A TURP op. (PROSTATE) Royal Gwent Urology Dept. Day Unit 07-Mar-2017 …

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A TURP op. (PROSTATE) Royal Gwent Urology Dept. Day Unit 07-Mar-2017 …
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Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

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Hi,

a TURP (Trans Urithral Resection of the Prostate)

prostate-03-turp-trans-urithral-resection-of-prostate

Yesterday afternoon I received a phonecall from Steff, in the Gwent Urology Unit, offering me the chance of bringing forward my appointment, due on 23-Mar-2017, for my TURP (Trans Urethral Resection of the Prostate) to tomorrow morning!

Steff suggested that I came into the Urology Day Unit by 10am, having nothing to eat or drink after midnight, so that I could be ready for anaesthetic in the morning if there was any delay or drop out by another patient – meanwhile assuring me that Adam Carter (my consultant urology surgeon) and the consultant anaethetist he had wanted for my op. would deffinitely have an alocated time for me in the afternoon if there was no morning cancellation.

As it turned out my op. was done just before lunch using an epidural anaesthetic – that is the one administered by an injection into the lower back, the downside of this form of anaesthetic, which deadens the nerves roughly below the point of the injection, is that it can, when the patient is taking anti-coagulants as I am, that if ANY mistake is made it can lead to bleeding into the spinal column which in turn CAN lead to long term paralysis!

The advantage, on the other hand is that it does not lead to unconciousness, as with a GA (General Anaesthetic) thus not only does it not leave anaesthetic in the system for a prolongued period after the operation, but it also meant, which I have alwaqys favoured, that I would be fully conscious and able to watch the operation being done on the screen.

Watching the surgeon slice away your own prostate from inside the bladder, whilst chatting about what he is doing, is a VERY strange experience!

The operation went well and just over an hour after the injection in the spine it was finished and after Adam had shown me the glass jar containing all the little bits he had cut away, which was quite a lot, I was transfered from the operating table onto the trolley and wheeled off to recovery where it took quite a while to get my temperature back up!

During the operation there is a constant flow of saline from the stand via the tube, into the bladder and out, sluicing the debris and clearing the blood so that the surgeon can see exactly what he is doing. During the operation I counted around 19 x 2L square plastic bottles of fluid so around 40Ls of relatively cold fluid, which drops the body temperature during the hour of the operation.

Then with a guage 22 three way catheter in place it was off to Ward D5East for a couple of days until the bleeding had slowed down a bit! Eventually, although I was still bleeding quite heavily and still had a 3 way catheter in, Adam Carter responded to my pleas to go home, where I could recover in greater comfort and with much better food! 3 days later the bleeding had reduced dramatically and I went back into the Gwent where despite no allocated ‘slot’ Steff fitted me in between other patients and and removed my catheter so that I could be TWOCed (Trial With Out Catheter), which once I had proved I could safely pass urine I was able to go home.

That is not to say that the bleeding has stopped! Minded that the operation was on the 8th. and it is now the 31st. there is still a small amount of bleeding – I guess mowing the lawn today didn’t help!

That said there seems no doubt that the operation would seem to have been a great success and at least I am not having to get up 3, 4 or 5 times a night to go to the toilet, which was the outcome of having a greatly enlarged prostate! The other great result of the operation was a letter from Adam Carter, the day before yesterday, to tell me that all the tissue he removed from my prostate (the jar!) had been biopsied and had been found to be perfectly normal prostate tissue free of any signs or traces of cancer.

A very reassuring outcome – I can recommend this operation to anyone with Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), a condition that affects older men (yep that’s me at 71!). Several friends of mine have had the op. with great outcomes and at the moment a friend of mine in his mid 50s is in The Royal Gloucester hospital with an enlarged prostate, which has inhibitted voiding of the bladder that has led to a severe UTI (Urinary Tract Infection), which in turn led to blocking of the urethra last Sunday night, leading to a blue lit ride in an ambulance, in extreme pain, in the early hours of Monday and now in the early hours of Saturday they finally removed his catheter but are still battling to control the infection and get his temperature down!

