Coude it be magic?

Our regular home nurse was out sick on Friday, so a replacement nurse came by yesterday to switch BR over to the coude catheter. I gave him the history of BR's issues with catheters, and described how the coude catheter should be inserted, just as it was described to me by the Mad Urologist. After a short prayer, BR removed the old catheter, William inserted the coude catheter while I held it in the correct orientation, and the balloon was inflated.

"BR, how does it feel?"

"That was easier than I was expecting. Best change in a long time."

About 20 minutes later, the flow started. Nothing but catheter!

24 hours later and we are about to ditch the Depend undergarments.

Baby, I love you, come, come, come into my bag
Let me know the wonder of all of you
Baby, I want you now, now, now, and flow on fast
Coude this be the magic at last?

Subject: Your backorder has been shipped

Want to fly from Austin to Chicago on a clear day? No problem.
Bad weather in Denver? Your flight to Chicago has been canceled.

It seems that as companies try to squeeze the very last drop of efficiency out of their operations, they also squeeze out all ability to deal with anything but the ordinary. We ordered BR's coude catheter on September 18. It was scheduled to ship on the 21st. Then the 22nd. Then it was marked "on backorder." That's not a good sign. A call on the 23rd revealed that the Fort Worth warehouse was out of stock, but the Jacksonville warehouse had some. It should ship within 24 hours and be delivered within 3 days.

Yet the web site never changed: "on backorder, scheduled to ship 9/22"

A call yesterday revealed the same information: Fort Worth doesn't have it, but Jacksonville does. It will ship within 24 hours.

Paint me skeptical.

This morning I got the e-mail I had been waiting for: Your backorder has been shipped

It should be here some time Thursday, so we'll move the home nurse visit from Wednesday to Friday, change the tube, and know by the end of the week if more drastic measures will be necessary to bring BR's bladder under control.

Catheters Gone Wild!

About three weeks ago, BR's suprapubic catheter went on strike. No amount of fiddling with angles and pushing and pulling would make the liquid sunshine flow through the tube without also flowing through his urethra.

On the first visit to the Mad Urologist, BR's normal latex catheter was replaced with a silicone "large lumen" model, in the hopes that bigger would equal better flow. Unfortunately, the nurse botched the insertion. Being made of a stiffer material, the catheter found itself exiting the bladder via the urethra. Can you guess what came next? Go ahead, guess. That's right. Balloon inflation in the prostate! After he realized something had gone wrong, the nurse called the doctor, who corrected the tube placement, and gave BR a two day Levaquin prophylaxis to keep the bacteria in his bladder from spreading to his blood stream.

Long story short, BR bled from his urethra for a week, the catheter only briefly worked well, and it hurt like hell when it was removed two weeks later.

Next, the Mad Urologist ordered video urodynamic tests to better understand what's happening when BR leaks. These tests are only done in their Round Rock office, which is about a 30 minute drive from home. For such a horribly uncomfortable suite of experiments, I have to say that Tracy, the nurse technician, made the experience as enjoyable as possible.

The tests showed that BR's bladder contracts in the presence of a very small volume of liquid, and that when it contracts, it does so with more than twice the normal pressure. Combine this data with the theory that the end of the catheter is migrating down to the bladder neck where urine can't get to it without a contraction, and we seem to have an explanation for the symptoms.

The Mad Urologist offered four options:

1. Try a catheter with a "coude" tip which when properly inserted may be less likely to migrate down to the bladder neck.


2. Insert a foley catheter through the urethra in addition to the suprapubic catheter. Double your pleasure. Double your fun.


3. Inject Botox into the bladder muscles to reduce the strength of the contractions. Lighter contractions may permit more of the urine to exit through the catheter.


4. Surgically close the bladder neck, forcing all urine to exit through the suprapubic catheter. The Mad Urologist is reluctant to do this because it limits his future options should BR develop other urinary tract problems, like stones.

So we are going to start with the coude catheter, which has been ordered and should be here sometime next week. If that doesn't work, BR says sew the bastard up.

The Birth of Bladderman

Contemplating a life full of catheters and urological problems, BR makes a dramatic decision...





He wants the ultimate urinary tract.
One impervious to all foreign contaminants.
One that knows when to hold 'em. Knows when to fold 'em.
Knows when to take a pee, and never runs.





A technician loads BR into the Urodynamo, and makes the necessary preparations.





With the push of a button, the transformation begins.

To be continued ...

Miss Blocked Catheter 2009

Here she is modeling the latest in catheter innovation.

Eureka! Area Man Discovers Potential Breakthrough in Suprapubic Catheter Management

AUSTIN, TX -- Steve, after struggling for months to find a solution to Bobrobert's clogged catheters, has discovered a simple technique which he believes will keep the Yellow River from breaching its levees.

"You see, about 10 days after a tube change, the new one just seems to stop working. But I noticed that when BR's legs are stretched, the flow starts back up again for a short period."

It was during one such stretching session that the idea finally hit him.

"What if I tape the tube to alternating legs each day? That should change up the angle that the catheter rests against the bladder wall."

Steve hopes that in regularly changing the catheter angle, bacteria will have less of a chance to build a dam of sediment around the tube openings.

Bobrobert is all for giving it a try. "Hell. I'd chew off my right foot if I thought it might get me out of these diapers."

