Here is December 30, 2008 trip to radiation. I don't use an alarm and have never overslept. All told this day we were gone two hours and 51 minutes. We drove 129 miles. The actual radiation session took about 12 minutes.
5:56 Wake up, look at the clock, turn back over.
6:07 Get up. No shower this morning. Go down to eat before 6:30
6:35 Decide to go. The predicted snow is not falling.
8:06 Get into the Camry. 85031.
8:12 Merge onto 94. Very light snow. 85033.
Mile 24 blowing snow. No slippery spots. Snow reminds me of smoke on the road.
8:36 6 oz. of water. 85061.
8:39 More snow, heavier. 85066.
8:46 Snow worsens. Decide not to turn back. 85073
8:48 St. Croix River Bridge. 85075
8:52 Rest Area. Two buses but not crowded. Urinate and defecate. This will be the pattern. 85078.
8:58 Merge again onto 94.
9:06 Merge onto 694.85085.
9:15 Turn onto White Bear Avenue. 85094.
9:20 Park in the Mohpa lot. 85095.
9:23 Register on Radiation computer.
9:29 Called in to radiation.Remove shoes. Lie down. Two x-rays. 7 radiation positions. Move/pause/generate/pause/whir/pause/generate/pause/whir/move and repeat. About 56 second in each position, plus time taking the x-rays and waiting for the doctor to check my position.Plus the time to walk in, take off shoes, get settled on the bed, get laser-adjusted on the bed and the reverse at the end, plus a urination. The bladder was filled just right this morning I thought. I will explain the position process in another writing. All this on the Varian machine. More on that later too.
9:45 Greet Mary as I come out of the door.
9:51 Turn onto Beam Avenue.
9:55 Merge onto 694
10:04 Merge onto 94.
10:13 St. Croix River Bridge.
Mile 17, 40 more acres for sale. More mile posts Ken Heintz creek, Wilson Creek, slippery at Mile 40
10:57 Turn onto Broadway. 85158. Menomonie, 14937. Streets slippery. Mary decides not to go to Colfax this afternoon.
10:55 Turn onto Meadow Hill Drive.
10:57 Enter garage. 85160.
Tuesday, December 30, 2008
Saturday, December 13, 2008
A Day in the Radiation Machine
December 13, 2008
I have completed four actual and one simulated radiation treatment. Here is their scenario.
It takes about an hour and five minutes to get from our house to the MOHPA clinic in Maplewood. We have been arriving about 15 minutes early. For a 4:00 pm treatment we would leave about 2:45. The drive is easy, a bit long, rolling Wisconsin countryside, including two herds of buffalo.
At the clinic I sign in, by typing my last name into their ‘radiation computer.’ When I click enter, the radiation therapists get a note on their computer that I am here. At the appointed time—so far they have been late only once, more on that below—one of them comes to call me in to the treatment room. In the room I take off my shoes and empty my pockets. One of the therapists holds a modesty towel close to my belt and I undo the belt and slip down the pants and underpants far enough so that I expose the three tattoos that they use to line me up. You can see one of the tattoos in the photo at the above left. It is about 2 mm wide.
As you can see on the picture above on the right, I lie on a bench, an elaborately technical bench about 19 inches wide and seven feet long. My feet go into the mold (the white thing under my feet) that they made on my first planning trip there in November. My head lies on the pillow and, to keep my arms from flopping around, I hold a plastic ring which lies on my chest; that’s what my hands are doing in the picture. The bench has no padding. The idea is that my body must be in the exact position that it was in on the planning day. Padding would add another element of inexactness so there is none.
After I lie down the therapists move me around using several laser beams targeted on my tattoos so that I am in the exact same position, or nearly so, as I was on the planning day. You can watch this process in the movie below at the end of this post.
As you can see in the photo, above me is a nice large photo of a seascape. After the therapists leave the room, they dim the lights and the bench slides me into the radiation position closer to the center of the machine. I am in that position in the photo above.
During this first week, I have had a two-part treatment. In the first part, the imager (the square thing hovering above me in the picture) takes “quick CTs” of my pelvic area. Back in the control room—I will write about that another day—the doctor and the therapists align that CT with the one taken on the planning day. They are looking for an exact alignment, as they deal with tolerances of less than a millimeter. One of the reference points that they use are the gold markers that were inserted in me some time ago.
