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Gat Goren Method, Part 3

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Posted 9/23/2013 2:28 PM (GMT 0)
We know shrinking the volume of the prostate is not the only answer for BPH problems. Proper functioning of the bladder in many respects is just as important. For those using catheters: From the Lancet

The Lancet, Volume 325, Issue 8428, Pages 563 - 565, 9 March 1985 <Previous Article|Next Article>
doi:10.1016/S0140-6736(85)91217-6Cite or Link Using DOI
BLADDER IRRIGATION WITH POVIDONE-IODINE IN PREVENTION OF URINARY-TRACT INFECTIONS ASSOCIATED WITH INTERMITTENT URETHRAL CATHETERISATION

P.J. Van Den Broek , ThJ. Daha , R.P. Mouton
Abstract

Bladder irrigation with povidone-iodine in the prevention of urinary-tract infections after single or intermittent urethral catheterisation was investigated in a controlled study. In the control group (36 patients) the catheter was removed after urethral catheterisation and emptying of the bladder, and in the trial group (42 patients) 50 ml povidone-iodine 2% was instilled and allowed to drain immediately before removal of the catheter. The incidence of bacteriuria was 28% in the control group and 4% in the povidone-iodine group. After the introduction of bladder irrigation with povidone-iodine in the orthopaedic department of Leiden University Hospital the incidence of hospital-acquired bacteriuria fell from 6·9% to 3·7%.
Posted 9/23/2013 3:25 PM (GMT 0)
Dave, Thunder,

about sclerotizing agents vs coils, I checked around, and from what I can tell, it could truly be a matter of the specific doctor's preference.  But that's just a guess.  I think since Dr. Gat is so adamant about getting every single miniscule bypass, capillary, etc. that he likes the glue because maybe it will flow its way into all these little places.  So it could be a "thoroughness" issue.  But for guys like me, that have no possibility of getting to Isreal any time soon, I'm hoping that the way my Dr does it will give good results. I've been feeling pretty good "down there" since my last post.  I feel much, much less pressure in that general region.  My flow is like the proverbial racehorse.

And yes, the coils are foreign objects that remain in your body.  They are platinum, so they do show up in metal detectors, but they don't interfere with MRI's, CT Scans, etc.

Also, Thunder, good call asking about the possible parallel left side bypass.  I'm going to mention that.  When he did my right side, I was awake, and during the procedure he would call for "contrast" and tell me to "bear down."  All the veins in my abdominal area would light up on screen.  I guess he was looking for bypasses.

Counting down until Wednesday.

Posted 9/23/2013 5:43 PM (GMT 0)
robc: It seems that you have done your homework and are prepared to quiz your doctor on some issues when you see him. Challenge him to find and seal all the collaterals.

It's good to hear that you've experienced some improvement recently. It should be even better once the other ISV and any collaterals are sealed. I have no idea how quickly you might expect relief, but keep us informed about your progress. We're all in your corner rooting for you!

{...}

Post Edited (Chicago Dave) : 10/21/2013 5:42:49 PM (GMT-6)

Posted 9/23/2013 7:22 PM (GMT 0)
Seems like embolization of the spermatics has been around for awhile...but only one side.

Cir Pediatr. 1995 Jul;8(3):123-7.
[Venography and percutaneous embolization of the spermatic vein with spring coil as treatment of the varicocele in childhood].
[Article in Spanish]
Rivilla Parra F, García Casillas P, Gallego Beuter J, Hernández Lezana AH.
Source
Servicio de Cirugía Pediátrica, Hospital Universitario San Carlos, Madrid.
Abstract
The treatment of varicocele is controversial in boys and it is a contributing factor to male infertility. Recently it has been proposed that earlier therapy of a varicocele during this period may improve the prognosis of infertility. We review our experience with the diagnosis and management of left varicocele in 30 pediatric patients 6 to 15 years old. All patients had clinically palpable varicocele. All were managed under local anesthesia by spermatic venography and percutaneous transcatheter embolization of the internal spermatic vein with spring coils. All achieved satisfactory occlusion, and during the follow up from 13 years to 9 months there was only one recurrence, noted in a patient 6 months after the procedure. Internal spermatic venograms allowed precise coil placement relative to collateral veins which could cause recurrence. Complications developed were phlebitis of the pampiniform plexus, leading to swelling and erythema of the left scrotum and mild flank pain, these symptoms resolved without sequelae. This a safe and effective nonsurgical method of obliterating varicoceles in children
Posted 9/24/2013 4:18 AM (GMT 0)
Martin, Robc,

