Post pre-op indications and experience

Brief warning... some of this is me being silly.  And it may get somewhat graphic... but it's hard to predict at the outset where I'm going with these things..

Late last week I did the doctor dance in preparation for the seed implants.  I saw my urologist and my radiation oncologist in one mondo doctor fun day full of information, probing, probing questions, and scans.  It even yielded a new and different CT scan methodology!  I keep finding new procedural things to laugh about.  Or at least things that make me do my best impression of my German Shepherd cocking her head with that "wtf?" look (actually, my German Shepherd is more polite).

Summary version for the ones who want to skip all the wordz:

• The hormone treatment has done what they wanted it to.
• The prostate volume is perfect.
• We're a "go" for the seed implants (on Dec. 10th)

Moving right along, I went to my urologist's office to get the volume of my prostate measured (an ultrasound deal that was fairly quick... but again with the dimmed lighting in the exam room, which still seems funny to me).  Then a brief consult with the doctor, who said that Betsy (not her real name) reported the volume was 21 cc's.  According to him that was perfect.  So, there's a trivia fact for you... and maybe you know a bar where knowing that could get you a free beer.  Have one for me!  :-)

I asked why that was such a great volume.  Well, he said, too small and the seed placement gets difficult, and too large and (weird simile coming up) we get into what he likes to call the 'imploding star' problem.  (Imagine me giving him a blank look here.)  "You know," he said, "the star goes red giant and then collapses into a white dwarf... so a prostate that's too big... gets the seeds implanted but then shrinks and some things don't work as well... "  I nodded my head to shake the metaphor loose.  It was beginning to hurt.

He then went through the procedure overview and gave me a prescription on a form that has (count 'em) 13 security features built in.  I didn't know so much security could be put in a bit of paper!  Of course he negated one of the features because (as I read on the back of the form, which is a wonderful combined feature list and marketing flyer) the form should have only ONE prescription per form.  Why?  Because that way they're more secure (not, as you thought, because we want you to use more forms and buy more from us, really).  So, some antibiotics for after the procedure and some stuff to help with "flow problems" ...which I should expect to happen for 5 or 6 weeks.

In case someone gets the wrong idea here, I think the urologist is a great guy. He just has some funny metaphors.  But then... you know... who doesn't?

Then it was off to the radiation oncologist's office and their funny quizzes. Really. Walk up to the desk and they ask you if you still live where you lived.  Same phone number? Same insurance? Assuming you pass this list (I always ask) they hand you a couple of paper quizzes. One asks about frequency and urgency of urination (on a 5-point scale). The other, similarly structured, is for men (duh) asking about erectile function.  Picture yourself writing the questions for these quizzes. Further, picture yourself reviewing and commenting on said deliverables (no pun intended).

And the pressure's on!  If you don't finish the quizzes in time, you have to take the unfinished ones with you to the exam room and (hopefully) finish before the doctor comes in. I hate timed quizzes... and I'm slow because I actually read the questions... but I managed to get these done on time.  Whew!

Next, a consult with the RO (radiation oncologist, of course) himself... and this guy actually asks questions and listens. I like that. He's also brutally frank. So I ask about the "wound to the area where they'll be putting in the needles" and he's curious. He wants to know what I mean. I say something to the effect that I'm expecting to have some pain due to the needles.  He asks how big I think they are... and I say "oh, something like a knitting needle" and he laughs.  No, no, no... (he said) ...think getting your blood taken.  No bigger than that.  You may be a little tender, but not a huge wound.  This won't be as painful as the biopsy was because we won't be going through the rectum (which is very sensitive).

So... I was relieved to hear this bit. Of course I didn't ask him if he'd experienced the procedure himself... but I thought it.  Doctors tend to minimize the actual effect.  Famous doctor line: "You'll feel a slight pressure now."
Oh right.

He told me about the position I'd be in (whoo-ee! I get a ride in the stirrups!) and the alignment plate used to guide the needles.  This image (from prostate-cancer-institute.org) is (I think) more accurate than the drawing I had seen previously).  I know... this picture isn't comforting either, but at least the needles are smaller. 

And wikipedia has an extensive article on brachytherapy (the technical term for radioactive seed implants).  And there's a very detailed article about it on article on it on the emedicine site.

He said he'd be using cesium (which I wrote down as "selenium" ...not sure why) which has about a 9.5 day half life. And he confirmed the urologist's opinion that 21 cc's was perfect.  Of course! Why hadn't I thought of that?  (And for the curious, the seed implants are pretty small)

When we were done talking he took me down the hall for a CT scan and another quiz. The technician looked me in the eye and said she had some questions before we did the scan.

1. What is your full name?
2. When were you born?
3. What is your favorite color?
4. What procedure are you in here for today?

OK... she didn't ask #3.  These questions cracked me up and it was very hard not to waste our time by being silly.  After # 2 I did ask "how am I doing so far?", but resisted a remark on the procedure question. Then we did one of the fastest, and oddly strange, CT scans I have ever had (and I've had a lot).

She had me get on the table (and made a forgettable remark about my height) and then, holding up a paper drape about the size of a small bath towel so that she couldn't see my pelvic area, told me to slide off my jeans ... oh, and underwear too... and then I was to lay back on the table.  When I had done that, she slid the drape down, down, down... and I found myself wondering again who these drapes are for, really.  I suppose it covered me up, to some degree... but to what degree...well...

She kicked off the scan, which was pretty quick, and then helped me sit up and turned away while I pulled everything up.  We chat a bit, and walk out of the room and there... where I didn't notice walking in... there in front of me is a bank of about 95 monitors (ok... I am making that up) and three women looking at the monitors (there are about 5, really).  And as I walk by, one of them turns, grins, and I swear she winked.  Really.  Or maybe it was the low-level light in the area.  Or maybe I'm more than just a bit silly.

You be the judge.  :-)