Off-topic: Mens’ Health and the Over-weight, Under-rested IT Professional

While visiting Utah for work, my wife and I stayed with one of our five sons and his wife over a weekend.

After going to bed Saturday night, I woke up shortly after midnight and needed to urinate.

We were sleeping in our grandson’s room — who was now sleeping in the same room as his parents — so I didn’t want to use the upstairs bathroom (which is next to the main bedroom where the three of them were asleep).

I walked down the 14 stairs to the entryway, through the living room, through the kitchen, through the dining room and into the downstairs powder room and closed the door.

Dribbles.

“Odd,” I thought. “I guess I didn’t have to go.”

I flushed the toilet, washed my hands, opened the door, walked back through the dining room, back through the kitchen, back through the living room, into the entry way, up the 14 stairs, and back to bed.

Seven minutes later, the cycle repeated.

In fact, the cycle repeated itself for the next eight hours.

Shortly after 8 a.m., I woke my wife and told her I must be constipated, because I can’t really urinate.

My wife — who has raised multiple Eagle Scouts — is always prepared and had me start taking a laxative. After a couple of hours with no real change, we determined we wouldn’t be able to attend church with our son, daughter-in-law and grandson like we were looking forward to and went to Urgent Care.

At the Urgent Care, after the initial urine analysis didn’t reveal anything, I was prescribed an antibiotic while we waited 48 hours for the cultures to come back.

We decided to head back to our hotel earlier than planned, said our goodbyes and started the 90-minute trip with my wife driving, as I was becoming quite uncomfortable.

The drive was challenging as every bump and dip was being magnified by the abdominal pain I was experiencing.

We made it to the hotel room and now — with much easier access to a bathroom — I tried to rest.

Around midnight Monday morning, the pain was so intense that I woke my wife and told her I needed to go to the emergency room (which is quite uncharacteristic for those who know me well).

When my wife asked me my pain level, I replied “probably a four.”

The drive from the hotel to the emergency room was excruciating and I, regrettably, directed my anger at my wife and her driving.

When checking in at the ER, the intake nurse asked me my pain level, to which I replied:

“May I please see the descriptions?”

“Those descriptions are for children, what’s your pain level?” was the nurse’s reply and query.

“I’m an engineer,” I shouted, “I need to see the descriptions!”

After reading the descriptions, I determined my 4 was actually a 7.

I was quickly admitted, assigned a room and an ultrasound bladder scan revealed I had an excessive amount of urine in my bladder.

A catheter was inserted into my urethra and at least 2,500 ml of urine was drained from my bladder! (The normal maximum is 300 ml.)

Oh, the relief!

After I had calmed down enough, the emergency room doctor ordered a Computed Tomography (CT) scan to better understand my situation and upon his review, I was informed I was leaving the emergency room with the catheter in-place and that I needed to see a urologist this week.

I informed my manager of my situation and was able to rest for the first time in 48 hours.

The next day — at 8 a.m. sharp — a dozen IT support personnel from work started a three-day, on-site Apple training class, lead by a rock-star, Apple-certified trainer from out-of-state.

Both me and my urine-collecting leg bag attended, on-time, each day. (Never underestimate the ability of a catheter and its accompanying leg-bag to make concentrating on highly technical material quite challenging.)

I took Friday off as a medical day and my wife and I visited a urologist where we learned that I didn’t have an infection and I could stop taking the prescribed antibiotic.

What I did have was nine bladder stones — who has ever heard of bladder stones? — and a significantly enlarged prostate (which my wife had to inform me was nothing to be proud of).

Not only would I need surgery to correct the issue, I’d be flying home with the catheter, which wouldn’t be removed until after surgery.

Deep. Cleansing. Breath.

We contacted our primary care physician at home and obtained a referral for a urologist in our area.

During our first visit to our local urologist, the catheter was removed, my urethra scoped and a new catheter was inserted.

The scope — which my wife was able to observe on a monitor — confirmed the earlier CT scan: My urinary tract was nearly completely compressed by my enlarged prostate and I had multiple large bladder stones which would need to be surgically removed. (The bladder stones were most likely caused by my prolonged inability to fully empty my bladder.)

The surgeon confirmed Transurethral Resection of the Prostate (TURP) was the best approach.

Transurethral Resection of the Prostate (TURP) is a surgical procedure performed to treat urinary problems caused by an enlarged prostate gland.

The procedure involves removing portions of the prostate tissue through the urethra without requiring external incisions.

As part of surgery preparation, we visited a local hospital so I could have an electrocardiogram (EKG); simple and painless.

For insurance purposes, the surgeon need to confirm the actual size of my prostate, which was accomplished via a transrectal ultrasound (TRUS) or prostate ultrasound:

The procedure uses a small ultrasound probe that is inserted into the rectum, which lies next to the prostate.

The probe sends sound waves through the rectal wall to the prostate, and these waves bounce back to create detailed images.

On a Wednesday morning, my wife took me to a local surgical center to have the bladder stones removed and the TURP completed.

We met briefly with the surgeon before the procedure and my wife offered a prayer.

I was then wheeled down to the operating room, sharing my patented “parade wave” during the entirety of the ride.

When I awoke, I didn’t feel any significant discomfort and I had a new catheter.

