A Little Snip and a Little Snip There

This is copied from a post that I placed on The Healing Well Prostate Forum. A great place for anyone who has or had prostatic cancer.

One of the things about having a RALP in a foreign country is being confronted with different cultural experiences. My surgery was done in a large hospital (800 beds?) in Luzern, Switzerland. The nursing staff was multilingual, as is the norm in Switzerland, and highly competent in my opinion. I do know good nurses from bad. In any event, the second day out of the OR, a nice Indian nursing instructor came in and asked in very good English, if she and a student could give me a bed bath as a teaching exercise. Now, I have spent 30 years or so in a teaching hospital environment, and I was fine with her request.

Before long I was lying on my back having each leg washed and dried. As I think we all know, pelvic modesty at this point in time is way out the window if you have had prostate cancer, so I had no compunction about these two ladies giving me a perineal wash. The student's English was limited to non-existent, so the instructor was doing a bilingual session. I became aware that the attention being paid to my penis was taking some time. I have to say that I have nothing in the way of a show-stopper in the penis department (John Holmes, I am not). Of course seeing a catheter was not unusual for both these women. What was unusual was that neither of them had ever seen a circumcised penis. When I inquired if there was a problem, the instructor said that they understood the importance of cleansing the foreskin of the penis, but they could not find one on me.

Thereafter, I gave a short history of circumcision, including the religious and social aspects of this procedure. The ladies were rapt with academic interest and spent some time discussing this in a Swiss dialect. This was accompanied with no small amount of manipulation, and at this point, I realized that indeed, the usual activity resulting from female manipulation was lacking in "the man". I also found it amusing and began to hope that my wife would not choose to make an entrance at this time. I thought that she would understand, but who can say? The ladies finished there explorations with newly acquired knowledge, finished my bath, thanked me nicely, and I did not see them again. I can tell you that I think the other students in the class got a new discussion of this pearl of nursing education at their next class. My wife took my news of this event with mixed emotions and was glad that she had missed the instructive events.

The Robot and Me

The Kantonsspital in Luzern was not unknown to me. I had been there to visit friends and to have an outpatient skin surgery in the past. I had already pre-admitted myself, so there wasn't much to do except go up to the Urology Floor. The head nurse greeted us, and I found that between the staff's English and my less than perfect German, we had no communication problems. I was admitted on a Tuesday for surgery the following AM. Dr. Mattei had told me that he does the robotics once daily, begins as the first case, and uses a dedicated team. Those were all important points for me. Blood work, chest x-ray, and EKG took up the afternoon. There were about 5 patients on the floor for surgery the next day, so we all traveled in a group to the various labs. A good night enema was the final prep. Before that, one of the nurses came in and gave me a detailed discussion of what would take place after the operation. The anesthesia doc and the professor of the department also came by to discuss his part of the following day. He laughed when I told him the last general anesthesia that I had was a tonsillectomy under open drop ether when I was in the third grade. Dr. Mattei also paid me a visit. Evertone from lab techs to Dr. Mattei wanted to know if I had any questions. I did not.

I slept well but was awake when Barbara arrived shortly after 6 AM. Anyone who knows Barbara will be assured that she loves me if she rose at such an hour. Shortly afterward, I left to go to the pre-op room. I had not received any pre-op meds until that point. An IV was started, and the anesthesia doc told me that he was going to put in an arterial line. Evidently, somebody turned out the lights then, because I knew nothing until about 8 hours later when I awoke in the post-anesthesia recovery room. The first thing that I did was to run my hand over my abdomen to see what sort of dressing I had. Any robotic procedure can be aborted and converted to an open procedure if conditions require this. I only had five band aid type dressings, so I knew that the robot had done its deed. I then became quite aware of a significant pain in my right hip and thigh. I had no other pain at all, but this was a real dilly. I had a pain pump hooked up to me that did a fine job, and because of the hip and leg, it got a pretty good workout. I stayed in this area almost 24 hours. It was not Heaven, but the nurses were angels that helped me turn and every so often rubbed my back with ice cold towels. That may not sound great, but it was just what I needed. I remember the doctor coming in. He later told me that he had been worried about me because I took so long to wake up. Truth be told, I had been awake but zonked out on the pain meds. The hip and thigh were the problem, and no one seemed to get the big picture. I went back to my room about 24 hours after awakening but stayed fogged out because I was pushing that little button on the pain pump every two hours.

