Murray's Story

My doctor has happily given me physical prostate exams since I was in my early thirties. I have a family history of prostate cancer and we both knew that at some point there was a very good likelihood that I’d end up with the disease, so he regularly did a rectal exam at least once a year and often more than that.

At least once a year, I had a PSA (Prostate Specific Antigen) blood test done as well. It’s a simple blood test that measures the level of the PSA in your blood, and I think it’s a valuable extra tool doctors should use to help determine someone’s prostate health. There’s a lot of debate about using the PSA test alone, for a myriad of reasons, but in my case we had a long-standing baseline measurement that, combined with regular manual exams, gave us a pretty accurate picture of my prostate health.

The Fickle Finger of Fate in person!

Lots of poking and prodding over the years! At one point, I asked him why he did both tests on me, since I’d been having PSA tests regularly for as long as the physical tests, and he had a really good PSA baseline reading for me to work from. His answer was, “Because I like to.”

He’s hilarious. I’ve been going to the same guy pretty well ever since he got into practice, so we go way back. He’s four years older than me, and he used to hang out with my older sister. I went out with his younger sister in high school, so we’ve known each other for over 45 years. We laugh a lot, so he can say things like that for the sheer fun of it.

A Speculum – and men are worried about a little finger!

The serious answer to my question is, of course, that the prostate is a gland that’s very easy for doctors to get a good feel for, because of where it’s situated in the body. A finger up the rectum can easily examine the prostate. It’s not the most comfortable thing in the world, but it’s over in a few seconds.

The prostate sits right underneath the bladder. A normal one is about the size of a golf ball and smooth and firm to the touch. A chart in my doctor’s office shows three phases of possible enlargements and equates an enlarged prostate to about the size of a racquetball, with a really enlarged prostate being the size of a baseball. Mine ended up halfway between a racquetball and a baseball.

I went to see my doctor in September of 2012 with a slight fever and some difficulty passing urine. It burned a bit to pee; the flow was restricted a little, and sometimes when I was done it still felt like I had to go. Most men notice a restricted flow as they get older, so that alone isn’t a red flag for prostate cancer.

A Digital Rectal Exam

I had been for a PSA test a few weeks before, so my doctor noticed my number had gone up, from around 3.2 to above 6. It’s not a good thing to have your PSA spike. After a physical exam, he proclaimed that my prostate was a bit enlarged and felt “boggy.” My first reaction was “What the hell does ‘boggy’ mean?” Because of the slight fever, he put me on an antibiotic for a couple of weeks and made arrangements for me to see a urologist. My prostate was slightly larger than a golf ball and smaller than a racquetball then, and ‘boggy’ meant it felt squishy, for lack of a better word.

A couple of weeks later, I visited the urologist and had what I can best describe as a “thorough and rigorous” manual rectal exam. He agreed with my doctor’s assessment of a ‘boggy’ prostate and said I had prostatitis, an infection in my prostate. He put me on a six-week course of Cypro, a very effective antibiotic designed for prostate and bladder issues. At the end of six weeks, my PSA had gone down to just over 4 and I was symptom-free. I danced out of my doctor’s office, thinking I had dodged a bullet.

In December it happened again, only this time my PSA was at about 7.6, so back on the antibiotics I went for another six weeks. This time the symptoms went away but the PSA stayed the same, so I was sent back to the urologist for another “rigorous and thorough” exam.

When he was done the exam, we went back to his desk and it was time for “the talk.” He said things didn’t feel right. He should know ‑ I think he grabbed my prostate and rolled it around in his hand! He said it was time to get a biopsy to be sure of what was going on.

I’m a pretty curious guy, so I spent some time online (which I know you’re not supposed to do) reading about how prostate biopsies are normally preformed.

Not too much to talk about really – the Radiologist sticks an ultrasound probe up your rectum and measures the size and shape of the prostate and then he or she inserts a needle to freeze the side of the rectum. After the freezing is in, a special instrument called a needle gun is inserted and samples are taken through the wall of the rectum and into the prostate.

After seeing the urologist on Jan. 3, I waited only until the 23rd to get the biopsy. It took place at St. Paul’s hospital and was done by a radiologist with an assisting nurse. I went in at 8 a.m. and they started the procedure at 9 a.m.

As I said, I’m curious, so when I was shown to the bed where my biopsy was going to be done, after I changed I asked the nurse to show me the needles and equipment they were going to use. I’m not squeamish and I’ve always tried to get videos of surgeries I’ve had over the years. Sounds a bit macabre, but I find it interesting. It doesn’t bother me at all to see an eye surgery or hernia surgery, and it doesn’t worry me at all to look at the equipment.

The ultrasound probe is about the size of your doctor’s finger, but longer. It’s connected to a screen so the doctor can see an accurate picture of the size and shape of the prostate.

The prostate biopsy needle gun

The freezing needle is just a fairly large needle, only the needle part is quite long – I’d say at least six inches. The biopsy gun kind of reminds me of one of those screwdrivers that has all the heads in the handle and you rotate the handle to push different heads out. It goes into you along the side of the probe, and when it’s used it makes a sound similar to a stapler, only a little louder. With each click a little piece of tissue is nipped out of your prostate.

This is the kind of stapler that the prostate needle gun sounds like

I’ll tell you right up front that this isn’t the most comfortable procedure you’d ever have, but it’s bearable. It takes about 30 minutes to complete from start to finish. There is pain, but in my case the pain was felt when the last two samples were taken. None of the other needles hurt at all, nor did most of the samples.

It was fascinating to see the radiologist at work. He did three biopsies during the morning I went for mine. Like me, one of the other patients was having his first biopsy. The other guy had been through one before and was very nervous about having another one. The radiologist treated each of us differently, so he’s a very good reader of people’s emotions. He was very supportive and gentle with the guy who was on round two, and very professional and quiet with the second guy. The wheels fell off the bus when he came into my area.

