Do You Pee Like A Horse

Not necessarily related, the peeing and the emptying fully!  For example, if I join my friends for a couple of good beers (rare, but I do on occasion), I will pee like the proverbial.  But when I'm done, there is still anywhere for 400cc to 600cc left "in the bag."  Just the way it goes, for those of us with permanently-stretched-out bladders.  Thus, for me, the self-cathing...

Cartoonman,

How agressively are you cathing these days? I pretty much stopped cathing lately but have no hesitation cathing if I feel the least bit of resistance because I'd rather cath than stress the system out with too much pressure. Last week I had a couple of 400ml natural voids with only 100ml retention. I was well hydrated during that period with some coffee but no beer.  My normal natural voids are 150-300ml, with 250ml as a mean if I'm decently hydrated. PVR's range from 30ml-150ml. So overall, I'm very happy with the results of my self cath bladder rehab and things seem to be getting better even off the catheter. 

As to the beer, haven't had much lately but curious if it will still put me into AUR. Plan to experiment one of these days!

Jim

Sorry I missed this, Jim.  We were out in a slot canyon in Southern Utah ten days ago, and my wife fell and broke her neck.  200 vertical feet of rope work (rappelling and belaying) to get her and the other 5 of us out, 5 1/2 hours of really intense living, I gotta say!  She's stable, thanks, and scheduled for surgery on THursday.  No head stands or canyoneering for a year, but she should recover fully.

Anyway, back to cathing:  I'm with you on the not-stressing-the-system thing.

I was doing the "JimJames 6 X Daily" regimen for a couple of months, but my Urolift doctor wasn't happy, mostly because of UTI-danger.  I get them about 2 X a year.  Do you have a better track record than I?   

Speaking of UTIs... We were out in UT for my second Urolift, after much discussion.  He said he would recommend a TURP at this point, but wouldn't to me, as he already knows what I think about THAT PROCEDURE!  But I had the beginnings of a UTI going out there, for which  he wrote a scripp for Cipro.  While dealing with Kim and her broken neck, in a trauma hospital in Provo, I got his text saying fuller culture showed I had a non-Cipro-responding bug, so we had to call off the Urolift.  And I got to carry Kim's bags home, instead of the other way 'round.

My voids are anywhere from 50 to 200cc (if well-hydrated); the residual cathings are 300-450cc when I'm on toppa things, but can be as bad as 800cc if it's late in the day, or I have been unconsciously holding or something else kept me from going/cathing.

I mostly cath at breakfast, lunch and before bed.  That said, I have a stash of several months' worth of catheters, and am thinking I will go back to "Jimmy's Special Method," once my wife is in healing mode and we have gotten my dad's 90 th birthday party (Nov 12) out of the way!  :-)

Cartoonman, so sorry about your wife. I wish her a speedy recovery!

I take issue with your doc on uti's and cath frequency. Intuitively it seems like he's right, but in fact studies show that UTI's decrease when cath frequency increases, as long as the frequency is not more than 6x/day. The reason being that less cathing means more stale residual which is a breeding ground for UTI's. You might want to check the literature yourself and then make a case to your doc. At the end of the day it's your bladder and your UTI's, so if he's reasonable then he should let you do as you want as long as what you want is resonable. 

Looking at your cath numbers I argue that your cath frequency is too low by normal standards, even forgetting about my more agressive approach. Normal standards say to increase frequency when you cath more than 400ml, and you are already pushing that but more important your bladder is holding more if you add in your natural voids. 

I'll give you some comparison numbers. During my first year I also had similar natural voids as yours, from 50-200ml, although since my cath frequency was 6x/day back then my cath volumes were less.

Today, I only have to cath maybe once every week or two (it's been over two weeks now). My natural voids are between 150-400ml with 250ml the mean if I'm well hydrated. Residuals are between 150 and 30ml. Mean is probably 100ml. But even with the 150ml residual, I would then probably void a couple of hours later and that would empty me down to around 30ml. 

Not saying my results will be your results but I see no reason not to go back to "Jimmy's Special Method" given both your cath numbers. 

