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Thread: Transient pain under rib cage and shoulder day 5&6 post RALP

  1. #1

    Transient pain under rib cage and shoulder day 5&6 post RALP

    Well my husband has arrived on the good side! Things have been doing pretty well. He is battling the normal constipation but making progress. I am because he has had this weird pain for the last few days. Nothing horrible, but annoying and unrelenting. It began under his ribs on the right side and was there for two days. It gradually left but now he is complaining about pain in his left shoulder. Could this be from the all the gas he had pumped into him for the procedure? I haven't read about this happening to others this many days out. Catheter out tomorrow. He is looking forward to not being tied to that anymore. Pathology report to follow. Thank you all. I cannot say how comforting it has been to take this journey with such great knowledge and support! The next leg of recovery begins tomorrow!
    Wife of newly diagnosed husband...he is 62 years old
    Family history..dad passed away from PCa...brother has very aggressive PCa Gleason 8 , outside capsule..is winning for 15 years now
    March 2017 Self referral to Rochester for 2nd opinion due to slowly elevating PSA with negative DRE over a 5 year period
    1st MRI March of 2017 negative, Neg DRE
    3 mo PSA for 18 months...Nov 2018 jump in PSA from 4.2 to 6.8
    2nd MRI Nov 2018..Fused Targeted Biopsy Dec 2018 (Mayo Dr. Mynderse)outpatient
    DX 3+3 Gleason 6 (all 6 of 14 cores ), bilateral involvement, all cores under20% except one at 40% and another at 80%
    Jan 17th RALP done Dr. Igor Frank , Methodist Hospital Rochester
    Pathology: 3+3 Gleason 6, SV-, EPE-, SM abuted less than 3mm, no LN taken, catheter 7 days, urine retention, catheter 5 days, min incontinence so far. ED improving . 20 mg Sildenafil daily for 3 months post RALP and as needed

  2. #2
    It does sound like gas, which can be referred pain to other parts of the body. Like chicken soup, a call to the surgeon's office couldn't hurt.

  3. #3
    The pains you describe sound very similar to what I experienced post-RALP. First it was dull pain in upper left quadrant, which was scary due to cardiac concerns. It then moved closer to my left shoulder and became more intense and felt very much like my dislocated shoulder/broken clavicle pains. A day or so later it moved to my right quadrant in the mid-rib area and felt like my previous broken rib episode. I saw my surgeon on day 6 post-RALP and discussed the pains with him. Apparently there are multiple theories about the pain:

    - referred pain due to gas pressure on nerves in the diaphragm area
    - actual pain in the area it is felt due to gas pressure in the shoulder or rib area
    - actual pain in the abdomen area that the brain mis-interprets as being from upper chest or ribs due to all the trauma in the lower abodomen

    His recommendation (he has done over 1,600 RALPs and another 1,000 other robotic urogenital procedures) was WALK - WALK - WALK!

    He was correct - I started walking 1/4 mile day five, 1/2 mile day seven, 1/2 mile twice on day 10.... and the pain moved around more, diminished, returned and by day 15 was just a distant memory.

    BUT - then my biggest incision for the "gas port" in my lower right abdomen started really aching as I stretched and walked. Again - surgeon says "I moved a lot of stuff, I cut a lot of stuff, I traumatized a lot of stuff in your abodomen, especially where we cut access holes - it will take a couple months before all the aches and pains are gone."

    And it was! At 3-months post RALP I was back to hard bicycle riding, long walks, and sailing my big boat.

    Patience and a reasonable expectation of various pains, aches, discomfort will get you thru the recovery.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 ALL Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    DRE small soft prostate w/no abnormalities
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA Post Surgery
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022

  4. #4
    Robotic prostate surgery involves getting pumped full of gas and being turned upside down for hours while the surgeon is doing the operation.

