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Am I messing up my hormonal status with supplementation ??

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 Posted 12/27/2012 4:54:01 AM
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Best of luck, Albedo.

D Dye
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 Posted 2/15/2013 10:02:40 AM
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I had my (bipolar) TURP surgery 3 weeks ago and recovering. Before deciding, I have researched, incl in this Forum, almost everythig I reasonably could and got to do something not to worsen my condition. So far so good and will happy to share information and progress.

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 Posted 2/15/2013 10:40:37 AM
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Thank you for letting us know and we hope that you continue to improve.

One of my relatives had this surgery, which completely relieved his symptoms. 
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 Posted 2/15/2013 11:11:22 AM
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Thank you DDye. Challenge is to see the effect on the post void residual (PVR).  Let me give a small update for the benefit of others who are or can be in my condition:

STATUS

• TURP (bipolar) done 20 days ago
• Main reason: huge PVR which increased over 6 years from 200ml to 800-900ml and no effect of large doses of tamsulosin (2x0.4mg). Prior to TURP I had a cystoscopy and pressure-flow study (both strongly recommended prior to decide)
• Surgery went very well, prostate was small (norm is around 30g), surgeon very well experimented and cautious (2000+ interventions)
• So far one complication: had to be re catheterized the very same day they removed the 3 ways surgery cath as I could not urinate at all (was very anxious, I think, but it is quite normal not going after the intervention for several hours even if you have the urge)
• 20 days after, I am drinking a lot (2-3l fluids), taking normal dose of tamsulosin in the evening (0.4mg) (will soon try to stop this under medical recommendation) and distigmine bromide (5mg) in the morning (not every day, 1 every 2-3 days)
• Can void 350-450ml typically at night (going 3-4 times) but also during day, this looks good. Had peaks at 500ml and even 600ml.
• Regarding stream I am waiting to see the TURP effect after doc agreed to stop the tamsulosin but it does not look bad.
• Scheduled for first control, in particular the PVR, in 2 weeks.

LESSONS LEARNED (so far and maybe in addition to what normally told to expect):

• Research, look for very experienced surgeon and ask opinions before deciding on the procedure. Very good source of information are the Guidelines of both EUA  and AUA and reliable discussion Forums.
• Try to relax if you are anxious (easier said than done, I was given an anxiolitic after removal of the surgery cath but, believe me, if I managed, you will also do!)
• Stay close to an ER for say the first week if you need by any chance a new cath. This helps also with anxiety.
• Have at hand a laxative if you got constipated. Plums worked great for me but had to take a glycerin suppository one day I was completely blocked.
• Of course drink a lot (in total I am taking 2-3l fluids, mainly water, no caffeine, 1-2 couples of green tea)
• Have a perfect diet (take proteins and foods rich in Vitamin A) and watch supplements in case you take them; avoid herbs and blood thinning substances for a while to speed healing of the scar. I am still taking probiotics, moderate doses of Vitamic C, Magnesium, Zinc, Vitamin D and ask doc first.
• Keep constant talk with doctor.
• Expect blood in the urine. I still have after 3 weeks mostly when seating, passing a stool but almost invisible after staying in bed (e.g. at night). Remember that also a very little blood make it impressive. Do not panic, it is normal. Doc confirmed.
• For recovery expect nothing at short term. Think about weeks and months, not days. From what I read, it is going to take 6-8 weeks with full recovery only after 3-4months. Take it really easy with work. Expect sex only after 1-2 months.

I hope this hels!


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 Posted 2/15/2013 5:20:41 PM
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albedo (2/15/2013)
I had my (bipolar) TURP surgery 3 weeks ago and recovering. Before deciding, I have researched, incl in this Forum, almost everythig I reasonably could and got to do something not to worsen my condition. So far so good and will happy to share information and progress.


Did you consider and discuss with your surgeon the possibility of going with greenlight (laser) PVP instead of TURP?


outlier@hushmail.com
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 Posted 2/15/2013 11:18:27 PM
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outlier (2/15/2013)
albedo (2/15/2013)
I had my (bipolar) TURP surgery 3 weeks ago and recovering. Before deciding, I have researched, incl in this Forum, almost everythig I reasonably could and got to do something not to worsen my condition. So far so good and will happy to share information and progress.


Did you consider and discuss with your surgeon the possibility of going with greenlight (laser) PVP instead of TURP?

