RADICAL PROSTATECTOMY
6.45am 25 July, Brisbane Private Hospital
My motherâs birthday, for Godâs sake. Sheâd be 98 if she was still alive.
Iâm 66 and four months. In two months time Iâll be older than my father was when he died. But letâs not make too much of this new event in my life. I was much sicker when I contracted mumps while recovering from chicken pox when I was 18 years old. At that time I had a fever of 40C for four days.
I was closer to death in 2000 at age 60 when I had 90 to 95% blockages in my arteries compromising 80% of my heart. I was a walking time-bomb and didnât know it, being practically symptom free.
I was symptom free this time also. The elevated PSA was picked up in a routine suite of blood tests. Luckily after a biopsy (a day procedure under anaesthetic), an ultra-sound, a bone scan and a body scan it was determined that the cancer was low risk at this stage and had not spread. Two main options for treatment presented themselves.
There was radiotherapy â an hour each day, five days a week for six weeks and monitoring forever after vs. an operation with the prospect of being clear of further problems.
The doctor put it this way. If you think you are going to die within 10 years, take the radiotherapy. If you think you are going to live more than 15 years definitely take the operation, but be honest, how long you want to live is irrelevant.
So we sat there calmly analysing how long it would be before I shuffled off this mortal coil. Generally Iâm quite fit. In rehabilitation sessions after the heart operation I saw how decrepit many people were in their 70s and 80s, swallowing fistfuls of drugs several times a day, but still alive and worth operating on. (Itâs when they say youâre too old to operate on that you know the end is nigh!) So I argued that, barring accidents, 81 was a reasonable expectation. The doc and my GP agreed.
But there are downsides to the operation. It is a two hour procedure with a scar from navel to crotch, so an extended recuperation period is indicated. Two weeks before I can drive and at least three months until I can hump bags of fertilizer, he said.
But there are nastier side-effects. Firstly, you have catheter inserted for the five days when you are in hospital. When you go home you have a 100% chance of having to deal with incontinence. But you have a 95% chance that it will clear up within a few months.
Secondly, he said Iâd have to expect erectile dysfunction. About a 20% chance of making it even with pharmacological aids, and then only after 12-18 months.
These nasties are also problems with radiotherapy, but typically to a lesser degree. Itâs just that radiotherapy can produce a few nasties of its own and you are never entirely sure that you are clear. To quote his report:
Complications include impotence and bowel irritation. If subsequent TUR surgery is required incontinence and urethral stricture are also significant risks. If radiation fails salvage surgery is very difficult and carries a high risk of major complications.
That does it, I thought. Cut the damn thing out and be done with it.
I didnât get a second opinion or talk to others apart from my GP and my wife. The way ahead seemed clear. Yes, my wife and I did talk frankly and honestly about what sex meant to each of us. We donât accept that the final chapter has been written as it were, but if it has weâll be just fine.
Now the jobâs been done and while my hospital stay was nowhere near as exciting as David Tileyâs it did have some moments, not all medical, that lodge in the memory.
On the first day the pain was extreme. They carve you about a bit while you are on the table. Also I have a lazy bowel and didnât manage to âvoidâ on the morning before the operation. Furthermore, I have a condition where at times the sphincter muscle cramps, usually about half an hour after bedtime, causing extreme pain. Then I also have some chronic lower back pain which was playing up big time.
It seemed to me that it was all happening at once on steroids. I rated the pain 9 out of 10 and rode the morphine button but it didnât seem to help. Then they offered me paracetamol. Paracetamol! And blow me down if it didnât do the trick. Together with the morphine it reduced the pain to 2 or 3 out of 10 like magic.
When you have extreme pain you first withdraw into yourself. Mark remarked on another thread that if it persists you tend to lose your sense of self. I didnât get that far, but I have no memories of the other patient in the 2-patient room on the first night.
This contrasts with the second patient who showed up late on day 2. He was a young man of Italian heritage, a sportsman who, I gather, had had season-ending surgery on his âwingâ (not sure which part of it.) Well he tried to get the TV working and kept pumping this remote control button to no effect. It turned out that he was pumping the morphine button by mistake. It wouldnât have done much to him because they have limiters on those things, but for whatever reason he was as high as a kite (probably the anaesthetic) and proceeded to ring up everyone in Australia and tell them the story at the top of his voice with paroxysms of laughter.
