Spinal claudication and RRP

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Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 4/18/2008 1:01 AM (GMT -6)   
Doctor: I've got good news and bad news. First the bad news: You have a rare, incurable disease that the medical profession has never seen before.
Patient: Oh, boo hoo! And what's the good news?
Doctor: We're going to name it after you.
So maybe some poor guy called Claude was the first to be diagnosed with claudication. :-) Actually I looked it up and it comes from a Latin word for "limping". And "limp" is somehow strangely relevant to prostate surgery!
After surgery, I had built up to a daily morning walk of about an hour. This is a serious walk, with many steps both up and down. No particular problems or undue stress. Then about day ten, after a half hour, I started to get an ache in my left thigh that got progressively worse. By the time I got home, I felt a considerable weakness there and had developed a limp. But after I sat down for 20 minutes with the leg raised, the ache and weakness disappeared and I was able to walk around normally the rest of the day -- but no long walks!
After this had been going on for a day or two, the urologist rang me with the results of my histology, so I asked him. He didn't know what the problem was, being mainly concerned about blood clots developing after the operation. A major symptom of this is swelling of the lower leg, which I didn't have.
I tried favoring that leg, and walking on the flat (no hills) and the problem still developed after about a half-hour. So I continued with my plan of seeing my usual doctor. He didn't waste time in diagnosing possible spinal claudication, and sent me for a spinal X-ray, which came back clear. I'd had a bone scan prior to the operation and that showed some "wear and tear" in the spine. My doc wanted to send me for a MRI scan, but the urology dept at the hospital, who have the final call on these things, said it was not necessary. So maybe that is a good sign.
Apparently spinal claudication is a common problem with old fogies like me, nothing to do with cancer, just degeneration of the spine, causing nerves to be pinched. Also it seems you can relieve the pain by leaning forward. I tried leaning forward, back, twisting side to side, and squatting (man, did those knees creak!), and none of that made an ounce of difference. Needless to say, I cut down the serious walking to half-an-hour at a stretch, until I felt the claudication just starting.
Then suddenly, about two weeks ago, the claudication vanished, almost as quickly as it arrived. I am now on serious daily walks of well over one hour and no sign of the problem again. On two days, I walked for a total of over three hours with some small rests, and still no problem.
So I'm not sure what the cause of it was. I've never had claudication before. I'm hopeful that it is not a metastasis starting in my spine (I've had absolutely no backaches). My theory is that is some strange side effect of the operation -- maybe something cutting off the blood supply to my leg nerves -- assuming nerves have a blood supply! I did come off pain killers about the time it started, but these were fairly tame Panadol and Codeine over-the-counter medications. These seemed very ineffective with the not serious abdominal pains -- maybe they were much more effective with the claudication.
Then today out of the blue, I got a call from the urology department at the hospital with an appointment for Monday, a referral from my doctor. So a big rush to get the PSA test done that I was due for  -- originally "no rush".  Now I have some PSA anxiety -- but as ever, I'm staying hopeful. Let's see what Monday brings.

Age 63. Other than cancer, in good health
Left hemi-colectomy April 2006 (colon cancer)
PSA 5.7, Gleason 4+5=9
RRP 7 March 2008, non nerve sparing
Histology showed clear margins and lymph nodes
Two nights in hospital
Catheter and staples out after 7 days
Continent, no pads needed from the get-go
No erections (of course!)
Experimenting with VED and Bimix

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 5/10/2008 9:10 PM (GMT -6)   
A belated update.
Monday came, went and is now long gone. I saw the urologist -- the one who did my RRP -- and he was very reassuring. My PSA (exactly 6 weeks post-op) was zero, so I am happy about that.
He explained that the PSA will show a rise long before any symptoms of metastasis -- like backaches. Typically with bone metastasis, the PSA reading will be "in the hundreds". So while my PSA is low, any little (or big!) aches and pains I get will not be a recurrence of cancer. I hope that this will be of some reassurance to others too.
As to what was the cause of my claudication, I'm still none the wiser. He explained that during the RRP I was lying in an awkward position: on my back with hips raised for two hours -- doesn't sound the most comfortable. This may aggravate any latent back problems. It seems a reasonable guess that the operation had something to do with the claudication, and he seemed to accept my theory that the mild painkillers I had been using might have masked the symptoms for two weeks.
But the main thing, is that two months post-op, I am still free of the claudication symptoms -- so whatever it was will have to remain a mystery.

Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0
No erections (of course!)
Experimenting with VED and Bimix

Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 5/11/2008 1:16 AM (GMT -6)   
Hi Piano,
Just a quick note to say that I have enjoyed reading your claudication episode. Glad that it went as quickly as it came. Even happier to read that you're doing so well with your operation recovery and the great PSA test result.
All the best to you in the years to come.

Born Sept., 1936
PSA 7.9
Stage T1C
-ve DRE
Gleason's Score 3+4=7
2 of 8 positive
Open RP 28 Nov 06
Post op staging T3
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06
Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA test Mar., 08 =.04 

Veteran Member

Date Joined Nov 2006
Total Posts : 1464
   Posted 5/11/2008 1:23 AM (GMT -6)   
Hey Piano,

I do a series of stretching exercises every morning for arthritis in knees hips and spine. When I neglect them, I get the achy legs. Might help, might not but maybe worth asking your doc for a copy...

Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."

Regular Member

Date Joined Feb 2008
Total Posts : 42
   Posted 5/11/2008 2:49 AM (GMT -6)   
Hi Piano
I read somewhere that the nerves in the pelvic area trace a path most often underneath the blood vessels. During surgery small blood vessels are either quartised ? / cut off. Apparently only a couple years after RP's came into vogue did surgeons realise this and started being careful about cutting off too many smaller blood vessels for no particular reason other than just to clear the view for surgical procedures. This sort of ties in with your theory.

Surgery is just a job for most surgeons. They cut out and go away. I suppose they learn more when we approach them with particular symptoms post surgery, so that responsible medical community can improve their technique for future patients.

After my surgery my surgeon told my wife that I had a blood vessel coming from somewhere in my pelvis which he had never seen before and he had to 'clip' them. I sometimes wonder whether all my cialis is going to waste, that many relevant nerves had been cut off already sad

Happy to hear that the problem has gone away. Please keep us posted.
Dx Age 48 Nov 07
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
No perineural or lymphovascular invasion in the biopsy specimen.
Rushed to Robotic surgery Jan 08

Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement
1st post op Psa <.1 (May 08)

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