Prostate Cancer Journal: Surgery & Recovery Update


It’s been six weeks since my robotic-assisted (da Vinci) radical prostatectomy, that is, the surgery that removed my cancerous prostate. My employer has allowed me to work from home for the last two weeks and next Monday I return to working from my office. I have been aware for a little while that the surgery and recovery stage of my cancer journal needed an update. I reread my earlier posts to the journal and to log in and say, “it’s done” seems not just anticlimactic, but some how to short-shrift those who have followed along. But that is the reality: it’s done.

The hospital we chose to deal with is probably one of the finest we have had opportunity to be associated with. The pre-op/registration appointment meant that we had all the paperwork and testing done the week before surgery. On surgery day we arrived about an hour-and-a-half before the scheduled surgery time. We waited only a few minutes before my wife and I were taken to a private room associated with the surgery center. Street clothes exchanged for the latest in open-back hospital attire; identity verified and double-checked; surgical procedure verified and double-checked; IV and monitoring attached. Just as the activity settled down, Pastor arrived. The staff gave us a good 15 minutes together. What comfort to hear God’s Word, to hear, that even in these circumstances that the Lord is faithful.

Since it was the day of Preparation, and so that the bodies would not remain on the cross on the Sabbath (for that Sabbath was a high day), the Jews asked Pilate that their legs might be broken and that they might be taken away. So the soldiers came and broke the legs of the first, and of the other who had been crucified with Him. But when they came to Jesus and saw that He was already dead, they did not break His legs. But one of the soldiers pierced His side with a spear, and at once there came out blood and water. (John 19:31–34)

frenchcrucifix-9As Jesus hung lifeless on the cross, He was preparing for His Sabbath rest in the tomb and His victorious resurrection from the grave on the eighth day. His battle was done. You are preparing as well, and before surgery it is natural to have anxiety, even fear. Put your trust in someone else’s hands. Your doctors will work to bring you health and healing. However, remember that you have already received better care than any earthly doctor could give.

Jesus Christ is the great physician of body and soul who will work through your doctors and nurses and medicines to bring physical healing. This same Jesus allowed the soldier to pierce His side that He might pour out the fountains of life for you. His holy water washes you in Baptism, and His holy blood feeds you at His altar. Even amid your trial and tribulation, look to Christ. See His pierced side and behold the medicine of immortality. You are healed, both now and forever.

Prayer
Lord God, heavenly Father, may the water and the blood flowing from Jesus’ side on the cross that healed the whole creation now heal this, Your loved one, in both body and soul; through Jesus Christ, our Lord. Amen. (Visitation, CPH 2008. 95)

Soon the room was again awash with activity as those who were to be involved with the surgery itself started checking in: surgical lead nurse, anesthesiologist, and finally my doctor himself. All is ready, now is the time: a handshake from my friend and Pastor, a last kiss with my wife, “I love you.”

Da Vince robot-assisted surgery

Da Vince robot-assisted surgery

Peace. Really I was at peace with whatever would happen. No matter the type of surgery there is always risk. No one expected any problems, no one wished for anything less than the best outcome, but should I not wake up again in this life, that was okay. Having done all that we could, I handed the rest over to the capable and loving hands of God. He would work out His will for me through the hands of doctors and nurses, and that was all right. I was at peace.

Surgery took about 3 ½ hours, during the course of which I lost my prostate, seminal vesicles and a couple of lymph nodes. The initial pathology done on the lymph nodes while I was in surgery indicated no spread of the cancer. That, together with the visual inspection of the prostate gave the surgeon the confidence to proceed with the plan to spare the nerve bundles on both sides of the prostate.

Two days later I was home. Six weeks later I am returning to work, the last puzzle piece to returning to a regular routine. Except for the six new scars on my belly, it is almost like nothing happened. The reality is that there a lot of fine stitches on the inside—bladder, blood vessels, and nerves secured in different places—and I must stay on my guard to not over do and allow for all the healing to continue over several more weeks.

