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.
27 November 2009
21 November 2009
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.
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.
20 November 2009
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.
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.
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