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Thread: Where to live if one cannot live alone?

  1. #21
    Quote Originally Posted by Brianm View Post
    I googled it, interesting; I had never heard of it.
    do a search on this site too... there are several discussions that you may find interesting & informative.

    Quote Originally Posted by Chris Chappell View Post
    Hey Brian, if you ever have any questions about colostomy, SCI in general, etc. I'm at Craig hospital: 303-789-8188.
    ...and take him up on this!

  2. #22
    Does insurance or medicaid pay for colostomy? Why is it not suggested or done at rehab? Just curious.

  3. #23
    Yes, insurance will pay for it, but we would rarely if ever consider doing it during initial acute rehab. Many people have significant neurologic return long after they complete rehab, and putting them through perhaps unnecessary surgery, and one that further alters body image (beyond the SCI) at that time would not be a good idea in my opinion.

    Keep in mind that all surgery has risks, including the anesthesia, there is a down-time for doing vigorous exercise post-op (which would require discharge from rehab and possibly a nursing home stay until you could tolerate intensive rehab again), and many people with SCI can manage a regular bowel program successfully and don't need a colostomy, etc.

    We generally reserve recommending colostomy for those who: 1) have developed a megacolon after a long standing SCI, 2) have failed to achieve a bowel program that prevents accidents or constipation, can be completed within 45-60 minutes, etc. in spite of all efforts and proper procedures, 3) have an unhealthy colon (ie, cancer, ischemic bowel disease, bowel rupture, penetrating wound damage to the colon, Chrohn's disease, etc. etc.) and/or 4) have chronic problems with stool soiling open wounds or pressure ulcers.

    (KLD)

  4. #24
    Sorry KLD, you're wrong on a couple points. A colostomy is a quick surgery that does not require post-op rehab. Most can leave the hospital the next day. There is healing time necessary but it doesn't interfere with life beyond just being a little careful. If you search CareCure you'll discover that several of us have opted to have the procedure on an elective basis in order to improve independence, yes, and sometimes as a solution/workaround to other complications. In Brian's situation it would be a reasonable option... and reversable if he ever wanted to revert back to "normal." I'm sure you have a decent GI physician nearby who would confirm this.

  5. #25
    Senior Member Cowboys_Place's Avatar
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    I see few people mentioned getting a colostomy and how much easier it made their life. I was wondering did you get the procedure done because you had to or because you figured it would just make life easier and what kind of dexterity does it take to take care of it. I'm a quad and need assistance with my BP (currently done by mom) but I wonder when that time comes that she can can no longer help me if it wouldn't be easier to find a caregiver to help with the colostomy bag instead of BP.
    I'm not sure what to do and I'm worrying myself to death over it.
    Courage is being scared to death but saddling up anyway. .(John Wayne)

  6. #26
    Quote Originally Posted by Scott Pruett View Post
    Sorry KLD, you're wrong on a couple points. A colostomy is a quick surgery that does not require post-op rehab. Most can leave the hospital the next day. There is healing time necessary but it doesn't interfere with life beyond just being a little careful. If you search CareCure you'll discover that several of us have opted to have the procedure on an elective basis in order to improve independence, yes, and sometimes as a solution/workaround to other complications. In Brian's situation it would be a reasonable option... and reversable if he ever wanted to revert back to "normal." I'm sure you have a decent GI physician nearby who would confirm this.
    That may be your personal experience; I suspect you were able to have a percutaneous (laprascopic) colostomy, but many cannot and have a big abdominal incision, which precludes doing any heavy lifting or independent transfers for many for several weeks. I have been doing this with our patients for the last 30 years, so I do have a bit of experience in this! Just last week discharged one of our patients who came in for a simple colostomy, had to have a traditional one, and he was unable to return home for 10 days as he was too weak (he lives alone, but has a paraplegic injury) to leave the hospital. I know very well that many people here on CareCure (and where I work) do just fine, and have often advised others here to consider an elective colostomy, but it is still major surgery, and not something I would ever recommend jumping into just a few days or weeks after a new SCI. Not all colostomies can be reversed. It depends on how it is done; and why.

