The first week

I was pretty uncomfortable when I got home and found it hard to stand from sitting or twisting in any way. This got better every day and by the end of the week apart from the odd twinge as long as I took it easy and slowly I became a lot more mobile. On the Tuesday I just took a few steps round the house but spent most of my time lying down and watching La Vuelta and Hong Kong squash on Eurosport. Wednesday I had a very slow walk around Greengates Park, about 15 minutes, with Julia but since then I have been doing two walks a day of between 20 minutes and 40 minutes, definitely getting a bit stronger and a little quicker each day.

I was surprised when I got home and weighted myself the next morning that I had gone up form about 13 stone 2 lb before the operation to 13 stone 10 lbs on my return 2 days later. I wondered if they had left some instruments in me. My tummy was quite bloated but for the best part of the operation day, Sunday, I hadn’t eaten of drunk. The next day, however, Wednesday 24th, I weighed in at 13 stone 3 lb which made a bit more sense. I had already decided to go on a low carb diet when I got back without sacrificing protein intake as I was concerned about putting on weight and losing muscle over the weeks of relative inactivity to come. I had also been advised to eat small amounts more frequently and avoid large meals so as not to overload my stomach. Constipation and straining were a concern, hence also the laxatives I was given as part of the discharge pack. By the end of the first week, Saturday 27th, I was down to 12 stone 10 lb.

One concern that is worth recording is that my wee remained bloody (rose, not claret) until Thursday evening, 4 days after surgery. The notes given as part of the discharge pack stated that this should clear within 24 hours and if not phone the hospital. This I eventually did Thursday morning where I was told not to worry about it too much if it was only pink but let them know if it continued for more than another couple of days. Needless to say since Friday 26th it has been clear a a bell. The other problem I had was quite a pronounced ache across my shoulders and occasionally at the top of my chest. This passed after a couple of days and when I mentioned this I was told it may be due to the gas they pump into my abdomen to make space for the operation which is generally dispersed within my body and has been known to cause some temporary chest and shoulder pain. So, so far so good.

Immediate post op and discharge

I finally went down to the theatre about 2.00 pm on Sunday 21st August and woke up in bed round about 7.00 pm that evening is some discomfort. Julia was there and apparently we had a conversation but I remember very little about it. She reports that I said I thought something had gone wrong with the operation as I had oxygen tubes up my nose and I don’t remember any one else coming back form the theatre with these. I also had a little more pain than I expected. She left after 30 minutes as I had fallen back to sleep. I was awake at midnight as I had to have some pain killers, a combination of paracetamol and Tramadol (officially a class A drug) and injection of Tynzoparin, a blood thinner. I had the first of these at midnight Saturday and I must have one every 24 hours for 28 days after the operation. These are to help avoid DVTs during a prolonged period of relative inactivity. By now a rather confused and near unintelligible man had been put in the bed next to mine and spent the next few hours calling for his wife. He thought he was in bed at home and that his wife was downstairs. He quietened down in the early hours and I eventually got off to sleep again.

I hadn’t eaten or drunk since 7.00 am before the operation. I had been given a mouth care pack back on the ward, basically a small amount of water and sponge ‘lollipops’ to moisten my lips and mouth, so by 7.15 am on the Monday I was looking forward to water, a cup of tea and some breakfast. During the operation and over night I had been on a hydration drip. I had to, and will continue until the catheter is removed, drink 2 litres of water a day to keep every thing flushing through. No fresh fruit on offer so a small portion of orange juice and a bowl of fruit and fibre cereal. Julia had brought me some fruit and a Sunday news paper the night before,placed on the seat beside the bed, but I couldn’t see these and hadn’t remembered. I was still quite sore and it was hard to change position in the bed without pain.

The doctors’ ward round took place about 9.00 am. I didn’t see Mr Singh, the surgeon who had carried out the procedure, but another surgeon who apparently assisted him. He told me that the tumour had been quite a lot bigger than expected and had poked out of the wall of the prostate a little more too. This meant they had to take a wider ‘clear margin’ in addition to the prostate on the side with the cancer than planned. There had been some discussion of whether they should remove the lymph glands in the circumstances but decided against it and stick to the original plan for surgery. Another complicating factor was that the prostate in that are had ‘stuck’ to the surrounding tissue. They don’t know yet if this was because of the penetration of the tumour or because of damage done by the targeted biopsies taken from the same area. All the material is sent of to the laboratory to grade the cancer in the prostate and to see if any cells had escaped into the surrounding tissue. I was warned that this increased the chance of needing addition radiotherapy but the results would be back in time for the consultation meeting 6 weeks after the operation. In the meantime we must just wait and hope for the best.

Later that morning Mr. Singh came to see how I was getting on and I told him what I had been told. He seemed slightly surprised. He confirmed what had been said but seemed slightly more relaxed about it. His assistant turned up at that point and seemed nervous that I’d now been told something different. I am assure him I hadn’t.

