Bob's Blog 9-5-15: Pee, as in PLEASE!

[BobN]

Bob Here.

As I was rat-a-tatting away at the keyboard, working on this blog, a picture of my mother suddenly flashed in front of me.

Now, this was not just a random wandering of the mind, although I am inflicted with those at an alarmingly increasing frequency these days.

It was as if Mom was actually standing at the side of my desk.  What made it doubly realistic is that she was wagging her finger with a look of severe disapproval, a situation I found myself in quite often as a youth.

As an adult too, for that matter.

I could also hear her voice quite clearly.

She was saying, "Robert (I was only Robert when I was in trouble), do you really think the act of excreting is an appropriate subject for a public blog??"

I mean, this was so real, I found myself answering her.

"Mom, this is about dialysis.  Dialysis patients talk about peeing all the time.  Usually in the past tense.  When you come right down to it, peeing is right at the forefront of why we have to go through these crappy treatments..."

She said, "Crappy?  Oh, so now we're using foul words to discuss your excrement story, are we?"

I tried to ply Imaginary-Mom with my smile, which historically only had a remote chance of being effective.

"Well, I was only trying to be consistent.  Get it?  Crappy...excrement...ha ha ha..."

Imaginary-Mom then just gave me her best "Where Did I Go Wrong?" look and continued berating.

"Why don't you talk about your grandchildren instead?"

I thought of a real smart-ass remark about changing diapers, but I kept that to myself.

Anyway, after concluding my imaginary discussion with my imaginary mother, I thought about it, and although peeing is not a subject that you'd likely find much about if you were perusing, say, Ladies' Home Journal, but for a dialysis blog, it's fair game, baby.

When I was first dealing with kidney failure, I really didn't know too much about it.

But, as I was learning the ropes, a few of the many conversations I had with doctors and other medical professionals stand out in my mind.

Including the one that included the cataclysmic revelation about peeing.

I remember the words as if they were just spoken to me yesterday, rather than a quarter century ago.

"In addition to everything else we've discussed, your urine output will likely diminish and, in time, stop completely."

I had been putting on a show of listening up until then.  I have this inborn aversion to being lectured, and when you first start dialysis, you're subjected to a lot of lectures.  But that last part really perked up my ears.

"How's that again?" I asked this kidney doctor whose name I forgot instantly after he introduced himself.

He looked a little flummoxed.

"Yes, well, as the kidneys produce urine, frequently kidney failure patients will...um...stop urinating."

I thought about this for a minute. 

Then I said, "I'm out."

"What?"

"Yep, this is no good for me.  Kidney failure.  Forget the whole thing."

"Uh...well..."

I said, "Hey, I mean it.  Potential trouble for your heart and lungs, fluid restrictions.  A diet consisting of bread and water.  I can handle all those.  But not peeing?  Nobody said anything about not peeing."

"Well, I mean, it's not like there's a lot of choice in the matter."

"Forget it.  I've seen every doctor east of the Mississippi.  In addition to nurses, social workers, nutritionists, therapists.  Everybody short of the guy who mops the floors.  And nobody said anything about not being able to pee."

"Well, we haven't had time to go over all the effects of renal disease..."

"You'd think that'd be the one they start with.  You know, something like, 'Oh, by the way, kidney failure means you won't be able to pee.  The rest is all details.'  Something like that.  You people ought to get your priorities straightened out."

The guy looked completely stumped on what to say next.

I continued to give him a hard time until he just got up and left in frustration.  I had a feeling later that he had a lot more he wanted to tell me, but I got hung up on the whole concept of eventually not being able to pee.

It may not seem like a big deal to non-dialysis patients, but peeing is one of those things you don't think about very often until you don't do it anymore.

And then, let's be honest, we think about it a lot.

And we don't think in medical terms either.

You know, the body's main way of clearing blood impurities and excess fluid, blah, blah, blah...

No, peeing is a way more meaningful part of our lives to be described away by something that sounds like you read it off of Web MD.

