15 days out from surgery

Hi Beaverduck. With your family history and G6 status just beyond good candidacy for active surveillance, I congratulate you on reaching your treatment decision. I'm sure others will chime in with pre- and post-op advice.

Mine is to relax from now forward and know that your doc and surgical team will be working for you. You have an excellent chance of having PCa behind you when you wake up! I suggest using that as your relaxation mantra.

Walking and stool softeners should be your best friends after surgery. Do not let yourself become constipated, but if your do, consult your surgeon's office or the help number you are given for which laxatives to use and in what order of strength. Follow your discharge instructions! Observe your weight-lifting restrictions -- your RP is an investment to protect!

Be very patient with your urinary and potency recovery! For continence, I saw improvement every day for a few days; then every week for a few weeks, and finally every month for a few months. Know that every guy is different! Urgency incontinence will be the first to disappear; stress incontinence (coughing, laughing, sneezing, etc.) is usually the last.

All the best!

Djin

Make sure your TV subscriptions are paid up and put new batteries in all your remotes.

Recovery can be boring...

You’ll need help at home.

I’ve yet to meet the man who didn’t.

That doesn’t get much press. Maybe it goes without saying. I don’t know.

But, it is the most important requirement. Or, it was for yours truly anyway.

Greetings, from the most anti prostate surgery guy on the WWW.
I had my surgery in November of 2009. My understanding is that things have continued to improve over the years in terms of outcomes and recovery. I’d like to share a few basic things that helped me out.
 Plan: Be the first case of the day for your surgeon. I also had an agreement that the chief resident (Brad Lake, MD at the time) could do much of the surgery including helping with the ports, establish access to the prostate, collection of lymph nodes, and closing. My Doctor was to personally do the dissection of the prostate and related tissues, the removal of the prostate and the anastomosis.
 Surgery: I was in the best shape of my adult life at the time of my surgery (almost 40 pounds lighter). I am a believer of “pre-habilitation”. I did a lot of jogging and walking leading up to surgery. When I woke up in recovery I didn’t take any pain medication. Did I have pain? Yes I had some but I was aware that I was going to have this discomfort, I did ask for something for nausea. To be completely honest I really wasn’t nauseated but I was very concerned about how much it would hurt if I had to vomit. Because I didn’t take pain meds I was awake in no time and out of recovery room. In 2 weeks I was back to work without any real difficulty. My surgery experience was a big non-event. However my brother would tell you differently. It took him much longer to get back up to speed. I believe that he was out of work for 6 weeks. He also had much more pain than I did. We had the same surgeon. Unfortunately even with a G6 pathology he failed surgery and had to have 7.5 weeks of radiation therapy.
 Pain: You can’t have stab wounds to the stomach and not have pain. But my pain was from a known source so I had no fear. I never took a pain shot or pain pill while I was in the hospital. I only took ibuprofen at home. Once they got me walking I exceeded what they wanted. I was ready to go home on post op day one. I really think I could have gone home same day. It is my understanding that a number of surgeons are now doing this procedure with only 1 port… that would be welcomed.

 Post-Op:
Immediate post-op. When I woke up I had a drain in my rt. flank. It was called a Jackson-Pratt. It was attached to a long tube that was draining fluid from my lower pelvis. It was removed during rounds at about 6:30 in the morning. It smarted some but only for a short time. While in the hospital I didn’t worry about food but I drank a lot of fluids. The abdominal distention that I had from the gas that they use during surgery to create an open operational field was uncomfortable. This gas isn’t in your colon, it is actually free air in the abdomen and it was slow to resolve. I think it actually caused me more discomfort than the abdominal wounds… I looked 4 months pregnant for several days. For robotic surgery they position you in a sharp head down angle and my family remarked about my face being swollen. It is also not uncommon for patients having this surgery to develop a very swollen (huge) and discolored (purple) scrotum. I did not have this but I know several people that did. You may want to plan on having some Ice Packs available just in case. We use frozen peas for ice packs at our house.

Long term Post-Op. The ride home (70 miles) was uncomfortable. I suggest you do some planning for that activity, good luck! I went home on post op day one and I went to the lazy-boy. I found the lazy-boy was easier than the bed to get in and out of. So I actually made it my bed for the first 48 hours. Before surgery I had attach 4x4’s to the chair so that it was raised up higher making it easier to get in and out of. It really helped but I only needed it for the first 48 hours, after that I was moving about with little difficulty. I’m not sure that I would do that again??? I took a shower on post op day 2 and daily after that. I had 2 pair of cotton sweat pants that I modified to accommodate the urinary catheter. On discharge they also include a leg bag for the catheter, I never used the leg bag. I took the standard urine bag and placed it in a reusable grocery bag. I fashioned a self-sticking plastic hook on a bedside table to hang the grocery bag on. I also used the same type hook in my shower. I had a folding table for my essential stuff at my chair and my bed.
Wound Care: Each physician individualizes this. When I got home I had a significant amount of drainage from the place that the drain was removed (right flank). I had to fashion a pad for that for about 48 hours. After I started showering I did not bandage any of the wounds.

