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From The Desk Of Clarence Bass

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“You’re so healthy otherwise, think of solving this problem as maintenance to make sure you stay that way. Just remember that you’re in charge.” Lynn McFarlin, MD, Cooper Clinic.

“There are no boundaries to what you can do for yourself if you speak up for your own cause. You don’t have to take your care or your situation at face value.” Miriam E. Nelson and Alice H. Lichtenstein, Strong Women, Strong Hearts

You’ve got a Bladder Problem!

Shortly before my last trip to the Cooper Clinic, an ultrasound examination of my pelvic area to find the cause of soreness in my hip (see article 143, Weight Training category) unexpectedly revealed that I was retaining an unusual amount of urine in my bladder. A body scan at the Cooper Clinic confirmed that I have an enlarged bladder. Dr. McFarlin recommended that I have the condition evaluated. A few weeks after my return home, I scheduled an appointment with a well-regarded urologist. 

I’d never been to a urologist and didn’t know what to expect. Since Dr. McFarlin had found that my prostate is not enlarged, I wondered what could be preventing me from empting my bladder. Frankly, I didn’t see it as anything more than a manageable nuisance. 

The urologist, a man of few words, scanned a long questionnaire I had completed prior to the exam, along with my report from the Cooper Clinic. He asked me a few questions about both. 

Without further ado, he did a “vigorous” rectal exam, confirming Dr. McFarlin’s finding that my prostate is normal in size. He didn’t explain what he was doing, but I knew from past experience. 

The next procedure was new to me, however. Again without explanation, he spread some lubricant on my lower abdomen and passed a wand back and forth over the area several times. What happened next was certainly more than I bargained for. 

He read off some numbers that meant nothing to me, and said sternly, “You’ve got a problem.” Startled, I asked what he meant. He explained that the numbers were the volume of urine in my bladder, and that it was an alarming amount in view of the fact that I had just voided a few minutes earlier.

Telling me to take a deep breath and relax, he next examined (scoped) the inside of my bladder, by inserting an instrument up through my penis. To put it mildly, it was an unanticipated and uncomfortable experience, especially for one who has always dreaded catheterization. “See anything unusual?” I asked.  “No,” he answered.  “Nothing that would explain the urinary retention.”

He scheduled me to come back for some urine flow tests, which include catheterization. He assured me that it would be nothing compared to being scoped. The only problem was that I had way too much time to think about it.  

Before leaving, I asked the doctor what he thought might be causing my problem. He said that he didn’t know but the flow tests might provide some clues. Almost in passing, he added that patients retaining that amount of urine often had to catheterize themselves three or four times a day to control the problem.

I had the uroflow and urodynamics tests a week or two later. He was right. Compared to being scoped, they were almost pleasant. (I told the nice lady doing the testing that the doctor said it would be lots of fun. She laughed, good-naturedly.) A few days later I returned to hear the results. The doctor said the tests confirmed that I was retaining a copious amount of urine, but not much more. He then repeated his previous comment about self-catheterization, adding: “That’s my recommendation.” Having had time to consider that solution and the effect it would have on my quality of life, I was ready with my response: “I’m not going to do that, unless it’s absolutely necessary.”

This time the shoe was on the other foot. It was the doctor’s turn to be surprised. He looked a bit stunned. I don’t think he was accustomed to having his recommendations summarily rejected. Happily, that was the turning point in our relationship. Things got better from there.

Instead of going home with a catheter kit in hand, the search for the cause of my distended bladder continued. My problem was eventually resolved satisfactorily. The doctor and I even came to like and respect each other.

Kissing Lobes

“Why not just follow the situation along?” I asked. “It doesn’t seem to be causing any serious trouble.”

“We don’t know that,” the doctor replied. He explained that urine backing up in the bladder could damage the kidneys. “You could also end up with a ‘floppy bladder’ [a loss of tone in your bladder],” he added. “We better get an ultrasound of your kidneys and your prostate.”

Convinced that the situation might be more serious than it appeared, I agreed: “Fine, let’s do it." 

Two weeks later, I was back for the ultrasound. “I’ve been counting the days,” I joked to the technician, who I had talked to by phone a few days before. “You better get a life,” she said, laughing. I liked her; she was pleasant and self-assured.

“Your kidneys are right where they’re supposed to be, and no fat to blur the image,” she reported. “They look good, no problems that I can see. Now, let’s look at your prostate....It’s not enlarged.” I said, "That's good."  She agreed. But then, the tone of her voice changed, becoming more serious. “You’ve got lobes on top of your prostate; I see a lot of men with the same thing,” she said calmly. “That’s something new,” I commented. “The doctor will probably want to talk to you about that,” she added. “I’ll bet he will,” I replied.

