Brachytherapy takes off in Wellington – or does it?

PROSTABLOG NZ: This story and picture in today’s Dominion-Post newspaper shows how poor media coverage is on the topic of prostate cancer.

It suggests that brachytherapy radiation treatment – largely available only at a private clinic in Tauranga for about $30,000 – is now fully available to the public at Wellington Hospital.

Is it? The story doesn’t really explain. What kind of brachytherapy are we talking about here?

Hopefully, someone can enlighten us…

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And then there’s a mate who truly loves his catheter – after having it, voluntarily, for more than a year

ME and my catheter.

PROSTABLOG NZ: More on catheters.

An English industrial design student called Sam Gough has been in touch to ask if he can use my account of having a catheter after surgery last March (see Comments).

Sam is researching medical equipment and is interested in the catheter.

If any of you have stories to tell about this indispensable – but seemingly at times devilish – piece of kit, please contact him at: samgough23@hotmail.com

I recounted a couple of negative anecdotes about catheters in last night’s blog, so perhaps I need to balance it with others that aren’t quite so downside.

One mate who went through radical prostatectomy a year before I did said it was a handy bit of gear: “You could go to the pub and just piss the beer straight through.”

He was surely joking, and it was probably just an attempt to allay my fears.

Another said: “Ah, the catheter…you’ll grow to love your catheter.” More irony, I guess.

Barry Young, president of the NZ Prostate Cancer Foundation told me that when he was recovering from surgery 10 years ago he had his catheter removed after a week or so, as you do, but then had recurring incidents of not being able to pee.

It would happen at the most inopportune times, so he had to learn to insert a catheter tube on himself.

Imagine that! After all, for some of us, the damned thing is put in place when we’re under anaesthetic, so we can only look and marvel later at how such a bloody big thick piece of tubing can be introduced to what you always imagine is a such narrow space.

Incidentally, Barry had the problem only temporarily. He has been fully recovered for 10 years, and probably – like all good boaties who suffer hell in a storm then quickly forget about it in the safe haven of harbour – now has trouble remembering the details. Maybe not.

The growing-to-love-your-catheter comment came back to haunt me straight after my surgery, when Bob Hale, the highly professional urology nurse at Wellington Hospital, came to see me in the recovery ward.

I made a gauche comment about “loving my catheter” and he looked at me sternly: “Having a catheter is one of the most uncomfortable experiences a man can have,” he said.

Bob turned out to be anything but stern. He was the one who took the tube out later and he did such a great job I felt no discomfort at all.

One more catheter anecdote: I have an old friend who, nearing 80, was admitted to Auckland Hospital with urinary problems and was discovered to have a very enlarged prostate. He had a catheter inserted for temporary relief and surgery was advised.

His response: no way. And he still has the catheter – a year later.

He truly loves his catheter.

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Wellington gets high dose brachytherapy unit to boost radiation treatment for prostate cancer

DOMINION POST: Prostate cancer patients are being offered faster, more targeted and more effective treatment with the introduction of a high-dose radiation therapy at Wellington Hospital.

The technique, “high-dose-rate brachytherapy” uses small plastic tubes placed into the prostate and irradiating it from inside.

It will cut radiation treatment from seven to four weeks and is especially effective for advanced cases.

Waikato Hospital is the only other NZ centre to use the technique. READ MORE>

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MY PROSTATE STORY: End of the golden weather (not what you think)

PART 21 of My PC Adventure – see full story HERE>

The headline for this – the penultimate chapter of my prostate story – isn’t what it seems.

It’s not a goodbye, nor a resignation to impending death, nor a signal I’m giving in to the vicissitudes of age.

It’s a metaphor, of course, drawn from a famous NZ play by that name ( The End of the Golden Weather  by Bruce Mason ) which spoke to my boyhood of  “…the eternal optimism of the child and the harsh certainty of age…”

To quote one tribute to Mason’s 1959 work:

“Golden Weather tells the story of the loss of innocence and of human fallibility…”

The end of my golden weather refers, in part, to the “official”  finish of my recovery from the surgery that took out the prostate cancer, a two-month idyll during which I’ve researched and written about prostate cancer in this forum, which began as a personal blog and has grown to a website with a following around the world.

(That’s one reason, incidentally, why I have explained “end of the golden weather” – now two of five visitors to this site are from the US. The proportion of Kiwi readers is about one in three).

In this case, “end of the golden weather” also has a literal meaning, since my time at home has been blessed with a remarkable (for Wellington) patch of fine, still weather, an “Indian summer“.

