Living Well

February 7, 2010

Prostate Cancer: Ongoing Followup to Cancer treatment

Filed under: personal mission,prostate cancer — dlneidert @ 1:11 pm
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A blogger that helped me originally in my own prostate cancer journey wrote, “Prostate cancer is a life long journey.”  I know this is the case as I continue going to my post prostatectomy consultations.  After my initial post operative work, the appointments began being set every three months for the first year.  The main objective of these consultations is to answer three ongoing questions:  What is the return of potency, How are you healing related to incontinence, and cancer management.  These are three ongoing questions I continue to answer as I am now in year 2 of my post surgery consultations.

Ongoing consultations are essential, especially in the area of cancer management.  The routine PSA report helps the doctor to know that no cancer has returned.  I always wait for the response, “Your PSA shows non-detectable.”  That means there is nothing to detect in the area of prostate cancer.  However, as I am aware, the PSA test can detect the return of prostate cancer well before it may in fact appear in the body in some location.  Thus, the ongoing consultations are essential.

My consultations started at 4 times a year for the first year.  These carried over into year two as well.  Now heading into year three, my consultations will move to every 4 or 6 months, yet to be determined by my surgeon.  In all years following, it will be at least once a year.  These consultations are essential, as my surgeon reminds me.  He tells me from his own experience that many men stop the annual PSA and thus short circuit the cancer management part of the equation.  Because of this, he finds at times men return to him in more advanced stages of prostate cancer by not managing it over time—being aware of your body and your own situation.

Cancer is a disease bent on your demise.  It will silently do what it does if men do not pay attention and manage it to a CURE.  Without paying attention, cancer can accomplish what it intends….the overtaking of your body.

I now deal with these consultations with resolve.  At first, it was pretty mental to work through the possibility that the cancer was not dealt with in the surgery.  But now the cancer management is about my ongoing life and taking responsibility for living well.  I have a choice about that, and you do also.

Prostate cancer consultations and cancer management are a part of living well.  Make them a priority.  Blessings, grace and peace.

David Neidert

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February 4, 2010

Prostate Cancer: My Experience with Sex and Potency following a Prostatectomy

Here is where most men want to know the effects of a prostatectomy.  It is in the area of sexual performance following this surgical procedure for prostate cancer.  What follows is my experience.  I am not trying to speak for all men because the range is huge related to sexual performance following this procedure.  I want to honestly respond to my situation related to the mechanics, but I also want to give some insights related to my emotional response to these things.

Sexual potency, as I understand it, will be affected to some degree in the treatment of prostate cancer, no matter the treatment method you choose.  Whether you choose hormone therapy, radiation, or other means including surgery for the treatment of your prostate cancer, there will be some decrease of potency; the ability to get and maintain an erection during intercourse.  Again, I can only speak of my experience following a prostatectomy.  You will have to have a candid conversation with your doctor about this issue if you choose another form of treatment for prostate cancer.

Because of the male anatomy and the nerves that operate the prostate and seminal vesicles, there is no way not to damage some of them in a surgical procedure.  Surgeons will use nerve sparing surgical procedures, but reality must also be understood here:  some nerves will have to be cut and you will lose some potency following this procedure. The goal is to return your potency to the best it can be following surgery.  This may take as much as 18 months to become restored or to reach the peak of your potency.  It is a time for patience and focusing on what matters in life.  That is why I spent time in an earlier blog writing about one’s personal attitude toward sexuality and the sexual act.  If this subject is not considered when you have prostate cancer, it can become a stumbling block for you in seeking medical attention and in your attitude during recovery. 

Again, there is a range of potency following a prostatectomy.  It can be less than 65% up to 70% or so with the help of ED drugs like Viagra, Cialis or others.  The ability to have an erection at 100% the strength pre-surgery is not a reality.   But, my experience is that I can have good sex and maintain an erection during intercourse that makes lovemaking enjoyable.

One of the first things that struck me about potency is that I can still have an orgasm.  It is different, but it still feels very good.  What is also interesting is that because I no longer have a prostate (which mixes the semen and sperm) or seminal vesicles (which produce semen or ejaculate) there is no longer an ejaculate.  Because there is no ejaculate, sexual intercourse is actually clean—no body fluids to deal with after intercourse.

