Doing a bit of my very own science!

[TMI] [Science] Caution: What follows deals with subjects that may make some people uncomfortable.  Various body parts and their function are discussed in plain language.

Update 31 Oct 2012: Added a new specimen and a bit more history. Inline below.

The general consensus among urologists about why some men leak after having their prostate removed and other men don't is that they don't have any idea.  I asked Dr Cavernosa about it and he said it was a frustrating topic.  He said he would sometimes think "I did a really good job on that guy and he leaks like a sieve."  Other guys who got exactly the same `reatment did fine.  Some guys leak, some don't.  Nine out of ten times the leakers get better with time.  Sometimes biofeedback can help.  But some don't improve and require additional work to restore continence.

I am just over four months out from a robot assisted radical prostatectomy and I still leak quite a bit.  I've been working with a biofeedback nurse who coaches me on my "kegel" exercises and hooks me up to a machine every couple of weeks to measure my "progress" and, to be fair to her, there has been some progress just lately.  But it has been maddeningly erratic with repeated alternate improvements and relapses. 

I have developed a theory about why I personally have leaked for so long and why I seem to be getting better.  It also explains the on-again, off-again nature of my improvements.  I have a dab of evidence which I will get to in a minute, but first the theory.

The Theory:

Because the cancer had grown near, but not into, my urinary sphincter (which the doctor and I wanted to keep) he had to cut things pretty close.  This meant that there were sutures very near to the sphincter and they irritated it.  These sutures should have dissolved fairly quickly but because I reduced my fluid consumption to minimize the leaking (Depends cost money) my urine was a bit concentrated and some of the minerals crystallized on the exposed parts of the sutures, slowing the rate at which they dissolved and making them stiffer and more uncomfortable.  In the last few weeks these encrusted bits of suture have been breaking off and being expelled with my urine.  They come loose at one end first and, for about a day, the loose end protrudes and pokes at the sphincter making my uncomfortable and leakier than ever.  Then the other end comes loose and I am better until the next suture starts making trouble.

The Evidence:

June 14th: I have my prostate removed.June 26th: Catheter comes out I leak like a sieve.
Aug 25th: I start biofeedback training.
Sept 12th: I notice a small amount of blood in my urine after doing my Kegel exercises.  Dr. C advises a three day break from the Kegels.
Oct 11th: While taking a shower I  notice a 5mm long piece of something on the tile. (How did it get there?  Did I mention that I leak?) It looks like a bit of uncooked Ramen noodles.  I discard it.
Oct 11th and 12th: My leaking is much reduced.  I am encouraged.  I wonder if the improvement is related to the object.
Oct 13: My leaking is worse than ever.  Then just before bed I notice another bit of material in the commode.  I retrieve it.
Oct 14th: Leaking better again.
Oct 16th: Find a bit more in one of my used pads.
Oct 17th:  Start radiation therapy (IMRT).  This will somewhat confound my reporting of urinary symptoms since the radiation can cause irritation.  Buy a fine-mesh tea strainer.  Keep it in my pocked and pee through it whenever I go.
Oct 18th and 19th: Feel like a bit of an idiot peeing through my tea strainer, especially at the state fair.
Oct 20th: leaking is definitely worse.  Nothing in the dratted strainer.  Discouraged.   Then at about 3:00 pm I catch a 5mm bit of suture in the strainer.  Feel better immediately.  Leaking lets up.  Take photos of my bits of suture and write a blog posting.
Oct 25th:  Catch a small piece in my tea strainer.  About the size of the piece from the 16th.  Shaped like a russet potato.
Oct 26th through 31st: Incontinence gets worse.  Develop constant urge and a prickly irritation (similar to urinary track infection).  Nothing in the dratted strainer.  Unable to comply with bladder instructions for IMRT.  (I am supposed to arrive full for the ultrasound fine-positioning.) Discouraged.  Worried that problem is the radiation.
Oct 31: (About 9:00 pm) Catch a 6mm piece of suture in the strainer.  More comfortable immediately but still rather leaky. Specimen has an encrusted cuff at one end and bare suture material at the other.  Cuff and bare portion are both approximately 3mm.
Nov 2: (11:00 am ish),  Catch a rather small (2mm) piece of lightly calcified suture.  The end of a piece of clear suture material is visible sticking out of one end.  


Here are my photos:

 My collection (photographed in a plastic bag).  From left to right (starting with the bit that looks like grass)
1) a fleck of mostly-dissolved suture from Oct 13th,
2) today's sample (Oct 20)
3) half of the Oct 13th sample,
4) the Oct 16th sample,
5) the other half of the Oct 13th sample

 Closer shot of Oct 13th (top two) and October 16th (bottom) pieces.

 Angled shot that shows the thickness of the calcification (or whatever sort of cruft it is) that has accumulated on the Oct 13th sample.  (The hole is where the bit of green suture material came from)

October 20th  sample appears to be a knot.