He turned out to be a total chick magnet – even the older ones wanted to mother him, so I had plenty of entertainment for 24 hours.
I couldnât complain about lack of attention, though. The care was excellent. Twice I was given a bath in bed without getting wet! It seemed to take only minutes. Then on day 3 a young student nurse took me to the shower, stayed there to help, made sure I didnât fall down and scrubbed my back. Then she coaxed me to take my first old-man stagger around the ward for exercise, one hand under my arm and the other carrying my âwee bagâ inside a plastic bag, and me thinking I was on a ship with the floor and walls rocking to and fro. But we made it safely around and back to the bed.
One night a youngish Chinese (a guess) person with scarcely any English showed up to do my observations. She messed up the first time with that thermometer thing they stick in your ear. It worked the second time, but she left the little protective plastic sleeve in my ear. She also took two goes with the automatic blood pressure machine. She was accompanied by another Chinese person just behind her shoulder who would just give you a big smile and then look up to the ceiling before the mask closed over her face again.
In retelling this I was accused of being racist, but I only describe what I saw. I noticed a badge on her which said âCPE Recruitmentâ? and suspect I was in the presence of Amanda Vanstoneâs Regulation 457. I have no idea what was going on, but my only complaint as a patient was that there was nothing to distinguish a person who may have been a novice nurse aide from a properly trained nurse.
Among other things the experience led me to reflect on care for the aged. We hear horror stories, but Iâm convinced they would mostly disappear with appropriate funding and staffing. Iâm sceptical though whether medicine has advanced as far as some claim with palliative care. I had an oxygen tube for the first few days and it left you with a horribly dry mouth. Also the pain reduction options seem limited. After they removed the morphine tube they offered me âsomething stronger than paracetamolâ. The problem was, though, that it was constipative. I declined that option but it still took me four days and two of their âthis will move anythingâ cocktails to achieve a bowel motion. Also they couldnât give me anything to make me sleep when I was on morphine so you tend to drift 24/7 unable to read much. I would have been sunk without my quality pocket radio, quality earphones and the ABC. Iâd hate to think what it would be like if I was really crook.
Robin Williams recently said that the male prostate gland was evidence against intelligent design. I tend to agree. But cancer of the prostate is quite common, so I thought I should do my bit here to demystify it a little. I havenât agonised, as Iâm advised many do, about âWhy me?!â? James Lovelock, who did a couple of decades of medical research before he got interested in the planet, reckons that most cancer is just the downside of breathing. Itâs all that oxygen, you see.
Bloody hell but excellent post Brian. Hope that the recovery is all going to plan (or better).
Great piece, Brian – thanks for taking the time. Keep on the recovery trail, & we’ll say some prayers for you.
Thanks, guys.
The doc said listen to your body and back off if it hurts. Well it hurts much less now (sneezing and such) but I tire easily and the incontinence thing is a complete drag as the day wears on.
I did pre-emptive pelvic floor exercises for two months, but after the op you can’t do any at all at first and then go easily because of everything they’ve cut.
But it’s a little better each day.
Sounds like you’ve got a good doc there.
I’m glad your hospital stay was free of complications, and that your convalescence, while slow, is likewise. Hope it stays that way.
That feller hitting the morphine button had me laughing out loud.
I am sure you’ve got strong recovery abilities, and the bags of fertiliser will soon be easy to hump. Until then, enjoy what chance to relax you are getting now.
I agree with you about the palliative care. I’ve just had some contact with three people campaigning for voluntary euthenasia, and there are some things that are pretty close to unendurable. Advanced aesophogeal cancer, the final stages of MS…
grim topic, and 81 sound minimal to me.
I went throught the same thing in 2001, Brian, at age 53: diagnosis of prostate cancer (PCa) in October and operated on in December. So I can say I pretty well know what you’re going through (you have my email address if you want to contact me). Post-op pathology indicated that had the diagnosis been 6 months later, the prognosis wouldn’t have been so positive.
And the diagnosis was really by chance. At age 50 my then doctor told me I had an enlarged prostate but indicated this was the case with most men my age and left it at that. Three years later I had a new doctor who I was seeing for chest pains. He asked for my medical history and then sent me for some blood tests one of which was for PSA, a test I had never heard of. PSA came back quite high, and another test indicated a lump on my prostate and the rest is history.
PCa kills as many men each year as does breast cancer (BCa). I can’t be strong enough in recommending every man 45 and over ask their doctor for a PSA test (earlier if your father had PCa or your mother BCa – children of parents with these cancers are thought to have increased risk of PCa).