An erection does not happen as quickly following this surgery.  While I am still stimulated visually, it takes manual stimulation to help achieve an erection.  I can maintain an erection for a period of time, but it is not as long in duration as it used to be.  Without an ED drug, I have a more difficult time getting and maintaining an erection.

The use of ED drugs is helpful.  I use Viagra.  But there is a loss of spontaneity with these drugs.  Most of them require you take them at least 1 hour before intercourse so that they are in your system.  Also, you cannot eat a meal in the 45 minutes before you take the drugs if they are to have their full effect.  Thus, you have to time you opportunity.  I chuckle to myself when I see the ED drug commercials and they say, “When the time is right.”  That is exactly the point.  You have to plan to use these ED drugs.  This changes the communication about sexual activity with your spouse.  You do have to plan and communicate that the ‘time is right’ for you to engage in sexual activity.  It will take energy, planning, and communication.  My advice is not to allow this to become a barrier, but to talk frankly with your spouse about this timing and the use of ED drugs.

 You can take ED drugs in various dosages.  I use either 100 mg or 50 mg.  I find that with the 100 mg, I am able to have an erection for up to one day.  So, if I take it on a Friday evening, I can still have the ability to get and maintain and erection the following day.  The 50 mg allows me to have an erection for about 4 to 6 hours.  Finding the right dose will be trial and error with your doctor.

The side effects are also as they describe in advertisements.  I begin to get a stuffy nose as the medication is taking its full strength; so I know when it is fully in my system.  I also get flushed and warm in my face.  I do have a slight back ache after the drug begins to wear off.  And, for me, the most pronounced side effect is that I do get a headache.  With the higher doses, my headache is more intense than with the smaller doses.  I am fortunate not to have experienced nausea, which is a potential side effect.

One thing to keep in mind about ED drugs is they will not help you have an erection, but will help you maintain one once you do have it.  What this means is that if you are not able to have an erection, the ED drugs will not provide one.  The drugs, as I understand, work to seal off the blood that flows into the vessels (soft tissue) of the penis, making the blood engorge the penile tissue and “sealing” it so that the tissue stays erect for a longer period of time.

I would also say one other thing about ED drugs and my use of them.  They do not always guarantee that I will be able to keep an erection during intercourse.  I have been pretty lucky most of the time, but there have been occasions when my erection begins to fade way during intercourse.  This is disheartening for me and I feel badly for my wife in this moment as well.  But it is a part of the relationship change and enhancement.  It means that you and your spouse will have to discuss this potential and to support each other during your lovemaking and the times beyond.  Lovemaking will not be simply about performance, as it may have been in one’s youth.  It will really be about intimacy and pleasure with your spouse that can take on new meaning and new adventures in the bedroom.

I have been candid here related to my experience with sexual potency following a prostatectomy.  I did not find as much information as I would have liked in my own journey, so I share my experience in the hope that it will give encouragement in your own journey.  No part of my experience is meant to dishearten you, but to help men know there is potential for a satisfying sex life after this procedure.  It will just be different and will open new discussions and intimacy with your spouse.  And in the end, I believe this is what love is really about—sharing ALL the moments and commitments of life with the person who is your spouse.

Blessing, grace and peace.

David Neidert

February 3, 2010

Prostate Cancer: My Experience with a Prostatectomy

A prostatectomy was my decision for curing my prostate cancer.  At 53 when diagnosed, this was the best option for me.  I went into this surgery well informed concerning all the positives and negatives of this radical surgical procedure.  My goal for it was the cure of my cancer and the opportunity to live well in the aftermath of this diagnosis.

During the consultation with my urologist, he explained the procedure very well and in detail, which included many drawings.  Right at the top of the page was a list of risk factors which he wrote in doctor-prescription type penmanship.  The risk factors of this surgery are: bleeding during surgery, infection following surgery, incontinence, impotence, anesthesia related risks (including death), damage to adjacent nerves and structures, a pathology report during the surgery that shows the cancer has spread to the bladder or other tissue surrounding the prostate.  While most of these are rare, it is important to know that these things still happen in the best of situations.