Yes emobolization is a very old technique with proven success, and sclerotherapy is also very old to treat leg veins. I think the quality of the doctor is probably the most important factor for long term success - Dr Goren also uses coils if he thinks the situation warrants it (the veins are too large to be closed with only sclerotherapy).

robc - am curious - how much does your procedure cost? Is it covered by insurance? And which hospital are you getting it done at?
Posted 9/24/2013 2:19 PM (GMT 0)
Thunder,

My procedure is being done at University of Pennsylvania Hospital in Philadelphia.  Unfortunately, I don't know the cost, because it is fully covered by insurance less a small co-pay; Insurance coverage is based ONLY on the fact that the pain in my scrotum is almost unbearable sometimes.  The only other reason they would cover is for infertility ... I'm 50 with four kids, so that would have been a hard case to make.  (Although those four kids were produced via IVF, but I digress ...)

The "theme" that I get after reading as much as I can, is that Drs Gat and Goren believe that all those miniscule capillaries and such have to be destroyed primarily because they add to the hydrostatic pressure on the whole system down there.  Whereas my Dr (and I would assume, the "mainstream") seal these off because they don't want recurrence.  I'm crossing my fingers that the result is close enough.

OT:

Wow, I just did what I always complain about other people doing ... paying no mind to the cost of my own healthcare just because I'm not responsible for the payment.  That's a pet peeve of mine, and now I guess I'm a hypocrite.

 

Posted 9/24/2013 4:10 PM (GMT 0)
wow - UPenn is where I went to school - I didn't know they could perform this operation there! What's the name of the Dr. you are seeing there?

Well I am glad there is a similar procedure in the US - even if it is coil based - because I am young and if there is re-currence in the future - say 20 years, it's good to know there is an alternative somewhere.
Posted 9/25/2013 7:19 AM (GMT 0)
Martin,

So this seems to be a "localized" way of introducing iodine instead of the systemic way through an oral supplement. Although I have not used enema before, but it does seem common enough that it should be safe. Although I am trying to understand the relation between getting rid of "mucus" in the colon and prostatitis.

I found another source of info about using enema as a therapy for prostatitis:
http://www.optimalhealthnetwork.com/Prostate-Health-s/336.htm

Suffice to say this is the first time I have heard of using enemas to cure prostatitis.

To be honest - is there any other disease beside prostate disease that has such a wide-range of remedies? The prostate has to win the Guiness record for having the most number of possible remedies...

martin victor said...
Thunder: Maybe this is the best way to counter act a stubborn case of prostatitis. On the curezone site they talk about homemade suppositories and the possibilities of iodine enemas being effective for prostat*** . Iodine can sting so use your discretion and experiment with small doses first.

Lugol's Iodine Instructions

ENEMA - Use a Fleet enema bottle. Empty out contents, wash out with hot water. Wipe off lubricated tip thoroughly with a dry paper towel and wash with hot water. Do not use any detergent! Fill up bottle with room temp water poured through a coffee filter. Preferable to boil water in glass container and let cool. Add up to 1/2 teaspoon of Lugol’s. After a few enemas, it can be increased to one teaspoon. Avoid spilling, it stains.