In the last few days, winter has roared in from the Antarctic, bringing snow to the South Island and to hills around Wellington.

Rain hits the windows on the southerly side of the house as I write this, and I know the days of teeshirts and sunhats are over for a while.

Tomorrow, I return to work. Truly, the end of the golden weather, but in fact something well overdue if I am to feel fully restored.

Which is what I want to write about: how do I feel about what’s happened (that classically banal and inappropriate journalistic question)?

Perhaps I should begin with what I don’t feel.

I don’t feel old. At 62, the body and mind are in the kind of shape my parents’ generation, the Depression and war-shaped cohort, associated with their 40s. My mindset accords with that silly epithet, “60 is the new 40”.

I am getting old, of course, but cancer has had no obvious role in that gradual process.

It didn’t turn my beard white, steal the hair from the top of my head, slow up my legs in social soccer games, nor account for loss of memory for people’s names after we’ve just been introduced, nor the keeping to speed limits, and restricting of booze intake to a Heinie a day, and the working day hours to no more than a dozen.

All those things have been creeping up since I was 30.

I don’t feel debilitated. I’m back to the fitness I enjoyed prior to the operation in March, easily able to walk briskly over my personal training challenge, Wellington’s Mt Victoria.

These pictures show the 151 steps I climb on the route to the top, and a view from that top after my first post-surgery ascent, about six weeks after the operation:

As I rather over-excitedly reported in an earlier chapter, my urinal turn-around time is reduced to that of a youngster.

I have no major problems with incontinence – just a little drip of a leak sometimes when I’m tired and forget to brace the pelvic muscle when I laugh or cough.

And the big one – suffice to say, that’s not a problem either, without the use of Cialis or the dreaded injections. Bang goes my excuse to browse in the adult shops for a cheap pump.

I don’t feel apprehensive. I’ve got cancer, but we got it early, it would seem, and it was slow-growing – Gleason grade 6 (I’m now thinking it was there for years before my GP, bless him, encountered it with his digit).

It hadn’t migrated out of the prostate, and prior to the operation my PSA was a mere .77.

I’m a little less sanguine about the “let’s cut the bastard out and be done with it” mindset I had early on, because research tells me there’s never any guarantee that something microscopic didn’t escape into my system during the op, or even during the biopsy. Highly unlikely…but possible.

I expect when my PSA is tested in August I’ll show the required nil level, but I’ve also read data which shows it might rise again after a couple of years. I need to show nil PSA for a decade before I can possible say I’m cured.

But something has changed. Ever so subtly.

It can only be described as an odd sense of betrayal. My body – until now more or less organically sound – has finally let me down in a most shocking way.

Okay, I’ve had marginally elevated cholesterol since 1991, but there is still medical disagreement about what that actually means. And I take a light dosage of blood pressure medication for something that runs in the family.

Neither of these has felt anything other than a mild indication of getting through the years towards maturity.

But cancer! That’s systems failure. That’s involved the first major invasion of my body, leaving a scar (physical and mental), and thoughts – which will no doubt recede – of organic deterioration, of a hurrying of the first steps towards the grave.

Sound morbid?

It does, doesn’t it, but actually it’s not something I’m dwelling on in a neurotic way. It emerges merely as one of the more philosophical after-effects of a mortal event, a reminder that, yes, there is death at the end of the journey, and there’s no way to dodge it.

It doesn’t affect my optimistic view of life in the slightest.

I come from a line of long-livers. My great grand-father died in his baker’s shop in London at the age of 99. My grandfather lived to 84, and my father convinced himself he would go at the same age, so did. On my mother’s side (she lived to 80), there was grandma lasting till 94 and grandfather going to 86. We don’t pop off early in my family.

Age expectation is a tricky calculation, incidentally. One of the interesting things in Michael Dattoli’s new prostate cancer book (reviewed recently on this blogsite) is a reminder that average longevity calculated at birth (about 78 for male Kiwis) is way shorter than that enjoyed by someone at 60 and beyond.

This chart from the Dattoli book shows what I mean:

This is important in the debate about population-based prostate screening. One of the arguments against it (and against surgical treatment after about 75) is the thesis that because many tumours are slow-growing, something else will getya before the prostate.

As age expectation rises significantly once you’ve reached 60 (compared with what you started out with, when accidents and other factors are probably much more influential), so presumably does the point at which “watchful waiting” should apply.

My life expectation in terms of surviving prostate cancer is also being extended as we speak by the massive effort by scientists and doctors – in the US especially – to achieve breakthroughs in testing, diagnosis and treatment.

