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....