A Prostate Experience

For those who don’t know, the prostate is a gland that the male urethra passes through and when, in a man’s maturity, the gland becomes enlarged thus constricting the urethra which causes difficulty to urinate. As well there are other complications such as cancer, leaking and incontinence.

In my case, the difficulty started slowly over a ten year period, with a weaker flow and needing to pee more frequently – especially at night when it was impossible to empty my bladder completely, meaning that after getting up to ‘go’, I needed to go half an hour later.

Doxazosin was the drug I was given to help me pee – the same drug as people with dicky hearts – it opens up your tubes. Gradually I had to increase the dosage but more than two tablets a day caused me to be a bit lightheaded so I didn’t go over that.

I found a ‘natural’ product called ProstateEze Max which I found to be very effective and I took it for perhaps six years. ($2.00 day)

But in the end the reality of the enlarging prostate has to be addressed. For a start there was to be a national programme where annually the prostate and bladder was scanned and the volume monitored – I had one of those and the scheme was presumably dropped because Oamaru hospital did not have the regular services of a radiologist. The current scheme is to take six monthly blood samples of men over 60 to measure the PSA levels – a gauge for prostate cancer. Also annual digital examinations, which is polite language for a doctor’s finger reaching up your anus to feel the size and texture of the gland – throughout the procedure, you are supposed to relax!

This does not measure or assist difficulties of urinating.

Within what I’m about to relate I will highlight some things/statements.

The time arrived that my flow was slow and the urge too frequent for my liking, so I went to the doctor who felt my bladder and suspected that I wasn’t emptying it – ‘it was the size of an eight month foetus after recent urination - dangerous for the health of the kidneys!’

I was asked if I had health insurance and my negative reply put me in a metaphorical cubbyhole.

I was sent immediately to A&E where I was told that I needed to have a catheter inserted. And that was a shock!

Inserting a catheter is eye watering stuff! A syringe-full of lubricant-cum-anaesthetic was inserted into the penis orifice – on both counts I’m not sure that it works, after all stuff is supposed to come out of the orifice, go not in!

As the doctor had to use some force shoving the catheter through the enlarged prostate gland he grunted in exertion, ‘Most men have this done at some time!’ The catheter is held in place by a balloon filled with 10ml of sterile water within the bladder.

Maybe some will want to know about the pain level of the procedure: You are fearful and it is not easy to relax – it is eye-watering but bearable.

With the catheter in, I was allowed to go home with a pamphlet of instructions.

It is the role of the District Nurse to keep an eye on you and supply the bags and straps for the catheter. They provide an excellent service and while they are females advising on male stuff, they do it well. But there are some things that are not quite covered by the manual.

There is a strap that is not provided, you have to pay $10 for. It holds the catheter tube from the exit point to change direction down the leg to the bag. The tube has to stiff enough not to bend while it is being inserted, so the bend puts pressure on the eye of the penis so the strap is necessary. I then had another valcro strap an inch or so below to take the weight of the bag. I held it in place over the catheter end where the bag tube is attached and the valve where the balloon water is put in/taken out.

You can feel the catheter tube inside you – especially close to your anus – especially before it becomes slightly more pliable. You feel it most bending over or sitting down. Bending over and sitting down alters the length of the tube between the penis eye and the bag, so it can pull, causing discomfort and adjustment to the straps helps.

Immediately after the catheter insertion the lubricant-cum-anaesthetic oozes down on the outside of the tube, causing irritation at the eye. This is fixed by washing the eye and the tube with a soft cloth and warm water plus a little mild soap.

Stuff (I guess bodily fluid) comes down the outside of the tube most of the time so the washing has to continue. But the penis alters in size/length caused by temperature and mild erections in bed, so it travels up and down the exposed tube – so to avoid infection, the tube should be kept clean.

As well, the irritation is avoided by drinking plenty of water – it is true that caffeine and alcohol are bladder irritants.

