January 2013

In the spirit of nothing staying static in our lives, New Years Day has not disappointed. We headed back into the hospital to see about getting the catheter removed. Sure, easy. When I finally got to see the Nurse Practitioner, she got herself all set up, pulled the sterile water out of the balloon that holds the catheter in & said, “Take a deep breath”. I was halfway through taking one when she just hauled it out. Just as well too, because it took my breath away. I couldn’t really describe it as painful as such, although it was, more a sensation of something getting dragged out of my body. Which of course it was. Some few seconds later, she asked how I was. I believe “breathing” was the answer! We then had to wait until I had taken a pee, which happened within about 10 minutes. Then she took a scan of my bladder & found some residual in there, which meant that I had not fully emptied it. The process is called a Trial Of Void for a good reason. However, the consensus was to let me go home.

“Going home” involved numerous roadside stops for attempts to pee with a bit more volume, and not too long after we did arrive home, it was obvious that there was zero flow and we were now back to square one. Then followed a rather traumatic trip for Julie, watching me writhing in agony while she drove. I did walk into the Emergency area, but my presentation at the Triage counter was somewhat ragged. As it happened, as I was ushered into the Emergency area, a male nurse, about to go on his break, noticed my predicament and asked the doctor if he could do a catheter insertion immediately. I suspect I mentioned this last month, but it seems that this is one of their favourite procedures, as it takes a patient in a great deal of pain to total relief within minutes. “Shove this thing in and bingo, you’re fixed.” Temporarily, at least.

The first of the photos for the year are of a guy feeding the lizards in the enclosure inside the hospital.

Given that I have now had a failed attempt at coming off the catheter, my chances of a successful attempt again are reduced. The Emergency Doctor recommended talking to a Urologist about the TURP (Trans-Urethral Resection of the Prostate), which I will pursue next week when everyone opens for business after the break. Meanwhile, I take great interest in my “bag”, either the leg bag or the larger overnight drainage bag. One tends to become somewhat attached to these things after a while and tends to talk to them. No, I’m not going crazy.

We’re now into the second week of January and I am WAY overdue for going back to work, but I just can’t yet. This morning I had an urge to pee and when I did, it just leaked everywhere. Further examination showed that the delivery end of the catheter tubing had been twisted overnight and was effectively closed. Managed to untwist it and re-open the flow. This happened again twice later in the day and I could see no obvious cause, so took myself yet again back to the hospital. You guessed it, by the time I got in to see someone, it was flowing again. The male nurse offered to remove it and insert one with a “bigger bore” and I politely declined. Meanwhile, I came across the nurse who had removed the first one and she was pleased to see me, but disappointed that I was back again. She suggested that if I have trouble getting into a urologist in Canberra, I should try Sydney. Only a 6-hour return trip for a 15 minute appointment, but at least I might be able to get one!

I dropped into work during the week, to show off the “plumbing”, and to give my colleague Clifton another chapter in the saga of my life. I also went in for real, just once, for a couple of hours, to get things tidied up and consult with the rest of the team on some upcoming training.

Meanwhile, back at the farm, it was sometime around this time that I walked out to the Sierra to get in and drive into town. As I backed out, I looked out over the right side and there was a bloody big brown snake on the move. I screamed (as one does) and he took off towards the dam. Update: The scream did nothing, because snakes are deaf – he probably thought it was time to get moving. I’m pretty certain it’s the same one I trod on a little over a year ago, and he is now twice the size. Even worse, I eventually figured out that he was probably lounging in the shade under the trailer as I walked past it, and when I stated the car, he decided to get out of there, which means I walked straight past him. Back in about the beginning of December, I invested in 2 Aussie made solar powered snake repellers that actually work, because I occasionally hear one of them and sometimes see the other shining its little light in the dark. They have an effective radius of about 20m, so we only need 2 of them to cover the whole bus area through to the shed door. It occurred to me after this incident that they don’t reach through to the other side of the shed where we park the cars, so I now have 2 more on order, one for the front of the shed somewhere and one for out near where Julie sits to have a smoke. That way, we’ll have all of the areas where we normally walk covered. If I am walking anywhere else on the property, I watch where I’m going and stick to the mown pathways.

