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PART 22 of My PC Adventure: full story HERE>

Bus2

I now catch the bus.

So! A lot of people do, every day, no big deal. Wellington is a commuter city, with an excellent public transport system (although the trains aren’t so good, I hear).

So what’s with the bus? And what’s this got to do with prostate cancer?

Bear with me. First, a little background on my family: the Tuckers are car people.

My father boasted he owned 59 cars in his life (not all at once, thank goodness). He had every post-War Citroen up to the DS19, an exotic spaceship that turned heads when he got the first one in our town in 1958.

ChevI suspect he compensated for short physical stature with his cars. The sight of him in his 1965 Chev Impala! It was a Yank tank with an underpowered V8, but oh the size of the thing.

My brother drives a Range Rover and a BMW, and happily pays $700 for one new tyre (well, not quite so ecstatically while there’s a recession).

mgMy life’s ambition at 19 was to own an MG sports car. I had it by 20, fire engine red with white-wall tyres.

But after a year I couldn’t tell if the young women who rode in it were loving the vehicle or me. The car, I suspect. An astute female friend called it my “big red penis” car. If only…

Life did not take on new meaning because of the MG, so over time I downgraded. I discovered that women, oddly, aren’t that impressed by cars.

Micra12Now it’s a Nissan Micra, whose only downside is causing offence to men in grown-up SUVs if I pass them on the motorway or drive in the fast lane.

Even so, we male Tuckers don’t bus. Ever. It’s not, well, manly.

I trammed to school as a little kid, but biked as soon as my legs could reach the pedals of a two-wheeler. It had a speedo, saddlebags and a whippy aerial (no wonder I was bullied).

MiniI had my driver’s licence at 15, to drive mum’s humiliating Morris Minor, admittedly, but then it was quickly on to a hot Mini with fat feet, twin carbs and overhead sliding sumps.

After that, never the bus. Buses were for other people, ones who make up the numbers. There’s no freedom in a bus. Standing on the side of the street in the rain, looking resentfully at single-occupant cars going to work. What is it with that, the resentment?

So, now, the bus.

Where have I been all these years?

marsOn Mars, perhaps, as was suggested none-too-politely by a grumpy bus driver when I first tried a bus and didn’t grasp that there are sections and zones and you have to know where you’re going, and putting money in the dish thingie and walking off to find a seat is not completing the full transaction.

“So, where are you going?” this first occasion elicited from the driver.

Me: “Um, doesn’t this bus go into town?”

“Yes, and then on as far as Wilton. How far are you going? How many sections?”

“Sections…well, town, of course. Why?”

“I have to issue a ticket.”

“I didn’t know that.”

“Which planet are you from – Mars?”

“I don’t appreciate the sarcasm.”

“Huh. You should try doing this job. You wouldn’t last a day. We’re short of drivers, about 30 short. Why don’t you apply, see how long you last.” And more.

He then drove like a maniac around our precipitous and narrow streets, just missing a couple of cars, muttering about how the country had gone to the dogs.

This was another reason why I should never bus, I decided. We were, after all, just following city council advice to leave cars at home because half the central city was closed off for a street carnival and a Harley Davidson rally.

Never again.

busBut, yes, again.

And I’ve got to tell you – I was wrong, wrong, wrong about the bus.

The bus, I’ve discovered late in life, is a plush, comfortable, insulated, calm place where you can sit back, catch up on the day’s missed phone messages and texts, read, daydream, look at people, watch the view, think about nothing.

air hornAnd avoid stress.

The bus is a far less stressful mode of getting home from work in the 5 o’clock rush.

No more barely contained road rage, exasperation at the stupidly of every other driver.

suvOr blasting wayward cyclists and pedestrians with the Italian air horn I was forced to install in the toy car because of the SUV bullies.

Or dodging protruding cars badly parked in narrow streets.

magic_roundabout_2Or death-defying lane changes enforced by traffic engineers whose idea of traffic light design is as chaotic as an English roundabout.

