Winter 2024: PSA

This is the report based on a blood draw on Thursday, Jan. 11:

 Fall 2021: PSA

Today I had a blood draw in the morning. This report came in later in the day:

Component: PSA (BECKMAN)

My value: 0.400 ng/mL

Standard range: 0.0 - 6.5 ng/mL

The Beckman PSA method was used to perform this assay. Results obtained with different assay methods shouldn't be used interchangeably. It is recommended that one assay method be used consistently to monitor a patient's course of therapy.

-------

The determination that this age-related PSA is either normal or abnormal is valid only if this patient has never been treated for prostate cancer and is not on any medication that would change the PSA value. Clinical correlation is strongly recommended.

Spring 2020 PSA

April 22, 2020 -- Had a blood draw today at  a nearly empty lab at Kaiser Permanente. A very short wait. The results:

PSA (Beckamn)  My value: 0.630 ng/mL       Standard Range:  0.0 - 6.5 ng/mL

This puzzles me. Perhaps the standard has changed over time, because I thought the standard range was 2-4, not 0.0-6.5. And when compared to my prior values, it appears that my PSA is on a gradual decline. Is that normal for a health prostate as a man grows older? Is this the result of atrophy?

April 30 phone consult:

Telephone consult with my gp: the bicalutamide and Lupron treatments were indended to block my testosterone. A shrinkage of the associated organs was to be expected. This is likely a permanent conditions. The good news is that the PSA numbers are so low (but far below the norm, I note). Exercise can build up muscle mass, which can increase testosterone, he observes. And I could talk to my oncologist about shots to address e.d. Compared to pills which cost a few dollars, the disposable needles that administer the shots are expensive, I say. Sex is getting increasingly expensive.

I point out to him that he's a young man, so now he knows what he has to look forward to. I also note that, ironically, Group Health sent out a publication years ago about the health benefits for older people enjoying sex.

Winter 2020: Long Term Impacts

Feb 11, 2020 --What are the longer term impacts of prostate treatment? One of the concerns is impotency, but that's not the only consideration. Radiation can result in reduced semen production, and diminished libido. I'm reminded of the story of the old man who continued to chase women, but forgot why.

For the frustrated, an Internet search yielded these foods that allegedly increase semen production:

• walnuts.
• citrus fruits.
• whole wheat and grains.
• most fish, especially wild salmon, cod, and haddock.
• most shellfish, especially oysters.
• vitamin D enhanced milk and milk products.
• dark chocolate.
• garlic.
• gensing
• bananas

These are likely to be far less expensive than rhino horn or the spleen of the black bear. Or . . . was that the gall bladder?

Spring 2019 PSA

Conditioning and testosterone

Hi, Tracy.
It has been months since I've posted to this blog. I'm doing so now after reflecting on my conditioning. Before I was treated for prostate cancer I was pretty fit. My weight wasn't quite where I wanted it, as I recall, but my stamina was fairly good. When I made my last failed run at Mount Adams, I was packing 50 pounds. I'm not sure I can do that now. Yes, I'm older, but I'm persuading myself that I should be able to get into condition. However, there are some things I've discovered:

Weight gain: I think the impact on my schedule from daily radiation treatment made me less active. Along with that was the impact the radiation had on my body. I experienced significant loss of energy and corresponding weight gain. And the Lupron shots and Bicalutamide that blocked my testosterone seem to have contributed to that gain.

Weight loss:  After the testosterone blockers wore off,  I have it hard to take off the weight I gained. Part of the difficulty is the belief that I can always take off weight, because I took off 35 pounds over five months about 12 years ago. So I can always get serious tomorrow. But I have gotten serious, and it still seems quite difficult. I think the radiation affected more than my prostate gland, and that I'm producing less testosterone now. I'm kinda fat. I took a photo of myself lately, and this picture here shows what I  look like on a good day.  People say I look fine, but when I get out of the shower, there's just too much tummy. This shows me at 200  pounds (bathroom scale--207 at 24 Hour Fitnesses' rather clunky scale). I managed to creep up to 210 recently, but then pulled myself down to 200. My top weight was back in 2004, when I weighed about 220. The incentive to lose then was when I realized I was within 5 pounds of obesity.

