Recovery

August 19, 2011 - August 21, 2011 I arrive home. Now we have to figure out how to manage the damn collection bag, where we're going to stash me and so on. We had thought of a few things before, like how to control "accidents". We got an absorbent pad for the bed from a medical supply house to put under me.

When I left the hospital, I had planned ahead for concealing the bag and wore loose sweat pants with elastic bottoms for my discharge. We drained the collection bag first and kind of folded it up, stuffing it into my right pant leg. Then I carefully inserted my foot into that pant leg. The mistake I made was first putting on underwear over the catheter. Don't do that, you'll cause pulling and possible bleeding at the head of your penis. Just go commando.

Catheter in place on right leg

The collection bag had to be drained every 3-4 hours or so. The nurse in Post-Op had said empty it when it gets about half full, and since you're also encouraged to drink plentiful fluids to aid healing, you're emptying it a lot, even in the middle of the night. The color of the collected urine is also diagnostic: clear like regular urine - good; red to dark pink - not so good. In my case, it was quite pink for the first couple of days, then started becoming more clear. This seemed correlated with movement: more movement, more pink; rest = clear. However, you are encouraged to move in recovery, at least around the house. So you are going to see a lot of pink.

The collection bag is a terrible nuisance to manage. Although we had a kit from the hospital that provided additional bags, we chose not to change bags as the process was unfamiliar to us, and you have to be very careful about hygiene and touching things. You need to keep the collection bag well below the level of your bladder. In my case, I just put it in a a 5 gallon bucket and hauled it around. That kept it off the floor and semi-protected it. This wasn't an optimal solution, and I'm not necessarily recommending it, but it worked for me most of the time. I stayed in my house until it was time to return to the urology clinic to get the catheter removed, so no one was going to see me with this thing. Most of the time I wrapped a beach towel around me and went commando to walk around.

Tissue passing about the 3rd day - normal, expected

I actually felt pretty good for having gone through surgery. I slept on and off the next couple of days. I go bored and started this blog. At one point, I wasn't paying attention to the catheter and pulled on it, injuring myself. Oh, and you will have some blood at the insertion point of the catheter, just expect it, clean it up periodically as best you can. Hygiene is important.

Boredom is maybe the biggest issue, followed by you have to think about moving around because you have this thing on you. Also, your household will be in minor chaos to accommodate your condition. I'm very set in my ways, I like structure, so this was an adjustment.

August 22, 2011 Time to get the catheter removed. It's now about 4 days since I got the catheter. I had adjusted to the discomfort of the catheter pretty well. Most people describe this as a feeling of wanting to urinate all the time. Well, gee, I'd pretty much been doing that for years by this time, so no big deal.

In the urologist's office, I asked the nurse if the catheter removal was painful. She said no. She told me to drop my pants to below knee level and lay back on the exam bed, putting a disposable pad over my genitals. "OK, take a deep breath and then let it out slowly...." It was over very quickly and the only thing I felt was, understandably, some discomfort at the head of my penis, which the catheter had irritated for a few days.

The nurse said: "You can try to urinate now, if you like. If you can, you can go home. But if your urine stream drops to a trickle by 3:00 (five hours later), come back here to the clinic. If you don't want to urinate now, that's fine also. But, again, if you can't urinate at all by about 3:00PM, come back here." I said I felt like I could go, so the nurse left the room for about 10 minutes or so. It felt strange to pee on my own after just letting the catheter do the work for a few days, and it took a bit of effort, but I passed about 100 ml of dark red urine, a little painful but tolerable. When the nurse returned, I said "Is this OK?" "Yes, that's fine. You will pass blood for a while. You're free to go." Woot!

I was very apprehensive about bathroom visits until 3:00PM. But I managed to pass a decent amount of liquid about 3 times by then, so figured I was OK. Early in the evening, I had a bit of a dribbling problem, but only once. I woke through the night about every hour and urinating, while taking some effort and causing some discomfort, gradually became easier. My stream was like a fire hose compared to what it had been before, and it was only going to improve.

August 23, 2011 I continue to slowly improve and get better results on this, the first full day after the catheter was removed. My stream looks good. Still getting some blood, but it's expected - drink more liquids to help.

