Wednesday, November 26, 2008

A Visit to the Urologist


Okay boys and girls, here we go again. I had another appointment at the Wilmington Veterans Administration Medical Center this morning. That meant rising out of a deep slumber this morning at 4:30 am. Oh how I love getting up at that hour. I couldn’t sleep anyway, knowing that I had to get up that early.

The American Legion Post 29 van picks me up at Routes 5 and 1 (just up the road about three miles) at 6 am. I was there about 20 minutes ahead of time. I wouldn’t want to miss my ride. The van arrives about 10 after 6. Just the driver and another old grizzled vet like me are going up today. The trip up was uneventful. In fact traffic was light. We arrive at the “city on a hill” (the way the VA building looks in the early morning sunlight just off of Rt. 141.) First thing upon entering the lobby, I have to scan my VA card. Yes, it confirms that I am 67 years old (you have to put your age in the computer to verify you are who you are) and have an appointment with the urologist today. My appointment with the urologist today is to go over the results of my CT-RAD scan of last Wednesday. That was when I had the dye injected though my blood stream by an IV injection.

The result of the CT-RAD scan is that I do have a renal calcli (that’s a kidney stone to those of you who haven’t had the “thrill” of passing one.) The good news is that it is small, only 4 millimeters. The bad news is that I will probably pass that kidney stone sometime during my lifetime. That’s a day I’m not looking forward to.

However, there is another interesting development. Since I passed blood the night before I passed my kidney stone (January 2, 2008 – oh I remember the night and following day WELL), the doctor felt obligated to advise me to get a procedure done that I was dreading. I’ve never been subjected to a catheterising before. That’s one bullet I’ve dodged. Well, the good doctor advised me to get a cystoscopy. What is that you say? Uh, it’s a small camera (yes, a camera) on the tip of a flexible tube (yes, they tell me it is very flexible once it is all greased, er, lubricated up) and inserted in my penis to take a picture of my bladder. They’re looking for a tumor which may or may not be cancerous. Here’s the problem. My brother had this done by a doctor who wasn’t really paying attention and the doctor punctured the wall of his urethra. My brother ended up in the emergency room because his blood was clotting in his urethra. Oh, did I mention he told me it was EXTREMELY painful. He said it felt like he had a lightening bolt hit him between his legs. He said he did not know such pain existed. He thought he hit the ceiling.

Needless to say, I expressed some reluctance at receiving this procedure after my brother’s experience. However, the good doctor was not to be swayed. He called in reinforcements. The head urologist came in and explained to me that the whole procedure, while not “pleasant” would take a total of 20 minutes, only 3 of which I would have the “flexible” tube inserted in my urethra. He explained to me that this is their standard procedure when there is blood in the urine. Now remember, I haven’t had blood in my urine since the night before I passed my kidney stone on January 3rd of this year. It is my understanding that blood in the urine before passing a kidney stone is a classic symptom. Now I understand why the doctor wants to check but I’m wondering, is this really necessary? Of course I don’t want to take the chance of being injured. As far as modesty goes, that’s been out the door a long time ago with my visits at the VA. A lot of them at the facility know me very well. In the ten years I've been using the VA facilities, they’ve seen everything. And I mean EVERYTHING. There is no corner or cubby hole of me that has not been examined, poked, or exposed to many and varied eyes of both sexes. I have no secrets. I'm an open book.

So here is my dilemma. Do I have the cystoscopy or not?

Just to end a perfectly beautiful day, on the way back to Slower Lower (Sussex County) in the van, we encountered a traffic accident on the other side of Dover. We sat in traffic a good hour and a half until we were directed to go back. Thus, the three of us took a meandering tour of the western side of Route 1 until we could connect to Route 1 again in Milford. We saw parts of Delaware we did not know existed. Delaware is such a small state, everything pretty much looks the same. Flat land, big chicken houses, WalMart trucks heading north and south (lot of WalMart in Delaware), and the big sky. Nice tour but we were all anxious to get home. You can't get lost in Delaware. Route 1, 13 and 113 run the length of the state. The other roads like Rts. 9, 16 run east west. Sooner or later one of those roads intersect with the powerful Route 1.

During our unexpected detour,I had plenty of time to think of “should I or shouldn’t I?” Originally they were going to schedule my appointment for December 24th. What a perfectly lovely way to spend Christmas Eve. No thanks. I reschedule it for January 29th, 2009. After I got home I called my brother (he lives in South Carolina) and told him of my situation. It brought back a lot of painful memories for him. He said if it was him, he wouldn’t have it done unless there was something wrong. I’m not passing blood now so, technically, there is nothing wrong. But, I’m still undecided.

While I was up at the VA today I had both of my computers on. I was transferring some of my 25,000 plus pictures from my old computer to my new computer. In those 25,000 pictures I have a lot of different people, places, and scenes. However, there is one picture I don’t have. If I do decide to get it done, you can be sure that will be my “picture of the day”. You might want to take the kids out of the room when you pull that one up.