Swimming: I have been swimming at the gym and worked my way up from pathetic to 1/2 km at a time. My styling is improving (you'll recall I was on my high school swim team) and my speed as well, and I feel good about that. However, I can't sink! I used to be able to let all the air out of my lungs and sink to the bottom. I could actually identify the point where the last mouthful of air allowed me to submerge. And I could hold my breath for a long time under water. Now I have little capacity for holding my breath a long time, and I just bob to the surface. It's a fight to stay under water. Fat has displaced muscle. Big time.

Upper body strength: I started doing pushups, and worked up to 150 a day in repetitions of 15. This was hard to sustain. It seemed that my arms would get only so strong, but no stronger, and that I was wearing myself out doing this. 15 pushups at a time is all I've build up to, and that's hard to do.

There was a time when I could push off the floor, clap my hands, slap my chest, and have my hands back in position to keep me from smacking my face on the way down. I don't see that happening again any time soon. What I do see, from time to time, is a big fat belly and some emerging muffin tops.

While I don't expect to be in the same shape I was in in my mid-20's, I would like to see improvement in my upper body strength in terms of strength and speed, but it's slow going.

Hiking: This is my strong suit, but nothing to write home about. I hike regularly, but I'm definitely not where I was. I sometimes hike was a group led by a man 10 years older than I (83) and he's hard to keep up with. Roger Matthews and I are talking about climbing Mount Adams next summer. I know people my age do that, and I am continuing to train for that possibility.

I am going to monitor my progress and speak with my physician in the near future. Next month it's time for another blood draw to measure my PSA. I'm optimistic that it is staying within normal range.

Love,
Dad

Another UTI

Sept. 9, 2018

Hi, Tracy.
Thought I was done with UTIs, but at this writing I'm struggling to beat one back without resorting to a visit to urgent care. Symptoms of mild pain and frequency were showing up and I wondered whether I was on the verge, and then I went for a hike yesterday and on one occasion had an accident.Today I was passing small amounts of blood, including tiny clots. So I am forcing liquids with the idea that I can flush out the problem. If that doesn't work, it will be back to urgent care.

But I've beaten one in the past with sufficent hydration, so I'm going to try that again.

We'll see.

Love,
Dad

PS:  

Sept. 10: Drank oodles of tea yesterday, and pain and color is now gone this morning. I will keep hydrating.

Blood pressure Aug 13, 2018

August 13, 2018

Hi, Tracy.
Had my annual physical today. Check out the blood pressure chart:

For years I was 120 over 68. Then it bumped up a bit at times. Now it's the best it's ever been.

My pulse was 58, but I was sitting up in an exam room.  I'm adding this on Tuesday afternoon at 1 p.m.: I  just laid down on the bed and took my resting pulse. It's between 46 and 48 bpm.

Love,
Dad

P.S. On Aug. 23 I had a return visit. My blood pressure was 138/76 and my pulse was 55.

PSA test, July 26, 2018

July 26, 2018

Hi, Tracy.
Thanks for the birthday call today, and for the inquiry as to what I wanted for my birthday. You were too late, although I didn't know it. I had my blood draw earlier, and it turns out that my present was already delivered: a PSA score of 1. More precisely, it is 1.00 ng/mL, while the standard is 0.0 - 4.0 ng/mL. Last March the score was 0.520 ng/mL.

Here a thumbnail of the score in the last couple years:

Component Value Date
PSA 1.00 07/26/2018
PSA 0.520 03/01/2018
PSA 0.400 11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 19 05/09/2016
PSA 16 02/17/2016
PSA 12 09/02/2015
PSA 10 02/23/2015 

I haven't talked to my oncologist yet, but I am confident that this rate is good. The numbers are gradually climbing to the norm at what I believe is a respectable pace. No discernible worries.

Update: Oncologist has scheduled my next blood draw for October.

