FOCUSED LASER ABLATION

John

That is good. You will be our "inside man for FLA". I think you said sometime in January. I was out of town and just got home in time for the Big Snow Storm Caly, our dogs name.

I have not called Dr K yet, but if he is going to do some trials, I would like to be onboard. I am waiting for some prices on PAE to see how affordable it is. I know it has been classified as Non surgical and some insurances are covering at least part of the costs. There are at least 8 "IR-PAE" doctors now in the US that have some credible numbers behind them through Clinical Studies. About FLA and Dr S, I would have to assume that he has not done that many FLA's for strictly BPH, otherwise you would have received some sort of communication from them. His assistant Lillian, seemed very nice and immediately responsive when I talked to her. I think that within the "IR-FLA" group of doctors, there have been only a few cases done because BPH was the primary need to be performed and that is why we are getting little to no information about this application of FLA.

Yes I think heworking on getting it set up on clinical trial site but you should call him as he is going to have to make it a small trial because he is partly funding part of your cost for participating in the study. I am not waiting I got to go and I will pay faultless price probably. I don't care this is too hard on me. But call him and ask and good luck. He is an amazing IR.

john

PS I got block on first response don't understand.

Good Luck and stay in touch to let us know the in's and out's.  I have already pasted my deadline with my co-pay free for the year to get any procedure onto this years schedule.  So, no matter what I get done, if the insurance is to pay it, I will now be out at least $2500 in co-pays.  I guess maybe I should get my Rotator Cuff surgery done this year with my co-pay met.  That is one I really have been putting off because of the long and sometimes painful recovery.  

If Dr K is going to run a small trail, I would assume that it would happen quite soon and therefore you would be a candidate even more-so than me because you have already sat down and reviewed all your data and have already had an MRI.  That is kind of funny about the IR-FLA doctors, they all want an MRI first before they accept you.  Where with the IR-PAE doctors, they just want to review what information that you have from your UR.  They all will be doing some-sort of an MRI before or during the process anyway.  Although, with a PAE, they are doing a CAT SCAN I think that guides them with their Catheter probe.  Going through those Very small prostate arteries they need something very acurate to guide them so that they are sure they are in the right ones when they inject the pellets, otherwise they could create some other problems, like with the bladder.  

Mike     

Best of luck I hope it's a complete success!

Michael

Please report back on the results. I am thinking about pae but this may be a better alternative.

Richard, 

I am doing well after just one week. The prostate is swollen and I do have some blood in the urine but it is always a small amount. Dr. K has told me several time everything is normal. 

I had more prostate removed than is normal in this procedrue for a few reasons.  I had a suspicious dark spot on the MRI in the transitional lobe that was not cancer according to the MRI. They decide since they are removing tissue and it will not effect the ejaculatory ducts, seminal vessicals or nerve bundel by ablating this area, the wanted to go ahead and remove it and biopsy the area. Second, my prostate was so large, 125cc, that they wanted to remove enough so I would have long term lasting results for many years hopefully the rest of this life. (Some doctors preforming this procedure would not do that and they would thereby have a second bite of the apple built in for a few yeas down the road). Third, I had a large median lobe and it was pushing up into the bladder at the base so that was also removed. I basically got 3 birds with one stone. But the recovery will be a little more. I don't have any issues with it now so far I am pleased.

I am now good enough to go back to work but will not do it until next Tuesday.  All the results are not all in yet but the fact that the erection works already makes me glad I try FLA. I was surprised on the second night to wake up with an erection even with the catheter and it has returned other nights following. It happened with and without the catheter in and to my surprize  was not painful or an issue. I just smiled and ignored it. I have not and will not ejaculate until more time passes. But so far so good. 

I need to retrain my bladder now as the BPH has taught it to go too often with urges from when the prostate was pushing up into the bladder. Since that tissue removal, I am now going about every two hours and I get up now 3 times at night still.  But getting up is not an issue of the procedure as I developed this habit from BPH over the years of suffering from the condition. 