I changed the bags fortnightly (the only time I removed the leg bag – some say it should be washed daily, I didn’t) and I stood on a sheet of newspaper because there are always drips of urine – you get good at it though. I chose bags with tubes that have ribs and you can cut to size. My legs are shorter than most and the length of the tube is critical for comfort when walking. It helps when walking to empty the bag because as it becomes heavier, it drags on the straps.

The tap at the bottom of the bag is really an on/off valve and it pays to check that it is closed after taking off the night bag – a couple of time I left a little trail of piddle.

The night bag pushes onto the tube outlet of the valve and I always put the bag in a bucket. On odd occasions I did not shut the outlet valve and so the bucket saved a lot of mess. In the morning I carted the bucket into the toilet, placed my bag-leg on the seat and removed the tube from the bottom of my day bag. Then I took the night bag and emptied it into the toilet.

I washed out the bag and tube and kept it in an old towel to dry out.

Being reasonably clean stops infections but I thought it unlikely for bacteria to travel against the flow.

Sometimes urine does not flow from the catheter leg bag into the night bag – it might be an air-block in the night bag, but more usually the tube of the leg bag valve is bent. I rectified this by passing the tube between my big toe and the next one.

Generally I’m fairly proactive but after my catheter was inserted, despite the advice from family and friends I did not ring the hospital. My thinking was that my referral went to the hospital so I would hear from them. But I didn’t! So after three months I rang to find I had obviously slipped through the cracks. The receptionist woman told me that I had been sent a letter for me to make an appointment and they were waiting for my response! So I was given a consultancy appointment that was another six weeks out – a bit long to have the catheter without replacing it.

I sent the hospital a letter of complaint – not about my lack of service but about their system. If a letter is not responded to, there should be a system to find out why. I also mentioned that I did not want to queue jump. Their reply was pretty much public-service-speak but it turned out that no letter had been sent to me so they apologised – unreservedly - I did not intend the receptionist to get into trouble, but she probably did.

The registrar saw me for my consultancy asking the same questions as my doctor and digitally examining my gland, no different to my doctor and he replaced my catheter – with some grumbles – on a bed-sheet that I thought could be cleaner.

When the inevitable infection occurred some ten days later, my doctor tried to access my hospital file to see what the notes recommended. The notes had not been written up. He told me that I would probably have a biopsy before a TURP operation could be carried out.

A fortnight later, being a little more proactive, I rang the hospital to see about my biopsy appointment. They have the capacity to perform only three biopsies per week and I was number 39 on the list and there would be emergencies in front of me also.

With that news I did two things – I rang my doctor to find the cost of a biopsy and TURP operation at a private facility. He did not know.

Secondly, I wrote to the minister of health, saying the hospital needed more funding (or sorting out) because if most men get this done at some time, the waiting list is going to grow exponentially. As well the digital examinations and six monthly PSA blood tests are not much use when no treatment can be done when problems showed. I told the minister that my motive in writing was to improve the system and not to queue jump. I suggested that with the amount of tax I had paid over the years I expected a better health service, which is why health insurance should not be a necessity – adding that if everyone had health insurance, the private sector could not cope anyway.

The cost of a consultancy, biopsy and TURP operation at a private hospital was around the cost of a new small car and the surgeon managed to fit me in almost immediately.

The day I was to go into hospital, the public hospital rang to say they could give me an appointment for a biopsy in a months’ time. Obviously the minister had been in touch and told them ‘up me’ on the list – politicians don’t listen. I asked when a TURP operation could be performed but that would be ‘way down the track’. The person I was speaking to thought I was wise to have the procedure done privately.

The efficiency, care and overall experience of the private hospital could not be faulted and now four weeks after my operation I’m progressing well.

But a week or so after my operation, the minister did reply, using uncommitted language that politicians use and inferring that I had been upped on the list. Of course they were working to improve the system and situation.