As it happens, I called the urologist’s office on Monday and was told, “Hmm, yes we can get you in at 2:15. Would that be OK?” Are you kidding? I’ll be there! It really didn’t matter to me that he was running 90 minutes late, at least I got to see him. He scheduled me into the hospital (his office is downstairs in the private hospital building and he probably holds shares in it) for the following Thursday for another Trial Of Void. They need 2 separate readings of less than 100ml in the bladder to be able to release me. Only one of my readings got anywhere near that, and after several hours of this frustrating process, the urologist was called and he asked that I be kept in overnight for further observation. When the reading got up to around 300ml and I was starting to feel somewhat tender in the area, he was called again and sent a colleague to insert yet another catheter. Yes, this time it’s a size 18. And yes, it’s a big sucker! However, the good news is when he finished his surgeries, he dropped in to check, and “going home” was mentioned. Yep, we can do a referral to the District Nursing Service tomorrow, sign all the forms and get you out of here. I got home about 10pm.

The training is on next week, on Tuesday, Wednesday and Friday, and I have promised that I will be there, given that I am one of the few people who will use it the most. Given the “draining” nature of the whole process of wearing a catheter (yes, pun very much intended), with its associated niggling discomfort, I think 3 days in one week will be quite enough. The long term intention at this stage is to allow the new drugs to take effect, while balancing work time on and off. The one I have been on for ages works on smoothing the muscle in the prostate that surrounds the urethra, with its consequent potential for blocking it off. The new drug contains the same ingredient, plus another that works to reduce the size of the prostate itself, which will certainly be beneficial in my case, as it has frequently been described as, “Ooh, that IS a big one.” Wait and see, before we look at the option of surgery.

The zoom lens on the camera has been in action again, capturing Julie talking to Shea, who visited us for a few days.

An indication of the strength of the side winds on the way home,

Yet another picture of Angel standing in her water bowl.

A delightful one of Summer rubbing her bum against the gate.

And a huge thank you to Shea for helping out by cutting the remaining grass and reducing our fire risk somewhat.

Meanwhile, Julie has had her own issues. She has often been working 9 hour days and for most of them, she is flat out for the whole time. She comes home exhausted. Just as well we are on daylight saving time, so that she can get home in daylight. So at various times of the day or week, we seem to take turns at one propping the other up.

Remember the training that I really had to attend? On the Tuesday, I got ready and got going, but my head was just “not right”. I got as far as Sutton, which is the next town along about 15km away, turned around and came home. Meanwhile, I had a visit from the Community Nurse to do an “admission”, just the same as if I was being admitted to a hospital. We talked about managing my catheter and she reiterated the need to drinks LOTS of water to keep flushing the bladder, so that any small bits of gunk that hang around in there anyway become diluted and won’t block the drain hole in the catheter. That’s happened a few times and I even resorted a couple of times to laying on the bed and pushing the catheter back in a bit, in an attempt to dislodge blockages.

Sometime later, after numerous temporary blockages, I called for some advice. It took the Nurse all day to get back to me, but she said that the “catheter guru” had said that I was doing a great job of managing my catheter and that there wasn’t much else they could do for me at this time. She also mentioned that the Foley catheter has a nasty habit of laying the drain hole onto the floor of the bladder, causing a blockage. By this time, I had figured out that this usually happened when I was sitting, which of course is what I do at work, all day every day.

Meanwhile, Julie and I had reviewed all the evidence we had available to us and decided that the outlook of wearing a catheter for an indeterminate period of time before the new drugs finally kicked in was not a viable option, leaving us with the last resort of having the surgery. The final piece of evidence was that my prostate is 3 times the normal size. So I reluctantly visited the urologist again and was scheduled for surgery on 12 Feb. He told me that I would have to be off all blood thinners for at least one week before he could operate, which meant getting off the aspirin immediately. I did that, and left a message for him that early the next week that I would be eligible for surgery by Friday and would be pleased to take any cancellations.

