Jan 19, 2011 Update

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Subject: Dad's Upcoming Procedure
Date: Wed, 19 Jan 2011 10:59:51 -0800

Cate, Bill, & Jim,

We have more information on Dad’s upcoming procedure on January 26^th. There are two approaches to opening the urethra. One involves laser and one involves scraping. The scraping procedure is a little more invasive. Either way Dad will be out of commission for two to six weeks depending on the severity of the procedure and his healing time.

As with any medical procedure, especially on an 87 year old, there are dangers. Dad is having a kidney function test on Friday and goes in on Monday for a pre-op check. His heart has tested well, but the anemia could be a problem. His procedure will last 2 hours. We believe his doctor to be competent and thorough.

Tom and I discuss our roles here at great length. We try to relay the information we have accurately and completely. We understand the distance between us must make it very frustrating for you. It’s difficult to word this without sounding dramatic. After all, the doctor says he has been doing this procedure for five years and has performed it on men as old as one hundred. Tom and Mary will take care of Dad after the procedure. They are very good at this and Dad is very comfortable with them. But Tom also wants all of you to know that his home is open to anyone who may want to come down to be with Dad before, during or after the procedure. It may be a bit crowded at his house, but he wants you to know that everyone is welcome.

Again, it’s difficult to convey this kind of stuff through an email. Are we worried? Yeah, we are our mother’s sons. It’s genetic. Dad has never had a surgery, so we have nothing to compare this experience to. Are we confident this is the right direction? We believe so. For Dad to want to undergo a surgery to correct this problem demonstrates how much it is cutting into his quality of life.

If anyone has any questions, please feel free to call. If anyone would like to come down, Tom’s home is open.

Love you all,

John

Jan 11, 2011

Hi Everyone,

He are some notes on Dad's visit today with Dr Chang.

Dad had a visit with Dr Chang today, two days after his surgery. Prior to the appointment, last night, dad pulled out his catheter during the night because it was leaking where the tube exited his body.

Both the doctor and nurse examined the catheter and made sure that all of it was removed, and it was. The doctor asked Dad if his flow was any better and he said it was the same as before the surgery. The doctor said that it was normal and that it might be due to swelling and that it could take a couple of weeks for the swelling to go down.

Dad was told not to drive for another week, and that he shouldn't play tennis or do any dancing for about 4 more weeks - so as to give himself time to heal properly. He was told that walking is good, but only in moderation, not walking more than one mile at a time. He should also be drinking more water than normal, but he does not have to drink large quantities. Dad need to be cautious, not doing anything strenuous, and was told to avoid heavy lifting.

Dad was given three meds when he left the hospital. Vicodin for general pain from the surgery; Toviaz (4mg) for frequency of urination or bladder spasms; Pyridium (200mg) for burning when urinating. All three are to be used as needed.

I then asked the doctor about the procedure and what he should be expecting. The doctor took another 10 minutes and told dad that some patients have a full urine stream within 48 hours, but it is not uncommon for men not to have a normal stream. Dr Chang said it could take 2 -3 weeks for the stream to return to normal because of swelling, if the laser surgery was successful. BTW, Dad only had the laser portion of TURP, not the portion where they use a tool to scrape the wall of the urethra. The doctor brought in some props and drew some drawing explaining the procedure further. He mentioned that while the prostate enlargement covers a broader area than the portion they removed. In the picture below, the area that they removed the tissue with the laser is approximately from the points of the ejaculatory duct to the prostatic utricle. The doctor explained that going below that there is a greater concern for incontinence. Generally when they relieve the swelling of the upper portion it also helps the lower area, but in some cases, and not way to predict which ones, removing the swelling in the upper portion causes the lower portion to become worse.

Dad will be re-evaluated at a follow up appointment on April 25 at 11:40 am with Dr Chang. Anytime during the week before that he needs call and go into Dr Chang's office for a uroflow test. This will basically test how strong a stream he has. The flow will take about 3 hours and most can be done at home, but the office needs to know when he is coming in. Dad has an instruction sheet on the procedure at home.

If Dad is still having problems urinating at his April appointment, they will probably schedule him for a TURP where they use a cutting blade to remove the swelling around the lower portion of the prostate, typically between Prostatic utricle and Prostatic Urethra portion of the prostate. This is a trickier area to cut around, thus the a more precise tool.

Dad also needs to repeat his Kidney test in about a month, the end of February. The doctor is looking to see if his kidney function is better, the same or worse. He said it should be the same or better, just not worse.

Toviaz side effects; dry eyes, insomnia and urinary tract infections and should not drink any alcohol. Constipation, and nausea and heartburn are also common side effects. The most common issue is that you feel you have dry mouth.
Vicodin side effects; vision, dizziness, shortness of breadth and constipation problems are typical.

Pyridium side effects; headache, stomach upset and dizziness are the most common side effects.

All three also says sever allergic reaction would be a rash or shortness of breadth.

Dad has information sheets on all three medications.

Please let me know if this is not clear.

Bill