At this point, we began discussing the surgical procedure, whether it would be done by the surgeon actually cutting me open or through a mechanical process called Di Vinci.  The Di Vinci is very successful and is widely used.  There are pros and cons to it.  Since I did not choose this method, it is important to have a detailed conversation with your doctor about it.  I chose being cut open by my surgeon for one reason:  he had trained to do this procedure in this manner and had performed over 600 surgeries like this.  I had confidence in him to actually use the scalpel as trained as well as having honed this skill over many years.  Additionally, this visual procedure allows the surgeon to see all of me at once, not only areas of me through a monitor, as with the Di Vinci process. 

As a side there is one item to ask your surgeon.  How many of these procedures have they performed?  This is very important because of the male anatomy in the groin area.  This surgical procedure, whether Di Vinci or manually, has potential to cut a number of nerves.  Nerves will be cut related to the prostate which effect the eventual potency issues faced in the future.  The surgeon is really trying to perform “nerve sparing” procedures, that is cutting as few of these nerves as possible.  Also, nerves that operate your bladder and also operate your legs run through this area of your groin.  One of the first orders of business is for the surgeon to locate and protect the nerves that go into your legs.  If this is not done properly, any disturbance or nick of them will cause you problems in walking.  I share all of this so that you see why you should ask the surgeon or listen for how many of these surgeries they have performed.  If your urologist has not performed at least 100 of these surgeries, ask for a second opinion or locate a surgeon who has a successful record with this procedure.  Remember YOU are responsible for your own health care and YOU have the right to get the best care, particularly with a procedure that will affect you for the rest of your life.  

Your surgeon will be removing your prostate and seminal vesicles during this procedure.  These two glands attach to your urethra (the tube that takes urine from your bladder down your penis to be expelled).  This “component” will be removed in one piece.  It is attached by nerves that come into play during sexual activity and give you the ability to have an erection.  This is where the surgeon will use nerve sparing procedures—attempting not to damage the nerves that will give you the ability to have an erection in the future.  This prostate/ seminal vesicle component is also attached to the vas deferens, which is how sperm get from your testicles.  These tubes will also be detached.  Finally, because this component is connected to your urethra, this tube going to your bladder will be cut on each side where the semen enters your urethra during sexual activity, the component removed, and your urethra sown back together again.  This part of the process will require that you have a catheter during the first 12 days or so after surgery.  This is because this internal stitching and section must heal.  The catheter will help keep the urethra open during the healing process.  You will wear this catheter home; it will likely be removed by your surgeon at your first follow up visit (but your surgeon will explain all of this as well as the maintenance of this catheter).

Following the surgery is the time of healing.  The healing process for me went like this: surgery was about 2 or so hours, I spent 3 days in the hospital, 12 days at home recovering with the catheter, office visit to remove the catheter (I used men’s urine pads after this for a while because there may still be some leaking as the bladder heals and becomes stronger), 2 weeks without driving (in that same period as the catheter), 2 weeks of lifting nothing more than a milk jug, 2 weeks more of nothing over 20 pounds, after 4 weeks as advised by your surgeon.

The first 10 or so days at home were difficult.  Because of the incision running from just under my navel to about the middle of my pubic bone, I could not get around very well.  I spent a good deal of time lying in bed.  The catheter also kept me from getting around much.  But, after the first week, I did find that just walking around in my house began giving me the stamina I needed to get stronger.  After the catheter was out (as well as the staples holding the incision together), I began walking outside (it was April of the year).  I walked a little every day and increased it over the weeks of my recovery until I was finally walking five miles every day.  I would highly recommend walking as a way to increase your stamina and energy during this time of recovery.

It was during this point that the waiting begins.  The honest surgeon will tell you that it will take roughly one year to 18 months to heal fully from this surgery.  It is during this time that one has to be patient with the issues of incontinence and impotency.   Here is where your confidence and communication with your surgeon are critical.  Constantly talk about each; be honest with how your body is responding during this time of healing.  It is no time to be macho in this healing process.  Playing that form of pride may hinder your complete recovery or not allow you to take appropriate steps if other medical measures are needed.