We talked and joked around a bit beforehand – I wasn’t too nervous yet and asked him to show me the gear and how it worked. He said, “Have you ever had one of these before?” When I replied that I had not, he said, “Well then, you’re in for a real treat.”

The prostate biopsy

Thinking back, I don’t think “treat” was the correct word at all.

He explained everything he was going to do to me before he did it, all the way through the procedure, which I really appreciated because that helps me to understand and be more relaxed. The probe was uncomfortable, but not painful at all. The needle to freeze the prostate also didn’t hurt at all. I didn’t even know he was doing it until he warned me it was coming, and then that he was done.

He took a total of ten samples from my prostate from each of four quadrants, and he told me where he was taking each one from as he did it. About halfway through, it started to hurt. He told me he could see I had a healthy set of tonsils. But I had my tonsils out when I was ten. When I told him that, he said, “Oh well, it’s that squiggly thing at the back of your throat then.” I laughed and said “You mean my uvula. I watch Dairy Queen commercials too!” His reply was, “I know it’s a uvula, I’m a doctor!” It reminded me of McCoy from Star Trek saying, “Dammit Jim, I’m a doctor!” It cracked me up and made the last few samples bearable.

After it’s over, you clean yourself up and they walk you down to a waiting area to recover. Walking there wasn’t a problem for me. As soon as they were done, everything felt normal, but a bit “heavy.” In the waiting area, they ply you with juice and water. You can’t leave until after you’ve had a pee, so they can monitor how much blood is in your urine. There is blood, but it’s not a big deal at all in most cases. Once the nurse is happy with how your pee looks, you can go home. Most people are there for about an hour, but I was a lucky one: I was there for four hours and never did pee. I had drunk about fifteen glasses of water and my bladder felt like it was going to explode, but I could not pee. Eventually, I talked them into letting me go home without peeing.

When I got home, I spent the next hour running back and forth to pee.

You’ll have a little blood in your pee for a week or two, and blood in your pee when you have a bowel movement for a few weeks. They also tell you that there’ll be some blood in your ejaculate for a few weeks – and that’s a bit of an understatement. Every man I talked to about this told me it lasted much longer than that, and initially it was dark brown – so be aware of that, or it’ll freak you and your partner out!

You take it easy for a day or two, and then comes the big wait for the results. I have to say, this was the hardest thing I went through in this whole journey. I knew I had a better than good chance of having cancer, and I waited until Monday, February 11th to find out the results. It was one of the longest and most nerve-wracking waits of my life.

On the afternoon of Feb. 11, I received “the call” that would immediately change the lives of my wife, my son and I.

I’ve been given bad news a number of times in my life, and although none of those phone calls or conversations were good, waiting for and getting the call from the urologist was the most difficult. Of course, that doesn’t count the really bad news of my parents and brother passing – but it’s certainly the most difficult call I’ve ever received that involved my own health.

My urologist knew that I was pretty sure I had prostate cancer, because we had talked about it in one of my earlier visits. Still, when he called and simply told me I did have cancer it was a pretty big shock. A little foreplay would have been nice, but in his defense, he was probably reading me as someone who knew the facts and probabilities, and thinking a direct approach was best.

In hindsight, maybe it was. But it felt like a kick in the stomach.

What I found interesting was that the urologist who examined me twice and who delivered the news wasn’t going to be the one doing my surgery. There are only a few doctors in town who do the procedure. Not that I have any complaints; the doctor who did my surgery was wonderful.

During an earlier meeting, he had talked to me about the various options available to me if it should turn out I had prostate cancer.

Currently available treatments include external beam radiation, a radical prostatectomy (surgery), Brachytherapy – a type of radiation therapy that involves putting radioactive “pellets” in the prostate, which can’t be done in Saskatoon and requires patients to go to Vancouver – active surveillance, hormone therapy and chemotherapy.

He told me on the phone that active surveillance was not an option for me because I had cancer in four of the ten samples they took during the biopsy, and although I was at a low risk level and my prostate was still smooth, surgery or radiation of one type or another were my only alternatives.

This brings up something that I think is important. If you’re in a similar situation, discuss all of your possible options with your urologist, and don’t stop asking questions until you get answers you understand. I did that, and it helped a lot. Even though I fully understood all the options, having someone say to you that “you do have prostate cancer,” or any type of cancer for that matter, is a jarring thing that will erase all logical thought from your mind for a while.

It was about this time that I decided to have a good, solid shot of rum whenever I went to a doctor and got any news, whether it was good or bad. I knew I’d be having quite a few doctor appointments, so I figured I’d have a built-in excuse for a drink that night!

The night after I got the news, I confess I had a few more than one. By the end of the evening, I was quite comfortable with the whole thing.

There are a few landmarks in this journey that really beg for a kind shoulder to cry on or someone to talk to, and this was the first and biggest. It was the only time so far that I’ve actually felt sorry for myself, and if it weren’t for a wonderful and supportive wife and son, and caring friends, it would have been a lot more difficult than it was.

I have prostate cancer, one of the slowest growing cancers out there, but nonetheless one of the leading killers of men. Twenty-five percent of all newly diagnosed cancers in Canadian men are prostate cancer, and one out of ten men will get it. I have a summer cabin at Pike Lake, and the guy in the cabin on one side of me has prostate cancer. The guy two doors down has it as well. I am shocked at how many men I know have prostate cancer, and I didn’t know about it.

It’s estimated that 23,600 Canadian men will be diagnosed with prostate cancer in 2013, and 3,900 will die from it. In Saskatchewan, about 650 men will be diagnosed with it, and 160 will die. It’s the most frequently diagnosed form of cancer in men. I don’t want to be one of the 160 for this year, or any other year!

The urologist told me that a “nurse navigator” would contact me shortly after our chat and help me to understand the process, what to do, what my options are – everything about dealing with prostate cancer. I got a call from that nurse the next morning, and made an appointment for my wife and I to meet with her on Feb. 13.

