ALERT: Graphic content intended only for patients who want to know more about these procedures.
April 5, 2012
Thursday
Round Rock: I drove up to the Round Rock office of Dr. Grady Bruce early... straight from UT after class. I was scheduled for a cyctometrogram and uroflow study with Tracy, and according to Dr. Lewis, who surprise-called me on my cell phone as I was driving back from Houston last Friday, Dr. Bruce is gonna stop in and see me while I'm there.
Round Rock: I drove up to the Round Rock office of Dr. Grady Bruce early... straight from UT after class. I was scheduled for a cyctometrogram and uroflow study with Tracy, and according to Dr. Lewis, who surprise-called me on my cell phone as I was driving back from Houston last Friday, Dr. Bruce is gonna stop in and see me while I'm there.
First thing: I have to report to the receptionist that I am no longer on my 36 month post-transplant Medicare and that Liz's insurance is covering this. She calls and they tell her I am on Medicare and then after some back-and-forth, they tell her this procedure is 100% covered... not even a co-pay. That pleases me. However, Dr. Bruce is aw ay "on call" somewhere and won't be back til 6. But, the 1:00 appointment no-showed so Tracy will be with me shortly. This I find out in response to my statement to the receptionist that I gotta urinate now and should I go or wait? Wait.
So, Tracy comes out and brings me back to a room with a barber style chair with stirrups and tells me to go into a adjacent bathroom, strip from the waist down and urinate into a large funnel sitting over a small beaker with a little grey tube leading outa the room and into the treatment room. I am thinking this is easy. I pee into the funnel and they somehow measure the "flow" in the little grey tube. Then we talk about it and that's that. I do so and put on a gown backwards and return to the barber chair room, where Tracy introduces me to Dr. Etsen Cho, who is going to observe and learn from my experience.
Oh. And, I hear from back somewhere that Dr. Bruce is back from his "on call" and available. That's good.
Well... there's a reason they don't tell you to much about cyctometrograms like they do with most "procedures" we patients volunteer for. You know: they usually have a nurse call and completely explain and give info about the procedure before you go in. Not in this one. And, I had been so busy in the last week or so that I hadn't even googled it.
Tracy invites me to sit in the chair and sets about catheterizing my penis! Oh. And, Oww! And "This stings!" Tracy asks me to breathe in through my nose, out thru my mouth... slowly... as she continues to try to run this catheter up my penis, through the prostate-squeezed urethra and into the upper part of the bladder. She is explaining to Etsen how she will try another size (?) or something while I am trying to breathe thru the pain of each of her attempts. No pain for the time it takes her to re-adjust her tools. That's nice and I breathe better. She apologizes for the pain... and we are off on it again. I breathe they way she suggests, harder and more forceful... she pushes that thing up there... and I am conscious of clenching my teeth so hard I worry I'll break one... and I can feel tears rolling outa the sides of my eyes and back down my face towards my ears. This is tough!
She pulls the catheter back out and says something like, "It's just to small an opening... I can't get it through... will have to get Dr. Bruce in to try." I breathe / sigh / relax. The women leave the room and I lay back and visualize how I can dissociate when they resume this procedure.
Tracy and Etsen return and we are talking about my years on dialysis, the kidney transplant, my teaching at UT, ..Macs versus PC's, and how this whole thing started: I thought I had a urinary tract infection and went to Dr. Krienke, who did a culture that showed it was not an infection and then about calling the Transplant Center when the painful urination continued... and about the hosptialization and yada yada yada.
Dr. Bruce finally comes in as I am finishing with Dr. Krienke and his referral to Dr. Floyd for me and Bruce says Floyd is part of his practice... and comments that I must have had my share of experiences with doctors... He sets about asking Tracy some technical questions and expertly inserts the catheter again (more of the same pain) while saying "We have some tricks..." and in it goes, with him concluding, "I think it's in... it's not getting shoved back out..." and I am breathing out and sensing that even though it is somewhat uncomfortable it is not painful at this point and I know I can handle it from here on out!
He says that now Tracy will continue the flow test and he will study the results, call Dr. Lewis, and meet with me as soon as he can to fill me in too. Tracy brings out the funnel and jar contraption and sets in front of my chair. I have these tubes up my penis and she describes that at some point I will either sit and urinate or stand up in front of the funnel and urinate into it, while the machine measures the "flow" and pressures on my urethra and my sphincter. Tracy continues; explaining to Etsen what she will be seeing on the graphic display and instructing me on what will be happening too.
Long story short: They fill my bladder with a solution and want to know when I first can feel the cool liquid in there; then when I first feel like I want to urinate but wouldn't normally go to the bathroom; then when I begin to think I might want to go to the bathroom; and then when I it is time to go to the bathroom; and "Now I want you to wait til you can't wait anymore..." Tracy concludes. We talk some more about trivial stuff (her going to UTA, marriage and family counseling, respecting our elders, etc.) while I continue to hold it as long as I can. She tells me that if I feel that I cannot urinate with two women in the room, I can ask them to leave right at the last moment. I am wondering how this all will happen and envisioning if indeed I will be jumping up to pee and yelling for them to get out... don't imagine that will happen when the time comes.
