Energy, Part IV: Big Dick Energy

(written mid-March, 2020)

Buckle in, folks, this one might be a little triggering for some of you.

On the Friday I finished my prednisone, I had a follow-up appointment with my primary care physician as an interim, stopgap step between the gout lady and my urologist appointment (which was still on the books for the Friday after that). The goal here was to check in and see how I was doing, and to probably get a prescription for some sort of anti-uric-acid drug I'd have to take every day.

"Your foot looks fine now," she said. "How do you feel?"

"Pretty much normal," I replied. "Slight muscle aches in the calf, like when you get a knot in the muscle, but that's about it."

"Well, your uric acid levels were high," she said, "so it was probably a gout attack. You said this has happened before?"

"Yes, but this was the worst one he's ever had," my wife chimed in.

"Yes," I said. "I agree. About once or twice a year I'll have it happen in one leg/foot or the other, or occasionally my arm, and it goes away within a few days. I thought it was tendonitis or repetitive stress injury, etc. before, but apparently it's not."

"The thing about gout is that it recurs, and that it's always damaging to the joints," said my doctor. "Which is why it's worse this time than before -- those joints are getting a little more damaged every time it happens."

This makes sense. My weight is also slowly creeping back up (though I don't know why) and that generally puts a little more stress on my body.

"So," the doctor continued, "I'm going to put you on allopurinol for the uric acid, and colchicine for flareups."

"My dad is on allopurinol," I said, "so I know the basics about it."

"It is the go-to gout medication," said my doctor. "Works pretty well, minimal side effects if any; it helps. But you'll have to drink a lot of water while you're on it."

"I've been doing that since this shit started anyway," I replied. "I have a 48oz Nalgene bottle that I try to drain at least once a day, twice if I can."

Note: even if I drink two of them a day, that's only 96oz of water. A gallon is 128oz. I don't know if you've ever tried to drink that much water (or liquid in general) in any given day, but it is hard. As I've told Daisy, I just don't think I can put that much fluid into my body on a daily basis. It feels like a job, it feels like I'm forcing it. It does not make me feel good. It makes me feel, well, bloated. With how I'm slowly gaining some weight back, I want to feel and look less fat, not more. 

"Well, keep that up," my doctor said. "It will only be beneficial in helping to flush excess uric acid out of your body."

"What's the colci....coldic...--"

"Colchicine," she replied. "It's a plant-based natural anti-inflammatory."

"Take it when you're having an attack and it will help," she said. "It's not an every day thing. If you take it every day it may trigger an attack and make it worse."

Note: I've not been able to find info on that, per se, but I did find this:

So, I mean, whatever.

Apparently if I start to have a gout attack, that stuff will kill it in 12-24 hours, so there's that. 

Anyway.

"So let's talk about my urologist appointment next week," I said. "Do you know how that will go, what I'm supposed to do beforehand -- fasting, drinking more water, etc?"

"I do know," she replied. "You don't have to do any special preparation for it or anything, but I'm pretty sure he'll want to scope ya."

Scope...me?

"The doctor takes a thin tube with a camera and goes up inside your urethra, all the way up into the bladder, and looks around inside to make sure there aren't any cuts or lesions, burst blood vessels, anything like that which may be causing the blood in your urine. If they see anything actively bleeding or anything like that, they'll cauterize it while they're in there."

As she said this, the look of horror I gave her must've been amusing, as a slow, evil smile spread across her face. The wife found the contrast between my face as well as the doctor's hysterical. 

"And, uh, there's not any other way they can do this? Like an X-ray or CT or something?"

"Nope," my doctor said, very much trying to hold back a laugh. 

As an aside, that IS incorrect, which I will get to later. 

What I wanted to say: AHHHHHHHHHHHHHHHH!!!!!!!!!! Oh my gods, I'm going to die, because fuck it, I'd 100% rather have the bladder cancer than deal with that. Bladder cancer at least gets me out of work on FMLA on whatever percent of my salary that would give me. Fuck it, no, no. No. My dick isn't falling off, so I'm not dying, thank you, check please, we're done here.

What I actually said:
"So, ahem, any special things I should do beforehand? Should I like, shave everything into a heart for the doctor, or something?"

