PSA .....Some Life Saving Information For All the Men In Your Life

Saturday, June 17, 2017
Times have sure changed,  haven't they?  We talk about everything these days, not just with our friends but on TV too.  It began with commercials about feminine hygiene products, then as if that weren't embarrassing enough for young women, it went to birth control, then incontinence and just to round out the conversation we had to talk about menopause.  As if discussing incontinence wasn't enough, now they talk about vaginal dryness and painful sex - during daytime and primetime TV.  Really?!?!  But men...well, men get discreet, romantic scenes with beautiful women to discuss their issues.  Their issues are discussed in abbreviations, like E.D. for instance.  They don't have embarrassing commercials about their man parts during football games or testosterone-laden action shows. But maybe there's something guys should be hearing more about, even if it IS on prime time TV, especially if that something could be life saving and life changing.  While it may be stepping away from my typical blog topics (a long way away), today John and I want to bring you a very special and very personal public service announcement that we're hoping you'll read and share with every man you know.  It may save their life!

Last August John came home early from his outdoor volleyball game.  That never happens, so as soon as he unlocked the front door I knew something was wrong.  Sure enough John had slipped on the grass making a play and hurt his back.  I knew from the way he was moving that it wasn't good so we made a trip to Urgent Care.  Before long we were back home with a diagnose of back strain and a supply of muscle relaxers and pain meds.  That was Monday, August 29th.  By that Thursday John's back was much better but he was experiencing frequent urination and suspected he might have a urinary tract infection since he'd had one once before on a road trip back from Indiana.  He saw his primary who did a urine culture which would take a few days to come back. He also said he had a slightly enlarged prostate .  In the meantime, the doc explained that he wanted to prescribe Cialis which (in addition to it's normal use) is now prescribed to help shrink enlarged prostates.  He told John that we had to go to a special pharmacy in Watervliet to get it because it was cheaper there.  When John came home and reported this to me, I was pretty perplexed.  Who prescribes Cialis for a UTI and why do we have to go to a 'special' pharmacy to get it?  Feeling a little like we were dealing with black market drugs, we called the pharmacy to see exactly what the doc had ordered and why they had it cheaper.  You can imagine our shock when we found out the script was actually for Viagara.  I about lost my mind. We immediately called the doc back and asked for something other than Viagara and now John was prescribed Flomax.  Ok, that made some sense.
Saturday evening John was no better, in fact he was worse.  A visit back to the local Urgent Care got him a script for phenazopyridine (Pyridium) - the stuff that makes you pee orange and relieves discomfort. By Sunday morning John was really suffering.  He was beside himself with UTI symptoms, frequent but scant urination and painful burning.  We called his primary and begged for and got an antibiotic.  The day went on and John got increasingly sicker and more agitated by the pain.  By early evening, John's belly was swollen.  He looked several months pregnant.  Trips to the bathroom were every couple of minutes but only drops came out.  I called Katie, our RN daughter, who came to access and she advised we get John immediate medical attention.  She and I took him to an Urgent Care in Malta.  This is what John looked like by now:
If you know John you know he does not have a belly.  He still has his youthful figure, but on this night he was looking like he had a passion for pasta and beer.  The doc there was really nice.  He did an ultrasound and diagnosed John with acute urine retention.  He attributed this to the pain meds John had been taking for his back and even though John had only taken a few over the past few days, the doctor felt it was the best explanation for the problem as well as his confirmation that John had a 'slightly enlarged' prostate.  Doc said he'd have to insert a catheter and drain the urine.  He also said the catheter would need to stay in until Tuesday (it was now the Sunday evening before Labor Day) when we would need to get a urologist to remove it.  Sounds ok and logical so far.   The catheter was inserted and the first bulk of John's backed up urine came out.  That very first 'tap' drained a whopping 1200 ml's of pee.  For the record, the average bladder signals the urge to urinate at about 300-400 ml's.   No wonder John looked pregnant! Immediate relief was felt and the pee kept coming.

