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Medical Forum / Diseases and Disorders / Prostate BPH / January 2006Flomax prior to PVP
I am scheduled for my second PVP next week with Dr. Lin, who unbelievably responds himself to all e-mails. When I had my PVP in 2/05 with another doctor, he told me it was o.k. to take Flomax up until the time of the surgery and Dr. Lin tells me the same thing. It would just seem that you would stop taking it so they could see the result when not on Flomax. With me, if I go one day without taking Flomax, it is like shutting off the water. Would like to hear thoughts from others. Thanks. > I am scheduled for my second PVP next week with Dr. Lin, who > unbelievably responds himself to all e-mails. When I had my PVP in [quoted text clipped - 4 lines] > Flomax, it is like shutting off the water. Would like to hear > thoughts from others. Thanks. Buford...this is a very good point. Please make sure to ask Dr. Lin (by email before the PVP), or when you have the PVP (I'm sure his answer wouldn't deter you from having it :-)), and get back to us later. This is why it is important for us to ask further when a doctor tells you something, and try to explain your logic (i.e. you can say "why is that" or "I would think you would get a better representation of my condition while not on the flomax", etc). Most doctors don't like you to pick their brain though, but if Dr. Lin answers e-mails himself, then he sounds like another good doctor (like Dr. Sancha). If you ask a doctor too many questions, he will probably label you as a pain in the a.s (PITA), and you may run a risk of being dismissed :-), like I have said in the past. But your question is certainly a legitimate one. Why are you having another PVP so soon. Am I correct in assuming Dr. Lin has already scoped you (while you were on flomax and not under anesthesia) to determine that you need another PVP, or is he just going by symptoms, and uroflow and retention tests. Alpha blockers are basically vasodilators (smooth muscle relaxers) and relax muscle in the prostate and bladder neck also - you can read the package insert on flomax which describes the static and dynamic components of BPH . I always thought if they plugged your nose up (which they do me immediately - even the more selective flomax - and I can't breathe at all so I can't take them - have tried hytrin, cardura and flomax), then why don't they plug your prostate up also. I have written this question in other groups (e.g. pharmacy, sci med, prostatitis), and this one also I think, and have never received an answer. I guess the effect on muscle tone is greater than the effect on dilating the blood vessels (which have smooth muscle in the walls) in the prostate. But I would think the two would tend to cancel each other, if you see what I am mean. So we are back to if it works, then don't ask questions - which I hate. If you care enough, ask Dr. Lin about that also (but maybe wait till after the PVP so you don't flood him with too much stuff that he may consider unimportant). As an aside I thought the purpose of PVP's, TURP's, etc. was to resolve the blockage problem associated with BPH, so you wouldn't have to use flomax and proscar. Your first PVP must have failed miserably. Also (for Dr. Sancha), if you read this please comment on it. Thanks...Pete Buford...sorry about asking you why you are having a second PVP so soon. I went back (starting with your 10/30 post) and re-read everything (long thread), so you don't have to explain why. But everything else I said still stands about asking Dr. Lin your question, and maybe my additional question about the flomax. Please get back to us. I am interested in your outcome and what went wrong with the first PVP. It looks like you got in with Dr. Lin pretty soon. If Dr. Lin scoped you (which I asked in my previous post below), did he say what went wrong (no doctor will bad mouth another doctor but he should have told you something, even if it is just that it didn't heal right). If the first doctor screwed up, then he should tell you whatever the standard boilerplate statement is, but it certainly won't be that the other doctor screwed up. Please let us know...Pete >> I am scheduled for my second PVP next week with Dr. Lin, who >> unbelievably responds himself to all e-mails. When I had my PVP in [quoted text clipped - 44 lines] > Also (for Dr. Sancha), if you read this please comment on it. > Thanks...Pete I only spoke to Dr. Lin on the phone and told him the complete story. He said since I was coming from out of town, he felt the best thing was to have me come in one day for an office visit and do the surgery the next day. He did say the first thing he would do is scope me because it could just be scar tissue from the previous surgery or a bladder neck obstruction but he seemed to think once he