More information:
http://www.prostate.org.au/ and
http://www.prostatehealth.org.au/
Hey your post is excellent. Here I was just agonising over the fact that my dad who is an 80 yo ca prostae patient was having such pain and such mood swings and your post came as a fresh breath. My dad is still in constant pain. He has undergone this past ten years..TUR, removal of the testes, radiation, chemo and you name it.
Thanks for the post and keep writing…ram (male,43, india)
Thanks again, folks.
ram, sorry about your dad. Growing old can become a full-time occupation in a sense. I’d really like to be fully operational until the end, but that is quite rare unless you suffer death by misadventure or accident.
Ron, thanks mate. Stories like yours do help, but also indicate the dangers of a lack of public awareness. I was not particularly aware of the prostate issue, apart from knowing that Wayne Swan had survived it and the tennis player Ken Fletcher recently died of it at age of 65. Now I find that almost everyone knows someone who’s had it or got it. The booklet the doctor gave me lists the age-related risk as follows:
40-49 1 in 1632
50-59 1 in 85
60-69 1 in 23
70-79 1 in 13
80 1 in 11
The life-time risk is 1 in 11, whereas my GP says it is 1 in 8 for breast cancer.
I’m out of my patch here, but I think breast cancer is more likely to spread. Some cancers are more aggressive than others and it is a question then, I think, as to when the cancer grows enough to reach lymph nodes. As against that it is almost certainly better screened and monitored in women than in men, which may affect the survivability.
I participated in a questionnaire researching the causes. The main curiosities were that they asked me if I was bald (yes), and at what age and whether I ate soy products (yes, also.) With the latter I understand there are particular concerns about GM modified soya, but they didn’t ask about that.
There does seem to be a genetic component. If you have a father with prostate in his 50s the risk doubles. If you have two close relatives in their 50s with the condition your risk increases 7 times.
But I agree totally with Ron that monitoring through blood tests is a wise precaution. In fact I’d suggest a complete suite of tests. Older people often get caught with thyroid, for example, and not know it.
You do take care, Brian, you hear?
Speaking of growing old. That’s a transition as huge as becoming a new parent and any other change. Bigger in fact, since ultimate issues are no longer to be put off.
Not to be intrusive, yet how are you doing those things?
Terrific post, Brian. I am a prostate cancer survivor from 1998. Post op, I had positive surgical margins (which means that cancer cells were found in post-operative pathology right on the edge of the cut tissue, suggesting cancer cells may still have been present within my prostate area). I therefore followed up with radiotherapy for 33 sessions. My PSA now is undetectable so I’m beginning to dare think I’m fully cured.
You certainly had a hard time with pain. My post-operation spell was relatively pain-free, although the fellow in the same recovery ward to me, operated on by the same urogolist, was having a particularly hard time. I refused sleeping tablets for my first night post-op, but had very little sleep due to my fellow patient’s traumas. The next night I accepted the sleeping tablet and slept like a log. Practices re sleeping tablets may have changed since 1998.
Operative anaesthetics have some personality changing characteristics it seems. I was woken up by a beautiful nurse after my operation, and I thought âI must have died, and this is heaven!â? I felt on a great high, to the extent of flirting with the her. Silly old bugger. I felt terrific however. I came back to earth with a thud during the next 24 hours.
I still remember ward nurses trying to make me get up and walk around not long after the op, after I had been moved to my own private room. However my left leg was still pretty well paralysed, and I told them. Nevertheless they persisted and two of them helped me out of bed into a standing position. My leg couldnât hold me and they struggled to stop me collapsing to the floor, barely succeeding. The effect on my wound hardly bears thinking about if I had landed with a thud on the floor!
Brian, I donât know the Brisbane situation, but I hope you would take advantage of local Prostate Cancer Support groups at your local hospital. We have really good ones here in Sydney, and ours at the Sydney Adventist Hospital at Wahroonga is really terrific. It really helped me enormously, and now as a survivor I am a co-facilatator volunteer with the group.
Iâd be more than happy to engage with you in exchanges of emails, patient to patient. As the originator of this thread Iâm sure youâd have access to my email address. Please donât hesitate to use it.
Just to clarify, I’m not the Ron in comment 6 in this thread. I think, however, that people named Ron are a high risk group for PCa. The name seems to be restricted to men born from about early nineteen-thirties to about mid nineteen-forties!!!
