Post-Op: Month one, week two, day two

Good news from my first visit to a new primary care doc -- Dr. Jon Kucera at the Northwest Buffalo Neighborhood Health Clinic, who is health proxy Bill Finkelstein's doc. My vital signs are all good. And some not so good news. After comparing my EKGs from December and April, which is what revealed that I'd had a heart attack, he said I should be on statins. 

Now I've resisted suggestions of statins for several years. I'm leery of the side effects (Monica's old boss was hospitalized by those side effects) and because they just seem like too much of an article of faith in the medical community. One of these days, they'll discover that they're actually harmful, like Tylenol. Nevertheless, us heart attack survivors are at high risk for a repeat episode, so if anybody should be popping a statin, it's somebody like me, a point driven home during the conversation about statins on "On Point" on NPR this morning. Like it or not, it looks like Lipitor ahead after the next visit to the cardiologist. 

Meanwhile, I seem to be gaining stamina. Wednesday began with an hour of cloudy, cool-weather weeding (the big Buffalo Garden Walk is a little more than a week away) and ended at the Sportsmen's Tavern with a rollicking show by Rosie Flores, the Rockabilly Filly, who I know from the days when I was going to the South by Southwest music conference every year in Austin. What's more, she still recognizes me. "You're so cute," she said.

Thursday, which also started cool, began with another hour of weeding, this time in the shade, (front yard is starting to look pretty good), followed by a visit to opening day of the annual Italian Festival in North Buffalo. Then, after a much-needed nap, it was off to the weekly free concert (the Buffalo Philharmonic playing Stevie Wonder songs) at Canalside downtown, which gave Traci, my niece visiting from Phoenix, a look at our revitalized waterfront. Big crowd. We all took lots of photos. Attached is a pic of Traci in the one of the Canalside attractions -- the giant Adirondack chair.

Post-Op: One month, one week, two days

   The good news is that I seem to be getting stronger. Today, Thursday, July 9, I drove outside the city limits for the first time since the surgery, a 20-minute trek through the rain to the Airport Bridge Club for my first visit to the bridge tables in, well, one month, one week and three days. 
    More good news there. Paired with Jean Macdonald, a capable player whose plans to play golf had been scotched by the weather, we came in first North-South with a 59.58% game. 
    But that was about all I could manage. I came home and fell asleep while waiting for a friend to arrive with Chinese food for a late lunch, then fell asleep again later watching Seinfeld reruns on TBS. I've still got a way to go.
   The bad news is I'm still looking for leakproofing on my urostomy bag. Sunday night and Monday night I awakened wet at 5 a.m. and had to apply a new appliance.
   Wednesday found me and health proxy Bill Finkelstein back at Roswell Park Cancer Institute, talking with an ostomy nurse who had a few suggestions about alternate appliance configurations, where to place the overnight catheter bag (not on the floor) and sleeping on my left side. Wednesday night was dry. Here's hoping for two in a row.

Post-Op: One month

   Yes, it was Wednesday, June 3, when I checked in to Roswell Park Cancer Institute for the surgery that removed a Stage 2-B cancerous bladder, a prostate gland that was 10% cancerous and a pair of lymph nodes that happened to be hanging around nearby.
   It's been a bumpy month of recovery, what with nine days in the hospital and adventures with dehydration, low blood pressure, blood in the urostomy bag and leakage from one of the incisions. Nevertheless, my surgeon, Dr. Guru, believes that I am now cancer-free and, for the past week or so, it seems like those bothersome complications are behind me. Excuse me for a moment while I knock on wood.
   Today, Friday, the visiting nurse, Maria, took a look at the incisions and said the scabs were healing well. Everything else seems to be proceeding as it should. The fatigue even seems to be subsiding, albeit ever so slowly. I can walk up to eight blocks now. But then that's my limit. And I still need naps.
   I'm also champing at the bit to do some gardening. But during the past hour, while Monica was mowing the lawn, I was reminded of one of my other limits -- the five-pound lifting limit. While seated and pulling weeds out of some of the many small pots on my flat garage roof, I felt a pain in my lower right abdomen after I moved the heaviest of the pots, which may have weighed as much as 10 pounds. The pain is gone now, but I have new respect for that five-pound limit. I don't want to feel that again.

Post-Op: Day 25

   "You look good. Your color is good," my surgeon, Dr. Guru, said Friday afternoon as he strolled into the examination room in the Urology Department at Roswell Park Cancer Institute. "I wish I felt as good as people say I look," I said. I'm still fatigued, I explained. I don't have enough energy to be up and doing things for more than a couple hours or so.

   This, he said, is normal. It will get better. As for the other complications -- the leaking surgical incision, the blood in the urine last Sunday -- those have stopped. And my blood work Friday, that was good. 

   The urine sample last Sunday, on the other hand, showed bacteria. Not unusual, he said, since we joined together body parts that aren't meant to go together. The section of intestine that collects the output from the kidneys still wants to act like an intestine, not a bladder, and it will have bacteria. To protect from infection and be on the safe side, he prescribed 10 days worth of Cipro.

   As for that feeling that I still have compression stockings on my toes, Dr. Guru said that also was not unusual, a leftover from the surgery, when my body was feet-up for hours. This too, he said, will pass. 

   To the doctor's amazement, neither health proxy Bill Finkelstein nor Monica had any questions. We'll see you in six weeks, he said. And after that, check-ups twice a year. Or maybe only once a year. All that's left to do is hydrate heavily, rest and recover. Wonder how long recovery road is going to be. From here, I can't yet see the end of it. 

Post-Op: Day 20

    First the stuff in the urostomy bag Sunday afternoon looks like Hawaiian punch. Then like cranberry juice. Then like dark cherry juice. I call health proxy Bill Finkelstein. Send a picture to my phone, he says. 

