HinesSight

I'm now quite confident that diet affects how easily I can insert a urinary catheter

A bit over six months ago I theorized in a blog post, "Diet could play a role when having a problem inserting a urinary catheter." 

I asked my urologist if he thought diet could play a role in the difficulty I sometimes have inserting a catheter. His answer: "Maybe." Not very helpful, as that left it to me to figure out my own answer. 

After a lot of experimenting with different foods (I'm a health-minded 73 year old vegetarian), I'm pretty confident that yes, at least for me, diet does affect how easy it is for me to insert a catheter into my bladder.

I seem to have found that "gassy" foods are bad for my catheterizing. I'm not sure of this, but it makes some sense, since the prostate and colon are close together, and in men a catheter has to pass through the prostate on the way to the bladder. Thus a distended intestine could affect the passage of a catheter.

Now I'm even more confident that this is the case.

I'm not saying that my experience is common, since as I noted in that first post, some Googling revealed that basically the only foods people using intermittent self-catheterization are told to be cautious about is caffeine/coffee and alcoholic beverages, since these are bladder irritants.

In August of this year I learned that my 50 year-old daughter has been diagnosed with irritable bowel syndrome. That got me to thinking that maybe my digestion issues could be described with that rather catch-all term.

My daughter was having stomach pain, though, while my primary problem was diarrhea in the mid to late afternoon. That indicated to me that certain foods probably were causing the loose bowel movements, since it didn't happen all the time.

So I started to study the FODMAP diet, downloading the FODMAP app for my iPhone developed by Monash University. I cut quite a few foods out of my diet: soy milk, apples, applesauce, oats, tomatoes, broccoli, pizza, soft cheese -- basically everything that the FODMAP app said could be bothersome.

I've been sticking with this FODMAP diet for several months. It could be a coincidence, but I've been having fewer problems with inserting a catheter five times a day now. It feels to me that as my digestive tract has calmed down, so has the difficulty I used to have getting a urinary catheter into my bladder.

Obviously I'm not conducting a scientific experiment. This is just my personal experience. I wanted to share it in the hope that perhaps some other catheter user would find that experience helpful, or at least interesting, to them.

Decaf coffee irritates the bladder because of acidity, as well as some caffeine

Since for a bit more than five years I've had to use a urinary catheter to pee, aside from the small amount I can release on my own, coffee has been a continuing concern for me.

For decades prior to having my bladder go on strike -- technical term, becoming atonic -- I was a coffee addict. I'd drink 4-5 cups a day, at just about any time.

After starting intermittent catheterization five times a day, and knowing that the caffeine in coffee stimulates the production of urine in many people, including me, at first I split the difference and tried drinking half-caf coffee: half caffeinated and half decaf.

But it didn't take long for me to realize that even half the amount of caffeine was irritating my bladder and seemingly making it more difficult to get a catheter to pass through the bladder opening. So I switched to decaf.

Better, yet I still experienced bladder irritation. I discovered that even decaf coffee has a decent amount of caffeine. HealthLine reports:

One study analyzed 16-ounce (473-ml) cups of drip-brewed decaf coffee from nine US chains or local coffee houses. All but one contained 8.6–13.9 mg caffeine, with an average of 9.4 mg per 16-ounce (473-ml) cup.

In comparison, an average 16-ounce (473-ml) cup of regular coffee packs approximately 188 mg of caffeine.

The researchers also purchased Starbucks decaffeinated espresso and brewed coffee and measured their caffeine content.

The decaf espresso contained 3–15.8 mg per shot, while the decaf coffee had 12–13.4 mg of caffeine per 16-ounce (473-ml) serving.

While the caffeine content is lower than that of regular coffee, it’s still present.

That led me to try some coffee substitutes. Cafix turned out to be my favorite. Reading the label when my first jar arrived from Amazon, I saw "Cafix crystals offer a rich robust taste yet none of the caffeine or acidity found in coffee or tea."

Ah, acidity. I'd forgotten about that. Acidity can be a problem for people with bladder issues. See here and here. 

So I stuck with Cafix for quite a while. But a few days ago I'd forgotten about what I'd forgotten, and looked longingly at a jar of Republica Organic Decaf, coffee from Australia that I'd also gotten from Amazon, tried for a while, then set aside when I gave up decaf.

I noted that Republica is 99.7% caffeine free, which by my calculation translated into a negligible 1 mg or so of caffeine in a 16 ounce cup. I prefer the taste of Republica over Cafix, because Republica tastes like coffee, because that's what it is.

However, I've had more difficulty inserting a catheter the past few days, which reminded me that acidity is an issue for people with a bladder problem just as caffeine is. Thus reluctantly I'm going back to Cafix tomorrow.

As much as I like the taste of decaf coffee, it isn't worth it if the coffee interferes with my ability to do my urinary catheter thing. I'll continue to have a 16 ounce decaf latte every Sunday during my weekly get-together with an old friend.

That one shot of expresso, I assume it is, doesn't seem to cause me any problem, maybe because it's just a one-time drink each week, not a daily consumption of decaf coffee.

UPDATE: Well, duh, somehow I'd never thought that decaf low acid coffee exists, but naturally it does, as revealed by an Amazon search shortly after I published this post and the idea entered my mind. So soon I'll be getting some Lucy Jo's decaf low acid coffee. Will be interesting to try it.

I offer advice to someone new to using a urinary catheter

Today I heard from a woman whose 56 year old husband had his bladder go atonic, dysfunctional, two months ago. Understandably, he's suffering both physically and psychologically given this abrupt change in his life.

She had read the essay I wrote for 180 Medical, which supplies my catheters, that had the not-very-cheery title, "My urinary catheter-related depression and anxiety." I was asked if I had any resources, advice, or support I could suggest.

Well, here's the thoughts that come immediately to mind. I'll use this blog post as a reply to the woman, copying it into my email reply. I'll speak to her husband, hoping that some of what I say can be of some help to him.

First, and most importantly, know that these early months in your newfound catheter life almost certainly are the most difficult you'll experience. Things will get easier with time. Hey, like me, you've spent your entire life up to this point taking going to the bathroom for granted.

When you had to go, you just went. If a bathroom wasn't available, a tree would do.

Now you're faced with having to organize your peeing, to schedule your peeing. That's a huge adjustment. It's completely normal to feel upset, angry, anxious, depressed, maybe even guilty if you think you could have done something to prevent your bladder from going on strike, as I like to put it.

Guilt is something I've wrestled with, as I said in my essay. Recently I had three sessions with a counselor. One useful thing he said when I started to talk about how I felt bad that I might have been able to prevent my bladder from going dysfunctional was this:

"Hey, Brian, had this ever happened to you before?" I said, "No, of course not." "Then how could you have known what to do, since you'd never experienced anything like this?" Good point. That helped me shunt my guilt into a corner of my mind rather than front and center.

I've also been helped by a talk I heard on Sam Harris's Waking Up app by a modern practitioner of Stoicism. He spoke about how each of us, without exception, is living a dream life. Why? Because no matter how difficult our life might be, someone else has it worse, so to them we're living a dream life.

I keep this in mind when I'm feeling sorry for myself because I have to insert a plastic tube into my urethra, and thence into my bladder, five times a day. There are many people who can't walk. There are many people with incurable cancer. There are many people with intense pain.

Would they be overjoyed to trade my bladder problem for their problem? Absolutely. Now, this only gets me so far, because even though I can envision having a worse problem that a dysfunctional bladder, the plain fact is that I don't have that worse problem. I have a bladder problem.

I do feel grateful, though, when I see someone in a wheelchair and realize that not being to walk would be a heck of a lot worse than not being able to pee properly on my own. (And it isn't uncommon for someone to both not be able to walk and need to use a urinary catheter.)

A lot depends on finding a easy to use catheter that is comfortable to insert and remove. I'm a big fan of the Flex Coude Pro pocket-size catheters. Being on Medicare, I don't have to pay a whole lot for them, since they're spendy. 

It was aggravating at first when I had to apply lubricant to an inexpensive catheter, be super cautious about not touching it with dirty hands, and all that. Now I can carry several Flex Coude Pro pocket size catheters in my hip bag for when I need to use one when I'm out and about.

(I much prefer private restrooms, but can do my catheter thing in a bathroom stall if necessary.)

Deciding how open to be with friends and family can be a difficult decision. Using a urinary catheter isn't a normal conversation topic. If you have a bad knee, or a sore back, that's easy to talk about. Having to stick a plastic tube into your penis, not so much, to put it mildly.

Since you're 56, probably you're still working. Depending on the sort of job you have, using a catheter at work either could be fairly easy or more difficult.

How open you can be with co-workers is another issue. It's hard to find humor in using a catheter, but you could always tell people something like, "In case you're wondering why it takes me longer to use the bathroom, here's why -- and it's probably not what you think."

Along that line, I tried out a hypnotist to see if she could make me feel better about my bladder problem. Once she asked me how long it took to do my catheter thing. I told her, around seven minutes, I guess. She said, since you do it five times a day, that's 35 minutes a day, right? 

Which helped me to realize that while using a catheter occupied a really big space in my anxious brain, it wasn't a huge part of my day. After all, obviously I was spending time in the bathroom prior to using a catheter. Now I was just spending a bit more time.

I was familiar with the term "differently abled" before. Now it means something real to me. And hopefully to you. We're both differently abled when it comes to peeing. Some people have to use a cane to help them walk. My whole life I've worn glasses or contacts to help me see. Now I use a catheter to help me pee.

Yes, it's a big deal. But not such a big deal for me as it was five years ago. Sure, adjustments large and small have to be made in our lives, and also in the lives of our wives. Yet life goes on. Hopefully these ramblings are at least some small help to you.

If I've missed the mark on what you're concerned about with your catheter life, email me and I'll try to share some ideas more tailored to your needs and situation. Know that you're not alone in your struggles, though sometimes it will feel that way.

Diet could play a role when having a problem inserting a urinary catheter

I've been doing the intermittent urinary catheterization thing five times a day since my bladder became atonic in May 2017, a bit over five years ago. 

Or as I like to say, my bladder went on strike back then and hasn't returned to work since. At least, not very well. I can pee some on my own, but not enough to stop using a catheter to empty my bladder.

At times I've suffered from some pretty severe anxiety and depression, which I described in an essay 180 Medical asked me to write. I've also wondered whether anyone cares about my blog posts where I talk about some aspect of my urinary catheter life. 

It could well be that most men who have to use a catheter have a much easier time with it than I have. That would explain the lack of interest in my blog posts, assuming they're discoverable via Google. Or maybe men just aren't into reading about health issues, another real possibility.

(I realize that women have to use a urinary catheter also. Yet since I only know what it is like for a man to catheterize, I have to talk from a male perspective.)

When it comes to diet, about the only clear piece of advice I've found on the internet is to limit or avoid coffee and other caffeinated drinks. That's because caffeine is a bladder irritant, and anyone who has to use a catheter already has an irritated bladder -- at least in the sense of not working well.

I started by drinking half-caf coffee: half regular and half decaf. Then I went to total decaf, after finding the coffee still seemed to irritate my bladder and make it more difficult to catheterize. After learning that even decaf coffee can have quite a bit of caffeine, I now drink Cafix, a coffee substitute. But I miss coffee, and frequently consider having a cup of regular coffee.

I asked my urologist if he thought diet could play a role in the difficulty I sometimes have inserting a catheter. His answer: "Maybe." Not very helpful, as that left it to me to figure out my own answer. 

After a lot of experimenting with different foods (I'm a health-minded 73 year old vegetarian), I'm pretty confident that yes, at least for me, diet does affect how easy it is for me to insert a catheter into my bladder.

I seem to have found that "gassy" foods are bad for my catheterizing. I'm not sure of this, but it makes some sense, since the prostate and colon are close together, and in men a catheter has to pass through the prostate on the way to the bladder. Thus a distended intestine could affect the passage of a catheter.

As a vegetarian I tend to have frequent bowel movements rather than infrequent. Once I totaled up how much fiber I eat in a day. It was a lot. So regularity isn't a problem. If anything it is being too regular, sometimes with loose stools that can be diarrhea-like.  

Recently I've been dialing back the amount of fiber I eat in the morning, shifting from one type of cereal to another. I can't be sure how this will affect my catheter use long-term, but so far this has coincided with an easier time inserting a catheter.

Anyway, I might be unique in this regard, since like I said, I've found very little information about the relation of diet to having difficulty inserting a urinary catheter when I Googled this subject.

I'm quite confident diet is a factor in how easily I'm able to get a catheter into my bladder, but I readily admit that I could be wrong about this.

My first counseling session: "I feel like you heard me"

I could have saved the $40 insurance co-pay by taking the advice of this cartoon and letting our dog make me feel better, instead of going to my first Salem Health counseling session.

But after seeing Wayne Halle, a MSW counselor, I'm convinced that I made the right decision to take my problems to a human, rather than a canine.

I was referred to Halle in late December after I told my family physician that I found a recent glaucoma diagnosis to be more than a little disturbing, especially when layered on top of a couple of other annoying health problems that I have.

However, early on in today's initial session I told Halle that since it took about ten weeks to get an appointment with him, now I wasn't as worried about my glaucoma. 

Of course, I quickly said that I have other concerns.

This was after I noted that like Halle, I too have a MSW (Master of Social Work) degree, as does my wife, a big difference being that soon after I got my degree, I realized that I wasn't really cut out to be a social worker, which led to me getting a job in health services research and then health planning.

My main takeaway from the 50 minutes or so I spent talking with Halle was how good it feels to be listened to attentively. That's why, when we were making plans for a second session, I told him, "I feel like you heard me."

Which isn't surprising, given that's what counseling/psychotherapy is largely about. It's also what everyday conversations should be about.  Often, though, we're guilty of paying as much attention to how we're going to respond to the other person, as to what they're saying. 

