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Medical Forum / Diseases and Disorders / Prostate BPH / April 2006Trouble voiding (sometimes)
1.) I am writing using a pseudonym so no physician will feel legally committed to any answer they provide here for free. I know for a medically responsible opinion I need to see a urologist but I don't want to pay $60 to a family practice doctor just to see if I need to see a urologist. I do have a friend that's a surgeon who could refer me without my needing to see an FP but I don't like to ask him too many questions. This is because, despite the fact he's retired, he still pays to keep his license to practice and be allowed to attend medical conferences. 2. Problem: I told my nephrologist I sometimes need to stand to urinate to make sure I void completely. Telling him that I have to stand to void thoroughly did not seem to be a problem to him. 3. My concern: I usually sit on the commode because I am tall and very myopic (near-sighted for non-med people who may not be familiar with myopia). My wife insists I sit even if I only plan to urinate because I miss the bowl so often. Well, I find when I sit, sometimes, but not always, I need to stand in order to void completely. Sitting I sometimes feel like I can't get it all out. 4. The reason I am asking here is because a nephrologist is not a urologist so I don't know if he has any knowledge about the urinary system beyond the kidneys. That is why I am writing, to see if I need to see a urologist. I also consulted a resident as a patient at the local general hospital and he did not think there was a problem either, but I don't know if he was just giving me his opinion or the opinion of a specialty oriented attending physician. I suspect if there was any question he would have had the attending make a referral to a different clinic but I am not 100% sure so I thought I should seek a third opinion. Thanks for a clue. Jan > 1.) I am writing using a pseudonym so no physician will feel legally > committed to any answer they provide here for free. No problem here. Only doctor that we have seen posting here is Dr. Sancha, a wonderfully helpful one from Spain. His Blog: http://drgomezsancha2.blogspot.com My first question is, have you been told you have an enlarged prostate (bph)? If so this is the group to talk to. During your physicals has the doctor performed Digital Rectal Examinations? http://www.webmd.com/hw/colorectal_cancer/hw4404.asp All here suffer from bph to some degree. If you believe you do have enlarged prostate, my one recommendation is to search out a Urologist who performs PVP (Green Light Laser). The first Urologist I went to did not. I then discovered this group and their discussions prompted me to search for a different Urologist. The options being TURP: http://hon.nucleusinc.com/generateexhibit.php?ID=2567 or Green Light Laser (equipment manufactured by Laserscope): http://www.laserscope.com http://www.laserscope.com/surgical/consumers/enlargedprostate.html Check Dr. Sancha's blog for more discussion of PVP. As just posted in a another thread, Laserscope has a list of doctors but it is not complete. Try to find one that has performed perhaps 100 procedures. > 1.) I am writing using a pseudonym so no physician will feel legally > committed to any answer they provide here for free. I know for a [quoted text clipped - 3 lines] > me without my needing to see an FP but I don't like to ask him too > many questions. Boy I wish I had a friend that was a doctor (lawyer is good also). Boy would I drive them silly crazy :-):-) . This is because, despite the fact he's retired, he > still pays to keep his license to practice and be allowed to attend > medical conferences. [quoted text clipped - 24 lines] > > Jan Jan...I am very curious as to why you are seeing a nephrologist (I have heard that nephrologists refer to urologists as friggen plumbers - lol). Please explain the relationship if there is one. Rich's comments and advice were good for the BPH stuff (if you have BPH)...Pete During a two month stay in the hospital due to a systemic infection (necrotizing fasciitis) where a few of my major organs shut down, including my kidneys, I had to have dialysis for a while until my kidney function returned. That is why I see a nephrologist, just an annual checkup to make sure my kidney function continues to improve. Lucky for me it has been improving some every year. I am in my mid-fifties now in case this info is relevant to my earlier question. Thanks. Jan > During a two month stay in the hospital due to a systemic infection > (necrotizing fasciitis) where a few of my major organs shut down, [quoted text clipped - 7 lines] > > Jan OK, you are about the age where bph can start being a problem. As part of an annual physical you should be getting a PSA test too (to check for prostate cancer). There was a discussion here just a while ago about standing or sitting. Only reason I probably go for sitting is that it often takes so damn long to get emptied out:-). Do you live in or near a large city. Most will have hospitals and Urologists that perform PVP. Thanks Rich. I am about due for a clinic visit so I will inquire about it. Being self-employed though and unable to afford health insurance, and now working just barely enough that the sliding scale will push me into the full payment area I probably won't even be able to afford medical care anymore, so it'll be up to me to start driving again so I can get a "real" job with a company that pays benefits (unlikely at my age) and be a risk to other motorists that haven't had to worry about my driving since the late 1980's when I realized I couldn't see well enough to not have a fender bender about 4x per year. Or I could rob a bank and if I get away with it I'll have enough money for medical care and if I don't I'll get free medical care in prison. Or I could move to Canada the way Mexicans move to the U.S. to get a better lifestyle only I would be looking for adequate medical care. Or I could just accept the fact that many people don't make it to their mid-fifties so if I kick the bucket it was probably just my time to go. Jan > Or I could move to Canada the way