I have options. That may sound anticlimatic after all is said and done, but there it is.

After driving back into the city for a abdominal/pelvic CT on June 22, I was scheduled back with the doc for a fun cystoscope on June 27. Of course, I had been taking pyridium for 7 days and for whatever reason, it seemed to make the leak worse. So by the time I got to the appointment on Wednesday a.m., I was pouring lovely orange urine everywhere. I mean everywhere. It was so bad that before he could do the scope, he had to pack the vagina with an entire roll of Kerlix! Talk about embarassing! And when the packing was removed, I leaked about 6-8 ounces of urine just falling out into a beaker. It was truly horribly awful. And guess what? That's right, there's a hole in my bladder! Only this time, the doc isn't flippant about it.

After I finally got myself back together, Dr. B. came in to discuss those options I mentioned earlier. The hole is not where this type of hole is usually located. It appears to be further back on the bladder rather than toward the front, according to Dr. B and it is about 1 cm in size. For reference, that's about the size of your pinky nail - so that's pretty sizeable. At this point, there are two options for surgery - transabdominal or laprascopic. Given that I had the transvaginal procedure previously and there were some complications with that procedure, he doesn't think that we should go that way again. (He's actually read the surgical reports and is familiar with the procedure and what occurred!) With the abdominal procedure, I would be in hospital 2-3 days, catheter for 10-14 days and out of commission for 4-6 weeks - very similar to what I had with the hysterectomy. Or we can do the laprascopic procedure going through the navel, with two small incisions on either side and it would take about 4-5 hours vs. 1.5-2 hours with the abdominal surgery.

Of course, I've still got the dilemma of some obligations that I have to take care of in August and early September. So I asked if it was a problem to wait. Dr. B. says that waiting means more healing time and that is not a bad thing. However, it is a "quality of life" issue at this point - can I stand the situation until September? At this point, I don't see that I have a choice. Since I didn't plan on having to have 2 additional surgeries after the hysterectomy, this has been a particularly difficult year for me. So I have a million things going through my head. He gives me a card with his direct office number and the person I'm to call and set up the surgery - now -for September. My brain is flying and I can't get my mind working to think of questions. So I'm driving down the road and it hits me - we didn't discuss the details of the laprascopic procedure other than the time. You know, hospital time, recovery time, catheter time. I really can't decide which way to go until I know those details. So when I got to my office, I called and left a message for Dr. B's assistant to please call me as I had some questions. However, things got a little strange and for a couple of days I really didn't care if she called or not.

Until this year, I cannot recall going to the ER for anything except a minor car accident more than 10 years ago. Well, I'm breaking all kinds of records for me this year! As many of you may know, whenever a urologist does a cystoscope or some other such procedure, it is common for them to give you an antibiotic before the procedure. So, having taken levaquin on a number of occasions previously, including as recently as March, I didn't think anything of taking a 500 mg tablet that morning before the scope. When I awoke at 3 a.m. with chills and aches I simply put it off to DH having cranked the AC down to subzero (he hates to be hot) and added another layer of cover. However, when I got up Thursday morning I was splotchy red all over my face, neck and chest. I went on to work, but the hives got worse and I started running a fever. So I came home, took 3 Benadryl and went to sleep. I awoke at 3 p.m.with hives now down to my stomach, my lips swollen and my throat closing up! That was just a bit too scary for me. So off we go to the ER again. I had already figured out that I was having an allergic reaction to the levaquin - the only thing I had taken differently. But the ER doc confirmed it. After a high dose Benadryl injection and a steroid injection, I was sent home with instructions to take 2 Benadryl every 4 hours and to fill a steroid script and take as directed. Oh, and before I got better, the hives would probably work their way down to my feet! Isn't that just too special. Oh, and don't take any more levaquin - ever. No problem. Don't want to repeat that little episode. The hives finally all went away on Sunday!

So for several days, I was a bit distracted and didn't really notice that Dr. B's assistant hadn't called me back. So on Tuesday, July 3, I decided to call her again. To my surprise the young lady, Gail, answered the phone. I explained that I had some questions about the surgery options and I told her what they were. She thought maybe I should speak with the nurse. When she came back, she said that maybe it would be best if I spoke with Dr. B. Would it be all right if he called me back to discuss the questions. I said sure. She said don't be surprised if he calls you on the holiday because he's on call and will be working. Honestly, I didn't expect to hear from him. I thought the nurse would ask him the questions I had and she'd call me back. So when I didn't hear anything Wednesday, I didn't think much of it. And Thursday was busy at work and I knew that Dr. B isn't in the office on Thursday. However, around 6 p.m. Thursday evening, I get a call.

It's Gail and she has Dr. B can I hold? Sure. And there was Dr. B on the phone. What questions do I have? I explained that we didn't go into the details of the laprascopic procedure and I really need to know what's involved so I can make a decision. He went back over the abdominal procedure details. Then explained the laprascopic procedure would take 4-5 hours. There would be 1-2 days in the hospital, catheter for 10-14 days, but I would only be out of commision for about 3-4 weeks. The basic surgery once he was in, was essentially the same just the approach was different. Of course, there is always the risk that the surgery might have to be converted to the abdominal procedure if there were problems with the laprascopy. Which method has the higher success rate? The abdominal procedure is the tried and true method. The laprascopy has been successful with others. So I asked, "Given that there were problems with the transvaginal fistula repair and the fact that the hole is not where is was expected to be, which would you recommend?" Without hesitation, he said the abdominal procedure. And it's not going to be a problem if I wait until September. No, it's not a problem - it's a quality of life issue for me. Okay, then we schedule the abdominal procedure for the second week of September. Is there anything else he can answer for me? No, he's answered everything and I thanked him for taking the time to call and go over the options again. He said he would have Gail call me to set up the surgery. This conversation lasted about 25-30 minutes!

If I wasn't already impressed with this doc, I have to say I would be now for sure. This is a busy guy. He has a busy practice and he is an instructor at a major medical campus. Yet he took the time call me, to answer my questions and help me make a really difficult decision. With any luck, I'll be leak free by Halloween! That will be just a few days shy of when I finally decided it was time to do something about the painful menses a year ago and make an appointment with the gynecologist. Maybe by Christmas, I'll be dry. Wouldn't that be nice? He'll be going back through the hysterectomy incision, so I won't have 2 scars. I'm not thrilled about the catheter, but 14 days is a heck of a lot better than 4 weeks! So, as I expected, I'm a perfect candidate for the "last resort" invasive procedure. But I really think that it is the best option to fix the problem. So now I wait. Time will likely fly by with a commitment at the end of August for 5 days and then a 3 day commitment the weekend after Labor Day, I'll be busy right up until the day of surgery sometime the second week of September.

Well, that's it for this episode of "As the Bladder Drains." Thanks again to all for your words of encouragement and support. Hope you are all staying cool in the heat of summer.