Post-op: Day 7

My surgeon, Dr. Guru, walks in with his associate about 4 p.m. today, Tuesday, hands me a stapled print-out entitled "Patient Report," points out the areas highlighted in yellow and declares that I should be pleased.

The bladder? Cancer-free, according to the lab report. The chemo and the TURBT procedures took care of it. The two nearby lymph nodes he removed? They were OK. The bladder cancer hadn't spread. No problem. The prostate gland? 10 percent cancer. It hadn't spread either. Now it's gone. Once I recover, I'm going to be fine. Healthier than before.

The next question -- when should I go home? The associate said a few days ago I could probably leave on Wednesday. Dr. Guru said he wanted to be sure that the now-pale pink fluid draining from my abdomen had decreased to acceptable levels. 

My opinion, having seen the nurses and aides empty the little grenade-shaped plastic collection bulb for the Jackson-Pratt Drain, was that I wanted to be cautious and not remove the drain too soon. My health proxy, Bill Finkelstein, had gone home with a JP Drain still in place after abdominal surgery a few years ago and was back in the hospital with an infection three days later. Fine. The drain can stay for another day. I'll go home Thursday. 

Monday's move to a smaller private room in a regular ward on the seventh floor was accompanied by my biggest parade of visitors. There was Bill, of course, and bridge players Sandi England and Jerry Geiger -- a jolly collection. All we needed was a deck of cards.

Following them were good friends Jack and Shelley Dumpert, who promised to weed my garden Tuesday (but had to postpone it due to the cold rain and fog). Then, surprise, Richard Allmond, a friend from the Lost Expedition pub crawl I led back in the 1980s. And finally, Monica and another good friend, Marti Gorman, who showed up just as I was reaching another recovery milestone -- my first bowel movement. Guess I'm almost ready to face the world again. Except for the JP Drain, all my medical missions are accomplished. 

Post-op: Day 5

How am I doing? Wrong person to ask. I'm just the patient here, with no frame of reference as to what's good or bad, aside from the fact that I hurt less than I did yesterday. And that was less than the day before. 
Still, in many ways, I can tell I'm making good progress on that road to recovery. One milestone -- passing gas. Hooray! My lower intestines are working. That was Friday afternoon. Another marker -- eating food, which off limits until I got gassy. Up to then, all I could do was wet my mouth by dipping a sponge on a stick into a glass of water. But now that I can eat, I'm not really hungry. So far I'm just doing soup, yogurt, apple juice and gelatin.
Ask Dr. Guru and his associates and they say I'm ahead of schedule. They say the surgery went well. They say I'm healing nicely (although the right side of my abdomen still kind of burns when I get up from bed or from my chair). And I'm ambulatory. I walk laps around the ward -- 6-East, the intermediate intensive care unit at Roswell Park Cancer Institute -- and I've gone down to the ground floor (by elevator) and out to the garden. Today, however, is the first time I've felt clear-headed enough to write.
Meanwhile, no problems with the urinary arrangement, although it seems very strange not have used a toilet since the surgery. Problem area instead has been the line draining a reddish Hawaiian-punch-like fluid from my abdomen. On Friday, a leak developed around the incision. The nurses finally resolved it by altering a stoma patch, like they use for the urinary opening, Right now, I'm dry.
Monday it's off to a regular ward -- 7-West -- where they won't be checking my vital signs so frequently. Nevertheless, the nurses and health care associates here on 6-East, which is nearly vacant at the moment, have been supportive and attentive, although even they have had trouble finding veins on me for drawing blood. Still, I have no complaints. When can I go home? Maybe as soon as Wednesday. It all depends on how soon they can remove that drain from my abdomen.

Surgery Diary: Day one minus one

     the trepidations crept in on me last night. after all, it's major surgery. what if i don't wake up? what if i do? what put the fears to flight finally were all the good wishes from you folks out there in the electronic ether and the hugs from my colleagues at the news monday night and my bridge-playing buddies at the tuesday game. 
     meanwhile, i got the flowers planted that i bought at mischler's over the weekend and had an evening of fun at "the book of mormon," which opened tuesday night at shea's performing arts center downtown. thanks again for all your encouragement. my proxies will provide updates for the next day or two. 

Week 19

The countdown began in earnest last Tuesday, May 26. I took the last blood thinners before discontinuing them in advance of the surgery, which is next Wednesday, June 3, at Roswell Park Cancer Institute. OK, platelets, time to thicken up.

          I’m good to go. The pre-op examinations a week ago, last Friday, at Roswell Park confirmed it. A stoma nurse looked me over and marked an X on my stomach, just above the navel and to the right. The anethesiologist thought everything was OK. An EKG and a blood test showed nothing to worry about. And the surgeon, Dr. Khurshid Guru, the man who brought robotic surgery to Roswell Park, seemed satisfied that everything was in order.

          The major questions about the surgery were answered at the previous pre-op meeting with Dr. Guru, right before my heart problems showed up. The only surprise, to me, was his suggestion now that my hospital stay might be 10 days. Previously, I’d been told it would be six to eight days. One thing they’ll want to see is how soon I’ll be able to poop.

As for the surgery itself, most of the info I already knew. It’s going to last six hours. The bladder, prostate and a couple lymph nodes will be removed. A section of my small intestine, a piece of the ilium, will be transported, blood vessels and all, to hook up with my kidneys and serve as a reservoir which will drain through the stoma to an external pouch. Oh yes, and there will be stents helping to keep things open. My assignment – drink plenty of fluids to maintain the flow.

