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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2008

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Followup from Skeptic, Post Davinci RP...the good, the bad and the     ugly

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skeptic - 05 Feb 2008 22:02 GMT
I'm about 10-12 days post op and somewhat hesitant to post this, as
some of the results and news are not good, but if it helps someone by
answering some questions like I had pre-op, then I'm glad to share.

A lot about the robotic procedure (forgive me if some of this is the
same for other types of surgery-I don't know) is pretty intense, for
example, my body was slanted backwards on the table toward my
shoulders to allow the organs to drift down from the prostate during
surgery, and I woke up with quite intense shoulder pain which lasted
for almost a week.  Also, I was intubated during anesthesia, so had a
mild sore throat for a few days.

OK, the good:  I was out before I ever entered the o.r. so there was
no apprehension over the procedure that day.  My doctor reserves
deluxe rooms at Mt. Sinai, which takes the edge off the recuperation
process....they really are the nicest rooms I've ever seen or stayed
in.  Bonus:  we saved a couple of nights in NYC hotel by having my
wife sleep over in the room on a portable bed...just ask. She was able
to order deluxe food from room service! and it was like a hotel room!
I know you don't choose a doctor or procedure on superficial stuff
like this but believe me, it helped.
As some of you may recall, I was a nervous wreck in anticipation of
this life altering event but felt a huge weight lift off my shoulders
once i woke up and realized that part was over...it was strangely
calming...and has been so since then.
Lastly, I had expectations of total lack of urinary function but
already I have about 50% control and stay dry each night.  I also
sleep all through the night.  The catheter removal was totally
painless and welcomed....had it for 7 long days...although I know
others have had it for much longer...SUCKS.

The bad:  I have the aggressive type of pca and it has already spread
to the lymph nodes...which were removed.  It was explained to me that
there are two schools of thought on this and other surgeons may have
opted not to go through with the RP and send me off to radiation
instead, but there's no point in discussing that...it's already
done....and frankly, I agree with it.

The ugly:  Since so many lymph nodes were removed, my Jackson Pratt
drain is still attached and draining lymphatic fluid......slowing down
ever so slightly so I may have this damn thing attached another two
weeks for all i know.  Also, I had a lot of post-op pain while in the
hospital which was barely relieved by morphine and percocet.
Fortunately, that has subsided.

So that's my story...I "survived" but I know the future dx is not
good....funny thing is...it doesn't bother me...I've come to accept
it.
I have slowed down my life and my thinking and just appreciate each
day I'm alive.  A decision was made, I followed it, I have a few more
to make, but that's ok...I am part of a plan now.
Steve Kramer - 05 Feb 2008 22:15 GMT
> my body was slanted backwards on the table toward my
> shoulders to allow the organs to drift down from the prostate during
> surgery, and I woke up with quite intense shoulder pain which lasted
> for almost a week.

The shoulder pain is due to the fact that they inflate you with air during
the procedure.  I can't remember why that effects the left shoulder (it was
left, correct?), but it does.  My wife had it also with ovary surgery done
with a scope.

> The bad:  I have the aggressive type of pca and it has already spread
> to the lymph nodes...

Damn!

> I have slowed down my life and my thinking and just appreciate each
> day I'm alive.  A decision was made, I followed it, I have a few more
> to make, but that's ok...I am part of a plan now.

That's a good attitude.  You still have a lot of life left.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA  <.1  <.1  <.1  .27  .37  .75            PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA  .34 .22 .15 .21 .32                       PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA  .07 .05 .06 .09 .08 .132 .145       PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04, <0.04 10/11/07
Non Illegitimi Carborundum

I.P. Freely - 05 Feb 2008 23:08 GMT
> You still have a lot of life left.

I've been constantly reassured when my onc keeps saying, "after relapse,
you still have many good years available". Heck, even my G-8/SVI/PSADT
stats give me surprisingly high survivability odd at 10 years.
Considering that I had CANCER three years ago, I'll take that to the
bank and worry about the 15-year point when I can see it with no other
major health threats looming closer. Hypothetical alligators don't bite.

I.P.
Steve Kramer - 06 Feb 2008 00:38 GMT
>> You still have a lot of life left.
>
[quoted text clipped - 4 lines]
> about the 15-year point when I can see it with no other major health
> threats looming closer. Hypothetical alligators don't bite.

I have to admit that I have a moment now and then of reflection or hope.
Yesterday, I replaced some flood lights in my vaulted ceiling with 7-year
bulbs.  It was kind of weird knowing that I'll be in no shape, probably, to
change them again.  But, I also feel that way when I consider retirement.  I
used to be a change-agent in my company.  With less than 13 months to go,
any project I get involved with now will not succeed (or fail) until after
I'm retired.  It's not much different really.  Just a matter of planning for
it.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA  <.1  <.1  <.1  .27  .37  .75            PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA  .34 .22 .15 .21 .32                       PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA  .07 .05 .06 .09 .08 .132 .145       PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04, <0.04 10/11/07
Non Illegitimi Carborundum

Alan Meyer - 06 Feb 2008 02:03 GMT
...
> Yesterday, I replaced some flood lights in my vaulted ceiling with 7-year
> bulbs.  It was kind of weird knowing that I'll be in no shape, probably, to
> change them again.
...