I hate to repeat myself, but as I said before: DON’T DO IT ALONE. HAVE SOMEONE WITH YOU. It’s hard enough to deal with when you have support. I would not have wanted to deal with this alone.

The kingpin of the whole process – the nurse navigator.

The nurse navigator is the fulcrum of the whole process of dealing with prostate cancer. She – in my case, both are female – is the person whose job can be described as answering questions like, “OK, so I have prostate cancer; now what do I do?”

There are two of them at the new Leslie and Irene Dube Urology Centre of Health at St. Paul’s. The Centre is a new area with 18 private rooms and the latest in technology and treatment for prostate cancer. An amazing place.

My wife and I met with our nurse navigator for a crash course on prostate cancer and everything associated with it shortly after I had been told I had prostate cancer.

Here’s where, in hindsight, I might have made a mistake. I went to meet the nurse navigator two days after I received the call telling me I had prostate cancer. I was still in shock or denial or something, because part of what we were told bounced right back at her when she told me. I simply wasn’t able to assimilate it. None of this was her fault. She did an amazing job covering all aspects of prostate cancer in a clear and concise way, and she showed empathy and understanding while doing so.

I should have gone to see my own doctor before I went to the nurse navigator, because I think I would have been in a better frame of mind when I met her. I’ve known him for so long; he knows how to calm me down and make me listen. That may not be the way to go for someone else – we’re all different. But bear in mind that the nurse navigator will tell you everything, so be ready to pay CLOSE attention.

The nurse navigator, when I look back at it, is the critical component to this entire process. She is the kingpin of the whole operation, as far as I’m concerned. I continue to rely on the nurse navigator almost on a weekly basis – she’s a sounding board for problems, worries, a cornucopia of useful and practical knowledge and above all, a friend in this fight I’m in.

By having nurse navigators, patients are freed from the uncomfortable position of having to make up their minds about treatment right at the time they get “the call,” and instead have some time and good advice to help make the decision that’s right for them. Plus, they speed up the entire process to get you treated quickly.

Patients get a comprehensive amount of information delivered in a way that’s understandable. The message is consistent, so there’s no confusion about who said what while you’re trying to decide the best way to go. The decision on surgery or radiation is yours to make. All the nurse navigators does is give you the tools to help you decide which decision is best for you, and then they make everything happen.

It’s a very frank conversation about prostate cancer. I found out how my cancer is ranked based on my Gleason score. She talked about the types of radiation available, and what active surveillance entails. I found out all the information I’d ever want to hear about how the surgery works. I found out about nerve-saving techniques that may or may not work in my case (no such luck for me), and I got an understanding of the incontinence and erectile dysfunction (E.D.) issues I would be facing afterward.

Part of the talk was about erections. That’s a tough topic for a guy to talk to another person about (unless it’s guys exaggerating about things with other guys), but it’s an absolute necessity because the reality is that there’s a high probability that erectile dysfunction will become the “new normal” for most. I was uncomfortable talking about it, and I vaguely remember muttering some banal answers just so she’d stop asking questions about it.

That was my second mistake in the initial consultation. I should have sucked it up and been a grownup. I should have known that such a conversation would come up, and met it head on (so to speak). I’ve had a couple of conversations with her about it lately and it’s a LOT more relaxed and open and that’s a very healthy thing.

She talked about it because most men aren’t able to have nerve-saving surgery since their cancer is either too close to the nerves or in them. The nerves involved in erections run alongside the prostate in a sheath, so if there’s any cancer on the outside of the prostate, or if there’s no room between the nerves and the prostate, the surgeon cuts the nerves off.

No more erections unless you have help – but there are drugs for that! “Happy Juice” is what someone I know calls it. I’ll tell you all about that later…

I’ll never forget being asked if my erections could be described as “pristine.” What the hell does that mean? And how do you answer a strange woman when she asks you that, whether she’s a professional nurse or not? I think I might have said something like, “Uh, they’re pretty good.” Jeez!

As I said, there are solutions to the inability to have erections, and many men continue to have happy sex lives after prostate removal.

There was a lot of discussion on incontinence as well, and the reality for me is that incontinence had a much bigger impact on my life than E.D. did.

So by the time the nurse navigator was done with us, we knew what the prostate is, where it is, what happened to me, what the biopsy discovered and what that meant. I clearly knew the treatment options for prostate cancer and which ones she thought I could choose from. I got a ton of written information along with her contact information, and I was told to call her if I had questions.

I went home, had a rum to think about it, and made an appointment to see my doctor the next day.

For me, the decision was easy: I wanted that thing out of me. I couldn’t stand the thought of something cancerous living inside me. When I went to my doctor the next day, he confirmed that he thought the best course of action for me was to have the radical prostatectomy. We’ve talked about prostate cancer a hundred times, so he knew the best thing for me was to get it taken out.

It was like a weight had been lifted from my shoulders. I immediately felt good about the whole thing and had a direction to go. I phoned the nurse navigator up and told her I wanted to have it removed, but that I wanted to request a particular doctor.

Then it was time to wait for a date, which turned out to be April 29.

After my biopsy, my wife and I went to Maui for ten days with some friends. We had a perfect holiday, and I forgot about all my troubles and just enjoyed the sun, surf and great friends.

Then, after the diagnosis and before the actual surgery, we went away again, this time to visit her sister and her husband in Palm Springs. (I know, tough winter.) My sister-in-law has some health issues herself, so being with them was very helpful for me as we had some talks about “things.” I got her perspective, and decided that I’d do my best to be as realistic and brave as she was in dealing with this. She was and is an inspiration to me.

Time was starting to catch up with me. In no time at all it was April, or as I call it “the month of the doctor.” I had a doctor’s visit about once every week – which of course meant a few rums later that day. This was turning out to not be too bad after all!