It's early days yet, and things could still go wrong. You have to be careful in recovery to follow doctor's orders and not overdo and take your time, or you'll injure yourself. However, I'm hopeful that this will be a big improvement for me.

Update: August 26, 2011 Now one week after my TURP. I still see some pink at the beginning or end of the stream, but I'm seeing clear without any signs of blood about half the time. Still stings a bit to urinate, a little strange to initiate a stream. Today I felt a little spurt and out had come a minuscule clot along with a small bit of tissue. Before the procedure, I got in the habit of doing a "double void": passing urine, waiting a few moments, then trying again. I found that habit initiates a minor spurt of bleeding, so I don't do that.

I'm getting up to visit the restroom in the night much less than after the catheter was first removed. Currently, it's about every 2-2.5 hours, also mostly that interval during the daytime.


Update September 19, 2011
Now a little over 4 weeks since the TURP. By about two weeks after, the pink residue of blood completely gone. However, by the third week, I started experiencing some incontinence, especially with both a a full bladder and a need for a bowel movement. This manifested itself by getting right over the toilet bowl and I let fly with a couple of short bursts, sometimes in the bowl but a couple of times in my underwear. I think part of this is mental, anticipating.


The urologist says that this "Transient Incontinence" affects 20%-30% of patients and usually resolves in a few weeks and can occur with laughing, coughing and exercise/sports. He recommended I do Kegel exercises, which strengthen the pelvic floor muscles. Here's one link, but there are many on the web. It's early yet, might take a few weeks to see significant improvement. But, I think the Kegel exercises are helping. You have to keep on them, do them every day.


Last week, I had a disturbing experience. I started bleeding bright drops of blood from my penis. I could still urinate and over about 5 hours, and passing a few strings/clots of blood, the blood faded to pink similar to what I was experiencing before. I thought, OK, that was probably to be expected.


However, after urinating about three times previously, I started a stream and then felt a tug. The firehose then turned into a dripping faucet. Ack, I've got an obstruction! I called the Kaiser Nurse 24-Hour Advice line (what a great service) and they hooked up with an on-call ER doctor, who also thought it was an obstruction. The consensus was to monitor, give it 3-5 hours. If I felt a great deal of pressure and still couldn't urinate properly, go to the ER.

So I waited a couple of hours, until I felt I could urinate again. The stream started slowly at first then quickly changed back to my accustomed fire hose. That was a relief! I looked in the toilet bowl and saw a great deal of foam and a single, tiny dark object. Stone? I didn't even feel it pass.

Passed Prostate Stone

I sent an email to my urologist and he said what probably happened was: a scab "unroofed", causing the blood, and the stone released from under the scab, causing the blockage. He said it was likely this would recur until about the 8 week point, when the prostate should be completely healed. Stay hydrated to help pass any stones. 

Now, remember, this is unique to my anatomy. The urologist said I had the most stones of any patient he has ever seen. So, this is unlikely to happen to you unless the urologist informs you that you have a large number of calcifications or stones.

TURP Procedure

August 18, 2011 12:15PM Arrive at Kaiser Permanente: Walnut Creek, CA. A nurse gives me a gown to change into, sock booties for my feet, and a hair covering. I meet with another nurse who confirms what procedure I am in for and that I have followed all of the pre-surgery instructions from the OR Education Nurse. There's an initial moment of confusion when the nurse says, "So, the surgery you are in for today is a Prostatectomy." I say,"No, I'm in for a TURP." "Same thing." "Sorry," I say, "I'm used to hearing the word 'Radical' in front of Prostatectomy". I get two new wristbands on my left arm, one clearly identifying that I have drug allergies. These are added to the bracelet I already received on August 16, to indicate my blood type and anti-bodies. A little while goes by and I get a cannula, a thin tube inserted into a vein to administer medication, on my right arm. I'm told that the estimated time I'll be in surgery is 98 minutes. Scheduled start time is 1:30PM.