Color due to medication, not blood.
Tuesday morning rolled around and after several attempts to find a urologist to remove the catheter we learned that a) urologists rarely have same-day appointments and b) catheters don't come out after a day or two.  They must remain for at least a week. We made an appointment for John to see a Physician Assistant in the urology office on September 12th.
 John had to arrive at the office first thing in the morning to have the catheter removed and return in the afternoon for an ultrasound to see if he was still retaining.  That afternoon the P.A. confirmed that John's prostate was slightly enlarged.  She also confirmed that he was still retaining urine.  So, she put the catheter back in and set up an appointment for him to see the urologist in a couple of weeks when the pain meds should be well out of his system.

On September 26th, John saw Dr. Seth Capello, a man who would become John's hero and is by far one of the sweetest and most competent doctors we've ever dealt with.  That day John had to take the catheter out himself in the morning and see Dr. Capello in the afternoon. Dr. Capello did his exam and once again not surprisingly, John failed the urine retention test.  He also had a cystoscope that day.  Dr. Capello explained that John's prostate was quite large, not slightly enlarged.  In fact, it was as large as the largest model on this display:
Normal prostate on top, John's was like the bottom one.
A normal prostate in a younger man is about the size of a walnut. From about the age of 40-50 a man develops BPH (benign prostatic hyperplasia) due to changing hormone levels causing the prostate to grow larger.  Excess tissue blocks the urethra making it harder for the urine to flow.  The enlarged prostate can also press on the bladder causing a need to urinate more often.  Dr. Capella says that about 50% of men have symptoms (problems) resulting from the enlargement, others do not.
A Normal Prostate
An enlarged prostate
So, those extra trips to the bathroom at night are not just due to normal aging, but rather due to possible prostate enlargement.  Doc explained that when he asks men how they're urinating at night, they often proudly respond, 'Great.  I pee four or five times a night'.  Well, that's not great.  It means there's a problem.  John wasn't peeing 4 or 5 times a night, but he was getting up once, sometimes twice a night.  He had no other symptoms of a problem, in fact, his plumbing was working just fine. ;)  The doc went on to explain that basically what had happened was that over time, as John's prostate grew, the bladder muscle had to work harder and harder to expel the pee.   So much so that now it was pretty much exhausted and combined with the narrowed urethra, it was impossible for the urine to get out without the help of a catheter.   Dr. Capello explained that there was a drug, Finasteride, that helps shrink the prostrate quite successfully.  However, it takes about 6-12 months for it to be fully effective.  He explained that John's sudden urine retention seemed to indicate that up till now, John was basically flying just above the tree tops.  His bladder was just barely able to get the job done, but now when it had quit, and he was not clearing the tree tops.  Hopefully the Finasteride would work enough in a month to get him flying above the tree tops again and he could continue on the medication until the prostate had shrunk to a more reasonable size.  Until that time though, he had to keep the catheter in.
Living with a catheter is definitely not the worse thing in the world, but it isn't the best either.  I will say I was a little envious of John's ability now to sleep through the night without any bathroom visits but a catheter isn't conducive for much else, including sports.  Also the bag that is used during the day that is attached to the leg doesn't hold a large amount of urine, so our road trips were a little tricky too.    Overall, despite the inconvenience, added work and limitations, John felt pretty good.
A month went by and John went back for another pee test.  At that visit he had to drink 32-48oz of water beforehand then do a urine flow test to check the rate of flow.  He also had an ultrasound to check the retention.  From those tests they found his flow to be slow and he was still retaining.  Dr. Capello wasn't confident another month on the medication would make enough of a difference to get the catheter removed so....... this is where I'll talk about the other option presented.
From the first visit with Dr. Capello, we were informed that there were surgical treatments available. The option he felt was the best option was a procedure called the TURP (transurethral resection of the prostate).  This procedure cuts away tissue blocking the urethra and bladder.  It is also the most common BPH procedure. It is non-invasive (well, sort does involve inserting a scope into the penis), effective and has an easy recovery.  We could have opted for that from the get-go, but decided to try the medication first.  Not that most men would prefer wearing a catheter....but less would sign up for a TURP as their first choice.  By now though, John was ready to be rid of the catheter and eager to get the TURP procedure.

