RALP by Vipul Patel planned for March ... but still undecided??

DavidG said...
i wish someone had told me about the 4-6 hours of pain right after surgery related to the bladder being reattached to urethra. I felt like it was exploding and had no idea what it was until a nurse told me in my room.

I had more or less the same thing. At the time I was convinced that my catheter was plugged up. In retrospect it was bladder spasms but at the time it felt like my bladder was full to the bursting point.

The first couple of hours after surgery are tricky for pain control. Not all men get the bladder spasms, at least not to the same degree. Men who do will have a lot more pain. The reason those first few hours are tricky is that the best pain meds can't be given until the anesthesia has mostly worn off. If your surgery runs long and they need to give you a bit more juice to keep you under while they finish up then it starts the clock over for how long before the pain meds can start and increases the chances that you will wake up hurting.

Some of the drugs you get in surgery are amnesiacs. They prevent short-term memory from being saved to permanent memory. I don't remember the recovery room at all. I do remember the elevator, just a bit, I think. They had sent my wife ahead and she was waiting at the nurses station on my floor. She says she could hear me swearing two floors away, alternately using language that would make a sailor blush and apologizing for it.

The first couple of hours in the room were pretty rocky. I remember one nurse who wanted to get me up for a walk (they like to get patients up and walking as soon as possible). As I recall, I told her that was "not %*$&!! happening". Finally, the word came up from the keeper of the timetable that I was go for morphine and life got better.

Men who have a lot of post-op pain tend to get stuck in the hospital. When you have any sort of abdominal surgery the don't like to let you out of the hospital until they are convinced your bowels still work. They prefer that you defecate but, after a robotic prostatectomy they absolutely won't send you home until you fart for them. Opiates tend to be constipating. They quiet the motions of your intestines that tend to move things on through. You tend to bloat which adds to your pain. The drugs for the pain make the bloating worse. Eventually things will work out in the end (so to speak) but your overnight stay tends to turn into two or three days in the hospital.

But one gets through it. It doesn't happen most of the time.

David, ***? He clearly used the word 'undecided'. Better to study the options now than when there are none.

 

I received an email from Patel today answering all my questions ....

I am "decided" now

tom0613 said...
I received an email from Patel today answering all my questions ....

I am "decided" now

Good for you.

One of the best pieces of advice I've seen many on this forum give once a decision is made is to not look back. Doubts are a part of this process but having a plan and moving forward is liberating in so many ways.

I am sure you'll do fine.

You know what, peter, if I have to check with a dictionary before making a post, it's not worth the effort. I meant no harm. From now on, why don't you and david just answer all questions. No one else need comment at all.
Good luck, Tom. I didn't mean to cause you any concern. Some of the people on here have a much tighter ass than need be.

GOP said...
You know what, peter, if I have to check with a dictionary before making a post, it's not worth the effort. I meant no harm. From now on, why don't you and david just answer all questions. No one else need comment at all.
Good luck, Tom. I didn't mean to cause you any concern. Some of the people on here have a much tighter ass than need be.

Ironic that someone with the GOP handle would accuse others of having a tight ass :)

Big Mac,

I have no doubt that Patel is a first class, first rate surgeon, with the numbers to back it. I think it would be a good choice for anyone seeking surgery as their primary treatment.

The seven-surgeries-a-day part does bother me, but that's just a personal observation. These RP's are complex surgeries at best. When my uro/surgeon does them, it's only one per day period. Yes, of course, with some of the lesser urological surgeries and procedures he performs, he may do 5-6 per day. But it's his personal policy, to never schedule any other surgery when he does and RP.

When he operated on me, I was his only show for the day, period. That gave me a sense of confidence. I knew he wasn't starting on me tired or frustrated from any other surgeries that day, and that all of his attention was focused on me, his only patient going under the knife.

Different doctors, different attitudes and approaches. I don't see either approach as a right or a wrong, just a patient's preference.

I would not have felt right knowing that I was number 3 through 7 of a 7 operation day for a surgeon, regardless of his skill or experience. Just my take.

David in SC

Bill, if this was facebook i'd "like" your post.

I had a similar experience. My guy does 4 a day and the day the cath was removed we all met up in his office and shared our stories and how happy we all were.

Some of these guys are driven/caring machines and their teams are an integral part of their success, from the billing coordinators to the nurses.

Takes me 3 days to recover when I fly back from India.

Wow...never knew this physician did 7 surgeries per day. At his web-site-stated 105 minutes average per, that means he finishes his last one about 12 hours after starting the first one assuming no breaks. The story about doing 7 after flying back from China would scare the bejusus out of me...jet lag is real...just sayin'. Have to share the same concerns as Purg.

And, GOP my friend, I don't blame you for being annoyed but per the old Seinfeld episode, "Serenity Now". The other guy is a classic internet troller and baiter...typical courage from behind a keyboard...

Jim

Davidg,
You said it, Patel really cares about men with PC. His team is just as important as he is. He always says WE not I. I really like that! No ego involved. He could not do what he does without his team, from the ladies in the office , assistants in the operating room to the aftercare nurses in the hospital.