October 31st specimen has a tail of bare suture material.  This one made me uncomfortable for a week.  My theory is that it came loose at the calcified end and stuck out of the sphincter wall like a thorn.  (Sorry about the photo: light was so-so.)

Sidebar: Prostate Biopsy -- What to Expect

I found this Creative Commons photo here.  If it is yours and you want a better credit, you have but to ask.

[SEX] [TMI] Caution: What follows deals with subjects that may make some people uncomfortable.  Various body parts and their function are discussed in plain language. 

If your urologist has reason to suspect that you have prostate cancer, probably based on the results of a digital rectal exam in which he felt a lump in your prostate or based on an elevated Prostate Specific Antibodies blood test (PSA), he may recommend a biopsy.  Medically, it's a pretty good test.  It provides useful information, is fairly simple, and if your doctor says you should get a biopsy then you should man up and get it done.   The procedure is approximately as uncomfortable as having a tooth filled at the dentist -- it's a bit worse than having your teeth cleaned but not nearly as uncomfortable as having a tooth extracted or being fitted for a crown. 

Here's what to expect based on my experience:

Before you go in your doctor will give you a prescription for an antibiotic which you are to start the day before the procedure and continue taking for several days after.  He will also probably prescribe an over-the-counter enema to be self-administered right before you go in.  He may prescribe a second, antiseptic enema as well.  If he does you'll have to pick that one up from your pharmacist.  I have had three biopsies over the course of a couple of years  and only for the third biopsy did Dr. Cavernosa call for the second enema.  I don't know if that is because it is a new thing that he has added to his routine, or because he had decided to take a lot more samples the third time and wanted to ensure that the extra punctures didn't raise the risk of infection.  In any event, the over-the-counter (Fleet) enemas are no big deal but the antiseptic (Betadine) enema, although tiny, gave me cramps that lasted for twenty minutes after it was expelled.

Your doctor may also prescribe a sedative (often Valium) to keep you calm during the procedure.  The best time to take it is in the waiting room after you check in.   If your doctor prescribes the sedative you will have to have someone come with you to drive you home after the procedure.   If he offers the Valium as an option my advice is to take it, and if he doesn't offer the option you might inquire.  I had my first biopsy without Valium and the next two with it.  My experience with the procedure is that it is not so much painful as extremely annoying and that any pharmaceutical detachment I can get is all to the good.

When you are called back they will take you to a room with an examining table and some equipment on a cart.  They will tell you to remove your pants and sit on the table.  They will give you something to drape over your legs while you wait for the doctor.  While you wait you can look at the machine.  Depending on whether or not you have taken the Valium it will be interesting or it will make you nervous.  Here's what you will be looking at and what it does:

The machine is a "prostate ultrasound system."  It has dials and buttons and a small screen like a television.  It will have a cable coming out the front that runs to a device shaped a bit like a sexual novelty item with a reassuringly non-anatomical design.  That dildo-looking thing is an ultrasound transducer.  It sends out a fan-shaped burst of sound waves that bounce off parts of  your prostate and are reflected back to the transducer to produce a black and white image that shows, basically, a slice through your prostate.  By moving the probe back and forth your doctor can  see the whole organ.  He will look for abnormalities and will also use the image to aim the small metal tube that runs along the side of the probe where he wants it.  Through that tube he can insert a needle to inject Novocaine (which he will probably do first) or a device called a biopsy gun which is spring loaded to shoot a hollow needle out the end and then pull it back quickly taking a small amount of tissue with it.  

When the doctor come in he will have you lay on your left side facing away from him and pull your knees up slightly towards your chest so he can get at your butt.  He will smear a bit of  KY Jelly on your anus and poke the probe up your behind.  By this time you are probably used to his finger but the probe is a bit bigger and more uncomfortable, especially as he grinds it around looking at the various parts of your prostate with the ultrasound.  There is a bit of a metal-on-metal sliding sound when he threads the syringe through the tube so he can inject the Novocaine.  The stick doesn't feel sharp, it's more of a sudden ache.  Then it's gone. 

The actual biopsies are more annoying than painful, although the do hurt a bit, especially when the doctor is taking samples of the apex of the prostate gland -- the part farthest from your bladder and closest to Mr. Happy.  Also, the biopsy gun makes a noise like a mousetrap going off.   My best analogy for the sensation, if you've never had a prostate biopsy, would be to lay on your back with your legs spread and have your wife push your balls aside so she can stretch a stout rubber band tight across the base of your penis just behind your scrotum.  Then over the course of the next fifteen minutes she should snap the rubber band without warning, six to fifteen times at random intervals, being sure to pull it back far enough so the noise alone would make you jump.  Something like that.  Then try it again with the Valium.  You'll see the difference.

When the doctor is finished he will let you sit up and hand you a box of tissues to wipe the goo off of your butt.  Don't be surprised if the tissue comes away bloody.  That threw me a bit the first time.   I'm sure Ethel would have found the experience familiar -- a once a month event --  but for me it was new and unnerving.  

