Wednesday, November 18, 2015

ZoomText Fusion, a quick review

The latest product from AI Squared is called ZoomText Fusion 10.1.  This is a ZT magnifier integrated with Window-Eyes 9.2.   This product seems to target people with progressive vision loss, such as those with retinitis pigmentosa, to transition seamlessly from magnifier to a full time screen reader.  Unlike the screed reader that was in the ZoomText Magnifier/Reader 10, the Window-Eyes  screen reader in the ZT Fusion has lot more capabilities. With my continue worsening vision, I have been looking into a full time screen reader for awhile.  I have tried JAWS and NVDA screen readers but found them hard to use because of all those hard to remember hotkey shortcut.  ZT Fusion is supposedly easier to use, especially for those who already familiar with the ZT Magnifier/Reader, that's me.  I have to give ZT Fusion a try so I downloaded the free 60-day trial before deciding whether to spend the money to upgrade.  BTW, the upgrade price from ZT Magnifier/Reader is $399 while buying a new copy is $999.

I installed the trial software in a laptop PC running Windows 7 Professional.  This PC already had ZT Magnifier/Reader 10 installed on it.  There is no need to uninstall ZT 10 to run the trial software.   During ZT Fusion installation, Avast anti virus program thought one of the file was a virus and stopped the installation.  I had to stop the anti virus program in order to continue.  I noticed the installation process has been improved.  There is a tool bar to change font size and enable or disable voice at the top of each installation screen.  If you enable voice, you would hear what button or options on the screen.  The setup wizard would run as part of the installation, you can choose to run the wizard or choose the default setting. If you choose the default setting, you can change the setting later.  It took about 5 minutes to install all the software components.  There was a progress bar on the screen but no audio feedback during this component installation.  If you can't see the screen, you might not know what's going on.

Oh, ZT Fusion supports Window 7, Window 8.1 and Window 10, it also support touch screen.   I am happy with Win 7 and have no plan to move to Win 10, so the additional Window OS support has no value to me.

After completing the installation and restarting the PC, you would see the ZT Fusion 10.1  tool bar which is very similar to the ZT 1Magnifier/Reader 10 tool bar but with an additional tab labeled Fusion.
Magnifier Tool Bar

The magnifier tab looks the same but has more finer magnification granularities for the lower magnification range.  While this is nice, I won't  upgrade for this feature because I don't think it would benefit me if my vision is getting worse down the road.

The Reader tab also look the same but has three new sections under Verbosity setting.  These new sections offer verbosity settings for common tasks, browser mode, and MS office.   Additional screen reader control can be found on the Fusion tool bar.  In addition to IE and Firefox browsers, the ZT Fusion now also support Google Chrome browser.   ZT Fusion also has bunch of settings for MS Office. This has little value to me because I use Firefox browser and Google Doc.

The Tool tab has an additional icon called Image Reader.  This is an additional  OCR and hardware product to read hardcopy documents.  I think my Abbyy OCR software and scanner could provide similar function.

Since I chose the default setting during the installation, I wanted to bring up the setup wizard to see what options were set.  The setup wizard is a new choice under the settings on the menu bar.  The setup wizard let you set the most common options for magnifier, reader, and tools in few screens.  Alternatively, you can do the same setting and more under each tab.  After revewing the settings and changing some to my liking, I want to look at what's new under the Fusion tab.  Clicking the Fusion tab would bring up the following Fusion tool bar which contain 3 groups.

Fusion Tool Bar

Settings: this icon would bring up the Window-Eyes 9.2 control panel.  The control panel contains many screen reading advanced options that are all new to me. Pressing PF1 key would bring up the window-Eyes user manual which has description for all the options.  I think I have to read through this manual in order to use the screen reader.

BrowserMode :  turn on or off automatic browser mode while on the web.  If you click on an input field like in a form, it would turn off the browser mode so you can enter data.  You can also manually turn off browser mode by pressing insert + z keys.

PageNav : pressing this icon while on a web page would list all the headings, links, and landmarks on that web page.  I think the Web Finder on the magnifier tool bar provides the similar  function.

TutorMode:  provide voice guide while you running application.  The amount of guidance is depended on the verbosity setting. For this quick look, I turned on the beginner level and checked many boxes on the verbosity setting for web. 

LearnCtr: contains online tutorial on various ZT Fusion topics such as magnifier, screen reader, web page, Microsoft office.

Pronunciations : offer a way to change the pronounciation of a word to your liking.

OK, let's take ZT Fusion to a spin on the web.  The first website I visited was  The site detected I was using a screen reader and offer a screen reader friendly website at  The website didn't offer this option when I was using ZT 10.  Once on the alternate amazon website, ZT Fusion read  out number of links on the home page.  The ZT Fusion turn on browser mode automatically, you can tell because the pointer was changed from an arrow to a pointing finger with arrow keypad symbol.  At this time, you can use the up and down arrow key to move around the webpage or use hotkey shortcut to do the same.

I then tried Fusion with Google Chrome.  The first time I was on the Google home page, it offered a link to turn off the instant search option, which I didn't do.  After couple of search, Fusion crashed saying it had compatibility issue and told me go the browser's advance setting to turn off some options.   

Next, I opened the Thunder Bird mail client.  ZT Fusion told me to use arrow keys to move around in this application.  I was able to read and send email.

Finally I opened a Google Doc.  The document was opened in browser mode.  While in the browser mode, I used arrow keys to move around the page to read.  To edit the document, I pressed insert + z to get into edit mode.  Fusion seem to work fine with Google doc.

After using ZT Fusion for few days, I don't plan to update at this time for the following reasons:

ZT Fusion feature

What’s in for me

Win 10 & touch screen support

Np plan to use Win 10 or touch screen

MS office support

I use  Google Doc

Google Chrome support

I prefer Firefox

Window-Eyes screen reader

Nice to have, but the regular ZT screen reader is OK for my need at this time.  I might use the free NVDA screen reader in the future.

Supposedly easier to use for current ZT magnifier user

Not really, I still have to memorize all those hotkey shortcut just like other full time screen readers.  I like the tutorial mode and the auto browser mode.