Prepped for Surgery in Pre-Op

A male nurse comes by and shaves my pubic hair. Bizarre. Next, the Anesthesiologist visits me to explain what his role is. He says that I'll be receiving a spinal tap that will make the bottom half of my body warm and numb. I'll feel pressure but no pain. He asks if I have a preference on my sedation, do I want to sleep through the procedure or be in a sort of hazy state? "Sleep through it." I also tell the Anesthesiologist that I'm anxious and would like to get something to calm me down. I'll get that as we advance to the OR. I ask how painful the procedure is, and the Anesthesiologist says "Not very. You will be fitted with a catheter and you will feel like you have to pee all the time, but that is more discomfort than pain." Now, the Anesthesiology Nurse arrives to give me a few more details. First, I'll get a numbing injection in my spine that will briefly feel like a bee sting. After that takes hold, I'll get the spinal tap. I'll also be fitted with a special pair of inflatable leggings on my calves. These use an air pump to push blood through the veins, first one leg then the other, to prevent blood clots while a patient is not ambulatory after surgery. This treatment is called IPC, Intermittent Pneumatic Compression. Finally, I am visited by my surgeon. We talk a few minutes about the procedure. He explains that he is using the latest TURP instrument that cauterizes as it goes. Blood loss from the actual surgical procedure may be as little as about a teaspoon. We wait. And wait. A nurse arrives to tell us that the surgery immediately before us is taking longer than expected. Finally, I get wheeled into the OR about 3:00PM. On the way, the Anesthesiology Nurse explains that the OR looks crowded, but they have everything they need close at hand. She pats my head gently as we roll into the OR. I'm moved up parallel to the surgical station and slid over, with help, to the bed. The IPC leggings are placed on my legs. I'm told to turn over on my side. "Oh, you have a beautiful back!" the nurse says. Really, I think, with the curvature of the spine and the deteriorating lumbar region? "All the vertebrae are nicely exposed, so I can see what I'm doing. OK, you'll feel something like a bee sting." That was just the numbing agent before the spinal tap. After that, I don't remember anything at all until I woke in the Recovery Room. My angel wife, knowing the operation was only supposed to be about 90 minutes, got some lunch near the hospital and came back, expecting me to be out of surgery. This hospital has a nice feature - a video monitor for viewing a color-coded status for patients, based on an assigned secret code, telling you what stage a patient is in: Pre-op, Surgery, Recovery, etc. The closest thing I can describe this as is like the display screens at the airport, tells you the status of your flight. My wife arrives back and checks the monitor - still in Surgery. OK. Waits a while, checks again. Surgery. Repeat, repeat, repeat. Now, she's getting a little worried. Finally, she sees I'm in Recovery. Guys, one thing to remember: supporting you in this is hard on your wife/girlfriend/partner emotionally. They are being thrust into a caregiver role they didn't ask for, and they're doing the best they can in something they usually know nothing about. Be a good patient, cut 'em some slack, and show some gratitude. My Recovery Room memories are very hazy. I do remember the surgeon visiting me and saying that the procedure was "very successful". Good. Now back to sleep. I wake later and shortly I'm being wheeled into Post-Op.

