Reality to Fantasy ...Sharing My Heart About Surgery

Tweet

Photo credit for ureteral stent

A ureteral stent is placed inside the ureter, entering first through the urethra and positioned up along the ureter so that one coiled end rests in the kidney and the other coiled end rests in the bladder. It keeps the ureter open to facilitate the passage of urine or stones without obstructing. It also aids in healing after the ureter has passed kidney stones or after procedures and surgery, so that it doesn't scar closed.


Photo credit

Some of you familiar with my posts over at my SeaSpray's It's a Wonderful Life blog, already know that I have quite the urologic medical history. All thanks to one "You've been working on it a longtime" 6 mm kidney stone that struck at 4 a.m., at the end of May in 2004 ...with* the* most intense pain I have ever experienced in-my- life ..trumping ..yes ladies ..trumping labor pain.

I will spare you the hideous details of that day ..but suffice it to know ..that stone was my #10 pain. Since then ..whenever asked about my pain level on the pain scale ..I base all answers using the mother of all kidney stones pain criteria. Works rather well. I pray I n-e-v-e-r have to set a new bar for pain again. That will be enough ..thank you very much. Oh wait ..there was the in office ureteral stent removal ..quick ..but an instant TEN on the pain scale chart.

So ..that day ..after the trip to the OR to have said 6mm kidney stone removed and 2 ureteral stents in and out during the month that followed the stone attack...I was cleared after the following KUB in the fall.

It never occurred to me I would ever see a urologist again in my life. I naively thought that chapter was closed.

But then 18 1/2 months months later ...on New Years eve - December 2005, while working my Patient Access shift at the hospital ... the little urinary tract infection I thought I had ...exacerbated into much more. I ended up one sick lady the next night ...admitted into the hospital for the week ..complete with a side trip into the OR at the end of the week. It turned out that my ureter was totally constricted. This happened because it was damaged by that first and only kidney stone ..the mother of all stones 18 1/2 months earlier. It caused my ureter to scar closed over time, blocking the urine flow from the kidney... causing a serious infection ...among other things.

So I had a ureteral stent placed by a new urologist, to aid in keeping the ureter open and facilitate healing. I have had long periods of time in between stenting in which my ureter remained open ..but did have a relapse in 08. Surgery had been advised ..but I have resisted with everything in me because I am considered a high risk for this surgery. I have tenaciously and in faith held on to the possibility that I am healed.

Then last weekend ..I experienced renal colic late at night (see this post in SS), ended up in the ED the next morning(Saturday), OR on Sunday morning and am now currently sporting another ureteral stent. To say that I have felt discouraged and afraid this week is an understatement. It would seem that the rock and the hard place I have been in over these past four years is closing in on me and I am being forced into having the surgery that I have desperately been trying to avoid.

I have the most amazing urologist who has been stellar with his care. He listens and we work well together. I am so grateful he has given me every opportunity to heal. I am grateful for all the work he has done ..all the time and energy he's invested into my case ...all the while taking good care of me. I am grateful to his partners and their office/clinic staff. If I had to go through this stuff ..then I am so glad I was under that group's care ..especially my urologist.

People do go through much worse things ..but this whole process has not been a day at the beach. It really helped me as a patient to be able to go to a warm, friendly upbeat medical office in which the staff was patient with this patient ..who could get a bit squirrelly every now and then depending on what the procedure du jour was.

Surgery was recommended early on ...but I just had to try to give my ureter every opportunity to heal with minimally invasive treatment before agreeing to the high risk surgery. I suppose I have prolonged the inevitable ..but I do not regret the extra time I have had.

I do not.

And so this week ... my time has run out. It would seem that with this most recent turn of events ..my ureter constricting again ..after only 7 months that the writing is on the wall and I have to do the surgery. Admittedly ..this past week ..I have not been taking it well. I have been having total wallow week. But today ..was the first day ..that I am beginning to wrap my brain around the fact that I am going to have to do the surgery. I actually had a good and productive day. I guess that happens ..good days when you rise up out of your self pity party. And fear. I actually have been way more fearful then feeling sorry for myself. Fear with a capital "F".