Ron, I have an elder brother named Ron, born 1935. I’ve also noticed that there are a lot of Brians about my age.
That’s fascinating.
I need sleeping tablets every night because my circadian rhythms have been stuffed since my early 20s. It happens. I confuse my body by changing drugs every couple of weeks.
In hospital this time they wouldn’t give me anything while I was on morphine because it might stop me breathing. Then later the duty nurse explained that legally they just couldn’t do it unless my urologist had prescribed it. So I read in the middle of the night and they had to wake me for breakfast. When I explained to my urologist he happily wrote out a script, but I passed the ‘voiding test’ and got out of the place before I got any benefit out of that.
On pain, it can be pretty ferocious with heart operations, but the only pain I had was in the lower back and my sinuses were mightily upset by an ill-directed airconditioning vent.
On anaesthetic, I had blurred vision a lot for the first few days. But my third roommate reacted by violent vomiting for about three hours.
During the hospital time after the heart surgery I had the most beautiful and one of the most scary dreams of my life.
AK I have in mind another post on growing old, post traumatic stress and facing the grim reaper. Maybe it’ll happen. We’ll see.
Your case was obviously more complex than mine, Brian, due to your heart situation.
You may want to compare notes with me on ED as the time approaches where that becomes more of a concern than it is now. My experience is that with men only 3 weeks out from a radical have other concerns uppermost, overall recovery and continence being obviously front of mind.
At our support group discussion meetings on the second Monday afternoons of each month the subject of ED arises quite regularly. Woman reckon blokes only ever think about One Thing. May not be entirely accurate, but ….
Naomi, the fertiliser isn’t Freudian, it’s real! Since I left the public service in 1991 I’ve been working something less than full-on mowing lawns and doing gardening for a range of people from pensioners to the very rich. I told the doc that the mower weighs 33kg which I pick up and put on the ute with ease when I’m fit. Bags of fertiliser are 40kg, which the doc introduced into the conversation.
Yeah and ‘humping’ to me from my youth primarily means building one of those huge stacks of wheat bags you ‘hump’ on your shoulder, now no longer seen at country railway sidings. A generational differnce in language use I fear!
Ron to speak plainly, by ED you mean erectile dysfunction, no? You are right that it is very far from one’s mind right now, and spot-on about what is front-of-mind right now, although I’m pretty confident that overall recovery will be OK eventually.
The heart isn’t a problem BTW. I think my cardiologist has me as a star patient and expects me to die from something else. I didn’t have a heart attack, hence no heart muscle damage. After that I was swinging a pick after 3 months, but I think it took 3 years to recover fully.
I have an aversion to male groups for some reason, but may take advantage of the offers of support from you and the other Ron as time goes by.
Once you’ve had a radical prostatectomy, Naomi, I’m afraid a bloke’s fertility’s kaput. You ain’t got the organ that makes the fluid any more.
PCa has been detected in men in their early forties these days owing to PSA tests. Unlike in older men, reproduction may still be an issue with these fellows. One answer for them is to have their sperm frozen before the op for use when and if required.
This is quite a different issue to erectile dysfunction, however. There are excellent treatments available for it these days. Unfortunately viagra is usually ineffective in cases where erectile nerves have been damaged or destroyed during surgery. But other treatments can be most effective.
Yes Brian, ED means erectile dysfunction or to use the vernacular, impotence.
I understand your aversion to male groups. Fair enough. Ours however is attended by many of the wives (or partners as the politically correct insist these days). We find that in many cases the wives have got more general knowledge about PCa than their husbands have.
A national survey by the Prostate Cancer Foundation of Australia found that while 78% of women felt well informed about breast cancer, only 58% of men felt well informed on prostate cancer. Yes as the other Ron has noted, as many men die from prostate cancer each year as women die from breast cancer.
I think its great that LP via you has illuminated this subject. I used to comment prolifically on blogs several years ago and this thread has prompted my come-back (on this subject only, however).
Sydney readers, in relation to Prostate Cancer, please support this event. Also it would help if were to spread the message to your friends and acquaintances:
http://www.fathersday5.com.au/default.asp?PageID=4362
Thank you Brian for your wonderful post. I am going to be a Dr. next year – I have seen people with prostate cancer but this post has given me hopefully a better understanding from a patient’s perspective – which is what many medical staff, including myself, always seems to lack.
