The last thing up my ass… was a rectal probe, part of an MRI examination, the final step in the effort to find out how widely my prostate cancer, diagnosed on biopsy a couple months ago, may have spread. I’ll get the results in about 10 days. The procedure, itself, was unique, and something I doubt I’ll ever be invited to do again. But if this procedure is in your future, you may find my experience interesting.
As with each of my visits at the National Institutes of Health, the staff was wonderfully professional. I thoroughly appreciated the time that they took to make me feel comfortable and I especially appreciated the benefit that they were extending. With this test, and others I’ve already described, I’ll have had an in-depth evaluation of the status of this cancer, and have been given a good basis for making treatment decisions. All that in a week or so. I’m sure I’ll be thoroughly nervous by the time that meeting happens. For now, let me simply tell you about this particular test, one that I looked up on the web but never found well described.
Things began with the MRI technician, a very pleasant fellow, telling me that I should undress and put on a hospital gown. The kind that opens in the back. He emphasized that everything was to come off, underwear included. Such complete disrobing had not been a requirement for any of the other imaging tests I’d undergone, but the rectal probe aspect of this test makes the need for nudity beneath the gown obvious.
The exam really is in two parts. The first is a brief scan to see if there is any blood remaining in the vicinity of the prostate, left over from the trauma of the biopsy itself. For me, that part of the exam only took about 15 minutes and had been done a month ago. There had been residual blood right behind the prostate and the radiologist felt that proceeding with the test would be a waste of time because good images would be impossible with the blood there. I was now back for part two, and the radiologist was ready to proceed with the full procedure. That is, a full prostate MRI with the rectal probe in place.
The technician invited me to lie down on the table that moves you in and out of the MRI magnet (as they call the machine). Then he started an IV so that contrast material could be pumped into my circulation at the right moment during the test. Once all that was done, the doctor was ready to insert the rectal probe. This is an aspect of the procedure that I was simply not looking forward to. Whether an enema or sex jumped to mind, the concept of having something stuck up my ass for the hour or so that the MRI test was going to take was simply not attractive. Also had a vague feeling that I might get a little hard with all this attention to my anus and I didn’t want to deal with that, either.
The doctor was very kind, almost apologetic, and explained that this would not be very uncomfortable, but the probe was entirely necessary in order to get good images. He said he’d take everything very slowly, explain everything, and that if I had any sharp pain I should tell him immediately. I was getting more anxious by the moment. Happily, however, my worries had been that I’d get a little hard from someone playing around with my anus was rapidly being overcome by the prospect of major discomfort. He then explained that after the probe was in he’d be inflating it so that it would hold itself in place, but that, because of an anesthetic lubricant jelly that he’d be using, after a few minutes I’d feel nothing at all. I can’t say this was sounding very good.
Then the doctor showed me the tool he intended to insert into my rectum. This bit of honesty confirmed my fears. Imagine something about the size and color of a corn dog on a big stick. The corn dog part was a large, thick rubber balloon with wires inside. It was deflated, now, but still pretty bulky, and squished in the palm of the doctor’s hand, it was a bit bigger than your thumb in diameter. The front end was made of thicker stuff and seemed not to compress as easily, so it was clearly the most bulky part, maybe twice the size of your thumb. The very tip was a sort of teat, just as is on the end of the average condom, but much heavier. Get the picture? The stick that this balloon was attached to was a stiff plastic tube about 18 inches long, and as big around as your little finger. Through this ran wires then led off to the machine. Another bit of tubing led to a huge syringe that would be used to inflate the balloon. The syringe held about 3 ounces. I could just imagine this thing swelling inside me. In his almost apologetic way the doctor assured me that once the first part of the probe was in, the rest would slide in more easily. Then he added that he’d done this many times before and there was never a problem. I couldn’t help thinking that if he’d been explaining intercourse to a virgin I think he’d have said essentially the same thing. “Just got to get the big part in, then everything else will slide in fine. Don’t worry. No problem.” Sounded vaguely familiar.
The doctor then asked me to roll over on my left side. And to draw up both knees. This was it. I was hoping for gentle. He put the lubricant onto the probe. “I’m going to start now,” he said and with no further comment immediately spread my cheeks a bit and pressed the probe against my asshole. Firmly. And then a bit harder. And it started in. He said, “The first part is almost in… there… and now it will go more easily… almost in… there… done.” It was all pretty quick, and I didn’t have to ask, “Is it in yet?” I knew. “I’ll inflate it now,” he said. “You will feel it sliding in deeper as I do,” he said. “That’s normal.” The inflation did not hurt, but I could feel the probe settling a little deeper inside. “I’ll attach the wire to your leg so it won’t pull out,” the doctor said. “Please roll slowly back onto your back.” I did, and, amazingly, everything was reasonably comfortable. I was frankly surprised. I guess the anesthetic worked pretty fast. And, in the midst of all this, my cock remained politely disinterested. For which I was grateful, though I suspect that with all the guys he’d done ahead of me in this test, the doctor has probably seen every possible reaction.
