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Getting back to normal activity after a prostatectomy

User
Posted 02 March 2016 18:04:23(UTC)

I'm 2 weeks after a robot assisted radical prostatectomy, and prior to this was very active. I'd be interested to hear of the early progress  that others made in their return to activity. Might just be when they returned to work, or it might be the milestones and timing of how they returned to a previous sport or pastime. 

For myself, regaining physical function will be about getting back into the mountains. Certainly, now I've switched from the bulky incontinence pads to the level two's, walking is more natural.

Has anyone failed to  regain their old capabilities because they avoid certain activities, fearing incontinence when their arena of action doesn't allow changing pads etc- or if that issue existed, how did they manage or overcome it?

Reading this, it sounds as if the issue of incontinence is to the fore. Maybe for you, the issue was fatigue or depression, coming to terms with the changes etc. Please share your thoughts.

User
Posted 03 March 2016 16:31:30(UTC)

I had my prostate removed by robot in April 2015 a few days after my 70th birthday. I was incontinent for two weeks and then gradually gained control again. I believe in the idea to stay as fit as one can so within 3 days of getting home (with catheter in, out 5 days later) I drove daily to a local wood and hiked 3 miles a day until the end of May, practicing my pelvic exercises as I walked.

On the 1st June I declared myself OK. My first post op blood test said I was OK as well, as did my surgeon, so I just got back to normal life. As my main hobby is long distance backpacking I 'celebrated' by hiking and camping 7 days of Offas Dyke Path. I had hoped to complete it all but I began to leak urine, but only when scrambling downhill stretches, it was the jarring I believe. Anyway it proved to me that I still had a problem to overcome.

I came home and continued with my wood walking circuit and ongoing pelvic exercises. On the 23rd July 2015 I went to Hendaye on the Bay of Biscay and over the next 45 days hiked, camped and hosteled on the GR10 across the Pyrenees (about 500 miles) to Banyuls Sur Mere on the Mediterranean. On Day 17 I found that I had a hernia, a consequence of my prostate op, so wasn't pleased. I managed to buy a truss so carried on to the finish.

My hernia was repaired near to Christmas 2015 and by the end of February 2016 decided I was again back to normal! Please note Mr. Hunt, the Tory geezer, I was operated on a SATURDAY! Admitted in the morning, operated on and home by 5.30pm!

I'm now back to my routine 3-5 mile off road jogging and/or walking most days of the week and so far I'm still feeling good.

I'm toying with the idea of hiking the Pennine Way in April 2016 and then to choose between the GR5 (Lake Geneva to Nice) or the GR10 route again, but this time from the Med to the Atlantic. For an 'old' bloke like me I like something to look forward to!

I am left with a couple of 'downer' issues but I do consider they are minor to me! Although I have full bladder control I am still aware that if pushed (e.g. too much beer) I cannot hold onto it as I could before my op. Secondly, I can no longer get an erection! I'm not too bothered about this, I just take the view I would rather be alive, well and continent than moping about my sex life. The one thing I am really pleased about is, that I am not on any medication and haven't been from day one after my operation. Lastly, my blood tests have all shown '0' and I have been discharged from the surgeon and other doctors care.

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User
Posted 02 March 2016 19:00:18(UTC)

Hello Walnut55 and belated welcome.

There are quite a few men on here who have had your experience and I'm sure they will tell you their stories.

Look up gunwharfman as he is a long distance walker and his profile may help you.

Gunwharfman is just one of a number of men though in your situation. Rest assure they'll be along

We can't control the winds - but we can adjust our sails
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User
Posted 02 March 2016 19:28:30(UTC)
W

We all recover at different rates so do not try to emulate others.

Return to work after RALP is often quoted at 2-6 weeks, but I guess that depends on what sort of job you do. I was back at work after 4 weeks and back out visiting sites and driving 1000 miles a week after 2 weeks in the office. Most of the people I worked with knew my situation so if I needed to go to the loo etc they understood.

