TURP! . . (excuse me)

Just background information:

The human nose and ears continue growing during a life time and so does the lowly prostate glade.  In older men, the prostate becomes so large that it strangles the urethra and make voiding Impossible.  This enlarged prostate condition is called BPH or Benign Prostate Hyperplasia.  One solution to this problem is to insert a Foley in-dwelling catheter and attached to a drainage bag which can be emptied daily.

(see pictures below) This is a drawing of the catheter (the inflatable balloon is inflated with a liquid and syringe) and the drainage bag with hose reaches down to the floor.  My wife fashioned a cloth bag which I could hang from my neck, but I didn’t go out much and standing in front of class of kids was out of the question. 

I wore a catheter for almost four months in the vain hope that drugs prescribed would kick in and I would be able to void normally, but that never happened.  I tried to make the best of it by saying it’s an outside purse when Thais looked at me or even holding the bag up and asking, “You want some chicken soup?”  With the catheter I had no pain or problems - it was just an esthetic and life style altering problem.  Inserting a catheter (and I had this done probably six times) was always painful enough to bring tears to my eyes, but the procedure done by nurses was short and once in caused no pain at all.

Prostate cancer is the third leading cause of death in men (females do not have prostate glands) behind lung and colorectal cancer.  I have had one friend die from prostate cancer and know two others who have been diagnosed with the disease.  If what I write below seems to make light of prostate cancer, nothing could be further from the truth.

TURP or transurethral resection of the prostate is the procedure I had on April 24 and I will describe a little in my personal experience.

BPH is not prostate cancer.

I had the procedure done at Rhuampath [Doctors Hospital] in Chainat, Thailand.  It is a small private hospital about a half hour drive from my house.  I give my overall experience an 8 out of 10 and most of the downside is because virtually no one in the hospital speaks English – or even cares to try and speak any language other than Thai.

My story begins here:

TURP . . . (excuse me)

“All men who enter here abandon your sense of personal dignity”  - a saying that should be posted over all urologists’ doors.

Early in April, before the Thai holiday Songkhran, I had images taken of my swollen prostate gland.  There are 74 provinces in Thailand and I am a big fan of Thai regional government hospitals.  These small hospitals take care of 85 – 90% of aliments (basically for free), but if you need a gastroenterologist or an urologist or other specialist you get referred to the province’s main hospital.  I have been in the main hospital in Chainat, Nakhonsawan and Phitsanulok provinces looking for an appointment with an urologist and/or gastroenterologist and never made connections. So I went to a small – for profit – hospital about a half hour from my house.

The imaging of my prostate was not a cake walk, but the procedure did not take long.  There were three nurses (one just to pin my arms in back of my head) in the operating room plus the urologist Dr. Pichit.  Cystoscopy has been around since the mid-1800 but advancements in lighting and conveying images got a lot better with fiber optics around the late 1960s.  (You can search Development of the Modern Cystoscope: An Illustrated History if you want a pictorial history of this device/procedure) 

Now, images are captured on cell phones.  Dr. Pichit showed my wife (but not to me) his cell phone images and explained to her using his index finger and thumb how my prostrate had closed off my urethra by pressing his thumb against his index finger. I would have liked to talk to the doctor myself, but he speaks no English and my Thai is rudimentary at best.  Something often gets lost in translation with my wife, too.  Asking her a simple question can set off a side trip into why-you-want-to-know-that land. So she set an appointment after Songkhran for the TURP procedure and told me this sometime later.

I arrived on 4/24/2017 at 9 am.  I donned the patient gown and had blood taken, an IV started, an EKG and chest x-ray performed while lying on a gurney.  For the next three days I would be lying down shifting only from gurney to bed.  I met with an internist (who actually spoke some English) who cleared me for surgery, crossing himself as he did (I’m joking, you knew that right?)

We went by elevator to a second floor room where I sidled from gurney to bed.  Hospital elevators are different than regular elevators.  Not only are they deeper to allow for gurneys, but they move imperceptivity without any jerks or noise.  I was thinking this when I noticed my wife (I often call her Chunky-in-charge) had disappeared.

