Checking In: 2023-09-08

Content warning: bodily fluids

Checking in for 2023-09-08:

Strap in; this is going to be a long one.

So remember how I mentioned that I was undergoing a test for protein in my urine. Should be pretty easy, right? Just piddle into a container. Yeah, once is pretty easy, but doing it over a 24 hour period makes it a little more complex. Since the whole point of the exercise is to collect all the urine over a 24 hour period. Without getting too much into the details (because there are details to come) the amount of protein excreted can fluctuate over time so it can't just be a one-time collection. The idea is that if there's at any point where protein is excreted that it's captured. The test instructions make it abundantly clear that if you miss even a tiny amount then the results of the test are going to be skewed and invalid. So the whole process requires you being extremely mindful about the whole process. I mentioned last time that we don't tend to be mindful during excretion (some of us more than others). So, paying attention is vital to getting a good sample.

I figured this would be simple. But I also realized there might be a few wrinkles along the way. The first part is the apparatus used to do the collection. It looks like a "flying nun" hat with a collection bucket in the center of a large, flanged, piece of plastic with some strategic channels placed throughout. The idea is to maximize the collection area and provide a measuring cup for how much volume was collected. It also has a small channel for where to pour things out.

The collection takes place after your first morning piddle. That way it can be over an actual 24 hour period without any ancillary urine. So I did my morning constitutional (both numbers one and two) and figured that things would go smoothly. Just for safe measure I took the anti-diarrhea medicine. I wanted everything to be perfect.

One of the side effects of all of my chemo medicine (the Lonsurf and the Bevacizumab (nee: Avastin, Mvasi, Zirabev) is diarrhea. My concern was that somehow I would get number two into my number one collection and make it 1.5. I wanted desperately to avoid this as much as possible.

When I noticed the twinges of diarrhea happening I thought "a ha! I shall be clever and remove the collecting apparatus". Which I did. Then I could do my number two without incident.

Anyone over the age of 40 may recognize the fatal flaw with this logic. See, as you get older you don't tend to be able to void everything in your bladder straight-away. Sometimes there can be a significant amount left over that requires you to piddle an encore; especially after a number two.

The smug feeling that I had averted disaster was met with the twinge that additional voiding needed to occur. Oh no! I didn't have enough time to move the collection apparatus back to the toilet before nature took its course.

"OK", I figured, "don't panic. Maybe I haven't completely screwed up the test quite yet. Maybe it's still OK."

Friends, the reason I'm writing this novella is because should you ever have to do this test (and I pray you don't because protein in the urine usually means bad things are afoot with your kidneys) I want to be the shining example of what not to do in these situations. To paraphrase Jerry Pournelle: I do the foolish things so you don't have to.

Later on the urges hit again. And I dutifully tried to keep the one from the two. And again my bladder proved it had not voided its last little bits. Those went uncollected as well.

At that moment my anxiety hit the roof. I wanted to be done with this damn test and already I had had two non-collection events in what was supposed to be a perfect streak.

I did what any self-respecting geek does when they need to satiate their anxiety over a medical process: I searched online for how to handle this situation.

Naturally there no explicit "if you are an overthinking dumb ass here's what you need to do" sites on the internet. But what I did find was that Lonsurf can cause protein in the urine. That's a common side-effect for 1/10 patients. What's not great to find out is that it can also cause some kidney damage for 1/100 patients. The protein in the urine is an early indicator that your kidneys aren't functioning properly. Normally your kidneys filter out the protein in such a way that it isn't excreted (it likes to keep the protein around for other uses like building cells and the like). If they're not keeping the protein that can be an indication that they're not doing their job. Which is bad. It's like a colander that has a big tear in it that allows the spaghetti to fall out the bottom while it's trying to just strain the water.

Reading that this whole Lonsurf thing might lead to kidney failure is not the sort of thing you want to be reading while you're failing to collect the evidence to support whether or not you're experiencing kidney failure. So I tried to call the nurses' station at Cancer Care Associates to get a verdict on whether I should continue. Unfortunately they were shut for the day and only their answering service was available. Rather than try to explain what was going on to someone who was going to try to relay that message in some strange version of telephone I decided to just toss the urine I'd collected and call in the morning for a verdict. I did this because it was clear to me that I'd need to retake the test.

I'm not going to lie: that thought broke me a bit. I was not even 12 hours into this test and I was already feeling anxious, afraid, and ashamed that I had failed. Not to mention that failing this test could have knock-on effects for my overall health. I'd created some serious stakes in my brain.

However, I did think of an alternative. I have a blood test that I need to do anyway to check my white blood cell count (and other items, like my protein). Would it be possible to also give a urine sample while I'm there?

Fortunately that seems to be the case. So we'll know more next week.

It feels silly to say this but this whole thing felt like an ordeal. It got me thinking about what was happening to my body and if I was experiencing additional, severe side effects. I don't know if I'm ready for those. This episode taught me that I'm clearly feeling some resistance and fear around the thought of more of my organs taking a beating. But that's also what we're testing for before things get seriously out of whack. It just requires patience and trust (and some careful aiming). And it requires patience to trust the results and trust those in charge of my care to have anticipated these roadblock and be nimble enough to think of alternatives.

I knew this collection would have its challenges but I didn't anticipate that it would break me in new and novel ways. Practice areas come in all shapes and sizes.