De-Catheterized

Foley CatheterMy urologist removed my foley catheter today.  This is a huge milestone.  This thing has been a prison sentence.  Like being tethered to myself with a ball and chain.  My urethra has only been penetrated by this catheter for eight days, but during that time this device has been responsible for a great deal of my discomfort and emotional state.  I probably don’t remember all my experiences, but I’ll relate what comes to mind.

Starting Monday when I had my first BM, that event also caused me to urinate outside of the catheter.  That burned my meatus (pronounced “me 8 us”).  A lot.  I learned I could mitigate the pain by physically coaxing the urine out of my penis with a pinching action.  Also, a vacuum is often created in the bag, which acts as a plug to stop the flow via the tube.  I have to blow air into it as a remedy.  To do that, I have to carefully place my lips on a recently sterilized section of tubing.  There’s a certain similarity to siphoning gas, not that I’ve ever siphoned gas.  Another hint, I learned that it’s better to string the tubing for the large foley bag down through my pant leg, like I do for the smaller bag, rather than have the tubing come out through the top of my waist when I sleep at night.  The tubing is long enough that I can still carry the bag in my hand.

I have to switch to the larger bag every night, which means cleaning the smaller bag, because the smaller bag can’t go more than two hours without the need for draining.  I drain the larger bag a couple of times in the middle of the night anyway, because it’s not really possible to sleep well wearing a foley catheter to bed.  Likewise, more cleaning when I switch back to the smaller bag in the morning.  It’s a fifteen minute routine I didn’t use to have – twice a day.  Double that to include the time it takes to clean my wounds.  I use a spray bottle of bleach and rinse with warm water.  This is the same procedure I use on my Camelbak reservoirs.

My abdomen suddenly improved dramatically Tuesday.  Apparently much of the gas filling my intestines cleared.  With this pain now largely gone, the discomfort from my catheter gained focus.  I think the pain was there all along, but the feeling was lost in all the noise from other body parts.  The shaft and meatus of my penis have been constantly sore.  This makes sleeping at night difficult.  Then there is an emotional impact from wearing a catheter.  I don’t know what could be more disheartening.  Adapting the smaller bag that straps onto my leg helped dry my damp mood significantly.  I went to a gathering Monday with my friends to watch the NCAA basketball final.  This was my first real social experience wearing my catheter.  I have such good friends, and old enough that they’ve experienced their fair share of medical history, that the evening was good.  It felt great to be out with friends.  I talked too much which made me short of breath and fatigued, to where I needed a drive home.  Otherwise, I was happy to get out.  I had to use the restroom once to drain my foley catheter.  Socially awkward.

cystogrpahyI arrived at Out Patient Services in the Longmont United Hospital Wednesday morning at 8:30am to receive a cystogram.  My tech’s name was Dave and the radiologist was Dr. Wall.  They were both personable and good about setting my expectations.  They had me lay supine on a table.  They filled my bladder with contrast, the term they use for a liquid that registers on the fuoroscope.  They leveraged my catheter for this with a reverse flow from the tube into my bladder.  They said I would feel discomfort.  I felt like I had a full bladder and needed to urinate, but this was not a painful procedure.  It took less than 30 minutes.

I learned from this procedure that in order to try peeing outside of the catheter, I need to push on my tubing to lift the balloon off the bottom of my bladder.  It’s normal position blocks the flow of urine other than through the catheter.  I was able to see this visually on the fluoroscope monitor and I was able to do this technique later at home when I felt the need to.  Dr. Wall told me it appeared my bladder was not leaking and I could expect for the catheter to be removed on Thursday.

Bard CatheterMy catheter is manufactured by Bard Medical.  The component pictured here with the balloon and small opening is the length of the catheter that sits inside my bladder.  The other end is taped to my thigh.  The Y-split to the little red endpoint is used to inflate the balloon for installation and deflate it for removal.  I was sent home from the hospital with multiple pairs of both the small and larger bags, straps and various parts.  With my expertise cleaning and caring for Camelbaks, I never needed to replace my originals.  I am disappointed with the constant vacuum problem that would trap urine in the tube before draining into the bag.  I emailed their support site for advice and received a response from someone with a PhD in their title the same day.  The response described the patch feature in the larger bag intended to mitigate vapor traps, or at least provide material to pull on in order to break the trap.  Unfortunately the smaller bag does not have this feature.