At least, I'm guilty of this. 

So it was refreshing to have Halle ask good questions about the difficulty I have in coping with a bladder that, as I like to put it, went on strike about five years ago and hasn't gotten back to working normally.

(Smooth bladder muscle, unlike regular muscle, doesn't recover when it loses its tone and becomes atonic, unable to properly push out the pee.)

I explained that one of my mental health concerns is a strong feeling of regret that I both failed to recognize warning signs that the prostate problem which I knew I had was morphing into a bladder problem, and also that when I had a urinary retention episode (unable to pee), I delayed seeking treatment, wrongly feeling that the problem would resolve itself.

Halle zeroed in on the key issue. 

"So tell me," he said, "before this happened, how many times in your life had your bladder stopped working?" "Um, none," I told him. "How then," Halle asked me, "could you have known what was going to happen, since you'd had no experience with it?"

Bingo. This interchange alone would have made the session worthwhile. My regret immediately lessened.

I'd had similar thoughts, but since the thoughts came from my own mind, they didn't have the impact  that Halle's words did. Meaning, I'm kind of immune to my own bullshit. My mind is continually churning out ideas, some of which make sense, and some don't. 

This is the problem with being your own therapist, something I alluded to in talking with Halle.

I told him that I have countless (almost) books about meditation, mindfulness, neuroscience, and such, many of which have good tips for dealing with anxiety and worries, of which regret is one manifestation. But it's difficult for me to break out of deep mentally unhealthy patterns on my own, since this is akin to me lifting myself off of the ground.

Someone else can do this, because they can use their legs and arms as leverage to raise me up. I, though, am stuck when I try to do the same thing.

This is the beauty of a skilled counselor like Wayne Halle. Within a few minutes of meeting this perfect stranger, I was telling him things about myself that I'd shared with only a couple of other close friends and relatives.

Such is the power of unconditional acceptance in a therapeutic relationship. I felt like the ideas and feelings I was sharing, though naturally familiar to me, since I was speaking them, had a special power when directed at Halle's welcoming and non-judgmental ears.

Somehow that made my concerns seem more manageable -- given that a stranger was listening to me with calm acceptance, unlike the often negative reaction I have to my own thoughts and emotions.

Which is damn strange, really, how I can be harder on myself than other people are with me. Anyway, I look forward to my next session with Halle, which won't be for about another month. (Salem, like most places, needs more mental health professionals.) 

Facing Catheter-Related Depression: Brian's Story

Today 180 Medical published the essay I wrote for them on their blog, calling it "Facing Catheter-Related Depression: Brian's  Story." 

They decided not to put my email address in, though I said this would be fine with me. In case anyone wants to contact me about what I wrote, my email address is in the right sidebar, or click here. 

The blog post looks great -- nicely laid out. There were a few edits to shorten the piece, but I didn't even notice what got left out. Jessica Flint's introduction was well put.

It’s not often talked about, but the process of catheterization can sometimes impact mental and emotional health. Some people may face catheter-related depression or anxiety while others might handle the transition to catheterization with few hiccups. Also, some may need to use catheters as a result of a traumatic illness or injury, which can also make a major impact on one’s mental health.

These issues aren’t necessarily rare, and yet most resources only talk about topics like how to use a catheter. Not many resources talk about how having to use catheters can make you feel.

In Brian’s personal story, he shares how he came to need to use catheters as well as some of the difficulties he has experienced. He knows firsthand how the transition to using catheters can be deeply frustrating and isolating for some. By sharing his experience openly, Brian hopes to help other catheter-users know they’re not alone in their struggles.

 

 

My urinary catheter-related depression and anxiety

Recently I finished a 2,500 word essay for the consideration of 180 Medical, the firm that supplies me with urinary catheters. After I got a message from 180 Medical saying that they welcome essays about how people experience using a catheter, I wrote back saying I'm interested in this, having written a bunch of blog posts about my life with a catheter.
Download 180 Medical essay PDF

(I've also copied in the essay below.)

A marketing specialist with 180 Medical read some of those posts and suggested I write about my catheter-related depression and anxiety. It took me quite a while to get around to this, since it required dredging up memories that I've tried to suppress as much as possible. But now I'm glad that I did this. Usually it's better to face our problems head-on.

My catheter-related depression and anxiety
by Brian Hines
[email protected]

I wish I didn’t have to use a catheter to urinate. I wish I hadn’t made mistakes that may have caused my bladder to become dysfunctional, leading me to need a catheter. I wish I hadn’t suffered from so much anxiety and depression during the four and a half years I’ve been a catheter user.

But wishes are one thing. Reality is another. I’m going to be real with you. 

If you’re looking for a feel-good story of how a 72 year-old man has been coping with his catheterizing, look somewhere else. Sure, now I’m doing pretty well with my catheterizing. This wasn’t always the case, though. So i’m not going to sugarcoat those hard times.

In a movie about the life of C.S. Lewis, Shadowlands, a student tells Lewis, “We read to know that we are not alone.” 

My hope is that some people who also have had problems with using a catheter will read this and realize that even though our struggles mostly are private, we share a determination to make the best of a difficult situation. 

Up until the age of 68, I had no significant health problems. My family doctor would tell me at my annual checkup, “You’re a poster child for growing old.” I’d earned a karate black belt at age 56. I’d take my boogie board on vacations to Maui and catch big waves with the locals. I took up senior citizen skateboarding when I was 64.

I figured, wrongly, that I had many more years of good health ahead of me.

Yes, I had a prostate problem. It didn’t seem like a big deal, though. I took several prostate medications. I needed to urinate more frequently, getting up several times a night. I always got an aisle seat on airplanes to ease a trip to the restroom. 

Looking back, I should have realized that I needed to see a urologist. It became more difficult for me to start peeing, a different problem than having to pee too often. Yet I didn’t mention this to my family doctor. I thought I was just having normal symptoms of an enlarged prostate. 

Then everything changed in May 2017. My wife and I went to visit an old friend who I hadn’t seen in over 40 years. We drove to the Bend area from a vacation cabin we owned with three other families in Camp Sherman, Oregon.

Before getting to his house, I thought about stopping to pee. But I didn’t need to go that bad, so I drove on. Once we got there, our conversation on a deck overlooking the beautiful Deschutes River was so pleasant, I didn’t want to interrupt it by going to the bathroom.

When I finally did, I couldn’t go. Since this had happened before, I figured I just needed to wait a while and try again. Except, I kept trying every half hour or so, until someone asked why I was visiting the bathroom so much. 

This went on until mid-afternoon. By then I really needed to pee, but still couldn’t. My friend and his girlfriend told me that this was serious and I needed to get medical help. Good advice, which I didn’t take.

Well, actually I did, sort of. We Googled the address of an urgent care center in Bend. Driving there, I peed in my pants involuntarily. Luckily, I’d brought along some extra clothes.

I changed in the urgent care restroom, then saw a male nurse who asked what my problem was. “I can’t urinate,” I said. “At least, not voluntarily.” For some reason he wanted a urine sample. “Um,” I told him, “I can’t pee, so that’s not going to happen.” 

He gave me a glass. “Drink three glasses of water,” he said. “Then try to urinate into this bottle.” I should have argued with him, but I didn’t. I sat in the room by myself and drank the water. Then went into a bathroom and couldn’t urinate.

By that time I was distraught. I wasn’t thinking straight. I couldn’t pee on my own but had wet my pants. I was frustrated, tired, fed up. Holding the empty collection bottle in my hand, I walked out and told a different nurse that I wanted to leave.

“Do you want a catheter,” she asked me. 

I didn’t know what a catheter was. I didn’t care what a catheter was. I just wanted to go back to our cabin, take our dog for a walk, and wait until I could pee on my own again. Yeah, none of that makes sense. But at the time it did, because I was so upset with how the day had gone.

“No,” I told her. “All right,” she said. “You’ll need to sign a release form absolving us of responsibility for letting you leave without treatment.” Big danger sign, in retrospect. Yet I scribbled my name on the form.

The memory of what happened in the urgent care center is as fresh today as it was four and a half years ago. I agonize over that single word that came out of my lips, “No.” What if I had said “Yes”? Why didn’t I say “Yes”? One word. One little word. Choosing one word over another may have changed my life for the worse, forever.

We drove back to the cabin. I involuntarily peed in my pants again. After all, I’d just drunk three glasses of water in the urgent care center, when I already had been unable to urinate for about ten hours.

That night I keep getting up to see if I could pee. I couldn’t. The pain was bad. As soon as the sun was up I told my wife, “I need to get medical help.” We packed up and drove two hours to Salem. I peed in my pants again. A Salem Health urgent care nurse sent me to the Emergency Room.

There I got an indwelling catheter. Several weeks later, still unable to urinate much on my own, I was told that I’d have to do intermittent catheterization. Which I still am.

Several months after my traumatic urinary retention episode, I asked my urologist if my atonic, nonfunctioning bladder would have gotten back to the way it was if I’d said “Yes” to the offer of a catheter in the Bend urgent care center.

He said, “Perhaps.” I held it together until I got into my car. Then I cried all the way home. 

Almost every day since, I’ve thought about how stupid it was of me to refuse the offer of a catheter. I should have asked what a catheter was. I should have asked what would happen if I didn’t get the massive amount of urine in my bladder out. But I didn’t. And I can’t stop blaming myself for that. 

My wife is a retired psychotherapist. She thinks I have PTSD, post-traumatic stress disorder. She’s probably right. However, it didn’t take long before I had an even worse mental problem: depression. 

(If you’re mildly depressed yourself reading this sorrowful tale, hang in there. It’s going to end on a positive note, once I get through the anxiety and depression stuff.)

I already wasn’t happy, to put it mildly, about facing a lifelong need to insert a plastic tube up up my urethra five times a day. When I started getting nighttime leg cramps, forcing me to wake up and walk around my bedroom until they went away, then doing this again a few hours later all night long, the lack of sleep helped push me into a full-blown depression. 

Not fun. At first I just thought I was tired. And sad about my non-functional bladder. Then my wife said, “No, you’re depressed.” She was right. 

I had no interest in doing things I used to enjoy, like write posts for my three blogs. From being afraid of dying, I started to think that, hey, death wouldn’t be so bad. At least I’d be free of feeling like I was in an emotional black hole with no exit sign.

My urologist’s office said there was no way the leg cramps could be related to my bladder problem. I pointed out that I’d never had leg cramps before, and now I did, shortly after starting to use a catheter. 

Fortunately, I was able to see a Sleep Clinic physician. After being prescribed gabapentin, the leg cramps went away. I also was fortunate that my primary care doctor’s office had a psychiatric nurse practitioner. She diagnosed me with Major Depression, Single Episode. 

So I now had a mental health diagnosis to add to my growing list of physical problems. I was prescribed an antidepressant, which over several months helped me climb out of the black hole I was in, along with counseling sessions with a social worker.

Depression was in my rear view mirror. Unfortunately, catheter-related anxiety was in the passenger seat right next to me, where it still sits. Worse, sometimes anxiety feels like it’s taken my place in the drivers’s seat — though gradually I’ve gotten better at keeping anxiety’s hands off of my mental steering wheel.

I don’t know whether the frequent trouble I have getting a catheter to pass into my bladder is typical for many men, or atypical. Regardless, this has been my biggest longstanding problem. 

In the early days I’d call my urology clinic and talk with the nurses who worked with my doctor. “I’m having trouble inserting the catheter,” I’d say. “Do you have any tips?” I’d be told to take a shower, go for a walk, or wait a while and then try again.

OK, but I wanted to get back to what I’d been doing before my bladder stopped working like it should. Eating out. Going to a movie. Visiting friends. If I went into a restroom at a restaurant to do my catheter thing, then found I couldn’t insert it, obviously taking a shower wasn’t an option.

And I didn’t want to interrupt a meal with friends by saying, “Sorry, I’ve got to go for a walk and then see if I can get a catheter into my bladder.” Not exactly a great dinner conversation topic.

Not being able to insert a catheter at bedtime was the worst. I was tired. I wanted to sleep. I needed to urinate. Yet sometimes I’d spend an hour or more lying on the bed, trying to relax with breathing exercises, so the damn catheter would pass into my bladder.

To make a long story short — and this story really is long — at times I got extremely frustrated and angry. My wife had to put up with quite a few outbursts where I’d either start crying or slam doors or both, because I was having such a difficult time inserting a catheter. 

I’d try catheters other than the Flex Coude Pro that I’d come to know and love. (Well, except when I couldn’t get it into my bladder.) But none of them were anywhere near as comfortable and easy to use as the Flex Coude Pro, so I stuck with it. 

Eventually I had the bright idea of trying a smaller size catheter, FR12 or FR10 rather than FR14. Often I could insert one of those when the FR14 wouldn’t go in.

Even so, I still am anxious about traveling or going anywhere where I might need to use a public restroom. I haven’t flown since I started using a catheter. I haven’t driven by car more than two hours from where I live. 

If I could be confident that popping in a catheter would go smoothly, I’d be hugely happier. That would allow me to view myself as simply differently-abled in how I pee. However, not knowing when I’ll have trouble inserting a catheter — I haven’t been able to predict when this happens — makes me anxious.

And when I have a particularly difficult time, my mind generates flashbacks to the traumatic day and a half back in May 2017 I’ve described. It must be similar to a war veteran hearing fireworks and feeling like it’s a roadside bomb. When I’m unable to insert a catheter, sometimes I feel panicked, like I did when I couldn’t pee at my friend’s house or in the urgent care center.

However, I don’t want to leave the impression that I’m a total catheter train wreck. I’ve learned a lot over the years. Most days now, things either go smoothly for me, or I’m able to handle occasional problems inserting a catheter with no freakout. 

I’ve accepted the fact that almost certainly I’ll have to use a catheter for the rest of my life. 