I had a few issues post op, so you never know what is round the corner.

Being almost dry two weeks after op was a massive bonus. ED is still work in progress but fun trying to find ways to recovery.

Never really been a sporty type but walking the dog was an incentive to keep motivated.

All the best with your recovery but do at your pace.

Thanks Chris
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User
Posted 02 March 2016 19:00:18(UTC)

Hello Walnut55 and belated welcome.

There are quite a few men on here who have had your experience and I'm sure they will tell you their stories.

Look up gunwharfman as he is a long distance walker and his profile may help you.

Gunwharfman is just one of a number of men though in your situation. Rest assure they'll be along

We can't control the winds - but we can adjust our sails
Thanked 1 time
User
Posted 02 March 2016 19:28:30(UTC)
W

We all recover at different rates so do not try to emulate others.

Return to work after RALP is often quoted at 2-6 weeks, but I guess that depends on what sort of job you do. I was back at work after 4 weeks and back out visiting sites and driving 1000 miles a week after 2 weeks in the office. Most of the people I worked with knew my situation so if I needed to go to the loo etc they understood.

I had a few issues post op, so you never know what is round the corner.

Being almost dry two weeks after op was a massive bonus. ED is still work in progress but fun trying to find ways to recovery.

Never really been a sporty type but walking the dog was an incentive to keep motivated.

All the best with your recovery but do at your pace.

Thanks Chris
Thanked 1 time
User
Posted 02 March 2016 19:37:07(UTC)
Hi there
I would say that if you are on light pads after only two weeks you are doing remarkably well. I love walking and my motorbike and the incontinence was my biggest problem.I was determined from the outset that I wanted to dictate what I did and not the incontinence so a lightweight backpack with spare pads and bags went everywhere. App on mobile phone showing location of toilets and worked a way of changing pads using the shelter of bushes if the countryside without it looking too rude.
Eventually changed to external catheter for long walks (sheath plus bag). Trusty backpack with plastic bottles to empty leg bag.Had to work on muscle control to help with stress incontinence when pulling motorbike onto stand, standing up and bending but just carried on regardless.I have to say that I have been lucky that this has been the only real problem and even this has not been that bad.
I hope things will progress well for you and you find yourself back on the mountains in a reasonable time. DON'T OVERDO THINGS!! It is a major op and you have to be sensible.

All the best

Kevan
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User
Posted 02 March 2016 19:55:42(UTC)

Having done too much myself too early, I would agree with Kevan above. If you feel ready to tackle things at 2 months , then wait 4 months. I definitely overdid things. Do not get on a bike whatever you do for 6 months. Just take it easy. It is a much bigger surgery than you may feel
All the best
Chris




If life gives you lemons , then make lemonade
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User
Posted 02 March 2016 22:29:26(UTC)

Originally Posted by: Online Community Member

Having done too much myself too early, I would agree with Kevan above. If you feel ready to tackle things at 2 months , then wait 4 months. I definitely overdid things. Do not get on a bike whatever you do for 6 months. Just take it easy. It is a much bigger surgery than you may feel
All the best
Chris

 

I guess, reading your reply, you tried a bike and had some adverse effects. What happened Chris, if you don't mind me asking? Your 'overdoing' tendency sounds familiar!

User
Posted 02 March 2016 22:43:32(UTC)

Thanks Johsan. Had a brief look at the profile of the man you mentioned. Sounds like he has an adventurous approach to life. 

User
Posted 02 March 2016 23:41:41(UTC)

There is a strong school of thought that getting back on a bicycle too soon after RP can prevent you from recovering erectile function. John was banned from cycling for 7 months - the surgeon said there was no point doing nerve-sparing just to have all the good work undone.

