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Medical Forum / General / General / January 2006

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Uncontrolled night-time urination

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John Curtiss - 03 Jan 2006 17:25 GMT
Sorry for the cross-posting, folks - I will drop the newsgroups where I
don't get any replies.

I have a relative with a night-time urination problem and am looking for
some good advice.

He is mid-70's and has Parkinson's with dementia now coming on pretty bad at
night.  He is waking up every 2 hours to either urinate but most of the time
he uses the Depends.  Most of the time this keeps his wife up all night
since he wakes her up as well.

I don't go with him to the doctor, so I have to rely on what his wife tells
me. The GP gave him some kind of sleeping medicine and says that "he is not
a candidate for surgery."  I can't get her to ask him what that means.
Anyone here know?

Some other questions I have are....

1 - Should he see a urologist?  His GP says he doesn't need to see one.

2 - How can I find out if their GP has any complaints or problems? He is a
member of AMA but I don't see a way to check there.

Thanks.

John
J. Davidson - 03 Jan 2006 21:52 GMT
John, I remember googling disciplined doctors or something and it brought up
the info I needed.  Also, if you google AMA physician search and go through
the steps I believe you can find your info here too.
good luck
Jackie
> Sorry for the cross-posting, folks - I will drop the newsgroups where I
> don't get any replies.
[quoted text clipped - 22 lines]
>
> John
Fred - 04 Jan 2006 06:16 GMT
Thank you, Jackie.

> John, I remember googling disciplined doctors or something and it brought up
> the info I needed.  Also, if you google AMA physician search and go through
[quoted text clipped - 31 lines]
> >
> > John
Jason - 04 Jan 2006 05:41 GMT
> Sorry for the cross-posting, folks - I will drop the newsgroups where I
> don't get any replies.
[quoted text clipped - 22 lines]
>
> John

John,
I am not a doctor. Yes, your relative should see a urologist. You may want
to do a google search related to Prostrate and also Enlarged Prostrate.
It's a common problem in men over the age of 60. One of the symptoms
according to my medical book is "increased urinary urgency and frequency,
especially at night".
Jason

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Fred - 04 Jan 2006 06:16 GMT
Thanks, Jason.  His doctor says "he's not a candidate for surgery."  Any
idea on why the doctor might say that?  He's in the advanced stages of
Parkinsons but otherwise has a strong body and is in good physical health.

> > Sorry for the cross-posting, folks - I will drop the newsgroups where I
> > don't get any replies.
[quoted text clipped - 30 lines]
> especially at night".
> Jason
David Wright - 05 Jan 2006 05:24 GMT
>Thanks, Jason.  His doctor says "he's not a candidate for surgery."  Any
>idea on why the doctor might say that?  He's in the advanced stages of
>Parkinsons but otherwise has a strong body and is in good physical health.

It is not a good idea to ask medical advice of Jason.  He might give
you some.  In general, taking it is unwise.  As he said, he is not a
doctor.  He's not any kind of medical professional at all, or even a
skilled amateur.  For example, he seems unaware of the difference
between "prostate" and "prostrate."

 -- David Wright :: alphabeta at prodigy.net
    These are my opinions only, but they're almost always correct.
    "If you can't say something nice, then sit next to me."
                                -- Alice Roosevelt Longworth

>> > Sorry for the cross-posting, folks - I will drop the newsgroups where I
>> > don't get any replies.
[quoted text clipped - 35 lines]
>> especially at night".
>> Jason
Jason - 05 Jan 2006 06:30 GMT
> Thanks, Jason.  His doctor says "he's not a candidate for surgery."  Any
> idea on why the doctor might say that?  He's in the advanced stages of
> Parkinsons but otherwise has a strong body and is in good physical health.

I don't know. I seem to recall one doctor saying that there is a greater
risk when elderly people are operated on. Doctors don't like to take
changes related to operating on "high risk" patients. The doctor could
solve the problem by referring your friend to a urologist. Urologists do
these sorts of surgeries on a regular basis and may do the surgery. One of
risks of this surgery is incontinence. The doctor might have other
reasons--ask him.
Jason

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Fred - 05 Jan 2006 06:53 GMT
I see.  Thanks again.

> > Thanks, Jason.  His doctor says "he's not a candidate for surgery."  Any
> > idea on why the doctor might say that?  He's in the advanced stages of
[quoted text clipped - 8 lines]
> reasons--ask him.
> Jason
Twittering One - 05 Jan 2006 05:35 GMT
"Banqueting
           With her in her wind-walled palace,
           Underneath her azured dais,
           Quaffing, as your taintless way is,
               From a chalice
Lucent-weeping out of the dayspring."
               So it was done:
I in their delicate fellowship was one ~
Drew the bolt of Nature's secrecies."

~ Francis Thompson,
>From "The Hound of Heaven"
nospam@aol.com - 05 Jan 2006 17:10 GMT
>Sorry for the cross-posting, folks - I will drop the newsgroups where I
>don't get any replies.
[quoted text clipped - 22 lines]
>
>John

His GP should have checked him for prostate enlargement.  It is possible his
prostate is fine.  Have you asked about that?

