Day 51 - Y2K Rerun

Think back 11 years ago to December 31, 1999 and how everyone was stockpiling things in anticipation of the world coming to a halt as we knew it because computers around the world would crash, wreaking havoc upon all civilization…  My shopping cart at Kroger this morning looked a bit like that of one of those panicky Y2K-ers.

I stocked up on all of the essentials in anticipation of my being housebound for two to three weeks.  All of the items were nonperishable (paper towels, Kleenex, laundry detergent, etc.) or canned goods.  I’ll hold off on buying fresh foods till Monday morning.  Now, if I need someone to run to the grocery store for me, it will only be for a few fresh things—loaf of bread, bunch of bananas, etc.

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About 4:00 PM yesterday afternoon, I called Dr. Cincy’s office to confirm the surgery preps one last time, and I asked if Dr. Cincy could call me at his convenience sometime between then and when he stuck a knife in me next week.  The last time we talked, I felt as though we left the lymph node removal discussion open, so I wanted to make sure that he and I were on the same page (remove them).

At 9:00 AM this morning, my home phone rang and it was Dr. Cincy calling from his home to answer my questions and review what was going to be done during the operation.  Yes, I selected the right surgeon.

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We had remarkably warm weather here today—in the mid 60’s!!  On New Year’s Eve!  I cleaned the salt and dirt out of the garage from the snow that melted off my vehicles, and I ran one of them through the car wash.  Of course, an hour later, it’s getting rained on.  Oh well.  At least all the salt and road grime are off it.

I decided to make a dry run to the hospital this afternoon just to be sure that I knew the tricks of how to get there, much like an expectant father rehearses before the delivery.  Don’t expect a birth announcement, however…  “Dan delivered a 45g tumor at 3:45 PM…”

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Finally, it will be a quiet New Year’s Eve here, and that’s the norm for me.  I’m not much of a reveler when it comes to ringing in a New Year.  Turn on the television about 5 minutes before the big moment, watch the ball drop in Times Square, and call it a night.  Woo-hoo!  J

I wish everyone a happy, healthy, and prosperous 2011! 

Happy New Year!

Day 50 - Green Light



All systems ”Go.”  The CT scan, X-ray, and physical all came out fine, so I’ve been given the green light to go ahead with the surgery next week.

You would have thought coming out of the doctor’s office after the physical, that I would have been relieved and upbeat.  I wasn’t expecting the, “Oh, s**t, this is really happening…  SOON!” reaction.  It was as though someone instantly turned up the anxiety knob.  My life is about to be irreversibly changed forever.  Oh crap.

I try to remember the key four-letter word in that last paragraph: Life.  I’m doing this to extend my life as long as possible, but the reality of all of the changes that will be coming make keeping that perspective a challenge.

That said, as the surgery grows closer, I am being optimistic about the outcome, but I’m also being pragmatic about it as well.

To me, the surgery is only the first step in becoming cancer-free.  Just because the prostate is yanked out doesn’t guarantee that I’ll be cancer free.  The same thing applies to any lymph nodes that may be taken during the surgery.  The only thing the surgery will tell us is how far the cancer has gone, and we’ll have to wait a week or so to get the pathology results back on the prostate and lymph nodes before we even know that answer.

Even if the pathology comes back negative for positive margins (meaning no cancer cells at the incision point), or if the lymph nodes are negative, I’ll still have another step to take before knowing that I’m cancer-free.  That’s waiting the 8-12 weeks for the post-surgery PSA test.

So while I’m confident the mechanical part of the surgery will go as planned without complications, you probably won’t see me popping champagne corks or doing a little celebratory jig until sometime in April.

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You’ve probably noticed that I haven’t commented much about my sleeping pattern lately.  That’s because it’s actually been quite good.  Except for one weird thing.

On those nights when I do wake up in the middle of the night, nine times out of ten (check my spreadsheet!), it’s between 1:00 AM and 2:00 AM (mostly between 1:00 AM and 1:30 AM).    Weird, huh?  I think so.