He had his op (was open RP though not Da Vinci) in January, was off work for almost 12 weeks (mainly because he wasn't insured to drive until 11 weeks) but worked from home from about 9 weeks. Was back in the gym as soon as he could walk standing up and back on the rugby pitch just before the end of the season. He had to get on with the walking etc because he had agreed to climb Kilimanjaro in between the op and the RT

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 03 March 2016 06:55:22(UTC)

Hi again
I did start riding my bike again cautiously with a new saddle that has the perineum cut-out. It wasn't painful but it wasn't comfortable either. It was only after I was doing this that I read " no cycling for 6 months or it can impair erectile rehabilitation " .
I am now approaching 9 months without the slightest of stirrings in the trouser department, despite me being young at 48 and having had double nerve sparing surgery. Cycling may not be the reason but it's a fair warning !
Chris




If life gives you lemons , then make lemonade
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User
Posted 03 March 2016 12:26:40(UTC)

Talking of stirrings on the trouser dept....

Has anyone had the experience of some ( very transient) penile fullness on defaecating? I had it once, maybe twice, there, but so short lived to think I had imagined seeing it. In no way am I thinking this means erectile recovery- it's just that we are told that surgery has caused trauma to the nerves and blood vessels responsible for erection, so it was unexpected- but it got me wondering where it came from.

OK, I get the trauma thing. So that is one reason for the  use of a vacuum pump- to draw blood into the penis and temporarily trap it there. An understandable way to get round the issue. Some external mechanical  force is used to change blood flow- and doing it in a very crude way- but it's the best available- or is it? More of this later.

Back to my original observation-  I'd guess I'm not alone in that, pre -surgery, occasionally , when 'taking a dump' ( defaecating), an erection would spontaneously occur. Presumably because the pressure in the rectum pressed against the prostate and associated structures causing a pleasurable sensation, or maybe the pressure just altered the venous leakage from the penis. Anyhow, the result could have been a stiffy. I'm not aware of any penile rehab measures that harness this phenomenon.

Now I understand that it's not a good idea after surgery to shove things up your bum, or to strain- there's the risk of all sorts of trauma- rectocele, damaging the anastomosis etc, but it does serve to  highlight the fact that direct stimulation of the external member is only using a small portion of the sensory area available - and this might have implications for rehab...Is anyone prepared to climb the wall of prudery to discuss this?

Anyhow, back to vacuum pumps.  I'm yet to get to that stage  where I could try one out-  but once again, I like to try and reason out why and how things work. Why do none of the vacuum devices have a stroke facility, i.e akin to the action of masturbation?

From a rehab point of view, surely this would be far more beneficial than merely sucking blood in and tourniqetting it. Whilst this technique may expand the corpus cavernosum and allows the possible resumption of some sexual activity, it sounds as if the period  inside the pump is spent in an entirely passive manner.. There does not seem to be a facility with vacuum pumps to provide sensory stimulus via a simple  up/down stroke whilst in the vacuum. All the action takes place after vacuum assistance- i.e. at a time of relative disadvantage.  I noticed that there were sex toys of poor quality that had this combined vacuum pump/ stroke facility- so it would seem it is do-able.  Maybe it doesn't get translated into a useable rehab device for reasons which I am ignorant of- or maybe it's just a mix of cost and complacency..

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User
Posted 03 March 2016 12:59:13(UTC)
W

Erection during motion even post RP is quite common,and I hope it is sign of recovery.

Do not expect an over night recovery.

Thanks Chris


User
Posted 03 March 2016 14:21:42(UTC)

Originally Posted by: Online Community Member
W

Erection during motion even post RP is quite common,
Do not expect an over night recovery.

Thanks Chris.  Isn't it interesting to observe that it is quite common, yet no penile rehab appears to utilise the phenomenon?

