12 replies to this topic

[DaveH58]

Have straight-cathed for about 30 years. Up until last spring, about a 16 month run with no uti. Beginning in April '09 have been getting uti's in succession. Rarely same organism. Also, always heavy sediment in the urine.
Local Urologists ( all completely useless ) are hell-bent that cause is a stricture preventing full catheter insertion into the bladder. While the alledged cause-effect makes sense, I am convinced and have argued strongly that the stricture is not precluding catheter insertion to the bladder. The urology attending and chief-resident are insistent I need a suprapubic. A lot of hoop-la over a recent dialation of the stricture citing hand-scan data ( portable ultrasound ). I can discern no difference between the before and after. Same insertion distance. Same cath volume. Same push and resistance.
Concern is that following complete cath I can still push out a good 50 mil via valsalva technique ( same before as after dilation ). A recent drainage study ( scintilation ) included a midway cath before the lasix push. Suprisingly ( to all but me ), the scan illustrated a good 40-50% residual in the bladder after the cath.
My read is that after 30 years of straight cath, I have developed an atonic bladder. The urologists will not give up on their suprapubic remedy. Further, based on what I've read a suprapubic is not indicated as treatment for an atonic bladder.
I suspect the attending is short on his next Bently payment. Thoughts welcomed.
Not seeing much anywhere on this combination of issues on a search.
- Dave

[Scribbler]

DaveH58, on Jan 9 2010, 08:38 AM, said:

Have straight-cathed for about 30 years. Up until last spring, about a 16 month run with no uti. Beginning in April '09 have been getting uti's in succession. Rarely same organism. Also, always heavy sediment in the urine.
Local Urologists ( all completely useless ) are hell-bent that cause is a stricture preventing full catheter insertion into the bladder. While the alledged cause-effect makes sense, I am convinced and have argued strongly that the stricture is not precluding catheter insertion to the bladder. The urology attending and chief-resident are insistent I need a suprapubic. A lot of hoop-la over a recent dialation of the stricture citing hand-scan data ( portable ultrasound ). I can discern no difference between the before and after. Same insertion distance. Same cath volume. Same push and resistance.
Concern is that following complete cath I can still push out a good 50 mil via valsalva technique ( same before as after dilation ). A recent drainage study ( scintilation ) included a midway cath before the lasix push. Suprisingly ( to all but me ), the scan illustrated a good 40-50% residual in the bladder after the cath.
My read is that after 30 years of straight cath, I have developed an atonic bladder. The urologists will not give up on their suprapubic remedy. Further, based on what I've read a suprapubic is not indicated as treatment for an atonic bladder.
I suspect the attending is short on his next Bently payment. Thoughts welcomed.
Not seeing much anywhere on this combination of issues on a search.
- Dave

I've no knowledge of your condition, and although you've not put your location on your profile I'm assuming your from USA.
Its sometimes difficult for people from another Country to give help as our systems are different. 5 minutes filling out basic info on your profile helps a lot.

I used a sheath and leg bag for almost 50 years; I didn't need to self cath. As I got older I had more trouble emptying my bladder so an SPC was advised.
They didn't offer any other option, which I now regret.

I've had my SPC 4 years but its not the great success I was lead to believe. I still get urethral leakage, which means I still need to wear a sheath, so I now wear 2 leg bags instead of one.

I cant comment on your condition, just tell you my own experience. If I had a choice now, I'd insist on having the neck of my bladder stretched; I certainly would have this SPC.

Mike

[SuzinNYC]

DaveH58, on Jan 9 2010, 09:38 AM, said:

Have straight-cathed for about 30 years. Up until last spring, about a 16 month run with no uti. Beginning in April '09 have been getting uti's in succession. Rarely same organism. Also, always heavy sediment in the urine.
Local Urologists ( all completely useless ) are hell-bent that cause is a stricture preventing full catheter insertion into the bladder. While the alledged cause-effect makes sense, I am convinced and have argued strongly that the stricture is not precluding catheter insertion to the bladder. The urology attending and chief-resident are insistent I need a suprapubic. A lot of hoop-la over a recent dialation of the stricture citing hand-scan data ( portable ultrasound ). I can discern no difference between the before and after. Same insertion distance. Same cath volume. Same push and resistance.
Concern is that following complete cath I can still push out a good 50 mil via valsalva technique ( same before as after dilation ). A recent drainage study ( scintilation ) included a midway cath before the lasix push. Suprisingly ( to all but me ), the scan illustrated a good 40-50% residual in the bladder after the cath.
My read is that after 30 years of straight cath, I have developed an atonic bladder. The urologists will not give up on their suprapubic remedy. Further, based on what I've read a suprapubic is not indicated as treatment for an atonic bladder.
I suspect the attending is short on his next Bently payment. Thoughts welcomed.
Not seeing much anywhere on this combination of issues on a search.
- Dave

Hey Dave, sorry to hear about your problem....I am also not familiar with your condition...the only thing I can relate to is that my boyfriend has a suprapubic cath and has been hospitalized 4 times in the last 4 months with chronic Uti's with pseudamonas present.....the suprapubics can present a higher risk of Uti's, so be careful about going that route. Best of luck to you.

Susan

[DaveH58]

Thanks for the comments. I posted here because I am unable to find anything about this combination ( atonic bladder + suprapubic ). Instincts / research tell me avoid the suprapubic. And searching has not identified suprapubic as a solution when dealing with an atonic bladder.
I've lost much faith of late in the US health care system. Not the costs, but the people. Seems specialists these days only drop you into a mold to generate cash flow. No one takes the time to listen. Curiosity is dead. Making matters worse, we have Thee Obama advocating those too old or too infirmed to serve as model Marxists simply "take a pill" and die. Purge the thought one spends money on the ill, disabled, and over 50!!! Progressives are such shitheads. I anticipate a wonderful future for the disabled in America.
But I digress ... apologies.
If I can locate good data on use, or contraindication, of suprapubic catheter with atonic bladder I will post here.
Again, thanks for the responses.
Regards,
Dave

[Tetracyclone]

Dave, I am all admiration for your work diagnosing your problems, but the anti-Marxist, anti euthanasia rant made me cancel my reservation to come see you. No info, just name-calling- such a fine way to make a point.

Edited by Tetracyclone, 11 January 2010 - 05:48 PM.

[Scribbler]

Tetracyclone, on Jan 11 2010, 03:14 PM, said:

Dave, I am all admiration for your work diagnosing your problems, but the anti-Marxist, anti euthanasia rant made me cancel my reservation to come see you. No info, just mane-calling- such a fine way to make a point.

I agree.

[edlee]

If you're going to make a "political" statement,,, try one that hasn't already been discredited by those you support.
ed

ps Sorry,,, you started this thread,,, you can say whatever you want,,, mea culpa.

[DaveH58]

edlee, on Jan 12 2010, 11:26 PM, said:

If you're going to make a "political" statement,,, try one that hasn't already been discredited by those you support.
ed

ps Sorry,,, you started this thread,,, you can say whatever you want,,, mea culpa.

