Yesterday, I took Bob to see the urologist. This was strictly a follow-up appointment, and I didn't have a lot of concerns, though I wanted to ask about our condom catheter blow-out problems and discuss his medications.
Bob had gotten a letter last month from the urologist informing us that his urologist was now retired and we would be seeing a new doctor. So I'm thinking, new doctor, maybe some new ideas. As Bob has been on several different bladder medications and none of them really seem to work that well.
So, anyway, we get there and the new doctor zooms into room and introduces himself. And I mean he zooms! He's this little Asian fellow and he talks really fast. He moves really fast. And I am mean really, really fast. I had a hard time understanding him and had to keep asking him to repeat himself. And the guy couldn't seem to sit still and kept jumping up and down and from subject to subject.
The first thing I ask this new doctor is about Bob's medications. And I pretty much just get the question out of my mouth and the doctor announces, "Let's do an ultrasound!"
Okay... though I'm not sure what brought this on. And the doctor zooms out of the room and the nurse comes in with a very small, portable ultrasound machine. When the nurse is finished, the doctor zooms back into the room, and he says, something like this:
"He's retaining urine! The ultrasound shows 300 cc though usually that ultrasound is not right, usually it underestimates, so if it's saying 300 cc it's probably really more like 500 cc and that is dangerous. Very, very dangerous! He could go into septic shock! That could be fatal! He's going to need intermittent catheterizations! And he's going to need a pacemaker in his bladder or an indwelling catheter, the pacemaker only has about a 50-50 chance of being effective, I can give you a DVD to watch, but we could also do a supra-pubic catheter! Do you know how to do an intermittent catheterization? You'll need to do this four times daily! If you collect more than 200 cc each time, then we have a real problem! All stroke survivors ultimately end up with this problem, I see it all the time, but this is bad! I've never seen it quite so bad!"
OK, by now, I am in shock. And don't know what to say. Because this has caught me completely by surprise. Plus, I can't get a word in edgewise. I do manage to sputter something about emptying around 2000 ml from the bed bag every morning, so it seems like he is passing fluid--and the doctor interrupts me with something like this:
"It doesn't matter how much urine comes out! It's how much stays in! The kidneys can operate at 20% of their capacity and you wouldn't even know anything is wrong until it's too late! Then it's septic shock! Which will be fatal! Or needing to go on renal dialysis! Because the kidneys shut down! And it doesn't matter how much comes out! It's how much is retained! If his kidneys shut down, he'll die! Understand? And you'll need to do an intermittent catheterization four times a day, to empty his bladder four times a day! And, as I stated before, if it's less than 200 cc, you don't have to worry! But if it's more! Well, that is dangerous! Very, very dangerous!"
Me, I'm still in shock and I don't say anything. Truth be told, I'm probably looking rather stupefied. But I'm thinking, four times day? Intermittent catheterizations four times a day?!!! Holy crap. Because that sounds like a real pain in the butt, not to mention, how expensive is this going to be? Because those catheters are single use only and just ten of them cost around $30.00 for the co-pay. And what about the condom cath? I'd have to remove that four times a day? And those are single use only.... and septic shock? renal dialysis? jeepers! This can't be happening.
And the doctor says something like this:
"You look like you don't believe me! Don't you believe me? You want to get a second opinion? Go and get a second opinion if that is what you want! But don't take too long! Because this is a dangerous situation!" Then he opens Bob's chart and shows me the results of the urodynamics test that Bob had done two years ago and he points to some pink colored squiggles on the chart and says, "See this. This shows his bladder is paralyzed. And this is not going to get better. It can only get worse. Worse and worse then it's pacemakers, I can give you a DVD, or a catheter or dialysis!"
Then Bob pipes up and says, "Hey, one, two..." and he's counting on his fingers.
The doc says, "What's he saying? What's he trying to say?"
I say, "I'm not sure."
Bob, still counting on his fingers, says, "One... two.... one... two... how much?"
The doc says, "What's he mean? What's he mean?"
Because I've become an expert on Bob-speak, I say, "I think he means he just urinated 1 to 2 hours ago."
Bob says, "Exactly!"
The doc says, "Well, that doesn't matter! It's not what comes out! It's what stays in!" Then the doctor stops and looks again at the chart, then he says, "Vesicare? He's taking Vesicare?!"
Which is the overactive bladder medication that the old urologist had prescribed.
And the doctor says, "Vesicare can cause urinary retention! Take him off the Vesicare immediately! Then bring him back here in a week, we'll do another ultrasound. Maybe it's just the Vesicare. Let's hope it's just the Vesicare! Vesicare will stay in the body for 72 hours so bring him back in a week!"
And I say, "What about the four times a day intermittent catheterizations?"
He says, "Don't worry about that right now! It might be just the Vesicare! We'll know, next week!"
The doctor zooms out of the room. The nurse comes in and drains Bob's bladder and gets 400 cc out. And we make an appointment for next week.
All I can say is, jeepers, and pray it's just the Vesicare...