I told my friends I had prostate cancer and that I’d be having surgery at the end of the month. It seemed that I was at peace with the whole process.

It was about this time that I started making jokes about being incontinent. There are a million of them, and I guess it was my way of dealing with the stress of the impending surgery. I thought they were hilarious, but then I’ve always thought my jokes were hilarious. My buddy “Beep” certainly did his best to add to the fun with jokes of his own.

My wife and I had a meeting with my surgeon about three weeks prior to the surgery date. This was to get acquainted and to see if we had any questions. The nurse navigators had done their job, because there really wasn’t a lot to ask about, but I appreciated the meeting because I got to meet the man who was going to have such a profound effect on my life. I felt reassured and comfortable with the surgeon and what was now coming at me like a freight train.

The following week was the pre-op physical with my family doctor, where we went through my entire medical history and put to paper the number of operations I’ve had in my life and the meds I take. When I counted up the surgeries, I realized I’ve had a few – never anything serious, but a ton of them nonetheless. He checked my heart rate and my blood pressure, which was through the roof the first time we measured it. After he basically told me to knock it off and relax, it went back to normal. He kindly offered to do a manual rectal exam “for old time’s sake,” and laughed his head off at his “clever” joke. I declined.

A week later it was time to go to the hospital for their pre-operative check and information session. This took three hours and involved getting blood taken and an ECG to see if my heart was in good shape. Call it ‘white coat syndrome’ or whatever you like, but again, my blood pressure was higher than usual for me. The technician took it a second time a few minutes later, and I was back to normal. Then we had two meetings, the first with a physiotherapist and the second with a nurse.

The physiotherapist talked about the male anatomy, showing us where everything is and what would happen. She used a model that was cut in half vertically. I kind of snickered at one point during her explanation, and then had to explain to her that what I thought was funny was the piece of the male anatomy she was using to lift and turn the model. It was just a handle to her, but precious real estate to me! She was great. She talked about the exercises I needed to do, the length of stay in hospital (three nights), and basically everything I needed to know to prepare me for the experience ahead and the recovery afterward.

After the physiotherapist, we met with a nurse to discuss the more practical aspects of pre-surgery, the day of and the time afterward. We learned about the two types of catheter I’d be using, how to care for them, what would happen after the operation in terms of pain control and all those types of things. She told me I had to lay low for up to six weeks after the surgery and that I needed to get pads or diapers to help with incontinence.

We went over the meds I take and how to care for the wounds I’d have. There would be five incisions in my lower abdomen, and they’d need some care, but not a lot. She talked about when it would be time to take the catheter out – whether I should get someone to do it or do it myself. She talked about the morning of the surgery, what I could and couldn’t do, and gave us a special kit of antibacterial towels to use the morning of the surgery to wash my body off and get rid of as much bacteria as possible. She told me the surgery would be up to four hours long and that it is considered to be major abdominal surgery even though it was going to be done by scope and not a large incision.

When she told me about making sure I drank plenty of clear fluids to keep hydrated prior to the day of surgery, I asked her to define clear liquids and asked if white rum and 7Up counted. She agreed right away, but unfortunately we were both kidding. She told me I may look like Mr. Pumpkin Head when I came out of recovery. You’re in a head-down position during the surgery, and some people swell up quite a bit.

So now I had all the knowledge my poor old bean could hold about the operation, the hospital stay, the recovery and pretty well everything I could expect to happen for up to a year. I had a lot more information, but also a feeling of being in control and having a clear understanding of the journey ahead.

As April 29 approached, I noticed my moods were all over the map. It was almost like I was bipolar – and I mean no disrespect to people with bipolar disorder. I was depressed, euphoric, angry, distant and goofy – sometimes all in the same day. It must have been tough for my wife and my son to live with me, and the closer the 29th got, the more up and down I became.

My sister-in-law came to visit a couple of days before the event, which helped me get my mind off myself and offered support to my family. I’m very grateful to her for coming. Having her there helped us all relax a bit.

The day before the surgery was the toughest day to date. I was nervous about the operation itself for quite a while. I’ve been put to sleep for surgery a dozen times throughout my life, so that really didn’t worry me too much at first, but it became a real problem for me the closer the date got.

For some reason, I was worried I might not wake up after the surgery. My doctor had told me that was a function of age, and that there was absolutely no reason to think this surgery would be different from any of the others. I felt fine with it after that – until the night before.

I think my heart rate was pretty high the day before, and my blood pressure was amped up too. Let’s just say it was also a lot easier to go to the bathroom than usual.

The morning came and I felt refreshed after a good sleep; I don’t ever have problems sleeping. I had to be at St. Paul’s by 9 a.m., with the surgery slated for noon. We were up by 7 a.m. and I had a shower and used those antibacterial pads to get myself all shiny and clean.

We went to the hospital and settled in for the wait.

I had a little entourage of three – my wife, my son and my sister-in-law, and we spent the morning chatting and trying to keep me entertained.

When noon rolled around, I was still sitting in the waiting area in my gown and booties waiting for the main event.

Someone came for me shortly before 1 p.m., which meant the surgeries before me had taken longer than expected. We walked for what felt like about a hundred miles from the waiting area to the pre-operative waiting area. The hospital staff were very kind to let all four of us into this area – normally only two people are allowed to accompany the patient. We sat and watched the flow of people in surgical dress all around us for fifteen minutes or so, and then the anesthetist came and introduced himself to us.

He was about eighteen.

Okay, maybe not that young, but he was a young guy. He really presented an air of confidence and competence, as well as a great bedside manner. He told me what was going to happen and that he’d try to make the experience as comfortable as possible for me and he’d try to make sure I wouldn’t have a headache when I woke up. I’d had trouble in the past with the drugs they use, and woke up on several occasions with a splitting headache that made me sick to my stomach. None of us wanted that this time around.