Any time soon they’re going to find a quick, non-invasive method of helping the medics know how bad the cancer is and how (or if) it should be treated.

This is undoubtedly an effect of the great surge into old age of my generation, the baby boomers, with our more positive attitude to aging and our demands (and wherewithal to pay) for better medical options.

So. How am I feeling?

Bloody good, bloody lucky, bloody optimistic.

Even so, I will be taking a few precautions.

The number of red meat meals will be dropped from four or five a week to one or two, the already fat-free diet will be applied even more rigorously, the brisk walks will be taken even more regularly, stress at work will be avoided (hah!), sunsets and scenery will be noted more diligently, the regular evening hit of red wine will be replaced with pomegranate juice (which looks exactly the same in a wine glass and, amazingly, tastes like a slightly sweet version of a Central Otago pinot noir)…but the single daily can of that nectar of life, the Heineken (no, they’re not paying me a cent), will continue.

This weekend we had a pleasant visit from my journalist colleague, Barry Young, who also happens to be president of the NZ Prostate Cancer Foundation.

Barry is 10 years free of prostate cancer after his prostatectomy, his PSA is nil, he can enjoy a good glass or three of red wine, and he tucked into seconds of lamb shanks (grown on the open fields of the Canterbury Plains, no doubt).

I’d be tempted to say us journos have an extra gene that bodes well when we get prostate cancer, but I know that’s not true (witness the death of the legendary Frank Haden a couple of years ago).

But our sense of outrage might help. It comes from our journalism-driven suspicion that there are people in positions of medical power who – with their dogmatic opposition to the promotion of prostate testing – are deciding the fate of a lot of men in this country.

This comment in no way applies to the medics who have treated me – surgeon Rodney Studd and the team at Wellington Hospital, Bob Hale at the urology department, the nurse-manager of the rehab clinic, and to GP Rob McIlroy.

Thanks to them, I feel confident of a long life. I don’t care about speaking too soon – I’m just not suspicious about tempting fate.

NEXT (some time away): PSA – wherefore art thou?

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OUR PROSTATE STORY: A wife’s side of the tale

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

By 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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MY PROSTATE STORY: Two out of three ain’t bad

PART 15 of My PC Adventure (read full story HERE> )

“It’s good news…” the surgeon begins.

After that, his words are a blur.

When you’re a cancer patient and you’re taking a phone call from the doctor about your test results, you’re not really going to hear much beyond that wonderful opening line.

It’s a Monday morning, 12 days after my radical prostatectomy, and surgeon Rodney Studd is relaying details of the lab analysis of the cancerous prostate he’s removed:

• The cancerous cells weren’t near the margins of the organ (which meant they weren’t touching anything else and thereby spreading);
• They were non-aggressive – a lowly 6/10 on the Gleason scale.

That’s two out of three, he says. Good news, indeed.

Erm…the third thing?

Ah yes, the PSA blood test I need to have a few months after the operation when there has been time for everything to settle down.

If that shows negative, I’m good to go (although I will need to be monitored in future to make sure nothing in there is changing).

It’s time to celebrate, even though his call follows a tense weekend as the after effects of my little accident the previous Friday begin to subside.

Blood and clots cleared quite quickly and my urine is clear again, but it’s hard to rid my head of the thought I’ve done some permanent damage.

Rod’s call certainly helps. I need to spread the news.

Lots of phone calls and text messages later, I’m exhausted and sleeping. When Lin gets in from work with a bottle of Bollinger, I can manage half a glass before dozing off. Some party.

The week plays out anxiously.

By Wednesday, blood drops have returned to the urine. However, it’s oldish looking blood and it’s watery, so perhaps my system is just clearing itself out. Lin consults Dr Google, who tells her this is a natural occurrence.

I want to call someone, but it’s Easter.

I try to get myself moving about more. My first proper walk is all of 100 metres down to the bus stop and back, and it goes okay, duck-shuffle though it is.

Next day I go up the street to the other bus stop, twice the distance away, and in my enthusiasm start to walk quite quickly, forgetting I’m supposedly an invalid.

Then I hang out the washing. I sit at the computer and hammer out a blog. The bleeding gets a bit worse.

Have I overdone it? Hell, I wish I knew.

On Tuesday, I shoot an email off to Rod with a still picture attached showing the colour of my urine.

I leave a message for Wellington Hospital urology nurse Bob Hale.

Bob gets back first. No problem. It’ll happen for a while. Don’t worry.

Rod emails back and says the same thing, and compliments me on the strong urine flow in the picture, which he says I must have taken one-handed.

I relax a bit. As they predicted, the blood gradually disappears, and is gone altogether by the weekend.