And you can listen to the bus driver’s radio communications with base as other drivers describe their crashes and coming forward as witnesses for one another because “that guy cut right in front of you, Dennis. Saw it plain as day.”

And you’re dropped off right at your door. Like a massive taxi.

200px-SnapperCardAnd if you buy one of the electronic tickets (mysteriously called a Snapper Card), you avoid the interrogation that seems to come with a cash transaction.

The machine growls at you (“don’t forget to log off”), but after a couple of trips you know what it’s going to say, and that it will say this to everybody. Nothing personal.

There are a few downsides, admittedly.

Buses don’t keep to the timetable. Or, presumably in an effort to do just that, they pull up a street short of your stop and the driver announces that he will be resting there for six minutes.

The bus you’re after will often be pulling away from the stop while you watch from the other side of the street, trapped by a pedestrian light that’s red so your bus can leave without you.

The numbers are hard to read on some buses. The one I catch is one of them.

While every other route has a bus with a giant illuminated number that can be read a kilometre away, my Number 14 is indiscernible until its upon you. Which is a problem when it pulls up at the far end of a big line of other buses at the city bus stop where I catch it.Bus 3

And there is a kind of subtle community living in buses. They are people in the know. They know the bus driver and address him/her by first name. They spread themselves out on a double seat to ensure nobody else can sit beside them.

They nod to their fellow community members, talk little and in code, look vacant but grim, and resent a newbie who is, so far, as open to this new life experience as a first day student on a gnome-painting course. I will learn from them, I know.

But to the point: this is all part of my new, post-cancer surgery existence, an adjusted life that involves less stress (no more road rage), more vegetables and fruit (no more ham sandwiches from Mr Bun eaten over the keyboard), less red meat (more hormone-crammed chicken and mercury-laden fish), more exercise.

catnapGoing back to work has, of course, been stressful (no more cat naps in the afternoon), but things have started to settle back into a manageable routine.

It helps that in order to catch a bus before they’re crammed in the rush hour, I try to leave work just before 5pm, as opposed to the old 6pm.

I’m also being cosseted at home. Lin has lost her government job, but is enjoying some time off, which means I’m temporarily off the chef roster (and the washing, and toilet cleaning roster, as well).

I’ve also learned not to rush rehab. It’s taken all of the nearly three months since the prostatectomy to rid the lower abdomen of sensitivity to tighter clothing, to fully adopt the Billy Connelly advice “if you get a chance to have a pee, take it”, and to let nature take its course when it comes to the intimate stuff.

buslaneSoreness after that was also a problem for a while. The medics urge almost instant rehab, within three weeks of the op, but although I’m sure that’s based on sound research, it seems to me that rushing to try out equipment that’s had a helluva rough ride can be less than productive.

Meantime, it’s life in the bus lane for me.

I’ll never again swear at a bus stopped with its rear end sticking out into the traffic and holding up us, sorry you, motorists.

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JUNE 12: NEW PROSTATE CANCER INFOLINK: Appreciating the value of penile rehabilitation requires understanding five concepts: the pathophysiology of erectile dysfunction after radical prostatectomy, cavernosal oxygenation, venous leak, and both the animal and human data supporting this strategy. READ MORE>

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JUNE 12: URO TODAY: A study has been done on whether the risk of death is associated with the time to testosterone recovery (TTR) after radiotherapy (RT) and hormonal therapy (HT) for prostate cancer (PCa). The results show that a longer TTR after RT plus 6 months of HT for unfavourable-risk PCa is associated with a lower risk of death in men with no or minimal co-morbidity. READ MORE>

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JUNE 1: NEW YORK TIMES:  “My goal last fall was to recover from surgery for prostate cancer and to slog through radiation and hormone therapy. My goal this fall is to run a marathon,” writes journalist Dana Jennings. “In the last year, my body has belonged to urologists and insurers, surgeons and oncologists, nurses and radiation therapists. It belonged to my cancer. By running again, I’m reclaiming ownership of my body.” READ MORE>

