Eight days ago I skied the American Birkebeiner … 33.5 miles of kicking and gliding through the forests of northwestern Wisconsin … now I'm resting after my enlarged prostate surgery which took place two days ago. My procedure used laser technology, and did not require an incision. You may read my earlier posts that describe my learning to deal with the events leading up to this surgery, including a trip by ambulance to the emergency room (part 1 | part 2). However, now my focus is on recovery. I have questions in my mind which any man might have:

• How much pain will I experience?
• Will my life return to normal … hopefully a better normal?
• How long will it be before I am able to take long distance skis and bike tours?

Given my "Green Laser Surgery" also included actual cutting with a microscopic knife which is attached to the laser equipment, my body experienced more stress than might be typical from this procedure. Thus, my doctor decided to have me stay in the hospital overnight. While everyone's surgery will be different, here are my recollections of the event:

• Once they gave me a sedative, I did not even remember leaving the pre-op room to receive anesthesia. 
• Apparently I did talk with my doctor in post-op. I have zero recollection of any conversation.
• I vaguely remember feeling a extremely strong burning pain in my urinary tract while waking up in post op, and asking for additional pain medication. My next memory was being in the secondary post op room (i.e. the location where you continue to recover, and family may now visit you)
• I actually gained 6 pounds in the hospital … all fluid. During my overnight stay I was hooked up and receiving intravenous fluids. This pumped the fluid level up in my body, and allowed the hospital staff to monitor how my new plumbing was working. Basically before I left the hospital the staff wanted to insure I had minimal bleeding, and was able to urinate on my own (i.e. catheter removed).

Basically, I lost 4 hours of my life. About 5 to 10 minutes after waking up in the second post-op room (not in the immediate post-op), my wife was allowed in to visit me.  In the days and weeks ahead I will blog about how fast I recover and am able to start serious physical training, both cross-country skiing (if any snow is left) and long distance bicycling. Right now I feel amazingly strong all things considered. I am taking some Tylenol for the pain, and have a burning sensation when I pass urine. Yesterday (post op day 1), the pain was more severe and accompanied by some mild nausea, but even this discomfort ended within ten minutes of going to the bathroom. This morning, the burning pain upon urination is much less severe. Pain of this nature is to be expected. Urine is acidic, and my urinary tract is inflamed right now. 

Overall given how I feel, I am very optimistic about the recovery process. My doctor does not want me doing to much … I would like to ski soon! We'll see. However, I very much want to thank my urologist and surgeon, Dr. Dean Tortorelis. He gave me permission to include his name in this post. Throughout this procedure Dr. Tororelis has been fantastic in terms of his medical ability, but also insuring both my wife and I knew the benefits, possible risks and complications of Green Laser Surgery.

In closing, here is a photo taken by my wife prior to my going into surgery. I originally said no to the "photo op", but given my daughter had texted my wife Molly and asked for a photo so she could see her Dad … how could I say "no" to Karen!

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Posts in this series:

1. Postate Problems and Nordic Skiing (trip by ambulance to the emergency room)
2. Prostate Problems and Nordic Ski Racing: Part 2 (competing with a catheter)
3. Post Op: 2 Days After Surgery (this post)
4. Post Op: 1 Week Later – Nordic Skiing! (amazing recovery)
5. Post Op: 4 Weeks Later – Cycling

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I joined 8,121 of my best friends and skied the 2013 Birkie yesterday. There were four races, and I competed in the 54 kilometer Birkie Classic (33.5 miles), which is the longest race. During the race I wore my GoPro camera mounted on my back and took timed photographs every 30 seconds. Here are the best of those photos. Some of the initial photos have snow smudges on them. I was tripped up by another skier during the mass start. Thankfully another skier called me over and cleaned my lens, and the residual snow eventually melted off from my body heat.

• Photoset: 2013 American Birkiebeiner GoPro Back Cam (244 photos)

Here are a few photos which give you an idea of what it's like to ski this event. I finished the 54 kilometers in 4 hours and 49 minutes. Considering I've been dealing with a medical condition and was in the hospital emergency room just a little over one week ago, and only received the green light to race on Thursday … for a man just shy of his 57th birthday I'm thrilled with my results (learn more about my personal ordeal).