Love,
Dad

Another Pesky UTI

May 15, 2018
Hi, Tracy.
Just when I thought it was safe to go back in the water . . . another pesky UTI. I've been back only a few days from my road trip, and today I felt that tingling that told me something was possibly happening. Then I had to visit the bathroom several times and it became increasingly obvious that that old aggravation was returning. I dropped an AZO pill to keep the discomfort down; that's the pill that produces that really rich yellow color like the freshest and richest of egg yolks. After a while that yellowing effect occurred, but then the color got richer with a healthy infusion of red. No question now.

I've been drinking lots of water and reading up on UTIs. One question I had is whether they can go away on their own. In rare instances they can. You can help this along by forcing water, which tends to reduce the ph of the urine; the closer it is to neutral, the better, according to one source. There are also the nostrums about what to drink to bring it under control, and some of the suggestions are way out. Cranberry juice is a familiar story, but today was the first time I read that you can add a teaspoon of urine to the water you're drinking and it may help.

No thank you.

One time at urgent care I passed a lot of bright red lemonade, and then the urine suddenly ran clear again. The medical staff prescribed antibiotics. My method this time is to see whether it will run its course and stop generating blood. I'm not burdened with incontinence, and the urge to pee hasn't been uncontrollable, so I'm going to treat this as a learning session. I'll eventually contact my urologist, but not until I've seen the progress of this latest aggravation.

May 15, 2018: Postscript

I slept through the night, awakening occasionally to pee, but never with great urgency. I experienced no incontinence. By morning the ASO was out of my system and the urine was clear. Not sure whether all the bacteria are gone from my system, but the symptoms are all gone.


Love,
Dad

PSA, Testosteron Levels

March 1, 2018
Hi, Tracy. I had my blood draw today, as part of the on-going process to monitor my prostate following radiation and hormone reduction therapy.  Here are the results:

Testosterone:

My value: 295 ng/dL Standard range: 170 - 800 ng/dL

PSA (Prostate specific antigen):

My value: 0.520 ng/mL Standard range: 0.0 - 4.0 ng/mL

In September 2016, my PSA score was 25. In November 2017, seven months after radiation ended, it was 0.4. So the score is recovering toward the normal range, but slowly. I take this as a very positive sign that this will have been a once-in-a-lifetime experience.

Love,

Dad

P.S. Msg from Dr. on March 2:

Your PSA is as follows:

Lab Results
Component Value Date
PSA 0.520 03/01/2018
PSA 0.400 11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 25.0 09/13/2016
PSA 19 05/09/2016
PSA 16 02/17/2016
PSA 12 09/02/2015
PSA 10 02/23/2015

We should repeat it in 4 months to see if it remains stable or continues to increase. I will place an order for July 2018.

Chacala, Mexico UTI

March 1, 2018
Hello, Tracy.
UTI's are never convenient, particularly when they occur in a foreign country and your cell phone has become difficult. This was the situation I faced Feb. 13-20 when I visited Joanie in Chacala, Mexico,

Here's a map showing how I got there, and some information from Wikipedia about this little Shangrila on the Pacific Coast of Mexico:

Chacala is a beach-town set in a small cove on the Pacific coast of Mexico in the State of Nayarit. It is located about 100 kilometers (62 mi) north of Puerto Vallarta. The name means "where there are shrimp" in Náhuatl, and is part of the coastline known as the Riviera Nayarita.[1] The population consists of approximately 300 full-time residents, but can swell to over 1000 during Mexico's most popular vacation periods such as Semana Santa, (Easter Week) and Christmas. Chacala is known for its physical beauty, unhurried lifestyle.

Chacala's small bay has a gently-sloped sandy beach ideal for wading out into the crashing waves.

I decided, spur-of-the-moment, to fly there, using airline miles on American Airlines. But after I purchased the tickets, I found myself with preliminary indications of a Urinary Tract Infection. (After a while you learn to see them coming.)  It came in the form of frequent needs to urinate, with a hint of discomfort. I tried to hydrate and clear it out, and it calmed down on my flight to Puerto Vallarta. I arrived, and hailed a taxi to the bus station. But enroute I decided I was tired and taking the bus to Las Varas and then taxis to Chacala seemed like more complication than I needed. So I paid the taxi drier to take me there.

