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Tuesday, February 11, 2014

A Serious Medical Concern or Just a Snapshot in Time?

Yesterday, we went to see Bob's urologist. This is a new urologist as Bob's former urologist has retired. And I'm really not sure if I like this guy...

Anyway, this was just a "six month follow-up" appointment, and the doc comes in and asks how everything is going and I tell him "fine", because truly, everything seems fine and Bob's been peeing like a racehorse.

So we talk for a minute and I mention something about Bob's condom catheter (which was probably a stupid thing to do, because I know this doctor is no fan of condom catheters, it was Bob's former urologist who prescribed those) and at that point, the doc jumps up and suddenly decides he wants to immediately do a sonogram on Bob's kidneys and bladder.


So I haul Bob back into some little, dinky, totally wheelchair-unaccessible room to have the sonogram done. Then I haul him back to the other room to wait for the doctor.

The doc comes back all flushed with excitement, and this is (you might remember) the speedy urologist who always talks fast-fast-fast, and he tells me that this is "just terrible" and that Bob has 570 ml of urine in his bladder and he shouldn't have more than 250 ml and this could cause renal failure and that could be fatal!

OK, now I'm a bit freaked out. Which is an understatement. As I'm really freaked out. Then the doc asks Bob if he can urinate? But doesn't give Bob time to answer. And then he tells Bob to empty his bladder, NOW! And he says "take all the time you need" and he leaves the room.

And I'm thinking, this is going to be impossible. As Bob usually cannot pee on command. But I ask Bob if he understood the doctor and when Bob shakes his head "no", I tell him that the doctor wants him to pee. Now. Does he think he can do that? Bob says, "I'll try."

So, I wait a few minutes and, lo and behold, Bob is actually able to pee. I can see around 100 ml in his catheter bag, plus there is more in the tubing, but that's not enough to bring him down to 250 ml in the bladder. So I ask Bob to try some more and he does, but he can't.

Then the nurse comes in and asks if we've had "success" and I tell her we did. Then they bring in a "bladder scanner" and rescan Bob's bladder and this time it reads 370 ml. Which is still too high.

Then the doc comes back and tells us that it's still too high. And he goes on and on about kidney failure and etc. and tells us that we have three options to consider, the first which is some kind of electrical gizmo that he could surgically implant in Bob's buttock that would send electrical pulses to the bladder and that might do the trick or, option #2, is to get a Foley or indwelling permanent catheter, or, last but not least, I can do intermittant catheterizations three times a day until the end of eternity.

Jeepers! None of these options sound good. And I certainly do not want to put Bob through more surgical procedures. And not to mention the co-pays, etc. So, I am sort of sitting there dumbfounded. The doc sees this and says that, well, we don't have to make a decision today. There's time to think about it, if that's what you want to do. Because, really, Bob is in no great danger at this moment, the danger of renal failure is more like five to ten years from now...

So, phew! I think, we'll think about this. And I tell the doc that and then he says, good, I'll see you next month and you can give me your decision then! GA! Then he tells me to "make sure" that Bob "empties his bladder" before the next appointment and we'll do another scan.

So we leave the doctor's office at about 2:30 p.m. and Bob can tell that I'm worried and he grabs my hand and says, "Don't worry. I'm fine."

We get home around 3:00 and at 3:15 p.m., Bob pees. I empty his catheter bag which reads another 100+ ml.

And at 4:30, he pees again. This time 200 ml.

Add that up, and since the 1:30 p.m. scan that read 570 ml in his bladder, Bob has now peed out 500 ml of urine.

Which means, if we had had that doctor's appointment at 4:30 p.m. instead of 1:30 p.m., the bladder scan would have only recorded 70 ml in his bladder --- as the last time I gave him fluids through his peg tube was at 12:00 noon --- and that doctor would not have been concerned at all...


So is this really a serious medical concern? Or just bad timing with that scan?--a snapshot of 1:30 that day, which doesn't mean it's like that always...  And/or, did I give him too much water at noon?

Inquiring minds would like to know!

And truth be told, I have no clue what to do now....

Thoughts? Anyone?


Rebecca Dutton said...

I would get a second opinion in six months.

oc1dean said...

Do you have the ability to email that exact question back to the doctor? Or another doctor?

Anonymous said...

If I were in your shoes, I'd continue with what you've been doing and not be concerned about what this urologist said. In the mean time, because time is on your side I'd try to find another urologist that you like and can converse with without panic. And as Rebecca said, get a second opinion before doing anything different.

Good to see you both had family visitors. I'm sure Bob really enjoyed the extra attention and visit.

Hugs, Dan

Diane said...

Dean, e-mail a doctor? Boy, I wish I had that ability!

Stephany Harvey said...

Or, at least, mail a hard copy of an (edited) version of your blog, just as written!

We, too, were frightened by a gregarious fast-moving urologist. When we went back for his re-scan, I was all "he put 600ml in the bag last night, so I knew he was doing fine", and he was all "pressures are way too high". (Please pardon the teen just fit the situation)

Little did I know that I was equating output of urine with health (having lost a husband to bladder cancer), when the doctor was concerned with the consistenly high pressure in the bladder, and the urine retained in the bladder, causing spasms, which are what would eventually do the damage by backing up into the kidneys.

He prescribed Vesicare, which I did NOT think was necessary, and which turns out to be very expensive, even with insurance.

My pharmacist did suggest a drug company discount to apply for, which came through, but I only got 1month of pills.

Lo and behold, within two weeks, he stopped his frequent urination at night, and even said the "pressure" was better, when he had never said anything about pressure. (And the man thinks he does not need further speech therapy). your research, maybe find another urologist, and keep an eye on the bladder pressures.

And, please, keep writing. I do so look forward to your updates.

Stephany in Iowa

J.L. Murphey said...

While Bob peed 500 ccs what you are not accounting for is urine still being released by the kidneys. So while Bob peed that much his kidneys may be producing that much again so he is still retaining urine.

I would get a second opinion as others have suggested. Make sure the doctor knows Bob's difficult with peeing on command is due to his stroke and not because of a urinary problem.

While urine retention is a problem because of the possibility of infection going from the bladder to the kidneys, I wouldn't overly worry about 5-10 years from now. It is a back seat issue. You only worry about the front seat issues today. A lot can change in that time.

My husband takes Flomax to increase the stream of urine put out with urination efforts. Try keeping an I&O sheet (fluid in and out). It would be a better judge of his kidney function.

Has Bob had a prostate exam?

Rebecca Dutton said...

Clients with spinal cord injuries who have zero voluntary control over their bladder live for decades by keeping track of input and output.