THE FOLEY CATHETER: I had mine for 10 days. 10 DAYS!!! Not sure how long they recommend currently. You will find that a crust develops on the foley at the insertion site into your penis. It is important that you keep that super clean. I used ivory soap and spent extra time caring for that area during my shower. After I got it adequately clean I used an ointment on the tube itself, (non-petroleum based lube. You can find something at Doctor Johns Boutique). On the morning of day 10 I got in the bathtub and used scissors and cut the foley, the water drained out of it and the foley slipped out into the tub without any discomfort. This saved me a 70 mile one way trip back to the urology office for a 5 minute visit. I didn’t much care for the catheter.

Urine continence: Or lack of continence. For the first 2 – 3 hours after I removed the catheter I was very worried because I could not feel anything. Urine just poured out. However things started to improve after a few hours. (I also removed my brothers catheter and he had a very similar type of experience) I used a (diaper) for about 2 weeks, after that only used thin liners. I used large pads on my bed so that I could sleep without any bottoms. I found out quickly that the groin area needs to have fresh air and stay dry to help minimize any smell and to avoid any tissue damage. DO NOT shave your pubic area shaving can cause micro abrasions and result in infections. It does help to clip the hair short to help control smell (think wet dog) and clipping hair also promotes air to the area. Clip do not shave. I consider myself to have been 98% dry at about month 2. Having said that I do from time to time have stress “leakage”. But that’s no big thing. Some say caffeine and alcohol increase leaking.

Walking: This is very important. It promotes healing and mental health. It also helps prevent constipation. For the first 3 days I did laps in the house. After day 3 I starting walking outside. Being out even in chilly weather was great for my mental health.

Visitors: Like you I had my surgery during flu season. I kept the grandkids away and sent out a notice that I wasn’t up to visitors. I only had a limited number of people come to the house. I would hate to get the flu while recovering from surgery. Unfortunately this year’s flu vaccine isn’t providing the best protection.

Erectile Dysfunction: Anybody’s best guess? I would suggest that you ask for a scrip for Cialis to help with ED rehabilitation. Lots of good info about using Cialis for rehabilitation online

Post-Op Pathology: Post-operative pathology is very important. After surgery it is not uncommon for the pathology to be staged different. I’m not sure what percentage of patients have an upgrade or a downgrade but it happens. My pathology was upgraded from 3/4 to 4/3. This caused me a lot of anxiety. The pathologist I spoke with said that overwhelming majority of my cell type was 4 so I basically consider myself a G8. I also had Perineural Invasion. The significance of this is debatable but it really added to my anxiety. You want to have clean surgical margins and clean seminal vesicles. As I said above I had asked for lymph nodes to be harvested during the surgery. All mine were negative for malignancy which made me feel better. Some doctors do not want to take nodes because of the possibility of lymph edema of the legs. I had a total of 14 nodes taken and I did have some edema in my lower left leg for a while but that resolved. Some pathologist are considered prostate tissue experts. You can have your pathology specimen sent to one for a second opinion.

Try To Relax: Fear of the unknown is understandable. You are going to have some real concerns. I remembered when I got fully awake in the recovery room I checked to see that I had all my parts and that I didn’t have any unexpected wounds. Unexpected as in they needed to convert to an open procedure. And I checked to make sure that I didn’t have a colostomy or a urostomy. All highly unlikely but I checked. The recovery room nurse asked me what I was doing and when I told her she had a good laugh. I’m not a good patient and frankly I was in a bad place mentally going into surgery. But once I got into the pre-operative holding area it was game on. Pain medicine is not a bad thing. It is not good to have serious untreated pain. In my case the pain I experienced just didn’t get to the level that I needed any medication. During the day while I snoozed when someone came into my room I had my wife wake me up and I instructed all staff that they had to use the hand sanitizer before they could do anything to me. I sent the wife to a local hotel for the night and I didn’t worry about if I got any sleep or not. I had something to read and I walked several times. In today’s world I would have a bunch of podcast ready.

Constipation: Do not allow this to happen. Don’t know if they still recommend this but I had to take a bowel prep the evening before surgery. I had to stay on clear liquids all day so I was empty. It took a few days to have the need to go. I already had some stool softeners on hand and started using them on post op day one. Having a BM with the foley in place was a very strange feeling. With my first BM I had some blood come out of my penis which was a big surprise. It made me sick. As it turned out it was nothing.