Once I am aligned the actual radiation treatment begins. The radiation unit (the radiator?), aka the 'linear accelerator', which is the round unit with the blue ring to my left in the picture, rotates overhead around to a position underneath me on my right. Call that position 1. In that position it emits two bursts of radiation. Position 2 is slightly higher and so on around me. Position 4 is directly above my pubic bone and then there are three more. Position 7 is underneath me to my left. In each position there are two bursts of radiation, that radiation being X-rays. They used to use cobalt but don’t anymore. The bursts are aimed at locations that the doctor has identified as highly probable to have cancerous cells. The bursts are not emitted for a length of time, rather they are emitted for units of strength. The actual length of the burst is determined by how long it takes to get through various environmental factors, such as humidity, in order to impart the number of units to me.
That’s it. The whole thing takes about 25-30 minutes from the time I enter the room until I put my shoes back on to leave. At this point in the sequence of treatment there are no noticeable side effects. Having one of these treatments is like having an x-ray of a broken bone. Right now I feel fine. No tiredness, no nausea, no pain in my pelvic area. And to repeat something I said before, no radioactivity that I carry around beaming at others. This is not the same as chemotherapy. They are microwaving me, not creating Chicken Kiev.
Let me add just a few notes. While this sounds like precise science, and it is, I am the factor that changes and must be accounted for. The issue is the amount of water in my bladder and the amount of gas and/or ‘matter’ in my bowel. I am supposed to duplicate the bowel/bladder configuration of the planning day. Well, easier said than done. The basic plan is urinate and evacuate one hour before the treatment. Since we are on the road that is not possible unless we happen to hit the Minnesota Rest Stop west of Hudson. I go when we leave. Then 45 minutes before the treatment I am to drink 16 ounces of water, which I do faithfully. The water reacts differently. In the early morning treatments, I never feel full, not like I have to urinate Right Now. The doctor even chided me that I was not full enough. In the afternoon treatments I often have the sensation, as my dad used to say, that my back teeth are floating. Twice I have gotten to the clinic and realized that I could not hold the stream for 30-40 for minutes, and one time, because of a technical problem they were 20n minutes late. Both times I snuck into the bathroom and relieved my self of a little of the liquid in the bladder, no small feat for a guy who wore Depends not even a year ago. And even after doing it twice the day the machine had problems, they still told me that my bladder was extremely full.
The point of this concern is that they want the bladder out of the way so that the small bowel gets pushed out of the radiation field. I will eventually get a better explanation but, as I understand it, they want to avoid the bladder and the rectum with the radiation and just hit the infected area. That is the point of the gold markers and the alignment and even of them moving the bench slightly one way or another.
One last note. I am learning all this. I am sure of the physical descriptions and sequences that I explain here. I am guessing at the rationales. I have asked the staff. They are patient and clear with their answers, but I probably have mistakes here. Just so you know.
Prostate Cancer and Sex, part 3
December 11,2008
The amazing thing about living with someone for forty plus years is the depth and breadth of the relationship. Life becomes a kind of endless dance where we anticipate each other’s moves and swirl gracefully into them. And that dance includes finishing each other’s sentences, knowing what scene in our past this current scene makes us think of, even getting up at the same time in the night to go to the bathroom (thank the lord for houses with two bathrooms). Of course that dance extends to sex. A certain look (yes, there actually is THAT look), a certain phrase, a certain wiggle or giggle, and the deal is on. This much time on dishes, that much time on email or tv or phone calls, or wine drinking, and then up to the bed and the, ah, consummation. If that look happens at breakfast, there is an entire day of something akin to squirming, waiting, anticipating. The drive home is sweeter, the meal tastier, the book less interesting. And if it doesn’t happen today—the day was rotten at work, a cold or headache started (for real), exhaustion kicks in—that is ok, because there is tomorrow. There is a basis, a bed rock, to life together, an understanding, an understanding that this important union is always possible, always there, always part of yesterday, today, and tomorrow. It is the air we like birds fly through, the water like fish we swim in, always there. And now it is gone.
