning to do more investigation. A digital rectal exam is also important as you
can 04/10/08: My general practitioner, Dr Charles Bennett, called with results of my recent PSA. The PSA had been running below 5 for many years but was now 6.8. He referred me to local urologist, Dr Shafquat Meraj. 04/28/08: Appointment with Dr Meraj for an examination and consultation. He scheduled me for biopsy of the prostate on 5/23/08. 05/23/08: Prostate biopsy by Dr Meraj. 8 am Fleets enema, 10:15 am Levaquin pill and do not urinate before biopsy. 11:15 am Dr Meraj took 12 samples for enlarged prostate biopsy. Sampling not painful but 2 hours later had pain in the butt, felt like mule had kicked me, but pain went away with activity. I did not take a pain killer as I did not have Tylenol at home, a non blood thinner. Have it in your medicine cabinet! I had blood and clots in my urine for a week, a normal occurrence. 06/09/08: Met with Dr Meraj: "Biopsy done on 5/23/08 showed very small amount of prostate cancer. Out of 12 samples, only one showed small amount. Bad news, you have prostate cancer. Good news, small amount, very early stage, very treatable, and slow growing. You are a very healthy 74 year old. Unlike many 74 year old men, you have no other serious health issues." Lab report on the biopsy: Specimen 2: Prostatic adenocarcinoma. Gleason score 7 (grades 3+4) noted in 1 out of 6 prostate core segments, approximately 10% of submitted tissue involved. Specimen 1: Prostatic intraepithelial neoplasia (PIN), High Grade. You can google any of these medical terms and get loads of information. Options: 1) remove whole prostate, 2) leave it but zap with radioactive seeds that stay in but decay away [as many as 100 seeds required due to large size of prostate], 3) zap it externally [6 to 7 weeks daily exposure], or 4) do nothing because I can live for 10 years before it kills me. He wants to treat me aggressively, surgically, to cure problem by removing prostate. He recommends da Vinci prostatectomy robotic surgery which is done through 5 small holes in abdomen. He asked that we [this is shared decision making with Donna] take time to think about it. "You will do well with any treatment option. A small percentage of treatments result in incontinence and/or ED." We googled subject and got loads of useful information to aid in the decision making. Note to all male readers over 50 years: I hope you are having PSA screening and digital rectal exam for prostate screening on an annual basis. If not, you should. Prostate cancer can pop up fast, without any obvious symptoms. Catching it early before it spreads is very important! 06/24/08: We met again with Dr Meraj for decision on what type of treatment and timing. At this point we were leaning towards the removal of the prostate by robotic surgery as much faster recovery, only 2-3 days in hospital, fewer side effects [no blood transfusion needed], etc. Operation would probably be at George Washington University Hospital using the da Vinci robotic system. I asked to wait until November for the operation due to our personal schedule but DrMeraj nixed that and wants it done without delay. I contacted Dr Jason Engel’s office and got a consultation appointment for the next day! A video of a robotic assisted prostatectomy operation is at http://www.dcurology.net/robotic/index.htmlhttp://www.dcurology.net/robotic/index.html.. In this video, the surgeon and narrator is Dr Jason Engel who did my operation.06/25/08: Met with Dr Jason Engel [Urologic Surgeons of Wash, 2021 K St NW, #408, Wash DC 20006, 202-223-1024, www.dcurology.net]. We brought the pathology report. We liked him. He has a wonderful sense of humor and is well experienced with about 1000 operations done by da Vinci. He said "Only because of my good health am I candidate for surgery at age 74." I was scheduled for da Vinci robotic prostate surgery on 7/16/08.07/16/2008: Arrived at George Washington Hospital in Washington, DC, at requested 6:30 am for 8:30 am operation. No food from the previous day and drinking a gallon of "Trilyte" to cleanse the bowel was not fun, but not a big deal either. A good friend drove us up at 5 am to NW Washington, DC, dropped us off, and also picked us up the next day. We got home the next day about 7:30 pm. Having a GPS StreetPilot device was important to navigate a city we seldom visit. Having a spouse to stay with me, I found important. It is another pair of eyes and ears and assistance with small task. However, the rooms should include some type of reclining chair. Donna sleeping in a regular chair overnight was real love! I am amazed at the lack of pain associated with this whole operation. My main discomfort was the hospital bed and the constant alarms out in the hall from an intravenous machine not being used but alarm mode. I believe the staff become insensitive to these irritating sounds. The operation was about 3 hours long. There were no complications. I have four small holes and a larger one at the navel that will quickly heal [see the photo]. The larger one at the navel is where I believe the prostate, in a robotic bag, was removed. Recovery time back to normal is less than two weeks. I am supposed to walk a lot, not be a couch potato during the day, not lift heavy loads, and not "chop wood." All males over 50 years of age should have a PSA test done as part of their annual physical. That is how my cancer was caught at an early stage. In a week [7/22/08 appointment] I will know the results of the detailed biopsy of the removed prostrate. The real clincher will be if the PSA test value goes to zero within three months [10/23/08 appointment]!
07/23/08: One week post operation. This is the day after removal of the catheter. It was in place for six days. No urine leakage occurred overnight. However, this morning, I am leaking only on getting up from a chair or coughing. I found the Depend "Shields" overkill [cost ~$0.50 each], and switched to Depend "Guards for Men" [adhesive inserts for skivvy shorts at half the cost]. There are other similar brands at even lower cost. This afternoon, I had my first success getting out of my computer chair and going to the bathroom without leaking on the way. Doing Kegel [you women reading this will know all about Kegel] muscle exercises will reduce the time to continence recovery. I am told to expect up to three months for full control based on results from da Vinci robotic surgery and an individuals skills at mastering the Kegel. One concern I had for a week or so after the operation was my scrotum swelled up so my penis appeared to be missing. This is normal and it has reappeared! 07/24/08: I am doing household projects without any difficulty or pain. I am not even aware I am wearing an absorbent pad. I have been trying to think and do Kegel exercises often. If kept in mind and done whenever you expect leakage, I often can avoid leakage until emptying the bladder. Donna says I am not doing it correctly but I am trying. 07/29/08: Nearly two weeks post operation. I am now subconsciously in the Kegel mode most of the time. I am experimenting with emptying my bladder more often, about every 30 minutes, during the day to see if I can avoid leakage. I have been using about 4 pads per 24 hours. However, the pads are so good you could get by with only 2 pads per day. I have not had a pad leak yet. Knowing you are leaking into a pad can be a little psychological downer. Don’t let it get to you! On the positive side, the pads do give you a more enhanced look in your jockey shorts, like you are better endowed! 08/20/08: Glory, glory, my exterior plumbing leak seems to be slowing! I am down to one Depend Guards for Men pad per day. This is about on schedule [~1 per day]. However, it will be months before I am willing to abandon a protecting pad. 10/23/08: This was the three month follow up appointment with Dr Jason Engel for PSA test and analysis. The analysis was done in his office so I got ‘instant gratification’. The result was a level of "0" indicating all prostate tissue was removed. However, PSA tests are to be done every 3 months for a year. I was advised to stop wearing absorbent pads and that there could be some leakage but this would help my training with effective feedback! The pads are gone and all is well. Looks like I may die of just old age now!
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