March 2, 1996

[Disclaimer: These reports are from a series of notes taken by me during my cure of prostatitis by Dr. Feliciano, Jr. in Manila during six weeks in February 1996. I had severe symptoms of prostatitis such that I rarely left my home and was completely unable to work. Much of this information was given to me verbally and at a time before the painful effects of my prostatitis had subsided. Many times I only made the notes after returning to my hotel room. Dr. Feliciano, Jr. had much more information than I captured in my notes. He has not reviewed this material for correction.  Due to all these factors the material here should not be considered necessarily accurate representations of Dr. Feliciano, Jr.'s beliefs. Any and all errors and misrepresentation are soley my responsibility.]

Report #2 touched on the role blockages play in creating prostatitis and its symptoms and should be reviewed before reading this report. In this third report I will discuss prostate blockages in more detail and show how they can manifest so many symptom variations. The fundamentals of blockage and ditritous are from Dr. Feliciano, Jr. The extrapolations into symptom variations and infection stages are my own thoughts derived by using his blockage model as a base.

Now let's take a closer look at blockages. Diagram #1 in Report #2 shows an overall view of the prostate with one duct illustrated. The duct consists of a long tube starting with bulbs of acini connected at one end and ending at the urethra. Fluid fills the acini and during ejaculation muscles compress the prostate causing the fluid to be expelled.

Now lets look at closeup of an acinus. Diagram #2 shows a normal uninfected sac containing prostatic fluid. The - marks in the diagram indicate normal prostatic fluid.

Figure 2. (Graphic pending)

Normal prostatic fluid is somewhat transparent. After doing a drainage Dr. Feliciano, Jr. collects a few drops of the fluid on a slide for his microbiologists to examine. They immediately check its PH and perform microscopic analysis of its contents. Simply viewing the fluid by eye you can quickly learn to see the difference between normal fluid and that from an infected prostate. Infected fluid will be cloudy and have visible precipitates in it. (The precipitates looked to me like tiny thin strips of plastic.) These precipitates are the result of the body's defense mechanism
fighting infection.

Now lets look at an early infected state of our acinus. Figure 3. shows the sac now containing bacteria (indicated by * ) some which have attached themselves to the acinus wall. The bacteria are surrounded by white blood cells (shown as W ) as the body attempts to fight back. Notice that the duct is still clear to pass fluid.

Figure 3. Early Infected Acinus Sac(Graphic under contstruction)

As the battle rages white blood cells are killed. These and other byproducts of the war create clumps of waste (pus.) If the infection is great enough then this detritus can build up to totally clog the passageway between the acinus and the duct as shown in Figure 4. Here @ is used to represent detritus.

Figure 4. Blocked and Infected Acinus Sac.  After the acinus is blocked it swells (not shown) and eventually the pressure becomes so great that further fluid build-up is impossible.

The resulting symptoms of prostatitis can be explained from this model. The swollen acini make the prostate tender causing the deep anus sitting pain common to many prostatitis patients. The combination of multiple swollen acini can push on major urogenital nerves that pass directly around the prostate thus causing phantom pain (referred pain) where areas other than the prostate appear to have significant pain. Typically these areas are the penis, testicles, back, legs, etc.

Note that the prostate doesn't have to show up as enlarged on examination for these symptoms to occur. Rectal ultrasound on my prostate showed a totally normal size. Another unhappy fact is that the color ultrasound totally failed to show up these blocked acini in my prostate. I know I had blocked acini because I actually felt two of them unclog during the very first drainage done on me by Dr. Feliciano. It was truly amazing! I felt two quick pops in succession. (When he was through he told me that he had managed to undo some blockages and I told him that I had felt them opening up.) My pain was reduced to around half of its previous level just by that first drainage.

The acini blockage probably acts in very complex ways depending on many factors such as the location and size of the acini, amount of detritus produced, pressure on that part of the duct, etc. As can well be imagined, once the blockage is in place there is little or no chance for antibiotics to reach the pathogen hidden in the acini. The pressure there prohibits any new antibiotic carrying prostatic fluid from being added.

THIS IS WHY IT IS IMPORTANT NOT TO TAKE ANTIBIOTICS UNTIL YOU ARE HAVING PROPER DRAINAGE DONE! To the extent that antibiotics do get into infected areas they are probably not going to be sufficient to kill off the pathogen(s) and you are just allowing the pathogen(s) to evolve to be immune to the antibiotic. Thus could be threatening the ability for you to be cured in the future. Dr. Feliciano, Jr. told me again and again to stress this point.

In much the same way that the geysers and hot springs in thermal areas of the world such as Yellowstone National Park exhibit wide multitudes of phases and eruption variations, so can some complex symptoms of prostatitis be accounted for by taking into account the many ways that fluid flow can be obstructed in prostate duct blockage.

