A New Equilibrium: A physician’s journey beyond radical prostate surgery – Part Five

Graeme RockerGraeme Rocker is a professor at Dalhousie University in Halifax

Editor’s note: Part I of this series appeared as a Humanities article in CMAJ; parts II , III and IV appeared on CMAJ Blogs.

 

At six months and counting, life has mostly returned to normal, although persistent heaviness in dependent parts still creates intermittent discomfort. A long bicycle ride with insufficient padding had me worrying about Fournier’s gangrene for days. Wearing old lycra with my new contours, I did a brutal number on one upper thigh and side of scrotum. The unpredictable need to empty the bladder quickly still challenge me, but continence, luckily, has not been an issue. My surgeon, after two post-op visits, is pleased with my progress. He says I need to wait a year for my new baseline in terms of heaviness and/or thickness of tissues.

There was a scare two months back. I went to a “Wine Summit” in Lake Louise – a wonderful event that combines the best of a glorious setting, phenomenal cuisine and great wines. Whether it was the long flight, sitting during lengthy tasting sessions, the altitude, or all of the above, I experienced substantial leg edema for the first time since the plaster casts of my rugby playing days. Memories of my father’s severe leg edema that preceded his fatal pulmonary emboli came very much to mind. Nothing for it but to purchase compression socks for the next long trip, and they seem to work well.

For months I had put off an appointment with the nurse at the urology clinic who helps men with their post-op problems subsequent to sacrifice of the vital nerves. A neighbor who had been through similar surgery earlier told me that he had opted for the self-administered needle with the ‘triple mix’ that can be restorative. Nothing had happened during his clinic session, so off he trotted in his running gear to go round the local park when all of a sudden – POW. His description of suddenly having to pull on baggy clothes by way of disguise and then nearly hauling himself off to the local emergency room with a dangerously persistent erection had us both in stitches.

When I finally mustered the nerve to present myself, the clinic nurse also recommended the injection route for me; understandably, I was less sure. A good friend in England, who supports a competing premier league soccer team (Aston Villa), said in one classic email, that he had tried the “bicycle pump” at four weeks after his prostate surgery, and that it had worked…”but that's a Villa fan for you.“ Not to be outdone, I asked the nurse about said bicycle pump, and was presented with an enormous plastic cylindrical object into which one places….and then under effects of negative pressure… Apparently this device can be rented from our pharmacy on a trial basis.

The nurse then broached the delicate topic of rekindling marital desire in the setting of new realities. After ignoring my suggestion that the English have now supplanted the French and Italians in matters of love, she suggested writing down and comparing (with my spouse of over 30 years) the 5 things one loves most about….and then she described the potential value of various sex toys, including, yes, the feather duster. My inner adolescent, never far from the surface, had had enough. “How many should I buy? Any particular colour?” I fled with prescriptions for both vacuum pump and the triple-mix high-octane injectable cocktail, prescriptions that I haven’t filled, and likely never will. My esteemed surgeon had said that most of his male patients, if they try these things, try once and not again. I understand that. The man down the street gave up because, while there can be a reaction to a pharmacological stimulus, “there is no glee”.

The wife of a university contemporary said months ago, “Quite frankly Graeme, at our time of life…” Quite frankly, at ‘my time of life’ I wasn't done with all this, new reality or not. So, one adapts to new intimacies. My wife and I, loving partners and friends for over 30 years, together find a new equilibrium.

Also on a positive note, friendships become more intense, more meaningful and more important to preserve, especially those at a distance, given future uncertainties.

I’ve embarked upon a fitness routine to get this body in better shape. It's a long and often frustrating road, but as muscles return, the fibrous keel under the vertical scar has retreated under a thicker outer layer. Just as the body takes its time to heal, so my mental outlook has changed. In matters clinical I am content to focus on the COPD outreach program I lead. I am more selective over whether or not to review scholarly articles in my field, and I am cutting back on traveling solo when heading off for presentations in venues of my own choosing.

I feared radiotherapy, hormone treatment and turning into a ‘he-she’, but with two undetectable post-operative PSAs, negative nodes and clear surgical margins, maybe we caught the tumor in time. My post-op Gleeson score suggests less aggression than the biopsies, but who knows. I am scarred in more ways than one, I miss my lymphatics, but I’m vertical, and in ways I would never have anticipated in the early post-op stages, I am content.

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