This is my third long post. The first was “Pavel’s Journey” and the second was “Brachytherapy Tomorrow.”
I am a very fortunate man. The surgery went very well and the post-operative complications have been zero. I was in the Ambulatory Surgical Center for a total of 5 hours and 40 minutes door to door. Now some details, which I’m including in the hopes that it will help others know more about
what to expect. I wanted to get it recorded before I forgot details that may be important.
I almost never get colds, especially bad ones. But I contracted a very bad upper respiratory infection that settled in my throat about
a week before surgery. I was checked out in person twice by a physician, once seven days prior to surgery and once two days prior. Both said I was “strep-free” and the lungs were clear. When I checked in for surgery on Thursday morning I was recovering well but still had a raspy voice and some coughing. I have also been titrating the dose of the generic for Hytrin up over the past week, now I take two per night. As of tomorrow night it will be three per night.
I found the magnesium citrate the day before to be nasty. I had 12 hours of the runs beginning about
two hours after drinking the second of two 10-ounce bottles.
Pre-Op; The Anesthesiologist:
He was clearly not pleased about
proceeding. My oxygen was 90%, below what they want. While my breathing was pretty clear, he felt there was “some lower lobe involvement.” The radiation oncologist just stood there with the $ 15, 000 worth of my customized radioactive seeds in a lead-lined envelope under his arm and stared at the young Anesthesiologist. His look said, “I know you’ll find a way to get this done.” So the Anesthesiologist said, “OK, why don’t I go over your risks with you?” When he had finished I knew my role was to say, “Fine, thanks Doctor, I appreciate your help, where do I sign?”
Pre-Op; The Radiation Oncologists:
There were two in my surgery, my main guy plus another doc from the department assisting him. I talked to both. My main guy says, “I think this should go fine but we will do some test needles in the first ten minutes to make sure we can get to the anterior of the prostate with the pubic bone interference. If we can’t get there, we’ll stop the procedure within ten minutes and go to Plan B, probably external beam radiation therapy.”
Pre-Op; Other Staff:
I see the orthopedic surgeon, who explains he is there to help them make sure they don’t dislocate my 6.5 month old artificial right hip as they manipulate me to get the needles at the correct angles. While I’m in Pre-Op they have been giving me an intravenous supply of two types of antibiotics to prevent any infection that might affect the hip replacement. I also see a surgical nurse who is wearing an attractive lead skirt. She shows me a surgical plan on the computer screen that was created by the dosimetrist based on the volume study. I ask her if she could print out a copy so I could have it to look at later. She hands my wife the photocopy and explains that part of her job in the Operating Room will be to call out the needle number and the
location on the prostate where that particular needle is supposed to go, carrying its payload of 2 to 6 radioactive seeds.
They wheel me in, I climb up on the table, lay on my back, and they start to position my feet into stirrups. I take a deep breath and the next thing I know I’m waking up in the recovery room. I was in surgery a total of 1 hour and 41 minutes.
I’m in recovery about
two hours. The surgeon came out and told my wife he was pleased with the way things had gone. No problems. After I can drink juice and eat a cracker, they wheel me with my wife walking along beside us to the Cat Scan room. They take the Cat Scans, then the female Clinical Liason works with me to take out the catheter. She has me straddle a toilet bowl and aim into the bowl. She then says, “Take a deep breath” and the next thing I know the catheter is firmly pulled out, not a great experience but not terrible. Immediately the urine begins to flow into the bowl. Just a little blood visible, but not much.
It’s Thursday at noon. I’m told to take it easy, not swim laps until Monday morning and even then take it easy, don’t overdo. The biggest concern is drinking a lot of fluids and keeping the urination flow going. I get a call from the surgeon at 4:00 PM asking me how I’m doing. He says the Cat Scan indicated that the seed placement was accurate and he’s happy. He tells me that if I can’t urinate for a three or four hour stretch I need to get into the ER for a catheter placement. After my catheter experience four hours earlier I am highly motivated to not need this service performed again.
It burns to urinate the four or five times I go prior to bed. No blood. Each time the flow wasn’t very full, kind of fits and starts. I wake up at 12:40 AM and have a free flow of urine without pain. This happens again at 1:50 AM. I’m happy.
Two different nurses call me the day after surgery to check in. Everything is fine.
It hurts mildly for the first 36 hours or so when I do a keegle exercise. The swelling is minimal. The bruising is not bad. It starts on both sides of the anus and extends up the middle of the perineum to the base of the scrotum. There are tiny needle holes in all of these places. By 72 hours post-op, the bruise had extended up my scrotum to the base of my penis. This is all very minimal compared with what I had expected.
They gave me one Percocet in the recovery room. I took three more over the course of the first day home, but didn’t take any more after that. I wasn’t in much pain, but I didn’t want to get into much pain, so I took them.
My digestive tract thankfully began to fully function again 48 hours post-op. Despite the bruising, no pain.
I’ve been resting a lot more than I probably would have because of the affects of the upper respiratory infection. If I didn’t have the URI issue I don’t really know how much I’d want to rest in these immediate days after surgery. I will swim and stretch a bit in the pool tomorrow morning and see how my energy holds out.
I have a follow up appointment scheduled with the Radiation Oncologist surgeon on May 23, four weeks and one day post-op.
The Dosimetrist Plan:
From the research we did in the months leading up to surgery, you don’t see much technical information about
the plan. For those of you who have detailed minds like I do, here’s what one looks like.
It’s called a “Needle Loading Report.” One table shows in detail the 24 seed-loaded needles numbered 1-24. The next columns over to the right show the retraction in centimeters ranging between 0 and 1.50, the hole
location based on a matrix I will describe in the next paragraph, and the number of seeds in the numbered needle. 2 needles have 2 seeds, 10 needles have 3 seeds, 10 needles have 5 seeds, and 2 needles have 6 seeds. 20 of the needles are RAPID strand, 4 are special loading.
The matrix is actually a 2-dimensional map of the prostate
locations for the seeds. I’m not really sure how they handle the fact that the prostate is three-dimensional and has volume, I’m just reporting what is on the Needle Loading Report. My guess is that the X-Y grid shows a flattened out prostate gland
The vertical, or Y axis, begins with 0 at the origin and goes up to 8 at the top. The horizontal, or X axis, begins at A and goes out 13 units to the letter M. So the furthest needle to the right is number 16, at L4. It has 1.0 CM of retraction and has 3 seeds. It looks to me like the plan is roughly a mirror image around an axis of symmetry running along the horizontal line Y = 4. From what I gathered in Pre-Op, the nurse in the lead skirt had a job of calling out the needle number, retraction depth and hole
location and then probably repeating it 6 or 8 times so no mistakes could be made. With roughly 90 minutes and 24 needles, they averaged just under 4 minutes per needle.
Unless I have some unforeseen complication or new insight, I won’t post again until my post-op visit on May 23. I’ll continue to monitor the postings, answer questions, and make comments to others postings when I think I might be able to be helpful. The reason I went into all this detail is because I believe there is a shortage of comment and a smaller body of knowledge available about
brachytherapy than other treatment options.
Overall, my wife and I are very thankful that we went this route and that the surgeon is happy and there are no complications as of yet. In my mind, brachytherapy is a miracle.
Diagnosed: 6/14/07 at age 55
6/7/07; #1-1 core on right side, less than 5%, Gleason 3 + 4 = 7
1/23/08; #2-2 cores both on right side, both less than 5%, Gleason 3 + 3 = 6