I'm not expecting an overnight recovery, but would like to question some accepted practice stuff whilst I'm relatively new to the post op recovery phase. I've noticed that in most new endeavours in life, there is a phase, early on, when inquiry is at its' height, even at the risk of displaying ignorance. However, time passes; the reality is that of living day to day, month to month, with the condition. Oftentimes, this can mean that developing the acceptance of the condition necessary for calmness of mind translates into an acceptance of the status quo, not rocking the boat. There is a definition of 'experience' which I like because it helps to ground me when I think I have it: Experience= making the same mistakes with increasing confidence, over an impressive number of years. I'm not in the experienced camp- I'm more at the stage of the annoying brat who asks apparently stupid questions...

I do not yet have the experience of the many contributors to this forum. That's why I have joined - to help in my journey and hopefully help others in turn. I realise that recovery has it's own timeframes; recovery from anaesthesia, soft tissue repair after surgery, the longer timeframe of the nerve component repair mechanism, and so on.  I think if we leave the questioning of these aspects of recovery to Urologists and nurses,  advances in rehab will be slowed. We're all on our own unique journeys, but there seems to be so much guff surrounding rehab after prostate cancer.

User
Posted 03 March 2016 14:29:26(UTC)

Thanks for your experience regarding bikes, Chris J.

I guess I hadn't realised the impact of perineal pressure on aspects of recovery.  Makes sense- until you mentioned it, I think I'd have used the degree of pain or discomfort in the saddle as a yardstick of how far to push things on the bike.

User
Posted 03 March 2016 16:31:30(UTC)

I had my prostate removed by robot in April 2015 a few days after my 70th birthday. I was incontinent for two weeks and then gradually gained control again. I believe in the idea to stay as fit as one can so within 3 days of getting home (with catheter in, out 5 days later) I drove daily to a local wood and hiked 3 miles a day until the end of May, practicing my pelvic exercises as I walked.

On the 1st June I declared myself OK. My first post op blood test said I was OK as well, as did my surgeon, so I just got back to normal life. As my main hobby is long distance backpacking I 'celebrated' by hiking and camping 7 days of Offas Dyke Path. I had hoped to complete it all but I began to leak urine, but only when scrambling downhill stretches, it was the jarring I believe. Anyway it proved to me that I still had a problem to overcome.

I came home and continued with my wood walking circuit and ongoing pelvic exercises. On the 23rd July 2015 I went to Hendaye on the Bay of Biscay and over the next 45 days hiked, camped and hosteled on the GR10 across the Pyrenees (about 500 miles) to Banyuls Sur Mere on the Mediterranean. On Day 17 I found that I had a hernia, a consequence of my prostate op, so wasn't pleased. I managed to buy a truss so carried on to the finish.

My hernia was repaired near to Christmas 2015 and by the end of February 2016 decided I was again back to normal! Please note Mr. Hunt, the Tory geezer, I was operated on a SATURDAY! Admitted in the morning, operated on and home by 5.30pm!

I'm now back to my routine 3-5 mile off road jogging and/or walking most days of the week and so far I'm still feeling good.

I'm toying with the idea of hiking the Pennine Way in April 2016 and then to choose between the GR5 (Lake Geneva to Nice) or the GR10 route again, but this time from the Med to the Atlantic. For an 'old' bloke like me I like something to look forward to!

I am left with a couple of 'downer' issues but I do consider they are minor to me! Although I have full bladder control I am still aware that if pushed (e.g. too much beer) I cannot hold onto it as I could before my op. Secondly, I can no longer get an erection! I'm not too bothered about this, I just take the view I would rather be alive, well and continent than moping about my sex life. The one thing I am really pleased about is, that I am not on any medication and haven't been from day one after my operation. Lastly, my blood tests have all shown '0' and I have been discharged from the surgeon and other doctors care.

Thanked 2 times
User
Posted 03 March 2016 19:29:35(UTC)

I like your style Gunwharfman! You're obviously not one for putting your feet up. That's an interesting observation about the downhill jarring. I guess it's the way the muscles act when they're paying out , rather than shortening as is more usual in many situations. I'll see how that affects me. Do you use walking poles?

