Second post : first problem.

For the second post in my ‘live’ series where we get to talk mainly about health related stuff we are going into ‘bloke-space’ and i’m going to do my absolute best to be funny, peurile and serious all at the same time.  To set the right mood take a look at the short ‘angry kid’ video….the series is really very funny especially if you have ever been slightly amused by anything like the Python’s, the Young Ones……even the Carry-On’s.

In real time i am now about 10 days post-op, iv’e had some rough days especially after nights when i just haven’t been able to get much sleep.  Not so much that the knee is painful but it’s now settling to a deep and uncomfortable ache and i am trying not to take any non-steroidals while i am also on anti-coagulants.  My new routine seems to be that i need an additional burst of sleep or rest/elevate leg in the morning, try and write up intil mid-day and then go out for a while.  The blog post routine that i am working on is to do one update and health related post each monday, an ocean ‘navel gazing’ (thanks ted) post mid week and then a boats, nuts-n-bolts post on the friday.

Meanwhile please be upstanding for my new blog character…..Angry kid.

Yes guys…..today it’s willies, wee-wee and prostates.  If that grosses you out i might finish the post by talking about something nice and boat-y.

In the first post of this series i just touched on the experience of being a 60 year old patient and the ‘young guy’ in a bay of 4 men.  We each had some lesser or greater degree of difficulty having a wee after our surgery.  I solved my problem by doing what i wasn’t supposed to (without supervision) and got myself up and standing….it was a nice ‘relief’ to get off my bum, get my surgical gown off, get my own clothes on and yes….empty a very full bladder.  Much more and i would have probably developed a problem technically called urinary retention or in bloke-speak…..can’t wee.    In this post i am going to talk all about that, a bit technical at times and hopefully a bit entertaining as well.

First though i am going to dial back a few years and then a few months so that you can get this in context.  I don’t have a fully ordinary urinary tract because my one has been operated on a couple of times in my twenties and forties.  There’s no real need to go into the details today except that the aftermath of my surgery results in not quite normal function and responses to everyday problems.  One of those problems is that in my job i just don’t drink enough water, but too much coffee, get dehydrated and typically get a bit of what is called urgency and frequency……once again in bloke-speak : i often need to go NOW , don’t pass very much and that can be a bit on the strong side (too much coffee). Most recently that small group of everyday problems masked the fact that i had a stonking UTI (urinary tract infection) and that only got picked up during the pre-operative checks at the hospital.     What was then quite funny from my perspective is that they were trying to contact me and i of course was at sea with Inanda and for all of the working day un-contactable.   My sailing hours are ‘start early and finish very late’ and of course the pre-op clinic hours are very much 9-4.  When we did finally both manage to be in time and range their information was quite a surprise as normally men will certainly be aware that such a problem is happening….possibly i just wasn’t paying quite enough attention.    Not a big problem though and a quick chat with my lovely GP followed up with a urine sample sent off to the lab resulted in a week of antibiotics and end of problem.

So anyway…..operation day.   Most of you will be aware that surgery of just about any kind is done with some degree of anaesthesia and that of course means that anaesthetists are involved.  I have spent the greater part of my clinical career working directly with anaesthetists because, up until recently, they were the guys that ran intensive care units and that’s where i worked mostly .     Most of you will also probably be aware of the general idea ‘general anaesthetic’ which in bloke-speak means being knocked-out (medically) for a procedure.  I won’t go too far into that because it’s a complex subject but just to say that often nowadays a ‘GA’ (general anaesthetic) isn’t how things are done because other techniques are safer.   In our department for example we do a lot of our procedures with either light (awake) sedation or local anaesthetic which is broadly similar to a dental anaesthetic.  A lot of joint surgery is now done with a completely different technique which is a combination of sedation (nicely asleep) and a spinal aneasthetic….that’s how it was done in my case.  I’m very familiar with anaesthetists, anaesthetic rooms and so on and this time completely fascinated to see what the process of spinal anaesthesia would be like because it’s one thing i’ve never experienced or even seen done.   The basic idea is to inject a local anaesthetic into the epidural space and , once again in bloke-speak, that’s the fluid space that surrounds the spinal cord.  The idea is to completely numb the spinal nerves that serve all the area below the waist.  From my perspective, sat up on the anaesthetic couch it was quickly, neatly and painlessly done and within seconds i lost all feeling, first in the toes of one foot, then my bum and then pretty much everything else.   At that point i remember being laid flat pretty quickly because what happens with the spinal aneasthetic is that you then lose all power and sensation so there’s a very good chance of simply toppling over.   After that i distinctly remember watching my legs being moved around but with zero sensation, then being definitely ‘happy’ when the first sedation hit the spot (like a triple Mount Gay rum and coke)…..after that it was being moved into the operating theatre, being checked in, saying hello to the surgical team in their space-suit like rig and then……goodnight…..

Cue fantasy boat/ dream boat…sadly not but hey !

001

So….fast forward a couple of hours later.

For some degree of brevity i will skip the next bit , waking up at the end of surgery, going into the recovery area and chatting with the recovery staff and then being moved up to the ward area.  At that point i am as awake as i ever am but with no sensation below the waist (my partner might comment that no sense or feeling above the waist is my normal state) and as soon as i could i found the bed controls, sat myself up and as soon as that happened the staff nurse (friend of mine) who would be looking after me came in to offer me the first in a series of mugs of coffee…..after 12 hours ‘dry’ the first one didn’t even touch the sides.   A couple of hours, at least 3 mugs of coffee and a couple of glasses of water i felt a bit more alive and with sensation below the waist rapidly returning……

For the main event of today’s post we need a bit more angry kid first.

