Monday, July 25, 2022

BPH


"I'm going to go pee. If the universe is bigger and stranger than I can imagine, it's best to meet it with an empty bladder".  - John Scalzi, Old Man's War


Even as a young man I occasionally got up during the night to go pee. If I felt any urge down there I just couldn’t get comfortable.  As I got older, the trips became more frequent.  In fact, the last time I can recall sleeping through the night was 10 years ago down in the Big Bend Country.  We were staying at The Gage Hotel in Marathon and after a full day of activity went over to Alpine for dinner and drinks.  And I had a few more drinks, then more than a few more drinks.  I was very thirsty.  My wife drove us back to Marathon.  I just remember that it was sundown and the mountains were beautiful.  We got back to The Gage, I fell on the bed and slept in my clothes.  Never moved.  And the next morning, other than being incredibly thirsty, I felt great.  I guess that’s what a good night’s sleep will do for you.

 

Since then, every night has been filled with trips to the bathroom.  At first one or two times.  Then three, often four times.  And then during the day I started having what I called “Peeing Encores”.   One goes and pees, then 10-15 minutes later, one goes and pees again.  Certainly not the best way to travel if you’re flying coach on a crowded flight sitting in a window seat. But it can lead to a fellow passenger giving up their aisle seat for you.

 

During my annual physicals the doctor would do the finger wave. (If you don’t know what that means, look it up.  And it has nothing to do with women’s hairstyles).  The doctor noted that I had a slightly enlarged prostate, but not to worry.  I told him about the frequent nighttime trips to the bathroom and he encouraged me to cut back on the antihistamines and limit my fluid intake in the evenings.  Of course, I did neither of those.

 

Finally, I decided to go to a urologist.  He put me on Tamsulosin (Flomax).  After 45 days, there was no improvement.  Then he said let’s add Oxybutynin a drug that calms the bladder.  The only effect was that it relaxed my upper stomach and gave me severe acid reflux which I had never had before and never want again.  So we stopped that.  A few weeks later, I decided to have the exam.  The exam being a cystoscopy procedure where the urologist inserts a device in the penis, runs it up the channel a ways, takes a look, a few images, pumps you full of fluid and then has you pee into a vial hooked up to machine that measures your “flow”.

 

Turns out that my flow was really bad.  And the images showed that I also was starting to develop bladder stones.  No trouble today but would only get larger and become big trouble tomorrow.  Indeed, I had the classic old man’s problem, an enlarged prostate, aka Benign Prostatic Hyperplasia (BPH).  Benign sounded good, Hyperplasia not so much.

 

So the urologist gave me several options including continuing medication.  But the reality was that surgery was the best option and the best surgical option was the tried and true “gold-standard” of BPH surgeries: TURP (Transurethral Resection of the Prostate.)   TURP is just medical shorthand and a fair bit of marketing genius if you ask me.  It sounds a whole lot better than saying we’re going to stick a cable in your penis and run it up through the urethra and use a little roto-rooter like instrument to carve out enough tissue so you can pee better and less often.  Now Mr. Click we just need a few signatures.

 

So I signed up.  It would require a night, maybe two, in the hospital.  Post-surgery I would have a catheter in for as long as necessary and might even get to wear it home.  I had a catheter several years ago with a left knee replacement.  I spent two nights in the hospital, even got up and moved around with it.  The nurse took it out before they sent me home and it wasn’t that bad.  But with another bit of good salesmanship, what the urologists don’t tell you is that the catheter they use after TURP surgery is the size of a small garden hose which in necessary to handle the volume of water and blood that comes out.  And just for fun it has an inflatable balloon that keeps everything open while your wounded and angry prostate responds to the invasion. Fortunately, they deflate the balloon before they take the catheter out, but it’s just one more thing.  What goes in, must come out.  

 

The good news is that I only had one night, one long sleepless night in the hospital with noisy equipment running to monitor blood pressure and keep the fluids pumping through the IV in my arm and out the catheter in my little friend.  I was also drinking water non-stop.  Anything to speed up the process and get me out of this cage.  But I did have my I-pad and my noise-cancelling Bose headphones.  So I watched “The Terminal List” or listened to classical music.  Every couple of hours the nurse came in to empty the catheter bag (which was at least gallon size) and muse about the color of liquid that had come out of my body.  The good news if there really wasn’t much pain, just a lot of discomfort and inconvenience.