My bladder has recovered some function, but nowhere near enough, I strongly suspect, to ever justify prostate surgery. I got a second opinion from a medical school urologist who told me, bluntly, “You don’t have a prostate problem, you have a bladder problem.”

However, I always thought I had a prostate problem. It never occurred to me that my bladder might stop working one day, and my primary care doctor didn’t  bring up this possibility. 

I haven’t stopped regretting walking out of the urgent care center in Bend. However, I do my best to tone down that regret by focusing on a couple of things that allow me to fashion a story which doesn’t have me as the Bad Guy as regards my non-functional bladder.

First, my urologist said that not getting medical care sooner could have harmed my bladder’s ability to recover from the urinary retention episode. Could. This isn’t certain. So regardless of how I acted that day, I might well have still needed to use a catheter.

Second, during a cystoscopy (scoping of my bladder) by the second-opinion urologist, he said, “Look at that pocket in the bladder wall. That was caused by the bladder trying to push urine through your prostate for a long time.”

A long time. Those words imply that my bladder was gradually losing functionality for quite a few years, so slowly that I viewed this as a normal part of aging for a man with a prostate problem.

It’s difficult, but I’m learning to forgive myself. After all, there may not be much to forgive. 

I try to remember that life is difficult for everybody, and I’m more fortunate than many. As my wife frequently reminds me, I’m pretty damn healthy overall. I use a chainsaw on our ten rural acres. I put 40 pound bags of salt in our water softener. I can bicycle, lift weights, do Tai Chi.

Life isn’t over just because I have to use a catheter five times a day. As I’ve described, there were moments when I thought life wasn’t worth living. Now, though, I’m almost as happy as I was before. 

Almost. And that’s good enough for me, especially given the much darker days I went through with my catheter-related depression and anxiety. 

 

My routine for using a pre-lubricated catheter

Since May 2017 I've used a catheter after having a urinary retention episode that showed my bladder had become atonic, a fancy word for not working any more as it should, likely due to my lengthy history of an enlarged prostate.

I haven't written a whole lot about my experiences with a catheter. Recently I decided I should, starting with a post that has a rather plaintive title, "I've learned a lot about using a catheter. But does anyone care?"

In that post I listed some questions that I wanted to address in other blog posts, regardless of whether anyone cares. If even one person finds what I have to say useful, that's good enough for me, even if I can't be sure that this person exists.

Question #2 was What routine should I use before inserting a catheter? Here's my answer.

This depends on whether a pre-lubricated catheter is being used. Early on I discovered the Speedicath Flex Coude Pro catheter, which I wrote about in my answer to the first question in my list.

It makes inserting a catheter much easier than the basic red catheter that I used for a short time before the Flex Coude Pro came into my life. That required the application of lubricant, a process I never felt comfortable with because I worried about contamination from my hands or whatever.

So I'd put on disposable plastic gloves, which further complicated the catheter insertion routine. This is my current routine, a much easier one.

(1) I pick a Flex Coude Pro from a drawer in the bathroom and place the sterile packaging it comes in next to the sink.

(2) I see whether I can urinate some on my own. Usually I attempt this while sitting on the toilet, since this was recommended by a physical therapist I went to who specializes in pelvic floor exercises, back when I had more hope than I do now that my bladder could recover quite a fit of functionality. Sometimes I pee standing up, if it feels like that is doable.

(3) I close the lid of the toilet, placing a towel over the lid. I do this because I like to have the urine resulting from a catheterization go into a plastic container with marks on it showing how many cc's of urine are in it. This helps me keep track of whether I'm drinking enough water and other liquids during the day. Obviously I don't do this when I have to use a public restroom, which is rarely. I put the container in larger containers, to minimize urine splashes on the towel or elsewhere. Here's a photo of that setup.

(4) I wash my hands with liquid soap. I've gotten into the habit of counting to 30 while I wash my hands. This isn't as crucial as when I had to apply lubricant to a catheter, but still important.

(5) I use a Handzies wipe to clean the end of my penis, using circular strokes that move away from the tip/urethra as the goal is to be sure that the catheter doesn't touch anything dirty when it is inserted. I like that Handzies are soap and water-based, as I got skin irritation when I was using alcohol wipes for a while. I count 40 circular wipes. Probably overkill, but I haven't gotten a urinary tract infection in over three and a half years of catheterizing, so I must be doing something right.

(6) I open up the Flex Coude Pro packaging and take out the catheter. Most of the lubricating liquid is supposed to be shaken out prior to use, so I hold the catheter over the sink with the non-insertion end down. I cough while doing this, which (perhaps) helps to relax the muscles that the catheter has to pass through.

(7) I stand in front of the toilet and insert the catheter slowly. My left hand holds the Flex Coude Pro in place, while my right hand pushes the catheter, enclosed in a sleeve so the hand doesn't touch the catheter itself, into my urethra. I hold my penis out at about a right angle to my body, or slightly lower. That works best for most men, given the curvature of the urethra as it connects to the bladder.

(8) After a successful removal of urine, I put the catheter back in the packaging and throw it away. I use a small cotton square moistened with tap water to clean the soap off the end of my penis, to avoid any possible irritation. I take a glance at how much urine was collected before dumping it into the toilet and flushing.

SpeediCath Flex Coude Pro is the best male catheter

Since May 2017 I've used a catheter after having a urinary retention episode that showed my bladder had become atonic, a fancy word for not working any more as it should, likely due to my lengthy history of an enlarged prostate.

I haven't written a whole lot about my experiences with a catheter. Recently I decided I should, starting with a post that has a rather plaintive title, "I've learned a lot about using a catheter. But does anyone care?"

In that post I listed some questions that I wanted to address in other blog posts, regardless of whether anyone cares. If even one person finds what I have to say useful, that's good enough for me, even if I can't be sure that this person exists.

Question #1 was What brand of catheter is best?

That's easy to answer: the SpeediCath Flex Coudé Pro. Yes, it's more expensive than most other catheters. But you get what you pay for. And in my case, Medicare is paying for most of the cost.

At first I was given some sample catheters by the nursing staff at my urologist. I started off using the basic red catheter that has to be lubricated. I wore plastic gloves because that was advised and I didn't want to get a urinary tract infection. That catheter took considerable preparation to use and wasn't very comfortable.

Then, on a return visit, a nurse gave me a sample of the original Flex Coudé  prior to it becoming "Pro." I instantly realized how much better it was. 

After washing my hands in a sink and cleaning the end of my penis, I simply open up the sterile packaging, take out the catheter, unhook the ends that are fastened in a circle within the package, and drain the lubricant into the sink.

Then the pointy end goes into the penis. A sheath covers the plastic catheter, so I never touch the part that goes into the urethra. Thus no need for gloves.

The design of the Flex Coudé Pro just seems really well thought out. There's nothing else like it, I'm pretty sure, because I've looked for a better catheter and haven't found one.

By the way, the "Pro" designation came after a minor redesign of the tip after a competitor, I gather, complained to Medicare that supposedly it didn't have a genuine coude tip.

So now the tip is angled slightly, rather than straight as in the photo above. I didn't find much difference in how easy the catheter was to insert between the original and Pro versions.

My urologist's office suggested I use 180 Medical for catheter orders. I've been happy with their customer service.

I've learned a lot about using a catheter. But does anyone care?

In May 2017 I had a urinary retention episode while on vacation in central Oregon that kicked off my life with a catheter at age 68. Now I'm 72 -- still doing the intermittent catheterization thing five times a day.

It took me about three months before I was able to first write about my situation in "Given my peeing problem, be warned about asking 'How are things going?""

Since, I've written fifteen other posts about my life with a catheter. That's a thin (thankfully) plastic tube that is inserted into the urethra and thence into the bladder to remove the urine that, for one reason or another, isn't flowing out like it needs to. 

Those posts are in the "Living With a Catheter" category of this blog, which used to be called "My Peeing Problem." Categories are listed in the right sidebar.

I've learned a lot about how a man, me, copes with the massively life-changing event of artificially urinating on a schedule rather than just popping into the nearest bathroom, or behind the nearest tree, to take a piss. 

I try to think of using a catheter as being differently abled, peeing-wise, but that only works in my better moments.

And much of the time, I'm not having a good moment. That was true more often in the early days of my catheter use. Now I've settled into a routine that goes pretty well for me -- aside from the occasional times that it doesn't.

The question I'm grappling with now, as indicated in the title of this post, is whether any man out there who is using a catheter wants to know what I've learned about handling life with a catheter. I've only gotten a few comments on the other posts I've written, so part of me wonders if there's any purpose in writing more posts.

In case you're interested in any of the following subjects, I'd appreciate your leaving a comment on this post to that effect. Or, email me.

I'm very much willing to share what I've learned, but I'd be more eager to do this if I had a sense that there are other men wanting to know what I've experienced during the past three and a half years. Here's some of the questions I've grappled with and found personal answers to.

(1) What brand of catheter is best?
(2) What routine should I use before inserting a catheter?
(3) What to do when a catheter won't go into the bladder?
(4) How to handle anxiety, and even depression, about having to use a catheter?
(5) Can you travel when you need to use a catheter to urinate?
(6) How much to tell others about your bladder problem?
(7) How to deal with urologists who aren't very sympathetic?
(8) What's the best place to get catheters?
(9) Could diet play a role in how easy it is to insert a catheter?

There's more that I could share about my life with a catheter, but these have been some key issues for me.

I might go ahead and write about these questions, sharing the posts as links underlying each question. As noted above, I'd simply feel better if I knew that some other men were interested in the answers.

Misfits belong in Salem's theatre community (and elsewhere)

Misfits don't fit in. Except where they do. Like, in Salem's theatre community.

There was a lot to like about today's City Club program, "On Stage: Salem's Vibrant Theater Community." But what I'm going to focus on is one thing Lisa Joyce, executive director of Pentacle Theatre, said.

She told us that misfits find a home in theatre, because everyone is welcome there.

I absolutely loved those words. And now, having written that five word sentence, I'm having trouble explaining why. So for the moment I'm going to take a detour around my personal feeling about misfits and return to it later in this blog post.

Elsewhere in her presentation -- Jay Gipson-King of the Chemeketa Community College theatre program and Vincenzo Meduri of Enlightened Theatrics also spoke -- Joyce talked about how Pentacle Theatre had put on some plays that explored LGBTQ themes.

She noted that some audience members had expressed concern about those gay-friendly performances. I was curious about this, so spoke with her after the City Club program concluded.

Joyce told me that it seemed to be a generational thing. Meaning, it was a few older Pentacle Theatre attendees who felt it wasn't right to present homosexuality as acceptable, since they apparently thought this was an unnatural "lifestyle choice." Which, of course, it isn't.

Young people, she said, have a different attitude toward LGBTQ people. And the theatre community, she added, is a haven for gays. So that was one aspect of what she meant by misfits.

Salem, along with American culture in general, has a way to go before all forms of gender and sexual identity are accepted fully. Narrow-minded churches are partly to blame, since gay youth are told that they are sinners bound for hell if they don't change to become god-fearing heterosexuals.

Which is impossible. Even for an accomplished actor. Life isn't a play. We can temporarily embrace a role for a theatrical production. But we can't change the essence of who we are.

So it's fitting that Salem's theatre community embraces misfits. Joyce, Gipson-King, and Meduri all talked about how being part of a theatrical production has so many wonderful benefits. 

Being part of a diverse team. Trusting yourself and others. Being fully present in the moment. Embracing difficult emotions. Understanding that there are no stars, just different people doing a wide variety of essential jobs -- acting, directing, set design, costume design, lighting, sound, makeup, ushering, marketing, and so much more.

But back to misfits.

I don't know what it is about that word, misfits. Every time I've typed it, I've felt something well up inside of me, a strong emotion that defies easy expression.

Well, Lisa Joyce spoke to me about how being part of a theatrical community has helped LGBTQ people come out as who they are, rather than disguising themselves behind a facade of societal normality. So maybe if I simply let words spill out of me right now, they'll say something authentic about my own sense of being a misfit.

Which goes way back, as strong feelings often do. Understand: I'm not equating my life with that of a gay person, or a person of color, or an otherwise marginalized person. I'm an old white heterosexual guy, with all that entails.

However, I was raised by a divorced alcoholic woman, my mother. It was tough, especially in my teenage years, when her alcoholism took a turn for the worse. I felt different inside, like I was a stranger in a strange land of children who had two more-or-less normal parents.

So that was my first taste of feeling like a misfit. I'll skip ahead fifty years or so to right now. 

Where, just as in my high school years, I appear normal on the outside, but feel like a misfit on the inside. Why? Because a bit over two and a half years ago my bladder decided to go on strike, for reasons that aren't exactly clear -- but the result is: having to, as the saying goes, pee in a "differently abled" way.

Namely, by using a catheter, a plastic tube thing that I insert into my urethra five times a day. (I've written about my condition so rarely, I couldn't even spell "urethra" correctly at first.)

This isn't something that I feel comfortable talking to people about.

At first I was clinically depressed, even somewhat suicidal, after learning that I'd have to do the catheter thing for the rest of my life. Since, I've written a few blog posts about my bladder problem, but by and large only my wife knows about the many struggles I've gone through.

So I feel like a misfit, even though my rational mind says things to me like, "Many people have worse medical problems" and "You should feel lucky that you're otherwise healthy."

Still, I feel like I don't fit in the big wide world of people who can go into a restroom at a restaurant, movie theatre, or wherever without it being an adventure (sometimes it is difficult for me to insert a catheter, a problem common to many men who have to use one).

Thus I avoid lengthy meetings, movies, gatherings, and, yes, theatrical productions, where I feel trapped by the uncertainty of not knowing whether a bathroom visit is going to have a happy or disturbing ending.

Anyway, I've explained a bit about why that word "misfit" resonated so deeply with me when I heard it today. I know what it is like to outwardly look like one sort of person, and to inwardly feel like another sort of person. 

