Biopsy-Daisy

Many years ago, Billy Joel signed his first recording contract. When the record was mastered at the wrong speed (Cold Spring Harbor was the record), he refused to continue with the contract. He moved to San Diego where he worked as the pianist in a piano bar. He consoled himself with the fact that he knew somewhere, sometime he would write a song about that experience. You may have heard of the song. It’s called “Piano Man” and was his breakthrough hit. Well, not that I’m claiming anything approaching the talent of a Billy Joel, but I had a similar experience with my biopsy which was performed yesterday. I considered delaying writing this until we got the results but I figure that whole experience will result in another blog.

This all began innocently enough (as it so often does) from my routine blood tests prior to my annual physical. I went to my doctor one early Friday morning in December and as is his habit, we discussed my condition, any complaints and my lab results. He was a little concerned that my Prostate Specific Antigen (PSA) was a bit high (4.5 as it happens and 2.6 is considered the maximum for normal) and a high PSA is a marker for prostate cancer. He said he was not too concerned because false positives are not uncommon.

So, off to the exam room. We went through the usual stuff, including the holding of the family jewels and turning my head and coughing. (I asked several years ago why doctors ask you to turn your head when they do this. The answer is so that you don’t cough in their face. So much for technical reasons.) Right after that comes the one “invasive” part of a man’s physical. Men, you probably know exactly what’s coming. Women, well, we only have one entry/exit point in that area of the body and the prostate is subjected to a physical exam by a finger inserted therein. He checked, found it to feel normal as well as finding no occult blood. So far, so good. Then he says, that he wants to do another blood test to check the PSA and see if it was actually a false normal. Of course he was apologetic knowing how much I hate needles but I understood. He said that based on the test, he’d decide whether it was necessary to see a urologist. He then proceeded to say that even if it was necessary, they do an ultrasound first. Based on THAT, he figured only about a 10% chance of needing to do a biopsy. So, aside from another needle in the arm, I walked out feeling pretty good.

Several days go by and no word from the doctor so I figured all was okay. But then he calls me and on the phone tells me that the second blood tests was much better and it was 2.7 and he was not concerned. Great! A couple days later in the mail, I receive the hardcopy of the blood tests and my doctor has hand-written on the side, “Based on what I see here, I want you to make an appointment with Dr. ___ for a urology consult. I think the chances of it being cancer are only 3-5%.

WHAT THE F*CK? First you tell me the results were fine and now you’re talking about odds of cancer? To say that this sent me into a tailspin would be an insult to every airplane that has ever crashed. I didn’t care if it was only 3-5%. He’s talking about cancer! So I dutifully call the XXXX Hospital Surgical Group (ain’t that a pleasant thought). This is in early January and they can’t get me an appointment until March. So, having no choice, I take it. So let me get this straight. There’s a chance I have a cancer growing inside me and you can’t get me in for two f*cking months to find out? That was when the panic button inside my head got pressed. (Oh. And for all of you tea-baggers who think that if government control of health care like in Europe means long lines and rationing of care, I suggest you think about two months before finding out if you might have cancer is just that. So take your anti-national health care and stick it in your own same place as where my exam is gonna be.)

I called my doctor back wanting to talk to him and yell about writing me a note about cancer and then my having to wait two months to find out. Initially, he defensively said the appointment was not his fault but I cut him off and proceeded to tear him a new one over what he had done. He has known me for 15 years and knows I have a critically low threshhold for bad medical news and any sort of diagnostically induced pain. Practically in tears I told him that he should have known better than to write anything about cancer. All he had to do was tell me to see a urologist. He became very contrite and admitted that he had made an error in handling it that way. Subsequently he even sent me a note apologizing.

