You mean this: Funny, that's what I thought of when she & I connected. I had that quote in my follow-up but it didn't flow well. You are both right. In fairness to the medical community, keep in mind that there are two different things going on here: 1-I bounced around providers for various reasons. 2-My long-term urine retention issue that I chose to put on the "I'll just live with it" track. A higher risk of UTIs comes along with this choice. 3-The inability to pee, which just started last Friday and which was initially thought to be an infection. This is lengthy, but it's important for me to not unfairly judge my current doctor (Dr. Murphy),and writing this helps to organize my perspective: Regarding #1 -A CT Scan for unrelated digestive issues found a bladder stone and calcium deposits on my prostate. I also have always had red blood cells in my urine my entire adult life...it's my physiology. Same thing with a brother. It was this CT Scan that put me on the urology path. -University of Virginia Health Systems (UVA) urologist #1 has no business interacting with humans on any level whatsoever. What an angry nasty person. -UVA urologist #2 was not much better...just less hostile with it. -UVA urologists wanted to do a bladder cancer screening and a prostate biopsy because they "felt lumps," aka Calcium Deposits. -I did not trust UVA to do any of this so went to Dr. Murphy on a friend's recommendation for the the stone removal. I wanted to get this done before I got older and the stone got larger. Doing all 3 while I was under anesthesia was Murphy's idea...UVA wanted to schedule them as 3 different events, with only the stone removal happening when I was put under. -I forget why I even went back to UVA. The LPN was the first one there to actually read the "How Often Do You Pee" questionnaire I filled out every visit, and she saw the retention issue. I had never said anything about it...I solely sought out a urologist because of the stone. I did not transfer my care to Dr. Murphy because his office is an hour drive and UVA is maybe 25 minutes, and at this time I thought everything was finished and I was in a routine maintenance mode. -The LPN put me on the self-cath train ("Anything over 100ml requires it. You may not even need to anymore after a while.") - I decided to have UVA do the urodynamics because they have all the modern facilities in a convenient location...and I wanted to have the underlying causes quantified. I knew I would have others provide any recommended treatment. -I did not feelcomfortable with anyone at UVA (I eventually came to believe that the LPN used me to fill billable hours during COVID), but I did believe them when they said I had to self-cath, so I sought out another urologist I could emotionally connect with who could escort me through the self-cath process. -I found a guy who was only 20 minutes away, and he spat on the ground at the idea of self-cathing when I was only retaining 400ml and had un-nice things to say about UVA claiming that bladder muscles get significantly better...so I transferred to him (Osborne). -Not long afterwards Osborne did an x-ray, saw the prostate calcium deposits, swore they were bladder stones (even thought it had been less than a year when my only stone had been removed), and insisted he schedule an appointment to "go in there and look around." I could not dissuade him. We even looked at the x-ray together with me asking "How can you tell that's in my bladder and not in my prostate?" in an unsuccessful effort to get him to take a second look through the process of teaching me. My tenure with Osborne was short-lived. -I went back to Murphy (who also agreed that 400ml is not a problem, if I am ok with the symptoms), and he's been my urologist ever since. -Of course, with issues such as I'm currently having, the 2 hour round trip is an inconvenience (I was on the road for a total of 4 hours yesterday), but part of this is my rural location. And it is low-traffic/mostly-highway/stress-free driving. Regarding #3 Background: Dr.Murphy is with VA Urology. This is a mega-practice with 40 physicians in 6 dedicated locations with their own surgery center. The primary location I go to has 2 receptionists sitting side-by-side who log in your arrival, and then you wait to speak with one of 6 intake people who make sure your profile is up to date. So this is not me walking in to a small private practice where my current issue would immediately be known to my doctor, informally or otherwise. -I had a hard time urinating last Thursday PM and into last Friday AM -They put a cath in me last Friday afternoon and sent my urine off to the lab thinking I had a UTI. At that time they scheduled a Retention Test for today (which I got accelerated to yesterday.) -The lab came back clean on Monday. I called the office early Monday morning to get the results (they may have intended to call me later.) In any event no one followed up to say "We got the results back, it's not an infection, this is the path forward." I am assuming they were waiting for the retention test results. And Monday was only the next business day after my late Friday afternoon emergency appointment