Urologist Appt, waste of time?

[gomer]

Today's urologist apt was a quickie.....

HI...

Try a pill...

Come back in 3 weeks....

My PSA (BPH) test was lower/better but still high.

I asked him WHY I was having voiding issues now, despite my PSA being down. He had not a clue. He is fully aware of my Diabetes, MS and kidney disease, all of which could possibility impact or be impacted by my voiding issues. He only was interested in my PSA and if I had to get up during the night, which I don't.

MY BP was up a little, just above my limit (set by other doc) and I noted that was highly variable, as well as my voiding issues. NO response.

My fears turned (what me might advise/Rx) out to be totally unfounded, he was not concerned at all. Maybe I am wrong, but I got the feeling he could care less about any voiding issues, unless I end up in ER totally unable to void. Any and everything was brushed off as just probably age related, and nothing worth bothering with.

My fam doc is the one who ordered I see the urologist, gave a specific reason, rising creatine, but he was not even interested in that. My urine test showed glucose (I am diabetic), urobiliruben (abnormal) and borderline qty of red blood cells, etc but since I am not getting visible blood in my urine, that was also a non-issue, protein (abnormal), previous check showed none.

The last time I tied a pill, all it did was cause me to loose control, I would wet my pants and not even know it, till someone else (one of my boys) noticed it, very embarrassing. If this new pill helps, great, if not, I was rather unimpressed by his so-so attitude.

I am confused, I do not know whether to be glad or sad?

Gomer Sir Falls-A-Lot

[minivanmama]

I can see why you would be confused i would be also. I know it must be frustrating.

I hope this will all get worked out soon and you will get to feeling better soon.

Lot of (((hugs)))

[gomer]

Thanks MVM...

I am getting better from the fall/broken ribs. Still HURTS if I move certain ways, lol, cough or sneeze....

I am now getting very nasty back pain, seems more likely lower spine than kidney (been there done that). I doubt its kidney related, which is an important but (I think) separate issue. For one thing the worst is when trying to get up from a lying flat on my back.

My thinking is, I may have injured it in the fall. I have been just recently winding down on the narcotic pain killer, so that may be why I am just now feeling it.

What I WANT is real answers. I hate it when I leave more confused than when I arrive. My #1 concern is any impact on my already comprised kidneys. His attitude did not help. Maybe I am being over critical of his attitude, but my confidence in him was lessened. I will wait and see when I see him again in 3 weeks, before I decide to BOTHER with him.

I have a renal clinic apt at the VA Thursday, same morning I have my MS clinic. So far the MS clinic/doc has been OK, but many VA clinics are worthless, but some are ok and even good, its kind of a crap shoot. All I can do is cross my fingers and HOPE, just better not expect much.

The VA diabetes treatment is an outright joke. FYI Diabetes is a leading cause of chronic kidney disease, what a combo? I went for several years managing my diabetes as good or better on my own w/o doctoring, frustrated with the VA on the diabetes issue.

I have been fighting for over 3 years on the kidney front, went thru 3 nephrologist in under 2 years before getting that somewhat stable.


Gomer Sir Falls-A-Lot

[Aponi]

hello

I would ask for a renal ultrasound to be done if it hasnt, and if it has to get a current one done up for comparrasion due to the increasing problems. If you present it in that manner, what doctor would turn that down? Mine didnt.

My uruologist wanted to do the same thing,, give a pill,, blah blah see u here in a few weeks.. and i said no wait a minute.. I am having more frequent urination, associated with pain and that i had felt giving the bladder a break and running tests would be the better route and waited to see his responce..he(dr) gave a bit of a pause then agreed with me. We had put in a foley cath, meanwhile he talked about a subrapubic cath (which I refused quickly),, so he said we can discuss that at a later time - i said that was fine.

So long winded here.. make another appt and say you are having problems and wish to make an appt to discuss things with the doctor. Re adress these things and if you have coppies of the bloodwork, etc that you mentioned above - bring those with you..

**if that doesnt work or refuses to listen, talk to your pcp and ask what you should do, maybe your pcp can put in a pull for you.. or like some neuros are bad,, other specialists can be too.. just keep that in mind, but i would try and talk to him/her once more.

wishing you best of luck, hugs

[cosake]

I wouldn't let it go - and get a second opinion if you can't get a satisfying resolution with this doctor.

Explain your concerns to your PCP and see what direction they recommend, or a referral to a second urologist.

Good luck - follow your gut that you know something is going on.

[gomer]

Thanks aponi

My voiding issues are weird/sparotic/erratic, but NO pain (other than the proverbial variety).

I had a renal ultra-sound done back before my great fall. The only thing noted was mild bladder distention, so that is probably not a big deal. I do have BPH, but my PSA is DOWN...go figure?

My Fam doc is the on who sent me to him for this appointment in the first place. He even stated his specific reason but the urologist was not interested in that.

