Sunday, March 22, 2009

I just got a great question from Tom's Grandma who is following my blog closely. I will answer it here because I think that one of my recent blog entries might have been confusing. I am starting to understand the records, and I have an idea of what they mean now. Here is an exert of her email:
I am always interested in finding out what terminology is used for the different medical conditions, I always look them up on and was surprised that the neurogenic bladder was mineral stones in the bladder. Couldn't find foley decompression on Mayo Clinic nor What is Foley decompression? Did they mention the fractures at all?
The hospital admission form did mention my fractures as the reason for needing pain control. As long as IV pain meds are needed to control pain (as opposed to oral meds), that is enough reason to admit me. According to the insurance rejection letter, they think that pain was controlled with oral meds only when I was admitted. They have the wrong information. In my case, I was put on both oral and IV pain meds, and as I progressed, I was slowly switched to oral meds only, by the second day.

Here is the definition of neurogenic bladder from

Neurogenic bladder is a urinary problem in which the bladder does not empty properly. Depending on the type of neurological disorder causing the problem, the bladder may empty spontaneously (incontinence) or may not empty at all (retention with overflow leakage).

Some of the common causes for neurogenic bladder are nervous system tumor, trauma, neuropathy, or inflammatory conditions (such as multiple sclerosis).
I believe that bladder stones is one of the causes, as you read in the definition. My situation was retention due to trauma. And this is what the doctor in West Virginia was worried about and his reason for transferring me to Roanoke.

A Foley Catheter is a bag with a tube that stays in the bladder, usually for patients who are recovering from surgery where they can't get up for a few days. The disadvantage of this is that the bladder gets lazy and forgets how to expel urine on its own (I think one of the doctors told me this). Based on some other notes I read, Foley Decompression is the process of weaning the patient off the catheter and observing the bladder's ability to recover on its own. At the W. Va. hospital I was given two chances to urinate on my own, and I was unable to, dispite have 1.2 L and .8 L in my badder each time (the average bladder capacity is .4 - .6 L). So the nurse put in a Foley and I was transferred to Roanoke.

On March 3rd, my second day in the hospital, the catheter was removed. It took a while, but I was able to go on my own. If I didn't, they said that they would perform an "in-and-out catheter" (no bag), and I would have to try again later. To sum up my answer to your question, the doctor can't just remove the catheter and send you home. You have to demonstrate your ability to go on your own. And that is my best guess for the meaning of "Foley Decompression," and that is why I was admitted to the hospital.

When I was at my PCP's (Primary Care Physician, Dr. D) office picking up the records, the nurse said I can set up a regular visit to discuss the records. So I think that after I have read everything several times, listed my questions, and drafted the letter to the insurance, I will schedule a check-up/consultation to go over everything. And luckily, since Tom's job is fairly flexible, he will be able to come with me, and for that I am grateful.

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