got in there he would have to do the PVP. Again, if he gets in there and the PVP is not necessary, he will not do it. >Buford...sorry about asking you why you are having a second PVP so soon. I >went back (starting with your 10/30 post) and re-read everything (long [quoted text clipped - 16 lines] >> Also (for Dr. Sancha), if you read this please comment on it. >> Thanks...Pete I also wonder why you need a second PVP. Probably the first was not aggressive enough, or you might have developed a bladder neck stricture? I had to do some reoperations during my learning curve, in one patient I left a relatively little mass of tissue that behaved obstructively near the sphincter, I had to vaporize it and the patient voided wonderfully. I also had two patients that developed bladder neck strictures, maybe due to excess of coagulation in the bladder neck area (this is a known complication of prostate surgery), it took 15 minutes to solve the problem under sedation and patients went home three hours later. They did not need a catheter afterwards. All are well now. So, try to find out why you need a second PVP. Surgery is not mathematics, doctors usually try to do the best job they can, sometimes you leave the theatre very happy with the result, and the patient is not so happy, and other times you are not so certain the job was so good and the patient is extremely grateful and satisfied... There are many factors that can explain a bad clinical result apart from incorrect surgical technique. Some patients have very weak bladders, and even after an open prostatectomy removing all BPH tissue need to self-catheterise, and so on and so forth. I have seen that the tendency in this group is to be very critical with doctors. I guess those patients that are happy with their operations do not feel the motivation to join a group like this, and maybe this group contains a high proportion of unhappy patients that is not representative of the general population. I will try to contribute with my point of view as a doctor. I am sure there are many PITA doctors around as there are also PITA patients ;-) The world is full of PITAs I'm afraid. Regarding alpha blockers, 40% of the prostate is made up of smooth muscle fibers, the tension in these muscle fibres is mediated by the alpha 1 adrenergic receptor. These fibres are specially abundant in the bladder neck area, where they constitute the internal urinary sphincter, its contraction is involunctary, and its function is to contract during ejaculation, to facilitate forward propulsion of the semen. BPH nodules grow precisely in this area, near the bladder neck, so when you want to remove the BPH tissue, you have to take the internal sphincter fibres, intermingled with the nodules. That is why many patients experience retrograde ejaculation. Some substances link to this receptor and induce an increase in muscle tone (muscle fibres shorten), as norepinephrine. The mechanism of action of alpha adrenergic blockers is to block this receptor and thus relax these muscle fibres. This decreases the tension inside the prostatic urethra and bladder neck and improves urinary flow and bladder emptying. Alpha receptors are ubiquous, you find them all over the human body, and there are different subtypes that allow for control of many body functions by the vegetative nervous system. The main clasification is alpha 1 and 2, but then you have alpha 1a, 1b, 1d, and so on. Different alpha blockers have different selectivity for different subtypes of apha receptors, that account for different effects. This explains some of the adverse effects experienced by people taking alpha blockers, hypotension, dizziness, running nose, etc. It is kind of complex, tamsulosin seems to be more selective for alpha 1a, and apparently produces less hipotension. interestingly, around 10% of patients on tamsulosin develop reversible retrograde ejaculation. This has been studied extensively, and drug companies carry out extensive clinical trials to demonstrate little advantages of one drug over the other. The big meta-analysis usually conclude that they are more or less equaly efficacious, but there are differences in the adverse event profile. Some alphas are good for patients with hipertension because they not only improve lower urinary tract symptoms, but also lower the blood pressure. This is probably not necessary for other patients..... Sometimes you develop secondary effects with one drug, but not from other from the same family. Apparently, the best tolerated is Alfuzosin. Fernando Gómez Sancha http://drgomezsancha2.blogspot.com Thank you Dr. Sancha for your description of the alpha blockers which was excellent. Please allow me to further explain what I was trying to get at. I know the nose and the prostate are two different entities, but I think my analogy may be valid. It is interesting