Some of the night urges are my own fault because I want to feel the stream so if I wake up not needed to pee, think about it, and I am anxious to get up and go pee as I have not seen this type of flow in years. it is stronger, wider and much more than pre op urination with the BPH and I really enjoy it. Dr. K says all of these things continue to improve as the body cleans and removes the coagulated tissue that was ablated. In another month I will go to my Urologist and get a PSA test just to compare. 

I am happy that it was all done with the vision and precision of the real time MRI machine and it was very specifically removal. My feeling before the surgery was I wanted to first do the specific removal of the tissue and IF it did not work then the random effects of cutting off the blood supply and shrinking the gland with PAE would be next. I currently want all the blood supply I can get to heal the prostate quicker and would not want to do the PAE first then FLA second. I don't thing now that will be necessary to do the PAE my stream is really improved and PAE would not have addressed the location pushing on the bladder nor would it have removed the dark spot. I  just love to watch it now and Dr.K bet me that I would be writing in script on the wall in 30 more days. 

By the way, Dr. K confirmed he is going to start a trial study and use it to write a paper and he is going to partially  self fund the procedure for 7 to 10 men. This will be done in the next 3 months. He will file this with Clinical Trials. I could not and would not wait. Had to get this done and glad I did. If you or anyone else may have interest in investigating this then  call him. I do not know the particulars. 

If you or anyone else on this thread want to see a side by side picture of my prostate before and after the procedure then just personal message me your email address and I will send you the photo. It is quite impressive. Also if you want to call me I will give you my phone number.  For more information on any of this. 

John  

Wow, I didn't know you were going in so soon. How long did you have the catheter in? Would he have let you self catheterize instead?

 

Hi John,

Best of luck in your recovery may it be everything you hoped for!

Michael

 

YES, I could self cath in fact I bought all the stuff just in case. But he place the foley and wanted to remove it on the third day. I said no leave it in as I could tell i need it. I used a bed bag at night and no problem. Slept all night on my side and it was fine. I did not awake and was not wanting to wake up and cath.  I was totally shocked. I did not have anyi ssue with that Catheter. We left the hospital about noon and went to a great seafood place. Then the next day my wife Dad and me toured the NASA Houston and saw mission control and an IMAX movie and road the TRAM for 90 minutes. We visited the Saturn Five rocket and the whole day I had the Cath in and a leg bag. I would just go dump the bag when it was time. Not an issue. I expected more and was in fear of the whole thing. When they put it in they had already given me the concious sedation and I felt and remember NOTHING about it. I Took it out my self at my choice back at home on Saturday after a six hour drive. It came out so easy it was like a peed it out of me with a little tug after I deflated the ball. No pain but some and blood and a clot or two on the shower floor. They gave me a drug call Uribel and it is so wonderful. I am still using it now. It stops all bladder spasms COLD I had none. It stops the urges to pee enough to feel almost normal. It stops all the stinging feeling when you pee after it comes out. This is a great drug. Uribel.

YES  I could have used a straight self cath but as It was no issue I just chose to keep the silicone catheter in place after the procedure. I had never cathed before and was scared of doing that catheting by my self. 

Personal message me your email and I will send the side by side before and after photos taken on the table during the procedure.

Sorry, better direct answer took it out on day 5. Wanted to wait till day 7 but decided to tak it out on Saturday.

Thanks j12080 for your update..! I live in Australia and plan to see Dr. K in the next couple months... THANKS..!

John

This is Mike or mikeskier. I will contact Dr K the 1st of next week to see what it will take to get on his trial. Give me what ever details that you have in a PMI. I am sure by now that you have this all packaged up to send out to all the respondents.

It is really good to know that things went better than anticipated. I know you have put a lot of time, research and money to get you to the decision that you made and went through with it. I hope that it continues to heal properly for you and gets all of your associated functions working normally.

You said you cathed for only 5 of the intended 7 days. Unlike RESUME, where they go through the urethra, the cathing was an on and off problem with that procedure. Things would go finext for awhile and then some clogging. Some had to go back through emergency to get re-cathed. Did Dr K set up your post op procedures differently because you live quite close. I would be coming from Michigan and have to decide if I need to spend multiple days near his office. I will probably be going by myself and rent a car and get a hotel room.