As I said in an earlier post, really gone. Images, situations, fantasies that used to work, not only don’t, they seem remote, even silly. So there I am, full of lupron, the testosterone done, the psa down, the desire not down, gone. And what of that dance, that air, that water? Gone?
For some people it is gone, and their marriage is over. Ours didn’t happen that way. Instead, I discovered--I think I always knew it, but was never tested—that we had woven a strong cloth and the sex was just one of the threads. The cloth didn’t unravel. All those years of traveling together, acting together—the kids, the book, the family crises, the parental deaths and worse the run up to those deaths, the laughter, the meals, the sense that we, together could accomplish anything, could get through anything, all of that kicked in. The rug got pulled out from under me but I landed in her arms. Her smile still there, her eyes like they sparkled on our wedding day (and among other days those when they were conceived), like they sparkled when we strode into Siyeh pass the first time, or the time we touched Emerald Glacier. Or the time she got off the train in Raleigh, just back from Europe, her hair short, wearing the scarf and coat it took me years to let her give away, that moment when the deal went down.
At any rate our history, alive as it is in the moment, and in the forecast for the future, sprung alive in a way that surprised me. Those moments, glances, dropped code words, gone, but not the support not the joining, the joining of a different type than sex, but, it turns out, as powerful. And so we can make fun of ourselves in situations that would have led to ‘intimacy,’ now passing at best with a smart crack and at worst unnoticed. I have had to learn to be sure to touch, to soothe, to run fingers through hair, to, with all the thrill of a 14-year old, cop a feel, accidentally run my hand over her ass, give a kiss. What can I say? I have been blessed with an incredible gift from cancer—an awareness of a depth that I not only did not know I had but didn’t know existed. I trust that the lupron and its effects will pass (at the end of May) and that at least some of the old way, old dance will return, but it will be so much richer for what I have found and can live now. Cancer gives strange gifts.
The amazing thing about living with someone for forty plus years is the depth and breadth of the relationship. Life becomes a kind of endless dance where we anticipate each other’s moves and swirl gracefully into them. And that dance includes finishing each other’s sentences, knowing what scene in our past this current scene makes us think of, even getting up at the same time in the night to go to the bathroom (thank the lord for houses with two bathrooms). Of course that dance extends to sex. A certain look (yes, there actually is THAT look), a certain phrase, a certain wiggle or giggle, and the deal is on. This much time on dishes, that much time on email or tv or phone calls, or wine drinking, and then up to the bed and the, ah, consummation. If that look happens at breakfast, there is an entire day of something akin to squirming, waiting, anticipating. The drive home is sweeter, the meal tastier, the book less interesting. And if it doesn’t happen today—the day was rotten at work, a cold or headache started (for real), exhaustion kicks in—that is ok, because there is tomorrow. There is a basis, a bed rock, to life together, an understanding, an understanding that this important union is always possible, always there, always part of yesterday, today, and tomorrow. It is the air we like birds fly through, the water like fish we swim in, always there. And now it is gone.
As I said in an earlier post, really gone. Images, situations, fantasies that used to work, not only don’t, they seem remote, even silly. So there I am, full of lupron, the testosterone done, the psa down, the desire not down, gone. And what of that dance, that air, that water? Gone?
For some people it is gone, and their marriage is over. Ours didn’t happen that way. Instead, I discovered--I think I always knew it, but was never tested—that we had woven a strong cloth and the sex was just one of the threads. The cloth didn’t unravel. All those years of traveling together, acting together—the kids, the book, the family crises, the parental deaths and worse the run up to those deaths, the laughter, the meals, the sense that we, together could accomplish anything, could get through anything, all of that kicked in. The rug got pulled out from under me but I landed in her arms. Her smile still there, her eyes like they sparkled on our wedding day (and among other days those when they were conceived), like they sparkled when we strode into Siyeh pass the first time, or the time we touched Emerald Glacier. Or the time she got off the train in Raleigh, just back from Europe, her hair short, wearing the scarf and coat it took me years to let her give away, that moment when the deal went down.