But hey, ten years ago, my doctor thought it advisable to have a biopsy and it was done within weeks – why have things deteriorated since then?

Knowing what I know now, the squeaky wheel indeed gets greased so it is necessary to follow up to make sure of your place on the list.

The other thing is ‘get the job done’. My quality of life would have been much better if I had the TURP operation ten years ago.

My surgeon said there should be no need to wait until it becomes unbearable – of course the cost means the option is not available to everyone.

Post script: The day I posted this, there was a newspaper story of a fellow whose experience was a carbon copy of mine.

White Ribbon Week

I didn’t wear a white ribbon last week, for that matter I have not worn any sort of ribbon, not because I lack empathy - I’m just not inclined to display. Even when I donate, I don’t wear those little sticker-badge things, (actually when I go to conferences or place where I’m given a name label, I don’t wear them). Perhaps I’m just contrary.

There is plenty of evidence of violence against women and girls, the statistics are pretty alarming! One in three, we are told, experiences some form of abuse! Personally, I have seen none of it – within my extended family, at work nor with friends and associates. Apparently that’s not unusual because abusers can be discreet.

I wonder if I did witness something, would I react like most, and do nothing? It’s hard to say, but hopefully I would be at least empathetic.

In a remote village, I once gave a lift to a Maasai woman who had been badly beaten by her husband and took her to a nearby clinic – I tried to convince her that hospital would be a better option but she refused because it would mean that she could not cook for her husband that night. She had facial bruising and damage to her ribs caused breathing difficulties.

Sanawari is really a suburb of Arusha, not that you think so at first. Most Friday and weekend nights we would be woken by a scream somewhere in the vicinity, of a woman being beaten by a booze-fuelled man.

In both these cases, it was not within my capability to intervene.

So perhaps I have nothing to contribute to White Ribbon Week that could help vulnerable women and girls other than relate to an episode that still haunts me about violence meted out to two brothers:

The Easterly end of my property was bounded by the main road – altered slightly today – and across the road, on a small area of flat land stood the first school in North Otago. The area was known as Otepopo. Nobody seems to know exactly where the school stood but it was roughly there.

In conversation about its possible location, a friend showed me a copy of an article written by one of the brothers that had attended the school.

I only had the opportunity to read the article once and the following is from memory.

Mid-1850’s the colony was far from established and the pioneers needed to be resourceful and hardy. The ferryman at the mighty Waitaki River wanted to educate his sons so they made to difficult journey to Otepopo where Mr. Robertson had his boarding school – the two brothers were to be the only boarders.

This guy Robertson turned out to violent and sadistic and although the article did not say so, he was undoubted a paedophile.

He apparently picked on the older brother most, though not sparing the younger. Most of the beatings were with supplejack, a vine that early fishermen used to make crayfish pots and eel traps, but a short length would be much like a cane.

For perceived or no reason, Robertson would strip the boy naked and thrash his back until it bled, then took delight in picking off the scabs, while the boy bathed; the wounds would remain unhealed for longer.

The need for firewood was constant and Robertson regularly took the boys foraging for wood up in the Otepopo Bush, often threatening them about how easy it would be to murder them up there and hide their bodies. One day Robertson’s victim did something wrong, so the lad was forced to lay his finger down and man bashed it with a hammer!

Robertson was a pious man and conducted services in the school, one freezing day, during the service he had the lad stand naked in an adjacent room, ordered not to make a peep, while the hymns and prayers were going on just through the wall!

The article didn’t elaborate, only saying that Robinson often took them to his bed and they were made to do awful things.

The boys planned to escape but remoteness was their constraint – they were not yet ten! Robinson’s last and incriminating act was to demonstrate what Hell was like, by taking the boy’s finger and holding it over a candle flame!

Shortly after, the boys’ father arrived and rescued them.

The primary court in Oamaru had no jail, so the man was fined £5, which he easily paid.