Although I would not be allowed up for three days (you might have put me in a closet because I wasn’t getting out of bed), the room was too small for her liking.  She was upstairs checking out the Deluxe rooms, still too small, before settling on the only VIP room.  She did this because she expected to stay with me with at least two of her daughters. So I sidled onto a gurney and up to the third floor. The room was spacious, well-appointed and probably could have slept five or more family members.  But let me make this clear:  I do not consider myself to be a VIP person, nor was I going to get off my bed, so . . . . But I suppose if you divided the number of people staying in the room by the extra cost, it was a deal.

I want to say something about the six-way power hospital bed.  My father’s 1956 Cadillac had six-way power seats, but I have never owned a car with power seats. Strangely enough given the bed’s raising, lowering combinations I could never get comfortable.  I think I’ve seen a Mr. Bean sketch where he gets compressed like an accordion in one of these beds.  Still, they are really a step up from the rock hard, gurney like beds I’ve been on.  My bed in the government hospital in Phitsanulok was a piece of plywood in a hall.

I was told I would have the TURP surgery in the evening. In fact, I was shipped up to the operating room at 4 PM.  Thai people may say things differently from one town to the next, but 4 pm is not the evening in English.  No matter.

I was whisked over an open walkway called the Sky Walk to the operating room.  There were four nurses and Dr. Pichit ready for me there.  I had little time to take note save for thinking the anesthesiologist looked like Edith Bunker in a snood. She had one word of English which was sleep – which there is no fighting it – so I did.

If you want more (almost too much) information on this procedure you can search this by ctrl and click below (The site is for medical professionals, so I can’t put the url here.)

Transurethral Resection of the Prostate 

If you are a candidate for this procedure, you might want to skip the videos – really.

I was out for about two hours.  Dr. Pichit told Chunky that the actual procedure takes about a half hour.  The doctor cuts off bits of the prostate and forces the tissue up into the bladder. The rest of the time is in irrigating the bladder to remove the tissue.  This irrigation process will go on for the next two to three days.  Prior to going to surgery, a nurse shaved my right thigh which is where the drainage catheter (one tube for clear saline to go in and one for blood and guts to come out) would be taped.  The catheter is taut and in a straight line which means if you even raise your right knee you will get an oowie pain similar to getting your dick (Johnson or willy for sensitive viewers) caught in a zipper.

As I was coming too and shivering from the anesthesia I was then taken on a gurney to ICU.

My wife came in and announced she was leaving.  I considered what she meant by this, but I was groggy and limply waved good bye.

At this time I had a bottle (the first of 13) of irrigation fluid going into my bladder and the drainage catheter coming out.  I also had two IV bottles (big and little) going into my right arm.  Periodically, I would get injections through a neat fire hydrant apparatus with a couple of outlets.  Hypodermic needles are passé and virtually all drugs enter the body through the IV.  We can be thankful for that.

In my time in ICU, I felt as if I was voiding Bobbie pins and I think I saw one fake eye lash courtesy of the operating staff (I’m joking).  But over time the color of the drainage bag went from tomato red, to strawberry red, to a rose wine.  When the bag turns golden (Gold is the urologist most perfect hue) you can leave.

After twelve hours in ICU I went to my VIP room.  My time here, flat on my back, was not fun.  At the end of my ICU stay a nurse said I could have a full breakfast.  This turned out to be a bowl of boiled rice and a small carton of soy milk.  When I made it known that I wanted neither, Chunky made a trip to a 7-Eleven store and bought 700 baht worth of junk food.  This would keep me and the girls alive for the next three days.

The girls all have smart phones.  They never talk to me and rarely to each other.  When I asked for water, one of them, without looking up, pointed to the counter beyond my each.  Great!  They only stopped watching individual programs when a favorite Thai program (no English, thank you) came on the TV.  I call this show the Marx brothers do Gilbert and Sullivan.  Five middle aged men, at least two in drag, do pratfalls and make jokes which they laugh at with the audience.  Then, one of them will start singing (Wtf).  The Thais think this is funny, but I have no idea why. I’d like to say there is no accounting for taste, but that’s not strong enough.