After the doctor and the technician made me comfortable with a pillow under my knees, ear plugs, and a headset that played music, the test began. A series of noisy banging sounds at various frequencies that lasted 45 min to an hour. The probe was not a problem. The only sensation associated with it was a mild sense of warm – which they said was from the anesthetic gel. The only thing that made the procedure difficult was pain in my shoulder that was related to something I had done at the gym. There’s no room to move around in the MRI magnet. Being forced to keep my arm in one position for a long time makes it impossible to relieve the aching, as I typically do, just by moving my shoulder around. It got really annoying. The probe had become a trivial problem.
Finally it was over. As the table moved out from within the magnet the doctor said that the test had gone very well, and that the images would be good. He’d look at them carefully in the next day or two, and report to the team that is going to make recommendations afterward. For now, he’d remove the probe and I did not need to roll again to my back. With that he deflated the balloon and pulled on the plastic stick. My asshole contracted involuntarily against the movement, but he had no difficult getting the probe out, though it seemed a bit rough. His final warning was that I might see a tiny bit of blood when having bowel movements because the procedure had been irritating to the rectal lining.
The radiologist did provide one additional bit of information. “Your prostate is very big,” he said. “About the size of a tennis ball.” My understanding is that an adult male prostate is about the size of a walnut. A tennis ball sounds big. Let’s hope its big enough that the cancer has, to date, all stayed inside, and removing the prostate will be all the treatment that I need.
So, the final diagnostic step has been completed. I feel completely comfortable with this group of people and look forward to their considered opinions. Then comes the decisions about surgery or not, robots or not, radiation or not, chemotherapy or not. All sorts of combinations, risk and benefits. I hope that they help keep things simple. I’ll let you know.
One last thing. The anesthetic gel wore off after as I returned to work. The resulting feeling was of soreness, not severe, but sort of annoying all the rest of the day and into the evening. Manageable. Hemorrhoid suppositories or cream might help. A heads up if this is something you ever have to face.
As with each of my visits at the National Institutes of Health, the staff was wonderfully professional. I thoroughly appreciated the time that they took to make me feel comfortable and I especially appreciated the benefit that they were extending. With this test, and others I’ve already described, I’ll have had an in-depth evaluation of the status of this cancer, and have been given a good basis for making treatment decisions. All that in a week or so. I’m sure I’ll be thoroughly nervous by the time that meeting happens. For now, let me simply tell you about this particular test, one that I looked up on the web but never found well described.
Things began with the MRI technician, a very pleasant fellow, telling me that I should undress and put on a hospital gown. The kind that opens in the back. He emphasized that everything was to come off, underwear included. Such complete disrobing had not been a requirement for any of the other imaging tests I’d undergone, but the rectal probe aspect of this test makes the need for nudity beneath the gown obvious.
The exam really is in two parts. The first is a brief scan to see if there is any blood remaining in the vicinity of the prostate, left over from the trauma of the biopsy itself. For me, that part of the exam only took about 15 minutes and had been done a month ago. There had been residual blood right behind the prostate and the radiologist felt that proceeding with the test would be a waste of time because good images would be impossible with the blood there. I was now back for part two, and the radiologist was ready to proceed with the full procedure. That is, a full prostate MRI with the rectal probe in place.
The technician invited me to lie down on the table that moves you in and out of the MRI magnet (as they call the machine). Then he started an IV so that contrast material could be pumped into my circulation at the right moment during the test. Once all that was done, the doctor was ready to insert the rectal probe. This is an aspect of the procedure that I was simply not looking forward to. Whether an enema or sex jumped to mind, the concept of having something stuck up my ass for the hour or so that the MRI test was going to take was simply not attractive. Also had a vague feeling that I might get a little hard with all this attention to my anus and I didn’t want to deal with that, either.