6 comments:

  1. Ron,

    Ah, the assurances of doctors. I'm not big on having procedures done unless absolutely necessary. And it is not skin off them is it? How well I remember the comforting words of the doc telling me to have radiation treatments for my Graves Disease. In a heavy German accent he said: "it can cause skin cancer. But we can cure skin cancer. It can cause cataracts, but we can cure cataracts. So you have nothing to worry about, it is perfectly safe."

    Yes, and when they were about to do it, every doctor, technician and nurse fled the room to hide behind a lead scheild, yelling as they ran, "don't move".

    Now three cataract operations later I can see how safe it all was.

    Happy Thanksgiving!

    lar

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  2. After your comment, now I'm leaning towards not having the procedure done. It's two against and one for (sort of.) As I said in my blog, my brother John had an awful experience. Talking to Bill B. last night, he said he had it done and "it was no big thing." I could have all kinds of invasive tests done to make sure I don't have cancer. Where do I stop? There is a little nagging voice in my head that says "This isn't necessary." I think I'm going to go with that warning voice in my head. Sometimes I think these doctors are too narrowly focused on their area of exptertise and don't see the big picture. My brother said when his urethra was punctured and the blood was clotting in his penis sending him to the emergency room, all the doctor said was "Oh, I'm sorry." I just don't see the overriding need for me to get this procedure unless I still had blood in my urine, which I don't. I'll think on this some more but I'm leaning towards not having it done. Thanks for your input.

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  3. jim rossignal11:45 AM

    Ron,

    I'm in agreement with the above two posts. I think there is a lot to be said for one's "gut feeling" in any situation. Sure, a doctor's advice is important but so is a thought coming from your own gut.

    It seems to me if blood is a classic symptom of a stone and a stone is what you had, then it doesn't take a genius to make the connection.

    I would say do some more research as far as what you're risking by not having the procedure done now and then later blood in the urine (not associated with another kidney stone) does occur. Is having the procedure now going to be of any benefit? How much? How often does the urethra get punctured accidentally during a cystoscopy? That kind of stuff.

    Plenty of doctors are just looking to do another procedure for any number of the wrong reasons. All you can do is be as informed as possible, weigh in the doctor's advice and YOU make the final decision. Heck, you're the one making the final decision anyway even if you're completely uninformed. They can't just drag your rear end into an elective procedure or most operations for that matter without you making that final decision somewhere along the line.

    Patients have a lot of power and a lot of responsibility along with it. It's something we often tend to forget.

    Good luck!

    Jim

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  4. Don't know when your brother had the procedure, but things have improved greatly in the past decade. My first catheter was done by an inexperienced ER doctor and was quite painful. The last one - in 2006 - was painless, except when the tube made its way past the prostate. After that it was fine. I had the thing inside for a week without incident.
    I agree with the comments above though, get another opinion or use "the Google" to learn more about the risk vs. the procedure.
    If the last blood was back in Jan. the risk is pretty slim.
    Did they take a urine sample this last visit? If there was a tiny amount of blood in the urine the test will show it.
    Just my two-cents, plain.

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  5. Jim,

    I've of two minds about having this procedure done. I understand why they want to do it, because I had blood in my urine. But that was only the night before I passed the kidney stone last January 3rd. I haven't had any blood since. They even tested my urine on Wednesay and found no blood or cancer cells. However, the one doctor pooh pooed that test. I think they have a protocal to follow when there is blood in the urine. This test wasn't called for months ago when I first went to the urologist. Why now? I think because the one doctor (he is very old and seems befuddled at times -there's a clue) has ran out of tests for me. He even asked if I had my prostrate checked (yes, I did the last visit -no need for another one one month later), and then asked if I had my testicles operated on (where did THAT come from?) All warning flags. I'm going to do some more research before I make my final decision. There have been ocassions in the past that I decided not to go with the doctor's recommendation and I lived to tell the tale. Two that I can remember is an electro cardiogram (there was nothing wrong with my heart - I bumped my elbow that why my arm was sore). The other procedure was to have gum surgery. Twice. Both times I declined. I didn't see the value. I'm going to give this a lot more thought before I make my decision.

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  6. Wayne,

    I've since talked to two friends of mine who have had the procedure. They both said "it was no big thing." My brother had the procedure done last year. He told me the person who performed it wasn't paying attention (he was talking to someone else the same time he was making the insertion in my brother's urethra). My brother said that some people do these procedure so often that they don't really pay attention to what they're doing and they get careless. I don't think that is what is going to happen to me. However, I don't see the value in getting this procedure since I have had no symptons simce January 3rd. That said, I still haven't made up my mind. More research needs to be done before I'm comfortable with my decision.

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