Unable to urinate? Is it BPH or Bladder Disease caused by DMT2?

Posted by heysp22 @heysp22, Apr 15 2:57am

My dad is 79 yo male with history of DMT2. Who been to the ER on 12/25 and 12/26/22, He was brought in by ambulance for having pain and not able to pass urine, started today the 25th. After they examined him. Placement of foley on the ultrasound shows his has 957mL of urine in his bladder and not his prostate. Plan to start with Tamsulosin and see an Urologist. Next day 26th, back to ER for more pain with blood clots in the bag. UA shows WBC clumps cystitis, Keflex was prescribed. Lab work unremarkable for AkI . BPH with LUTS and change Foley size 16 to 23 then sent home the same day. Got an office appointment with his PCP 12/28. (At this point not impressed of communication from the involved doctors). My dad get an Urgent Urology Referral Appt for 1/3/2023 in Orange County per his insurance. That night he started to have seizures at my home. Call 911 and he was taken to Hoag Hospital ER and admitted. He stayed there for about a week. Now the hospitalist is explaining that had hypoglycemia, that caused ARF and infection on his prostate. What? My dad does not have a prostate problem ever. So now I do my owe collection of his medical records. Because I'm no doctor, and want to get an idea what going on and the research starts from Mayo Clinic, John Hopkins and Cleveland Clinic along with U.S. Department of Health and Human Services, National Institutes of Health . American Urological Association Education and Research, Inc. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Journal of Urology and Atlas of Human Anatomy book. By keeping his records and cc each doctor they were able to keep current. None of them use the same same labs. My dad decides not to do any surgery and want to try meds first for the enlarged prostate (Which we don't believe is causing this) and the Foley in and changed every month now is every three weeks because of plugging and bladder stones. A year is passing us by. His PSA Level went from 0.4 in 2015 to 56.92 in 2022. With meds it jumped down to 27.30 Dec 2022 and 0.6 in 2023 now its 0.3 in 1/2024. Whats was caused his infection his DM meds per the doctor at Hoag. He is home now. Mean time I am requesting for some type of rectal exam be performed or new x-rays be done for comparisons to see if worsen or improved from his hospital stay. Before any surgery happens TURP procedure. The doctor got put off by this. He gave us an order for an ultrasound of his Renal and Bladder finally. Had an appt to see him for the results. I got sick and unable to drive him, we missed our appt in Nov 2023, his next appt is not until Feb 22, 2024, more time is passing by. Stop me if i'm wrong how about a phone call. Something, We finally see the doctor and tells us that he referring us out to other Urologist for consult and HoLEP procedure. Trying to ask him why based on what? What changed to have TURP to HoLEP? When did he decide this? Why? Writes the referral and walks out. Now my dad is fed up with doctors with no answers. What are we missing? HoLEP first appt August 1, 2024. Anything?

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@heysp22

@samcal9977zz and @heisenberg34 , did you ever find out what body part failed to cause you from urinating? Are you wearing a foley catheter presently? My dad is really not liking it, any suggestions? Still trying to get an earlier appt at UCI for Consult to see if he can have a Holep procedure?

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I was urinating OK, but there was blood in my urine with occasional small clots. The ER stuck the catheter in and I was sent home with it and two bags. Whenever I passed urine, there was an uncontrollable urge to try and "help" the flow by forcing the bladder to do its thing. That sent painful spasms all the way down to my feet. Could hardly keep from crying out. After five days I had to get it out. Urology was no help. No appointment for weeks. That's when I called PCP. She told me to come in right away. Ten minutes later, and the cursed thing was out. Urology finally called me several days later. THANKS! Went in and am scheduled for cystoscopy in early June to check bladder for any issues. Two different urine cultures came back negative, so no infection.

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And76 and there you have it...our awesome healthcare system at its finest. I am sorry you have had to go through all this stuff. And, I can't imagine how your poor father has managed to go through this. I am 76and am totally frustrated by the incompetence and lack of empathy exhibited by most of the dostors here. In our prvious home, I never had this kind of treatment (or, lack, thereof).

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@heisenberg34

I was urinating OK, but there was blood in my urine with occasional small clots. The ER stuck the catheter in and I was sent home with it and two bags. Whenever I passed urine, there was an uncontrollable urge to try and "help" the flow by forcing the bladder to do its thing. That sent painful spasms all the way down to my feet. Could hardly keep from crying out. After five days I had to get it out. Urology was no help. No appointment for weeks. That's when I called PCP. She told me to come in right away. Ten minutes later, and the cursed thing was out. Urology finally called me several days later. THANKS! Went in and am scheduled for cystoscopy in early June to check bladder for any issues. Two different urine cultures came back negative, so no infection.

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@heienberg34, I actual understand that... like i said earlier. Why are we letting time go by? Okay I understand for swelling to come down, start of new medicine to see what's working. It the other time and waiting for the longest appointment schedule ever. My dad has made his catheter more useful. He still works and uses his power tools and works on cars. If the top part of the foley folds alittle with a kink in it. That urine is now getting backed up into his bladder and not the bag. I made different straps for the hose and bag, more secure under his pants. I just need to remind myself he not without medical help 24/7, its the waiting between steps of getting back to a close baseline like before. That is complaint.

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@heisenberg34

I have always wondered, how do I find one of those hospitals like the ones on TV where the patient is seen immediately, assessed by a team of ER docs, sent to a beautiful room, then another team comes in to give the final diagnosis. If none is found, the team members will spend time perusing journals, past history, eventually coming up with a unique and effective treatment plan. I want to go to one of those hospitals...PLEASE!