For me, this time of recovery was filled with prayer, reading, reflection on life, listening to music that gave me strength, being with family, relying on family, and considering the good that could come out of this moment in my life.  Prostate cancer IS a life long journey.  This time of recovery can give you the opportunity to consider it, plan for it, and focus on living well in the midst of your journey.

Blessings, grace and peace.

David Neidert

February 1, 2010

Prostate Cancer: Mission Guided Consultation

My sister is a health sciences educator at a Midwestern university.  On an early test in one course, she asks, “Who is responsible for your health care?’  It is a multiple choice question with answers like the insurance companies, doctors, etc.  The correct answer is YOU.  You are personally responsible for your health care and understanding what is happening.  This may not have been the case in an earlier time (and still is for many senior adults because they do not understand nor question authority), but you are responsible for what happens in a prostate cancer journey and consultation.  If prostate cancer is your journey, you will have to make some decisions along the way.

My own consultation took three hours.  Since I had already chosen a very good surgeon, this was a highly informative time together with me and my wife.  From the start, my advice is go prepared to ask many questions AND to stop the surgeon along the way and ask more questions.  If you want to live well, you have to ask the right questions in the process.

As I write this blog, I am looking at five yellow legal size pages of notes given to me by my doctor after the consultation.  It contains very rough drawings, types of treatments, side effects, and many other items to help me make a good decision about my treatment.  These are the history of that three hour consultation and the reminder of the choices I would have to make along the way.

I was 53 when diagnosed with prostate cancer at Gleason 7.  This age and Gleason Score changes the options often available for younger men that older men have available to them.  After we discussed the biopsy results, we began examining the options for treatment.  At 53, the goal was cure.  At 83, the goal may be to retard the growth of the cancer.  But for a young man, the goal is cure by the types of procedures.  If the cancer is slow growing, early stage, then one option might be the best.  But if fast growing with a high Gleason Score, many options might be taken off the table.  A good article concerning this appeared in the New England Journal of Medicine (Winter 2008).

Drawing a hierarchy of treatments, my surgeon explained six of them to my wife and me.  There may be more that you read about, but these are the typical treatments to choose from.  In the hierarchy, “watchful waiting” was at the bottom because of the Gleason Score and my age.  Both were against me.  Next was a series of chemical injections.  Again, this put time against me as this takes a number of injections to see results.  Fourth on the list was hormone therapy.  This can be a good option for older men with slow growing prostate cancer or early stage.  Hormone therapy retards the growth of the cancer.   These were treatments 6 through 4.  These treatments are not cures.  They are means to control prostate cancer.   Here I say emphatically:  You MUST consider your age in treatment AND you must ASK your doctor all the risks and side effects of each of these treatments.  EVERY treatment does have a side effect from impotence to incontinence to breast tissue enlargement (hormone therapy) that you must be aware of before you make a final decision.

 For me the goal was cure.  Cure treatments would allow me to live well.  Cure treatments also have their side effects, but would allow me to still life a full life.  In a previous blog, I talked about my personal mission and how it guided me in this particular choice.  Additionally, I had a trip planned for Egypt.  I had tried for 8 years to get to this country that I taught about every year at my University.  But because of so many circumstances, I could not get there.  I wanted a cure—one that would give me life and allow me to live this dream of touring archaeological sites in Egypt.

Curing prostate cancer is never 100%.  As I know intellectually and my doctor reminds me in the ongoing blood tests, “It only takes one cell to get away and multiply again; so we work at cure and ongoing monitoring.”  THIS is the life long journey started with prostate cancer, as with any cancer.  For me the options for ‘cure’ were freezing the prostate with liquid nitrogen, radiation, or prostatectomy.   Freezing may be a good option, but does have some dangers associated with it.  While there are significant safeguards, if an area unintentionally gets frozen, it is destroyed; no turning back.  Radiation is a good cure, but again, age is a factor.  The return rate of cancer following radiation may be as much as 15% over 15 or so years.  Thus if you are 80, that is not a problem.  But if you are 50, that is a problem.  And if radiation is used, it burns up the prostate and the tissue around it.  In essence, as my surgeon said, your prostate is like a charbroiled brisket.  If the cancer would return, there is nothing to surgically remove or radiate again.  You may be faced with chemotherapy as the only option.  The final option for me was surgery, a prostatectomy.  The cure rate is approximately 93%; remember nothing is 100%.  This is the cure treatment I chose, again because I want to live long and well.  There was a good deal of life remaining for one seeing the future from age 53.  I will explain this procedure in the next blog and the options related to it.      

