prostate philippines patients stories
TITLE: Case study of the Manila Protocol: A woman’s view
By K. Hardin
My husband is 70, both of us working, and this is a case study still in progress as of August 2013. He has healed considerably and the Prostatitis Foundation asked us to write up the story. My family and I have no medical training and are not affiliated with any source or authority mentioned in this article. But I do want other people to find healing!
In 2004 my husband’s PSA test result moved above 4 and a local urologist (actually a surgeon as they are in the US) recommended biopsy and more. We read a little and my husband chose watchful waiting combined with 2-3 times a year fasts according to the prostate cancer survivor and writer Larry Clapp. [1; for sources see below] These fasts improved our health and the PSA wobbled above and below 4, never as high as 10.
In 2010 when my husband first developed acute symptoms, it became an emergency. A disagreeable dinner partner while we were traveling abroad launched him into a stress-induced 24 hours of suffering and not peeing. His bladder was drained by a kind Filipino nurse; a testicle then got infected and suddenly he was in a frightening level of pain. He was home in a US hospital for antibiotics and observation, and I began to search for possible solutions besides the drugs and cutting (or freezing or microwaving) that the local urologist advocated. My husband’s emergency responded to the antibiotics and he came home for 6-10 weeks recuperation. He was left in a rather intolerable condition—namely getting up to pee too often to get a good night’s sleep, and the worry and exhaustion of not being able to empty your bladder, the doctor’sominous threat of future cancer, and a prescription for “pills for life and then the knife.” (Specifically to start with, finasteride/Proscar and tamsulosin/Flomax.)
I am the kind of person who reads my way through challenges in order to learn and act. In my readings—mostly on the web but also into the medical literature—the Prostatitis Foundation  and Dr. Antonio Feliciano’s method [3 is highly recommended; 4, 5] stood out as more reasonable and less invasive. My husband’s diagnosis was benign prostatic hyperplasia,  and that seemed like an older man’s version of a prostatitis diagnosis. Since we had no way to get to Dr. Feliciano in Manila, we pursued a facsimile of his approach, going to see a provider in Tucson for a week, twice. We later learned that the Tucson protocol had diverged from the Manila protocol. In any case, relief was not yet in sight.
Our jobs then took us to Asia briefly. With the airfare to Manila covered, we called Dr. Feliciano and arranged to become his patients for the month of June 2012. (He treats the partner of the man with prostatitis to identify and clear up any infections that could reinfect the man via sexual contact.)
We reserved a short-stay studio apartment  with an adjacent luxury supermarket, movie house and mall. Upon arrival we began thrice-weekly taxi rides to the clinic. We holed up in that heavily-guarded middle class skyscraper-plus-mall for days. It was hot out. My husband was still ill. We were worried. And we were on a mission. So tourism was minimal. Pharmacies in and near the mall were our outings. I tore through the novels of F. Sionil José. This homebody approach was crucial to our success.
The clinic staffs were entirely professional, warm, patient. Consultations, procedures, exams, and lab tests were done by the doctor and his small team except for two trips to the Manila Doctors Hospital for measurements of my husband’s prostate size (transrectal ultrasound) and bladder emptying (pre and post-void bladder ultrasounds). This medical model, keeping the patient close so that data gathering and learning is easier and more secure, was novel to us, coming from the factory system in the US which chops every medical interaction into separate pieces. During the month my husband stopped taking one of the two drugs that he had taken since summer 2010.
We have been back in the US 13 months. By the third month back my husband stopped taking the other US-prescribed drug he had continued to take as a sort of security measure. He measures his healing as not getting up at night to pee more than once, a feeling of emptying the bladder, and feeling generally normal. With some protest, our local urologist has agreed to measure my husband’s post-void and his prostate size every six months, with my husband not on any pills. We are equipped with an emergency supply of alfuzosin from Dr. Feliciano should my husband’s peeing stop completely; this is like a safety net he has not needed to use.
The only prescription from Dr. Feliciano we have not found in the US is (over the counter) betadine mouthwash, which he advises before oral sex, along with betadine or other very sudsy soap washing our genitals before sex. (As we talked with him over that month, Dr. F. also warned us off the sex tourism that plagues Manila, explaining it as a sure way to introduce new organisms to confound the examinations and stop the healing. He said that some of his patients had done this, to their detriment.) As for scrubbing your mouth and your genitals—if young people practiced this from the start we would have more health and less misery in the world.