Of course, I believe that all of us, at least at one time or another, feel like we don't fit in.

My bladder problem just has given me a much better appreciation of what it is like to have a permanent attribute of one's self that isn't easily shared with other people. So when Joyce spoke about the theatre community welcoming misfits, I immediately resonated with her words.

Misfits of the world, may we all live long and prosper. And look forward to a day when that word falls into disuse, because everyone is viewed as fitting in. 

Men's "locker room talk" not conducive to openness about health problems

I had my annual physical today, Medicare variety, since I'm 70. I'm fortunate to have a family physician who is caring, compassionate, and willing to talk with me for as long as is necessary when I have a concern or question.

Oh, the physician is also a woman. Which almost goes without saying from the description I just offered up.

I'm not saying that male doctors always are businesslike and brusque. But most of the physicians of my sex I've gone to have been quite a bit less pleasant than my current family doctor.

She and I talked about my only significant health problem -- a bladder that went on strike about a year and a half ago, and never returned to work. So I've had to pee via a catheter, currently about five times a day.

This isn't the worse possible medical problem, not even close. But it isn't fun, to put it mildly. And a bladder problem isn't something I feel comfortable talking about with most people.

Why? In large part because I'm a man. Men don't share as much intimate information with other men, compared to how women talk with other women.

Today my doctor spoke about a colleague, a male doctor, who she is treating for a prostate problem.

She told me that according to him, it's tough for him to talk about that problem because of "locker room talk."  What she meant by this was how men put a lot of emphasis on the macho functioning of their genitals. So since the prostate is connected to the penis, as is the bladder, problems in these areas get associated with impotence, weakness, unmanliness.

Which is bullshit, of course.

I'm trying to be more open about my bladder problem, but it's tough to do, because I'm going against the grain of 70 years of being a man.

Here's a typical locker room conversation that I overhear at my athletic club:

"How's it going?"
"Great, couldn't be better. And you?"
"Tremendous. Hey, good talking with you."
"Yeah, good to see you, man."

Not much space in there for vulnerability, transparency, openness.

Now, my doctor did wisely advise me to choose with care those who I talk with about my bladder problem. Baring my medical soul to the grocery store clerk who asks me how my day is going isn't appropriate. However, I certainly can be more open with friends than I typically am.

This just requires some rethinking of what it means to talk like a man. There's a time and place for locker room talk. And also a time and place for unbridled honesty.

I'm trying to cultivate my experiencing self, rather than my remembering self

There's nothing wrong with memories, nor with anticipations -- which basically are imaginings of future events which could become memories.

If we couldn't remember the past or envision the future, we wouldn't be fully human. I've read about people who have a brain defect that leaves them almost totally in the present, and they can barely function.

But as I wrote about yesterday on my Church of the Churchless blog, I'm trying to be more attuned to the present moment. 

Partly this is because I've developed a chronic health problem that makes it tough for me to travel. So for about fourteen months I haven't journeyed more than a few hours from where I live. 

So when I remember how much I used to enjoy going to Maui on a vacation, or flying down to southern California to visit my daughter and her family, I can feel sad about my current situation. 

That's one reason I try to remain mindful of the present moment.

Another reason is I've found that paying close attention to what is happening right here, right now, makes time slow down for me. And since I'll be 70 in a few months, it makes sense to suck as much time as possible out of the years I have left to live, rather than having them speed by in a blur.

(I realize that it can sound sort of strange to speak of manipulating time. However, while clocks in everyday life run at a constant speed, leaving relativity theory aside, our subjective sense of time does vary considerably.)

In the past I've blogged about the interesting differences between our experiencing self and our remembering self. I put it this way in "Do you want life to be experience, or memory?"

The thought experiment is this: consider a vacation that you're planning. Then imagine that after your vacation is over, all of your photos and other mementos of it will be destroyed. Not only that, your very memories of the vacation will be obliterated through an amnesiac drug.

Would you still go on the vacation? If you have trouble answering this question, this points to a need to adjudicate a conflict between your experiencing and remembering selves.

In a milder sense, my wife and I face this conflict whenever we go to our habitual vacation spot on Maui, Napili Bay. Mostly we sit on the beach, not doing much of anything except enjoying the warmth and people/ocean watching. I boogie board, as I've done many times before; my wife snorkels, as she's done many times before.

When we return home, we don't have many travel stories to tell. No adventures to relate, no "you won't believe what happened..." tales.

However, we hugely enjoy our not-much-of-anything experience while we're on Maui. The lack is when it comes time to answer someone's question, "How was your vacation?" If it was important to us to entertain our friends and relatives with a fascinating slide show of our travels, we'd head somewhere that would buttress our remembering selves.

As it is, we favor our experiencing selves. So probably we'd be more likely to take a pleasant vacation that ended in amnesia than people focused on memories, photos, vivid stories, and such would be.

Now, in my current difficult-to-travel condition, I'm not even able to take my experiencing self to Maui.

So my experiences are going to be even less appealing to my remembering self, which seems to bear a close resemblance to the narrative self, that chatty part of our mind which takes direct experiences, adds interpretations to them, and tells stories about them to both ourselves and others.

Most days I don't have a whole lot to say in response to a question like, "Have you done anything exciting lately?" My honest answer would be, not really, unless you call going to my Tai Chi classes, grocery shopping, walking the dog, exercising, watching TV, reading, working in the yard, writing blog posts, and such to be exciting. 

But I try to keep in mind that even when I was able to travel, those trips didn't take up much of my life each year. Most of the time I was doing just what I do now, unexciting stuff. 

What's changed, really, is that now I don't have recent memories of traveling here and there, nor do I have anticipations of future distant travel, because that isn't going to happen given my health condition. Thus my experiencing self hasn't changed all that much, while my remembering or narrative self has. 

It's a hard habit to break, recollecting pleasant memories and envisioning future enjoyable experiences. I've been doing this my entire life, so focusing more on the present moment is a challenge for me.

However, this feels like something I need to do.

Otherwise I'm going to have regrets about what I'm now unable to do -- travel easily, or far. My present moment experiences are fine. As I said in yesterday's blog post, echoing a Sufi saying, my new adage is I'm a child of the present moment, who finds delight in small things. 

Obviously at 69 years old, I'm not really a child.  

But I aspire to being able to take childish delight in the ordinary things of life that surround me. My experiencing self can enjoy these small things. My remembering self, or my narrative self, won't have much to say about them. No big deal.

I'm already wordy enough. More present moment experiencing and less mental chatter about the past or future is what I need right now.

(Here's a link to someone else's well-written words about the experiencing self and the remembering self.)

New life goal: be a humorous mindful Taoist stay-at-home

I find many things weird. Most of them reside within my own cranium. After all, that's really the only place weirdness resides -- in a human mind. Like, mine.

One of my weirdnesses is that even though I'm an avid blogger, for the past year I've largely avoided writing about the Central Fact of my life since May 2017.

Namely, my 68 year-old bladder deciding to call it quits during a visit to central Oregon, which led through a series of increasingly disturbing events to my current state of being an Old Man Who Has to Pee Via a Catheter. 

I can sum up my situation in two words: not fun. At one point I could have done this with one word: depressing. Fortunately, I've moved on to not fun, though depending on my mood, at times I'd use stronger language, like fucking awful.

I'm not sure where I am on the Seven Stages of Grief.

I'm past Shock, mostly. Denial is tough to hold onto, since I've been doing my catheterization thing for a year. Anger is there, though not as much as it used to be. There's nobody to Bargain with, since three urologists have told me my damn bladder is never going to recover, and I don't believe in a supernatural being who could, say, accept my immortal soul in trade for a fully functioning bladder.

(Since I don't consider that I have an immortal soul, I'd be glad to surrender that nonexistent thing.)

I've gone past Depression with the aid of a Mirtazapine prescription and the passage of time. So that leaves Testing, since I'm nowhere near Acceptance of a condition that I find annoying, irritating, limiting, and distasteful. 

Testing, says the image above, involves finding realistic solutions. That's a downer, because I'm much more attracted to unrealistic solutions, like staying high or drunk all of the time. 

Given that I've meditated every day for the past fifty years or so, having started during my college Yoga phase in the late 1960's, I've been thinking that more mindfulness could be a step toward a realistic solution, as I wrote about on my other blog in "Mindfulness has become my meditation."

So I've been reading Jon Kabat-Zinn's big thick 600 page book about mindfulness-based stress reduction, "Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness."

One of the things I like about mindfulness approaches is that they don't have the sort of goal-oriented focus that meditation often has. Like, God-realization, a calm mind, emotional control, higher powers, that kind of stuff. Instead, Kabat-Zinn says that mindfulness is simply about remembering as best we can to be present in all our waking moments.

So if I'm sad about having to spend the rest of my life sticking a plastic tube up my uretha five times a day so I can artificially pee and avoid kidney damage, that's OK. I just need to be aware that I'm sad. And because emotions always are changing, at some point I will be less sad. Maybe even happy.

Until I'm sad again.

Which for me these days, doesn't take long. Unless I drink coffee. Then the sadness is temporarily ameliorated, though the urge to pee is hastened. So that's the problem with being high on caffeine all the time, which otherwise strikes me as a fine idea.

It's tough for me to travel long distances given my bladder problem. So I've only left Salem four times in the past year: twice to go to Portland for medical appointments, and twice to central Oregon to spend time at a house in Black Butte Ranch that we have a 1/4 share interest in.

Since mindfulness has roots in Buddhism, and I find Buddhism unduly serious compared to Taoism, I figure that part of my "realistic solution" should be grounded in Taoist philosophy. Here's a quote from the Gia-Fu Feng and Jane English translation of the Tao Te Ching that offers up a semi-spiritual rationale for staying close to home.

A small country has fewer people.
Though there are machines that can work ten to a hundred times faster than man, they are not needed.
The people take death seriously and do not travel far.
Though they have boats and carriages, no one uses them.
Though they have armor and weapons, no one displays them.
Men return to the knotting of rope in place of writing.
Their food is plain and good, their clothes fine but simple, their homes secure;
They are happy in their ways.
Though they live within sight of their neighbors,
And crowing cocks and barking dogs are heard across the way,
Yet they leave each other in peace while they grow old and die.

Sounds good. Aside from the knotting of rope in place of writing part. I'm going to stick with my MacBook Pro. 

Thus now I've got mindfulness and Taoism as two legs of my Testing/seeking realistic solutions stool. It seems like another leg is needed for stability. I'm leaning toward humor, especially of the cynical, self-deprecating variety, to help prop me up while I'm staying mindfully close to home, leaving my neighbors in peace while I grow old and die.

David Sedaris is a good humor model for me to emulate. I read him early on in his writing career, then lost touch with him. Recently I saw Sedaris interviewed by Steven Colbert, and I liked his style. Got to admire a gay guy who wears shorts to an interview on network TV.

Having bought Sedaris' new book, Calypso, I'm feeling more inspired to take a stab at writing about the humorous side of using a catheter. That will wait for another blog post, since I've blabbed on enough in this post about my favorite subject, me. 

I'll simply note that I admire David Sedaris' honesty and sometimes caustic humor. He is marvelously adept at writing about everyday life in ways that simultaneously make me want to laugh and cry. Calypso, I've read, is a bit darker than his other books, which is fine with me, since it matches my mood most days.

Here's a passage from the book that's appealing because my bladder problem has caused me to follow an ironclad rule: I never go anywhere where I can't escape -- for whatever damn reason my body or mind conjures up. Here Sedaris is talking about friends of his partner (maybe husband), Hugh.

His friend Jane saw some ugliness as well, and though I like both her and Sue and have known them for going on twenty years, they fall under the category of "Hugh's guests." This means that though I play my role, it is not my responsibility to entertain them.

Yes, I offer the occasional drink. I show up for meals but can otherwise come and go at my leisure, exiting, sometimes, as someone is in the middle of a sentence. 

My father has done this all his life. You'll be talking to him and he'll walk away -- not angry but just sort of finished with you. I was probably six years old the first time I noticed this. You'd think I'd have found it hurtful, but instead I looked at his retreating back, thinking, We can get away with that? Really? Yippee! 

Between the black and white of suicide, there's a gray area

The recent suicides of Anthony Bourdain and Kate Spade have gotten people talking about the problem of taking one's own life. That's good. 

But I don't feel like we're talking about an important issue that is almost a taboo topic: the gray area between (1) the black badness of people killing themselves when there are better options available to them, and (2) the white goodness of people taking control of their death when they are suffering and only have a few months or less to live.


What I see as a gray in-between area is when a person considers that life doesn't seem worth living, but they aren't terminally ill, and there really isn't much or anything that can be done about the bleak situation they're in.

Is it OK to kill yourself in such a situation? I lean toward saying "Yes," but I'm not completely sure. Which is why I call it a gray area. 

Now, I want to be clear that my use of the term gray area doesn't mean that someone is semi-suicidal, as in this person's description of how they feel most days. What I'm talking about is the middle ground of a societal agreement about when it is right or wrong to kill yourself.

As noted above, virtually everybody would agree that if a person is thinking of committing suicide when there are better options open to them (such as mental health treatment, or changing one's situation), every effort should be made to prevent them from taking their life.

And at the other end of the suicide spectrum, if medical professionals agree that someone is near death, and they're seriously suffering from their terminal condition, there's increasing agreement that assisted suicide, or medical aid in dying, is morally acceptable. 

(Seven states currently allow this, including Oregon, where I live.)

That's the black and white of suicide. The difficult gray area is when a person has very good reasons to feel that they don't want to keep on living, and there's little or no chance of changing those reasons, and they aren't terminally ill.

On a personal note, fairly recently I had direct experience of what it is like to be so depressed, the idea of not being alive held considerable appeal for me. Fortunately, I got help with my depression and am feeling much better now. I wrote a blog post during my dark period, "Too depressed to do anything else, I'll write about my depression."

