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adventures with my 85+ year old Bladder

Updated through October 30, 2018

Dear Friends,
This tale seems to have turned into:
    - a Shaggy dog story - an endless pointless tale intended be be a disappointment
    - The Perils of Pauline
Sorry about that.

Table of Contents
     - Background
     - Adventure at Stanford Medical. Honeymoon period - Monday Oct 22, 2018
     - Adventure at Stanford Medical. Honeymoon is over - Tuesday October 23, 2018
     - Comments from the Doctor's Office - October 24, 2018
     - Comments from Others - October 25, 2018
     - Removing the 2nd Foley - October 29, 2018

Background
In October 2016, I thought an unnamed surgeon had not prescribed the proper drugs after my first bladder surgery.
After finding trace of blood in my urine, a cystoscopy was ordered and performed. The Dr. found "small" patch of white with little projections. The surgeon thought it best to get tools in there and check it, and while he was in there, scrape the middle lobe of my 5x sized prostate.

So a week later a later, the Dr. performed a "procedure" in a surgical center across the bay "resecting" the tumor.
from https://www.healthwise.net/stanford/Content/StdDocument.aspx?DOCHWID=uh1456

Transurethral Resection (TUR) for Bladder Cancer Surgery Overview

Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is often used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.

A thick catheter hung from my "private" parts which connected to a black rubber thingy with three outlets. I have pictures, but they are too gross even for me :-((

Foley catheter
Foley catheter from Wikipedia
In urology, a Foley catheter (named for Frederic Foley, who produced the original design in 1929) is a flexible tube which a clinician passes through the urethra and into the bladder to drain urine. It is the most common type of indwelling urinary catheter.

The tube has two separated channels or lumens running down its length. One lumen, open at both ends, drains urine into a collection bag. The other has a valve on the outside end and connects to a balloon at the inside tip. The balloon is inflated with sterile water when it lies inside the bladder to stop it from slipping out. Manufacturers usually produce Foley catheters using silicone or coated natural latex.[citation needed] Coatings include polytetrafluoroethylene, hydrogel, or a silicon elastomer the different properties of these surface coatings determine whether the catheter is suitable for 28-day or 3-month indwelling duration. A section cut of the distal end of a Foley catheter. The image shows a burst balloon, balloon lumen and main drain lumen Foley catheters should be used only when indicated, as use increases the risk of catheter-associated urinary tract infection and other adverse effects.

Everything was so-so until I got home. (The wife was driving). I had just gotten into the house when AN ENORMOUS PAIN GRABBED my bladder area. I could barely get to a chair to collapse. The pain was even worse than a steam burn I got 50 years previous.

I wanted to go to a local Emergency Room to stop the pain. But I thought I couldn't walk reliably to the car. We called 911. By the time they arrived (a fire truck arrived first :-) the pain was less but I have a 911 ride to a local Emergency Room (ER).
I specified to the 911 driver that I refused to go to the ER at Washington due to previous experiences

A doctor at the ER ordered a shot of morphine (Hey, that stuff REALLY works :-) then asked if I had taken my bladder anti-spasm pills.
No, I wasn't given/prescribed any - she checked my meds, and none of that type was listed.
She gave me a few and wrote a prescription. Life was much better.

After maybe a week, I went back to the local unmentioned provider to have that the monster catheter three way thingy removed.
And I changed urologists !!

Another cystoscopy at the unnamed medical service in October 2018
Almost two years later I had occasional fleshy bits and blood in my urine. So went back to the same unnamed institution to have them see what was going on.
I took of cell phone movie of the cystoscopy monitor. Unfortunately, I didn't have my glasses on and couldn't see to zoom in, so the images are small zones of the real movie. I figure that 12 shots will be too much already yet.
The run time of the procedure and the movie is almost exactly 5 minutes. I'm not posting that monster movie file :-)

A fluid is pumped to provide space between the camera lens (or equivalent) and the tissue.

Starting up the urethra.

Most uncomfortable part
Urinary sphincter,
"RELAX" as best you can.

Enlarged prostate
Odd stuff in the prostate

arrive in bladder

"Oh darn"

"Unfortunately"

"that's a cancer that"

"They look like what
we call superficial"

He counted 4 tumors
He said "I sorry"
"Yeh, that's not good"


"There's a blood clot
on there - that black ..."

Retreating
"in the prostate area,
we need to shave that out"

I asked if my 2016 tumor was "benign". The doctor said "not benign, just slow growing." He did not use the "c" word.