As we understand it, BPH signifies prostate muscles that have gotten big in time because of prolonged and hidden infection of the prostate glands. The infection irritates the muscles and in time they become big, similar to muscles becoming well developed when you do weights. This enlargement may or may not encroach on the urethra. If the prostate muscles become big towards and around the urethra then one will eventually have urinary obstruction. In my husband’s case the prostate infection affected a large area of the prostate, hence he went into an episode of urinary retention. Luckily my husband`s prostate muscles enlarged away from his urinary tract (slowly and over a long time), which pushed up the PSA. (PSA does tend to increase with size of prostate.) Our Manila visit concluded no suspicious evidence of prostate cancer based on Dr. Feliciano`s digital rectal examination and ultrasound examination. Dr. Feliciano also does not anticipate my husband going into an episode of urinary retention in the future (based on the ultrasound study) as long as my husband`s condition is properly monitored by a responsible doctor. Maybe careful prostate drainage and correct use of antibiotic totally cleared the infection. Perhaps regular ejaculation will help keep the prostate glands clear so that the prostate muscle is not irritated.
To this day my husband can tell when something is putting him under too much stress to pee. He takes showers twice a day to relax and pee easily. He drinks less alcohol and exercises more. We have taken some (more to come) steps towards a more relaxing life. And under these conditions he wakes only once a night (or so) to pee and goes back to sleep without the anxiety of “What is going on, will I ‘obstruct’ again, is this how my life is winding up?” etc. We have talked with Dr. Feliciano and sent him my husband’s local test results. Recently my husband’s PSA, which we continue to measure as part of mollifying the local urologist, spiked above 10. But the PSA had just been officially discredited  so it did not change my husband’s approach to health. It is very helpful to have a good, if long distance, caregiver in Dr. Feliciano, via Skype.
Our local urologist derided all this as “medical tourism.” Undoubtedly US doctors would love to increase their share of that very real medical tourism market! What was key for us was getting a written reportfrom Dr. Feliciano to share with him. He could not refuse the report and it helped us negotiate my husband being in charge of his own health care.
Now, “if you go…”” Take a loving caregiver and good cook with you. Don’t vacation in the Philippines. Shelter yourself as best you can and devote yourself to rest and nutrition—a skyscraper-cum-mall is cheap by US standards and affords life in a bubble compared to roughing it or going broke in a luxury hotel (which are also in-your-face prostitution marketplaces).
In closing, Dr. Feliciano’s fees are not as high as health care costs in the US—where only if you’re lucky are they paid by insurance. And he has an approach that makes sense and works for us.
These are available online, through interlibrary loan, or at a university or medical center library.
- Clapp, Larry, and Tom Plant. Prostate Health in 90 Days. Carlsbad, California: Hay House, 1997.
- Hennenfent, Bradley. The Prostatitis Syndromes: Approaches to Treating Bacterial Prostatitis, Non-Bacterial Prostatitis, Prostatodynia, Benign Prostatic Hyperplasia, … And Possibly Preventing Prostate Cancer. Smithshire, Illinois: The Prostatitis Foundation, 1996. Can be obtained from http://prostatitis.org/monograph.html
- Feliciano Jr., A. E. “Repetitive Prostate Massage.” In Textbook of Prostatitis. J. Curtis Nickel, editor. Oxford, England: Isis Medical Media (1999): 311-8.
- Nickel, J.C., J. Downey, A. E. Feliciano, and B. Hennenfent. “Repetitive Prostatic Massage Therapy for Chronic Refractory Prostatitis: The Philippine Experience.” Techniques in Urology 5, no. 3 (September 1999): 146–151. PMID: 10527258. http://europepmc.org/abstract/MED/10527258
- Dr. Feliciano and his Manila Genitourinary Clinic are on the web at http://www.prostate.com.ph/, and are reachable by phone (632) 853-6050 or email firstname.lastname@example.org.
- “Prostate Enlargement: Benign Prostatic Hyperplasia.” National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). U.S. Department of Health and Human Services. http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
- We used the website Vacation Rentals By Owner, http://vrbo.com to make arrangements with an apartment owner from a distance. VRBO is just one of the services like this available at this time.
- Barry, M. J., T. D. Denberg, D. K. Owens, and P. Shekelle. “Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians.” Annals of Internal Medicine 158 (2013): 761-769. http://annals.org/article.aspx?articleid=1676183. See also the accompanying shorter “Summary for Patients.”