Lovenox

<div class='quotetop'>QUOTE(huskers @ Feb 12 2007, 11:26 AM) [snapback]389022[/snapback]</div>

Haven't had any fibrillation since the operation. That part may have been a success, though to really test it I'd probably have to give it one of the triggers, like caffeine, and I'm not going to do that for a long while yet.

The urinary problems: no change. But I have an appointment with the urologist tomorrow. I fear the worst: a transurethral exam, which was more painful than the prostate operation itself, because I was unconscious for the operation.

Possible problems:

1. No problem; just slow healing after the damage caused by the catheter, requiring patience.

2. Some kind of blockage, perhaps a large blood clot, requiring invasive measures to clear it away.

3. Actual damage to the urethra, prostate, or bladder from the catheter, requiring surgery.

Best outcome for tomorrow, see #1 above.
Next-best: Send me directly to the operating room for another prostate operation and get the darn thing over once and for all.
Worst: Another agonizingly-painfun transurethral exam.

 

Hi Jayman.

Well it sure sounds as though your dad had it a lot worse than I did. When I had my prostate operation (is a resection procedure the same as a transection? I remember them calling it a transurethral transection) the operation itself was fast and painless as I was out cold. The catheter afterwards was in for a day or so, and was uncomfortable, but tolerable. Urinating after they removed it was the most painful thing I'd ever experienced.

Before that operation, he used a catheter to go in and look around. That was agonizing.

For this operation, they used a very small foley catheter, precisely because they were aware of the previous operation. After the operation, the sensation of having to pee was enormously more intense than after my prostate operation, and though smaller, the sensation overall was much more uncomfortable, though urinating afterwards was somewhat less painful.

The latest news, as of this afternoon, is that I have begun passing the occasional blood clot, and am actually feeling much better. I have no discomfort between trips to the bathroom (I had been in nearly-constant distress) and though the flow is still slow, it is better than it was, and now I am hopeful that maybe I'm finally on the mend. Tomorrow late morning I see the urologist. This is not the one who operated on me. The prostate operation was in Fargo. This urologist was called in only after they had had trouble with the foley after my heart operation.

 

This morning I saw a urologist (not the one, obviously, who operated on me 4 years ago in Fargo). He said that my prostate is extremely large. He said that if I continue having touble urinating, or cannot empty completely, I'll need another prostate operation. He said that what the other surgeon did, 4 years ago, was completely inadequate and entirely the wrong thing to do. When I told him that that surgeon had told me I'd be good for ten years, this guy laughed.

But he said that I cannot have an operation while I am on Coumadin. And I think the heart surgeon wants me on Coumadin for at least a month, maybe longer. (But the pharmacist said they might be able to switch me from Coumadin to Lovenox again, which would allow an operation.) I really don't want another operation while I am still sore and bruised from the last one, but I want to get this damn thing over with, and I am worried I could have a crisis and actually be unable to urinate.

Apparently the urinary catheter used for the heart operation irritated the prostate enough that it closed off a little bit more than it was already. It had been allowing me to pee just fine, but it was marginal. So now it's very iffy. During the night, the past two nights, I have been nearly unable to pee, but I can manage during the day. The question is, will the prostate revert to its former condition as it heals from the irritation, or will it remain nearly closed? When I asked the urologist, he said it's a 50/50 chance. If it recovers, I could schedule another operation when it's convenient, after I'm recovered from the heart operation. If not, I'd need to do something very soon.

He said, with the present size of my prostate, he does not even know if he could get a catheter in. But he did not say what the alternative is if I have a crisis and cannot pee.

The one bit of good news is he said he'd put me under total anesthesia before performing an examination with the scope. That was agonizingly painful when the other urologist did it before my first prostate operation.

 

<div class='quotetop'>QUOTE(jayman @ Feb 13 2007, 07:03 PM) [snapback]389946[/snapback]</div>

Yep. The ultrasound can tell how big the prostate is, and also how much urine is in the bladder. So they have a look before and after you pee, and they can see how much remains afterwards.

<div class='quotetop'>QUOTE(jayman @ Feb 13 2007, 07:03 PM) [snapback]389946[/snapback]</div>

Yep. I tried it way back when. It didn't help much, and it had side effects. I also tried Proscar, which takes a long time to take effect (months) but it didn't help. And there's an herbal medicine called Saw Palmetto that works like Proscar, which I tried, and it had no effect at all. Today's urologist was not surprised none of these worked for me. My prostate is just too damn big.

<div class='quotetop'>QUOTE(jayman @ Feb 13 2007, 07:03 PM) [snapback]389946[/snapback]</div>

No, the Fargo urologist didn't botch the procedure. It was a 100% success. What he did was the wrong procedure, because instead of the ten years of relief he promised, I got 4. My prostate was too big for that procedure. He opened it up a little, when he should have reamed it out.

<div class='quotetop'>QUOTE(jayman @ Feb 13 2007, 07:03 PM) [snapback]389946[/snapback]</div>

Gosh. This guy didn't put it in dry. He first squirted in a local anesthetic and left it there for a while with a clamp on my penis, then he inserted the scope with lubricant. But it still was agonizing.