I mention this because it was a wake-up call for me, given that I've been a person who had a distinct fear of death, which to my atheist mind means being gone forever -- a disturbing sensation I described in "Death and the primal fear of non-existence." 

So it was a decidedly unusual experience for me to be aware of my thoughts about death during my depressed period, which were along the lines of You know, being dead doesn't seem so scary anymore. In fact, it sounds pretty damn good.

Thus even though I wasn't really in the gray area that I'm talking about here, because my suicidal tendency was situational, curable with an anti-depressant, plus the support of loved ones and the passage of time, now I have a better understanding of how someone can feel like life isn't worth living, because the situation they're in is just so damn shitty.

And sometimes shitty situations can't be changed, as when someone has a chronic medical condition and it seriously affects their quality of life. 

Like I said, I'm undecided about this gray area of suicide.

My leaning is toward society being more accepting of people taking their own life after careful and full consideration of the pros and cons of committing suicide, when there is little or nothing that can be done to change the situation that is causing them to contemplate choosing death over life.

Autonomy is a wonderful thing. Conversely, feeling trapped is a bad thing. I readily admit that even in my current non-depressed frame of mind, I feel comfort in the fact that if the quality of my life ever degrades to a really low point, there's the option of ending my life.

Writing those words just struck me as strange. I almost feel ashamed, or embarrassed, to have said what I just did. But it's how I feel. And I know that I'm not alone in feeling this way. 

The strangeness of saying "there's the option of ending my life" seems to come from a taboo in our society against talking about the suicidal gray area I'm referring to. 

We're accustomed to urging people contemplating suicide for bad reasons to seek help. Increasingly, we're accustomed to praising people who are terminally ill and choose to hasten their death to avoid needless suffering. But there's an awkward silence about those who have good reason to feel that life isn't worth living, and those reasons are difficult or impossible to change.

I don't know how to deal with this gray area. I just wish that as a society, we could talk about it more openly and honestly. This blog post is my small step in that direction.  

In my final hypnosis session I meet the V.P. in charge of my goals

My sessions with Emily Cahal of Salem Hypnosis Solutions have been delightfully varied. Today, my fourth session, and the last for a while, featured me meeting the Vice-President of my psyche in charge of achieving goals. 

(I've described the three previous sessions here, here, and here.)

Per usual, before the actual hypnosis session Emily and I talked about how things have been going with me since we last met. Naturally the focus was on how I've been dealing with my chronic health problem, a bladder condition, since that was my motivation for giving hypnosis a try.

I told her that though it's difficult to prove cause and effect, I felt like the previous session did help me come to grips with a "caged" feeling of being unduly constrained by my health problem, which makes traveling long distances quite difficult. 

A symptom of that feeling had been a strong desire to revisit my motorcycling/scootering days, since my mind argued "If you can't travel very far, you should find a way to make traveling locally more fun." But after considering the pros and cons of a Can Am Spyder, or such, after our third session I found that desire had abated a lot. Almost non-existent, in fact.

Instead, I'd been doing my best to focus on what sounds like a platitude (because it is), yet is something I struggle to put into effect: Be Here Now. 

A motorcycle forces this, because otherwise you're at high risk of getting into an accident. But I can stimulate my senses and quiet my "monkey mind" without getting on two motorized wheels. I can simply pay closer attention to what is right at hand, rather than what awaits me around the next bend of the course my life is taking.

So that led to a theme of the pre-session discussion between Emily and me: how I need to find a better balance between (1) setting a goal and working to achieve it, versus (2) relaxing into the reality of the present moment. 

Before a chronic health problem became a big part of my life, I'd always felt that I could overcome my problems. Or at least, stand a good chance of doing so with sufficient effort and energy. So the frustration of being told by three urologists that I've got to cope with my problem for the rest of my life has sent my psyche into a sort of hamster-wheel frenzy.

It wants to escape the cage I feel myself in, but there's no way out. 

Emily summed things up in a wise fashion. She told me that instead of seeking a solution, I should aim for "mastery." Meaning, I should try to deal with my health problem, and problems in general, with less emphasis on a particular outcome. Instead, mastering a problem might not result in anything changing with the problem itself, but rather with how I look upon it. 

At least, that's how I view the term, "mastery."

During the hypnosis session Emily started off, as before, by getting me into a pleasantly relaxed state.

She had me imagine walking down a forest path and coming to a clearing. In the clearing was a crystal clear pond with pebbles on the banks. I sat down on a warm flat rock, picked up a bunch of pebbles, and tossed them one by one into the pond, watching the ripples dissipate before I tossed the next pebble, which I could see sinking down below the surface to the bottom of the pond.

After that, my favorite part of the session was meeting up with a personified part of myself, the Vice-President in charge of my goals. He had a great corner office with a beautiful view. But I was the President, so I got to give the V.P. some marching orders, along with a critical assessment of how he's been doing.

In response to Emily's questions, I told the guy that while I appreciated his hard work, he needed to chill out more. Relax, dude, sometimes you try way too hard. That was part of his new job description. 

Several times Emily had noted in our pre-session conversations that intelligent people, among whom she was kind enough to include me, often are prone to perfectionism. I guess I knew that about myself, but it was good to hear it nonetheless, because sometimes the most obvious facts about ourselves are what we pass over.

So it was healing to be able to talk to the goal-setting side of myself, that Vice-President who is prone to pushing too hard when there's a brick wall between me and what I desire. Frustration results when I keep on forcing what is immovable. Pushing the river, in other words.

Interestingly, when I Googled that term and found the above link, the reference was to a chronic health problem:

The simpler description is this: my chronic disease can make me feel I’m drowning. The personal image that comes to mind is Venice during a heavy rainstorm -- when there is also an acqua alta (high water) alert. Then the canals overflow and flood the city. The only way to navigate is by walking on the top of the infamous catwalks the municipality quickly installs. During those times I have quite literally felt water flowing above and beneath me.

(I just ordered the book mentioned in the Psychology Today article, "Dancing at the River's Edge.")

It's hard to break life-long habits. I've always enjoyed the sensation of working hard to power through a problem. Even if I couldn't succeed, or achieve most of what I sought, my self-image was of someone who never quits, who fights on against long odds, who does his best to attain a Possible Dream.

But now I'm faced with what almost certainly is an Impossible Dream: having a functional bladder again. 

That isn't the worst thing in the world, not even close. I'm thankful that I don't have a host of other health problems that would restrict me even more, or be more difficult to deal with on a daily basis. Of course, with time I might have one or more of those worse health problems.

Emily Cahal has helped me better understand what I already knew: it doesn't make sense to get all tense and worked-up over a goal whose purpose is to make me happier and more relaxed. Down that way lies, if not madness, unnecessary anxiety. 

I'm going to do my best to master the art of trying not to try, of simply doing rather than worrying about what I'm doing while I'm doing it. Yeah, I know this sounds obvious. But if I'd been able to see the obvious, I never would have sought the help of Emily and hypnosis. 

Which, I'm really glad I did.  

My third time is a purple charm with Emily Cahal of Salem Hypnosis Solutions

Today I had my third hypnosis session with Emily Cahal. I've blogged about the first two sessions here and here. It left me feeling good.

Not that the first sessions had me feeling bad. Quite the opposite. I simply felt like today we went a bit deeper into my psyche, which might be a result of me becoming more familiar with Cahal's style and with hypnosis in general. 

I like how Cahal blends traditional counseling with hypnotherapy.

First we talked for about fifteen minutes about what's been going on with me during the past week. My focus, of course, was on my Damn Bladder Problem. (Hopefully I'll eliminate the "damn" in my description of it when I feel more comfortable with a new normal, as the saying goes.)

I told her there were two ongoing storylines in the psychological drama within my head. One is a lingering sense of self-criticism and self-blame caused by my feeling that I failed to recognize and deal with early signs/symptoms of the bladder problem. 

I realize this sort of judgement isn't productive, but it's been tough for me to stop ruminating about it. Cahal had an interesting observation that rang true to me: when I piece together chains of cause and effect that led to my health problem, I'm not seeing the entire picture.

Meaning, ruminators like me seize on parts of the big picture, yet fail to grasp the entirety of what went on. So when I berate myself for not having gone to a urologist before my bladder decided to go on strike, I'm not realizing that whether or not I did this or that, the outcome might very well have been the same.

That made me feel a bit better, so thanks to Cahal for that.

My second concern was feeling confined, like I'm in a cage -- albeit an expansive one -- since my bladder problem makes it difficult to travel, and my peeing now is on a schedule, rather than being "free form" like it was before. 

I told Cahal that my wife, Laurel, has been looking into van conversions that feature a mobile bathroom. While I appreciate Laurel's concern, and recognize that this could make it easier for me to travel, I'm not all that enthused about the idea, since it screams "old man with a bladder problem" to me.

What does excite me is memories of how much I enjoyed my Suzuki Burgman 650 scooter that I rode for three years a while back.

Because I feel caged-in by my health problem, and motorcycle enthusiasts like to call cars "cages," this helps explain why my psyche has been longing for a freer form of transportation, maybe a three-wheeled Can-Am Spyder for increased safety over what a regular motorcycle offers.

So those themes set the stage for the hypnosis session. 

After getting me nice and cozy with eyes closed in her zero-gravity chair (poetic license, of course) via progressive relaxation of my head, eyes, arms, legs, and such, we went back in time to my troubled 16-year old self.

This was when I first recalled feeling that all was not well with the world, that it was really shitty, in fact, because my mother's alcoholism was in full bloom, and things got really weird at night when she was drinking heavily. Now, the first few times Cahal had me recollect childhood memories struck me as a bit strange, since I had trouble seeing a connection with my present problems.

But I'm beginning to understand the wisdom of why she does this in her hypnosis sessions. At least, I'm gaining some understanding from my point of view.

Cahal asked me if the painful experiences my 16-year-old self had were caused by me, or by the situation I was in. I had to answer, "the situation," since I couldn't see how I was responsible for my mother's drunken ravings that I couldn't help hearing, even with a pillow over my head, from the bedroom next to hers.

Likewise, my current difficulties aren't really caused by me, even though I'm the one experiencing them. They're caused by my Damn Bladder Problem. At least, most of them. (Naturally I wasn't perfectly happy before my bladder problem; I just had different sorts of difficulties.)

So it was freeing to relive some painful memories and realize more fully than before that I wasn't the cause of them, nor was my mother, really. We were both trapped in a situation not of our own making -- which fits with my long-held conviction that free will is an illusion, albeit an illusion that is very difficult to see through, or give up.

My favorite part the hypnosis session was near the end, when Cahal introduced me to a bag that was purple for some reason (best not to wonder too much about the why's and wherefore's of hypnosis, especially during a session; but I couldn't resist Googling this, and did find a You Tube video about a purple bag hypnosis session that seems similar).

The marvelous thing is that everything went into the bag. I mean, everything. 

Cahal likely was reading from a script (I had my eyes closed, so couldn't tell), but this doesn't matter. If it was a reading, it was a highly dramatic reading, beautifully done. What went into my purple bag was every conceivable thought, memory, emotion, experience, desire, fear, pain, worry, joy, experience, imagination, whatever. 

The bag must have been infinitely expandable, because by the time Cahal was done, I couldn't envision any part of me, or my life, that wasn't in the bag -- past, present, future, it all was in the purple bag.

Then...the good part. 

I was asked to take out of the bag what I really needed, and wanted. Cahal loves the word "useful," so I'm pretty sure she used that term to describe what should come out of the bag. This is the stuff I need to keep. The rest could be discarded. Which we did in a football-like fashion.

The bag was kicked away. Far away. So far away, it went into interstellar space. And beyond. For all I know, the bag has reached the edge of the known universe. Maybe even the edge of the unknown universe. 

Now, as with my other descriptions of my hypnosis sessions, I realize that I'm not doing justice to them. And I'm being much more analytical in those descriptions than my state of mind was during the sessions. Like I said, for me hypnosis is an intriguing blend of counseling and... something else that's difficult to describe.

I only speak a few words during our sessions. So the work that's being done, and it might be better to call it play rather than work, is happening mostly on an unconscious or subconscious level. Or rather, on a visualizing/feeling level rather than conceptual/thinking level.

I have a feeling -- that's all it is, a feeling -- that the benefit I'm getting from Cahal's hypnosis sessions isn't something that I'm aware of. Which sounds sort of strange, since usually we know whether we're getting our money's worth from someone. Yes, ordinarily this is true.

But I've read enough neuroscience books to realize that most of what we are isn't known to us.

Our conscious awareness is just the tip of a much vaster unconscious iceberg. A thought comes to mind and we think, "I'm having a thought." Actually, though, the thought came from elsewhere, not from an "I," because there is no one at home inside my head, certainly not me. 

My second hypnosis session got me way small

As I said in my blog post about my first hypnosis session with Emily Cahal of Salem Hypnosis Solutions, we had to make a decision about which way to proceed.

She told me that there were two basic ways we could go with hypnosis. Basically, one way would focus on my particular presenting problem, so to speak. The other way would be more general, delving into my habitual way of dealing with life's problems. 

Interestingly, as we chatted before beginning the second session, Cahal indicated that though we went the more general way last week, she favored going the more specific way this time. Which was just how I'd been feeling.

It wasn't that I didn't find value in delving into some childhood memories of how I deal with stress. I simply wanted to experience a session or two where we focused specifically on my bladder problem, and my worries associated with dealing with it.

So last Monday Cahal started off like the last time, getting me loose and relaxed with eyes closed through what was a lot like a guided meditation. Body part by body part, head to toe, we got rid of physical tension I was carrying. 

