My Appointment

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Good morning Guy's.  Instead of hooking into another discussion I just did my own to tell you all what went on at my appointment.  Some of you have been asking......................... Well things went well  Was with him for about 45 minutes. First of all my bladder is good clips still in the same place so prostate is wide open.My problem is my sphincter muscle.  Most of the time it get loose when you get older.  My is to tight.  He explained that when I pee the sphincter will open enough to go but my steam is small.  But when they have to catheter or if I try to self cath my sphincter muscle put up fight.  That is why it was so pain full in the hospital.  He did had some trouble getting the scope in this morning.  He also saw some scar tissue from when I did CIC.  So what he wants me to do is go to Pelvic Health and Rehabilitation. For Pelvic Floor exercise.  I ask if they were kegel  but he said no.  He told me what is was but don't remember.  He is also putting me on Flexeril to help relax the sphincter.  He want me to try it.  When I get it I will have to see how he wants me to take it.  He hope it will relax the sphincter.  Going to read up on it before I take one.  He hopes it will help my flow.  He is also giving me ciprofloxacin 500 MG for 7 days so I don't get a infection.    We will see.  He told me if I have a problem to just e-mail him and he will get back to me.  Nice guy.  Well that's it for now.  The last few days been the pits.  Going to lay down and relax.  Take care all and good health.  Ken         

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  • Posted

    Hey Ken hope it all works out for you. Flexeril isn't to bad just a bit over a hang over in the morning. Only I didn't like about it was after 3 days it gave me strange dreams. Good luck.

    Jim

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  • Posted

    Hi,Ken. Good to hear that all went reasonably well. What about the Cipro? You are aware of the risks, aren't you?

    Hang in, there. Best of health to you.

    Regards, alan86734.

     

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    • Posted

      Yes I have taking them before.  The only thing it did for me is made my prostate smaller.  We will see.  It's only for 7 days.  I have to call made a appointment pelvic place.  This should be interesting.  Thanks again  Ken       

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  • Posted

    Ken,  I keep on warning people in all Forums about Cipro and Floroquinolones:

    The moderator approved a link to it and  Floroquinolones:

    https://patient.info/forums/discuss/fluoroquinolone-toxicity-syndrome-427305

    Google for the makers letter on conditions it should not be prescribed for.

    "Letter from Bayer to Doctors Regarding Cipro and Avelox"

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  • Posted

    Hi Ken - good to hear things went well for you overall.

    Which sphincter muscle is causing you problems - the external one or the internal one? My external sphincter is also very tight due to my BPH and causes me to wait a good minute or more when I CIC until the catheter can get in. I was also told that Kegel exercises which strengthen the external sphincter can make things worse so I am anxious to hear what your new exercises are so I can try it too.

    Also why did he prescribe you CIPRO - for what?

    Good luck Ken!

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    • Posted

      It is the external sphincter.  He said that is is very tight for a my age  I'm 62  I guess he does not see it to much.   We had a laugh.  I told him at lease something is tight and works good.  When I go I will let you know what are the other exercise that I will be doing going to call later.  I told him that I use to do kegel but he said that this is something else.  After a scope they give you a antibiotic but when he was in he saw some scar tissue on the sphincter from when I did CIC a few weeks ago and I did have a lot of bleeding.  There was some in the urine this morning.  He is just playing it safe.  Which is fine.  I don't want to deal with a infection.  Take care  Ken     

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    • Posted

      I know that when the internal sphincter muscle is damaged from many uro procedures like turp, holep .. then it is important to strengthen the external sphincter muscle to control incontinence. Ththese are the kegel routines.

      But we have the opposite problem and need to relax the external sphincter as well as the pelvic floor muscles which grip the top of the prostate. I CIC 4 times a day and the catheter goes in easily for 6 inches till it hits the start of the prostate. Then I jus apply light pressure and repeat "relax, relax" until it opens which takes about 30 seconds. Then the catheter slips in the remaining 6 inches ok.