Good luck John,

Mike

Mike, I will pm you but I don't know much about this trial deal with  Dr. K (Kar a man ian). My involvement was that when I contacted him on very late notice that I needed wanted go ahead now with this procedure on the 19th he tried to tell me he had 3 procedures that week and one was a very complicated cancer case and he wanted me to consider waiting into January. That is when he told me about the trial study he was planing to do. I told him I wanted to go ahead now I did not care about that or about saving money. It has to do with my job and getting off any other time. I wanted 5 or 6 days there and then a week at home and that is what I got.

On the trial He has said in other convesations that it was harder to get the equipment companies or the Univeristies to fund these BPH project with Intervention Randiology as opposed to the ease of Urology getting trials funded. Reason being is that the cost of Interventional Radiology trail involves much more expenses and that the other reason was that the Urology field is much much larger and more powerful a group than Interventional Radiology.  He said in time it will come.

So, he wants a papper published on the FLA procedure for BPH. Cancer is easier to get and is exactly the same procedure of removing tissue. The only difference is that the tissue has cancer in it prior to removal. So I guess I can say I had Cancer surgery without the cancer.

On this trial all I know is he plans on supporting part of the cost with his own money for 7 to 10 men who qualify and sign up for it. But I am sure it will still cost something for the procedure under the trial. I never ask what the deal was, I just said let's get me going. Because he was so busy he had his associate Dr. W  in on part my procedure while he was on the cancer case. 

I am feeling better and had a big increase in flow last night. I passed 375 cc in one trip last nigtht and I must tell you I had no idea taking a pee could feel so good. I am serious it was wonderfully strong and hard and just kept coming. I was up 3 times but did not have to go and could have waited. I just wanted the experience again. I only peed 225 and 250 those times. Still was nice to see and feel. It has been a long time since I peed like that. 

Dr. K wants me to stop doing that and hold it longer and I easily can do that. My only consern is a little blood at the start of each urination. It is about a half of teaspoon each time. He told me that was normal and not to let it concern me. He said it could go on for about a month but would not be an issue. They really took out a lot and my prostate is going down in size now and I can feel it. I am pretty happy so far. I am anxious to try the orgasm part but I am detirmine to wait 30 days. Dr. K says to go anytime I feel ready. Nope, I will wait. 

Cathing was not  problem for me. Yes I had it out in 5 days. Seven would have not been bad either. But, If you are going to be there for a couple of days I am sure Dr. K will have a solution for you. I would not have had a problem flying with the catheter in me. It would have been easier than driving 6 hours with it. I do not live that close to Dr. K so it was an almost all day drive I made. It did not hurt, and it did not cause any issue taking it out or afterwards. He had a lot of things that helped like an attachment to my upper leg to hold the tube in place. I got out each day and moved around. You might think about UBER use instead of a rent car. Or, Dr. K may have Sam pick you up.

I am really glad you are calling him next week no matter what you do. I would like to know you opion on him especially as compared to Dr. S. after you talk to him. 

Thanks for the ongoing updates... Cheers

John

When do you go back to work? How are you feeling now? How close are you being the way you thought? Why did you have blood in urine when all the prostate tissue removal was on the outside of the prostate? Did you get a hotel near his facility? You don't think I would need a rental car? How long do you think he would want me in the area, being that I live in Michigan? I noticed that his office is southside of town and the airport is about 30 min north. You were saying the order of procedures you would consider, FLA then a PAE. If they do FLA 1st, would that not damage the blood vessels on the outside of the prostate that the PAE procedure that the catheter has to go through to block with the Pellets? Did your insurance cover any of the tests? or were you out for almost all of the $22k? Right now my wife is the only one working and she just went through uterine cancer and radiation for just about all of 2016. We were out a lot of copay. That is why I am trying to be carefully about how much my medical obligations are.