At any rate our history, alive as it is in the moment, and in the forecast for the future, sprung alive in a way that surprised me. Those moments, glances, dropped code words, gone, but not the support not the joining, the joining of a different type than sex, but, it turns out, as powerful. And so we can make fun of ourselves in situations that would have led to ‘intimacy,’ now passing at best with a smart crack and at worst unnoticed. I have had to learn to be sure to touch, to soothe, to run fingers through hair, to, with all the thrill of a 14-year old, cop a feel, accidentally run my hand over her ass, give a kiss. What can I say? I have been blessed with an incredible gift from cancer—an awareness of a depth that I not only did not know I had but didn’t know existed. I trust that the lupron and its effects will pass (at the end of May) and that at least some of the old way, old dance will return, but it will be so much richer for what I have found and can live now. Cancer gives strange gifts.
Thursday, December 11, 2008
Prostate Cancer and Sex, part 2
December 8, 2008
Anyway on to sex. There are two issues—emotional/relational and physical. Let’s talk about physical first. The deal is, Can you get a hard on? Well, sorry, erection. My answer is yes, with difficulty, and nowhere near as hard as before. Let’s talk about that. The basic rule is Use it or lose it. But the physical reality is that those nerves were severed, even though laproscopy, which I had, is more precise than the previous method of the incision from the belly button to just above the penis. The result is that what used to happen, well, more or less with a thought (remember the 5th grade joke? What’s the lightest thing in the world? A cock, because it can be raised with a thought.), doesn’t. Thoughts won’t do it. So the usual fantasies, whatever yours are—you don’t think I’m going to tell you mine, I hope, not on a free blog—won’t do it. I couldn’t/can’t get into much of a ‘state.’ I tried looking at porn, reading some porn, and, while I understood the attraction of certain scenes, even words, and poses, not much happened. By that I mean that I could get to a state emotionally where I wanted to have sex, but no matter how I went about it, the erection was never the, well, rod it used to be. Talk about the spirit willing but the flesh weak.
Now an interesting thing—during this period, from roughly 8 weeks after the operation until about one week after I received the lupron injection, from March till October, though the erection was weak, the orgasm was not. The orgasms were fantastic, among the best I have ever had. They went on for a longer time and the intensity, the way they grabbed me inside, in my chest and head, was more powerful than nearly any I had ever had. I wondered before the first one what it would be like without an ejaculation. I was surprised. It was exactly the same, same buildup, same quivering, same peak, same screaming climax, same feeling of let down and being over. Now the one thing I will reveal. Since these accompanied an erection that was not particularly erect, they took place in my wife’s hand. There was no, well, mess, another surprising thing, and I found I didn’t miss it.
During this period, I was supposed to use two aids to erection—a vacuum pump and one of the erection pills, Viagra or Cialis. The vacuum pump is exactly that, a pump. It has a long tube that fits over the penis and a pump handle on the end. A person, me, lubricates the end of the penis, so it will slide in the tube, and also lubricates the front edge of the tube so that the tube fits against the body with an air tight seal, thus allowing the vacuum to work. The pump creates a vacuum and the vacuum makes the penis extend from its limp state into the cylinder in a semi-erection. The idea is to pump the handle and enlarge the penis, then push a button which releases the pressure, and the penis shrinks back to its original state, then pump again. During each cycle the penis gets longer and more engorged. For me it never got to a consistency that amounted to what I would think of as a ‘usable’ erection. The company supplied some rubber band-type objects that could be applied to the base of the erection, preventing the blood from draining out, and the result could be used in sex. According to the literature that came with the pump, this erection should work, leading to fun and excitement. For me it never did. Frankly I got as far with the porn as with the pump. I still use it but it is boring. Each daily session is 15 minutes, so I drop my pants, turn on a TV, one of the ones that are out of the way, and do the ‘exercise.’ I call it, not very reverently, a vacwhack, but I suppose that merely serves to cover my frustration that it has not worked particularly well for me. I keep at it. The literature, and the sex therapist, say it eventually will work, and that as a result of using it, I will not lose it.