After 18 days, my scar has healed beautifully and the only sensitivity I have is from the gens, which are still slightly swollen.

I use a horseshoe pillow on the computer seat to give a bit of clearance.

Then another problem arises – the dreaded incontinence.

So far, this hadn’t been an issue. But, mysteriously, when the blood disappeared, I suddenly found I was having trouble holding it back whenever I climbed up from the sofa or a chair or out of bed.

Right – get back to the pelvic floor exercises, which I hadn’t been able to do for a while because of the raw feeling in my groin.

The feelings of leaking slightly last just a few days. Then, everything seems to be back under control.

I sleep six or seven hours without having to get up to pee. This is helped by taking my blood pressure pill – a diuretic (piss-inducing) – in the mornings.

I try my first can of Heineken. Nectar. But just one a night.

The walks get longer.

The autumn weather has been superb for Wellington, calm, sunny, warm, perfect for perambulations around the block. I shed the slippers for proper shoes. I’m even trying hills (small ones – Mt Vic will have to wait).

I wish we had a dog. I feel like an old perv on the prowl. I start carrying my camera on my shoulder, which at least makes me think I’m walking slowly with obvious purpose.

Here’s one of the results – a beautiful day down at nearby Evans Bay. It’s nice to have time to look at things properly.

I’m on the mend. For sure.

NEXT: Sorting out the other thing.

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A hand too far – oops

PART 14 of My PC Adventure (see full story HERE> )

FORGET Marx, Kinsey, Salinger,  Solzhenitsyn, et al: in my view, Philip Roth wrote the 20th century’s most revolutionary book.

Portnoy’s Complaint, his 1969 account of sexual frustration and the creative solo ways it might be relieved, changed everything for young men around the world.

Brought up on our fathers’ homilies about “self abuse”, blindness, insanity and the growing of hairy palms, we were liberated by Roth’s frank revelations about masturbation, although not necessarily uplifted.

His tale of the fate of a parcel of liver ‘twixt the neighbourhood butcher shop and his family dinner table was compellingly shocking.

Why am I telling you this?

Regard it as my version of the television AO warning: readers may be repulsed and offended by the content of the following story.

Got your full attention now? Good, let’s proceed (but you have been alerted).

During the various processes already narrated in My PC Adventure, there was opt-repeated medical advice that I should visit the rehab clinic after my radical prostatectomy for help in regaining erectile function. Polite term for being able to get it up again (sorry, but let’s be frank about this).

I learned that restoration of spontaneous nocturnal erections is important for the good health of the old fella. The sooner the better. There was talk about injections (ahhh!), Viagra and other stuff.

Fair enough. I booked an appointment for about a month after the op.

But then, home alone 10 days into my recovery and a couple of days after the catheter was so deftly removed (and I was continent, and peeing bloodlessly and with commendable force) I decided perhaps I should just experiment a little, freelance, to see what happened. To see, I suppose, whether I really needed to go to the clinic at all.

Spending $12 on a viewing of SkyTV’s Spice porn channel seemed like a justifiable investment.

It was slow, at first, but, hey, bingo: 75% function. Woohoo!

But wouldn’t you know it. That other warning from our fathers about the standing thingamajig having no conscience (or, in this case, no sense of caution) turned out to be so, so accurate. I was like a teenage driver – no frontal lobe development, no sense of fear, invulnerable and reckless.

An orgasm at this early stage of recuperation seemed like a miracle (although I’ve since read on the web of some overly keen soul who had intercourse the night after his op…and suffered two days of agony in return).

My agony started about five minutes after the feeling of euphoria began to fade.

What agony!

It resembled something called “lover’s balls” that an adolescent male can suffer if, as Mick Jagger puts it, he can’t get no satisfaction after a period of prolonged tumescence (an hour or two of holding hands in the movies with the object of one’s desire will do it).

I upped the painkillers, trying the codeine for the first time. No relief.

After an hour, I rang Lin at work and gasped that I needed to go to A and E. Could she come home and take me, please?

My explanation in the car on the way to Wellington Hospital was met with amusement and sympathy.

At A and E, I staggered around in the empty waiting room while the bureaucracy filled out my name, date of birth and other obviously vital statistics, then – after 10 excrutiating minutes – I was led through to a bed.

I blurted out a coded explanation, well rounded with verbal self abuse, while they pumped in increasing amounts of morphine, to little effect.

Then  I raised my knees and the pain suddenly subsided. I saw why when I looked into my underpants and saw a spectacular amount of blood emerging from the end of my penis.