Upgrade for $399

Too expensive, I would consider it for $100.

I will continue to use the ZT Fusion until the end of the trial period.  Who know, I might find some functions' I can't live without and bite the bullet.  Will update this as I learn more about ZT Fusion.

As a side note.  For the past few days, I have had few  crashes on Fusion start up and couple of crashes when trying Fusion with IE and Google Chrome.  These crashes might suggest stability issues and this is another reason that I don't want to upgrade.  The ZT Magnifier/Reader 10 is much more stable.

ZT released an update for Fusion on 12/16/2015.  After running Fusion with the update for few days, I don't think the update make any improvement.  I told ZT about this and they had me install an utility to collect system dump.  When I run the utility, all I got was a blank window screen, I had no idea what it done.

ZT released another update on 1/7/2016.  The release note didn't say what the update fixed.  The Fusion with this second update seem to be more stable.

After 60 days of free trial, I have decided not to update to Fusion Ver 10.1 for the above reasons.  After I deleted the Fusion trial software, I attempted to run the ZoomText Readder/Magnifier Ver 10.1 free trial, but keep having trial has expired message.  I guess I can only run one free trial software per PC.  When I delete the ZT Ver 10.1 software, it also deleted my current ZT Ver 10 software from the PC as well.

Disclaimer:  I am no expert on ZoomText products, this post may have inaccurate statements.  Please visit the following link for the most accurate and up to date product info. 
Zoom Text Fusion product info

FWIW, this July 2015 WebAIM survey seem to suggest that Window-Eyes is gaining popularity as a primary screen reader.  However, I think the gain is partly due to its inclusion with MS Office.  The following diagram is from the survey. 
Screen reader usage trends

Wednesday, October 28, 2015

I hate Comcast, but little less this time

When I received my latest Comcast internet bill, I noticed my monthly internet cost has gone up from $54.99 to $82.99 for the Blast tier service.  The current download speed for Blast tier is 100Mbps.  The bill indicated the Performance tier would be $69.99 per month.  The current download speed for Performance tier is 50Mbps.   In order to save few bucks I want to downgrade my service back to Performance tier but I dread to call Comcast due to previous unpleasant experience.

When I call Comcast to downgrade my internet service, I was pleasantly surprised to talk to a very cheerful service reps.  I told her I want to downgrade my internet service to Performance tier due to the high cost, she offered me the current internet promotion.  She said the current offer for Blast tier is $69.99 per month and Performance tier is $59.99 per month.  She also said that the Blast download speed is 150Mbps and download speed for Performance is 75Mbps.  She even offered free cable TV with the $59.99 Performance service.  In order not to deal with Comcast, I declined all the offers and just change to Performance internet only service.  I just don't want to deal with cable box and another remote control, and then have to call them to cancel cable TV service later on.

I really hate the Comcast confusing service levels and  promotions. I also hate the annual price increase. Unless you beg, you don't get the lower price.  I was surprised to get the lower price without begging this time, I guess I was lucky to talk to a cheerful person.  All the people I deal with on the Comcast toll free number before gave me the impression they were either inpatient or grumpy, or hate their job.  Anyway, I am still looking forward to sign up the gigabit internet service offered by our city next year.  The charter price will be $49.99 per month for as long as I stay in the current address.  My advice to Comcast is to simplify your pricing and have more cheerful service reps.

This AskBob article mentioned the Colorado municipal broadband.

My history dealing with Comcast.

I hate Comcast

I hate Comcast, continue

Bye Bye Comcast cable TV

Tuesday, September 8, 2015

Why I hate retinitis pigmentosa

:rant on.
The reason I hate retinitis pigmentosa(RP) is because it screw up my life big time.  For those who are reading this post, you probably already affected by this incurable blinding eye condition.  While you are slowly going blind and may be depressed, some people would try to cheer you up by saying something like there are worst medical conditions than blindness, this is a new challenge to do thing in different way, god give you RP for a reason, or other politically correct positive spin on blindness.  From my personal perspective, almost nothing is worst than blindness, not even life terminating illness like cancer.  With terminal cancer you know you have certain amount of time to live thus you can look forward for the end of suffering.  On the other hand, blindness has no certainty.  You could flatten by a truck next time you cross the street, or you could suffer blindness until age of 100.  The only certainty is that you can't do many things on your own and your quality of life keep worsening.  While some people look at the world through a pair of rose-colored eyeglasses, I live in a real world.  There is just not one thing good about RP.  Just for fun, I put down some positive spins about blindness that I heard over the years.

