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.