Excellent Max. GPs have a very important role in the diagnosing of prostate cancer. Some are much better than others. I owe my diagnosis to my own GP who gave me a PSA test back in 1993. He sent me off to a urologist who undertook a biopsy – an invasive process (I know you know what I mean) that came back negative. It wasn’t until my fourth biopsy (in five years) in 1998 that I was finally dianosed with PCa. But it was the first alert in ’93 that made me conscious of the situation, and my GP made sure I had regular follow-up tests.
damned good to have ron commenting again.
Just on this issue (which I’m intensely interested in), Homer. These days I just lurk in blogs’ backgrounds. I know what you’re up to though, don’t you worry about that!!!!!
Nice to see a post from you Brian, and I hope your convalescence is fast and uncomplicated.
Brian:
That’s the spirit!
Paracetamol and similar “simple” analgesics are indeed sometimes better than “strong” ones like opiates (morphine, Pethidine, codiene, etc.); it’s horses for courses.
The shortage of experienced nurses can be traced back much further than DIMIA’s latest bit of Aussie-bashing to the days when academic hippies dragged nursing education out of the hospitals and got rid of thousands of “unqualified”(???) nursing aides in a counterproductive Reform By Sledgehammer campaign.
Sexual dysfunction? Why not have a yarn with some young paraplegics – you never know what lateral thinking they might come up with; it wouldn’t do any harm…..:-)
Good on you, Brian.
Thanks very much for sharing that story Brian. So much of it is so very familiar, although my big hospital adventure 4 years ago was for a very different condition, namely 16 broken bones and associated soft tissue injuries.
The topic of pain relief is an interesting one. It wasn’t until about 7 days after hospital admission that I started (after much pleading) to get the megadoses of morphine that finally allowed me a decent night’s sleep. Some doctors are absolutely dead set against the use of morphine, as my original treating orthopaedic surgeon said- “it isn’t part of my philosophy”.
I was still taking morphine until about six months ago. I found that some GPs would happily prescribe it whereas others at the very same clinic were adamant that they wouldn’t presribe it under any circumstances. The weird thing is that morphine has no life threatening side effects whereas the alternative pain killers mostly do- including death.
As to funny (or quirky) incidents, some type of foul-up occurred when a trainee doctor took my blood. Somehow or other blood spurted out of my vein and all over the poor bugger. It was in his hair, on his glasses, tie and coat. I’m not sure who was more shocked, him or me.
I’m also with you on the limited effectiveness of even the very best palliative care.
I’m absolutely convinced that euthanasia is the best option, for me at any rate, when the end is nigh. The thought of joining the endless wards of grey, wasted and spiritless souls I saw once I could move about in a wheelchair fills me with dread.
It may depend on the hospital, but I found recently that pain relief is at the top of the agenda. There’s the self administration button Brian referred to, and I had doctors saying things like “there’s no reason you should be in pain, just press the button.” And a strange team that goes around each day asking the same question endlessly; “on a scale from one to ten, how would you rate your pain..” they can’t stop unpleasant things, but at least I think they often happen against a base level of drugs that take away a lot of nastiness.
Ron,
come and share a coffee at Eatwood sometime. Damned fine coffee too
David, the normal nursing staff kept asking me about the pain out of 10 also. So I guess the philosophy and practice of individual doctors and hospitals do vary, as you say.
They have a counter on the morphine button so they can tell how many times you pressed it. I think it also tells them how many times the machine released morphine because, as I said earlier, I understand there is a limiter on these things.
I’m sure they can kill the pain most times, but it seems to me there is a penalty in relation to the quality of your consciousness. While my experience was limited it did tend to confirm my previous support of some notion of voluntary euthanasia.
Also there is little they can do for an old guy I know who is wracked with athritis pain, but is living at home. He mentioned a cortisone injection every three months, but the pain was in his eyes and his voice.
Before the op they had a similar obsession about allergies. I reckon I was asked 15 times. Then at the last station before the theatre a nurse appeared and said, “Hi, my name’s Rose. Do you have any allergies?” I answered “No”. She marked it on a sheet and took off.
I decided she was the one that counted, the others were all back-up.
Steve, it sounds a rugged time you had. I’ve found a similar prejudice with some doctors about sleeping pills. Some doctors are most reluctant to prescribe them, while others will accept that my circadian rhythms have been stuffed for decades, that I’ve tried all the usual remedies and chalked up a 100% failure record, and that I’m not depressive but would be if I didn’t sleep.
