Cardiovascular :: Deciding To Refuse Cardiac Catheterization


May 31, 2015

After doing the best I can to ferret out the risks vs benefits of cardiac catheterization.  92% of my brain says, "No."  That niggling 8% is a real pain.

I am female.  I am over 60.  I have not had a myocardial infarction, (that they're telling me about anyway).  I have some stress wall hypertrophy, but that's pretty much it.  If I could get the physicians/cardiologists, to give me better evidence of need for such an invasive procedure, I might consider it...however...

I know me.  Just having the procedure would be psychologically, and, therefore, physically, ruinous.  I think I understand - but who can understand this really - that choosing not to have the catheterization, and whatever may happen as a result, means I might sign out quite unexpected.  But is this a better way to live?  I think so.

I have not felt "well" for at 7 years.  (I'll spare you the ailments).  However, I don't get colds, flu (no vaccinations)...I don't have hypertension.  I'm told I have angina, but I am convinced that the post-meal sensations I get are due to gastric/diaphragm...more on that order of things.  I don't have frank chest "pain."

I'm figuring that it will be a complete crapshoot to refuse the catheterization, but I am 100% certain, that there is a better chance of me surviving an invasive procedure if I don't die before I have it, then lending myself to what looks like a never-ending routine of invasive procedures.

What I'm currently hoping for, but have been unable to get, is a cardiologist who will agree to fully monitor me; one who truly understands the various medications available and who would find one that is best suited for this particular body, and who considers cardiac catheterization, et al, a last resort, rather than a first.  (Nice fantasy).

So far, I've had the general practitioner I see, attempt to scare the hell out of me without telling me on what evidence he was doing so.  (I would change to another GP if there was another one around).  That kind of tactic is not only useless, but demoralizing.  When it comes to "heart," demoralization can, without a doubt, lead to "heart trouble."

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Since I posted a thread about self-catheterization -- more formally called Clean Intermittent Catheterization (CIC) -- there have been a few different discussions on the topic in various threads. I thought it might make sense to bring those discussions over to a dedicated thread. With that in mind, I will summarize and/or copy and paste some of what was said before into this thread for better continuity.

My story in a nutshell. 68 years old with BPH probably since my late 20’s. Watch and Wait strategy with on-and-off trials of Tamsulosin (Flomax) with poor results.  Symptoms were the  normal retention issues resulting in frequent urination with incomplete emptying, urgency, and having to go to the bathroom at night in increasing frequencies. Near the end, two or three uti’s per year often accompanied by gross hematuria (bleeding).  

Two years ago things got significantly worse and I couldn’t urinate on my own without physically pushing against my bladder (Crede Maneuver). That led to another trip to the urologist where  ultrasound showed significant retention and hydronephrosis (water in the kidneys). I was told I needed an operation (this facility primarily did Turps) but first I had to rehabilitate my bladder because at the time  it was too flaccid (stretched) for a good surgical outcome. I was given the choice of wearing a Foley Catheter for six weeks, or a program of self-catheterization (CIC) in order to decompress the bladder. I chose CIC so I didn’t have to wear a Foley 24/7, and also because I felt it put me more in control.

Six weeks later my bladder was rehabilitated to the extent they could do a Turp, and the hydronephrosis was gone. After doing some research and a lot of thinking I decided to put off the Turp due to the potential of irreversible side effects, primarily retrograde ejaculation. Two years later, I am still doing CIC while waiting for newer procedures with better outcomes and fewer side effects.

I will detail my experiences with CIC in following posts -- but to summarize, once mastered, it’s a painless five minute procedure that allows you to empty your bladder completely any time you want. With CIC, I therefore have no retention issues, no urgency, and in most cases sleep 6-8 hours through the night without having to get up and go to the bathroom. No UTI’s in over 18 months. And because my bladder has been partially rehabilitated, I can urinate normally about 50% of the time without using the Crede maneuver.  My IPSS Score (International Prostate Symptom Score) would be Zero (the best), albeit with a little mechanical assist.

As of now, nothing that I have read about the various current procedures has tempted me to have an operation. That could, or could not change, in the future, but the nice thing about CIC is that you can stop it any time you want with no repercussions. The caveat is that CIC should be done under the supervision of a doctor who will monitor your BPH as required. Similar to seeing a doctor on a regular basis during a Watch n’ Wait BPH strategy.

I know many of you here have already had operations like Turp, and in most cases people seem pleased with the outcomes. CIC certainly isn’t’ for everyone, and I can understand why someone does not want to carry around a urinary “tool box” with them. On the other hand, with practice, it’s not the traumatic and scary procedure some think. I can honestly say right now that for me it’s about as traumatic as brushing my teeth.