that you mentioned runny nose as a side effect of alpha blockers. If you recall I said they plugged my nose up completely (and immediately - i.e. congestion), which to me is kind of the opposite of runny nose. I associate runny nose with being more related to taking antihistamines, versus for congestion, you take the standard decongestants (not to say you couldn't have both). I know there are many medicines that say they have double (juxtaposed) side effects, i.e. they can cause high bp or low bp, speed heart up or slow heart down, constipation or diarrhea, or runny nose or congestion (in this case). I have never understand this, and guess it relates to a persons metabolism and the fact that different people react differently to different medicines. I would think that a side effect should basically be in one direction and not two, if you see what I mean, but I guess there are exceptions to every rule. Having said that, please bear with me and help to answer what I was asking. I will repeat that alpha blockers also relax the smooth muscle in the blood vessels (i.e. they are vaso-dilators), which attributes to their previous use in treatment of high bp (they are no longer a drug of choice for high bp - due to later development of more effective drugs). Now here is the key to what I was asking. I believe the reason that alpha blockers plug my nose up completely is because of their vaso-dilator effect which is dilating the blood vessels in my nose (as well as all over my body - even the more selective flomax which targets the alpha 1a). In other words the blood vessels are expanding (if you wish) and swelling my nasal passages shut. Standard decongestants are vaso constrictors (which is the opposite of a vaso dilator), and they are used to supposedly open up your nasal passages by constricting the blood vessels. So if you follow my logic, I was asking why wouldn't the vaso-dilator effect of the alpha blockers used to treat BPH, also swell up the prostate (so to speak) and have a counter effect to the benefit achieved by the muscle tone relaxing effect in the prostatic urethra and the bladder neck. Like I said before, my only guess is because the muscle tone effect is greater than any negative effect created by the blood vessels dilating. I hope you see what I am getting at, and would appreciate a response if you would be so kind. Thank you again. I save every one of your responses, and appreciate the time you take in responding to the group. Sorry if I sound a little negative about doctor's (and I always point out that you are an exception). I have been to many bad doctors in my life (in most of the specialties) and they don't explain things as good as you do, and are not as knowledgeable as you are, and they don't respect my right to study my diseases, and I am paying them for their time. In short I have been abused by doctors and I have nothing to show for it. I have had blood lost in a hospital, and a radiologist misread my scans, and I have been insulted by doctors. Most of them just want to get you out of their hair and go on to the next patient. You are a rare exception to the norm, and I praise you for that...Pete > I also wonder why you need a second PVP. Probably the first was not > aggressive enough, or you might have developed a bladder neck [quoted text clipped - 68 lines] > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com How could you learn if you have bladder neck stricture? Can it be detected with a CTSCAN or other imagig? > Thank you Dr. Sancha for your description of the alpha blockers which was > excellent. Please allow me to further explain what I was trying to get at. [quoted text clipped - 122 lines] >>Fernando Gómez Sancha >>http://drgomezsancha2.blogspot.com jc...why are you posting this to me (buried in this thread). I suggest you repost it as a new post. I am not a doctor, but the I believe the best way of observing anything is by actual observation by endoscopy (ie EGD, colonoscopy, bronchoscopy, cystoscopy, etc). In the case of the bladder neck it would be a cystoscopy. I am not qualified to comment on whether various imaging would pick up a bladder neck stricture. Dr. Sancha could answer that...Pete > How could you learn if you have bladder neck stricture? Can it be > detected with a CTSCAN or other imagig? A flexible cystoscopy will show if there is a stricture. It is difficult to see with imaging techniques, even in a urethrogram. Fernando Gómez Sancha http://drgomezsancha2.blogspot.com Pete, There are different kinds and subtypes of alpha receptors in blood vessels of different parts of the body, that is what causes selective vasodilatation in certain areas, as the nose, but not in other areas, as the prostate. There is no vasodilatation in prostatic vessels. and thus, the effect in the prostate is just to relax prostatic smooth muscle