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PostPosted: Fri May 01, 2015 5:11 pm 
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Slight variation on an old topic. I joked in another message that I should title this something like "Diapers, Enemas, Catheters, and Cruise Ships," for reasons described below.

My urologist is indicating that I may need to go with intermittent catheterization due to urinary retention. The diagnosis is not final as I am scheduled for the urodynamics testing. There are some special considerations, described below.

You may find it interesting that one consideration is my desire to work on my "bucket list." I'm not getting any younger, and like to travel. Because of my bowel incontinence and diapers, I have to take my enema equipment and a sizable diaper supply. I always am at risk of overextending and going to "a bridge too far." My wife and I would like to go on another two lengthy cruises before I have to pack it in due to age and health. However, the diaper supply for a 25-day trip is daunting, to say the least. :(

When I asked whether my urologist would consider prescribing me a condom catheter for night use, particularly during travel, he asked whether I had considered intermittent catheterization. I really hadn't, but it makes sense if it would let me get through the night without leaking. It seems do-able as, although I am bowel incontinent, I normally do not have bowel movements at night. I still could wear a cloth diaper as a backup, but hopefully not wake up to find it wet. During mornings at sea I might be able to cath and just wear a pull-up and plastic pants on the ship (saving another diaper). Am I hoping for too much?

Of course, at this stage I am not sure what is covered by insurance but I think intermittent caths are covered by Medicare when there is a statement of need from a physician. I think the same also may be true for condom caths.

A quick Google search indicated that the following intermittent cath brands seem to be popular:
GeeWhiz catheters
Coloplast Speedicath catheters
Men’s Liberty

In the U.S., does you physician prescribe the brand or do you select that?

Where do you start?

What should I look out for or avoid.

Normally I would approach this in my usual manner - slowly, and with a lot of research. However, we will be approaching the point where we have to put a deposit on the cruise. Due to my preventive enemas it is easier if I can get a cabin with a bath tub and take the enemas in the tub - just in case.

A related topic is using an external catheter. That could be used in lieu of the intermittent catheterization or aboard ship to reduce diaper use.
I don't know whether to start that as a separate topic or not. Schoppy, wheels, guys, what do you think?

--John


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PostPosted: Sat May 02, 2015 7:44 am 
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If you do go down the route of self cathing you should be given some samples to try. When I was doing it I was not that keen on the speedi cath I found it a bit stiff almost sharp. I used one by Vapro that I found to be very comfortable.

4wheeldave.


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PostPosted: Sat May 02, 2015 8:29 am 
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Well, let's start with a bit of history. I was put onto intermittent catheterisation (IC) a couple of times in the past but was very unsuccessful. I don't think at those times I had and residual urine but the procedure was mostly to 'air' may 'part' a bit. I found the result was that using a catheter every 2 hours was fine but then I'd get leaks and had to move to 1.5 hours and the whole process became a waste of time. I also had an operation called Clam Ileocytoplasty (CI) (bladder enlargement by sewing gut into the bladder to expand it and stop it contracting so much.)

A couple of years ago, though, I noticed that my drainage bags didn't fill unless I forced the issue with pressure over the bladder and checks by the urologist and nurses revealed up to 500ml residual urine. There was no choice - by cathetered full time or use intermittent ones. I opted from IC and have been using it successfully for nearly 2 years. Due to the CI I have quite a good volume - up to 1.5 litres overnight and so I manage to do IC 4 times in 24 hours and remain dry in between. It's a win for me not to go to bed in protection!

Now as to the procedure itself, I was offered a couple of choice of catheter and settled for the Coloplasyt Speedicath Compact. It would have advantages from you, John. If you look at the illustrations you can see the part that goes furthest into the body is much thinner than the main catheter and so is much easier to pass - especially with an inflamed prostate. Now I don't have any sensation 'down there' so I have no idea if this hurts or not but after a bit of practice I can have the catheter in and drain very quickly. I was told I didn't even need to do any prior washing. The biggest deal with the particular cath is the size - not much bigger than a pen and it goes back in the tube for disposal so no messy waste at the end.

The real idea, apart from draining residual urine, is to drain frequently enough so that leaks don't happen. Given a full draining of the bladder, there is more capacity than prior to using IC so it might viable to stay dry by this means. let me know if I can help further.


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PostPosted: Sat May 02, 2015 10:15 am 
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Interesting. Looking at old messages I see that users have a wide variety of preferences in selecting intermittent catheters, just as we do in diapers.

