My name is David Cuyp Bunting and I was born on September 22, 1940.
My parents were Jane, a homemaker, who smoked and died of lung cancer at
about 70, and Van, a middle level sales executive, who died of a heart
attack at 59, largely induced by excessive drinking. I have sisters Cathy
and Debbie and a brother, Henry.
I went to Ohio State, Wisconsin and took a Ph.D. in economics
at the University of Oregon in 1972. Currently, I am a Professor of Economics
at Eastern Washington University, Cheney, WA. My
work largely involves teaching and research, with an emphasis on the latter.
My research areas involve health economics, local economic development
and macroeconomic theories of consumption. I consider myself an active,
publishing scholar. I enjoy my work, although the challenges are far greater
than the rewards.
I am married to Susan. We live in Spokane, WA and have two sons:
Max, a graduate of Evergreen State College, now a graduate student at Eastern
Washington University, and Henri, a sophomore math and music major, at
the University of Oregon.
DIAGNOSIS & DECISION
Every year or so, I have a physical examination. In the fall of 2002,
lab work on my blood revealed a PSA count of 5.5, up from a count of 4
on my previous physical. My primary care doctor referred me to a urologist
who did a prostate biopsy. This resulted in a Gleason score of 5 (I think),
which the urologist said indicated a high probability of prostate cancer.
While briefly covering other remedies, he recommended surgery to remove
my prostate within four to seven weeks. He thought that surgery was best
for me because my age and health profile indicated that it would have a
high probability of eliminating the cancer, thereby returning me to a normal
The recommendation was a complete shock. There is no history of
prostate problems in my family. I was heavily involved in my academic research,
had papers and projects underway, enjoyed a happy home life, was relatively
free of debt, and Sallie Mae was still paying for the education of my kids.
Shock aside, I had to deal with this unexpected event. As
an economist, I am routinely involved with complicated statistical issues
and I'm accustomed to dealing with experts on technical issues I have little
or no knowledge about. My rule is to carefully consider the comments
of these experts, especially when I pay for them. I had no reason to doubt
the competence of the urologist nor am I a medical doctor or a prostate
cancer expert. After talking the matter over with my wife for a day or
so, we decided to rely on expert opinion and scheduled surgery. Because
it required three units of my blood, it was scheduled for January 30, 2003,
about thirty days in the future.
This thirty day lead-time gave us the opportunity to research prostate
cancer and to discover if surgery was in fact my best option. I searched
the web, including prostate-online.org, told my friends and co-workers
about my condition, and talked with my supervisors and benefits people.
I was especially interested in the experiences of others who had had the
surgery. We attend an Episcopalian Church and my wife is involved in its
activities, both directly and through an extensive email network. She also
has another email network of friends and relatives. As we went public with
my problem, I was first surprised and then overwhelmed at the encouragement
and support I received. People sent cards, prayed for me, burnt candles
for my recovery and put me on their prayer lists. I was truly touched by
all this encouragement as I realized I was not alone in my battle.
The immense number of web pages and library materials dealing with prostate
cancer limits its usefulness and is, frankly, overwhelming. I could not
evaluate the technical arguments and lacked the time to read long descriptive
essays. I could find no layman's guide to prostate surgery and its consequences.
In the end, the book we found most useful was "The Complete Cancer Survival
Guide," which briefly reviewed the diagnoses and treatment of prostate
cancer (among 25 other cancers) and outlined general steps to follow when
deciding about surgery. I was especially interested in the experiences
of other surgery patients but could find little beyond general discussions
of incontinence and impotence.
We still had many questions: Was my PSA test accurate? Should I have
more tests? Was surgery the best solution? What about radiation,
chemotherapy or dietary solutions? Was this the best doctor to do
the surgery? We needed some peace of mind, so we did three more things:
1. I found three people who had had the surgery. The first man
was, himself, a doctor. His response to his diagnosis was similar to mine:
research and second opinion. I learned the surgery was very invasive
and required extensive recovery time, but that normal life could be regained.
The second person, a co-worker and professor of government, more or less
repeated what the first told me. Both emphasized using an experienced surgeon.
The third person was not very analytical and provided little information
about his experiences beyond "terrible."
2. We got a second opinion from another urologist. He confirmed
the recommendation of surgery in all respects.
3. We met with our urologist again and were satisfied that he
was sufficiently experienced.
We decided that surgery was indeed the best option to eliminate my
SURGERY & HOSPITAL STAY
For me, surgery was easy. I went to the hospital, took off my
clothes and put on a gown. They rolled me into the operating room and then
I woke up in another room. For my wife, the surgery was a tremendous emotional
strain as she waited six hours to determine its outcome.