He is dismissing all voiding issues on the BPH, possible but I seriously question, and NOT interested in any further testing, or considering there might be more here than BPH involved. I question blaming BPH for 2 reasons; -1- my PSA is down from before, -2- I would expect the issues to be more consistent, less varied if it is due to BPH. I am not a doc so that is just my personal uneducated logic.

I did have copies of my latest labs, heck HE is the one who ordered them, & done in time for my apt. so he already had them.

I am not going in and complaining the ceiling is too white or anything, just like it is, no more or less. They do ask a list of questions, but even long lists of Qs often do not cover MY issue at hand, plus I can not always answer the Qs well with the limited answer options. Yes and No are not always fitting answers for me.

For me its a pipe dream to just go to any doc for anything and expect to get things tested and answered. I fell last month, ambulance to ER, Xray crew from Hell, told NO broken bones, given modest (worthless pain pill) and flexeril and sent home. Two days later my kidneys start failing.

MY son could not get me out of my recliner etc I was in such pain. Had to have an ambulance crew get me out of my recliner (no fun), back to ER, and took the jar I was using so they would be able to SEE what was happening. One look at the urine sample spoke volumes, kidneys do not go into acute failure due to bused muscles. and sent for X-rays again. Five broken ribs, so admitted to the hospital on Ox (was low/80), Morphine and IVs for the kidneys.

IN 2007 it took me 3 different eye docs (one I had been with for over 12-15 yrs) just to get my past ripe cataracts done. In 2008 it took me 3 nephrologist over about a year to get my kidney disease stabilized. It's just the way things have long gone for me. Very frustrating to say the least.

Gomer Sir Falls-A-Lot

[gomer]

cosake...

I called my PCP this morning, but it about the nasty back pain. I just finished tapering down on the Vicoden and along with the taper my lower spine hurts like 7734 when I try and move while in a laying down flat position. I literally screamed in pain twice trying to get up while on the exam table at the urologist yesterday. They had to raise the back slowly and I had to maneuver a bit just to be able to get up & off.

I think I did more than just break 5 ribs, although that (& acute kidney failure) is probably the worst of it. I think the fall made an existing back problem much much worse. His PA returned my call, saying my doc said to just apply heat and take a NSAID and give it 2 weeks. I am NOT supposed to take NSAIDs due to chronic kidney disease, (1 baby aspirin is the exception) plus I think it related to the fall, no reason for it otherwise I can think of.

It is already at least FOUR weeks out. I think I just did not feel the pain as much before due to being on morphine and vicoden, then tapering the vicoden down, plus I could not sleep in a bed at all, till a few days ago (can you say La-Z-boy?). My left arm was swollen and had to let out my watch band 3 notches. At least that is coming down now and already been able to tighten it 1 notch. I had told them in ER about my arm, but they did not think it was an issue to bother with, and it seems to be healing ok now.


Gomer Sir Falls-A-Lot

[Scooter24]

Gomer -had similar experience at the VA with a urologist PA 2 weeks ago, I asked my nuero to give a referral after hearing a urologist speak at our support group and a brief discussion with him afterwards with him telling me that there are a few meds that should help me". I went to my appointment and explained why I was there to the PA, he looked at me and said "well you have MS so the only thing I will do with you is have you start using a catheter much else would be a waste of my time." I explained to him what the civ uro said & that I was not willing to do that at the moment and he said well go see him and pay him then. turned back to his computer and started typing and said "if you change your mind come back and see someone else."

Needless to say I told him what I thought of him and told him he would be more atune to working in the proctology clinic and walked out. I have sent the director of the VA center a ltr along with a copy to the clinic manager and my congressman. Most likley he won't get fired but hopefully it will get his attention.

[gomer]

I tried a med a few years ago (4+, that was B4 my formal MS Dx) and all it did for me was to lose control. I quit it because I would wet myself big time w/o even realizing it.

Very embarrassing when you wear light pants and someone else in the room notices you are WET and you had no idea it even happened.

Everyone is different, and what works for one person may not work for another, and may even be a problem.

The bladder distension is minor, my main concern is preserving my kidney function as long as I can.

Scooter..The VA is always a crap shoot, there are good, bad and even a few ugly docs etc everywhere. Q? What 'support group' (MS or other) were you attending? As far as I know there is NO MS support group at my VAMC.

Gomer Sir Falls-A-Lot

[gomer]

Scooter....
I am still digesting last Thursdays double header.

The renal clinic doc said my kidneys are on the small side. He said that usually means its not likely from my diabetes but from blood pressure. I looked up small kidneys on the web and from what I could find small kidneys is normal from CKD and does not point to or away from either diabetes or HBP?

He also said that my function loss was expect able due to my age, and that my kidney function was about as bad relatively speaking decades ago. Yes we do loose some small amount of kidney function as we get older, but not like mine have done.

Five years ago I was at eGFR 60, then 50s, then 40s and even dropped into the mid 30s a couple years ago. Going thru several nephs, one would catch something another missed/ignored and got it back up to the 40s mostly and sometimes even hit a 50s. All that even before the acute kidney failure last month, (now recovered). My function level is a bit erratic, that does not make me feel all that cozy about the issue.