In Post-Op with Nausea

In Post-Op, Feeling Good & Able to Take Nourishment

I have a poor memory and sense of time for my initial stay in Post-OP. There are no clocks in view, so I don't have any idea what time it is. Later, I found out that, instead of surgery taking the estimated 98 minutes, it took 2.5 hours! I'm actually feeling pretty good for having just come out of surgery, no obvious pain. At some point, my wife arrives and I'm glad to see her. I kind of drift in and out of wakefulness. After some time, I start feeling nauseated. I vomit twice (into conveniently available bags), dry heaves, while my wife is still visiting me, and the nursing staff administers Reglan, an anti-nausea medication. The nausea is a reaction to the anesthesia medicines. My wife leaves about 8:00PM, after I get sick. I throw up a third time later on and am administered Zofran, another anti-emetic. Time passes. I drift in and out of sleep. My nurse Ruthie comes in periodically to check on me, take my vital signs and temperature, emptying my urine collection bag at the foot of the bed. I barely notice that I have a catheter placed. A BP cuff periodically inflates, forming a counter-rhythm to the IPC leggings which inflate first one leg, then the other. Somewhere in the night, I get sick again and Ruthie gives me more Reglan. August 19, 2011 Time flows, I wake, I sleep. Finally, I'm awake and feeling like the nausea has passed. I'm awake for about 5-10 minutes when I see someone fumbling with the curtain, trying to get into my bay. It's a technician there to take my blood. "What time is it?" I ask. About 4:00AM. I'm awake for maybe another 45 minutes, then sleep. About 6:00AM, additional nursing staff arrives. Much later, a nurse comes by and asks if I want breakfast. "Is it Jello, or real food?" "Real food," she says. "I'll be ready for it in a little while, maybe 15 minutes or so." Food arrives about 7:30AM, a little bit before my wife. It's scrambled eggs, diced peaches, low fat milk, blueberry muffin and cranberry-raspberry juice. But, my wife has brought me a scone from Peet's Coffee Shop. I ask the nurse is it OK to eat the scone? She says, sure. This will become significant later on. My urologist surgeon comes by to see me. I ask for a repeat report on my surgery as I was kind of hazy when I saw him in recovery. He goes over the meds I'm prescribed and future appointments. I'll return to the urology clinic on Monday, August 22 (about 4 days later) to have the catheter removed. "You'll want to take your pain medication before you come in on Monday." That sounded a bit ominous, but really it wasn't. I eat, I'm ready for discharge. Time drags on, so I just sit back and relax and let it go at its own pace. The main nurse comes by and gives us a kit of collection bags (small 3-4 hour bag plus another large bag like I'm using) and paraphernalia for the catheter, explaining quickly how to use them. Sort of as an afterthought, she hands me a breathing exercise device, a Voldyne 5000, without any instructions on how to use it. Some kind of dual-tube device, which was in all night, is removed from my nose. "What was that, anyway?" "That was oxygen." The nurse explains that for the first day or two, I should stick to food that is easy to process: eggs, maybe toast, yogurt, soup, fruit. She said I shouldn't have had the scone my wife brought (uh-oh!). We wait some more. And wait. Finally, about 11:30 AM I'm wheeled down to the Discharge Pharmacy to pick up/get consultation on the meds I'll be taking home. Three of these are "as needed" and the only one I took was the pain medication, as a precaution. I also got an antibiotic and a stool softener, absolutely required. I arrive home about 12:30PM. Continue reading....

Getting Closer

Mid-June 2011 Things are looking good. Blood in my urine (hematuria) has all but disappeared. I had a previously scheduled appointment for the urologist for July 8. There were Laboratory tests to be done, and I knew a urine culture might be required if I had an infection. Since it takes a few days to get a culture, I went for Labs a few weeks before the scheduled appointment date. BAM! Infection with Enteroccocus. In my own experience after the first infection in 2007, I only found out I had a UTI when I did lab work - I wasn't recognizing any symptoms. In retrospect, I did have subtle symptoms: it was harder and harder to start a urine stream, maybe about 10 seconds longer, and it took more effort. I was on a 17 day course of Nitrofurantoin (Macrodantin) to resolve the infection. July 8, 2011 My wife went with me to the urologist appointment. The urologist had previously stated that repeated infections could be cause for a procedure. We mutually agreed that it was time to do the TURP (Trans Urethral Resection of the Prostate, AKA Prostatectomy, not to be confused with a Radical Prostatectomy). As part of the appointment procedure, I had taken a urine sample in the urologist's office. He said, well, we don't need this. I replied that, since I didn't seem to have symptoms with UTI's, I'd rather get the sample tested to see where I am. Turned out I still had a residual presence of Enteroccocus. I emailed the urologist and he requested a prescription for Nitrofurantoin to be used if the infection flared, or right before the TURP. A couple of weeks later the scheduling nurse from the urologist's office called to say they had a date for the procedure, August 18. That was still almost a month away and I actually wanted to get it over with. But other dates were even further out into September. August 18 it is. In the weeks leading up to the TURP, I put myself in a special frame of mind. I had always been a worrier and very anxious. I put the worries away and just enjoyed each day, every little thing: walks with my dog, talking to my wife, early mornings at my favorite Peet's coffee shop, beautiful days. There are risks of complications and even mortality from any surgery, no matter how seemingly trivial. In this case the numbers are good: 0.2% mortality rate! You're more at risk of death as you age, usually from cardiac events. I was 60 years old and in relative good health. I looked at the numbers and they seemed overwhelmingly positive. I had already made up my mind that I had to do this procedure and my fears weren't going to get in the way. If I didn't do something, I would put my bladder and even my kidneys at risk. Put in that context, it was an easy decision to support. August 02, 2011 I took a battery of Lab tests as preparation for the TURP surgery. The tests included CBC (Complete Blood Count); INR; Electrolytes; Creatinine; and Blood Type/Antibodies. One of the tests was a urine culture. You guessed it: I had a UTI. With a few exceptions for patient privacy, Kaiser posts Lab results online in your web account. The urine culture read "GREATER THAN 100,000 COL/ML ENTEROCOCCUS". The urologist proactively contacted me by email and instructed me to take the full 7-day course of Nitrofurantoin I already had failed and waiting. August 15, 2011 The Physician's Assistant helping Urology called with questions and instructions in preparation for the surgery. There were questions about what medications I was already taking and when I last took them. This is Important! Some things that seem benign like Advil (Ibuprofen) and multi-vitamins can have implications for the surgery, and you need to stop them at least 7 days prior to the procedure. I was taking Advil and just lucked out that the last time I took it would be 7 days prior to the TURP. August 16, 2011 I visit KP Labs for final tests before surgery. These include an EKG, and blood typing and anti-body tests. The blood typing and anti-body tests must be done no more than 72 hours before surgery. After the blood tests, I get the first of three bracelets for the surgery, on my right arm. This bracelet must remain on through the surgery. August 17, 2011 2:00PM: I talk to the OR Education Nurse, who gives me final instructions, what to expect, and goes over some of the same material as the PA. Here are the particulars:

• Critical: no food after midnight
• Clear liquids such as apple juice, coffee no milk/cream/sugar, tea or water up to 8 ounces no later than 3 hours before your scheduled arrival time.
• Need to shower before surgery; use no other additives on skin besides soap
• Only approved necessary medications taken with small sips of water
• No: objects in the mouth - piercings, mouth guards, dentures, contact lenses
• Bring case for glasses

What to expect:

• You will be at the facility at least 5-6 hours
• You will be in at least one hour before surgery begins
• Surgery is estimated to take 1.5 hours
• You will be in the Recovery Room at least 1 hour; then moved to Post-Op
• Before you leave for home, you will have to be able to walk short distances
• Surgeon will meet with patient in Recovery Room to discuss status after surgery
• Doctor will meet with/call loved one/family member after meeting with patient
• No one may visit you in the Recovery Room

3:00PM: OR Scheduling calls and says to arrive at 12:15PM on August 18. Continue reading.... Skip to TURP description....

Run-up to the TURP

2010 I now enter the Kaiser Permanente (KP) health care system. I immediately found a doctor (GP) that I liked and started working with him to manage my other health issues. I had high cholesterol which was maintained with medications, but I kept flirting with high Fasting Blood Glucose (FBG). One year I would be 102, the next 108, then I'd get it down to 85. When I entered KP, my first labs indicated FBG of 105 in May 2010. My doctor suggested losing weight and watching the carbs to lower the FBG and also help maintain good cholesterol numbers. I'm 5'7" and was about 155 at the time, which was an acceptable BMI of 24.3. However, I still had significant body fat, especially in the "love handles" area. Having an in-range BMI yet having too much fat for my body type illustrates the weakness of the BMI, to me. So I resolved to lick the FBG problem by increasing my exercise to walking 5 miles per day 3-4x/week and torquing up my aerobic exercise at the gym to 90 minutes on the elliptical machine. I also made a special effort to avoid the white stuff: bread, potatoes, rice and sweets like cookies and candies. From May to September, I lost 20 pounds. My cholesterol improved to very good numbers (total 153, LDL 78, HDL 65) and my FBG came down to an in-range 96. That was not as good as I was expecting, but my doctor said he didn't care as long as the FBG was below 100. OK, so now I'm dumb and happy and thinking everything is going good. I just have to keep doing what I've been doing to maintain my health. Nov 2010 - Say Hello to my Little Friends I awake one morning and find a field of rusty-red quarter-sized spots in my white cotton briefs. WTF? My first thought was, I must have caught my penis on my zipper fly or something and just didn't notice it. So I did the ridiculous man thing and just ignored it. Until the next time, a couple of days later. Nope, can't ignore it now. Turns out the rusty-red color was an indication that the blood's source was the prostate. The prostate has something akin to varicose veins called varices. These can become fragile and bleed. I visit my GP who immediately makes arrangements for me to see a KP urologist, in about a week. He also set me up with a CT scan, explaining the risks of radiation exposure and seeking my consent to the scan. In the CT scan, you take Iodine as contrast agent. You'll be asked if you are allergic to Iodine. I just didn't know, but figured I was OK because of using Iodine for cuts and scrapes in my past life. The procedure takes about 30 minutes or so. The protocol at KP is to give you a summary of everything discussed, including future visits, when you leave your GP. It would have helped if I read it. Right in the summary, I later found out, was "cystoscopy". This was a procedure I vaguely knew about but filled me with dread. The urologist is going to shove a camera up my penis! A cystoscopy is a procedure that uses a device called a cystoscope to enter the penis through the urethra. The cystoscope has a telescope/microscope mounted on a flexible tube, essentially a camera that allows the urologist a view of the prostate and bladder.