Geysers between eruption stage appear totally calm on the surface for minutes to years at a time before erupting. Likewise, acini ducts may remain blocked for various periods of time, only to unclog when sufficient pressure builds to forcefully eject the detritus on through the duct.

For some patients the acini never unblock and symptoms are experienced continuously. For others breakups occur but perhaps only for a portion of the blocked acini thus causing only a reduction in symptoms. If any live pathogens remain in the acini after the unblocking the entire sequence of blockage and opening can repeat. Cycles of clogging and unclogging can make symptoms come and go. And just like geysers, the periods between flare-ups can range anywhere between minutes to years.

One month into my prostatitis I had a solitary instance of an unblockage that left me with the only pain free period I had during my prostatitis.  Unfortunately, 12 hours later the pain slowly came back as the duct(s) reclogged, never to recover again until Dr. Feliciano's drainage treatments.  I understood none of this at the time. During my prostatitis I had asked every urologist I had seen about my 12 hour pain-free episode but all I got back were blank stares. When I told Dr. Feliciano about my pain-free period he immediately had an explanation that fit the scenario.

Just as thermal activity in geyser areas changes over time, so have some prostatitis patients experienced changes in their symptoms. I myself started with severe testicular pain which later diminished only to be largely replaced by deep anal pain from the prostate itself. I have heard one prostatitis sufferer say he has had so many changes in his symptoms that he has lost track of their number. This is not so surprising when you consider that minor changes in the locations and spread of infection in the prostate can have major consequences on prostate fluid dynamics and how the urinary nerves that surround the prostate are irritated.

Other symptoms, such as blood in urine and the presence of sand or stones during urination can be explained by this model also. Prostate calcifications (stones) deserve enough coverage that they will be explained in a later report, but let's look at blood in the urine (red blood cells.) This can be caused by things other than prostatitis so it is important to investigate those other things while checking out prostatitis. White blood cells are carried by the blood to get to infection sites so it is no surprise that blood may be present where infection fighting is an ongoing activity.  After proper treatment is started the blood disappears.

At times Dr. Feliciano will find blood in the prostatic fluid of a patient where there had been no blood before. This is considered normal and the blood will soon stop making its appearance in future drainages. What is happening is similar to the popping of a pimple. At first pus is released and this is commonly followed by blood. Then both pus and blood disappear as healing commences.

Prostatitis patients not being treated by drainage may have blood either continuously or sporadically. This is understandable because there can be multiply infected acini with various phases of those that are contributing blood and pus to the prostate fluid.

Finally let's discuss an obvious problem that prostatitis causes. With pathogens constantly living in various acini, these pathogens can continue to propagate on out into the rest of the urinary tract causing cycles of infections and reinfections as a result. This is one reason why treatment with an antibiotic may seem to work for a spell one time, but not another.  The prostate can be the cause of a re-infection at any time depending, as we've seen, on a number of complicated conditions which may themselves even change over time.

Seeing the complicated symptom patterns that can arise from infected acini, an attempt to scientifically discover what prostatitis is by studying its symptoms would probably be a Herculean task.

Dave takes a question:

In one of your posts, you mentioned an American was cured after (or before) you during your time in Manila. How are these American men knowing about Dr. F.? Is anyone in the US referring them to Dr. F?

It all happened because of the Internet, more specifically because of the Prostatitis Foundation's web site. The original North American patient saw some information on Dr. Feliciano, Jr. posted there and made follow-up contacts with Dr. Feliciano. Fortunately, he also contacted me asking about some medication I had taken and telling me about his pending trip to Manila. That led to me giving Dr. Feliciano a second look.

I had initially put Dr. Feliciano aside as a possibility because of the 100% cure rate claimed (too unbelievable.) But as it turns out, this posted literature was originally done for local patients in Manila. After all, if you were in Manila and reading this brochure in his office it wouldn't take long for verification of this success rate. Unfortunately, when posted over the world-wide Internet this same brochure doesn't have the same viability when read by people thousands of miles away.

The 100% cure rate should be interpreted as follows: If you have prostatitis and you come to the clinic and completely follow the treatment proscribed you will be cured. The cause of prostatitis is simply understood and treatment simple to apply. (As explained by the postings I'm doing.)

You have bacteria or some other pathogen, you eliminate the pathogen and the disease goes away, that's all there is to it. As I've already indicated, here in North American doctors are not culturing what's there, and they consider draining the prostate to help eliminate pathogens
inadvisable. Because of these two facts the medical community here is totally helpless to either understand or treat prostatitis.

David Trissel
Austin, Texas