It doesn’t seem to be tied to running to the bathroom or what time I go to bed; nor can I think of any external influence that’s causing it—furnace kicking in, neighbor coming home, train passing through town three blocks away, etc.  It’s not every night that it happens, but when it does, it’s usually at that time.  In fact, two nights I rolled over and looked at the clock and it was 1:09 AM.  Both times.  (Cue the “Twilight Zone” theme…)

The good news is that I can fall back asleep in short order after looking at the clock and saying, “One o’clock again…”

Just a meaningless observation…

Day 49 - More Running

The appointment I had this morning was with my local urologist, but his office here in town was booked this week, so I had to drive the 50 minutes to see him in his Cincinnati office. 

We chatted about the differing views that the surgeons had regarding the lymph nodes and he agreed with Dr. Cincy—take ‘em out and make sure there’s no cancer in them.  (I didn’t tell him which doctor recommended what.)

We also talked about some intermittent discomfort I’ve been having in my back near the left kidney (the one that produced the kidney stone almost six years ago).  He ordered an x-ray and CT scan just to take a look and see.  If there is any sign of a kidney stone, they would want to deal with that before doing the surgery.

He asked if I could do the scan this afternoon, and I said, “Yep.  This is at the top of my priority list right now.”  However, I was looking forward to playing in Cincinnati this afternoon.  He scheduled the scan back here at the hospital at home, so that meant driving the 50 minutes back to get the scan.

Fortunately, the Radiology department at the hospital wasn’t busy, and I was in and out of there in less than half an hour.  The CT scan technician hinted that he didn’t see anything, but the radiologist would review the scans and have the results tomorrow.

After the scan, I returned home for lunch.  As I sat there, munching on my spinach and spring greens salad (turning over a new dietary leaf!), I thought, I’m going to go out and play.  Back in the car and back to Cincinnati to do the things that I planned on doing before the CT scan got in the way.

So now I’m back home to a pile of stuff that I’ll tackle in the morning before my final pre-surgery physical tomorrow afternoon.

Day 48 - Errands

Today’s emotions were a bit like the weather: Sunny and bright in the morning, giving way to clouds in the afternoon.

I started the morning running a few errands.  First, paying and mailing another medical bill; second, running to the bank to deposit a check; third, calling the surgeon’s office to confirm the instructions for the day before; and finally, a run to the pharmacy to drop off two prescriptions that I’ll have to take the day before the surgery.

The call to the surgeon was a kicker.  In a nutshell, I’m not supposed to have ANY solid food AT ALL during the day before the surgery.  No breakfast, lunch, dinner, or snacks.  I forewarned her that she’ll have one grumpy-assed patient on her hands on the day of the surgery.  She laughed.  The other fun part is that I get to repeat the “internal cleansing” that I did for the colonoscopy.  Yippeee!

After lounging around in my new robe all day yesterday, I knew that I had to formally cancel the scheduled surgery date with Dr. Indy.  His assistant coincidentally called just as I was sitting down to write the e-mail to her.  I think she was a bit miffed, but so was I.  If a doctor never answers your follow-up questions, it’s time to find a new doctor.

I had lunch at home and then headed to Indianapolis to take advantage of some of the post-Christmas sales.   Macy’s had a deal on t-shirts and underwear, so I picked up some new t-shirts and really loose boxers that will accommodate my extra plumbing better than my thongs.  (Just checking to see who’s really reading this thing!!  J  Of course, with that visual, you’ve probably been blinded and won’t be able to read another word.)

So after getting the essentials taken care of, I headed off to Best Buy and one of the malls to see what kind of trouble that I could get into.  That’s when the emotional skies turned from sunny to gray.

You all know me.  Normally when I shop, I hesitate because I haven’t done my Consumer Reports analysis before making the purchase (see section on surgeon selection).  That’s just me.  But now, I hesitate before purchasing anything for a different reason.