fibres. This vegetative nervous system works at an inconscious level, we cannot influence it. It helps the body to perform automatic functions, as the digestion of food, thermorregulation, and it is extremely complex (with this abundance of receptors in different parts of the body). A nice example of how the vegetative system has evolved, imagine you are in the jungle, a lion roars behind your back, this triggers a vegetative response. Norepinephrine is released from the adrenal glands, and this causes: pupil dilatation (it would allow to see the lion better), tachycardia (it prepares you for running), increased respiratory frequency, the blood is diverted from the gastrointestinal tract to the muscles, etc... So it is not so simple as "if it causes vasodilation of the vessels in my nose, it must also do the same in the prostate. Merry christmas to all, Fernando http://drgomezsancha2.blogspot.com Thank you Dr. Sancha...The main reason I asked was that Hytrin and Cardura used to be prescribed a lot for hypertension in the older days (and probably still are). I realize flomax is more targeted and not approved by the FDA for high bp. But all three plugged my nose up immediately and I kind of figured the hytrin and cardura were dilating a whole lot of blood vessels (since they were prescribed for hypertension), so maybe they would be dilating some vessels in the prostate also. I have studied a little about the autonomic nervous system, and it's two main subparts, the sympathetic nervous system and the parasympathetic nervous system, but I certainly appreciate you taking the time describing the vegetative nervous system. I really wish you were my doctor and I truly enjoy reading your informative responses. You have an excellent author style - the way you explain things fully and in a meaningful way. Merry Christmas to you and your family also. The politicians in the U.S. are banning the word "Merry Christmas" this year since the phrase "happy holidays" is more politically correct, due to the damn protesters. It's difficult to understand where the world is going these days. Best wishes...Pete > Pete, > [quoted text clipped - 24 lines] > Fernando > http://drgomezsancha2.blogspot.com Snipped. Merry Christmas to you and your family also. > The politicians in the U.S. are banning the word "Merry Christmas" this > year since the phrase "happy holidays" is more politically correct, due to > the damn protesters. It's difficult to understand where the world is > going these days. > > Best wishes...Pete Please accept with no obligation, implied or implicit, my best wishes for an environmentally conscious, socially responsible, low stress, non-addictive, gender neutral celebration of the winter solstice holiday, practised within the most enjoyable traditions of the religious persuasion of your choice, or secular practices of your choice, with respect for the religious/secular persuasions and/or traditions of others, or their choice not to practice religious or secular traditions at all...and a fiscally successful, personally fulfilling, and medically uncomplicated recognition of the onset of the generally accepted calendar year 2006, but not without due respect for the calendars of choice of other cultures whose contributions to society have helped make Britain great (not to imply that Britain is necessarily greater than any other country or area of choice, and without regard to the race, creed, colour, age, physical ability, religious faith, or sexual orientation of the wisher). This wish is limited to the customary and usual good tidings for a period of one year, or until the issuance of a subsequent holiday greeting, whichever comes first. "Holiday" is not intended to, nor shall it be considered, limited to the usual Judeo-Christian celebrations or observances, or to such activities of any organised or ad hoc religious community, group, individual, or belief (or lack thereof). Note: By accepting this greeting, you are accepting these terms. This greeting is subject to clarification or withdrawal, and is revocable at the sole discretion of the wisher at any time, for any reason or for no reason at all. This greeting is freely transferable with no alteration to the original greeting. This greeting implies no promise by the wisher to actually implement any of the wishes for the wisher her/himself or others, or responsibility for the consequences which may arise from the implementation or non-implementation of the same. This greeting is void where prohibited by law. No electrons were harmed during the making or transmission of this message. No guarantee is given or implied that this message is virus free. Protecting your computer from infections and attacks is not my responsibility. No copyright is claimed for the content of this message. This message is for the recipient only. Anyone else reading