The pathology of the prostate showed a slightly elevated incidence of cancer than did the biopsy, but in the end it was all removed. Barring the cancer raising its ugly head in the future, no further treatment is indicated. In a couple of weeks I will take the first post-op PSA test and it is expected that the level will be <0. The post-op appointment and blood test results are scheduled for the day before my fifty-first birthday. I anticipate that we will be celebrating being cancer free, being a cancer survivor.

There are certainly some life lessons that I will take away from this journey. While this leg of the journey certainly may be done, the journey itself is not over. The Lord has used this awful disease in ways I already know, and in ways that may not yet be apparent. While we have had a good and solid marriage, dealing with this cancer has retuned to us a tenderness borne of deep discussions that hadn’t been part of our conversations for, well, probably before children, or before embarking on the return to school that lead to the call into the public ministry. Known to hold hands when we walk together, I find we touch a little more, cuddle a little more.

Perspective is another gift of the cancer journey. Probably like most males, my self-identity is hooked into my work. Six weeks away from work. I’ve never taken six weeks away from my work. I have come to realize that work is not only the tasks that make up the job but also the people with whom I work. The relationships are nearly as important for being successful in my work as is completing the tasks. And here’s another: as important as my work is, my time away from work is equally as important. The time outside of work needs to be carefully guarded and used. It is in this time outside of work that I can attend to my relationship with my wife and family, recreate, and attend to the several other interests that make life varied and interesting. Now that the largest chunk of my schedule will again drop back into place, it will be important for me to find the means that will allow this fresh perspective to create a healthy balance for my life.

Journey continues

Journey continues

So, I thank God for my cancer. I thank God for the changes that I have seen and the changes that I cannot yet so clearly discern or to which I cannot adequately give voice.  Those who have followed my journey through these writing, those who have prayed on my behalf, now thank God with me for using this prostate cancer for my good.  And thank you, so many of you, brothers and sisters in the body of Christ, for your prayers, thank you for your many messages, your tender thoughts and good wishes.

Now, its time to move forward—off to the next leg of this journey called life. May it be less eventful than the last.

Other  posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.

Prostate Cancer Journal: My Friend Peter


I made a new friend last week. You don’t always get to pick your friends ahead of time, and such is the case with Peter. He showed up during the course of my prostate surgery. I was totally unaware of his arrival, but he was greeted by everybody in attendance as one uniquely qualified for his task. By the time I regained my senses after the surgery, Peter had obviously become a fast friend. He cared for me deeply and touched me in ways I had never experienced before. And I found I couldn’t leave him behind. Upon my release from the hospital, my wife and I made a place for this new friend in my life.

bestest buds

Peter has been faithful; despite my outbursts and even wishing him harm, he as stuck by me without question or recrimination. Peter is giving; he retains nothing for himself but passes on all that he has every minute of every day.

These hot, fast friendships have their challenges. We found that Peter was a bit demanding and a bit clingy. And while his friendship tapped an inner well I rarely thought about, having him around each minute of each day is wearisome. Peter is an “up front” sort of friend, but admittedly very private. So, getting ready to leave the house with Peter is stressful and frankly exhausting.

My friendship with Peter is as close a relationship as I have ever experienced. It is also an ill-fated relationship, for today Peter and I must be parted. The reality is that I must move on in my recovery, and I have to go, alone. Peter cannot go for me. The absence of his indwelling presence will be a void in my life.

Farewell, my friend, Peter.

[During a radical prostatectomy, a foley catheter is inserted into the urethra. The catheter assists the surgeon during the transection and resection of the urethra and then supports the urethra as it heals. The patient keeps the foley catheter in place from 7 days to 3 weeks depending on the procedure and the surgeon involved. I named my catheter "Peter."]

Other  posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.

Prostate Cancer Journal: The Choices We Make


With treatment, I am not very likely going to die as a result of my prostate cancer, as my father before me did. The scoring and grading complete, I am among those with a 90%  chance of being prostate-cancer-free through at least the next ten years (10 years is pretty much the extent of the data), and can look forward to being a cancer survivor. Thanks be to God that such mercy has been given to me.

