Patients speak about prostate cancer and laparoscopic radical prostatectomy
Joseph Letts, Hartford, Connecticut
I have always been a very active, healthy individual. Annual medical checkups have been a part of my life from the age of 12. Sure, I had my tonsils and adenoids out in 1958. Appendix went in 1972. Then there was the matter of that darn disc in my back that got away from me in 1994 that resulted in a lumbar laminectomy. But for the most part, I haven't had anything that would slow me down.
At age 12 I learned to scuba dive. By age 17 I was the youngest scuba instructor in Canada, on my way to accumulating over 3,000 hours underwater. At age 19 I joined the Canadian Navy, saw the world and was a ship's diver and sonarman. At age 21 I made my first of over 400 sport parachute jumps. At age 24 I learned to fly and to this day hold an active commercial pilot's license with an instrument rating and over 1200 hours pilot in command time. At age 27 I was an expert parachuting instructor and rigger. I owned and operated a skydiving center and a parasail operation on weekends while holding down a successful management career in the Canadian banking industry. At age 30 I was living in the Bahamas continuing to pursue my successful banking career. On weekends I could be found free diving from my boat to depths of over 60' on the Bahamian reefs with my Hawaiian sling. Spear fishing some of the largest grouper and hogfish you can imagine while dodging hammerheads and barracudas that wanted the rent paid on their turf! My dive buddy would be alarmed because of the length of time I would remain underwater. A three-minute breath holding dive was not unusual for me. On the side, at the Nassau International Airport each morning at 0630 I could be found teaching individuals how to fly before the commercial air traffic picked up. At 35, back in Canada, I quit the banking industry to turn a part time hobby into a full time business. For 5 years in Canada I ran my own retail scuba diving, skydiving and travel company. During this period I also started a company to develop an environmentally sensitive resort on the Turneffe Islands off the coast of Belize.
At age 38 while on a scuba diving trip I met my wife. About two years later we were married. I sold my businesses and immigrated to the US. At age 40 upon immigrating to the US I became a stockbroker. I was right on time to experience the ramp up and apex of the greatest bull market I believe we will ever see in this country for many, many decades. My wife and I were by now very comfortable with our life. Frequent travel, a plane, a boat, we were looking forward to an early retirement at 55. We were growing in our spirituality and thanking God for all of his manifold blessings.
Then, at age 49 I was diagnosed with Prostate Cancer.
My world felt like it had come to a screeching halt. You know that feeling.
The call had come one sunny day in May of 2002. After my urologist of many years had noticed my PSA rise over a five-year period from a 1.4 to a 3.9, he recommended I have a biopsy. After two agonizing weeks where the pathologist seemed to be as uncertain as I was, I was told that I had prostate cancer. A Gleason 6 score. As a precaution I underwent an MRI, a CAT scan and a Bone Scan. No evidence of any malignancies. That was the good news. But I still struggled with the diagnosis. After all no one that I knew had ever had cancer in our family. I was reassured time and time again that I was lucky that I had caught it so early and that it was such a small concentration I should not be concerned. Well, I was concerned and it was second opinion time.
After a consultation with a well-respected radiologist, my initial biopsy slides were reread in June of 2002 and it was determined that the results were at best inconclusive. Yet another biopsy was recommended to remove any doubt.
Meanwhile, my wife, a registered nurse, took charge of our family's newly created Homeland Cancer Research Department (HCRD). She had learned of a proton radiation therapy for prostate cancer that had fewer side effects than traditional photon therapy. We decided this would be the course of action I would follow. I was booked for a September 2002 date at Loma Linda University Medical Center to undergo 8 weeks of proton radiation therapy. I of course had immersed myself in my work, reluctantly admitting that I had this disease. You run the gamut of emotions. You know this as well. Denial, anger, fear, uncertainty, apprehension and finally an acceptance and trust. Mine flowed exactly in that order. The emotions would become so strong that as I was preparing for work I would feel totally lost. I would ask myself, "Is this all there is to my life?" But my emotions only got to the fear stage.
