Tag: MRI


Lucky, Lucky Bastard

14
October

It really is amazing what you can be grateful for, when you have the right perspective.  I was diagnosed with prostate cancer four weeks ago today.  But the disease has not spread beyond the gland itself.  That’s the wonderful news I got this morning, after four long, anguished weeks of waiting.  And gloriously grateful am I to receive it!

With a PSA level of 9.5 and a high Gleason score of 9, I had pretty much convinced myself that my cancer was bound to have spread throughout my body, with the attendant impact on my chances of recovery.

The nurses had given me an unofficial heads up that the MRI and bone scan results looked good.  But the results had yet to be reviewed by the medical team and there was always the risk that they would spot something untoward.

This morning my mind was put at ease in the Rapid Access Prostate Clinic.  If I won the Lottery it couldn’t top the feeling I have now and my prospect for a full recovery is now far better than I dared hope when I was diagnosed four weeks ago.

Of course, once you are diagnosed with cancer, you are never completely out of the woods and there is always a chance that it could rear its ugly head elsewhere in my body, at any time in the future.  But I could also be hit by a bus before that happens.  So life goes on regardless and the spring in my step that eluded me on D-Day has finally materialised.  In a peculiar way, being diagnosed with cancer has given me a new lease of life.

I also, finally, have a date for the surgery to remove my cancerous prostate gland (and a few other bits and pieces) – I go under the knife on Thursday 27th October.  The tumour in my prostate measures 1cm x 1.9cm.  Given that a prostate gland is about the size of a walnut, that seems quite large, not that it will bother me after the 27th.  While the surgeon is in there, he’s going to remove lymph nodes in the pelvic area, as there is a chance that cancer can spread to these.  So the surgeon’s instructions on the day will be “if in doubt, whip it out”!

Apparently, the consequences of losing my prostate gland may not be as severe or as long lasting as I had feared.  I will certainly have to cope with some urinary incontinence and erectile dysfunction following surgery.  But the extent of these side effects varies greatly from one patient to another.  I could be back to my old self within weeks or it could take a year or more.  There is no way of knowing at this point.

Urinary incontinence may not be quite as bad as I’d feared.  I had thought I would have no control whatsoever, pissing myself all the time – not cool!  However it is, apparently, likely to be only when there is pressure on the bladder, such as when standing up from a seated position or bending over, stuff like that.  The silver lining is that it gets me out of many of the household chores I hate.

Urinary control is based on two sphincter muscles: one behind the prostate and one in front.  I will lose the rear one in the surgery but it’s the front sphincter that matters most.  I can prepare for this over the next couple of weeks by stopping a slash in mid-stream.  It’s not the most edifying of exercises but hardly the most arduous either.  So I can live with it (“live” being the operative word).

I’ll be wearing a catheter for two or three weeks after surgery and it is when this is removed that I’ll know what I have to deal with.  I’ll be wearing ‘pads’ (an awful word) to soak up the (hopefully) odd dribble for a while.  I have only discussed this with one other prostate cancer patient so far and he was still having problems since his surgery in January.  I’ll be talking to many more before my date with the scalpel.  So hopefully I’ll learn of others who have had a better experience.  Either way, it’s inconvenient but not the end of the world, all things considered.

Of course, the second major side effect of radical prostatectomy is erectile dysfunction (ED).  Similarly, this may not be as long lasting as I’d first feared.  There is no real pattern in the experiences of previous patients.  So, again, it’s a case of ‘wait and see’ (the traditional ‘suck it and see’ seems hardly appropriate, under the circumstances).  The Lovely Colette (TLC) can be assured of undisturbed nights sleep for quite some time following the surgery.  It can take weeks, months or years before normal service is resumed, if at all.  There is hope though.

One option is to take a quarter of a Viagra tablet six out of seven days.  This does not mean I’ll be walking around with a stiffy all the time (sorry ladies!).  To achieve the desired state, a full tablet at the weekend should do the trick.

Funnily enough, it is important to achieve erections in the first year following surgery, if only chemically induced.  If this doesn’t happen, the tissues involved effectively form a kind of scar tissue that reduces the probability of being able to get it up naturally.

There is also the option of using an injection into the base of the penis, which would definitely perk Horace up (‘Horace’ is how TLC and I affectionately address my cock).  The thought of sticking a needle into Horace seems kind of cruel.  But if tough love is what he needs that’s what he’ll get – and he’ll bloody well like it!

Overall, today has been one of the best days of my life.  The cliché that “today is the first day of the rest of your life” takes on renewed meaning after you’ve been diagnosed with cancer.  So many clichés like “life’s too short” and “don’t sweat the small stuff” assume new meaning that you had previously taken for grated.

When you are faced with the cold, up close and personal prospect of imminent death you undergo a life-changing transformation that is utterly irreversible.  Having being diagnosed with a life-threatening condition is not necessarily the end.

Blessed as I am with the beautiful family, friends and colleagues I have, I now realise what a lucky lucky bastard I am!

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Dial M for Magnetic Resonance Imaging

1
October

It’s now been two weeks since D-Day and there are still no outward signs of any symptoms of prostate cancer.  As welcome as this is in itself, it is a mixed blessing in a way.  Feeling physically normal makes it harder to truly accept that you have cancer.  Maybe there has been some mistake?  No. I was never one for clutching at straws and it is highly unlikely that both the PSA test and biopsy got it wrong.  If life has taught me anything, it is that knowing a thing and feeling it are two very different affairs.  So, I must accept the diagnosis and keep preparing for the worst, like hearing a tsunami warning and bracing yourself for the tribulations to come.

