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After RALP: Walking, Passing Gas and other Milestones to follow

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Posted 11/15/2013 4:26 PM (GMT 0)
Well Guys, as a new member of the "other side" club, I have to admit that so far so good.
I had my RALP on Tuesday 11/12/13 with Dr Tewari at Mt Sinai in Manhattan.

As a new member of this "club", I promise never to suggest that what I chose to do based upon my personal situation (https://www.healingwell.com/community/default.aspx?f=35&m=2845398) or resulting outcomes that I am subject to, whether good or bad, indicates what anyone else should do or expect as their outcome. While there are no guarantees, you can make choices that make sense to you and which you can live with regardless of the outcome.

I had a lot of pain during my three hours in the recovery room and was medicated multiple times. When I finally got to my room I was actually feeling pretty good. Within 1 1/2 hours, I was up and walking the halls for about 40 minutes. I really was motivated to jump start my body. I'm a walker who always walks 2.5 miles a day on the treadmill at 3.8 mph. That and a little weight training is basically the only physical activity or sport I participate in. I'm not a big guy: 5'7" and 133 lbs.

Next day I did two 40 minute circuits of floor walking and felt pretty good till late morning when the gas pains (or maybe bladder spasms?) forced me to get some Tylenol with Codeine. That worked like a charm, but still could not pass the gas. My doctor's protocol is that you stay on a liquid diet until you pass gas and that the best way to get there is to walk...3 miles per day. I was discharged on Wednesday.

On Thursday I got to use the treadmill at the hotel I'm in for 45 minutes early in the morning at a slow 2 mph which I did again in late morning...and then lo and behold, I started passing gas while seated upright. I did discover that when I layed down a little while later, the gas just started pouring out. Maybe it would have come out earlier if i had tried laying down sooner but who knows. I now was passing gas like a champ and could get off the liquid diet I had been on for 3.5 days.

Now a little while before the gas came out naturally, I did a No-No. I
strained a little to try to push it out which resulted in a very tiny discharge of urine from the penis outside the catheter which caused a sharp momentary pain at the penis tip as the urine pushed the sticky with blood penile tissue away from the catheter as it went out.

Makes me wonder what it might be like for one's first bowel movement if any pushing/straining can bring on this painful rush of urine? Anyone have any thoughts on that?

I am feeling fine with no pain on day 3 post surgery. Past results are not necessarily indicative of future results, ie bladder spasms, pain, etc but hope springs eternal. That's my story so far.
Posted 11/15/2013 4:36 PM (GMT 0)
sounds like you're doing great.

Here's a tip about BMs, get a commode... Sitting down low results in the cath pulling. I ended up trying to squat but that was a pain.
Posted 11/15/2013 5:52 PM (GMT 0)
If you've been taken pain meds you'll like have a bit of constipation as well. You might want to consider a stool softener for a couple days to help easy things out. Keep up the walking - that helps a lot too.

The first BM after surgery is always the worst. It gets better after that.

and welcome to the other side. Before you know it this will all be just a bad memory.
Andrew
Posted 11/15/2013 7:01 PM (GMT 0)
clanda:

Sounds like you are doing great. Next milestone is taking a shower!

Keep walking, but listen to your body and don't overdo it.

-Gedman (a fellow Dr. Tewari patient)
Posted 11/15/2013 11:01 PM (GMT 0)
Hi Clanda,
You are doing fine...keep going.
Wishing you a speedy recovery.
Posted 11/15/2013 11:38 PM (GMT 0)
Hi Clanda, glad you are doing well. As far as the urine leaking around the catheter, I had this issue every time I sat down to have a BM. Really freaked me out the first time but was told that it was nothing to worry about. Just really had the urge to pee and I think it was spasms making me feel that way, especially when having a BM. Like someone else said, after that first BM things will really start feeling more like normal. Anyway, good luck with the rest of your recovery and take care.
Posted 11/15/2013 11:53 PM (GMT 0)
Thanks all of you for the suggestions. How else would I ever get such info if not for you all?
Posted 11/16/2013 12:51 AM (GMT 0)
Hi JG,
This is your bud back home in Boynton Beach.
Be sure your wife gets you some stool softeners. They will really help ease things out so to speak. I was really afraid of the first BM. When I did have one, it didn't hurt with the softeners. In fact, I remember getting off the toilet and having to sit back down 5 times before I was finished. I know, too much information.