I hesitate because I ask, “What if…  What if the cancer doesn’t go away?”  It’s not a strong feeling.  It’s not a dire feeling.  It’s just one of being practical.  “Do I really need this…?  Will I be able to use it?”  I hate that I think in those terms, even if only for a few seconds.  I’d much rather think, “What’s the user rating on this product?  How many stars did it get?”

You’ll be happy to know that I just muscled through those feelings and bought what I wanted this afternoon, cancer be damned!  J  As one friend reminded me, “I’ve never seen a funeral with the hearse towing a U-haul trailer filled with money.”  You can’t take it with you, right?

Besides, what I bought was something practical and will be used whether I’m cancer-free or still fighting this: new cookware.  My old set is nearly 17 years old and the non-stick coating just isn’t functioning the way it should any longer. 

I’ve got some more pre-surgery tests tomorrow and a physical on Thursday.  If those go well, then we’re on for next week.  And I’ll have to admit that the anxiety level is beginning its slow but steady climb.  That’s to be expected.

So that’s it.  Time to un-box my new cookware.

Day 47 - Quiet

One of the gifts that I received for Christmas (by request) was a new, big, fluffy bathrobe for use in the hospital and around the house afterwards.  Of course, I had to take it for a rigorous test spin when I got out of bed this morning.  I wore it all day.  All freakin’ day.  J  It works great!

That meant today was a day of total relaxation.  No calls.  No lists.  No organizing.  No cleaning.  Not even checking the mail.  Just lounging around in my robe, getting caught up on reading some magazines, watching a little Food Network, and even taking a little cat nap in the middle of the day.

All good things must come to an end, however.  When I went to get dressed to go to the market, I couldn’t find my wallet.  Full panic ensued.

I tore apart my home office, bedroom, utility room, truck, both bathrooms, and even went through the trash and dirty laundry.  It was nowhere to be found.  I knew that I had it with me for the trip back from my sister’s yesterday—I took money out of it to pay the toll on the highway—so I knew it had to be here someplace. 

Then I remembered…  I had gone into the living room to make a phone call last night and forgot that I took it out of my pocket when I sat on the sofa.  There it was on the coffee table.  Crisis averted.

So now that I found it, I can head off to the market and restock for the week.  Tomorrow, I’ll get back into the preparation mode.

Day 46 - Home

As I was pulling out of the driveway Friday morning to drive to my sister’s house, I noticed an envelope leaning against the front door.  I put the truck in park, hopped out, and grabbed it.  It was a FedEx from Dr. Indy’s office.  I tossed it on the passenger’s seat, put the truck in reverse, and forgot about it until I checked my mailbox when I returned home this evening.  There was a brown envelope also from Dr. Indy’s office.

I’ve yet to look at either, and probably won’t until tomorrow.

Christmas with the family was fun, although I’ll have to admit there were a few moments where I really had to force myself not to go down the “woe is me” path.  Watching a three-month old baby experience her first Christmas was a great way to get my mind on happier things.  (Plus, it can be a hoot watching all the adults interact with the baby, too.)

In any case, I’m safely back home, putting all the gifts away, and mapping out what has to be done over the next week or so.  I have a couple of pre-surgery appointments later in the week, and then I should be ready to go.  In theory.  The closer I get, I’m sure the anxiety level will increase.

For privacy reasons, I won’t post the exact details of the surgery here on the blog.  I’ll send out an e-mail with that information later in the week.

Oh.  And my apologies for my poor punctuation on my Christmas greetings (cleaned up since originally posted).  I used my phone to do the posts and apparently there's some compatibility issues with posting to the blog from a phone.  (Hey, worrying about punctuation means I'm not worrying about cancer or surgery for a few seconds... )

Day 45 - Christmas

Merry Christmas to everyone!

Day 44 - Family

Christmas Eve with family.  What else needs to be said?

Day 43 - Tests

Today began with a drive to the hospital where I’m having surgery for some pre-surgery tests: EKG, blood work, and urine screening.  Of course there was one more round of medical history questions.  “When was the last time you stubbed your little toe?  When was the last time you had a hangnail?”  Okay, maybe not quite that bad.  But it seemed like it.