Which goes totally against the faith in God that I really do have ..and goes against my normally optimistic and upbeat see the glass half full personality. I guess I latched on to the words .."She's not a good candidate for open surgery" or "It's not a good situation" and knowing I need to go to a teaching hospital and different surgeon ..it all just paralyzed me with fear and I have never been willing to move forward. Ironically ..had I never heard the words ..or understood why I was high risk ..I would've had the surgery. But I know too much. And so I froze and resisted.

I also really believed I was healed because things were going so well. But, it is a silent chronic condition (You can't feel yourself scarring) and unfortunately I don't have warning until my ureter closes off and then it is a big deal and not something I can keep doing.

But what about faith? Is God not God? Do I trust him or not? Well it seems I will be free falling ...relying on his guidance and protection, because it is now out of my control. I don't like not having control. I have to let go. I have to have trust ...trust with a capital "T" in every person involved with my health care, ...especially the operating surgeons ..the gas doc and all the staff involved in the OR and post-op. All I can do is give it to God at that point.

Maybe it has always been that way and I just didn't see it.

It is not easy to surrender ...to let go.

It is not.

But ..I know ..sometimes we have to do ...what we have to do... and now this is what I have to do. You can see how much I have wrestled with this.

And I had 2 C-sections. I do know something about open abdominal surgery. But it's a much shorter surgery and ...you get a baby in your arms. After the reconstructive urology surgery ...I get another stent in my rebuilt ureter. Not as warm and cuddly as a new born baby. Well ..maybe if they let me hold it first. ;)

And ..actually ...I am a bite the bullet ...just do it ..face it and get it over with person. I always have been. Except with this. I have felt a MAJOR red light in my spirit. Friends, family and physicians ..have all told me to do the surgery. But it is NOT like going in for a routine appendectomy or gall bladder surgery. This surgery is a lot more involved.

And you know ..if a person has to have an emergency surgery or they WILL die ..the choice is obvious ..try to save your life with the surgery. I on the other hand am not under imminent threat of death and get along just fine with being stented ..although really, really inconvenient and some really can hurt. It's just a whole other ball game when it's not emergent.

A good example would be the pain of a stuck kidney stone. I KNOW ..I would take my chances dying ...over living with that pain ..which would be impossible to live with anyway. Or like we have a friend who went in for a regular checkup and his doctor heard something abnormal with his heart and sent him to a specialist the same day. That specialist told him you will be in the OR tomorrow having open heart surgery because you could die at any time. He had the surgery the next day and is alive and well now.

He did not have an option because death was imminent.

A coworker of mine said that she knew she could die while having the bariatric surgery, but she made up her mind if it was her time ..then it was her time. She urged me to do the surgery. But I could not.

Anyway ...I know I have to have a major attitude adjustment. I am grateful that there is a solution and I have an opportunity to have it fixed. The risks just scare me is all. And I pray there are no complications.

By the time I am actually going for the surgery I will hold my head up and demonstrate faith, fight to pull through and will have hope and a can do attitude. And not for show ..but really do it ..for me, for family and for the surgeons. I want to be strong for myself and others.

So ..today ..really was a turn around day for me. And for the first time since one day last year ..I did get a green light in my spirit about it. I won't be doing it just yet ..but fairly soon. I need to work that out with my doctor. And I imagine that between now and the scheduled surgery ...I will vacillate between fear and faith ...but I am going to counter the fear when it hits with hope, good thoughts and faith along with prayer.

I hope I haven't offended anyone by sharing this... my heart ...about these things. I know people everywhere go through difficult situations and have to make tough choices. I'd like to know if anyone out there has ever been in a similar situation ..even if not medical? A situation in which they stalled and put off doing something that needed to be done? Have you felt afraid? How did you over come it? Or do you wrestle even now with fearful thoughts or serious concerns?

