Saturday, November 29, 2014

A Bladder Infection - or Not?

On Friday 21st, Pam reported a problem with her "water-works".  Instead of all her urine going into the leg-bag via the suprapubic catheter, she felt there was quite a bit being passed urethrally into the Tena (brand) pad in her undies.  I have been in the habit of keeping a pad there, just in case this happened.  By Monday it had become a serious issue if, for no other reason, we were suddenly going through 6 or 8 pads per day (instead of just one).

In the past, this event was always caused by a bladder infection and with antibiotics, was soon rectified.  So I took a urine sample to Dr Meyer and his nurse tested it as being positive to infection.  Dr Meyer prescribed Cephalexin antibiotics for the mean time and forwarded the urine sample to a pathology lab for thorough testing.

I immediately started Pam on the “Keflex” (as they’re also known - and as you may already have read in earlier posts), but the problem continued unabated.  When I rung Dr Meyer for the test result, two days ago (Thursday 27th), he told me that there was no infection found (!)

No infection?  Well, a test is a test and so I stopped giving Pam any more Keflex – what was the point?

As I explained in the previous post, Pam was getting the District Nurse every Tuesday and Friday, so yesterday morning, when Sarah came to give respite care, I asked her to phone me if the District Nurse came while I was out, because I needed to ask her about Pam’s urine problem.  So down town I went, intending firstly to get my daily wonderful Grande Latte from Mocha Mecca's in 8th St.  Parking was difficult, but I got one in Langtree Ave about halfway down to 7th St. and walked back for my coffee.  I ordered and payed for my Grrrrrrande Latte, set myself down at a table and commenced reading the complementary Sunraysia Daily.  I hadn’t read much when my mobile phone rang – and sure enough, Sarah was telling me that the District Nurse had indeed arrived.

Fortuitously, the Latte had not yet been made so as I left they sweetly said they still owed me one and I said “I’ll be back”.  The nurse was still there when I got home and she heard my story and proceeded to ring the Continence Nurse.  No luck unfortunately, so Sarah offered to take notes if she did manage later to get in contact and I headed off back into town - for my coffee from the wonderful staff at Mocha Mecca's, for starters.

When I got home, I learned that the nurse had contacted Dr Meyer – and he suggested I use a larger-gauged catheter.  Beauty, I thought – Pam’s PEG tubes are bigger (I think), so I'll use those instead - if I can squeeze them into Pam.  I knew one was 12-gauge and the other, 14-gauge – sadly, the 14-gauge were the urine catheters.  Darn!  I’d run out of respite cover, so I’ll have to put up with Pam’s wee problem (and so will she) until Monday at least.  Anyway, yesterday afternoon, just in case it was the suprapubic catheter that was causing the problem, even though I had only replaced it on Saturday 22nd as it was due to be changed anyway (after being in for 7 weeks) and Pam’s problem had already started, I pulled it out and replaced it.  On inspection, there was nothing wrong with the one I'd just extracted, so this new one won’t be any different, and guess what? - It’s not!  What a waste of a good catheter!

Now I have to wait until Monday to do anything and Murphy’s Law states Pam’s problem will get worse in the meantime.  (Bugger Murphy!)

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I wrote that last bit on Saturday 29th November and here it is now Wednesday, 3rd December and I have to say that I'm confused.  Murphy must've read what I wrote because almost as soon as I pressed 'Post', Pam's urine problem ceased.  Whilst I was somewhat relieved, I wasn't convinced it was going to last long because nothing had been done to make it come good.  Sure enough, on Sunday night, urethral flow once again resumed.  Many more Tena pads were filled, but Monday night she came good again and that lasted until I came home from band practise last night to discover that Pam's pad needed changing yet again.

It comes good, goes bad, comes good, and so on; without any apparent cause.  Pam's Case Manager from Bendigo Health, Peta Webber, suggested the possibility of a real bladder infection happening this time - if indeed it wasn't there from the very beginning and that I could/should get another urine test done.  I agreed, hoping an infection could indeed be found - that would explain the urine problem - and so I went to Dr Meyer's clinic to see if he could be asked to send Barratt and Smith Pathologists a referral for a urine test, and then I walked to Barrett and Smiths to tell 'em what I'd done and that I'd be back tomorrow with a urine sample.  So here's hoping...

Well, here I am a month and a bit later (19/01/15), apologising for not updating this post sooner.

The second urine test also turned out to be clear, so out of desperation, I contacted Kath Modoo (Mildura Base Hospital's continence nurse - mentioned above) to see if I could try the larger diameter catheter - which was earlier suggested, as also mentioned above.  Kath brought out a 16-gauge catheter for me to try and although I had visions of it being too big to fit (into Pam's surgically-made openings), in fact it went in quite easily.  This catheter is opaque and looks like it means business.  Well, the good news is, that for all December and more than half of January, right up until now (at least), my darling Pammy hasn't urinated urethrally at all!

I have still got twenty-seven 14-gauge catheters that I now won't be using and because I've written 'Urine' on each one's envelope (so that I couldn't confuse them with the PEG-tube catheters), they're probably only giveaway items at best - all still sterile, sealed and good.

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