Continent or not

By Dr. Jim Ferguson
Old shoes, old dogs and an older, but lovely, wife are blessings. I’m glad I don’t need to make a fashion statement and can focus on function more than form in the shoes that I wear. I do appreciate the discomfort that women sometimes endure in their quest of the perfectly stylish shoe, but as a man I’m glad it’s something I’m not challenged to do.

Recently, I was forced to buy new footwear when the sole of my ancient golf shoes separated on the back nine. I taped the sole back to the shoe and finished the round, claiming equipment failure as the cause of my otherwise poor play.

We have two old dogs. One came to us as a runt of the litter rescue and used to follow his instincts of treeing squirrels, chasing those arboreal rats from my bird feeder. I’ve written about Uncle Jack in past stories. I believe Jack has become a bit forgetful as he’s aged. He seems to have forgotten that he was bred as a squirrel hunting dog. But then his ancestry is also a bit confused because his brother is also his father. I’ve learned some breeders use males from the previous litters to sire future litters with the same female mother. Close breeding can produce genius, but more often idiocy. As a result humans have a prohibition against marrying close relatives. Perhaps violating the laws of consanguinity has fostered Jack’s early forgetfulness.

We inherited the second old dog from my daughter when her family got a hunting dog. The growing and energetic puppy often knocked little children and old dogs over, so Carlos was retired to our older folks home to live out his final days. Unfortunately, he’s lost his hearing and eyesight, and has developed increasing urinary incontinence.

In my geriatric fellowship training, I learned that one of the most common reasons for nursing home placement is incontinence. I remember receiving a frantic phone call from a patient in her 70s who pleaded, “You’ve got to help me, Doc. Mother is killing me.”  You see, Mama was in her 90s, demented and incontinent.

My daughter in Portland is now potty training my granddaughter. We’ve gone through this right of passage with our Knoxville grandchildren who are now, for the most part, fully continent. We used cloth diapers when our kids were coming up, and I’ve found disposable diapers a godsend, though it’s better not to need either. Astronauts use Depend diapers when they do spacewalks, and some older folks need a bit of help when bladder control becomes a bit iffy. I doubt that we will resort to doggie diapers. I did find it ridiculous that some Democrat Senators are being mailed Depend diapers to aide their filibuster of Trump’s appointment, Brett Kavanaugh, to the Supreme Court.

Men and women are different. The bladder outlet (urethra) is shorter in a woman than in a man, and, along with sagging as a result of childbirth, so-called stress incontinence is not uncommon in women, especially in association with laughter or coughing. Anatomically, a man’s urethra traverses the prostate which typically enlarges as men age. As a result the flow of urine is often retarded, so urinary incontinence is less of a problem. You might rhapsodize that aging men and women are like ships passing in the night, where men can’t pee and women can’t stop.

Another type of urinary incontinence is urge incontinence. This results from bladder muscle instability as muscle coordination is lost. We have all had the “urge” to go, but control may be increasingly difficult in this condition. Caffeine is a bladder irritant and will promote the urge to urinate, and may transform the old “house key in the door lock” image a reality. And to complicate matters further, there may be a combination of both stress and urge type symptoms and physiology in the same individual. Lastly, obstruction to bladder emptying from an enlarged prostate may produce what is called overflow incontinence. In this scenario, the increasingly distended bladder compromises muscle control with dribbling, analogous to water flowing through sluice gates of a dam. Interestingly, severe constipation can produce similar dysfunction and incontinence.

Sometimes, I believe the President would better serve the country if his verbiage was more circumspect and continent. However, in a street brawl diction is often less than genteel. I am not excusing Trump for what I consider his indiscretions. But, it is clear that we are in a war of ideology with Trump against the media, RINOs, the intelligence community leadership, Hollywood, academia, the ruling class in Washington, Putin, China and progressive-socialist-leftists everywhere. I don’t include Democrats because they are an entity of historical interest only. The last Democrat, Zell Miller, died earlier this year. The moniker Democrat is now a façade.

A TV commentator recently branded Trump as “the Disruptor in Chief.” I suspect she is right. Trump is opposed to the world government movement, disproportional tariffs and Washington’s status quo which has not served America well.

Twenty years ago I read a book called Generations, the History of America’s Future. I was intrigued by the title. The authors looked at the history of America in terms of generational cohorts with repeating characteristics. As a baby boomer, I came of age in the turbulent 60s during the so-called “counter culture movement.” Two generations prior to Boomers, the Greatest Generation rescued our country and the world from the throes of the depression and World War II. Conflict resulted from an internal ideological upheaval in the 60s and an external threat in the 40s. The futuristic prediction of the book was that America would enter a time of crisis from an external force comparable to World War II beginning in 2014.

I thought that the external force might be militant Islam represented by ISIS and the Iranian mullahs. However, Trump took the fetters off our military which then destroyed ISIS. Trump is now challenging Iran, North Korea, China, Putin and even the EU’s trade policies.

America’s energetic gladiator is a champion to those who elected him. At the same time our gladiator is despised by those he’s defeated. However, for our un-Civil War to end there must be an accepted winner and loser, for only then can mercy be extended to the vanquished.

 

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