      In my case part of the problem are the large side lobes of my prostate (no median lobe) which push the urethra closed at the start of the prostate.

      I went to physio once who stuck his finger up my anus to teach me how to control the various pelvic floor muscles. It almost killed me and caused terrible bleeding so don't let anyone do that to you!!

      I'll be anxious how those pills work. Good luck Ken. Howard

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    • Posted

      Yes Howard I will let you know.  My doctor knows how I feel about Turp and Holep.  So this better work because there will be no cutting Yes it's the one before the prostate.  He told me when he put the catheter in when I was asleep he had no problem  But I was out so my body let him do it.  Everything else is fine so this one thing I will deal with.  This may be a little personnel but First let me tell you I try CIC on Monday had no problem pulled up on the penis and it went right in.  It was very easy.  Will I tried it again yesterday to make sure.  I was in so much pain that it got caught.  He said I pushed it into the sphincter.  It hurt a lot.  Well  I was home alone and I use a testosterone gel in the morning my night time I was a little in the mood.  Put some porn on.  Well when my orgasm hit.  I wanted it stop.  I was in so much pain.I could not believe it hurt so bad.  Told my doctor he said it was from the CIC and the pelvic floor.  He said try to hold off for a few days and let him know if the pain goes away.  I have had my doctor for over 3 years and he has only did that once to me.  I will not be doing that.  Don't think that is my thing.  I will let you know how things go buddy  Take care  ken   

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    • Posted

      Hi Ken - I understand what you are saying. Sometimes I also have problems getting the catheter past the external sphincter. Usually it is because of constipation and pushing too hard.

      I have learned when there is pain, really bad pain when the catheter tip hits the  external sphincter then I take out the catheter and DO NOT force it, otherwise there is bleeding and swelling which makes it even worse to CIC the next time.

      Then I take 2 motrin and hold off 12 hours before CICing again. Usually this is all it takes to get back to normal CICing without pain. I can pee on my own ok but my residuals are 200ml usually so I need to empty my bladder often to help restore its muscles (jimjames taught me that).

      So please don't give up on CIC but just don't force it if there is pain and try again later. I find if I wake up in the night then my external sphincter muscles is really relaxed and the catheter works great without pain.

      Also like you if I try CIC soon after ejaculation then forget it - no way to get in. Also if I have been sitting a lot or been stressed.

      Good luck, Howard

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    • Posted

      Hi Ken,  When you were CICing did you use coude catheters?  I had the problem getting them in until I switched to coude and that solved it. Plus I had to switch from speedi-cath to cure as the speedi-cath were way to stiff and caused a bunch of problems.  I had my Urolift done on Tuesday.  Will get this indwelling catheter out on Monday, and hoping I can urinate on my own.  Hope you get that sphincter problem figured out.

      Take care!

      Riggs

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    • Posted

      Hi Hank, I have been using Cure Hydrophillic Coude Catheters, 12fr for several months now and haven't had any problems with insertion, irritation or bleeding. By far the best catheter that I tried and I tried most of them. I finally found a no hassle supply company that I get them from. Other companies spent countless hours trying to get through to to get things changed or ordered, etc.. But the Cure catheters were a blessing. Hope all is well! Riggs

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    • Posted

      I will not give up on CIC but will not do it until I really need it.  Took a couple of the pills today.  Had a good nap.  Just got back from getting my son going to just relax  Take care  Ken 
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    • Posted

      I guess we are all different and have to experiment to find what works best for each of us. I started with Speedicaths 14 coudes but had trouble getting past the start of the prostate. So I tried many others including the Cure ones but they were too flexible and just bunched up. Finally a year ago I went back to the Speedicaths and tried adding some lubricant gel to the catheter package after opening it up half way and waiting a minute (someone here recommended that). Anyway it worked great and I have no trouble slipping past the external sphincter now. Also it helps to relax the pelvic floor muscles which is why it is easier for me to CIC when I wake up at night. Good luck to everyone. Howard
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    • Posted

      Good morning all.  Well it is only been a day that I started the pills.  I do know they make me sleepy.  Got up at 5 AM and 6 am to go to the bathroom also went now.  I don't think there is any change yet but not much pain in the groin.  But still pain in my back.  I will keep you all informed in a few days.  I wish you well and good health to all of you.  God Bless  Ken

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    • Posted

      Hi Jim - I did try the coude speedicath 16s last year but they sure are intimidating - look like a horse catheter. But I am so big at the start of the prostate all it did was cause pain and bleeding.

