I was bending over a table in the urologist’s office with the Dr. and a male nurse behind me. They were manipulating an ultrasound device with a special gun attached that fired hollow needles to take biopsies of my prostate gland. There would be around twelve shots. Fortunately they had given me a mild anesthesia.
“Three, two, one.” Pop!
“Uhhhhh!”
It all started around September of 2005. I was sitting on an examining table in my physician’s office. The doctor sat in a chair beside me looking over the printed results of my recent blood work from the lab. “Mmmm, your blood pressure was fine; we have that down. Cholesterol looks good; liver looks good.” He turned the page. “We might have a problem here. Last year your PSA* read 3.2, which was a little high, but we decided to watch it. Now, it’s up to 7.9. This definitely must be checked out. I need for you to make an appointment with an urologist today. You don’t have to meet with him today, but you must make the appointment.”
I told him that I would make the appointment and he was quite adamant, saying that he needed to know if I didn’t. I might be a little chicken when it comes to my nether parts, but I’m not stupid. I assured him that I would call right away, which I did.
*PSA stands for prostate specific antigen. When the prostate gland, which is unique only to males, has a problem, it produces antigens to combat it. These antigens are specific to the prostate and can be detected in the blood stream.
Dr. Jones was quite serious when he looked over the lab results. “7.9 is pretty high. Normally, we like to see it 4 or below. We’ll need to get a biopsy. I’ll have Susie make an appointment.”
So here I was, “Three, two, one.” Pop!
“Uhhhh!”
The results of the biopsy came back from the lab, and I was on my way to hear the results. I was a little worried but, at the same time, I was a bit smug. After all, wasn’t I Superman? I’d enjoyed perfect health my entire life. Surely it was some small infection or something. I turned down Thirteenth Avenue in South Jacksonville Beach where the office was located. When I signed in I noticed that the day was October thirteenth. I turned and walked over to a seat and there was a Gideon Bible sitting on the table beside it. Oh my God, I’m in trouble, flew through my head.
I was ushered into Dr. Jones’ office, feeling only slightly less smug. He came walking briskly in, had a seat at the desk by where I was sitting and opened up the paper work.
After scanning down the page he said, “Okay, the results are positive.”
Positive, positive, That’s great! Wait a minute. This kind of positive isn’t the good kind of positive. He means the results have come back positive. I have prostate cancer. Well, I’d like to pretend that I’m John Wayne or Bruce Willis in one of the tough guy movies and that I was unfazed by the news, but I was at a loss for words, which is very uncharacteristic of me.
Dr. Jones explained the results to me, showing me diagrams of the various stages and types of cancer. He said that prostate cancer is the most common and most treatable type of cancer, and that every male would get it if they lived long enough. It is also very slow -growing. He said I was fortunate because it had been found very early and was localized on the left side of the gland. He began a list of my options. He said that the most effective treatment is total removal of the prostate gland, although there could be complications, including incontinence and loss of sexual function. (Oh boy, having to go in a plastic bag and loss of sexual ability, not my cup of tea.) But he said that modern surgical techniques were excellent, and that the chances of that happening were very low.
The next option was radiation therapy. I would receive doses of radiation daily, five days a week for several weeks. There would be diarrhea, some difficulty urinating and tiredness as a result of the treatments.
Another option was implants of radioisotopes, called seeds. This procedure required that the seeds be implanted in the prostate at strategic locations, where they would release doses of radiation to destroy the cancer. Sometimes a combination of the radiation therapy and seeds might be used.
In radiation therapy, the radiation destroys the cells it passes through. This includes collateral damage to the good cells in the path of the beam, but they can regenerate and heal themselves. The cancer cells cannot repair themselves and die off. Radiation therapy stops cancer cells from dividing and growing, thus slowing tumor growth. In many cases, it is capable of killing the cancer cells, resulting in the shrinking or elimination of tumors.
The last treatment mentioned was cryogenics, which is using freezing temperatures to treat the cancer. This is a relatively new technique, and there isn’t much data available yet to determine effectiveness.
My head was swimming. I was sitting stoically, nodding my head to everything he mentioned. He said one problem with radiation was it messed up the area so bad that if it didn’t work, it made surgery much more difficult. (The knife, scalpel …was I going to have to undergo an operation? Me? Could this be happening to me?)
Dr. Jones told me that I should take a month or two and think about it. He said a few people rushed right into surgery before they hadn’t healed from the biopsy and that caused problems. He suggested that I get a folder and start researching everything about the cancer and procedures. Dr. Jones recommended that I talk to other cancer survivors and ask them about their procedures and results. He told me that if I wanted to get a second opinion he had no problem with that.