You're probably wondering about John's PSA levels during all of this, as well as his PSA history.  His primary had been keeping an eye on them prior to all of this.  A normal PSA level is anything below 4.0.  On 7/29/13 his level was 3.2, and on 8/12/14 it was 3.95.   In retrospect, after knowing what we know now, John probably should have had another PSA after 2014 or been referred to a urologist for further monitoring.  Now, with the prostate so enlarged, a test would be inaccurate and inconclusive because of the inflammation and irritation from the catheter.  So, during this ordeal, we had no idea what the PSA was and had to hope that the enlargement was benign.

On November 9th, John had his TURP.  As surgeries go, the TURP was pretty easy.  I think the worst thing John could complain about was the dry mouth he had immediately afterwards.  The surgery itself  lasted about 30 minutes or less.  John had to spend the night in the hospital (not admitted but in the recovery room they have for TURP patients) and was released the next morning.  He came home without a catheter and was pain free and peeing like a race horse.  At his two-week follow-up appointment, John was given the go-ahead to resume all of his normal activities - including his favorite one, volleyball.  Oh...he could resume his other favorites too. Wink, wink. We had to wait 6 months to check John's PSA levels.  Although, the doctor felt pretty confident this whole time that John did not have prostate cancer and the biopsy from the TURP came back negative, it was still looming on our minds.  Finally in May,  John had his level drawn.  His PSA was 0.6.  Yay!!  Prostate cancer is generally not in the part of the prostate that was removed however, so John will still need to keep an eye on his PSA levels in the future.  John is still feeling great, not getting up at night to pee, and is medication free.  All systems are working properly!

So what's the take-away message here?  Why are we putting this on the blog?  Because it's important and because men don't talk about it!  Yet, when John began telling his friends, his choir members, a neighbor, etc...several men admitted they also have/had prostate problems.  Some had had surgery and others were taking the Finasteride with success - because theirs was caught in time.  We're talking about it because the TV commercials about men making multiple trips to the bathroom at night are only talking about Flomax, not about prostate issues themselves.  We're talking about it because it should not be something to be kept a secret or be embarrassed about and because it's a problem that can be easily addressed.
So here's what the men need to know:
  1. If you're over 40, your prostate is probably growing.
  2. Even if you're not having symptoms, you may be experiencing changes that could suddenly become a problem.
  3. You should be having PSA tests and should be keeping track of the results.
  4. Depending on your results, your symptoms, and the quality of your primary, maybe you should be seeing a specialist (urologist).  If your primary gives you Viagara for frequent urination and UTI symptoms, run like the wind to another doctor.
  5. Don't assume that everything that is happening is normal and age related.
  6. Other than skin cancer, prostate cancer is the most common cancer in men.  About 1 in 7 men will be diagnosed with prostate cancer in his lifetime. About 6 in 10 are men 65 and older, the average being 66.  (John is 66.)  Prostate cancer is the third leading cause of cancer death in men behind lung and colorectal cancer.  About 1 in 39 men will die of colorectal cancer. (Statistics from the American Cancer Society 2017 statistics)
Symptoms of a prostate problem:
  • needing to urinate more often
  • waking up to urinate many times during the night
  • feeling that you can't wait to urinate
  • feeling like your bladder isn't completely empty after you urinate
  • having a weak urine stream
  • needing to push or strain to start urinating.

Our story has a happy ending, but not all do.  Please share our story with as many men as you know so that their stories can have happy endings too.  We can't control everything that interferes with our quality of life as we age, but we can improve some.  This is one that can not only improve the quality of life, it can actually prolong it.  Women have pap smears and mammograms, it's about time men get diligent about their equipment too.  Start talking prostates with the men in your life today!
Disclaimer:  We are not medical professionals.  We are just sharing our experience.  Consult with our own physician for medical advice.

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