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Unable to urinate? Is it BPH or Bladder Disease caused by DMT2?
My dad is 79 yo male with history of DMT2. Who been to the ER on 12/25 and 12/26/22, He was brought in by ambulance for having pain and not able to pass urine, started today the 25th. After they examined him. Placement of foley on the ultrasound shows his has 957mL of urine in his bladder and not his prostate. Plan to start with Tamsulosin and see an Urologist. Next day 26th, back to ER for more pain with blood clots in the bag. UA shows WBC clumps cystitis, Keflex was prescribed. Lab work unremarkable for AkI . BPH with LUTS and change Foley size 16 to 23 then sent home the same day. Got an office appointment with his PCP 12/28. (At this point not impressed of communication from the involved doctors). My dad get an Urgent Urology Referral Appt for 1/3/2023 in Orange County per his insurance. That night he started to have seizures at my home. Call 911 and he was taken to Hoag Hospital ER and admitted. He stayed there for about a week. Now the hospitalist is explaining that had hypoglycemia, that caused ARF and infection on his prostate. What? My dad does not have a prostate problem ever. So now I do my owe collection of his medical records. Because I'm no doctor, and want to get an idea what going on and the research starts from Mayo Clinic, John Hopkins and Cleveland Clinic along with U.S. Department of Health and Human Services, National Institutes of Health . American Urological Association Education and Research, Inc. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Journal of Urology and Atlas of Human Anatomy book. By keeping his records and cc each doctor they were able to keep current. None of them use the same same labs. My dad decides not to do any surgery and want to try meds first for the enlarged prostate (Which we don't believe is causing this) and the Foley in and changed every month now is every three weeks because of plugging and bladder stones. A year is passing us by. His PSA Level went from 0.4 in 2015 to 56.92 in 2022. With meds it jumped down to 27.30 Dec 2022 and 0.6 in 2023 now its 0.3 in 1/2024. Whats was caused his infection his DM meds per the doctor at Hoag. He is home now. Mean time I am requesting for some type of rectal exam be performed or new x-rays be done for comparisons to see if worsen or improved from his hospital stay. Before any surgery happens TURP procedure. The doctor got put off by this. He gave us an order for an ultrasound of his Renal and Bladder finally. Had an appt to see him for the results. I got sick and unable to drive him, we missed our appt in Nov 2023, his next appt is not until Feb 22, 2024, more time is passing by. Stop me if i'm wrong how about a phone call. Something, We finally see the doctor and tells us that he referring us out to other Urologist for consult and HoLEP procedure. Trying to ask him why based on what? What changed to have TURP to HoLEP? When did he decide this? Why? Writes the referral and walks out. Now my dad is fed up with doctors with no answers. What are we missing? HoLEP first appt August 1, 2024. Anything?
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Did they do a PSA level in his blood work? That is the only test currently done to determine prostate issues. If they did a bladder scan they may have looked at his prostate too. I’m 72 and I hope you’ve asked your dad what he wants at 79? Putting him on an injectable to lose weight I question. Is the doc speaking about one of these new weight loss drugs that treats both DM and weight? Also, make certain your docs records show that you have authorization to be involved in your dad’s care. BTW docs are just too damn busy to take time to talk with each other because they have too many patients to see and not enough time. I’m a retired nurse and being on the receiving end now is eye opening.
Docs don’t have time to speak with each other regarding shared care of a patient due to time limitations, too many patients, etc. PSA does not directly check for cancer but for prostate size. In the olden days they digitally checked it and verified with a PSA and now only PSA. Cancer diagnosis is by biopsy. Injectable weight loss drug sounds like one of those new one that cost a ton, treats both DM and weight and has terrible side effects. At 79 is that what your dad wants?
@jenatsky , He has me research. Here he is working on his balance his food and outdoors activities. Sill working on his DM2. See his is where he gets concern his PSA blood level done 2015 level 4.5, in 2011 level 7.89, ok he calls me, look something wrong. 12-2022 his level 56.92 I looked 2 x's, 01-02-2023 inpatient his level 27.30. repeated on 1-25-2023 level 6.03 and 12-14-2023 is 3.0. Here we are 2024, he feels great but unable urinate on his own. He has me down as his advocate for his medical care. So i'm always reading everything about his condition under medical boards and here for common ground. For his doctor help him find an answer. i'm doing all of research making more information available.
@jenatsky, Nailed it. I agree.
What did his doctor say as a cause for his urination flow issues? I know that long term unmanaged DM2 can cause damage to the bladder. I presume a urologists is following his care? Has he had any success in weaning off the indwelling catheter? What’s the short and long term outlook?