To lubricate tip, use only olive oil, butter, vitamin E gel. Do not use any commercial chemical lubricants. Do the enema. Hold it in for 5 to 15 minutes or as long as you can. Initially, you may only be able to hold it in for a few minutes. It is preferable to lie down. Expect loads of mucus, gel, trash, undigested food and several movements within hours as mucus keeps coming out. If you’re mucus loaded up, repeat enema daily for 2, 3 or 4 days. Then, once a week for 4 weeks until mucus/trash free. Maintenance, one enema a month.

http://thebreathoflife.net/herbalstore/catalog/mi_lugols.php

Post Edited (thunder2004) : 9/25/2013 4:46:20 AM (GMT-6)

Posted 9/25/2013 1:47 PM (GMT 0)
Thunder...Many pharmaceutical drugs are given rectally. They travel up the hepatic portal system and are very effective when one's digestive system is impaired or digestive enzymes are known to destroy the drug. Colonic irrigation, including coffee enemas have been used by naturapaths to remove toxins from not just the colon but from the whole body. I would imagine iodine is just as effective especially since we know it is very absorbable through the skin and its proximity taken as a rectal enema is close to the prostate. http://www.peak-health-now.com/coffee_enema_facts.html
Posted 9/26/2013 3:59 AM (GMT 0)
Thunder, Dave,

Well, I did not have a very good day.

I went to my procedure at Penn, which if you recall, was to go occlude the left-side ISV after having the right side done a month ago, and having no luck at that time "finding" the left side.

Two hours today under the radiation thingie, and guess what?  The left-side ISV doesn't even show up!  Poking, prodding, venography, contrast, fluoro-whatever ... NOTHING.  They went by every known route, and used every size and shape catheter they had.

My Dr, who is the Chief of Interventional Radiology at Penn, said he has been doing this since the early 90's, and has never come across a case like mine.  (Lucky me.)

He told me I might want to consider a traditional surgeon, so they can open me up and actually go searching for the thing.  When I told him that chances are, they would tie up the ISV but would never catch all the collaterals (even with the microscope) he agreed, but said at least the varicocele would go away.

So instead, it's back to another CT-scan, this time "High-Def" or something, which will show all the little veins, etc. in order to determine how to proceed. 

If all this radiation doesn't kill me first.

Posted 9/26/2013 12:44 PM (GMT 0)
robc...Since you have indicated you are feeling better, why proceed with any more intervention? Best maybe to leave things alone, and wait for another day if a problem appears.
Posted 9/26/2013 1:57 PM (GMT 0)
robc: Sorry about the new stumbling block. Well, you might have intuited more unexpected problems. It seems like a good idea to go through with the high-def CT scan. If the chief of IR couldn't find the ISV, no one could. (The ISVs are very small veins that decompose rapidly upon death. It's not like they are massive structures.)

We're glad you got some improvement already. Keep us informed.
Posted 9/27/2013 2:59 AM (GMT 0)

Chicago Dave said...
Random thoughts from a random mind...

#1 It annoys me that Dr. Gat doesn't answer my emails. But oh, well.

#2 For those guys waiting for their GG procedures to fully kick in, how about Glycine, Alanine and Glutamic Acid for symptomatic relief of prostat*** symptoms? I always love hearing about *empirically* successful treatments, even those that work mysteriously. And Martin sometimes likes to theorize about how they work.

I heard of this treatment 20 years ago, and apparently it goes back much further, to 1958. It has an interesting history:

QUOTE:
"The value of the Glycine-Alanine-Glutamic Acid mixture for relief of symptoms of benign prostatic hypertrophy was suggested by a chance observation made by one of us (J.C.G.)(1) and an associate. A group of allergic patients were being given an amino acid mixture and during the course of treatment one of the patients volunteered the information that all of his urinary symptoms had disappeared. This led to a trial of that particular amino acid mixture in non-allergic patients with urinary symptoms. Patients with enlarged prostates and associated urinary symptoms experienced prompt and rather spectacular relief of their symptoms. A number of these patients have been observed over a prolonged period of time. They remain symptom free while taking the medication, but soon after discontinuing it the symptoms of urgency, nocturia, etc., returned. This has been the experience of several physicians who have tried the amino acid treatment at our suggestion."
UNQUOTE

http://prostex.com/feinblatt-bph-article/

Full disclosure: Twenty years ago I tried tried these amino acids--purchased separately at a health food store--and did *not* notice any improvement. But I personally never got any relief from *any* herbs, supplements or drugs, except high-dose cranberry concentrates and alpha blockers. Still, it might be worth a try considering the low downside risk.