The other strategy is the erection-aid drug. You have no doubt seen those ads of a gray-haired guy, usually with a woman young enough to be his daughter, dancing off the floor to the elevator which they take to an upper, secret floor and a night of wild bashing, lashing and crashing. I doesn’t happen like that, at least not for me. Remember I mentioned headaches? I got them. Over and over I would take one of these pills—note that they don’t make you horny, they only get you an erection; you have to make yourself horny, though what guy my age wouldn’t be so at the thought of a sweet young thing not only choosing him, but expecting that she could get physically from him what she couldn’t get from some 25-year old? Ah, well, what bull. The headaches. The next day after taking one of these my head would pound, and pound. Just like the bad old days, it felt like a nail driven through my right eye into my brain. I spent a number of next days dragging through the rituals of the day. And to combat the headache effect, I began to drink a lot of water, 4 liters a day. That helps some, I have to admit, but of course if you drink that much you pee that much. So then I was like the guys in the ad who kept missing the big event (and being not so much laughed at as tsked) because I was constantly running off to the bathroom.
These pills come in various sizes, 40, 20, 10, and 2.5. I kept lowering my size intake, hoping to get to the therapist’s recommended intake of three times a week. I couldn’t. No way could I do that and go to work or have any kind of day on the days after I took the pills. I have to admit there was a certain licentious thrill to taking them at first. I was one of those guys who could chemically overcome the body and perform for my woman, satisfying her just like I did 40 years ago. No doubt there are many men who have very satisfying experiences with these drugs. I didn’t. As I said I got as far with the porn and that was not all that far. I will keep at this of course, but the failure of it to work has led to some other emotional realizations.
I suppose that the medication that bounced me into another realm was lupron, an estrogen. Lupron reduces testosterone on which prostate cancer feeds. Less testosterone, less cancer. It is admisnistered in a shot (in the butt) that lasts for four months. I got the shot. It worked. My psa was cut by more than half. The upshot though is a total loss of libido. I mean total. I have to admit; I have seen many sexy women and pictures of sexy women. It used to be that I would look and think ‘nice.’ My wife and I had a kind of dance, you know what I mean, that could go on for two days, extended foreplay, thrilling, fun, compelling, satisfactory beyond belief, never boring, never something to take or leave. Now I don’t notice, hardly look, and never think ‘nice.’ At most I look and think, I used to think nice, now I just look. In other words I exist in the world sexlessly. There is no desire and no action. I had to learn that I had to still fondle and kiss and touch and caress and make jokes. I did, and I feel good about that.
So let’s go on to the emotional/relational side of this. I have already done quite a bit of explanation of the emotional. In the early months the emotional desire was there and could be acted upon. We could do the dance and hop into bed and, though the mechanics were a bit different, have a satisfactory, thrilling event. (Sorry, in spite of saying earlier that I would be candid, I can’t. A) it really isn’t your business and B) use your imagination.) But the point is that the physical and emotional changed, but remained at least similar to previous.
With the lupron that is over. No hopping into bed, no thrilling, and, in that sense, no satisfactory. If that were the basis of our marriage—no thrills, no satisfaction, no relationship—ours would end. And so I have had to take on the relational task of having my best friend and the only sexual partner I want, and have ever had, be just my best friend. What to do? I feel like the answer is one that I can’t joke about, even though I find that laughing is probably the best way to handle the condition I have, we have, and the cards we have been dealt. So I need to end here and begin again another night when I can focus just on the relational and the amazing power I have found in this new state.
Anyway on to sex. There are two issues—emotional/relational and physical. Let’s talk about physical first. The deal is, Can you get a hard on? Well, sorry, erection. My answer is yes, with difficulty, and nowhere near as hard as before. Let’s talk about that. The basic rule is Use it or lose it. But the physical reality is that those nerves were severed, even though laproscopy, which I had, is more precise than the previous method of the incision from the belly button to just above the penis. The result is that what used to happen, well, more or less with a thought (remember the 5th grade joke? What’s the lightest thing in the world? A cock, because it can be raised with a thought.), doesn’t. Thoughts won’t do it. So the usual fantasies, whatever yours are—you don’t think I’m going to tell you mine, I hope, not on a free blog—won’t do it. I couldn’t/can’t get into much of a ‘state.’ I tried looking at porn, reading some porn, and, while I understood the attraction of certain scenes, even words, and poses, not much happened. By that I mean that I could get to a state emotionally where I wanted to have sex, but no matter how I went about it, the erection was never the, well, rod it used to be. Talk about the spirit willing but the flesh weak.