Adventure at Stanford Medical. Honeymoon period - Monday Oct 22, 2018
I didn't want another bladder surgery at the unnamed institution. The new urologist referred me to a Dr Shah at Stanford Medical.

I looked up Dr. Shah, impressive, an associate professor, lots of medical papers. During the introductory visit I offer to show him my home movie of the previous exam. Dr. Shah said he prefered to read the report. I ask that he prescribe an anti-bladder spasm drug so I don't get nailed as happened last time.
He sends two prescriptions to my local pharmacy.
- OXYBUTYNIN CL ER 10 MG TABLET - reduce bladder spasms
- NITROFURANTOIN MONO-MCR 100 MG - anti-biotic - start course before surgery

Next visit is the pre-op - yes, I'm alive (good vital signs ;-)

Planning
Monday October 22, arrive at ... at 8 AM for surgical prep. I need to be driven home after recover from anaesthetic -
Wife is recovering from shoulder surgery and can't drive yet - we arrange for a son (Edward) to be our chauffeur :-)
We live across the bay, and the morning commute is notorious! And I don't know its timing, so we decide to leave really early ( 6 AM ) to assure I'm not late.

All goes according to plan, we arrive at surgical center at 7:00 - I guess we beat the worst of the commute.

About 8:30 into curtained room, hospital robe, onto ?gurney?. IV needle ...
Later three anesthesiologists arrive for a chat, verification that I have obeyed the "nothing in stomach" protocol. I ask if I will get explosive gas (ether) - "Oh No, we use (long chemical sounding name) flouride. (?Isoflurane, ?Desflurane, ?Sevoflurane) You will not explode :-)"
Later three doctors drop in - including Dr. Shah. I ask if the others are students? They smile, say No, and one says he is chief of section.

about 10:45 AM, I get wheeled into the IMPRESSIVE surgical room. Two HUGE defused lamp fixtures overhead. The mask for gas is applied and I get saturated with oxygen, then the ???flouride anaesthetic gas starts. I get to feeling half awake, thinking "I want to see what it feels like to go unconscious ..." and don't remember anything more. ...

As I awake (pleasantly) I see the clock on the wall read 12:14 and I am being wheeled out of the operating room. Everything is pleasant, pretty soon Betty is brought in. At slightly after 2 PM, a son (now chauffeur) arrives and I am wheeled to his car. Nothing hurts, this is dreamland -

Tuesday (the following morning) Betty and I remove the "Foley" as instructed (20 cc from balloon) at 8 AM, not all that bad. Wonderful !! I am free of such things :-))

Adventure at Stanford Medical. Honeymoon is over - Tuesday October 23, 2018
As mentioned above, at 8 AM I am in happy land - no pain, no pain pills, catheter out, free as a bird, feeling great. The "kids" call on a linked line, and I give a happy, glowing report :-)

About 2:00 PM I wonder why I haven't had the urge to pee. So I try - nothing happens.
About 3:00 PM I decide to go poop and see if that will start the pee. Only poop -

The instructions say if questions/problems call nnn before 5, and after 5 the Emergency Room at another phone number. So at 4:30 PM I call the first number, and am told the staff leaves at 4:30 and has left. The operator transfers me to the Emergency Room number - long wait -. The ER says they will call a Dr. who will call me.

About 5:30 a Dr. calls - says he can meet me at ER at 7 PM. I head across the bay (against the commute :-) and arrive at 6:20. Get ticket from valet parking in front, advised that if I get it stamped parking will be free.

By say 6:30 I'm registered (they said there was a call ahead about me arriving) and start sitting. At about 7 PM I mention to the Visitor Assistant that a doctor was supposed to meet me "here" at 7 PM.
At 8 PM I tell the Visitor Assistant that I could be waiting at an ER much closer to home and that I plan to leave in ten minutes. Eight minutes later I am summoned and taken back to a comfortable leather chair (no arms) in a curtained area with patients about (I think location D10).

About 8:30 I get a little urge to pee, and am shown a toilet. I go in, lean over the toilet and WOW I HURT. I pee some into the toilet but am covered all over with sweat - I pull the Emergency Cord and assistant hurries in - by then I have my head on some supporting bar, and feeling faint.
Assistant gets a rolling chair and gets me to a bed in D10. She sees my sweat soaked shirt and gets me a hospital robe and warm thin blankets.