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MAY 25: NEW PROSTATE CANCER INFO-LINK:  A group of German researchers has developed a method to predict the duration of urinary incontinence after radical prostatectomy based on potential risk factors. READ MORE>

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MAY 14: MARKET WATCH:  The latest science-based guidelines on nutrition and exercise as they relate to prostate health and cancer prevention are now available in a new publication from the US Prostate Cancer Foundation. The guide, Nutrition, Exercise and Prostate Cancer, is available in electronic form on the foundation’s website, www.pcf.org. Individuals can also order a printed copy of the booklet online. READ MORE>

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MAY 14: JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION:  A diet and exercise regime reduced the rate of self-reported functional decline (compared with no intervention) among older, long-term survivors of colorectal, breast, and prostate cancer, says a new US report.    READ MORE>

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PART 18 of My (Our) PC Adventure:  see the full story HERE>

lin01By LIN TUCKER

A few of weeks before Christmas, 2008, a very worried Jim told me that our GP had found some roughness when performing a digital examination of his prostate.

He’s the family worrier, so I went into reassurance mode with comforting words such as “found something early”, “stats in your favour”.

I must internalise worry, because no alarm bells rang: maybe it’s the two years of nursing training I did, so I understand the odds are usually in the patient’s favour.

Besides, Jim has had regular checks and his PSA reading was never high. Well, that’s what we thought then.

Fast forward to Christmas Eve: my niece from Canada has arrived to spend Christmas with us. Jim says he still hasn’t heard about his biopsy test results. I say “no news is probably good news. However, if you’re concerned, why don’t you call the surgery.”

He calls, and the nurse says yes, the results are back, but you will need the doctor to interpret them. A small tingle replaces the former insouciance I have been feeling.

Some time later, the doctor hasn’t called back, so Jim phones him and is told that the tests show cancer cells present, but the situation is not considered so urgent that it couldn’t have waited until after Xmas. An appointment will be made for him to see a urologist.

The cancer word is a bit scary, although Christmas and a vacation with an old nursing friend are enough to keep my mind from dwelling too long on any worst-case scenarios.

Jim doesn’t follow the accepted male ideology that you ignore symptoms; he is not shy about getting medical advice and for this I’m grateful. It means that as a partner I’m fully informed about the options, as – being a journalist – he will have done exhaustive research.

Knowledge is powerful as a tool for my peace of mind. If I can rationalise, I can cope.

I took him to the hospital for the biopsy prior to Xmas. Although the procedure is not entirely pleasant, Jim didn’t find it too much of an ordeal. But after the effects of the biopsy, which was quite invasive, he needed a bit of looking after.

Jim made another visit to the urologist just after New Year and returned with material to read and view, and a request to discuss it with me and make a decision about treatment.

At the end of January, I go with him for the treatment consultation. The urologist is young enough to be up-to-date, but old enough to have some gravitas, which is very comforting.
 
We’re informed that three of the 12 samples have shown cancer. On the positive side the cancer is not of an aggressive nature. 

The urologist mentions “margins”, where the cancer cells might have migrated to the surface of the prostate and affected other tissue. Not quite so straight-forward after all.

On balance, though, things are more favourable than not; I tend to concentrate on the positive.

Right from the beginning, Jim is keen on having a radical prostatectomy rather than brachytherapy. I’m a little worried that he’s making the decision on a cost basis, but the literature seems to lean that way. The urologist says he is a good candidate for surgery.

Jim can have the operation done at the public hospital by the same urologist, so we wait for a date. Hospital surgery waiting lists vary and Jim is hoping it will work out during his between journalism courses, a break when he can have plenty of recovery time.

His wish is granted – March 25, the day before his students graduate – oh well. 

