Wednesday, 3 May 2017

Bladder Clinic

I went to the Bladder Clinic yesterday. It's not as exciting as it sounds. I've been getting bladder infections on a persistent basis since last October. We, the various doctors and I, do not think this is a good thing. We need to find out why. While, as with all things ALS, there is not certainty, we think we know what is going on.

First of all, it is definitely ALS related. This is not simply a function of aging or some other side effect of life. What the urologist thinks is happening is that when I pee, my bladder is not emptying completely. This is a function of two things combined. First of all, I am sitting down all the time, even when I pee. My bladder is resting in there, not draining to the bottom as I stand or walk. So there is a small bit of urine almost permanently captured in there. Second, my core muscles have failed enough that I cannot squeeze out my own bladder anymore. That means the small amounts that remain can be bigger than small.

At first I thought this had to do with my condom catheters. In fact I was certain it had to do with them. The urologist doubts that. It is possible, but unlikely. What is more likely is that small amount of urine remaining in my bladder is prone to developing bacteria, the kind naturally found in the human gut. So my bladder is very nicely providing a warm, moist, nutritious habitat for nasty bugs.

The solutions are much more complicated. Basically it falls into three choices. One: learn to use a Foley catheter, one that reaches well into my ureter, one that will "tickle" my bladder into squeezing out any remaining urine. I would have to do this every time I go pee, or at least fairly often. Two: have a permanent, in-dwelling catheter attached directly to my bladder with a tube poking out of my lower abdomen. It would have a permanent bag attached. If I wanted, or needed, to take the bag off, I would have to put a clamp on the tube. Three: live with getting infections periodically and keep a steady supply of antibiotics, really powerful antibiotics, on hand for when they start up.

I've decided for option three. It is the least invasive, least intrusive method. It is also the most convenient. It's not as if this is going to be a long term issue, at least not for me. These days I choose comfort and convenience over anything else. It sucks, being a chronic antibiotic user. This may be what takes me, an untreatable, antibiotic resistant infection. But something's going to take me, so I might as well be comfortable along the way.

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