And what better town to have your surgery than Celebration, FL, 5 miles from Walt Disney World.

Bill

Tudpuck - "let not your heart be troubled". But I do think you need to review the definition of "troll". Also, just to be clear, I come from a culture that places great emphasis on respect for elders so of course I would be nothing but respectful with you, but trust me, I don't hide behind bandwidth.

Back tot he actual issue here, I do genuinely appreciate those that have reservations about surgeons that do multiple surgeries a day. Fully understand their concerns. I think it might be a different perception that some of us may have, however. My concern was the surgeon who does one or tow every fortnight. Someone who isn't specialized in this area and who doesn't only focus on this area. The first guy I was going to have surgery with was a lovely man and a great urologist, but he just didn't see enough traffic to build up his "portfolio". He couldn't afford to focus only on this type of surgery. He had a practice and did many other things. After what I consider some sound advice and some thought, I decided to go with someone who was 100% dedicated to this procedure, someone who did it day in and day out and was an expert.

Also, my guy does 4 day, Patel claims to do 7 a day. Doesn't mean they do these numbers every day of the week and that they always reach that limit.

My guy does 4 a day three days a week. The other two days he's in the office so that he is accessible to us and so he can meet new patients. He schedules his 4 2 hours apart with a lunch break. My guy usually completes them in under 2 hours but, like mine, they can go over that time. It's not a big deal, the guy after me waited a little longer in his comfortable room with views of Central Park. I actually went in twenty minutes early. And my guy doesn't only do the surgery, he talks to all of us right before the surgery, briefs our families right after surgery while we're still out or in recovery room, and then stops by one more time before he leaves for the night and again first thing in the morning. Meanwhile his entire team, including his dedicated nurses and his own urologist come by throughout the stay. It's an approach I was very comfortable with. Some see it as a factory approach, I see it as a fine tuned top of th eline approach. Works for some, doesn't for others. What is certain, however, is the very high success rate guys like Samadi, Patel, Menon, and Tewari achieve. Of course they are not alone in achieving these standards, but I woudl certianly be confident in stating that choosing any of these is a wise choice.

Tud,

I am glad to see at least someone see my point. I think doing 7 complex surgeries by the same surgeon on the same day, would be considered "assembly line" surgery.

Not sure why a surgeon would use this as an advertising plus or a "bragging point". There are so many things that can and do go wrong with RP surgeries, whether it be robotic or open, or if a robotic has to be switched back to open due to surgical difficulties.

Then on the human nature and fraility of the flesh side, we need to get real. Doctors are human like the rest of us. Everyone has their own fatigue levels and endurance abilities. There's no way, I would believe that a surgeon would have the same amount of energy, physical - mental - emotional, at the end of a 7 complex surgery day as he does at the start of the day.

I would love to see certified and verified results from the patients, especially concerning those with incontinence and/or ED issues. And I don't mean the surgeon's "advertised rates". I mean real numbers. I consider zero incontinence as meaning you don't leak, drip, or need ever a single pad. I consider zero ED as meaning you can get it up on your own, good enough for penetration and completion - without the need of any sex drugs, pumps, injections, or perhaps even inflatable women (through that one in to lighten it up). So to what degree to these assembly line surgeons measure success?

Make sure anyone reading this, I have already stated that this Dr. Patel probably is a great surgeon with a lot of experience. Not knocking a single thing about him or those that used him, that' not my point.

My surgeon only does open surgery. This was the case in 2008, and is the case in 2013. His practice, however, does robotic since 2009, and they have their own very experienced robotic guy. My surgeon has done over 600 open surgeries, and from what I have researched over the years, that makes him very experienced at them. He still feels strongly, that the tactile feel of being able to touch what he is cutting makes him a good surgeon, especially when things don't go as planned, or if in a case like mine, where a previously unknown issue in my anatomy would have snagged an otherwise normal operation.

We put too much emphathis sometimes, in my opinion here, on some exact number that a surgeon has to have to be able to trust. What I don't see being pushed - what is the quality of the surgeries, what are the outcomes, and what do the patients really think 1 year, 5 years, and even 10 years out. What shape was that patient left in, and was it truly a successful surgery in terms of cancer eradication and minimalizing of serious side effects?

Seven complex RP's in one day, and on a regular basis at that rate, would make me strongly re-consider. Just my personal take, not being judgmental to anyone's prior or future decision.

Just trying to help men really think through these very critical decisions.

david in sc

Work related fatigue is a well known and documented fact. Especially among medical professionals. In the world of nursing, its a serious problem in many areas of the country. My wife has been a nurse for over 15 years, and sees this all the time with her staffing needs. Nurses, doctors, etc - get burned out. Especially when they are forced to work double or even triple shifts.

There is no way that someone is as sharp at the end of a 12 hour day as they are at the start. That is not reasonable for anyone to believe. Doctors are still human like the rest of us. When medical mistakes are made, it has often been contributed to "work fatigue".

david in sc