In late July of 2002 the results of the second biopsy came back negative as to prostate cancer. I gave thanks to God and resolved to change my evil ways, improve my diet and move ahead free of this devil. My wife, while not saying so at the time was much less confident than I was that I had dodged the bullet. I was advised to monitor my PSA quarterly. Any spike above a four should be considered suspicious for a 50 year old. Indeed in September a follow up saw my PSA drop to 3.2 from 3.8. Progress!
During the December of 2002 I experienced a decades old friend once again: prostatitis. A trip to a new urologist in January (can't have too many second opinions for a Type A personality, right?), another review of my history, a DRE and in January of 2003 my new urologist recommended I undergo another biopsy to "really find out what's going on and remove all doubt." Go on number three biopsy. I was seriously thinking about getting a tattoo of the Detroit/Windsor tunnel on my lower back. Might be fashionable who knows? This time it was confirmed. I had Prostate Cancer. No less than 10 pathologists confirmed the findings.
Welcome back emotions. Denial, anger and fear had already been taken care of, it was now a matter of me dusting those guys off, reacquainting myself and moving on to uncertainty, apprehension and finally acceptance and trust.
I was simply going to reschedule a date with Loma Linda University Medical Center for my proton therapy right? Well, not so fast. With no discredit for the many hours my wonderful wife spent researching, I unceremoniously appointed myself head of our families Homeland Cancer Research Department (HCRD). This was no time for delegation. No uncertainty allowed. I had to make a decision that would affect the rest of my life, our married life together. I was only 50 years old. This pox should not have been on me for at least the next 15 maybe 25 or more years. Now I'm going to fix it. I am not going to succumb to it. I'm a Type A, hear me roar!
Radiologists, Pathologists, Urologists, Surgeons, talk to me! Give me the information that I need to make the right decision here. Referrals, I want referrals. I want to know who you've radiated, I want to know who you've operated on, I want to see them walking, talking, breathing, enjoying a quality of life that I might not have. I want evidence that you're good! I want you to tell me what I should do! I want to read your surgical procedure manuals. I want to completely understand proton accelerators. I want to understand how radiation heals. I want to understand side affects. I want to understand the survival rates. Why should I have surgery versus radiation or vice versa? At 50 years of age what would you do Mr. Radiologist, Mr. Surgeon? I researched and ultimately "online queried" myself into encyclopedia status.
You know what I found out? There is no one out there that will give you the answer you're looking for. There is no one that is going to make this decision for you.
In my case, early stage prostate cancer could have been treated successfully by either radiation or surgery. Pick your poison. In my case I could pick the club I wanted to join. Surgery or Radiation, lots of benefits, probably a 97% cure rate for both. No one was going to drive me to my welcome to the club meeting.
Here's how I got through the uncertainty and apprehension phase. Maybe it will help you. I knew I couldn't live with an organ that had let me down. I couldn't live with a "cured" cancer in my body. The uncertainty would be too great. When I scuba dive, I have a reserve air supply and a spare regulator attached to me. When I skydive I have a reserve parachute. When I fly I have redundant navigation and communication systems, only one engine, but redundancy elsewhere. After all there are many fields to land in should the engine quit! Usually when a piece of equipment fails me on any of my adventures, if I cannot reasonably explain the failure and expect a 100% repair, it is heading for the scrap heap and a better alternative is coming aboard. My prostate was cancerous. It had failed me. Emotionally and for the future, I knew it had to go. Others might arrive at a different decision but at 50 I did not want to revisit this problem when I was 65 or older. It was coming out.
I knew that if I were to elect radiation and the cancer returned, they called the procedure a "salvage operation". Done some of those salvage operations diving and they usually aren't pretty. I could only imagine what a surgeon would be up against. But if I had surgery, the radiologists could standby and help me out of a recurrence should I need them. Most likely regardless of my age. The emotion of uncertainty had officially been put to rest.
My wife was not entirely comfortable with my decision. Early on in her career, she had been a nursing supervisor on a surgical floor and had seen Radical Prostatectomy patients. She had seen the lengthy recovery times and some of the complications. To be honest with you, the video that my local urologist gave me explaining the surgery, I couldn't watch to completion. I'm a guy that faints at the sight of a needle. I'm a medical wimp. I admit it. I couldn't envision myself going through such an invasive, barbaric procedure. What about incontinence, what about impotency? My wife and I should have a lot of good years left. To her credit, she knew that what would make us happy would be what made me happy. Her uncertainty was still there but my prostate was still coming out. I needed someone not only good enough to remove my prostate but also to remove her uncertainty!
