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Patients speak about prostate cancer and laparoscopic radical prostatectomy

John Barnette, Brenham, Texas

I am a 55-year old self employed engineer living outside of Brenham, Texas on 41 acres with my wife, Gay, and our assorted animals. Our two daughters are grown and live in Austin, Texas and we have a 5-year old grandson. I have always considered myself very healthy. I work out, eat a healthy diet, and am very active.

My family calls me a "machine." I bought an 1880's farmhouse 14 years ago that was being used as a barn. I cut the house in half, moved it 5 miles to our farm, and spent the next 6 years restoring it myself. Then, 6 years ago, I bought an 1850 log cabin skeleton from Missouri and restored it over the next year. The cabin serves as my office during the week and doubles as a bed & breakfast cabin on weekends.

In August, 2003, during my annual DRE, my primary doctor felt a subtle firmness on one side of my prostate. No need to worry because my PSA prosate specific antigen level was just 0.4 ng/ml. During my previous exam, in 2001, my PSA was 0.2 ng/ml. But just to be safe, my doctor said to come back in a month and we'd redo the DRE. We did - same result. Over the next week, I went to two urologists who both felt the subtle firmness, which can be one of the warning signs of prostate cancer, but assured me it was nothing to worry about since my PSA was so low. I could just monitor my PSA and redo the DREs in several months. Or I could go in for a prostate cancer biopsy procedure.

I chose to have the prostate cancer biopsy procedure. My urologist, my wife, and I were shocked when, on September 23, the prostate biopsy showed a Gleason score 6 prostate cancer. It was the all time lowest PSA with cancer the urologist had heard of. I had always wanted to be distinguished for something. My urologist said that prostate cancer treatment options include open prostate cancer surgery, radiation, cryotherapy, watchful waiting. No mention of laparoscopic radical prostatectomy (LRP).

After recommending open surgery as the best option for me, my urologist informed me he did not do prostatectomies any more. He was just too busy dealing with the negative consequences of open prostate removal. Huh? My enthusiasm for open prostate surgery began to dampen. He gave me the name of a urologist and a radiation oncologist and bid me good luck in my decision. About this time, I talked to my childhood best friend, now living in Seattle, who had open prostate surgery 1½ years ago. The story of his recovery and consequences took the starch right out of me.

As it turned out, it was fortunate that my urologist had stopped doing prostate surgery or I would have probably signed up and had it. Instead, I expanded and intensified my research and then discovered references to LRP and Dr. Krongrad. One article got my attention because it discussed the pros and cons of LRP. I was immediately drawn to the stories of patients who had had LRP and all the other valuable information.

I had read enough regarding LRP to know that LRP is technically difficult and that surgeon experience was a must. Dr. Krongrad had more LRPs under his belt than anyone else by a wide margin. Plus, he co-wrote the LRP Technical Manual. Plus, he brought years of wide experience in dealing with prostate cancer and men like me. Plus, as you'll soon read, he is accessible.

I emailed Krongrad the next day. As is everyone's experience, I was shocked to actually get a response within a few hours. I talked with Ruth regarding insurance issues; she was very patient and let me babble on about all my concerns. That was it. I decided to go to Miami, scheduled for LRP on November 18, 2003.

The next 7 weeks were anxiety ridden for Gay and me, with lots of insomnia waiting for our trip. Dr. K gave me names and phone numbers of 24 former patients who'd had LRP. Each evening I tried to call one man and hear about his experience. This was great anti-anxiety therapy. On the other end of the spectrum were family members and friends who shared castration jokes, their way of showing they care.

On Sunday, November 16, we flew to Miami and checked into our hotel, Casablanca on the Ocean. Not the Ritz, but adequate and had a kitchenette with ocean view. The next morning, we registered at North Shore Hospital. That afternoon, we met Dr. Krongrad at his office. After our meeting, during which he answered all our questions, we felt very confident. We had taken control of cancer treatment, done our research, and now were ready to entrust my health to Dr. Krongrad.

Tuesday, November 18, at 6:00 AM, I checked in at North Shore. In Surgery Prep, the nurses and technicians went about their various tasks getting me ready, all very friendly and professional. The anesthesiologist came by to explain how my cocktail would be administered. Dr. K performed LRP at 7:30 AM. The surgery took about 2 hours.

I awoke in Recovery and, with Gay by my side, was wheeled to my private room. They may have taken my prostate gland, but left me with a new friend, I called him "Foley" (the catheter). When you are tethered to someone in such an intimate way, you get to be pretty tight. In fact, I did not go anywhere without Foley. As far as pain, I took a couple of Tylenol, not for LRP abdomen pain, but to relieve backache. I have a history of backaches, particularly when trying to sleep flat on my back, which is pretty much the only option.

My night at the hospital was uneventful and I checked out of North Shore the day after the LRP, went to our hotel, and tried to sleep. By this time, I was passing gas which was a good sign. I had the same backache issue when trying to sleep. So I decided if I'm going to be sleep deprived, I might as well be sleep deprived at home.

We cut our stay in Miami a day short, rescheduled our flight and left Miami Thursday morning at 10 AM, less than 48 hours after my prostate cancer surgery. Between the 3-hour flight to Houston and the drive on both ends, we did not get home until 5 PM. It was kind of an endurance test. Dr. Krongrad gave me some good advice for the flight. I thought I was going to be clever with my buddy Foley and not drink much liquid the couple of hours before the flight. This way I would minimize the risk of exposing Foley to the passengers. Dr. K told me, no, you need to hydrate yourself before and during the flight. He said airplanes are notorious dehydrators. Also, he said that as soon as the captain turned off the "Fasten Your Seat Belt" sign, I needed to get up and walk around and then get up again several times during the flight.

Over the next few days, I became obsessed with saying goodbye to Foley. At home, I was able to get better sleep: a couple of hours in bed, then a couple of hours sitting up in a recliner, then back to bed.

One week after LRP, with Foley still an intimate part of me, I awoke in the morning to discover my plumbing still worked. It was a little uncomfortable but I was ecstatic that the message was getting through.

Finally, the anticipated day arrived and I said my farewells to Foley. I had my primary doctor do the honors. I took an adult diaper to his office. Prior to removing Foley, the doctor asked if his nurse could watch, as she had never seen this done. I said heck no, bring the whole waiting room in, at this point there is no limit to what my vanity can abide.

Gay and I went to our favorite Mexican restaurant to celebrate. I pigged out and drank lots of water. Before leaving the restaurant, I went to the men's room to check things out. To my surprise, there were no leaks. Then I peed like a racehorse, stopped the flow, then peed again, all under my control.

Once we got home, at first I took the diaper off and inserted a pad. After an hour, there were no leaks. So, I took the pad out and have not used anything since. This was more than we could have dreamed about. I was 100% continent immediately. Tighter than a tick.

Two weeks after LRP, I worked 40 hours. The photo you see is me two weeks post-op.

Gay and I could not be happier with the whole experience and particularly the outcome. We feel blessed to have found Dr. Krongrad. Obviously, we are sold on the LRP procedure. More importantly, we are sold on Dr. Krongrad's skill and the caring manner with which he and his staff carry out their mission.

Good luck on your journey.

# # #  John's 8-year update # # #

It’s been 8 years since Dr. Krongrad performed LRP on me.  I’m still cancer free and my plumbing still works good as ever.  So grateful I found Dr K back in 2003 when LRP was not as readily available as it is today.  

He had firmness, one of the warning signs of prostate cancer, undergoes the biopsy procedure showed Gleason Score 6 prostate cancer.