Saturday, January 18, 2014

Thoughts from (for) the Cath Club

Some thoughts from a member of the Cath Club...

Now, gentle readers who are Guys, I begin with the words of my doctor: We're men. Eventually, we will all need to face this.

Guys, if I can speak for Us while I'm speaking for myself, we are relieved if not grateful that we don't have to deal with the things women have to deal with. Breast-mashing mammograms. Having one's hoopajoop prodded and plungered. And of course, menstruation and (shudder) pregnancy. Oh, it is such a blessing to not have to deal with those.

Said women probably feel the same about us and our catheters, as well as other Issues we have with our biological hardware. I know women have to catheter themselves sometimes, judging from the range of products available via the internet, but their devices don't have to travel as far as ours. Or deal with getting past the prostate—the prosgate, as I've taken to calling it.

The physiology of The Nozzle and its connection to the bladder is not as fixed and immovable as it is in the anatomical models you see in doctor's offices or biology classrooms. Here's the way it really works, and why we have problems with it... Imagine an unpoppable water balloon, filled with water why not. It is glued to a rope that comes directly out of (goes directly into) the valve through which you inflated the balloon; in our model, that's the prosgate. The balloon and its rope goes at the bottom of a paper grocery bag, which is then filled with other stuff (none of which will ever pop the balloon, that's important for this particular model). The other end of the rope runs through the bottom of the grocery bag, but doesn't tear the bag (again, important for this particular model).

Now, slosh the bag around. Stuff inside it moves, and jostles the balloon and its attached rope. The balloon never comes free of the rope, but the angle at which the rope connects to the balloon, and the precise direction that the valve of the balloon points changes a lot. A lot.

Which is what makes catheterization tricky and/or annoying. From the outside world to the prosgate, it's definitely a direct and (with luck) unblocked path, but direction? Shape? Who knows? But the good news is, the right-for-you catheter can work its way through this ever-changing path and go right where it's supposed to go, without difficulty or (we hope very much) any pain. Right cath, right technique, zero pain.

Zero. Remember that (and take refuge in that promise... I know I do).

So anyway, anyone wanting various versions of "how to catheterize" can find them elsewhere. Easily. Too easily. What I want to share with you is what I've learned so far that's not under the ever-so-easy-to-find "how to" umbrella, so that you won't have to take the time or have the "fun" I did learning them.

Here's the first of the Really Big Things...

There are a lot of catheters out there. You'll see sometimes them marked with a measurement in "Fr.", which for whatever reason is read "French," but functionally means "inches." They come in various types and designs. And the promised First Big Thing is...

The one that works for you, works for you. Period. When you know what works for you, don't waste your time with the rest of them, because they're not the one that works for you. Once you finally find the one that works, stick with it. Doing said experimentation might not be fun, it's "not so bad" but still kinda frustrating; that's completely normal and just remember, if it fails, IT failed, but YOU didn't.

Now, visualize the bag with its protruding rope. The angle at which the balloon joins the rope has changed. And you can't see it, the bag not being transparent. And now you see why this can be so annoyingly tricky.

The catheter that works for me, that I'd also recommend pretty much anyone should at least try if the first one they tried with you didn't work so good, is one with a "coudé" tip. I've tried one from Bard, which is my "B" choice, but the one I'm really enjoying right now (and "enjoying" comes directly from ease and comfort of insertion through the prosgate) is from Medline (don't try to order this by phone directly from Medline, I tried, they won't help you unless you're on their "business" list--although once I found whatever website did let me order them, it became simplicity itself).

The hook at the end is what makes this a coudé catheter. And don't worry, it's not like dragging a hooked finger across your everything, it's nice and soft and comfy. There's a little knob at the opposite end that you can use to show you which direction the coudé bit is pointing; once you get a chance to look at and fiddle with (outside The Nozzle), you'll instantly see how it works.

And Big Thing Two, also a Big Secret to using these things: Goop and angle. Lube the bejesus out of the tip (a trick I learned in the hospital) and generously for the part of its hose that's going to be inside your hose (urethra, I mean), sufficient lubrication guarantees comfort. And with the right cath, it is comfortable. It is. Really!

As to angle... if the tip is pointing in the right direction, it's going through the prosgate. If it isn't, it isn't. And if it isn't going in, it's because the tip hasn't found the bladder sphincter, the prosgate. Pushing harder does nothing besides hurt and cause damage. If you see blood, you've caused damage and pushed too hard. Don't do that. Really.

Now, this panicked me earlier this week. It's not going in, I can't make it go in, catheterization failure after failure. Four, five times in a row. Very concerning, to say the least. I went to the urologist to talk to him, he said that yeah he could scope me, but basically I just wasn't finding the prosgate and that's why the catheter wasn't going into the bladder. Using the right catheter made beaucoup difference!

This morning, I was using one of my preferred catheters (I chose the "B" version, for whatever reason) and it wasn't going in... rather than be concerned or panic, I remembered the magic formula: More goop, correct angle. Pull it all the way out, goop it up to beat the band, try again. When it wouldn't go through, pull back a little, twist a little to change the angle, try again. When I realized that I was basically using the cath tip to "find the hole," it was just a series of try/pull back/twist/try again until I could feel the tip starting to nose its way "into the hole" and once it did, it was simplicity itself to cross the prosgate.

But really... use the right cath, and everything becomes easier. Everything. Everything.

Wow, "the right tool for the right job," especially when you're sticking a straw in... the Nozzle, as they said on the Venture Brothers.

But to sum up the big tricks... more lube (as Mythbuster Jamie Hyneman would be the first to tell you), and then, when you're running into problems even finding the prosgate, change the angle—or, to paraphrase Steve Jobs of blessed memory:

Cath different.

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