PAE w/ Dr. Bagla 9 Days Ago (Nov 2019)
Posted , 16 users are following.
I used the experiences a several men who posted on this site to make my eventual decision to have PAE done and have Dr. Bagla do it . I thought I would recount my experience in hopes it might help someone else.
I am 55 y.o. and I've had gradually worsening BPH symptoms since my early to mid-forties. While I was never in as bad shape symptom-wise as many stories I read here, it affected my quality of life and I wanted something done. For instance, I could always urinate on my own, never had to cath, I just had a weak stream and a frequent urge to go. Sometimes when I hit that bathroom, I would pee out literally a couple of cc's of urine and that was it. Other times, it was a "normal" amount. I could never tell how full the bladder was based upon how the urge felt.
I highly endorse Dr. Bagla. Professional, courteous, competent. The staff is efficient and competent. Like another post I recently read, I really felt like I was in good hands.
Because of my height (5' 10"), Dr. Bagla gave me a choice of having the catheter inserted in my wrist versus my groin. He said it made zero difference to him in terms of difficulty or effectiveness. But the benefit to me was a better recovery. Less restrictions on walking post-procedure. I chose the wrist. Side note: I was at the upper end of the height range to choose the wrist because of the length of catheters available.
Day 1, I walked out of the office and felt more normal, not groggy or drugged, than I have with any other surgical procedure. They use a 'twilight' sedation versus a general anesthetic. Didn't feel much, if anything, day one except I was winded, out of breath, walking back to the hotel after dinner. I had to stop 3 times to catch my breath.
Day 2, I began to notice my urine stream was noticeably stronger. Not working with high pressure yet, but definitely an improvement.
Days 3 and 4 were the worst, recovery-wise. I had an unrelenting urge to pee, even if there wasn't anything in my bladder. It was worse sitting than standing. So, I stood for 3 - 4 hours in the airport waiting for my flight. I ran out of pain meds for the urination Day 4 (Sunday) and had to suck it up until Monday to get another Rx. This was the worst of it for me. In hindsight, it was not that bad. I may have had a little blood in my urine initially but it's hard to say because the pain meds turn your urine a deep orange-ish yellow.
I am now 9 days post procedure and I feel normal. Stopped taking the pain meds day 6 though I could have done without starting day 5. My stream is stronger but I still get up at night a couple of times to pee. I do believe I evacuate more urine from my bladder during the day so that is an improvement.
Why I chose PAE: Every other procedure I read about mutilates the prostate and requires a catheter. No thanks.
Also, I may change urologists. My former urologist retired so they assigned me to a different doc in the practice. He's really young. Probably a smart, knowledgeable guy. But he was really negative on the PAE. He really tried to persuade me not to have it done. He kept pitching Rezume. My assumption is he pitched PAE as a negative because he couldn't do the procedure and make a buck off of it, not because it was best for me or what I wanted. Being more charitable, maybe he's just not knowledgeable about PAE? I don't know which it is, but I don't think my well being and my wishes were upper most in his mind. He would have happily mutilated my prostate with a laser if was willing. Again, no thanks.
I am happy to update this as I put more time post-procedure behind me. Also willing to answer any questions.
Mark
0 likes, 60 replies
Marty02 mark770
Posted
I had PAE several years ago. It is a wonderful procedure. Gave me 50% improvement in terms of nocturnal urgency problems, but not enough to make me stop looking for bathrooms wherever I went. Unfortunately, my large median lobe was the culprit. PAE is not always effective on median lobes.
HOWEVER, there is a new surgical procedure called Aquablation. I had it done at Winthrop Hospital in New York ten days ago by Dr Chris DiBlasio. I am already feeling the benefits of a normal happy bladder. i can empty, have a strong stream and go for three to six hours between feeling any need to urinate. Still a trickle of blood comes out once in a while, so I am still healing. Its only been ten days!
Aquablation uses high velocity saline water jets to remove prostate tissue with the "Aquabeam" robot. No heat, vapor, laser, etc. Same outcome as TURP without sexual side effects or long recovery. Yes, the catheter was uncomfortable but mine was removed the day following the procedure prior to hospital discharge, although I was told prior to admission that I should anticipate having a catheter for two days after surgery.
