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Thursday, May 26, 2011

What Next?

Friday night we were settling into a weekend of family.  One offspring was home from Montreal and another was returning very late at night from a three week vacation.  The other two were only able to pay phone and skype visits.

It had not been a particularly dramatic week for Michael despite some anxiety over the bedsore that had developed a few days earlier. And that was only when the nurse visited after I thought it prudent to alert the medical staff of its existence at least. I had already gotten treatment under control but somehow the presence of medical people always raises his anxiety levels no matter how minor the problem - the main reason I hesitate to include them unless absolutely necessary and I'm not sure why I did this time.  I suppose it was a moment of doubt that crept in when I read about pressure sores online and the advice was categorically to alert a health professional.

In fact, the week had been rather positive despite that slightly rocky beginning.  After all, Michael outdid himself mowing the lawn on Thursday and repeated the performance on Friday for about five minutes, albeit with frequent falls. On both occasions he came in exhausted and drenched in sweat.  Michael, who used to love the sun and would tan to a beautiful mahogany-brown every summer, has become terribly sensitive to the heat now, a function of some of his Parkinson's medications. Profuse sweating is a common problem he suffers in the full sun, so really I shouldn't allow him too much exposure at all.  But he does still love it and it's hard to deny him the pleasure of rare Canadian heat.

Perhaps he was dehydrated on Friday night.  I don't know. I was rather preoccupied and happy about the arrival of our kids and was probably not paying much attention to whether he rehydrated sufficiently or not after his exertions.  Not long after our first child arrived home late in the evening, I became aware that he was spending a lot of time in the bathroom. Whenever that happens I barge in on him, denying him any privacy in that department.  That night he was perched on a stool I keep in there for his use in the shower.  He was inspecting himself rather carefully and anxiously.  When I asked him what was wrong he showed me bright red blood in the toilet, obviously produced during urination and, from what I could tell, it had followed his pee, not preceded it, resting on the bowl of the toilet above the water line.  He was understandably alarmed. My first thought was that he was on the brink of another urinary tract infection like the one that had caused so much trouble back in September.  I asked him all the usual questions: Is there pain on urination? No. Is there any pain in your pelvis? No. I checked his temperature and blood pressure but both were normal.  I felt his pelvis and his back around his kidneys for pain, thinking that he might have a kidney infection or another stone, something I hoped he'd never have to experience again after an agonizing attack several years ago. But there was obviously no pain.  Hmmmm. What could it be?

Thinking that dehydration could somehow be the culprit, I forced him to drink two tall glasses of water on the spot.  What was puzzling was that normally in the evening he is trotting back and forth to the washroom several times an hour. Fortunately he only has a few paces to travel each time with his specially equipped washroom right next to the living room. But after all that water, he didn't produce any urine for over an hour and had become rather distended in the pelvis.

When urination finally resumed I watched closely. Yes, still a fair bit of blood but still no burning or pain anywhere.  The blood was obviously following the urination process and was even staining his daytime protective underwear.  He was so alarmed I had to stop him from pulling down his pants to inspect himself while sitting on the couch.  There are a few things I try not to expose the kids to.

I have a very old book, simply entitled  "Symptoms" by Dr. Isadore Rosenfeld, that has helped over the years to calm my nerves when faced with various ailments and odd symptoms displayed by family members.  I pulled it out and consulted the section on blood in the urine.  It indicated that any bloody urine should be reported, and that painless and post urination blood might be nothing other than a mild UTI or the result of an injury (perhaps incurred during one of his many falls that afternoon). Or it could be an indicator of something more serious.  In any case, I realized I'd better make a call.

It was now fairly late but I have learned that the special number I have been given for medical support of my home care patient will connect me with a sympathetic nurse at any time of the day or night.  Michael's file is immediately available to the on call nurse, so after she had consulted it she felt that, with no other symptoms, I could probably relax and do a reassessment in the morning, calling again if necessary.  I felt comfortable enough to let it go for the night, not wanting to add to Michael's anxiety.  I reassured him it was probably nothing and hustled him off to bed, needing, however, to give him extra anti-anxiety medication and extend our prayer time to calm him. He had a night of noisy breathing but was otherwise quiet once he finally relaxed.

The next morning he had mercifully forgotten all about the incident.  There was no further blood and there hasn't been any since, at least nothing visible. There could, of course, be microscopic blood present. After reading in my book about one of the more alarming possibilities, I hit the computer to do more research on bladder cancer which is often pain-free and can show frank bleeding following urination.  All the other possible symptoms are present too but are misleading because he has displayed frequency of urination and low pressure for years, common symptoms of Parkinson's disease. Colour change of his urine is not a reliable indicator of anything either since his medications are responsible for a rather alarming array of urine hues. He has never been a smoker, at least not for any extended period and not for over thirty years, so he is not in the highest risk category for this disease, but he is male, which makes him several times more susceptible than a female the same age. There could also be prostate trouble.

With all this in mind, I finally called the visiting nurse today, now Wednesday, and left a message requesting a urinalysis which, I believe, may only show if there is infection and blood present, not if there is cancer lurking.  That, from what I understand, would require a whole raft of tests that I shudder to even read about let alone pursue, given my poor husband's sensitivity to all things hospital related. I have yet to hear back from her.

But I am getting way ahead of myself imagining the worst case scenario even though, in the past, I have found it to be a very useful strategy to prepare myself for terrible things.  In my experience, often those dreadful things come to pass so having imagined them first has helped me to cope. Last night I asked Michael a hypothetical question:  If he were ever diagnosed with a life threatening disease like cancer, would he want me to pursue all possible treatments for him or not. I'm not sure whether his silence on the matter indicated a refusal to talk about it or an inability to absorb and process the question, but that silence is leaving me, once again, to guess and do the best I can on the bumpy road ahead.

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