What did Dr. Guru think of the neo-bladder, the all-internal alternative about which my sister-in-law in Arizona had forwarded an Internet link. It’s a longer surgery and a longer recovery, he said, and it’s more appropriate for a younger patient. It takes a bigger piece of the intestine, which still wants to act like an intestine instead of a bladder, and then there are complications involved in making it all work. One fine day, I keep thinking, they’ll make new bladders with 3D printers, but that day isn’t here yet.

Meanwhile, health proxy Bill Finkelstein pressed one of his major complaints – being promised return phone calls and not getting them earlier this month when he wanted to find out the new date for the surgery so he could make arrangements to be there at the hospital. Dr. Guru explained that since the schedule was full, it was hard to find a time, but conceded that callbacks should have been made. My significant other, Monica Neuwirt, who also was there in that little examination room, contended that this was not the kind of thing that Dr. Guru should be concerned with. Well, yes and no. Does everybody have these problems?

Week 18, Day 6

   Now when people ask how I feel, I tell them, "My cardiologist says I'm fine." And if he thinks I'm OK, then I'm OK. 

   I talked with my cardiologist, Dr. Edward Spangenthal, on Monday after an EKG and after questioning by his nurse Dawn and stethoscope listens by him and his assistant Evelyn. The twinges I've been feeling in my chest, he said, are nothing to worry about. The EKG was good. The heart sounded good. A blood enzyme test turned up nothing. 

   So twinges and all, I should stop worrying. Heart-wise, I'm good to go for surgery the following week, on Wednesday, June 3. I'll find out all about it Friday at the pre-op get-together with the surgeon, Dr. Guru. 

   The entire visit at Roswell Park Cancer Institute was unexpectedly quick and easy, less than an hour. I barely got to crack open my New Yorker magazine before I was called in for the EKG. The hard part was setting up the appointment.

   Health proxy Bill Finkelstein started calling Dr. Spangenthal's office at Buffalo Medical Group at 8:30 a.m. Monday, sat on hold for 45 minutes twice, then got through just to be told that he sees patients at Roswell Park only on Mondays and Thursdays and his schedule was full. 

   But then Bill did an end run -- a conference call to Amey, the assistant to Dr. William Morris, the man who inserted the stents in my heart. She heard about my twinges, made a call, then got back to us. Get to Roswell Park as soon as you can, she said. By any means necessary, as Spike Lee puts it at the end of his movies. Sho nuff.

Weeks 17 & 18

Suddenly I’m thrown back to the big question that taunted me in the middle of the chemo treatments a couple months ago – how active can I be? Only this time, the limiting factor isn’t fatigue from the chemo. It’s those newly-installed stents in my heart.

          Not that I hadn’t been advised to take it easy, but I felt good after getting the stents. So last Sunday, Mother’s Day, two weeks minus a day after the stents, the lawn needed mowing. It’s never seemed like heavy exercise. I figured it wouldn’t hurt as long as I beat the height of the 80-degree heat and the sun by going out at 10 a.m. By the time I finished some 45 minutes later, I knew it was too much.

          Since then, I’ve felt on-and-off pains and tingles. A call to the cardiologist’s nurse on Monday prompted two pieces of advice: 1. Don’t do that again and 2. If you feel bad, go straight to the emergency room at Buffalo General Hospital. So on Thursday health care proxy Bill Finkelstein also did extra duty as my lawn mowing proxy.

          But the heart thing has become much more worrisome than the cancer thing. The cancer is treatable and predictable. It’s causing a major change in my life and it certainly could snuff me out, but it shouldn’t. The heart, on the other hand, could turn on me at any minute and kiss my butt goodbye. That’s what happened to my cousin Marsha, my mother’s brother’s daughter. She died suddenly Wednesday of a heart attack in Florida at the age of 62.

          Meanwhile, I’ve been playing bridge by day and working by night. Today, Friday, the bridge was a regional tournament in Rochester, an hour’s drive away on the Thruway. At least at bridge, I told a friend, there are retired medical professionals in the room. What if you get stricken while you’re driving, he asked. Guess I’ll just have to pull over, I said. Sudden thought – better not put the car on cruise control. 

Week 16, Day 6

Post-stent checkback Monday with cardiologist Dr. Edward Spangenthal is my first visit to Roswell Park Cancer Institute that lasts less than an hour. And now that spring is here in full flower, it’s the first visit where the cold air blows out from the main lobby instead of gusting inward.

There’s almost no wait before a nurse takes my blood pressure and pulse, well within the normal range, and assesses my blood oxygen – 99 percent, up from pre-stent levels. Another nurse listens to my chest with a stethoscope and asks questions about medications and side effects.

Then Dr. S. himself steps in, does his own stethoscope tour, and says that things are good. He wants to keep me on blood thinners for three more weeks while the stents heal in, then go off them for a week prior to the bladder surgery. I’d resume them later when the urology surgeon, Dr. Guru, gives the green light.

That puts my big date sometime in early June, exact time TBA. We get to speak a little later with one of Dr. Guru’s assistants, who says that he does surgery on Mondays, Tuesdays and sometimes Wednesdays. Earliest date, then, would be June 1.