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Trans-rectal ultrasound

From: jworthey@starpower.net
Subject: I enjoy a Trus
Date: 20 May 1996 03:58:17 GMT
As previously reported,I sent a notebook to my urologist on April 1, with info about Dr. Feliciano's treatment, Dr. Tarfusser's treatment, and other background stuff. When I saw him on April 9, he volunteered that he would do a version of Dr. Feliciano's treatment. Before starting any drainage, he wanted to do a trans-rectal ultrasound, TRUS, which finally got done this Wednesday, May 15. He said he didn't want to mash down on the prostate if it had a cyst that might rupture externally to the gland; also, if I had something wrong with a seminal vesicle, there would be a separate treatment for that.
An unstated possibility was that he would find cancer. That was on my mind as I went for the appointment. It's not exactly that I fear dying, but my plan has been that I will first get cured of prostatitis and have some kind of normal sexual experience once or twice before I die. Whatever the exact cause, I've had pain that interferes greatly with sex since just about the time of my first sexual experience. Anyway, back to the clinic...
I went in the room with the ultrasound machine, and the nurse asked me to sign a consent for the ultrasound and another for a biopsy. I said, wait a minute, I'm a motivated patient and I'll undergo any pain, but a biopsy doesn't seem appropriate. We want to try to get rid of bacteria already in the prostate, not introduce new ones. She went and spoke to the doctor and came back and said, OK, no biopsy. She said usually when they do the ultrasound, they're looking for cancer, etc. I mention all this because it speaks to two newsgroup themes: the nurse is not accustomed to taking prostatitis seriously, and the more the patient knows and speaks up, the better. In this case, I don't think the doc planned to do a biopsy.
He came in at this point and said he wasn't going to scrub, his hands were probably a lot cleaner than my rectum.
The ultrasound probe did not look quite Dr. Tarfusser's cartoon. It was like a stick with a knob, kind of like the grip end of a baseball bat, but only a couple centimeters on the largest diameter of the ellipsoidal knob. The screen of the electronics showed the doc's name and mine. So, I stripped to an undershirt and got on the table with butts toward the electronics. The doc came back, I tried to relax. Somebody put a condom (or similar)over the probe, then some slippery goo, then the doc maneuvered the knob into the rectum.
I felt just a moment of pain and then it was your basic weird medical experience. I asked the doc if I could have a picture, he said yes. Then he spent quite a while scanning different things. The instrument had a flat keyboard (waterproof, cleanable). He worked the probe with his right hand, commented that he couldn't type very fast with just the left hand. So, he's working this thing around, then stopping to go tap-a-tap with the other hand, I guess reaching across. We chat pleasantly about what he sees: a small cyst (not sure about the term) on a seminal vesicle that he might treat if the drainage, etc, doesn't cure me. Big stones near the urethra, including some in "the front" of the prostate where he says the massage can't reach. (I'm not clear what this means.) But apparently there are some stones that might yield to crushing and pushing them out. He also sees a small anomaly in the prostate (abscess?) that is apparently a cancer candidate ("food for thought," he says). In the end, he decides there is no cancer or cyst that will prevent us from proceeding with the drainages.
The nurse only gave me one picture, but I think there are some other "extra copies" that went into the file. They all just look like aerial views of Chesapeake bay anyway, unless the doc explains them to me. They do have the labels he typed in.
Then I went to the lab to give a semen sample. Luckily I brought my own naked magazine, because they don't supply them. On my own initiative, I asked the phlebotomist at the laboratory reception desk for antiseptic wipes. She wouldn't normally have supplied them. I don't know from microbiology, but I have this vision of them wanting to dismiss any germies as contamination. Come to think of it, I don't know if they were going to culture this specimen or just count the spermies, or what.
The urologist seems like a real person. He doesn't "act like a doctor." He seems like a smart, hard-working technician who has some nice skills and equipment and wants to help me. That is sort of the persona that he cultivates. Recall that this is a real HMO.He's on salary and presumably doesn't get an extra nickel for treating me versus giving me a brushoff. It is part of the shtick in this HMO for the docs to be humble and helpful.
Now he has a vacation, only 1 week. My first drainage is the 28th, Tuesday after Memorial Day. Bright and early. He warned me that I might not feel like going to work afterwards. That's great; I guess that means one heavy-duty prostate massage.

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