The C word ... cancer

On September 21, I was diagnosed with prostate cancer. Hearing the words, ‘cancer’ felt so terminal. Teresa and I were shocked, terrified and overwhelmed. So let me step back a few weeks before continuing.

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Annual physicals are no fun. My annual physical has been in July for several years. It would start with a blood test, and then a visit with the doctor a couple weeks later. July 2017 was no different. At the appropriate time during the physical, the doctor became by best buddy, but this time was different. He had a very serious and preplexed look on his face. He said, “Your prostate has a different texture and does not feel the same”.

That alone may not have been reason for concern, but he noticed that my PSA results had jumped from the normal 1.6 - 1.8 to 3.6. We talked about waiting for a few months, or taking additional steps immediately. In the end, he suggested I see a urologist right away.

It took nearly a month. I meet with a urologist in August. He took my history and then did an exam. He said it was nothing to worry about yet, but that it was not normal. He said it could be a calcium deposit, but he would do an ultrasound and then if necessary a biopsy at our next visit.

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The following month, the ultrasound was schedule. The process was not painful, but it was no walk in the park either. Things when well, until I heard him talking ... it was not normal, and I new it wasn’t normal when he gave me an injection in the prostate. The biopsy was painful, at least that shot was pure pain. He proceeded to take twelve slices, and I was so glad to be finished with that. He told me many times that my prostate was not enlarged at all, and did not look like the prostate of a 59 year old dude. I kept thinking, just take the whole thing, now please ... this hurts.

A week later, September 21, we met with him for the results of the biopsy. Cancer .. that was a punch in the gut. He said, “it’s a very aggressive form of prostate cancer, and you could have weeks or years to live”. My Gleason Score was 7/8. I am sure I was sheet white, and feeling like death had just trumped my hand. A year earlier, my father had been diagnosed with brain cancer, and he passed away on January 23, 2017 .. it was so close, and the word, ‘cancer’ resonated over and over. Not long ago I also lost an uncle to PC, and another had been treated successfully. I was very aware that PC could be a killer, and I didn’t want to be the next victim. 

The urologist scheduled an additional test for October 30, and also scheduled a full body bone scan for October 9 at Kettering hospital, and then we parted ways. We were left to deal with the angst alone. 

By the way, don’t ask me to explain the Gleason Score in any detail. The scores range from 2 to 10. You add two numbers together, and get a score for each side of the prostate. 8, 9 and 10 are considered an aggressive form of the cancer. That 8 looked very scary, and I was totally freaked out. 

Five weeks .. wait 5 weeks for more testing. Who is going to help me with this cancer, and why this test? As it turns out, the doctor, the urologist, was leaving for vacation, and his office was even shutting down for a couple weeks. My mind was on overdrive at this point. I can’t wait .. what do I do? 

Once at home, I called my family doctor. After all, he stared this sequence of events with that exam in his office. The most important call of my treatment was that phone call. The scheduler that answer the phone was so patient and kind. I told her I had just been diagnosed with Prostate Cancer. She said, “My husband had prostate cancer”. She shared their story. I am not going to share those details, but her kindness and the reassurance helped so much. It was not that she listened .. it was that she engaged with me. She is not paid to do that. She is paid to schedule doctor visits. We talked a long time, and I am so grateful for her patients and attitude.

I met with the family doctor the next day. As it turns out, the nurse that I met with prior to the doctor seeing me was the wife of a prostate cancer survivor. She was also very kind and openly shared their story. My doctor and his staff were amazing all through this. I had a great visit with the doctor, and started to decide on a plan.

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I posted the following words on Facebook soon after I received the news: “Well, this is not the news you want to share with friends. Today I heard those dreaded words ... “It’s cancer” .. yes, those words. Yes, the timing is really bad.“

I have been very transparent on social media through this process. The outpouring of love and support has made a big difference. It was in all of that support that I found the strength to move forward and to own my health care.