with the Physician's Assistant. So we're only talking a matter of a few business hours (if that) with no doctor yet involved. But a call should have happened at some point to tell me that it was not an infection and to not anticipate getting an antibiotic (even if they knew I had already found out), and it's the only ding I can give them. -When I found out that my lab came back clean, I accelerated the Retention Test from Friday (today) to Thursday (yesterday) because if things were not fixed, I did not want to head into the weekend with no care available (other than the ER.) I needed a day's breathing room, knowing the test had been scheduled as a formality under the assumption that I just had a UTI. -I [barely] passed the Retention Test yesterday and they sent me home. I'm certain that things were temporarily dilated by the catheter and that's why I passed. -I could not urinate at all after I got home yesterday, so I put a gun to my own head and forced me to drive myself back to have another catheter inserted...under significant duress and much protest. -The RN who I then encountered and who I love so much is working with my doctor's nurse (who spends as much time with me on the phone as I need) to schedule an appointment with him. My next Retention Test will be last next week. I don't know what the next exam will be for...most likely prostate and urethal stricture. I don't think my bladder muscles are totally shot, but this latest problem certainly must have put more stress on them. Last Friday I was at 900ml and yesterday the nurse drained almost a litre from me. Once the underlying issue is fixed, a Retention Test will measure my bladder muscles. I have no issues with this practice other than the lack of followup on this one issue. But again, I went in on an emergency basis last Friday to see a Physician's Assistant because I could not urinate. At a place like this they do not just "fit you in" to see your doctor. Heck, Murphy may have been at one of their other locations that day. To my way of thinking, the upside to a place like this is they get lots of experience with lots of patients both in the exam rooms and on the operating tables. Assuming a given level of competency and capacity to learn (and I think Dr. Murphy has those), there is a benefit to be had. My bladder stone surgery went off without any problems whatsoever.
Everyone here is a Godsend in their own right. Don certainly is that on this subject, as well many others. Personally, I am grateful to him for taking the time and the effort to straddle the line that's implicit in discussing these issues with strangers. We all grasp for answers, but must be mindful that only we are accountable for the decisions that we each choose to make in our own lives. It's like investment advice, but the consequences can be graver. I appreciate Don taking the risk to help.
Sorry you have to deal with this, and I am hoping your right about the bladder muscles. Maybe the stone just weakened the muscle temporarily? I know you'll be glad to know something soon. I'm going a little nuts with my sugar this week it's hard to bring it down with exercise and diet.I exersise to music but that gets boring after a while too. Plus, haven't seen a heart doc since they put stents in and only take 1/4 aspirin a day. Meds make me sick literally. The assistant told me to take the Plavix that made me deathly sick and I'm not evacuating on that. John, I do hope you can get to where things get less difficult. Hubby and I keep you and others here in our thoughts and prayers. I tell my son and daughters to take care of themselves because they will pay for it later, but they don't listen any more than I did.
thanks! I'm now scheduled for an ultrasound and biopsy "procedure" next Tuesday. Not looking forward to it, but it's time.
Pretty much all of the treatment options for prostate cancer come with a 95% or better success rate, but that doesn't mean they're a load of laughs. Let's pray that the biopsy is negative for cancer. I don't know how old you are but at some point, doing nothing is sometimes a viable option because prostate cancer is a slower moving cancer than some. Of course, your options will be discussed with your doctor and, in such matters, it's probably a good idea to pay close attention to what they say, although there's nothing wrong with a second opinion.
What Ken said. Lots of prostate cancers progress so slowly and present so few symptoms that they are merely monitored (I think the term is "active surveillance.")
@John Brunner when they do a retention test, are they injecting fluid into your bladder and seeing how much drain, or are they simply doing a bladder ultrasound scan to see how much you retain after urination? The scan is a simple procedure, and I don't know why they would have to schedule that separately, and it is probably a better gauge of how well your bladder empties since it doesn't have the issue of the catheter artificially dilating your urethra. My urologist starts looking for causation at 200 ml and starts worrying at 400 ml retention. When I was diagnosed after the back injury, 2600 ml was drained and it put me into renal failure.
