Pramilaben (name changed for patient’s confidentiality) was extremely tired and fade up with the quality of her life. Pramilaben, in her 60s had a healthy life till about five years ago. This is when she first noticed that she was unable to watch her favourite TV program till the episode ends, as she needed to rush for urination in between the program. She lived in a village in Gujarat all her life, but her abled sons brought her to Surat City, so they could take care of her better. Her urinary problems were getting worst day by day so the intention was also to consult doctor for her. She had started waking up at night, which she had never done before. She knew that something wasn’t right with her but couldn’t pinpoint at anything in particular. Within a year she was passing urine every 15 minutes in a daytime. She started waking up 6-7 times or more during the night to pass urine, which resulted in her having sleepless nights. She noticed the gravity of problem more and more as she could not hold her urine. The moment she had a desire to pass urine, she had to go to urinate as she couldn’t hold on to it. This is regardless whether she was watching her favourite program, guests at home, or she was at somebody’s house. Matter was getting worst as she started noticing urine leakage. Things started becoming very embarrassing for her.
Her daughter in law, took her to the local doctor. The local doctor (possibly a GP), who didn’t know what to suggest, and did nothing more than reassuring her that she will get better and that these are the normal symptoms with increasing age. The daughter-in-law wasn’t convinced and took Pramilaben to the urologist who carried out some investigations, and also carried out a procedure called cystoscopy and urethral dilatation. Her main issue was not at all the narrowing of urethra (water pipe), hence no wonder she had no relief from her symptoms after the procedure. The daughter-in-law continued taking Pramilaben to some other urologists in town for 3 years but there was no relief from her symptoms. Ultimately, she was informed by one of the Urologist that there isn’t much anyone can do for her symptoms, and she would have to put up with them. By this stage she was really frustrated.
Her quality of life had become terrible, she had leakage of urine and the problems of frequency as well as urgency were ongoing. Her clothes had a smell of urine due to leakage, which prevented her from going out and enjoying her life with her sons, daughter in law and her grandchildren. Her confidence level had shattered, her depression had mounted, and she was feeling miserable. Neither Pramilaben, nor her family could work out what to do to make the mother feel better. Having no symptomatic relief Pramialben stopped visiting urologist or any other doctor for her symptoms as she had literally given up (before they decided to consulted me). She had compromised and decided that there is no treatment to relieve her from her symptoms and she would have to live with the symptoms for the rest of her life.
It was just three days before the Junta Curfew (on Sunday 22 March 2020) one of her son came to know about me, when he read about me in the newspaper. He searched for number and called me immediately, made an arrangement with me to bring his mother. They insisted that they wanted to visit me same day only and couldn’t wait. I could feel the pain and desperation in his voice. This was Friday and despite, it was not my usual clinic day. I could not deny seeing Pramilaben same day, altering my other schedule significantly. I spent significant amount of time with them understanding the history, going through previous paperwork, investigations and treatments she had so far. After making a comprehensive summery of her notes, and forming my opinion of her issues, and examined her. She had tried several medications for 3 years without any effect, which proved that her condition was refractory to the medical treatment and the surgical treatment was perhaps the only option for her. I carried out necessary investigations before making sure that the surgery would help her. I discussed the surgical option in detail with her and her sons, including the pros and cons of the surgery. Since it was Janata Curfew in 2 days’ time, I gave them option of performing the surgery after the matter of the coronavirus settles. This would also give them time, if they required mental preparation to undergo surgical procedure. At a time, to my recollection there was only one coronavirus case in Surat.
Pramilaben and her sons were so desperate for the treatment I recommended, and so keen for her to have surgery that they didn’t want to wait any further. She was so fade up with her condition that she just wanted the surgery to get over and done with. She was desperate to feel better. Her plight was as such that she didn’t care of curfew, coronavirus and possible lockdown.They wanted the surgery either same day or the next day. In these circumstances I discussed with the hospital whether they would allow routine surgeries and whether I could post her surgery the next day that is Saturday. By that time the hospital had almost made up their mind that from following week all routine OPDs as well as all routine operations were to be cancelled until further notice. However, I managed to convince the hospital and they agreed for me to perform the surgery next day, considering a semi emergency nature of her surgery. I carried out the Cystoscopic Intravesical surgery (through the telescope) (scar less technique) on her on 21 March, just a day before the Janata Curfew.
Next day on Sunday, I went to visit her at the hospital at 5.30am before the start of Janata curfew, so I could return back by 6.30am and release my driver, for him to reach his home in time. I went back to visit her again after 9.00 pm after the Janata curfew was over. However, the police had blocked several roads but cooperated with me and my wife(who was driving the car), as I was a doctor and was going to the hospital to visit the patient. Her urinary tube (catheter) had come out successfully during the day and she was able to pass urine on her own. By the time I met her at night she had started noticing some change in her symptoms, such as no leak and reduction in frequency of her urination. However, it was only a first post-operative day and besides the catheter had come out on that day, I was happy with her progress. I had already explained them that, even though some effect can be seen in day or two, but it may take 2 weeks to see the complete effect of the procedure. She was happy saying that she has waited 5 years to get better and another couple of weeks for complete recovery aren’t going to make much difference!
Next morning despite curfew being carried on I had to go and visit my patients and also to review Pramilaben to discharge her. She looked happy when I met her in the morning. She told me in excitement that she did not leak in day as well as night time and she woke up twice only in the night instead of 6-8 or more times. I explained to her that she would notice even better result by two weeks. Happy sons and their mother Pramilaben left hospital for home. Pramilaben was a new cheerful person compared to distressed Pramilaben I met, when she first came to see me. Since then the lockdown started and I couldn’t see her in the clinic personally as I would normally do.
I called Pramilaben’s family after a week post- surgery and after 3 weeks again. Both her and her sons spoke to me. Pramilaben was happy that ultimately, she had relief from her symptoms, and she regained her quality of life. Her leakage of urine had stopped completely, and her clothes were not smelling of urine. She has now stopped waking up at night and can enjoy her favourite program, without urgency to pass urine and without frequency. She is able to play with her grandchildren and has started enjoying her life again. She feels more confident in the house now and has recommenced normal household chores which she was most worried about. Off course due to lockdown she isn’t able to go out, but she thanked me many times that I fixed her problem before start of the lockdown. She told me that she is obeying lockdown and social distancing with all honesty and wants the coronavirus to go away from India. I would be looking forward to seeing new Pramilaben once lockdown ends.
• Don’t give up on urinary problems as treatment could be just phone call away.
• In initial stages of these symptoms, change your lifestyle, reduce acidic juices, caffeinated drinks and stop alcohol as well as smoking.
• Train your bladder and brain (bladder drilling exercises) by trying to postpone urination in stepwise manner.
• If in doubt or need help, then see a urologist who is specialised in treating these problems.
• Ask your doctor/surgeon reason for the surgery they suggest or do for you and also ask risks Vs benefits for that surgery, as if you don’t ask then who would?
• Before seeing doctor write down all your questions to be asked to your doctor.