So my doctor’s office got me a much sooner appointment with a different doctor in the same practice. We go through the usual questions, he snaps on the plastic glove and I bend over once again and with that the exam is over. We sit down and he looks at my PSA results and confirms that I am, indeed, 57 years old. The next words out of his mouth are that as a result of those factors we should do a biopsy. It took a second to register. What had my doctor said? First an ultrasound and then a 10% chance of a biopsy? I started crying and the urologist was all concerned that I was panicking over cancer until my wife explained that it was the procedure itself that frightened me. He was nice enough to give me a prescription for valium…one freakin’ 10 mg pill. Great. He also reassured me that the biopsy was nothing compared to a vasectomy and it happens that my vasectomy was really a non-issue.

So, here I am in full panic mode (okay, maybe not full PANIC mode but major fear-ridden mode) not so much over the chances of cancer but over what sticking a bunch of needles into my prostate is going to feel like. Those of you on Facebook may recall that all my status posts were various quotes about fear. I had long discussions with several of my Facebook friends, several of whom have been through extensive and painful procedures. While they provided love and support, they also provided some tough love and told me to not anticipate what I don’t know. One of them who is a doctor (who recently was in Haiti for disaster relief) reassured me that it was not a bad procedure at all.

At some point, it percolated through that I could not live through the intervening time in fear and I made a conscious decision to let it go. I really did pretty well. My wife detected a few things that indicate that my stress level was higher than normal but she’s seen me for 37 years and knows every subtlety of tones of voice and body language. All-in-all, however, I was okay, aided by my own doctor giving me some additional valium. I knew that I had enough to get me through something equivalent to my vasectomy and with the assurances that this would be less of an issue, I was doing pretty well.

So yesterday morning rolled around. It’s amazing how quickly time passes when you have something like this coming up. Three weeks ago it seemed so far away. Now it was here. To my surprise, I was pretty calm all morning. I was restricted to clear fluids, so I had my coffee, had a little bite of chocolate and went about acting normally. The minutes crept into hours and suddenly it was 1:00 and time to take my first valium. Now I recall from my vasectomy how quickly and how hard 10 mg of the stuff followed by another 5 mg a half hour later knocked me into left field. This time, I barely felt the effects, so I quickly took another 5 mg. I was still totally conscious of all that was going on around me. So while I was waiting for Joy to park, I knocked back another 5 mg and then when we were in the waiting room, another 5 mg. I was getting concerned at this point because I could feel that there was a slight buzz around the edges but I was entirely aware of everything. This is not good.

The door opened and a female in scrubs called my name. I grabbed my iPod and followed her. She led me to the rest room where she tols me to empty my bladder. Now this, I will admit, was affected by the valium. It was kind of like trying to hit the pot in an airplane lavatory during moderate turbulence. That having been completed, I was led to a room. I was told to remove my pants and undershorts, get on the table and lay on my left side in a fetal position. I doffed my pants, put on my iPod and set it for the playlist of my favorite songs and hopped up.

The doctor told me that first I would feel the ultrasound probe and then a slight stick. So there I am, lying on my side, singing along with Ah-Ha’s “Take on Me” and I feel a sharp sensation in the area of my prostate from the local anesthetic shot. It goes away in about five seconds and I figure, “OK, not bad.” The second one though, yow! He had to caution me not to move but that went away pretty quickly, too. A few minutes the other doctor (the one who did the consult) came in to do the actual biopsy. This was actually the least of it. There were about ten sensations akin to what you would feel from snapping a rubber band on your skin. And that was it.

I hopped off the table and the doctor said, “Any questions?” I asked how long I before it was okay to have sex. He looked at me and smiled and said, “As soon as you’re out of my sight.” I checked with the appointment people but my wife had already made the follow-up for the results for next Wednesday.

We left and I had already said that under the directions of my doctor friend (the one who had been in Haiti) and one other friend I was in search of a bottle of Eger bikaver wine. But first, I wanted food. Much to my embarrassment, what I wanted was a McDonald’s hamburger and French fries. And we could not find any Hungarian wine so I settled on a nice Tuscan Chianti.

So, I am here to tell you, that the procedure itself is really not all that bad. I’m living proof that if I can endure it, any male can endure it. And if your doctor says you should do have it done, do it. Now, all I need to worry about is the results. Stay tuned. Hopefully that will be a very, very short and not-unhappy experience.