While my urologist was out, I decided I wanted to see someone at OSU, The James. I considered many alternatives, but I wanted help from someone that worked with prostate cancer every day, and that understood the latest research. I started reading as much as I could find. To me, very early in the process, it seemed that a radical prostatectomy was the right option for me.

I talked to so many people that had survived PC, but a dear friend that had it in his early 50’s reached out to me by email. Those email conversations were the most important. I owe my friend Chris for his understanding, patience and kindness. Thank you, my friend. You made a difference.

I still had this problem .. my urologist was out of town, and my records were in his office. It didn’t matter that I wanted to see someone at OSU, I was stuck. I left a message at their office, then called OSU. They were kind, but they needed my records in order to proceed. I was stuck until someone returned to the urologist office. Once they did, I immediately arranged to pickup my records, and dismissed them from my medica care. My family doctor transfered the records to OSU, and a few days later I had an appointment.

Everything about treatment seemed to come slowly. From the time I first knew there was an issue, to the time I was diagnosed, to the time I saw a surgeon .. it all took so much time. I had read that prostate cancer is a ‘slow’ cancer, but it was inside me, and I was frustrated more often than not.

Then there is the depression. There are some really negative people in this world. I remember a conversation I had with someone at work ... so much negative energy. He was just trying to help me see the facts, and understand this was not going to be easy. At that point in time, I needed positive energy. I decided to avoid anyone that could not contribute to positive thoughts.

I had a full body bone scan and a PET Scan on October 9th at Kettering hospital. Other than a long day, this was painless. When it was finished, I had to get the high resolution images on CD to take to OSU, but other than that, it was done. I walked out with two CD’s, and a thankful heart. Something actually was moving forward.

I didn’t expect to hear anything from this test until I met with the surgeon at OSU. As it turns out, they sent the results to me, at home. When I came home from work on Wednesday, October 18, I had a letter waiting for me. I guess that since I had fired the urologist, and since he was the one that ordered those test, they just sent them to me. NO CANCER IN THE BONES .. that’s my version of the results. They did spend most of the letter talking about my bones, and various issues relating to aging. This was the 1st time in my life that I was happy about being told I was getting old. That was a turning point, and the best news of 2017 yet.

On October 26, I visited with the surgeon at Ohio State. He was so very detailed. He gave me all the stats, talked through all of the options, and was so very good at helping me with questions. They took blood samples, and we scheduled the surgery for November 7.

Radiation was an option that was discussed. Clearly, that would avoid surgery, but 8 weeks, 5 days a week of radiation was not attractive. There are many options with radiation, but in the end, I went with surgery. I felt that for us, for me .. the best solution was to remove the prostate.

Given my Gleason Score was so high, the doctor told me he would do some extra cleanup in the pelvic floor. That would include the removal of the nearby lymph nodes. He said that would add about 20 to 30 minutes to the procedure, but it improves my odds for the long-term.

So the date was set for November 7. Report time: 5:00A. The good news ... we have a date, and a plan.

That went well for a few days, then I received a call from the hospital. They said the robot was not available and my surgery would be delayed. They were talking late December, unless I wanted to have it done one November 22. That’s the day before thanksgiving, and my 60th birthday. I didn’t even give it a second thought ... ‘let’s do it’. I love thanksgiving, but I need this cancer removed from my body.

Did I mention that my surgery was going to be robotic? The surgeon told me that robotic surgery lowers blood loss, reduces the risk of infection, and recovery is much faster .. that all sounds good. They call it da Vinci Surgery.  Compared to the surgery that was common years ago to remove the prostate, this is amazing.  Read more here

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About three days before the surgery, the surgeon called me and told me that after a review by the team at OSU, they had downgraded my cancer. Recall my Gleason Score was 7/8. He said they had determined the correct score was 6/7. That may sound insignificant, but that meant I had a much better outlook for the future, and that my overall risk was reduced. I did a little happy dance right there in my office. This did not change the strategy for the surgery, but sure felt better.

One of the reasons I chose to go to OSU, was my opinion that I wanted to be treated by someone that did this surgery frequently, and was very involved in prostrate cancer every day. This revised diagnostic confirmed by believe. I’m not suggesting you have to have your surgery done at OSU, but I do suggest finding someone that does this frequently and at a hospital that specializes in cancer.