Of course, I had a catheter in, but that didn't seem to bother me like a lot of others had reported. I was drinking as much water as they asked, and other than the first day, I saw no blood in the bag.. They stopped the pain pump the next day, and all of a sudden, I was hungry. One must be aware that the food in this hospital was good! Each day, I got a choice for breakfast that included any thing one could wish.For lunch and dinner, one got three menus from which to choose each time. By Friday morning, I was up and ready to eat. It was a shock when I sat up on the side of the bed to eat. My right leg shot up like a chorus girl kicks. I could not bend my knee because all those muscles were out. I had not noted this while lying down, but unless I took the left leg and held it down against the right, the leg stood straight out. The doctor was in at least daily, and when he saw this, he got the PT folks up to see me. In the meantime, I was up to sit in a chair a lot. Walking was another matter, as my right knee was not very stable. I made my own diagnosis of neurpraxia and all agreed that this seemed to be the case. The PT brought me a walker with which I could manage quite well. I knew that neurpraxia is usually a benign injury, and time would be my best friend. Later that day, I walked in the hall a bit. The Dr. Mattei came in and spoke in detail to Barbara and I about the surgery, what was done, and why it took about twice as long as the usual. He was to be off for the weekend, and asked if I would like to go home until Monday. Sweeter words I had not heard in some time, so I grabbed at the chance. I would have to come back on Monday to have a cystogram, and if it looked good, the catheter could come out. The nurses outfitted me with bags, etc. for the catheter, gave me instructions, and urged me to call if I had a problem.

One must understand that no matter how nice the hospital, home looks great. It did! There were no problems other than a leaky catheter bag which was replaced by my local urologist on a Saturday afternoon. Monday was to be the big day for the catheter removal. That was OK with me. Catheters can be downright convenient though. Looking for a bathroom is mostly only for a place to empty the bag. Nevertheless, I was looking forward to Monday.

We were there early on, a resident took me back, did the cysto, saw no leak, removed the catheter, and I was ready to go to the floor for one more night. Apparently, a lot of men have trouble with frequency that first night, so they are asked to stay close. Dr. Mattei came around that evening and was amazed that I had had no problems of any sort, was voiding normally, and met him in the hall. We had a chat, and he asked when I would like to go home. I told him "right now". I called Barbara to come and get me. He signed me out, gave some meds, and I was on my way. Other than the rare complication of the neurpraxia (which was rapidly improving), the robot was a piece of cake.

Prostates, modesty, and other things-part one

A few of you readers know that I had an operation this summer. In the Spring, I found an elevated blood level of something known as prostate specific antigen (PSA). I have measured this for some years, and this time it was above normal by about twice the level of last year. So, it was time to investigate. I went from my family doc to a nice German Urologist in a nearby city. The upshot of that was that a biopsy was done at eight points in my prostate. By that time, I had been investigated with a repeat PSA that was still elevated and a DRE (digital rectal exam) commonly known as a "finger wave". The biopsy showed that I had PC (prostatic cancer). I should say that way back in my training years I had spent three nice months on the urology service in Memphis. I enjoyed urology because I had some mighty good staff men who let me do a lot. Prostatic cancer (PC) is a common thing in older men, so I never really felt the shock that people feel with the word "cancer". There are various ways to treat PC. Surgery, radiation, hormone therapy, what is called active surveillance, and sometimes a combination of these and other modalities. It has been said that all men will get PC if they live long enough but few will die from it.