Click upon any image to view at full size and resolution. In general these photos are of Classic Wave 3, and after the two trails merge later in the race, also include Skate Waves 4 and 5. Conditions were slow yesterday due to the seven inches of new snow that had just fallen within the past 24 hours. However, the new snow made for a Winter Wonderland!

The Start

 

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Early Kilometers and an Early Aide Station

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Birkie Warrior and the Classic Only Trail

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Another Aide Station and Snow Laden Pines

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Bitch Hill had a curvaceous leprechaun at the summit to greet the skiers!

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The finish on Main Street in Hayward!

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Our Birkie! (left to right)

Me, Molly (my wife), Erik (my son), Pastor Greg: Everyone else but me did the 50k skate, while I skied the 54k classic. Congrats to Erik and Pastor Greg on their first Birkies!

This post continues my documentation of  how one man is dealing with an enlarged prostate. In my case, I am very active and in the midst of my Nordic Ski racing season. Suddenly being faced with an enlarged prostate which requires surgery was not part of my original training schedule. Today's post will focus more on some of medical issues one must face. As noted in my first post (read for background), we men don't tend to be very good about discussing medical issues, let alone our prostates … a very personal part of our body.

One final comment before getting to the heart of this post, I will use "soft language" to describe certain parts of the body. While not a prude, I do not want the automatic search engine spiders to pick up on certain words / body parts and make the mistaken assumption that this web content should be blocked (i.e. not family friendly). Now on to the medical part of this entry …

On Tuesday I had a renal ultrasound, which thankfully confirmed I did NOT have any kidney damage resulting from my episode last week. When your enlarged prostate blocks normal urine flow, things back up into your bladder. If you bladder becomes full, your kidneys act as an overflow outlet. You will have some indication that you are experiencing the same problem if in addition to pain in your lower left abdomen, you also experience pain in your lower back … essentially the location of your kidneys. Get to a doctor immediately if this happens to you. Don't wait. While your kidneys normal function is to eliminate waste from your body, a backflow is dangerous, and over a period of time your kidneys might be damaged. While an enlarged prostate can be taken care of via various medical treatments, damaged kidneys are another matter. Get help!

Yesterday, I saw my urologist for the second time. It had been one week since my first visit. As you would expect, wearing a catheter for 8 days was not fun. My ego and pride, which should NOT be an issue with this problem, were hurt. This emotion was dumb on my part. The first part of my doctor's appointment was a general consultation outlining what would be our plan for the next two hours. However, both my doctor and nurse were thrilled I had raced over the weekend in a cross-country ski race, and complemented me on how I adjusted to the catheter (i.e. an initial ski earlier in the week when I tested how to keep my tubes and bag in their proper place, followed by a trip to the pharmacy to get some self adhesive ace bandages to keep everything on the inside of my leg).

Now came the medical procedures, which were not pleasant. After your "private parts" are numbed up on the inside, your urologist will use a fancy scope that allows your doctor to see inside your urethra. In my case, the blockage was obvious. The second part of the examination was to fill my bladder with fluid and determine if I could successfully void the liquid out of my system. This was painful, but necessary. The same scope the doctor uses to look inside you, has intakes that allow sterile solution to be slowly forced into your bladder via a syringe.

Once this is done, and things are pulled out, I was left on my own for five minutes and given the chance to try and void the liquid. In my case, only about 1/3 of the liquid came out. While I could understand this intellectually, it became much more obvious and dramatic later in the examination. The key point was I needed surgery to increase the size of my urinary tract. I will be undergoing Green Laser surgery in one week. This surgery is less invasive than what men had to experience in the past, and does not involve any incision.

Previously I mentioned that I understood intellectually that I was not able to pass all the fluid injected into my body, but as with everything … a picture is worth a thousand words. Thankfully, I will not have a catheter for the next week leading up to my surgery. However, the dangerous blockage which landed me in the emergency room can not be repeated. Thus, I was taught to self catheterize myself. This procedure is surprisingly easy and quick. One is given a three foot long very narrow tube upon which one puts lubricating jelly. Very slowly one inserts the tube into one's private parts and pushes it deeper into your body … past my prostate where I could actually feel the resistance / blockage. What was amazing, once the catheter reached my bladder, whoosh! Urine came out with a rush. All of this fluid was blocked and would have eventually backed up into my kidneys resulting in the same dangerous event and pain. Within a few minutes I completed the procedure and withdrew the catheter. Hopefully, this is a process I will only have to perform once per day. That is the expectation. I am also on some medication which helps me pass urine more easily.