My advice: no large median lobe, do PAE first; otherwise do Aquablation. Google it!
dantec Marty02
Posted
I also consulted with Chris Diblasio a few months ago and I am scheduled to see him again this thursday. We discussed both Holep and Aquablation but he felt Holep would be better for me because I have also been suffering from chronic prostatitis for 25 years. He has had good success using Holep in this case because he found large amounts of calcium deposits in and around the ejaculatory ducts while doing the procedure in many chronic prostatitis patients sufferers and by aggressively removing the tissue in that area the patients got substantial symptom relief. Apparently he feels he would not be able to achieve the same result with aquablation.
He did say that Holep pretty much guarantees RE, while aquablation does not.
We did not discuss cost but it is my understanding that medicare and most other insurances won't cover aquablation. Did you pay for it out of pocket? If so can you tell me the cost. PM me if you want to. Also, did insurance cover anything, i.e. the hospital portion of the bill?
dale75649 dantec
Posted
Before my PAE, I tried palmetto and Chinese medicines, but wasn't able to see (or feel) any improvement. Post PAE, it seems to make a difference for me. Saw Palmetto contains a variety of chemical compounds, one of these compounds was developed as a drug used in Western medicine. When I try substances, whether herbal or prescription, I like to experiment if practical. I switched between prescribed drugs multiple times trying to figure out which symptoms improved, and which were side effects of the drugs themselves.
gene97713 dale75649
Posted
Dale,
where is that information that Saw Palmetto is used in Western prescription medicines comes from, rather than hearsay?
Here is the latest from the Web:
"Saw palmetto has been used to treat symptoms of enlarged prostate (benign prostatic hypertrophy, or BPH), such as increased night-time urination or decreased urinary flow. ... Saw palmetto should not be used in place of medication prescribed for you by your doctor. Saw palmetto is often sold as an herbal supplement."
No mention of official pharmaceuticals using it in medicines. Study after study showed that it's very close to placebo for BPH. Improves urinary flow and decreases inflammation in some.
In my view and vast experience, official alpha-blockers (if chosen correctly) have less side effects and are much more effective than herbal supplements.
Anybody can claim otherwise?
Marty02 dantec
Posted
Dr DiBlasio walks on water, in my book. I feel you are in good hands. My information is he uses HoLep as necessary and is one of the best HoLep doctors out there.
My insurance is BCBS and they pre-authed Aquablation (after some back and forth). Too soon to say I DIDNT get a surprise bill.
Best of luck!
derek76 gene97713
Posted
What side effects did you have ?
derek76 gene97713
Posted
Many German doctors prescribe Saw Palmetto according to posters in the past. Others have used beta sitosterol with good effect. There is a very small amount of beta sitosterol in saw palmetto.
gene97713 derek76
Posted
The data is outdated. Numerous study showed that Saw Palmetto is a good as listening to music for your BPH. Tried Beta sitosterol, from online store. Haven't seen any results. The warning is: don't use it longer than 1 month, Can cause impotence. Sterols are good for your cholesterol but there is no proof they shrink the prostate. It's rather the opposite. Beta Sitosterol increases the amount of estrogen in man's body, which according to modern theories caused the growth of the prostate adenomatous tissue. It lowers testosterone . Modern theory suggests that BPH develops in men with rather lower testosterone levels than high levels. Beta sitosterol in amounts of 1-3 g is present in margarine an yougurts. No need in supplements if you consume these products
It's known to cause impotence in some patients. Below is an excerpt from a clinical study. Probably one of the "good" ones. Lowers LDL by 20 mg/dL particularly in older adults, but has side effects. All natural additives that work, have side effect and are not necessarily better than specially developed drugs. Just a huge cash cow for a suppliers, which are not regulated or checked for quality and substance
On the basis of extensive safety evaluation studies, the plant sterols are generally recognized as safe (GRAS) when consumed in margarine at the recommended doses. However, a review of the literature suggests that beta-sitosterol may cause GI adverse effects as well as impotence.27 In 1 study, adverse reactions deemed related to beta-sitosterol use were flatulence, discoloration of the feces, appetite changes, dyspepsia, leg cramps, skin rash, and leukopenia.7 In rats, a decrease in testicular weight and sperm concentration occurred with prolonged treatment at a low dose (0.5 mg/kg) of beta-sitosterol. Antifertility effects were noted at a higher dose (5 mg/kg).7 In a study of rats, administration of a phytosterol diet for 5 weeks resulted in increases in systolic and diastolic blood pressure values.28, 29 A 1-year study in healthy patients consuming 1.6 g/day of plant sterols contained in a dietary spread demonstrated cholesterol-lowering effects as well as general tolerability with long-term consumption.30 Increased concentrations of phytosterols in erythrocyte membranes may result in increased fragility; episodes of hemolysis have been reported, but these adverse reactions occurred in patients with sitosterolemia.31 Despite no evidence of harm with beta-sitosterol use, hydrogenation into transfatty acids does occur with margarine ingestion. Therefore, margarine cannot be recommended as the sole therapeutic option in the diseases mentioned in this monograph.