So now, questions to know in the consultation or ask of yourself in the process:

  • What is my Gleason Score?  Is my cancer slow growing, early stage or fast growing?
  • What factor does my age play in the treatments for prostate cancer?
  • What are the side effects of each treatment offered to me?
  • What is the cure rate for each of the treatments offered me or are these treatments meant only to retard the cancer’s growth?
  • What is my goal in prostate cancer treatment related to my age and circumstances?
  • What is the percentage of reoccurrence of prostate cancer if I use this treatment option?
  • What does my wife need to know about these treatments or options?  What is she feeling about these cancer issues?
  • Finally, remember to ask questions, ask questions, and ask questions…..

 

 My personal mission and desire to live and live well helped me choose that option of a prostatectomy.  It allows me the best option for living a long life and growing old with my lovely wife.  While nothing guarantees anything, choosing this option from a place of being fully informed allows me the greatest potential to live as it is intended.

Blessings to all you men in the prostate cancer club who are currently faced with many decisions.  Make them well and with focus on life!  Grace and peace.

David Neidert

January 30, 2010

Prostate Cancer: My Story Guided by Personal Mission

Life is about choices.  My personal mission guides me all the time.  It guides my thoughts and how I make decisions.  Because I want to “invite people to abundant life by choosing God’s best” I am writing this particular blog on the area of my prostate cancer surgery and future.  This is my experience.  I want to weave through it how my personal mission helped me (and continues to help me) make decisions 1 ½ years after my cancer surgery.  I write it as an encouragement to men who are facing the reality of prostate cancer and potential surgery or other treatments.

I am writing, too, because when it was determined that I had prostate cancer; I joined a ‘secret club.’  I use this phrase because of encounters I have had with men concerning their own potential of cancer.  I have often had men come and talk close up to me about ‘their situation.’  This is a private matter for men, but I want to break that silence and talk frankly and authentically about prostate cancer, its treatment, and the life journey.  In the end, it is my hope by sharing my story; other men will find abundant life by how they make choices in their own prostate cancer situation.

After I was diagnosed with prostate cancer, I began researching about this disease.  While I found a lot of good medical advice, I didn’t always find how men actually worked through this emotionally.  As I stated in a previous blog, the outcome of prostate cancer always revolves around three ongoing concerns: impotence (the inability to have an erection or sustain an erection during intercourse); incontinence (the inability to hold one’s urine and thus a man leaks, often forcing them to wear absorbent underwear), and; cancer management.   I have this discussion every time I see my surgeon.  But I did not find any reflection about these topics in my internet search.

I don’t take these lightly because for men they are important issues.  Plus I think it important not to just deal with these three areas of concern, but with the emotions that go with them.  I will deal specifically with impotency in another blog, because it is the one that I did not find a good deal of information on.  Since this deals with sexuality, I will deal with that later.

There is a billboard near our house that says, “You wouldn’t tell a person with cancer to just get over it.”  The billboard is about how we sometimes respond to people about depression.  It is an apropos statement because a person getting a diagnosis of cancer does not get over it, but this diagnosis also can lead to depression.  In my own case, I realized that I was a victim of a drama not of my own creation.  There were ‘actors’ coming in and out of my life that I did not create, but had to acknowledge and work with in this journey.  For me, I would have moments of heavy sighing….just a ‘soul sigh’ because I had cancer in me that I could not control.  It was growing and I couldn’t do anything about it.  I was moving to the instructions of a lot of people simply following their directions and making decisions on the advice they gave me. 

This is where my personal mission came into play.  In these moments, I kept asking myself what was important in life. What had I determined was important for living well?  How would I honor God in how I lived my life and made choices about this cancer journey?  How would I set an example for my children and other men I came in contact with?  My personal mission served as a foundation for the choices I would have to make.