 

<div class='quotetop'>QUOTE(jayman @ Feb 14 2007, 03:54 PM) [snapback]390547[/snapback]</div>

Four years ago I had a trans-urethral transection. The surgeon described it as cutting a small notch out of the inside of the "doughnut." He said I'd be set for ten years. Four years later I figured, based on the rate my flow had diminished, that I had maybe a year, or two at most, to go. Then the catheter for the heart operation irritated it so much that it's nearly shut.

I saw a urologist yesterday, and I'm set to see another in two weeks. Then I'll decide between them, but either way I expect to have a more radical procedure (a TURP or something along those lines) very soon. Ideally, in March, to give me time to recover fully early enough to get my condition up for this summer's Canada hiking trips.

The good news is that the nurse who is regulating my Coumadin says it's an easy matter to take me off Coumadin and put me on Lovenox again, long enough to have the operation, and then go back onto Coumadin, which the heart surgeon wants me on, because of the risks of a clot following the heart operation.

No fun at all, but at least there's the hope of getting back to health.

 

My appointment with the second urologist has been moved up to this Monday. I phoned and argued the urgency of my situation. I was lucky that the phone was answered by a nurse (capable of understanding the situation) rather than a receptionist (trained to pretend that those slots set aside for urgent cases do not exist). Last night I was able to pee, though not to empty, so I am actually feeling much better. An operation is in my future, but am no longer fearful of an imminent complete shut-down.

 

<div class='quotetop'>QUOTE(nicos @ Feb 16 2007, 09:42 AM) [snapback]391538[/snapback]</div>

Thanks Nicos. Right now I'd say it's downgraded from nightmare to bad dream. The prostate seems to be recovering. And I'm feeling well enough to think about how amazing it is that in 4 hours on the operating table, and one night in hospital, going in through the veins, without ever opening the chest, they may very well have cured my atrial fibrillation, which was taking such an extreme toll on my quality of life.

And the prostate was going to need another operation before too long anyway.

But an external catheter during the heart operation sure would have saved me a lot of pain and anguish.

 

<div class='quotetop'>QUOTE(geologyrox @ Feb 17 2007, 07:20 PM) [snapback]392211[/snapback]</div>

Okay, I'll take you up on that if I'm ever in Florida. Actually I have a Cuban pen-pal there, so it's not impossible... just extremely unlikely, as I cannot abide humid climates. I just finished listening to the audio downloads of the two "Foundations of Western Civilization" courses (ancient and modern being taught by two different professors -- both fascinating, though crammed with details I'll never remember) and the Dutch Masters course on DVD (exclusively while exercising on my treadmill).

Update: The prostate seems to be improving. Last night I managed to void at least enough to get a decent night's sleep (i.e. not be awakened by an over-full bladder more often than is "normal" for me). Tomorrrow I see the second urologist, and perhaps decide whether to ask for a prostate operation immediately, or risk waiting until fall.

On the heart itself, I've had several bouts of a-fib, but they stop within a minute or two. The cardiologist had told me that the burn lines themselves could cause a-fib until they finally heal and scar over, at which point they will (if successful) electrically isolate the heart from the suspected source of extraneous impulses. Before the operation, the a-fib would last for hours, and would repeat, on and off, all day long, for days at a time, before disappearing for days. This, so far, has been the very occasional few seconds, so I am hopeful that it's the normal progression of things. I can't remember if it's supposed to take one month or two for the burn lines to heal, but I do heal more slowly now than I did when I was young.

Meanwhile, the really nasty bruises around one of the insertion sites is beginning to look less nasty. Things are looking up.

 

<div class='quotetop'>QUOTE(DaveinOlyWA @ Feb 18 2007, 10:58 AM) [snapback]392432[/snapback]</div>

That's awful about your accident! But I'm glad you were not hurt. That's the most important thing. I generally oppose draconian law enforcement, but in the case of drunk driving (even without an accident) I'd impose a minimum one-year jail term for the first offense, with loss of driving privileges until the offender could demonstrate that he'd entirely quit drinking. For a second offense I'd impose life in prison without parole. Society treats drunk driving about like it treats parking violations, but the death toll justifies regarding it as attempted murder.

As for the Tesla, if I were to order one this month, with a 50% deposit, the most optimistic estimate would be delivery in the spring of 2008. The deposit is refundable, but the interest is not, and that's a significant amount of money. It would not surprise me if a few of the early buyers cashed in by selling theirs, but they'd probably get more than I'd be willing to pay.

But if I do get one, you'll be welcome to come see it. I think you'd be out of range for me to make the trip there in a day. Plus, I don't think I'd want to drive it in your traffic.

I'll survive. The biggest question now is whether I need another prostate operation right away, or whether I can wait until fall. Of course, I could always fall off a mountain this summer. I'm planning to hike in some pretty spectacular (and steep) terrain.