Yes, this was discussed with 3 urologists including my surgeon. One is a promoter of ‘Greenlight’ laser vaporisation (KTP) but in my case case consensus from all was going for the "Gold" standard which is still TURP. In the medium/longer term KTP might take over. I asked and obtained the "bipolar" version of TURP which reduces intra-operative bleeding but even so I was told that was not necessary for small prostates as mine which do not require a long resection time which increases the intra-operative bleeding risks. KTP is very much recommended in patients on anticoagulant medications and at high CV risk. When I considered the huge experience and track record of my surgeon on conventional TURP and the published equivalent results on PVR (my concern) when you compare TURP vs KTP (e.g. see pp 55-59 of the EAU guidelines (HERE)) decision was done quite rapidly. In all process, once decision to intervene surgically is done based on your symptoms (actually my situation was nasty as mostly asymptomatic) and lack of medication effects, I felt the most important was not the technology at a particular moment of time but the trust you put in your surgeon at that particular moment of time (btw, I also consulted with 3 different GPs) and a careful research in reliable journals based on RCTs. I also involved from the start my family and work colleagues so to be fully supported.

I hope this helps.


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 Posted 2/17/2013 5:20:32 PM
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albedo (2/16/2013)
outlier (2/15/2013)
albedo (2/15/2013)
I had my (bipolar) TURP surgery 3 weeks ago and recovering. Before deciding, I have researched, incl in this Forum, almost everythig I reasonably could and got to do something not to worsen my condition. So far so good and will happy to share information and progress.


Did you consider and discuss with your surgeon the possibility of going with greenlight (laser) PVP instead of TURP?

Yes, this was discussed with 3 urologists including my surgeon. One is a promoter of ‘Greenlight’ laser vaporisation (KTP) but in my case case consensus from all was going for the "Gold" standard which is still TURP. In the medium/longer term KTP might take over. I asked and obtained the "bipolar" version of TURP which reduces intra-operative bleeding but even so I was told that was not necessary for small prostates as mine which do not require a long resection time which increases the intra-operative bleeding risks. KTP is very much recommended in patients on anticoagulant medications and at high CV risk. When I considered the huge experience and track record of my surgeon on conventional TURP and the published equivalent results on PVR (my concern) when you compare TURP vs KTP (e.g. see pp 55-59 of the EAU guidelines (HERE)) decision was done quite rapidly. In all process, once decision to intervene surgically is done based on your symptoms (actually my situation was nasty as mostly asymptomatic) and lack of medication effects, I felt the most important was not the technology at a particular moment of time but the trust you put in your surgeon at that particular moment of time (btw, I also consulted with 3 different GPs) and a careful research in reliable journals based on RCTs. I also involved from the start my family and work colleagues so to be fully supported.

I hope this helps.


Yes, thanks. Unfortunately, up here in Canada (especially in the boonies of British Columbia) choices for any specialist are severely limited. The regional  urologist I depended on until a few years ago  gave up (without referring me to anyone else)  when his one and only remedy for bacterial prostatitis didn't work. I have him to thank for the past few years of progressively worse infections.

I eventually went to Rome for direct injection therapy, and foolishly failed to get lab tests ordered by Prof. Guercini (www.prostatitis2000.org) while I was there. We both assumed I'd be able to get them from the provincial lab near home - wrong!

The lab refused to culture or otherwise analyze two successive sperm specimens, reporting only that they were "contaminated" with "several intestinal parasites". They didn't explain how the urine samples provided at the same time managed to avoid being contaminated, nor did they offer any advice on how to deal with this issue.

My own physician refused to go to bat for me with the microbiologist, saying it was probably "a one off", and when it happened a second time, and my former physician of 20 years (now semi-retired) received the "second off" non-report, he also refused to take up the cudgels for his patient saying "North American labs probably don't culture sperm for pathogens". Well, maybe, but if so, they should admit the limitation and not try to shame the patient to cover up their own limitations.

Since Dr. Guercini in Rome recommended a laser PVP (the triple direct injection wasn't enough to stop the UTIs - I had another proven one shortly after my return) I looked for  a urologist in Calgary (the nearest large city) who practiced the procedure, and found only one. Happily he's accepted me for a consult, but because of our ridiculously amateurish referral system (a letter or FAX is sent, the patient is told to wait for news - or to call, depending on the consultant's whim -  and there's no one checking to see whether  the referral or the notice of an appointment  reached their destination), the referral was twice (!) FAXed to the wrong number (so much for medical records privacy;  ironically, my clinic refuses to use e-mail for privacy reasons), delaying my consultation by almost two months on top of the "normal" three months wait once I was properly in line.