Now an interesting thing—during this period, from roughly 8 weeks after the operation until about one week after I received the lupron injection, from March till October, though the erection was weak, the orgasm was not. The orgasms were fantastic, among the best I have ever had. They went on for a longer time and the intensity, the way they grabbed me inside, in my chest and head, was more powerful than nearly any I had ever had. I wondered before the first one what it would be like without an ejaculation. I was surprised. It was exactly the same, same buildup, same quivering, same peak, same screaming climax, same feeling of let down and being over. Now the one thing I will reveal. Since these accompanied an erection that was not particularly erect, they took place in my wife’s hand. There was no, well, mess, another surprising thing, and I found I didn’t miss it.
During this period, I was supposed to use two aids to erection—a vacuum pump and one of the erection pills, Viagra or Cialis. The vacuum pump is exactly that, a pump. It has a long tube that fits over the penis and a pump handle on the end. A person, me, lubricates the end of the penis, so it will slide in the tube, and also lubricates the front edge of the tube so that the tube fits against the body with an air tight seal, thus allowing the vacuum to work. The pump creates a vacuum and the vacuum makes the penis extend from its limp state into the cylinder in a semi-erection. The idea is to pump the handle and enlarge the penis, then push a button which releases the pressure, and the penis shrinks back to its original state, then pump again. During each cycle the penis gets longer and more engorged. For me it never got to a consistency that amounted to what I would think of as a ‘usable’ erection. The company supplied some rubber band-type objects that could be applied to the base of the erection, preventing the blood from draining out, and the result could be used in sex. According to the literature that came with the pump, this erection should work, leading to fun and excitement. For me it never did. Frankly I got as far with the porn as with the pump. I still use it but it is boring. Each daily session is 15 minutes, so I drop my pants, turn on a TV, one of the ones that are out of the way, and do the ‘exercise.’ I call it, not very reverently, a vacwhack, but I suppose that merely serves to cover my frustration that it has not worked particularly well for me. I keep at it. The literature, and the sex therapist, say it eventually will work, and that as a result of using it, I will not lose it.
The other strategy is the erection-aid drug. You have no doubt seen those ads of a gray-haired guy, usually with a woman young enough to be his daughter, dancing off the floor to the elevator which they take to an upper, secret floor and a night of wild bashing, lashing and crashing. I doesn’t happen like that, at least not for me. Remember I mentioned headaches? I got them. Over and over I would take one of these pills—note that they don’t make you horny, they only get you an erection; you have to make yourself horny, though what guy my age wouldn’t be so at the thought of a sweet young thing not only choosing him, but expecting that she could get physically from him what she couldn’t get from some 25-year old? Ah, well, what bull. The headaches. The next day after taking one of these my head would pound, and pound. Just like the bad old days, it felt like a nail driven through my right eye into my brain. I spent a number of next days dragging through the rituals of the day. And to combat the headache effect, I began to drink a lot of water, 4 liters a day. That helps some, I have to admit, but of course if you drink that much you pee that much. So then I was like the guys in the ad who kept missing the big event (and being not so much laughed at as tsked) because I was constantly running off to the bathroom.
These pills come in various sizes, 40, 20, 10, and 2.5. I kept lowering my size intake, hoping to get to the therapist’s recommended intake of three times a week. I couldn’t. No way could I do that and go to work or have any kind of day on the days after I took the pills. I have to admit there was a certain licentious thrill to taking them at first. I was one of those guys who could chemically overcome the body and perform for my woman, satisfying her just like I did 40 years ago. No doubt there are many men who have very satisfying experiences with these drugs. I didn’t. As I said I got as far with the porn and that was not all that far. I will keep at this of course, but the failure of it to work has led to some other emotional realizations.
