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Cycling after RARP - surgeon said wait 6 weeks

User
Posted 28 Jun 2020 at 09:04

I see some different opinions on here about how long you should wait after surgery before cycling. Cycling is very important to me. Without it, I wouldn't have held it together waiting an extra two months for my RARP surgery while COVID displaced elective surgery and introduced new treatment risks.

When I had my initial surgical consult (17/03/2020) I asked him "How long before I can cycle?" (He turned up on a city bike, which I found most encouraging). Unhesitatingly, he said "6 weeks". My hospital "discharge information following robotic prostatectomy" leaflet also says...

"Bike and horse riding should be avoided for 6 weeks"

This is echoed on the discharge summary
"No driving 2/52, no heavy lifting 4/52, no bike riding/horse riding 6/52"

So that's pretty clear and consistent advice. 6 weeks it is. I'll be riding again on 24th July (but building up again gradually).

I realise that every single case is different, but this is generic advice - certainly on the "discharge information following robotic prostatectomy", which was a photocopied sheet. I was treated in Oxford and have mostly only good things to say about it.

I've seen some people advocate the idea that "you need to wait six months to give the nerves a chance to recover".

I wonder if the guidelines have changed/updated or are different in different places or with different surgeons/procedures? Something doesn't quite add up here.

I had a bilateral nerve-sparing RARP procedure. I was quite surprised on the 4th night after surgery to find that I was already feeling some nocturnal stirrings "down there" with catheter still in (quite uncomfortable actually, but fairly reassuring at the same time). πŸ˜€ Day 14  - "wow it works already" - bit painful around the urethral join (or somewhere round there where it's trying to stretch), but deffo at least 90% of 'normal service' resumed. Pretty amazed and chuffed about that, since I'd resigned myself to the possibility of ED.

So I don't see any reason (in my case) to deviate from the instructions I've been given. But, as a thought exercise, if I hadn't been so fortunate as to recover erectile function so quickly, would some people still advise staying off the bike for longer, even though it contradicts what I've been very clearly told?



_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jun 2020 at 10:03

I have no direct experience of this, and I'm not against disregarding advice if I can see that my circumstances are exceptional, or I just have a different interpretation of risk and reward in some aspect of life. Expert advice is often arbitrary, why is 1 metre safe rather than 2 metre? why did 21 units alcohol suddenly drop to 14 units? why is eating eggs good for you one decade and bad the next? 

But, with respect to nerve damage and recovery after operations, I have no knowledge to inform myself sufficiently to contradict the professionals. From a risk reward point of view, a fully functioning penis for the rest of your life is a great reward (you don't miss it til it's gone). I like cycling, but I would give up anything (even beer) for six weeks if it ensured little percy was happy. If I ignored advice and things went wrong I would have only myself to blame, and a whole lifetime to regret it. So personally I would follow doctors orders on this occasion, it's only six weeks.

I would ignore anyone who says six months. I don't know where the six week brigade are getting their evidence let alone the six month brigade. Their are people who are very risk averse, if you listen to them you would never leave your house for fear of being run over by a bus.

So that's just my opinion, no evidence to back it up though. 

Dave

User
Posted 28 Jun 2020 at 10:36

Originally Posted by: Online Community Member
I like cycling, but I would give up anything (even beer) for six weeks if it ensured little percy was happy. If I ignored advice and things went wrong I would have only myself to blame, and a whole lifetime to regret it. So personally I would follow doctors orders on this occasion, it's only six weeks.

I would ignore anyone who says six months. I don't know where the six week brigade are getting their evidence let alone the six month brigade. Their are people who are very risk averse, if you listen to them you would never leave your house for fear of being run over by a bus.

So that's just my opinion, no evidence to back it up though. 

Yeah. Thanks Dave. I pretty much agree with that. Just to be clear, I am strictly following the instructions I've been given.

There's no way I'm getting on a bike before 6 weeks even though 'little percy' is already perking up. I had assumed the reason for the 'no cycling' rule was because of general surgical damage. As soon as I got my surgery date I put the "+6 week" date on my Google calendar as something to look forward to.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jun 2020 at 12:29
John was a keen cyclist, covering similar miles to you. He asked how soon he could get back on the bike and was told 6 months. The urologist (one of the 'golden list') said "what is the point of me doing everything I can to save the nerve bundles if you don't give them the best chance of recovery?" J found it incredibly difficult at times but he stuck to it - it would have been daft not to, having gone to the trouble of forking out Β£000s to get the best surgeon we could.

Each man makes his own decision. You are regaining function, that's brilliant news, and your uro thinks 6 weeks is fine, also brilliant news as it means you can get back on your bike without risking years of regret and double think. If on the other hand, a man was left with permanent ED and had got back on his bike at 6 weeks, there would always have been that niggling guilt that perhaps the ED could have been avoided.

And I will be brutally honest; having had 10 years of a sh1t sex life, if I was looking back now and thinking he hadn't done everything he could (e.g. if my husband's decision had been to get back on his bike as soon as possible rather than follow the advice), I would probably have divorced him by now.

Uros have personal preferences, as do oncos and patients. Just because one uro says that 6 weeks is fine doesn't mean that another uro is wrong to say longer.

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

User
Posted 28 Jun 2020 at 13:01

Excellent reply. Thanks Lyn. πŸ˜€There's always more to it than meets the eye.

I guess one of the reasons why I was curious about the different advice from different sources is whether or not newer data/research/techniques have come to light in recent times or whether it's just different opinions.

