Emergency IP kits for the compulsive

Emergency kits for the compulsive IP-er

            If you’re a worry-wart like me or a survivalist you might consider these extra kits.

            For the emergency automobile trunk backpack: in addition to the fire extinguisher, first aid kit, flashlight, emergency blanket, a few bottles of water and food bars and whatever else you’ll think you’ll need when stranded in an hours-long traffic jam, or worse, we IP-ers have some special needs. I keep the equivalent of the Day-Tripper (see last week’s blog) in the trunk backpack.

            Bug-Out-Bag: Survivalists know all about this. Our Southern California family has had to evacuate in minutes because of wildfires and we each have a backpack with water, food bars, first aid kit, cash, extra clothing, etc. Now I have IP supplies as well. My IP B.O.B. contains enough supplies for four days, about half the contents of the One-Weeker.

            I rotate all my perishable supplies and my catheters, gel and saline every six months – January and July. That way, nothing gets wasted but we’ll be ready the next time a fire roars up the canyon behind our home. Your catastrophe could be a flood, hurricane or tornado. Not being able to pee might also be a catastrophe.

           

IP Travel Kits

Travel kits for IP-ers.

            The One-Shot. This is small enough to fit in my jacket pocket, and ladies have even more options. It’s for brief outings like the theatre, restaurants, etc, and an emergency in case of an unexpected leak. I haven’t had to use it yet.

            Contents are in a zip-lock bag with one each: catheter, packet of lube, 2x2 gauze pad, 1/3 sanitary pad, folded paper towel, hand sanitizer, paper tape, large spring-type paper clip to hold my shirt out of the way.

            The Day-Tripper. This is the one that is always with me in my vehicle. A small camera bag is ideal; a small fanny-pack works fine.

            Contents: 4 each of catheter, lube, gauze, pad. One hand sanitizer, clip, a couple of small zip-lock bags for disposal if needed. Two folded paper towels.

            The One-Weeker. A soft computer case with 50 catheters (packed at the last minute – few of us have that many extra) and matching numbers of lube packets, a sleeve of cotton rounds, a full roll of paper tape, a liter of sterile saline or your favorite irrigation fluid, syringe and fluid container, paper towels, about 10 absorbent pads, a few zip-lock bags, hand sanitizer and shirt-holding paper clip. I pack a large (24” x 30”) disposable pad in case of a night-time leak at a hotel or someone else’s home.

            Next week’s blog: emergency kits for the compulsive.

Have Indiana Pouch, will travel.

            Plan ahead. For a car trip we aim for a 4-hour pit stop at a nice facility such as a Hilton Garden, Marriott, etc. Their restrooms almost always have a diapering station, even for dads – perfect for laying out the items we need, or at least a handicapped stall with plenty of room.

            I’m prepared to cath early at 3 hours if traffic up ahead is likely to be heavy. One extra catheterization per day is no big deal if it will avoid being stuck with no place to go.

            You probably won’t have to irrigate during a day trip unless you have a young IP and still have lots of mucus.

Airplane lavatories are cramped but still have enough counter space. If you do have to have saline for irrigation in your carry-on, a letter from your doctor should take care of that problem to get through security.

Be sure to make a practice run at home to be sure that you will have everything you need in your travel kit.

I have five (!) different kits for travel – will cover them in later blogs.

Irrigation solutions

Irrigation solutions

What is the best/safest/least expensive/practical irrigation solution for an Indiana pouch?

            My surgeon recommends sterile normal saline, which costs more than $10 per liter. One liter lasts about a week, a fair piece of change in a year -- a problem if you don’t have insurance coverage. It is sterile, with a long shelf life and it is probably the safest irrigation solution available.

            Is sterility critical? No, since the IP usually has a few benign bacteria in it, as noted in an earlier post. However, be sure to maintain every element of your irrigation – hands, catheter, irrigation solution, solution container, syringe, etc. -- scrupulously clean. You don’t want to replace the good bacteria with the bad ones.

            Does it have to be a “physiologic salt solution” like normal saline?  Normal saline is neither too concentrated nor too dilute so that it can be given intravenously. The normal urinary bladder and the bowel-become-bladder can tolerate both a concentrated (“salty”) or a very dilute urine, so tap or distilled water are both OK for irrigation. Again, the emphasis must be on near-sterility, so boil your water.

Avoiding infection

Almost all IPs contain some bacteria. Studies show that they are the same types that occur in the large bowel but apparently the pouch and bacteria have reached a truce and they don’t usually cause infection. That truce does get broken occasionally and most IP-ers can expect to have a UTI eventually. Here are some thoughts on minimizing infection. We'll cover cranberry and other products another time.

            Use disposable catheters whenever possible. Medicare patients are eligible to receive up to 200 catheters per month. (Tips on care of reusables in a future blog.)

            Drain the pouch as completely as possible every time.

            Follow your doctor’s orders regarding irrigation. Most recommend it daily.

Maintain extreme cleanliness of the irrigation syringe. Although I have seen recommendations for using a turkey baster, the bulb is difficult to clean and can’t be visually inspected. I re-use “disposable” syringes for about a week, rinsing them first in tap water and then in a 50-50 vinegar solution after each use.

Gloves are not necessary but thorough handwashing is a must. A hand sanitizer adds to protection but handle the catheter and syringe carefully anyway.

Thoughts about stoma care

    These comments are in response to remarks that I have seen on this blog and others, and result from my own observations
.
    I cover the stoma with a "cotton round" (suggested by my wife, who uses them to apply skin care products) after having gone a few months using 2 x 2 gauze pads. The cotton rounds are more absorbent and less irritating than the gauze. They are held in place by paper tape. The tape is slightly irritating (the subject of a future post) but that hasn't changed in nearly 1 1/2 years.
    Leaks are inevitable and unpredictable so I cover the cotton round with 1/3 of a sanitary pad -- only the end third since the absorbent granules tend to drift from the cut ends -- also held in place with paper tape. The smaller (not "maxi") pads are less bulky but still hold a lot of fluid. A built-in benefit is that they mask odor very well.
    I haven't noticed any change in trouser waist size, a concern of one blogger.

A future post will deal with the mucus issue. I invite your questions and comments as I do the research.

Stone formation is fairly common in persons with and Indiana pouch. Infrequent irrigation appears to be one cause. Check with your urologist to determine how often you need to irrigate.

            There are other factors that increase the risk of stone formation in those with normal plumbing as well as persons with an IP. Be sure that your urine doesn’t become too concentrated. It should always be light yellow with only a mild odor.Your fluids needs vary greatly according to your size, activity, the weather, humidity, etc. Don't put too much stock in "8 glasses a day" or similar suggestions.

            A generation ago physicians advised persons with a tendency toward kidney stones to be on a low-calcium diet but we now know that the opposite is correct. Too little dietary calcium allows oxalate, which is especially high in plant foods such as spinach and rhubarb, to be absorbed.