I also had to watch some terrible movies.  One set entirely in an eastern European train yard had Matrix-like bad guys all dressed the same in dark glasses and black trench coats.  In 90 minutes more ammunition was expended here than the Germans spent on the siege of Leningrad.  Another movie had a group of five mountain climbers in some scary scenes.  Then, these people were in tunnels, then one got his foot caught in a bear trap (no bear ever appeared), then the five were slowly killed off by a grubby looking teenage character.  If Aristotle who once asked which do you prefer probably improbabilities or improbable probabilities had been in the room with me he would have cried out “For the love of Zeus” and left in five minutes.  Unfortunately, caught in a spider’s web of IV and catheter tubes, I was going nowhere.  The bed was also too far away for the remote to work, too.  Sigh.

Dr. Pichit was off on Wednesday (does this sound like the US), but on Thursday he suggested I stay on more night.  I could get up and walk a little.  I got some contradictory advice on whether I could use the toilet or had to go in the bed pan or pampers.  Chunky didn’t want me to get up.  Her eyes narrowed and said you want blood clot?  You want to have surgery again?  Finally, I just got up.  I could have used help, but got none.

The IV and irrigation bottles ended during the night.  Only the little plastic fire hydrant remained for drugs.

On Friday morning around 6 am a nurse came in and unceremoniously (without telling me what she was doing) removed the drainage catheter (a minor oowie).  A final meeting with Dr. Pichit and the chief nurse around 10 am and we could go home.  Chunky and the girls had brought in so much junk a shopping cart had to be brought in for all the junk.  My Bermuda shorts had disappeared and I had to leave in my black boxers.  My flip flops had been left in the emergency room on Monday, too, but a hospital employee found them.

My Bottom Line  

It took three hours for my bladder to get back on track.  In six hours I was voiding, without pain or burning, in a pretty normal manner.  Twenty-four hours later I am voiding almost normally.  I am very pleased with the results.

The total for the procedure and hospital stay (remember the VIP room) came to $1,700.  The average cost of the procedure in the US is around $10 K (and can be as high as $20 K).  The average cost in a western hospital in Bangkok that specializes in Medical Tourism is around $4K.

The largest expense in the $1700 bill was drugs (all those IV and drainage bottles, antibiotics, miscellaneous other drugs and take home drugs) ran up the total.  One nurse was giving me an injection once and when I asked her what it was for. She said peptic ulcer.  I don’t believe I have a peptic ulcer.  I also got a shot of morphine in the ICU.  The night nurse asked me several times if I wanted it, so I finally broke down and said sure.

The $1,700 also included a fee for a cancer biopsy.  I should have had this first, but I couldn’t make connections at the government hospital.  Perhaps because I was old and my PSA (the indicator of prostate cancer) wasn’t particularly high the two doctors I saw didn’t want to do the biopsy.  Being a government hospital, there may have been a long waiting list, too . . . I don’t know.  I should know in two weeks if my prostate (what’s left of it) is cancerous or not.  I will keep you posted.

All of this went on my Visa Card which is just about tapped out.  I think if I make the minimum payments by the time I get it paid off the (Elon) Musketeers should be playing AA ball on Mars.  Sigh.

A year and a half ago I thought I was dying.  I was being kicked out of a government hospital and Chunky got my oldest son on her smart phone.  I had lost 30 pounds and was very weak.  I couldn’t walk by myself and was not very coherent.  Andy started a GoFundMe campaign and twenty or so people made some very generous contributions.  Today, I am dribbling and whizzing around and feel capable of work, but my financial situation is still sketchy. 

If anyone has an idea on how I could make money, (maybe there is a new pet rock fad sweeping America that might catch on here or knows of a sponsor for my teaching) I’d love to hear it.  In the meantime if you’d like to make a small contribution, I’ll post my

paypal.me/PoetryfromThailand  link. 

Better yet come to Thailand.  I saw an airfare from LAX under $600 which is half price.  There is yet another spa/motel/restaurant going in near my house.  We could whiz around and have some fun on the cheap.

FG       4/29/2017