And you know how much I *love* supplements and procedures with low downside risk!

#3 An anonymous reader from Mexico alerted me to a new medical device for BPH. Called TIND and manufactured in Israel, it is available to patients now in Europe. The urologist inserts this funny-looking thing in the urethra and lets it expand and press against the prostate for five days. The benefits last for years--supposedly. I'm thinking that it might offer GG patients some benefit in cases of pinched urethras. But I wouldn't expect it to help guys who have an enlarged prostate lobe pressing on the bladder rather than the urethra.

Check out the photo. It looks like the creepy tracking device from the movie The Matrix. You remember it--the spider-like device that the Agents planted in Neo's chest:
VIEW IMAGE

http://www.medi-tate.com/

QUOTE:
"TIND presents a viable alternative to surgery for patients suffering from an enlarged prostate caused by BPH (Benign Prostatic Hyperplasia). The TIND device, currently available only in Europe. The TIND is placed in the area in which the prostate has blocked the urethra, causing BPH symptoms by obstructing the flow of urine.

"The device is deployed in a very simple minimally invasive procedure at a urologist’s clinic. TIND insertion takes just 5 minutes, after which you can go home. There are no catheters, no bleeding and you are able to go back to your normal activities fast. While the device is left in your body for 5 days, your lifestyle will not be affected.

"How does TIND work?

"The device starts working immediately after deployment by exerting pressure on the prostate urethra tissue from the inside, reshaping the prostatic urethra and helping clear the path for the flow of urine. The great advantage of the device is that it was designed to leave your sperm ducts intact, which reduces the chance of any sexual dysfunction (predominantly retrograde ejaculation).

"After 5 days in the body, the device is removed in a quick process that takes just minutes. You will notice that your BPH symptoms have significantly decreased. Results will continue to improve over the course of 3 months, and you will enjoy them well into the future."
UNQUOTE

Not all guys with BPH will qualify for treatment:
QUOTE:
"However if you have any of the following, you are not a candidate for TIND: urethral stricture, an active urinary tract infection, suspected or proven prostate cancer or underwent interventional prostate treatment in the past."
UNQUOTE

#4 Thunder: I take it as a good sign that there are *differences* in your symptoms before-and-after GG. You've even noticed a little improvement already.

True, I thought you'd have more improvement by this time, but give the body time to heal itself. My own progress came much slower than expected, too. Dr. Gat had promised me improvement by six months after treatment, but it actually took almost two years for me to get good results.

-dave

Dave,

More on TIND with great images. Looks like a homemade urethra stretcher.

http://www.innomedicus.com/index.asp?Language=FR&page=tind

Howard
Posted 9/27/2013 1:26 PM (GMT 0)
Robc,

Specifically, while he was "finding" the ISV, were you flat on the bed or were you at around a 30 degree angle with your head higher and feet lower?
Also, when he injected the dye, did he only ask you to "bear down" or did he apply external pressure as well?

I think you should definitely go with the high def CT scan, are they going to inject you with a radiaoative tracer?

If you are going to get injected with a radioactive tracer, make sure you take "green tea ECGC" extracts or pomegranate extracts prior to the injection, and also some days afterwards, it will GREATLY mitigate the radiation damage. (you should take green tea and pomegranate before you fly too on the plane)

Feel free to email me at yudeng2004 (@) hotmail.com anytime if you want to discuss anything...


robc said...
Thunder, Dave,
Well, I did not have a very good day.

I went to my procedure at Penn, which if you recall, was to go occlude the left-side ISV after having the right side done a month ago, and having no luck at that time "finding" the left side.