She showed me the image on the film. It looked like two mounds sitting side-by-side on top of my prostate, apparently pressing or protruding into my bladder. It was quite a sight. I felt sure we’d found the cause of my problem.

A short time later, I was sitting in the examining room, waiting for the doctor. When he appeared, I said: “I guess we’ve found the problem.” He looked at me blankly, and said nothing. Apparently, he had not seen or been told about the ultrasound results. He proceeded to exam the film, moving from frame to frame. I waited for him to see what the tech had shown me earlier. “Whoa,” he said when he spotted the abnormal formations. He called them “kissing lobes.” He explained that the lobes are in the area where the urine drains from the bladder through the prostate, and then through the penis to the outside of the body.

“That’s the problem, right?” I asked again. “Probably, but we can’t be sure,” he answered. He took the film to show one of his partners, a older male urologist I’ve never met. “We think removing the lobes is worth a try; we can’t guarantee it will solve the problem, but we believe it will help.” That was Friday morning. We agreed that Carol and I would discuss it over the weekend and let his assistant know on Monday whether we wanted to proceed with the surgery.

I called Dr. McFarlin that afternoon and explained what had happened. He was familiar with “kissing lobes” and confirmed everything I had been told (except the self catheterization part, which he agreed was "no way to live"). The technician was correct that kissing lobes are common, but usually on enlarged prostates. My case was a bit unusual, because my prostate is small and otherwise normal. He called the surgery I would have a “partial TURP.” TURP stands for “transurethral resection of the prostate,” where the surgeon removes part of the prostate through the urethra, the tube that drains the urine from the bladder to the outside. My surgery would be partial, because only the lobes would be removed; the rest of my prostate would be left intact. The channel through my prostate didn’t need to be enlarged or hollowed out, which sounded good to me. He encouraged me to have the surgery. “You’re so healthy otherwise, think of solving this problem as maintenance to make sure you stay that way,” he counseled. “Just remember that you’re in charge, ” he added.

I called the urologist’s office on Monday, and the surgery was scheduled for Wednesday, August 10. The surgery was about seven weeks ago, as this is posted.

Shaken Expectations

I’ve managed to avoid any kind of surgery for my entire adult life; the last time I had surgery was in the fourth grade when I cleverly shot myself in the knee with my dad’s 45-caliber automatic pistol. I haven’t spent a single night in the hospital since that incident. I dreaded going into the hospital. Hospitals can be dangerous places, with all the ailing people and the prospect of contracting a staph infection. Not to mention hospital food.

I certainly didn’t look forward to having a rather large instrument inserted through my penis for the purpose of chopping and burning off the top of my prostate. And those darn catheters. Lance Armstrong wrote in his book that one of the most painful incidents in his long struggle with cancer was having the catheter removed. My Dad also had a bad experience with a catheter in the hospital. Well, those things turned out to be nowhere near as bad as I feared. Moreover, the food was pretty good. I wouldn’t want it as a steady diet, but I enjoyed it for a few days (along with food Carol brought in for me).

My hospital experience was no picnic, mind you, but certainly not terrible. The worst part was getting my drainage system going again after the catheter was removed. I was motivated, because I really didn’t want to be sent home with a catheter in place. It was a close call, but I left the hospital sans catheter.

Frankly, I was treated very well. The nurses--all of them--were wonderful. The high point was having a fit-looking nurse recognize me in the recovery room from seeing my photos in Muscle & Fitness. She commented on how good I looked. Considering the circumstances that was a bit of a stretch, but it made me feel good anyway. She and a male nurse from the recovery room even visited my room the next day. I autographed a book for the nurse and her husband. Again, I was treated very well.

The most troubling thing about the whole experience was having my expectations shaken. As Carol observed, the whole situation went against my experience so far and my optimistic view of the future. I expected a few problems to come with aging, but frankly I didn’t expect this so soon. I went to the doctor with what I considered a minor problem—and ended up in surgery. I was probably the healthiest person in the hospital. One nurse, a kind and caring older lady, asked how long I’d been sick. I snapped back, “I’m not sick.” But there I was thrown in with a bunch of sick people. It just didn’t seem right. Darn it, I didn’t belong there, and I wanted out ASAP. I came away feeling more vulnerable than before, my rose colored glasses a little cloudy for the first time.

Fortunately, about that time I received a long hand-written letter from my Aussie friend Roy Rose (see Success Stories (3), item 1) that helped me regain perspective. As luck would have it, he was relaxing at home recovering from prostate surgery (a full TURP) three day before--and feeling good, philosophical, about the whole experience. The surgery had gone well. “No problems at all,” he wrote. “Hopefully, now trips to the loo will be less frequent and more productive,” he added matter-of-factly. What he said next was right on the money—and exactly what I needed to hear: “Coming during the great run I’ve had my whole life with excellent health, this is but a mere hiccup.”

