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Gedman's plan

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Prostate Cancer
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Posted 2/21/2013 9:21 PM (GMT 0)
I introduced myself on HW 3 weeks ago. It's been a whirlwind since then, and the HW community has been amazingly helpful.

I worked with my urologist, two radiation/brachy docs (Dr. D. Nori at NY Columbia Presbyterian and Dr. M. Zelefsky at Sloan Kettering) and one RALP doc (Dr. Ash Tewari at NY Columbia Presbyterian). Everyone told me that surgery is the best option for me, given my age, health, and prostate profile.

So, here is the plan/schedule:
  • Last week of Feb - Kegel exercise biofeedback session with the Urologist (an optional thing that I agreed sounds worthwhile to help with managing incontinence).
  • Second week of March - Big prep day: 1) prostate MRI; 2) complete medical workup: metabolic panel, EKG, PT/PTT, INR, CBC, BUN (I have no idea what most of those acronyms stand for); 3) meeting with surgical team to discuss everything I need to know about the surgery and the recovery plan; 4) meeting with the anesthesia team.
  • Third week of March - Full physical with my internist to get medical clearance for the surgery.
  • Last week of March - Kegel exercise biofeedback session #2.
  • First week of April - RARP with Dr. Ash Tewari.

Dr. Tewari has dedicated rehab teams for incontinence/ED. He wants me to try Viagra before the surgery to see how my body handles it. Overall, he made me and my wife very comfortable, and he clearly/directly answered all of my questions.

-Gedman
Posted 2/21/2013 9:32 PM (GMT 0)
fantastic
Posted 2/21/2013 9:38 PM (GMT 0)
That sounds great. Fast but thorough work!

Keep us updated as you work through the plan.
Posted 2/21/2013 9:40 PM (GMT 0)
It sounds like you've consulted with the right kind of team of doctors. It must be reassuring to know that they all agree about the best course of treatment for you. Keep us posted and ask any questions that might come up as you get yourself prepared for you're date with the surgical team. Best of luck.

Jim
Posted 2/21/2013 9:50 PM (GMT 0)
Nice job!  I'm not familiar with Dr Nori, but Drs Zelefsky and Tewari are recognized leaders in brachy/radiation and surgery...you have leveraged your odds for a good outcome by going with someone at the top of their field.

Your participation in the PC/Aerobic Challenge, and your sustained efforts after the Challenge ends (this week), will also likely help to minimize your recovery.

best wishes...

Posted 2/21/2013 10:02 PM (GMT 0)
Great doctors, great plan, good luck!
Posted 2/21/2013 10:10 PM (GMT 0)
Gedman...good work on doing your homework and going to experienced guys to get your best odds. Good luck and I'm sure everything will go great.

Jim
Posted 2/21/2013 10:11 PM (GMT 0)
gedman

Well thought out. You have covered all I can think of an more!

Do keep us advised on how things go for you.

Hugs

Bud

We will beat this crap
Posted 2/21/2013 10:34 PM (GMT 0)
gedman,
I don't understand all the abbreviations either but in a short time you have become something of an expert and can help "newbies" in the future if you so desire..I commend you for doing your "homework" and coming to a reasonable decision..At your young age you had every reason to "vent" but you didn't do that so I'll do it for you..It really hurts to hear about you young squirts are going through...So much for an old man's disease..I wish you the best!
Bill
Posted 2/21/2013 10:40 PM (GMT 0)
gedman,
You have done a lot in short time. Glad HW has helped you. Sounds like you found us just after the PC was found. Perfect timing!

Now prepare like you getting ready for a heavy weight fight, because you will be. Exercise, start eating better, if you haven't already, loose a few lbs. if you need to, and don't look back, only forward.

Good luck with the fight, keep us informed of your progress.

Bill
Posted 2/21/2013 11:10 PM (GMT 0)
Gedman - Way to go!  Congrats on making your choice of treatment - bet it feels like a huge weight off of your shoulders, eh?!?!  You went about it the right way - got advice from guys that have been there, done that, as well as a plethora of medical professionals.  With that kind of prep work, you will do just fine!