These were awful things for those young boys to endure and the warning is, such evil people do exist and persist – as bad as that? Maybe not, but you can bet there are still instances.

Look for the signs, speak up, and offer a non-judgmental ear.

Abuse is not ok.

Angie's Gold

It happened in Central Otago, at a place called Naseby where during the 1890’s it was a remote, bustling goldmining town. 

Angie was just eight years old when she found the gold nugget, after a severe rainstorm which caused the water race to burst and sluice away a large area of land. She was the first one out there hunting with her dog, Muffin, who liked nothing better than  chasing rabbits – and it was good to get away from those filthy miners.

Angie knew that the nugget was valuable, but had no idea just how much it was worth, recalling that the last stagecoach taking gold to Dunedin had been held up; two men killed and the robbers made off with the gold – they were wild times with jealousy over gold and land. Men often lost their gold gambling or buying cheap liquor! Angie had seen it all!

Her father owned the general store, selling all manner of goods to the miners; flour, shovels, nails, pick axes, knives and her mother, Sarah, helped in the store as well as doing laundry out back for the town’s two pubs.

She imagined what her father and mother would say about the nugget and guessed she wouldn’t have her treasure for long, so she decided not tell them about it yet.

‘Father?’ she asked that night at the dinner table, ‘Can anyone sell the gold they find?’

Her father peered sternly at her over the top of his spectacles, and she felt the heat as her cheeks reddened.

‘No,’ he replied, ‘to sell gold you have to own a Deed of Claim that allows you to work a specific area to fossick for gold.’

Chewing on a piece of gristle, Angie realised she couldn’t keep the secret from her parents so reached into her pocket and quietly placed the gold nugget on the table.

Both parents stopped chewing and stared at the nugget, then at Angie, and back again at the nugget.

After a lengthy inquisition, Angie’s father agreed the gold was hers by right but it should be hidden for safety.

‘We could hide it in a jar of marmalade!’  Angie suggested brightly.

‘Now that’s a good idea,’ agreed her father, ‘we could display it and nobody could ever guess that gold was in there.’

Father sold clay jars of marmalade in his store and mother had a half used jar on the kitchen shelf. With the gold nugget safely inside the jar and covered with marmalade, they needed to seal the top so flies or bugs didn’t spoil the jam so used candle wax as a seal – Angie’s chin jutted out with pride at the neat job and now the marmalade would keep fresh for many years!

The jar survived a few dangers: Bad Kenny broke into the store and among other items, he stole the jar right next to Angie’s! There was the fire that burnt one end of the store and there was looting! And the time Muffin chased a rat that knocked over several jars and five were broken!

When Angie was fourteen, she boarded the stagecoach to Dunedin, where Father had arranged a job for her at a general store on the main street. Not a paying job, just lodgings and food.

Her bag (with the jar inside) was missing when she went to pick it up but saw a man making off with it down the street, so she chased him!

‘Go away!’ he growled aggressively, making it obvious that he was prepared to fight for her belongings.

There was no help at hand for Angie, so she poked him in the eye with her parasol! The pain caused him to drop the bag, cursing. Quickly she retrieved it and scampered off towards the store!

She worked happily there for three and a half years and made friends with the storekeeper’s wife, Molly. Through this friendship she negotiated the rental of a small spare room at the rear of the store.

Angie found that Dawson, the jewelry-man down the street paid a fair price for black-market gold, nuggets or dust, and when he saw her nugget, his eyes narrowed but she bargained hard and sold three quarters of her nugget, by weight, for eight hundred and fifty-three pounds!

She kept the other quarter ‘in reserve, for an emergency’.

Angie used the money and the room to set up a small factory making jam and cordials using local and imported fruits.

Her business thrived, expanded and became profitable so she had no need to cash in the last quarter of her gold nugget, which much later, she gave to her daughter, Primrose.

Together they built a new factory and named the company after her, which became famous for quality jams, cordials and specialized in marmalade.