At this stage I have no idea what I will tolerate well, but for travel the design of the Speedicath is very interesting.

As part of my peeing during the night is due to retained urine, I hope that self-cathing just prior to going to bed would keep me dry through the night - at home and particularly during travel. I gather that this is difficult to predict.

What about cathing while on-the-go, out of the house? Due to the sanitation requirements how does one handle that in a public restroom? Is it practical to even consider?

Once you are experienced with self-cathing, about how long does it take?

Thanks for all of the info, guys!

--John


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PostPosted: Sat May 02, 2015 11:51 am 
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John,

the way I have been told to cath, and this is not quite what Coloplast says but hey, is this -

1. If I have showered or bathed in the previous 24 hours there's no need to swab the glans.

2. The whole of the catheter is contained in the tube so is sterile. When you open the tube the end you hold sticks out. You can grasp that without affecting the sterility of the catheter. Pulling the catheter out readies it for use.

3. Without touching anything with the catheter, it is pretty simple to push the end into the meatus in the glans (squeezing the glans with the other hand makes the meatus a more round shape to help this. Push the whole tube in and drain.

If you are in a stall, just drain over the toilet bowl. I've even managed leaning against a gate on one occasion. Sterility of the catheter is fine and it matters not where it is used. It is as discrete as one can get and, after use, the tube can be dumped in the waste and no one will know what it is - unless you meet another user and then it won't matter!

I am keen on this catheter because of the compactness and easy disposal but for you, John, it is also helpful as the inner part is only 10 FG, really quite small so should slip past you prostate without problem.


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PostPosted: Sat May 02, 2015 2:03 pm 
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What wheels says is totally spot on. This proses of IC is very quick and simple. The speedi cath compact although not my choice is indeed very compact. It is in a green tube a bit like a Cuban cigar I always thought. They are so easy to cary around you could put a couple in your pocket. You do not touch the part of the catheter that goes into the penis at all.

4wheeldave.


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PostPosted: Sat May 02, 2015 3:38 pm 
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I guess my concern here would be the cruise ship itself. A cruise ship is a closed environment; everyone on board can bring an infectious organism along. Self cathing introduces a foreign object into the body; if it is not sterile enough for the body's natural defenses to do their work, disaster can result. My wife and I took a cruise from Vancouver to coastal Alaska and back several years ago; other than being fed such rich food that we needed days to recover after we got home, it was a delightful, relaxing time. I requested a handicapped cabin; although it did not have a porthole or a balcony, the toilet was spacious and efficiently laid out. There was more than enough room for me to store my supplies.


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PostPosted: Sat May 02, 2015 4:06 pm 
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Location: North Carolina - Raleigh area
Thanks to all for your good comments! :D

From what Wheels and 4Wheels say, the self-cathing sounds do-able from the physical aspect.

If I understand you guys correctly, I should be able to self-cath in the stall of a public restroom.

Patrick, my very germ-conscious retired RN wife goes over all cabin surfaces with an antiseptic wipe when we first go aboard. However, I think that with the exception of handicapped cabins, the word "spacious" normally would not apply to cruise ship cabin toilets. :D As I am the guy who has to give himself enemas in those cruise ship bathrooms (as a boater, I will not call them "heads"), I think I know how many square feet there are in the bathrooms for each grade of cabin.

With experience, how much time does it take? If you are in a group and go to a public restroom will you be gone a conspicuous amount of time?

--John


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PostPosted: Mon May 04, 2015 4:22 pm 
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Extra point I forgot to mention.

The procedure, clean intermittent catheterisation (CIC) is just that. It is not sterile nor intended to be and it carries risks of infections. Sure the catheters used come sterile to the point they come out of the tube for use but, nonetheless, infections are possible. Mind, done carefully, my rate of one infection in 2 years isn't that bad.

What has to balance out decisions is that not using CIC and leaving a residual amount of urine in not risk free either, In fact the infection risk in this case is higher than doing CIC. A urethral catheter, a Foley, is even worse for infections. I think my record is about 6 hours before infection with a Foley!

So, anyone deciding what to do and whether to go for CIC, remember the infection risks cut both ways and CIC is actually a bit less risky than doing nothing.


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PostPosted: Mon May 04, 2015 7:16 pm 
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Wheels, good point. I was concerned about the risk of UTIs.

--John


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