By now we’re in early March and I’m given the “realignment” news at work. I’m numb: another team has also been disestablished. Work is a flurry of shock, questions, and a couple of weeks’ consultation period.

The following weekend, we’re off to New Plymouth to enjoy the wedding of Jim’s niece, Jaclyn. It should be a wonderful weekend catching up with his nephew’s newish son, family and friends and getting our minds off the pending surgery and redundancy.

The operation itself doesn’t worry me unduly. However, the risks of anaesthetic are very real and I’m feeling some disquiet, while trying not to show it.

The wedding day is wonderful, perfect even. The weather shines, the venue is fabulous, the bride’s mother and father behave well (their rift is still somewhat raw). Tensions are non-existent. Jacs is marrying an Australian and he has plenty of family and friends for support. The speeches are hilarious and heartfelt. The bride’s sister, Philly, makes a very warm and loving speech to her big sister. We leave at 11pm and they’re all dancing up a storm.

Next morning, we’re sleeping in when we’re woken with a message that Rob is trying to get hold of us: some accident…Philly’s seriously ill in hospital. We get to the hospital and find she is in an induced coma and they have called a helicopter to take her to Wellington, but they need to carry out emergency intervention!

We try to console each other, joined now in a wave of horror equal to the joy of the day before. It is all surreal. We take Rob’s wife home and keep busy with household chores, when we’re called to say the outcome is not good. We rush back to the hospital.

I stay outside minding the young ones, who are moving quickly into shock, recalling the morning’s events of hearing screams, Philly on the floor of the unit, having apparently fallen from the balcony above.

About 2pm, she is pronounced dead and we go back to Rob’s to prepare for the coming funeral in four days. The Aussies and guests silently file back to what was going to be a post-wedding friendly international cricket match. Instead, the wake starts.

The family tensions buried for the wedding quickly resurface under the stress. The estranged fiancé and his family are also in the mix; it’s not pretty. Eventually, we farewell the yellow coffin.

Due to the funeral, Jim has to change his pre-op check date, hoping he will not lose his place in the operation queue. I am hoping for this, too, as I don’t think I can stand any more waiting to get his situation resolved.

Away from the funeral-wedding, we start to prepare mentally and physically for the operation. When we go to town he walks home to Hataitai over Mt Victoria to get fit. I’m unable to concentrate much at work. 

Jim and I head for Wellington Hospital at 6.45am on Wednesday, March 25. He has a bag packed with PJs, clothes and toilet gear. We spend an hour or so in a small room with no windows where he changes into the sexy nightgown, socks and hat. No need for the contents of the bag – I take it home. Nobody gives clear instructions that you will spend the small time in hospital in their gear and won’t need clothes until you are discharged. 

A number of staff come in with their various checklists and tick off all the boxes, some for a second or third time. Part of me is glad they are being so careful and another part is just screaming “get on with it”.

We are then escorted up to pre-op, where he is put in a bed. More checks and a visit from the surgeon. I’m relieved when he promises to call me after the op, which should take three to four hours.

I wave Jim through the doors and set off home. We live only about five minutes away, and there’s no point hanging around the corridors.

I had intended to go into work, but there’s no point: my mind is mush. I go home and wait. About noon, one of Jim’s work colleagues calls. I tell her no news yet.

At 12:25pm, the urologist calls…relief, all went well and looks good. I figure that is code for no obvious signs of marginal cancer cells…hope I’m right. I let out my breath.

I have Jim’s cellphone, so I text all and sundry, call close family, and head back to the hospital about 3pm. It’s going to cost a fortune in parking fees.

He’s sitting up in bed looking morphine-sleepy. I don’t stay long, leave money for a morning paper, his cellphone with all the incoming well-wishing messages. It was good to touch him and know he’s okay

Next day, I come back at about 10am when visiting starts. He’s had a reasonable night, aside from bringing up the jelly he tried for dinner. We visit until lunch, then I leave. I go back to tuck him in late afternoon.

