Pre-Admission Appointment.

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JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 12/19/2009 12:43 PM (GMT -6)   
I'm expecting a call anyday for my pre-admission appointment prior to open surgery now scheduled
for January 20th.

Since I have never had an operation or been in
a hospital, what do they do and what could I expect
during the pre-ad ?

Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. (not ordered
by first urologist)
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
 
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
at London (Ontario) Health Sciences Centre.
 
NOPE, that just changed to January 20th. (2 days earlier) and the venue for entertainment gets moved to the University Hospital.
 
Need to get this over with ASAP so next season
I can continue with motorcycling, sailing  and enjoying life, TOGETHER with my wife, Debbie.
.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 12/19/2009 1:05 PM (GMT -6)   
In my case, they checked and recorded by insurance plan details, my living will and any other legal documents, explained in detail the process of my admission, the testing and what I would have to do pre-op, such as taking an enema, etc. The ran a 12 lead ekg, chest xray, general thump and listen exam, a blood draw for testing, just a general medical exam to make sure I was fit enough for the surgery. Also a comprehensive medical history was taken.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/19/2009 1:49 PM (GMT -6)   
Not much to add to James post. Pretty much a non event, altho some hospitals annoy the h*ll out of you with taking history information by a nurse, then a PA, etc. Just procedure, but most guys just want to stand up and say enough already !

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 12/19/2009 2:45 PM (GMT -6)   
Mine was just like the other guys. They also typed and crossed my blood and gave me a wrist band in case I needed blood during surgery (which I did). They also gave me a bunch of anti-bacterial cloths to use at home the night before on my body and again the morning of the surgery. The open surgery was not bad. I remember being in the pre-surgery area and the anesthesiologist saying he was going to give me something to make me relax. The next thing I knew I was awake and in recovery. My surgery lasted 6 hours because of some difficulty with reconnecting my uretha. I am obese and it really added to the problems for the surgeon. Pain was not much afterwards - took Vicodin for 2 days at home and then switched to anti-inflammatory. I only spent two nights in the hospital. They had me up and walking the day after surgery. Pay attention to the discharge instructions as far as cleaning your incision. A small portion of mine became infected (I don't know if I left the hospital that way or it was a result of me being a little afraid to get it wet in the shower). The doctor pulled the staples in that area and my wife plugged it with sterile gauze daily to let it heal. No pain, but my surgery was on October 22 and the incision just finished healing today December 19). I was required to have the cathetor for 3 weeks because they wanted to make sure the work they did on the bladder connection healed. Was not really a problem. Had one for one week in July and this was much easier. I stuck with the larger overnight bag and just laid it on the floor where I sat. When i went out I placed it in a shopping bag and carried it. I stayed out opf work for 6 weeks to make sure I was healed. I sit most of the day and the only problem I had the first week back was some pain after about 4 hours of sitting. I adjusted to it quickly and am now fine. Over all, I think the open surgery is not really that much worse than the robot. I guess it is all about the surgeon and what he is best at.
Age 63, PSA 2009 5.66
Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
MRI and Bone Scan Negative.
Open Surgey  October 22, 2009
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Incontinance after 8 weeks - 2 pads per day.
ED - Yes (will start Levitra in January)
30 day PSA (ultra-sensitive) .07


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/19/2009 3:02 PM (GMT -6)   
Same thing James above said, pretty typical of most hospitals pre-surgery
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA:
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 12/19/2009 4:43 PM (GMT -6)   
Usually a pre surgical exam means an EKG, Blood work and a chest Xray.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 12/19/2009 8:26 PM (GMT -6)   
Looks like you will have the same surgeon as I did, but at another hospital within the same group. 
 
Pre-op stuff is standard. They want to know what meds you're on and those that can affect surgery. Even though you've probably been asked that before. Also, they will do an EKG and complete med history to evaluate your fitness to anesthetics. Pretty normal stuff along with the bloodwork. If you're on aspirin, they'll want you to stop. If you're on any supplements, they may want you to stop those, also. They can affect bleeding and clotting.
 
One thing I would add is...the state of your mind in the recovery room when you wake up from surgery. The first thing I remember was a very efficient nurse right in my face asking me about pain and how I was doing...on a scale of 1-10. Those questions should be mutually exclusive. I kept answering "7" to how I was doing (10 being good). I believe that was interpreted as "7" on the pain scale (10 being bad). They kept giving me demerol, thinking I was in pain and I kept answering, I'm a 7. I think the multiple injections slowed my bowel recovery time and I could have been released earlier than 48 hours. The nurses that were taking care of me in my hospital room after the recovery room, told my wife they thought I was one of the happier patients they've dealt with.
 
Be careful with the catheter. It will be your friend for 2-3 weeks. Don't let it get tangled in anything and keep it clean (lots of posts here about catheter care). David in SC can probably give you the best advice on the catheter.
 
