Mets Day 109 - new hope for continence

Today I had my Foley catheter removed, which always is a welcome thing.  Before it was removed, Hazel, the GW nurse who specializes in pelvic floor issues, filled my neobladder with about 320 ml of saline.  She then removed the catheter, and asked me to void the saline into a beaker and assess how difficult it was to drain the neobladder.  It was almost like the pre-neobladder days:  a single powerful stream for the first 80%, then another push to get the next 15%, and one more for the last 5%.  It was very unlike the voiding I've been experiencing since my surgical catheters were removed, where I had to strain to get out a few cc's, then regroup and try again.  Hazel said that increasing the size of the opening in the bottom of the neobladder from the size of a pinhole to about the size of a pencil would do that. 

To make sure this wasn't a one-shot (ahem) deal, she had me go out and get lunch with instructions to drink lots of Diet Coke, or, in other words, have a normal lunch.  I enjoyed a seafood salad at District Commons, and made sure the waiter kept bringing me new glasses of soda.  I returned and once again filled Hazel's beaker with a strong, steady flow.  I thought that I might have got my man card back a few weeks ago, but this was much more powerful experience.  It's a nice thing to go with the flow. 

Hazel said that I should notice an immediate improvement in nighttime continence.  She said that my pelvic floor muscles seemed to be strong (as shown by my daytime continence), and she did not think that I did not need to do kegels or other pelvic floor muscles at this time.  The key to nighttime continence, she said, was to make sure the bladder was fully emptied before going to bed.  Before, when the exit from my neobladder was the size of a pinhole, I was unable to empty the bladder, no matter how hard I strained.  Now, I should have a good urine flow.  In addition, she said that I should avoid sodas or other drinks with bladder irritants in them after 6 pm or so, and not drink anything a couple of hours before bed.  Even though my neobladder had a demonstrated capacity to hold more than a liter of fluid, she said that I should try to drain it every couple of hours during the day, so that it had no more than 400 ml at any time.  She warned that, if I continued to overfill the neobladder, eventually it would stretch out and lose its ability to compress, so I would be unable to fully drain it. 

These events have tremendously boosted my hope that I can start getting a good night's sleep -- something I have not had for three months.  In turn, I can look forward to my mind being more clear, and able to focus on work.  I went into the office after my appointment, and everyone was glad to hear that I might soon be able to return.  I have a major case that is set for trial in October, and would like to be able to resume working on it.  I still don't know what I want to do in the long term, but the hope that the three months of fog might be lifting is very exciting to me.  I'm going to give it a week or so to see how things are going, and assuming all goes well, I think that I'll try easing back into work.