It so happened that an old partner of mine has a son who is an urologist in the USA. We had been together earlier in the year when I was in the USA, and he had related that the son was doing a new procedure on the prostate using robotics. Now my experience doing open prostatectomies in past years had led me to believe that open prostatectomies were brutal and bloody. The fact that robotics had taken all that away was interesting, and it became even more interesting when I found out that I had PC. The doctors all went over my treatment options with me, but I knew that the robotic way was going to be what I wanted. The mentality of a surgeon is to cut it out, if it is cancer. Enter here the Internet. An unbelievable amount of information is available about PC there, and I began to research robotic assisted laproscopic prostatectomies (RALP). I also decided that I would feel more at home in a Swiss hospital than back in the USA, so I went on the hunt for one close to me. A little less than a year before I got the diagnosis, the Luzernerkantonsspital in Luzern had added a new man to their urology staff who was trained in RALP. I checked him and his credentials out on the Internet and even read some of his papers which he had published. He looked like the guy for me, so the local urologist called and set me up with an appointment with this doctor. Dr. Mattei turned out to be a super nice guy who answered most of my questions before I could ask them. He didn't mind telling me the straight scoop about his training, number of procedures done, good and not so good points about the operation, etc.

I signed on to meet the robot with him as soon as it could be done. That turned out to be a good 5 weeks later. The interval is needed because after biopsies are done, the prostate must return to normal before the robotic surgery can be done safely. The month of June and first week of July went slowly, but the time gave me a chance to study more on what was going to happen. I found some well done podcasts on the Internet to watch the operation, and I read about patients that had had this done. The RALP is truly a fascinating method of removing a prostate and its associated structures. The patient is under anesthesia on an operating table. The robotic machine is fixed in position over him, five or six arms of the robot are inserted into the abdomen through small openings (band aid size), and the surgeon sits across the room at a computer console. The surgeon uses movements with two fingers of each hand to manipulate the arms of the robot. The computer dampens down his movements so they are far more precise that with a human hand. The whole thing is seen through a 3-D camera with a great light source and 10x magnification. Watch a podcast if you want to see more. After the surgery, a catheter remains in the bladder for 3-4 days, but the patient often leaves the hospital the next day. Two or three ounces of blood loss is the average opposed to 8-10 times that with open prostatectomies.

When the big day on 8 July arrived, I was more than ready. The Luzern hospital is less than 30 minutes drive from home, so we were there in plenty of time on the day of admission. More will follow.

The New American Football

I was born and grew up with SEC college football. I was educated at The University of Tennessee, so I have orange blood in my veins. I have always said that SEC football beats hockey by miles and is exceeded only, sometimes, by bull fighting. Well, this Fall is the first in over ten years when I have had the chance to see live college football. I owe this to my 13 year old grandson, Peter, who I suspect one day may be an ESPN reporter. Anyway, Peter clued me in about ESPN 360, and I subscribed. For a few Swiss Francs a month, I get more college football live and archived than I can watch in a week. Some things have changed!

I know this sounds like an old man, but I am an old man. Growing up in high school and college, as well as 25 years living in the USA, I watched a lot of football live and on TV. The quarterback was the smartest guy on the team. He knew all the plays and led the squad. Each team member depended on him to tell them the upcoming plays, so they knew what they were to do. Today, it seems that the game is run by the assistant coaches and the head man. Most of this done while the assistants are sitting in the boxes high above the stadium talking into radio headsets to the head coach down on the sideline. He keeps a paper of some sort in front of his face so the lip readers in the area cannot tell what he is saying. Guys along the sideline with him then give all sorts of hand signals to different members of the team on the field. Before the ball is snapped, the team all stops and turns to the sideline to get instructions.