What I said when we got out to the car, much to my wife's again, hysterical laughter:
AHHHHHHHHHHHHHHHH!!!!!!!!!! Oh my gods, I'm going to die, because fuck it, I'd 100% rather have the bladder cancer than deal with that. Bladder cancer at least gets me out of work on FMLA on whatever percent of my salary that would give me. Fuck it, no, no. No. My dick isn't falling off, so I'm not dying, thank you, check please, we're done here.

I'm sure the phrase "they're going up my peehole" was uttered a few times as well, while I did my best to hold back tears.

The wife, infinitely amused by this, was pulling up videos of the procedure on YouTube later that night. "Oh, I found video of it, it doesn't look that bad, do you want to see?"

"FUCK NO I DON'T WANT TO SEE IT!"

[EDIT: I later did watch a video of the procedure and it is pretty much the most horrifying thing I could have imagined, with little exaggeration.]

For a full week I dealt with the fear of the scope, knowing that the next Friday, I would have a camera -- and not a small one, either -- shoved up my peehole. UP MY PEEHOLE. It is supposed to be an out hole, not an in hole. 

I felt the need to tell my coworkers -- management especially -- that depending on the results of said scoping and any subsequent, ahem, work that would need to be done. Getting scoped is one thing -- finding something that needs to be repaired, or cauterized, is something completely different and would make for a rough few days afterwards, which would mean I would not be going to work after such a procedure for at least one day, maybe more.

"They, uh, can't go up the butt instead?" asked my Director.

"Sadly no, though I fucking wish they could," was my reply.

The appointment came, and externally I was cool as a cucumber -- internally, I was at possibly the most anxious I've ever been for any doctor's appointment, ever. This was evident in my blood pressure, which was forty points higher than usual when they took it in the office that day.

Daisy, the wonderful wife that she is, did everything she could to keep from giggling at the situation. She failed.

Now, I'd like to rewind here for a minute to set the scene: at this point I had been on allopurinol for a week, all gout symptoms were gone, I'd been drinking close to a gallon (again, not an entire gallon most days, but close) of water every day, and I hadn't seen blood in my pee for over two weeks -- probably three at that point. Physically, I felt great. I felt better than I'd felt in some time both mentally and physically. At this point I was sort of wondering why I was actually even there, so far removed from the original situation and cause for concern. 

The urologist I saw was probably in his early seventies, if not older, and had zero sense of humor about his job or his patients whatsoever.

After the nurse got a urine sample from me to run through the labs there that day (!), the doctor came in and asked me a long list of questions, including asking if I had diabetes twice.

I don't -- every blood test I've ever had confirms that I don't, I'm just fat. It's okay, I'm that rare type of healthy fat person that people can't believe when they see.

"Okay," the doctor said, "I'm going to go get the results of your urine sample, and I'd like you to undress from the waist down, put on this gown, and jump up on the table for me. I'll be back shortly."

This is it, I thought. This is when they put the scope up my peehole.

I am not generally scared of a lot. I used to be anxious about everything possible, but at this point, even for most medical stuff, it's meh. I used to hate having my blood drawn and would nearly pass out (or actually pass out) every time it happened. In comparison, I've been stuck with so many needles over the past two months, either to put something in me or to take blood out of me, that it's become completely routine and doesn't really bother me anymore. The last two blood draws I had were nearly painless and didn't bother me in the slightest, and between those, my tattoo, and the other things I've been injected with over the past few months (vaccinations and the like), I've been fine.

But this, this was different. For quite obvious reasons.

The doctor came back in, told me to lay down on the bed, and let me know in his old, slow and metered voice that he was going to perform an exam of my midsection and genitalia, which he did. It was fast and minimally invasive, and didn't bother me in the least. It rather tickled as he was pressing against some different places on my abdomen and pelvic region, which made me laugh slightly, because it felt like when my cat walks on me with all of his weight. He even apologized when he had to examine my actual genitalia, which I found amusing until I was in the car later, thinking to myself perhaps he was apologizing because it's so small and was frightened when I was there. 

"Okay, well, nothing seems to be out of the ordinary so far," he said. "Hop off there, turn around and put your elbows on the bed, and spread your legs as far as you can go -- I'm going to check your prostate."

...okay.

