Sunday, October 23, 2011

Will the ER folks know about your Indiana Pouch without an ID bracelet?

Will the ER folks know about your Indiana Pouch without an ID bracelet?
            Even before I underwent my radical cystectomy/Indiana pouch I had read about the value of wearing a medical identification bracelet. If you happen to be brought to the emergency room alone and unconscious after an accident it’s possible that the medical staff will try to catheterize your bladder in order to a) verify that you don’t have a kidney or bladder injury and b) monitor your urine output. If your stoma is a cosmetic masterpiece, integrated into your bellybutton, no one may be aware of it.
            A catheter inserted into your urethra won’t go very far and it obviously won’t yield any urine. Besides wasting precious time it could lead to an erroneous diagnosis. The stoma may leak eventually but that may take some time depending on the circumstances of your injury and your state of hydration
            Medical ID bracelets are commonplace. Medical responders know to look for them.
            They vary from plain stainless steel ($24.95) to 18-k gold ($2600). Yes, that is twenty-six hundred dollars! Some of the pricey ones look more like ordinary jewelry and the relatively inconspicuous medical symbol might be easy to overlook in the complicated and busy atmosphere of an emergency room setting.
            My rather plain ($44.95, no tax or shipping) stainless bracelet is engraved with my name and phone number on one side and the medical information (radical cystectomy Indiana pouch) on the other.
            Persons with a more complicated problem may want to use a vendor that includes access to the patient’s medical history for an additional fee.

Saturday, October 15, 2011

Will an Indiana pouch mess up your body chemistry?

Will an Indiana pouch mess up your body chemistry?
            The segment of colon that replaces the bladder works well as a reservoir but it allows chemicals such as hydrogen ion and chloride to get back into the bloodstream. The resultant excess in the blood of hydrogen and chloride ions produces hyperchloremic acidosis in some Indiana pouch recipients. Luckily, most patients will escape this problem but there are factors such as poor kidney function that make it more likely to occur.
            The tendency toward acidity can lead to loss of calcium from the bones, increasing the risk of osteoporosis. It’s not that simple, however, since there are several other factors that contribute to osteoporosis. Bladder cancer is a disease of the older generation, in whom osteoporosis has become increasingly common. The main cause of this condition is lack of exercise, not calcium deficiency. Studies have confirmed that simply adding calcium to the diet will not prevent fractures.
            Some patients with an Indiana pouch develop vitamin B12 deficiency but that is also not necessarily due to the revised anatomy. Vitamin B12 is absorbed from the last portion of the small intestine but only a scant few inches are used to form the Indiana pouch. About 10 percent of seniors develop vitamin B12 deficiency for other reasons.
            A simple blood test can identify hyperchloremic acidosis and treatment consists of taking sodium bicarbonate. This should only be done under the supervision of a physician. Self-medication could cause other problems.
            A special type of x-ray examination can indicate osteoporosis or the stage that precedes it, called osteopenia.
            The blood test for identifying vitamin B12 deficiency is not entirely reliable but all seniors ought to be on a daily multivitamin anyway and should be checked periodically for anemia due to other causes.

Sunday, October 9, 2011

Tape causing irritation around the stoma?

Tape causing irritation around the stoma?
            Some persons are sensitive to the adhesive material on paper tape or bandages. Applying a thin coating of over-the-counter 1% hydrocortisone cream is usually all that it takes to reduce the redness and irritation. Stronger steroid creams might work a little better and faster but they are more likely to cause thinning of the skin over time.  
            Hydrocortisone cream relieves a myriad of skin problems but it shouldn’t be overused. Like any medication, use only as much as is necessary to fix the problem.
            Yeast infections near the stoma are more likely in persons with diabetes. Using hydrocortisone cream might relieve the redness a little but it is not likely to clear it completely. Sometimes a yeast infection will be characterized by “satellite” lesions about a millimeter in diameter at the margins of the affected area.
            If any readers have some other thoughts on this topic, please respond. We welcome your input.

Sunday, October 2, 2011

Should you stockpile urostomy-related supplies?

Should you stockpile urostomy-related supplies?
            The relatively brief but widespread power outage that hit the Southwest in September should make us think about being prepared to get along without our usual source of urostomy care supplies like catheters, dressings, pads, tape, lubricant, etc. in the event of a much more prolonged situation.
            The emergency kits that we described in July are designed to get us through a week or two. The folks in tornado-ravaged Joplin, those flooded into isolation in Vermont and refugees from the fires in Texas had to survive without their usual suppliers for a much longer period.
            The kinds of items that we need might not be readily available from FEMA or the Red Cross if we are subjected to an event like those. A weeks-long power outage would make it impossible for your local pharmacy’s cash registers to work. A catastrophic interruption in fuel supplies would prevent restocking from warehouses hundreds of miles away. You could probably re-use catheters – but only if you had a safe water supply.
            The American Red Cross and other agencies provide lists of emergency supplies that every family should have on hand. For those of us who need more than the ordinary first aid supplies, a little extra planning can spare real discomfort, or worse.