Football equipment has steadily changed over the years much to the well being of the players. Helmet design is a lot safer, as are the other pieces of equipment that players wear. Shoulder and hip pads were long time standards. Today, a lot of players look like they are in full body armor. They even wear gloves. They still seem to have a lot of injuries. I wonder if this isn't because they are so well padded that they can hit each other much harder. When an injury happens, it usually isn't terrible, but there are a lot of bad knees and shoulders in these player's futures. If your CAT scan and/or MRI scan looks OK, then you will likely be in the next game's lineup.

It took me a few views before I realized that some of the players did not have a real shag carpet hanging out from under their helmets. Some of these players are immense and yet still very quick on their feet. In my day, a lot of the team weighed at or near 200 pounds. Today, that is considered light unless you play quarterback or kicker. Three hundred pounds and 6-plus feet tall are the rule. Frequently, I feel like a spectator watching in the amphitheater, as the gladiators duke it out.

Maybe, I have this all wrong. Football is still a great sport, but I fear that the culture has left me a bit out of date.

Mr. Jones

I could swear that I have written about Mr. Jones before, but I am getting old. Anyway, Mr. Jones was a patient of my dad's and worked in Jackson, TN for the Illinois Central railroad as an engineer (he drove trains). I must have been about four years old when my dad came home from work one day and took me to the IC station. Mr. Jones had asked him if he thought that I would like to ride in the engine with him when The Seminole (a famous train of the day that came through every other day on the way from Chicago to New Orleans (I think)). The engine had to go to the yard to get more coal and water in Jackson, and it was that trip that I made more than once sitting in Mr. Jones ' lap.

Oh My!! Was that a treat or what? It was a combination of several things, excitement, fear, and a treat too. The steam engines of the day were hot, noisy, hissing, and lots of other things that awed a four year old. We sat on the left of the boiler with a firebox underneath. The fireman, who in those days was as far as a black made in the rail business, was constantly shoveling coal from the coal car into the hellish firebox to keep the steam up. There were a variety of valves, wheels, etc. that had to be manipulated too. Then there was the whistle! It seemed about to blow me out of the cab, but Mr. Jones would let me pull the lever. We made the trip to the yard and back as often as my dad could take me, and I have never forgotten the smell of that burning coal.

One day close to the time that Mr. Jones was to retire, he came through town on The City of Miami which had become diesel powered. He pushed me up into the cab. It was clean and cool. The horn sounded like a horn and not a whistle. I didn't know that I was seeing the end of an era. Had it not ended, I wonder if I would not have been an engineer like Mr. Jones.

A Light Extinguished

A light became evermore dim and finally died out this week. "B" was a force in so many lives that she will be remembered by many from all walks of life. She died after several years with a form of cancer that spares 96% of people who have it. Ironic as that seems, she never did act as most ill persons. Her past history of illness ran from the rare to the unusual, and I often told her that if I were her physician, I would run out the back door when I saw her enter my office.

Her life began in Norway but ended after 40+ years in Switzerland. She and her husband, "A" produced three children that I often called "Stepford" children. They in turn, had grandchidren that are superlative. These gave her great grandchildren before she died. I have no idea how any step children there are to count. Numerous kids from Switzerland, the Balkans, and elsewhere lived for varying periods in her home. To this day, they all remember her. I am certain that more will turn up at her memorial service.

Then, there are the "step adults" who were fortunate enough to become her charges while vacationing in Switzerland. These people and their activities would fill a sizable book, and they all remembered the lady with a smile who could seemingly make things gone wrong OK again. The stories that she could tell about American tourists were many and always showed the fun she had with them. One of her cures for a kranky American was to invite that person to sit and have some Congnac. A lot of fussy folks have left her house feeling much better than they entered. She and "A" always planned a weekend excursion with the Americans in a car, so they go places that were not always reached eaisily by public transport. These along with frequent dinners helped make her a favorite with all her guests and resulted in many repeat visits. These Americans reciprocated when she traveled to the USA. People actually got mad when she and "A" were not able to visit just them. Everyone always considered them "their" friends. They certainly had more friends in the USA than I did.