I’ve taught my GP a lot about sleep. She’s a good learner, but somehow I still get to pay her rather than the other way round.
Brian,
My father-in-law had the heart/prostate double. In his case it was an angioplasty then prostatectomy, the latter about three years ago. He was a very fit bloke in his mid 50s when it all hit, so the bad health took him by surprise.
I scrounged up lots of information about prostate cancer at the time, but I recall this site:
http://www.prostatehealth.org.au/v3/index.htm
had some good information.
For my father-in-law the incontinence was a big deal. His wife managed to find some really good products which meant he felt more confident about going out and not worrying about what might happen. He did alot of pelvic floor exercising and in the end he regained contience pretty much by constantly clenching his pelvic floor.
I believe that this is no longer the case, that at some stage he could let go and it was ok. He does have to preemptively clench the pelvic floor before doing any heavy lifting however. He also tends to have to use the toilet a little more strategically than before, but only as much as his wife, and no doubt many many other women who have also given birth.
I can’t contact him at the moment, but at a rough guess the serious incontinence was on a time scale of months (1-3), and the “active continence” was maybe 6-9 months.
ED is, I think, a fact of life for him. It isn’t something he talks about a great deal, but please don’t underestimate it’s effects. Self-confidence is a funny thing, we are fragile beasts when it comes down to it.
Best of luck.
I’m interested that your doctor did a routine PSA, Brian. Were you not forewarned and given the option of deciding not to have the test?
Thanks for your post Brian – try to do all your exercises and rest up.
My elderly mum fractured her hip May this year, and her shoulder last May (Incontinence and a prolapsed uterus are two other things on her list of ailments unfortunately)
Anyhow, I accompanied her and dad to public hospitals both times and stayed until she was through emergency, and into the ward etc (and would recommend St Vinnies over POW – in Sydney btw)
In relation to pain medication – one of things the nurses and I had to make Mum understand, was to not let the morphine drop right down, until the pain is back, and then you ask for another top-up, and then have to wait for affect etc.
It is preferable to get the ‘pain under control’ and then keep it that way – especially for those first few days as the body is healing itself, then start knocking off the dosage, as the pain decreases.
As my mum didn’t drink at all (or take drugs!) she was unused to feeling ‘out of control’ and she really struggled with the morphine last year and feeling “out of it”.
This year, I visited her on the second night and she looked like just a junkie – nodding off mid sentence and was quite relaxed, and within another day or so, she was on the paracetamol only (or possibly Panadeine ie. same with some codeine), with the major trauma of the break and subsequent operation already behind her etc. Only months of rehab ahead.
I think the paranoia of the medical profession in respect of ‘pain relief’ was an over-reaction to the over-prescribing of opiates, barbiturates, hypnotics like Valium etc, and medications for conditions like hypertension etc – for decades until the 1990’s – without adequate follow-up or determining any other treatment options etc.
andy, it happened this way.
Every year I go to see my cardiologist around Feb-March. (He was so happy he only wants to see me every second year from now.) This year on my suggestion my GP asked for a complete suite of tests, instead of just the cholesterol. It costs no more, but I guess the GP has to spend time looking through it all.
When I saw her she said the only anomalous result was the somewhat elevated PSA. She said, “Come on, we’d better have a look” and so she did a digital examination. She found a noticeable lump on one side and recommended a specialist.
He did a digital examination and said there was only one way to find out for sure and that was through a biopsy.
A biopsy was done by day surgery under anaesthetic, for which I was grateful, and an ultrasound at the same time. This showed up cancer. At that time he gave me a booklet “Localised prostate cancer: a guide…” published by Andrology Australia and we went from there. The doc I saw emphasised that I would be making the decisions. He’d been doing this stuff for 15 years and had done about 800 prostate operations.
I found the nursing staff had a lot of respect for him and knew all his protocols.
jo, I heard a lot about pain on the radio a few years ago when Geraldine Moses, a local pharmacist, used to do talkback. She used to emphasise the importance of eliminating pain completely as the key. If you just damp it down it’ll keep coming. She also emphasised that it can become a disease in its own right. She was quite keen on paracetemol.
Don’t try this at home, but my heart surgeon had a similar philosophy. He said codeine is just going to muck up your bowel and he prescribed 2 panadol every 4 hours for up to 4 weeks. It worked like magic for me. No morphine. In the hospital this time they would only give it every 6 hours and the pain always reappeared between the 4 and 6 hour mark. But unless otherwise advised by you doctor, just follow what’s on the bottle, OK?