That night wasn’t quite so good, bit of pain. Next day it’s up and showering, the drain having been removed. He may come home tomorrow.

Yes, after the night from hell (including him wrenching the catheter tube out and wetting the bed thoroughly), having been moved from the “must-be-watched-closely cubicle” across from the nurses station to one around the corner, he is happy to be coming home.

Eventually we’re allowed to take him, and his spares home. I drive carefully, but Newtown roads are not in good shape. You would think streets and roads around a major hospital would be smooth.

At home, Jim is doing well and the first night we attach the extra catheter bag for the night and all goes smoothly.

We are lulled into a sense of false security. The next night, the valve joining the bags doesn’t work, so I’m changing a wet bed at about 3am. The following night I get to change it twice. Finally we get it right.

He gets the catheter out after six days. This process is very interesting, as this is a teaching hospital and I learn a lot. I take JT home with his “pad”. I’ve purchased a “dry sheet” for any accidents: I’m too old to be changing beds in the early hours of the morning. I sleep patchily as it is.

At work on Friday I get a call from JT at 3pm. He sounds in severe pain: “Come home, please. I need to go to A & E.” I make the fastest trip home. On the way to the hospital, he tells me how he came to be in that state. Feeling chipper he found that he was getting some penile action, so he tested it to the point of orgasm, which caused muscle spasm of the acute variety.

Oh no, I thought. I hope this doesn’t put his recovery back at all.

ED do their thing with so much pain relief an elephant would be downed. Then he’s finally able to pee and the pain stops. He can go home.

But this is not to be the last of his tribulation. That night he has trouble peeing and at 3am I get the car out of the garage (why do all these things happen at this hour) for another trip to hospital. Sorry darling, but I’m just so tired.

But then he passes a massive clot. Much relief, more mess, but the pain is over, and recovery resumes. 

Eventually, the blood in the urine passes, and normality (whatever that is) returns. 

Each day I come home, JT looks and seems to feel better. I am so enjoying his recovery. So far, so good.

NEXT: Spreading the news.

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PART 16 of My PC Adventure (read full story HERE>)

Freud said that in the end everything comes down to one thing – sex.

He was right, if you look at the way this story is ending up. To be more precise – at the Erectile Dysfunction or Impotence Clinic (I prefer the first – sounds more optimistic).

So far, my recovery has been orderly, on target and highly encouraging, but there remains this question about erections.

The question is more in my mind than that of the people treating me, who are strongly urging an early course of rehab treatment.

That’s because the sooner it’s started, the better the likely results. Put another way: “If you don’t use it, you’ll lose it.”

My doubt has arisen over the experiment I tried 10 days after the surgery, and the ghastly result (see Part 14: A hand too far...). I find it difficult to contemplate going through that again.

However, the signs are actually good.

I don’t appear to have suffered permanent damage, there’s no blood anywhere, I’m getting the occasional nocturnal/early morning spontaneous erection, and with a bit of mental effort and careful massage, the same result – with about 90% function – can be achieved.

So, a month after the radical prostatectomy, off I go to the clinic to find out more.

The nurse/manager is someone I knew 40 years ago when we were youngsters growing up in the same town, so a bit of time is spent catching up.

That eases any tension or embarrassment, not that I actually feel any, to my surprise.

Right. Down to business. It consists of the nurse taking me through the various options, which begin with prescription drugs.

The one the clinic prefers is tadalafil (Cialis),  mainly because its effects last longer.

Here’s what the clinic website says:

Oral phosphodiesterase type-5 inhibitors (PDE5 inhibitors) such as Viagra, Cialis and Levitra are first line therapy for ED.

The efficacy of sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are very similar. Because efficacy is very similar amongst the three agents, side effects and time-to-onset will be the main distinguishing factors.

Viagra and Levitra feature rapid-onset of action, whereas Cialis has a long window of opportunity for use.