Balking phones and missing passwords

After I arrived, the fun began. My new Verizon phone reads a finger print or requires a PIN for access, and for a while it opted for the PIN, but the interface didn't provide an "action" button once the PIN was entered. When I tried to e-mail Kaiser Permanente, I realized that I had not brought my updated password for my laptop -- had changed the password after losing my original phone in Zurich. Meanwhile, I was enduring sudden urges accompanied by incontinence. I had brought a diaper along as well as several absorbent pads similar to what ladies use. Joanie and I decided to take a bus to Las Varas, where there was a pharmacy where I could purchase diapers and she could have her non-working cell phone fixed. At the cell phone repair facility my phone decided to display its number pad with a new symbol -- a check; to my embarrassment the lady at the counter pressed the check and I was into my phone for the first time in a couple days. That was handy, because Verizon requires your phone to be working so that they can send you a text message so that you can get your phone working. Technology like this is very aggravating when you are in Mexico with a UTI.

There's a small mountain near the beach -- it's actually an extinct volcano, and we hiked to it's caldera.

The caldera of a small extinct volcano overlooking the bay.

Too late the banyo

And down the beach there was a tapas bar protected by a structure with a thatched roof. We went there to read one day, when the urge hit me just before the bar opened for business. The surf and the calm lulled me to a sense of complacency, and I failed to act before the urge hit. By the time the owner had unlocked the bathroom, I was pretty sure it was already too late, and I was right. Afterward I quietly offered her 100 Pesos and apologized to her for losing control and directing fire to the waste can in the banyo. (Where, in Mexico, they normally deposit the tissue due to plumbing problems.) A few days later she joined Joanie and me at our Valentine's day dinner, acknowledging by that gesture her forgiveness and understanding.

The mural urinal

The trip back to the airport was punctuated by several needs to stop -- the advantage of taking a taxi instead of the bus. It also represented an introduction to a Mexican custom -- peeing on a wall in plain sight. We were stopped in traffic and I exited the taxi, crossed in front of stalled cars, descended to a lower street, and looked in desparation for a banyo. The driver caught up with me and direted me to a wall. The next stop was a few miles down the road at a gas station, where he purchased a bag of peanuts. In the car he offered me some and laughed when I noted that this trip came with a meal. There was a significant language barrier, but we were able to share that joke.

Incident on the plane

There were other accidents, of course, and I learned that the best solution was just to walk out into the surf, so that no-one would wonder why my safari pants were wet. That didn't work on the plane home, however, when I made the silly mistake of sipping water while I was waiting for a passenger to exit the bathroom. I was pleasantly surprised at how the absorbent pad had caught most of the urine so that it wasn't obvious to others on the plane what happened to me in the aisle.

Things are better now. I got home, drank lots of fluids, and eventually urinated the offending bacteria out of my system. It was just one more aggravating experience on what I believe will be the final stretch toward recovery.

Later this morning I go to Kaiser Permanente for my blood draw to see what my PSA level is.

Love,
Dad

Recovery

Dec. 6, 2018

Hi, Tracy.

I went to a movie tonight -- the latest Star Wars episode. I was able to sit through the whole movie without having to get up and rush to a bathroom. I will continue my antibiotics for the next few days, but it appears that my UTI is a thing of the past. I will continue to drink lots of water and do pre-emptive peeing, But I think the bad is over with.
Love,
Dad

Another UTI: Managing incontinence

Jan 1, 2018

Hi Tracy

As I explained, two days ago I had another UTI. It came on about 2 p.m. when I was at a phone store, trying to have technical support connect a new phone with my existing phone number. I had just urinated before going there -- yielding up a small amount -- and already it was time to urinate again. And after a few minutes, when the phone assignment had been completed, I had a need to urinate yet again; only this time there was an off color in the liquid -- a trace of pink.

