Day 33 - HELP!

 

Okay.  I was a bit naïve going into today’s meeting with Surgeon #2, Dr. I.

I thought I would ask the same 37 or so questions that I asked Dr. C, get essentially the same responses, and then make my choice based on the answers and his interaction with me.  But what Dr. I would do during the surgery is sufficiently different from Dr. C’s approach that it threw me for a loop.

The two areas of concern are how each would treat the lymph nodes and the nerve bundles.

Dr. I didn’t think it was really necessary to remove the lymph nodes because the likelihood of them having cancer in a case like mine is small.  There also is a small risk of damaging a major nerve that controls leg movement, as well as a nearby vein.  I don’t recall Dr. C mentioning those risks to me.

Dr. C wanted to take the nerve bundle on the right side where the tumor is, more as a precautionary measure in case the cancer had spread to it, too.  Dr. I, on the other hand, felt that he could leave part of the nerve bundle even though it was close to the tumor.

There’s one other dimension that comes into play, too.  The hospital where Dr. I operates is a teaching hospital at a major university.  It’s very likely that a resident would perform part of the operation (under his direct supervision).

‘Cause I’m me, here’s a nice little summary table:

	Surgeon #1 Dr. C	Surgeon #2 Dr. I
Experience (# of robotic surgeries)	700	1,000
Robotic prostatectomy best course of action for me?	Yes	Yes
Lymph nodes	Remove	Leave in (But possibly remove those on the right side closest to the tumor.)
Nerve bundles	Take nerve bundle on right side where tumor is; leave nerve bundle in place on left side.	Take partial nerve bundle on right side; leave nerve bundle on left side.
Teaching Hospital	No	Yes May have resident perform part of the surgery under his direct supervision.  He would personally perform the “important” parts of the surgery.

From a personal interaction perspective, Dr. I was okay.  He wasn’t as personable as Dr. C.

It was obvious that he hadn’t read any of my material prior to meeting me.  We spent the first ten minutes of the meeting flipping through my charts, trying to get a good understanding of the exact nature of my cancer.

For being the chairman of the urology department at this university, you might expect him to be a little full of himself or arrogant, but he wasn’t.  You could definitely tell that he was in an academic and research environment.  He recited a number of clinical studies and articles that he had either done personally or had read in journals like the New England Journal of Medicine.  When he disagreed with a study’s outcome, he said why he thought they erred.

He didn’t break out any anatomical drawings and explain to me exactly what he was going to, as Dr. C had done.  Nor did he want to feel the mass that he’d be dealing with—in other words, no DRE as Dr. C had done.  Dr. I, however, was very knowledgeable of his own complication statistics, citing how many times he had to do a blood transfusion; how many times he nicked the rectum wall; etc.  Dr. C wasn’t so detailed.

Dr. I did say that some surgeons treat every prostatectomy the same, and perform the same steps in each.  He said that he tailors the surgery to the specific case at hand.

As far as the number of surgeries performed is concerned, I don’t know that there’s a significant difference between 700 and 1,000.  It would be more telling if it was 100 vs. 1,000.

So I think that Dr. C is more personable and more thorough in his explanation with the patient.  But I think his approach may be one of a full frontal assault on the cancer—take it all: Prostate, lymph nodes, and nerve bundle—to make sure there’s no cancer left after the surgery.  There’s some appeal to that approach.  Get it over and done with knowing there may be heavier casualties (sexual function gone) but very little chance of the cancer recurring.

Dr. I seems to be very data and fact driven (sound like someone else you know?).  His approach may be a bit more refined—take only what needs to be taken, and then just a tad more to make sure the cancer is gone.  He did state, however, there may be a risk of recurrence and the need for radiation or hormone therapy later on if he doesn’t take quite enough.

One thing I didn’t do was tell either of them that I was seeking another surgeon’s opinion.  I didn’t want that to taint what they would tell me—they might become defensive or otherwise pitch their services to me.

So there you go.  Just how in the hell am I supposed to sort this out and choose??  I may make a few phone calls to places like the Mayo or Cleveland Clinics, see my personal physician, see my urologist, or just break out the Tarot cards.  I’d hate to go for a third opinion, but I just may have to.

I did reserve space on both of their surgical calendars for the first week in January.  It’s easier to cancel an appointment than get one.

Any words of wisdom would be greatly appreciated!!