All that remained now was to get onto my feet and walk a few paces when I felt able and, all being well, got through the discharge procedure so Julia could come to pick me up and take me home. I had a couple of short and very slow walks down the ward corridor and by lunch time I was given the all clear to go home. Unlike last time I was on the ward after my bike accident, April 2015, I was to be discharged from a special unit in ward 19, the other end of the hospital, too far to walk but I would be picked up and taken there in a wheelchair. I found getting dressed and packing very painful and after a while went to the nurses’ station to request the pain killers I had, as is my normal practice, turned down in the morning. I handle low levels of aches and pains pretty well and have always preferred not to take drugs if not necessary as there is always the possibility of side effects some of which can be long lasting and damaging. However, I didn’t think I could get through discharge and then home by car without some help. They gave me another 2¬†paracetamol and 2 Tramadol and within 20 minutes or so I was feeling better. The nurse taking me to the dischareg unit came for me at that point and finished my packing and put my socks on for me, put my shoes on and tied my laces. The first time anyone had done this for me since my mother over 60 years ago!

There was a slight hiccup and delay as my prescription for take home pain killers was wrong and had to go to another doctor to be altered. The discharge procedure took nearly 3 hours in all (it only took 1 hour on the ward last time) but went fairly smoothly. Most of the time was waiting for the prescription to made up by the pharmacist. I was given a packet of paracetamol and of Tramadol and two packs of Movicol, a mild laxative and stool softener. They were keen that I didn’t strain while going to the toilet especially as lack of activity could cause a degree of constipation. I was also given a pack of 28 preloaded disposable hypodermic needles for the self administered¬†Tynzoparin injections. These could be done by a visiting district nurse but I had watched the first two given me by nurses and decided I would start of by trying to do it myself.

Then I was ready to go. I had phoned Julia a little earlier and I walked to the entrance with the nurse carrying my bags and medication so that Julia could just pull up and I could get straight in. She was there, it was about 4.20 pm by now, and I had an uncomfortable ride to Greengates in the beginnings of the rush hour traffic. However, it was good to be home and after a light dinner all that remained was to stay awake until midnight to give myself the my first injection.Although quite fearful about this it was OK and I’m sure I’ll get used to it. In fact you are given a 2 hour window either side of the 24 hour period so I did it at 10.30 and continued to do it at 10.00 pm, our normal bedtime, give or take. The next morning, Tuesday, we would plan my recovery programme – particularly exercise and diet.

Countdown to the operation

After the information I was given by phone reported in the last two posts, I had a meeting with my consultant on the 21st July. The additional tumours detected by the MRI scan and following targeted biopsies show a significant volume of more aggressive cancer that is pressing against the prostate surface and there is some evidence that cancer may have begun to poke through into the surrounding tissue. Active surveillance is no longer an option and, for reasons described in earlier posts, surgery seems to best choice as it leaves radiotherapy as a possible plan B. If the tests of the surrounding tissue that will be removed along with the prostate are all clear radiotherapy may not be needed but will be used as a backup if cancer cells are found outside the prostate. I have opted for the surgery. I was told that the provisional date for the operation is Wednesday 24th August but might be earlier as they have begun to do weekend surgery to help clear a back log of operations.

After this meeting Julia and I were invited to a seminar on the 4th August with other men due to have the operation over the next few weeks to meet with the surgeons, radiologists and physios to have the operation explained in more detail, what the side effects are and how these are treated. Mr Singh, who will be my surgeon, was very enthusiastic about the semi-robotic procedure that the BRI are now very experienced with and the much better rates of recovery obtained. We were shown one of the arms that are inserted through a small 2 cm incision with the surgical implements and how they worked to get round corners and into the restricted areas that in the past have made prostate removal such a tricky business. The operation involves 5 small ‘keyhole’ incisions for the surgical instruments and the camera. A slightly larger incision is necessary for the removal of the prostate. They will be taking some additional tissue from around the prostate where the tumour is poking through and tests will show whether any cancer cells have leaked out. If so I will need 4 weeks of radiotherapy in due course when I have recovered sufficiently from the operation but all being well this won’t be necessary. However, I’m not optimistic about this and so far my intuition to fear the worst has proven to be correct. I hope I’m wrong this time. On the whole the seminar was positive. A patient who had the operation a couple of months before spoke about his experience and I found this to be encouraging. He had a Gleason score of 9, so a higher risk than my score of 7. He is currently waiting to see if he will need radiotherapy but has had little problem with incontinence. The other highlight of the seminar was the talk about Viagra and the vacuum pump and there use to try and rehabilitate erections. These can take up to a year to return and for some men it never does. I depends on how easy it was to get erections before the operation and how much nerve damage is sustained. The Viagra and pump are to help keep the blood vessels in the penis fully functional so that all is well if and when the nerves get their act together sometime in the future. The pump produces an erection that deflates as soon as the pump lets in air again but apparently it can be sustained for a while with the use of a rubber ring that acts like a tourniquet. This looks quite painful so I don’t think I’ll bother! The combination of the Viagra (3 to 7 a week for 10 days or so I think) and the daily use of the vacuum pump is just to keep things ticking over and to prevent your member withering on the vine,so to speak. The other rather disconcerting aspect of the operation is the necessity to self-administer injections into the fat of your tummy with a blood thinning agent. I think this is for about 10 days and is to minimise the development of possibly life threatening blood clots. Our man said he had no trouble with these and the needles used were about as thin as you can get. We’ll see.

Anyway, I have just learnt that my operation is now confirmed for Sunday 21st August, three days time, and I will be going into Ward 14 of the Bradford Royal Infirmary 2.00pm Saturday afternoon.

Update: Saturday 20th August, 12.00. Just been told there won’t be a bed ready for me at 2.00 pm and so I’ve been asked to come in for 6.00 pm. It’s still OK to eat as usual before then as they will be ‘starving me on the ward’.