Through all of this I was trying to stay focused and get some work done. In retrospect, I was not nearly as effective as I was hoping. I was working, but my mind was often on the surgery. It was becoming increasingly difficult to focus. Now the time was extended, and the effort to focus more difficult.

My family was very supportive during this time. One son and his wife agreed to accompany us to OSU. I was concerned about Teresa having to do this alone, and they agreed to come along. We planned to drive over the night before the surgery and spend the night at a local Marriott. I had a report time of 5:15A, so this really helped. My oldest son agreed to watch the dogs. That was significant .. the dogs fare like babies sometimes.

The day of the surgery came quickly. I arrived at they hospital at 5:00 .. and things happened quickly. Everyone was so kind, did their jobs so professionally. I was in the PreOp room by 7:00, and the next thing I new I was awake in recovery.

My surgery was schedule for 4 hours. It took 6. The extra time was required because they took lymph nodes as part of the strategy to treat my aggressive cancer. The doctor met with Teresa and said it looked like there was no cancer outside the prostate, but pathology would test the removed material and we would be given an update in a couple weeks.

 Nov 22, just before surgery

Nov 22, just before surgery

I didn’t have much pain. The front of my stomach / chest felt like it was just hanging on my body. I was up walking that evening, maybe 5 or so hours post surgery. To be honest, the cathidor was more of an issue that the IV or the incisions. When I was able to finally look, I could see 7 incisions. One was still connected for drainage. They superglued them closed so I had no stitches.

Early Thanksgiving morning, they started to become concerned that I was not generating enough urine. As it turns out I was very dehydrated. Once they increased my fluid intake (via IV mostly), the output increased. By noon, I was ready to be discharged, and head home.

So what did they do during my surgery. First, and most important, they removed my prostate. He had told me he was taking the prostate and was not going to be able to preserve the nerves. When he actually was doing the surgery, he saved the nerves. This is good for the future. More on that later. For now, picture this: the nerves are attached to the prostate on the outside surface. To save them, the robot had to peal them off the prostate and then reattached them inside (somewhere).  They will take some time to start working again. I am grateful for the attempt to save them.  He also took 37 lymph nodes.

It was so good to come home. I was not in pain, but getting up and down was not easy. Teresa had to help me when I got in the wrong position. I could not sleep on my side, my preferred sleeping position. I sleep on the couch or recliner for the first 7 days. 

 Just after surgery

Just after surgery

It was a week after my release before the catheter was removed. I’m not going to go into details .. let’s just say I was very happy when it was removed and I could start to function again.  The catheter made sleep difficult, and was just not fun. I finally got a good nights sleep, in our bed, that night. 

I started walking right away. At 1st, it was .5 to 1 mile a day. I’m on the 3rd week now, and I’m at 3.5 to 4.5 miles a day. I can’t lift anything heavier than 10 pounds. I return to work soon, and then plan to retire at the end of 2017. That was already in the plan, and I’m continuing with that plan.

A couple of comments about the side effects of radical prostatectomy. The side effects of the surgery and of radiation are about the same. The 1st is urinary incontinence. This is tough, and takes time. I am not doing to bad, but I’m still not ‘normal’ yet. Some guys never get back to normal. I am hopeful.

The second common issue is erectile dysfunction. Again, some men recover in a few months to a year to 18 months. Some don’t. Time will tell.

That can all be depressing, but I am alive. The doctors primary goal is to preserve life. I have talked to men that struggle with these outcomes. I get it .. but I also am extremely thankful to be alive.

That’s my story. I am happy to talk with anyone that wishes to discuss PC and the surgery option. I am grateful to everyone involved in my journey. Those that supported me emotionally with kind notes and calls, the doctors and staff, and especially my family.  When it’s all said and done, it’s about those you love. For me, that’s my wife and my family, and great friends. ❤️❤️

And now to continue the healing process.  

~ Rick


©2017 Rick Cartwright