I walked out of the office in a daze, phoning my wife from my truck to break the news to her. Next I called both daughters, who didn’t take the news well. I assured them that I’d be fine, not sure that I believed it myself
One of my friends is a medical physicist in Chattanooga, Tennessee. We are in constant touch via email, and I wrote him about what I had found out. Steve replied that if he had a life threatening disease, he would be sure to get a second opinion. He told me the names of physicians he was familiar with at Mayo Clinic and at the University of Florida Shands Teaching Hospital. I called Dr. Jones’ office for a referral, and found that my insurance wouldn’t cover Mayo, and that I would have to opt for Shands. I was pretty annoyed that the insurance company could dictate my options—after all, I was the one with cancer--but such is life in modern America. So, I set up an appointment at Shands. It would prove to be serendipity—the best thing that could have happened.
Steve also conferred with his colleagues and sent me valuable information, which I included in my folder. I heard from a bunch of friends who had been through treatments. Some had the surgery, some had the radiation, some had the seeds. All seemed satisfied with their treatment. At first I was leaning toward the surgery, albeit reluctantly. Surely no one relishes undergoing the radical removal of body parts. Then I read up about radiation and seeds and vacillated some more.
Finally, on November 8, I had my first visit to Shands. I was introduced to a physician who talked to me and colleted information. I underwent a series of examinations, including a physical, electrocardiogram, and more blood work, going back on November 28 for more testing. A female physician’s assistant was one of the examiners. She told me she needed to check my prostate, and to drop my pants and bend over. I said I just had a rectal exam and the results were in her paperwork. I hate rectal exams, and if I can get out of one, I’ll try. She told me that she needed to examine me anyway but that I shouldn’t worry because she had a little finger—small consolation.
After a series of visits, I eventually ended up with my radiation oncologist, Dr. Harris. He is a magnificent fellow, very professional and comforting in his mannerisms. He informed me about the different radiation procedures and consequences. At that time I still thought I would have to make the decision as to what type of treatment I would have.
“Ah,” said Dr. Harris, “we need to get an ultra-sound scan of that prostate to see where we stand so as to make the proper recommendation for treatment.”
That was not in the least scary like the prospects of surgery, seed implants, biopsy, rectal exams and others. I was scheduled for the test on Thursday, December 15. I had been present at the ultra-sound scanning of my pregnant wife, and I’d had a scan when the biopsy was performed. They weren’t all that invasive. I wasn’t worried. The Fleet enema they prescribed for the morning before should have tipped me off.
I was in for one of the most miserable couple hours of my entire life! When I got in the room, the technician and doctors started setting up a laptop and an ultra-sound machine. Then, I watched as the tech fitted the bed stirrups--big, high stirrups with blue foam places for my feet and legs, and Velcro straps to tie me in. The things were at least two, maybe closer to three feet higher than the table. They were setting up contraptions that defy description all over the room. I looked at the ultra-sound machine and the tech plugged in a probe that was 12 inches long and as big around as a thumb. My God, I thought, S&M. I still wasn’t overly worried, but that would prove to be short lived.
Dr. Harris came in. Then he mentioned one of the most frightening words in the English language, “catheter.” Holy moly! They’re gonna’ stick a tube up my manhood, flew through my mind. It was quickly becoming my worst nightmare. Let me tell you, the insertion of a catheter is no cakewalk.
Once Dr Harris had passed it down to the bladder, he said: “Okay, you might feel a little discomfort as I inflate the balloon on the end.” I did. I experienced an overwhelming desire to urinate. Next he told me it might be a little cold as he filled my bladder with liquid. It was. Dr. Harris spent a great deal of time getting my legs in the stirrups, adjusting them, and strapping me in. About this time, I was zoning out, trying to get into a mentality where I could handle all of this.
Next came the pint of lubricant up the old wazoo, and then the probe. Holy mackerel, the probe! Dr. Harris asked if it was the probe or the catheter that was making me so uncomfortable.
I replied: “Damn, Doc, it’s both of them. And, I don’t want to hear of all the terrible things the Americans are doing to Iraqi prisoners. Right now I’ll tell you anything you want to know!” That pretty much cracked both doctors up.
Dr. Harris continued to adjust the probe, and the other doctor manned the ultra-sound machine. I was about to die. It was hurting badly and he apologized but stated it had to be done because if they didn’t get good images the whole procedure would be worthless. I was glad to hear, “There, I think we are in a good position,” but I didn’t think my position was worth a darn and my legs were starting to shake badly. It had been at least 40 minutes since my legs were strapped in.