The first choice was to accept that I had prostate cancer and would have to do something about it.  At 53, there are not a lot of options.  Older men have more options related to prostate cancer, but younger men have to be intentional in seeking consultation that will help them win over this disease; to find a cure.  If one is in their 70s, wait and see can be an option; but at 53 waiting is not in one’s favor.  So the first choice was, “Who should I listen to?”

I had a plethora (dozens actually) of people ‘telling’ me how to proceed.  Everyone had their own story, their own advice.  I had a number of people point me to experimental drugs, herbs, new techniques, and a host of other ways to deal with prostate cancer.  But, each man has to deal with this journey how they view as the right path.  After a lot of reading, I intentionally chose a well respected surgeon (plus a dear friend put me in touch with him).  This was and has been a key for me.

As I close today, my mission guided me to choose a good doctor.  In today’s health environment, YOU are responsible for your own health care.  The Ad Council has a good commercial.  A person is asking all kinds of questions of a waiter about what is in a particular menu item at a restaurant before they order it.  But in the next scene, they are sitting on a table in a doctor’s office.  The doctor says, “Do you have any questions?” To which the patient says—“no.”  We would rather know how many calories are in a plate of food than what is happening in our bodies!  Men, in particular, are more likely not to ask questions. 

Thus the desire to live well allowed me to make a good choice—I have things that I believe I am to do in this world; a table of opportunity set before me.  So I chose a good doctor and took control of my health care at that moment.  I had some depression along the way as well, yet my personal mission, faith, and life of prayer helped me work through these moments of ‘soul sigh.’ 

A personal mission and future hopes guided me in this initial endeavor.  It can guide you, too.

Blessings, grace and peace.

David Neidert

January 26, 2010

Prostate Cancer: Personal Mission Helps in Facing Identity Issues

Consultations can be overwhelming.  That was the case with my own prostate cancer consultation two weeks after my biopsy showed I did have cancer.  My doctor, Dr. John Ramsey of Urology of Indiana, spent three hours with my wife and me discussing the biopsy, treatments, and the outcomes of any decisions we would make.  My wife and I sat as he drew pictures, explained in detail procedures, and thoroughly outlined any options we might have before us.  He answered a lot of questions.  In the end, because of my age (53 at the time), the best option out of six potential solutions was surgery.

This is where personal mission, faith, and belief in living well help one to make decisions that matter for the long term.  Knowing what is important allows us to evaluate all the complexities and make more effective decisions in the moment.  Having a written mission statement and living it out can make decisions easier.

I have to back up a little to describe one of the issues that men MUST face, discuss, and talk through related to prostate cancer.  It is the issue of male sexuality.  Again, I am no psychologist, but I do understand myself and am aware of the many innuendos our society places on virility, mostly subconscious.  As a teacher and student of ancient history for thirty years, I know that sexuality has permeated every culture of the ancient world, from fertility cults to ritual practices to architectural design.  It doesn’t matter if you consider the Far East, Ancient Middle East, or Meso America, you will find sexual rites a part of every society (we just don’t read about them in our history books).  The phallus (as well as women’s sexual anatomy) can be found in all cultures as a representation of masculinity, virility, and power.  In ancient myths, sexuality, intercourse, and male power displayed in the phallus are commonplace, even if we never read this kind of literature in polite circles.

One of the very real outcomes of prostate cancer (whether through surgery or leaving it untreated) is the loss of impotence (erectile dysfunction).  This is a fact of the male reproductive system.  The nerves that allow for a male erection are side by side with all the nerves connected to the prostate.  While I do not know all the physiology, I have given recommended websites to help men understand their anatomy.  The bottom line is that erectile dysfunction will increase with prostate cancer.  Thus, men must think through this part of who we are.

