cath. "I'll get up in the morning and there won't be any leakage, either, it's just amazing. Before I would have leakage every night."
Mansfield , now 49, lives with his wife and two daughters in Fountain Valley , Calif. He likes to fly and belongs to International Wheelchair Aviators. Not only did bladder augmentation solve his leakage problem, it simplified his life. "I don't have to sleep with a condom Catheter. I don't have to have pads or anything. It used to be a real pain in the ass. I just couldn't stand the thought of a Condom Catheter. Too much junk. I want to simplify my life. It was a great benefit." And he has fewer UTIs.
Even through suprapubic placement, bladder augmentation and creation of "pouches" allow for more lifestyle freedom, better bladder management and fewer UTIs—provided that lifestyle stress and other potential complications are in check—surgery always carries a risk and should only be undertaken as a last resort. For most people with nuerogenic bladder, clean intermittent cathing in combination with overall good health will result in a relative UTI-free lifestyle. But not everyone gets the same results. Some people will need to switch from clean to sterile technique due to frequent infections. "There are some people..where sterile catheters used every time has reduced their rate of infection," says Diana Cardenas, SCI researcher and director of the Northwest Regional Spinal Cord Injury System. To get insurance carriers to pay for large numbers of hydrophillic or sterile catheters, a pattern of several UTIs per year must be documented. Cardenas says it is also a good idea to rule out stones and re-check cathing technique and frequency, water consumption, etc.
What about sepsis? Can't a UTI spread to the bloodstream and quickly cause a life-threatening situation –septic shock—which some reports indicate was responsible for Christopher Reeve's death? Dr. Cardenas says there is no reason to fear a runaway infection if you are taking good care of yourself "Most of the time if you seek medical care you can get treated, and most of the time sepsis is not going to do you in," she says. "When
it can do you in is if you're already in poor health, if you already have poor nutrition, if you already have another problem or severe injury."
Usually, before septic shock sets in, a person with sepis feels very ill and has a high fever. Seek out a doctor at the first sign of infection and insist upon being seen. Dr. Cardenas cautions that some subjects in one of her studies, however, seemed less aware of developing infection. "They don't notice they're feeling kind of
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BLADDER MATTERS, CONT'D
bad, or they or they don't notice changes in their Spasticity, or maybe they don't have spasticity, or they don't notice some of the other signs that some people say they notice, like cloudy urine, strong smell, etc. Some people actually said the first sign they had was they were really sick with a fever."
Besides staying vigilant and in good overall health, the best defense against sepis may be to be thoroughly educated about bladder management and infection. Dr. Cardenas did a study where one group of SCI subjects reviewed cathing technique and received education about appropriate bladder volume, appropriate fluid intake and output, things to watch for, and what infection looks like. "We found that the people who got this simple education process, which also included an exam, actually turned out to do better and have fewer infections and less bacteria in their bladder over the follow-up period than the group that didn't get that education," she says.
So there is no silver bullet when it comes to avoiding UTIs. No magical vaccine, no perfect surgery, no absolutely bacteria proof technique, although some are arguably better than others. What counts in the long run is knowing the basics and consistently sticking with them.