Some people believe RP just a minor inconvenience, more power to them and I wish you the best.  For me,  I was able to see for more than 40 years, going blind is a crippling handicap because:
  • I can't recognize the face of my wife, my children, and my friends. The clear face images of them in my mind were probably 10 years old.  Positive spin: they are forever young in your mind.
  • I feel guilty of passing this gene to our children.  Have I known  what I know now, I would not have any kid.  Even though I knew I had RP, I took the gamble in believing my kid would only have 50% chance of having RP.  Looking back, I think it was irresponsible  of me to take any chance to subject our children to this terrible condition.  Guilty as charged,  I hope someone would find a cure in their life time.   Positive spin: God has plan for everyone, even the blind one.
  • I can't do the job I like.  I was an electronic engineer before RP terminated my career.  I loved this job, I would have stay in this job until my boss sick of seeing me.  Anyway, I had this fun job for almost 32 years.  Positive spin: enjoy the early retirement.  Many people want to retire early and couldn't, lucky you.
  • On the subject of job choice, while this no longer affect me, I have heard some totally unpractical advice to others.  For example, many years ago in one of the RP support group, A young man  asked the group whether he should enroll in the Air Force Academy  because he want to be a fighter pilot. Even though he said he couldn't see well at night, many people said, go for it, follow your heart, don't let RP stop your dream, there would be a cure by the time your graduated.   Well, I hope that young man wake up from the dream long time ago.
  • I am no longer a productive member of the society.  I am now a burden of SSA.  Before you say why not find another job, I don't think anyone would hire a blind old man. Even a greeter at Walmart needs a pair of working eyes.  Even I found a job, there would  probably no way for me to get there in my area due to minimal public transportation service.  Positive spin: you paid the tax, why not enjoy the benefit.
  • I can't have a driver's license.  Now I have to depend on other to drive me around.  If I want to have dimsum, not a chance unless someone willing to drive you there.  My life events have to scheduled around others.  Positive spin: no more car payment, insurance payment, or up keep.  Enjoy the half bus fare too.
  • I loved to watch movie on big screen.  I haven't stepped in a movie theater for years because I couldn't see the whole movie screen.  Watch Star War movie on DVD with descriptive audio is just not the same.  Positive spin: save money on the ticket and pop corn and soda.
  • I enjoyed reading books and magazines.  Now a day, I have to listen audio books and magazines instead, the experience is just not the same.  No audio could fully describe the pictures, diagrams, or any other visual elements.  Positive spin: free audio book and magazine download from BARD. 
  • I loved cooking.  In my  early better eye years, I often invited my friends over to share my Chinese cooking and BBQ.  Couldn't do that easily anymore.   I tried to cook some lunch recently for myself and made a mess.  I had to trouble my wife to clean it up.
  • I feel my life like that of a critically ill patient in an ICU.  Instead of breathing tube, IV lines, etc I have to depend on various low vision aids just to keep up with simple daily tasks.  Without these tools, I would be completely helpless.  FYI.  this is list of low vision aids I been using.
  • I hate using restroom in public places, especially the one with dim lighting,  because I find it extremely humiliating to ask someone for the location of an urinal or a toilet.  I try to hold the business if I could. 
  • So what can I do? A whole lot of nothing.  I eat, sleep, poop, and ponder the meaning of my life.  I had  nightmare as the result from these pondering.
The reason I write this post is that no one wants to talk about blindness in negative way probably due to the current state of political correctness about every thing.  Mass media only talk about how a blind person climbed  a mountain or flew an airplane or other inspiring stories.  Those stories gave the public the misconception that blind people have extraordinary power.   I guess no one want to know how most blind people struggle with daily live like me. I am just bit tired of hearing all those inspiring stories and I hope this post would provide some balance.  Secondly,  I feel good about this ranting, it is better than seeing a shrink. 

Final rant, awhile back someone  said to me that God gives the toughest  battle to his strongest soldiers  When I question is this how your God rewards his strongest soldiers by disabling them with a blinding disease?  I was told not to question it because God works in a mysterious way.  I think this is a shipload of crap, what an irrational rationalization.
:rant off.


  • The bar chart shows blindness is one of the top fear medical condition among American.  Read the full AFB opinion survey here.

bar graph showing how many Americans believe that severe vision loss would have the most negative impact on their quality of life (21%), compared to paralysis (also 21%), HIV/AIDS (16%), cancer (14%), stroke (11%), heart attacks/disease (6%), diabetes (4%), and deafness (3%).

Tuesday, August 18, 2015

Roof replacement project, my recent experience.

My recent encounter with roofing contractors would make you think that Colorado economy is so good that some roofing contractors could afford to ignore their potential customers. 

Our house is 20 years old and its roof is showing sign of deterioration.  Although it is not leaking, I don't think it would last another year of Colorado's harsh  winter.  Rather than waiting for roofing problem to occur, I proactively get it replaced.  I followed the general recommendation for selecting a contractor.  In my case, I was looking for a contractor who been accredited by BBB, in business for few years, have insurance,  and within 30 miles radius from my house.  Before contacting any contractor, I used online estimator to get a rough idea how much my roof replacement project would cost.  I wanted to remove the original shingles, and install Class 4 impact resistant shingles, and any other worn out roofing parts.  The reason for choosing Class 4 roof shingle is that hail storm is very common here and class 4 shingle would reduce my home owner insurance premium.   The online  estimated cost was between $6000 to $7500. With that number in mind, I contacted the following contractors and was very surprised that some of them don't care about my business.  Originally I was just go to call 3 contractors but it turned out I had to call few more just to get 3 estimates because some of them just ignored my call for whatever reason.  I suspected that summer time is a prime time for roof replacement and some of the contractors so busy that they could ignore my call.  I think this is a good thing too because they would probably ignore any call to correct their potential workmanship problem.  For 2 weeks, I contacted the following contractors:
  • Hometown roofing, Greeley.  I received a postcard mailing promoting roofing and other home improvement projects in our city, so I gave them a call.  Someone took down my name and phone number and said someone would call back to schedule an appointment for an estimate.  No one ever call back.
  • B&M roofing, Frederick.  Pick this one from BBB site.  Someone took down my name and phone number, but no one ever call back to schedule for an estimate.
  • NorthernLight roofing, Longmont.  A project manager came to our house the day after I call them.  He sent me a project proposal the next day.  His roof replacement cost was at low $7K.  The cost including the upgrade to 30# underlayment, and optional ice shield at the valley.   He also wanted to replace all 5 vent caps, which I think was not necessary.  This contractor would use Owens Corning Duration Storm Class 4 asphalt shingle.
  • Creative roofing, Longmont.  The owner came to our house the same afternoon I called.  I think this is a small owner operated business.  Not accredited by BBB.  He said he doesn't need insurance because he would do the work himself.  The only reason I contacted him because he replaced the roof of my next door neighbor.  After looking at my roof he immediately gave us an  estimated cost of  low $6K.  The ice shield and 30# underlayment was included in the cost.  He had the lowest bid, but I was worry about the insurance. This contractor would also use Owens Corning Duration Storm Class 4 asphalt shingles.
  • Colorado roof topper, Mead.  Left contact info on their website.  Got an email reply couldn't do estimate until at least 10 days out.  Since I was expecting the third estimate the next day, I told them don't bother to come.
  • 3R roofing, Boulder.  The owner came to our house the next day after I contacted him online.  His estimated cost was at mid $6K.  Ice shield and 30# underlayment were included.    He was very responsive to all our questions and provided all the insurance documentation.  This contractor would use Certainteed Northgate Class 4 asphalt shingle.  We went to couple of our local building supply store to look for sample but no one carry this brand of shingles.   I asked the contractor about this and he told us that Owens Corning happen to have a larger market share in this region and assured us that CertainTeed Northgate is better shingles for this climate base on his experience.  He came by and drop off a sample for us to look at.  I searched the web for user review on this shingle but found none.      
  • Sunny roofing, Longmont.  Their website said they do roofing in our city, but when I call, they said they no longer do roofing in our city. 
With three proposals on hand, we had to pick one.  I don't like the Northernlight proposal, because it seem  like they want to charge everything extra.  For example, other contractors use 30# underlayment as standard, they wanted to use 15#.  Upgrade to 30#  would be couple hundred dollars more.  Other example, other contractors would install ice shield at valley area as standard installation, Northernlight said this is an option for extra charge.  They also wanted to replace some other stuff that I don't think is necessary.  I was go to pick Creative roofing, but I was really worry about the lack of insurance issue.  What happen if he got hurt on the job, would we be liable for his medical bills?  We finally decided to go with 3R roofing even though I was bit concern about the CertainTeed shingles.