We have made friends with Summer, the horse, which is not all that hard when you take her a carrot. One of her favourite places to hang around is just over the fence from where Julie sits to have a smoke, so they tend to hang out together. Horses are herd animals, so we’re pretty sure she is quite lonely. One night, Julie pulled out a comb that was originally bought for the dogs and proceeded to brush her with it while I stayed at her head, patting her neck. After a while, she softened, and had this lovely dreamy look in her eye, while Julie was clearly enjoying the experience too.

We need to do that more often, especially as Julie seems to be once again being picked on at work. She hasn’t had a trouble free job since she got here, and is starting to wonder whether she has “Abuse Me” tattooed on her forehead. This time, it has been her colleague loudly correcting her in front of a whole line of patients waiting to be served. Personally, I think she needs to take said colleague into a back room and get as angry with her as she sometimes is with me. A sentence starting with, “How dare you!” seems to me to be a good way to start the conversation. Again, she loves the job, despite it being as exhausting as it can be; it’s just those she works with that get in the way of enjoying it.

Yesterday I got a call from the hospital, asking whether I could be at the hospital tomorrow. Ah, yeah! Hang on, tomorrow’s Saturday. It looks like the urologist has decided to get some of his waitlist out of the way by working on the weekend. Which is good for me, because Monday is the Australia Day Public Holiday, which means one less day of leave that I have to take. I’m already in a negative leave balance. I told my bosses that I’d be off for at least a week, arranged for a Community Nurse to visit on Tuesday, made a couple of other calls and messages, and did some essential shopping on the way home. No time to re-think it now! Just pack and be ready in the morning.

So, today is Australia Day (26 Jan), I’m awake, I can’t sleep and I guess I’m ready. Stay tuned.

Pictures include more wildlife.

Smoke from a fire about 10km away, across the river and over the hill.

The dam floor looking dried and cracked.

The big willow tree down by the river which self destructed in the winds.

The leg bag.

A sequence of Kelly guarding his food, then proceeding to eat it as Angel approached.

We arrived at the hospital, I was admitted, and no sooner had the nurses done their preliminaries, I was called for surgery. On entry to the pre-theatre, I spoke to the anaesthetist, who told me that he and the urologist had decided to catch up today on some surgeries that had been cancelled by a power outage earlier in the week, and had decided to include me, as I was keen to get it over with. That of course is all I remember until becoming vaguely aware of Julie saying, “Oh, you’re awake.” Prior to that, I had apparently “woken” every 5 minutes and asked “report?”, to be told that there was no report. It’s just as well that I don’t have a secret lover!

Here’s what I sent out in the early hours of Sunday:

For those that celebrate it, Happy Australia Day for yesterday.

As is apparently quite common after an anaesthetic, some drugs tend to have the reverse effect,  so after a really good sleep yesterday, during which my blood pressure dropped quite severely and one of my question responses was described as “vague”, I have had virtually no sleep overnight.  If anything, I’m more wired now at 4:30am than when I arrived!

I have not yet received a report on the success or otherwise of the operation itself, but given the amount of blood that has been flushed through the catheter since yesterday, it appear obvious that a lot of work got done.  By my calculations, over 30 litres of saline solution has been flushed through my bladder so far, and the good news is that the colour is starting to clear, which means that the initial bleeding has probably stopped.  The night shift Nurse just told me that this figure can range from 40 to 600, so I guess I’m doing pretty well.  This is achieved using a humongous 22 bore triple catheter, which pushes the saline and drains the other stuff.  And thought an 18 was big.

