Jan 26, 2007
I took Gary to the urologist today, and the focus was Gary’s “leaking problem.” The doctor seemed very knowledgeable about spinal cord injuries and their effect on the urinary system, which was a relief. In fact, he explained the effects much more thoroughly than Gary’s doc at Shepherd did, though we are sure that is because that doc’s manner with patients is brusque. (Gary parodied it as, “You don’t need to know that, go away and don’t bother me.") This local doc mentioned how the kidneys can cause a lot of problems (in fact, kidney problems used to be the #1 killer of those with SCIs). He said that the signal to the bladder is relaxed – hyporeflexive – so the bladder doesn’t know when to contract and relax. This evidently causes high pressure on the bladder, which puts pressure on the kidneys. The problem with that is made worse if there is some infection in the bladder, because that infection can then travel to the kidneys. So the goal is to keep the pressure in the bladder as low as possible and to keep the bladder as clean as possible (i.e., free of bacteria) – by using “clean technique” in doing the Ics.
To deal with the leaking problem, the doctor suggested three things. First was to have x-rays done of the urinary tract (kidneys, the bladder, the ureters, and the urethra) – the test is called an IVP. Gary is having that done at the hospital (tomorrow, the 31st). Normally one is supposed to drink a prep that “cleans one out,” but fortunately the doctor said Gary only has to prepare by sticking to a clear liquid diet from 4pm on. Thank God – I would hate to have my saintliness be tested by having to clean Gary up all night long due to the effects of a laxative. Gary considers having to be on a clear liquid diet that long sacrifice enough. We are going to take quad pillows to pad him off so he isn’t lying on that hard exam table for hours (the test is supposed to take an hour, but we are supposed to allow 2- 2 ½ hours from arrival to departure). Also we are hoping they let me back in there with him because it would seem like he would need help in doing weight shifts while on the table.
The second thing Gary will have done is a urodynamics test to see what his bladder is doing. The bladder will be filled and a catheter put in that has a pressure sensor, to measure the pressure at various times. The test will also measure how well the bladder muscle stretches during filling, how well it holds the urine, and how completely it voids. Gary will have this test done the last week in Feb.
The last thing the doctor suggested is that Gary go on a medication called Vesicare. The doctor suspects Gary’s bladder is contracted and spastic, so in between his IC’s it is spasming (LOL -- I first wrote "spamming"). The med will relax the bladder and allow it to hold urine longer. The doctor said the side-effects are typically dry-mouth and constipation. He says children with spina bifida are on such meds from birth and no long-term side-effects have been noted other than the above. So far Gary hasn’t noticed any side-effects but neither has it stopped him from leaking. He read somewhere that it may take a few days before effects are noticed.
I took Gary to the university afterwards. As I pulled into a parking lot, someone swung around the corner of the parking lot that attaches to it (making a T with it). The driver had her head turned and was talking and laughing with her friends. I hit the horn, which fortunately stopped her from plowing head on into us. She smiled at us and drove on. Meanwhile I’m having a heart attack.
I took Gary to the urologist today, and the focus was Gary’s “leaking problem.” The doctor seemed very knowledgeable about spinal cord injuries and their effect on the urinary system, which was a relief. In fact, he explained the effects much more thoroughly than Gary’s doc at Shepherd did, though we are sure that is because that doc’s manner with patients is brusque. (Gary parodied it as, “You don’t need to know that, go away and don’t bother me.") This local doc mentioned how the kidneys can cause a lot of problems (in fact, kidney problems used to be the #1 killer of those with SCIs). He said that the signal to the bladder is relaxed – hyporeflexive – so the bladder doesn’t know when to contract and relax. This evidently causes high pressure on the bladder, which puts pressure on the kidneys. The problem with that is made worse if there is some infection in the bladder, because that infection can then travel to the kidneys. So the goal is to keep the pressure in the bladder as low as possible and to keep the bladder as clean as possible (i.e., free of bacteria) – by using “clean technique” in doing the Ics.
To deal with the leaking problem, the doctor suggested three things. First was to have x-rays done of the urinary tract (kidneys, the bladder, the ureters, and the urethra) – the test is called an IVP. Gary is having that done at the hospital (tomorrow, the 31st). Normally one is supposed to drink a prep that “cleans one out,” but fortunately the doctor said Gary only has to prepare by sticking to a clear liquid diet from 4pm on. Thank God – I would hate to have my saintliness be tested by having to clean Gary up all night long due to the effects of a laxative. Gary considers having to be on a clear liquid diet that long sacrifice enough. We are going to take quad pillows to pad him off so he isn’t lying on that hard exam table for hours (the test is supposed to take an hour, but we are supposed to allow 2- 2 ½ hours from arrival to departure). Also we are hoping they let me back in there with him because it would seem like he would need help in doing weight shifts while on the table.
The second thing Gary will have done is a urodynamics test to see what his bladder is doing. The bladder will be filled and a catheter put in that has a pressure sensor, to measure the pressure at various times. The test will also measure how well the bladder muscle stretches during filling, how well it holds the urine, and how completely it voids. Gary will have this test done the last week in Feb.
The last thing the doctor suggested is that Gary go on a medication called Vesicare. The doctor suspects Gary’s bladder is contracted and spastic, so in between his IC’s it is spasming (LOL -- I first wrote "spamming"). The med will relax the bladder and allow it to hold urine longer. The doctor said the side-effects are typically dry-mouth and constipation. He says children with spina bifida are on such meds from birth and no long-term side-effects have been noted other than the above. So far Gary hasn’t noticed any side-effects but neither has it stopped him from leaking. He read somewhere that it may take a few days before effects are noticed.
I took Gary to the university afterwards. As I pulled into a parking lot, someone swung around the corner of the parking lot that attaches to it (making a T with it). The driver had her head turned and was talking and laughing with her friends. I hit the horn, which fortunately stopped her from plowing head on into us. She smiled at us and drove on. Meanwhile I’m having a heart attack.
posted by Peg Daniels at 8:11 PM
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