Having finally completed reading the Understanding Prostate Cancer booklet, I now have some figures to quantify the likelihood of post-surgery issues.  There is a 70% probability of urinary incontinence during the year following surgery, dropping to 10% thereafter.  The likelihood of erectile dysfunction (ED) is also 70%, dropping to a less encouraging 30% a year after surgery.

Urinary incontinence is pretty much something to be coped with but there are some well known drugs for treating ED, like Cialis and Viagra.  Another drug I hadn’t heard of before is Caverjet.  According to booklet, Caverjet is “injected into the penis using a small needle to cause an erection”.   I’ll have to take their word for that because I cannot conceive of any cause/effect relationship between ‘needle’ and ‘erection’!  On the other hand, the most memorable sentence in the whole booklet, also about Caverjet, is: “a prolonged erection longer than 3 hours needs urgent medical attention”.  Intriguing!  I dare say, if I had a stiffy like that, it’s the lovely Colette who would be in need of medical attention. Ha Ha!

At a yoga class for men with prostate cancer on Monday I met John, who had his radical prostatectomy in January.  He still has problems with his waterworks now and you can tell from his demeanour that he’s fed up with it.  But John is happy to have survived and talk among the men is mostly about check-ups and comparing notes about doctors and treatments.  I was by far the youngest there and felt a bit like an interloper, with my week-old diagnosis and yet to commence treatment.  But it is an exclusive club and I will be fully inducted soon enough.  There is a common misconception that prostate cancer only affects men over 50.  So I wondered if my presence made my senior fellow patients feel a little bit better, by reducing the average age profile.

Yoga is something I had not tried before and I did find it relaxing.  Being the new boy in the class meant I kept glancing around me to see what everybody else was doing.  Connie’s verbal instructions were clear enough but I’m a visual kind of person and tend to understand what I see better than what I hear.  I will keep going to the weekly class, not least for the sense of camaraderie and mutual support that only fellow cancer patients can provide.

The strain of the impending treatment and uncertainty about the outcome is starting to show in Colette.  My wife is being exceptionally nice to me and, as every married man knows, this is cause for concern!  Colette has not read as much as I have about prostate cancer, its treatment and their consequences, both inevitable and potential.  She needs more time to get her head around it all and she feels a need to await the MRI and bone scan results, to know exactly what we’re faced with.  I have tried to convince her to avail of supports from the Irish Cancer Society and the ARC cancer support centre in Eccles Street.  But everybody is different so I don’t push it, trusting that Colette will find the inner strength to deal with this in her own time and her own way.

Colette has told Grace that I will be spending some time in hospital soon, without going into detail.  At just six years of age, I don’t expect that this will mean very much to Grace.  She has not mentioned anything to me about it so I wonder how much she will understand.  At some stage, we are going to have to explain to Grace why I am ‘not myself’ and not going out to work.  But before we can do that, Colette and I need to understand more about that lies ahead ourselves.

The highlight of this week was having my MRI scan yesterday.  This and the bone scan are the great swords of Domacles hanging over my family.  Everything is on hold pending the results of these tests, which will establish whether and to what extent the cancer has spread.  At risk of being melodramatic, I see these tests as indicators of whether I am going die of this cancer or survive it.  Concerns about incontinence or ED pale into insignificance in comparison with a literal matter of life or death.

I had not had an MRI scan before and it was more or less what I expected.  On exchanging my clothes for a most unflattering gown, Frances went through the obligatory checklist to make sure I didn’t have any metal in or on my person and whether I suffered from claustrophobia.  The scan would take twenty minutes and there would be a lot of noise so I’d have headphones on with the radio station of my choice.  It was tuned to Lyric FM but, as much as I like classical music, the choice seemed a bit clichéd for the task at hand.  So I opted for Newstalk, which I would normally be listening to in the car on the way home from work about now.

All prepped and ready, Frances left me alone in the room and the sounds from the headphones changed from classical music to Newstalk.  At this point, it occurred to me that I was about to be scanned for signs of the spread of cancer throughout my body.  I would be unable to move for twenty minutes inside a giant magnet and I’d have George Hook in my ears.  Oh well, in for a penny in for a pound, there’s going to be far worse than this to contend with later.

The first thing that struck me on entering the MRI scanner was how much more confined was the space than I expected, the top of the chamber no more than a couple of inches from my face.  I imagined how much like being in a coffin it must be, without the cheap wood and frills.  Not the most comforting of thoughts when you’re being scanned for a spread of cancer through your body.  It also confirmed my wish to be cremated when the time comes. But, being something of a science fiction nerd, I also found it a curiously interesting experience, wondering how magnetism ‘sees’ inside the body and making a mental note to Google it later.  When the scan started, it was indeed very noisy and I was glad of the company of George Hook for twenty minutes.

When it was all over, Frances returned and had checked up to find out whether there was any progress on my bone scan.  I had mentioned earlier that I was still waiting for an appointment for one.  To my surprise, there is an appointment in the system, for next Thursday, and Frances surmised there is probably a letter in the post for me.  She gave me a number to ring on Monday to confirm it.  My appointment is with, of all things, the “Nuclear Medicine” department, much to the titillation of my inner nerd.  I mean, “nuclear” medicine – how cool is that!

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