I mean, when you have normal kidney function and you go to pee, you're in command.  You go at your own pace.  At a place of your choosing.

Well, okay, if you've had a few and you let loose on your neighbor's rhododendron because he made too much noise last weekend, that's another story.

But otherwise, you're able to take care of business.  No machines, no needles, no tubes, no alarms, no cramping, no nausea, no itching, no ridiculous diet.

It's like, one and done.

Now, however, it's WAY more complicated.

Normally you wouldn't normally think of urination as being a great conversation starter, but it's surprising the kinds of questions that arise once the subject springs up.

We were at a party a long time ago, seated at a table and a person who I would describe as a casual acquaintance broke with the regular party banter and dropped this bombshell in the middle of the room.

"So Bob," she said.  "I hear that people on dialysis don't urinate.  What's that like?"

My wife was, of course, with me and immediately sensed big trouble on the horizon, because 1)  She knew I hated parties, didn't want to be there, and was in something of a raw mood and 2)  She also knew I generally didn't like discussing dialysis with strangers and had little patience for what I called "DDQ's," or "Dumb Dialysis Questions."

She muttered an "Oh boy" under her breath and also saw fit to dig her fingernails into my thigh under the table with the underlying message of "Don't Make a Scene."

But I warded off the pain and answered calmly.  "Oh, it's not too bad," I said.

Everyone at the table was now staring, waiting for me to expand on that.  The wife looked like she was internally debating whether she should throw up, excuse herself and look for the quickest way out of town, or just grit her teeth and bear it.

"There are actually some advantages," I continued.  "You can take long drives without having to stop."

Everyone just nodded a little.

"You never miss the good part of a movie because of a wizz-emergency..."

A little laughter and a couple of people looking like they wished they were somewhere else.

"And maybe the best thing."  I paused.  The wife had bloody murder in her eyes.  "Whenever someone wants to know who peed in their pool, I'm never a prime suspect!" I said gleefully.

At that point, the wife broke in and desperately tried to change the subject.  "Hah hah, very good honey.  So, didn't they do a great job with the landscaping back here?"

The great majority of folks, however, understand that not peeing means more than going a long time between bathroom breaks.

I remember the first time I was relating the possible consequences of kidney failure to someone I knew.  His reaction was classic.

You know, I was going through the most dire possibilities and he was just nodding with a hint of understanding the gravity of each.

I said, "I mean, if you don't watch your fluid intake, fluid could build up in your lungs."

<Nod Nod>

"And if you don't watch your potassium intake between treatments, it could actually stop your heart."

<Nod Nod>

"And if too many impurities build up in your system, you could just die outright."

<Nod Nod>

"And, a lot of dialysis patients stop urinating..."

"Wait a minute," he said.  "You stop what?"

"Urinating.  You know.  Peeing..."

"You don't pee??  Seriously, you don't pee??"

I said, "Well no.  But what about all those other things I told you about?"

"Yeah, those are bad.  But not peeing?  Man that's serious."

Anyway, all this talk about peeing brought to mind one of my favorite peeing jokes.

This guy and his wife go to the doctor.  The doctor takes the husband first and asks how he's doing.

"Just great," he says.  "I feel good and I'm still in control of my bowels and bladder.  In fact, when I get up to pee at night, the good Lord turns the light on for me."  The doctor just nods.

Later, the doctor has the wife and asks how she's feeling.  "Just great, no issues at all."

The doctor says, "Good.  But your husband said something about the good Lord turning the light on for him when he gets up at night to pee..."

"Oh no," says the wife.  "He's peeing in the refrigerator again."

That one always cracks me up.  I used to wonder if that fate awaited all of us, but for dialysis patients...

Well.  You know.

Thanks for reading.  Take care.

[kristina]

Thanks again Bob for your wonderful and witty thoughts...
... I am just in the process to collect and observe my 24-hour-amount of "output"
and I also continue to drink regularly a cup of peppermint-tea, which "inspires" my regular output despite dialysis...
Thanks again Bob for your thoughts and best wishes from Kristina.