They began to lock the images down and print them out. Dr. Harris said, “We are just about done. It’ll be about ten more minutes. You are too tense, try to relax.” Oh, sure. Try to relax with a magic wand up your wazoo, a tube inserted in your manhood, your legs hoisted three feet up in the air and spread-eagled, and a man between them. Anyway, I conjured up some courage and tried. Oh no!
Dr. Harris just said, “Ooops, you moved, we’ll have to start over . . .”
I about passed out. Damn, I won’t move again if it kills me.
After an eternity, and with great relief, the doctor said that he felt we had good images and removed the probe. It was just in time, because I was at the limit of my endurance. He pumped the fluid out of my bladder – more fun – deflated the balloon, and removed the catheter. More pain. When they unstrapped my legs I found they were frozen in that position. I was lying there on my back with my legs stuck in the air, like a dead roach. Finally, I got them limbered up and the doctor helped me sit up. My God I was sore, but mighty grateful to have the torture over.
There would be more pain as my various nether parts began to function again. And the burning when I relieved myself was really awful. It lasted until that night. The next day my butt was so sore it was difficult to move around. There was good news, however. When Dr. Harris came back in the room after reviewing the images, he said that that my prostate was not enlarged as he had feared it might be. That made me the perfect candidate for radioactive seed implants which is the least invasive of all the procedures. The procedure was scheduled for January 26. Oh Boy! More fun. But, as it turned out, it wasn’t over.
In the mean time, the original pathology report had arrived at Shands, and they did more blood work to compare, and to see where I stood. After reviewing the lab work, Dr. Harris had me in for another consultation. It turned out that the type of cancer I had was quite aggressive, and that ruled out the seed implants. He told me that they recommended radiation therapy, and that I would have to have a CT scan so that they could determine dosage and methodology. The CT scan was scheduled. With great trepidation I learned that there would be another catheter involved. I hate those things!
The day arrived for my CT scan, and I was escorted to a room that looked like something out of Star Wars. There was a long flat table that led into a huge circular machine. I was given a gown to put on, which I did. I lay down on the table and Dr. Harris came in. I had told him about the pain I suffered from the last catheterization and he was concerned that it not be as bad this time. It was still uncomfortable, but it wasn’t as bad as the last one. This was partially due to the fact it only remained in long enough for him to inject fluid into my bladder. It was then removed and there was no associated pain afterwards.
I folded my arms across my chest and the table slid slowly back into the CT machine. I was the hole in a donut. The technician had told me that the table would move slowly back and forth across my groin area several times while it did the scan. A little while later it was over. Chalk up another great prostate adventure.
There would be 42 radiation treatments. The first 28 would be direct beam radiation, and the last 14 would be IMRT. Intensity-modulated radiation therapy is an advanced mode of high-precision radiotherapy. It utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation dose is designed to conform to the three-dimensional shape of the tumor by modulating—or controlling—the intensity of the radiation beam to focus a higher radiation dose to the tumor while reducing radiation exposure to surrounding normal tissues. Treatment is carefully planned by using 3-D computed tomography (CT) images of the patient. These are combined with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape. The doctor went over the side effects again, and told me that he would have the office call to schedule the first treatment.
At the time, I had been thinking about finding a place closer to home for the treatments. I live in Neptune Beach, and Shands is all the way in and across the town of Jacksonville. Then I got to thinking. That is stupid. The drive is nothing. I am being treated at one of the top hospitals in the world that has the most highly trained physicians anywhere. They are not only up on cutting edge technology, they teach it as well. And the equipment is the latest and most advanced of all. Dr. Harris knows my case and my physiology in depth. There was no other choice.
Wednesday, February 1, I reported to Shands for blocking. I was led to another room in the Star Ship Enterprise and was asked to lower my shorts, with a towel to cover myself of course, and lie on a table. There was a massive cylindrical drum of a machine suspended by a huge arm over the table. I assumed this would be the radiation machine. Once I was up on the table, they raised it and positioned me underneath the machine. There were laser lights pointing at different parts of my body around my waist. They x-rayed my body below my waist from several different angles. The technicians began to draw targets on my body with indelible ink. I was not to wash these off. There was one on my lower abdomen and one on each side of my hips.
The next day, the treatments began. I was zapped Thursday and Friday, and had the weekend off. The machine would swivel underneath the table and zap the prostate. Then it would rotate to one side and zap it from there. Next it would swivel overhead and irradiate from that position, and then revolve around to the other side for the last treatment. The whole process took less than 15 minutes. Since the radiation damaged healthy tissue as well as the cancer, the weekends allowed time for healing. As I found out, it also let the patient recover mentally.