While my prognosis is just about the best that one could hope for, I am at somewhat of a loss before a buffet of good treatment options. Advancements in medicine offer those with prostate cancer a plethora of choices of excellent treatments:  da Vince, brachytherapy, IMRT, IGRT, clinical trials, active surveillance, proton beams, HIFU, laparoscopic robotic radical prostatectomy, cryotherapy. While the biopsy was certainly uncomfortable and nerve-wracking, and the news that I had cancer invoked rage and fear, having to pick my own treatment may yet be the most agonizing part of this journey through prostate cancer so far. Continue reading

Prostate Cancer Journal: Positive for Cancer


Ever since hearing that my elevated PSA might be a cause for concern, I had been preparing myself for the news, preparing myself to hear that I had prostate cancer. Dad had it, why shouldn’t I? I’ve been steeling myself so that I wouldn’t scream, or yell, or, God forbid, cry when I heard the news.

“Mr. Kinnaman, your results came back positive…” That really is the only thing I heard in our brief conversation. As Dr. de la Paz continued to speak I looked at the pictures on my desk, pictures of my wife and I on a cruise, pictures of our four grandchildren. I ask a few questions, write a couple of notes that mostly make sense later, but while hearing, I really am not listening. I have cancer.

The Roller coaster of Rage and Fear

boulder-dashRage is what fuels all the reading, it is the cranking up of the roller coaster, “clack, clack, clack,” as I am taken higher, the rage that this should happen to me “clack, clack, clack,” higher and higher; rage, being pushed on by the idea that if I read enough I can find a solution, rage that compels me to exhaustion to find the next website, the next procedure, the next presentation on YouTube. And then just as I reach the pinnacle and seemingly have nowhere else to go, I overtop and begin the free fall into fear: fear of loosing my health, fear of the surgery, fear of radiation therapy, fear of incontinence, fear of impotence, fear that I’ve let you down, fear that dying will hurt, fear of leaving my wife alone. While on the way up it felt like rage would leave me with no place to go, fear seems like it could go on forever. And along the way fear throws me into switchbacks of loathing and pity and ultimately into the 360° of doubt: did I do enough, should I’ve been more vigilant, can I make a treatment decision that will make a difference? Continue reading

Prostate Cancer Journal: The Waiting is the Hardest Part


universal-no-symbolThis will be an intensely personal post. If you came to this blog expecting something else, you might want to take a break from reading this now, head over to the archives, and wait until the more characteristic posts make a comeback.

This week I have been doing a lot of waiting. I no longer know what to do with myself.

Carly Simon’s lyrics are so overdone that they have become trite (except for Heinz, I guess), but they are running around in my head abreast with Psalm 130:

We can never know about the days to come
But we think about them anyway….

Anticipation, anticipation
Is making me late
Is keeping me waiting.

-Anticipation, Carly Simon

Out of the depths I cry to you, O Lord!
O Lord, hear my voice!
Let your ears be attentive
to the voice of my pleas for mercy!

If you, O Lord, should mark iniquities,
O Lord, who could stand?
But with you there is forgiveness,
that you may be feared.

I wait for the Lord, my soul waits,
and in his word I hope;
my soul waits for the Lord
more than watchmen for the morning,
more than watchmen for the morning.

O Israel, hope in the Lord!
For with the Lord there is steadfast love,
and with him is plentiful redemption.

And he will redeem Israel
from all his iniquities.

-Psalm 130

cubs_fan

I'm a Cubs fan. I know about waiting.

In Spring 2002 suddenly appearing “liver spots” (actually petechiae bruising) had been met with curiosity on Thursday. I rarely show bruises, much to my wife’s dismay as she seems to share a genetic link with bananas when it comes to bruising; so I didn’t make much of them. Dad had liver spots, so probably would I. On Saturday a couple bruises, startling purple and red explosions, appeared over a very short period of time. I called my GP’s exchange. Interrupting his golf game, he likely saved my life. Instead of saying “come and see me on Monday,” instead he said “hang up the phone and go to the emergency room. Now.” He said he would meet me there. That didn’t sink in.