A specialist ran a scan over my belly and said the news was good – no blood in my bladder. He rang surgeon Rod for advice.

A couple of hours later, I was able to pee into a bottle, so they allowed me to go home.

Little did I know, my troubles were just beginning.

Doped up with morphine, I dozed through Coronation Street and something else, then – about three hours after getting home – went to the loo.

Oh hell – nothing. Even though my bladder felt full.

I returned to bed and dozed, awakened every hour or so by the urge to pee. But nothing would come. And the agonising pain was back.

About 4am, I decided I needed to go back to hospital, probably to have a catheter inserted again to clear whatever was blocking the tubes. As I dressed, doubled up with pain, I had a sudden urge to go at the other end.

When I did, the pain eased off greatly, so we postponed the run to hospital, even though I still couldn’t pee.

At 6am, I got up to try again – with spectacular result.

A blood clot the size of a .303 bullet shot out and smashed into the back of the toilet seat.

It was followed by a gusher with the momentum of Huka Falls.

Oh my God, the relief! It was over. 

In fear of the clotting happening again, I drank copiously and peed hourly for the next couple of days and nights, after which the blood cleared from my urine and everything felt fine.

Rod rang on the Saturday morning to see if I was okay. He explained that while the performance was encouraging, it had caused a spasm in my pelvic floor muscle, and since things were “still pretty raw down there” that had caused the bleeding.

Had I done any permanent damage? He doubted it very much. Just relax and take it easy.

NEXT: Being a patient patient.

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Peeing like an 18-year-old…yes!

PART 13 of My PC Adventure (read the full story HERE)

The 18-year-old occupies a mystical place in the minds of baby boomer males, because of a piece of supposed medical science that emerged when, for us, it was already too late.

According to this story, men at 18 were at the peak of their sexual powers: from then on it was gradual decline. The same story said women reached this stage at 35. The fodder for fantasy was extensive.

But 18-year-old males have another attribute, much under-appreciated by them – they can pee highest up the wall (even over it).

In the post-RSA generation of testosterone-driven management power games (the days of the Brierly boys) the epithet about young male managers competing to piss highest up the urinal wall ruled supreme. Metaphorically speaking, everybody in the board-room was eternally 18.

Now I’ve discovered a way to get it back: have a radical prostatectomy.

Surgeon Rod said this would be the case (although we didn’t use the 18-year-old simile), but I may have overlooked his advice on one of the better side effects of the treatment, because I was preoccupied with scoping my fears about incontinence and functional dysfunction.

My first pee after getting the catheter removed was spectacular. If you can stand the sight, click on the arrow:

[youtube=http://www.youtube.com/watch?v=yOr8W7hsQQs]

UPDATE: You Tube has removed this video, citing it an offence against their community guidelines. Here’s a still from it:

Getting to this milestone, naturally, was not uncomplicated.

After six days of Mr Catheter, Bob Hale rang from the Wellington Hospital urology clinic to say they’d successfully completed the move to the new building and my tentative appointment for 1pm was confirmed. I got there to discover I was his first ever patient in the new quarters.

I hid my terror beneath talkativeness. How was he going to get this thing out of my thing without it hurting like hell?

First things first. I laid on the bed and he prepared to remove the clear plastic dressing from my wound: “Open your eyes,” I was instructed. “There’s a bit of hair regrowth…” Off it came. No problem. No pain. Every gain.

He had a young Indian med student with him, so Lin and I got a good running commentary on procedure.

Next job: to very gently pump 150 mills of water up the tube and into my bladder. Lying back on the bed, I was unaware of the process.

Then: “Open your eyes.” He was going to withdraw the tube. Oh shit!

But…nothing. I FELT NOTHING! And then it was out. Big phew! What a master.

Okay, says Bob, gently sit up. He held a pad beneath my willy. Nothing leaked.

Okay, now sit on the edge of the bed. Same. No leakage. “Excellent.”

Now stand. Just a drip or two.

Okay, here’s the bottle. He turns on a tap to run water, and he and the student retire behind the curtain. I think to myself: ‘It’s okay, Bob. I’m not piss proud any more.’

I pee. “Listen to that,” says Bob. “That’s a very good stream.”

Exactly 150 mills in the bottle. Splendid.

Next, he fits an absorbent pad to the inside of my Dan Carters.

It’s there to take any “accidents”.

It has a sticky side which adheres firmly to the material of the underpants. Ingenious.

The pad he uses is bulky and I immediately think of Elizabethan gents and their cods-wallops.

Later I discover that pads come in various sizes.

I’m able to switch to slim versions that are barely noticeable.