Then I got small. Psychologically. Cahal had me imagine a Small Brian who could go anywhere in my body, sort of like Fantastic Voyage without the submarine. Small Brian journeyed to my bladder, where he reported on how things felt down there.

Then I got to imagine teeny tiny massage therapists doing their thing on tight muscles in my bladder area. That was even more fun. As an added benefit, Cahal suggested that I envision some soothing lotion being applied to the muscles also, to get them even more relaxed.

I must have been more into a hypnosis zone this time, because I don't recall as much from the second session.  But I do remember being guided into an examination of my Book of Life.

The book basically contained a record of all my experiences.

Cahal had me zero in on some noteworthy negative experiences, those that carried some powerful emotional residue. She explained that the pages of my Book of Life were encased in acrylic, or some such material, so that when I touched them, I wouldn't feel the hurt they embodied.

I didn't reveal what the pages consisted of. I just recollected various experiences one by one. Cahal then said that we were going to take out that page, crumple it up, and throw it away. Bingo! Bad experience discarded. 

To add some extra oomph to the exercise, with my eyes closed I could hear Cahal ripping a piece of paper from a notebook, crumpling it up, then tossing it away. As I recall, after we'd discarded a bunch of unwanted pages from my Book of Life, they were incinerated into ashes, then the ashes were thrown to the winds. 

Can't get more gone than that. In my imagination, at least. It remains to be seen how really gone those negative experiences are from my psyche. I can only hope...

What gives me extra hope is some scientific findings contained in an article in the April 2 issue of The New Yorker, "Are We Already Living In Virtual Reality?." I'd brought a copy of the article to give to Cahal, since some portions of the piece about Thomas Metzinger, a philosophically-minded neuroscientist, seemed highly relevant to hypnosis. 

As you can read in the excerpt below, Metzinger speaks about our inability to recognize the unconscious mental models that determine how we experience reality. In his book, The Ego Tunnel, which I've read and enjoyed, Metzinger speaks of the walls of the tunnel as being transparent to us. 

Further, he says in the book, "Although our brains create the Ego Tunnel, no one lives in this tunnel. We live with it and through it, but there is no little man running things inside our head. The Ego and the Tunnel are evolved representational phenomena, a result of dynamical self-organization on many levels."

Here's the excerpt from The New Yorker article:

In a Frankfurt cake shop—“They say this is where Adorno took the women he seduced; many historical conversations happened here!”—Metzinger teased out the implications of this view of existence. “Do you know what an ‘illusion of control’ is?” he asked, mischievously. “If people are asked to throw dice, and their task is to throw a high number, they throw the dice harder!” He believes that many experiences of being in control are similarly illusory, including experiences in which we seem to control our own minds. Brain imaging, for example, shows that our thoughts begin before we’re aware of having them.

But, Metzinger said, “if a thought crosses the boundary from unconsciousness to consciousness, we feel, ‘I caused this thought.’ ” The sensation of causing our own thoughts is also just another feature of the self-model—a phantom sensation conjured when a readout, labelled “thinking,” switches from “off” to “on.” If you suffer from schizophrenia, this readout may be deactivated inappropriately, and you may feel that someone else is causing your thoughts. “The mind has to explain to itself how it works,” he said, spreading his hands.

Lately, Metzinger has been thinking about his own experience as a meditator. At the center of the meditative experience is the exercise and cultivation of mental autonomy: when the meditator’s mind wanders, he notices and arrests that process, gently returning his mental focus to his breath. “The mind says, ‘I am now re-directing the flashlight of my attention to this,’ ” Metzinger said. “But the thought ‘I am redirecting my mind-wandering’ might itself be another inner story.” He leaned back in his chair and laughed. “It might be that the spiritual endeavor for liberation or detachment can lead to new illusions.”

He looked at me reassuringly. “This doesn’t mean that nothing is real,” he said. “It doesn’t mean that this is the Matrix—the simulation is running on some hardware. But it does mean that you are not the model. You are the whole system—the physical, biological organism in which the self-model is rendered, including its body, its social relationships, and its brain. The model is just a part of that system.” The “I” we experience is smaller than, and different from, the totality of who and what we are.

It turns out that we do, in this sense, possess subtle bodies; we also inhabit subtle selves. While a person exists, he feels that he knows the world and himself directly. In fact, he experiences a model of the world and inhabits a model of himself. These models are maintained by the mind in such a way that their constructed nature is invisible. But it can sometimes be made visible, and then—to a degree—the models can be changed.

Something about this discovery is deflating: it turns out that we are less substantial than we thought. Yet it can also be invigorating to understand the constructed, provisional nature of experience. Our perceptions of the world and the self feel real—how could they feel otherwise?—but we can come to understand our own role in the creation of their apparent realness. “The compensation of growing old,” Virginia Woolf writes, in “Mrs. Dalloway,” is that, while “the passions remain as strong as ever,” we gain “the power which adds the supreme flavour to existence,—the power of taking hold of experience, of turning it around, slowly, in the light.”

Here's how my first hypnosis session went

Today I had my first real hypnosis experience with Emily Cahal of Salem Hypnosis Solutions.

Back in college I'd dabbled in self-hypnosis as taught by a Yoga teacher I was studying with.

And I'd seen a form of "show business" hypnosis during an assembly at a high school where I briefly was a teacher's aide following my college graduation. A hypnotist did his thing on stage with a female student, then told her to go find Paul Newman in the audience. She walked by me, looking into the bleachers, then leapt into the second row where I was sitting and gave me a hug. 

I suspect I was singled out as Paul Newman because I was older than the other students, but at the time it made me feel a bit movie star'ish regardless.

During the introductory part of today's session Cahal made clear that what she does is nothing like that sort of hypnosis. She explained that much (or most) of what results in our thoughts, feelings, and actions originates in the unconscious, which isn't under our direct control. 

My reason for making an appointment with Cahal was that my wife, a retired psychotherapist, thought it could be helpful in getting me to relax more with what I like to call my Damn Bladder Problem. I'm managing OK with it, but sometimes tension, anxiety, or some other force makes it difficult for me to do the self-catheterization owing to a tightening-up in my pelvic region.

As I explained to Cahal, I can feel relaxed and "normal" (whatever that is), yet at times some of my bladder muscles clearly have a mind of their own. So I was hoping that hypnosis could help me stay in a relaxation sweet spot.

She told me that there were two basic ways we could go with hypnosis. Basically, one way would focus on my particular presenting problem, so to speak. The other way would be more general, delving into my habitual way of dealing with life's problems. 

This second way would take us into my childhood where, Cahal said, we first develop our coping mechanisms. I told her that I liked that idea better, since I'd like to be able to relax more generally in various types of situations, not just those involving my chronic health problem.

We talked some about a subject that fascinates me, both intellectually and personally: how efforts to resolve a problem, which in my case was excessive tension, often backfire because effort can exacerbate the problem -- such as not being relaxed enough. It's kind of like the familiar "don't think of an elephant."

Trying not to do something can paradoxically make that something happen. So this is an argument in favor of hypnosis, which works on more of a subconscious or unconscious level. 

I then was invited to sit in a zero gravity chair that, when reclined, put me in a pleasingly comfortable position. Cahal started off by inviting me to relax both physically and mentally with my eyes closed. 

I won't go into too many details of the hypnosis session. I'll just hit some highlights that struck me as particularly interesting.

These involved a latter part of the session where I was interacting with my youthful self, initially 10-12 years old, then more like 16 years old as Cahal led me into some questions about my relationship with my mother during a period when her alcoholism was in full bloom.

She had mentioned that I shouldn't over-think my responses to her questions, but rather respond intuitively with what first popped into my head. This made the hypnosis session quite different from a regular counseling session, which in my experience involves more cognitive deliberation.

Heart versus head, basically.

The most moving part of the session for me was when I was invited to give my youthful self advice from the perspective of my current 69 year-old self. I have to admit that I've been skeptical of the value of "inner child" work, because rightly or wrongly it's seemed to me that I've pondered my childhood, with its mixture of dysfunction and normalcy, in sufficient depth to make any further pondering superfluous.

Hypnosis, though, had some surprises for me.

I found it easy to give some advice to the youthful me as if he was still a child: "Don't worry, everything changes, mostly for the better." I also enjoyed Cahal's observation that it was the situations I found myself in that were the problem, not me.

She asked if I felt I was a good person, and if I felt my mother was a good person. I answered "yes" to both questions. It was freeing, in a way, to speak out loud what I'd said to myself countless times after my mother died in 1985. Well, not only to myself, but also to my imagined mother (being an atheist, I don't believe she can hear me now).

"You were the best mother you could be, so thanks for that." 

We then moved to the present, with Cahal inviting me to imagine my youthful self co-existing with my present day self. Give your youthful self a hug, she said.

I then realized something that had never occurred to me before: I couldn't recall ever being hugged by a man during my childhood years. I had no contact with my father after my parents divorced when I was three, or thereabouts. My male relatives weren't hugging types. So when I visualized my youthful self getting a hug from my current self, it almost brought tears to my eyes.

Now, I don't know what all this means. Much more, of course, occurred during the hour or so hypnosis session. I don't know what all of that meant either. 

Strangely, which really isn't so strange, really, this is why I feel positive about hypnosis after my first experience with it.

I've done an awful lot of conscious deliberating about my life, both past and present, since my bladder problem changed a lot for me. If all of that deliberating had been fruitful, I wouldn't be feeling the need for help with relaxing into what could be called my "new normal."

(I don't like that new normal, so I've been loathe to use that term, but as time goes on I'm coming to recognize that reality doesn't really give a shit about what I like or don't like, it gives what's coming to me regardless.)

So I enjoy the feeling that what occurred in today's hypnosis session is akin to seeds planted in my unconscious which will germinate outside of my awareness. I've got several more sessions scheduled; thus, more seeds should be planted. At the very least, I'm trying something new, and this old dog should be able to learn some new tricks.

I want to mention that throughout the hypnosis session I felt quite normal, not at all under the control of the hypnotist. It was a lot like a guided meditation, though I readily admit that almost certainly there was more going on behind the scenes of what Cahal was doing than I'm aware of. 

Here's how Emily Cahal describes hypnosis in the FAQ page on her web site. This rang true for me, in part because I'm habitually prone to locking my car door, walking away a few steps, then returning to check whether I really did lock the door. 

HOW DOES HYPNOSIS WORK?

Using analytical hypnosis to address issues, such as: weight loss, smoking, depression, childbirth, stress, sports performance, confidence, habits, cravings, and fears, is about behavior modification. There is a developed behavior that is guiding your automatic reactions to events.

These reactions are based on your previous experience. When you are trying to change a behavior, it can be a very real struggle as your conscious mind attempts to change what your subconscious mind already has in place. You can compare it to the mindless way you may have trained yourself to lock the door when you get in the car. At first it takes conscious effort. Eventually it becomes automatic, to the point that you may not even know if you locked it or not without checking. Once that simple habit is in place, changing it is possible with some effort and repetition.

A habit can become stronger and more complex when you apply emotions and time. If someone has a strong fear about car doors being unlocked, they probably took on that fear at some fearful time in the past. It could have been someone’s innocent statement about car-jackings, a horror movie or a personal fearful moment. Any of those situations have the potential to create a fear behavior. The emotional content of this habit makes changing that behavior more involved. The simple fact that our mind does create behaviors means that our mind can change them, if we understand how.

Hypnosis has shown to be a rapid way to change behaviors, especially with modern hypnosis techniques. When using the very same principles behind our natural behavior creation, we can easily quit old habits as well as create new ones.

Time slowing down is a side effect of my chronic health problem

By and large, I'm sticking with my previous assessment of my atonic, underactive, neurogenic, screwed-up bladder: IT SUCKS, big time. 

But here's a positive side effect. Time has definitely slowed down for me.

Since I'm 69, and not getting any younger (which seems to be standard for everybody), I'm pleased that the days have been passing more slowly since my bladder decided to go on what appears to be a permanent work stoppage for the rest of my life.

I'm curious whether other people with chronic health problems have experienced the same phenomenon, time slowing down. Naturally I Googled this, but couldn't find any references to it. 

So on the chance that I'm the first person in the history of the world to have discovered that time slows down in the presence of a chronic health problem, I'm non-humbly calling this the Hines Effect after moi. 

(Hey, since I'm not going to live forever, leaving behind a scientific term that's named after me is a far distant second best.)

What seems to be happening is that because I have to self-catheterize about five times a day on a fairly strict schedule, rather than heading to a bathroom on demand as I used to do, I've had to become much more self-conscious of everything having to do with urination.

How much I'm drinking. What I'm drinking. Where I need to be when the time for self-catherization comes around. How my bladder is feeling, urge-to-urinate-wise. 

It's a lot like enforced mindfulness, albeit of a rather strange variety. I'm having to pay way more attention throughout the day to something that I used to take for granted: peeing. 

The subjective experience that results for me is of time passing much more slowly that it did before my bladder went on strike.

(After a serious urinary retention episode about 10 months ago, I can urinate some on my own, but not nearly enough to keep up with what's being produced by my kidneys; hence, the need to self-catheterize.)

I'm pleased that time has slowed down, though I'd be even happier about this if my life were more pleasant. But if I didn't have my chronic health problem, time would have kept on speeding by as it did when I was "normal." 

My pre-bladder-problem sense of time was that I was having a birthday about every six months, and reading the Sunday paper every couple of days. Not literally, of course, but subjectively. Back then I sort of cruised through life on auto-pilot, because I was healthy and enjoyed my various routines.

Now, I'm having to pay close attention throughout the day to what my bladder is doing, and notably, isn't doing. The five times I day I self-catheterize require a certain ritual that is considerably more involved than simply popping into a bathroom and peeing away.

My theory -- which is needed to justify naming it the Hines Effect -- is that my experience of daily life now has considerably more events or impressions in it. This produces the sensation of time slowing down, as noted in a Psychology Today article, "How the Brain Stops Time."