When 3R came by with the project contract to sign, we were surprised to learn we need to pay half the cost up front.   This was never mentioned before and the other two contractors wanted full payment on job completion.   I have heard stories about contractor just took the money and disappear.  I was a bit concern, because this contractor has been in business for many years and no complain in the BBB site, I took a chance and signed the contract.   He said he would do the job on Saturday and should be done in one day.  Much to my relief, the roofing material were delivered to my house on Thursday afternoon.

 The installation crew shown up on Saturday 8AM. The weather was sunny and hot.  I think it just took about an hour for them to remove the old shingles, the rest of the day was spent on new shingle installation.  We were told before hand to remove things that are hang on wall because the vibration might knock them off.  Anyway, a ceiling light cover in a closet was shook loose and broken on the floor,  luckily no one was in the closet at that time.  , The crew of three worked until 8PM.  Unfortunately the crew was not able to complete the job because they didn't have enough shingles.   A very small section of the roof and the small bay window roof were not done.  Look like they just need one more pack of shingle to complete the job.  Because it was weekend, they couldn't get more material until Monday.  I was a bit anxious when the weather turned rainy on Sunday, but it was only a short shower in our area. We noticed a long section of metal drip edge on the ground after the crew left.  I thought it was leftover material and didn't say anything.  

On Monday, the owner came by and installed few shingles on the roof, but he said he would let the crew finish the shingle installation on the bay window on Tuesday.  I didn't know the reasoning behind this, delay but the crew did finish the job on Tuesday morning.   A city building inspector came by afternoon and approved the job.  I wondered what the inspector was looking for, he didn't even go up to the roof to look.  He just walked around the house and looked at the roof from the street.  We then sent the project invoice to our insurance company and they gave us 15% premium discount.

My wife later noticed that one section of drip edge look different from the rest.  I think  the crew forgot to replace one section of the drip edge.  I hope this was just a oversight and they didn't forget to do anything else.  Because of my extreme poor vision, I was not able to see what the crew did on my roof.   I just hope this contractor has ethical business practices and has not cut corner on material or workmanship.   I know I need to trust someone, trust but verify, but this is hard to do when you can't see.  I am waiting for the first major rain or snow storm to hit this area to test their workmanship.  I will keep my fingers cross and update this post as needed.

So, would I recommend 3R roofing?  I would give a cautious nod, definitely including this contractor in your consideration.  They were very responsive to all my questions and their price was reasonable.  It would be nice if they have not forgotten one section of the drip edge and have not miscalculated the amount of material for  the job.

We had similar experience with gutter contractors.  The week after the roof replacement, we decided to replace the gutter too.  We called 4 gutter contractors and only one bother to call back.  Rather wasting more effort to get more estimates, we just gave the job to that contractor, Rainminder Seamless Gutters in Longmont.  They seem to do a good job. 

Update 10/3/2015
According to tjhis article, BBB rating doesn't mean much.

Friday, August 7, 2015

GreenLight Laser Surgery for BPH

Warning: This blog post is rated PG-50 for adult language, explicit description on a man's unique body part and its function.   Some people may find these info too graphic and disturbing.  Consult your doctor for your personal health issue.

In this post, I talk about my BPH being mis-diagnosed as OAB for years, my decision to have the GreenLight Laser surgery, and my post surgical recovery process, as well as possible complication.

While all men and women won’t able to escape from dead and taxes, many men over age 50 won’t able to run away from another  issue. Enlarged prostate affect many man over age 50 which many men won’t want to talk about it or try to ignore it. Although this is a man's problem, it might affect his bed mate as well.  You might want to give your man a nudge to seek treatment if his problem is affecting your quality of life, in fact, you may save his life because prostate cancer has similar symptoms.

I start having prostate issues around age 50.  Initially the symptoms were just a bit annoying, like I had to wake up at night couple of time to urinate and had few drops of urine leakage afterward.  Gradually the frequency of night trips to the bathroom was increased to about every 2 hours and I had the feeling I couldn’t empty the bladder completely.  Because I couldn’t sleep well due to the frequent night time bathroom trips, I was dead tire during daytime.  Luckily my wife was a heavy sleeper and my frequent bathroom trips did not wake her up.

I mention this urinary problem during an annual physical to my family doctor, Dr. L.  He checked the PSA level and he checked prostate size, wich was within ormal size range.  He said all my plumbing were normal and I might just have an overactive bladder(OAB) and prescribed a drug called Oxybutynin  to treat OAB.  The medication made my mouth and nasal passage very dry, plus it made me very constipated.  Worst of all, the drug did not alleviate my OAB symptoms at all.   I told Dr. L about this and he changed to another OAB drug but the second drug caused even more side effect and it did not help my prostate problem either.  He suggested me to see an urologist.  Because I wrongly assumed only women would have OAB,  I rationalized I was just overreacting to this seemingly minor annoyance, the problem wasn’t that bad, I didn’t see an urologist immediately.  Beside, a “real man” just won't talk about his bladder problem and I really dread the digital rectum exam, I feel so violated by this procedure.  Also I had an even more serious health problem to deal with at that time, I was going blind due to RP.
When my urinary problem gotten worst about a year later, , I decided I should see an urologist to deal with it.  I went to see Dr. M, an urologist in the same medical clinic as Dr. L.  He checked my kidney function with blood and urine tests, checked my prostate with the dreaded digital rectum exam and he looked inside my bladder with a cystoscope to rule out other prostate issues.. .  He said my prostate  and everything were within the normal range and he also believed I had an OAB.  He prescribed Detrol LA to treat this. I tried the Detrol LA for three months but the drug did not help.  He then wanted me to try a none drug treatment procedure called  Percutaneous Tibial Nerve Stimulation(PTNS).  He said this procedure works for about 50% of his patients so I gave it a try. 

