Thursday, May 03, 2007

I digress

My husband has been treated over the last 10 months - on and off as the NHS schedules permit - for a suspected kidney stone. After his initial collapse in the small hours of a July Saturday, I took him to Warwick Hospital A&E where the initial diagnosis was either aneurism or kidney stone; later refined to kidney stone after X-rays and a urine analysis, the latter containing blood and signs of an infection. No stone had showed up on the X-rays, but as some stones only showed on an ultrasound scan, and as the ultrasound scanner had broken, he was told to see his GP and get referred to a urologist. This was done, and in October he had the first ultrasound scan which showed a 6.4mm (!) stone, probably uric acid based, in the left kidney. The consultant (November) recommended lithotripsy and this was done in January. In March a second ultrasound scan was due but postponed on the day of the appointment. He finally had the scan in early April, and no sign of a stone was found. Conclusion: the lithotripsy had been successful and the stone had been shattered and passed. However he was still suffering from fairly constant low-level pain in the bladder area, and having to pee much more often than was normal.

He went back to the GP who said that if the stone had been passed, the pain and frequency should be diminished, so he should really phone the Urology dept. and demand to see the Consultant, not the specialist Urology Nurse who had dealt with the case since the first 5 minute session with the Consultant back in November. Our GP was clearly unhappy with the Nurse Led Urology unit and argued that a nurse did not have the skills to deal with complex cases.

Phoning Warwick Hospital Urology Dept is a task best tackled on a full stomach and a free day because it often takes the best part of a morning to get as far as the answering machine. This milestone was reached and a message left by about 11am, and to everyones surprise the Nurse called back at about 4pm. Here the story takes a dramatic turn. Could he come in for X-rays tomorrow - say 11 am? Of course he could.

On arrival the Nurse greeted him before he had chance to sit down and a full one hour consultation later he had been given another Ultrasound scan, a prostate examination, a urine flow rate test, forms for an immediate X-ray, a blood test, a urine analysis, a prescription for a course of tablets to help increase the urine flow rate (Contiflo XL - 400 micrograms) and an appointment for a review of the results of the X-rays one week later.

From the US scans, urine flow and my husband mentioning that he had had Benign Prostate Hyperplasy (BPH) for about 15 years, she proposed that he could well have stone fragments blocking the urethra where it was being narrowed by the oversize prostate. Hence the urethra relaxing medication which might help the fragments to pass. She also recommended giving up strong coffee and drinking cranberry juice instead. If an infection showed in the urine sample, antibiotics might be needed later.

One week later at 11am sharp, he was back with the same Nurse comparing the X-rays from last week with those taken by A&E last July and concluding that there was very little difference. We still await the blood and urine test results and an appoinment with the consultant, but I have to say at this point that we seem to have had excellent service from the Nurse Led Urology unit. More later...

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