Chapter 5: Unrequited Urologist

I’m confident in declaring that we all love a good night’s sleep. For some people, it’s a precious thing. So, can you imagine the utter frustration of waking every forty minutes because you’re busting for a piss? Can you imagine the drudgery of going through it, night after night? You’ve got eight hours for sleep and seven interruptions. Would it drive you nuts? Would you go off your rocker? I can’t see why not.

A seven-piss night is best done in summer unless you have good heating in the loo. It’s not just a matter of popping out of bed for a quick one, then back into the warmth. No, it’s a miserable process if the loo isn’t heated. For one thing, you’re going to be in there for a good fifteen minutes.

This type of leaking is very challenging. You’ve been awakened by the urge. In your sleep you’ve been holding on. Then, when you awaken, there’s no way you’ll get out of bed immediately — particularly in winter with no heating in your bedroom. So, you keep hanging on. This hanging-on is isometric exercise for your bladder’s sphincter muscle. It gets stronger every time you hold on longer than normal. By the time you get to the loo, your sphincter is in spasm, shut tight. So, you need to sit down and take your time.

I was experiencing this type of problem decades before my PSA (Prostate-Specific Antigen) increased above normal. In terms of my current or historical health issues, this pissing problem was certainly well entrenched in my historical issues. As such, there was no connection in my mind between pissing problems and elevated PSA.

So, about ten years ago, when my PSA became elevated, the GP was very persuasive and I accepted the referral to the urologist. To my surprise, the referral involved the GP sticking his finger up my bum. I hadn’t seen that coming. He said he couldn’t write the referral letter if he wasn’t able to say whether or not there were lumps or crustiness in my prostate.

He explained that although he felt no lumps or crust, this didn’t rule out cancer. He was talking about cancer. He wasn’t talking about a pissing problem. When the discussion is cancer, I’m all ears. So, I booked the appointment with the urologist. At that point, I was on a mission to see if I had cancer or not.

At that stage, BPH (Benign Prostatic Hyperplasia) wasn’t even in my vocabulary. My pissing wasn’t part of this new story about elevated PSA. My pissing problem, in my mind, was very much entrenched in a story about histamine, irritation and inflammation. Also, I hadn’t discussed my pissing problem with the GP. I always considered it one of those weird things about me. I was never game enough to bring it up. I assumed it would be one of those expensive time-wasting exercises that gets nowhere.

When the elevated PSA came to light, I felt somewhat detached from the knowledge. I couldn’t connect with it organically. Like, high PSA, so fucking what?! But cancer, you say? At that point, we were purely discussing the PSA number on the pathology report. The number said “cancer”. My experience of myself didn’t say cancer. The GP’s finger didn’t say cancer.

But just the idea of cancer is a boogeyman. As a small toddler, I always needed the hall light on outside my bedroom at night because of the boogeyman. Remember, I’m one of those absorptive types. I guess I did become a bit obsessive and immersed in the cancer idea. It needed to make sense to me in relation to my experience. Ok, so prove to me that I have cancer.

Back then, there was no slap from a damp tram ticket on the horizon. I will admit, at the time I wasn’t looking for learning. But learning can happen, even if you don’t know about it. I’m thinking more about the type of accidental learning that comes from an encounter with a contrary, grumpy, and rude urologist.

Before the urologist’s appointment, I was required to arrive with a full bladder. When I arrived, the receptionist took me to the toilet. She instructed me to leak into the cone and to empty my bladder. I’m thinking, what’s this got to do with cancer?

I wasn’t there to discuss pissing. I guessed that because he’s a urologist, he needed to know about my plumbing. But I wasn’t there to talk about my plumbing. I was there to see if I had cancer. I was definite about that.

To my mind, the appointment started very badly. He started by showing me the results of my pissing test. The plotted graph showed a very poor flow rate. In effect, he was saying that my pissing was piss-poor. At that point, I really wasn’t reading the room. I’m very dyslexic, and reading the room isn’t my strong suit under pressure in unfamiliar territory. In retrospect, I think I was supposed to be amazed by his revelations. I would have looked vague and blank. If he was reading me accurately, he’d have picked up on my utter disinterest.

Clearly, I’d hurt his feelings. He seemed to get grumpier. Then he pulled out a clipboard and started grilling me with a series of very personal questions in a brisk, matter-of-fact manner. These were very personal matters. Like, how often do you have sex? Get fucked, my brain says. We’ve only just met. I don’t think I like you and you haven’t mentioned cancer once. I’m here for the cancer!