Best to you, keep us posted, and once you come up on the other side be prepared to stay with us - both to keep us posted as well as to help the next newbie that comes along to join us!

Posted 2/21/2013 11:42 PM (GMT 0)
Gedman - a couple of thoughts

1. try Cialis - it's longer acting. I'd say after the operation, to use a daily does of Cialis for psychological reasons at least. some doctors talk about getting the blood flowing but I don't think that there is conclusive evidence that there drugs promote any faster healing. I would use it , depending on the severity of any ED issues, just to feel "normal"
2. Get in as good shape as you can in the next month. the stronger and more energetic you are going into surgery - the easier it is to recover (me thinks).

Best of luck!
Posted 2/21/2013 11:54 PM (GMT 0)
Sounds like you have it covered.
I was sent to a session with a biofeedback nurse as suggested (strongly) by my uro . well worth it. I contribute my fast recovery to learning how to kegel correctly long before surgery. (can't give all the credit to my surgeon).

All the best, keep the questions coming.
Posted 2/22/2013 12:42 AM (GMT 0)
Congrats and very impressive (and fast) work! You asked the right questions, sought out the right people and made a reasoned decision--way to go!

Good luck with everything and make us proud!
Posted 2/22/2013 1:35 AM (GMT 0)
gedman,

sounds like a very sound plan and course of action, and that you have done your "homework" well. sounds like you got a first class team in place, both pre and post surgery.

I wish you the best of outcomes, before and after, please keep us well posted.

david in sc
Posted 2/22/2013 2:21 AM (GMT 0)
Hey Mr. BB. Glad I inspired you to wake from your HW slumber!

The Urologist I'm working with is in the same office where Dr. Chughtai sees patients (61st Street building on the 12th floor, which is where I'll be doing the Bio-F sessions). I'll definitely be on the lookout for Cecilia!

-Gedman
Posted 2/22/2013 3:16 AM (GMT 0)
Gedman, hope you don't mind but I'm going off your thread / topic..... to say, Hey Mr. BB - nice to hear from you! You are one fortunate fellow to have Ms. BB out here with us. So as much as we like the missus, don't be a stranger!!!!
Posted 2/22/2013 3:21 AM (GMT 0)
another special thread.
Posted 2/22/2013 5:04 PM (GMT 0)
Gedman,
Good going. You researched all your options and got 2nd opinions from the best doctors. That's about the best that you can do.
Good luck.

JT
Posted 2/24/2013 4:47 PM (GMT 0)
Gedman-
It sounds like you have done your homework and have a good plan in place.

I can help with what the acronyms/tests are, as I am a health professional:

metabolic panel-- this will check your electrolytes and glucose in blood

EKG- heart rhythm (mainly to make sure you can make it safely through a surgery)

PT/PTT & INR measures your blood clotting time to ensure you don't have a higher risk than normal for bleeding after the surgery (if it was elevated might indicate a clotting disorder or liver problems), PT (prothrombin time) and aPTT (activated partial thromboplastin time) vary between labs, so they use INR (international normalized ratio) to allow for a standard measure across labs.

CBC- complete blood count- will measure your red blood cells, platelets, and white blood cells

BUN- probably included in your metabolic panel, but along with serum creatinine are a measure of your kidney function. sometimes creatinine is a bit elevated in those with prostate cancer because of urinary retention due to tumor size. it can also be elevated right after surgery (due to various factors such as lack of perfusion during the surgery or dehydration), and will usually go back to normal a few days after surgery.

Hopefully this will put you more at ease.
best of luck, and thanks for sharing your journey.
Posted 2/26/2013 10:58 AM (GMT 0)
i think preop physical therapy for "pelvic floor strengthening" should be routine.

i thought i knew what kegels were but after leaking and dripping for weeks i went for the treatment.

they put a pressure probe in your butt and measure the effectiveness of your kegel and give you advice on how to increase their effectiveness. they give you a specific program of exercizes, and do a weekly followup (again with an up-the-butt).

i am much better after just the first week, still a ways to go , but i feel so much more in control of my destiny now.

studies have shown doing this shortens the length of incontinence but a HUGE amount.

i wish i'd had it presurgery...

dave
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