I knew what that meant. I drove straight home, peed again, and first saw blood, and then clots in the urine stream. I went to urgent care, where I passed a small specimen because I really didn't have much in my bladder. (I stopped hydrating so that I could  be dry at my next destination.) I met with a doctor and asked why I was having recurrent problems. She offered the observation that there's a distinct possibility that the microbes causing the problem come from outside the body and work their way up the urinary tract. Recommended treatment -- plenty of flushing activity, attention to bathing regularly and perhaps (my opinion) changing underwear more than once a day.

When I got home I drank water every time I urinated, and tried to pee before I had to. By midnight the urine was clear. I had already started on antibiotics.

However, although the urine was clear, sometimes the urge can accelerate rapidly from a mild sensation of need to an accident. And so I continued the practice of hydrating, but peeing before I even feel the need. In other words, stay ahead of the process.

What I'm finding is that it's also a policy of staying ahead of Dr. Pavlov. The moment I enter a bathroom the urgency accelerates, or in cases where there was no perceived need, an urgency emerges. So, yes, if you were wondering, I keep pads handy while this temporary aggravation exists, and I have been known to wear diapers -- but manly diapers, the kind that remain undetected beneath my trousers.

It has been a full nine months since my last radiation treatment and my second (and last) lupron shot, and the after effects are still being felt. The good news is that, while this effect is aggravating, it is manageable.

Love,
Dad

Another shoe drops

November 20, 2017

Hi, Tracy.
Just when I think I know what's going on, new information pops up. Apparently my UTI is a UTI after all, but maybe no longer.

In my last post I said the problem with my urinary tract infection was that it wasn't an infection, but more likely the result of irradiation, and that I had been prescribed medication. Well, the story has changed.

First the information was that a specimen showed no indication of bacterial infection. The doctor used a cystoscope to peek into my bladder and found it inflamed, theorized it was from radiation and  authorized medication to calm things down. Before his examination, my symptoms had already calmed down and after the exam they went away almost entirely. I concluded that the meds were likely keeping at bay a problem that was already diminishing.

But then, after I passed the information on to my radiology team, I heard back that I indeed had an infection after all -- involving e-coli! And then the urologist confirmed that. However, before he he had sent a camera up my urethra to study my bladder, he took the cautionary step of an antibiotic injection in my hip to prevent potential infection.

Put that all together, and now the theory is that I indeed had a UTI, that the radiation from last spring was not the source of the problem, and that the antibiotic I was given as part of the examination is what took care of the UTI.

So I purchased, a month's supply of bladder-soothing Elmiron for $40 (cost to Kaiser Permanente: $750), and I only took a few pills before the doctor said don't bother, wait and watch.

And that's where I'm at. Things have calmed down. I store my pads and diapers for the next crisis. I will just sign off with the same moniker as the famous author of "Yellow River" --  call me I.P. Daily.
Love,
Dad

Cystitis

November 13, 2017

Hi, Tracy.
My urologist may have solved the mystery of the symptoms I've been experiencing that are similar to a urinary tract infection (UTI). It appears that my bladder is inflamed for reasons other than a bacterial infection. The most likely explanation is a residual effect from the radiation treatments I experienced for eight weeks in February and March.

For the past couple weeks I've had symptoms; then they disappeared; then they reappeared. On one occasion, I was passing cranberry-colored urine, and then it suddenly cleared up. And I do mean suddenly. At one moment urination was painful and bright red, and then it wasn't. This past weekend I decided to cancel travel plans in December because I was suddenly needing to urinate several times a day. Yesterday I stayed home because I was not willing to leave the house. And I have been wearing the adult equivalent of diapers.

This morning I saw the urologist, who gave me a dentamicin shot in the hip to fight possible infections from the procedure that soon followed -- the uncomfortable numbing of my urethra, and then the insertion of a foot-long tube with a camera on the end, that slipped past my prostate and into the bladder, to take a look. This procedure is called a cystoscopy, and it uses a cystoscope, a tube with a lens on the end. It has about the thickness of a catheter. It stung a little, but with the anesthetic squirted in ahead of time, it wasn't much worse than the hot sensation that occurred during urination. In fact, while the cystoscope was entering, I felt like I had to pee. Afterward I did, comfortably.