Maximum levels in the bloodstream are reached within 45 minutes with Levitra, an hour and 10 minutes with Viagra, and 2 hours with Cialis. Conversely, the half-life of Viagra is 4 hours, for vardenafil 4 to 5 hours, and for Cialis 17 to 21 hours.

cialislargeApparently, the oral drugs aren’t particularly effective in prostatectomy rehab.

But since the other options look far more challenging, I guess we all want to start with something as simple as popping a pill.

I’m given a couple of samples to try at the appropriate time.

By the way, when is that? Is intercourse okay? Yes, absolutely.

Oh. I’d read a comment on a US discussion group in which a surgery patient was told to encourage erections by all means, but not to touch for about three months.

The nurse is surprised. Hasn’t heard that. I think I’ll go with her advice, and make a note to treat the comments of fellow travellers, well-meaning though they be, with some caution.

Next, we talk about something that makes the boys cringe just at the mere mention: injections. And not just injections, but self-administered ones.

However, it’s not as bad as I imagined, I think, as we go through it (although that judgement will be made if/when I try it).

The needles are very tiny and they are meant to go into the flesh on either side of the member, not blood vessels (so we steer away from the top or bottom).

The drugs recommended by the clinic are Papaverine and Phentolamine. A third, prostaglandin, apparently causes a bit of temporary pain after it’s injected, so we don’t go there in my case.

I’m given what is informally dubbed a starter pack, two week’s supply of Papaverine/Regitine - three pre-filled syringes to inject each week.

The nurse takes me through the injection procedure, including warnings. For instance, if blood appears in the head of the syringe I’ll know I’ve hit a blood vessel and should withdraw and try again.

The needle goes in either side, between the base and half way along (I won’t say “up”, because we’re not there yet). That way, stiffness is induced near the base, which is where you need it, obviously.

You need to vary your target so as not to cause scar tissue.

The biggest thing that can go wrong, it seems, is that old adolescent affliction I referred to earlier, clumsily, as “lover’s balls” – priapism.

This is the erection staying up there for four hours or more, instead of the hour or two that’s intended.

The nurse has had only one such case in years, so that’s encouraging. But if it happens, you need to head for A and E and get them to give an antidote, as well as drain off the “old” blood. Gulp.

Okay, what else?

vacuum-deviceThere’s the vacuum pump, which is used to literally suck the penis into shape.

The clinic has a couple and it can lend one to me, if I want to try, or I can head for an adult shop and buy one.

I daren’t ask why they sell them, but I suppose I can guess. 

Ones in the sex shops are as cheap as $80, while the top of the range ones like the clinic owns cost nearly $700.

inflatable-penile-prosthesisFailing all else, there are operations to fit an implant or an inflatable prosthesis.

I’m far too squeamish to think about them.

So what do I want to do?

I pick up the pills and syringes and promise to go home and consult, and think about it.

From what I’ve described about my current condition, she says it’s possible I won’t need anything.

But I need to think carefully about it: if it becomes apparent I need more help and the pills aren’t enough, I will have to seriously consider the injections. If I decide against them now, it might be too late a year down the track.

How long would I need to use them? A year to 18 months. Hmmm.

I have read in my web-searches that spontaneous nocturnal erections are important for penile health. So that alone, from a purely selfish perspective, means I need to take this aspect of my recovery seriously.

Hanging up my boots may not be an option.

I’m not sure if I’m going to let you know how I get on. Perhaps there is, after all, a limit to my self-inflicted  privacy intrusion, and it’s not just my privacy that’s involved from here on.

NEXT: My prognosis.

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CANCER CONSULTANTS.COM: Men who received two sessions of stress management before undergoing radical prostatectomy for early-stage prostate cancer reported fewer mood problems before surgery and better quality of life after surgery than men who received usual care, according to the results of a study published in the Journal of Clinical Oncology. READ MORE>

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