When I was done, I was completely registered for the surgery and the nurse even gave me the little plastic ID bracelet that I’ll have to wear once I'm admitted to the hospital.  “Make sure you bring this back on the day of the surgery,” she instructed me.  Wow.  I guess I just show up, put the bracelet on, get undressed, and lay on the stretcher.  I guess that’s efficient.

The rest of the day was spent making sure everything was in place at work for my extended absence. 

In the evening, I went to the local watering hole here in town to meet up with an old boss of mine and a few others for a holiday beverage or three.  My former boss left the company seven years ago and took a job in North Carolina.  It was good to get caught up and hear some of his funny memories of working here.

Well, it’s almost 9:00 PM and I should get things organized for tomorrow, Christmas Eve.  I wish everyone a very Merry Christmas!

Day 42 - Preparation

Today was a productive day getting organized for being off work for six weeks.  I was able to pull some reference material together, contact lists, etc., for others to refer to while I’m out.  I also had an interesting phone call this afternoon with a gentleman from another of our locations.

He needed an assist with something he’s working on, and as we were wrapping up the conversation, I asked what his timeline was for a response.  I mentioned that I would be off work on January 4^th for surgery and would try to get something to him before then.  He inquired about the surgery and when I told him that I had prostate cancer, he opened up.  He had been through the same surgery 3 months ago.  He shared his story with me and I really appreciated having another patient’s perspective.

I also had to call the FMLA/Short-term Disability (STD—could they possibly not think of a better acronym???) administrators to get that paperwork rolling.  The person on the other end of the phone showed little compassion.  When she asked why I needed to be out on leave and I told her that I had cancer, she didn’t even bat an eye before tabbing to the next field in her database.  Perhaps you become numb hearing everyone’s ailments all day long and my expectations are too high.

Tomorrow morning I have an appointment at the hospital for an EKG and some blood work; next week I have two appointments for more pre-surgery screening.  Hopefully everything comes out okay and no one stomps on the brakes to delay the surgery.

Finally, there were no real doubts about my decision today.  No second-guessing.  No buyer’s remorse.

Time to throw a load of laundry in the washer and get ready for Christmas Eve at my sister’s.

Day 41 - Selection

A day of meetings kept me pretty busy and my mind occupied on things other than the upcoming surgery.  But when I returned home for lunch, there were two messages on my answering machine—one from the insurance company and the other from the hospital.

The call from the insurance company was interesting. They said that they learned that I’d be an inpatient at t a hospital soon, and that they needed to collect some important information.  When I dialed the number that they left, the entire battery of questions that needed to be answered was done with an automated voice recognition system.  I didn’t speak to a human once in the entire call, yet I answered everything they needed to know.  Isn’t technology wonderful?  (Sarcasm.)

The call from the hospital was to schedule some pre-surgery tests—an EKG and some blood tests.  Those will occur Thursday morning in Cincinnati. 

Later in the afternoon, I had to call the hospital again to preregister for my stay.  Again, another battery of questions.  I’ve never been asked what my birthday is so many times in my life!  J

I’m going to schedule one more meeting with Dr. Cincy to ensure that we’re both on the same page prior to the surgery.  As far as I’m concerned at this point, he’s the guy.  No more research.  No more reading.  Move the burden from my shoulders to his and have faith that he’ll give me the best possible outcome.

I feel comfortable with my choice and I don’t feel as though I’m settling.   Let’s move forward and take the next step in the process.

Day 40 - Crossroads

Indonesia.  France.  Germany.  Denmark.  U.K.  Russia.  Canada.  U.S.  I’ve had page views from each of those countries since the launching this blog.  Wow.

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Für meine Freunde in Deutschland:

Vielen Dank für Ihren Kommentar. Wenn Sie möchten, senden Sie mir bitte eine E-Mail mit dem Link in meinem Profil. (In der "Über mich" Teil weiter unten.) Wenn Sie dies tun, kann ich dann, um Ihre Kommentare zu antworten.