Keep up the walking and water, as I said, I was told at least 8 bottles of water a day. Careful on the treadmill with the catheter.

Good talking to you the other night, you sounded great.

Weather here is going back into the 80's. Enjoy the cool weather while you can

Bill from Florida cool
Posted 11/16/2013 6:12 AM (GMT 0)
I took stool softeners, too. Glad I did. I was told to be careful not bear down during a BM. First time I sat, I absent- mindedly pushed a bit and some pee/bloody goo came out around the catheter and it gave me a good sting. From then on I was simply patient and let things happen slowly - which they, thankfully, did. Keep walking. It gets all the internal motors running. Gravity helps, too, when you are upright. You'll keep feeling better. By day 5 I went back to work. Not cuz I'm brave or tough. I simply felt fine.
Mikey
Posted 11/16/2013 5:27 PM (GMT 0)
Hi clanda, it sounds as though you're making good progress. I was among the lucky ones that had no pain nor discomfort following daVinci surgery. My wife (an RN) recommended I take pain medication the evening of the day I had surgery just to have it in my system and I did. I was bloated and the nurse on duty had me up walking around before bedtime to make sure I had no trouble with gas during the night. The next morning I was terribly hungry but I couldn't eat solid food until I passed gas. When I finally succeeded, my wife rang the nurse, who brought me breakfast (french toast). That was the most delicious meal I had that week. The only anguish I had following surgery was months later when my incontinence and ED didn't resolve as I expected.

Mike
Posted 11/17/2013 12:13 PM (GMT 0)
Been taking three stool softener pills daily since Wednesday and lots of prune juice since starting light solid food mid-day on Thursday. Still no BM. Anyone have any previous experience on how long to go without some formal laxative like Milk of Magnesia or something else. Over the years, I've gotten in the habit of taking three daily does of Metamucil and a stool softener to be "regular" (plus 4 prunes). It has worked for me. Unfortunately, my DRs protocol precludes Metamucil till after the BM so I follow the protocol but don't quite understand it. I would just like to achieve this milestone without doing any damage to myself. Any thoughts?
Posted 11/17/2013 1:14 PM (GMT 0)
It took me about 3 days after surgery. Are you taking any pain pills other than Tylenol? I ate a little more food than you, ex. Boiled Chicken and rice with fat free gravy, pb and jelly sandwiches, soup and crackers.
Keep taking the stool softeners and it will come, probably today!!

Good luck, let us know! It is a milestone day!

Bill from Florida cool
Posted 11/17/2013 1:32 PM (GMT 0)
Clanda
Stool softeners are important to minimize straining. I had urine and blood squirting outside of my cath too and it's scary but normal. I held tp in front of cath while having BM to catch the blood and urine. Goes away in a week or so. After cath removal in a week or two post op you'll probably be in depends for a while and using pads thereafter for a while.
Prostate Surgery isn't the worst experience. I had rotator cuff repair a year ago nine months before RP which was many times worse than RP!
Hang in there and tell us your pathology results.
Your stats on bx look good.
Bob
Posted 11/17/2013 1:34 PM (GMT 0)
Hmmmm. I wasn't precluded from eating or my psyllium prior to my first BM. My surgery was on a Wednesday afternoon. I had two small meals in the hospital before I left Thursday morning. I ate pretty normally and took my normal one tablespoon of psyllium (Metamucil) on Thursday along with stool softeners. On Friday morning, after the two mugs of coffee that always seems to get my bowels moving, I had my first BM. It wasn't record setting, but it got the process back on track. What can you take from this? Maybe coffee. Have a couple cups of Joe with, maybe, some pancakes and syrup and then just sit around peacefully for a bit. I'll bet it happens this morning.
Mikey
Posted 11/17/2013 1:57 PM (GMT 0)
Success! Another milestone! I had my first BM and it was painless and "strain-less". Oh what a relief it is! Now what i take away from this experience and the experience of others is that there is no single medical protocol for dealing with eating, passing gas, eating more and then going. I think that this is the takeaway for me and perhaps should be for others perhaps. These protocols are not carved in stone and one size does not fit all, through i suspect they all eventually lead to the same "outcome", thank God! Thank you guys, as usual!!!
Posted 11/17/2013 3:01 PM (GMT 0)
Great news. Enjoy a bit of solid food to celebrate!