I suppose that the medication that bounced me into another realm was lupron, an estrogen. Lupron reduces testosterone on which prostate cancer feeds. Less testosterone, less cancer. It is admisnistered in a shot (in the butt) that lasts for four months. I got the shot. It worked. My psa was cut by more than half. The upshot though is a total loss of libido. I mean total. I have to admit; I have seen many sexy women and pictures of sexy women. It used to be that I would look and think ‘nice.’ My wife and I had a kind of dance, you know what I mean, that could go on for two days, extended foreplay, thrilling, fun, compelling, satisfactory beyond belief, never boring, never something to take or leave. Now I don’t notice, hardly look, and never think ‘nice.’ At most I look and think, I used to think nice, now I just look. In other words I exist in the world sexlessly. There is no desire and no action. I had to learn that I had to still fondle and kiss and touch and caress and make jokes. I did, and I feel good about that.
So let’s go on to the emotional/relational side of this. I have already done quite a bit of explanation of the emotional. In the early months the emotional desire was there and could be acted upon. We could do the dance and hop into bed and, though the mechanics were a bit different, have a satisfactory, thrilling event. (Sorry, in spite of saying earlier that I would be candid, I can’t. A) it really isn’t your business and B) use your imagination.) But the point is that the physical and emotional changed, but remained at least similar to previous.
With the lupron that is over. No hopping into bed, no thrilling, and, in that sense, no satisfactory. If that were the basis of our marriage—no thrills, no satisfaction, no relationship—ours would end. And so I have had to take on the relational task of having my best friend and the only sexual partner I want, and have ever had, be just my best friend. What to do? I feel like the answer is one that I can’t joke about, even though I find that laughing is probably the best way to handle the condition I have, we have, and the cards we have been dealt. So I need to end here and begin again another night when I can focus just on the relational and the amazing power I have found in this new state.
Monday, December 8, 2008
Sex and Prostate cancer, part 1
November 30, 2008
IT is time to talk about sex and prostate cancer. Just so you know, there is no way to do this without being graphic, at least in my opinion. So if this is a concern to you, all you need to know is this. Erections are difficult to achieve, orgasm is possible, ejaculation after surgery is not possible. Lupron, an estrogen, dramatically reduces your libido.
To help you understand what I will eventually discuss, you need to know that in my 30s I got terrible migraines, all on the right side of my head, often so strong that I was in bed for three days. They went on for years until I had my teeth straightened when they basically ended. I don’t know if that is a cause/effect relationship. They were so disabling that then, and now, I would/will do about anything to avoid them. Since my surgery I have had them again, though no where near as serious, and that fact colors the story I am about to tell.
When I was talking to doctors and a sex therapist prior to my surgery, I discovered anatomical facts that I never knew. The three experiences of erection, ejaculation and orgasm are independent. Erections are caused by nerves along and throughout the penis region. They get cut during the surgery. As a result it is harder to get an erection after the surgery. The nerves can be retrained but as you will see it is a laborious project. Ejaculation is caused by sperm moving up from the testicles and moving out the penis mixed with the fluid that the prostate produces. Not only is the prostate gone, so is the connection of the testicles to the penis (by means of the vas deferens). Orgasm is caused by stimulation; it is a whole body experience (or so I have learned). Orgasm without ejaculation is as pleasant as it is with ejaculation. I will try to check my facts. So separate are these three that the sex therapist told me that it would be possible to have an orgasm as you rolled out of prostatectomy surgery. Brr. The general outline of what I say here is true; I am not entirely clear on the anatomy.
One more fact for you. The prostate surrounds the urethra. It is in between the bladder and the penis. The prostate is about an inch in diameter. After it is removed, there is a one-inch break in the urethra. The urologist sews the two loose ends together, rejoining the urethra into a workable tube for your urine. That inch has to come from somewhere. There is only one place. The bladder doesn’t move. Your penis is shorter. If and when you achieve an erection it is not as long as it was. If the size of your ‘manliness’ is an issue, it is one that you have to face when you decide to have surgery.