Through a referral from my local radiologist I was directed to a top-notch surgeon here in Michigan. He brought up the fact that the early stage of my cancer and my young age would lend itself well to a relatively new procedure that he unfortunately did not perform. However, a younger, equally talented colleague did so. Then and only then after almost 10 months of research and investigation was I introduced to the procedure that I now know as a Laparoscopic Radical Prostatectomy. With all the research I did, I don't know how I missed it. He assured me it was less invasive, gave a better field of operation, magnification and vision for the surgeon, had little blood loss, had a faster recovery time, could be more effective on nerve sparing and all you needed was an overnight hospital stay. Sounded good. I told him I would refer his recommendation to my Type A researcher back at the HCRD and get back to him. Later I would learn the surgeon's colleague that would do the LRP did not have the level of experience I wanted. Indeed, in this case it seemed as if I would be his first LRP patient. This would do nothing to resolve my wife's uncertainty. It would certainly do nothing for a medical wimp.
That same night, a search of the web and God's providence led me to Dr. Krongrad's Website. Obviously a world-renowned expert in his field, having performed one of the first LRPs in this country many years ago, Dr. Krongrad's web site logically laid out the entire procedure (and yes I did read the manual). His website gave remarkable first person recovery testimonials. When my wife and I came upon the site that first evening and began to review the procedure, Gail openly cried. She looked at me and said, "This is what we've been looking for!" I could see Gail's uncertainty begin to evaporate. It was now the end of February; at around 7PM that evening I emailed Dr. Krongrad for more information. Within four hours, I had a response from Dr. Krongrad inviting me to contact his office in the morning and get something scheduled. A four-hour response time to my first email from a world-renowned surgeon? A response at 11PM at night written by the surgeon himself? My wife and I felt as if we had found something and someone quite special. Going forward, we were not to be disappointed. This personal touch has been repeated over and over again.
A call to Dr. Krongrad's office and a conversation with Ruth, one of the most efficient human beings on the planet, had my surgery scheduled for April 14th. We would fly to Florida for a consultation 10 days before. All medical records needed to be forwarded. Within a day of overnight expressing the records, I received a personal phone call from Dr. Krongrad acknowledging he had reviewed my records and was looking forward to meeting my wife and me on our visit to Florida. Just to maintain the Type A personality, I had another consultation set with a traditional surgeon at Johns Hopkins in Baltimore, the day after our scheduled meeting with Dr. Krongrad in Florida. The moment we finished our lengthy consultation with a very patient and understanding Dr. Krongrad our decision was final. Surgery yes. LRP only. Dr. Krongrad only. The HCRD had ruled. Following the consultation we went directly to the North Shore Medical Center in Miami where Dr. Krongrad performs his surgery and preregistered. Nothing but more glowing comments there from all present about his staff and his abilities. This was starting to feel really good. Apprehension had finally been laid to rest. Houston, Acceptance and Trust have landed!!!
We never kept the appointment in Baltimore. Rather we cancelled and because our tickets could not be changed (air miles) we went to see the National Aquarium and enjoyed a fabulous seafood dinner and a night of comedy at The Improv. We also cancelled my April 30th date with Loma Linda for proton radiation therapy. We also cancelled my April 16th traditional surgery here in Michigan. I was having a LRP on April 14th in Miami, Florida.
We arrived in Miami that Saturday. Stayed at the Marriott Residence Inn five minutes from Dr. Krongrad's office in Aventura, FL and next to the truly fabulous Aventura Mall. We most highly recommend the Marriott. Their staff will even do your grocery shopping for you at no charge. Just leave them a list. They could not have been more accommodating during our stay. The efficiency room we were in was simply wonderful and conveniently located to shopping, pharmacies, movie theaters and of course the beaches! It was so pleasant, we elected to not return home right away, although some of Dr. Krongrad's patients travel home two to three days after surgery. Rather we decided to turn the trip into a mini vacation and stayed two weeks, letting the Michigan weather improve in the process!