I also discover by accident just how clever the mechanics are.

I drop one into the toilet pan and when I fish it out, there isn’t a drop spilt as I transfer it to the rubbish bin.

Now that’s absorbent!

Women readers (if there are any) will be smiling, I guess, since I now realise their knowledge of absorbent pads is a lot greater than that of me and my male peers.

Next, Bob runs through the exercises.

Exercises? Yep, I will need to learn to flex my pelvic floor muscle.

Let’s give it a try. Yep, I’ve got it straight away: feels like tightening the rectum, while the willy gives a little twitch.

Practice at this will be needed over following weeks so the sole remaining sphincter (valve) at the foot of my bladder isn’t required to do all the work when it comes to damming things back.

A well-trained pelvic muscle will complement the process, and stop me peeing myself at the wrong times, such as when I cough, sneeze or get up suddenly from a chair.

It will take about three months, apparently: clench and hold for up to 10s, do it 12 times, with rests between, and keep breathing. Then 12 short ones.

Takes about five minutes a day, and later I find myself doing it on walks, sitting in the car, lying watching telly.

Back home, I get the urge to have my first try at freelance peeing.

The result is a shock.

I’m used to hunching above the pan with my left forearm leaning on the wall, but now it’s an entirely inappropriate stance – my urine emerges in such a rush of fire hydrant power it hits the back of the seat.

I reel back and find I can get it in the pan from a metre away.

I let out a whoop that has Lin running into the bathroom in panic. Wow, the sheer joy of it, after years of struggling to get a stream.

A friend told me before the operation he had seen men in tears at the urinal of his club, desperately trying to have a leak. If any of them are reading this, think about it.

If this is “quality of life” change, then I’ll take it, thanks.

NEXT: Bloody disaster!

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All quiet on the Western ward…then home to my bed

PART 11 of My PC Adventure (read full story HERE)

THERE’S nothing like your own bed.

We’ve all said that. I kept saying it and saying it as I settled very slowly onto the king-size and took in the surrounds. Ahhh…

There was only one thing missing – a control panel to set the bed at any angle you like, a device that became a favourite toy during my brief time in the surgical ward at Wellington hospital. But you can’t have everything.

What I had instead was loving care from Lin, real food, McCavity the cat (pictured), a night shirt, HD TV to watch the cricket, radio to listen to RadioNZ National, a bottle of lime juice, remote controls, a toilet just down the hall, sun coming in through the window, a view of blue sky and rooftops, concerned neighbours, books, phones, a stash of fruit and an array of lollies (jet planes, 72% chocolate, liquorice, pine-apple lumps), enough painkillers to start a drug lab, well-wisher cards and flowers, the electric toothbrush, the bedside magnifying light…and, of course, some additional plumbing strapped to the side of my leg.

How did I get to this paradise?

Let’s step back a few hours on that notable Friday, the day I came home, just a couple of days after the radical prostatectomy operation that would change my life (and hopefully prolong it).

The morning began strangely in the ward. About 6.30am, after hours of little abatement in the circus – beepers beeping, buzzers buzzing, nurses poring over charts and administering, codgers trudging to the loo – everything suddenly changes.

The staff seem to vanish. This is probably entirely inappropriate as a simile, but it was like a concentration camp as the Russians approached – the guards melted away, and the inmates suddenly felt very alone.

The only person left to cope with the cacophony of beeping and buzzing is an elderly aid, who is preoccupied with cleaning up the mess from Mr PI’s “sit”.

Mr Seaman is half dressed and confused. His operation has been cancelled (all that finger-pricking for nothing). Mr PI is back to “hallo, hallo…” after his unfortunate experience with the buzzer. Mr Newcomer lies and listens to his radio and remains aloof.

Nobody answers the buzzers.

This goes on for about half an hour, then just as suddenly we’re “staffed” again, with a new shift of nurses frantically boning up on who’s in, what meds they need, what tests, and so on.

Mr PI is whisked away to the shower by a young Polynesian male nurse, who deals with him politely but firmly.

Mr Aloof has a visit from God, who tells him his operation is postponed.

As for me, well the phalanx is back, swooping in without warning, and we’re discussing my home-going. “Has he had a bowel motion?” asks Phalanx Leader, this apparently being one of the rules for freedom.

For some reason, I feel jocularity is required, so blurt out Billy Connolly’s line: “Never trust a fart.” Everyone looks blank (unsurprisingly). I’m trying to indicate that a movement is imminent, trust me, but the point is lost. We all let it pass (the remark).