this will be killed. I think that about covers it. ;-) Derek. PS I am also unsure about wishing you a Happy New Year as other religons have different calendars from us. "10-4 Good Buddy and if you're not PC, there's no such thing and wouldn't that be a shame! Let's hope all of us BPHers have a calm, serene and free flowing 2006! Thank you for taking the time to write such an extensive response. I certainly do not condemn my doctor on the first PVP. He has an outstanding reputation in the community and is highly regarded as one of the best. I failed to ask him how many PVPs he had done so that is my fault. Anyway, maybe I will get to the bottom of it soon. Thanks. >I also wonder why you need a second PVP. Probably the first was not >aggressive enough, or you might have developed a bladder neck [quoted text clipped - 67 lines] >Fernando Gómez Sancha >http://drgomezsancha2.blogspot.com Dr. Lin did not do my first PVP which was done in 2/05 and yes, it failed miserably. It is as if I had not had the procedure. Thanks for your input. Will keep you posted. >> I am scheduled for my second PVP next week with Dr. Lin, who >> unbelievably responds himself to all e-mails. When I had my PVP in [quoted text clipped - 40 lines] > >Also (for Dr. Sancha), if you read this please comment on it. Thanks...Pete Pete, I am extrememly happy to report on my second PVP yesterday. As you know from previous post, this one was performed by Dr. Lin. I will try to respond to you and Dr. Sanchez in this post. Dr. Lin said there was not enough tissue removed on the first PVP plus there was some bladder neck problems in addition. All I can relate to you is my experience in both PVP's. The first was performed in another city by a very reputable URO in Jax, FL. I had a catheter for five days with a lot of bleeding. Could not go very well once the catheter was removed and as time progressed, I could not really tell I had a PVP done because I was in the same shape with urinary retention as I was before the PVP. It is only day two of my second PVP. I have absolutely zero pain. There was only a small amount of blood yesterday and none today and my flow is so strong, I actually have to back down on it because of the pressure. I had a catheter for five hours and was released from the hospital the same day. The only problem I have encountered is burning when I urinate and that is standard. Lots of water helps a lot. I am on Cipro for 8 days as a precaution and Dr. Lin said if I had any problems to call him anytime. I'm sure it is as Dr. Sanchez said, only the problem folks air the complaints but I am not really airing any complaints. I am simply stating the difference in the two procedures and the second one could have not gone any better; the first one could not have gone any worse. Dr. Lin is the fine URO that everyone on the group has stated so there is really nothing more I could add about him. I will say the Flagler Hospital in St. Augustine is one of the finest hospitals I have ever been in. When I was in Jax, FL for my first PVP, you were in a large room with curtains around everyone and everybody knew what the other was having done. At Flagler, they put you in a private room with TV and the whole bit and you stay there once you check in and you are returned to that same room once surgery is completed. Your family gets to wait in that room. The nursing staff was wonderful. I had one nurse yesterday morning stating she had reviewed all the meds I was taking prior to coming back and she hoped it was alright but she said a special prayer for me on the way back. She said she risks her job everytime she does this but she does it anyway. What a terrific nurse! Will keep you posted on my progress. >> I am scheduled for my second PVP next week with Dr. Lin, who >> unbelievably responds himself to all e-mails. When I had my PVP in [quoted text clipped - 40 lines] > >Also (for Dr. Sancha), if you read this please comment on it. Thanks...Pete Buford, so glad to hear your successful story finally after suffering 10 mos post your 1st pvp done by a REPUTABLE uro. Thank you your sharing for those future pvp candidates. Welcome to join the happy pvp campers. Burning for 2 to 3 weeks is normal. You might see tiny blood again in week two for couple days, which is normal too. Happy Happy New Year. >...extrememly happy to report on my second PVP yesterday. >... there was not enough tissue removed on the first PVP The first was [quoted text clipped - 3 lines] >had a PVP done >It is only day two of my second PVP. ... absolutely zero pain. .. my flow is so strong, . ... a catheter for five hours and was released from the hospital the same day. ... burning when I urinate and that is standard. > the second one could have not gone any better; >the first one could not have gone any worse. >Dr. Lin is the fine URO that everyone on the