The PTNS treatment is like a single needle acupuncture.  During each treatment session, a nurse would insert a long thin needle at a nerve point on inside of my left ankle.  She then connect a wire from a small pulse generator to the needle.  A second wire from the  generator is tape  to the bottom of my foot to provide a return path.  She then turn on the generator and gradually turn up the pulse intensity level until I told her to stop.  She said I should take the pulse as high as I could without it hurting me.  I always told her to stop when I feel the tingling at my upper leg.   The generator has a timer and it would turn off the pulse after 30 minutes.  I took the full 10  PTNS treatment course  without any symptomatic relief.  At this point, Dr. M was perplexed with my lack of improvement with my OAB treatment and I stopped seeing him.  I even seek second opinion from another urologist in another clinic.  He just did the dreadful digital rectum exam and said I had OAB and prescribed another OAB drug which I didn't even bother to fill. 

 Out of frustration, I seek alternative treatments forOAB.  First, I tried acupuncture.  I found a local acupuncturist who supposedly specializes in bladder issues.  During the initial session, she exam my tongue and feel my pulse at the wrist, and said my frequent night time bathroom trip is due to kidney deficiency.  She believed  acupuncture and Chinese herbal medicine would help my body to rebalance the ying and yang energy. I had 4 acupuncture treatment sessions and took a bottle of Chinese kidney tonic with unknown ingredients. The acupuncture and the kidney tonic did absolutely nothing to my prostate symptoms. She said I might need more sessions to see any improvement but it is getting expensive and I didn’t think it would work, so I stopped the acupuncture treatment.  I then tried Saw Palmetto supplement, which also didn’t help.  At this point, I just gave up and suffered this problem in silent for couple more years while the problem kept getting worst.

At round age 56, the prostate problem was so bad, I went back to see Dr. M again for help.  By that time, I had to get up about every 90 minutes at night to urinate.  Some time I couldn’t start the urine stream immediately and once started, the stream was very weak, plus I couldn’t empty the bladder in one setting.  I had to go back to the urinate 3 or 4 times within 5 minutes or so to feel the bladder somewhat empty then I felt my bladder full again in about 90 minutes.   After some more tests, he determined I am suffering from the symptoms of benign prostatic hyperplasia (BPH), BPH is also called enlarged prostate.   The BPH diagnose was confirmed by bladder ultrasonic scanner which check the post void urine residual in the bladder.  The urodynamic measurement also show I had very weak urine stream.  My BPH symptoms score was 31, which indicate I have severe prostate problem.  Base on these test results, Dr. M prescribed Flomax to treat this BPH problem.  He said this drug is very effective for most men.  I took this drug for about 3 months and it seem to provide some symptoms relief but I really hated the side effect.  I was suffering stuffy nose and constipation with this drug.  Dr. M then change to a fairly new drug called Rapaflo.  Both  Flomax and Rapoflo are alpha blocker to relax the bladder neck muscle so make urinating easier.   Rapoflo worked very well for about a year with minimal side effect.  Because this is a relatively new drug, there was no generic version, so it was fairly expensive.  Dr. M had to get special authorization from our insurance company to prescribe this drug. After a year on Rapoflo, it seem to loss its effectiveness.  Dr. M then added another drug called Finasteride, this drugsuppose to shrink the size of prostate.  Dr. M told me to take both drugs together for 3 months to see if they would help my problem, they didn’t help. 

After reviewing all my previous treatments, he said other drug treatment probably won’t work for me and I should consider surgical treatment option.  He said even though my prostate is relatively small at 40g, but unfortunately, most of my prostate grow are inward to the urethral, the tube that carry urine out of the bladder.  I guess why my doctors didn't initially believe I had enlarged prostate because all my enlargement was inward while the outside was within the normal range.  I would think the cystoscopy could detect this condition.  He said he usually recommend surgery when the prostate size is larger than 80g.   Because of my inward prostate grow, my urine flow was severely constricted.  He offered me two minimally invasive surgical options.One option is called Transurethral resection of the prostate (TURP), the second option is call Photoselective vaporization of Prostate (PVP), this procedure is also called GreenLight laser treatment.  He said even though my prostate is not that large, but in my case surgical option should be considered.  He gave me some information to read about each procedure.  Because I really afraid of any sort of surgery, I researched extensively on each procedure on the web and it took me few more months to decide to take the surgical option, and all the while I was suffering even more severe BPH problem like occasional urine retention and painful urination.

