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Wednesday, March 19, 2014

Armed & Dangerous

And that was me. When we headed back to the urologist.

You might remember, the last time I took Bob to the urologist, he had a bladder scan which indicated he was retaining urine. At that time, his PVR (postvoid residual urine volume) had measured 370 ml. The doctor flipped out at that number, said it was supposed to be 250 ml or less and gave me three options for Bob, which were an indwelling catheter, or a surgically implanted bladder stimulator or 3 times intermittent catheterizing daily. None of which sounded appetizing, to say the least.

Since then, I've done my research and have learned a lot about PVR (including the term PVR!), so I printed off some literature, got out my highlighter and, thus, armed, I was ready for battle.

Among my weapons were these highlighted tidbits:

From AHRQ (Agency for Healthcare Research and Quality), a paper entitled Evidence Based Practice Center Systematic Review Protocol, Chronic Urinary Retention (CUR) Treatment:

There appears to be little standardization in the duration or PVR volume necessary for CUR diagnosis and treatment . Research studies often use PVR volume greater than 300 ml to diagnose CUR; others have used 100 ml, 400 ml, and 500 ml.

From the National Center for Biotechnology Information (NCBI):

There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds range from 300 ml to 1000 ml... Most studies seem to describe the condition as either a PVR of greater than 300 ml in men who are voiding, or greater than 1000 ml in men who are unable to void.

And from the UK National Institute for Health and Clinical Excellence:

Guidelines define CUR as a postvoid residual urine volume of greater than 1000 ml.

 Now I know, 1000 ml sounds like a lot of urine, but I wanted to point out to this speedy urologist that there are different opinions out there and his "magic number" of 250 ml, is not necessarily an agreed upon standard. Also, I planned to argue that since Bob can't pee on command, he really doesn't have a true "post-void" urine volume.

Also, I had documented Bob's urine output after the scan at his last appointment as:

2:00 p.m. scan showing 370 ml PVR
3:00 p.m. emptied 100 ml 
4:00 p.m. emptied 200 ml

And I also remembered that six months prior, Bob's PVR was 250 ml, exactly.

So, thus armed, I prepared for battle and we went to see the urologist.  Before we left, I had urged (begged!) Bob to try to pee as much as possible. Also, I made sure I didn't give him too much water when I administered his noon meds.

And I tell you, I was nervous. I do not like confronting doctors. Especially ones that think they know everything. My Plan B, if I couldn't convince this doctor to "go lightly" on Bob, was to get a second opinion from another urologist.

So it was a great relief when the scan was done and it showed only 218 ml still in Bob's bladder! AND, directly after the scan he peed out another 30 ml.

And the urologist gave us a reprieve.  Until June.

So all that research/preparation, and I didn't even need it.

Though, believe me, I will save these documents and all my notes and arrive ready for another battle, next time....


oc1dean said...

But our doctors know absolutely nothing, why should we trust any words that come out their mouths? When I've handed printed research to my doctor he dismissed it out of hand. Its why I am the way I am.

Mike Furr said...

:) love it, armed and dangerous! :) you go girl!

Barb Polan said...

Even if you're disappointed you didn't use your research, it did make you feel better about Bob not needing any "help," right? That must have been worth it.

I love that you are so ballsy in your caregiving for Bob.

Jenn said...

Yup, Barb's right. You are ballsy! lol. WTG Diane! <3

Rebecca Dutton said...

Go armed to Bob's next appointment with this doctor. You may need it. And don't hand him your documentation. Make him sit there and listen to you. You rock Diane!

Anonymous said...

If it comes to a face off with the doctor over your research and information, don't be surprised if he just point blank dismisses it because you found it on the internet regardless of the integrity of the site. In the meantime, keep up with your education on this and other issues as time allows. Your tenacity and difficult work you do for Bob always amazes me.

With deepest admiration, prayers, and hugs, Dan

Theresa Loder said...

Wow what a great job you are doing

Take care

Linda said...

I love you being armed and dangerous.
I like having my research done and sorted out in my own head. Then you can at least be in a conversation rather than being talked at.