Cystoscope on flexible tubing

When I arrived at the urologist's office, he first went over the results from the CT scan. "Here's the money shot!" he said, and pointed to images of the prostate/bladder area, clearly identifying the problem so that even I recognized it. "OK, " he said,"Let's do the cystoscopy". I must have reared back with my eyes wide because he then said "You know what that is, right?" "Yeah, you're going to shove a camera up Mr. Happy! I wasn't ready for that." "Well, if you're not prepared to do it today, we're booking weeks out. The next window will be in January." After a moment's hesitation, I thought I'd better get it over with. "OK, let's do it. But I have to tell you I don't have much pain tolerance." "This is not a painful procedure, it's just a little uncomfortable." Uncomfortable. Right. A male nurse led me to the in-office procedure room. He gave me a gown to change into and swabbed my groin down with antiseptic. A local anesthetic was applied at the entrance to my penis. The doctor prepped the cystoscope and said, "Wiggle your toes and act like you're urinating. OK, we're in". It wasn't that bad. It just felt uncomfortable, like the urologist had said, kind of like you have to pee really badly. "Yes, that's the problem, " the urologist said. "I can turn the camera around so you can take a look." "Uh, that's OK doctor." The procedure took about 10-15 minutes. After the cystoscopy I cleaned up and left. The urologist had prescribed Tamsulosin (Flomax) and Finasteride (Proscar). I explained how Flomax works previously in this blog, but you can also see its action described here. I had explained to the urologist that I had tried Tamsulosin before in 2007, but I had a reaction to it. Nevertheless, I said I was willing to try it again. The Finasteride was new to me. How does Finasteride work? It blocks the conversion of testosterone to DHT, lowering the total amount of DHT in your body. DHT is important for enlargement of the prostate, so blocking it can help shrink the prostate. Finasteride works slowly, sometimes taking 6 months to a year to show results. The two drugs, Finasteride and Tamsulosin, are more effective for relieving symptoms when used together. I held off on using the Finasteride until I could determine if I could use Tamsulosin. I didn't want to take two drugs at the same time and then, if I had an adverse reaction, try to figure out which one was causing the problem. I stopped and started Tamsulosin about 3 times, each time I thought I had a possible reaction. First it was for sudden itching, but my wife reminded me that I get seasonal (Winter) itching spells. I experienced some relatively benign side effects on Tamsulosin in addition to the high heart rate. Many people experience nasal stuffiness/congestion on this medication. I have very productive sinuses and have year-long allergies which means I frequently have congestion in my left nostril, which I have grown accustomed to over time. Strangely, the Tamsulosin dried me out completely. First, I would feel the Tamsulosin "hit me", an unpleasant kind of drug rush, about 45 minutes after taking it. Then, my nose would dry out. The other side effect I had, which is quite common, is retrograde ejaculation. You will orgasm, feel the muscular release of orgasm, but little to no fluid will be produced. Weird. The last time I stopped Tamsulosin, I had an adverse reaction that was a little scary. I usually took the medication after dinner, between 6:00-6:30PM. I awoke at 3:00AM with my heart pounding. Well, maybe it will wear off. This was not as stupid as it sounds, as by this time I had had some hour-long episodes of rapid heart rate with this drug. By about 6:00AM, I still felt my heart racing. I got out my blood pressure monitor. Hmn, my BP is a high but my pulse is at least 110 and sometimes 130. OK, I know the drug will wear off eventually, I've got to wait it out. Finally, about 12:00PM, my pulse reliably returned to 72 or so. I talked with the urologist and he suggested one other drug in the same alpha-blocker family as Tamsulosin. That drug was (doing this from memory) Terazosin (Hytrin). I took a couple of doses of Terazosin and started experiencing the same rapid heart rate, although for shorter periods of time. Nope, the alpha blockers weren't going to work. Next I went on the Finasteride, with some apprehension. Turns out I didn't feel any side effects from it except sexual side effects. Gradually, I noticed that when I ejaculated, the semen volume was getting less and less. Over several months, I saw less and less blood in my urine. I'd notice it about every 2-3 weeks for about 3 months, then every 6 weeks, then 2 months, then not at all. There seemed to be a correlation of sexual activity to the bleeding. If I had too much, bleeding would occur. Less sex meant less/no bleeding. One of the nice things about Kaiser is you can schedule a telephone consult with your doctor. On one of these calls to my urologist, I asked what would push me over into getting a TURP (which was his preferred procedure). He replied that repeated infections or continued blood in the urine would indicate it's time for the procedure. Continue reading.... Skip to TURP description....