Monday morning, my wife and daughter and I arrived at the hospital bright and early. It was one of the most efficient hospital check-ins I have ever experienced. I was prepped and made to feel very comfortable. Despite the fact that I knew I was in the most competent hands, I was nervous. More nervous than a wintry 100' under the ice scuba dive. More nervous than a 15,000' skydive with 20 other jumpers. More nervous than shooting an instrument approach landing in our plane to minimums in crappy weather. I mean I was nervous. If I wasn't I guess I wouldn't be human. The relaxation cocktail I was administered intravenously helped a bunch. The anesthesiologist gave me an excellent briefing on the procedure. Dr. Krongrad came by and gave me further assurances. My goodbyes were said to my wife and daughter and I was wheeled into Operating Room 5. Someone said something about the camera, after which I don't remember a thing.
My surgery was scheduled for 1130. I was number 2 of 3 LRPs on Dr. Krongrad's schedule that day. I was one of 8 LRPs done by him that week. On my day, my fellow patients were from Spokane and Caracas. Yes, Venezuela. Individuals are traveling from throughout the world to have Dr. Krongrad do their LRPs. There is simply no doubt in my mind as to why. When you can combine expertise (surgical proficiency), with volume (number of patients treated) and efficiency (a well trained, coordinated team, my anesthesiologist was also a cardiologist), this makes for an incredibly safe and competent environment under which to pursue LRP. My research tells me that Dr. Krongrad is probably the busiest LRP surgeon in the world. It's abundandtly clear why that is the case.
I was in the OR right on time. My scheduled three-hour procedure lasted approximately two and a half hours. I awoke in the recovery room. As my wife was walking in, all I could say was, "Unbelievable, this is unbelievable!" I had absolutely no pain. Sure, you know you ache a little abdominally but no true surgical pain! As a tribute to my anesthesiologist, I had no nausea whatsoever after surgery. The catheter, later to be called my buddy, and the surgical pelvic drain was a little uncomfortable as you might imagine (you get used to it), but nothing you can't sleep through! I didn't take as much as a Tylenol during the recovery and subsequent healing phases. The only surgical evidence I had my prostate removed were the three small quarter size band-aids that covered the entry points. One of the entry points accommodated the drain. The entry point below my navel where the camera made me a star, only had a band-aid to hold the incision closed. In three days, even the band-aids were gone.
On the evening after surgery, in my very comfortable private room at North Shore Medical Center, Dr. Krongrad was there to speak with us. As I was getting out of bed for my ceremonial walk around the ward, I asked Dr. Krongrad whether or not I should worry about anything. He said, "Worry about everything!" In that simple statement after my surgery, I realized that through my research, through my analysis, through my decision making process, and through my emotions, I had worried about everything. Yet when my wife and I made our final decision on this procedure and entrusted my health and our future to Dr. Krongrad and his team, I was and we were done worrying. I accepted and trusted my decision. I accepted and trusted Dr. Krongrad. After the surgery, even with his permission to worry about everything, now there was nothing to worry about. I had made the right decision.
Upon getting up for my ceremonial walk around the ward, (with remarkable ease I might add), "Spokane" and I happened to meet in the hallway. It was truly a Kodak moment. Our families chatted and "Spokane" and I chatted openly. I learned that he too had done his research, he too had arrived at the same conclusion I had. He too could not have fathomed a traditional surgery.
If my memory serves me correctly one of the individuals I spoke with during that week had actually been rejected for traditional surgery and yet was approved for a LRP. This speaks volumes as to the nature of this surgery when compared to a traditional RP. "Spokane" and I both agreed that this was absolutely one of the most amazing procedures we could think of. To think that only hours after having a radical prostatectomy we were up and cruising the halls carrying on what in spite of our less than flattering hospital gown dress was a normal conversation. (You know when fashion enters into the equation you're feeling pretty darn good!) We were both truly pleasantly amazed and highly complimentary of Dr. Krongrad and his team. "Caracas" having been the third surgery that day and on a later schedule was still resting and wasn't cruisin' with "Spokane" and me. My wife and I did speak with his family and they were pleased to report that he was doing great as well! I have a funny feeling it was "Caracas" running around the halls later that evening as I was trying to sleep!