 Normally, the bladder appears pink, but there were places where mine was red -- inflamed. In the absence of any bacteria, the most likely explanation was collateral damage from radiation dating back to the end of March. The painful symptoms prior to and during urination probably fall within the definition of "referred pain," which means one part of your body is experiencing discomfort that is expressed at another point.

The meds I'm going to take to deal with the inflammation are not inexpensive.  My prescription for pentosan (a.k.a. Elmiron) is $750, but because I have health insurance I pay only $40. Pity those who aren't covered.

PSA update

Buy the way, kiddo. I got more information clarifying what my PSA scores will indicate from now on. My PSA will continue to rise from it's present level until it reaches a new baseline. After radiation, you'll recall, it was less than 0.02. It is now 0.4. My understanding is that it should level out at about 2 or whatever is my "new normal." And then it should stay there. If it doesn't, that will get our attention.

Love,
Dad

PSA score, 7 months later . . .

Nov. 3, 2017
Hi, Tracy
What I thought is a urinary tract infection apparently isn't. My urologist says my urine culture proved negative for a UTI. However, I've been prescribed three doses of Monurol instead of the single dose I took Oct. 21. I take these at two-day intervals. So we'll see.

And now for the big news: When they drew blood due to all my excitement yesterday, they used some of that blood to test my PSA score, and  the results are listed below, showing what the score was historically. You will recall that my radiation treatment ended March 28, 2017.

Lab Results

Component     /  Value Date 
PSA 0.400      11/02/2017
PSA LESS THAN 0.02 04/25/2017
PSA 25.0         09/13/2016
PSA 19              05/09/2016
PSA 16              02/17/2016
PSA 12              09/02/2015
PSA 10              02/23/2015

You can see from these results that the PSA peaked at 25 on September 13, 2016; dropped to 0.08 % of  that score on April 25, 2017; then recovered to 1.6 % of that highest score by November 2, 2017.

Here is what the doctor had to say about the score and rebound:

You may get some increase in the PSA as the testosterone levels get back to normal. Once the PSA level is steady, then a recurrence would be consider your nadir stable PSA plus 2. So, the PSA response it good so far.

The next blood draw to measure my PSA would be in March, 2018.

Love,
Dad

It's baaaaaaack. Has UTI returned with a vengeance?

Nov. 2, 2017
Hi, Tracy,
In Jaws, the tag line is "just when you think its safe to go back into the water..."
Well, everything looked like it cleared up from the last UTI. And then that tingling sensation returned a bit this week, so I made it a point to stay hydrated. But I was noticing that there were these little Dr. Pavlov moments continuing. Just the thought of peeing made it happen. But if I moved fast enough, no disasters.

Until yesterday, when I walked to Seattle City Hall a couple times for a demonstration by the homeless community. Things got dicey walking home.

I woke early today and walked back downtown for the "die-in" at city hall, taking time to use the portable toilet outside city hall where the camp out was held last night. I photographed the die-in and headed home.

I can't remember the exact order of events, but they were exciting.  Either before or after I went to city hall I passed a lot of red urine and a really healthy blood clot. I went to urgent care, and a medic put an IV in my arm. I was given a specimen bottle. I had an empty bladder, so I hydrated in the exam room and he left a plastic bottle for the overflow. But when the time came, things happened very fast. Not all of the urine got in the overflow bottle, and only a small amount got into the specimen bottle -- but enough to test. I could barely stop peeing. The fluid was a cranberry red. After that session, I rehydrated, and later passed another sample, which was almost clear, and that's the way its been for the past 10 hours -- clear urine. No blood at all. Go figure.

This is really strange.

But the initial prognosis is another UTI. The technician told me the fact that the blood had been clotting earlier in the day was a good sign. I left there about 1:00 p.m., and walked to the downtown library branch for a short meeting. There is almost no tingling, although there is still some urgency when it's time to pee.