One of the strangest side-effects of intense fear is time dilation, the apparent slowing-down of time. It's a common trope in movies and TV shows, like the memorable scene from The Matrix in which time slows down so dramatically that bullets fired at the hero seem to move at a walking pace.

In real life, our perceptions aren't keyed up quite that dramatically, but survivors of life-and-death situations often report that things seem to take longer to happen, objects fall more slowly, and they're capable of complex thoughts in what would normally be the blink of an eye.

...fear does not actually speed up our rate of perception or mental processing. Instead, it allows us to remember what we do experience in greater detail. Since our perception of time is based on the number of things we remember, fearful experiences thus seem to unfold more slowly.

I'm not afraid, but my chronic health problem does produce a pervasive sense of caution, wariness, concern. Thus I'm having to remember more things than I did before, which apparently produces the feeling of time slowing down. 

All in all, I'd rather have a functioning bladder with time going more quickly for me.

But it's good that a crappy situation has the side benefit of elongating my subjective experience of life, since while I'm not as happy as I was before, I still find life very much worth living and generally pleasant. 

Here's how I feel about my atonic, underactive, neurogenic, screwed-up bladder

Regarding the title of this blog post, in two words, IT SUCKS. Big time. 

Before I elaborate on this, let me address what I tell myself, and what my wife tells me: there are many worse health problems. 

For sure.

Aside from not being able to pee properly without the aid of self-catheterization -- not fun, but better than getting kidney failure from a backed-up bladder -- I'm basically a pretty damn healthy 69 year old guy. 

I wouldn't trade my bladder problem for, say, cancer, heart disease, or loss of a limb. And I've no doubt that people with more serious medical problems than a FUB (fucked-up bladder) have good reason to tell me, Dude, consider yourself lucky.

Look, I know all this. Yet I'm still seriously pissed-off at not being able to pee.

I've described my urinary retention travails in previous posts in this blog's "My Peeing Problem" category. Most recently, I had a third urologist tell me that, to put this in non-clinical terms, I'm screwed. 

Not for a while. Not until drugs, or surgery, or pelvic floor therapy, or whatever, does its thing. For the rest of my life. My bladder, I've been told, has decided to go on strike for the duration. 

Well, more accurately it's on a perpetual work slowdown. I can still pee a little bit, but not nearly enough to keep up with what's coming into my bladder. So four or five times a day I use a catheter to do what my bladder no longer can handle: getting rid of urine.

As a journal article puts it, this is the Other Bladder Syndrome: Underactive Bladder.

Mostly people talk about needing to go too often. Indeed this was my problem until about six months ago. I had a mildly enlarged prostate that I thought was being treated adequately with Flomax and Avodart. 

I'd have to get up several times at night to pee, then go back to bed. On long flights I'd head to the lavatory more often than most of the other people on the plane. During intermission at a play I'd visit the restroom... just in case.

Belatedly, I now realize that I should have paid more attention to some increasing problems. Like, taking longer to get a urine stream going. And a few times, not being able to pee at all for a few hours, even though my bladder was full. 

Live and learn, as they say.

Unfortunately, I learned too late and am now suffering the lifelong consequences. As one urologist told me, the progression of BPH, an enlarging prostate, can occur so slowly, so gradually, it is like the proverbial frog being boiled in water.

If the heat is turned up slowly, it's hard to tell what's going on. Until you're cooked. Which, apparently, my bladder is.

Frustratingly, I've been told by several urologists, "You don't have a prostate problem; you have a bladder problem." But when I've pointed out that it must have been my prostate problem that led to my bladder problem, I basically have been told that it really doesn't matter what the cause was -- my bladder has stopped working, regardless.

So one reason I'm writing this post is to urge men to go to a urologist sooner rather than later. Don't ignore symptoms like taking a long time to get your urine flow going, or not being able to pee at all for a few hours even though you really need to go. 

I thought I was OK. I figured the medications I was on for BPH would take care of my prostate problem. I had no idea that an enlarged prostate could lead to a non-functioning bladder. 

Like I said before, I was an idiot.

I ignored signs of impending urinary function doom because, well, just because. It wasn't that I tried to fuck up my bladder. That just happened, and now I've got to deal with a majorly sucky situation for as long as I live, according to three urologists.

An old friend had a favorite saying: No one's life is ever completely wasted. They can always serve as a horrible example to others. 

I'm hoping that by yelling loudly enough through my blog, and maybe other social media, I can reach at least a few other guys who might otherwise ignore the "gradually boiling frog" of what could become a serious bladder condition. 

I don't like my catheter-filled life, yet I've got no choice now but to deal with it. Other men with an enlarged prostate who are at risk of developing acute urinary retention that could turn into chronic urinary retention -- my fate -- you do have a choice. 

Don't follow my horrible example.

Do what I didn't do. Make an appointment with a urologist. Get checked out. Don't think that just because your family doctor has prescribed some prostate medications that seem to be working OK, you'll be able to pee pretty much normally for the rest of your life.

I thought that. I was wrong. And now my life sucks. Don't follow in my idiotic footsteps. Be smarter than me. In another post I'll explain exactly how my life sucks. For now, just believe me. It does.

(There are various terms for an under-functioning bladder: atonic, neurogenic. This Medscape article has lots of information about a neurogenic bladder. I forced myself to read it even though it was depressing. But if you want to motivate yourself to avoid getting a screwed-up bladder like mine, take a look at "Neurogenic Bladder.")

Five observations about Ed Asner's show, "A Man and His Prostate"

Last night my wife and I saw Ed Asner perform "A Man and His Prostate" at the Elsinore Theatre here in Salem, Oregon.  

It's an entertaining reading by Asner of what a different Ed, Ed Weinberger, wrote concerning what he went through after he collapsed while on a vacation in Italy. Since I'm not going to describe the show in much detail, you can read a review to learn about it. 

What I want to do is share five observations of A Man and His Prostate based on my personal experience of being also a man, with a prostate, who has had prostate problems of his own.

(1) Funny to hear about, not so amusing to experience. Weinberger's writing and Asner's performance are wonderfully light-hearted.

It was great to view the humorous side of a prostate problem. But I can pretty much guarantee that when Weinberger was experiencing his prostate travails ("two hours from kidney failure" due to urinary retention, we learn) there wasn't nearly as much amusement in them.

This isn't a criticism of the show, nor of the copious laughter that accompanied Asner's reading. It's just an observation that if someone with a serious prostate problem is overly sensitive, they might find that parts of the show hit an emotional tender spot.

(2) Flomax isn't as scary as Asner's side effects bit proclaims. Asner said Flomax, a commonly prescribed drug that makes it easier to urinate, "has more side effects than a divorce." 

That's certainly true. As regards potential side effects, at least.

But virtually every prescription drug comes with a disturbingly long list of possible side effects. Asner correctly said that dizziness is one of them, and I did indeed experience some dizziness after I took my first Flomax and got out of bed that night to, naturally, pee. 

But my bout of dizziness lasted only one day. Since, I haven't noticed any Flomax side effects. Your results may vary, of course. And I have to admit that this statement about Flomax on the Drugs.com site is worthy of making a joke about. 

Flomax may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

(3) My doctors always have done a digital prostate exam at my annual physical. Ever since I turned forty or thereabouts, I'm pretty sure I've always gotten the not-so-fun digital, as in finger, prostate exam that plays a pretty prominent role in A Man and His Prostate.

By its absence. Weinberger, as read by Asner, complains to his doctor (during a phone call after he was admitted to a Florence hospital) that he'd never gotten a finger up the ass in the many years they've had a doctor-patient relationship. 

This surprised me. I've always figured that men of a certain age get their prostate felt by their doctor through the rectum wall as a matter of course. I wrote about my experience of this after switching to a woman physician in "Female doctors do it better."

Naturally I was curious as to how the most intimate and least favorite part of a middle-aged male annual physical exam would go. I’m pleased to report, just fine. This was the first time that my prostate had been examined by a female doctor and I can confidently say that, based on this sample of one, women do it better.

More gentle, for sure. Smaller fingers are nice. More communicative too. This was my first prostate exam where I got a running verbal commentary from the doctor: “Hmmmm. Feels pretty normal. Regularly shaped. Just about normal size. Well, let’s make that a normal size for men your age who have a somewhat enlarged prostate.”

Great. A prostate exam is the only time you don’t want to hear from a female who is inspecting your genital area that you’re larger than average. Maybe Flomax will get me nearer to normal.

(4) There's good reasons to either get, or decline, a PSA test for prostate cancer. Actually the mention of a PSA test only came up after Asner's reading when a Salem Health (sponsor of the local show) physician talked about the importance of screening for prostate cancer, which is a major killer of men. 

I've gone back and forth on getting a PSA test after the United States Preventive Services Task Force recommended in 2011 against getting the test in most cases. I talked about this in "Why I still decided to get a PSA test" and "My prostate is featured in the AARP Bulletin!"

My basic feeling, which is still my current feeling, is that the results of a PSA test provide information that either can be accepted or ignored depending on a man's personal circumstances. The test isn't very accurate, but a positive result should lead to consideration of other sorts of tests than point to whether a prostate is cancerous. 

(5) Asner's worries about impotence after prostate surgery were amusing. My favorite part of the show was near the end, when Asner relates Weinberger's anxiety about not being able to get an erection following surgery (even after viewing Italian porn on his hotel room TV), with his wife arriving the next day. 

He has the bright idea that a massage with a "happy ending" is called for. And it would be for his wife -- an oft-repeated statement that always got laughs from the audience. 

Eventually we learn that there was indeed a happy ending to this tale, though not the one initially envisioned. 

Now, I'm no expert on impotence following prostate surgery. However, I do know that low dose daily Cialis has been approved by the FDA as a treatment for men who have both an enlarged prostate and erectile dysfunction at the same time. 

Just an observation, along with the four others that I've listed.

Bottom line: if you have the chance, go see A Man and His Prostate. Ed Asner is going to be 88 in a few days. It was inspiring to me, a comparatively young 69 year old, to see Asner perform the show so competently and vigorously. 

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.

Too depressed to do anything else, I'll write about my depression

It's a new experience, being depressed. Now, to be honest I haven't actually gotten a depression diagnosis. But my wife, Laurel, is a retired psychotherapist. And she tells me, "Brian, you aren't just tired. You're depressed."

At first I didn't believe her. But Laurel gave me a Psychology Today article, "Depressed Without Knowing It," and that helped to change my mind. 

I knew that several health problems had made me anxious, sad, worried, nervous about the future. I also was feeling a lack of energy, and was having trouble doing things that I used to enjoy. But since I'd never suffered from depression, being a pretty damn optimistic person, it took a while for me to realize that something different was happening to me.

Like, tonight I'd semi-happily watched an Oregon-Wyoming football game. Then I suddenly felt a wave of what felt like tiredness wash over me. I didn't feel like doing anything. All I wanted to do was lay on the couch. 

I told Laurel, "Sometimes doing nothing feels like what I want to do." 

She let me lay there for a while. Then -- and I'm really fortunate to have a live-in therapist -- Laurel knelt by the couch and started to talk to me. 

Did I want to watch TV? No, I said. Did I want to read something? No, I said.

We kept talking. Eventually I told her the truth: "The only thing I really feel like doing is writing about what I'm learning from my depression. For me, blogging is like a diary that I can look back on when, hopefully, I'm feeling better."

Interestingly, as soon as I decided to be open with the world (or rather, the few people who will happen upon this post and decide to read it), I sensed some energy returning to my addled brain. I guess this is why writers write when they can't do anything else.

I don't have any fantasies that a waiting world really cares about how I'm feeling. This is one of the things I'm learning from my depression: I don't matter to other people as much as I thought I did.

Understand, I don't mean that I don't matter to my wife, daughter, dog, and other loved ones. Rather, what I'm realizing is that when I can't write blog posts as often as I usually do, or pursue the citizen activism activities I used to dive into with a lot more energy than I have now, life goes on.

This shouldn't be a shocker.

I'm just one person. There's billions of people in the world. Heck, there's over 160,000 people in just my home town of Salem, Oregon. Why would I think that what I'd been doing to help change the world, or Salem, was so crucial, so important, that my lassitude would make much of a difference to anyone but me?

So this strikes me as one benefit of depression. It leads me to a sort of Buddhist-like insight: my self isn't as central to reality as I thought it was.

Now, this insight is both sort of depressing (or disturbing), yet also a relief. It takes some of the pressure off me to get back to acting "normal," since I'm realizing that while my usual life is important to my near and dear ones (our dog would miss our evening walk, and even more, me preparing her evening meal, if I wasn't able to do those things), for most people I'm simply an occasional thought. 

Here's another semi-Buddhist'y insight: I don't even matter as much to myself as I thought I did. 

During the past few weeks I'd have occasional (OK, frequent) crying spells and near-panic attacks when I'd think, or tell Laurel, "I feel myself slipping away." Yet obviously there was still a Me able to say that. What I really meant is that the Brian I was used to being was feeling more and more foreign to me, like a person I used to know well, yet now was fading from memory.

In my saner moments I'd grasp that the cosmos doesn't give each of us a Lifetime Guarantee that the person we most enjoy being is going to stay that way. Change happens. Life happens. Illness happens. Suffering happens. Shit happens. 

We've all got to deal with it.

The (likely) fact that I'm depressed shows that I'm not dealing with it as well as I could, since I know quite a few people who have more serious health problems than I do, and they sure seem to be handling life better than I am. But this isn't a competition, and I guess I need to stop comparing myself with others -- including my previous self.

"It is what it is, dude" probably is the wisest thing I tell myself these days. 

Well, equally wise is a new mantra that I started repeating today: Feel more, emote less. By this I mean that letting myself get overwhelmed with emotion doesn't work out very well. Better is when I simply am aware of how I'm feeling at the moment -- tired, satisfied, worried, peaceful, anxious, whatever. 