GOOD LUCK!

Hero

Wow I would have to say that this thread is some of the best ideas I have seen since joining three years ago. As Halbert said buy the animal pads from like Walmart or somebody a lot cheaper. If you are going to stay in a motel room the nite after you get out of surgery make sure you cover the bed with the pads cause you will leak from the drain and such. If your car ride is more than 4 hrs make sure you stop every hour 2 at the most and if it's over 4 stay somewhere on way home. You will not be much in the mood for traveling... Pads in car and pads at home I wished I would have had this advice when I had my surgery. Use your leg bag at least once or twice when you get home if nothing else gives you something to do and take little short walks!! Make sure you will have somebody around for the first couple of days just make sure they have lots of patience! 😜😂😃 The only other thing I might add is a couple pairs of loose atheletic shorts lot easier to run the cath tube down and out! Wish you the best and hope it's one and out!!!!!!!!!!!!!!!! oh yea if your interested in a little hanky panky and have a willing partner go at it like you were 18 AGAIN!!!!!!!!!!!!!!!!! Larry

Maybe I'm a little different than some others who had surgery....just going to relate my own experiences. I'm not overweight, in fact very slim so maybe that helps. 72, almost 73, and live alone. I had single port robotic surgery on Oct. 4, 2019 and went home the same evening. No drain due to the single port. Had a buddy of mine bring me home from the hospital and drop me off at my garage....lol. It took some practice to get the changeout between the small catheter bag (I had my catheter in for 12 days) and the large one but after a day it went fairly easily. I used the large bag only while sleeping, hanging it from the night stand drawer next to the bed. When I got up I switched bags and just put up with emptying it several times a day....the catheter only bothered me where it exited the penis tip so I kept vaseline around that area. Toward the end of the 12 day period it started leaking around the outside of the catheter for some reason. Was glad to get it removed....just kind of slid right out, no pain. Going back some, I had no pain from the two small incisions, one lower right ab, one right below the navel....never took any pain meds....was doing situps on my bench a few days later as a matter of fact. Some reports indicated your penis gets an inch shorter from the operation....mine didn't change. I didn't need any stool softeners....worked just fine. One thing I found odd....I got half erections while sleeping with the catheter in for a few days....now been total ED since then...nothing at all, but wanted to wait until the incontinence issue got under control before addressing that issue. After the catheter was removed.....I didn't expect the degree of incontinence and before I got smart and ordered a penile clamp (Cunningham) I found myself keeping styrofoam coffee cups on the night stand, living room end table, and computer table. As soon as I would move, pee would start to come out so I found myself clamping my penis with my fingers, sticking in in the cup, and heading for the bathroom rather than wear a thick pad and have it soaked in an hour. I had bought lots of pads, thick and thin, diapers, etc....most are still in the boxes....lol. I'm active, and running around the house or outside constantly filling the pads wasn't something I wanted to deal with but had no other alternative for several days until a friend of mine who regretfully has full time incontinence due to PC, told me about the clamp. Well, it was a life saver....can't describe the relief and freedom it provided. I had to trim the foam a little but hardly knew I was wearing it and I could go hours and hours before going to the bathroom....to the gym, out shopping, driving. If I was to give you one piece of advice....buy one, if you don't need it great...if you do, you have it. Best PC move I made. It took me about 2 - 3 weeks before the incontinence issue started to come under some control, and now, after about 4 months post op, I'm dry.....haven't worn the clamp in a few weeks. Initially I wore a light pad with the clamp in case pee might push by the clamp but it never did. I tried the diapers once....made my bottom sweat terribly. My night time incontinence totally improved about 3 weeks after post op. I never leaked in bed, not with or without the catheter. Kegels are extremely important....start well before your op, and yes, walking and stairs help alot too. I'll be going for my second PSA test in about 3 weeks. Hope you do well with your surgery!

Welcome back BD.

The only thing I recall to do in the weeks prior to surgery are the Kegel exercises and making sure your liquid intake, diet, and pooping schedule are working well together with stool softeners and/or Miralax as required before and after surgery. Of course, you should be exercising and walking a lot getting ready for the slow period after surgery. The hospital and/or doctor will give you all the instructions you need for day before prep.

I did not get too excited until the week before then started the prep work:
• Brought recliner chair up from basement to main floor family room (used for most prior surgeries)
• Had quilt and electric blanket handy for sleeping in chair first few days and nights at home.
• Made sure I had bacterial ointment for catheter tube interface and alcohol wipes & wet wipes for cleaning when I got home. Bacteria is evil so it must die.
• Made sure I had some loose elastic waist pants for hiding walking bag.
• Made sure I had some slip-on shoes which were quite handy.
• Got a longer flannel night shirt for sleeping with tube.
• Wife made couple sets of jockey underwear with Velcro on one side for working around tube after all hooked up.
• Did not worry about Depends or pads since that is for catheter-out day, a week or two later. I still have a bunch left so don't buy too many. You can always get more at Target or Wal-Mart.

