Sunday, November 27, 2011

Are abdominal exercises OK for persons with an Indiana pouch?

Are abdominal exercises OK for persons with an Indiana pouch?

            Getting back to an exercise routine as soon as your surgeon gives you clearance is important. Regular physical activity will improve your mood, give you more energy and boost your immune system. Everyone should exercise almost every day and it should include both aerobic (walking, jogging, swimming, cycling) and resistance type (weights, machines) exercise, preferably on alternate days.
            Almost any ordinary exercise routine will contribute to strengthening your abdominal muscles and sit-ups aren’t necessary. Even walking will help to strengthen your “core” muscles, including your back and abdomen.
            Anyone starting an exercise routine after a long layoff needs to have a physician’s clearance. Bladder cancer patients are usually older than 50, the age at which silent problems such as hypertension and type 2 diabetes become more common.
            Unless you are well-versed in exercise physiology it is prudent to have a session or two with a fitness center trainer or a physical therapist in order to know how to exercise safely. Age is certainly not a barrier to exercise but as we get older our range of motion is sometimes limited, joints are not as well cushioned and tendons are more fragile. It’s important to start slowly. There’s no need to hurry.
            Specifically, abdominal exercises are not harmful once you have been exercising regularly for a couple of months. Strengthening your abdominal muscles will not harm the stoma.
            Occasionally persons develop an incisional hernia – a defect in the abdominal wall at the surgical incision. In overweight persons with a weak abdominal wall that is a genuine risk.

Sunday, November 20, 2011

How do you clean/sanitize/sterilize your equipment?

How do you clean/sanitize/sterilize your equipment?

            As I noted recently, it isn’t necessary for the things that you use when you catheterize your Indiana pouch to be sterile. In my opinion, however, the catheter should be the sterile, single-use type. For those who must re-use catheters, anything but meticulous cleanliness is an invitation to infection.
            Your irrigation syringe and fluid/saline container should be kept as clean as possible. My choice, based on my surgeon’s advice, is to rinse them several times immediately after use with plain water and then to rinse them with a 50/50 solution of white vinegar (acetic acid). When possible I let the vinegar solution remain in them for an hour or so.
            I have seen blog posts that recommend a turkey baster instead of a syringe. The inside of the bulb is hard to clean and there’s no way to see inside it.
            Bleach is not a preferred disinfectant for a couple of reasons. First, it needs to be in contact with the surface in question for at least 10 or 15 minutes. Second is the stain problem that every housewife knows when a few drops land on the wrong item of clothing.
            Alcohol has an undeserved reputation as a disinfectant. After all, wine “turns” as a result of the growth of microorganisms, which actually thrive in the alcohol environment. Alcohol works sometimes – but don’t rely on it.
            Germs hide in protein-containing material, hence the need to clean catheters carefully. Mucus can form a bacteria-protecting film on the inner (invisible) wall of the tubing.
            The bottom line: there is no perfect disinfectant. Cleanliness is paramount.

Sunday, November 13, 2011

Flying and train travel with an Indiana pouch

Flying and train travel with an Indiana pouch
            Travel with an Indiana pouch really isn’t much of a problem. In July 2011 we described the various kits that we put together for trips of varying duration. The toilet facilities on trains and planes are small and a little cramped but they have enough counter space to lay out your supplies. The very best situation is the facility with a diaper changing station, common in hotels and rest stops but not on the typical commercial airliner. (Will the new Boeing Dreamliner be the exception?) Even men’s restrooms often have diaper changing stations. That should be a legal mandate.
            I have found that the biggest challenge is an area flat enough to open the catheter package. In the worst case you can tuck it into one of those paper seat cover dispensers. Guys can tuck the paper sleeve into their trousers and so can women who wear slacks. Another option is the waste dispenser, which usually has a metal flap that closes with a spring and will hold the sleeve in place.
            The easiest solution might be to use the facility in the airport waiting area, which almost always has restrooms with a diaper changing area. Most domestic flights are shorter than four hours and making an extra pit stop might be the best option.

Sunday, November 6, 2011

Are hand sanitizers worth using?

Are hand sanitizers worth using?
            It isn’t necessary to use sterile surgical technique when catheterizing an Indiana pouch but we encounter numerous sources of bacteria in ordinary living and it makes sense to minimize the chances of transferring bad bugs to the pouch where they might cause infection.
The best way to prevent disease transmission is thorough handwashing with ordinary soap. The procedure should take at least 20 seconds, about the time it takes to hum two verses of “Happy birthday to you.”  Use water as warm as you can tolerate and air-dry or use paper towels.  If you use a cloth towel it should be one that no one uses but you.
A waterless hand sanitizer is a good back-up and sometimes it’s the only thing available. It’s an indispensable part of our travel kit.
Be wary of the alcohol-type sanitizers. Alcohol really isn’t a very good antiseptic. In fact, microbiologists sometimes use growth media that contain alcohol in order to cultivate certain types of bacteria. A cursory swipe like the one that lab techs use before they draw blood from you is more to get off surface dirt than to kill germs.
There are only a few published studies on hand sanitizers but the most effective ones so far are those that contain benzalkonium chloride. That substance has been used as a clinical antiseptic for decades. Although there are a few exceptions, bacteria are not likely to become resistant to it.
Some persons might develop irritation from using a hand sanitizer that contains benzalkonium chloride but the addition of allantoin tends to reduce it.