In a nutshell,  TURP uses an electrified wire loop to cut away the excess prostate tissues that is blocking the urethra.  This is the gold standard for BPH treatment because it has very long safety record and has long lasting result but it has potentials of greater blood loss and longer healing time.  Some people have the TURP may need to stay in hospital overnight. The newer GreenLight aser uses high heat to vaporize the obstructive tissues.  This option has became more popular now because it has been proven just as effective as TURP but with  less blood loss and shorter healing time.  People on blood thinner medication have less complication with GreenLight Laser and usually no hospital stay.  Both these procedures have the potential side effect of retrograde ejaculation and the need of catheter and urine bag after the surgery.  Depends on your condition and your doctor, the catheter would stay in your bladder for few hours to few days.    There is even a newer treatment option call Urolift.  Urolift procedure does not remove any tissue, instead it uses staples  attach the obstructive tissue to the inner surface of the urethra.  Urolift  has no blood loss and no sexual side effect.   his procedure is so new, it is not yet available in Colorado.   I was really hoping for this option.  After months of reading and procrastination , I decided on the GreenLight laser treatment.  The fear of post surgery complication and unknown recovery process were the main reasons of my procrastination.  I hope the following details would put some of you at ease and help you make the right health care decision.
After telling  Dr. M about my choice, he scheduled the surgery for August.  One week before the surgery day, I went to his office for the pre-operative physical exam.  He listened to my heart and lungs, he ordered baseline EKG and blood works.  He said I was in good physical shape for the procedure.  He prescribed four medications to be taken after the surgery.  The medications were:
·       Ciprofloxacin 500mg.  This antibiotic to be taken twice a day for 7 days.
·       Ketorolac Tromethami 10mg.  This is an an anti-inflammatory drug to be taken 4 times a day for 5 days max.  This is a very potent medication; it has some nasty side effect and must be taken with food.
·       Diazepam 5mg.  This is a muscle relaxer to be taken 3 times a day as needed.  This drug would help to reduce burning sensation during urination.
·       Hydrocodone/Acetaminophen 5/325mg.  This powerful pain killer to be taken 4 times a day as needed. 

Three days before the surgery, I got a call from a nurse from the surgery center.  She took down a list of medications and supplements I am taking.  She told me not to eat or drink after 12AM and arrive at the surgery center at 7AM.   She told me to wear loose fitting pants because I would have a catheter and an urine bag attach too my leg after the surgery.  A pair of shorts would be perfect.

Monday, surgery day.  We arrived at the hospital day surgery center at 7:00AM.  I was given an ID bracelet on my right wrist, I was also given a bracelet on my left wrist which ID me as legally blind.  This ID was really helpful because the hospitals staff seem to  take extra time with me.  They would tell what they going to do on me before doing anything.  I already pre-register and provided insurance info few days ago.  I was in the prep room around 7:30AM.  I was told to remove all my clothing and put on a hospital gown. They also put a pair of compression socks on my legs to prevent blood clot forming. A nurse took my weight, checked my vital and inserted an IV line on the back of my left-hand after she checked my ID.  The anesthesiologist came by around 8:30Am. He asked some routine medical question and gave me a choice of spinal tap or general anesthesia, I chose the genera anesthesia because I don’t want to feel anything. .  He said both methods are safe and had about the same amount of side effect after waking up. Dr. M then came by to let me know the procedure will take about an hour and he l do the surgery soon.  I was wheeled into the operating room around 9:00am and all the while I was having second thought on the surgery.  I was just hoping I made the right decision.

The operating room was cold and I was cover under couple of warming blankets.  After one more ID check, I was hooked upTo a BP monitor, oxygen monitor, and EKG monitor.  I was told a breathing tube will be place in my mouth after I gone under.   The anesthesiologist said he would start the drug and told me I should seel sleepy soon.  The next thing I knew I was waking up in the recovery room.  I had absolutely no memory about the surgery.  I asked for the time and was told it was 11:15AM.  The first thing I felt was the very bitter taste in my mouth, the second thing was I felt I has a full bladder and had a strong urge to urinate but couldn’t. The OR nurse  told me the surgery is done andI have a foley catheter inserted in my penis.

The OR nurse brushed my teeth with some water and gave me few ice chips to chew on to get rid of the bitter taste.  Next an urine bag was connected to the Foley catheter.  Once the drainage started, the urge to urinate went away within few minute.  Dr. M came by to let us know that procedure went well.  He told me to take out the catheter at home on Wednesday 7AM and come to see him for following up on Wednesday 3PM.  The initial drainage in the bag was pinky in color while we were in the surgery center, but it changed to darker red after we gone home.  Dr. M told us to expect blood in the urine bag for couple of days.  He also told me reframe from strenuous activities for 2 weeks.

We were given one small and one large urine bag. The small bag would only hold about 500ml of urine.  The small bag has 2 Velcro straps that can be used to attach the bag to my leg so I can walk around with it.   The large bag would hold about 2l of urine and it has couple of hooks to hold the bag onto a bed frame or other things.  Either bag must be placed blow the bladder for proper drainage operation.  Because I don’t plan to go anywhere for the next 2 days, I asked the nurse hook up the larger bag to the catheter.  I would just carry the large bag when I move around inside the house.

While waiting the anesthesia drug to wear off in the recovery room, I felt a bit light headed and nausea.  My BP was at 85/55.  The nurse gave me a cup of apple juice to drink and few crackers to eat.  My BP was back up to round 125/85 after few  minutes.  The nurse asked whether I need a pain killer which I declined. 

Because I don’t see well, a nurse instructed my wife how to empty the urine bag, how to clean the leakage around the penis and how to remove the catheter.  She also went over all the medication and other discharge paper work.  We were back home round 12:30PM.

Because I haven’t eaten anything after 8PM the day before, I was very hungry and thirsty.  After lunch, I took a Cipro and a Ketorolac pill and took it easy.  I had no pain from the procedure.  I think the most uncomfortable part was the catheter in the penis.  Wife emptied the urine bag twice and the urine in the bag was red.  I was not able to sleep at all that night due to the catheter.

 Tuesday, The day afger surgery  In the morning, wife noticed the overnigh urine in the bag still bright red but not thick like blood.   Wife emptied the urine bag around noontime, the urine was red.   Even though Dr. M told us the blood in the urine is to be expected for few days I still gave his office a call just to be sure.  His nurse said it is OK and not to worry.  I also told the nurse about the constipations I am having probably due to Ketorolac medication.  She told me to drink 60 to 80 Oz of water plus it is OK to take a laxatives to help me go.  I had the feeling the balloon tip at the catheter prevent the stool to move.  Anyway, I took a dose of Miralax for constipation relief.
In the afternoon, the urine drainage was somewhat clearer.  But In the evening, the urine drainage was a bit reder than in the afternoon.  I was a bit worry because GreenLight Laser supposedly have minimal bleeding, but I had tendency to overreacting on health problem.

Wednesday,2 days after surgery. Slept about 3 hours last night.  Wife emptied an almost full urine bag at around 1AM and again at around 6AM, urine color was light red. I Had an erection while sleeping which was a very painful experience because the catheter was still in the penis.  Try not to do that if you can help it.

