Friday, February 10, 2012

A Half-Year of Medical Excitement

Over the past half-year, I've had my fill of medical excitement. I lay these adventures before my readers for whatever educational or humor value they may have.
In September, I went for a check-up at my doctor's and, when he did the manual prostate exam (ever so much fun, as you may know), he felt what he thought was a nodule on my prostate. He referred me to a urologist who would have more experience and therefore a better perspective. I went to the urologist about three weeks later. He did both a manual and an ultrasound exam. He said that one lobe of the prostate seemed "harder" than the other and scheduled me for a biopsy on a Wednesday a few weeks later. My PSA level was 3.3, which he said was okay, but he wanted to be on the safe side. In preparation, on the evening before the procedure, I took two Cipro tablets to guard against infection from the procedure. I took two more the evening after the procedure. On Wednesday afternoon, a couple of hours before the procedure, I had to give myself an enema (a first for me, and not awful, but by no means a fun experience). By the way, I think it is hilarious that the bottle is "disposable", as if someone would want to save and re-use it.
The procedure itself was uncomfortable, but not painful, involving first, an antibiotic solution inserted into the rectum, then a topical application of a local anesthetic, then an anesthetic injected into the prostate. After getting an ultrasound overview, the doctor took several samples for the biopsy with a probe. I felt that process almost like being "flicked" with a finger. The doctor provided a running commentary during it, which was interesting. I found it, even under the circumstances, somewhat educational.
After it was over, there was so much blood coming out of my anus that you'd have thought I was the most popular dance partner in Cell Block D at San Quentin. The doctor said I should expect blood in my stool for a couple of days, and possibly in my urine and semen, but that's normal. It may be normal, but it's somewhat unnerving to have my bunghole become the Red River Valley. I know that October is Breast Cancer Awareness Month, and pink proliferates, but pink urine, I thought, is a bit much. A word of advice: If you ever have to have a trans-rectal prostate biopsy, do not wear white underpants. Seriously, I have to find some humor in an otherwise extremely undignified undertaking. I can find the humor because the urologist called a couple of days later to say, "No cancer. No problem."
Around the same time I was having my adventures in prostate medicine, I also consulted Dr. Denne, the surgeon who removed my gall bladder a couple of years ago, about repairing a hernia. I've had the hernia for years, and it never really bothered me, but, after ordering a CAT scan, my doctor suggested consulting a surgeon about having it repaired. Dr. Denne strongly suggested having the repair, and she explained that having it done laparoscopically would likely have a shorter, less painful, recovery period. I decided to have it done, but scheduling things around the holidays was difficult, so we scheduled it for January 19, a Thursday.
Preparation on my part wasn't too bad. I had to stop taking my daily low-dose aspirin for 10 days prior to surgery, and I had to have blood work and an EKG done within the month before surgery. I did that on my birthday for several reasons. One: It was an easy day to remember. Two: It gave me the chance to have strangers wish me a happy birthday (As you know, medical records always require the patient's date of birth, so whenever the person registering me, or the tech doing the tests, asked for DOB, they would notice it was that very month and day.) Third: It allowed me to say, "I'm getting a hernia surgery for my birthday." The night before surgery and the morning of surgery, I had to wash with an antiseptic wash (Hibiclens) from the neck down, and I couldn't eat or drink anything, even water, from midnight the night before the surgery. Fortunately, they scheduled me to report to the hospital at 7:30 in the morning.
Beth, of course, took me in to the hospital (Bryn Mawr, which is about 10 minutes from our house), and registration, history and pre-op took about an hour. Since Dr. Denne did my previous surgery, some of the members of her team had been there for my gall bladder episode and remembered me. Happily, no one said, "Dude! You almost died!" this time. I suspect that, because I don't take many drugs and I rarely drink alcohol anymore, I am very susceptible to anaesthesia. I remember being brought into the operating room and transferred to the table. I was introduced to the surgical team (who were all wearing caps, masks and gowns, so I don't think I could recognize any of them if I saw them on the street), and the next thing I remember is slowly waking up in the recovery room.
In the recovery room, they checked my vital signs and asked about my pain level (The ever-popular "on a scale of one to ten" question), then brought me up to a room, where Beth came to sit by my bedside until I'd be discharged. I was incredibly dry-mouthed and thirsty, so I drank several diet ginger ales (which I don't much like, so that tells you how thirsty I was). While I was in that room, they took my vitals several times, and eventually I asked when I would be discharged. The nurse said, "That's up to you. You can be discharged when you urinate." A bit later, I called for a nurse to escort me to the washroom (Hospital policy requires an escort, and, besides, I was hooked to an IV line, and to the pneumatic leggings that squeeze the calves to keep blood clots from forming). She handed me a urinal "pitcher", which I took to mean I had to produce a certain amount of urine. I asked, "Is there a magic number?" She said, "Yes, but I'm not going to tell you what it is." I assume that was to make sure I didn't "cheat" by watering down the sample. I found out later that the magic number was 250 mL (about a cup), and I had certainly produced more than that.