OK. I had a rougjh day and should not have made political references. That said, I take the last post as permission to ramble. So I will.
Not sure who I am supporting in all of this or who/what has been what. I know only that the America I knew is quickly slipping away. And I can't help but have concerns as Thee Obama and Chief publically decries spending money on sick folks. Imagine that?! Folks who are ill and about to die ( e.g. the elderly ) spending more healthcare dollars than the young and healthy. Such an unjust concept.
Collectivism, no matter who is in charge, cannot work. It is but trickle-up poverty masquerading as fairness and equality. By necessity, competition cannot exist as all things monetary are recast in the currency of power. In the end, the very few ( always those with the wealth BEFORE the conversion ) control the many but society has far less to show for it. Wealth is neither created nor destroyed, and power is all that exists. Unless born as one of the few in power you cannot rise above your station in life. You forever slop with the unwashed masses. We see it already in the US political system where generation after generation of the same family assumes power. No one else can play except by the grace of the few.
Conversely, free markets now and always will be the solution. Free markets lead to wealth. Wealth affords society the capacity to care for those unable to care for themselves. In the ultimate free market, infinate wealth is created and things such as healthcare rationing become a non-issue. There exists an overabundance of resources to cover needs as they arise.
Admittedly, with wealth comes disparity. Some folks are poor. In the end one must acknowledge that the wealthy tend to control the poor. The positive is that with free markets there remains always a pathway to wealth. The club of power remains open as long as you are smart and industrious enough to amass wealth.
I would much rather be down and out in a rich society than in a poor one, Marxist or otherwise.
And so it is ca. 2010 America as Thee Obama and his Mao-worshipping ilk strive to destroy the greatest wealth creation machine the world has ever known, all in an effort to make the world more fair. Again, trickle up poverty.
When the US goes belly-up, and it will happen sooner than later, the world will become a nasty place. When we finally destroy free markets, remember to thank Thee Obama for the gift of unending poverty, war, and pestillence.
Peace to you, comrades.
- Dave
PS ... You know us yanks. Cleaning our guns and always up for a fight. :-)
PSS ... $107 Trillion in unfunded US liability and counting

[edlee]

Since you bring it up,,,,, What the FFFF???? Let's see,,,, O doesn't want to spend money on the elderly,,, which Fox network show did that come from??? You can't rise above your station??? I would think that O disproves that load.

Free enterprise,,, free markets lead to wealth,,, well,,, yeah,,, but ,, if you will forgive the paraphrase of an old adage,,, a rising tide DOESN'T lift all ships,,, not if they're sitting on the bottom already. Perhaps the best example of free enterprise and free markets is in Somalia,, where you are free to ransom any boat you can seize for as much as the owners will pay.

While the possibility of the US going "belly up" is all too real,, the idea of blaming one man or one party for that downfall is,, frankly,,, laughable. And turning "Maoist" will bankrupt the country,,,,,, remind me again,, who do we owe all this money to???

Regardless of party or ideology,,, all governments are really only huge Ponzi schemes waiting to be discovered.

Now, can we please leave the politics to the politicians,,, they get paid for it, after all. If you have something new, bring it up,, but this blame thing is becoming a bit disingenuous, don't you think?
ed

[Tetracyclone]

Ed,

It would be lovely to know more about you. A profile?

We are into profiling on apparelyzed.

[edlee]

Sorry about that,,, been here two years and just kept putting it off.
ed

[Darth JsinHarm]

I was finding this very interesting until I read the Marxist comments. Man, I still don't see how anyone can believe this B.S. especially anyone who is handicapped. Do you think the right gives a shit about you? Who was it who banned stem cell research because they didn't understand the science of it? I've been paraplegic since 1990 and I can tell you my medical bills went up more and insurance wanted to cover less and less every year Bush was in office. Don't get me wrong, I'm not Obama's biggest fan either right now. I was a huge supporter and got into many internet "discussions" about him and all the B.S. lies the right was trying to spread, but I'm very disappointed in his performance so far. Seems he's been more interested in trying to win over the haters rather than bringing about the change we believed in.

And let me tell you pal, I have a good friend who lives over in one over those evil Socialist European countries, Norway. She is a home health aid and goes on trips with her client and does a lot for him. She works more for more of an independent company that directly for the government so she doesn't make what she would in a government job. But she really likes her job and knows a lot so we talk about my issues sometimes and she can't believe that American doesn't take better care of sick and handicapped people. She said the government pretty pays for all of his medical costs. And guess what, he isn't sitting at home on his ass doing nothing, he owns his own business (can't recall what it is right at this moment). So he pays taxes, and he is taken care of, much better than we are. I went to Oslo back in March 2001 and loved it. I found it a very wheelchair friendly town, had to pay to use the bathroom a couple of times but they were huge I almost could have lived in it. I don't speak Norwegian but they spoke pretty decent English and got me in a "wheelchair accessible" hotel room and it was perfect from the get go. Here I have to explain to people what the hell a shower chair is. I even went up this crazy hill to a really old monastery over with these old civil war type cannons they tried to right the invading Nazis off with. I honestly felt more comfortable there and was impressed at how accessible everything was.