Per Dr. M’s order, I removed the catheter at 7AM,  In order to remove the catheter, I first had to deflate the balloon at the tip of the catheter by cutting off the small plastic tube that was used to inflate the balloon with water.  The balloon was completely deflated after the water was drained in few seconds.  The catheter was inserted about 3 inches deep.I slowly pull it out while running hot water over it to make the process more comfortable.  I felt way better after the catheter was taken out.  Had a bowel movement soon after removal of the catheter.  Had little bit of light red leadage from penis. 

11AM had the first pee after the catheter removal.  Urine had little bit of blood,  Had severe Burning sensation.  The urine flow was involuntary interrupted due to burning sensation but resume soon after.  I felt the bladder was not empty this time.  Took a Diazepam to see if it would help.  Since I couldn't see whether I had blood in the urine, I used a piece toilet paper to touch the tip of the penis after each urination.  If I see a stain, I knew I had blood in the urine.

2:30PM had urgency to pee but only small amount of urine came out.  Had few drops of blood.  Had burning sensation again.

3:00PM follow up with  Dr. M.  He told me to empty the bladder.  He then used  a bladder ultrasonic scanner to see how much urine was left in the bladder.  He said there was only 1 Oz urine left in the bladder.  He said this is a good sign and told me to drink plenty of water to flush the whole urinary track.  I told him about burning sensation and bloody leakage, he said all these are normal healing process and should go away in few days. I was told to come back in one month for follow up.

6PM. I had the full bladder.  Urine stream was strong, no constricted feeling with urine flow.  Notice small blood strain on the paper underwear.  Burning sensation was not as bad as before.  Be sure to get some disposable underwear to catch the leakage.

Thrusday, 3 days after the surgery.  Had a good night of sleep for many years.  I only woke up twice during the night to pee.  Urine stream was strong and completely empty the bladder.  I only felt Very light burning sensation, I think the Diazepam really help.  I am still drinking a lot of water.  So far, I haven’t taken the prescription Hydrocodone/Acetaminophen because I had no pain.

 Friday, 5 days after the surgery.  I had to wake up 4 times last night to empty the full bladder because I drank a lot of water during the day.  I couldn’t tell whether any blood in the urine but I felt a small blood clot came out one time.  I only experienced slight burning sensation wile urinating last night.

Urine in the morning was normal, no blood.  Minimal burning sensation.  Last day on Ketorolac medication.

Saturday, 6 days after the surgery.  Had to wake up few times to urinate because large mount of water intake during the day.  Minimal burning sensation.  Urine flow was strong and bladder was completely empty.  No blood in the day time urine.  There were only small of leakage on the paper underwear.

Sunday, one week after the surgery.  Everything seem fine.  No blood in the urine but still having light burning sensation while urinating.  We went out to eat and then go shopping.  I noticed if I stand too long, more than an hour, I felt some pain at the groin area and I had to sit down to alleviate the pain.

I am very happy with the result so far.  While I had last minute doubt  about my decision even while laying on the operating table, I am glad I took the plunge and had the surgery.  .  I only wish my doctors had the correct diagnose sooner.  Because of the misdiagnose, I was treated for OAB instead of BPH for years.  Finally, I must thank my wife for emptying all those urine bags and making sure I take the correct medications at the right time.  Without her help, my recovery process would have been much harder the first week.  I know I am still weeks or even months away to fully recover from the surgery and to have normal bladder function.

Monday, 8 days after the surgery.  Nothing unusual to report.  However, I have noticed I need more frequent urge to urinate even though the bladder was not that full.  From my research, this is part of the healing process too.  It might take some people few months to have regular urge.

Tuesday, 9 days after the surgery.  Minor set back this morning.  I was constipated and had to strain to get it going.  There was a blood stain on the toilet paper.  I didn't take Miralax yesterday,  I think I would take a dose of Miralax for the rest of the week..  No blood in the urine for the rest of the day.

As a side note.  I have noticed my vision is bit blurrier.  I don't know if this has anything to do with the surgery or the medications I took.  I think I also gain couple of pounds due to lack of exercise.  I can't wait until next week to go back to my exercise routine again.

10 days after the surgery.  Wife said there were some blood in the toilet.  I was a bit constipated and had to strain a bit to get it going.  I have ran out of laxative.   

11 days after the surgery.  Constipated again in the morning.  Had to give a push to get it going.  Big mistake.  I saw a bright red stain on the toilet paper.  Although I am drinking plenty of water or juice, and eating plenty of fruit, I guess lack of exercise really make my bowel sluggish.  Need to get a bottle of Miralax.

12 days after surgery.  Little bit of blood in the urine.  Burning sensation at the end of urine stream.  Took a dose of Miralax.  There was a small blood clot pee out once.

13 days after surgery.  Still having a bit of blood in urine.  Burning sensation at the end of urination.

2 weeks after the surgery.  Not much changed, still have bit of blood in the urine and burning sensation at the end of urination.  I am just a bit worry about this, I might give my doctor a  call tomorrow just to  be sure.  I found some people talked about their recovery after the GL surgery, some people had blood in their urine for few weeks.  Also I still waking up 3 to 4 times a night to pee,  this is suppose a normal post recovery process and may take few months for some people to correct.

15 days after the surgery.  I am easing back to my exercise routine.  I rode my exercise bike at half speed this morning and had a short walk with my guide dog after noon.  Urine seem to be clear most of the day, but had a bright red spot on the toilet paper in the evening.  Still having burning sensation at the end. 

16 days after the surgery.  Rode exercise bike at half speed.  I saw a big red stain on toilet paper.  Wife said there was a bit more blood in the toilet than yesterday.  Well,  I guess I am not ready to go back on exercise routine yet.

17 days after surgery.  No exercise bike, but went out with guide dog for a short walk.  No blood in the urine all day.  Stinging sensation at the end of urination.  I didn't call my doctor about the blood in urine, lets wait and see.

18 days after surgery.  No exercise bike.  Went out for a short walk.  No blood in the urine all day.  Stinging sensation at the end of urination.

19 days after surgery.  Ditto.