My prayers for your continued recovery Brian.
“I’m interested that your doctor did a routine PSA, Brian. Were you not forewarned and given the option of deciding not to have the test? ”
Doctors regularly take a blood sample for a whole suite of situations. You can always refuse to consent to these or tell him/her to restrict it to say potassium or cholesterol etc etc. Most patients eyes just glaze over when a doctor goes over the reasons for each test. Pathology tests always come with a range of normal readings so that your doctor will be able to alert you to what may be abnormal or unusual. You can then refuse further investigation or treatment. I just can’t see the point of your question. What premium is there on ignorance?
Not that this is an unusual question, Andy. Even some doctors make the same point as you, including Professor Coates of the Cancer Council several years ago, who promised to sue the first doctor to give him a PSA test. I find it very difficult to understand this promotion of ignorance.
Another point is that given the present prevalence of professional litigation, it’s a pretty reckless doctor who omits to do this sort of thing. I guess if there was a groundswell of patients pursuing ignorance, doctors may be advised to change their practice. I see no evidence of such a groundswell.
Brian says:
“Don’t try this at home, but my heart surgeon had a similar philosophy. He said codeine is just going to muck up your bowel and he prescribed 2 panadol every 4 hours for up to 4 weeks. It worked like magic for me.”
What works for one person will not work for another. I’m currently prescribed Celebrex and Panedeine Forte but I only take them when pain is really acute as they are largely ineffective. Moreover, my GP reckons long term use of such drugs will damage your heart and liver. I used to take Vioxx until it was withdrawn from sale due to the heart attack scare.
Opiates can cause appalling constipation but apart from that I’m not aware that they damage your bowel.
GPs at my local clinic, in Collingwood, are reluctant to prescribe opiates in part because a steady stream of junkies roll-up with fake claims of chronic pain and beg for opiate prescriptions.
Work is ongoing on finding better pain killers and hopefully a major breakthrough will occur soon.
I hope you recover well Brian.
God, those anti-pain drugs screw up the digestive tract don’t they? I had a shoulder reconstruction a few weeks back and was prescribed panadeine forte (because I’m allergic to pethadene, the typical pain relief for this operation). Anyway, I was blocked up for a week and it took all manner of stuff to get my bowel working again. Really, really uncomfortable experience.
Mick:
It’s probably the opiates (like codeine)that slowed down your gut movement and bogged you up. If ever you are in a similar podition again, ask about non-opiate analgesics.
Some doctors are wary of prescribing morphine, and sleeping tablets to a lesser extent, because they can be quite addictive.
I am unable to have take NSAIDs, such as Ibuprofen, Voltaren and Vioxx, because they cause me serious gastro problems. There has also recently been studies that indicate that they may also contribute to increased risk of heart disease.
The scary thing is that you can buy Ibuprofen in the supermarket.
Brian, excellent post. Hope recovery goes well. Can Mark lift a bag of fertiliser?
I’d have to get a bit fitter, I suspect, Pollytickedoff. I mean I’m sure I could lift one, but lifting quite a few I suspect would be a challenge!
Brian — Great post.
We wish you a swift and sure recovery! You’re needed back on the beat…
Pollytickedoff, when I grew up we dug postholes with crowbar and shovel, made the posts by cutting down hollow trees and cutting them up with the cross-cut saw, splitting them with mallet and wedges. If you couldn’t carry two 4-gallon buckets of milk at once you were considered useless.
Mark fortunately grew up in an era when there was more of a premium on using your brain.
Just on sleeping tablets, they are not chemically addictive but you can become psychologically dependent on them and they tend to lose their effect over time. Which is why I keep swapping and it seems to work out OK.
The newer ones, Stilnox, can be a hazard, as they work within about 15 minutes and you can pass out if you are not in bed. Could be a problem if you took one and hopped into a warm bath. No pharmacist has ever warned me about this. There used to be a medication helpline set up by the same Geraldine Moses I mentioned before. I’ll check it out tomorrow.
Steve’s right, of course, about the individual reaction to drugs. Moses used to stress that the generic does not necessarily work the same as the brand name drug.