So a question has to be answered.  Will men lose their lives to try and save an erection by not having surgery (or other treatments) or take the treatments or have surgery and save their lives?  Will my identity be wrapped up in my ability to have an erection or will it be built on character, purpose, and living well in all life areas?  Our world is saturated with sexuality.  It tells us if we are not sexually capable, we are actually not men.  Just consider hand gestures used in profanity.  Consider statements made in movies, like “what’s the matter, can’t get it up?”  Men are portrayed as less than adequate in all kinds of commercials and media if they are sexually unable to perform.  Prostate cancer leaves men with this very possibility of impotency.  It is important to know that if nerves get cut during surgery or even damaged by radiation or other treatments, the ability to either get an erection or maintain one will be diminished. Viagra, Cialis, and other ED drugs can help, but men MUST know that they DO NOT restore an erection to 100%.  So, this section and answering these questions are critical for men and their wives related to prostate cancer.  (More in future blogs about ED drugs).

For some time, I had the Bible verse on my mind that whoever seeks to save their life will lose it, but whoever looses it will find it.  That verse along with my desire to live well forced me to have to think clearly about this part of prostate cancer.  My friend David, however, was the one to force the issue.  I did not know he knew I had prostate cancer.  David had undergone a prostatectomy (full removal of the prostate) about a year earlier.  He stopped by my office to just “talk.”  He asked how I was, but then forced the discussion of sexuality and impotence.  I am a private man by nature, but I needed him to talk frankly with me.   I needed him to be honest with me from his own experience.  He talked most candidly about the change in the sexual relationship with his wife, but also the joy of it….the deeper parts of intimacy came through.  They had found newer ways to love each other sexually.  But before he left my office he said, “Seek the higher good; save your life to find more life.”  That was honest and that was the confirmations of my own thinking…possibly lose the potential of some sexuality to find wholeness, well being, and life.  Trust in God and trust that my life decisions would matter over the long term.

So it was at the end of the three hour consultation that Dr. Ramsey asked, “What do you want to do?  You can leave and take a few days to think about it, if you like, just don’t wait too long.”  I leaned forward onto the table where we had talked that evening and said to him, “There is something you need to know about me.  I am a man of deep faith and a man with a mission and purpose in life.  I want to grow old with my wife because I love her and there are things I have yet to do in this world.  I make the decision to have a prostatectomy.  When do we schedule it?”  Dr. Ramsey chuckled a little in response, “You are pretty sure. That is one of the most purposeful responses I have ever heard.”  My wife nodded in agreement.   He continued, “Sometimes men leave here because they cannot consider the possibility of impotence and never come back.  It is an important decision to make so that it doesn’t take your life.”  And with that, we scheduled the surgery for the next opportunity.

You see, it does matter that we have a sense of purpose, a mission, a deep faith that will help us think through difficult issues, even the issues of sexual identity and performance.  If we know what we believe, we can be confident in whatever life presents us.  In the blogs ahead, I want to outline tools to use for writing a personal mission statement.  I will return again with frank sharing on the topic of prostate cancer, because I needed a place of authenticity in my own journey; but I did not always find them.   I some future blogs, I will talk about these last 16 months of my own prostate cancer journey and the aftermath of it.  But for now know that a personal mission can help you choose life in life’s toughest moments.

Grace and peace.

David Neidert

January 25, 2010

Prostate Cancer: How Personal Mission Helps in Crisis Decisions

This blog is my first public sharing about prostate cancer.  I will be sharing a number of important topics during the upcoming blogs on this cancer journey.  I share them because I have had many men come and ask me about their own prostate cancer issues.  I am sharing frankly and authentically about my journey.  I am not an expert in prostate cancer, but I do understand my own emotions about it.  I want to be frank in these posts so that other men with prostate cancer in their future can find some honest insights into what they will experience.

My cancer journey started in December 2007.  I have an accountability partner.  This is friend who I meet with regularly to discuss life, my goals, and areas of concern or frustration in my life.  He is a really important friend.  One of my commitments to him is to have an annual physical since I am 55 years old (I was 53 at the time of cancer discovery). 