The final part of my examination was the consultation. I invited my wife into the doctor's office, and we all discussed my enlarged prostate, and what is involved with green laser surgery. If you have a wife or significant other, I very much recommend making that person part of the decision. It just makes everything easier if the medical treatment and risks are understood by everyone before your operation.

Tomorrow it's off to ski the Birkebeiner which is America's longest cross-country ski marathon. I will be sking in the 54 kilometer classic race, which is about 33.5 miles. Between the various races, there will be 10,000 racers competing. Over the past seven days I've kept up my training, and even competed in the Book Across the Bay race. Thankfully, for tomorrow's race I will be NOT wearing a catheter. However, over the past week I learned how to adjust. If you are an athelete, here are some practical recommendations for competing with a catheter:

• First … you CAN compete!
• Second … you don't need a last minute trip to the bathroom! 🙂
• Third … don't wear underwear or a supporter … better to let your tube swing more freely
• Fourth … immobolize your tube on the inside of your leg
  • Use self adhesive ace athletic bandages with some athletic tape
  • By keeping everything on the inside of your leg, you can't fall on anything and cause problems … it's physically impossible unless you somehow are able to turn your legs inside out!
• Fifth … get some neosporin antibiotic ointment. Put this on the tip of your private part. In addition to helping you resist infection, it helps with chafing. It's worth using this ointment all the time … not just while competing.

Here are three photos from last Saturday's race. One competes at night while skiing across the frozen ice of Lake Superior. Luminaria light the trail every 50 meters, with bonfires each kilometer. Molly and I actually skied the course backwards arriving at the start just 10 minutes before the start. Given the temperature was only 3F, this timing was perfect. Before we knew it the sun had set, and the race was on and we were heading back across Chequamegon Bay.

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Posts in this series:

1. Postate Problems and Nordic Skiing (trip by ambulance to the emergency room)
2. Prostate Problems and Nordic Ski Racing: Part 2 (this post)
3. Post Op: 2 Days After Surgery (surgery ends up a bit more severe than expected)
4. Post Op: 1 Week Later – Nordic Skiing! (amazing recovery)
5. Post Op: 4 Weeks Later – Cycling!

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Photos: Skiing Over Before the Race!
(click to maximize any image and view at full size) 

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Using my GoPro at the start and just afterwords …

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Yours truly at the start of Book Across the Bay. I'm the second classic skier … wearing the partial yellow jacket. My thanks to photographer Kelly Randolph who took this image and was gracious enough to give me a copy.

This blog post almost writes like one of those horrible commercials … Prostate Problems? Get control of your life and go Nordic Skiing!

It took me a while to decide whether to blog about my recent problems, but then I decided "we men" don't talk about our health problems, which not only is a shame, but can be dangerous. Thus, swallowing my pride I decided I would use my blog to tell the story of dealing with prostate problems. Please chime in via the comments section with encouragement, or your own observations. Here is my story as it stood last Wednesday: (will update this blog post in the days ahead as I progress through this medical situation)

• Wednesday Leadup (Feb. 13): Came home from work at 7:30 am. Convinced I had the flu. Throwing up violently by 8:30. HUGE, deep intense pain in my lower back and left abdomen. Called the nurses hot line during a break from all the pain, and am convinced to seek medical attention. Drove myself (really dumb) to a local urgent care. Immediately seen and misdiagnosed as having this year's flu, but quickly the focus turns towards the potential of kidney stones.
• Wednesday Emergency Room (Feb. 13): Decision is made to transfer me by ambulance to a local hospital. I was still in severe pain. While on ride to hospital was given morphine for the first time in my life. After arriving at hospital was given stronger pain killing drugs. Entered "La La Land" of hallucinations. CT Scan determined that the problem is not kidney stones, but an enlarged prostate which is blocking most urine flow. A catheter was inserted and pain started to disappear. (i.e. I could not void all my urine, and it was backing up into my kidneys)

Now you have the basic facts, but what about the emotions? At age 56 and a hard core athelete who was training for the Birkie, I was depressed. This was not my idea of a good time! On Thursday morning I saw the urologist, and my initial diagnosis looked good … just an enlarged prostate. No masses appeared on the CT Scan which might be indicative of cancer. However, more appointments are scheduled for next week which will give my doctor all the data he and I need. As I left the doctor's office I was given a brochure for Green Laser Surgery. I suspect with a high degree of liklihood that some kind of surgery is in my immediate future.