User
Posted 03 March 2016 19:32:19(UTC)

If erections while defecating were down to stimulation of the prostate via the anus, there is nothing to hang ED treatment on post surgery for the simple reason there is no prostate any more ... one of the reasons gay men need different support post-up. No prostate, no sexual stimulation. It's like expecting a woman to orgasm without a clitoris.

I think you have misunderstood the purpose of the vacuum, it isn't designed for enjoyment. In terms of penile health, the vacuum should be used to enforce and deflate the penis repeatedly over a short period of time, not to engorge and then maintain, so pleasure giving would defeat the object. As you say, if you want a pump that strikes or stimulates they are easy to buy online but I can't see it being an NHS priority.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 03 March 2016 20:22:02(UTC)

Originally Posted by: Online Community Member

If erections while defecating were down to stimulation of the prostate via the anus, there is nothing to hang ED treatment on post surgery for the simple reason there is no prostate any more ... one of the reasons gay men need different support post-up. No prostate, no sexual stimulation. It's like expecting a woman to orgasm without a clitoris.

Lyn, We were talking about erection associated with defaecation POST prostatectomy...and your comment about gay men is rather cut and dried. A man without a prostate who engages in receptive anal sex may also have pleasure and potential orgasms from the highly sensitive anal sphincter; prostatectomy under these circumstances  does not equate to a woman orgasming without a clitoris- a better analogy there would be if a man had no glans penis. The prostate undoubtedly provides pleasure, but it is common for the receptive man to engage in or receive manual stimulation of the penis to reach orgasm.

 

I think you have misunderstood the purpose of the vacuum, it isn't designed for enjoyment. In terms of penile health, the vacuum should be used to enforce and deflate the penis repeatedly over a short period of time, not to engorge and then maintain, so pleasure giving would defeat the object. As you say, if you want a pump that strikes or stimulates they are easy to buy online but I can't see it being an NHS priority.

 

No I haven't misunderstood, you have. You appear to fail to understand that since a major purpose of the penis is enjoyment, it might be beneficial to design rehab to be as task specific and natural as possible . Enjoyment can be harnessed to benefit rehab, it is not contrary to the aims of rehab - it will not ' defeat the object' -quite the opposite in fact The penis is richly supplied with sensory nerves, glans and shaft.  Currently, the pulling of blood into the member via a pressure differential takes place in a vacuum. You say that this encourages penile health. Yes, the corpus cavernosa fill up... and that's it. Hmmmm?

Pumps that mimic the natural mechanical deformation of the penis during masturbation or penetrative sex are not easy to buy online. In fact i'm not even sure if they exist. I am not suggesting incorporating  some random stimulation to a vaccum pump , rather,something that not only fills up the corpus cavernosa, but also mimics the mechanics, in a step down from normal unassisted penetrative sex. Seems like a no brainer to me.

I am well versed in the business of NHS priorities, but since neither of us has carried out a cost- benefit analysis on my idea, I will say no more.

User
Posted 03 March 2016 23:16:44(UTC)

But if you want your penile exercises to be pleasurable, you could just masturbate! However, masturbating 5 times, three times each day might be a bit wearing after a while.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 04 March 2016 13:06:41(UTC)

Originally Posted by: Online Community Member

But if you want your penile exercises to be pleasurable, you could just masturbate! However, masturbating 5 times, three times each day might be a bit wearing after a while.

Lyn, I'm not on here to feed your unconstructive trolling. I think it best I ignore any of your  responses from now on.

 

User
Posted 04 March 2016 13:31:20(UTC)

Gosh, no-one ever referred to me as a troll before - or unconstructive. I have been around here long enough to be neither. You on the other hand seem to know a little bit and then misunderstand .. or to be a very knowledgeable person having a laugh at members' expense. I haven't decided which yet but am happy to promise not to try to help you ever again.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


 
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