He then got me up on the couch with my pants down. I hate that. He fiddled with my limp penis and flicked it aside. I thought, what the? Then he got me to roll over to face the wall while he did his digital exam. He stuck his finger up my bum to give my prostate a jolly good rub. He sighed, withdrew his finger, and ripped off his rubber gloves. Then he told me to get dressed and sit on the chair.

He started talking about my next appointment and what I needed to do in the meantime. He wanted me to have ultrasound scans and pathology tests. He also provided a prescription for a “benzo-like” medication to relax the prostate’s smooth muscles, to free up my piss-poor pissing. I was thinking, what is it with this guy? He’s only interested in my pissing.

At that point, I was paying attention because he looked like he was about to wheel me out the door. So, I diverted his attention and asked him about the cancer diagnosis. By the look on his face, I’d say he wondered if I’d been paying attention. By his body language, I’d obviously put him on the spot. He curtly confirmed that his finger didn’t find lumps or crusts. I trust his finger. Then he produced a sheet of paper with a hundred dots printed on it (ten rows by ten columns). He showed it to me. He said, see all those dots? I said, yeah. He said, look at the bottom row. That’s your chance of having cancer. That’s ten percent. I was very surprised that he thought that I needed a visual aid to grasp the concept of “ten percent”. I said, “ok, so…”

He immediately began writing notes in my file. Head down, writing away, paying no attention to me. There was no answer. I have a ten percent chance of having prostate cancer, so what’s next? No, he’s just writing notes. I said, “well, is that it?” He looked up briefly and waved me off. And that was it.

When I left his room, I did make a follow-up appointment at reception. I guess I was so traumatised by the appointment that I was acting obediently. I was in a bit of a daze and a spin as I drove home. The drive takes a good forty-five minutes.

I had a lot of time to think as I drove in silence with no radio. By the time I got home, I’d concluded that I’d had it with GPs and urologists. I didn’t do his scans or pathology or take the “benzo-like” medication. I cancelled the follow-up appointment with a good two weeks’ notice.

All the same, I did learn that pissing problems can be related to high PSA levels. So, I filed that information away for later.

That appointment was ten years ago, when I was in my mid-sixties. It was during my mid-to-late sixties that I had that window of health and bliss. For example, I found I could lose weight. In my late fifties, I’d reached one hundred and twenty-five kilograms. I lost about five kilos by giving up alcohol. Then I did the 5:2 diet and got myself down to one hundred and ten. I plateaued there. Then, in my late sixties, I had my diet under control by eliminating histamine. I got down to ninety-five kilos. My guts were good and I had willpower.

During this time of health, I was pretty well headache-free. My gut felt fine. I was pooing like a trooper, regularly every morning. I’d never pooed like that throughout my life; maybe when I was a kid. My pissing wasn’t a problem. It wasn’t perfect, but tolerable. At night I’d have two or three interruptions. I could sustain full-hour sessions with clients. I could drive anywhere without fear of busting on the way. I was smiling at the sky and skipping through the daisies. I was cooking with gas, as they say, during those halcyon days.

By the time I got to seventy, something started to go wrong. I could feel it. I had no energy. I couldn’t do anything without becoming overwhelmed with fatigue. I started putting on weight. My pooing reverted to its old erratic and irregular habits. I couldn’t think or function properly. I’d lose track of conversations in therapy sessions. This was not good. I was also getting very irritable and felt quite alienated. I found that I really couldn’t work. Generally, I found people irritating.

While this was happening, I didn’t realise I’d lost significant lung capacity, and my prostate was going gangbusters.

The slap from the damp tram ticket was approaching, but not there yet. Because I was blissfully unaware of these new developments, I beat myself up for not being on top of my game. I believed I was failing at managing my histamine sensitivity. Still, I remained hopeful and optimistic about eventual success. I pressed on regardless. Realistically, though, I was on the downhill slope. If I’d stayed there and floundered, I would have just skidded on into the kicking-bucket as a consequence.

I’m guessing, but it was almost two years of suffering before I got around to seeing the GP. Some people will always ask, “What took you so long?” I don’t know. I’m a bit bloody-minded about some things. I’m a bit of a cheapskate when it comes to spending good money on wild goose chases. And I thought eventually I’d crack it.

I guess you could say I was jolted out of my optimism by a bladder infection about a month before I saw the GP. Again, some people would be puzzled by how long it took me to get to the GP. If you’ve ever had a full-on bladder infection, you’d probably wonder how I didn’t end up in hospital.