AZOKaren visited the Urologist with me this morning for the foley catheter removal.  I didn’t know 100% that it would be removed, although the radiologist did set my expectations for this the previous day.  Dr. Webster first reviewed the biopsies from my surgery.  The three prostate carcinomas were Gleason score 6.  Nothing was found on my lymph nodes.  I was able to ask for a prescription of AZO – or at least I think that’s what I’m getting – to address the extreme burning in my meatus that is expected for the next couple of days.  Dr. Webster further reviewed my next steps to address urinary issues and erectile dysfunction.  I’ll meet with a physical therapist as soon as I can schedule a meeting, to address urinary function.  I won’t begin to work on ED for another month.  Karen left me alone for the actual procedure.  Unexpectedly, so did my urologist.

Nurse Brittany and her new intern Abigail performed the necessary steps to remove my foley catheter.  She had me lay back on a table with my upper body propped erect by pillows.  Intern Abigail observed and took notes as Nurse Brittany explained each task.  She first placed a tray between my legs to catch urine.  Then she removed my leg bag and its section of tubing, and discarded it in the trash.  Next she deflated the balloon that anchors the catheter in my bladder.  Nurse Brittany then injected three or four syringes of water into my bladder via the catheter.  She kept going until I told her to stop.  Last step was to pull the catheter out.  From the effort Nurse Brittany expended prior to the big tug, advising me to relax, I was braced for some pain.  I also expected this to be too quick to hurt for long.  In the time it took her to reel in that line, I could have read Moby Dick.  A tougher guy might describe this as discomfort.  I’m categorizing it as epic prolonged pain.  The final task was mine to expel all the water from my bladder into the toilet, which I was allowed to perform without an audience.  Lastly, Nurse Brittany scanned my bladder with some ultrasound device to confirm I did indeed empty my bladder.

We arrived home to a shipment on the front porch of Amanas smoked ham and assorted sausages and cheeses dispatched by my older sister Sandy in Marion, Iowa.  I made a ham and cheese sandwich from it, on Rudi’s Spelt Ancient Grain bread, and am eating some again now as I write this blog.  Before I ate lunch, I went for a walk.  A real walk.  Previously, with my catheter, my longest walk was only a half mile.  Typically divided in two segments by a short rest period at the mailboxes or coffee shop.  Shoot, until Tuesday, I couldn’t even actually walk.  It was more of a shuffle.  Understand, there is not much more you can do with a catheter tethered to your bladder.  It would only take a quarter mile for blood to start streaming through my catheter.  Not enough to be concerned, but certainly enough to make me pause.

Today, I wore my Garmin to record a three mile walk.  I averaged a 17:30 pace alongside the Left Hand Creek.  Considering my typical walking pace is 15 minute miles, and the average walking pace is closer to 20 minute miles, I’m happy with today’s pace.  The weather was full sun, mild breeze and 51°.  I wore walking shorts.  You have no idea how proud I was to be wearing shorts.  Make no mistake, wearing a catheter is completely demoralizing.  Not the best scenario at a time when maintaining a positive outlook is paramount.  I felt good about my shorts.  I felt good about my pace.  I wasn’t very dizzy or breathless afterward, and I burned 300 calories – my daily average intake on that clear liquid diet.  What a difference two days and catheter removal can make.

This completes my surgery phase.  I consider myself to be starting the real recovery phase.  The blog posts will decrease in volume, as they already have.  I suspect I’ll recount my medical professional visits.  First one should be with Physical Therapy.  Then a visit with my doctor, or at least his nurse, for PSA blood tests, followed by a urology visit in a month.  To sum up the last week, surgery was tougher than I expected.  Not much actual pain but extreme discomfort, fatigue, and an emotional roller coaster for the eight days I had to endure attachment to that dispiriting catheter.  I’m set now for Jen’s breakfast party Saturday.

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