In August 2017 I had a biopsy confirming that I had prostate cancer. I had no symptoms, but my family doctor, Dr. Patricia McGarry, noticed that my PSA level was up a bit compared to my previous annual Wellness checkup.
Of the many options available I decided to take the advice of oncologist Dr. Lawrence Mendelsohn at CARTI who suggested a robotic radical (complete) prostatectomy.
Urologist Dr. Keith Mooney performed the surgery on Friday September 29th. My recovery has been slower than expected due to trouble with the catheter, but the doctor says that the final result will be as expected. He had previously told me that temporary incontinence is normal, but most men get back to normal after 2 or 3 weeks of wearing a pad / diapers following removal of the catheter - normally usually no later than 14 days after surgery.
Latest Update: On Friday October 20th (day 22) the scan (voiding CYSTOGRAM X-Ray) showed no internal leakage, and I was finally freed of both tubes (catheter and side drainage). I am thrilled to progress to the next step in my recovery which is overcoming incontinence which includes Kegel excercises. I am making a special effort not to leak when I stand up. If I go to the bathroom before I feel the need to go, the leakage is less. However, that means getting up every hour or two during the night, and compensating for restless sleep by taking naps in the daytime.
The following is my somewhat detailed description of my surgery and the immediate aftermath:
WHERE: The surgery was at CHI Saint Vincent Hospital in Little Rock. CHI = Catholic Health Initiatives. Dr. Mooney likes the St. Vincent team that works with him as he does these surgeries all day every Wednesday and Friday. He says he has done over 2,500 of them, and only had 5 or 6 complications.
Data entry inefficiency: The day prior to surgery, someone called and asked a comprehensive set of questions as part of the hospital pre-registration. When we got to the hospital we waited to see a registration person who had all the pre-registration info on her screen, but had to check it all and transfer some of the info to another form or system. She printed some paperwork, and we took it to the outpatient area. I was taken to prep where I had an EKG, and the intake nurse had to ask me many of the pre-registration questions again and enter the answers in yet another form or system.
Surgery delay: My surgery was delayed because the anesthesiologist did not have me prepped in time. He seemed to be struggling to concentrate and keep up. The intake nurse wanted him to work with me first because my doctor was ready for me, but he had to just start at the first patient and work his way to me as patient number 4.
I remember transferring to the operating table, and then shortly after that I was out. Dr. Mooney told my family that the surgery went well, and that I would probably go home Saturday afternoon. My family was expecting to see me in recovery but did not actually get to see me until we were reunited in a hospital room about 6 PM.
Missing nurse: Initially my nurse could not carry out the doctor's orders because I was "not in the system". Later the nurse was not available for several hours. For 3 or 4 hours the machine that was supposed to be measuring blood pressure, oxygen level, etc was constantly alarming and my wife would push the button every few minutes. The IV machine started alarming as well. She was able to stop that noise, but the machine was no longer working until my wife finally figured out how to start it. After about 6 hours my nurse finally reappeared. He said that he and all the other nurses on the floor had been trying to stabilize a patient who eventually had to go to ICU. I was in pain because I had received no meds since coming to the room. The nurse gave me a shot of morphine and eventually got me started on my meds which included blood thinner, anti-nausea, Tylenol, medication for bladder spasms and antibiotic drip. He also got the pressure cuffs hooked up to prevent clots in my legs. My sheets needed changing because blood had spilled on them but no clean sheets were available. They did eventually find one fitted sheet and the used blankets for everything else. By this time it was 1:30 AM. Later the day shift nurse was able to find some clean sheets and change the bed.
Caution: not for the squeamish. On Saturday I got up and walked and sat in the chair for several minutes. We noticed that the hand sized midlevel drainage bottle was filling up very fast, and the catheter was not draining. Urine was going into my abdomen and out the little drainage tube in my side. If the bottle filled up, and was not quickly emptied, pressure would build up in my lower abdomen. When the elasticity of my abdomen reached its limit, searing cramping pain would stretch across my abdomen. After the little drainage bottle was emptied and as it filled up again in a few minutes, the pain would start subsiding.
The nurses made notes about how much fluid was emptying via the side bottle and how little urine was emptying via the catheter, but nothing was done about it. I stayed Saturday night in the hospital. Sunday I got up and started to walk, but was leaving a trail of blood due to a saturated bandage. I got back in bed and waited a couple of hours for the nurse to change the bandage. The nurse practitioner who makes rounds for the surgeon on weekends knew that urine was draining out the little side drain, and said that I had won the lottery on that. She said that I could go home if I felt up to it, so a couple of hours after telling my nurse that I was ready to go home, she released me on Sunday afternoon. My wife felt if we could get out of the hospital we would be able to get some help with the problem since no one seemed concerned at the hospital.