Background

NOTE: I am not a Doctor! This information is not intended as medical advice and should not be used as such. If you seek answers to your questions about prostate problems, consult your physician. Why this blog? This is a journal of my experiences with an enlarged prostate (BPH) and its medical consequences and remedies. The motivating factor in writing this blog was to help other men navigate the emotional and physical maze that is prostate disease. When I researched BPH and the various surgical procedures used to alleviate problems, I found web forums useful, but there was always something missing. Though they might be available, I couldn't find any support groups for BPH in my area. I needed something that spoke to me. I experienced a lot of anxiety, fear and a feeling of being alone with my problem. I think a lot of our identity as men is tied up with our sexuality. Some of the procedures to diagnose problems, such as a cystoscopy, are not especially painful but are invasive and can leave you feeling violated. I felt, in a strange way, that my manhood was being assaulted. I was reluctant to speak about my problems to my friends and acquaintances out of a misplaced sense of shame. I don't want someone to go through what I went through. I feel an obligation to publish this information so someone will have an easier time with their journey. So, I'm writing this to help a brother out. The more you know, the more comfortable you'll be. Early Warning Signs As I analyze my condition, I now realize that my problems were a long time in the making. One of the tell-tale signs was waking up at night to urinate. I probably have been getting up at least twice a night for over two decades. I'd hear 70-ish men complain that they have have to get up once a night to make a restroom visit. Pffft! That's nothing, I've been doing 2-3 times that since my early 40's. I had chalked it up to being a generally anxious person and having a stressful job. Gradually, as I approached my mid-50's, I started adapting to the disease in subtle, unconscious ways. In my head, I'd map the location of available restrooms if we were out and about anywhere, even if we were just in the local neighborhood. For longer road trips, my wife and I would stop about every hour or so to "stretch our legs" and "get gas" (uh-huh, yeah, right). I learned strategies for seeking out restrooms anywhere. Starbucks, grocery stores and hotels like Holiday Inn Express became my friends. First Indications In January 2007, I had a routine colonoscopy. I was 56 at the time. Ten days after the colonoscopy, I got up to use the restroom in the middle of the night. Surprise! Ow, ow, ow! What the hell is that?!? I was peeing glass. Well, that was special. Like many other men, I thought perhaps this was a one-time occurrence. If it the pain diminished or went away, I won't have to go to the doctor. Big mistake. I had a urinary tract infection (UTI) that was not "going away" by itself. When I continued to have symptoms of burning urination at the beginning of the stream, having to urinate more frequently, and having a more urgent need to urinate, I realized I had to see my doctor. I had an Enteroccocus infection. I was put on a 7-day course of Ciprofloxacin (Cipro) antibiotic which is considered the gold standard for treating UTI's. I'm allergic to Penicillin so that ruled out some other antibiotics. I was still experiencing symptoms after 7 days, so my doctor put me on a second course of Cipro. I took two doses of Cipro on the second course and suddenly started feeling what I would describe as flu-like symptoms: aching muscles (myalgia) much more than a workout would give you. This turned out to be a rare but known side effect of Cipro. I immediately stopped Cipro and about 3 days later the achiness resolved. Back to the doctor. He consulted with a specialist to find an antibiotic that would work for me. Doing this from memory now, but I believe that was Macrodantin (Nitrofurantoin). The symptoms went away after this course of meds. While I was dealing with the UTI, I had another issue to deal with: my PSA (Prostate-Specific Antigen) score was rising. It had always been in the normal range: about 2.3 for several years. Now, over about 6 weeks, it rose to 5.3. This can happen with UTI's, however it could also be an early indication of Prostate Cancer. My GP referred me to a urologist for further evaluation. First Urology Experience At the first office visit with the urologist, I was quite anxious. I normally have well-controlled high blood