I'll be taking antibiotics, but the one they wanted to give me -- Monurol -- was out of stock until Friday afternoon. So I've decided to take it easy and not go anyplace special for a couple days until I have the antibiotic and things calm down again.

The medics took several vials of blood--enough to check my PSA levels for the first time since the end of my radiation treatments. I expect to have a consult with my urologist in a few days, and there will be more to tell.

Love,
Dad

P.S. Nov 3: Test results show  1,000-10,000 colony forming units of bacteria per milliliter in the blood.  Internet research (and who doesn't trust the internet?) suggests that the measure for whether I have a urinary tract infection is 100,000 cfu's. So maybe I don't have an infection, but in that case, what is going on?

UTI? No UTI? That is the question.

Sunday, Oct. 29, 2017
Hi, Tracy.
As far as I know, the latest urinary tract infection is gone, but it has left reluctantly. Until a day or so ago, I still had to visit the loo several times a day, with some urgency. One afternoon when I arrived home I was fortunate enough to have a coat I could hold in front of me as I made my way to the apartment, where I could get out of my wet jeans. On another occasion, there was some blood in urine. And even now, when I first enter the condo, or pour myself a drink of water, I sometimes feel Dr. Pavlov tapping me on the shoulder and I hasten to the bathroom.

Rather than panic, I took a Flomax the other day, started drinking plenty of fluids, and placed a pad in my underwear. I thought I was done with those, and almost donated the package, but now I've decided to hang on to them for a while longer. For the time being I plan to continue with plenty of hydration until I'm confident that I have flushed out the demons.

The adventure continues . . .

Love,
Dad

P.S. Oct 31, 2017 (Halloween). Hiked Tiger 3 today and had "urgencies" at least five times, involving a couple minor accidents. 

Yet another pesky UTI

The "egg"

Saturday night, Oct. 21, 2017
Hi, Tracy.
This time the UTI came on rather rapidly. In the morning there was a little tingling when I peed, and I noted it, and wondered whether I needed to drink more fluids. By afternoon I was peeing small amounts over short intervals,  the stream was pink with small clots of blood, and there was a burning sensation. By nightfall, I was suffering incontinence and having to rush to find a bathroom.

I had spent the afternoon with a friend who came in on the ferry and left by the same route. So I had to walk up Madison, not confident that I would make it without an incident. Fortunately, there were places with bushes along the Madison street route. As soon as I got home I called the Kaiser Permanente on-call nurse, who suggested that I come in. I also began drinking lots of fluids, and that helped to relieve the discomfort when I urinated.

The experience made me wish I hadn't been so quick to stop carrying absorbent pads. I got some out for the trek to Kaiser Permanente and they were used. I drank more water as I awaited in the urgent care facility for the medical staff to see me.

When I was  consulted by a member of the medical staff, I raised the question as to whether my recent self-administered test for libidinous responsiveness might have irritated the prostate and caused a problem. Was this the "ex post" fallacy, or was there a connection, I asked. He noted that I had experienced several UTIs and said this was definitely a legitimate question and I should ask the urologist.

Before heading home I picked up two medications from the pharmacy: Azo tablets for urinary pain relief; Monurol, an antibiotic which I dissolve in water and drink. I will take yogurt two hours before or after, to put some probiotics into my system, because the Monurol can cause diarrhea. And the Azo also give you very orange sweat and urine. (Check out the "egg" in the accompanying photo higher on this page.)
Cost for this adventure:\
$20 co-pay
$4.95 for the AZO, which I purchased as an over-the-counter medication. It would have been more expensive if I used a prescription. (Go figure.)
$38.68 for the Monurol (fosfomycin tromethamine)

Sunday morning, 7 a.m. 
I took the Monurol at midnight, two hours after eating the yogurt. I rose a couple times during the night to pee, and the pain was mostly gone. This morning I peed a clear stream with no pain and  no evidence of blood.

And the night shall be filled with music, 

      And the cares, that infest the day, 

Shall fold their tents, like the Arabs, 

      And as silently steal away.  --Longfellow

Love,
Dad