Now, several thoughts ran very quickly through my mind at this point -- the first was oh, I'd so much rather have this done to me than get the scope, followed by I guess I should have expected this, since, well, all guys get this done to them at some point, followed by but they don't usually have their wives in the room to witness it, followed by this is going to be an interesting story to tell the guys at work.

And by the time these thoughts ran through my head, he was inside me.

Look, over the years, especially in my younger years, I had my share of questionable sexual experiences, and only a few of them have involved a man inside me. So by those standards, and approaching it from that point of view, it was fine. During the 20 seconds or so that the exam was actually taking place, I thought about this particular meme I'd seen a few weeks before:

This did not happen to me, but as soon as I felt him press on and feel around my prostate, I started laughing.

The wife, who did not know or understand why I was laughing, also found this hysterical as well, and did her best to stifle her own laughs.

And then his fingers were out of me and he was done.

"Everything feels pretty good and normal to me," the doctor said, with a quizzical look on his face. I tried not to look him in the eye.

"You can get dressed now," he added. "Here's some tissues to wipe the jelly out of your rectum. I'll be back in a few minutes."

Wipe the jelly out of your rectum!

I thanked him, I think; I was trying too hard not to burst into insane peals of laughter like a twelve year old, despite the fact that I'd just been violated.

"Wipe the jelly out of your rectum!" I whisper-yelled to the wife once he was out of the room -- my wife whose face was red with laughter -- as I was, ahem, attempting to do so. "Oh hell, there's so much of it, it's all up in there. Don't look at me. Don't you look at meeee!"

Once I, ahem, wiped the jelly out of my rectum, I regained my composure and re-dressed myself.

"The look of horror on your face..." Daisy started.

"It was fine," I said. "It didn't hurt or anything. Just felt odd."

This is true. I now no longer understand why all of the guy-dude-bros get all nervous or worked up about the procedure. It didn't hurt, it was only slightly uncomfortable for less then twenty seconds total, and there are far worse things to get shoved up one's ass than an old dude's rubber-gloved fingers.

"Did you like it?" Daisy asked, with a smirk.

"It's not something I'd like, choose to do just willy nilly," I said, "but I didn't dislike it; it is what it is."

It was at about this point when the doctor came back to the room.

"So," he said, "your urinalysis is clean, and looking great. No blood at all, nothing."

"That's very good to hear," I said.

"Your prostate feels normal, and I didn't detect any abnormalities in my exam, so that's good too. What I'd like to do next is to schedule you for a CT scan of the pelvic region, both with and without dye, to get some imaging done -- sort of like an X-ray -- to make sure there's no stones or anything else in there that would be a cause for concern, and then come back here to discuss the results a few days later. Does that sound good?"

"Sure," I said. Because, at this point, why the fuck not, right?

"I don't expect to see much of anything as you're asymptomatic for any problems right now, but if they do see something on this scan, I'll want to perform what they call a cystoscopy."

AHHHHHHHHHH!!!

"A cystoscopy is when we insert a flexible tube with a camera and a light on it up through your urethra into the bladder so that we can, well, look around and check for any problems visually."

I could begin to feel my hair standing on end.

"Now, I know that sounds scary, but it's not that bad," he added. "we coat the scope in novocaine jelly so that you don't feel it as much and to minimize any after-pain -- it's also so we don't have to perform an injection of novocaine into the penis, so you don't have to worry about that."

AHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!

"Oh, that's neat," I said.

"Now, we'd only need to do that if we see an issue in those CT scans," he said. At least that's what I think he said; I was terrified beyond the capacity for rational thought at this point.

"I get that," I replied. "Better to be safe than sorry, and eliminate all doubt."

I thanked him, and he left -- and the nurse returned.

"I scheduled your follow up for a week from today," she said. "So I need you to call the hospital to get the CT set up good to go for sometime between now and Wednesday, otherwise the next open slot is in another three weeks."

"Uh, okay," I said.

I would later realize that this nurse lady, brusque as she was, was doing everything she could to pull some strings and do us a favor to get this done as quickly as possible. Daisy and I agreed, as with the coronavirus ramping up and everything getting put on lockdown more and more every day, the thought of getting all of this shit taken care of ASAP was first and foremost in our thoughts.