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@heisenberg34 thanks for a good laugh! 😆 Sitting here watching those medical shows like Grey’s Anatomy, Chicago Med, The Good Doctor and Transplant, I too wonder where those hospitals exist! lol!

Transplant, for one, is set in a hospital in Ontario, Canada, and so far removed from Canadian (albeit I can only speak about Ontario) health care! Nowhere can you be greeted outside the entrance doors (or even if at death’s door in the waiting room) and ushered immediately into a room replete with state of the art equipment at the ready! 😄 Even if you are brought in by ambulance (you do get seen faster - but just a bit) you have to wait to be triaged and put in line for treatment! lol.

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@samcal9977zz

That was standard medical care in the 60s and 70s. And not just for rich people...for everyone.
And it could be standard medical care today if medical care was not controlled by corporations, to glean the profit margins they want. I guess folks don't know, but back when I was a kid, hospitals were not run for profit. And I think some of them ran at a loss. They just did what was necessary for patients. And if they went into the red, they contacted some wealthy donors and got their funding that way, not on the backs of sick people.

As of about oh, maybe 10 years ago, 25% of the major US corporations paid exactly ZERO in taxes. If they paid their fair share? Yes, medical care in this country could be entirely different.

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@samcal9977zz Not to mention in the fifties and sixties doctors even made house calls at any hour of day or night, with little thought to fee payments!

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@rashida

@samcal9977zz Not to mention in the fifties and sixties doctors even made house calls at any hour of day or night, with little thought to fee payments!

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Yup, exactly. I had home visits from doctors, when I was sick as a child.

Different era.

Things will turn around again. Ignorance doesn't win. It has a short burst of attention grabbing behavior...then dies out, because, ultimately, people are not interested in lies and spin.

We will see another era of proper, honest, caring medical professionals.

I am 63. I may not live to see it come around again, but it will come around again.

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@heysp22

@colleenyoung , for an update, we did see his primary doctor and explained the result of his tests. The 2 scans came back according to his age okay. Lab result ( Kidneys) are still consider high but lower in the high level. I hope that makes sense. I just hope that we are not following the wrong diagnosis but with same problem body area. I still believe that when he had a seizure from him being hypoglycemia and the injury with his kidney, that it
could did/do damages to his nerves end that control the bladder neck area. With Chronic UTI on 2 different spots in his bladder. Its hard to say what stopped him from urinating This is a hard subject to fully understand about my dads privates.Something is not adding up right.

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@heysp22, thanks for the update. I know. It's hard to have the parent-child roles reversed and have to talk about a parent's private parts.

I see you mentioned that he is finding it hard to get comfortable with the Foley catheter. You might find helpful tips in this related discussion:
- Foley Catheter Discomfort: How do you walk comfortably?
https://connect.mayoclinic.org/discussion/foley-catheter-dis-comfort/

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@samcal9977zz

Yup, exactly. I had home visits from doctors, when I was sick as a child.

Different era.

Things will turn around again. Ignorance doesn't win. It has a short burst of attention grabbing behavior...then dies out, because, ultimately, people are not interested in lies and spin.

We will see another era of proper, honest, caring medical professionals.

I am 63. I may not live to see it come around again, but it will come around again.

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House calls...what a great thing that many of us older folks were able to experience. Not today. Imagine dragging a sick child who has a raging fever into the local ER and being told to have a seat and wait for the next available person (ER doc, nurse, EMT, orderly, janitor, etc.). The last place I want to go unless I am on death's door step, is our local ER here in our new town. Nothing like our ER back in PA. For the most part I have seen very little empathy from medical personnel here.

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@heisenberg34 I feel for you reading your complaints but medicine is not practiced like it used to be. Most docs work for someone else (big corporations, venture capitalists, etc.) and have limited time with patients. A 15-20 minute visit these days is usual. The problem is due to Obama Care opening up health insurance to many folks who couldn’t afford it. But no one ever considered the fact that we needed more practitioners too. Since we have this huge healthcare system the government needs to subsidize medical education to train more docs. And the number of geriatric docs has always been small and now even smaller. No you most likely receive healthcare like you used to. I’ve learned to accept what I can control and what I cannot and try to remain healthy.

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Well this weekend, I went back in my Dad's medical records, starting from 2022. In the beginning, with the questions being asked, Of why is Dad still not able to urinate on his own, and still using a catheter? What body part failed or not working? Was it from the acute refractory severe hypoglycemia secondary to diabetics medication in the setting of acute renal failure? At the same time, would this cause him to have enlargement of his prostate? PSA was 56.92. How are we unable to know or determinate what caused an infected his prostate to have a high PSA? Today his PSA level is now 0.3. What I understand that a PSA blood test is to measure cancer? And not the measurement of the prostate itself. This is were I get confused about this. I wished on July 27, 2023, Urology surgeon to explain this or at least research to find at why this happen. To understand why a TURP procedure was ordered only. To really make sure that its the prostate and not a bladder neck problem causing the urine retention. No scopes or CT or KUB or biospy has been ordered. I can't find in the records that mention a rectal exam being performed on the prostate. But on February 22, 2024 for an office visit to go over lab and ultrasound of renal and bladder results in September 2023 to say that he transferring him to UCI Urology for Consult for HoLEP if that. Appointment set for August 1, 2024. In between this time his won't do any further testing, just come in every three week to change his catheter. I"m really concern now. I have reached out to the referring doctor for help in communicating with the surgeon on this decision. We'll see what happens today May 7. Has anyone been through the procedures or even had a delay of care? Do you think its to late for my 79 year old Dad?

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