On a lighter note ...here is the visual of where I am at:

All this time ...if forced into the surgery ...I have envisioned myself on the stretcher... with all fours ..arms and legs braced against entering through the door of operating room. Then recently ..in my mind's eye ...I had 2 legs and one arm in the OR ...but boy was I tenaciously holding on to that door frame with a right handed vice grip. And THAT is just the pre-op area.

Even though I am more accepting today ...I may just scramble ..regroup like a cat and get all scrappy and then with the determination of a mule brace all fours ...again ...against the final OR door.

I can imagine gouging my nails into the metal frame in my attempt to hold on.

Then ..they STILL have to get me onto the table.

Okay ..so I am gonna have to work on this more. I am making progress. :)

I know the OR staff appreciates patient cooperation in sliding from the stretcher to the OR table. And I am a frequent flier OR veteran at this point and I can skootch to the spot with the best of em. However, they may have to drug me first ..dull my natural instincts. Or is that when they flare up ..no inhibitions? I've always worried about being too breezy with words in the OR once they give their special happy cocktail. But ...I think for this surgery ...I will welcome any kind of breezy. :)

Don't Ask Me To Call

Tweet

People that have loved ones going through cancer treatments often ask me, what they can do for their loved one. How can they be of help? Everyone is different, and everyone's mechanism of coping is different. I can't answer that question for everyone. Some people would love company, and others are not up for it. It also changes, depending on where they are in their treatment regime.

I can say, please don't use the 'ol, "If you need anything, call me." An ill patient has enough on their plate. Most of us aren't going to speak up, and ask you, “Could you please pick something up for me at the store?” I'm one of those that would never ask. No one wants to be a burden.

Think on your own. You know the person better than I do. If you are running out to the store, it might be good to check in and see if they need anything. This way, you can help them, and they won't feel like they are putting you out.

Sending a note or a card to let them know you are thinking of them, helps to lift their spirits. Let them know you care and that they are thought of.

One of the nicest things someone did for me was to buy me a beautiful, soft pair of pajamas. They were wonderful. Our skin becomes sensitive, and things that might not have bothered us before now feel scratchy and painful. Unscented lotions are wonderful. Please don't make a gift basket with perfumes or scented soaps. Our sense of smell can be heightened during treatments. We can become quite sensitive to smells. They can increase our nausea.

Another thing, don't judge us by your standards. I've heard people whisper in disgust that someone chose to wear a scarf, over a wig. I heard them say, “Why doesn't she wear a wig?" Some don't wear the wigs, because they are scratchy and hot! Our skin is already sensitive, and it may be painful for them or it may be 90 degree weather. Don't judge them. There are any numbers of reasons they may opt for the scarves or a cap, over a wig. I chose a wig, but that was my own preference. I just wanted to blend in as I did before. That was my prerogative.

Don’t blame them for their illness. There is such a culture of blame in our society. I do have some insight into why that is, but that’s for another post.

Don’t tell them the horror stories. They don’t need to hear about Aunt Freda’s battle, and how she lost it. You would think that would be common sense, but I can tell you from experience; common sense is not so common. I shudder as I recall all the horrid things people couldn’t wait to share with me. Think on it first….is it going to be something that will instill hope? Will it make them smile? Will they think how wonderful that you shared it with them? If the answer is no to any of those, keep it to yourself.

Be sure to let them know you love them, and that you care about what they are going through. Never underestimate the power to heal, when you show others how much they are valued, wanted and needed.

I’d love to hear some ideas from those of you that were parents during your treatments. What were some of the most helpful things people did for you? What helped the most? What other ideas do you all have that would be great gift ideas or ways to help those struggling through treatments?

The Lotteries We Don't Want to Win

Tweet

by Lockup Doc

Winning the lottery--yes, I've heard the horror stories of how people's lives have taken a turn for the worse after it's happened. But, like many others, I still wonder what it would be like. I'd be willing to take my chances with the win!

But this post is not about money. Not at all. Actually it's about gratitude.

It's about the many 'lotteries' in life that have nothing to do with money and everything to do with suffering, disability, and even death. It's the lotteries we don't want to 'win.'