 

“Take a deep breath Mr. Click and when I tell you to breathe out, I’ll remove the catheter.  There may a be a little bleeding.  Okay?”  As if I was going to say, “Nah, I think I’ll just wear this home and wait for it to slip out on its own someday”.   So I took a deep breath and she said breathe out.  As I did, in one smooth, quick motion she pulled the garden hose out.  And it did hurt.  How could it not?  And it was a bloody mess.  But it was out, thank God.

 

But before they would let me go home I had to conquer the pee challenge.  I’m chugging down water like crazy and peeing as best I can into one of three numbered quart sized pitchers. The goal is to see if the urine has an ever-decreasing amount of blood in it.  If not, the nurse suggested that they might have to put the catheter back in and send me home with it.  That was at once more than enough motivation to keep me chugging water to clear up the stream.   The nurse was taking pics of my output and mailing them to the urologist who would make the final decision about the release with or without the garden hose.

 

I do believe in prayer.  But, in the grand scheme of things, I wasn’t sure if God cared all that much if I had to go home with a catheter or not.  I concluded that if I did, there must be a reason and it must be for the best.  So I alternated between praying that my pee would clear up enough to pass inspection;  but if not, praying that I would deal with all of it graciously, being thankful that I lived in a time when such medical solutions are available.  Thank God for doctors and nurses.  Thank God for those who invent, design and manufacture the technology and equipment used in modern medicine, including catheters. Thank God that I live in this time and this place and have access to medical care.  And thank God for anesthetic.

 

Now almost two weeks post-surgery, things are getting back to normal.  It will take 4-6 weeks to determine how effective the procedure is in correcting my “pee problem”.  At this point, I am optimistic. But, also realistic enough to know that time takes its toll and something else in this old body will start to fail one of these days. 


“For dust you are and to dust you shall return.” Genesis 3:19



Sunday, July 3, 2022

Alter or Abolish

 

These days it’s a real challenge to write about serious matters.  Somewhat like walking on broken glass. Therefore, one is left to write about dogs and butterflies, or what they had for breakfast.  Even those innocent topics can draw fire from those who are ever ready to be offended.  And just try saying something about abortion, guns, critical race theory, climate change, crime, vaccinations, immigration, inflation or education.  Good luck with that.

 

Now it would appear that July 4th has been added to the list of “hot topics”.  With the recent Supreme Court ruling that returned the abortion issue back to the states, the whole idea of American Independence has once again gone under the microscope of public opinion.  

 

This is not the first time American Independence has been questioned.  Slaves were, by definition, not independent.  Even after slavery was abolished, black citizens were only as independent as white citizens would allow.  Not that long ago, women by tradition, law and holy scripture had very little independence.  Native Americans became dispossessed prisoners, forced on to land not of their choosing. Living in ways they did not know or understand.  Independence lost.  Those Americans who labored on farms and in factories were only as independent as the next harvest or paycheck.  And while new immigrants found America to be a better place than the one they left behind, economic freedom and independence would be hard to come by.

 

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness…”  The Declaration of Independence goes on to insist that Governments exist to secure these “Rights” and when such Governments fail to do so; the people who are governed have the Right to alter or abolish such Governments and institute new ones.  

 

In July 2022 we find ourselves, those who are governed, somewhere between “alter” and “abolish”.  The genius of our Founding Fathers was the creation of a Constitutional Republic of States, a Federation, that gave us the best system yet devised by which people might secure those Rights of Life, Liberty and the Pursuit of Happiness.  A system of checks and balances, alteration and amendment.  But it’s not perfect.  Not long after the ink was dry we fought a Civil War where over 600,000 Americans lost their lives in the name of freedom and independence because they could not agree on what those words meant. 

 

On this July 4th, take care America.  We must come together peacefully and resume this Life, Liberty and Pursuit of Happiness adventure even if we cannot agree on exactly what those words mean. Perhaps we start by listening more and talking less.  Seek to understand, not just to be understood. And we could certainly use fewer fireworks and more forgiveness.  Let's try a little tenderness for a change, America. 

 

“Parents wonder why the streams are bitter, when they themselves have poisoned the fountain”

- John Locke