We talk and just enjoy our visit until I can't hold it any more... and I stand up, holding my tubes and all, and relieve myself over the funnel ("Ahhh") as the women watch the measurement graphs charting my performance! What a scene! With all those tubes up there I have to concentrate to ensure it all goes into the funnel. Then Tracy asks how that is like usual and I (without even thinking of that absurdity of that question) report that I didn't feel like the flow was a forceful as usual when I feel this kind of urgency to urinate. I add that I think the tubes up there may have impacted the normalcy of my gushing flow... or something to that effect. Tracy considers that and nods that that reflection might have some merit... also saying to Etsen that my flow seemed, on the graphing display, to be less than a normal flow. I, in my mind, agreed... and yet the part of me that is happy this is over doesn't really care at this point about the findings. I just don't want them to say, "We gotta do it again..."
Tracy concludes that we are done for now. She simply slides them tubes out and I get dressed. As a kind of debriefing gesture, I ask Etsen if her name means anything special in her culture (she is from Camaroon) and she replies that it means 'hut' and was her grandmother's name. Tracy comments that she loves ethnic names and we are all smiles as we say our goodbyes. "What a day" I think to myself as I drive away towards the south.
She pulls the catheter back out and says something like, "It's just to small an opening... I can't get it through... will have to get Dr. Bruce in to try." I breathe / sigh / relax. The women leave the room and I lay back and visualize how I can dissociate when they resume this procedure.
Tracy and Etsen return and we are talking about my years on dialysis, the kidney transplant, my teaching at UT, ..Macs versus PC's, and how this whole thing started: I thought I had a urinary tract infection and went to Dr. Krienke, who did a culture that showed it was not an infection and then about calling the Transplant Center when the painful urination continued... and about the hosptialization and yada yada yada.
Dr. Bruce finally comes in as I am finishing with Dr. Krienke and his referral to Dr. Floyd for me and Bruce says Floyd is part of his practice... and comments that I must have had my share of experiences with doctors... He sets about asking Tracy some technical questions and expertly inserts the catheter again (more of the same pain) while saying "We have some tricks..." and in it goes, with him concluding, "I think it's in... it's not getting shoved back out..." and I am breathing out and sensing that even though it is somewhat uncomfortable it is not painful at this point and I know I can handle it from here on out!
He says that now Tracy will continue the flow test and he will study the results, call Dr. Lewis, and meet with me as soon as he can to fill me in too. Tracy brings out the funnel and jar contraption and sets in front of my chair. I have these tubes up my penis and she describes that at some point I will either sit and urinate or stand up in front of the funnel and urinate into it, while the machine measures the "flow" and pressures on my urethra and my sphincter. Tracy continues; explaining to Etsen what she will be seeing on the graphic display and instructing me on what will be happening too.
Long story short: They fill my bladder with a solution and want to know when I first can feel the cool liquid in there; then when I first feel like I want to urinate but wouldn't normally go to the bathroom; then when I begin to think I might want to go to the bathroom; and then when I it is time to go to the bathroom; and "Now I want you to wait til you can't wait anymore..." Tracy concludes. We talk some more about trivial stuff (her going to UTA, marriage and family counseling, respecting our elders, etc.) while I continue to hold it as long as I can. She tells me that if I feel that I cannot urinate with two women in the room, I can ask them to leave right at the last moment. I am wondering how this all will happen and envisioning if indeed I will be jumping up to pee and yelling for them to get out... don't imagine that will happen when the time comes.
We talk and just enjoy our visit until I can't hold it any more... and I stand up, holding my tubes and all, and relieve myself over the funnel ("Ahhh") as the women watch the measurement graphs charting my performance! What a scene! With all those tubes up there I have to concentrate to ensure it all goes into the funnel. Then Tracy asks how that is like usual and I (without even thinking of that absurdity of that question) report that I didn't feel like the flow was a forceful as usual when I feel this kind of urgency to urinate. I add that I think the tubes up there may have impacted the normalcy of my gushing flow... or something to that effect. Tracy considers that and nods that that reflection might have some merit... also saying to Etsen that my flow seemed, on the graphing display, to be less than a normal flow. I, in my mind, agreed... and yet the part of me that is happy this is over doesn't really care at this point about the findings. I just don't want them to say, "We gotta do it again..."
Tracy concludes that we are done for now. She simply slides them tubes out and I get dressed. As a kind of debriefing gesture, I ask Etsen if her name means anything special in her culture (she is from Camaroon) and she replies that it means 'hut' and was her grandmother's name. Tracy comments that she loves ethnic names and we are all smiles as we say our goodbyes. "What a day" I think to myself as I drive away towards the south.
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