[casper2636]

It never dawned on me how much time I spent in the bathroom peeing, until I stopped. Frees up hours in a day. No more leg crossing, dancing, or feeling like I'll just pop. My family runs in and out of the bathroom all day long (big believers of cleansing the body with water and drink tons, to my envy!). Yes, Bob, you have found the one highlight to kidney failure! I needed something to put a positive spin on this situation! I'll remember this on my bad days.

[PrimeTimer]

      Since he does home-hemo, guess I could say my husband "goes" for over three hours at a time.

[Jean]

Okay, this was the best blog EVER!!!! Personally, I am looking forward to not getting up in the middle of the night because of the pain in my bladder. Thanks a million Bob, this made my day.

[Simon Dog]

     Since he does home-hemo, guess I could say my husband "goes" for over three hours at a time.

Funny how NxStage promo materials would let you think you have 2 - 2.5 hour sessions, but many of us run more like 3.5.

[Vt Big Rig]

     Since he does home-hemo, guess I could say my husband "goes" for over three hours at a time.

Funny how NxStage promo materials would let you think you have 2 - 2.5 hour sessions, but many of us rum more like 3.5.

Not to mention the set up, prime,and "breakdown" time!!!!!

[Simon Dog]

Not to mention the set up, prime,and "breakdown" time!!!!!

Which is nothing compared to doing this stuff on the BabyK.   I previously had a BabyK on an every other day schedule, and the total time it took was at least what NxStage takes on a 5 day schedule.

[PrimeTimer]

     Since he does home-hemo, guess I could say my husband "goes" for over three hours at a time.

Funny how NxStage promo materials would let you think you have 2 - 2.5 hour sessions, but many of us rum more like 3.5.

Not to mention the set up, prime,and "breakdown" time!!!!!

Yes, I've been known to have a breakdown or two. Oh...you were probably talking about the machine and cleanup. 

Took a real whiz to invent the cycler. And then they approved of peeing under the cloak of darkness...and in your own bed no less! 

[Angiepkd]

Too funny and very true!  When I wasn't peeing, I thought about it a lot, often feeling like I still had to "go".  My friends were amazed at someone who didn't pee, and I was the best road trip partner around.  After my transplant, I was obsessed with pee - color, amount, etc.  Odd that something most people don't think twice about becomes so important to us! 

[BobN]

Thanks everyone.  Once again...stay dry. **wink wink**

[Riki]

This reminded me of a story.  As we all know, our bodies talk to us when something is wrong, and I think those of us with chronic kidney disease have learned how to listen.  I know i have.  A few years ago, my body was telling me that I had an infection.  I could feel it.  Since it was a weekend, and there were no clinics open, off to the ER I went.  The nurse goes through all the info with me, vitals, meds, and that I'm a dialysis patient.  Then she asked for a urine sample.

"I can't give you one."  I tell her.
"Oh, did you just go?"  She asks.
"No," I say, "i'm a dialysis patient.  I don't pee."  She gave me an odd look.
"So, how do you get rid of fluid?"  She asks
"Dialysis."  This is when she starts to laugh.
"I knew that," she said.

Even medical professionals can have brain farts, I guess

[Charlie B53]

I am on PD a bit over two years.  Kidneys a hair below 6%.

I still P, just not very much.  But having two liters of fluid in me even just a little urine in a bladder constantly under the pressure of always holding that two liters of dialysate makes a LOT of pressure and I have to go like RIGHT NOW, only maybe to make a quarter of a cup.

[Riki]

It took 3 years on PD for me to stop completely.  In the end, it was only a little dribble.  I'd take pee breaks at work just to get away from my desk, knowing full well that no peeing would be done

[PrimeTimer]

It took 3 years on PD for me to stop completely.  In the end, it was only a little dribble.  I'd take pee breaks at work just to get away from my desk, knowing full well that no peeing would be done

You may have just answered the mystery behind people who seem to stand around over in the next bathroom stall at the office.