Und bitte verzeihen Sie mich für mein schlechtes Deutsch.

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Today got off to an early start when I drove to my biofeedback session in Cincinnati.  As I was sitting in the waiting room, I was reading my book and it said, “…this is an expensive way for a man to learn how to start and stop his stream, and indeed, critical studies have demonstrated no great benefit to this elaborate and expensive procedure. “  Something reassuring that I needed to read 10 minutes before starting the session.

One thing that did make the session worthwhile is the lesson that I learned about the catheter and drainage bags.  It was very informative and gave me a better understanding of what I’m in for.

After that appointment, I had another appointment with my family doctor here in town.  I wanted to get her take on the lymph node dilemma—take them out or leave them in.  I thought that she might be a bit more committal with her recommendation, but she really wasn’t.  “It’s your choice,” she said after explaining some pros and cons.  She suggested that it might be of value to talk with an oncologist who deals with prostate patients, and I may take her up on that suggestion.  But that leads to another issue which I’ll talk about in a minute.

Needless to say, the events of the morning didn’t exactly put me in a cheerful mood for our Christmas lunch with our team at work.  Or for the rest of the afternoon, for that matter.  Especially when I read, “…as surgical procedures go, radical prostatectomy remains one of the most delicate, intricate, and flat-out difficult to perform correctly.” 

I’ve learned through this whole process that you really do have to educate yourself and be your own advocate.  But for those of you who really know me, you know that I can take educating myself to an extreme.  At some point, I’m going to have to stop and just take that leap of faith.

But there are still some questions that need to be asked and answered, and I’ll do that.  Will I ever get comfortable with the notion of having to go through this?  Nope.  I need to identify the point at which I can follow the book’s advice:

“Now we’re at a crossroads.  Educating yourself is just half the battle—the half you can control.  The other half involves a leap of faith: You must find a doctor you can believe in, and then you must be able to accept that doctor’s advice.”

“…Release the burden from your shoulders.  Let go and allow the doctor to take over.  Spend your energy and strength following that advice, recovering from the treatment, and beating this disease.”

I think I’m getting closer.  But I also know that I have until the day before the surgery to change my mind.

*             *             *

An update: Neither Dr. Indy nor anyone from his staff has yet to contact me with answers to my questions from last Tuesday, with the orders for the pre-surgery physical tests, or the DVD and information packet concerning the procedure.

Day 39 - 20th Century

Okay.  I know it’s really the 21^st Century, but I finally joined the 20^th Century this afternoon.  “Huh?” you ask.

Well, you know what they say about old dogs and new tricks…  I finally took a couple of my CD’s and ripped some songs from them in MP3 format to upload onto my phone.  (Yes, I know…  I’m the last guy on the planet to convert to pure digital music.)   Having some tunes available over the next few weeks will be a good distraction.

Speaking of distractions, you would think that I might have turned to television to take me away from my thinking about cancer.  Interestingly, that’s not been the case at all.  In fact, if I’ve watched more than four hours of television since Day 1, I’d be surprised (aside from listening to the news and weather as I’m getting ready in the mornings).

I took a break from reading “Surviving Prostate Cancer” today.  While it’s been very educational, I can only take so much of it at once.  I may read a few sections tonight before going to bed.

Tomorrow morning, I head to the urology center to learn how to control my bladder sphincter through biofeedback a session.  In other words, I’m being potty trained again.  J  Hey, if it helps prevent me from peeing in my pants after the surgery, I’m all for it.

My refrigerator is in need of restocking to get me through the short week, so I need to run off to the grocery store.  Plus, you would think that I was smart enough to throw a load of laundry in while I was ripping songs, but noooo…  So when I get back, at least one load is going in the wash.

That’s my Sunday!

Day 38 - Reading

Another good night’s sleep had me sleeping in until 9:00 AM this morning.  Loved it.  J  And I didn’t wake up like I did yesterday, and that was good, too.