The discharge nurse made sure that I wouldn’t experience any blood clots and manually — by hand — flushed the catheter repeatedly until the output was only a light red (compared to the dark red when she had started).

We left the surgical center around 6 p.m. and my wife drove me in search of food.

After arriving home — even after the TURP and a new catheter — I was again unable to urinate.

My wife contacted the on-call nurse from our urologist’s office and we were directed to a local emergency room, arriving around 8 p.m.

We were quickly admitted and assigned a bed in the emergency room area where the catheter was removed and a new catheter was attempted to be inserted, which failed.

A second attempt also failed, as did the third and fourth attempts.

In fact, attempts five, six, seven and eight also failed.

When a ninth attempt was suggested, my wife, who had counseled with the on-call urologist, demanded that I be admitted for emergency surgery.

Around 6 a.m., we were informed I would be admitted for emergency surgery.

Around 10 a.m. — after the longest four hours of my life (which were preceded by the longest ten hours of my life) — I was finally wheeled into the operating room.

The urologist removed a baseball-sized blood clot from the previous day’s surgical area and cauterized at least three “bleeders.”

When I awoke in surgical recovery, the nurse helped me better understand the current situation:

I now had a continuous flush catheter, which allows sterile fluid to be introduced into the bladder and then flushed out via the catheter, which helps avoid blood clots.

My white blood count was elevated, requiring multiple overnight stays until any signs of infection were resolved.

The week after I was released from the hospital, we visited our urologist for our first voiding trial: the catheter is removed, the patient drinks large amounts of water and attempts to urinate on their own.

If urination isn’t going as expected, the patient returns to the office no later than 1 p.m. for another catheter to be inserted.

As you probably guessed based on the length of this post, I failed the first Voiding Trial and had to visit the urologist’s office for another catheter.

Normally, a nurse is able to insert a catheter. However, this time, a nurse practitioner had to use a scope to insert the catheter.

A urethra scope with guide wire is a specialized medical procedure used to safely insert a catheter when standard catheterization is difficult or impossible.

This technique combines visual examination of the urethra with precise guide wire placement to ensure proper catheter positioning.

The urethra is scoped from the penis to the bladder and a guide wire inserted through the scope. The scope is withdrawn while advancing the guide wire and a Foley catheter is threaded over the guide wire. The catheter is guided into place along the wire, then the guide wire is removed.

Triple-Ouch!

Two weeks after our previous office visit, I had a second Voiding Trial.

The catheter was removed and I was again instructed to drink a large amount of water and return to the urologist’s office no later than 1 p.m. if I was unable to urinate.

By 1 p.m., I felt I was able to urinate, but by 6 p.m., I was again retaining urine and my wife took me to the emergency room.

The trip to the emergency room was excruciating and, regrettably, I again directed my pain and discomfort at my angel wife’s driving.

Once at the ER, I was quickly triaged and assigned a bed, but then had to wait for the on-call urologist to arrive, who then had to go in search of missing “puzzle pieces” to fully assemble the medical equipment to complete another urethra scope with guide wire. (My favorite part was when the nurse practitioner had to manually create a passage for the guide wire in the catheter.)

More than 1,500 ml of urine was drained from my bladder and I almost immediately fell asleep while my wife worked on getting me discharged.

During this office visit, we were informed that the catheter would need to remain in-place for another month to give my body more time to heal.

Additionally, the prostate relaxation / reduction medication I had been taking only at night — which causes dizziness — would now needed to now be taken twice daily.

A catheter for Christmas

While this made sense mentally, the news was challenging emotionally as we were scheduled to spend Christmas with one of our sons, daughters-in-law and two grandchildren, out-of-state.

After a month of healing and increased medication, I was optimistic for my third Voiding Trial. After all, third try is a charm, right?

As before, the catheter was removed and I was instructed to drink a large amount of water, but return to the urologist’s office no later than 1 p.m. if I was unable to urinate.

Again, by 1 p.m., I was having some success urinating, but by 8 p.m., I was again retaining urine and my wife took me to the emergency room.

My wife had been in contact with the urologist’s office and the on-call nurse instructed us to not let the ER nurse remove the catheter without first talking with her.

We informed the ER staff that the last two catheters required a urologist to scope the urethra and that my current catheter was not to be removed without first discussing with our urologist’s office.

After consulting with our urologist’s office, the ER doctor made the decision that a smaller catheter should be attempted and if it was unsuccessful, they would involve the on-call urologist.

The smaller catheter was able to be inserted on the first attempt and more than 900 ml of urine was drained from my bladder and I again feel asleep while my wife arranged for me to be discharged.

Two weeks later, we were again in the urologist’s office for Voiding Trial No. 4.

By noon, we had returned to the urologist’s office.

Fortunately, during this visit, a catheter was able to be inserted without the assistance of a scope.

We met with the surgeon and determined that I would need to be trained on how to use a straight catheter on my own.

A few days later, we were again in the urologist’s office where I was trained on using a straight catheter by myself.

After a first successful attempt in the office — a requirement to be able to leave — I never again needed a catheter.

After an additional two weeks, we visited the urologist’s office, which started with a bladder scan, revealing only 15 ml of urine (zero to 300 ml is normal).

I informed the surgeon that I hadn’t needed a catheter since being trained two weeks earlier and we set an appoint for a two-month follow-up visit.