A few minutes later, the head nurse came and got me. There were goodbye hugs and love-yous all around.

It took a couple of seconds to get into the operating room, and once inside I was introduced to everyone in there. I liked that a lot, because it really helped calm me down. As you can imagine, I was pretty relaxed by this time and ready to get things underway.

I lay down, had a chat with my surgeon and the doctor assisting him and listened while the eighteen-year old anesthetist explained what he was doing to the sixteen-year old intern watching.

Maybe I was a little off on their ages.

They checked my blood pressure one more time, and it was low. I had been calm all morning leading up to this – weird how the day before was frenetic but the day of was all calm.

The needles were put in my hand, the music in the operating room was turned down, and I quietly drifted off to sleep. It was a very pleasant experience.

I woke up about two seconds later to a nice lady patting my shoulder. We apparently had a wide-ranging discussion about Las Vegas. I’ve been there once a decade ago, but supposedly that’s what we talked about for quite a while until I was ready to go to my room.

I don’t remember any of that.

The one thing I do remember about waking up in recovery was saying out loud, “Yes! I made it!” That’s all, though.

I was wheeled out to meet my family, who had been waiting outside for a little over three hours, and we chatted all the way back to my room. I apparently was quite chatty and animated, but I don’t remember one single thing about the trip to the room, or much else for a few hours after that.

There was no pain, and I didn’t look like Mr. Pumpkin Head. That was a relief to both my family and me. I was pretty tired, so they didn’t stay long.

I was able to sit up that evening. I was determined to, because a friend of mine who had this surgery said he couldn’t sit up. It hurt like crazy, but I did it.

I had a great sleep that night, except for being woken up to take pain meds I didn’t need.

The pain meds are important, whether you think you need them or not. They want you to take them, because it would be harder to get pain under control if it gets too severe and you have no meds in you – they’d have to use more powerful drugs. They also give you a Heparin shot to help prevent blood clots.

I was in the hospital for Monday and Tuesday nights, and just before noon on Wednesday morning, I went home.

That blew me away, and it still blows me away when I think back on it. I had what’s considered to be major abdominal surgery. They talk to you constantly about breathing exercises you need to do and coughing to help keep your lungs clear after being under for so long. They give you Heparin shots every day, and you have to wear support hose all the time because of the danger of blood clots. They monitor you constantly. Yet I was done surgery by 4 p.m. on Monday, and home by noon on Wednesday.

I’d like to tell you the hospital food was gourmet, or at least great, but you know it wasn’t. However, I was hungry, so it still tasted pretty good.

The ward I was in is amazing – a special ward for urology, plastic surgery and ear, nose and throat patients. The 18 rooms are all singles, and nine are earmarked for urology – mostly prostate patients.

The group of nine rooms I was in had two nurses and a floater working in them – I think. I heard them check into the computer system when they came on shift, and they said that certain rooms were primary, and others secondary. The nurses wore a device around their necks to let them speak directly into the system in hands-free mode. The technology in that ward is fascinating, and I’m itching to go back and see exactly how it works.

As one nurse goes off shift and a new one comes on for each patient, they get together in your room and the outgoing nurse briefs the incoming nurse on your progress. You’re right there and able to ask any questions you want. What a fantastic way for a patient to be actively involved in their own care. I loved that process.

The care I received in that ward was absolutely amazing. All the nurses were friendly, efficient and professional, and I always felt I was in very capable hands. My surgeon came to see me each day at 7 a.m. and the surgeon who assisted also saw me every morning. I always felt I was getting the best care I could have from everyone.

The days after surgery were spent getting to learn about my new plastic buddy attached to the side of the bed – a large catheter bag that looked to me like it would hold about a week’s worth of urine. It had a carrying handle so I was able to take it off the bed and carry it around with me whenever I went for a walk around the ward. You’re encouraged to walk as much as you can, so I took a lot of walks. It was fun to look around the ward and talk to the nurses as I walked around.

On Wednesday morning, a nurse came in to give me my lessons on how the travelling catheter bag and the large catheter bag worked. Once you’re out of the hospital, catheter care is on you, so you need to learn how to empty, change from bag to bag, and clean each bag. She also pulled the drain out.

I had five incisions: a large one under my belly button that the offending prostate was removed through, and three others across my lower abdomen for the various tools the surgeon used. One still had a drain in it, for fluids to leave my abdominal cavity after the surgery. It didn’t hurt at all and I slept quite comfortably with it in place.

I was lucky that the surgeon removed only my prostate gland and the nerves beside it. The lymph glands looked normal, so he didn’t take any of them out. Had they been removed, I would have had a second drain in my side. I needed the catheter for a week, but if they had removed any lymph glands, that would have been two weeks.

The only times I noticed the catheter was when something pulled on the tube; otherwise, I really didn’t know it as there. The tube is taped to your leg, for good reason – it’s no fun at all to that tube tugged on!

By Wednesday afternoon I was comfortably sitting in my favourite chair with three people eager to do things for me. I tried to milk that for all it was worth, but they soon figured me out, and things returned to what would now be the “new normal” we’d be living.

A catheter is a long tube about a foot in diameter that’s shoved up your penis through the urethra into your bladder.

Okay, it’s really not that large – maybe an eighth to a quarter of an inch in diameter. It’s made up of two tubes, one long and one short. The long one ends up in your bladder and has a bulb on the end to hold it inside the bladder. The short tube is used to fill the bulb with saline. When you want to take the catheter out, you cut the short tube to let the saline out, then pull the long tube out.

It was a long week with that tube in. You have to be scrupulously clean at the site the catheter goes into you, and clean the catheter bags every day. The big bag goes on at night, and the travelling bag is used during the day. You need to drink about ten glasses of water a day to keep your bladder healthy and help in healing, so when the travelling bag is on, it gets dumped out quite a few times a day. The larger bag will last an entire night.