With that duty done, they gave me my discharge instructions. Basically, these were: I should not drive for at least three days, until I was comfortable behind the wheel. I should drink lots of fluids and eat whole grains and fiber to keep me "flushed out". I was not to lift anything heavier than 15 pounds for two weeks. I should walk every day, building up to my normal routine. I had a prescription for Percocet, but I didn't fill that because I didn't have that much pain. I didn't even take Tylenol. I scheduled a follow-up with Dr. Denne two weeks from the surgery. For the first couple of days, I walked slowly and I couldn't bend over very gracefully, but otherwise I think I did well. I slept through the night in our bed. The biggest downside at that point was that coughing was more painful than I'd have thought (I guess that's why the standard hernia check requires you to cough.), and I discovered that, while I was "out" in the operating room, the surgical team did a bit of "manscaping" on me, and I was not looking forward to the itching that I anticipated when that started growing back. Despite the possible discomfort, I do not intend to scratch my crotch. I will channel my inner Spock and find a Vulcan level of tranquility and forbearance. (Vulcans, even those in Remedial Math class, do not scratch their crotches.)
We were home by about 2:30 in the afternoon, so it was a fairly quick adventure. On Friday, Beth and I took a couple of walks around the block. On Saturday, because of the snow, I stayed indoors and paced around the house like a caged tiger. That Sunday morning, Beth drove me to church and came back later to pick me up. I think I would have been fine walking, but Beth was a bit nervous because there was still snow on the ground.
Within the first week post-surgery, I was in pretty good shape, I think. I was back to walking my normal two-and-a-half-hour (total) time outdoors, with a half hour indoors. No pain. No discomfort. I was just waiting to see Dr. Denne, the surgeon, the following week to have the "no lifting more than 15 pounds" restriction lifted. There was a fly in the ointment, however.
On the Monday after the surgery, in the span of two hours, I saw two doctors and picked up two prescriptions. I'd had a red left eye for about a week at that point (starting days before the surgery), so Beth sent me to my doctor. He didn't like the look of it, so he sent me to Dr. Negrey, an ophthalmologist (but not before writing me a prescription for blood pressure medicine). The ophthalmologist diagnosed iritis, an inflammation of the eye, for which he prescribed steroidal eye drops. He told me that iritis is "idiopathic", meaning "arising spontaneously, from obscure or unknown causes". I thought, but did not say aloud to a guy messing with my eyeball, "On House, Dr. House once said, 'idiopathic: from the Latin, meaning 'we're idiots because we can't figure out what causes it'." Being who I am, I thought, but again, did not say aloud, "I wonder if I could've been exposed to Red Kryptonite."
I returned to the ophthalmologist that Friday, and he noted that I'd made remarkable progress, but I still had some "inflammatory cells", so I continued the eyedrops, but with less frequency over the next week, and returned the following Friday. He also sent a note to my primary physician to send me for a chest X-ray and some blood work, to rule out "associated medical conditions", which I assumed meant things like lupus. On top of that, I was scheduled to see Dr. Denne on that following Friday and I had to return to my regular doctor the week after that, so he could check how the blood pressure medicine is working. I told Beth I've gone from being "Iron Man" to the old guy who lives between doctors' appointments. Beth will have none of that attitude and told me I am not allowed to get down in the dumps about any of this, so there!
When I returned to Dr. Negrey, he noted further improvement and had me step down the frequency of the eyedrops over the next week and a half, with my next visit scheduled for Wednesday of next week. Later that afternoon, Dr. Denne, the surgeon, was very pleased with my recovery and gave me the okay for resuming all normal physical activity. The Monday after that, my regular doctor, Dr. Hobson, checked my blood pressure and it was good, so that medicine seems to be doing its job. He also took blood for the tests Dr. Negrey wanted, gave me a PPD (purified protein derivative) test for tuberculosis and sent me for a chest X-ray to look for sarcoidosis. Having been checked for sarcoidosis, rheumatoid arthritis, lupus, tuberculosis, and God know what, my fear, although a small one, was that, in testing for so many things, they might find something seriously wrong with me. Dr. Negrey, the ophthalmologist, did say that the associated medical conditions are rare, "but we would be remiss not to check". I'll tell you: Between the prostate biopsy, hernia surgery, iritis, blood pressure and cholesterol medicines, and testing for all manner of dire illnesses, I've been getting a more focused view of my mortality. I don't believe my demise is imminent, but I do realize that I'm closer to the end of this path than I am to the beginning. It's odd, but, when I was young, I knew, not believed but absolutely knew, that I would not come to any serious physical harm, but, once I turned 30, I completely lost that absolute certainty. Since then, I still haven't come to any serious physical harm, but I now know that it is at least possible. I guess that's more realistic, but it's less fun. Don't worry, though. I'm not depressed, clinically or otherwise. I'm still enjoying my life, and working hard at keeping healthy and fit. I just wish I could be healthy and fit without working quite so hard.
At this point, I've been cleared of pretty much everything I was tested for, with the exception of HLA-B27, which, as I understand it, is an antigen associated with a predisposition for some inflammatory autoimmune diseases, such as iritis and rheumatoid arthritis. As my doctor explained it, and as best I understand it right now, it's not something to panic about, and it may not have any actual effect, but it's something to note in my file and watch to see if I develop any noteworthy symptoms. My guess is that it may mean that I'll be more prone to recurrence of the iritis in the future, but that seems treatable with a minimum of inconvenience, and if I develop arthritis, well, I'll deal with it. Way in the back of my mind, though, is the nagging hope that this still just might develop into a super-power.
In summary, then, I seem not to have anything dreadful, I just have something to add to the minor list of age-related complaints, and, despite years of carefully crafted image, I really don't complain too much, I think. Thanks for reading.