Photo by MarkyBon

Recently a nurse I work with had a screening 'virtual colonoscopy,' a procedure utilizing CT scans instead of a the traditional colonoscope to screen for colon cancer and other intestinal abnormalities. There are pros and cons to having the virtual colonoscopy instead of the traditional colonoscopy. What's interesting, fortunate, and tragic all at the same time is that she was found to have renal cancer (not colon cancer) during this routine screening procedure.

So, as an aside it was very fortunate in her case that she had the CT-based procedure instead of the traditional one. The traditional colonoscopy would not have picked up the kidney cancer.

But the point I want to emphasize is that she was asymptomatic and taking care of herself by seeking preventive health care when out of the blue the screening test she had done was positive for cancer. I'm sure that nobody diagnosed with cancer every expects it, but many people do develop symptoms or, in the case of breast cancer, find a lump. Maybe they don't expect to be told it's cancer, but many times they know something is wrong. It must be a total shock when a seemingly healthy person has a routine screen and his or her life is forever changed with the results coming back positive for cancer.

None of us is immune from this scenario. Any of us could receive a dire diagnosis at any time. The fact that most of us are as healthy as we are is nothing short of a miracle. There is so much that must go 'right' for the human body to function properly that I never cease to be in awe about it all.

I look at it this way:

--The odds of winning the MegaMillions jackpot is 1 in 175,711,536. 
--The lifetime risk of developing an invasive cancer is 1 in 2 for men and 1 in 3 for women.

Of course cancer is only one of many possible types of medical illness that could strike. Factor in the risk of heart disease, other medical illnesses, and risk of accidents and we've got a lot to be thankful for when we and our families get through another year healthy and safe. 

Winning the MegaMillions suddenly seems less exciting.

How to Avoid Getting Reamed Out By the Doctor :)

Tweet

I had planned to put up an entirely different post that I was tweaking, but then after seeing this scene on Scrubs tonight ..I knew it just had to be this Scrubs clip with the practically growling.. then extremely angry radiologist ( I LOVE it!) . Then Elliot (Dr Reed) comes to the rescue for her colleagues by reminding him of his mistake with a patient and threatening to figure out how to help said patient physically and financially bitch slap him if he doesn't cooperate with getting the cat scan done. It's only 55 seconds in length and I highly recommend it for a good laugh. It's one of my all time favorite Scrubs scenes. :)

Oh! And check out the radiologist. He came in with his robe on. HILARIOUS! :)

And so after seeing this again tonight and about 10 times on YouTube replay (Remember? I LOVE it! :), I began thinking about doctors losing their tempers at work. I had seen it more than a few times times in the ER. Sometimes it would be an ED doc and other times an attending doc. I was always glad it wasn't me. And I felt sorry for the person getting reamed out. And did I say that I was glad it wasn't me? Self preservation and all. :)

Once it was because someone ...thinking they were doing the right thing ....for a woman who had an eyebrow laceration ..shaved the woman's eyebrow. The staff person didn't know the Dr would suture it without shaving. Suffice it to know that the doctor was NOT happy.

Sometimes it was over something serious. Sometimes over seemingly trivial things.

There was one doctor ... a tough as nails surgeon ...who was notorious for his bad temper and his reputation preceded him. Staff was on their toes around him and didn't seem to care for him ..although they always said he was an excellent doctor.

I had heard the stories.

Then after I had been working at the hospital for two years it happened. One Saturday afternoon this hot tempered surgeon came in to see one of his patients that showed up in the ED. We were really backed up and there were patients that had to be registered before his and so this doctor was waiting to get his patient's chart.

I knew he would expect to get it immediately, but other patient's charts were a priority. My anxiety was building. Finally ..I processed it and was on my way ...nervously on my way ...walking it down the hall to the room he was in. With head held high and a smile on my face ...I cheerfully walked into the room and said "Hi! Here's your chart." I then handed him his patient's chart ...expecting the worst.

I could see his mouth was open and he was all set to yell at me ..until he looked downward and saw my 7 month pregnant belly. Then all he did was close his mouth and take the chart from me.

Phew! I was relieved when I left THAT room!