I drove to town every weekday for treatments. For the first three weeks, I could tell no difference in my body. Then on February 24, the bowel problems started. It was awful. I ached when I urinated, and hurt when I had a BM, which happened about every 30 minutes during the days. That would continue over the days that ensued. I tried several different things and finally discovered that if I took Milk of Magnesia at night, I could evacuate myself and get relief from the pain and frequency. Then the aching started when I urinated.
In my consultation with Dr. Harris on Tuesday, March 7, he stated that my IMRT treatments would start the 14th. When I came out of the treatment room that day, the technician escorted me to the CT room again. “What, we didn’t tell you. I’m sorry. You have to have another CT scan.” Oh boy, another catheter. Don’t I love catheters! Dr. Harris came in, inserted the catheter, and filled my bladder with fluid. He pulled it back out immediately and this time it wasn’t bad at all. Then he said, “The good news is this will be your last catheter. When you have your IMRT, however, you will need to have a rectal balloon. The balloon will move your rectum out of the way to avoid hurting it with the intense radiation.” Oh, joy, the agony and the ecstasy.
I had to ask. “God, what’s that gonna feel like?”
With his usual grin, Dr. Harris replied, “You’re about to find out, bend your knees for me.” I was lying on my back on the table and did as I was asked. Now there may be those folks who aren’t bothered by stuff like this. I am not one of them. So there I was, zoning out again, trying to withstand the uncomfortable feeling while the machine whirred and the table slid to and fro. The next thing that happened was the technician told me she needed to make a cast for my legs to rest in. It was imperative that I was in the exact same position every day. Finally it was over and the balloon hurt just as bad coming out as it did going in. Fourteen days of this, oh my God!
On March 14, the IMRT treatments started. I had been worried about my frequent BM’s and the possibility I could mess the table, not a good thought to me. I developed a plan and it worked. I ate a large supper at night and around midnight, got up and dosed myself with Milk of Magnesia. I figured I’d just clean myself out and not have anything in my bowels. The next day, I fasted until after the procedure and ate again the next night. It worked, and I was much more comfortable all day as well.
The first day was the worst, and it was another procedure that was close to being unbearable. The tech had asked me to come in early because they had to do a lot of measuring and relocating my targets. They would need a full set of x-rays first.
So, “Mr. Robertson, roll on your side and let’s get this balloon inserted.”
I felt like I was facing a firing squad waiting for them to pull the trigger. I was told to roll on my back, which I did, feeling all the world like a corn dog and they had me lift my legs so they could slide the cast under them. Then the technicians began to draw new marks on my hips and lower abdomen. Some of the new beams would come in at an angle from both upper sides. IMRT would beam down on me from five locations – beneath, on both sides and at two angles from the top. The direct beam radiation only used four locations.
Finally the technicians left and the drum began to rotate and stop, take an x-ray and rotate again. It seemed like forever before the technicians came back in and told me the Dr. had looked at the x-rays and they were good so they could start the treatment. I decided I was going to say something funny every day, to ease the pressure. Keeping my sense of humor seemed like an important thing to do at this point.
I found out that if I counted out seconds to myself between each rotation of the drum, it helped take my mind off of the discomfort. I would start anew each time it rotated and found that it took about 50 to 90 seconds on the average between each rotation. After the first week of IMRT treatments, I was never so glad to see a weekend in my life. Two days of relaxation and no balloon were certainly welcome. It had been a rough week. My rate of urination had increased to about once every 20 or 30 minutes, and I was still struggling with the BM. It was aching when I urinated. It would, however, be better soon. Of course, with only two days to go, the radiation machine broke and delayed my last two treatments until 4 days later after the weekend.
The final day gives cause for celebration. I will no longer have to drive to town daily and, halleluiah, no more rectal balloons. Next comes the healing, which will take a couple months. In all, I have come through all of this fairly well. On the bright side of everything, we live in a miraculous age. Fifty years ago, my life would have been over.
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Reviewed by April Smith
7/12/2006
Thank goodness the cancer was caught and treated. It sounded like an intensely uncomfortable procedure, but definitely worthwhile. Good health to you! Thanks for sharing, April
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Democratic Dilemmas and Divine Inspiration examines the significance or relevance of the idea that the U.S. Constitution was, as many believe, divinely inspired. How much did that belief matter to founders of the nation and how much does it matter no
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