Tag Archives: dignity

Older Men’s Urinary Problems (and what I wish I’d known)

Okay this is a bit crass, but it’s the first thing that came to mind as I started this post. My Dad used to cite the three rules of being an older man: 1) never pass up an erection, 2) never trust a fart, and 3) never pass up a bathroom.

As I look back on his last year or two of life, I know we did things mostly right, but I wasn’t aware of the options for urinary incontinence, and I wish I’d known to pursue it a little harder. I’ve been surprised to find how many people found my blog posts about end-stage congestive heart failure, so I’ve decided to put one more bread crumb out there for adult children who are trying to figure out how to help their fathers with urinary urgency, benign prostatic hyperplasia or acute urinary retention.

Urinary urgency – especially that interrupts sleep — is a common complaint of older men. My Dad, like many, took Proscar (the generic is finasteride) for the presumed source of the problem: an enlarged prostate.

His concern about having to “go” urgently kept him from activities he might have enjoyed. When he had an independent living apartment, he said the reason he wouldn’t participate in group outings was the lack of a bathroom on a bus. He didn’t want to go to movies for the same reason. The first thing he did in any new location was to locate the nearest bathroom.

His urgency increased significantly over the 12 months before he died. On a trip to Seattle, he couldn’t make it from the dining room to our guest room and wet himself – twice. It was heart breaking. Those accidents increased in frequency.

The month before he died, he was in excruciating pain in the morning when he was unable to void — at all. For a long time, he had experienced a weakened stream. But looking back on it, I realize that he was also having real trouble starting to go. And that had been true for some time.

When my brother took him to the urgent care center at the nurse practitioner’s urging, they drained 1 liter of fluid from his bladder and he came home with a diagnosis of acute urinary retention. Three days later, the same thing happened. This time, he went home from the ER with a catheter, which became permanent. (To his credit, the Sutter General triage nurse listened to what we said about how much urine was drained a few days prior and he immediately admitted Dad, saying, “Wow. That must hurt.”)

It had never occurred to me that there was more he could do besides taking the Proscar. I knew he had some kind of prostate surgery years before, but apparently the prostate can enlarge again.

In conferring with the urologist, we learned that he wasn’t on a second medication that is frequently used for benign prostatic hyperplasia (BPH), Flomax (tamsulosin). He started on the drug, but later discontinued it when his condition deteriorated (and we realized that the potential of a fall due to a dizziness as a known side effect was worse than dealing with the catheter).

Unfortunately, Dad’s health went into a slide about the same time that we figured out the BPH problem, and the urologist, Dad and I agreed that he needed to get stronger before it made sense to remove the catheter and try a non-surgical treatment. (Though my brothers and I were very concerned about Dad’s dignity and comfort, the catheter turned out to be a blessing in disguise. Dad quickly lost strength, and having the catheter kept him from having to endure adult diaper changes.)

If Dad had improved, he would have been a candidate for cooled thermotherapy, a therapy that is feasible even for patients on blood thinners. This is how the urologist’s brochure described it:

Cooled ThermoTherapy™ is performed in your urologist’s office in just under 30 minutes. You will be on an exam table in a comfortable position. You will be given medication to help you relax and may receive local anesthesia. The treatment is performed with a small flexible catheter that is inserted into the urethra. This catheter contains channels to circulate cooled fluid around an antenna that produces targeted heat within the prostate. The heat reduces excess prostate tissue. The proprietary cooling technology protects the healthy urethra and maintains patient comfort during treatment.  Once the treatment is completed, you will be able to go home. You will typically wear a temporary catheter for a few days to allow the prostate to begin its healing process.

For us, it’s all water under the bridge. We did the best we could. But maybe we could have made life a little less anxiety producing if we’d known sooner that there were some options for Dad’s urinary urgency. I hope you find this helpful.

By the way, I found MayoClinic.com to have the best information about BPH symptoms, causes and treatment options.


Filed under CHF and Other Medical Problems, Uncategorized

The Circle Closes

Silent movies used to use a particular edit to denote finality: a circle that grew smaller and smaller until everything went to black. When Looney Tunes lampooned the technique, Porky Pig suddenly squeezed through the shrinking circle, to stutter “That’s all folks,” before popping back into Toon Town, the window closing behind him.

I’ve often thought of the end of life in those terms. The past few weeks,the circle has been closing.

With an underlying diagnosis of congestive heart failure, and the instinctive discipline of my Dad, it’s been hard to predict how the final years of his life might go. My Mom’s terminal lung cancer had a pretty known trajectory; although she was given weeks to live, she lived nearly four months, but either way – we knew it wouldn’t be long, and it wasn’t long.

Every day now gets a little tougher. Dad is growing weaker. He sleeps more, and sometimes is not strong enough to stand and walk. He is very short of breath even at rest, and eating and drinking is becoming more difficult. His heart rate is lower and becoming irregular, and his blood pressure is up. He is working hard just to breathe and talk.

So I wonder, perhaps for the first time: are we now in the final period? I won’t call it the home stretch because there’s nothing homey or relieving about it. I have been with two people when they died, and it was hard work for them, leaving this world, even with great comfort care.

A week ago, my brothers were worrying about Dad’s dignity as he left the ER with a catheter. One of them said it was “one more blow.”

Funny, as Dad has needed more personal care this week, dignity hasn’t felt like a big issue. Words from Tuesdays with Morrie came floating in to my head, so much so that I dug the book out this morning:

“Mitch, it’s funny,” he said. “I’m an independent person, so my inclination was to fight all of this — being helped from the car, having someone else dress me. I felt a little ashamed, because our culture tells us we should be ashamed if we can’t wipe our own behind. But then I figured, Forget what the culture says…. I am not going to be ashamed. What’s the big deal?

“And you know what? The strangest thing.”…

“I began to enjoy my dependency. Now I enjoy when they turn me over on my side and rub cream on my behind so I don’t get sores. Or when they wipe my brow, or they massage my legs. I revel in it. I close my eyes and soak it up. And it seems very familiar to me.

It’s like going back to being a child again. Someone to bathe you. Someone to lift you. Someone to wipe you. We all know how to be a child. It’s inside all of us. For me, it’s just remembering how to enjoy it.”

Hundreds of times, my Dad has said to me, “Everyone needs a mother.” Everyone does.

I am hoping that I can do what mothers do in these final stages: make the boo boos feel better, and chase the nightmares away.


Filed under Uncategorized