derek76 gene97713
Posted
Have you read saw palmetto from the full wiki . Much of what you say in it.
gene97713 derek76
Posted
of course
Marty02 dantec
Posted
Clarification to my comments: Aquablation promises the same outcome as TURP with far less incidence of sexual side effects when compared to TURP, it does not - to my knowledge - fully eliminate the possibility of sexual side effects Although my experience has been positive, readers should ask their doctor about this procedure and PAE. (Why is there no way to edit your own post here?)
dantec Marty02
Posted
I am scheduled to have Holep with Diblasio in January. He felt that because my main complaint is chronic prostatitis in addition to bph, Holep is a better option because he has more control over getting at the parts of the prostate that could contribute to the pain. What kind of anesthesia did you use?
Marty02 dantec
Posted
Nerve block for lower body plus propofol for sleep (and enjoyment). No general anesthesia needed.
doug04815 mark770
Posted
Mark, did your insurance cover the procedure? At 55 I know that you are not using Medicare. Maybe someone else knows if Medicare covers PAE.
alex23431 doug04815
Posted
it does. i had PAE in Kaiser. I payed 10 $ for everything. it was done through wrist.
mark770 doug04815
Posted
Doug,
Yes, I have Blue Cross for Federal Employees and they pre-approved it. Cross your fingers. I'm also one of those you hear about in the news who were the recipients of so-called 'surprise medical billing.' Nothing to do with this procedure. But I'm always wary of what can go wrong with U.S. healthcare insurance billing. Cautiously optimistic it will be paid by BCBS with no surprises.
Two side notes: I had a different federal employee plan a couple of years ago. That plan denied pre-auth for PAE so I had to wait until open season and switch to BCBS, then submit again for pre-auth. I had no guarantee it would work but my strategy was based upon the knowledgeable billing folks in Dr. B's office.
Off topic. My son was hit in the face with a baseball. I took him to the ER. Thankfully, nothing was broken. But from the looks of it, I thought surely something was fractured. Anyway, the BCBS paid the ER visit w/ no out of pocket to me. It was really an ER type of injury. But, the doctor was not in-network for BCBS. I paid his $600 bill entirely out of my pocket. At that rate, based upon the time he spent with my son, he makes about $2400 / hour. Good work if you can get it. But it's also bullshyt. Something like that shouldn't be allowed to happen. Hope Congress does something.
doug04815 alex23431
Posted
Thanks Alex and Mark for your replies. Alex, did Bagla do your PAE?
gene97713 mark770
Posted
In order for Congress to vote, firstly we have to vote. My bills for PAE from UCSD clinic for 2 hrs in X-Ray room, including doctor's fees of $40K were $110K. At the time I was covered by three different insurances. The still argue who is supposed to pay the bills. Because it was a clinical study, I believe that bills were eventually forgiven due to the time elapsed but could be sent for collection as well. I was told in advance that the max out of pocket could be $5000-6000. One of my insurances was Medicare + Medigap. The don't do any preauthorization. Was no way to know. Nobody was able or willing to answer the billing questions. I couldn't wait any more and decided to take my risks. Very few insurances cover PAE, but you were lucky with BCBS. Medicare and FDA approved PAE in June 2018 as a legitimate health care procedure and should pay for it.
alex23431 doug04815
Posted
no, it was done by Dr. Kotton in Kaiser in Oakland.