I went to my doctor as promised and completed my physical.  While all was good, my doctor said, “Your PSA is just a little high.  Let’s send you to a urologist for a follow up.”  I went to a urologist in the following week.  While his bedside manner was lacking, in retrospect, he was the first to detect my cancer by digital rectal exam (DRE).  I didn’t really want to accept that initial exam from him, so I began praying about my next steps and where I should go in this process.  I couldn’t ignore it; I had to deal with something that several doctors told me might be growing in me.  A dear friend (who had dealt with prostate cancer) led me to Urology of Indiana and Dr. John Ramsey.  As a side, I would encourage any man thinking they have prostate cancer to locate a urologist they are comfortable working with.  This is a critically important issue.  We all must take charge of our personal health.  My desire for a second opinion (allowed by most medical plans) was a way that I did take charge of my own physical health. 

It was now January 2008.  I had been dealing emotionally with all that was transpiring over the course of three weeks.  I had a range of emotions—fear, disbelief, anger, denial—emotions that moved from moment to moment, day to day.  I began searching websites and found many that described prostate cancer as a “life journey.”  I realized this was becoming the start of a much longer pilgrimage than initially imagined.

My faith was a solid foundation during all this time.  As I have stated in my “Who I Am” section, I am a believer in Jesus Christ.  I believe he watched over me and was protecting me in this journey and initial discovery.  Not only did we discover I had cancer, but also an aneurism.  I was finding that my faith was a central point for me.  A stable faith continued guiding me in times of doubt and frustration.  Believing that God was watching over me was essential to giving perspectives to the tears I shed at times wondering about the upcoming doctor’s visits.

A month of waiting and personal agonizing had now turned into February 2008.  On Feb. 20, I had a biopsy.  A prostate cancer biopsy consists of inserting a probe to the prostate through the rectum (the probe is about the size of a frankfurter).  This probe has a needle in it that inserts a Novocain or anesthesia into the prostate.  The prostate is a gland that sits on both sides of the urethra, the tube leading from the bladder into the penis for urination.  One half sits on each side of the urethra.  The prostate holds the semen that is emitted during intercourse/ ejaculation.   The probe then has a needle that grabs microscopic sections of the prostate.  Typically there are four to six sections taken from each side of the prostate.  The probe sampling stings a bit.  The noise of the probe is like a loud mouse trap snap.  This snap startles, but the Novocain makes this tolerable.  You are lying on your side in a fetal position during this procedure.  After the biopsy, you are a bit tender in sitting and will experience some blood in your urine over the coming day or so.  The procedure takes about 30 minutes, in which you are awake the entire time.  Once the procedure is complete, the waiting begins.

On Feb. 26 my doctor called.  I definitely had cancer.  One side of the prostate was a zero (on the Gleason Scale), but the other side of the prostate was a seven on the cancer scale of zero to 10.  This meant a series of appointments must now begin.  The first was to have a full body bone scan.  Prostate cancer makes its path into the bladder and bones.  Prostate cancer is always prostate cancer, except that it can lodge in the bones or move to the bladder (which is only separated by millimeters of tissue).  So, my first appointment was a full radiation body bone scan to determine if the cancer had spread.  With a report that the cancer had not spread, I was ready for my first major consultation on the steps we would now need to take to deal with my prostate cancer diagnosis.

During the weeks between January 1 and Feb. 26, I had a lot of time to process my thoughts and emotions.  I had to deal with them….any man with prostate cancer will have to deal with them.  I had to deal with the possibility of the spread of the cancer, the possibilities of complications, the fact that I am young with this disease, and the effect this diagnosis might have on my sexuality and sexual relationship with my wife.  But in it all, I was focused on the items I have already been blogging about….having a personal mission and knowing what really matters in life.  My faith, my mission, and my determination to live well were always at the center, even in times of grief and anxiety. 

Having a personal mission helps in crisis decisions, like those of cancer.  Whether it is cancer, a broken relationship, a loss of a job, or other events that happen in life, I am convinced that knowing what personally matters and making a choice to live well allows better decisions and choices to be made.  Having a personal mission doesn’t change the fact of the situation or maybe even the outcome, but it does allow you to be in a place for creating a brighter path through these life events.  A personal mission helps make the decisions cleaner and more definitive.  It also adds courage for the long outcome, not the short term issues.

My faith, mission and life purpose would allow me to make some choices.  I will explain how in upcoming blogs.

Grace and peace.

David Neidert

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