He has parkinsons and dementia.  You should make sure he has good insurance
because he most likely will not get better.  And watch his reactions to the
sleeping medications because they can cause problems which are worse than
insomnia.  

Speaking from experience.  

Ora
ironjustice@aol.com - 05 Jan 2006 19:06 GMT
I would look into erythrocytosis / polycythemia ..

An increase in iron in the body has been shown to produce increased red
blood cells .. and increased red blood cells have been linked to
increased vasopressin ..

Increased vasopressin leads to polyuria ..

Decreasing red blood cell count / treating erythrocytosis leads to
decreased incontinence ..

Coincidentally Parkinsons' recently has been found to have some
significant recovery by elimination of red meat {high iron] and
inclusion of riboflavin {iron chelator] in the treatment regimen.

Excessive voiding is evidence of a impairment of vasopressin and
impairment of vasopressin
is associated with .. excess .. red blood cells  .. causing .. polyuria
/
excess voiding ..

J Vet Intern Med 1997 Sep-Oct;11(5):300-3

Polyuria and polydipsia and disturbed vasopressin release in 2 dogs
with
secondary polycythemia.

  van Vonderen IK, Meyer HP, Kraus JS, Kooistra HS

 Department of Clinical Sciences of Companion Animals, Faculty of
 Veterinary Medicine, Utrecht University, The Netherlands.

 In dogs, secondary polycythemia (SP) may be associated with polyuria
 and polydipsia (PU/PD). The pathogenesis of this PU/PD has not yet
 been explained. We hypothesized that hyperviscosity and increased
 blood volume in SP might affect vasopressin (VP) release, resulting
in
 PU/PD. This hypothesis was tested in 2 dogs with SP caused by renal
 neoplasia and PU/PD. Osmoregulation of VP release was studied by a
 modified water deprivation test and by investigating the VP response
 to hypertonic saline infusion. Water deprivation test results were
 consistent with an inability to produce concentrated urine despite
 increasing plasma osmolality. During hypertonic saline infusion, the
 osmotic threshold of VP release was markedly increased in both dogs,
 resulting in a delayed VP response to increasing plasma osmolality.
 The sensitivity of VP release was low normal in both dogs. We
conclude
 that blood hyperviscosity and increased blood volume led to impaired
 VP release and polyuria.

 PMID: 9348498, UI: 98009104

    _________________________________________________________________

Coincidentally .. again .. diabetic have JUST been found to be ..
hyperviscous .. and what do THEY .. have .. ?

Increased urination .. ?

Yep ..

Who loves ya.
Tom..

Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com

Man Is A Herbivore!
http://pages.ivillage.com/ironjustice/manisaherbivore

DEAD PEOPLE WALKING
http://pages.ivillage.com/ironjustice/deadpeoplewalking
Fred - 05 Jan 2006 21:14 GMT
Many thanks for the info!

> I would look into erythrocytosis / polycythemia ..
>
[quoted text clipped - 67 lines]
> DEAD PEOPLE WALKING
> http://pages.ivillage.com/ironjustice/deadpeoplewalking
kumar - 13 Jan 2006 08:11 GMT
Can't we relate Uncontrolled and excess night-time urination with
acidosis/acidic urine? Can't we relate excess iron digestion so
absorption with hyper gastric acid, heme based foods and with iron
supplements? Can't we relate excess iron with acidosis?
> I would look into erythrocytosis / polycythemia ..
>
[quoted text clipped - 67 lines]
> DEAD PEOPLE WALKING
> http://pages.ivillage.com/ironjustice/deadpeoplewalking
REP - 13 Jan 2006 11:06 GMT
> Can't we relate Uncontrolled and excess night-time urination with
> acidosis/acidic urine?

Anecdotally speaking (and probably in general as well) no. While
anecdote is not the plural of data, I have a urinary pH of 4.5 - 5.5 and
do not experience any, let alone excess, nighttime urination - and I
take 60mg Lasix before retiring!

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"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather

kumar - 13 Jan 2006 11:45 GMT
Then what can make one to urinate more and uncontrolled in night? I
doubt that quantity of urine is always relevant to it? Can it be some
problem in contracted/relaxed condition of bladder?

> > Can't we relate Uncontrolled and excess night-time urination with
> > acidosis/acidic urine?
[quoted text clipped - 7 lines]
> "Did Father shoot him? I will eat Grandfather for dinner."
> - Helen Keller, on learning of the death of her grandfather
Jason - 13 Jan 2006 16:55 GMT
> Then what can make one to urinate more and uncontrolled in night? I
> doubt that quantity of urine is always relevant to it? Can it be some
> problem in contracted/relaxed condition of bladder?

Do you have this medical problem? I suggest that you call your doctor and
request a complete physical exam. Prepare a list of questions and ask the
doctor to answer those questions. For example, if you urinate many times
during the night, it could the result of several different medical
problems such as
an enlarged prostate. A doctor can easily determine the reason you urinate
several times each night.

