Sunday 20 January 2013

Prostate Exams: The Fickle Finger of Fate - Bottoms Up Gents

When I was in my fifties I thought I was still young. Now I am somewhat north of that and my thoughts have changed. We all go through routine medical procedures as we age. Often follow-up visits to other specialists are recommended just “to be sure nothing else is going on”. When I hear that I fear something else is going on. I am right. I am getting old.

As a man I am at the age when that infamous annual finger-poke is recommended by my personal physician to check for prostate problems. While I am on the topic let me clarify something. The word is prostate, not prostrate. The latter is the position you are asked to assume in order to receive the former.

The procedure is normally performed during a routine physical. For those prurient females or for guys who are about to experience this most intimate of doctor / male patient relationships for the first time, I will tell you what to expect. To any female readers I recognize that women suffer a digital examination in a different and even more intimate orifice than we do, often from a male doctor.  There are no stirrups ladies – but there is plenty of intimacy.

Basically, you drop your drawers and lie prostrate on your side on “the table”. “The table” is covered by a microscopically thin roll of paper. This paper is to protect you from all of the creepy crawlies deposited by previous patients. Think about this! The examiner sees fit to wear latex gloves impervious to most bacteria while examining you on the table. You however are placed on a piece of tissue through which, in microscopic terms, you could drive a truck full of bacteria. Perhaps I am being too anal. Perhaps it is appropriate!

Some doctors prefer you to turn away from them – then you can’t see the smile on their face. Others ask you to turn towards them in which case you pretty much have your face in an area of their anatomy which I will leave to your imagination. That’s one of two moments I wish he were a she. The doctor, as mentioned, wears a latex glove - or is it two? I never really noticed. If not, there must be a lot of single gloves being discarded. Maybe the right-handers and the left-handers do an exchange - good for ecology.

He applies a suitable lubricant to you and the glove - WD40, 10W30 or some such thing. The examination only requires one finger. The other hand is busy holding things apart to give the proper - access. Use your imagination. With more portly men I suspect he probably needs the second hand just to extricate the first one. You are warned that there might be a feeling of “pressure” or of wanting to have a bowel movement. This is accurate!

The whole thing only takes a few seconds just like a male’s role in the more common act of intimacy. If it takes him longer I suggest you turn around to see just what the other hand IS doing! That’s about it. You are told you can put your clothes back on. I usually take this option.

There is instant verbal feedback – usually while you dress. If you are asked to join him in his office, start worrying. In my case I was told that I had “quite a large one”. This is the second time I wished he were female. Then those words might have been music to my ears. Just the same he said things felt normal. Maybe to you Doc. Nothing about the entire process felt normal to me.

Often a PSA (prostate-specific antigen) test is recommended along with the regular blood tests performed by a lab. The PSA level can lead to an early discovery of prostate cancer. It costs an extra $35.00 at time of writing - not covered by our provincial medical plan. Funny how politicians are such masters at covering their own butts but they won’t cover mine.

Mine had been high three times in a row (my PSA count, not my GP). He referred me to an urologist. This is a specialist in butt-poking, rising PSAs, and other male parts that won’t rise. The good news was that this Master of The Poke also told me things felt normal but he wanted to see me twice a year. Is he weird or do I just have a nice butt? The bad news was that he suggested another follow-up procedure - in the hospital. It was to be - this is where it got scary - a prostate biopsy just “to be sure ... etc.!” No question about it - biopsy is a scary word.

This latest procedure was arranged. He explained why and attempted to reassure me. The PSA count is often misleading. Also, if there were a small growth in the prostate, the digital exam could miss it. This was very reassuring. The procedure would be quite painless. An “instrument” would be “inserted” (guess where) which would take several samples from the prostate. How? It would just shoot a little probe through the rectum (as in MY rectum) and into the prostate itself. Painless you say? Then he proceeded to further reassure me by saying that even the sampler could miss a small growth if it happened to probe on either side of it.

I left in a euphoric state of reassurance. As luck would have it the famous blackout of September 5, 2003 happened the evening before my biopsy. The hospital would not let him operate in the dark – good call - although something from the reassurances above told me that was exactly what he was doing. A few weeks later it was done and a couple of weeks after that I went to see him for the results. NEGATIVE. The bad news? As I said above, he wants to give me the poke twice a year now. Hopefully my GP will no longer feel the need.

Shortly thereafter, it was broadcast that several hospitals had reported that improper sterilization “procedures” were used in many recent prostate biopsy examinations with a risk of HIV & Hepatitis infection to the patients. Patients at risk would be contacted. Great - I am still waiting for the call. Feeling reassured.

Think you know everything about my butt now? Too much detail? Too bad. This could be you. I also happen to suffer from the occasional swollen hemorrhoid. Perhaps from all of this butt-poking? It ain’t from the sun shining therein.

As an aside, my GP has also scheduled me for a Barium Enema! That’s also fun and a topic for an entirely separate story – separate preparation; separate specialist; separate procedure; separate follow-up. Separate reassurance. Same butt!

And finally since all of this found nothing alarming he referred me to the big Kahuna of all specialists – the Proctologist! You think I was having fun before? This guy sticks a camera up your bum and watches it on TV. In this case he is looking for colon cancer. It seems to me there is potential for a new reality show here. I always wanted to be on the big screen but this is not what I had in mind.

All of this was to make me feel more confident that I was in good health. Let’s recap. The finger poke is not reliable. The PSA is not reliable. The biopsy is not reliable. Hospital hygiene is not reliable. The colonoscopy is quite reliable, but for a different type of cancer. The bills for all of this? You can bet that THEY are reliable. Thank you Medicare.

I was left with more than a couple of questions. How does a vet do the same exam on an elephant? I shudder to think. How can modern hospitals fail to properly clean something which has been inserted in a person’s ass? When I hear the expression “up yours” in the future will it trigger some of these memories?  Why would a Proctologist really want to be a Proctologist anyway? Can a doctor do their own “digital examination?” Would all of this have been more tolerable if women had been administering these procedures rather than men? I suspect I would have been even more embarrassed but for good reasons!

I thought by now I had been poked and prodded so often by so many that I would take it all in stride. Not so. Last week in the grocery store I stopped at the meat counter to ask the butcher to select some beef tenderloin. When he came over to the counter in the white lab coat and put the latex gloves on I instinctively turned around, bent over, and was loosening my belt before I realized it. When I came to my senses and turned back he was running for the nearest exit. I understand he has never been heard from since. That is only hearsay however - I’ve been banned from the store.

The truth is - all kidding aside - if any one of these procedures does turn up a problem that is a threat to my life or yours - it is worth it.

That’s a wrap – a bum wrap.

The Brewster

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