I had never been a hospital patient in my adult life and had no
idea what that meant. I remember the surgical nurse telling me to put my
hands on her shoulders as I got a spinal shot and later waking up with
a terrible thirst. I found out that the surgery was a success - no other cancer was found - and I had a big samurai incision in my lower abdomen
of about eight inches. I had two drain tubes stuck in my side and
a catheter in my penis to drain my bladder. I was in the hospital for eight
days. The first couple of days are a blur. Any movement was difficult and
I was thirsty. I ate ice cubes and self-medicated with the pain medication
pump to control pain and nausea. With time I became more aware of my circumstances,
but I was so weak I could do little to help myself. Every 15 minutes, day
or night, a nurse would come in my room, check my vitals, my incision,
empty the pee bag if needed, and generally try to make me as comfortable
possible. Modesty was irrelevant; during my stay I had more people--women
and men, black and white, young and old--touch, clean or inspect my penis
than I had had in my entire life.
After a day or so I started moving a little and taking short walks.
After two or three days, my rehabilitation began. This meant I had to get
out of bed and walk around the ward, using the apparatus holding my IV
and pee bags for support. In the beginning, lifting my feet to get out
of bed was nearly impossible. Susan would help me get up, find my robe,
and then guide me as I stumbled to the elevator door and back. Soon
I was up to 50 feet in ten minutes, then 100 feet in ten minutes and finally,
if I rested four hours in between trys, I could do the course twice a day.
The most important factor that affected my hospital stay was the support
of my wife, Susan. I had great trouble sleeping and I would lay awake waiting
for the day to start with her arrival. Her smiling face was the boost I
needed to get through another day. She worried about my comfort, got new
ice cubes, and shielded me from visitors I could not converse with.
Eight days after the surgery, I returned home weak and
with a catheter to connect my bladder with the outside world. The catheter
drained into either a bag attached to my lower leg or an overnight bag
next to my bed. While it was a nuisance and sometimes painful when I walked,
my greater recovery problem was lack of stamina. For the first couple of
weeks I just laid around, dozing and reading magazines like the New Yorker
and the Smithsonian. I ate little. I had brought home some office work
but had neither the interest nor concentration for it.
At first a typical day for me was: wake up, dump a quart
of pee, toast or cereal; read the paper; rest from the hard work of reading
the paper; dump another quart or so; rest, take a short walk, lunch and
dump, rest, walk, rest, dump again, rest, walk, dinner, rest---and finally,
after a tiring day, to bed.
My rehabilitation largely involved rest and walking. The first walks
were short and difficult. With my wife's encouragement and assistance,
I tried to walk to the big tree and back. Next I aimed for the second big
tree, then the bus stop sign before my house, then the sign after the house, and so on. After these walks - never more than four or five minutes - I was nauseous and tired. After a couple of weeks, we went on an outing to the super market. I walked from the parking lot to the store, rested, walked
halfway through the store, rested, finished the tour, rested, went home
and took a nap. Week by week, my endurance slowly returned and I was able
to walk farther and longer. As the Great Wall of China was built
a brick at a time, so rehabilitation progresses a step at a time.
On Wednesday in the fourth week the catheter came out. Within a day
I was having trouble urinating and by Friday morning I could not pee at
all. I contacted the urologist and was told to come to his office immediately.
He did a soft tissue scan and determined that scar tissue from the surgery
was closing off part of my urinary tract. He then inserted a small TV camera
through my penis to more closely examine the problem, inserted another
device in my penis to expand the constriction (sort of like boring out
an engine cylinder of a car), drained my bladder, and reinserted the catheter
under local anesthesia--a very unpleasant experience. Day surgery a week
later fixed the scar tissue blockage problem and re-established normal
functioning. Just a normal recovery week: switched from slippers
to shoes on Tuesday; a camera up my penis on Friday.
My long-term goal has been to return to life as I knew it before
surgery, but with qualifications. While I needed to recover strength and
stamina, I also decided to get serious about health and diet. I walk every
day, aiming to walk about an hour. I started with short walks and now try
to do three twenty minute walks daily, usually with Susan. Although the
pace has recently increased somewhat, I walk against time rather than for
distance. I carry a stopwatch and explore the neighborhood. I also look
for bad parking spots, away from where I want to go. This adds to my walking
time and allows me to avoid spas and gyms. I weighed in at 246 before
surgery; I now weigh 225. I used to be Dave, the guy who would eat or drink
anything. No longer. Ribs and beer are now largely memories. Because of
inactivity after the operation, I lost flexibility and arm strength. I
cannot touch my toes or twist caps off bottles. To solve these problems,
I recently started doing yard work and signed up for a yoga class.