-Gedman
Posted 11/17/2013 10:14 PM (GMT 0)
Congratulations!!!!!

Amazing what we we celebrate these days in the PCa world, isn't it!

Next milestone, catheter removal and pathology report

Bill from Florida cool
Posted 11/19/2013 4:14 PM (GMT 0)
Well, this has been an interesting morning. I learned that I am a very lucky man on at least two major counts. What I have learned might also be useful for others in deciding on any course of treatment or AS.

While still waiting till Thursday to get my catheter removed, I received my pathology report via email. While not an expert at reading them, I believe (unless told otherwise) that I dodged several bullets. I'll let you all judge for yourselves.

But wait...there's more. By most standards of Active Surveillance thinking, I was a good candidate for AS after my biopsy. However, I chose to "get it out" via RALP based on my "Wildcards" as described in my thread https://www.healingwell.com/community/default.aspx?f=35&m=2845398

I showed a very low volume of cancer in only two cores on one side of the prostate and my Gleason was 3 + 3.

I am now, after surgery, a Gleason 7 with 3 + 4 and with bilateral involvement. The cancer is now considered high grade and the biopsy missed one side.

So not only do I wind up with a terrific pathology report (in my opinion), I also learned that my cancer was actually high grade with more involvement of the gland. I am a lucky man. See the results below:

SURGICAL PATHOLOGY:
Final result
COLLECTION DATE: 11/12/2013
SPECIMEN SOURCE:
A. RIGHT POSTERIOR APICAL MARGIN
B. RIGHT ANTERIOR APICAL MARGIN
C. RIGHT POSTERIOR PERI~APICAL MARGIN
D. RIGHT POSTERIOR APICAL MARGIN
E. RIGHT ANTERIOR APICAL MARGIN
F. PROSTATE AND SEMINAL VESICLES
G. PELVIC LYMPH NODES
H. PERI~PROSTATIC FAT
CLINICAL HISTORY:
63 year old male prostate cancer
.
DIAGNOSIS:
A. RIGHT POSTERIOR APICAL MARGIN, EXCISION~
- Fibromuscular tissue/ negative for tumor or prostatic glands.
B. RIGHT ANTERIOR APICAL MARGIN, EXCISION~
- No tissue received, insufficient for diagnosis.
C. RIGHT POSTERIOR PERI~APICAL MARGIN, EXCISION~
- No tissue received, insufficient for diagnosis.
D. RIGHT POSTERIOR APICAL MARGIN, EXCISION~
- Fibrovascular tissue, negative for tumor OR prostatic glands
(Cryosection only)
E. RIGHT ANTERIOR APICAL MARGIN, EXCISION
- Fibromuscular tissue, negative for tumor or prostatic glands.
F. PROSTATE, RADICAL PROSTATECTOMY~
- Adenocarcinoma of prostate.
Gleason score 3+4~ 7/10.

G. PELVIC LYMPH NODES, DISSECTION
~ One lymph node, negative for tumor (0/1).

H. PERI-PROSTATIC FAT, EXCISION-
- One lymph node, negative for tumor (0/1).

Synoptic Report Format for Prostate Tumor
ProcedureDiagnosisGleason
ScoreTumor
location-
Radical prostatectomy
Adenocarcinoma of prostate
3+4~ 7/10
Tumour location Bilateral
Extraprostatic Extension Absent
Perineural Invasion Present
Lympho-Vascular Invasion Absent
SeminalVesicle Invasion- Absent
Surgical Margins- Negative for Carcinoma

Additional Pathologic Findings-
- High grade prostatic intraepithelial neoplasia
- Nodular prostatic hyperplasia
Regional Lymph Nodes:
- One pelvic lymph node, negative for carcinoma (0/1)
PATHOLOGIC STAGING (AJCC 7TH ed, 2010)-
Primary Tumor:
- pT2c Organ confined, bilateral disease
Regional lymph nodes:
- pNO No regional lymph node metastasis
Posted 11/19/2013 6:21 PM (GMT 0)
Well JG, it looks like you did know what you were doing. Most would have suggested AS with your stats but you chose the aggressive approach.

In hockey, when an offensive man gets a break way, one on one with a goalie, the goalie usually moves out of the crease to meet him head on and deny him of a one on one goal. Sounds like that is what you did with PCa, you denied it!!!!!

Congrats on your report!

Bill from Florida cool
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