      I had the same problem with the coude 12s speedicaths but they just bunched up light spaghetti. I have some samples of the new coude Flex 14s but haven't tried it yet. I know these are softer so would they just bunch up as well at the external sphincter? Lately it has been getting much harder for me to get past the external sphincter without pain and bleeding - after 1600 caths I would think it would get easier!

      Are you still catheter free for almost a year now?

      Thanks Jim. Howard

       

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    • Posted

      Hi Howard,

      I've never seen a Speedicath 16, but I can imagine they look intimidating! I mentioned going up a size because that is the protocol when you can't get through. Did you actually try the 16, I wasn't clear on that. And when you say, "external sphincter", I assume you are referring to the region around your prostate and not the sphincter going into your bladder?

      I tend to agree that the Flex 14's are likely to bunch as well, however it is a different coude design, so figured it was worth a shot with little downside. Forgot, have you talked to your uro about this? He might want to scope or do some imaging to see what is going on inside.

      Thanks for asking about my progress. I was off the catheter completely for around six months. That said, I was having some difficulty initiating a void several times a week -- usually at night -- and it just became easier to self cath at those infrequent times rather than walk around for ten minutes while waiting for things to happen naturally. Currently I cath 3-4 times a week, again, almost always at night. The rest of the time my voids come very easy, no hesitancy, and are often in the 300ml range, sometimes even 400ml. My residuals are generally under 100ml, and with a second void can be down to zero, per my home bladder scanner. My IPSS score is in the "mild" range. This compared to cathing 6x/day over three years ago with significant residuals with an IPSS score in the "severe" range. I doubt if I could have gotten a better result from any surgical procedure, and actually those were the thoughts of my urologist! Not saying everyone will get these results from CIC alone, but any progress is progress. Like anything else, it's risk versus rewards, and with CIC, that means matching it up with the risks and rewards of a potential surgery. I believe CIC has been inadvertently (or possibly intentionally) stigmatized by most of the medical community, and this is unfortunate because in many cases it does make more sense than surgery. But if you think about it, what is more natural -- CIC or roto rooting your prostate?

      Jim

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    • Posted

      Thanks Jim - you have always been my role model for CIC ( as a lurker!). I am referring to the external sphincter muscle which is why I am interested in Ken's results here. I did try the 16 once and while it went down the urethra ok to the start of the prostate it hit a brick wall at that point and I hit a blood gusher coming out the cap!

      I did write my urologist about this new problem. It is very weird. For example, last night at 11pm I had a good NV (250ml) but then when I cathed right afterwards as usual, when I hit the external sphincter there was a severe pain on the left side and the catheter filled up half way with blood. So I aborted it,took 2 Motrin and went to bed. Then I was awakened at 2 am with a lot of bladder pressure and w/o doing an NV I went straight to CIC and all went well w/o any pain or bleeding. I took out 600ml and went back to bed and slept to 7 am when I tried to CIC again right after a pee and poop and the same problem occurred again. Weird, Now I am NVing about 200ml every hour and will give the prostate a rest.

      I forget about your own situation. Did you actually have a urinary obstruction like BPH or was your bladder flaccid due to other reasons so you were able to rejuvenate it and strengthen the bladder muscles over time with CIC?

      Thanks again as always. I should put this post in your CIC thread but it is relevant to Ken's drug if it helps relax the external sphincter muscles. Howard

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    • Posted

      Hi Howard,

      Like I suggested to Ken, probably a good idea to have your uro look inside and possibly some imaging. Preferably someone experienced with CIC, as unfortunately not all uro's are.