    You misread my comment above also when I referred to rehab. I was responding to the question about why colostomies are not just automatically done during the INITIAL ACUTE REHAB after a SCI. If you have surgery like that in rehab, they would be required to transfer you out of the rehab unit to a general med-surg unit until you were accepted back into the rehab program (able to tolerate 3 hours minimum of therapy a day). I never said that someone who has been injured a long time needs to go to rehab after a colostomy.

    By the way, we have the ONLY GI surgeon in the world who is also board certified in SCI Medicine where I work, and he does all of our GI surgical procedures, including this one.

    (KLD)

  7. #27

    Another option

    My father lived in independent senior living housing for several years. They provide meals centrally, and have non-nursing staff who assist (for an extra fee) with things like bathing, dressing, etc. I don't know about BP because he didn't need assistance while he was there; for him it was the ability to socialize and have friends and transportation that made it good.

    Obviously their primary direction is seniors, but the starting age for his complex was 55; everything is wheelchair accessible (no motorized for his complex, but most admit it); transportation to doctors, hospitals, stores, etc is provided.

    His complex was completely privately paid, but it was way cheaper than a nursing home locally.

    Again -- just another option
    WP

  8. #28
    Quote Originally Posted by SCI-Nurse View Post
    That may be your personal experience; I suspect you were able to have a percutaneous (laprascopic) colostomy, but many cannot and have a big abdominal incision, which precludes doing any heavy lifting or independent transfers for many for several weeks. I have been doing this with our patients for the last 30 years, so I do have a bit of experience in this! Just last week discharged one of our patients who came in for a simple colostomy, had to have a traditional one, and he was unable to return home for 10 days as he was too weak (he lives alone, but has a paraplegic injury) to leave the hospital. I know very well that many people here on CareCure (and where I work) do just fine, and have often advised others here to consider an elective colostomy, but it is still major surgery, and not something I would ever recommend jumping into just a few days or weeks after a new SCI. Not all colostomies can be reversed. It depends on how it is done; and why.

    You misread my comment above also when I referred to rehab. I was responding to the question about why colostomies are not just automatically done during the INITIAL ACUTE REHAB after a SCI. If you have surgery like that in rehab, they would be required to transfer you out of the rehab unit to a general med-surg unit until you were accepted back into the rehab program (able to tolerate 3 hours minimum of therapy a day). I never said that someone who has been injured a long time needs to go to rehab after a colostomy.

    By the way, we have the ONLY GI surgeon in the world who is also board certified in SCI Medicine where I work, and he does all of our GI surgical procedures, including this one.

    (KLD)
    That's all fine and dandy, but your post that I rebutted would be rather discouraging to me if I were Brianm. The last thing he needs is a mindset of defeat when there are options to help set him free from personal care that he can't manage independently.

  9. #29
    Agreed KLD about the acute care perspective. The colosotomy or ileostomy is something to consider probably 2-3yrs+ post injury.

    That being said, I agree with Scott. Your post, maybe not intentionally, was dismissive and defeating. Remember, we live as paralyzed quads everyday and although you have 30yrs of nursing the disabled, you, yourself are not paralyzed. Respectfully, there's a big difference between practical application and real-life.

    Ultimately, we're trying to help Brian and potentially other patients choices relating to their independence. Are my decisions (or Scott's) the right ones, no, not necessarily for everyone but they're options, things to think about and ways to gain independence if chosen.

    Scott's counsel to me 5yrs ago was invaluable as was DeadEye's. Since then I've privately counseled 6 others (2 paras, 4 quads) through their colostomy journies. I have never heard anything negative from their decisions. Yes, some have a less than ideal experience / recovery, or a more difficult time adjusting but ultimately, in their words: "they've gained a level of independence beyond anything they could have imagined."

    To me, it's an option worthy of consideration. Good luck to all.

    Onward and upward,

    Chris

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