Sure they pay a little more taxes, but I would be able to pay a little taxes for more assistance for myself and others too if I didn't pay out over 10% of my annual income for medical expenses (not including what I pay for insurance which is about to change and is going to be worse than it is now). So if you want to have an intelligent conversation as to why Universal Healthcare isn't a good idea that's fine but I think you are going to have to come up with something better than that death camp nonsense. If you don't no one is going to take you seriously

[gimpfriendly]

Dave

Two of my patient's have SP 20gauge one uses latex caths (C1-3 complete) and one uses silicon with silver(C3-5 incomplete) to reduce infection.
One pt C1-3 has had SP for 2 years no infections The other has had sediment and infections issues starting about a year after surgery. The part the doctors don't understand is my pt (C1-3) is atonic and he has had the best results. I recently did pH test on both looking for reasons why one pt had issues and one did not. The C3-5 had very alkaline urine and C1-3 has very acidic urine. The doctor said pH should not make a difference.

As to your America not taking care of it's handicapped I disagree. I currently work for a pt who receives almost 24/7 care paid for via us government, disability income of 1800+ a month, all meds, doctor visits, supplies and grants for a business via DRS to fund a business. One day just for fun myself and another co worker added up how much this patient got from the US government it equaled out to over $120,000.00 in one year. If that is not taking care of our disabled I don't know what is.

I have worked for various SCI patients for over 5 years of my nursing career from vent dependent to para's that needed bowel training. Sorry you feel the US has failed you. I will be more than willing to share how my patients have received these services. Just be ready to fill out forms.

Good luck with what ever choice you make.

DaveH58, on Jan 13 2010, 01:19 AM, said:

edlee, on Jan 12 2010, 11:26 PM, said:

If you're going to make a "political" statement,,, try one that hasn't already been discredited by those you support.
ed

ps Sorry,,, you started this thread,,, you can say whatever you want,,, mea culpa.

OK. I had a rougjh day and should not have made political references. That said, I take the last post as permission to ramble. So I will.
Not sure who I am supporting in all of this or who/what has been what. I know only that the America I knew is quickly slipping away. And I can't help but have concerns as Thee Obama and Chief publically decries spending money on sick folks. Imagine that?! Folks who are ill and about to die ( e.g. the elderly ) spending more healthcare dollars than the young and healthy. Such an unjust concept.
Collectivism, no matter who is in charge, cannot work. It is but trickle-up poverty masquerading as fairness and equality. By necessity, competition cannot exist as all things monetary are recast in the currency of power. In the end, the very few ( always those with the wealth BEFORE the conversion ) control the many but society has far less to show for it. Wealth is neither created nor destroyed, and power is all that exists. Unless born as one of the few in power you cannot rise above your station in life. You forever slop with the unwashed masses. We see it already in the US political system where generation after generation of the same family assumes power. No one else can play except by the grace of the few.
Conversely, free markets now and always will be the solution. Free markets lead to wealth. Wealth affords society the capacity to care for those unable to care for themselves. In the ultimate free market, infinate wealth is created and things such as healthcare rationing become a non-issue. There exists an overabundance of resources to cover needs as they arise.
Admittedly, with wealth comes disparity. Some folks are poor. In the end one must acknowledge that the wealthy tend to control the poor. The positive is that with free markets there remains always a pathway to wealth. The club of power remains open as long as you are smart and industrious enough to amass wealth.
I would much rather be down and out in a rich society than in a poor one, Marxist or otherwise.
And so it is ca. 2010 America as Thee Obama and his Mao-worshipping ilk strive to destroy the greatest wealth creation machine the world has ever known, all in an effort to make the world more fair. Again, trickle up poverty.
When the US goes belly-up, and it will happen sooner than later, the world will become a nasty place. When we finally destroy free markets, remember to thank Thee Obama for the gift of unending poverty, war, and pestillence.
Peace to you, comrades.
- Dave
PS ... You know us yanks. Cleaning our guns and always up for a fight. :-)
PSS ... $107 Trillion in unfunded US liability and counting