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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Family knows you better than anybody. So when Dr. Muff got sick, his little girl said to him: "You don't look right, daddy." She described him as pale and gray. So today, about eight hours after LRP, the wife of one of my patients said: "His eyes are bright."

 

All I could see was a patient waking up from anesthesia. A tiny bit still groggy, a bit puffy, in a way that anesthesia makes people look, which I can see but they often cannot. My patient felt generally well, with minimal discomfort, had taken some water with no nausea or vomiting, with vital signs stable. He said he was feeling more coherent. But were his eyes brighter? Not that I could see.

 

So I'd wave this off except for one thing: It's not the first time I've heard stuff like this. As one example, when Gerry woke up, he said he felt that his "mind was clearer than it's been in a long time." And his wife said that Gerry's "color returned immediately," which I could not see.

 

Riddles:

 

What do the wives see that I cannot?
What about removing the prostatitis prostate improves cognitive function?

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Replies to This Discussion

Perhaps a subtle expression change from "giving up" to "hope" or "pride". You would need to know someone very well to see this.

It takes a lot of soul searching and mental strength to decide to go against what 99.99% of the medical profession recommend (to do nothing) in search of relief through a major operation.

I try to imagine myself in the same position on awakening, "I found the courage to do this, now I am committed to my decision. I will work my way through the side effects over time for a better life-I am proud of myself".

This would be my clarity of thought if I awoke with minimal discomfort.

Just my two cents..!!
So thw wife sees a very subtle change related to emotion? If so, why don't I ever hear such comments with cancer patients? They definitely change emotionally post-op: Much less anxious.
I guess they were much less drained physically with cancer as they had not been in pain for years beforehand. Their body had not been fighting a "possible" infection. If chronic tonsillitis makes people feel "under the weather" or even quite ill & fatigued, then chronic prostatitis certainly can & does. Perhaps its something to do with the burden being lifted from the immune system?
Cancer patients are terribly drained in many cases. Afraid of cancer death, afraid of radiation and chemo, afraid of surgery, afraid of the stigma ... As intensely afraid, anxious, and depressed as many severe prostatitis patients.

Immune system? Hormonal system? Neurological system? It's a mystery.
Well, Dr.Krongrad, I didn't say "His eyes are bright", when I saw Nick in the recovery room, but if I had it would have meant "he looks good!", he doesn't look sick any longer. As a nurse I think a person means the "sparkle" is there. As medical professionals, we have seen very sick patients whose color is bad, and you might say their eye's are dull and "lifeless". However, since I am sure most of your patrients are like Nick, walking into their surgery as congnezant as they ever are, the wives may expect to see their husband looking quite "sick" after surgery, and when they see them looking just as normal as before, perhaps a little sleepy but looking very much what I call "with it", their saying their eyes are bright means, "I see my man is OK!" Also when a man has been suffering for many yeasrs and the toxic poison of the infection is gone, I can see a wife seeing the subtle changes that means his body is no longer under attack. Wives see things, people who don't know them as well, would probably miss. It is subtle, like at first, identical twins might be hard to distinguish one from the other by someone who does not know them intimately, but for one who does, there is no problem in knowing which is which.
There are two things happening at the same time: 1) Within hours of waking from anesthesia,
prostatitis patients are reporting that "the fog has lifted." They say this in various ways but with clear reference to cognitive function -- ability to think. And they distinguish this from any reference to pain, comfort, or hope. I have never seen any other kind of surgical patient, including thousands of prostate cancer patients, wake up and say they can think more clearly than before surgery. 2) Correlated with above, the
wives of prostatitis patients but not other patients are reporting that their husbands' faces/eyes/skin have improved relative to preop. This is apart from the effect of anesthesia, which makes almost all patients look lousier, not better, in the first few hours: Puffy, sleepy. And they're not talking about pain, comfort, or hope. This seems to be something else. Let's also take a step back to remember that severe chronic prostatitis, but not prostate cancer, is associated with non-pelvic chronic complaints, such as
fatigue and
social isolation. In other words, the illness is almost inherently
multi-dimensional: Pain, fatigue, impaired cognition, depression, isolation, impaired urination ... Some of the non-pain aspects can be
severe. Watch
Gerry's prostatitis surgery video and notice how he kept forgetting to turn off the stove, which suggests disorientation. And that after surgery his abilities recovered fully; listen to how his wife describes this. My questions: 1) Is increased mental ability caused directly by prostate removal, indirectly by increased comfort, indirectly by increased hope, or something else? 2) In the first hours, are the wives "seeing" increased mental ability? Sue makes a good point: Wives are experts on husbands; that's because they see them day in and day out. My corollary: I am an expert on surgical patients; that's because I see them day in and day out. And what I think I am seeing in prostatitis surgery patients is something I do not believe I have ever seen before: Surgical improvement of mental function. So what explains it? My bet is on prostatectomy, not comfort or mood. Now I just have to prove it.

I am certain that my decreased cognitive ability is caused by a combination of the following:

1)Pain killers. (especially Lyrica-affects memory and even speech at times)
2)Pain.
3)Anxiety.
Post-op patients have pain and pain killers. And the prostatitis patients still report improved mental ability.
In my case my prostrate was badly infected by an mdr e-coli which I believe was the main reason for my "fog", I was living with an infection, but the pain also contributed. The pain from my T-8 Spinal cord injury is constant and intense, and my mind and thinking has been affected, but this pain is nothing compared to the pain from my infected prostrate, it was so bad I became unaware of the pain from my injury. I have no doubt a pain that was much worse than that of my injured spinal cord affected my mind as well.
As for how it affected my thinking, my short term memory was terrible, forgetting things, leaving the stove on, not being able to concentrate, driving poorly, I hit a few curbs, I just felt "dull". Upon awakening from surgery my mind felt amazingly clear, miraculous is the word that comes to mind.
Pete's prostatitis surgery story is now posted in his own words. fyi.

I can't believe it because these are things I noticed. When I always thought antibiotics had cured me because all of my symptoms would go away. I would notice things like my mind would be so much clearer, it's like a fog lifts that you forgot was there. It's almost a sense of euphoria that I would feel on these 'good times'. My eyes would go nice and bright blue, and my skin coloir would change. I would feel so healthy that it's hard to describe, because you forget what it feels like. Explaining these things to the doctor would make you look mad :)  but it is so so true.

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