I’m prescribed laxatives, which will replace the delicious kiwifruit concentrate that has been administered up till then to “keep things loose. We don’t want you straining…”

I’m introduced to one of the team, Bob Hale, the senior urology nurse, who will be providing catheter and post-operative care. Another mistake on my part: I relate my friend’s remark about everyone growing to love their catheter.

Bob is stern: having a catheter is one of the most uncomfortable (or a word to that effect)  experiences a man can have, he says unsmilingly.

They move on, and I’m left to assume I can escape. I announce this to a nurse, who says fine, but I need to fill out some forms. That will take forever, so why don’t I get dressed and head down to the lounge. He’ll get the discharge papers mailed out to me.

Surgeon Rod appears, togged up in white gummies and dark blue overalls (he must be operating again today) and asks how I’m going. I’m good. No pain, and the catheter bag is starting to run Chardonnay.

Did he get it all? “I think so.” The lab analysis will tell, and he’ll have that in a week or so. He asks me to cough gently while he feels for the hernia, and it seems fine. “I’ll give you a call when I’ve got the results,” and he’s gone.

He thinks so…hmmm.

The nurse comes back to remove the drip valve from the back of my hand.

Lin arrives and we get me dressed. We’re off out of here, me waddling at pensioner pace and feeling strangely disoriented, woozy, frightened, hopeful.

Sitting in the lounge, we wait for a while, visited a couple of times by the nurse, who explains why the ward emptied out earlier: there was a major emergency in another section and everyone went to have a look. Oh well, it’s a teaching hospital, and people have gotta learn.

The handsome young Asian doc comes past and wishes me well. Surely, Shortland Street will snap him up before long.

Bob arrives with meticulous advice and my catheter take-home pack. He says the catheter will be in until the following Wednesday, when I need to come and see him at the urology clinic. They’re in the middle of moving into the new hospital, so he’ll need to let me know if they’re ready that day. He’ll be removing the catheter and advising me on after-op care.

I totter down to the main entrance, feeling vulnerable and weak, and lean against a railing in the door airlock while Lin gets the car. The short drive home is dominated by pothole avoidance.

At home, I change into a nightshirt and collapse, slowly, into bed. And doze…

NEXT: Learning to love my catheter – not.

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No party, of course – just a circus

PART 9 of My PC Adventure (click HERE to see the full story so far)

OF COURSE, there was no party in Ward 29 of Wellington public hospital on my first day of post-radical prostatectomy recovery.

But it was a circus, and it stayed that way for the two nights and three days I was there.

What sounded like a party was in fact the ward admin office, which – I discovered when I finally ventured out of bed to go to the loo – was just over the corridor from my part of the ward, a four-bed room partitioned by curtains and thin walls.

The noise was staff. I’m not sure if they were loud or not; it’s just they sounded that way while I was still spaced out and needing peace and quiet. Why did they let the phone ring so long…and who the hell would keep ringing so long when it was obvious nobody was going to answer? Wrong number?

It was a circus because a constant stream of performers passed before our eyes and within earshot, each with his or her own act – doctors, nurses, aids, cleaners, caterers, visitors, patients, surgeons, the paper man (selling DomPos, bless him), administrators, technicians, managers, students, even a librarian, who popped in to see if anyone wanted something to read.

The worst performers were the patients. We were impatient patients, some of us, demanding, rude, loud, irrascible, unreasonable…and forever needing to pee (if we didn’t have hooked-up plumbing).

The nurses, by and large, were beautiful human beings, serenely immune to the grumpiness of their charges.

When you’re sick and helpless, anyone who is prepared to pass you the drink of water that’s just out of reach so you can dampen what feels like fatal thirst will be regarded with awe and limitless gratitude.

Well, maybe. The guy next door, whose ugly-sounding face I never saw, grouched endlessly at anyone who came near him, and spent long periods on his cellphone complaining about the service, especially “that silly little doctor”.

Listening to him (there was little choice), I felt ashamed to be a middle-aged man. Perhaps he’d been caught by the recession and hadn’t kept up his medical insurance, because he obviously believed he shouldn’t be in such an awful place among such people. He was someone used to being in charge; here he simply wasn’t.

The oddest performers in the circus were the lightning one-act players, people (not necessarily in white coats) who would sweep in, look blankly at my room-mate, Caroline, and me, say nothing, then turn and walk out. Who were they? What did they want?

In the end, we took to saying: “Yep, we’re all here.”

Now, let me take stock.

