im 7 weeks post T12 incomplete sci with a flacid bowel. ive been trying to establish a bowel program with no success. i eat a normal ballanced diet and am as active as possible. i seem to crap my diaper at any time, whenever, where ever. any suggestions?

This might seem like a weird question, but, how's your crap ? Solid or more liquid ? You might want to change your diet just a bit.
Also you are have a pretty recent injury, it take some time to sort things out with your bladder/bowel after injury, I'm injured for 10 years and still have occasional accidents, small ones though.

hate to say it, but its early days.

You need to train your body to go at the same time everyday. Pick a time that is good for you and at that time, have a caregiver pull all of the crap out and then insert a suppository. Within an hour timeframe, have your caregiver pull out all the crap in there until their finger comes out clear. They need to digitally stimulate you until there is no more. If you do this the same time every day, your body will learn to go at this same time.

You could get a routine like this every other day as well, once it's established.

I'd recommend getting off any/ all stool softeners first. If your stool just goes out when and wherever, maybe your body's digestive system already works well enough without the use of softeners.

I also had some major issues with bowels for quite a few weeks after my injury. What's already been said is true--it just takes some time to get the bowel program down, and you need to make sure to do it at the same time of day every time you do it. Also, I added a reasonable amount of fiber to my diet, to keep the bowels solid, and quit taking the senna tablets that they wanted to give me in the hospital. But what was really effective, I think, was that I worked out a program where I lengthened the amount of time I spend working on it:
1. Use a suppository if you need to; I don't. 2. Dig stim for one full minute. If nothing comes out at first, still continue until the minute is up. If there's a lot, just keep dig stimming until it stops, regardless of how long it takes. 3. Wait five to ten minutes. 4. Repeat steps 2 and 3 until nothing else comes out. Going through these steps 3 times each session usually works for me.
Also, I don't know how often you're doing your bowel program, but you may need to do it every single day. I did until mine became reliable, then was able to switch to just doing it every other day.

Yep I was crapin myself 2 or 3 times a week for the first 6 months or so.Soon you will learn to "Feel" when you are full. You willl also begin to see signs that tell you "It`s time"
Example: My legs will spasm more when Bowel is full I get a tingle in my lower back and get goosebumps on my legs.
Hope this Helps

Mal

UHH This persn is a T-12 PARA No need to have a caregiver d this. Do it yourself. You will be much Cleaner and will get to know when you are "Done" or "Finished" Saradise is correct though Don`t stop until your fingers(Gloved of course) come out wet but clean. I Myself do not use Anthing other than digital stim. Yu are very New and this will take some time befre you get the "Hang" of it.

Regards
ML

Ok, since I have a completely flaccid lower bowel, I'm gonna give it to you straight. I hate to tell you this, but flaccid bowel means that without an assistive device or surgery, you will always have this problem. I'm a volunteer for now at a rehab center, and start school this fall for occupational therapy, so I get to talk about SCI medical issues quite a bit with other injured people, doctors, and therapists. Just so you have an idea where my information comes from.

The finger-in-the-butthole routine is worthless for you, and so is the line about how you are going to eventually learn to know when you are full. Trying to establish a routine and get your bowel to go at the same time every day is a bunch of misinformation. If your lower bowel is truly flaccid, you are NOT going to be able to know in time to get to a toilet, get ur pants down, transfer, etc. In fact, the act of transferring can often cause enough pressure on your bowels to push the crap right out. With flaccid bowel, most laxatives, stool softeners, fiber products, etc, that doctors or others without truly flaccid bowels tell you to try (even in low doses) will only make the problem much worse. Now, there is one thing my colon-rectal surgeon has given me for the time being until I get to surgery. It's called Pamine. It gives a bit of drymouth, but in the right dose, it can help for a while. It was originally made for irritable bowel syndrome, but helps to dry the stool enough so it at least doesn't turn into the river of crap that normally happens all the time.

The problem with a flaccid bowel is that the bowel sphincter has no tension or reflex. This renders fingers mostly useless, and suppositories totally useless. Suppositories work on the premise that the rectum will hold them in long enough for the medication to cause the reflex in the bowel that produces a bowel movement. Without the sphincter tension and the bowel reflex, suppositories cannot work. They will simply fall out.