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Fred - 15 Jan 2006 08:40 GMT
The relative I'm working with told the Dr that he hadn't had a prostate exam
in 3 years, so the Dr gave him a rectal exam on the spot.

Stupid question probably -- was this the right exam?  I thought a prostate
exam was unrelated to rectal exam

John

> > Then what can make one to urinate more and uncontrolled in night? I
> > doubt that quantity of urine is always relevant to it? Can it be some
[quoted text clipped - 7 lines]
> an enlarged prostate. A doctor can easily determine the reason you urinate
> several times each night.
Mxsmanic - 15 Jan 2006 10:37 GMT
> The relative I'm working with told the Dr that he hadn't had a prostate exam
> in 3 years, so the Dr gave him a rectal exam on the spot.
>
> Stupid question probably -- was this the right exam?  I thought a prostate
> exam was unrelated to rectal exam

A digital rectal examination is a prostate examination.  The prostate
is very near the rectum, so a doctor can feel the state of the
prostate simply by inserting a finger in the rectum and palpate the
prostate through the rectal wall.  This is precise enough to allow the
doctor to get a pretty fair idea of the gross state of the prostate.
Certainly if it is enlarged or badly diseased it can often be felt.

A PSA blood test can also be used to screen for prostate cancer.  It
just screens for cancer, however; it doesn't say much about benign
enlargement of the prostate (for that, the DRE is simple and easy).

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Fred - 16 Jan 2006 07:41 GMT
Thanks very much!!

> > The relative I'm working with told the Dr that he hadn't had a prostate exam
> > in 3 years, so the Dr gave him a rectal exam on the spot.
[quoted text clipped - 12 lines]
> just screens for cancer, however; it doesn't say much about benign
> enlargement of the prostate (for that, the DRE is simple and easy).
Mxsmanic - 13 Jan 2006 20:58 GMT
> Then what can make one to urinate more and uncontrolled in night?

Increased production of urine, decreased capacity of the bladder, or
problems with the detrusor or the parts of the nervous system that
interact with it.

> I doubt that quantity of urine is always relevant to it?

Correct.  See above.

> Can it be some problem in contracted/relaxed condition of bladder?

Yes.  Problems with the detrusor can produce unusually frequent or
infrequent urination, up to and including incontinence and retention
leading to stagnation and infection.  Problems with the nerves
interacting with the detrusor can have a similar effect.

Physical encroachment on the bladder (as during pregnancy) can reduce
its useful capacity and increase the frequency of urination.

Note that while some conditions may increase the _frequency_ of
urination, they may not necessarily increase the _volume_ of urine
excreted.

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kumar - 16 Jan 2006 12:27 GMT
Urination - excessive at night
http://www.nlm.nih.gov/medlineplus/ency/article/003141.htm

The above link gives lot f informations in this respect.

> > Then what can make one to urinate more and uncontrolled in night?
>
[quoted text clipped - 19 lines]
> urination, they may not necessarily increase the _volume_ of urine
> excreted.
Mxsmanic - 16 Jan 2006 12:36 GMT
> Urination - excessive at night
> http://www.nlm.nih.gov/medlineplus/ency/article/003141.htm
>
> The above link gives lot f informations in this respect.

Yes, although mostly just the same things that have already been
discussed here.

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John Curtiss - 17 Jan 2006 10:38 GMT
Thanks for the link!

> Urination - excessive at night
> http://www.nlm.nih.gov/medlineplus/ency/article/003141.htm
[quoted text clipped - 24 lines]
> > urination, they may not necessarily increase the _volume_ of urine
> > excreted.
PF Riley - 12 Jan 2006 04:13 GMT
>Sorry for the cross-posting, folks - I will drop the newsgroups where I
>don't get any replies.
[quoted text clipped - 11 lines]
>a candidate for surgery."  I can't get her to ask him what that means.
>Anyone here know?

Remember rule #1: Never believe what a patient tells you their doctor
said.

Why don't you get the relative to sign a release form for you to talk
to the doctor yourself? I'm sure you would be much more satisfied than
soliciting useless advice off Usenet.

PF
Fred - 12 Jan 2006 08:05 GMT
"PF Riley" <pfriley@watt-not.com> wrote in message

> Why don't you get the relative to sign a release form for you to talk
> to the doctor yourself? I'm sure you would be much more satisfied than
> soliciting useless advice off Usenet.

Understood and agree, but it's a delicate situation.  And I'm not looking
for diagnoses here - just things to check into and other general info. I
would not recommend anyone take a posting for the truth, but the are a great
source of information.

What I have gotten from helpful folks here far surpasses anything I have
heard from friends, relatives, support groups or any of the govt agencies -
fed, state & local.  Because of usenet postings, we located an adult day
care center, assisted living facilities, doctor sources, details about
medicine, etc., etc. - the list goes on.

It has pointed me to many, many avenues that I would have otherwise missed.
 
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