That 2,600 makes me astonished you're still around to talk about it. OMG!!! My doctor has me coming in every 6 months for tests to make sure the urine is not backing up as yours was. Wow, buddy. What a nightmare. There are a couple of retention test types. I've frequently had the ultrasound. The "injecting fluid" one is what they sometimes do when they remove a catheter. They inject a measured amount of fluid through the catheter, remove the catheter, and then measure how much you pee out. It's "Retention by Deduction," where a passing grade is determined by how full the cup is relative to what they put in you. Since you were catheterized because you could not urinate, they do this procedure to see if the condition has been resolved before they just send you home, or if you need to be recatheterized. Obviously, they cannot do the ultrasound because--assuming the catheter was doing its job--you are empty (or close to it.) So this test is concurrent with having the catheter removed at the clinic I go to. Your point regarding being catheter-dilated is well-taken. As you allude, it is why I was able to excrete enough to pass the test but still was not able to urinate again. As an aside, the removal of the catheter last Thursday was the most painful thing I was ever experienced. I was screaming. She had a problem deflating the balloon, and I don't think she got it full deflated. It was not like that when I had my only other one taken out in the mid 90s. It didn't occur to me what had happened until the next day. Now I'm friggin' enraged. Anyway...I'm remembering some of my issues from when I had kidney stones. My GP was a nephrologist, so I never saw a urologist for my stones except the one "stuck stone" catheter episode in the mid 90s. That urologst wanted to see what the composition of the stones was, so he gave me a jug to pee in for a 24 Hour Urine Test. I used to drink so much water and urinated so much that I had to drive back to his office mid-way through to get a second collection jug because I already filled up the first one. I've had routine physicals and the Blood Sugar Fasting Tests, then later the A1C tests. At some point my A1C became "pre-diabetic" (likely when I stopped exercising), but that's been later in life...so diabetes is not the underlying issue for the amount of excretion...it's just "me." The 1990s urologist did not run an ultrasound on my engorged bladder when my stone was stuck, but the technology may not have existed back then. But all this gets me to wondering if the volume of fluid I run through my system has not contributed to all of this. I had one full-blockage and a smattering of partial ones, all acting in a system that urinates well beyond the volume of others. That state-of-being may be why my stones were generally not problematic and I was always able to push out the ones that were. I took a look at my overnight collection bag this morning. 850ml in less than 7 hours, and that's with zero fluid intake because I was sleeping. So it's no wonder my bladder muscles have gotten stretched so much.
@Don Alaska I forgot to mention something you'll find interesting. When I first started seeing the nephrologist, he put me on hydrochlorothiazide (HCTZ.) HCTZ is a blood pressure medication. My blood pressure has always been normal-to-low. So I went home and pulled out my PDR and read that one of the side effects was to reduce the excretion of calcium. "That can't be good for a guy with kidney stones," I thought. So I called him up and asked. Me: "You've put me on HCTZ and it prevents me from getting rid of calcium. I have stones. Don't I want to get rid of it?" Doctor: "Think about it. If you excrete calcium, where does it go?" Me: [3 seconds of awkward silence] "Uh, through my kidneys???" Doctor: chuckles Me: "Thanks, Doc. See you later."
Actually, I'm 100 miles from the Maryland border¹, close to Charlottesville in the center of Virginia. And I HAVE been seeing pee specialists. I went through 3 urologists at the University of Virginia Health Systems, and then another urologist in Charlottesville. The current guy is in Richmond (about an hour away.) I like the doctor, but he is part of a 6 facility/40 physician business. He splits his time between 2 locations and the surgery center. So while he is a good doctor and technician, he has no idea this is going on with me. It's not an old school doctor's office where people "just know" what's going on. So this is Urologist #5 for me. I'm not changing up again. Lord knows what I might land in. And this latest issue is an administrative problem in this large business...they failed to make an appointment with my doctor at the time I had the emergency catheter inserted (and they failed to call me when the lab came back Negative), and the place is too large for anyone to have even noticed. When I went in to have the catheter removed and the Retention Test done, I came in to that side of the building on the second floor...there was no preceding or following chat with my doctor (if he were even on site then.) That part of the facility has a waiting area with a capacity of about 50, all of whom are there in the exact same situation...they have an appointment with some technician to have a procedure done, and will likely not be seeing their doctor that day. They all suck. It's a horrible industry. My main concern now is demanding that the one nurse I trust be the only one who shoves stuff inside of me and yanks it back out...but she's in Facility A and the appointment with my doctor this Thursday is up the road in Facility B. (My experiences with the highly rated UVA Health System is the subject of another rant.) ¹Just because Maryland is 100 miles away does not mean it is a 2 hour drive. You go maybe 15-20 MPH, on good day. If I did any doctor stuff up there, I would have to leave here at 1AM and spend the preceding night in a hotel.