I expect that a TURP is very much on the cards for him, once the infection is cleared and his regular urologist can get him a bed in the Royal Gwent for the operation.

In my case – thanks to Adam Carter, Steff and the rest of the team who looked after me in the Gwent.

Regards,
Greg_L-W.

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Posted by: Greg Lance-Watkins
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23-Feb-2017 – 10:30hrs. Royal Gwent Urology Dept. Day Unit for A TURP op.

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23-Feb-2017 – 10:30hrs. Royal Gwent Urology Dept. Day Unit for A TURP op. :
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Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

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Hi,

well if I was in any doubt that I needed this op. the numberr of times I woke and had to go to the toilet during the last few nights was fairly convincing! One starts to wonder why one goes to bed if you get up in the morning more tired than you were at bed time, the odd nap not withstanding!

So anyway we got up showered etc. in a less leisurely manner than normal – then checked I had meds. and other kit sorted and off to the Royal Gwent, in Lee’s car the buffeting of Storm Doris was considerably more noticeable than in the Volvo!
Lee dropped me off and ensured that I wasn’t subject to an NHS unscheduled cancellation but all is well and at least I know all the medical staff apart from the young Doctors on rotation! I must have had around 14 or 15 trans urithral procedures for bladder cancer etc. over the years.
This is somewhat more consequential but much the same.
So it was now the waiting game I had to check in in the morning but I am on Adam Carter’s afternoon list due for 14:00hrs.
Registrar Matt came round explained procedure yet again.
Then Catlin (Consultant Anaethatist) was with me for about half an hour! Going through details and facts and finally arriving at the conclusion that she was not happy to do the op. without a direct instruction and further discussion as she felt on a rough estimate that there was a 10 to 15% chance that due to anti coagulents I might well bleed sufficiently to catastophicly drop my haemaglobin level qand supply of oxygen to my heart thus inducing a heart attack that could/would prove fatal for me.
So it was time for all to think again!
I said I believed that the risk was mine to take and if this was the best odds available I would go ahead!
After prolongued conversation with Adam Carter (Head of Urology) who I have had as my consultant for many years and further talk with Catlin we have decided to try to improve the odds by closer contact with my cardiology consultant Patrick and ensuring Catlin & Adam were hands on for the op. and a HDU (High Dependency Unit) bed was available, pre booked for 3 or 4 days, for me so that I can be closely monitored after the op.
So now we are aiming for 23-Mar-2017 to go ahead with everything in place!
If you are reading this as a prospective TURP patient or a friend of someone about to have one DO NOT PANIC – each person is very different and my case is fairly extreme as I have no lefy coronary artery, and have had a massive heart attck as a result and already I am a bit of a miracle to be here atall! My coronary consultant has said I must take anti coagulant daily and this increases bleeding and the risk as a TURP under those circumstances can bleed heavily and take longer to heal. So don’t panic – I’ve had TURPs previously to my heart attack and had absolutely no problems.
Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
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  5. I DO have a Voice Mail Message System
  6. I ONLY GUARANTEE to answer identifiable eMails
  7. I ONLY GUARANTEE to phone back identifiable UK Land Line Messages
  8. I do NOT accept phone calls from witheld numbers
  9. I Regret due to BT in this area I have a rubbish Broadband connection
  10. I AM opposed to British membership of The EU
  11. I AM opposed to Welsh, Scottish or English Independence within an interdependent UK
  12. I am NOT a WARMIST
  13. I do NOT believe the IPCC Climate Propaganda re Anthropogenic Global Warming
  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
  15. I AM IN FAVOUR of rapid research & development of NEW NUCLEAR technologies
  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
  17. I do NOT believe in GODS singular or plural, Bronze Age or Modern
  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
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  23. I do NOT believe in prolonging human life beyond reasonable expectation of sentient participatory intellectual existence
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pre-op for TURP – 08-Feb-2017 – 14:30hrs. Royal Gwent Urology Dept.