Actually ..I remember another night where I had to do a chart for one of his patients and it was delayed because we were busy ...and through the glass facing the hallway ..I could see him walking by with steam coming out of his ears ..well okay ..if it was a cartoon it would've been. I knew he was looking for his patient's chart and I thought "This is it ..he's gonna yell.", but when he rounded the corner and saw me ..he softened and never yelled.

Instead ..he just stood by the side of the counter where I was working on another patient's chart and began talking with me ..which slowed me down a bit. Over time I learned about his hobby that he was passionate about, his time in the first Gulf war and stuff. Too bad I wasn't a surgical groupie back then. I could've heard some neat stories ..I'm sure. He was really very nice.

So ...the moral to the story is that if you don't want to be reamed out by a doctor ..be sporting a 7 month pregnant belly. It seems to soften them somewhat. :)

And maybe my determination to have a positive attitude, despite the apprehension I was feeling also helped diffuse the good doctor's wrath.

Running with a Dog Can Help Improve Exercise Habits

Tweet

I recently wrote a piece about maintaining an exercise regimen. I tried to keep it short and to the point since simple usually works better than perfect but complicated. However, there are endless helpful tips that can be discussed about exercise. What I want to discuss today is how dogs can help people to stay active and maintain a regular fitness routine.

We’re a dog family. And I love our dogs--most of the time. The two young ones are still a bit young (about 2 years old) and still can be quite naughty and destructive. After watching countless episodes of one of my favorite shows, The Dog Whisperer, I will never forget Cesar Millan’s mantra for having a “balanced” dog: exercise, discipline, and affection (in that order).

I’ve become a firm believer that he’s right. Exercise, in particular, is truly a “magic pill” when it comes to reducing behavior problems, especially in young dogs. Barking, eating the couch, restlessness, and compulsive behavior all seem to be lessened by frequent exercise. Humans often greatly underestimate the need that dogs have for physical activity. A ten minute walk once a day is not enough for a younger dog.

Fortunately I enjoy running. And what I wanted to share with you is the fact that running with our dogs has been an invaluable incentive for me not to skip my routine. The dogs depend on me! They want to go. Unlike their human companions, they never say, “Nah, it’s been a tough day. I’m just gonna sit down and watch TV instead.” On the contrary. It’s more like, “What? It’s time? Let’s go! Let’s go! YYESSS--I can’t wait--I think I’ll run in circles a few times. Come on, put on your shoes, put that leash on me. Right now! Let’s go!” Their enthusiasm truly makes it fun. And the companionship of having a running partner makes it more enjoyable, too.

Runner’s World published an article recently citing 5 reasons to run with your dog. There are probably more than 100 good reasons. But the two I mentioned--the incentive to run regularly and the added joy of it are the most important to me.

Please keep in mind that you don’t have to be a runner to have a dog be your fitness partner. Walking and hiking are also great activities that you’re more likely to do regularly if you have a dog in need of exercise. I'd bet there are many people who aren't exercising regularly who have dogs who need an extra daily dose of physical activity. It's a win-win opportunity that shouldn't be overlooked!

What do you think? I’d especially like to hear from other dog lovers who have found a way to stay more fit with the help of the canine spirit.

Photo by ceiling

When Life Hands You Lemons

Tweet

What would you do if you could no longer do some of the things you loved? What if you had to watch your dreams slip away? What if you could no longer support yourself? How would you cope when life has changed its course, and there is little hope of it ever being the way you had envisioned it?

Situations can arise which alter your income, your abilities, your independence, your status, and the way you view yourself. When a serious injury or illness occurs, each one of these things can be affected.

We are always going to have things happen to us in life. Everyone will face something at some time or other. This isn’t going to change. This is life.

We can try to plan out our lives. We can set goals and work toward achieving them, but there are times that life will intervene, and we will find ourselves tossed from the path and flung into an open field.

In our moments of adversity we need to find those things we can control and change. Control is what we crave when circumstances have tossed us off the path, and down the embankment of life. We can wallow in our disappointment and pain or we can decide to plot around our obstacles and find our way, even in the dark. We must decide it will not defeat us. There may be something else ahead we are meant to do. We can't know at the time. At the time, all we can do is make a new plan.