I went through different phases, physically and mentally, during my cath 2 plus year cath process. At one point, once I reached a progress plateau, I tried to see how little I could cath. Sometimes I could go for days without cathing but it was a bit of a strain at times, but on the other hand I wasn't cathing much. Then I made the decision not to force things at all. If the bladder wasn't flowing real easy, then cath. So basically I started at 6x/day, dropped way down to not every other day, and then jumped right back up a regular cath schedule, often 6x/day. And then the magic happend and things started working on their own. I still do tune up days every couple of months if needed where I might cath up to 6x/day, but basically I'm cath free for all practical purposes, with decent void volumes, acceptable residuals, no frequency, and average only getting up once at night which I attribute as much to nocturnia as bladder function.

I will get back to you on the UTI thing later. Unless you already have, just don't pop that Cipro till you read my next post!!!

Jim  

 

Thanks, Jim, snd I appreciate your sharing these details.  This is an example of why this forum is so valuable!  I will add this info to your earlier "Jim's Magic Process" post, that I saved at the time.  

Interesting point, and makes sense, re high retention leading to stale residue leading to lively breeding ground for UTI nasties! 

And no, we dumped the Cipro as soon as the Big Nasty showed up in the over-the-weekend-deep-dish culture.  I'm now on Doxycyclene 100s, 2 X per day.  Take with food!  I learned that one the hard way...  :-)

Oh, and as for my Urolift doc and that he "should" let me do what I want...

This guy, Dr. Steve Ganges, is the one exception I have found, in the dismal swamp of urologists!  He and I have conversations; he doesn't proclaim from on high.  He asks questions---and sometimes my opinion!  I have told him that I trust him as a surgeon, but I do not trust TURP as a procedure, and he respects that.  He has his reservations about PAE and Rezum, and has expressed them.  He's well-read and was the first to do Urolifts in the US--- he did the FDA trials.  When I'm free of this UTI (and Kim is on the mend from Thursday's suregery) I will schedule a return to SLC and have a follow-up Urolift.  He's done only twoothes, so this is quasi-experimental, within the world of Urolifts.

I hope all goes well for you and your wife.  I will keep in her my prayers.  Good luck with the Uro-lift  Your doctor seams like he's a good one.  Not alot of doctor listen to there patients.  It's there way or nothing.  Take care  Ken 

Yikes, falling down a canyon (and belaying back up with a broken neck) and self-cathing are not typically topics that are discussed, together.  I'm amazed at your ability to comingle with detachment these topics.  I'm still stuck on the broken neck part.  I did a bit of belaying and rapelling a very long time ago as part of a course, and it's not for the faint of heart unless you're only 3 feet off the ground--intense living, indeed!

And this is decidedly off topic.  Is that a violation of terms?

Harvey

Self cathers are an active and hardy lot! Cartoonman obviously one of the hardiest! So, tried a pull up today per your motivation. Well...got some work to do!!!

Jim

My track record with UTI's is a little better. Maybe once a year now, but here's the thing.

When you self cath, literature and best practices strongly suggests not treating asymptomatic UTI's, often called Asymptomatic bacteriuria, sometimes called "colonization". 

Colonization is harmless and normal for those that self cath but clinically it can look exactly like a UTI. For this reason, many urologists treat colonization with antibiotics when they shouldn't. Even some of the very good urologists do this, because unfortunately many of them are not that knowledgeable about self catherization and it's unique issues.

Like a real UTI, colonization can manifest itself with both positive dip stick results (positive leucocytes, nitrites and blood), as well as a positive urine culture. But again, that doesn't mean it needs treating with antibiotics. And you really want to use antibiotics as little as possible because of the resistance issue. 

A couple of months ago, for the first time in well over a year, I had some burning during urination. Being between urologists, I went to the local doc in the box and had a urinalysis done. I already knew the results since I use the same dip sticks at home but I sat there patiently awaiting the results "Mr. JimJames", the nurse said, "your urine is positive for leucocytes, nitrites and blood, you have a UTI. Here's some Cipro". 

So they wanted me to take the go-to drug Cipro, even before the culture came back, since Cipro usually takes care of everything.  But I asked for Macrobid as well (Nitrofurantoin) because I try and avoid the fluoroquinolone group of antibiotics if possible, for which Cipro is a part of. So the plan was I was going to take either Cipro or Macrobid, my choice.

They wanted me to start something right away, but I decided to wait and see what the culture said, as well as to see if my symptons progressed.

Turns out, like yourself, I also had a "non-cipro responding bug" which surprised the docs in the box. Still had the burning, so decided to bite the bullet an take the Macrobid, which was one of the drugs indicated for my bacteria.

