A Brush with Death and Much Discomfort

This blog was silent during the month of July and August. The cause was a medical issue.

The event started on July 6, 2016 at 10:00 PM when I went down below to floss my teeth. I discovered that I could not lift my left arm. I returned to the salon hoping the problem would go away. It did not. In fact my left arm got numb and my left hand began to tingle. Something was definitely wrong.

I searched the internet for my symptoms and learned that I was having either a heart attack or a stroke. Oops. I woke up Diana and announced we were going to the emergency room.

Fortunately, South Shore Hospital is only 17 minutes from the boat. So somewhere around 1:00 AM, I presented myself at the emergency room and announced that I was having some kind of cardiac incident. They took action quickly. An EKG revealed that I had atrial fibrillation (no surprise - it was diagnosed in 2005), a Cat Scan of my head showed that I did not have a stroke (good news), a subsequent CAT Scan of my left arm showed a massive blood clot from the elbow to the wrist (not good news).

It was now around 5:30 AM. Enter Dr. Kevin McBride, a vascular surgeon. Dr. McBride explained that I had a massive embolism lodged in my left arm and that he needed to "dig it out." He also explained that I was very lucky. Had the embolism gone into my brain, whose arteries were mere centimeters away from the path it took, I would have died (not good). He also spent some time getting to know me. Dr. McBride was a class act.  I signed the papers authorizing surgery.

According to Diana, the surgery lasted seven and a half hours. During that time Diana went home to take care of Kodi's needs and when she returned I was still in the operating room.

The next thing I recall is waking up in intensive care. It was now 1:00 PM. I was asked to urinate and that's when thing got even more complicated. I was barely able to do so (read as a few drips - perhaps less than 10 ML - not good). Turns out I could add urology problems in addition to my cardiology problems. Enter Dr. Feldman, a urologist, who informed me that I needed to have catheter inserted (not good at all).

I remained in intensive care for four full days, I had no use of my left arm, was unable to sleep and was stuck with a catheter, which by the way I had "installed" until August 1st. In total I spent 7 days in the hospital. Discharge was July 14.

The next big question was where do I go next. The options were back to the boat or to a rehab center. Diana investigated local facilities but in the end we decided that I would return to Guided Discovery. The doctors approved and arranged continuing care (nursing and occupational therapy) from South Shore Visiting Nurses, which worked out very well.

My sleep problems continued. The combination of pain in my left arm, the catheter, intermittent restless leg, fatigue from lack of sleep and anxiety about falling asleep resulted in chronic insomnia for about 40 days.

Being in the hospital for 7 days is no fun at all and fraught with risk. Throughout the ordeal there was Diana at my side. She was with me almost all the time including staying through the night. This involved frequent trips back to boat to take care of Kodi. Diana was on top of everything as I was out of it most of the time. Supporting Diana was Lesley who visited frequently and stayed over two nights. While it's no fun sleeping in a hospital bed, especially with a left arm out of commission and a catheter, sleeping on a hospital chair with the frequent interruptions that occur throughout the night is also no picnic.

I was also cheered up by visits from friends and family including my sister, Myrna, boat neighbors Skip and Jan, our friend Betsy and a surprise visit from my former brother in law Michael. I had company most of the time. That said, I'm not sure I was such good company.

Overall, I was impressed with the care I received at South Shore Hospital. The nurses were friendly, responsive and efficient. My vascular surgeon Dr, McBride, my cardiologist, Dr. Schubert and my urologist and Dr. Feldman were all impressive and I felt they took a genuine interest in me as did the interns who supported them.

Meanwhile, recovery on the boat proved to be a good decision. I enjoyed sitting and reading on the aft deck and being able to sleep in my own bed. I also enjoyed being with Diana and Kodi 24/7.

Now to urology. According to medical sources, all men will have an enlarged prostate if they live long enough. Well, I've made it 73 years and up until the July 7 surgery was not overly concerned. Yes, my internist had reported an enlarged prostate but had not recommended any treatment. For the record, I noted on the medical record that I maintain that I was urinating 3 to 4 times per night and that the stream was not strong. I also noted that day time urination was OK.

