Tbh, his Ketamine use makes me very very happy. He should do it more often.

Why? Ketamine abuse leads to severe damage of the urinary tract system. According to various sources this is already happening - and the damage is irreversible. Patients suffering from them are unable to pee - while having a massive urge to do so (imagine a decade long UTI, with your bladder really filled to the brim but you can’t pee physically). And in the end it fucks their kidneys up due to the urine backing up into it. (And no, he can’t get a transplant then. As the ureter is the problem and damaged beyond repair there isn’t that much that can’t be done then)

Furthermore the combination of drugs he admits he takes is a prime setup for a ketamine induced persistent psychosis. Elmo is already showing massive signs of intermittent or persistent psychosis, but things can get worse - far worse for him. Because the combination he takes can sometimes lead to a chronic persistent psychosis with auditory or visual hallucinations, delirium and ongoing psychosis symptoms. In other words: He would get so batshit crazy that a normal person would either be admitted in time and for a long time or kill themselves. In his case it’s more likely that his staff would make sure he doesn’t kill himself and lock him away. (Kill as in “running over a highway butt naked because the Zombie cows hunt them” or “trying to stop a train by a naruto move”)

When I still worked in a psychiatric hospital we gad a similar guy - actually not unintelligent,but fried his brain with a similar mixture. In the end result he needed massive loads of drugs so he wouldn’t be in a constant state of panic (mostly because every shadow was a giant spider trying to kill him) but basically made him a zombie. And,as he did a few awful things in this state of terror(setting fire to the psychiatric hospital twice, push a old lady in front of a bus -she was not hurt as the bus was imaginary,too-, stabbing a kindergarten teacher in front of her class) he was with us for years in a locked/high security ward. Aftee that he left us towards a similar ward in a permanent nursing facility.

There is a good chance he won’t have a nice retirement life. Which is well deserved.

Difficult to say and Urology is absolutely not my subject (funny enough I am writing this in my urologist’s waiting room), but a few things to consider:

• Unlike normal urinary retention his ureter will be heavily inflamed. That can also include the Urethra(to a far lesser extent than the ureter,though) and might at some point even inflame the prostata. This makes regular catheters really uncomfortable and also hard to get in. So… there is that.

• Additionally frequent single use catheterization into an inflamed tissue increases the risk of infection. Additionally the user needs to keep strict hygienic standards…which addicts often can’t follow. So either he has someone doing that for him or the perspective is rather uncanny. Even with that his erectile function might be impeded.

• On the other hand a permanent catheter had its own drawbacks and I am not sure if he would accept one. Because that would mean no more children (at least not the normal way), having the bag attached permanently,etc.

• The other option is a so called suprapubic catheter - a small surgical hole above the pubic bone with a permanent catheter placed in it. Also a nasty thing in terms of germ ingress.

Last but not least: The catheter will solve the “urine in the bladder” issue,but not the kidney issues as the backup there to a certain degree happens above the bladder - inside the ureter. It can be mitigated by putting a ureteral stent in them,but these are mighty uncomfortable and need to be replaced every few months - via endoscope. Through his dick.

So in the end: Don’t do Ketamine,guys.