I’m offering my experiences and thoughts on CIC for any of those who haven’t yet made up their mind on an operation. It even can make sense for those of you who don’t need an operation yet, but want to increase their IPSS quality of life score. In fact, wish I had done CIC earlier while on Watchful Waiting. Didn’t realize how much BPH had been affecting me for most of my adult life until I was able to empty my bladder completely.

CIC doesn’t have to be a permanent solution, it could just part of a waiting strategy like I’m on, until better surgical operations are developed with better outcomes and fewer permanent side effects.

For any number of reasons, the majority of urologists don’t seem to offer CIC as an alternative to surgery. My current urologist doesn’t as far as I know, but he’s OK with what I’m doing because it works for me. So, either you have to find a urologist you can convince to go along, or go to some of the major teaching hospitals where CIC is probably more in use and better understood. That is where I was taught, albeit not very well, but that is another story.

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In 2009, I was diagnosed with Thoracic Osteoarthritis, Degenerative Disc Disease, and Fibromyalgia - and in November 2015 diagnosed with Cervical Radiculopathy. As you see, I have dealt with chronic pain for a long time, and I am tired of it – it’s exhausting and limits my day to day activities.

Anyway based on my MRI results and my physical symptoms - the surgeon diagnosed me with Cervical Radiculopathy and *suggested* a Posterior Cervical Decompression (PCDF) as well as an Anterior Cervical Discectomy with Fusion, ( ACDF).  No pressure … he told me to just think it over and referred me to Physical Therapy.

Since the diagnosis, I am doing a ton of research and educating myself about my condition and the surgery.

Last week I asked my physical therapist what she thought of the surgery and she said, “I had time to have the surgery later”. (I’m 63 and not clear about what “later” even means This week my primary care doctor said outright, that I do not want this surgery because it may not relieve the numbness and pain, and does nothing for the arthritis in my neck, and there will be issues with scar tissue and that my condition is not that bad – yet. He suggested I get a second opinion. I agreed to get a second opinion.

Cervical Radiculopathy Timeline

January 2015 I developed a pinch nerve in the left side of my neck along with the slow progression of excruciating numbness and/or pain in my arm, fingers and thigh. In June 2015, my primary care doctor diagnosed me with pinch nerve and referred me to PT along with the suggestion that I get a back massage. I had tried PT before for my osteoarthritis and hated it. So, I decided to try yoga instead.

Through yoga, I relieved most of the thigh and neck pain and increased my range of motion. However, the numbness and pain in my fingers and in my arm became worse - along with the loss of grip strength. I informed my primary care Dr. in Oct of 2015, he referred me to an orthopedic surgeon, who of course ordered an MRI.

As I said, based on the test results, the surgeon suggested surgery but wanted me to first try physical therapy, this time I went. I started twice weekly therapy sessions in November 2015 and so far it’s effective. After 6 weeks of passive exercises, my arm pain had diminished significantly and the numbness decreased to a ‘low buzz’.

Because I was progressing so well - the week of Christmas 2015 the therapist changed to more aggressive exercises (10 mins on the treadmill, resistance bands, etc) I felt ok while there. However, by the time I returned home after the session the pain in my neck and back was out of control. I had learned many PT pain intervention techniques and I tried them all but the pain escalated. Numbness increased significantly in my thumb. In addition to that I now not only have pain on the left side of my neck but also the right - along with a considerable decrease in my range of motion on both sides of my neck. My grip strength decreased almost immediately and I am dropping things again.  Thought it best to cancel my next appointment, ha-ha! Although I feel better, today I am still in pain - most movements makes it worse. At this point, I’m confused and not sure what to do next. My next PT appointment is on Jan 5th and I see the surgeon on Jan 19 to inform him of my decision.

My questions.



1. Without ongoing physical therapy –(i.e. the rest of my life) will the symptoms of Cervical Radiculopathy return? (Anyone have experience with this?)

2. With degenerative disc disease, overtime, will my disc continue to lose height and stack on top of one another causing even more pain? (So far because of this I’ve lost 2” in height.)


3. From the point of being diagnosed with Cervical Radiculopathy what is the longest time anyone has waited in deciding to have the surgery or not to have surgery?

4. Why would waiting for the symptoms to get worse be beneficial to obtaining a positive outcome or to justify the surgery?

5. Finally, why are some medical professionals against having this surgery? Has anyone experienced being discouraged from having the procedure and how did it influence your decision to have or not have the surgery?

 I thoroughly understand this is a major surgery with a very rough and long recovery period. To be honest at age 63 – I am more worried about recovering from the anesthesia and if my body can withstand the actual length of the surgery, and those factors are certainly not going to get better as I age.

I also understand that I need to rely on the medical professionals’ opinions however, I have been ‘burnt’ in the past with so-called medical opinions. That is why I am seeking experiences related to this from ‘normal’ folks ---I need a different perspective from people who have dealt with this process. 

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