I agree totally that paying for surgery and then not following the surgeon's advice would be ludicrous. In fact not following the surgeon's advice would be foolish irrespective of NHS or private. (That's why I'm still enjoying😱 my TED socks for another 13 days πŸ˜‡)

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jun 2020 at 15:02

My surgeon was quite happy for me to start cycling again at 6 weeks. In the end  I actually started running at 6 weeks and cycling at around week 8 as I didn't want to rush. Was probably week 12 before I started feeling I could push things a bit more

User
Posted 28 Jun 2020 at 15:08

Originally Posted by: Online Community Member

My surgeon was quite happy for me to start cycling again at 6 weeks. In the end  I actually started running at 6 weeks and cycling at around week 8 as I didn't want to rush. Was probably week 12 before I started feeling I could push things a bit more

I'm planning to ease back into cycling very gently after 6 weeks (e.g. up and down the road on day 1 - see what it feels like the next day, then a bit more the next day if OK). Walking for the next 4 weeks.  Who knows? I might even try a run (not a big running fan). Already have a Specialized Sitero saddle with a huge perineal cutout and no nose, which I've been using since Feb.

It was perineal pain back in November that made me get my prostate checked out in the first place.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jun 2020 at 17:18

Cycling
Cycling is a unique exercise to be careful with as the seat of the bike puts direct pressure on the area where your prostate was. As a result, cycling should be avoided for the first 12 weeks after surgery to allow the new join between your bladder and urethra to heal before being subject to the sustained pressure and trauma from a narrow bike saddle. If your saddle is wide to distribute the pressure (as in a gym exercise bike) or has a perineal area cut out then you can cycle after 6 weeks but for no more than 30 minutes at a time.

This is an excerpt from the Santis website. I guess if there has been a change of view in recent years, it is because prostate friendly saddles are so much easier to source than they used to be?

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

User
Posted 28 Jun 2020 at 17:54

Yes saddles with cutouts are much more common than they were, say, 10 or even 5 years ago.

30 minutes? 😱I would hope to build up to that, but I have been known to do 10 miles in that time 😜

This was me really going for it a week before my surgery. (Just in case, for whatever reason, I never got to do it again).

https://youtu.be/Qguja7iPsmY

My wife had knee problems last year. She couldn't ride at all. Last summer, over 4 weeks I got her from 50 yards up and down the road to 10 miles in very controlled, gradual steps. I'm hoping to be able to ramp up my riding a little quicker than that, but with the same idea. Certainly won't be planning any really hard efforts or long endurance rides for several weeks after starting back.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 29 Jun 2020 at 08:29

I'm using Zwift at the moment to build fitness back up. Find it a nice controlled environment and, especially early on, didn't want to find I had some discomfort and be miles from home.

 

User
Posted 29 Jun 2020 at 08:41

Originally Posted by: Online Community Member

I'm using Zwift at the moment to build fitness back up. Find it a nice controlled environment and, especially early on, didn't want to find I had some discomfort and be miles from home.

That's also a good idea and an option. I bought a manual turbo trainer as 'insurance' in case cycling was forbidden during lockdown. But I haven't used it because cycling was still allowed. I also have a lot of circular local routes which involve "never being more than a few miles from home". I think if one builds up slowly and sensibly (like any rehabilitation scheme) it should be OK. The only way to find out is to have a go.

There's also the "phone call of shame" for a pickup if you can't make it back, but that's very much a last resort. πŸ˜‚

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 29 Jun 2020 at 12:47
Being a keen triathlete, I was itching to get back on the bike again (especially with the quiet roads during lockdown) but refrained until I had my three month follow up call with consultant. He did seem quite surprised at the time that I hadn't started riding, but was happy for me to do so as long as I was sensible! I had started running after about 8 weeks which helped me mentally and fitness wise.

I'm now about 15 weeks post RARP and enjoying riding again with no discomfort.

User
Posted 29 Jun 2020 at 13:17

Originally Posted by: Online Community Member
I'm now about 15 weeks post RARP and enjoying riding again with no discomfort.

Excellent! Very glad to hear that.

I'd have a go at triathlon but there's two small issues.

1. I'm crap at swimming πŸ˜‚
2. I don't like running (unless chased) but, who knows? I might try a run after week 4 if I get bored of just walking

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 24 Jul 2020 at 11:09

Update. I walked a lot in the first 6 weeks. But found walking a bit tedious during the 6th week. Tried a walk-run on day 29 (4.2 miles with about 5 one-minute running intervals) and obviously used muscles that are not used to exercise. My calf muscles weren't talking to me for a week afterwards, but no continence issues, thankfully.

Today is 6 weeks since surgery. Yesterday evening I put on my new Prostate Cancer UK cycling jersey and did a 5 minute "let's see if this hurts at all" ride up and down the road. It turned out fine and still felt fine this morning. It was a tester for a first 'proper' ride today.

Just back from a 5.5 mile ride (20 minutes), taking it fairly gently. It felt absolutely fine. Really enjoyed it. No stress incontinence issues or anything. Didn't even give that a second thought.

If all still feels well, I'll do another one tomorrow.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 24 Jul 2020 at 12:10

Fantastic, sounds like you are making great progress Alex. Just don't over do it 

User
Posted 04 Aug 2020 at 22:08

Video call with surgeon today 7.5 weeks post-op.

With respect to cycling the key thing he said when asked how much I could/should do was

'Your perineum will let you know if you're overdoing it. I assume you have a perineal cutout?' (I do. Quite large.)

I specifically asked whether or not I could harm my erectile nerves and was told I would be fine. That isn't necessarily transferrable to everyone though as I imagine each case is different. Ask YOUR surgeon.

I'd gradually built up to 40 minutes/12 miles over the last 10 days or so. So I celebrated by going out and riding 17 miles in an hour. My perineum hasn't yet said anything. We'll see what it feels like tomorrow. πŸ˜€

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

 
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