“I love your attitude,” I wrote back. That’s exactly how I should be looking at my little brush with urology. If anything I should be thanking my lucky stars—and my health lifestyle.

Dr.McFarlin’s advice is worth repeating: “You’re so healthy otherwise, think of solving this problem as maintenance to make sure you stay that way.”

Preventive maintenance, indeed. As my friend Roy so wisely termed it, “just a hiccup” in the grand scheme of things.

Speaking of prevention: After three weeks of doctor-ordered rest, I’m training again—and enjoying it more than ever.

Good, But Not Perfect, Result

After deciding to have the surgery, I sent my urologist an autographed copy of Challenge Yourself with a short note: “Thought you might like to look through one of my books. You’ll see that I’ve been managing my health successfully for many years. Thanks for helping me understand my bladder problem. Looks like I need a little help with maintenance.”

Things went more smoothly after that. I had come to appreciate him as a urologist, and I believe he understood that I wanted to be actively involved in my treatment. We’re a team. He explains the options, and I decide. I’m not willing to take things at face value. I want to be provided with the information needed to make an informed decision.

Pax Beale didn’t beat around the bush in his book Body For The Ages (article 129, Personalities category). “A doctor who wants to control you is a doctor you don’t want,” he wrote. “If you are not acute, then you should be in charge.”

After the book and note, my urologist did a better job explaining things to me. After he briefed me on the surgery and what to expect in the hospital--he said I wouldn't like it, but to go with the flow--I congratulated him. “That was your best explanation,” I said. He smiled.

I believe he did a good job on my surgery--I learned in the hospital that he is well regarded. What’s more, he did everything possible to make me feel comfortable. For example, he called my room to tell me not to worry when I was having trouble voiding after the catheter was removed. It was normal, he assured me. And he sent me home on the third day--without the catheter.

My follow-up appointment about three weeks later confirmed that the surgery did help, as he predicted. I’m still not emptying my bladder completely, but the residual volume is a fraction of what it was before. “We made progress,” the doctor told me. “I’m much more comfortable with your condition.”

Me too. We’re both happy. And we’re friends, not close friends, but we understand each other better, after a bit of a bumpy start.

I learned a lot, about myself and connecting with doctors. I hope our visitors will benefit as well. 

Knowledge is Power

And one more thing, very important. Before the surgery, I was operating on half or less of my bladder capacity. I was waking up several times during the night to empty my bladder and going annoyingly often during the day. Unfortunately, after the surgery restored most of my functional capacity, the frequent urges continued. Coping strategies that worked when my bladder was obstructed worked against me after the surgery. I tried a number of things, but nothing seemed to work. Bad habits are hard to break. 

The doctor offered no guidance, so I taught myself about bladder retraining the same way I taught myself how to do the Olympic lifts, I read about it. Using Amazon.com, I located and ordered Overcoming Overactive Bladder: Your Complete Self-Care Guide (New Harbinger 2004) by Diane K. Newman, RNC, MSN and Alan J. Wein, MD. This little book (142 pages) proved to be a godsend. Among other things, Newman and Wein helped me understand how the bladder works, and in one short chapter explained bladder retraining. Once I grasped the basic principles, which have much in common with progressive resistance weight training, I reduced nighttime trips to the bathroom from 3 or 4 to a more normal once or twice in a matter of days. Daytime urges were cut in half as well.

As Miriam E. Nelson and Alice H. Lichtenstein wrote in Strong Women, Strong Hearts (article 153, Diet and Nutrition category), “You don’t have to take your care or your situation at face value.” Knowledge truly is power.

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FINAL UPDATE: Unexpected Benefit 

Dr. McFarlin was "right on" when he encouraged me to have the "maintenance" work done to continue my lifetime run of good health. I had my final checkup on December 6, four months after the surgery, and I've made real progress since my three-week exam. My bladder function is now virtually normal. I sometimes sleep through the night without being awakened by the call of nature, and I almost never get up more than once. I can't remember when I slept so well, but it's  been a long time.

What's more, my improved sleep pattern seems to be having a positive effect on my workouts. I'm responding better in both my weight and aerobic sessions. I can't prove it, but I believe the sounder and deeper sleep may be allowing my body to secrete more human growth hormone (HGH). 

HGH, a hormone secreted by the anterior pituitary gland, is thought to have a positive effect on muscle mass, strength and fat loss, according to Physiology of Sport and Exercise (Human Kinetics, Third Edition, 2004), the authoritative and beautifully designed and illustrated text by Jack H. Wilmore, PhD, and David L. Costill, PhD. It is also believed to enhance healing.