   Shortly after 6 p.m., just as Monica is about to put dinner on the table, Bill calls back. Get down to Roswell as soon as you can, he says. Dr. Syed is there right now. Last week there was one emergency weekend run to Ward Seven West. And now this weekend, two. I'm a little alarmed. Will I have to stay the night?

    With Monica and Bill looking on, Dr. Syed sees dark red goopy things in the bag and proposes that this may be partially clotted old blood that's decided to move out. He sticks a tube into the stoma (no feeling there ... amazing), draws out a sample of what's inside and designates it for a lab test in the morning. I'll be going home. Keep an eye on it and keep hydrating, the doctor says. Pointing to the bottle of water at my side, he adds, "That's your buddy."

    Today, Monday, the colors begin as pink grapefruit juice and evolve into lemonade. Only drama comes when I stand up abruptly from the computer this evening and catch the edge of the bag against the edge of the dining room table, separating the front of it from its adhesive backing. A quick replacement is in order. Though I can probably handle that by myself, I'm grateful I'm not home alone.

    Meanwhile, I take my longest walk since the surgery this afternoon -- 4 1/2 blocks to the M&T Bank on Elmwood Avenue and back, unaccompanied and a little tentative, picking out the shadier sides of the streets. I come home hungry and ready for a nap. 

Post-Op: Day 18

Recovery is not a straight line, my surgeon, Dr. Guru, said Thursday in Roswell Park Cancer Center, moving his hand up and down to illustrate. Seeing one of the downs before him at this first post-release examination, he declared me dehydrated and ordered an infusion of saline solution. 

So the two-hour visit went into overtime -- a morning-long IV session, with a half-hour search for a workable vein ending at the base of my right thumb. Please, I entreated the gods who look after you in situations like these during one of my gassy abdominal cramps, don't make me deal with a bowel movement while I'm hooked up. 

The IV worked. My weary voice perked up. My shuffling step was springy enough that I turned down a wheelchair and exited on my feet. Nevertheless, on Friday, when a technician was checking my sleep apnea machine to see why it was drying out my mouth all the time, he turned to me and said, "You look dehydrated."

So I have renewed my quest for fluids I can swallow in quantity. Beer doesn't count, I'm told. What a shame. I've fallen back on Vitamin Water (about to polish off my second of the day) as an alternative to just plain Poland Spring. Health proxy Bill Finkelstein bought me a mango-pineapple smoothie from McDonald's, recommended by one of the bridge players who relied on that while recovering from colon surgery. Could be a winner. It has real fruit in it and it's definitely tasty.  Recommendations, anyone?

Recording my fluid intake now, with the goal of least three quarts a day, I see all I need to do is six to eight ounces per waking hour. Doesn't sound that hard. But it is. 

Anyway, once I was hydrated, the leak revived through the small incision scab next to my navel. Coincidence? And once again, the struggle was on to patch it up and keep it from soaking me from the waist downward. 

Monica finally turned to a mini urostomy bag like the one that worked so well after Dr. Syed applied it at Roswell a week ago. But the bag caught nothing. The incision still leaked. Maria, the visiting nurse, gave it a try this morning (Saturday), using some paste to improve the seal, but again no luck. Finally, Bill set up another visit to Roswell, where a nurse on my last ward, Seven West, determined that the nearby bag collecting urine might be the culprit. Now, with two new bags, so far I'm dry. Bliss. 

Post-Op: Day 12

    Gee, but it's good to be back home, even though everywhere I look, there are things I want to clean, weed or rearrange, but can't. In the meantime, Monica has decided to thin out my wardrobe while she has the energy advantage. "Strike while the iron is weak," she told a phone caller.
    But the pleasures of home have not been without other complications, as well. Not with the basics, thank God. The urostomy is working fine. The 17 stairs to the second-floor bedroom? Not an obstacle. What to wear? T-shirts and sweatpants with elastic waistbands. No, the complications came up elsewhere:
    1. That sore left foot (Monica's diagnosis: plantar fasciitis), which inhibits walking as much as I should.
    2. Constipation (I'll resist dwelling on the delights of strawberry Milk of Magnesia).
    3. The leaky incision just left of my navel, which put Monica's talents as a teenage candy-striper to the test. To soak a succession of T-shirts, bandages, towels and improvised plastic barriers she deployed, it generally took two hours or less.
    And 4. Surprise! Low blood pressure, by-product of the switch from hospital blood pressure meds to the stronger ones at home. The visiting nurse took a reading Friday and it was fine. Had it been checked after that, I might have guessed why I felt so light-headed and listless.
    It was health proxy Bill Finkelstein's alarm at Monica's last-gasp leak treatment -- an Ace bandage around my waist with a towel tucked inside it, on top of the usual little taped-down pile of gauze -- that prompted the phone calls which took us back to Roswell Park Cancer Institute Saturday evening, to the ward I left 48 hours earlier, Seven West. One of Dr. Guru's associates, Dr. Syed, agreed to meet us there around 8 p.m.
    His solution -- a small urostomy bag to fit over the leaking incision. While we waited for one to arrive, I asked for a blood pressure reading. When it came up 71/52 and 72/51, the health care aide thought the computerized testing machine was malfunctioning, but an old-fashioned pump-up cuff yielded the same results. A few laps around the ward lifted it to 90/62.
    Meanwhile, the bag worked. Thank you, Dr. Syed. Once in place, it immediately started filling. And today, Sunday, the seepage seems to have stopped entirely. As for blood pressure, now that my blood pressure cuff at home has been located, the readings are improving, but they're still low. No more pills till they climb some more.