Two hours today under the radiation thingie, and guess what? The left-side ISV doesn't even show up! Poking, prodding, venography, contrast, fluoro-whatever ... NOTHING. They went by every known route, and used every size and shape catheter they had.

My Dr, who is the Chief of Interventional Radiology at Penn, said he has been doing this since the early 90's, and has never come across a case like mine. (Lucky me.)

He told me I might want to consider a traditional surgeon, so they can open me up and actually go searching for the thing. When I told him that chances are, they would tie up the ISV but would never catch all the collaterals (even with the microscope) he agreed, but said at least the varicocele would go away.

So instead, it's back to another CT-scan, this time "High-Def" or something, which will show all the little veins, etc. in order to determine how to proceed.

If all this radiation doesn't kill me first.

Posted 10/1/2013 5:28 PM (GMT 0)
Thunder,

I just came back from my Hi-Def CT Scan (with dye.)  It is confirmed ... I am a freak of nature.  I DO NOT have a left-side gonadal vein (ISV.)

They have a perfectly clear picture of all these little capillaries, vessels, and things ... NO ISV.

They don't know if I was born that way, or if it "died" at some point.  There seem to be, instead of one larger vein, a whole bunch of very tiny ones.  When you think about it, that would make sense:  The pressure of a fluid at the bottom of a standing column doesn't depend on the size of the column, but just the height.  So a bunch of tiny ones going the same height would actually cause more pressure than just the one larger vein that's supposed to be there.

He told me to go see the surgeon, and maybe using the microscope he can tie off all those little veins one at a time.

Ugghhhh .....

Posted 10/5/2013 4:56 AM (GMT 0)
robc,

Even if you have small veins that run all over the place, they all have to come together once you get near the testicle, so a skilled surgeon is supposed to be able to find all of them. Dr. Gat once mentioned the best ones for varicocele surgery are at Cornell University.
Is your hi-def CT scan covered by insurance?
Posted 10/5/2013 4:59 AM (GMT 0)
WEEK 8 Update since GG:

In the morning, I do not feel any varicocele anymore, but it gets bigger throughout the day, especially late in the evening. The left testicle does not descend as much as before, but because it is now raised, I feel more "congested" in the pernium since the spermatic cord is now raised.

The positive is the scrotal varicocele cannot be felt in the morning anymore, but the negative is that it gets bigger throughout the day, which technically should not happen.
Posted 10/5/2013 7:47 PM (GMT 0)
robc: Thanks for keeping us posted. I'm sorry that you have some anatomy that is stumping your doctors, but I'm glad you've had some improvement so far.

Thunder: Thanks for the update! I'm glad you continue to show improvement, even if it's slow.

Martin: I told Grizz you discovered an interesting post about iodine and the prostate on the Wheatbelly board, and he was fulsome in his gratitude.
Posted 10/7/2013 12:11 AM (GMT 0)
It's been a few weeks since I posted. I have been laying low because a couple of days after my incredible urine burning that seems to have been brought on by adding 300 mcg potassium iodide with my daily BP med MicardisHCT, I started to have an amazing improvement. I have been waiting for the other shoe to drop, but as of now (knock on wood) the improvement seems to have stuck.
My getting up at night dropped down to twice a night, most nights. Total 24 hour voids is averaging about 12 to 14 (down from 20 to 24). Urgency has changed from a 4 second run to the toilet, to a leisurely walk to the bathroom and no more accidents. This is all in the last couple of weeks. Since I use a disposable urinal at night with cc markings I have also noted that I am now voiding 10 to 12 ounces per void. An incredible improvement. And there's no burning most of the time. The only setback I have had was after eating yogurt and Alfredo sauce with lots of parmesan cheese, which caused burning urine for about a day (but at a level 5, rather than the level 9 I had several weeks ago). I feel like I am finally getting most of what was promised with my GL laser turp, but 15 months later.
So what has changed? Just three things.
1) I stopped my blood pressure meds. A couple of times a month I take a B complex and magnesium if my energy bottoms out, and twice this month I have taken an Aleve. Other than that, I haven't had any pills since I stopped the BP meds 2-1/2 weeks ago.
2) I stopped drinking liquor.
3) I cath once a week on Sunday with a 16 FR cath. The last two weeks my PVR has been 40ml to 50ml. When I was cathing every two weeks it was 150ml to 200ml. My uro had recommending cathing every two weeks to "keep the channel open". He had that right, but the frequency was not often enough to do the job. Prior to cathing I paint the head of my member with 10% povidine solution, then cath and take a shower. After I cath I take one 500mg cipro as a prophylactic.

