OK boys & girls, time to strap on those protective helmets because here comes another snooz-a-rama.
When we last saw our hero, he was valiantly battling the Big I with everything he had. His medical sooth-sayer had just told him to do kegels until his butt fell off for another month, and then he would prescribe a bio-feedback visit if necessary. However, his treacherous physical therapist (PT) wife went BEHIND HIS BACK (I KNOW!) and looked up bio-feedback PTs in the area and called one. She was booked up until January (January!). But this did not stop his wife. She called in a professional favor (zounds!) and the next thing he knows, our hero is steering his horse-less carriage toward the lair of the evil bio-feedback PT with his wife seated beside him. "What ho, wench!" he said as they approached the walled structure. "If anybody sticks an electric probe up my ass and gives me a shock, I WILL be pissed off." "Chill it, home skillet," she said demurely. "Nobody will shove a rod up your butt. I think she uses a baseball bat." "Well," he replied (pausing for maximum dramatic effect), "That's better." Suddenly, our hero finds himself trapped in the examining room with the evil bio-feedback PT and his PT wife baring down upon him. The lights are bright, there is no escape. The interrogation is about to begin. Let's watch...
That's actually how I felt about the whole deal that my wife suddenly arranged - but the visit was fantastic. The bio-feedback PT was very experienced, very professional, had worked with a lot of PCa patients, and obviously had a real interest in the medical part of what was happening to guys with the big I. The fact that she was attractive was not a negative thing.
She spent a LOT of time with us, and I learned a lot. I found I was doing kegels pretty well, just not often enough, and probably not well enough. After the long discussion, she gave me a mini DRE to check my kegel performance. That was not too bad. Apparently my reaction time is delayed for some reason. She'll say, "Squeeze" and I'll think, "Squeeze" and one or two seconds later it happens. It should be instantaneous.
I learned that the following MAY INFLUENCE your recovery from incontinence:
1. High muscle tone vs. low muscle tone. High muscle tone guys sometimes have trouble relaxing. Being too tight is as bad as being too loose when it comes to incontinence. I am generally a high muscle tone guy.
2. Butt pain. If you have had trauma down there, the muscles contract and sometimes it takes a while to get them to relax and/or to re-train them. I had severe butt pain for 6 weeks after the surgery. She was very interested in that, and I just assume I got a 6-week late start in recovering.
3. Pelvic floor use. If you have a condition (say, oh, life long constipation) that causes you to use your pelvic floor muscles more than normal, sometimes they just get a little worn out - as in slow and unresponsive.
4. If you had a cast iron bladder, and could hold it forever - that is not necessarily a good thing. OR - if you had prostate swelling over time, not so good. Both of those conditions cause the final sphincter to get weak and lazy, so when the primary sphincters suddenly disappear from surgery, the final sphincter - bladder line of communication is not fully functional. It takes a while to get it going.
5. Your bladder can be irritated and you won't even know it. Irritation causes you to urinate more frequently. What causes bladder irritation? Just about anything you eat (or anything I eat). Alcohol, citrus, anything remotely spicy, ice cream, (but not cookies) and on and on.
I now have a whole regimen of things to do, things to track, and things to report back - and probably things not to eat. It has been quite an education. If anybody in the Fairfax, VA area needs a bio-feedback physical therapist, I HIGHLY recommend Joanne Gryski of Centreville Physical Therapy (CPT).
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late Jan '08 - after I was rejected. Their lab said PSA 4.5. PSA again in Feb '08: 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were cancerous and the 6th did not look good.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.
Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph nodes and associated glands all appear to be cancer free.
July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.