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pre-op for TURP – 08-Feb-2017 – 14:30hrs. Royal Gwent Urology Dept. :
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Posted by:
Greg Lance – Watkins
Greg_L-W

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Hi,

well that was very straightforward!

I arrived very early as the management of the Royal Gwent leaves much to be desired, most noticeably on the issue of parking! For over a year now the car park at the hospital has been a building site where they have been building a really ugly structure that looks for all the world like porta cabins faced with tedious red brick with defacing paterns in a yellowy coloured brick – to replace the porta cabins that have housed A&E for years.

There is now virtually no parking at the Royal Gwent rendering the hospital even more dysfunctional than control of the Trust has increasingly been under5 the aegis of the National Ass. for Wales! (so aptly named).

I was fotunate and found space at my regular side street parking (sorry no clues 😉

Arriving at the urology department I popped in to see a few ‘old friends’ staff who have been providing me with excellent treatment for almost 20 years now, yes there are a few who have been in that department that long including two nurse practitioners Maureen and Janet.

I was fortunate to bump into Adam Carter my Consultant, who I last saw in June last year when we discussed the advisability of my having a TURP (Trans Urithral Resection of the Prostate)

prostate-03-turp-trans-urithral-resection-of-prostate

and he decided this should be scheduled as urgent! The aim being not to remove the prostate gland, which should be about the size of a walnut, but in many older men (& yes I have reached that stage!) the prostate becomes enlarged. Thus the aim is to cut away (resection) part of the gland to reduce its size as it can cause difficulty in urinating but also causes increased fgrequency, poor flow and urgency! We had a somewhat woefull laugh at the state of the service under the National Ass. for Wales’ management such that urgent had finally brought me in 7 months later for my pre op.!

Once again Teresa carried out my pre op. with the normal range of urine test, questions, swabs of mouth, nose and groin to check for any infections, blood test, normal obs. (weight, blood pressure, Oxygen levels, pulse rate, temperature etc.) + a detailed check on my all too dodgey heart and finally an ECG.

I was pronounced fit to join Adam Carter’s list for surgery but with the proviso that my results were cleared by my Cardiologist and the Anasthetic Department was aware and appointed a suitable consultant anethetist to manage any problems that might develope during the procedure – including, I pressume, the detail that my heart might stop!

The normal procedure in the Gwent Urology Department is that on the next working day, Bridget who is responsible for scheduling and the battle with the bed management department in the hospital phones and lets you know when and where to turn up to be sliced and diced!

Because of the checks with other departments it was not until the following Thursday that she was able to alocate a ‘slot’.

I am now due in at 10:30hrs. on Thursday the 23-Feb-2017 showered (no creams or talcs. etc) having had nothing to eat and only a small amount of plain water to drink that day – I will be on Adam Carter’s list for operation that afternoon and since I have to have a full anasthetic I will be in, at least, overnight!

I would normally have had this op. on an epidural block where they inser a needle into the lower spine and anethatise the nerve serving the body from there down – however as I am on blood thinners to cope with my heart and the absence of a Right Coronary Artery a needle in the spine can cause a bleed that could result in paralysis, if not worse!

My urology consultant would rather I stopped taking the blood thinners but my cardiologist rather ruefully points out that I can continue to function with a hugely enlarged prostate and a dodgey bladder but I wont last much over a few minutes without a hear!

All rather a simple decision, but it does make my surgeon’s job a little harder and calls for a consultant anethetist!

Somewhat like Arnie – ‘I will be back’ with details after the op. I may even have some diagrams but I promise no photos!

Think of Lee on Thursday for whilst I’m sleeping my way through the whole procedure she will, yet again, be concerned about the outcome!

Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
Calls from ‘Number Withheld’ phones Are Blocked

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NB:
  1. I NEVER post anonymously on the internet
  2. ALL MY BLOGS & WEB SITES are clearly sourced to me
  3. I do NOT use an obfuscated eMail address to hide behind
  4. I do NOT use or bother reading FaceBook
  5. I DO have a Voice Mail Message System
  6. I ONLY GUARANTEE to answer identifiable eMails
  7. I ONLY GUARANTEE to phone back identifiable UK Land Line Messages
  8. I do NOT accept phone calls from witheld numbers
  9. I Regret due to BT in this area I have a rubbish Broadband connection
  10. I AM opposed to British membership of The EU
  11. I AM opposed to Welsh, Scottish or English Independence within an interdependent UK
  12. I am NOT a WARMIST
  13. I do NOT believe the IPCC Climate Propaganda re Anthropogenic Global Warming
  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
  15. I AM IN FAVOUR of rapid research & development of NEW NUCLEAR technologies
  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
  17. I do NOT believe in GODS singular or plural, Bronze Age or Modern
  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
  22. I do NOT trust or believe in armed police
  23. I do NOT believe in prolonging human life beyond reasonable expectation of sentient participatory intellectual existence
  24. I believe in EUTHENASIA under clearly defined & legal terms
  25. I try to make every effort to NOT infringe copyrights in any commercial way & make all corrections of fact brought to my attention by an identifiable individual

Please Be Sure To
.Follow Greg_LW on Twitter.

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Check Your Prostate But Maybe Take No Action!

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Check Your Prostate But Maybe Take No Action!
~~~~~~~~~~#########~~~~~~~~~~

Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

~~~~~~~~~~#########~~~~~~~~~~

Hi,

more about YOUR Prostate:
prostate-01-it-is-hereWell that is where it is guys!

prostate-04-walnut-sized-okIt should be about the size of a walnut if healthy

prostate-01-it-is-hereYou should have a DRE (Digital Rectal Examination)
every so often & maybe also a PSA (Prostate Specific Antogen) Blood Test too.

prostate-02-an-ultra-sound-scan& maybe a Prostate Ultra Sound Scan

prostate-03-turp-trans-urithral-resection-of-prostateEven perhaps a TURP (Trans Urithral Resection of the Prostate)

‘Active Monitoring’ of Prostate Cancer Does Not Increase Death Rate

Active Monitoring’ of Prostate Cancer Does Not Increase Death Rate

By DENISE GRADYSEPT. 14, 2016


Robert Boulton, a prostate cancer patient, was initially assigned to receive active monitoring but switched to radiation treatment after four years, when his P.S.A. went up. Credit Alexander Atack for The New York Times

A new study offers important information to men who are facing difficult decisions about how to treat prostate cancer in its early stages, or whether to treat it at all.

Researchers followed patients for 10 years and found no difference in death rates between men who were picked at random to have surgery or radiation, or to rely on “active monitoring” of the cancer, with treatment only if it progressed.

Death rates from the cancer were low over all: only about 1 percent of patients 10 years after diagnosis.

But the disease was more likely to progress and spread in the men who opted for monitoring rather than for early treatment. And about half the patients in the study who had started out being monitored wound up having surgery or radiation.

The patients are still being followed, which should reveal whether the death rate will eventually increase for the men assigned to monitoring.

Doctors say the findings should help reassure men that surgery and radiation are equally reasonable choices in the early stages of the disease.

“I can counsel patients better now,” Dr. Freddie C. Hamdy, a leader of the study from the University of Oxford, in England, said in an interview. “I can tell them very precisely, ‘Look, your risk of dying from cancer is very, very small. If you receive treatment you will get some benefit. It will reduce the disease from growing outside your prostate, but these are exactly the side effects you might expect.’”

Active monitoring involves regular clinic visits with physical exams of the prostate, periodic biopsies and blood tests for prostate-specific antigen, or PSA, a substance that may indicate the disease is worsening. Between 40 and 50 percent of men with early prostate cancer in the United States now choose active monitoring.
Continue reading the main story

The study, published Wednesday in The New England Journal of Medicine, was the first to include detailed information from patients about the side effects of treatment.