Thinking it over, I might have waited a little to see if I could flush it out of my system without the antibiotics but I hadn't taken any antibiotics for awhile and really wanted to move on.

The Macrobid cleared up the burning within a week and my urine then tested negative for both leucocytes and nitrites.

Then, a couple of weeks ago my urine turned very cloudy, had an odor and I had some mild discomfort with my bladder. My guess was that the bug I had before was back, or possibly picked up something else. I leaned toward the former.

If I had gone to the doc in the box this second time -- I did not -- they no doubt would have handed me Cipro and/or Macrobid again. My old urologist probably would have done the same if the culture came out positive. Some uroloigsts might have held back treating given my mild symptons and CIC status.

But, I don't have a urologist now, so made the executive decision myself.  I decided that even though I had some symptons, since they were quite mild, and no burning during urination, that they were more toward the asymptomatic side than symptomatic. So instead of taking antibiotics I upped my fluids and started cathing several times a day (even though I didn't need to)  to help flush out the bacteria. Even did one or two bladder irrigations with an antiseptic solution and sterile saline but not sure that was needed.

A few days later the odor went away completely. A few days after that the bladder discomfort disappeared. A week later the nitrites that were positive became negative. 

The point of this long story is that when you self cath, UTI's are not so clear cut and if you don't really need antibiotics don't take them.

-- Jim 

Well, actually, we were in a larger canyon, hiked around and up to the BACK of the canyon, 250 or so feet up, then descended DOWN INTO the slot canyon, which had a series of rappells and very short horizontal spaces of 15 to 25 feet.  It was on one of the horizontals that Kim fell off a wall (handhold broke off) and she pitched into a hole, onto her head.  So we bellayed my wife 200 feet DOWN (longest belay of 65' with her doing all the hand and foot work.  All clear? :-)

Thank you for this perspective, Jim.  My UTIs have always been symptomatic; it was I who noticed them, not a test!  Dramatically once while we were on honeymoon in France (That one was totally MY fault; mind on other things!  ;-)    And I can't have the Urolift until I come up "clean!"

That's good you're not being over treated but next time you have a UTI wih symptons -- if they're not too terrible -- you might try flushing it out of your system like I did. You would notice some improvement within a week so don't think it's too much of a risk but YMMV. In any event, the two a year you report isn't really so bad. I told my uro that I could live with a couple of UTI's a year vs stopping self cathing and having a procedure. He said he could live with a couple as well -- mine, of course

You know more than me about Urolift, but maybe you UTI reprieve was for a reason? Maybe a few months of agressive self cathing might do the trick without more staples?

Jim

I'm a FaceBook freak and reflexively wanted to hit "LIKE!" to your comments!  :-)  

Well, the "UTI reprieve" actually made it possible for me to carry Kim's bags as we traveled, and assist her; we were in Utah for the surgery, and she had intended to help ME out!  In the brief window between her getting stabilized and my Uro-doc texting me the bad news, we had decided to go ahead with my Urolift, and the two of us attempt to limp back to PA!  In that sense, the infection was surely a good thing!!!  :-D  

Yes; but, ooh, that hurts!

Good going!  On what are you pulling yourself up?  I'm sure it must be very securely fastened.  In any case, keep at it, every few hours, or whenever you're near whatever it is you're pulling yourself up on.  At the same time, try to get your legs into an L position.

I'll call my urologist tomorrow to see what I can do to get those Speedicaths.  Why would I begin with a FR 14 and then move to a FR12?  I would think I would want to use the smallest diameter possible and never increase it, unless its flow rate was exasperatingly slow.

I fround Coloplast SpeediCath - 14" Male Hydrophilic Intermittent Catheter online.  It says it has a straight tip rather than a Coude tip. Are they different?  

However, with my Medicare, it's probably more convenient to get them from my local pharmacist, if they stock these. 

Harvey

Pharmacists don't stock SPeediCaths, as best as I've been able to determine.  Google Comfort Medical catheters; I get mine from them.

Straight tip and Coude ARE different, and the difference matters!!!  You should try each one; one will work fine, and the other won't!  I tried straigh and it worked; I tried Coude and it hurt like hell!  

I find FR 14 allows me to pee at 100cc/10 secs, about normal.  That's why I like em!  :-)  

Medicare covers up to 6 caths per day.