I got the CT scan scheduled for 4PM on Tuesday, and the follow-up with the urologist the following Friday at 3PM, same time as the previous appointment.

"No food for four hours before the scan," the nurse said. "Clear liquids are fine. Call them to reschedule if you get sick between now and then, as they won't do it if you're sick. It should be fast -- they'll want to do one scan without the dye and one scan with the dye to see the contrast in reflectivity. You won't drink the dye, they'll give it to you in an IV drip. It's an iodine-based dye."

Greeeeeeat. I hate IV drips. Those are the most painful needles they can possibly stick into you. And you have to wait for the stuff to empty inside you.

And all this for a little blood in my pee weeks ago.

So that brings us up to the present. On Tuesday I'll go in and have that done, and I'll be taking off work for the night for rest purposes afterwards, as I will have to get up early to do it and it's a good excuse to not have to go in and deal with the normal horseshit of my job, especially when I expect that job to only get harder over the next few weeks while this coronavirus stuff ramps up.

I will, of course, make sure everyone here is updated with the latest once we see what happens.

Energy, Part III: Big Foot Energy

(written early to mid March, 2020)

Picking back up from where we left off...

My testosterone, upon being checked at that doctor's appointment, is 470.

This is now statistically average/slightly below average for someone of my age. The ideal is 500-520 or so, roughly, but 470 is in the normal range.

I feel no differently whatsoever. And, for the record, my blood results for my thyroid were normal -- which will, as planned, make me personally request a full thyroid-specific work-up over the spring/summer, especially if nothing else changes. I respectfully disagree that there's nothing going on there.

However, there were trace amounts of blood in my urine, as I told the doctor there might be. She didn't see it as a huge cause of concern at the moment and said to come back in over the summer to do another pee-in-a-cup test.

A few nights later at work, I noticed a lot more of a pink tinge to my urine than before, and upon a phone call back to the office in the morning, I was set up with an appointment for a urologist three weeks in advance -- it was the soonest I could be seen. Could be something, could be nothing, but they were going to see one way or another.

"I'm scared," I told the wife.

And I am, but I'm also sort of...excited? I don't know if that's the right word to use. I'd like to have an excuse, more than anything else. That's probably the best way to put it.

"Brandon missed work tonight?"
"Yeah, he's got bladder cancer, I guess it was a rough day for him."

Etc.

I don't want pity, but I do want something that can be pointed to as a scapegoat so that people will leave me alone, so to speak. If that makes any sense. A crutch. Something I can point to that other people will say isn't my fault so that I can get a free pass on shit I would otherwise be forced to expend physical and emotional energy on because it would be expected of me.

"Can't work today, I have cancer. I'm salaried anyway, so I'm still getting the same paycheck. Will be back tomorrow or the day after once this particular flare-up dies down some."

Some of you are probably appalled by this. Did you just say you'd rather have some form of cancer than be a fully functional human being who contributes to society?

Yes, yes I did. I'm so beaten down and weary that I kind of just want to retire and not have to deal with it anymore. I did what I wanted to do with my life -- I worked some interesting jobs, met some interesting people, got married, and bought a house. Check, please. Stop the ride, I want to get off. I envy those born into privilege, people who can just up and decide exactly what they want to do with the rest of their lives and when, and if that decision is "I want to watch Netflix and play video games and read comic books all day," then that's what they do.

I've contributed enough to society. I'm burnt out now. This world sucks and I'd like to withdraw from it as much as possible.

In saying this, I would later come to find out I spoke too soon, for multiple reasons -- Coronavirus being one of them, of course, but surprisingly not the most pressing.

Last week, I woke up on Thursday to my foot hurting.

Meh, I thought, must've pulled a muscle in my sleep.

It ached somewhat, and felt a little stiff, but I didn't think much of it. I'm old, my body aches, and I have been known to pull muscles in my sleep. This isn't incredibly out of the ordinary.

I lived with it, woke up on Friday for an interview (I'll discuss this later) to said foot hurting even more, took some ibuprofen for it, which helped somewhat, and went on with my day. By the time the interview was over and I was back home, my foot was hurting so bad that it felt like it was screaming at me.

"What does it feel like?" Daisy asked.