      It sounds like your bladder is alerting you by 600ml, however yo do have to be careful if you're going to "give the prostate a rest" that you don't over expand your bladder. If your uro is close by, you could ask for some additional bladder scans while giving things a rest, or you might be a good candidate for a home bladder scanner if you don't mind spending a few bucks.

      As far as relaxing the sphincters go, you could try relaxation exercises but the question is whether it's the external sphincter or an inflamed/expanded prostate. There are also some meds that might help such as Daily CIalis. A low tech sitz (hot water) bath is also worth a try.

      Yes, my flaccid bladder was secondary to an obstructive prostate, which is the usual case, but not always. My PVRs gradually increased throughout the years until I was unable to void without using my hands (crede technique) to help the bladder along. In addition, I think years of "holding it in", be it during sporting or social events, or just logistics, probably didn't help either. What the CIC did for me was first to decompress the bladder to give it some time to heal and regain elasticity. So later on -- and it took a few years -- it was able to overcome whatever resistance the obstructive prostate was causing. I have also learned to relax more during the void process and try and go when nature calls.

      Jim

      Jim

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    • Posted

      Thanks Jim. Is there a preference for a flexible cystoscope over a rigid one? I think my uro has a rigid one.

      Do you think your prostate has grown over the years or do you follow a diet low in growth hormones (dairy; red meat).

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    • Posted

      @Howard: I think my uro has a rigid one.

      -------------

      Run!!! Not kidding! Is he over 60? Some of the older uro's still use the rigid. And while it has a place when certain instrumentation is used, for the most part you want a flexible scope. A rigid is much more invasive and will require twilight sedation unless he is a sadist, like an older uro I had over twenty years ago. But seriously, ask in advance if he uses a flex or a rigid. If it's a rigid, I would look elsewhere. In fact, that's what I did when a recent Uro (he was in his 60's) suggested a rigid cystoscopy for bladder cancer screening. I found a younger uro who used a flex and didn't understand why the older uro felt a rigid was necessary.

      I haven't had my prostate measured for several years now but it did grow over the years. Keep in mind that prostate size and bph symptoms do not necessarily correlate as some men have few symptoms with a large prostate and some many with a smaller one. The shape of the prostate as well the health of the bladder also contribute.

      My diet varies but is very low in red meat. Mostly fish and white meat chicken or turkey for animal protein. Not sure how much of a difference that has made with my prostate but hopefully it makes a difference with my cardio system.

      Jim

      Jim

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    • Posted

      Thanks Jim - I will definitely follow your advice on the scope.

      My uro just responded to my email about my cathing problem and he said I probably damaged my urethra and should have an indwelling put in for 2 weeks! That doesn't make sense as I pass through the urethra fine - it is only when I hit the top of the prostate that I start to have problems.

      Anyway I took some motrin and will go to bed - hopefully I can cath ok when awakened during the night when my sphincters and pelvic floor muscles are relaxed. I actually miss cathing during the day and that nice empty feeling afterwards.

      Apologies to everyone here as this should be on Jim's CIC thread.

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    • Posted

      Howard,

      He may be right or not. Could be stricture or false passage, but again there are ways to find out. Diagnosis before doing the scope and/or imaging is putting the cart before the horse but doc's do that all the time.

      Jim

      Jim

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    • Posted

      Howard Jim is right they all ways want to go forward with procedures that are not needed.  I don't know if this will work but the Monday before I went to see the my doctor I self cath and it went right though with no problem.  When I put the catheter in I pulled my penis forward and it passed everything right into the bladder.  But on Wednesday when I tried it again I hit the sphincter wall.  That is what my doctor told me on Thursday.  I think the reason you don't have to much of a problem at night is your more relaxed.  Try not to do the 2 weeks of the catheter.  UTI are a pain.  Just do what you think is right for you/  Good luck  Ken    

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    • Posted

      Howard, yes, if you are constipated then all bets are off, and anything can happen. I found out that when I am constipated, all BPH symptoms are worse, and cathing became more difficult. Hank
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    • Posted

      " When I put the catheter in I pulled my penis forward .."

