AUR Options--Continued from Previous Post

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Michael - 07 Aug 2007 21:47 GMT

I was the OP in the other recent AUR Thread. Today I saw the uro
(actually his nurse assistant did most of the work). I am a new
patient of this uro with a long history of BPH. Flomax has been
prescribed but I rarely took it. I was getting by until my AUR
episode of 10 days ago. Catheter inserted, left in for 10 days.

Short version of today's uro appointment. Filled out detailed history
citing BPH, med-averse attitude etc. The nurse injected 240 ccs of
fluid into me, removed the catheter and said if I did not pass close
to 240 out they'd have to reinsert the catheter pending additional
tests. I was only able to pass 179. At first she said the catheter
must go back in until the next tests (cystoscopy and something nuclear
test) could be scheduled. I asked her if there was any interim way I
could take my Flomax and/or other meds (I suggested alfluzosin)
without the catheter to see if that helped.

At that point the uro made his appearance (first time) and said take
Flomax for two days (Tuesday, Wednesday) at which point I come back in
on Thursday morning for a cytoscope and a retest of the 240 in/240
out. He said if I don't do better than 179 out (about 5 minutes later)
the catheter goes back in. He was dismissive of alfluzosin and said
Proscar takes 6 months to work. I said but if the Flomax helps--I
have never taken it every day, 1X per week usually--why would the
catheter have to go back in on Thursday.

So......I have urinated without it since today's appointment of 2
hours ago. Slow but sure trickle as opposed to the total shutdown on
the AUR attack day.

Thoughts? Why not give the Flomax more than 2 days to kick in before
next test on Thursday? Why not give Proscar a chance and why so
dismissive of alfuzosin which I have read so many good things about?
If he insists on reinserting the cath pending the nuclear whatever
test may I refuse/seek a second opinion for treatment options? Am I
putting myself at tangible ongoing risk of AUR repeat by not having
the catheter? Believe me I do not want to go through AUR again but it
seems I am being rushed before less "quality of life" diminishing
approaches (i.e. Flomax, Proscar, alfuzosin)
are attempted without the catherization pending further analysis

Ongoing thanks..

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Pete - 08 Aug 2007 00:55 GMT

> I was the OP in the other recent AUR Thread. Today I saw the uro
> (actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 30 lines]
> If he insists on reinserting the cath pending the nuclear whatever
> test may I refuse/seek a second opinion for treatment options?

Michael...Of course you can always refuse treatment, or seek a second
opinion. I think you should have a cystoscopy, but if you go to another uro
it will just be more time lost in scheduling for the office visit and then
cystoscopy, and you are suffering. I wish you the very best of luck and
hope you can find relief...Pete

Am I

> putting myself at tangible ongoing risk of AUR repeat by not having
> the catheter? Believe me I do not want to go through AUR again but it
[quoted text clipped - 3 lines]
>
> Ongoing thanks..

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Rich256 - 08 Aug 2007 00:55 GMT

> I was the OP in the other recent AUR Thread. Today I saw the uro
> (actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 37 lines]
>
> Ongoing thanks..

I still recommend a second opinion.

I remember several here said they had PVP by a Dr. Malloy in
Philadelphia.

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Ed - 08 Aug 2007 01:09 GMT

>I was the OP in the other recent AUR Thread. Today I saw the uro
>(actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 35 lines]
>approaches (i.e. Flomax, Proscar, alfuzosin)
>are attempted without the catherization pending further analysis

Well, you can't go on with this threat of acute retention. If you end
up with too much urine in the bladder you risk permanent bladder
damage. Can happen if you become blocked up and emerg takes too long
to get you unplugged.

So that means meds or surgery. Or struggle on, but learn intermittent
self-cathetirization. (I would learn ISC regardless, just in case.)

Most of us don't like drugs, but you might want to give Flomax a try.
Worked pretty good for me. It takes a couple of days to become
effective. Proscar or Avodart take months to work and usually don't
help flow that much, but do slow (or stop) further prostate growth.
And that is good, isn't it?

So if Flomax works, you might want to get on Proscar or Avodart and
try the meds solution. My uro says to try meds first before surgery.
And if the side effects are not too troublesome, then you have bought
yourself a couple years, maybe more. Otherwise, you probably need
surgery - TURP or PVP.