After I got home, a few things became obvious:
• Stay away from pain pills that constipate, they are not really needed IMHO. Most bladder spasm and gas pains do not respond well to narcotics and there was little incisional pain.
• Eating a controlled diet is important, nothing that messes with the poop schedule is very helpful the first few weeks. The first post-op poop is an experience.
• Coffee and alcohol is out for a while. Drinking lots of water is important and green tea was fine for me. Carbonated stuff is not recommended by many.
• Finding appropriate sitting pillows for chairs was important for butt ache (donut pillow would have been a good idea). Sitting at computer desk or on hard chair was not good idea without giant pillow.
• Swelling and bruising was a lot more than expected in my case.
• Upper back gas related pains were not expected and worse than any surgery pain for a few days post-op.
• Walk as much as possible as soon as you can. I would walk up and down stairs when I could not sleep at night.
• Baby powder helped when the hairs started growing back.
• Catheter out day is glorious. You are free and feel much better.

Island Time is correct about assistance. My wife took a week off work and it really helped. I have heard stories about those who get little help in their recovery and it must be terrible. How do you dry your back after a shower holding a bag? Putting socks on or off does not seem possible when you get home. Plus you have to keep all your new plumbing clean after changing bags, etc. so a little help goes a long way.

BTW, you will walk away from the catheter bag at some point on the first day home and remember not to do that again until it happens a second time. Always be aware of the bag relative to Mr. Winky.

I wished I had a good recliner that first week! If you don't have one I know you can rent them from many medical supply stores.

Mumbo said...
Welcome back BD.

How do you dry your back after a shower holding a bag?

I just took the catheter bag off when getting in the shower and let the tube drain, then put the bag back on after drying off. That's what the hospital told me to do and it seemed to work well.

Lots of great responses

One thing I did was not try to change the bag to the leg bag and used the pail. I wasn't going anywhere anyway. Emptied with the release lock at the bottom of the bag and wiped it down with alcohol prep pads. Can get a small box of the alcohol pads at the grocery store, usually by the pharmacy as diabetics use them for their injections. They are great for other things too, like cleaning small cuts and eyeglasses.

I did the shorts instead of the snap sweats due to my surgery being done in August.

Best of luck with the surgery and definitely walk, walk, walk even if it is just from room to room in the house.

I had a dx similar to yours with G6 and pirads 5 and I also chose surgery.
Not much to say to the extensive list of advices already given. Anyway, I will summarize my experience. Everybody is different and you can expect a few of the different problems people have reported here, but be sure you will not experience all them.
The plastic bucket was very useful for me to go around the house (not problem to stand up and walk or to perform small home tasks). I had two sets of disposable bags, big size for the night, smaller (and attached to the leg when I went outside home) for the day. They are cheap. I always slept in my bed; I did not use a recliner. I had to care about the catheter sleeping on one side with the bag resting in the bucket aside in the floor but it was not so difficult. I took short street walks with the leg bag (I had the catheter for 15 days). I also experienced mild spams. They lasted about one and a half months though they were not frequent. I should mention that I believe a muscle or nerve on the left side of my body was affected, because of some mild bothers I occasionally experience alternating from my back to my lower leg, mainly when I am sitting in a rigid chair. Also, my navel port did not properly heal until 40-50 days. Otherwise, not further issues from the surgery itself.
about secondary effects, I bought thick pads (diaper type) for the first days after catheter removal. It is important you take one with you if your catheter is going to be removed by a nurse or a doctor, otherwise you may have an unpleasantly wet return home. I switched to lighter and even lighter pads, wearing normal boxers after two months. I was weighting the pads to watch my progress. This gave me a reassuring accurate prediction of my expectations. I know most people recover earlier from incontinence, be optimistic about that. But ED is an issue for me and I guess for many others. It was already before surgery though not so much as it is now.
Be sure that this will come and gone in a blink as everything in life. Surgery itself is not the type of threatening event you probably are imagining now (as I did). These days will fade in your mind before you even realize it. And I wish PCa will be not among your main future worries anymore after this stressful time.

InTheShop said...

F8 said...


"all your remotes"

old guys are easy to spot

I'm so old that I have remotes that I have no idea what they're for ...

i'm so old that i can't even operate the TV in the front room. well, until my wife explained that there's only one remote and i can talk to it