      Ken, I found out that first pulling the penis UPWARD makes CIC easier. After you think that the catheter had passed the external sphincter, then you can point it forward, aiming for the toilet or a receptacle. Hank

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    • Posted

      I would say that, yes, pulling penis upward to start, however I find that changing the angle (head twd opposite wall) just *prior* to prostate/external sphincter helps move it around. For me it's not two positions but a gradual movement with a bit of "feel" involved as the catheter passes through.

      Jim

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    • Posted

      Howard,

      If I don't trust your urologist's guess, it would be remiss for me to have you trust my guess. Between a scope and imaging, you should find some answers. How much confidence do you have in this particular uro? If not enough, then you might seek a second opinion on this.

      Jim

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    • Posted

      I trust your "guess" infinitely more than any uro I have known because you have lived through this disease and share your knowledge without making millions of dollars from it!

      I do not trust this uro and have made another appointment with a new uro (my 5th) to review my situation. I wish you had your own practice!! Thanks Jim. Howard

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    • Posted

      Good evening Howard.  I am on 10 MG 3 times a day.  The only side effect I see is that it makes me tired.  I can live with it if that is all it is.  I take one when I get up one in the afternoon.  And one before I go to bed. I feel like it is working.  When I pee now I don'y have a feeling that I have to go again 10 minutes later.  I think that is good because I will not have any surgery.  Be well  Ken  

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    • Posted

      Howard,

      I've been taking magnesium citrate lately for matters unrelated to the prostate, but one of the by products is that it softens your stool, if that is an issue with you.

      Jim

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    • Posted

      Hi Howard, if you have BPH, don't ever be constipated. 😀 Jim suggested Magnesium Citrate. That would work. I try to eat lots of fruits and vegetables, and with more fiber food. I also take some Magnesium Oxide with every main meal, which is cheaper than Citrate, and has less elemental magnesium, so your body can tolerate higher doses.

      You can also try some other stool softeners. Hank

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    • Posted

      Howard and Hank,

      As mentioned, I didn't take Magnesium Citrate for constipation, but stool softening just happens to be a side effect of a mineral that many of us are deficient in, and can be beneficial for many things such as heart rhythm and blood pressure regulation.

      I started with 250mg a day and then upped to 500mg. Most would suggest taking the 500mg in two separate doses for better absorption. Also, as Hank suggests, you want to start with smaller because the stool softening effect might be more than you want. This gives you a heads up as well as your body to adjust.

      Jim

       

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    • Posted

      I just picked up some more tonight as well! Each of my capsules is 125mg. Just start with a lower dose and work up after seeing how your stools react. I'm currently on 500mg a day (two doses of 250mg) but I started with 250mg/day. You could even start with 125mg if you wanted to play it conservative.

      Jim

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    • Posted

      I am currently taking 500mg Magnesium Oxide with breakfast (my main meal), 250mg MO with dinner, and 250mg Magnesium Citrate before bedtime. I really think that if one can manage his constipation, he should be able to scale down his BPH meds and/or postpone surgeries. Hank
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    • Posted

      Again, too much magnesium maybe unsafe. Therefore most of my magnesium intake is magnesium oxide which has very poor absorption, not very good as a supplement but very good as a stool softener. Hank
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    • Posted

      That is a very hopeful message Hank - thanks for that. I will get some magnesium oxide too and experiment with both. Thanks guys! I just want to be able to do my cathing again 4 times/day without pain like I used to before this constipation started. I've fitted CIC nicely into my lifestyle over the past 2 years and can manage it ok - it keeps us from surgery!! Howard

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    • Posted

      Howard, if you can control your constipation, you might be able to reduce your cathing frequency as well, because your PVR will be lower due to less obstruction. It is what I am doing, once a day before bedtime. When I was badly constipated, I felt like I had to cath every hour. Wish you the best. Hank
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