For the first weeks after surgery the mantra is first get healed, then get dry, then get hard. The healing for me was uneventful. The catheter was in for 10 days—I can’t remember now if I have its removal and use covered in other parts of this blog. It was hard to sit on a hard seat because that plastic thing was sticking up past the incision, but otherwise I quickly adjusted. You carry the bag for pee around. They have two sizes, a small one to put under your pants if you go out and a large one for night use. I used the large one all the time. I didn’t go out. It wasn’t pretty and I covered it if I had visitors but otherwise I just hauled it around. The incontinence for me was also uneventful. Not everyone’s is and I am thankful for that. I did the Kegel exercises, squeezing my rectum and penis muscles to get control. I wore depends—usually two a day—for about 6 weeks (I think).
During the time I was incontinent I only lost control once, and that was at night in bed. Amazingly since the operation I have had any number of dreams where I had to go to the bathroom, or was in the dream actually peeing, only to wake to realize I needed to go, but I have never wet the bed since. And now as I approach a year since the surgery I have incontinence drips sometimes during a sneeze or if I sit or bend wrong, but not enough to worry about.
Sex is another matter.
IT is time to talk about sex and prostate cancer. Just so you know, there is no way to do this without being graphic, at least in my opinion. So if this is a concern to you, all you need to know is this. Erections are difficult to achieve, orgasm is possible, ejaculation after surgery is not possible. Lupron, an estrogen, dramatically reduces your libido.
To help you understand what I will eventually discuss, you need to know that in my 30s I got terrible migraines, all on the right side of my head, often so strong that I was in bed for three days. They went on for years until I had my teeth straightened when they basically ended. I don’t know if that is a cause/effect relationship. They were so disabling that then, and now, I would/will do about anything to avoid them. Since my surgery I have had them again, though no where near as serious, and that fact colors the story I am about to tell.
When I was talking to doctors and a sex therapist prior to my surgery, I discovered anatomical facts that I never knew. The three experiences of erection, ejaculation and orgasm are independent. Erections are caused by nerves along and throughout the penis region. They get cut during the surgery. As a result it is harder to get an erection after the surgery. The nerves can be retrained but as you will see it is a laborious project. Ejaculation is caused by sperm moving up from the testicles and moving out the penis mixed with the fluid that the prostate produces. Not only is the prostate gone, so is the connection of the testicles to the penis (by means of the vas deferens). Orgasm is caused by stimulation; it is a whole body experience (or so I have learned). Orgasm without ejaculation is as pleasant as it is with ejaculation. I will try to check my facts. So separate are these three that the sex therapist told me that it would be possible to have an orgasm as you rolled out of prostatectomy surgery. Brr. The general outline of what I say here is true; I am not entirely clear on the anatomy.
One more fact for you. The prostate surrounds the urethra. It is in between the bladder and the penis. The prostate is about an inch in diameter. After it is removed, there is a one-inch break in the urethra. The urologist sews the two loose ends together, rejoining the urethra into a workable tube for your urine. That inch has to come from somewhere. There is only one place. The bladder doesn’t move. Your penis is shorter. If and when you achieve an erection it is not as long as it was. If the size of your ‘manliness’ is an issue, it is one that you have to face when you decide to have surgery.
For the first weeks after surgery the mantra is first get healed, then get dry, then get hard. The healing for me was uneventful. The catheter was in for 10 days—I can’t remember now if I have its removal and use covered in other parts of this blog. It was hard to sit on a hard seat because that plastic thing was sticking up past the incision, but otherwise I quickly adjusted. You carry the bag for pee around. They have two sizes, a small one to put under your pants if you go out and a large one for night use. I used the large one all the time. I didn’t go out. It wasn’t pretty and I covered it if I had visitors but otherwise I just hauled it around. The incontinence for me was also uneventful. Not everyone’s is and I am thankful for that. I did the Kegel exercises, squeezing my rectum and penis muscles to get control. I wore depends—usually two a day—for about 6 weeks (I think).
During the time I was incontinent I only lost control once, and that was at night in bed. Amazingly since the operation I have had any number of dreams where I had to go to the bathroom, or was in the dream actually peeing, only to wake to realize I needed to go, but I have never wet the bed since. And now as I approach a year since the surgery I have incontinence drips sometimes during a sneeze or if I sit or bend wrong, but not enough to worry about.
Sex is another matter.
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