Man, I am sorry you are having such trouble with the Urology business @John Brunner. My DIL had a bad experience this week with a neurosurgeon in Anchorage. She did all the fasting stuff and was scheduled for a nerve and muscle biopsy. She and my son drove all the way into anchorage, signed in, and were taken to the surgical suite where she was prepped and put on the table in the imaging center (it was supposed to be a guided biopsy). The surgeon popped his head in and said, "Oh I won't be doing that procedure today as I have not read the case notes yet." Needless to say, DIL and son were absolutely livid on their way back home. This biopsy has been scheduled for 3 weeks and the surgeon didn't have enough respect for his patient to notify them that it wasn't happening or to at least read the case notes. It isn't just Urology that is the issue apparently. American medicine has really fallen off the cliff during the pandemic and may not recover. I always advise people to leave Alaska for treatment if they have serious issues, but perhaps it isn't better outside either.
That's a rude, disrespectful arrogant thing to do to your friend. Experiences over my life have been opposite ends of the spectrum. I had a herniated cervical disc in the late 90s and I got in an FDA pilot program. I had one of the first cervical "cages" installed, done by a great orthopedist and a neurosurgeon who went on to be a hospital administrator. My GP was a nephrologist, and I had the guy for over 25 years. I loved the guy. He was from Belgium. The last 8 years or so of his practice, he went to the MDVIP concierge service, which I joined. I was still driving the 2 hours to his office after I moved so he could do my annual physical. He retired. I don't know if my current issues are due to the location or the times, but little of my experiences have been good here. Keep in mind I have the state capital available in one direction (my urologist is in the western burbs of Richmond), and the University of Virginia Hospital System in the other direction (Charlottesville.) Quality care should not be a problem. >I went off my statins when I lost my insurances, and when I got coverage again my GP referred me to a cardiologist at the "gets many accolades" UVA Health System because my cholesterol was so high. With nothing more than an EKG (no conversation regarding my diet or exercise habits), the guy just says "Go vegan." I literally saw the guy less than 2 minutes. Of course, it was stupid to send to to a cardiologist just because my numbers when up when I stopped taking my statins, but I thought I might benefit from the thorough cardiology exam (that I did not get.) I did not return for the "follow up"...my GP can do a lipid panel, and I won't have to listen to the cardiologist's Irish "Fellow" complain because she has to pay for her own education and healthcare here in the states. >I have a gastroenterologist I first saw 4 years ago for a routine colonoscopy who at my first visit told me to take start taking Metamucil (again, with no discussion regarding diet, and I was having no GI issues...it sounded like something he told all of his patients and I figured it would not hurt me.) I saw the guy maybe 6 months ago for an issue, and when he read Metamucil on my list of supplements & meds, he just about yells "You're supposed to be getting your fiber from your diet!" (He's always had the "I should have picked a different line of work" aura about him.) I had an encounter with a UVA urologist (the first one I saw) who was just as irrational and confrontational. My worse dating relationships have been more stable than these guys. >My GP's practice here got bought by UVA Health Systems, and his computer monitor gets more eye contact during an exam than I do. An upside is he refers me out for tests & such with no hesitation (I'm sure it generates business for the Mother Ship), but I don't get the level of care I used to from my long-term GP. At least he's not a jerk, and I have him trained to not ask about flu vaccines, but now he is a UVA employee. As I said, I like my current urologist, but his practice is huge and you can get lost in it. I just want my current issue diagnosed & treated, and The Good Nurse to show me how to self-catheterize so I can get off of this roller coaster...and I don't want any more partially inflated Foley balloons drug through my prostate as I scream, if possible. Oh...and please don't insert a catheter in a bladder that contains 900ml of urine and pull the container away when it hits 400ml so the rest can flow all over the table and the patient. I wonder how my doctor will react when I tell him the catheter nightmares. I've already bounced around providers...I wonder if he's put a label on me.
With regard to diet search Dr Berg on youtube. Try his techniques for one month. It might be terrible because it is different than you are used to. It is not vegan, although it makes use of all the fresh veggies around, this time of year. He explains statins and cholesterol differently. Sadly very low carb means what you think. But it is not Atkins. He has some fun recipes. Just different. As I have said, I don't do doctors. I did not run for flu vaccines because they were free at Walgreens, even before covid. I don't know my cholesterol but I know my sign is Aquarius. Hugs to you, John
With my bladder issues, I don't want to hear from an Aquarius or a Pisces right now, if you catch my drift. Maybe I'll check out Dr. Berg. I've mentioned before that when I was first diagnosed with high cholesterol in the 80s I rapidly pounded down my numbers by going meatless, but I could only do that for 6 months.