As I understand it (research is often inconclusive), sleep quality has an effect on the release of HGH. It's common knowledge that older people don't sleep as well, for various reasons, such as aches and pains, and like me before the surgery, an overactive bladder. As the quality of sleep deteriorates, so do recovery and probably the release of HGH and other hormones.

Wilmore and Costill say that production of HGH has been shown to increase as a result of exercise. The benefit of supplemental HGH (direct injection or through use of other drugs or supplements to stimulate release) is another matter, however.  "It is unclear if human growth hormone has ergogenic properties in young, healthy athletes," they write. "However, major health risks are associated with the use of growth hormone."

Carol says she sees the difference in my general demeanor, and I know I feel better. My goal has always been to look as good at 70 as I did at 60 and 65. Now that I'm sleeping better, I'm more optimistic than ever. My photos show little, if any, change in my physique from 60 to 65 (see photos below and on our Pictorial page). Time will tell, but I expect to do it again at 70. 

                                                                                  

              

Clarence -- at 60 and 65 (Better, worse, the same?)

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Reader Feedback

[Editor's Note: This article seems to have hit a nerve with many readers. The response has been unusually  large and thought provoking. We value and appreciate every email and the many good wishes. Here are some notable excerpts.]

"My one and only hospital experience (besides my children being born) was in the third grade and I had to be catheterized - I still shudder when I think of it even though it was 38 years ago!!"

"Good for you for taking charge and learning what you needed to know."

"Except for shooting yourself with your father's gun, which doesn't really count, you haven't spent a night in the hospital since you left the incubator.......Good Lord Clarence, that's a good and very long healthy run! I'm glad you received some recognition in the hospital. You've probably done more to keep people out of that place than anybody in the country."

"Pax Beale is right about Doctors and control."

"There are some things that no amount of healthful living will prevent....I recall reading that shortly before Jackie Kennedy died of non-Hodgkins lymphoma she said something like, All those push-ups and I'm dying anyway. The implication was that the exercise was wasted because of her premature death. Well, shoot, she looked great her whole long life up until her dying day. And she was vigorous, too. What more can you ask for? No one is immortal."

"Thank you for your detailed and honest article. Looking at it as maintenance helps a great deal. I found it a bit scary but motivating to do a number of things my wife has been after me to do. There's a lot of check-ups and maintenance work that I need to do."

"I appreciate your analogy of doctor/patient as a team. I recently had some back pain due to a work related injury and went to a chiropractor. He initially advised me to stop doing squats and deadlifts. I ignored the advice, and told him what I was going to do. We have since grown to understand each other better, and my relationship with him is fine now."

"You touched on so many important issues: the anxieties that health problems generate; the insensitivity that too often accompanies our encounters with health care providers; the great challenge of maintaining autonomy and not getting sucked into the sick role....One thing you describe to which I especially relate was the notion of shaken expectations....I always felt I was doing my part to ensure a long, healthy life. Over the last 5+ years, however, I've had a number of mostly minor health issues crop up; in addition, two chronic but manageable problems were diagnosed. After feeling  that profound sense of shaken expectations, I realized what I suppose so many before me have: Your genes have a lot of influence over your body's course. But what's between our ears is just as strong and ultimately more valuable."

"It is a learning process, I guess, and also a reality check--no one is a superman!"

"I took note because I was getting up once or twice, sometimes more at night, and going frequently throughout the day. My doctor thinks my getting up may be related to coffee and drinking too much water. I have cut back on both, and try not to drink anything a few hours before bedtime. My getting up has reduced to once a night!"

"Your disclosures give us out here the reminder that we have the right to refuse, stall and compare options before we submit to a form of treatment."

"Patients want to know what the heck is going on when doctors start probing us. We are not machines or specimens - we are people with fears and emotions!"

"I can certainly relate. At age 47, I was in the best shape of my life. That all changed when I was rushed to surgery with a ruptured appendix. I was scared to death. The whole experience was overwhelming. I was actually so overcome with emotion the day I finally made it home that I started to cry."

"I see your prostate is nice and small. I suppose your healthy lifestyle had something to do with that. I believe in prevention....I had a wee good humored chuckle at the part where you barked at the woman who asked how long you had been sick. I can just imagine that scenario."

"What struck me about your experience is that doctors are so used to the pill mentality--that no patient would actually work to treat himself and that what patients all want is an easy quick fix--that he didn't even give you a chance to help yourself--until you pushed him to try a different path."

"As a surgeon myself, I squirmed a little at your description of your treatment. You didn't have an ideal experience."

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