Once I did get motivated, I was off to the bank and barber shop to get my hair cut for the holidays.  My barber is living with prostate cancer, but he’s 73 and has chosen the watchful waiting.  Besides, I’m not sure he could stand another surgery.  He’s had a kidney removed because he had kidney cancer; lung cancer; and a heart by-pass.  It’s good to see that he’s survived all that and is still in business.

When I got home, I reorganized one of my closets after years of just putting more and more stuff into it.  I may work on the dresser in the guest room tomorrow in anticipation of my sister staying with me for a while.  She’ll need someplace to put her clothes.

And this evening was spent reading more in my new book for nearly four hours.  I’m about halfway through it now and obviously took a break to update the blog.

So that’s about it for this Saturday evening…

Day 37 - Sad

Sad. 

That’s how I felt right out of bed this morning.  It was really odd.  Not depressed (I think).  Not angry.  Just sad.  And a bit emotional. 

I swear, if my reflection in the mirror whispered, “Boo!” I would have been in tears.  And considering that I haven’t shed a tear since the beginning of this journey, perhaps it’s time.

And the sadness lasted pretty much through the entire day, much like the gray clouds that have been hovering overhead for much of this week. 

I think I may be coming to terms with the fact that this could be bigger than I have thought it was all along.  Even when the surgery is a success, I’ll still have cancer in my thoughts for the rest of my life.  Will it come back?  Will it appear elsewhere?  When can I call myself cancer-free?  Five years?  Ten years?  Ever?  What will I have to give up in order to increase my chances of remaining cancer-free?

So what does one do to shake the sadness?  Shop.

I ran to Jungle Jim’s market to pick up the Christmas goodies that I usually bring to my sister’s house, and a few extra things for me leapt off the shelves and into my cart.  Just like Christmas shopping on Day 28.  J

So if red wine helps prevent prostate cancer and dairy products feed prostate cancer cells, does having wine and cheese turn into a zero sum game?  Do they cancel each other out?  Just wondering…

The next chapter in my “Surviving Prostate Cancer” book talks about the effect of diet on prostate cancer.  Red meat and other sources of animal fat (e.g., cheese) are big no-no’s.  Fruits, vegetables, grains—all good guys.  (Back to that “What will I have to give up to remain cancer-free” question.)

The “tease” on the book is from USA Today: “The ultimate book on the No. 1 men’s disease in the world…should be in every man’s home.”  I’m only through three chapters of the book, and I’m beginning to see why they said that.  It’s well-written and quite thorough. 

Guys, if you have a history of prostate cancer in your family, you should check it out because you’re at higher risk than most.  (It was only $11.55 on Amazon.com, and, no, I don’t get a commission!)  Getting through the remaining nine chapters will be my goal for the weekend.

Enjoy yours!

Day 36 - Snow

Snow.  Shoveling snow at 6:30 AM.  Ugh.

I was supposed to meet a friend for breakfast at 7:00 AM and we knew that it would be a little iffy with the forecast.  Sure enough, there was about three inches of snow on the ground this morning, and that was enough to postpone our meeting, so I was out shoveling it off the drive before heading to work.

I stayed up reading my new book, “Surviving Prostate Cancer,” a little later than I should have been—11:45 PM—but it’s a very informative book.  I made it through about 85 of the 575 pages.  You’d think that I would be tossing and turning all night, digesting what I had just read.  I didn’t.  It was a good night’s sleep.

I’m still waiting to hear back from Dr. Indy concerning the follow-up questions that I sent to him at 9:30 AM Tuesday morning (it’s now 7:00 PM Thursday night).

I forgot to mention that I called the American Cancer Society hotline the other night and spoke to a very nice young woman.  Of course, they can’t give out specific guidance on medical treatment, but she pointed me in the direction of more information on their website.  

At work, I’m beginning to get things lined up for me to be out 6 weeks (with time off for the holidays in that number).  Making contact lists, step-by-step instructions for some of the quirky things that I do, etc.  I also approached one of my neighbors (with a snowblower) to see if he would be willing to clear my drive if/when it snows during the 4 weeks after the surgery that I'm not supposed to lift anything.  He kindly agreed.  (THANKS!!)

