Hope vs. Reality vs. Idiocy: my chronic condition conundrum

When my wife and I talked with an Oregon Health Sciences University urologist three weeks ago about my bladder/prostate problem, wanting to get a second opinion from Dr. Jonathan Witten, I told him that I was looking for a balance of Hope and Reality.

Meaning, I explained to Witten, I was desirous of getting more hope for eventual recovery of my peeing ability than my local urologist, Dr. Mhoon, had offered up. But I also wanted to know the reality of what my prognosis was. 

(For background on my urinary retention and weak bladder problem, which led to depression, see here and here.)

Dr. Witten described prostate surgery options, focusing on the TURP procedure. I mentioned, though, that my local urologist had said that I didn't have a prostate problem, I had a bladder problem. Was there anything that could be done about an "atonic bladder"? (Dr. Mhoon's disturbing description of a bladder opposite of a toned one.)

Unfortunately, Witten told us, there isn't. He said there was no way to strengthen the bladder, unlike, say, physical therapy for an ailing knee or shoulder.

That was my first strong dose of Reality. But since Witten had reviewed my medical record, and he'd talked quite a bit about the benefits of prostate surgery, I focused more on the Hope side of our visit with him.

So when Dr. Witten said that he wanted me to have another cystoscopy procedure -- where a urologist delves around the urethra and bladder with a flexible (thankfully!) probe with a tiny (also thankfully!) optical device attached -- because he wants to see the prostate and bladder himself before doing a prostate operation.

OK, I thought. No big deal. The procedure itself is easy to tolerate. 

What concerned me in the days just before last Friday's appointment with Witten was the uncertainty of what he'd find. Still, optimistic me had been telling a few friends in the know about my bladder problem "Prostate surgery could be in my future."'

Well, not any more.

I got a GIANT dose of reality from Dr. Witten when, after finishing the cystoscopic look-around, he said, "I don't think you're suited for the TURP procedure." Showing my predilection for Hope over Reality, my brain actually thought this in the second or two before Witten's next utterance.

Oh, so he's going to recommend one of the other prostate surgeries he'd mentioned before.

No, actually he wasn't. Because Witten then said, "It wouldn't do you any good, given your weak bladder."

Yikes. I'd asked for Reality. And here it was. A bit later Witten added, "So let's have you come back in a year." Which he changed to "a year or six months," maybe because my shocked expression demanded a small dose of Hope. 

I'd been looking forward to the prospect of prostate surgery at least helping reduce the number of times I need to self-catheterize in order to get rid of the urine that my recalcitrant bladder won't let out on its own.

This is not a fun thing to do, believe me. However, it's a heck of a lot better than the renal failure my local urologist had said could be in my future if I allowed urine to back up in my bladder. Nonetheless, Dr. Witten had basically just told me, Your bladder isn't going to recover. So I was screwed.

My hourlong drive from Portland back to Salem was spent with my mind playing variations on You're screwed. The worst part was -- and the worseness hasn't gotten any better in the 36 hours that have passed since the second cystoscopy confirmed my atonic bladder -- that I'm the victim of my own repeated idiocies.

Idiotic move #1 was not realizing that the gradually increasing problems I was having with urination should have caused me to head to a urologist. Instead, I stuck with the prostate medications my primary care doctor had prescribed. I truthfully told her that I "only" had to get up a couple of times a night to pee.

But I didn't mention that sometimes it took me a long time to urinate, standing in front of the toilet. In retrospect, this was my bladder screaming, Hey, I'm getting weaker. Dude, you need to go to a urologist and talk prostate surgery. I ignored that voice, though.

Idiotic move #2 was not dealing with the severe urinary retention problem that hit me when we were in central Oregon visiting an old friend in late May of this year. I'm too embarrassed to share all of the stupid decisions that resulted in me taking 24 hours before getting to an emergency room, where I was catheterized to let my VERY full bladder empty.

I don't know what caused my bladder to get damaged and atonic. My Hope side likes to believe that years of a gradually enlarging prostate and consequent problems with peeing resulted in my bladder getting more and more flaccid. But my Reality side says that waiting 24 hours when I had full-blown urinary retention contributed to the bladder damage.

Thus I'm now trying to deal with my Idiocy. It appears that my bladder is just going to do whatever it is going to do. Which likely isn't much -- maybe for the rest of my life.

What's consuming me now is the "crime" I committed on myself due to the above-mentioned idiocies. 

If I'd been responsible for causing someone else to suffer serious bladder damage, I'd feel terrible about what I'd done. So it isn't surprising that I'm now berating myself for what amounted to "negligent homicide" on my barely alive bladder. I can't help revisiting the crime scene of what I could have done to prevent the seemingly untreatable bladder problem that I'm now stuck with.

Sure, Idiocy isn't a crime. However, the consequences of Idiocy can be serious offenses.

I'm not going to let myself off the hook lightly. I feel like I've got to figure out what character flaw, personality quirk, mental aberration, or whatever caused me to fuck up my own bladder, to put the matter crudely.

This will sound really weird, but I'm a weird person, so here goes. My search for clues to my Idiocy led me to remember my favorite Rumi quotation this morning:

Fear the existence in which you are now! 
Your imagination is nothing, and you are nothing,
A nothing has fallen in love with a nothing,
a nothing-at-all has waylaid a nothing-at-all.
When these images have departed,
your misunderstanding will be clear to you.

As strange as it may be sound, these wise words from Rumi (translated, of course) strike me as being a pointer to the forensic evidence I need to investigate in the course of my inquiry into how I damaged my own bladder through stupendous displays of Idiocy.

Comments

[Rain Trueax]

Not sure it'll make you feel better but maybe this was just one of those DNA cards that we sometimes get dealt-- the ones we'd prefer we hadn't. It might be you could have delayed it but we just live into where a lot of things show up. It's human nature to blame ourselves but so much is not in our control. We just have to roll with it.

[Rain Trueax]

I had another thought on this. Have you considered turning to Eastern medical treatments-- in particular acupuncture? Once someone has gone through what Western medicine can do, I don't think you can lose much by talking to other practitioners of some of the older medical treatments that sometimes have more promise where it comes to chronic conditions. I've had acupuncture treatments in the past and they can strengthen our own immune system as well as stimulate organs. I don't know anything about this specifically but you might consider asking for recommendations in the Salem area for those who have helped with other conditions where Western medicine mostly has given up.

[Brian Hines]

Rain, a much belated reply. I did go to a local acupuncturist for one session. It was just too strange/weird for my admittedly Western (mostly) mind. I may give acupuncture another try at some point. I just figured that it was quite unlikely that what was being offered would benefit me, and there was a cost in terms of money and time that I didn't want to incur.