20 days after surgery.  Ditto.  One tiny blood clot came out.

3 weeks after surgery.  No blood in the urine for the past 4 days, but still having stinging sensation at the end of urination, but not as bad at last week.  To day would be my last day taking Miralax.  I plan to start back on exercise routine again tomorrow.  Unless my recovery changed, no more daily  update on this post.  My next update probably after my one month follow up with my urologist .
4 weeks after surgery.  I was back on my exercise bike at half speed for the whole week.  I was also using the 5 lbs dumb bells with weight training.  No blood in urine for the past week.  Still having burning sensation at the end of urination, but the intensity and duration have lessen somewhat.  I notice few drops urine leakage at the end of urination, I hope this is just a temporary problem.  I still need to wake up 3 to 4 times a night to urinate and had the feeling of not completely emptying the bladder.   I only had these problem at night, I hope these were temporary problems too.  My one month follow up with Dr.  was delayed by a week because Dr was not available.

5 weeks after surgery.  Back to my regular exercise routine.  There was one incident at mid week with trace of blood in the urine.  Other than that, no noticeable change from week 4.  I am losing patient, I wish recovery could go faster.  At this time, I find the frequent urgency to urinate most bothersome.   The urgency sometime could be triggered by drinking a cup of cold water, seeing toilet or even just the thought of urinating.  If I hold the urgency for couple of minutes, it usually goes away. 

6 weeks after surgery.  No blood in urine.  Noticeable decrease on burning intensity and duration, but I can definitely feel it and the end of urination. 
Post surgery follow up with Dr. M.  During the office visit, he had me empty my bladder and then scan my bladder to see how much urine was left.  He said I had about teaspoonful of urine left.  I complained about frequent urgency and leakage, he prescribed Oxybutynin  to treat the OAB symptoms and wanted me to take it 3 to 6 months.  He said my OAB symptoms are very common after prostate surgery.  He scheduled a 6 month follow up.  You might recall that Oxybutynin  was the first medication I tried and I didn't like the side effects.  I will give it a try again to see if it would help this time around.

7 weeks after surgery.  The burning sensation is almost gone, I just feel a very slight brief sting at the end.  I am hoping that would gone too by next week.  The Oxybutynin didn't seem to help my OAB symptoms, but I have only taken the medication for 4 days. 

8 weeks after surgery.  The burning sensation at the end of urination has completely gone, I guess that mean I am completely healed.  It has taken longer time to recover than I like but I am glad it is over.  I am still happy with the result.

 The Oxybutynin has not helped my OAB symptoms.  The drug gave me very dry nosal passage and stuffy nose.  The side effect is very uncomfortable.  The most bothersome side effect is constipation.   I think I go to stop taking it and just live with these OAB symptoms for awhile and I hope they would go away in the near future. 

Three months after surgery.  The symptoms of OAB have not improved at all, and I told my doctor about this.  Well, he wanted to double up my oxybutynin and take laxative as needed to relieve constipation.  He said I could try another OAB drug but he said all could cause constipation.   I decided not to take any more drug for now because I just hate constipation.

At this time I am not even sure I have OAB because I only have frequent urination problem while sleeping.  From what I read on the web, I might have nocturia.  

In a nutshell, this is my current status

Before GL procedure

After GL procedure

Hesitant at start of urination

Full throttle

Weak urine stream

Pee like a horse

Dripping at the end

Full stop at the end

Imcomplete voiding

Completely empty

Frequent urination

 Some what worsen at night

More control over urge to pee

Cold water would trigger strong urge to pee

 I-PSS score  : 24

 I-PSS score : 8
Mainly due to nocturia and urgency.

Four months after surgery.  No change on my night time urination problem.  In addition, I had slight stinging sensation during urination for the pass month or so.   I have found that red wine would let me sleep for about 3 hours then the hourly urination would return.  At first I thought the night time urination was due to alcohol intake so I stop drinking red wine for couple weeks just to see what happen.  What I found was as soon as went to sleep I had to pee about a hour later and continue do so hourly.  I also noticed washing my hands with cold water sometime would cause strong urge to urinate.  

It seems the Green Light surgery fixed one thing but created another problem.

Seven months after surgery.
Had a follow up visit with Dr. M.  At the clinic, I was told to pee and had an ultrasound scan on my bladder.  The result indicated that I was able to empty the bladder completely.  I told Dr. M that I still need to pee 4 to 5 times at night.  I told Dr. M that I haven't taken the oxybutynin because of the constipation problem.  He wanted me to try a different drug called Imipramine 25mg once daily before going to sleep.  He said this drup was intended as antidepressant but can be used to treat night time urination.  He said this drup should not cause constipation.  He wanted me to try it for 4 weeks and call him back with the result.  After I gone home I look up the info on the drug,  one of the common reported side effect is constipation, WTF ??? 

I tried the Imipramine for 6 weeks with no noticeable better result.  I told my doctor about this and he told me to double up on the dosage for another 6 weeks.  I decided not to do so because I just don't like the side effect.  Beside in my recent eye chect up, the eye pressure has increased to the point that I need eye drop to control it.  From what I read, Imipramine could affect eye pressure for some people, I just couldn't risk any more damage to what little vision I still have.

12 months after surgery.

I have noticed some of the pre-surgery urinary issues seem to resurface. At night, I have to strain a bit to start to pee and I have the feeling of not completely emptying the bladder sometime.   These issues are very minor and not that bothersome at this time.  I was told the GL procedure should help my urinary issues for 3 to 5 years for most people. This is really disappointing, I was hoping I don't need to deal with these issues for few years, I guess I am one of the unlucky one, but I have no regret with my decision on this surgery. 

Thank you for reading.  I would love to hear your experience.  Unless something change, no more undate on this post.


Reference material

I did not make the surgical decision lightly and I had done a lot of research before making that decision. Please google the following items for more information to help you which BPH treatment is right for you.  There many YouTube videos on the this subject too.
  • BPH treatment options
  • BPH symptom score 
  • GreenLight Laser for BPH treatment
  • TURP
  • TURP vs. PVP
  • Urolift
  • Overactive bladder