Men who had surgery to remove the prostate were the most likely to have lingering impotence and urinary incontinence. Those given radiation reported bowel problems after six months of treatment (usually with gradual improvement) but not urinary incontinence. Sexual function also diminished after radiation, but recovered somewhat.

But there were no differences among the three groups in anxiety, depression or their feelings about how their health affected their quality of life.

Dr. Peter T. Scardino, a prostate surgeon and chairman of the department of surgery at Memorial Sloan Kettering Cancer Center in New York who was not involved in the study, said the research was important because there was little previous data comparing surgery, radiation and careful monitoring in men with early prostate cancer.

Dr. Scardino said the findings helped confirm that active monitoring is a valuable approach for many men. He said that it was appropriate for a third to a half of men with early prostate cancers, and that only a third of those patients would need treatment within 10 years.

But Dr. Scardino emphasized that the monitoring must be done regularly and with great care, for the rest of a patient’s life.

He added that an important message from the study is that early prostate cancer is not an emergency, and men have time to decide what to do about it.

Worldwide, there were 1.1 million cases of prostate cancer and 307,000 deaths from it in 2012, the latest year data were collected by the International Agency for Research on Cancer. In the United States, about 181,000 cases and 26,000 deaths are expected in 2016. The average age at diagnosis is 66 in the United States, and the disease rarely occurs in men under 40. Most men who have prostate cancer do not die from it, according to the American Cancer Society.

The disease often grows very slowly — but not always. Some cases are potentially deadly, but tests cannot always tell which ones. The uncertainty leaves many men in a quandary, particularly because of the bowel, bladder and sexual problems from treatment.

In 2012, the United States Preventive Services Task Force, an independent panel of experts picked by the government, recommended against routine screening for prostate cancer with the PSA test. The group said screening finds many tumors that may never have harmed the patient, and leads too many men into unneeded surgery or radiation, with their troubling side effects.

Dr. Hamdy’s team set out to address the quandary. They studied 1,643 patients in Britain ages 50 to 69 who had early prostate cancers, found with routine PSA testing and then a biopsy if the PSA was abnormal. All the cancers were localized, meaning they were confined to the prostate and had not spread to nearby tissue outside the gland, or to distant organs.

The patients had PSA measurements of 3 or higher, and about three quarters had a Gleason score of 6; the rest had higher Gleason scores. Gleason scores are a measure of aggressiveness and range from 6 to 10 in cancers, with higher scores being worse.

The patients were then assigned at random to one of three groups: A third had surgery, a third had radiation, and a third had active monitoring.

Though death rates from the cancer did not differ, more men on active monitoring had progression. The disease spread to distant parts of the body in 33 men on monitoring, 13 who had surgery and 16 who had radiation. The differences were statistically significant.

Other progression, to nearby tissue outside the prostate, was also more common with monitoring: 112 cases, compared with 46 each in the surgery and radiation groups.

As time went on, more and more of the monitored patients wound up having treatment.

Dr. Hamdy said not all those who left monitoring actually needed treatment.

“We know that 80 percent of them had not shown signs of progression,” he said, adding that anxiety on the part of the patients or their doctors, or some suspicion of progression, may have pushed them into treatment.

Robert Boulton, 76, a retired maker of rubber gloves, was initially assigned to active monitoring but switched to radiation treatment after four years, when his PSA went up. In an interview, he said two doctors recommended the treatment and one opposed it, so he went with the majority advice.

He said his only side effect was what he called “man boobs,” swelling in the breast area from the hormonal treatment that is routinely given along with radiation.

“I’m feeling fine now,” he added. “No problems.”

Another patient, Douglas Collett, 73, was also assigned to active monitoring in 2008 and has stayed with it. When he was first told he had cancer, he wanted to get rid of it immediately, he said. But when he learned more about the disease and the side effects of treatment, waiting made more sense, and he actually felt relieved when he was picked for the monitoring arm of the study.

He realizes the disease could progress, he said, and if it does he will probably have radiation to treat it. In the meantime, he said, “I’m fit as a flea.”

To view the original of this article CLICK HERE

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Greg_L-W.

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