I will try to call you Monday or Tuesday to talk before I call the Dr. If Dr K does not cover at least half the costs, then I will wait to get PAE on a trail or get my insurance to cover it. REZUM is covered 100%. I checked with them already, even though that procedure was 3rd on my list. I am sure if I could wait 2 years that all 3 of these procedures would be covered. Even though the initial costs are higher, the total costs to them for an FLA will be totally less because they are most likely permanent. Urolift and itind are definitely temporary and both are 100% covered.

Thanks John for all your great info and support. I will call you.

Mike

Mike I am not sure why I had the blood except that they had to get close to the bladder and the cath might have rubbed a spot on the tissue but it seems ok now. They always touted "little to no blood procedure", I got little. It was never much blood just a few drops at the begining of each urination. 

I am going to work tomorrow! I think I am a lot better. No pain. My urineation is trips are farther apart as I am training the bladder to wait longer. My stream is a lot better than before the procedure. I am happy with the quick results. PAE naturally will take a litter longer for the tissue to atrophy and disolve out ot the prostate. But I think PAE is a great treatment. The men who have talked about the quick results are see immediate results from the prednisone FLA did not work, I would then do PAE as it would still do the same thing the treament is designed to do after FLA but I dont think I will need it and this is a longer term decision on whether or not I might need it. I think I am pleanty good now with the FLA and I still need more time for final results. 

I Only got up 2 times last night and it was 5 and a half hours apart. My problem is I am a light sleeper and wake up anyway so I am relearning that also. I am expecting more results over the next 30 days as the prostate size goes down more. 

There are many hotels around the area and Dr. K or Sam would set you up when you tell them what you need. I would say if it was me, I would consider staying for about 5 days if it was me. I stayed down near UTMB as I told you Walser assissted Dr K as he was really busy that week with Cancer and I was detirmined to do it that day. This is not necessary for you but if you are by yourself and traveling alone all the way back to Michigan, you may want to be close to Dr K for a while and you can alway check out early and go home. There are two airports Houston International and then south of town there is Hobby Airport and it may be closer. I know Southwest Air flys into Hobby not sure who else. 

As far as PAE and the blood arteries that are stopped up, these are outside the prostate. You need to ask all of these questions to Karamanian and I a sure he will answer. He always told me the truth about the competing treatments and never tried to tell me one was better than the other. They all have good and bad and he is a very trained Interventional Radiologist who has done both Ablations and Embolations many times. He knows his stuff and he is very forthright in his information. 

I don't know what he covers on his trial deal. I paid all mine because Medicare will not assist in either FLA or PAE. Sorry to hear about your wife. I know how hard it is when both of you are laid up at the same time. My wife fell and broke her leg when we went to North Carolina to visit Dr. Isaacson in  September. It has been a mess. 

YES by all means, feel free to call me if you want to before you call him. But you are going to find out that when you talk to him, he will talk to you for a long time and many times if you want that. He always talked to me for over an hour every time I call him. I have not heard from him now since Thursday as he told me I was doing good enough that he would stop calling me everyday. And I am, I am considering going and playing golf today! My wife says no but she is not stronger than the desire to play golf. The Doctor said do what I want to except lifting heavy objects. 

I will talk to you soon. 

John

John

Happy New Year 2017 and hope you are BPH Free.  How are you feeling today?  I think it has been over a week for you know since you had your FLA procedure. Has your internal swelling went away?  Are you urinating fairly normal now without any pain? 

I have been in and out all day today so I will call you about 10am your time CT on Tuesday.  I think Tuesday would be a better day to call Dr K.  You said he went to Florida over the holiday and should be back now.  

I don't know why your responses keep getting moderated.  I am just wondering that because they have had to delete so many of your responses, that they are looking at everything you write.  

I went to that other forum you said was better, It looks like it is strictly about men with prostate cancer with all of the options.  There looks to be a lot of information.  Thank goodness I have not been diagnosed with cancer.  I have a friend of mine that got diagnosed last February with a high risk prostate cancer about the same time as my wife found out she had uterine cancer.  He tried to get on the Proton Therapy program, but it would have been out of network for him and they wanted about $125k to complete.  So he went ahead with Barachy Internal Radiation Therapy and a Hormone Therapy along with it.  Everything seems good, except he has trouble sleeping.  He was a very healty and active guy before he found out, but he is still scared to death that it will re-occur.