A common consequence of surgery is incontinence. I did not suffer complete
lack of control, "flooding," after the catheter was removed. Instead, the
surgery seems to have reduced my bladder size to that of a grape or raisin,
so that I have to urinate much more often. Also my internal controls seem
to be messed up so that I am less certain about when I have to pee and
when I have stopped. I have about 99% control, but suffer occasional, annoying
drips or random squirts when I cough or quickly move. As a consequence,
I have to wear some sort of protection against damp underwear and pants.
Finding the best protection has been a real chore. I tried various pads,
both for men and women, guards and protective underwear without finding
a completely satisfactory solution. My current strategy is to simply change
more often. My urologist tells me that the incontinence should disappear
as my body adjusts to its new configuration. I sure hope so. Another common
consequence of prostate surgery is impotency. While my sex drive since
surgery has been zero, I await the future developments optimistically.
In the turmoil surrounding prostate cancer and its remedy, it
is easy to overlook the need for assistance and for nearly continuous long
term support. Having a second person help me during my time with prostate
cancer and subsequent rehabilitation was by far the most important factor
in the whole episode. My caregiver was my wife, Susan, who not only provided
counsel, care, and comfort but also served as driver, protector, nurse,
and maid. Without her, I would have been lost.
Before surgery I needed to talk over the problem with someone. After
surgery, I was nearly helpless for weeks. In the hospital, conversations
with visitors or instructions from medical people were incomprehensible.
After the hospital, I was still unable to drive, cook, get prescriptions
or take care of myself. I could not bend over to pick up the morning newspaper
nor cover myself before I dozed off reading it. Decisions were required
that I could not make. I needed assistance--someone who would ensure my
general welfare and well-being. I cannot imagine going through prostate
surgery with its prolonged recovery without this person. In my case, the
task of caregiver, actually the burden, fell to Susan, who performed heroically.
Other arrangements obviously can be made but, whatever they are, they should
not be ignored or minimized.
It also should be obvious that prostate cancer is expensive to resolve.
Two months after surgery, my medical bills (fortunately mostly covered
by insurance) approach $40,000 with more arriving daily. Further, I was
on medical leave from work for almost three months (at full salary).
I returned to work on a limited basis, about two months after surgery.
While still lacking stamina and finding concentration difficult, I am optimistic
about the future and eager to restart work and projects.
Going in to the prostate surgery, I thought my struggles would
only involve myself and my family. I was wrong. I also had tremendous,
unexpected support from friends and associates through their cards, letters,
good wishes and prayers. With this support, and with my wife's assistance
and encouragement, I endured the surgery and nine weeks of rehabilitation.
On April 25, almost three months after my initial surgery, I went to
the urologist for a checkup on my recovery. Overall, my progress has been
excellent. My PSA score is zero, as expected. My occasional
and erratic drips and squirts of urine are normal and should slowly disappear.
I have no fluid retention, while my bladder size and urination are approaching
normal. The urologist pronounced my progress at various times as "superb,"
"wonderful" and "great." While he did caution me to take it easy, no medication
or special monitoring was prescribed. Probably the best indication of my
progress is that the next follow-up examination is not scheduled for three
I am quickly returning to life as I knew it before the surgery.
I am back into my "big boy shorts" (normal underwear) with a pad or some
tissue. While efforts to continue to lose weight have failed so far, I
have not gained any. Recently I ordered some sort of fish with 5 level
(maximum) hot curry at a Thai restaurant and ate it with no subsequent
difficulties. Last week I mowed the lawn. Susan I have continued to walk
about an hour a day. In two weeks we start a yoga class. I have returned
to work with some administrative rather than classroom assignments for
Spring quarter. At first I had some trouble reading documents and following
discussions in meetings. I could not concentrate and people seemed to be
talking too fast. These problems are now largely gone.
Because of my surgery I had to cancel a paper scheduled for a
February economics conference in New York City and push back some other
projects into summer and fall. Finally, I have begun to restart the
postponed research projects and to begin some new ones. While I still have
some stamina problems and seem to sleep more, I think I am about 95 percent
recovered. I look forward to regaining the last 5 percent. Looking back
over the past forty years, I can see missed opportunities and dumb decisions,
but if I had to relive those years, my guess is that things would have
turned out pretty much as they actually have. My long-term prospects are
excellent and I look forward to a normal life expectancy. I could not ask
I want to thank David for taking the time and energy to record his thoughts
and recovery for us. While some of the details might be uncomfortable
and even frightening, and not necessarily typical of major university-based
cancer centers, I think it helps to know what you might experience if you
are considering surgery. We, of course, wish a continued and permanent
recovery for David and best wishes to his family.
- Diane Johnson
We often emphasize how the diagnosis of prostate cancer is really a
"family affair" because everyone in the household and extended family are
affected as well be it socially, emotionally or financially. It is more
of a reinforcement to encouraging greater education and information on
prostate cancer so that we can, to better protect our loved ones, make
informed decisions as to screening and treatment.