For the finger part- If your stool becomes large and hard, it may be necessary at a few times in your life post injury to use the finger routine (until a better alternative is used), but it will be very few times that it will help. With the sphincter flaccid, the stool will generally come out well before you have to worry about trying to get it out. It's usually more of a battle to keep it from pouring out all the time. With most injuries above T12 (upper motor neuron injuries), there is still a reflex and tension. With injuries at or below T12 (lower motor neuron injuries), the reflex and tension just aren't there.

There are several other threads on here that deal with flaccid bowel, and I have gotten some really nifty input from others. One of the suggestions is the Peristeen system, but if you're in the US like I am, it's not available yet. Another is to go to a site called medicaltoys.com and get an enema bag with inflatable nozzle, as it will work pretty similar to the peristeen system. I'm actually debating whether to get one or not to try until the surgery...

If you're not up for that (and I suspect few are..) then see a colon-rectal surgeon. There are 2 surgical options that are fairly low invasion and could help immensely. First, there's an artificial bowel sphincter (similar to the artificial urinary sphincter). That would allow you to (given that you have enough sensation to know when you are full) merely aqueeze a bulb in the scrotum that would open your bowel sphincter and allow you to crap, but would be shut the rest of the time. The other is the Antegrade Continence Enema, which I am still waiting on the state rehab commission to get the paperwork to my colon-rectal surgeon so I can have it. This is a laproscopic surgery that creates a small tube for you to feed a catheter into. The cath is connected to a saline or soap and water bag. When the water flows into the bowel, it washes the bowel out from right to left. This means that there will be no stool left in the bowel to accidentally come out. If done every 48 hours, accidents are extremely rare to non-existent.

I hope this helps, and I apologize for the length. There is just so much info available, and I feel everyone should have as much info as possible. Best of luck.

JAX

First off- DON'T WORRY! You are still at an early stage of your injury and it is normal to have problems like this for a while. I spent five months in hospital (just got out there in April, I'm a complete T12) and for maybe a few weeks now and then my bowel would behave- then it would mess up and be that way for another few weeks before another rythm took over.

My bowels did not get into a proper routine until I got home and I was getting up and over the toilet for peristeen anal irrigation at the same time every morning (9.30am). Since leaving hospital I have had little trouble. This is down to several reasons:

1. Medication- heavy painkillers, which I assume you are still on, are terrible for constipation, especially codeine or morphine based medications. They will mess up your bowel regime, count on it. Eventually you won't need these strong medications and that will help your bowels.

2. Routine- hospitals like to tell you they have a routine and that they are putting you in one. Chances are they will help you move your bowels at varying times every morning or evening or whenever you happen to move your bowels. For me they had me up at 6.30 one morning and 8.30 the next. They tell you a few hours doesn't matter, but it does and it will. Try and make them see this.

3. Diet- this takes some real experimentation. It took me four months to get it right. I take three senna, a glass of fybogel (isphagula husk) and a fruit smoothie (heavy with fibrous fruit like Kiwis) every evening and I get good results in the morning. High fibre things like All-Bran, wheat cereals and certain types of fruit will help. Some medicines like Lactulose, which they seem to use a lot in hospitals, may actually work against you. So- experiment and it'll come in the end.

4. Things to Avoid- if you know of foods that, pre-injury, sent your stomach mad then avoid them. Also, don't dwell on any accidents you may have. It is normal and it won't keep happening. You will get into a routine, it will take time, perserverance and patience but you will get there.

Good luck,

Karl187.

Karl, the reason you don't have accidents is the anal irrigation itself. It clears enough stool from the colon to keep the stool being produced from forcing out the stool already produced.

Flaccid bowel means " very little to no sphincter tension or lower colon reflex," so the stool just keeps coming out until you go about 18 hrs without food. Then the accidents are slowed for a time-about 12-18 hrs after you start eating again. I've done it. If you dry the stool a bit with a medication like Pamine, it can keep the accidents from being a shit-stream (or a drizzling shit-stream), but that's really about all you can do without something like the peristeen or the ACE, or the ABS.