At home almost no urine was draining from the catheter, so we called the doctor's office. The nurse on weekend duty called and said that we should go to the emergency room where they would wash out the catheter, and if that did not work, they would remove it and replace it. Fortunately I knew that remove and replace was not an option after my surgery. The part of the urethra that passed through the prostate gland had been removed with the prostrate, and the urethra had been sewn back together. The catheter tube was inside that repaired urethra and was helping hold the two pieces together.
The ER people flushed out the catheter, and it seemed to be working a bit, but by the time we got home, it was not really working. My wife called the answering service again, but no one answered the phone. Every 10 to 20 minutes I had to empty the little bottle. A couple of times I went to sleep and was rudely awakened by extreme pain when the bottle filled up. After several hours, the catheter started draining, and I was able to sleep for a while.
Monday: As long as I stayed in bed, the catheter worked well. I thought the doctor might review my record and realize that I needed help with my complications, but instead a clerical young lady called to make an appointment to have my side drain removed. Glenda told her that we needed to see the doctor or someone about my complications and insisted we have an appointment that day. We were finally able to get an appointment to see a nurse practitioner early in the afternoon.
When we arrived, the catheter was not draining. The staff at Arkansas Urology prides themselves on patients having to wait in the common area less than 30 minutes, but then we waited for over 2 hours in a little room with only a stool for Glenda to sit on. Her back was hurting her the whole time. We were the last patient of the day for the nurse practitioner who did not seem to believe that urine was draining into the little side bottle - it was mixed with blood and did not smell like urine. However, she became a believer when the bottle soon filled up, and she saw that fluid was still under pressure and flowing as the bottle was being emptied, and the bottle completely filled up again in just a couple of minutes. At that point she realized that something was really wrong, and called in Dr. Mooney. The surgeon said this was really rare, but it happens sometimes, and he had an assistant make an appointment for me to have a scan (voiding CYSTOGRAM X-Rays) the next morning that would show where the leak was. The most time consuming part of making such an appointment is getting pre-authorization from the insurance company. Monday night after a few hours of lying in bed and emptying the little side bottle, urine started draining through the catheter, and I was able to get some sleep.
Tuesday morning we went to St. Vincent Hospital for the scan. While we waited, the registration person had to repeat the same steps that had been done prior to surgery - read through all my info and transfer it to some other form for printing.
We waited in the scan area for almost two hours because the wrong procedure had been ordered. Fortunately the staff knew that the order to remove my catheter was not appropriate for me, so we had to wait for new orders from the Doctor's office and a new approval from the insurance company.
After the scan was complete, we returned to Arkansas Urology to wait for the staff to download my images. Dr. Mooney spotted two small tears. I did not understand how such small tears could be responsible for the catheter being completely useless for hours at a time, but I had to trust the doctor. He said that I should stay in bed as much as possible, and that it would gradually get better. He would leave the little drainage tube in and remove both it and the catheter at the same time after having another scan that shows no leakage.
Tuesday night the catheter worked. On Wednesday my urine was bloody. It had been bloody a few days before, and cleared up for a while. This time it was only bloody after I sat in a chair to eat, and then cleared up shortly after going back to bed. I had noticed that nothing was draining while I was sitting, so the increased pressure must have caused bleeding.
Wednesday afternoon Glenda bought me a doughnut cushion to sit on. If I position it just right and do not lean forward, the catheter drains while I sit. However, after being in bed for 22 or 23 hours a day, I am trying to get used to sitting up again. There is still a bit of urine draining into the little bottle - more when I am up out of bed, so I am still trying to take it easy.
On Thursday a nurse called to give me the lab results of the lab. The cancer was contained to the prostate, and I am now cancer free. That means no additional treatment will be needed after the surgery.
How am I doing? My attitude is good. I feel fortunate that I do not have to suffer through chemo therapy as often is the case with some cancers. As I told the Quantum nurse who called to check on me, I believe in prayer, I have a lot of friends who are praying for me, and no matter what happens God is in control. She said she could not argue with that.
The pain has not been bad at all except for when the little drainage bottle filled up. I have had very little pain from the incisions and catheter. The only pain medication I took after leaving the hospital was Tylenol for a few nights. I have had to spend a lot of time on my back in the bed which gets tiresome, but fortunately we have an adjustable bed that can ease pressure points that become painful after lying in the same position for several hours. I am much better off than a co-worker who had to spend weeks sleeping in a recliner chair after lung surgery.