I kinda am confused, but about 10:30 Dr. "Calab" shows up, inserts another "Foley", sends a prescription for "TAMSULOSIN 0.4 MG CAPSULES" describing this as an "Alpha blocker" that should ?relax me and promote peeing. I head for home about 11:00. I go to sleep in my recliner.

Wednesday Oct 24th, no fun, Kinda hurt, and if I move, the Foley thing shifts in my insides and was really unpleasant. A neighbor nurse came over and asked if she could look. Anything !
"Oh, this isn't right at all! Who did this?" I told her a Stanford doctor. She said something like "Doctors should do things they know - This is work for nurses, we know about these thing." Then she showed Betty that a little clamp was not holding the hoses properly. Then she said "There should be a tube between the Foley and the bag. Did you take it out?" No way, I touched nothing -
She said I should go to some facility and get a tube, and that the bag should be attached to the lower leg, not the thigh.

So I go to the local Kaiser ER. The entry person says that they are very busy, but fixes an wrist band, and I wait. After two hours I say goodbye and head for the local PaloAlto Medical - In 10 minutes a sympathetic male nurse says he can fix it but needs a Dr's instruction to do it. In another ten minutes the tube is added and the bag tied to my lower leg, and most of the discomfort is gone, gone, gone :-)

So, Stanford Medical called with an appointment to remove the Foley and this bag - set for Monday, October 29, after commute time at the Emeryville facility, about 30 miles away (twice as far) - "Soonest available", getting paranoid, I wonder if this is to spread out the work?


In case you think I've been too detailed, you are correct - but I left a lot out.


Comments from the Doctor's Office - Wednesday October 24, 2018
Dear Mr. Thelen,
I hope you have been recovering well since the procedure to resect your bladder tumor. I heard about the need to have the Foley catheter put back in. That is not uncommon in men in your age group. I am optimistic you will be peeing normally soon.

The pathology report from your operation Monday shows that you had the lowest stage, lowest grade bladder cancer recurrence possible. There was muscle present in the specimen and it was NOT involved with cancer. This is very encouraging news! To check for recurrence, you need to have someone look in your bladder every 3 months from now on. You can have it done with Dr. Shinghal or you can contact my clinic to make an appointment with my team. Dr. Shinghal and I have a great working relationship and I am comfortable with you having your cystoscopy with either of us - go with whatever is easiest for you.

Thank you for entrusting me and my team with your medical care. Please reach out to us if you have any questions. We wish you good health!

Sincerely,
Jay Shah, MD
Associate Professor, Department of Urology
Stanford University School of Medicine

PS, sorry to reach out to you over MyHealth instead of the phone. I am currently traveling for work and I did not want you to have to wait until I got back to get the results.
Study Result
Narrative

Accession No: SHS-18-38365
SPECIMEN SUBMITTED:
A. POSTERIOR BLADDER WALL
B. BLADDER NECK AND PROSTATE

DIAGNOSIS: A. URINARY BLADDER, POSTERIOR, TRANSURETHRAL RESECTION
- PAPILLARY UROTHELIAL CARCINOMA, LOW-GRADE, NON-INVASIVE (SEE SYNOPTIC TABLE)
-- LAMINA PROPRIA AND MUSCULARIS PROPRIA ARE BOTH PRESENT AND UNINVOLVED BY TUMOR

B. URINARY BLADDER NECK AND PROSTATE, TRANSURETHRAL RESECTION
-- PROSTATE WITH NODULAR HYPERPLASIA

ROJANSKY/RICHARDS/KAO

COMMENT: Please see synoptic table below for more information on the bladder tumor:
URINARY BLADDER: Biopsy and Transurethral Resection of Bladder Tumor (TURBT)
SPECIMEN
Procedure: TURBT
TUMOR
Tumor Site: Posterior wall
Histologic Type
Papillary urothelial carcinoma, noninvasive
Histologic Grade: Low-grade
Tumor Extent
Tumor Extension: Noninvasive papillary carcinoma
Accessory Findings
Tumor Configuration: Papillary
Muscularis Propria Presence: Muscularis propria (detrusor muscle) present
Lymphovascular Invasion: Not identified
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pTa: Noninvasive papillary carcinoma

CLINICAL HISTORY: Bladder cancer

OPERATION: TURBT with blue light

GROSS DESCRIPTION: Two specimens are received labeled with the patient's name and medical record number.