I have those same creepy feelings more and more as I get
older, knowing that I'm a hell of a lot closer to the grave than
the cradle.

But I put them to myself a different way.

Each time I do something that I know I will not be able to
do forever, whether it's finishing a physical or a mental task,
I think to myself: "Old age and death haven't claimed me yet!
I did that one more time!"  In what is perhaps a silly way,
I feel a little extra sense of accomplishment.

   Alan
skeptic - 06 Feb 2008 22:32 GMT
By the way, whiel I am quietly recovering, I do greatly miss my daily
glass of wine.
My discharge instructions say alcohol "should be avoided"
Any comments on this?
Is there any harm drinking very moderately while recovering?
BH - 06 Feb 2008 22:41 GMT
I'd have my glass of wine, or two, and enjoy it!

>Is there any harm drinking very moderately while recovering?
RP in 1995 (age 52)
RT in 2000
ADT (Casodex) 10/06 - 8/07
Latest PSA - 0.18

burney dot huff at mindspring dot com
safire - 06 Feb 2008 23:37 GMT
> By the way, whiel I am quietly recovering, I do greatly miss my daily
> glass of wine.
> My discharge instructions say alcohol "should be avoided"
> Any comments on this?
> Is there any harm drinking very moderately while recovering?

None of the published post-op instructions that I've seen mention
avoiding alcohol.
Steve Kramer - 07 Feb 2008 03:00 GMT
> By the way, whiel I am quietly recovering, I do greatly miss my daily
> glass of wine.
> My discharge instructions say alcohol "should be avoided"
> Any comments on this?
> Is there any harm drinking very moderately while recovering?

You were given a prescription, no doubt, for a narcotic; probably either
Darvon or Percocet (or some other oxycodone derivative.  Since it's been
almost two weeks, I'm guessing you no longer need the narcotics.  I never
used them after leaving the hospital.

If you are using narcotics, they are depressants.  Alcohol is also a
depressant.  Using them together can cause potentiation, which means that it
may not have just an additive effect, but may have a geometric effect.

If you are not using the narcotics, alcohol can still thin your blood
thinner than you might want with your wound.

However, I don't think that a little wine at dinner is a serious risk.
Steve Kramer - 07 Feb 2008 12:00 GMT
>> By the way, whiel I am quietly recovering, I do greatly miss my daily
>> glass of wine.
[quoted text clipped - 15 lines]
>
> However, I don't think that a little wine at dinner is a serious risk.

Holy Crap!  I forgot the disclaimer.  I am neither a doctor or pharmacist.
I.P. Freely - 05 Feb 2008 23:01 GMT
> I woke up with quite intense shoulder pain which lasted
> for almost a week.

On the bright side, maybe that drowned out some pelvic pain. Small
favors and all that ...

> Also, I was intubated during anesthesia, so had a
> mild sore throat for a few days.

More drugs. MORE DRUGS!   ;-)

> My doctor reserves
> deluxe rooms at Mt. Sinai, which takes the edge off the recuperation
[quoted text clipped - 4 lines]
> I know you don't choose a doctor or procedure on superficial stuff
> like this ...

I would definitely consider such "superficial" stuff next time. You and
I *slept* through our surgery; I wouldn't care if it was in a clean
cave. But the next week was one of ... no, definitely THE longest,
deepest nightmare ... of my life. Whole pages about that here years ago
barely did it justice. You'd think I was treated by socialized medicine.

Oh, yeah ... I *was*; the VA system.

My next inpatient surgery will be somewhere else, under different
coverage, unless those surgeons and that hospital can persuasively
promise me a far better and safer recovery. I don't care how nice the
room is, or whether they feed my wife, but I will sign a blank check
next time to avoid the dangerous recovery ward dungeons I have
experienced in the VA system. I ... they ... oh, fuhgheddaboutit ...
don't get me started again. And thanks for convincing me to change my
care selection priorities next time.

> As some of you may recall, I was a nervous wreck in anticipation of
> this life altering event but felt a huge weight lift off my shoulders
> once i woke up and realized that part was over...it was strangely
> calming...and has been so since then.

Amazin' how much weight a couple of ounces can take off our shoulders.

> The bad:  I have the aggressive type of pca and it has already spread
> to the lymph nodes...which were removed.  It was explained to me that
> there are two schools of thought on this and other surgeons may have
> opted not to go through with the RP and send me off to radiation
> instead, but there's no point in discussing that...it's already
> done....and frankly, I agree with it.

So do some mighty big names in the field.

> I know the future dx is not good....funny thing is...it doesn't bother
> me...I've come to accept it.

That's great, as long as "accept" means peaceful but ever-informed
vigilance and choices.

> I have slowed down my life and my thinking and just appreciate each
> day I'm alive.

I think that was part of my determination to speed up my life, in the
form of more exercise. Just think: now that I've faced down two cancers,
my health, for now, is significantly *better* than it was pre-diagnosis.
  I'm hanging my hat on THAT until the next alligator appears. Yours is
lymph node involvement; mine is G-8, SVI, and negative margins (implying
my next PSA will be remote in origin.)

Have a great recovery and put this threat to good motivational use.

I.P.
 
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