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....