After work, I returned home to another inch of snow on the driveway, and a foot or so of snow piled up where the plow went by.  So I ended the day just as I had begun it—shoveling snow.  Ugh.

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Oh.  I forgot.  An administrative note...  If you leave a comment using the "Anonymous" feature, it's truly that unless you leave a clue for me to figure out who you are...  Location... Initial(s)...  Of course, you may be intentionally trying to drive me nuts...  And that's okay, too!  

Day 35 - Thinking

So after last night’s lengthy ranting (which really helped me organize my thoughts), I’ll try to keep this post short.  Besides, my new favorite bedtime read, “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer,” just arrived and I want to tear into it.

Dr. Indy still has yet to answer my follow-up questions despite a call from his assistant wanting to confirm the surgery date.  I asked if she had given the questions to Dr. Indy, and she had, but said that he was tied up in meetings and surgery all day yesterday and this morning.  “He’s pretty good about e-mailing patients.”  Okay.  I didn’t commit to her date yet.

I did e-mail my coworker who had been through this to see what his experience had been with the lymph nodes.  He didn’t know for sure whether they were there or not; he only knew that Dr. Indy would do what was needed to get rid of the cancer.

I’ve pretty much made up my mind that I’ll go to Dr. Cincy for the surgery.  I’ll hold off until I hear from Dr. Indy and see what I glean from my new bestseller in the snowy days ahead (good time to curl up with a book, eh?).  There would really have to be some compelling revelation from either that would change my mind.

Finally, I’ll have to admit that I seem to be falling back into a more normal sleep pattern, which is good.  It makes it a little easier to be around me when I’m not so grumpy.  J

Day 34 - Research & Analysis

After publishing last night’s post, I crawled into bed and began searching through my favorite bedtime read, “100 Questions and Answers About Prostate Cancer,” for any information on what to do with the lymph nodes.

There on pages 62 and 63 was the following:

Not everyone needs a pelvic lymph node dissection.  When the risk of having positive lymph nodes is low, such as occurs in men with a low Gleason score or a PSA < 10, a lymph node dissection is unnecessary.

The main risks of a pelvic lymph node dissection are bleeding, nerve injury, and lymphocele.

·         Bleeding: …are near large pelvic arteries and veins, called the iliac vessels.  Injury to these vessels or their branches may cause bleeding.

·         Nerve injury: The obturator nerve supplies muscles in the leg…If the nerve is cut or damaged at the time of surgery and the damage is recognized, it may be sewn back together.  If the injury is not recognized, it may lead to permanent inability to cross your leg on the side of the injury.

·         Lymphocele: A collection of lymph fluid that collects in the pelvis.

Reading that reinforced what Dr. Indy had said, and that was reassuring.  I slept pretty well considering the mode I was in much of the afternoon and early evening.

This morning, I called Dr. Cincy’s office and explained that I had been there last Thursday, and since meeting with him I had some follow-up questions for the doctor.  I mentioned that I had them written down, and the receptionist asked if I could send them to her, and she’d get them to the doctor and he’d call me when he had time.  I fired off my questions at 9:08 AM.

At 11:04 AM, Dr. Cincy called me to go over my questions.  We talked mostly about whether to keep the lymph nodes or not based on what was on page 62.

He was familiar with the recommendation to keep the lymph nodes when there are low Gleason and PSA scores, but he suggested that it’s not just about the scores.  He was concerned about the volume of the tumor as well.

Even though my Gleason is 6 and my PSA is 5, with 11 of 20 biopsy samples having cancer in them, he thinks that the volume of my tumor is large enough to warrant checking out the lymph nodes by removing them.  That was a reasonable explanation and, to me, showed judgment beyond looking at the studies or statistics.

He said that if I wanted to leave the lymph nodes in, he’d be willing to do that.  It would be my call.