The first specimen labeled "posterior bladder wall" is received in formalin and consists of three soft pink to tan papillary tissue fragments that aggregate to 1.4 x 0.8 x 0.6 cm. The specimen is entirely submitted in one cassette labeled A1.

The second specimen labeled "bladder neck and prostate" is received in formalin and consists of 2 g of multiple rubbery pink focally nodular tissue fragments that aggregate to 3 x 2.2 x 1 cm. The specimen is entirely submitted in two cassettes labeled B1 and B2. Singel (10/22/2018)

I have reviewed the specimen and agree with the interpretation above. CHIA-SUI KAO, M.D. Electronically signed 10/24/2018 5:41 PM

Comments from Others - October 25, 2018
from Carl, another retiree
Hi Ed

I had a foley cath for a week, took it out and couldn't void, so back for another week.

After the plasma turp, I had it in for about a week, but now everything is roses.

Carl


Removing the 2nd Foley - October 29, 2018
So, after the Monday Morning Commute, I drive to the 5800 Hollis Street Emeryville Stanford Medical facility - 30 miles away - arriving before the 11:30 appointment.
They use valet parking (that causes its own complications later.)

Everything goes smoothly. The game plan is to back-fill my bladder with 250 cc of fluid to help me pee soon. Then the operator (Physician's Assistant or nurse or ...) says that I should blow out. I finally understand that she means like blowing out candles - so I "blow out" and she quickly pulls out the Foley. She agrees that the idea was to distract me and keep me from fighting (flinching/tightening_up) the removal.

Now the plan is for me to pee - and if I can't pee another Foley goes in for another week - No way, I privately plan that if I can't pee to escape and take my chances locally again. The thought of another week with an accursed Foley makes me desperate. Life is too short for that crap.

So I wait ... that assistant pops in on a ten minute basis to check progress. Every little while I try to pee - but it hurts and I flinch, but I think the flow started, but it didn't - nothing -

After about two hours I decide that maybe a going to a bathroom setting and pooping will get my brain in order and I maybe will really pee. I successfully poop, but get dizzy and feel faint. I think I got back to the room under my own guidance - but then I really feel faint. I call the assistant for help - she takes my blood pressure - it was less than 80 over 50 ? - from my normal 130/90 - I can barely see.

They talk of something that sounds like Vagovagal reflex or Vasovagal response - I'm not really clear about this ...
Amateurs can get dreadfully confused browsing medical books or the Internet -

I try to fight this weakness flexing arms and lifting feet - when I talk I sound to myself like I am in another room - for a short while the back of my hand seemed orange and purple.

After an unknown time interval, they call 911 - and the people in blue attach another set of electrodes ... They suggest that they take me to a hospital that I don't know - I ask to go to a Kaiser institution because Kaiser has records on me.

By now I am up to feeling weak and wobbly, but think I can make "wise cracks". Folks are polite.

About 4:30 I am in Kaiser Oakland, room C15. Dr. Middleton prescribes 2 liters of IV fluid. I would like to object, that I drink water like a fish, and that I am not dehydrated, but fortunately keep my mouth shut.

Time passes and passes - about 8:30 I finally pass about 150 cc of urine, less than the the amount pre-set into my bladder so many hours ago - what the heck ??
A little while, more urine - I am saved - I can go home without a Foley.


BUT - by now the Emeryville Stanford valet parking has closed for the day - what to do?
I wish that I had already subscribed to Uber or Lyft ... My mind is not clear enough to subscribe now -

I call another son, Carl, who lives a few miles north of Oakland Kaiser. Carl arrives and gets to chatting with Dr. Middleton who comes from the hills of Tennessee - good for a lot of kidding - They have a good time - Carl then takes me home -

Next day, Tuesday, I must recover the car from Emeryville valet parking.
I call Emeryville Stanford, I'm coming to rescue my car. OK - You have the valet ticket? Good !

Wife Betty sets up the trip with Uber, about half the price of a cab which wants $3/mile -
Uber driver is from India, works as a programmer from home for Bank of America, codes mostly in JAVA ... Betty asks if his parents (in India) are likely to choose a wife for him, He says "yes". Betty asks that if he does not like the choice - can he refuse that choice? "Yes"
I give him 5 stars on the Uber "Ap", and Betty gives him a good tip -

My car is parked right by the check-out stand. - The valet folks remember me being hauled out on my back and are happy for me.

"All's well that ends well" :-)