A typical urinary catheter

The catheer is held inside the bladder by a balloon filled with saline solution

When it was time for the catheter to come out, and I had several options: I could use home care, go to my doctor, go to a medi-clinic, or ‘man up’ and do it myself. Never one to shy from a challenge, I decided to do it myself.

Everyone was creeped out by the idea of me pulling that tube out. My friends all said I should get a nurse or doctor to do it for me, but I decided to tough it out. I attached it to the bathroom door, drained the bulb, and slammed the door.

Imagine how that felt.

The large catheter for night time use attaches to the bed

The daily wear catheter attaches to the leg

I’m kidding. Actually, I drained the bulb and gently pulled it out. It was a bit uncomfortable, but only for a few seconds. And then I was golden. Free, unencumbered and feeling great! I clearly remember seeing my neighbours on the street outside our house and dancing a little jig to show them the infernal bag was gone. It was a wonderful feeling, and I felt I was surely on the road to recovery now and that all I had to do was deal with that pesky little bit of incontinence the doctors and nurses said I could expect.

Some guys don’t have any incontinence. For others, it lasts a long time. Most doctors will tell you that you’ll be at the point where you’re going to end up somewhere around a year after surgery.

I figured I had this thing under control, that I’d be incontinent for a few weeks, and should be back in business within a couple of months. It didn’t quite work out that way.

I was told much later that the average time for a man recovering from a radical prostatectomy to gain some significant amount of control over incontinence is around four months. There I was, one week after surgery, thinking I had control. I didn’t.

The first day the catheter came out, I was overjoyed and felt I had regained my freedom.

I was, as I soon discovered, wrong.

I decided I should have a glass of water and lie down for a half-hour or so. They tell you to drink ten glasses of clear liquids at least every day, and that it’s a good thing to lie down and let your bladder fill up at least once a day. That way you’ll have a full pee, and it’ll make for a healthier bladder.

Here was where all my kegeling exercises would come into play. I had done thousands of kegels prior to surgery and felt I had the exercise down pat, so filling up the old bladder and holding things back while I walked to the bathroom to void was no big deal. After a half-hour or so I needed to pee — the first time I’d felt the urge to pee in a while. So I tightened up my sphincter (the muscles in the lower abdomen that you use to keep control) and stood up.

Urinary incontinence happens at the worst times

Have you ever seen indoor rain?

I had no control whatsoever, and when the urine started gushing out I ran for the bathroom, leaving a trail of pee across the hardwood floor in the living room and the tile floor down the hallway to the bathroom. My underwear was soaked, as were the shorts I had been wearing.

I figured that was just an accident, and that I’d be able to control this by being more cognizant of my bodies’ needs. I needed to go more often. When I did that — although every single time I stood up, I peed — I made it to the bathroom and the pads I was wearing absorbed all the urine.

The next day, I decided to try again. This time, when I stood up, I grabbed onto the end of “Mr. Happy” and held the pee back until I got to the bathroom.

This part was amazing. I had the flow and power of a boy again, which is incredibly satisfying. My bladder empties so fast now that I don’t have enough time to enjoy the greatly increased flow. I got to the bathroom, opened the toilet and aimed at the water like I have forever, then let go and had a very enjoyable pee.

Only problem was that I aimed where I had for the past few years — the back of the bowl — because I was used to a reduced flow. I blasted pee off the top of the lid and all over the bathroom walls and floor. It was everywhere. As I cleaned up the mess, I was sad and happy at the same time — sad because I sprayed pee everywhere, and happy because I peed like a laser.

It’s not the major events, it’s the constant dripping that drives you crazy

That has only happened one other time, after I was lying down. A storm hit and started spraying water through three open windows in the house. I jumped up to close the windows, and left a trail of pee from window to window and into the bathroom. I could not stop it no matter how hard I tried. By this time, I had learned to stay on the tile floor.

Oh, the irony. In trying to save us from getting water on the floor, I doused it with pee instead. Again, I got rags and cleaner and dealt with the mess.

Those episodes are quite frustrating and difficult, so my modus operandi very quickly became to pinch the end off until sitting on the toilet, then release and enjoy the feeling.I kegel sixty times a day, and I try to kegel every time I stand up or cough, strain, bend over or exert myself in any way.

This is a difficult struggle for me. At times I have success at preventing peeing when I stand up, but for the most part I fail and a little bit comes out. Not much, but it happens just about every time.

Depends Guards are for maximum protection – you need these for the first few months!

When I’m out and about, I pee constantly. The pads absorb it, but I can tell you it’s disconcerting to be standing there, talking to a store clerk, while you’re peeing a bit. Its very discouraging and depressing for me, because I thought it’d be a lot easier to get control of things than it’s turning out to be.

Then I catch myself and remember that all I have is a little urinary incontinence problem that will probably go away entirely. Knowing there are people whose incontinence will never go away, or who have much worse problems than this, helps me to put and keep things in perspective.

I use Depends Shields for “light times”

It’s been six weeks since my surgery as I write this, and I am starting to get some semblance of control over minor incidents. Yesterday, I stood up twice in a row when I felt that my bladder was semi-full and managed to not pee. Some days, I use a half dozen pads; on others I use more than twice that. I still can’t get up from lying down to fill my bladder and get to the bathroom without pinching the end off.

Sometimes I feel like this is never going to get better, and I get depressed. At the start of this journey, I made the most jokes about peeing and incontinence. Now I don’t think they’re nearly as funny as I did then.

An acquaintance of mine called me the other day to ask how I was feeling and express his wish that I get better soon. Then he said that I had better not tell him I wear a diaper because he’ll use it to crush me in public whenever he can. I was furious at his insensitivity and lack of knowledge about how prostate cancer works.

I don’t wear diapers — they’re quite uncomfortable and hot for me. I wear pads that have a sticky strip that sticks to the inside of my underwear. They can absorb about a half-gallon from the looks of it, and they work very well. Actually, I have no idea how much they can absorb, but it’s quite a lot.