Good luck with your surgery and keep us posted.
 
All the best.
 
Mike
 
Mike
-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/19/2009 8:41 PM (GMT -6)   
Mike, you do realize the pain scale is 1-10 with 10 being for the most severe pain. lol. Come on fess up, you just wanted so of that dandy demoral, that's great stuff when you really hurt. Just messing with you brother. Bet you didn't feel any pain when they were doing that.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA:
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 12/21/2009 8:03 AM (GMT -6)   

Greetings, JB.  Just a couple of things to add.  Sounds like you might be similar to me - I had never been put under - never had a broken bone, never even had a stitch.  Other than being too fat, in very good health.  When I was answering the nurses questions she finally said, I think I better check with the anesthesiologist just to make sure - I didn't have enough hospital experience for a 55 year old guy.  She gave his office a call and said everything was fine.  All together it took a couple of hours between the blood draw, chest x-ray, and all the questions.

One other thing I did that I don't know how often others have done.  I was given the option of going to the blood bank and giving a unit of my own blood.  I did this about 3 weeks prior to surgery.  They gave me a special band to wear on the day of surgery so that they would use my blood in case I needed it.  I didn't need it and unfortunately, just as they advised me in advance, my unit of blood was destroyed.  Just a thought.  David


Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 1/13/2010 2:16 PM (GMT -6)   
.
Well it was just like you guys said, no big deal, just a 'hurry up and wait' routine.

Went into the exam room right on time, 1pm. waited
25 minutes and someone came in to do the EKG.

Waited 20 minutes and a doctor came in to check on medicine, ask questions, took blood presure (too high)

Wait 30 minutes and someone wants to know if blood transfusions are okay, if needed.

Wait 15 minutes for a nurse to come and explain the pre stuff, recovery and the catheder thingy.

Wait for 30 minutes and someone takes me and borrows four vials of blood.

Go upstairs and wait (did I mention the "WAIT" before ?)
and they take a chest xray.

Ninety minutes later and we are back home.

What was I worried about anyway.

Jerry.
.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. (not ordered
by first urologist)
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
 
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
at London (Ontario) Health Sciences Centre.
 
NOPE, that just changed to January 20th. (2 days earlier) and the venue for entertainment gets moved to the University Hospital.
 
Need to get this over with ASAP so next season
I can continue with motorcycling, sailing  and enjoying life, TOGETHER with my wife, Debbie.
.


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 1/13/2010 3:13 PM (GMT -6)   
Good luck on the 20th, and keep us posted.

Mike
-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.
-Bladder control within 48 hours of catheter removal
-ED ongoing but improving significantly with Trimix at 7 months post-op. Oral ED meds didn't do much.


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 1/13/2010 3:24 PM (GMT -6)   
Jerry, Good luck. I had open surgery in pre-op holding I spoke with head nurse and signed some papers. Talked with the anesthesiologist about the cocktale that he would give me. Rolled me into Surgery fully awake. I moved from my bed to surgery table by myself. I spoke to the Dr before surgery in the surgery room. I actually asked the staff and Dr to join me in a prayer befor they started. THEY AGREED!

As soon as I finished the prayer the juce was pushed. Next thing I knew I was in my room . Don't even remember the recovery room. Pain was about 3. Very simple easy procedure for me.

In you want more info you can e-mail me.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 1/13/2010 3:25 PM (GMT -6)   
JB  - Dr Chin did my RP at Victoria hospital in London on Oct 23 09.  They did the pre admit there about a week earlier.
 
If you have no other health issues, then the scenario Jim sketched is what they do.  I'll add that they go over the catheter routine pretty thoroughly.  In addition you get some reading material to take home that outlines in detail what will happen the day of surgery, the day after, the first day home and what to do at home.
 
I found all of this very clear and I followed the instructions carefully at home.  A nurse comes to your home shortly after you return from surgery to monitor how things are going.  She was the one who took out the staples.
 
I had quite a bit of concern about the surgery beforehand even though I know that Dr. Chin is one of the best surgeons in Ontario and probably in Canada.  When you read what has happened to others, the mind can start to worry.
 
The surgery went well.  As indicated below I have had no problems except of course for ED.
 
Hope that everything goes well for you with your upcoming surgery.  You certainly will be in the best of hands.
 
Don't hesitate to email me if you have any questions.
 
 
Skeener

Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 07/10.      


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 1/13/2010 3:29 PM (GMT -6)   

jb - I see I just replied to an old post of yours.  Glad to read that your preop went fine.  Am sure the surgery will too!!

 

Skeener

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/13/2010 3:58 PM (GMT -6)   
Jerry, glad the pre-op went well for you. Sounds pretty typical. At my hospital, my pre-ops have lasted as little as 30 minutes to a much as 4 hours (due to emergencies going on). I am off for my next pre-op around noon tommorow. Hoping it will be one of the shorter versions myself. Good luck to you.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

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