I've spent since January 07 researching, trying, and discussing these things with my colon-rectal surgeon. We tried everything to avoid surgery, but it's come down to that anyway. I've also discussed these problems with several others with flaccid bowel. Some are on here. Those with flaccid bowel have given me a general consensus that the options I've laid out are the ones that work for flaccid bowel. Of course, the peristeen works well for reflex bowels as well from what I've gathered.

The painkillers do cause constipation, but pomerv isn't having that problem. If the painkillers that generally cause constipation are not causing constipation, then that is a pretty good indicator of flaccid bowel. Usually, when this happens, the person will actually experience more accidents for a good while after stopping use of those painkillers.

For someone with flaccid bowel, the senna won't do any good. If the problem is that the person is crapping all the time, why would you suggest that the person take something that makes ya crap more easily? That doesn't make sense. That will just increase the number accidents. The bran cereals and high-fiber foods also usually cause more problems for someone with flaccid bowel. Ask any good OT at a good rehab center, and you will see that I'm not trying to be pessimistic, but that I do know what I'm talking about. Or for that matter, ask somebody else who has a flaccid bowel. It's not a good idea to take a LAXATIVE when you're already crapping too much. Flaccid bowel + stool softener or laxative or 'high fiber'=diarrhea disaster, and sometimes dehydration. I've seen it firsthand in others, as well as experienced it myself.

I appreciate you trying to encourage pomerv, but please don't try to sugar coat things or fill the person with misinformation about how laxatives and stool softeners will help to keep a person from crapping all the time when the person has flaccid bowel. A quack doctor and a shitty OTA did that to 3 of us that went through the "rehab" at Scott & White, so I'm kind of experienced in this area myself, and have some other people's experiences to base this on.

Now, if pomerv's bowel isn't flaccid (though from the original post, it certainly sounds that it is, considering the statement "im 7 weeks post T12 incomplete sci with a flacid bowel") then maybe trying senna would help, but not until about now if pomerv started in late April/early May. It takes at least 2-3 months for the bowel to actually start straightening out enough on its own before it will do any good to try to time-regulate it with diet and/or meds. Then it takes another month or 2 for the bowel to start "learning." That's not including the time it takes to figure out what upsets the bowel post-injury that didn't pre-injury (and there is a good chance that there will be several things that go on that list). Yes, it takes time, but saying it won't keep happening...llike it will just go away on it's own...That's like saying that he won't keep not being able to walk and his legs will start working on their own. Bowel accidents will happen off and on for a long time to come, though less often, unless something like the Peristeen is used. Then accidents are extremely unlikely. However, don't forget that the Peristeen isn't very readily available to us on this side of the pond (in fact, it's not actually sold here at all, but some have gotten them from friends in the UK or other countries who could get a scrip). So if pomerv is in the states, there's not a very high likelyhood of being able to get the peristeen. Our only options at the moment are buying an enema system from medical fetish sites/stores, or having surgery.

[For those who think about the Zassi system as a possibility, I've got one in the closet, and it's worthless unless you have a water hose in the house. (But then, what would you need the Zassi for at all if you had a water hose in the house? You could just use the hose.) It's meant to be left in for 2 or 3 weeks at a time, and will not do any good for flaccid bowel evacuation. Tried it with a SCI bowel specialist, an OT at Seton, and my wife (who is a nurse) all present, and to no avail.]

Jesus, lighten up a bit. I ain't a doctor, just giving my two cents like everyone else on here. I also do consulting work for a university on SCI and health issues- it doesn't make me an expert and nor does what you do make you one either. All we can share is experience. I did that, and so have you- no need to jump on a high horse about it.

Sorry to single you out here, but you are the one from whom I saw the most misinformation, and I decided to tackle all the bad advice at once. Since your 1 post included almost all of the misinformation that several others did altogether, your post made the best single example with which to straighten out the misinformation. I'm just as upset at how several others decided that their reflex bowel solutions would somehow magically work on a flaccid bowel. Plus, I'm not appreciative of you trying to downplay and make light of pomerv's genuine concern. That's the kind of attitude that causes bigger problems for people. People don't want to have their genuine concerns turned into a joke.

Read the original post. It clearly states in the first line that pomerv has flaccid bowel.

