If you haven’t already, read parts 1 and 2 before reading this part
The day after the biopsy I felt pretty normal. I had passed one large blood clot from the surgical wound site, but other than that there was no blood in my urine or elsewhere. The only pain I had was from my torn left Achilles. The next day, however, I woke up with a sharp pain in my right heel centered on the back of the heel and extending down to the “tip,” i.e. the point where it goes from vertical to horizontal and becomes part of the sole. I thought it might be plantar fasciitis or Achilles tendinitis, both of which I’ve had before. This mystified me since I had been doing nothing strenuous due to the previous injury on my other ankle and the biopsy. This pain grew worse and worse over the next few days. By the time for my return to Dr. A for the results I really, really could hardly walk. It was excruciating. I would avoid going to the bathroom as long as possible so I would not have to walk the ten steps there. I used the guest bathroom rather than walk the extra twenty step to the master bath.
Even so, I drove myself to PAMF for the appointment. It took me forever to walk from the parking lot to the building now that I had pain in both feet/legs. I’d always been impatient waiting for those geriatric geezers who took a century to make it across the crosswalk to the front door, blocking my entering car. Now I was one. I’ll be more patient in the future. Of course Dr. A’s office had to be the absolute farthest one away from the elevators.
Dr. A saw me promptly and told me right off that I had prostate cancer. He said I had a 7 on a scale of 10. That stunned me. I not only had not expected a positive result, but 7 out of 10 sounded scary. He began to describe my options. He listed them in this order: watchful waiting, active surveillance, brachytherapy, external beam radiation, and prostatectomy. The first two are, as they sound, undertaking no active treatment, but keeping an eye on the progress of the cancer. Most prostate cancers are slow-growing. Dr. A said this was not recommended for a level 7 biopsy result. Brachytherapy is where a radiation oncologist implants radioactive seeds in the prostate to kill the cancer cells. External beam radiation is where the prostate is X-rayed from outside the body over a period of days or weeks. He offered to put me in touch with a doctor who did those radiation procedures. The prostatectomy is where the surgeon removes the entire prostate. Dr. A. would do the procedure using the Da Vinci robot system. Five small incisions (holes) are made around the pelvic region and small instruments are inserted allowing the surgeon to cut the prostate loose, separate the blood supply and nerves, then remove the entire prostate and sew together the bladder and urethra. I asked what he recommended and he said the prostatectomy. I asked nothing else and he told me little else. When it was over I mentioned to him how I had this severe pain on my right heel, the uninjured one, and asked if it could have anything to do with the prostate situation, as unlikely as it seemed to me. He said no. I said I was going to call Dr. M to get a cortisone shot, which had helped the last time and asked if that would be okay. His response was, “I would.” This turned out to be a big error on his part. I left with a flyer, a video on disc, and a knot in my gut.
Even though I had no appointment, Dr. M saw me that afternoon. He took a great deal of time, too, going over my biopsy results with me, much more than Dr. A, and much better information. I’ll tell you more about that in my next post, but let’s stick with the heel pain for now. When I asked Dr. M for the cortisone shot, he checked my medications for the biopsy and saw that I had taken Cipro. He told me that Achilles tendinitis is a known side effect of Cipro, especially in older men, and that it increases the likelihood of a tendon rupture. Not only that, but a cortisone shot would increase that risk even more. He refused to give it to me. He prescribed a topical NSAID.
You might think that it is excusable that a urologist wouldn’t know about Achilles tendon ruptures, but you would be wrong. Any doctor who prescribes Cipro should be aware of its side effects, but a urologist especially. It probably should never have been prescribed at all in my case. Why? I have since learned that there are seven risk factors for Achilles tendon rupture or acute inflammation. They are:
- Over 65 years of age
- Active athletically
- History of tendon ruptures
- Blood type O
- Cortisone shot
I have the first five by dint of my genes and Father Time and Dr. A had just given me number 6 and recommended number 7. My existing tendon rupture in my left leg may have confused the question a bit, but I had made clear to Dr. A that it was the new, unexplained pain in my right heel that came on after the biopsy that was motivating me to ask for a cortisone shot. That was the acute pain. It should have been obvious to him it was caused by the Cipro. He knew of the first four risk factors in my case and could have asked about my blood type. Since urologists deal with older men constantly, they should at least be aware of the risk of Cipro and if not choosing another antibiotic, at least warn patients of that risk, especially when the patient makes the doctor aware of the tendon pain. The pain in my right heel went away after about another week, fading steadily as the Cipro worked its way out of my system. My left tendon is still injured and still hurts almost two months after the tear. I still can’t run. That one wasn’t caused by the Cipro, but it may have been exacerbated by it. The use of Cipro at all was probably a mistake and the recommendation to get the cortisone was certainly a major one.
I’m also unhappy about the information I got, or failed to get, from Dr. A that day about my cancer and my options. More about that in my next post.