This is much more of a bodily feeling than a mental sensation. I can be tired, yet I don't have to worry about being tired. Yeah, I know: Mindfulness 101. Also Cognitive Therapy 101. It's just a new experiential insight for me, separating what is actually going on with me from the stories I tell myself about what is going on.

Heck, I love to tell stories to myself. And, others.

But I'm finding that when I'm in a depressed state of mind, it's best to let the storytelling fade away into a corner of my mind rather than taking center stage. When I talk to myself, these days often it isn't a conversation that I really want to have. So I'm doing my best to live as much as possible in the actual here and now rather than an imagined there and then.

Or, an interpretation of here and now that gets too far away from the physical facts of what I'm feeling at the moment. 

Lastly, I've got to give a shout-out to one of my favorite authors, Jack Haas. He wrote one of my favorite books, "The Way of Wonder." It's a strangely wonderful book that I bought nine years ago and have re-read several times. I've written several blog posts about the book and Haas' other writings (you can search for them in the Google box in the right sidebar). 

Today I thumbed through "The Way of Wonder" and came upon this passage. Perfect for my depressed mind!

We must forget the forgettable, become fools, have no purpose, and make the mind new at every moment. We must live without knowing what it is to live, and be without knowing what it is to be. That is how we plug into the mystery. That is how we... be.

(In case you're wondering, yes, I have some good doctors who are aware of my not-so-good state of mind, and I've got an appointment with a mental health nurse practitioner next week.)

My wife says I shouldn't tell you this, but I am anyway

I usually do what my wife, Laurel, says. But this morning, after we talked about my health problem, I went to my laptop and wrote just the title to this blog post. 

It's taken me all day to decide whether to do what the title says.

Since I'm typing this now (8 pm), that's a pretty good sign that while I recognize the truth of what Laurel told me -- there are nasty people out there in social media who will make fun of you for being honest about your urinary problem -- as a long-time writer and blogger I feel like I'm in Word Jail if I can't openly express how I'm feeling.

Plus, I've found that when I'm honest about speaking my mind in a blog post, often, if not usually, some people will tell me, "Thanks, that's how I see things also, but usually nobody talks about this stuff in a public way."

So what the hell... now that I've gotten a few sips of wine in my system and loosened my writing inhibitions I'll just speak as if I were at an AA meeting. 

"Hi. I'm Brian. I've got a peeing problem. More exactly, a urinary retention problem apparently caused by many years of a gradually enlarging prostate that finally stretched my bladder to such an extent it doesn't work well anymore."

A few weeks ago I got up the guts to talk about this in a blog post, "Given my peeing problem, be warned about asking 'How are things going?'"

Since, I had more testing and a non-cheery consultation last Wednesday with my urologist who basically said that prostate surgery might help me, but even after surgery I'd probably still have to use a catheter to urinate as I am now, just less often.

After the Urodynamics testing my wife and I had to wait for over an hour in an exam room before the urologist gave us the news. Anticipating he wouldn't have much positive to say, I spent much of the hour crying on my wife's shoulder, leaning over in a chair with my hands pressed to my forehead all totally depressed, and looking at my iPhone to distract myself.

And that was the high point of my day. 

Now, a few days later, I've gotten a Xanax prescription from my family physician to help me sleep at night. Leg cramps, maybe brought on by stress, have been waking me up. Even though I'm going to get a second opinion on my bladder condition, and I certainly haven't given up hope on recovering, it's just damn tough to face the prospect of not being able to pee properly for the rest of my life.

I'm 68 and otherwise in good health, so I've been envisioning that my "golden years" would be more pleasant than they are right now.

But in my saner moments, which come and go even in my current anxious/depressed/worried state, I realize that, as I said in my first post, everybody is dealing with some sort of problem. 

Everybody is struggling with something. 
Some ways into my urinary problem treatment, I'd find myself getting a bit irritated when I saw people going into a restroom and coming out in a short time, their peeing business all completed with no problem. Heck, I even look upon our dog peeing a dozen times during our evening dog walk with envy.

I had an obviously erroneous feeling: that most people were living happy carefree lives, just as I had before my urinary retention problem popped up. 

Well, here's the truth. My life always has had plenty of problems. I wasn't completely happy before my emergency room visit, just as I'm not completely happy now. There's always something messing up our life, physical, psychological, social, whatever.

On the positive side, I feel more compassion toward people with obvious health struggles now. Someone using a walker, crutches, a wheelchair. Someone battling cancer, heart disease, diabetes, fibromyalgia, whatever. 

Life is tough. Every single person I encounter, no matter how cool, collected, and I've got my shit together they appear, has some real problems they're having to deal with as best they can. 

Just as I am. My peeing problem isn't anywhere near as serious as what other people have dealt with for months, years, decades, maybe a lifetime. 

I'm not saying that we all need to be completely transparent about our personal struggles, just that I've learned, and am still learning, that keeping our problems to ourselves may feel like the right thing to do in our hide in a cave moments, but we need to remember that everyone needs a shoulder to lean on.

And it's tougher to be aware of those shoulders if you don't say, Hey, friend, I could use some support. 

So this is one reason I've decided to add a "My peeing problem" category to this blog (in the right sidebar). Dealing with it is a big part of my life right now. Not so much physically -- using a self-catheter to urinate only takes about 5 minutes four times a day or so -- but psychologically. 

I'm a philosophical sort of guy. My wife is a retired psychotherapist. Which basically means that we're just as screwed up as everybody else is, but we can maybe describe and analyze our screw-ups a bit more cogently than most other people can.

In future posts I want to talk about how I'm dealing with what might turn out to be a chronic health problem. (Click on the "My peeing problem" category to find them.) For now, I'll just speak a bit about my biggest struggle: getting out of the confining cage of my own self-absorption.

Like others with a serious health problem, I've been spending a lot of time with doctor visits, pharmacy visits, dealing with medical supply companies, adjusting my lifestyle to fit my condition. All that is necessary. Yet it also drives me crazy. I'm tired of focusing on me. I want to get back to relating with the world as normally as possible, like I did before.

I want the part of me that has a health problem to be as small as possible, so there is more room for all of the other people, activities, loves, causes, passions, and such that were my main focus before my consciousness zeroed in some three months ago on what my bladder was doing (or, failing to do).

I'm coming to feel that story-telling is what I've got to work on. Meaning, I'm spending way too much time and energy on making up stories about how my life is going to go from here on out. 

Sometimes those stories are positive: "I'll get a second opinion. The doctor will have a brilliant solution to my peeing problem. I'll be back to normal, or near-normal, is less than a year." Sometimes those stories are negative: "I'll never get better. Instead, I'll get worse and turn into an angry depressed old man whose only joy in life is boring other people with talk about how his urinary tract doesn't work right."

(Hey, I'm off to a good start with my blog posts!)

Here's my saner-moment take on this. I wasn't able to predict that I'd get the problem I have now, so why the heck should I have any confidence in my ability to predict what will happen in the future? 

Which doesn't mean that I shouldn't plan ahead -- like I am with arranging for a second opinion. That's clear and present reality. However, I'm finding that what hurts my precarious mental health is making up stories about alternative health futures that are almost totally fictional. 

Often I feel like commentators on cable news who utterly failed to predict that Trump would become president, yet, now that he is, confidently hold forth on what is going to happen next with President Trump. With them, I think, "Hey, you guys were clueless about how the election would turn out, so why should we believe your prognostications of how the Trump presidency will turn out?"

Likewise, I don't know. 

That's one of the mantras I repeat when I'm going to sleep. I don't know. 

It helps me a lot. What I know is how I feel right now, what I have to deal with right now, what needs to be done next right now. Yeah, I know this is a cliche for people in tough situations: "One day at a time." But it's a truthful cliche.

Lastly, I've been heartened today by a couple of things my wife and daughter shared with me. Laurel, my wife, has memorized this poem by Wendell Berry, "The Peace of Wild Things," which I found by Googling a line that she recited to me this morning.

When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children's lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.

And this afternoon my daughter, Celeste, sent me an Instagram post by actress Lena Dunham. 

Given my peeing problem, be warned about asking "How are things going?"

Seems like it's time for me to come out of the closet. A medical problem closet. One that too many of us -- especially men -- keep ourselves in. 

I've got a peeing problem. Now, this isn't unusual for men my age (I'm 68).

I'd been taking several prostate medications that appeared to be working fairly well. But a few months ago a UTI, urinary tract infection, kicked me off into a state of hardly being able to pee at all rather than my previous state of having to pee too often.

Urinary retention obviously isn't anything to ignore.

I had to wear a catheter for two weeks after going to the emergency room. That was followed by going to a urologist who scheduled various tests. I'm still being evaluated. The basic problem seems to be an enlarged/stretched bladder that, hopefully, will get back to normal (or near normal) after what I'm doing now: not-so-fun, but necessary regular self-catheterizing because more pee is being produced than is coming out.

I'm not writing this blog post to tell you all about my medical problem. What's more interesting, and way more universal, is what I've learned from this experience so far. 

Being a (wordy) blogger, for now I'll just hit a few highlights of what my urinary adventure has taught me. Later I may expand on these lessons.

(1) Keeping a problem private is fine. Until it isn't. 
At first I had no desire to tell friends or relatives about my peeing problem. After all, it isn't like I was on crutches and could say, when asked what happened, "Oh, bit of a fall on a black diamond ski run; just one of those things." I felt like withdrawing into a cave where I could lick my urinary tract wounds in private.

OK, not literally. I'm nowhere near that flexible. I'm talking psychologically.

Gradually, though, I began to have a feeling that keeping this private was too much of a strain. So I told a few friends, but not many. I still had a typical male sense that I should just tough out what I was going through pretty much on my own -- naturally with the support of my wife, doctor, and dog.

Which reminds me of my tennis-playing days at a club level. I was part of a group of four men who played doubles every week for years. Our conversations weren't exactly deeply personal, as evidenced one day when one of the guys mentioned his divorce. It turned out that he'd been separated from his wife for maybe a year. He just never felt like talking about it.

Four women who knew each other well... I'm pretty sure the divorce would have been discussed at every get-together. 

(2) Being open about your real life usually is a very good thing. 
Yesterday and today I had two experiences that propelled me into deciding to open up about my peeing problem. Probably not coincidentally, they both involved women.

I'd been having leg cramps at night that seemed to be caused by my body tensing up with a need to urinate several hours into sleep-time, but not having the ability to do this. Both my urologist and primary care doctor weren't very helpful or even particularly sympathetic, basically saying I needed to figure this out myself.

So I set out for my favorite Salem marijuana store to get some topical cannabis and some vapeable mixtures of CBD and THC for relaxation and pain relief (both of which worked great, by the way!). 

My "budtender" was a woman in her 40's who listened to my medical tale with attention and compassion. In the course of discussing the benefits of cannabis, she was very open about her own health problems -- which were complex, extensive, and way worse than mine.

I told her not to take this the wrong way, but I felt a lot better after hearing about her medical challenges. Not because she had them. Because she was handling them so well. In just a few minutes we went from being complete strangers to sharing some intimate details about our lives.

Her openness was refreshing. I drove away from the marijuana store feeling good about both the products I'd purchased, and the free gift of this woman's candid communicating about her own health struggles.

(3) Vulnerability isn't a weakness, but a strength. 
Then, this morning I fired up my iPhone's "Calm" meditation app. I enjoy listening to the Daily Calm guided meditation where a woman with a pleasing voice and (no big shock) calm demeanor addresses a different theme each day, 

Today it was Vulnerability. Good timing, because what she talked about fit in with my above-mentioned conversation in the marijuana store and my increasing feeling that when someone asks me 'How are you?" it isn't always good to glibly answer "Fine."

The Daily Calm woman spoke about this.

Sure, regaling a supermarket check-out clerk with the details of your health struggles after she says "How's your day going?" while weighing a bunch of organic bananas really isn't appropriate. But when a co-worker or close friend asks about how we're doing, being honest probably is better than being fake'y.

"Not so good; I've been feeling isolated lately." "I'm struggling with some family problems; thanks for asking." "My back pain has been driving me nuts; hopefully it will feel better soon."

It takes courage to trust in being truthful. You have to believe the person you're talking to actually wants to know how you are, rather than engaging in the familiar ritual of "How's your day going?" "Fine, how about you." "Great, just great."

This almost always isn't true, which gets me to my last point.

(4) Everybody is struggling with something. 
Some ways into my urinary problem treatment, I'd find myself getting a bit irritated when I saw people going into a restroom and coming out in a short time, their peeing business all completed with no problem. Heck, I even look upon our dog peeing a dozen times during our evening dog walk with envy.

I had an obviously erroneous feeling: that most people were living happy carefree lives, just as I had before my urinary retention problem popped up. 

Well, here's the truth. My life always has had plenty of problems. I wasn't completely happy before my emergency room visit, just as I'm not completely happy now. There's always something messing up our life, physical, psychological, social, whatever.

On the positive side, I feel more compassion toward people with obvious health struggles now. Someone using a walker, crutches, a wheelchair. Someone battling cancer, heart disease, diabetes, fibromyalgia, whatever. 

Life is tough. Every single person I encounter, no matter how cool, collected, and I've got my shit together they appear, has some real problems they're having to deal with as best they can. 

Just as I am. My peeing problem isn't anywhere near as serious as what other people have dealt with for months, years, decades, maybe a lifetime. 

I'm not saying that we all need to be completely transparent about our personal struggles, just that I've learned, and am still learning, that keeping our problems to ourselves may feel like the right thing to do in our hide in a cave moments, but we need to remember that everyone needs a shoulder to lean on.

And it's tougher to be aware of those shoulders if you don't say, Hey, friend, I could use some support. 

I had to struggle to begin writing this post. Now, I'm glad I did.