    Sounds like the kind of transient irritation that would be expected from a traumatic event. By all means, if its bothering you, discuss it with the surgeon. But it doesn't sound abnormal.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

  5. #5
    Hi Wog! Definitely check with the MD first. Most likely this is due to gas trapped in tissue compartments

    I experienced some very minimal shoulder discomfort (more like a "mild awareness") a few days after surgery - RALP lasted around 3 hours. However, a few years ago, my son had his appendix removed laparoscopically which lasted about 30 minutes. He developed very uncomfortable shoulder pain several days after surgery. It persisted for a few weeks. He was in good physical condition (hiked the Appalachian Trail) so the MD's had no cardiac concerns!

    Good luck with your upcoming appointment and catheter removal! In my case, a nurse filled my bladder with a radio-opaque solution through the catheter and took a few X-rays to check for any leakage and then handed me a large stainless steel measuring cup. She told me to get catch the urine that was about to flow out! The catheter removal was quick and painless and the outflow was impressive. I decided to test the breaks and Low & Behold it stopped!!! I tried this a 2nd time. Again successful! Although successful, it did NOT mean that I was continent! The ride home was 2 1/2 hours and I had to have my wife stop at a rest area. The Tena Pad was pretty saturated but easy to change. At first I was going through about 8 pads/day. This gradually decreased and by 3 months was pad free.

    Prostatectomy results in fairly major neuro-vascular insult. This takes time to both heal and repair. At 1st there is a fear that there is minimal control and gradually the sense that it is improving. Well it will improve!

    MF
    Last edited by Michael F; 01-23-2019 at 05:18 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = Gleason 7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left Positive Margins + EPEs. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO / Prostate Size = 32 grams; Tumor = Bilateral; 20% / Perineural invasion: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  6. #6
    Thank you Sailor and Tonic for your reply. We will confirm at catheter removal tomorrow if the blizzard heading our way doesn't stop us. My husband is determined to get there no matter what!
    Wife of newly diagnosed husband...he is 62 years old
    Family history..dad passed away from PCa...brother has very aggressive PCa Gleason 8 , outside capsule..is winning for 15 years now
    March 2017 Self referral to Rochester for 2nd opinion due to slowly elevating PSA with negative DRE over a 5 year period
    1st MRI March of 2017 negative, Neg DRE
    3 mo PSA for 18 months...Nov 2018 jump in PSA from 4.2 to 6.8
    2nd MRI Nov 2018..Fused Targeted Biopsy Dec 2018 (Mayo Dr. Mynderse)outpatient
    DX 3+3 Gleason 6 (all 6 of 14 cores ), bilateral involvement, all cores under20% except one at 40% and another at 80%
    Jan 17th RALP done Dr. Igor Frank , Methodist Hospital Rochester
    Pathology: 3+3 Gleason 6, SV-, EPE-, SM abuted less than 3mm, no LN taken, catheter 7 days, urine retention, catheter 5 days, min incontinence so far. ED improving . 20 mg Sildenafil daily for 3 months post RALP and as needed

  7. #7
    Thanks Michael....The golfer is appreciative of you sharing what may happen at tomorrow's appointment and leakage. We will come prepared!

    Thanks Southsider for your encouragement
    Wife of newly diagnosed husband...he is 62 years old
    Family history..dad passed away from PCa...brother has very aggressive PCa Gleason 8 , outside capsule..is winning for 15 years now
    March 2017 Self referral to Rochester for 2nd opinion due to slowly elevating PSA with negative DRE over a 5 year period
    1st MRI March of 2017 negative, Neg DRE
    3 mo PSA for 18 months...Nov 2018 jump in PSA from 4.2 to 6.8
    2nd MRI Nov 2018..Fused Targeted Biopsy Dec 2018 (Mayo Dr. Mynderse)outpatient
    DX 3+3 Gleason 6 (all 6 of 14 cores ), bilateral involvement, all cores under20% except one at 40% and another at 80%
    Jan 17th RALP done Dr. Igor Frank , Methodist Hospital Rochester
    Pathology: 3+3 Gleason 6, SV-, EPE-, SM abuted less than 3mm, no LN taken, catheter 7 days, urine retention, catheter 5 days, min incontinence so far. ED improving . 20 mg Sildenafil daily for 3 months post RALP and as needed

 

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