For a tiny little bit more gross-ness the staff nurse did warn me that it might be a good idea to stick a wee bottle between my legs in case of ‘dribbles’….it can happen just because of the spinal anaesthesia and loss of sensation.  It took a few hours for normal sensation to return again a bit like a dental anaesthetic and it was my inner thighs that were the last part to return to normal.  With, by then, an obviously full bladder  i knew i would have only a short window of opportunity to empty it before potentially going into retention : bloke speak again….not being able to go.  The reality is that i thought about it and carefully got myself sitting up on the side of the bed, feet on floor, made sure i had a reasonable amount of balance and strength and had a go from that position….no luck so i took a risk and stood in the zimmer frame that had been parked by my bed.  Result : great relief all round and catheterisation avoided.  My mate the staff nurse came into the bay a few minutes later to find me changed into my own clothes and a brim-full urine bottle by the side of the bed…..and yes she did tell me off a bit.

This isn’t the main event of today’s post though, really everything so far is by way of a gentle introduction to the much more serious problems that men uniquely have with their genito-urinary system (waterworks).

The simple post-operative problem i had and in fact that 3 out of the 4 of us had in that bay is a full bladder and the effects of the spinal anaesthetic.   Anatomically and if you will, mechanically/functionally, the problem is really created at the base of the bladder where a full bladder tends to compress a small (normally) structure that you may have heard of….the infamous prostate gland.

Here’s one i prepared earlier. (side view)  Think of it as a Haynes* manual of where all the bits and pieces should be .

Prostate In Male Reproductive System Male Reproductive System Prostate Gland Prostate Gland Male

Front view, normal and enlarged prostate.

whymendontli

Downwards pressure from a full bladder tends to compress the area anyway which is why it can be difficult even in normal situations to start to pee with a very full bladder. Lots of sailors will be aware of this especially when trying to pee aboard a race boat that’s bouncing it’s way upwind and up-channel. When i get to that series of posts i am actually going o talk about really basic things like this aboard boats….because taking a pee and taking a dump are actually everyday problems that sailors have to deal with ! It’s made a lot harder when the little prostate gland gets inflamed or enlarged and that’s the main event in today’s post.     Many years ago one of the problems i had just before i needed surgery was severe prostatits (inflamed prostate) and that was actually recognised by the consultant that sailed with at the time.

For the main event today let me refer back to the first post in this series and where i said that 2 out of the 4 of us in the 4 bed bay had been treated or were being treated for prostate cancer.  We were all in the roughly same age group and as i said before, 2 of us were on our first joint replacement and the other 2 on their second.   Now, its a bit sneaky being a nurse in that situation because there are things that i am almost hard-wired to pay attention to. .  The  situation became apparent on our second night when the next 2 post-op patients joined us and one of them really couldn’t pee.  In a small room like that it’s all-but impossible not to overhear the conversation that was going on and yes he had already had radical surgery for his prostate cancer.  Now i know it’s a poor use of bucket numbers but that was then a 50% rate of prostate cancer in just that small group of men….plus me with my ‘other’ waterworks problems.      The actual statistics aren’t quite that bad, i will add some data links below, but around a 13-15% chance in white males risk and significantly higher (25%) in ‘black’ males.    Age at diagnosis is now the significant one for me personally as the highest group of new cases is the very same demographic as most of us MOB’s.  The risk simply goes up with age.

Link (cancer research uk) https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence

I have no intention just to scare anyone but, once again referring back to my first post, i would like you to do 2 things : first, pay attention to signs/symptoms that you might be having and secondly think about this in terms of Petersen’s second rule……”Treat yourself like someone you are responsible for”.    A 15 % chance of anything happening (white blokes) and 25% (black dudes) is really worth taking note of and doing something about if there are any signs that it might be happening.   At this stage i could continue with a long section of what to watch out for and what to do about it, instead of that i will post a link so that anyone who is concerned or interested can go and read what the experts say.  Remember that your first port of call is your GP and crucially don’t be embarrassed by any of this….he or she (in my case) won’t be.  I have a lovely and professional female GP who would listen and ask the right questions….remember that this is routine stuff for them.  In a future post i’m actually going to talk about GP consultations and how to get the best from one.

Just before i finish up for this post i want to add a note of ‘don’t panic’ and that’s because you might think i am taking one thing : some urinary system ‘signs’ of a problem and immediately conflating those with prostate cancer.  Cancer is a big scary word right ?    Well it’s not quite like that in this case at all.  There are definite signs that we might have a problem in the waterworks department and those are the kind of things i touched on earlier : frequency, urgency, poor volume etc etc.  That quite definitely doesn’t aleays and immediately scream prostate cancer, in my case it was simple prostatits secondary to a problem called a stricture (narrowing) and in many men the same symptoms can relate to a benign increase in the size of the gland…..that’s called benign prostatic hypertrophy (BPH) by the way and is quite common.   There is also a commonly used drug (Tamsulosin) which is an alpha-blocker which another patient was recieving.   As i said earlier though and i will repeat again : pay attention to anything to anything that might be going on and consider that you are the one being responsible for yourself so go and have a chat with your GP.

I guess that’s it for today.   This series of posts might just be the most important ones i ever do in the blog, you lot, my readers, i know are mainly in about the age group where health problems are appearing.  If you managed to get through the post and gained anything from it then i would just ask you to do one thing and that is to ping the post to at least one other bloke but the more the merrier.  I could finish with another great Angry kid video but i feel that you’ve all had enough for this post.

Last word….apparently the demographic of visitors/readers of blogs like mine is the same as users of online porn…..so here is today’s ‘hot’ pic…enjoy

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*There is apparently a Haynes ‘man’ manual and a HGV version…..i didn’t know that.

https://haynes.com/en-gb/man-manual-2nd-edition

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