People & Lifestyle story, December 2005
A SURGEON’S TALE By: David Barnard 18th December 2005 |
By the middle of December 2000 I had completed over 21 years as consultant oral surgeon in Portsmouth and was starting the last 6 months of a 3 year term as Dean of the Faculty of Dental Surgery at The Royal College of Surgeons of England. I had also just been elected President of the British Association of Oral and Maxillofacial Surgeons. Although I was enjoying every moment of meeting the challenges of what was undoubtedly the pinnacle of my professional career, there is no doubt that this came at a price. My weight had increased to 18 stone and with a high pressure and unhealthy lifestyle it was clear that there was going to be a day of reckoning sooner or later. I needed a jolt and I was about to get one!
I casually mentioned to my GP that I had experienced recent problems with urinary function, (my wife later said that it was several years!). A subsequent PSA was 4.2 and I was referred for a urological opinion. On learning that there was a small chance of prostate cancer I initially agreed to a repeat PSA in one month. However, following further discussion, (and increasing anxiety on my part), a biopsy was organised 2 days later.
On St. Valentine’s Day 2001, while chairing a meeting at the College, I took a call informing me that the biopsy confirmed a diagnosis of prostate cancer. I guess there is no easy way to say it and no easy way to hear it. My diagnosis of prostate cancer at this time was pure serendipity and, as events turned out, most timely. At first it seemed unreal and the following day I gave a planned lecture to the Dental Society at Guy’s.
Two days later the consultant urologist fully explained the implications of the cancer and the options for treatment. I might have practised in a surgical specialty for most of my professional life but I had little contemporary knowledge about prostate cancer - I was suddenly a patient with all the usual questions and worries. I decided to explore the option of surgery, (perhaps predictably for a surgeon), and was referred to Professor Kirby with a view to radical prostatectomy. A date in 10 days time was confirmed, together with an invitation to lose a couple of stone in the interim. Struggling up the South Downs over the next week with 2 totally disbelieving border collies was a test for all three of us! This was clearly the start of a long journey. I had no doubt that I wanted to approach the problem positively and as soon as possible with the treatment option which would provide the best chance of cure. All this was now at the top of the agenda - everything else was secondary.
My wife and I decided that we wished to be totally open about the diagnosis and treatment. Accordingly I wrote to senior colleagues and staff members with whom I worked. My wife spoke to friends. Everybody was most supportive which we both appreciated so much. We never regretted our early decision to be open and adopt a matter of fact approach.
Prior to surgery I had the opportunity to talk with a previous patient which was both helpful and reassuring. Surgery and the immediate postoperative period were uneventful. However, although the Gleason score of the biopsy specimens was 7 (4+3), the surgical specimen ranged up to 10 (5+5), together with a positive margin. There was no evidence of local spread. A decision was made to have a mop-up course of external beam radiotherapy beginning 6 weeks post surgery. This was disappointing but an easy decision in the light of the initial philosophy for management.
During radiotherapy I experienced increasing problems with urinary flow which was initially thought to be a side-effect of this treatment. However, 2 months after the completion of radiotherapy my flow rate was getting worse with an increasing residual volume which was intensely debilitating. My wife blew the whistle on me and a surgical solution was needed with an immediate urethrotomy. It was felt that intermittent self-catheterisation (ISC) would reduce the risk of further problems and after initial reluctance, I could soon complete the task in less time than it took to clean my teeth! I continued with ISC for 6 weeks and then celebrated with an extended holiday by the Mediterranean. I have to admit that I packed a box of catheters but thankfully they remained unused. This episode demonstrated how important it is to seek prompt advice if you are in difficulty. It also emphasised the important role of partners as without my wife’s intervention I could well have ended up in serious trouble.
Throughout the year following surgery, I completely reorganised my lifestyle in terms of diet and exercise. I joined the local gym and daily walked my dogs for miles. I lost 6 stone and felt fitter than I had for years. Returning to professional work in January 2002, I discovered how much more difficult it was to keep up the new routines. In an attempt to force the work-life balance I decided to learn to fly and got my PPL the following year. In 2005, for reasons unconnected with prostate cancer, I made the decision to retire completely. I am pleased to say that at 5 years post radical prostatectomy my PSA remains undetectable and I have no troublesome, functional problems as a result of surgery or radiotherapy. My weight remains under control.
I consider myself very fortunate in having my cancer diagnosed at an early stage to allow potentially curative treatment. Some of my experiences were trying at the time but taken stage by stage, and with the excellent professional and personal support which I enjoyed, the journey was satisfactorily completed. The time out was longer than anticipated but the outcome is everything for which I could have hoped.