Got a call yesterday from the VA, seems the renal clinic did a referral to urology, a bit confused after what what the renal doc said?????????????

Gomer Sir Falls-A-Lot.

[onlyairfare]

Gee Gomer, sounds like you could use a good primary care doctor to coordinate all these opinions.

The urologist is a surgeon, so he looks for surgical problems, not underlying kidney disease, which your nephrologist should be attending to. Still, with known BPH and some bladder distention, as well as blood in your urine, I would think the urologist would want to do a cystoscopy. If there is bladder distention, that could also cause the pressure to be backing up further - into the kidneys.

If they were my kidneys, I'd want to have another renal US to look for problems upline from the bladder. Especially with diabetes potentially causing renal failure from "above" in the kidney tissue itself, rather than from pressure in the area where the kidneys empty into the ureter.

eGFR down into the 30's sounds worrisome. Glad it is back up, but I hope you can get everything tuned up and working optimally.

[Scooter24]

Gomer- I have 2 different support groups I go to if they are having a gust speaker I am interested in hearing speak, the civ one is a town over but it is on Friday am and that is one of my golf days son unless the weather is lousy I don't get to that one very often.

Our VA infusion nurse has started a MS support group , I have been to it 3 or 4 times but don't really fell too comfortable at it. it is a group that has been going for a while and every one knows the others, may be if I go more I will feel like I fit in a little better but really at this times I don't need the support but rather info I get from the speakers.

I got the most and best info from the annual PVA meeting they had at the VA in Oct, I learned of alot of benefits that I wasn't aware of and ones that I didn't realize I was eligable for.

[gomer]

AirFare..... of ALL people I KNOW urologist are surgeons....

I was having problems w/infections etc at the time I had cancer surgery. It was my urologist that did BOTH a cystoscope and also removed the unrelated cancerous lymph node in my upper leg. He Dx a valve issue, but nothing serious needing surgery.

He also felt he got all of the cancer...looks like he was correct. This Jan /Feb (Dx & Px) marks my 30 year anniversary cancer survival, not bad for a 10% chance of surviving 12 months...ha ha, was so not funny back then.

With all this kidney and voiding issues etc, I am a bit CORN-fused..... Especially since my fam doc sent me to ER Jan 12th for an emergency evaluation due to kidney related electrolite issue, then a week later fall and break 5 ribs and 2 days later go into acute kidney failure & hospitalized a few days.

I agree, a eGFR in the mid or low 30s is nothing to LOL about. Too close for comfort to 29 and stage-4, aka dialysis planning stage. My kidney numbers are a bit unstable, so that makes the eGFR estimates unreliable. The lab slips always note eGFRs are reliable only if kidney function is stable or in a SLOW decline. Not sure what constitutes SLOW here.

My fam doc told me he expected the urologist would try the TURP route. Right now I am trying Flomax, but now I am having diarrhea problems, worse than voiding issues, probably from the flomax. A few years ago I was put on Doxazosin and all that did was make me loose bladder control.

Gomer Sir Falls-a-lot

[gomer]

Scooter.........

"well you have MS so the only thing I will do with you is have you start using a catheter much else would be a waste of my time."

I was doing some research for my own situation. From what I came across was that the above is one accepted std view regarding MS related voiding issues, but its NOT the only one. Your voiding issues may be slightly different than mine, plus even if the same, people & their MS etc vary as well.

So far I have tried a couple meds and they both create other problems for me. One was incontinence and that latest diarrhea.

I am still having BP problems. MY BP will be fine in the morning & thru early afternoon, but by late evening my BP is HIGH, even with several meds for it. I am on double max of lisinopril even, at least no problems with that one.

I seem to get the rare adverse side effects of some meds. I had a rare but nasty problem with statins. I was on simvastatin for several years. I kept trying to tell my fam doc I thought it was a problem for me. I almost lost what limited walking ability I had. so I simply stopped the statin and sent my fam doc a letter telling him I had stopped it and we would see what happens. My next quarterly apt, he was convinced, it was obvious my walking had improved from stopping the statin. Statins in some people, even w/o MS, can have muscle problems from statins. Due to my MS it was an even bigger problem.

Gomer Sir Falls-a-lot

[gomer]

Update........

I went for my urology apt today w/Dr CarJar. Could have been done with a email or text etc. He just stood there said I had neurogenic bladder and my options were to either go back on flomax or tuff it out, put up with it, jar in car etc. Heck I just TRIED flomax and NO THANK YOU DIARRHEA.

My concern remains is my blood pressure rises a lot in the evening, after having voiding issues most of the day. (and of course drinking liquids) By morning my BP is fantastic. Combine that with an unstable kidney situation, I am just not quite comfortable.

I am thinking of dropping my PCP (as suggested) a note and update him what is and is not going on, before I go back to my local urologist. .

Gomer Sir Falls-a-lot