Also, avoid substances that either drive the PH into the alkaline range or cause irritation, such as dairy products, coffee, alcohol, carbonated beverages, orange and grapefruit juices, and tobacco. One of the main causes of infection and disease is irritation, which can, in a small percentage of individuals, result in cancer. Since chronic irritation from indwelling catheters increases cancer risk, it makes sense to minimize irritation by using a silicon-coated Catheter (it's slicker), or one coated with an antimicrobial to reduce risk of infection.
Mary Thompson, 43, of Del Mar, Calif., is a well-known wheelchair marothoner, having completed 10 marathons. But her athletic life would never have been possible had it not been for a course correction she made a long time ago.
Injured in 1982, Thompson, C7-8 complete, had an indwelling Foley Catheter until 1988. Predictably, her bladder shriveled—causing high pressure, dysreflexia and leakage—and she had endless UTIs, so many that her doctor suggested a urinary diversion. "I had an `Indiana pouch' surgery, she says. "They completely redo your system—like the bladder itself is not really working anymore. It still remains in there, but they use your colon and intestine to build a new one." After the surgery she continued to have UTIs only slightly less frequently, but the real advantage was a change in lifestyle.
The surgery created a new opening (stoma) in her belly button for intermittent cathing. "You can see it and get to it easily," says Thompson. "When I had the pouch created it gave me a lot more freedom. I could go places without cathing. Sometimes I can go six hours without cathing, and sexually—that was definitely better. But I still had UTIs. Until recently, when I've had fewer."
Why did she continue to have UTIs until only recently? "The only way I can account for this is in the last few years I quit racing. I still do some marathons,but before that I would do up to four marathons a month, so maybe my system was run down. Maybe my body's immune system was more at risk. I can't really tell. But the new technique I use is I rub an antibiotic cream on the base of my belly button where you insert the catheter, so it gets rid of some bacteria, and I've been doing that just in the last three years."
Thompson married about six years ago, has a master's in Social Work and has taken a position as a social worker in at Sharp Rehab. "I'm hoping I'll find my niche," she says.
Interestingly, Tammi Ridley, C5-6 of Pasqual Valley, Calif., near San Diego, had a similar experience, only her
her infection-free period came right after her diversion surgery in 1996 and lasted several years, right up until recently, almost a reversal of Thompson's experience. Still, Ridley is pleased with the outcome of the surgery. "The pouch completely changed my life," she says. "It gave me a lot of independence, although in the last few years I've started to get infections again. But I lead a very demanding, stressful life. I own a restaurant—a wine bar—have a live entertainment venue, I still practice law and have a farm. A whole lot of things going on."
So why have Ridley's UTIs returned after years of being free of problems? "Because I get maybe 3 or 4 hours of sleep, I have a lot of responsibilities. I'm just run down," she says. Could she go back to being infection-free if she took better care of herself? "I think so, yes. I just had a kidney test, which is one of the first things to go, and my function was better than normal."
The parallels are obvious. Both Thompson and Ridley are happy with the freedom and convenience of the diversion surgeries, and both have had periods of recurring UTIs as well as relative freedom from them. Both attribute their run of UTIs to being run down from overactivity. Thompson's road racing used to take up most of her time and energy, while Ridley's responsibilities have escalated since she bacame owner of Friar's Folly, her wine bistro, in San Marcus, Calif.
Ridley's role as bistro owner, besides being time-consuming, carries a built-in factor. "My life is centered around wine, and coffee, and if I don't balance it out very well—if I drink too much wine, too much diet Coke, too much coffee, it's a problem."
So what's the antidote? "Water is good for your bladder," she laughs, remembering Rule One. And don't forget Rule Two: Keep your life in balance.
Extreme leaking is another reason for having surgery. In 1993 Robert Mansfield fell from a construction project, sustaining an L1 injury. "I'm one of those really lucky people who have an incomplete lower injury," he says. Mansfield is almost a full-time wheeler, but says, "I do walk a little bit with Loftstrand crutches and I do a lot of standing. If I stand—and my bladder's around 200 cc full, I'll have a leak." Absorbent underwear and "manhood pouches" leave a lot to be desired. Prior to his 1996 surgery, Mansfield had UTIs every two months or so. But the most vexing problem was leakage while he slept. Dr. Wachs recommended bladder augmentation after doing bladder studies. Unlike Thompson and Ridley, who have pouches, Mansfield's surgery was true bladder augmentation. "About 3 inches above my penis there is a vertical scar that's probably four inches long. That's where he went in. He used a piece of my bowel to enlarge the bladder. I was in the hospital about two days." Now his bladder holds 600-800 ccs easily and he sleeps all night without getting up to