One of the things everyone tells you when you have your prostate removed is that you’ll need to wear pads for a while because you won’t be able to control your dribbles.

I’m told that the average amount of time before men turn the first major corner and start to realize some control is around four to four and a half months. I’m lucky — I’m a couple of months early. But honestly, it hasn’t made me a lot less frustrated.

Urinary incontinence isn’t a lot of fun, but it’s not the end of the world

Now, I can stand up from a chair and control it until I get to the bathroom almost every time — at least at the start of the day. Toward the end of the day, my muscles get tired and I’m less able to control things. Into the afternoon, I can handle a full bladder most of the time now, but not all that much in the evening. They don’t want you going to the bathroom a lot and would rather your bladder was mostly full before voiding, but that’s very hard to do at this point.

Even though I’m going through a really positive period in terms of control, I have had days with no urinary control at all, right from the time I get up in the morning.

You get used to all the peeing as the weeks go by. It actually becomes the focal point of your recovery, and your life, in many ways. Your control or lack of control dictates your social schedule and what you do with your day.

For instance, I know the location of every bathroom in every building I enter. I carry a “go bag” with extra underwear, pads and cleaning materials and extra shorts or pants, depending on what I’m wearing. I always wear black or dark shorts and pants. I haven’t worn blue jeans since my surgery. Everything is due to a lack of control.

But once you start to get some control, it’s as if a whole new world has opened up. I can go to a restaurant and not have any major accidents, although I’m not ready to try a movie yet. The feeling of accomplishment in getting up, holding it and making it to the bathroom is only beaten by the satisfying sound of being able to pee to the bottom of the bowl.

I’m coming up on three months since my surgery. I wear pads 24 hours a day still, although I can go from before bedtime to noon on just one of them now. I still pee a bit when I’m not focused. Later in the day, I pee whether I’m focused or not, but the pad usage has gone down from literally one an hour to about five or six a day on a normal day.

Things are looking up, and the light at the end of the tunnel doesn’t look like reflected light off a pool of urine anymore.

The catheter was a minor inconvenience – one that I have, many times in the past few months, wished I could get back. I never got up in the night to go to the bathroom pre-prostate surgery. For the first month after surgery, it was every two hours. Three months after surgery, I was down to one time a night. At first, I remembered the nighttime catheter with some wistfulness; I really would have liked a good night’s sleep.

At ten weeks, I suddenly noticed I was beginning to turn a corner. I could stand up without peeing, if I really concentrated. I could hold it and walk to the bathroom and have a pee like a normal guy again, and it was thrilling. Finally, I had a break from the constant dribbling. What brought on this change were three visits with physiotherapists who specialize in dealing with incontinence issues.

Although I had been kegeling like a madman for weeks, it turns out that I was doing it incorrectly. The physiotherapist performed an internal exam and had me kegel while she determined the strength of my pelvic floor muscles.

This was disconcerting. I was lying there, with a woman using her finger up my rectum to test the muscle strength and talking me through how to do the exercises correctly. Her head was right beside my knee, and we carried on a conversation like nothing else was going on. It was surreal, but it’s the reason I got to where I’m at in terms of control today.

What a fantastic resource the physiotherapists are. When you’re told how to kegel, it seems easy, but, like any other exercise, it’s much more effective when done correctly. The physiotherapists are new to the Urology Centre, and I was one of the first people to go through sessions with them. It’s golden – worth every bit of discomfort a person might feel about getting an internal exam. I’m to the point now that if I met the Physio. on Second Avenue and she wanted a look, I’d drop my drawers right then and there. Okay, maybe I wouldn’t. But the thing is, privacy or embarrassment doesn’t matter – the only thing that matters is that these are health care professionals who have a real positive impact on your life.

Once I started to turn that corner, everything changed. As the days progressed, I had more and more control. I can now even control the ‘biggies’ when my bladder is full. I’m not free from incontinence by any means; I still use about four pads a day. But when you consider that at first I was using one an hour or so, four pads over twenty-four hours is a major improvement. I still pee when I cough, sneeze or exert myself without focusing first. I still have accidents. But I’m improving.

The improvement isn’t constant, either. I’ll be having a great day and then the next day will be three steps back. But the bad days are starting to get a bit fewer.

I found out from one of the physiotherapists that the average time for men to gain some sort of significant continence is about four months or so. I wish I had known that earlier on; I think it would have maybe eased some of the demoralizing days somewhat. I needed to know that that light at the end of the tunnel was sunshine, rather than the light reflecting off a puddle of urine.

And speaking of urine: I am amazed at how much urine the human body can produce in a day. It’s mind-boggling – the darn stuff just keeps coming out, whether you’ve been drinking a lot of liquids or not. We’ve thrown out some garbage cans full of pads that were pretty heavy!

Most men recover a fair degree of control, and by the end of a year you can tell pretty well where you’ll be from then on. My focus going forward is to concentrate on doing my exercises religiously. I took a week off and took a few steps back, so I’m going to focus on doing them every day. I need to learn to focus on the times when I exert myself in any way and try to learn to control them. All recovery now is exercising, focusing, keeping healthy and going for regular checkups. I have prostate cancer, and even though I feel great and my prognosis is good, it can come back, so I need to be vigilant.

I went back to visit my surgeon for my two-month visit. Prior to the visit, I had blood work and a PSA test done.

The visit was to get the results of the PSA test. If there was no PSA in my system, I was in a great position – if there was PSA, then the probability the cancer had spread was much higher.

It was a nervous day.

My wife and I walked into the doctor’s office with a great deal of trepidation. What would we do if the news was bad? I can empathize with every man who makes this particular trip.

Actually, I feel for every person who makes a similar trip – it’s tough.