After the first day on the opposite leg, the tube has been flowing well. Says Steve, "One more day of dry, and BR's wish will be granted."

What's mayan is urine.

Things are looking up! The urologist instructed us to have BR's catheter changed twice while he was taking the antibiotics to keep the tube from reinfecting the bladder. After the first change, no more leaking!

Tuesday was cystoscopy day. Now don't get me wrong. We love this urologist, but the office is straight out of the 1970's. Everything has 30 years of wear and tear on it, and there is the faint scent of every incontinent patient lingering in the air. I would put the average age of the people in the waiting room at about 65, and I've decided to take that as a good sign that his patients stick with him.

The procedure went well -- only discovering the expected irritation on the back of the bladder caused by the constant rubbing of the catheter. It did, however, have the unfortunate side effect of bringing back the leaking. Drats!

Oh, and after the stirrup experience, BR is better equipped than ever to empathize with the entire female race.

Another Thursday. Another catheter change, and we are back to the world of dry.

What a difference a doctor makes!

Quick recap on BR's bladder issues.

BR has been having a lot of bladder pain, cramping, and urine leakage from his urethra despite having a suprapubic catheter. We saw a urologist last Wednesday who refused to do anything for BR other than deflate the catheter balloon down to 10cc, and that was at my suggestion. She insisted on a whole bunch of tests that were going to take weeks to execute.

Last Friday, BR's urinary tract infection (UTI), which the urologist has diagnosed but did not treat, had flared up so badly that we couldn't wait any longer, and called the urologist to see if the urine culture had come back. The office was closed. No warning. No notice. No antibiotics for BR. We asked the answering service to please page the doctor, but they didn't hold out much hope.

We decided to call the other urologist on BR's referral to see if they could help. The office was closed, but the scheduler was able to get BR an appointment for Monday morning. We jumped at the chance to cut ties with the first urologist, but that still didn't fix the immediate problem.

As a last resort, we got an emergency appointment with BR's primary care clinic. His doctor there had prescribed antibiotics in the past even before getting a culture -- using the test to validate treatment, rather than delay it. Unfortunately, BR's doctor was also on vacation, and the doctor covering his patients saw the referral in the records and wanted to contact the urologist before doing anything. We told his nurse that the urologist was the worst doctor ever, and we shouldn't hold our breath waiting to hear from her. Two hours later as the office was getting ready to close, they finally gave up waiting and decided to do their own urinalysis. The doctor gave us a Cipro prescription, and we were on our way.

BR's bladder pain and cramping improved over the weekend, but the leaking didn't.

This morning, we saw the new urologist. He took BR's full medical history and listened to the problems we were having. He recommended a cystoscopy as the best way to figure out what's going on inside BR's bladder. We agreed and scheduled one for early next week. He also recommended trying one of the medications that can control bladder spasms. Without hesitation, he gave us a four weeks supply of Enablex from his stash of samples and told us to start taking them right away. If the problem was gone by next week, he'd still do the cystoscopy just to validate the results.

I'll say it again. What a difference a doctor makes! I took great pleasure calling the first urologist to cancel all the tests and follow-up appointment. Worst. Doctor. Ever.

Beggars can't be choosers, I guess

I was able to get BR an appointment with a "Urology Team" today. I was really relieved that we wouldn't have to be making another visit to the ER. Unfortunately, the urologist wanted to treat BR as a new patient, not as a patient with an urgent issue.

"I can't treat you until I get the results of a urodynamics test"

"What does that do?"

"It measures the strength of your pelvic floor."

"We already know his pelvic floor muscles are all messed up. That's why he has the suprapubic catheter."

"Think of it as a cardiologist ordering an EKG."

"OK. Where do we go to get one."

"You'll have to come back in two weeks."

"But it hurts and leaks now!"

We finally got her to sit and listen to what lead up to the current situation. I explained about the bad tube change, and how none of the changes since have done any good. I also explained my theory that maybe the nurse was over-inflating the catheter balloon, and that was causing the bladder to spasm and release through the urethra, thinking it was full.

"How much is she putting in?"

"I think she's shooting for 30cc."

"That's way too much. 10cc should be enough. Let's check that."

She then pulls 25cc of water from the balloon, and puts 10cc back.

We scheduled the test and said our goodbyes, not really happy with the experience.

Fortunately, BR's spasms have reduced in frequency and severity. We'll see how tomorrow goes.

Trying to reign in the worry

BR had yet another catheter tube change yesterday, a week earlier than usual. That makes three tubes in five weeks, and none have resolved the bladder cramping and pain, the leaking, and the sediment in his urine. At least it's not blood anymore.

Sediment. What a funny word for "the bacteria are renovating your bladder -- please pardon our dust."

We got a referral to a urologist today. Of course, we got it at 5:15pm, and they all closed at 5. I'm watching him like a hawk for any sign of fever. Without blood, the chances of sepsis are slim, so a fever would be more of a sign that the infection is spreading up towards the kidneys. And kidney damage is something we will definitely want to head off with an ER visit.

Pain killers. Tranquilizers. Adult undergarments. I want them to be enough to keep him comfortable until the urologist can see him. But I can tell they are not. I need a distraction.

Once Jordan and I get BR resting in bed this evening, we will be going to see the new Harry Potter movie. A couple hours at Hogwarts to temporarily displace the worry.