Mexicans move to the U.S. to get a > better lifestyle only I would be looking for adequate medical care. Or > I could just accept the fact that many people don't make it to their > mid-fifties so if I kick the bucket it was probably just my time to go. If your problem is only bph and you are still able to pee, the fortunate thing is that treatment can be put off for a long time. There are medications that allow putting off treatment. Many swear by the herb Saw Palmetto. Recent studies say it is of no help but many say it helps them. You still have a way to go before you can get Medicare. It will cover most everything. I am not certain if PVP is offered by Canadian Medicine. Perhaps it is being looked at by some of the Socialized medicine countries because the cost is getting close to that of TURP. Treatment in other countries can be a lot less expensive because the doctors don't have to pay for the outrageous malpractice insurance. Of course you couldn't sue them if they made a mistake either. Something I read a few days ago shows that some doctors have to pay over $200,000 a year for insurance. That would be almost $1000 an office day. >> Or I could move to Canada the way Mexicans move to the U.S. to get a >> better lifestyle only I would be looking for adequate medical care. [quoted text clipped - 16 lines] > doctors don't have to pay for the outrageous malpractice insurance. Of > course you couldn't sue them if they made a mistake either. You can't sue them in the U.S. either Rich, unless they operate on the wrong side of your body or leave a scalpel in you :-) . > Something I read a few days ago shows that some doctors have to pay > over $200,000 a year for insurance. That would be almost $1000 an > office day. >>> Or I could move to Canada the way Mexicans move to the U.S. to get a >>> better lifestyle only I would be looking for adequate medical care. [quoted text clipped - 18 lines] > You can't sue them in the U.S. either Rich, unless they operate on the wrong > side of your body or leave a scalpel in you :-) . Naw, you can sue them if they look at you the wrong way. I got kind of upset when talking to a lawyer after my 92 year old father died from Alzheimer's and a fall. He asked if there was anything the doctors did that might have caused his death!! He was handling the estate but had a buddy all set to take on a doctor or hospital. Some lawyers specialize in suing doctors that practice in those medical fields such as Obstetrics which is inherently risky medical procedure to both the mother and the child. John Edwards became a multi-millionaire handling malpractice cases. A while ago I saw an interview of a Female Lawyer on TV. She was complaining that her doctor dropped her simply because she was a lawyer. Then then interviewed him. He said on one particular day she was in court in the morning calling him a quack and that same afternoon she was upset because he was late for her appointment. He said he simply could not afford to deliver her child. And it is not just the cost of the insurance, it is also the time lost in court. Gotta defend the doctors a bit. How about going to your mechanic and telling him you are going to pay him for 10 minutes of his time to determine what it wrong with your car? If he makes a mistake you are going to sue him for everything he has. If that was the case I am certain his rates would go way up. When we were young there wasn't a lot they could really do about most diseases. They could treat broken bones and the like. But before penicillin and other wonder drugs it was mostly just luck if you survived some diseases like pneumonia. Even removal of appendix was a pretty hazardous operation. >>>> Or I could move to Canada the way Mexicans move to the U.S. to get >>>> a better lifestyle only I would be looking for adequate medical [quoted text clipped - 20 lines] > > Naw, you can sue them if they look at you the wrong way. I'll stand on my statement Rich. You can sue him for looking at you the wrong way but you will lose. I talked to a malpractice lawyer once and he said it would cost him $25,000 just to open a case in Baltimore which is the corporate boss location. Unless you can clearly show a mistake (like I mentioned) and get another doctor to testify against another doctor (which is next to impossible), you will not be succesful in suing a doctor (and certainly not for a pvp that wasn't performed properly - try proving it - no way). It is difficult to prove pain and suffering also (two big words they use). I don't want to argue about this. Have a nice day...Pete I got kind > of upset when talking to a lawyer after my 92 year old father died > from Alzheimer's and a fall. He asked if there was anything the [quoted text clipped - 28 lines] > survived some diseases like pneumonia. Even removal of appendix was a > pretty hazardous operation. > I'll stand on my statement Rich. You can sue him for looking at you the > wrong way but you will lose. I talked to a malpractice lawyer once and he [quoted text clipped - 5 lines] > way). It is difficult to prove pain and suffering also (two big words they > use). I don't want to argue about this. Have a nice day...Pete No argument Pete. Just the fact that some doctors have to charge an extra $200,000 or more each year to pay their malpractice insurance. Doctors in other countries can charge that much less. >> I'll stand on my statement Rich. You can sue him for looking at you >> the wrong way but you will lose. I talked to a malpractice lawyer [quoted text clipped - 10 lines] > extra $200,000 or more each year to pay their malpractice insurance. > Doctors in other countries can charge that much less. I agree with you Rich. We are usually on the same page together. It is a rotten shame what a viscious game it has become, and us patients get stuck in the middle. I hate lawyers worse than doctors, but unfortunately we need both at times. Like I said I wish I knew a good lawyer :-) ...Pete Read the newspapers to find a good lawyer. Go to the law library and read apellate cases and see who won. There are lots of ways to find a good lawyer and lots of ways to help a mediocre lawyer win but NEVER go to a TV lawyer for a