When I got to the emergency room they were expecting me. That didn’t sink in either. After exchanging my clothes for theirs, a blood sample was taken, and a physical exam was conducted. I became a bit of a curiosity as seemingly random medical personnel would knock on the door and ask if they could examine me. By now I knew the “liver spots” were actually petechiae, that is pinpoint bruises, and they were showing up everywhere. If you are old enough to remember the water-color books for children that had the pictures filled with dots—a child paints with a dampened brush that releases the color in each dot—well, that is what I had come to resemble, especially on my arms and legs. But they didn’t hurt. No one said any different. And it didn’t really sink in. Continue reading

Prostate Cancer Journal: You’re Going to Do What?


universal-no-symbolThis will be an intensely personal post. There is no delicate way to describe what took place during the prostate biopsy. If you came to this blog expecting something else, you might want to take a break from reading this now, head over to the archives, and wait until the more characteristic posts make a comeback.

A Bit More Waiting

waiting-roomYou can read a lot about the procedure that is technically known as transrectal ultrasound-guided prostate biopsy on WebMD and the many good sites that have written about men’s health and prostate cancer. Most of them will say that it “doesn’t hurt much,” that it’s “not so bad.” But, “doesn’t hurt much” and “not so bad” only seemed to mock me. Despite the vast amount of information I had accumulated over the previous ten days, I am wading deep into the unknown, nearly drowning in a mix of fear and anxiety. As I drove the thirty minutes to the office I’m thinking about the needles. Upon checking in I am shown into a standard exam room by an efficient but very kind nurse who checks my vital signs and goes over a list of questions about my medical history. Then she explains everything that is going to happen from that point forward. Her calm, deliberate, two-minute speech drains away some of the fear that has been washing over me in waves. The nurse leaves, and following her directions I get naked. I put on a hospital gown so it opens in the back and have a seat on the exam table as I wait for the doctor. I’ve been told it will be about ten minutes. This exam room has two carts set up with monitors and keyboards. The nurse has one powered up and sitting next to the exam table. I recognize the image on the screen as the pie-wedge that will display an ultrasound image. But it is the wand clipped in readiness on the side of of the cart that gets my attention. The business end is about eight inches long and about the diameter of a roll of nickles. The doctor is obviously an advocate of safe sex as the wand is sheathed in a form-fitting condom. From my reading, and the nurses’ explanation, the wand will be used to get an ultrasound image of my prostate gland and map where the doctor will take his biopsy. That’s okay. What sets off alarms is the very slim metal tube that runs down the length of the wand. I start to go into meltdown as my forced-calm exterior gives way to the anxiety within. The metal tube indicates the ultrasound wand’s second use: to guide the placement of the biopsy needles. One at a time, a dozen needles will be shot down that metal tube by a spring-loaded biopsy gun, through the wall of my rectum to snatch and bits of tissue I wasn’t all so sure I wanted to surrender. Continue reading

Prostate Cancer Journal: Today I take the test


Or maybe it is more accurate to say that today the test takes me.

universal-no-symbolThis will be an intensely personal post. If you came to this blog expecting something else, you might want to take a break from reading this now, head over to the archives, and wait until the more characteristic posts make a comeback.

This afternoon I will be heading over to my doctor’s office, a urological specialist, and have a transrectal ultrasound-guided prostate biopsy. This test will be used to determine whether my elevated PSA blood test results are indicative of prostate cancer or infection or something else altogether.

picture-3Since getting the report of my PSA (prostate specific antigen) levels ten days ago, I have only talked about this with my wife, pastor, and three trusted friends. Those who know me may be surprised that I told that many others about the impending biopsy. When it comes to such personal details, I tend to be intensely uncommunicative, a New Englandish “It’s my business, and only my business” attitude–although I have never lived in New England. I have decided to leave my comfort zone and journal about this experience for two main reasons. First, as a coping mechanism to help give the swirl of emotions some expression and a place to “live” besides in my gut. And second, the majority of my male friends are in their forties and fifties (the women are never older than twenty nine), and if the sharing of my journey–wherever it may lead–gets even one of them into the doctor to begin getting an annual PSA, than this breech in my personal space will be very much worth it. Well, maybe a third reason: wives and mothers get your forty-year-old husband or son to the doctor annually–the years of health and life you will give them is worth the nagging! Continue reading