And so it goes. Having consults with three urologists is something I can only dream of. I wouldn't dream of accepting any further treatment or advice from the fellow who "treated" me until it was clear everyone that the treatment was useless ("that ought to be enough" he wrote to my physician, when I had completed his three month course of hytrin and bactrim "the patient should stop taking antibiotics" - the patient did, and had another e.coli UTI a week later...). I understand he does TURPS, although he never suggested the surgery to me - I'm guessing his main preoccupation is with cutting out prostates. So the new guy in Calgary, whom I've never met, is my last hope of standard medical help, short of going to the US or back to Rome (where the greenlight PVP would cost me 12,000EU plus my travel costs, I'm told).

Until then, I'm basically reduced to self-diagnosis and self medication, except for the six month course of alfuzosin I was prescribed in Rome, which will finish shortly. If the laser treatment doesn't work, my last trick is to repeat a three month course of Levaquin  I was prescribed about 10 years ago, which resulted in by far  my longest UTI-free interval in the last 30 years - a little over two years.


outlier@hushmail.com
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 Posted 2/18/2013 12:02:42 AM
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Thank you for describing your case Outlier as it can help others. Looks like another story of the absurdities of the medical system of which doctors and patients are often suffering. I know nothing about UTI and went to give a quick look at the EAU guidelines to check Levaquin (Levofloxacin) which has shown some longer term effectiveness for you  (p. 106, HERE):

".... 16.7.6.3 Group 3 fluoroquinolones
The main difference in the spectra of activity of group 3 fluoroquinolones (levofloxacin) and group 4 fluoroquinolones (gatifloxacin and moxifloxacin) is that the former have a higher intrinsic activity against Grampositive pathogens, such as staphylococci, streptococci, pneumococci and enterococci. However, group 3 and group 4 fluoroquinolones have comparable activity against Gram-negative pathogens. In addition, they have improved activity against the so-called atypical pathogens, such as Chlamydia, Mycoplasma and Legionella sp. In addition, group 4 fluoroquinolones have improved anti-anaerobic activity. The only group 3 fluoroquinolone available for parenteral use is levofloxacin; the left enantiomer of the ofloxacin racemate. The main indications for levofloxacin are respiratory tract infections, and, due to its high renal elimination rate, UTIs, as well as skin and soft-tissue infections. Among group 4 fluoroquinolones, gatifloxacin (not on the market in Europe), moxifloxacin and trovafloxacin have been licensed. However, in June 1999, trovafloxacin was taken off the market because of severe side effects. Thus, to date, no parenteral fluoroquinolone of this group has been made available. Apart from respiratory tract infections, these broad-spectrum fluoroquinolones are appropriate for treatment of skin, soft-tissue and intra-abdominal infections, and oral treatment of gynaecological infections. However, final judgement of their position in the treatment of these diseases is not yet possible. Gatifloxacin has the highest renal excretion (about 84%) after oral administration. It is therefore also the most suitable for the treatment of uncomplicated and complicated UTI. Urinary excretion of moxifloxacin after oral administration is only in the range of about 20%.
..."

I wish you a great luck for your next steps in the war you are conducting.


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 Posted 2/18/2013 7:14:38 AM
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albedo (2/18/2013)

...
".... 16.7.6.3 Group 3 fluoroquinolones
...

I wish you a great luck for your next steps in the war you are conducting.


thanks again albedo. No one had mentioned the Group 4 fluoroquinolones to me. I don't expect to have much luck with the local medical establishment bringing up this possibility of treatment, but maybe the new urologist in Calgary will be receptive. I shall certainly ask Prof. Guercini for his opinion on these as a possible solution to my condition.

Levaquin is known to have some very serious side-effects, and I believe there is or has been a class action suit over it in the US. So  a decision to take it should never be made without serious consideration.


outlier@hushmail.com
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 Posted 2/18/2013 10:02:55 AM
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While not being a cure for an active infection, am wondering if cranberry and/or blueberry extracts or juice might at least help a little with prevention.

http://www.lef.org/magazine/mag2010/apr2010_Halt-the-Vicious-Cycle-of-Urinary-Tract-Infections_01.htm


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