July 25, 2011 Update

Dad had asked Tom to call Dr. Chang, the urologist, for a consult on why he was peeing so much. Tom took dad today and they performed an ultrasound. There were no major revelations. Dad has some blockage of the kidneys and Dr. Chang ordered a test for that. He is also going to do a urine retention test. Have Dad drink a lot of fluids in Dr. Chang’s office and then they will measure how much Dad pee’s and the strength of the stream. That test is tomorrow. There is also some blood work being done to determine the state of his kidneys. Dad’s been doing well the last couple of months. He was scheduled to do a kidney follow-up with Dr. Nichols in August, so the timing of this is about right.

That’s it for now. Hope everyone is well,

John

May 20, 2011 Update

I'm in 100% agreement with most of what you said and 120% with the rest, including my cooking skills. :)

Thanks for a great update.

...Jim

On May 20, 2011, at 12:57 PM, "John "  wrote:

Dad played tennis this morning. He seems relaxed. He played well. He went to Grant’s baseball game last night and enjoyed seeing Grant hit the game-winning run in the bottom of the last inning. 

We have cancelled Dad’s appt with Dr. Chang. He’s happy with his prostate function and for now sees no need to have the tests Dr. Chang wanted. 

This is a risky strategy and could come back to haunt us later, however I believe that this approach is best for Dad. Who knows how long his eyesight and/or kidneys will last? Since these don’t appear to be easily treatable conditions, I agree with the approach to let him have as much fun as he is able to right now. (I know that last sentence sounds ominous. It is not meant to be. I just want to acknowledge that we are aware of the risks involved in this decision.) For now he continues to appear stronger, healthier (probably from Jim’s cooking) and has resumed his activities and that is the most encouraging sign of all. 

John

May 17, 2011 Update

We saw Trevor the PA at Dr. Nichols office. He had some interesting insights on Dad’s health issues. After describing Dad’s health status before the biopsy and his status now, he did seem to agree that the information we could have determined from the tests was not worth the procedure. His feeling is that a bone marrow biopsy is needed and the two main diseases that could be determined from that are not treatable, so why bother.

Dad’s wound is healing nicely. The HH nurse yesterday had to use the wooden end of the Q-tip to get the wicking material in. Tonight we remove the wicking material for good and see what happens. The HH nurse is scheduled for tomorrow morning and I’ll be there to see if we might be able to discontinue that service. Dad is anxious to get back to tennis and with the nurse coming M-W-F that is difficult. The PA prescribed one more week on antibiotics as insurance against another abscess.

On the anemia front, while Dad’s numbers are low, they are not catastrophic. If they do get low enough for him to have a transfusion, then a nephrologist (kidney specialist) would prescribe epoitein(?), a hormone to stimulate the bone marrow to produce more red blood cells. The PA’s feeling was that the anemia is caused by Dad’s renal insufficiency. We will monitor Dad’s Red Blood Cells and kidney functions every three months. As for future doctor visits, he has one with Dr. Chang near the end of the month. No more with Dr. Nichols (unless the wound starts acting up again) for three months.

We got to spend some time in conversation while waiting for the doctor. Dad says he is eating well. He is feeling good and wants to get back to his routine. I think he is looking forward to living and not constantly going to the doctor. He is looking forward to the Boston trip in the fall. And, as a by-the-way, feels that Boston Rob did a great job on Survivor and deserved to win the million bucks.

Love,

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