I was lucky; my test results showed no measureable PSA in my blood. I have to get it checked again in another year. Many, many men don’t get that news; theirs is that the cancer is still there or has spread, and that thought immediately resonated with us. We felt incredibly grateful. It’s a selfish emotion, but I think a human one, and I can tell you that there was no euphoria on either my part or my wife’s. Once we got into the privacy of our car, we both had a little cry about it.

The doctor then said it was time to get my prescription filled, and that the nurse navigator would facilitate that.

The prescription was for Happy Juice.

Erectile Dysfunction is often a byproduct of a radical prostatectomy

When you have those nerves removed and you know that you’ll have erectile dysfunction, at first it’s the furthest thing from your mind. At least it was for me. I thought, and said, “Who cares?” The most important thing to me was looking at the grass from above, rather than below. Whether I could ever have sex again was so far out of the equation that it didn’t exist. Now, the doctor was telling me that Happy Juice could well bring that back into play!

I got the prescription filled and dutifully brought my new prescription, alcohol swabs and needles to a visit with the nurse navigator. Oh, didn’t I tell you that needles are involved? They are. But before you crawl away screaming, let me assure you that it’s not all that bad.

The visit with the nurse navigator is to tell you all about the medication, how it works, what it does, and what to expect from it – oh, and how to give yourself the injection. I was prepared for this, so unlike the conversation we had about erections at the beginning of this journey, this time there was a lot of humour involved. I started by giving her a rough time about the drawings used in the little handbook they give you. The guy in the drawings is not normal, unless he’s some porn star. The drawings showing the procedure and how to do the injections made it look easy. In reality, it’s not that easy.

When you first see the needle for Happy Juice, this is how big it looks because of where you’re going to stick it

First of all, you have to find the little guy. It’s like a turtle – it sees the needle coming and turns into an ‘innie.’ One person referred to it as a “button on a fur coat,” and that’s pretty apt.

She went through the booklet, and we talked about the technique that needs to be used, how and where to give the injections and how much medication to put in the syringe. I got all that, but then we had to go and do a sample injection. By this time, as I mentioned before, I don’t worry about dropping my drawers in front of people, so even though she was there giving instructions and illustrating where to inject and where not to inject on my precious piece of anatomy, I was having fun. Why not?

This is what the needle really looks like – it’s an insulin needle and very small

So I gave myself the injection. It was pretty difficult to do the first time, but now that I’d done it, it wouldn’t ever be that difficult again. The jokes were flying around like crazy, but the nurse never lost her professionalism and empathy.

You’re wondering if it worked or not, aren’t you? They tell you that due to nervousness, the test injection doesn’t usually work, but that the next one might, depending on the amount of medication you need. It sort of worked, but not well enough to be functional. So Happy Juice is an appropriate name for it after all.

This brings me to the end of my journey with regard to these blogs. My journey with prostate cancer will be carried on in one way or another for the rest of my life.

I’m at six months post-surgery now and am fully back on my feet. I wear one light pad a day (over 24 hours) and put a medium pad on when I have physical work to do. I can control leaks when I cough, sneeze or exert myself if I concentrate, and I’ve just begun not wearing any pads at night and when I’m around home during the day. I put a light one on when I go out. I don’t get up at night to pee and life is pretty well back to normal – but it’s still a new normal. I’ll have some incontinence issues to deal with for the rest of my life, as well as erectile dysfunction issues. I don’t care about either of those – I’m alive and feeling well and happy.

I may live a full life and I might not – it’s not really up to me, so I’m fatalistic about it.

The important thing I learned from a man named Lawrence LeMoal, who is in an entirely different situation than I’m in, is to live every day and appreciate everything I have and enjoy my family and friends and those who are important to me. Lawrence’s story is one of sadness and despair, which he has turned into something uplifting and a valuable life lesson to us all. You should read his blog . I’ve read it several times and I think he’s the definition of courage.

It’s pretty easy for me to tell my story about my journey with prostate cancer. All I give up is my privacy in telling you my story. Mine, at this point doesn’t have an end. Lawrence’s, like so many men, does have an end. His courage in talking about his journey is beyond compare and if you’ve been kind enough to follow my blogs I urge you to read Lawrence’s – they will give you a new and improved outlook on your own life and are an inspiration.

Movember is an important month in raising prostate cancer awareness. It’s gathering steam in bringing awareness to the forefront of people’s minds throughout November, but it’s only a part. We need to be aware of men’s health issues all year round, not just in November.

Even groups like Breast Friends have recognized the importance of awareness with prostate cancer. Everyone knows this amazing award-winning group of women from Foam Lake who have done so much for breast cancer. They’ve written a series of cookbooks, the sales of which have raised over a million dollars in support of Breast Cancer research. They’re an inspiration and the sales of their latest cookbook, called “Breast Wishes; For the Men in Our Lives” will go to cancer agencies, be used to buy equipment or pay for research or patient needs.

Men – you need to get tested. Man up and go to your doctor and get that rectal exam. For ten seconds of mild discomfort, you could gain a lifetime of living.

So many men don’t want to talk about prostate cancer, or rectal exams. It’s by talking about it and getting the exams that prostate cancer can be changed from one of the leading causes of cancer death in men that affects 1 in 6 men, to a memory. Early detection is the key to survival – I can attest to that personally; without those rectal exams performed by my doctor for all those years it would never have been caught so early and you might well be reading a series of blogs much like Lawrence’s – only not nearly so eloquent.

There’s a huge debate about the efficacy of PSA tests. In my opinion they’re an additional tool that doctors should use in helping to determine whether there’s a risk or presence of prostate cancer. Combined with regular physical exams and even biopsies and ultrasound if needed, plus new technologies coming on stream, doctors are getting more and more options at their disposal to try and beat this disease.

I hope these past few weeks of blogs have encouraged you, or someone near you to get tested. I’ve learned first hand how precious life is and what’s important and what isn’t.