Good luck and let us know what happens.

Ed

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Michael - 10 Aug 2007 07:00 GMT

> >I was the OP in the other recent AUR Thread. Today I saw the uro
> >(actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 59 lines]
>
> Ed

Rich, Pete, Ed:

I canceled the second appointment with this stick the catheter back in
uro and have set up two second opinion appointments with other uros.

The irony (to me): on the one hand the guy I saw three days ago
clearly indicated I am an ongoing imminent risk of a second AUR
episode, especially if I do not walk around (again) with a catheter
until he figures out what to do next. On the other hand the
two other uro with whom I will be having second opinions refuse to
schedule me for the near future--or I should say their receptionists
refuse I can't even get the doctor(s) to call me--because they feel I
am neither an emergency nor at imminent risk

After two days of total relief--no catheter plus a bladder that
enjoyed the ten days of relaxed catheterization--the third day (today)
I'm back to where I had been for 7 years before the recent AUR attack:
BPH, difficulty urinating (but passing something) and basically
comfortable.

My gameplan as imperfect as it is is to try to make it to first
scheduled second opinion appointment (August 30th) without another
episode, take my Flomax and then hope one of the two other uros agree
that if surgery is a must then PVP for sure.

Gratitude does not begin to express what I feel for the thoughtful
feedback you have each provided to me.

Hope you are all well.I'll try to find this Philly area doc who does
PVP.
#1

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Rich256 - 10 Aug 2007 14:45 GMT

> > >I was the OP in the other recent AUR Thread. Today I saw the uro
> > >(actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 93 lines]
>
> - Show quoted text -

Good luck. Stick with the Flomax. That stuff does work but with it I
had extremely dizzy spells.

I will assume the new UROs do PVP. There is the experience
requirement too. As someone else here said it is probably better to
get TURP from an expeienced doctor than PVP from an inexperienced.
Dr. Sancha recommended finding one that had performed at least 100
PVP. When I first went to the PVP doctor he had done only about 50.
He talked me into trying TUMT first. No help at all so a year later I
went for PVP. By that time he had done over 200.

I don't remember you saying what your age is. That can make some
difference too. I am a pretty old guy so just to be able to sleep an
hour or two more at a time was the prime requirement. With either
TURP or PVP you can expect retro. But when it comes to the
alternative of having to wear a catheter I would go pick the retro!!

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Michael - 12 Aug 2007 16:20 GMT

> > > >I was the OP in the other recent AUR Thread. Today I saw the uro
> > > >(actually his nurse assistant did most of the work). I am a new
[quoted text clipped - 110 lines]
> TURP or PVP you can expect retro. But when it comes to the
> alternative of having to wear a catheter I would go pick the retro!!

Update, Chapter 222:

After 2 days of walking around without a catheter and trying to be
scrupulous with the Flomax, by Day 3 I was starting to shut down
again. By Day 4 (Saturday) my second episode of AUR had struck (within
2 weeks). Off to the ER catheter back in...that's the bad news of
course.

Good news (of sorts): on Monday I have an appointment with the Dr.
Terrance Malloy (Pennsylvania Hospital in Philly) about whom Rich
had such favorable things to say. The (other) uro who wanted to stick
the catheter back in while he conducted a series of tests
(beginning with the
cystoscopy) and who warned me I was at risk for another shutdown--he
turned out to be correct-- may or may not be experienced at PVP (I did
not stay with him long enough to find out) but because of the lead to
Dr. Malloy in this Group (I did my own research too) I'm seeing Malloy
Monday and doing whatever he wants.

PS--I am still furious at the several less credentialled docs who I
tried to get an appointment with for a "second opinion" telling them I
was at risk but who refused to schedule me for weeks. I say the docs
but more accurately it was their idiot schedulers. As soon as Malloy's
Nurse heard the situation on the phone (the day BEFORE my second AUR
attack) she scheduled me for 3 days later.

I asked all the other docs' "schedulers" to please have the Doctors
themselves call me back for prioritization. None did. Brutal.

Again thanks for all the feedback and Rich thanks for mentioning Dr.
Malloy in this Thread.

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