Now after surgery I could not adequately empty my bladder. Dr. Feldman explained that retention of urine would lead to kidney failure and dialysis. Hence the need for the catheter. I did not tolerate the catheter well and constantly begged for its removal. Well, that occurred twice between July 7 and August 1 and each time I failed to void enough urine to be catheter free.

On August 1, Dr. Feldman's nurse taught me how to how to self-catheterize (no fun). My task was to do it four times per day and track my urine output. Then things got more complicated when the doctor's office informed me that I had a UTI (urinary tract infection), a common problem with long term insertion of a catheter). A five day regimen of antibiotics was prescribed with a urine test on the 6th day. The sixth day turned out to be a Friday so I did not get the results until Monday. Bad news. The infection was still present. The doctor prescribed 7 more days of the same antibiotic. We questioned this course of treatment - why would two more days of the SAME antibiotic make a difference?

In the middle of the UTI, I had a Urodynamics Test. This test is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. The test involves measurement of urine output naturally and with catheterization. Note: According to sources on the internet this test should not be done while the patient has a UTI.

Fast forward to Thursday of that week (August 18). I was not doing well (characterized by frequent urination - 20 times per day) and experiencing pain in my kidneys. While visiting Dr. McBride on Thursday I urinated almost nothing four times within 40 minutes and started shaking. Dr. McBride told me to IMMEDIATELY report to the emergency room at South Shore Hospital.

When I was two minutes from the hospital I got a call from Dr. Feldman, which I had expected, and told him that Dr. McBride had ordered me to the hospital. Since Dr. Feldman's office was next to the hospital, I stopped to visit with him, Dr Feldman informed me that I would need prostate surgery and that that would require coordination with my cardioligist because of the blood thinner, Xeralto, that I was taking. Boy was this getting complicated.

At Dr. Feldman's office I exhibited an elevated body temperature, was shaking and in pain. Dr. Feldman called the emergency room and gave instructions to put me on a VERY powerful intravenous antibiotic. This hospital stay lasted four days. I was discharged on Sunday, August 21 with an oral prescription for 7 more days of the powerful antibiotic.

My ability to urinate and void my bladder continued to improve day by day. Additionally, I researched "inability to urinate after surgery" and found that the problem was not uncommon (i.e., up to 70 percent of patients have minor trouble urinating after surgery). Additionally, I met most of the criteria for this occurrence of this problem:

• Over 50 years of age.
• Male.
• Preexisting enlarged prostate.
• Lengthy surgery and anesthesia time (i.e., 7 1/2 hours).
• Large quantity of IV fluid (that over-stretched the bladder making it harder to empty after general anesthesia).
• Beta-blockers (for my atrial fibrillation).

Time for a second opinion. Diana arranged an appointment with Dr. Carpinito, the head of urology at Tufts Hospital. Dr. Carpinito was also rated the top urologist in Boston in 2015. I met with Dr. Carpinito on August 26 and shared with him my urination data, which by then showed that I was on the mend. Dr. Carpinito advised me to catheterize once a day to verify that I was not accumulating excess urine in my bladder. He also advised that I should have a cystoscopy to get an accurate assessment of my condition.

The cystoscopy took place on September 7. A cystoscope is a thin tube with a camera and light on the end. During a cystoscopy, this tube is inserted through the urethra and into the bladder so the doctor can visualize the inside. The urethra is the tube that carries urine out of your bladder. The doctor also gets to view the prostate as it surrounds the urethra. The procedure is tolerable (but like everything else - not fun).

Good new and bad news. The bad news. The cystoscopy revealed significant blockage (three on a four scale according to the doctor). The good news, I was able to void the bladder with the urination at the end of the procedure. This was verified with an ultrasound that showed zero urine retention. More good news, my ability to urinate had returned to normal by August 31. Dr. Carpinito gave me a pass on surgery, took me off off self catheterization and said he would see me in a year. HURRAH!

Today I am clearly on the mend as evidenced by that fact that I am back to walking three miles a day with the furry kid and have been doing that for the last 15 days. I have 95% usage of my left arm and I am sleeping at night. Definitely a happy ending.

Written by Les.