I’m lying on my back on a very comfortable adjustable bed (I’ve found the controls); I’m retained in the bed by sides, like a cot; as you can see from the picture, I’m wearing a nice little off-the-shoulder number (the classic “arse-flap” hospital gown); I have oxygen going up my nozzer; I have saline pumping into the back of my left hand (I beep when the drip dispenser behind me nears empty, which seems to be every few hours); I have a bedside cabinet on my left, but it’s too far back to reach (and I daren’t move); I have a tray-table on my right, also too far back to reach; I have the buzzer in the bed beside me, but I’m reluctant to try it, given the amount of buzzer-abuse that seems to be going on.

When I lift the bed cover I see a tube coming out of my lower right side, siphoning bloody liquid towards a container at the foot of the bed, and alongside it another tube which emerges from the end of my penis, this one taking bloodied urine in what looks like a constant flow (note to self: better drink more water).

I’ve had a breakfast of cold, leathery, white toast and marmite, and a cup of strong tea, and I’ve kept it down.

There is no pain.  But my right knee feels numb, and my backside and lower back are getting sore (I never sleep on my back, usually).

However, there are plenty of distractions from such minor discomfort.

For instance, the arrival of the top-line act, a phalanx of doctors, fully-fledged and student, who appear suddenly, pull the curtains around, and peer at me with urgent interest.

“Hello, how are we today.” Never better.

The rest of the dialogue is the top man (who may or may not have introduced himself) talking to his throng. We take a look at the wound and pronounce ourselves happy.

Then we’re gone. Well, they go, I stay, none the wiser. Did I miss something? Apparently not. Right. Get on with the recovery.

One of the angels tells me I’ll be getting up today. Yeah, right. “Yes, miss, later.” Much bloody later.

Another one comes to fit my catheter bag. This takes some pondering, especially to cut the tubing to the right length. We agree the bag will be strapped to my outer right calf, just below the knee. A strap goes round my thigh to make sure there is no tugging on my willy.

At this point I realise the willy appears to have taken fright and retracted inside my body. Seinfeld loser George Costanza’s “I’ve-been-swimming” excuse for hyper-shrinkage has nothing on this. This…this is disappear-age.

What they say about leaving your dignity at the door of the ward seems all too true. Oh well. I’m sure they’ve seen it all before, even if they are young enough still to be at school.

Lunch arrives. Smells good, says Caroline, whose sole sustenance comes down a tube. It’s soup with industrial-strength taste of old shoes, a brick of potato-dominated frittata (inedible), and the ubiquitous jelly and ice cream. Mmmm. I get to fill out a menu for tomorrow; reads delicious. I order a drip, like Caroline’s.

Next, we lose the oxygen. And the saline drip. Finally, a nurse arrives to remove the drain. This becomes something of an ordeal for me and her because it enters my body at the most ticklish and sensitive spot I have. I can’t help but tense up as she withdraws tubing that measures 20 metres minimum. But it gets done, without fatality.

I amuse myself sending texts, especially to the class who will be graduating today. Miss you, guys.

A man arrives to offer a shower, advising that I need to wash the mess between my legs. What mess? There is no mess that I’m aware of. Later, buddy.

The hours slip away in pleasant conversation with Lin and Caroline, and her daughter, a constant visitor.

Then I muster the courage to get up. Am I boring you with this? Sorry, but it’s such a big deal when you’ve been lying there thinking of blood clots forming in your legs unless you go for a walk.

Caroline gives a thumbs up as I totter out and down the corridor – to find there are only two loos and they’re both occupied. I wait, enormously relieved that nothing has split or spilled, and I haven’t passed out.

Finally, I’m in…then, of course, pause to ask myself what I’m doing here in this spacious bathroom and toilet: I don’t need a leak (that’s taken care of).

So I have a wash and sneak a look in the full-length mirror, and see for the first time that below my conveniently swollen stomach I’ve been vertically stitched from just above the boys to just below the belly button, and I’m bald as a coot. They shaved me (of course), even taking a patch of hair off the top of one thigh.

Right. That’s enough looking. You’ll just make yourself faint. Back to bed, boyo, as fast as the legs and the stomach will go.

My rest from exhaustion is broken by a visit from the anaesthetist who did my pre-op assessment. I mention the numb knee; it’s a temporary after effect of the spinal anaesthetic, he says. Let him know if it persists. It doesn’t.

The afternoon ends with my submitting to a neurological exam on my head. The Asian doc who assisted with the operation has appeared with an admiring student, who needs a practice run doing the exam: “Are you bored, Mr Tucker?” Yeah, a bit. “Do you mind if we…” No problem. It passes some time. She does well, and I learn useful stuff.

NEXT: A night to remember, then home at last.

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