"Sort of like a stress fracture, almost, but I didn't do anything to it."

The pain was primarily the top of my foot, radiating down the inner side, under the arch, and looping around the toe (but not affecting the toe, oddly enough).

"Sounds like gout," Daisy said, showing me an article on her phone.

"I don't think it's gout," I said. "It's the same sprain I get in my foot from time to time that just really hurts for a few days and then goes away after I take enough ibuprofen for a while."

It's shocking that I think like this, but it's true. It has happened before, and usually lasts three or four days at the most before it just, well, vanishes -- and then I go back to normal. It happens in my arms once in a while too, which I have always classified as tendonitis and then treat it the same way. 

"Besides," I added, "how the fuck would a vegetarian get gout? It's caused by eating a lot of red meat, organ meats and stuff like that, seafood, and drinking a lot of beer. I do precisely none of those things."

I have had maybe two beers in the past six months and have been vegetarian for a year and a half, going on two this summer. I'm not gonna say I'm the healthiest person on the planet, but I have taken great strides in cleaning up my diet. Indeed, aside from the occasional real cheese or food containing milk or eggs, I am almost 100% plant-based and vegan. I am careful about this. I am meticulous about this. Anyone who knew how I used to eat before versus how I eat now would be shocked and amazed.

But I mean, still, this shit happens.

Anyway.

By Saturday my foot was really swollen and I could barely stand or walk. It was hard to sleep. I couldn't put my foot in a position where it didn't hurt -- elevated, angled, resting, etc. It was maddening. The pain was so uncomfortable it made me sweat. I forced myself to walk on it to to go the grocery store, where I used the cart as a walker, and I'm not sure I've had physical pain so strong in some time. When I went to bed I took 800mg of ibuprofen (which, again, seemed to take off the edge a bit and make it functional to walk around, even with pain).

When I woke up six hours later on Sunday morning, out of a dead sleep because the pills had worn off, I finally agreed that I should probably go to the doctor, because this shit wasn't getting any better at all, and was actually slowly getting worse. 

"What's your schedule like tomorrow?" I asked the wife. 

"Why?"

"Because I probably should go to the doctor to get this looked at," I said. "It's not getting better. It's awful. My foot is really swollen, red, and hot to the touch, and nothing really seems to be helping."

"Why don't we just go now?" she asked.

It was Sunday afternoon, around 3PM. I was planning to work that night, though the chances of me being able to successfully do so were rapidly dwindling. 

"Dr. [Name] isn't in on Sundays."

"Then we'll go to the primary care clinic place, it's open until 8."

I hemmed and hawwed for a few minutes, during which I reached out to my team onsite at work to let them know what was going on. Regardless I'd have to miss work as I didn't think I could even sit at my desk for the entire night. 

"Fine," I said. "Let's go."

So I hobbled my ass downstairs to the car, carefully, while my wife gave me the new nickname of "Hobbles," and we went to the clinic.

Going to a primary care clinic on a Sunday night is bizarre. For one, there's nobody there -- I was the only patient in the building, and there was one on-call nurse there and a blood-draw nurse along with the receptionist. The rest of the building was spookily empty.

I filled out the paperwork, did our copay thing, and then waited in the patient sitting room for about 20 minutes for the on-call nurse/doctor/lady to come in and look at me.

"Take off your shoes and socks so I can compare," she said. 

I did, and she stared at my foot for a good twenty seconds, then looked at my other foot, then back up at me, then back to the painful foot.

"...what? What is it?" I asked.

"I, well, I don't think this is gout," she finally mused. "I'm leaning more towards a diagnosis of cellulitis based on the redness and swelling. Look at how your foot is swollen and red up past the ankle, and spreading, and compare it to your other foot."

I did.

"Do you appreciate the difference?" she asked.

Note: I don't really remember her asking this, but the wife's reaction to that question, when she told me later, was priceless and I wish I would've seen her face. 

"Yes," I said. "It's swollen and red." No shit, doc. That's why I'm here.

"It could be gout and I may be wrong, but I'd like to treat you for cellulitis, prescribe you some Bactrim to quell it, and draw blood to test for both. Worst case is that if it's gout, the blood test will tell me from the uric acid levels. If it's cellulitis, the Bactrim will knock it out."