The trouble was, I didn’t realise at first that the problem was a bladder infection. It involved the seven-piss nights. During the day, I was pissing around the clock every forty minutes or so. I’d be utterly busting and nothing would come out. When it did, it was a dribble. And the end of my penis would burn. But right up to the last minute, I was beavering away on my histamine strategies. I started to investigate sugar as the new enemy. I suppose it was at least related to weight gain. But I was grasping at straws.

Then, on a Friday evening, it hit me: this must be a bladder infection. I remembered what I’d learnt about elevated PSA and pissing problems. It could be that my prostate was jammed up. I remembered the link between swollen prostate, bladder retention, and bladder infection. But it was Friday, late in the day. I wouldn’t get a GP appointment, and I didn’t want to sit in the hospital ER all night.

I remembered something about cinnamon as an antibiotic. I made myself a tea with a heaped teaspoon of Ceylon cinnamon powder. I immediately got some relief that night, with only six pisses. The flow improved a bit. So, I had more cinnamon tea, two a day for the next week. The infection was gone by Sunday. There you go, I thought – done and dusted.

But no, I was not done and dusted. I had a swollen prostate. My pissing was not good. My histamine reduction diet wasn’t cutting it. I needed to remain free of dietary histamine anyway, but this wasn’t fixing my prostate. I had to honour the facts. My PSA was high because my prostate was enlarged. This caused bladder retention. This in turn causes bladder infections.

What was causing my prostate to enlarge? Rapid cell growth will do it. Turns out, PSA goes up when prostate cells become more active. There are a few reasons this happens. One is cancer, which speeds up cell growth. Another is inflammation, known as prostatitis, which can come from infection or irritants. And lastly, it can be due to BPH (Benign Prostatic Hyperplasia). That’s caused by DHT (dihydrotestosterone), a hormone made from testosterone, which binds to prostate cells and makes them grow and multiply.

In the past, I assumed my PSA was elevated due to prostatitis from histamine as the irritant. Why not? At the time, it may well have been the case. But now it looks like something else is kicking it along. If it’s not cancer, then it must be BPH. But what if it is cancer? What if the ten percent has turned up to bite me? Clearly, things could be getting out of hand. I started to question my ability to figure this out. I started to think I should see a GP. But I wasn’t quite ready. First, I wanted to test out the naturopathic approach to fixing the BPH.

Based on my reading, I started consuming a tincture consisting of fifty percent nettle root extract, twenty-five percent each of Jerusalem artichoke extract and fenugreek extract. This mix showed some promise. In the beginning, I even experienced some piss-free nights. Generally, though, I wasn’t completely satisfied, and it’s very expensive to do it this way.

I consulted the naturopath at the dispensary and she suggested a purpose-made remedy for my specific problem. This product is a large soft capsule containing zinc, red clover, nettle root extract, and saw palm fruit. She said it could take up to twelve weeks to kick in. She said it probably won’t reduce my prostate, but the saw palm fruit will prevent further growth. This is because it’s said to inhibit the enzyme that converts testosterone into DHT. She said overall I should see improvements in my pissing: less frequent, better flow, better drainage.

In the end, I did yield. I saw the GP and now, after the third appointment, I’m waiting for the sniff test results. I haven’t taken up the latest urologist referral because I’m still testing the naturopathic approach. There are no side effects that I’ve noticed. My pissing is less frequent, with better flow and drainage.

My assessment of my pissing progress is measurable. Firstly, I simply count the number of pisses during each night. Secondly, I can score myself when I leak. One point for leaking standing up without dribbling all over the floor and everything else. Another point for being able to hit the back of the bowl at least once. Another for hitting the back of the bowl right up to the end of the leak. My night-time pissing is getting less frequent and I’m hitting the back of the bowl now with more three-point leaks. Before I started the saw palm remedy there were no three-point leaks. So, for the time being, I’m happy to take it as far as it goes.

In any case, I can easily be brought back to reality by repeating the last PSA and ultrasound measures. There’s nothing like a longitudinal study with a series of repeated measures to get me excited. There’s science in them-there repeated measures. Like, am I retaining less in my bladder now, or am I kidding myself? I will yield to the results. And of course, a good picture, like an X-ray or scan, will always help me to visualise the issue with confidence and understanding. So yes, I’ll go see a urologist if I find that I can’t manage my BPH.