medical case because they usually won't handle the case themselves if it's anything serious. They are in cahootz with the insurance companies and will settle for more than the insurance companies would pay you, but for a serious case a TV lawyer will refer it out to a GOOD lawyer in exchange for 40% of the verdict or settlement. So the TV lawyer gets 40% after expensives and your lawyer gets 40%, so what does that leave you. It leaves you more than you'd have gotten if the TV lawyer didn't refer it out, but less than you'd have gotten if you let a good TRIAL lawyer with a reputation for winning handle it from beginning to end. The secret of having a good trial lawyer is one who can do medical research as well as legal research. The better he or she understands your case the better job they can do hiring expert witnesses, and the better experts they hire the more likely you'll get a great settlement or verdict. The doctor's hope lies in treating the patient like a human rather than as a lab animal. When we get treated like lab animals we have no respect for the doctor and that's the number one reason doctor's get sued so much. An M.D. after their name just means they're smarter than most and they worked their a.ses off during their residencies. They can't even write prescriptions for themselves without violating their code of medical ethics. Sucks, huh? I thoughtI'd become an ophthalmologist to get all the legal cocaine I could snort and then I found that out! What a bummer! ;-`) > Read the newspapers to find a good lawyer. Go to the law library and > read apellate cases and see who won. There are lots of ways to find a [quoted text clipped - 25 lines] > the legal cocaine I could snort and then I found that out! What a > bummer! ;-`) Thanks Jan...but I think you misunderstood me. I don't go aroung trying to sue doctors. I just meant it would be nice to know a lawyer for stuff in general (not malpractice per se). But I appreciate your comments. And I am a serious animal lover, and hate research on animals although I guess it has to be (but with restrictions I hope)...Pete >> Read the newspapers to find a good lawyer. Go to the law library and >> read apellate cases and see who won. There are lots of ways to find a [quoted text clipped - 27 lines] > > Thanks Jan...but I think you misunderstood me. I don't go aroung Damn it, that was supposed to be "around" :-):-) > trying to sue doctors. I just meant it would be nice to know a > lawyer for stuff in general (not malpractice per se). But I > appreciate your comments. And I am a serious animal lover, and hate > research on animals although I guess it has to be (but with > restrictions I hope)...Pete >>And I am a serious animal lover, and hate >> research on animals although I guess it has to be (but with >> restrictions I hope)...Pete Ohh, you would not like what I did to work my way through school!!! Perhaps I mentioned it before. I worked for a French Doctor in the Physiology Department assisting in experiments putting dogs on artificial hearts and lungs so surgery could be done on the heart. These were all stray dogs that were going to be put away anyway. They didn't suffer. Without that type of research, open heart surgery never would have come into being. I doubt that any heart by-pass patient will say animal research is not necessary. Yeah, don't do research to see how much pain they can withstand!! We got to know our way around the heart. Most of our effort was in determining what drugs could be used. Lots of math calculating probability. With my slight experience with that muscle and seeing how complex it is makes me admire anyone who can get through medical school let along become a real expert in any field. And at the same time I realize that they can’t be 100% correct on many problems. Many would require extensive and expensive testing. Unfortunately the world can’t afford that type of treatment for everyone. The alternative, unless the patient is terribly rich, is to treat for the most likely cause and hope for the best. Unfortunately that is where the Lawyers come in. The patient can’t afford all those tests and no insurance is willing to pay, so the doctor made what he though was the correct decision but it didn’t work. But as you say you can’t always sue. A friend was incorrectly diagnosed and treated with much pain and suffering. His first doctor wanted to send him to the Mayo Clinic but the insurance refused (That doctor dropped that insurance company). Finally they relented and sent him to the Mayo Clinic. It took their doctors 10 minutes to point out a tumor (one of his previous doctors had said “I wonder what that lump is?”. My friend talked to some Lawyers but their opinion was that too many doctors had tried to treat him and they all made the same mistake. Regardless our medical costs are supporting hundreds or thousands of Malpractice insurance companies and trial lawyers. Something needs to be done and bureaucratic medicine is not correct the answer. >>> And I am a serious animal lover, and hate >>> research on animals although I guess it has to be (but with [quoted text clipped - 46 lines] > Something needs to be done and bureaucratic medicine is not correct > the answer. Agreed...I do remember you talking about the animal research before and I may have not have said anything because I didn't want to get into it (not worth searching). Based on what you said I am sure you would totally, categorically, and absolutely enjoy this movie I just saw about a pioneer in heart surgery (Alfred Blalock) at John's Hopkins and his black assistant who never went to medical school. The movie is called "Something the Lord Made" and if you haven't seen it, give it a try Rich. It's right up your alley. You will love it...Pete > During a two month stay in the hospital due to a systemic infection > (necrotizing fasciitis) where a few of my major organs shut down, [quoted text clipped - 7 lines] > > Jan Thanks Jan...boy, it sounds like you were one of the lucky ones to get that infection. It would probably be good to go see a uro, and probably one that does pvp's, just in case. Best wishes. Pete |
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