pressure, but the nurse measured my systolic BP as 160. I was unprepared for the first test the urologist routinely does - the Uroflowmetry, or urine flow test. As the name suggests, you urinate normally into a special urinal that has a device attached for measuring the flow rate. No big deal at all. The mistake I made, but was natural/routine for me now, was that I visited the restroom before seeing the doctor, so I didn't really have good volume. The urologist said my flow was weak. We moved to another room at the urologist's office and did a sonogram of the prostate. The urologist said the prostate didn't look all that large, but it had quite a few calcifications (AKA "stones"). These are actually quite common in middle-aged men. They are generally considered benign and have no correlation with prostate cancer. However, if you continue to read this blog, the stones will become significant later on in My TURP Story. The urologist said prostate cancer usually does not display such velocity (2.3 to 5.3 in 6 weeks or so) in the rise of PSA, but that we should do a biopsy to be sure. We scheduled one for six weeks out. I was anxious and fearful the whole six weeks. What if it IS cancer? Well, if it is, early detection and treatment is the best hope for a good outcome. Prostate Biopsy I arrived at the urologist's office again unprepared. They wanted to do the Uroflowmetry again. Would you people mind telling me what you expect of me for the next office visit? The actual biopsy was not scary at all. The urologist gave me a local anesthetic (Lidocaine) in the rectum which numbed the area where the biopsy was to take place. After that, I could feel pressure but no outright pain. The actual biopsy instrument is a kind of air-powered gun that is quite loud. The urologist warned me that the instrument makes a lot of noise, but not to be concerned about it. The procedure is also guided by sonogram. Samples are taken from two different locations in the prostate, 10 each location in my case. The entire prostate cannot be biopsied because there is a section facing away from the rectum. It's possible you could still have cancer in the section that isn't surveyed. After the first biopsy "pop" from the instrument, I started to relax. There was no pain, only pressure. I joked about it kind of like being at the dentist, only the other end is worked on. The whole procedure took about 20 minutes. I was left alone to dress when I noticed bright red blood seeping out of my penis and freaked out. I summoned a nurse and asked if this was normal and she said yes, it's expected. That's a channel for residual blood to flow. The urologist scheduled another office visit about 3 weeks out to go over the results of the biopsy. His nurse said to expect to see some sign of blood for about 2 weeks. In my case I was seeing blood in my urine for 3 weeks. When I returned to the urologist's, he gave me good news: the biopsy was negative, no cancer found. Prostate biopsies initiated by PSA scores are somewhat controversial. I have read estimates that about 80% are negative. Also, the biopsies can rarely register false positives. The CDC has recently clarified its position on the role of the PSA test in detecting prostate cancer. It follows guidelines "which state that there is insufficient evidence to recommend for or against routine screening for prostate cancer using PSA". See this page for more information. However, the urologist did put me on a medication to help my urinary symptoms. He prescribed Flomax (Tamsulosin), a popular medication in the alpha-blocker family. Flomax works by relaxing the veins of the prostate and the bladder neck, to allow better flow of urine. I took two doses and felt quite strange on the medication, hard to describe. Flomax may take up to 7 days for you to see noticeable improvement. In my case, I saw results from the first dose. Unfortunately, I felt so odd on it, I decided "I'm not taking this shit!". Look at this link for information on Flomax. On the next annual visit (2008) to the urologist, I said I had stopped taking Flomax. The urologist kind of responded, well, there are other medications that you can try. I didn't show any interest at the time, so no new prescriptions were offered. The last time I saw this urologist was 2009, no change in meds or prognosis. In 2009, I was still in the United Health Care (UHC) insurance system. In 2010, I changed to the Kaiser Permanente (KP) system due to the high cost of UHC. KP was roughly half the cost of UHC. Continue reading.... Skip to TURP Description....