Re Andy’s query and Ron M’s response, I do recall the Coates contention, I think, that you are better off not knowing you’ve got cancer of the prostate. I daresay it is because it sometimes proceeds slowly and the side-effects of treatment are so adverse. Giving it any chance to spread seems to me just crazy.
Thanks j-p-z and everyone. This little exercise has been a big help.
I wanted to go back to Aidan’s comment about “constantly clenching” the pelvic floor. This is spot-on as far as I can tell. The physio I went to tried to get you to be able to control your pelvic floor saddle independently of all other muscles. There is a tendency to recruit other muscles in the area, which will do no good and just tire you out.
We are all meant to activate our pelvic floor, not just suffering sods like me. As tigtog said here it can be good for your sex life. But I find activating them particularly difficult when you are walking.
I rang the physio who saw me in the hospital today. He said 10×10 seconds at least 6 times per day, but preferably every hour and every time you think of it in between. But not too intensely – as calibrated by stream interruption.
I’ve just checked out the medication helpline I mentioned yesterday. It is now a national service called Medicines Line. I’m sure it is the one Geraldine Moses launched out of the Mater Hospital pharmacy a few years ago (same phone number.)
You call 1300 888 763 where you get a recorded message, including a direction to a poisons helpline if you need it. You leave a message and a pharmacist rings you back.
I have only used it once, with excellent results.
Abbott under fire over prostate comment
The man is an irresponsible idiot and should be not be health minister.
I had no PCa symptoms and if it hadn’t been for my doctor recommending a PSA test, I hate to think what situation I would be in today.
I couldn’t agree more, Ron. I had no symptoms and while mine turned out to be ‘low risk’, one number further up the scale they use and it wouldn’t have been.
Today I talked to a man in his 40s whose father died of prostate because he found out too late. He’s off to get a test.
Abbott’s comments are risible and dangerous.
Brian, I don’t know if there’s a link but there was a brief item on one of the news broadcasts on tv last night about former State of Origin Ref Barry Gomersall’s battle with prostate cancer.
Kim, I googled but couldn’t find a link. From one that failed it seems that Gomersall may be trialling a new treatment.
There was also Ken Fletcher tribute here, the best tennis player to come out of Brisbane ever, an amazing life, and who died recently from prostate cancer. I saw him once in an exhibition match with Rod Laver when they both came to our school.
While I’m here, I found this book by Peter Dornan about a week ago. He’s a physio about 10 minutes from here who had the prostate op in 1996 and found how to fix incontinence. He also started a support group here.
I’m getting there, I think, btw, possibly a bit ahead of schedule.
I wasn’t paying much attention, Brian, but I think he was saying he was given 6 months to live, but was now doing well.
Very glad indeed to hear that you’re doing well!
To Brian and others, my very best wishes for a good recovery!Interesting reading and written with a real human element.
Just got diagnosed with bladder cancer. Where I am from diagnosis to first treatment is a long wait. In the meantime I just try to find some stuff on the internet; until very recently I was not aware that bladder cancer has such high numbers. If it is not one cancer it is another. Waiting is cruel and unusual punishment. The worst part if I were in jail I would get treatment at once. (That is Canada for you!)
Les, sorry to hear and I do hope that all goes well.
I tried to add some reflections on the private health system in a later post. One of the attractions here in having the option to go private is that one retains better control over the timetable for treatment.
Personally I would sacrifice quite a lot to retain these options. If the government subsidy of private health insurance premiums ceased it would create real difficulties for us, but we would tighten our belts quite a bit if necessary to stump up the extra cash.
Brian, I’m sorry to say that I hadn’t read this thread until tonight! I hope that you’re feeling much better and that life is becoming ok.
Stories such as yours are very informative for young (32) guys like me. I have noted slight physical degradations in the last few years in my memory and a few other things, but I’ve adopted strategies to deal with these. I think I’ve been extremely lucky with minimal physical problems (not even a broken limb my entire life). My dad, 57, apparently has no prostrate issues, which is good news for him and hopefully for me too in the future!
Even though I feel a long way from having many medical problems, it’s close enough for me to think that I have to do what I want to do, there’s no second chance.
Life is short and I want to make the most of it.
As it happens I had my 6-month check-up a couple of days ago – a PSA test and a 10 minute chat with the doc for which he charged me hansomely.
Everything is brilliant. So far so good!
Don’t go to the mater adults emergency if you’ve been attacked! They’ll fail to run the necessary tests for evidence and they’ll fail to call police to investigate the crime. STAY RIGHT AWAY!