At my last writing, in my old blog, I had chosen to go back to school. I had landed what I thought was a wonderful new position. I was now in my chosen field. Life was going to be great! I was excited. I was doing well in school. A lot had changed, but a lot was coming back to me as I studied and prepared. I was showing no evidence of disease and I felt that I was finally putting my life back together. God had other plans.

To make a long story short, an injury, surgery and subsequent treatments came, and a new diagnosis unrelated to cancer came. I was now unable to do those things I’d been planning and prepping for. It doesn’t look like I will ever be able to do them.

After the tears, and feelings of loss, I was determined to get back to as much as I possibly could. I did absolutely everything my doctors suggested and ordered for me. We didn't know what the outcome would be, but we worked together to improve what we could. I've had to face that things will be different. I've had to make adjustments, but it's okay.

Now, I’ve found a wonderful new job and I love it! I have amazing people to work for and with. It wasn’t anything at all like I had in my life’s plan, but it is terrific. It is better than what I had. Better!

You see, we can plan all we want. Things will happen to us. I could have never foreseen all that has transpired. We aren’t all just about our physical injuries and limitations. We are spirit inside these bodies. It matters more what is going on within our spirits. If I had just stayed locked into my own self pity, I would have never left the house; I would have never found this wonderful new position. I would have never worked hard to regain what I could physically. I would not have moved forward. My eyes would have been blind to the possibilities that lay before me. I would have missed out.

Don't give up when these things happen in life. As long as we are alive - there are possibilities for our lives we aren't even aware of. Hold on through the pain and trying times in your lives.

"The man of virtue makes the difficulty to be overcome his first business, and success only a subsequent consideration."
Confucius

photo by Muhammad Ahmed

Using Technology to Help Aging Parents Stay In Their Own Home

Tweet

One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)

Nobody wants to face this situation. In fact, I’ve seen repeated instances of families in denial about the fact that their aging parents were declining mentally--often slowly but clearly drifting out into the sea of dementia. Usually the adult children were concerned about the well-being of their parents but understandably didn’t want to admit to themselves that there was a problem. Add to this the fact that patients developing dementia often lose their social skills later in the course of the illness, and many who have only brief social contacts with the person may very well be fooled into believing that they haven’t changed. Other patients may not be losing their memories, but they may have experienced a decline in their physical health that has caused themselves and others to question whether they can continue to live alone.

Enter technology.

It’s not a panacea, but we’re going to continue to discover new ways to use technological advances to solve old problems. For some families, it may be possible to utilize technology to help voluntarily provide supervision to those struggling to maintain their independence because of physical and/or mental challenges.

The New York Times recently published an article that gave examples of technology being used to monitor aging persons in this manner. One system cost a family $8,000 to install, but given the fact that that amount of money gave the family peace of mind, reduced guilt (a common emotion in adult children of aging parents, especially when they live far away from each other), and equaled only 2 months in an assisted living facility made the investment worth it. This particular system allowed the adult son of an aging woman to login over the internet and see her vital signs, which cabinets and doors had been opened, and whether she had taken her medication. The mother was somewhat reluctant at first to have this installed in her home, but now she really likes it.

I believe that the key to such a system being implemented in an ethical manner, as pointed out by a psychologist interviewed in the article, is that the person who will be monitored absolutely must agree voluntarily with its implementation.

Some will reject the general idea of monitoring technology, citing that it is intrusive, controlling, and maybe even “evil.”

Technology is not evil!

As with so many things in life, HOW it is used is what matters. If such monitoring is done covertly, even with good intentions, then it’s just plain wrong. On the other hand, as awkward as it may be for most adult children to discuss such an issue with their aging parent(s), if they all can agree on such monitoring and work collaboratively to provide supervision while maintaining dignity and independence, then I believe it will be a viable alternative to moving into an assisted living facility or nursing home for some people.

What do you think about this? Is it frightening, or is it an opportunity that, if used appropriately could help people?