By early Thursday evening my depression deepend. Wearing a catheter was a new and undesirable experience. The unknown was facing me. I still wanted to ski the American Birkiebeiner. However by bed time Thursday night, and after talking through the problem with my wife, and making a phone call to my older brother who had also had prostrate problems, I had decided to attack life. My doctor and nurse had said to not rule out the Birkie. Thus, my goal was to learn how to adjust my life.

Friday afternoon I took my first step. After work I skied 8.5 kilometers, not very far by Birkie training standards as my body was still messed up from its shock on Wednesday … and oh yes … I was wearing a catheter. Thus, I figured out different ski clothes to wear (baggy long underwear and ski pants) to fit over the catheter, and took off onto the trails. By the end of my ski, I had completed my hilly circuit in a little under 5 minutes per kilometer (classic, not skate). The skiing went surprising well. Although I did not quite push myself at 100%, I did not lay back either. I learned that my catheter's tubing snakes around to the outside of my leg while skiing. If I fell, crashing upon my tubing would not be good. Thus I abbreviated my ski, and made a trip to the local drug store where I bought additional wraps to really immobilize the tubes in their proper places.

What does the future hold?

• Getting rid of this catheter at some point?
• Skiing the Birkie?
• Surgery? (treating just an enlarged prostate and hopefully no cancer)
• A return to normal including sex with my wife?

The stats say over 50% of you guys will join me in this journey. Hopefully you may learn something from my experiences. Expect this blog post to be updated as I work through this medical problem. Catheter is not a dirty word, but it was hard to talk about it at first and admit to friends I was wearing one.

One important postscript. Do your loved ones have the information they need to help with your medical care? In our case the answer was "no". Learn about Wednesday's events from my wife's perspective when she gets a call from her husband in the emergancy room … remember I'm on morphine and much stronger drugs. Molly Hoeg's blog post: Are You Prepared?

Post Updates:

• Saturday, Feb. 16: Decided to ski Book Across the Bay tonight.
  • Completed 20 km ski on the frozen ice of Lake Superior last night (photos)
  • Molly and I skied the course twice (over and back, don't take the bus to the start)
  • The catheter was chafing while I was skiing. Some research indicates I should get some neosporin antipiotoc ointment to apply where the catheter enters my body.
• Tuesday, Feb. 19: Next planned update … renal ultrasound medical appointment

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Posts in this series:

1. Postate Problems and Nordic Skiing (this post)
2. Prostate Problems and Nordic Ski Racing: Part 2 (compete with a catheter)
3. Post Op: 2 Days After Surgery (surgery ends up a bit more severe than expected)
4. Post Op: 1 Week Later – Nordic Skiing! (amazing recovery)
5. Post Op: 4 Weeks Later – Cycling!

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My immediate future holds the great combination of:

• 50% work as a software consultant
  (and) 
• 50% long distance cycling trips

As a warm up, my bride of 30 years (thanks, Molly) and I will bike 500 miles along the upper Mississippi (Great River Road). We'll actually be in the middle of our ride on the 21st of May, the day of our anniversary. Doesn't everyone bike 70+ miles on such an epic day? We will be in search of ice cream to celebrate!

However, the Father of Waters trip will only be a warm up for the 2,000+ mile Grand Gaspe Tour which will start in early August. Both rides have their own custom designed jerseys created by the crack artistic design team of Rich and Molly. We use Voler's semi-custom design studio.

If you're curious, here' s a link to last Summer's Trans Superior Tour in the Lake Superior Region. A quick browse and read might help you understand why I love long distance cycling. In fact, to really understand, you must read: Purple Cows at Dawn!

Here are the proofs to our two new jerseys. If you see us cycling on the highways and byways of Canada and the USA, please gives us a wave and stop to chat!

(click to maximize any image)

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30th Wedding Anniversary Tour

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Grand Gaspe Tour

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The Grand Gaspe Tour "Basic" Route
(side trips will be added!)