What's new, what's old

Hello, again. I've been on hiatus for a while because over the last five months or so, I've either not really had anything interesting to say (often) or I've been too wrapped up in the business at hand to step away from it and blog (much less often).

It won't really take that long to catch up. Since last October, I stopped smoking pot and started baking and eating pot brownies, my dog developed Addison's disease and almost died, we broke a record for total snowfall in a season, and my mother-in-law was diagnosed with, and had surgery for, breast cancer.

What brought me back was this morning's visit to the urologist. Over the last couple years, my bladder symptoms (urgency + frequency) have gotten worse, although it's happened so slowly that it almost hadn't registered. Today, though, the urologist told me that he's pretty much used every pharmaceutical trick in his bag and doesn't have any new drug options for me. Instead, he said he thinks I'm a good candidate for getting a gizmo called Interstim (a.k.a. "the bladder pacemaker") implanted.

Interstim delivers a contant, mild electric charge to nerves near the base of the spine. What good will that do? The urologist explained that Insterstim fixes bladder function similar to the way a good hard smack fixes an old TV: it's not clear why it works, but it does. Here's how the process goes: First, they would implant the wires in a procedure during which I'd be sedated but awake. There are 4 wires, and they go in near some nerves at the base of the spine. After that, I'd go thru a two-week trial period during which the wires would be connected to a pager-sized control gizmo. The control gizmo can turn each of the four wires on and off independently and, I think, change the polarity of the charge sent to each wire. For two weeks, working with someone at the hospital, I'd go through different settings on the gizmo while keeping a pee-pee diary. After two weeks, they look at the results. If I've gotten at least a 50%benefit from the gizmo, they replace the pager-gizmo with a device that would be permanently implanted under the skin just north of my behind. If I haven't gotten a 50% benefit, the wires come out and I go back to my non-bionic bladder.

Cool, huh? There's a waiting list right now, so I wouldn't be able to get hooked up until July, but I told them to put my name on the list. The urologist says there's about an 80% chance that I'll see a dramatic improvement and a 20% chance that it won't do a thing for me. There's slightly larger than an Oreo under my skin, but not nearly as much as the Botox injection. And supposedly, my HMO will pay for it with minimal fussing (we'll just see about that).

So now we're all caught up. That wasn't so bad.

This glass is half full.

Sure, it sucks to be diaper-dependant at the age of 36, to be allocating money to your section 125 account for the substantial amount you will spend over the course of the year on Depends, to fret over whether to pay a few bucks extra to get them shipped from Amazon instead of going through the grocery checkout line with them.

On the other hand, when, on occasion, you roll over in bed just a little too far toward your sleeping spouse, such that when you wet the bed, as you do maybe 1 out of every 3 nights, thereby actually wetting the bed and not merely the waterproof pad on which you sleep , consider this: the perfect cleaning product for the task is an enzymatic spray that is available at your local pet store, and the packaging of that product features a sheepish-looking beagle, not a picture of the sheepish-looking 36-year-old man that you see in the mirror.

One mystery solved

Last Wednesday, I started feeling really crappy: achy, tired, and a little dizzy. It was a familiar feeling. I'd last felt it the day a few years ago when I'd mistakenly taken my bedtime pills in the morning. This time, though, I was certain that I'd taken my AM pills (after the last med mix-up, I bought a pill case of an entirely different color and design for my AM pills). The only thing I could think of was that I had probably missed a couple days of amitriptyline after forgetting to pick it up at Walgreen's.

Well, Friday morning, I figured it out: yes, I had correctly taken the pills from the AM pill case, but I had mistakenly portioned out the elongated, white nefazodone tablets, instead of the elongated, white Provigil tablets. So I wasn't getting the Provigil boost, and was instead giving myself more than double the correct dose of nefazodone and getting most of it in the morning. So I sorted out the right pills, and started feeling better almost immediately, although I woke up with really sore hips on Saturday.

It sure would be helpful if the makers of ordinary-looking white pills would give them some kind of obvious distinguishing mark, like a wacky shape or some kind of color. Flomax is good: orange/green capsule; Cymbalta is good, too: blue/green capsule. But Provigil kinda looks like nefazodone, which kinda looks like Tylenol. Baclofen and amitriptyline are both ordinary-looking round pills. I guess I can understand why the generics might forgo fancy shapes and colors, but Provigil? That stuff is expensive. My HMO pays good money for the stuff. You'd think a Schedule IV drug would have some flashy color or something. Oh well.

By the by, you've probably seen the articles about the discovery of three genes that are linked to MS. See the WaPo article here. According to the Post, these findings give you and me "new hope." I think that's hyperbole, of course, because this kind of study seems more to suggest how much we don't know about MS. After all, the Post article quotes one of the investigators as saying, "We suspect there will be dozens, perhaps hundreds of gene variations associated with MS."

Speaking of new hope, I have officially concluded that I received no benefit from the Botox procedure. No change in urgency, emptying, bedwetting, dribbling, or any of the bladder-related indignities. Too bad. On the other hand, I got to see what the inside of my urethra looks like, so it's not a total loss.

Big day?

Today, I get my Botox injection. Maybe. I'm still waiting for my HMO's Care Management Department to tell me whether they'll pay for it. I guess anything involving Botox gets extra-careful attention. Because, you know, it might not really be about improving my bladder function, it might just be costmetic. Because, I don't know, I have a wrinkly urethra?

More good news on Botox for bladder issues

New research shows Botox injections in the bladder detrusor remain effective after multiple injections. My urologist has mentioned this as an option a couple of times, and I'm thinking that I might give it a go some time in the not-so-distant future. My pee-pee problems are still pretty manageable, but I have noticed that things got a little worse over the last year or so. I'd say there's been a 25% decrease in the time between "I gotta go" and "I seem to be going." According to the study, participants receiving Botox got a mean maximal cystometric capacity increase of 144 ml. That's about half a beer, right?

Link to abstract.