If you are observant after the procedure you may notice some bits of absorbent material lined up on a tray beside the machine.  On each one is a small smear of blood and something that looks like a grain of rice.  Those are the biopsy samples the doctor took.  They will be packaged up, labeled, and shipped off to a pathologist who will stain them, slice them up and look at them with a microscope to see there is any cancer.  It will take about ten days to get the results back.  

Those can be a very nervous ten days, waiting to find out if you have cancer.  After my first biopsy I made it three days before I called my regular doctor to get something to calm me down a bit.  Xanex works well for that if you need it and, often, just to know you have a pill or two in your pocket that will help if you start to freak out is enough to calm you down and you don't have to take them. 

The paperwork your doctor will give you will tell you to expect to see some blood in your stools, in your urine or in your semen following the procedure but that it should mostly be gone in a week.  In my experience that is a bit optimistic.  They are easily right about blood in the stools.  There usually isn't much and it tends only affect your first bowel movement after the procedure.  After that there is no blood in your stools... not exactly.  We'll get back to that.  As for blood in your urine, it will mostly be gone after a day or two for stand-up peeing.  But, if you have some sit-down work to do at the same time, the pressure when you defecate will often force out a drop or two of  blood from your prostate which will tend to drip out of your penis with your last bit of urine.    So, no blood in your stools, technically, but there may be a bit of it in the toilet nonetheless.

As for blood in your semen, that's where I think they are just lying about the week.  For the first four or five days your semen will be bright, vampire-movie blood red.  Then it will darken to a chocolate syrup color for about a week.  (If it stays red for more than a week you should probably tell your doctor.)  Then, gradually over the course of five or six weeks, it will fade through cafe latte colors then  tea-with-cream, and gradually back to normal.  With me it is about two months before I feel sufficiently normal to resume the usual business of pestering Ethel.  

I suppose, medically speaking, I could start earlier, but there are times when it's just hard for a boy to feel pretty.

I should repeat my standard disclaimer that I am not a medical professional and there is nothing like medical advice to he had here.  These are just my personal experiences and thoughts as a patient.

Journal: A Joke to Tell Your Urologist

Dr. Cavernosa seemed to like this one:

 My Diary

Diary Entry: 23 January 2011

January 23rd.  My 59th birthday!  I woke up this morning with my usual glorious erection.  Reaching down, try as I might, I could not bend it! 

Still as virile as ever!

. . .

Diary Entry: 23 January 2012

January 23rd.  My 60th birthday!  I woke up this morning with my usual glorious erection.  Reaching down I was able to bend it ... just a little.

Journal: First Post

[SEX] [TMI]

What the hell am I doing setting up an anonymous blog when I ought to be spending the time with Internet porn and self-abuse?

Ethel is out of town,   I dropped her off at the airport to fly off to her annual week-long reunion/hen party in Atlanta with some of her girlfriends from her time when she worked at GA Tech,  It's been a long time since they worked together but they still get together every year.  They  hit the Georgia Aquarium, eat at Miss Pitty Pat's Porch, do the art museums, stuff like that.  This year there is the added attraction of getting to see the twins.  

So Ethel is OK.  If I keep my voice calm and serene on the phone with her she can be happy.  Ethel is out of the way and I am rattling around the house on my own.

I have stuff I ought to be doing but I tend to spend my time obsessing about the unfortunate side effects of my anticipated prostate surgery.  Mostly I worry about my sex life and whether there will be one.  I figure, realistically, I have a 50/50 shot.  Nervous odds.  There is a factoid on hears that men think about sex every ten seconds.  Research suggests that this is overstated but nobody disagrees that they think about sex a lot. 

This doesn't make us men rapacious predators -- at least not most of us -- its just something that goes on in our minds and affects our point of view.  When a heterosexual man sees an attractive woman on the street he takes a minute to review her clothing; he inventories the closures he can see and those he can infer, or which he remember from prior experience.  He then knows how those clothes could be removed in the event of an emergency and, that important safety protocol having been established, he goes on his way.  I suspect the procedure for gay men may be similar except that a small fraction of them might add in speculation about whether the woman's clothes would fit them and how they would look.

 

Unfortunately, since diagnosis of my cancer, I have an anxiety bulb plugged in on the same circuit as my libido.  I see that same attractive woman and I am about half way thought my inventory of buttons and hooks when this damnable voice in my head says: "Even allowing for the hypothetical latitude generally allowed in idle male sexual fantasies, why would she let you to do that? " or more colloquially: "Yeah, like that could happen."  

 

So since I was diagnosed, thing that usually make me think about sex make me sad, and things that usually make me horny make me anxious.  There are two ways to attempt to deal with that anxiety.  I can complain to the world in my anonymous blog or I can take the steps needed to stop thinking about sex.  

 

So, thanks for your patience, hypothetical reader, you've been a slight help.  But I really must go watch some porn, whack off, and get on with my honey-do list.