Twenty-four hours after my surgery I was released, walked to our car and returned to our room at the Marriott. Two days after surgery, I returned to a normal diet and went to a movie with my wife and daughter, one of many we would see that week. Buttered popcorn never tasted so good! Day three post surgery we were at the beach where I got in a little deep and fried my cell phone when I forgot it was in the pocket of my shorts. Thanks for the quick replacement action Sprint. While at the beach we got a call (before I fried my phone thank goodness) from Dr. Krongrad personally giving us the post-surgical pathology report. My cancer was confirmed a Gleason score 6. It had concentrated itself on the right side of my prostate but had begun to move to the left side. The good news was it was contained within the prostatic capsule and had negative margins. God willing, I should experience as complete a cure as one can pray for.
The Saturday following my surgery we had the occasion to stop by the office so the Doctor could check everything over. (Note we were being seen on a Saturday!) What greeted us was a meeting that we will always cherish. In the office was "Austin" who had has his surgery the Wednesday before me and was having his catheter removed that Saturday. Also present was "Oklahoma" a gentleman accompanied by his lovely wife and older son. We learned that "Oklahoma" would be having his surgery the Monday following, one week to the day after mine. Hopefully in our brief conversation with "Oklahoma" and his family we were able to impart a sense of peace and calm as they approached this procedure. Was that family us less than a week before? They already knew that they had made the right decision to be in Dr. Krongrad's care, but it is always nice to see someone who has already been there.
While in the office "Austin" boisterously approached me and asked, "Are you a before or after?" I proudly stated that I was an after! He then proceeded to ask the same question to "Oklahoma" who replied nervously, "A before". Think about this for a moment. Where else in the world could you put together three men of different ages, two of whom have had a radical prostatectomy within the past ten days and have to ask who is the before and who is the after?
So there we were two veterans, a senior and a junior at Krongrad U letting the freshman know that before he knew it, he too would be graduating and a member of a very unique alumni! Following this exchange, "Austin's" wife produced a digital camera and all three of us posed with Dr. Krongrad and Ruth. While we were only ships passing in the night, our voyages were charted along the same course. We all expressed the desire to stay in touch. I sincerely hope that happens. Maybe a class reunion in Florida as the snow flies up north?
We flew home two weeks after arriving in Florida for my surgery and mini vacation. Monday morning, at home, two weeks after my surgery and again with Dr. K's blessing, and with my private nurse looking on, I retreated to the sanctity of my cave (shower) and removed my own catheter! Sorry buddy I just had to do it. Wouldn't you say not bad for a guy that would faint at the sight of a needle before this?
It is now three weeks since my surgery. Yesterday was such a great day that my wife and I couldn't resist pulling our plane out of the hangar (honest, Dr. I didn't do it - we had help) and going flying! Our trip took us from our home base of Marine City, MI west to Jackson MI for lunch and then north to Lansing, MI to visit my son who attends Michigan State University and then back home. It was an absolutely glorious Spring day to be alive! We returned after about three hours of flying around and seven hours of just goofing off and took the picture you see here.
As you might have guessed, for me incontinence at this point is not a major problem. Each day I improve and I personally believe within the next few weeks it will not be an issue at all. As an aside, I must admit my 19 year-old son cringed just a little when I whipped a spare (don't leave home without it) Maxi Pad out of my pocket at the Executive FBO at the Capital City airport in Lansing and began to let him know the advantages of Maxi Pads with wings over the Kotex pads with wings. Seriously though, it is part of the recovery process and a sense of humor does help! We pray, thanks to the dual nerve sparing procedure that Dr. K performed, our quality of life will return to where it was prior to my diagnosis, just as it has for many if his other patients. Now its only time and hopefully, God willing, I have a lot of that left. We feel blessed to have found this procedure and thank God that there are human beings such as Dr. Krongrad and his team that can give back to us so painlessly what we so sorely crave when we lose it, that being our health and well being.
Hopefully my experience will help you through this difficult time. Let your emotions run (they will anyway), do your research (you likely have the time), worry about everything (it will ensure you do the best job for you and your family), then stand up and fight this disease.
After you are done worrying about everything, turn it over to the Lord, and worry about nothing. (Philippians 4:6-7) Dr. Krongrad and his team along with the Laparoscopic Radical Prostatectomy procedure will do the rest. God Bless, and good luck from my wife and me with your very personal decision making process.