group has stated so there is really nothing more I could add >about him. >I will say the Flagler Hospital in St. Augustine is one of the finest >hospitals I have ever been in. When I was in Jax, FL for my first PVP, you > Buford, so glad to hear your successful story finally after > suffering 10 mos post your 1st pvp done by a REPUTABLE uro. Thank [quoted text clipped - 23 lines] >> hospitals I have ever been in. When I was in Jax, FL for my first >> PVP, you Buford...I did not receive your post above regarding your second PVP (that Pat responded to). It may be a problem with my ISP. Did anyone else get it besides Pat. Also could you resend it again in a reply to this (copy/paste it, or whatever). Thanks...Pete >> Buford, so glad to hear your successful story finally after >> suffering 10 mos post your 1st pvp done by a REPUTABLE uro. Thank [quoted text clipped - 28 lines] > anyone else get it besides Pat. Also could you resend it again in a > reply to this (copy/paste it, or whatever). Thanks...Pete BTW Buford...did you ask Dr. Lin about what you were asking in your original post in this thread, about stopping the flomax prior to the PVP, and your statement [["It would just seem that you would stop taking it so they could see the result when not on Flomax"]]. No one ever answered it (not even Dr. Sancha - he may have missed it when he was responding to all the stuff I wrote). I would be curious to what Dr. Lin said if you remembered to ask him. Thanks...Pete To be perfectly honest, I forgot to ask. I was so nervous about everything anyway, I just didn't think about it. Sorry about that. Buford >>> Buford, so glad to hear your successful story finally after >>> suffering 10 mos post your 1st pvp done by a REPUTABLE uro. Thank [quoted text clipped - 9 lines] >wrote). I would be curious to what Dr. Lin said if you remembered to ask >him. Thanks...Pete Pete, There is not much of a point in suspending flomax one you have decided to go to surgery again. Obviously the result of the first operation was bad. If you suspend it, the flow is probably going to deteriorate around 2-4 mL/second, and the symptoms would be worse. If I planned to operate someone for a second time because of a bad result and he was suffering from bothersome symptoms, I would recommend taking flowmax until the day of surgery. Happy new year, Fernando Gómez Sancha http://drgomezal Rha2.blogspot.com Thanks Dr. Sancha...would it make any difference if it were first time surgery versus second time surgery, and is it possible that the effect of the flomax on the muscle tissue could bias the surgeons aggressiveness (i.e. the amount of tissue that he vaporizes/removes). Happy new year to you also, and to everyone else...Pete > Pete, > [quoted text clipped - 11 lines] > Fernando Gómez Sancha > http://drgomezal Rha2.blogspot.com See if you get it this time. I have copied and pasted below: I am not too good with this anyway. Pete, I am extrememly happy to report on my second PVP yesterday. As you know from previous post, this one was performed by Dr. Lin. I will try to respond to you and Dr. Sanchez in this post. Dr. Lin said there was not enough tissue removed on the first PVP plus there was some bladder neck problems in addition. All I can relate to you is my experience in both PVP's. The first was performed in another city by a very reputable URO in Jax, FL. I had a catheter for five days with a lot of bleeding. Could not go very well once the catheter was removed and as time progressed, I could not really tell I had a PVP done because I was in the same shape with urinary retention as I was before the PVP. It is only day two of my second PVP. I have absolutely zero pain. There was only a small amount of blood yesterday and none today and my flow is so strong, I actually have to back down on it because of the pressure. I had a catheter for five hours and was released from the hospital the same day. The only problem I have encountered is burning when I urinate and that is standard. Lots of water helps a lot. I am on Cipro for 8 days as a precaution and Dr. Lin said if I had any problems to call him anytime. I'm sure it is as Dr. Sanchez said, only the problem folks air the complaints but I am not really airing any complaints. I am simply stating the difference in the two procedures and the second one could have not gone any better; the first one could not have gone any worse. Dr. Lin is the fine URO that everyone on the group has stated so there is really nothing more I could add about him. I will say the Flagler Hospital in St. Augustine is one of the finest hospitals I have ever been in. When I was in Jax, FL for my first PVP, you were in a large room with curtains around everyone and everybody knew what the other was having done. At Flagler, they put you in a private room with TV and the whole bit and you stay there