The final question that I asked him was, given my status, and given the procedure that he described on Thursday, what percent chance do I have of being cancer free at the end of it all.  His answer: 80%.  That’s a good number, but a bit lower than I expected.  It also makes me want to read between the lines and say now I know why he wants to remove the lymph nodes, too.

I also had some questions for Dr. Indy after yesterday’s visit, and I e-mailed those to his assistant (without calling in advance as I had done with Dr. Cincy) at 9:27 AM.  She opened the e-mail at 10:10 AM (return receipt); it’s now 9:11 PM, and no response from Dr. Indy yet.

I will say, however, that one of Dr. Indy’s nurses called around 5:00 PM as a standard follow-up to my visit.  She asked if I had any questions that I needed answered, and I told her that I e-mailed them to the assistant this morning.  She was unaware of that.  She also asked if I was given a booklet or CD describing the procedure yesterday, and I did not receive either.  She’ll mail those to me.

This afternoon, I spoke with a coworker who had breast cancer and cancer was found in her lymph nodes.  And, just by coincidence, I ran into a retired coworker who had his prostate robotically removed five years ago, and they took his lymph nodes.  When they did the biopsy on the lymph nodes, they found trace cancer cells.  (I didn’t think to ask him what his Gleason and PSA scores were.)  As a result, he went through chemotherapy and radiation, and five years later, there’s no sign of cancer.

The kicker with prostate cancer is that you can look at the Gleason and PSA scores and make the assumption that the cancer is contained within the prostate based on historical studies and statistics for those given scores or combination of scores (Dr. Indy’s approach).  But you don’t know how close the tumor has come to the edge of the prostate until you actually take it out and section it in a biopsy (Dr. Cincy’s approach).  Only then will you know if you have what’s called a “positive margin,” meaning that there are cancer cells all the way up to the cut edge of tissue removed during surgery.  A positive margin indicates that there may be cancer cells remaining in the body.

I’ll have been sewed up and super-glued back together for a week before the biopsy results come back, and then it’s too late to go after lymph nodes or other tissue if there is a positive margin.  At that point, they’d have to do some sort of screening (CT scan?) and perhaps another biopsy to check if the cancer has spread.  If it has, then chemo, radiation, and / or hormone therapy are all options.

If you take the lymph nodes with the prostate, at least they can be biopsied right away, and you’d get the results about the same time you’d learn whether there was a positive margin.  I suspect that you’d have the same result: CT scan and chemo, radiation, and/or hormone therapy.

I guess it comes down to this: If you’re going to get to the same ultimate destination, does it matter which route you take?

I think with Dr. Cincy’s approach, you get there faster.  I’ll know pretty much at the same time: Positive margins?  Yes/No.   Cancer in lymph nodes?  Yes/No.  If Yes, chemo and radiation begins now.

With Dr. Indy’s approach, you go: Positive margins?  Yes/No.  If Yes, take more time and scan and biopsy lymph nodes.  Cancer in lymph nodes?  Yes/No.  If Yes, chemo and radiation.

As a data driven guy, I can understand Dr. Indy’s approach.  Let the facts at each step of the process dictate what the next steps will be.  Why mess with the lymph nodes until you know that you have positive margins?  If you have a positive margin, then you proceed with testing and biopsies; if you don’t, then you haven’t removed the lymph nodes unnecessarily.

As you can tell, I can argue both positions pretty well.  Before writing this, I would have told you that I was pretty strongly in favor of Dr. Cincy’s approach.  But the act of writing this has made me take a second look at Dr. Indy’s approach.

The good news is that I don’t have to make a decision before I go to bed.  Or tomorrow.  Or Thursday.  Or Friday.

I did order a book this morning from Amazon.com that was a “must read” according to the Prostate Cancer Foundation for anyone about to undergo a radical prostatectomy.  I splurged for next day delivery, so it should be here tomorrow.  Maybe that will provide additional insight…

Thanks for listening to me today and for letting me “think out loud” on this blog tonight.