I am wearing some delightful pressure stockings, as are others I have seen, in addition to a device that stimulates the lower legs on a regular basis, with a noise that reverberates through the  whole bed, so my normal head position with my ear on the pillow can’t be used, adding to the lack of sleep.  I did manage to get a dose of codeine provided when my Restless Legs Syndrome started my left aching, so I am now comfortably pain free and should be for a while yet.  It didn’t work for the leg, but it did for everything else.  But since the legs only ache when I an trying to sleep and I am now wide awake, it’s all good.

The forward plan is for the flushing to continue until the colour is clear, and tomorrow (Sunday) we do another Trial Of Void, which means the catheter comes out and we see whether I can void (empty completely) my bladder.  That is likely to be a rather messy and potentially painful process, but the other good news is that they are usually successful and I should be discharged on Tuesday morning.  The rest of the week will revolve around retraining my bladder and cleaning up the accidents.

In theory, although I can’t any work around the property, I should at least be able to walk around it for increasing lengths of time and check out what needs to be done later.

Meanwhile, Julie makes contact on Sunday morning. This is what she posted on Facebook later in the day:

Ok – Julie is about as mechanical as a mouse. Um going to take a shower this morning – nice except there is a SPIDER in the shower. Take shower head to flush spider down the drain – opps broke shower head hose. NOW WHAT! Oh no shower. Get dressed – looked at “screws”. Get shower head/hose loose. Take to hubby in hospital to give advice (silly me!). Help hubby have a shower so I can have one too – umm nothing like in a motel/hotel! Oh well, feel better and longer shower then I would have had at home due to water restrictions! Go to Magnet Mart, ask for help, but he doesn’t have the foggiest idea, so here I am matching hoses. FINALLY, he says, that should work! Hmmmm, go home and fix shower – Yeah water and shower. Just need Hubby to screw in tighter. I CAN DO THIS! YEAH ME!

I an very proud to report that she brought the flexible hose in and I was able to check that the shower head screwed into both ends equally easily, so all she had to find was a similar length into which it would also screw in easily to both ends. As above, she did that on the way home, put the whole thing back together and it only needed very minor tightening by me when I got home. Well done, dear!

And here is the report that I sent to the folks at work on Monday evening:

The urologist discovered that my prostate is 4-5 times normal size.
He worked on me for 2.5 hours to create a nice wide channel.  He also removed 2 stones from the bladder.
I used the lower end of the amount of saline (45 litres out of a range of 40-300) to flush the gunk out within 36 hours.
The flushing catheter came out early on Monday morning and I was cleared to go home around lunch time.
I am peeing like a young man, but still need to clear out blood clots and scar tissue over the next 4-6 weeks.
This week, the main effort will be to re-train my bladder to hold a decent amount before needing to empty it.
I’m still very much in recovery mode, so I am tired and need to pace myself, but I am also VERY happy with the result.

Tuesday morning: Having left the Community Nursing Service with a couple of conflicting message over the previous few days about coming to see me this morning, I called them. The Nurse was delighted to hear of my progress overnight, as the bladder had stabilised from needing to go about every 10 minutes and leaking even before I got there, to being able to hold a reasonable amount and give me fair warning when it was time to be emptied. I am very careful to clean the toilet bowl of the bloody remains after each time I go, because I don’t really want Julie puking when she sees it.

More fresh mushrooms.

And I FINALLY got the male wren in the clear and in the sunshine. Still not as good a picture as I would like, as he was nearly 20m away, but I got him.

I am now alternately doing a little of “something” like tidying up the bus, doing the dishes or going for a short walk, and resting. It’s a bit difficult to sleep during the day after a superb drug-induced sleep overnight, but when the head or body says “rest”, I just sit and sometimes manage to lay back and snooze for a minute or two. I keep reminding myself to resist the temptation to go and “do” something. More like, do things for 10 minutes and sit down for an hour.

And some good news to finish off the month. I slept in this morning because I had been wide awake at about 03:30, having discovered that the natural hydraulics were working. I was so excited that I told Julie and got the usual grunt response. Yeah, she’s been exhausted lately. This aspect of the surgery had been bothering me, as it is one of the risks, so it’s great to find out it’s not a side effect that I will have to deal with.