"Sure," I said.

I mean, sound enough logic, right? I just wanted the shit to be gone so I could go back to feeling normal again. 

She had the blood draw lady take two vials of blood, almost completely painlessly for once, and sent me off to the pharmacy for the Bactrim, which we picked up on the way home. As soon as I was inside I popped off the cap and took the first dose.

And...nothing happened.

I had taken the night off, and I tried to just...rest. It had been a really long, bad weekend of pain and I just wanted to not hurt for a while. I slept off and on in the overnight hours, and when I went to bed for good I made sure to take the next dose of Bactrim first. When I awoke, late-morning on Monday, I was still in pain and nothing had really changed. I took the next dose of Bactrim.

The doctor lady called me shortly thereafter. 

"How are you feeling?" she asked. 

"Well, it hurts," I said. "It's basically exactly the same as it was last night."

"No progress at all?" 

"Nope." 

"Okay," she said, "then stop the Bactrim. I have your blood test results here and they do show elevated uric acid levels in your blood, so it is probably gout then. I'm going to prescribe you a steroid anti-inflammatory, prednisone, and I want you to make a follow-up appointment with your normal doctor within the next three days, even sooner if you don't start feeling better once you're taking that, okay?"

"Completely stop the antibiotic?"

"Yes," she replied. "I don't see any infections in your blood so it's probably just the uric acid and gout."

Allllllrighty then, doc. 

I have always been told that you do not just stop an antibiotic once you start taking it, you have to take the entire dosage over the metered, allotted time. But, she's more qualified than I am, so whatever.

Daisy picked up the prednisone from the pharmacy on the way home from work, and I took the first dose of it as soon as she walked in the door. I decided I could work, that the pain wasn't so severe that I couldn't sit at my desk (and I didn't want to burn another night of PTO). 

Here's what they don't tell you about prednisone -- while it will rapidly drain any swelling and get you feeling almost immediately better, that fluid it drains off you all has to go...somewhere.

In my case, once I got to work, I could feel my swelling in my foot go down by at least half within a few hours...and I had to pee seventeen times that night.

Okay, that might be an exaggeration, but not by much.

The other place the fluid felt like it went was to my lungs, which was a little strange.

I don't know if you've ever been drunk, but you know that feeling when you're drunk where your lips feel a bit numb and your lungs feel gummy and, well, liquidy, and it's a little harder than usual to breathe? Yeah, it was that. 

By the end of the night at work, "Hobbles" was walking almost normally and the vast majority of my foot pain was gone.

By the next night, the swelling was completely gone, with maybe 5% of the pain left, and I was walking normally again.

By Wednesday and Thursday that week I was back to normal, with no changes but a little aching in my leg similar to when you get a knotted calf muscle in your sleep.

Here's the other thing they don't tell you about prednisone -- some of the side effects are weird.

For the days I was on it, I was constantly hot and sweaty. That is a known side effect -- I mean, it's an anti-inflammatory that is pulling fluid out of you, and sweat is another way for it to come out of you to be sure. The larger part of it is that you're told to drink a lot of fluids as it helps break down any further uric acid buildup. 

While I try to stay adequately hydrated, this isn't always completely possible. I work overnights, and that pretty much requires coffee and energy drinks in order to stay awake. Both of those, apparently, are not great for you if it's all you're drinking most of the time, which for me was sort of the case -- I would drink two to five cups of coffee and two or three tallboys of Monster or what-have-you every day, and not much else, just to keep going. 

Well, when you go from drinking that to cutting energy drinks out almost entirely (which I have done) and drinking close to a gallon of water every day instead...things happen to your body. I now sweat a lot more, for example. I almost never sweat before, except in the summer when it was super-hot. Now, if I fall asleep in my chair in my bathrobe, and the room is too hot, I'll wake up drenched. This is new.

The prednisone was given to me on a five-day cycle. In addition to it making me sweat more, it sometimes made me a bit foggy or slow as well. Not tired, not like, drunk or anything...but slower. Enough to where I noticed it. Enough to where some people at work noticed it, and I had to tell my fellow leadership peers that it was making me a little spacey but fine, just give me a little more leeway on some things until it wore off, etc. 

There IS more, of course, but I'll be covering that in subsequent posts...