The doctor was very kind, almost apologetic, and explained that this would not be very uncomfortable, but the probe was entirely necessary in order to get good images. He said he’d take everything very slowly, explain everything, and that if I had any sharp pain I should tell him immediately. I was getting more anxious by the moment. Happily, however, my worries had been that I’d get a little hard from someone playing around with my anus was rapidly being overcome by the prospect of major discomfort. He then explained that after the probe was in he’d be inflating it so that it would hold itself in place, but that, because of an anesthetic lubricant jelly that he’d be using, after a few minutes I’d feel nothing at all. I can’t say this was sounding very good.
Then the doctor showed me the tool he intended to insert into my rectum. This bit of honesty confirmed my fears. Imagine something about the size and color of a corn dog on a big stick. The corn dog part was a large, thick rubber balloon with wires inside. It was deflated, now, but still pretty bulky, and squished in the palm of the doctor’s hand, it was a bit bigger than your thumb in diameter. The front end was made of thicker stuff and seemed not to compress as easily, so it was clearly the most bulky part, maybe twice the size of your thumb. The very tip was a sort of teat, just as is on the end of the average condom, but much heavier. Get the picture? The stick that this balloon was attached to was a stiff plastic tube about 18 inches long, and as big around as your little finger. Through this ran wires then led off to the machine. Another bit of tubing led to a huge syringe that would be used to inflate the balloon. The syringe held about 3 ounces. I could just imagine this thing swelling inside me. In his almost apologetic way the doctor assured me that once the first part of the probe was in, the rest would slide in more easily. Then he added that he’d done this many times before and there was never a problem. I couldn’t help thinking that if he’d been explaining intercourse to a virgin I think he’d have said essentially the same thing. “Just got to get the big part in, then everything else will slide in fine. Don’t worry. No problem.” Sounded vaguely familiar.
The doctor then asked me to roll over on my left side. And to draw up both knees. This was it. I was hoping for gentle. He put the lubricant onto the probe. “I’m going to start now,” he said and with no further comment immediately spread my cheeks a bit and pressed the probe against my asshole. Firmly. And then a bit harder. And it started in. He said, “The first part is almost in… there… and now it will go more easily… almost in… there… done.” It was all pretty quick, and I didn’t have to ask, “Is it in yet?” I knew. “I’ll inflate it now,” he said. “You will feel it sliding in deeper as I do,” he said. “That’s normal.” The inflation did not hurt, but I could feel the probe settling a little deeper inside. “I’ll attach the wire to your leg so it won’t pull out,” the doctor said. “Please roll slowly back onto your back.” I did, and, amazingly, everything was reasonably comfortable. I was frankly surprised. I guess the anesthetic worked pretty fast. And, in the midst of all this, my cock remained politely disinterested. For which I was grateful, though I suspect that with all the guys he’d done ahead of me in this test, the doctor has probably seen every possible reaction.
After the doctor and the technician made me comfortable with a pillow under my knees, ear plugs, and a headset that played music, the test began. A series of noisy banging sounds at various frequencies that lasted 45 min to an hour. The probe was not a problem. The only sensation associated with it was a mild sense of warm – which they said was from the anesthetic gel. The only thing that made the procedure difficult was pain in my shoulder that was related to something I had done at the gym. There’s no room to move around in the MRI magnet. Being forced to keep my arm in one position for a long time makes it impossible to relieve the aching, as I typically do, just by moving my shoulder around. It got really annoying. The probe had become a trivial problem.
Finally it was over. As the table moved out from within the magnet the doctor said that the test had gone very well, and that the images would be good. He’d look at them carefully in the next day or two, and report to the team that is going to make recommendations afterward. For now, he’d remove the probe and I did not need to roll again to my back. With that he deflated the balloon and pulled on the plastic stick. My asshole contracted involuntarily against the movement, but he had no difficult getting the probe out, though it seemed a bit rough. His final warning was that I might see a tiny bit of blood when having bowel movements because the procedure had been irritating to the rectal lining.
The radiologist did provide one additional bit of information. “Your prostate is very big,” he said. “About the size of a tennis ball.” My understanding is that an adult male prostate is about the size of a walnut. A tennis ball sounds big. Let’s hope its big enough that the cancer has, to date, all stayed inside, and removing the prostate will be all the treatment that I need.
So, the final diagnostic step has been completed. I feel completely comfortable with this group of people and look forward to their considered opinions. Then comes the decisions about surgery or not, robots or not, radiation or not, chemotherapy or not. All sorts of combinations, risk and benefits. I hope that they help keep things simple. I’ll let you know.
One last thing. The anesthetic gel wore off after as I returned to work. The resulting feeling was of soreness, not severe, but sort of annoying all the rest of the day and into the evening. Manageable. Hemorrhoid suppositories or cream might help. A heads up if this is something you ever have to face.