Tomorrow

Mike    

Hi John, I'm glad to hear you've had positive results from having this procedure. 

Yes sir I am headed to work. I am feeling really good. Had a good night got up twice but it was my own fault as I wanted to watch the stream I am now peeing! I know that should not intreigue me so much but it has been a long time since I made suds in the toilet!! 

It has now been 17 days since the procedure. Next stop on this recovery train will be SEX. I have the erection, I just want to wait another week or two and be sure. I know me and as I put together more and more great days, I will pull the trigger so to speak. No pun intended. It was a lot of money I spent but I am close to saying it was well worth it. Give me the rest of this week and I will have an opinion. I know this, the Doctor I have is the best person I have ever met. May God make a special place for him as he cares about people like no one I have ever met. Both he and Walser were great to work with.

Mike I look forward to your call. Even though I will be at work, I have plenty of time to talk to you as long as you wish. Talk to you then!!!

john

Hey  John....I am so happy for you.  You said you were going to wait at least a month.  Well when you decide it time.  Go out for dinner make a night of it and enjoy life.  Have a great year  Ken

Uust a short note on Rezum. I called the company and talked to their customer service specialist.  When I asked about sexual side-effects as retrograde ejaculation, things went silent.  In the field. I talked to an office that did many of them.  There is about a 10% chance of retrograde ejaculation.  The company is not being completely straight on sexual side-effects.  

I talked to an office that does it - yes they agree 10% If you look at Rezum's web site they quote a study to support no side effects - I saw some summary of that study, it says no ED, I didn't see anything about Retro.

The last time I checked their web site, I also noticed how the side slipped the retro issue with the wording. I think the Jersey Doc said he won't recommend Rezum if retro is an issue. That makes sense. Some may not mind it, but personally I would rule out Rezum with a 10% chance of retro, since there are other options. 

Jim

Yes I agree 10% is to much of a risk.  Over the last few months many men have had the Rezum procedure and have came on here and they were pXXXed they had it.  At that time they were told 4%.  I was told that a good urologist could control it.  But to me that is only the placement of the injection.  Once the steam is inside the prostate it is going to distroy all the tissue.  It does not know the difference.   The steam is not going to stop at the ejaculatoty duct or seminal vessel and say Oh I can't touch them I have to go around.   I feel many of the procedure should be ajusted for the patient and how he wants it.  He is the one that has to deal with the side effects not the doctor.  I do feel that the Rezum procedure is good to a point but only if you have the right side done.  It would relieve the size of the prostate on that side and you will peed better.  Not having the steam put in the left you avoid any chance of retro.  It will stay normal.  We as man have to deal with alot and we have to give up many things as we get older.  Why should that be one of them.  We need to fight and be aware of the way  urologist talk with us about the problem.  They have a habbit of suger coating everything.  Have a good day Ken

Moderator comment: I have edited this post due to the swearing. These are open forums so as per the T&Cs please do not use offensive language in posts otherwise they may be deleted.

Hi Kenneth, I don't know if I agree with that you are saying, because if the steam destroys all the tissue why is it only a10% rate ?

I saw other people who were angry that they still had to get up 3 or more times a night even though they can pee better. So if the doc just does only one side those will complain as well.

Hi Mike and Ken,

Getting up at night is often non bph related, i.e. nocturia.  So rezum or any other prostate reduction procedure can't help if that's the case. That's why some people report peeing better (their obstruction was relieved) but still get up at night. 

Jim

Hi Jim of course I am aware, just saying .. if you speak to some men who want to do a procedure and the results, the first thing they say is "now I only get up once a night" clearly they expect or hope any procedure will help with that.

I guess it depeands on the doctor.  It could me the placement of the shots top and bottom leave the middle alone  But I still will not take that chance.  Also alot of getting up at nght after a procudure is habbit.  If you have done it for years your still going to do it after. HAVE  HAVE GOOD DAY KEN 

Hi Mike,

I guess I'm not following the train of thought here then. That happens

Jim