That's it, the whole program. My head is still having a hard time figuring it all out. All that pain, inconvenience and angst for so long seems to have lifted. Sure hope it stays that way.
Posted 10/7/2013 2:06 AM (GMT 0)
Bob: I'm glad you're feeling better! Whatever you're doing, just keep doing it.
Posted 10/7/2013 5:03 AM (GMT 0)
Thanks Dave.

Chicago Dave said...
Bob: I'm glad you're feeling better! Whatever you're doing, just keep doing it.

Posted 10/7/2013 9:19 AM (GMT 0)
Robc,

I just came back from ultrasound - and the left side still show venous reflux. I am not sure why there is still reflux (meaning backward pressure still exist). I called Dr. Gat and he verified that this is to be expected within 1-1.5 years after the procedure.

I also told Dr. Gat specifically about your case, and he said he recommend you see Dr. Marc Goldstein at NYC Cornell (the one in NYC) for microsurgery, who is considered to be the best.

Thunder.

robc said...
Thunder,


I just came back from my Hi-Def CT Scan (with dye.) It is confirmed ... I am a freak of nature. I DO NOT have a left-side gonadal vein (ISV.)



They have a perfectly clear picture of all these little capillaries, vessels, and things ... NO ISV.



They don't know if I was born that way, or if it "died" at some point. There seem to be, instead of one larger vein, a whole bunch of very tiny ones. When you think about it, that would make sense: The pressure of a fluid at the bottom of a standing column doesn't depend on the size of the column, but just the height. So a bunch of tiny ones going the same height would actually cause more pressure than just the one larger vein that's supposed to be there.



He told me to go see the surgeon, and maybe using the microscope he can tie off all those little veins one at a time.



Ugghhhh .....

Post Edited (thunder2004) : 10/7/2013 8:23:56 AM (GMT-6)

Posted 10/7/2013 2:43 PM (GMT 0)

Re the TIND.

As far as I can see the TIND works by producing necrosis in the strips of prostate against which the metal strips bear during the five days the TIND is in place - the pressure exerted by the metal strips depriving the strips of prostate of oxygen.

How is such necrosis inflicted without there also being necrosis of the urethra?

Post Edited (ac72) : 10/7/2013 8:48:25 AM (GMT-6)

Posted 10/7/2013 3:07 PM (GMT 0)
I could be wrong, but looking at the first video, it looked to me like the necrosis was mainly at the bladder mouth. This would seem to be like the TUIP procedure. As far as necrosis of the urethra within the prostate, I think it grows back. When I had the GL laser, it vaporized the tissue of the prostate by going through the urethra within the prostate, so that part of the urethra gets vaporized in the process.

ac72 said...
Re the TIND.
As far as I can see the TIND works by producing necrosis in the strips of prostate against which the metal strips bear during the five days the TIND is in place - the pressure exerted by the metal strips depriving the strips of prostate of oxygen.
How is such necrosis inflicted without there also being necrosis of the urethra?

Posted 10/7/2013 6:48 PM (GMT 0)

Bob_NJ

thank you for your kind reply to my TIND question.

So there were never any problems with incontinence from the GL Laser for all the associated (temporary) destruction of the urethra, the prostrate itself taking the place of the lost section of urethra?

Post Edited (ac72) : 10/7/2013 12:51:37 PM (GMT-6)

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