once you check in and you are returned to that same room once surgery is completed. Your family gets to wait in that room. The nursing staff was wonderful. I had one nurse yesterday morning stating she had reviewed all the meds I was taking prior to coming back and she hoped it was alright but she said a special prayer for me on the way back. She said she risks her job everytime she does this but she does it anyway. What a terrific nurse! Will keep you posted on my progress. >> Buford, so glad to hear your successful story finally after >> suffering 10 mos post your 1st pvp done by a REPUTABLE uro. Thank [quoted text clipped - 6 lines] >besides Pat. Also could you resend it again in a reply to this (copy/paste >it, or whatever). Thanks...Pete > See if you get it this time. I have copied and pasted below: I am not > too good with this anyway. <snip> Got it Buford...thanks. Glad your procedure went so well. Sometimes the news servers that ISP's use don't accept all the messages (eg, instead of downloading 300 headers it downloads 297 - it's complicated - could be several reasons, da da da da). But usually if it rejects one it will keep rejecting that same address- oh well. Take care and keep us informed...Pete Day three and things are not going as well. Flow has diminished and had to start taking Flomax to get the flow going. Hope it is temporary because this is how it all started on my first PVP. Maybe my body is just not right for the PVPs? Will keep you posted. Buford >> See if you get it this time. I have copied and pasted below: I am not >> too good with this anyway. [quoted text clipped - 6 lines] >several reasons, da da da da). But usually if it rejects one it will keep >rejecting that same address- oh well. Take care and keep us informed...Pete > Day three and things are not going as well. Flow has diminished and > had to start taking Flomax to get the flow going. Hope it is > temporary because this is how it all started on my first PVP. Maybe > my body is just not right for the PVPs? Will keep you posted. Buford...God, I hated to hear that. My heart is with you for sure. I don't know what to say - maybe some kind of inflammatory response from the surgery. Please ask Dr. Lin about that. I wonder if it could have anything to do with taking the catheter out to soon, but you said you were voiding real good on the second day and the third day the problem started. I am surprised the flomax works so good for you guys, so apparently even if it may be inflammation or surgical trama, the muscle relaxation from the flomax helps. If it doesn't get better by after New Year's, e-mail Dr. Lin and see what he says. I wish you the very best and please keep us informed. And maybe start a new thread...Pete From my experience, there is always one question I would ask that I did not ask: "How many PVP's have you done?" I think you can still have a reputable URO but also have one that has not done many PVP's. As I think back on it, the first URO really tried to talk me in to a TUNA but I kept insisting on the PVP because of all I had read on it. Take it from my experience, ASK THE QUESTION. Happy New Year. Buford >Buford, so glad to hear your successful story finally after suffering 10 mos >post your 1st pvp done by a REPUTABLE uro. Thank you your sharing for those [quoted text clipped - 15 lines] >>I will say the Flagler Hospital in St. Augustine is one of the finest >>hospitals I have ever been in. When I was in Jax, FL for my first PVP, you I asked that question and he had done over 50 PVP but I still let him talk me into trying TUMT first. He had done over 500 TUMT and said the success rate has been over 80%. I don't know where I fall. Maybe 81% because there definitely was improvement but not as much as I hoped. Or it may be my bladder. I will find out when I go back again. He has now done over 100 PVP and said the results on all have been excellent. It goes back to a discussion we were having on another thread. I now think it always gets back to what the financial benefit to the group might be. I really now suspect that they do the standard procedure and if is not adequate they do it again. They get paid the same flat rate for each time. It is a problem with our method of how the insurance companies pay the bill. The same rate for a one hour procedure as for a three hour one but they will get paid three times for three individual, one hour, procedures. Still better than not being covered at all. > From my experience, there is always one question I would ask that I did not > ask: "How many PVP's have you done?" I think you can still have a reputable [quoted text clipped - 26 lines] > >>I will say the Flagler Hospital in St. Augustine is one of the finest > >>hospitals I have ever been in. When I was in Jax, FL for my first PVP, you |
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