How much experience do you have with flaccid bowel? Do you have one? How many people do you know with them? How much time have you spent learning the difference between flaccid bowel and reflex bowel? I deduce (based on the advice given in your post) that the answers to the first 2 are both probably "No." The 3rd is probably "I don't know," and the 4th is most likely "Not very much," or "None." Sharing experience is helpful if you actually have experience with that particular issue. It's not very helpful if you don't. It could actually be quite harmful in this case.

Sorry to burst your "I do consulting work for a university" bubble. For what university do you consult? On what SCI and health issues do you consult? I certainly hope not SCI bowel issues. If you do consult on SCI bowel issues, you should be fired. I'd hate to have you working on staff anywhere dealing with SCI bowel problems. The advice you gave for flaccid bowel could easily cause much worse than the existing problems.

I'm not claiming to be an "expert", but I do (unlike you, apparently) have a clue about flaccid bowel. I talk to SCI specialists and colon-rectal surgeons. What I do makes me much more informed as to the options available for those with flaccid bowel than you seem to be from your advice. I am working to become an OT in order to help as many as I can to keep from having this kind of misinformation fed to them. I'm not on a "high horse," but I am sick of the way that people who have no clue what flaccid bowel even is start rattling off crap that is only used for reflex bowel.

You sound like the doc and the OTA I had at Scott & White, giving people reflex bowel solutions when they have flaccid bowels. Then telling people to "calm down" or "lighten up." What makes you think this is a joke?

This is not a joke, it's a person's well-being. How did you feel when you were first injured and crapped yourself ? Was it funny? I'm figuring that it was quite the opposite. It was for me, and I'm betting that if you asked others, you would find that it was quite a concern to them as well.

Controlling the flaccid bowel issues and stopping accidents can easily mean the difference between staying home all the time and actually being able to go to school, get a job, and even go on a date. (Shitting in the cinema or office or classroom are not things a girl or boss or professor easily forgets.) Also, I don't think you understand the medical consequences that can be caused by using stool softeners, laxatives, and the like with a flaccid bowel. I can tell you from personal experience that the diarrhea and dehydration are not fun. Neither is having to go to the ER because the bowel medications for reflex bowel were given to someone with flaccid bowel and caused the dehydration. The dehydration can come on pretty fast when you're having to stay on the bedside toilet. Did you even think about that?

I don't like having to be a jerk, but I have a big problem with people giving advice like yours and that from some others. I was much nicer to you in my other response than I have been to many others who decide to misinform on this issue. People don't listen anymore. If you really cared about helping pomerv, you would not have given information that could easily worsen the problem. Think about that for a second.

How would you feel if you tried all the things people advised for your flaccid bowel, only to discover that those things are not even supposed to be used for flaccid bowel, but could rather make the problem worse? It's extremely disappointing and frustrating (as if the flaccid bowel and SCI weren't frustrating enough already) to learn that the advice you have been given was total misinformation. Take it from somebody who's been there. It's not a laughing matter. So don't even bother trying to make yourself seem like some good guy "just trying to help," when you obviously don't give a damn about the original poster's health or concern.

For a start Jax, an internet forum is the L-A-S-T place I would go for advice on medical issues. I would consult a doctor or nurse, i.e. experts with medical qualifications- not someone on an internet forum who could pretty much be anyone in the world. I was told in hospital to check these kinds of forums to see what e-x-p-e-r-i-e-n-c-e-s people had of the issues at hand, not to get expert medical advice. Anyone seeking that here really needs to assess their line of thinking.

I'm also not making light of pomerv's situation- I've been in a similar situation, funnily enough. I was making light of your attitude which was heavier than most doctors, especially for someone who is not a doctor or medical professional.

I do consulting work at Queen's University Belfast School of Nursing and Midwifery and I assisst in the structure of post-graduate modules within the field of specialist practice, pain management, patient services and fracture trauma. I also guest lecture in these areas as an 'end-user' of NHS services. My input is nothing more than the sum of my e-x-p-e-r-i-e-n-c-e. (There's that word again...). This is also mostly unpaid consultancy (except for some fees for guest lecture spots) as I am not a medical professional and, let me re-iterate strongly, neither are you. So I made an error in not understanding the full idea of a flaccid bowel and perhaps offered less than sage advice- but of course, we're now back to my original point: If you have a medical query then seek the help of a MEDICAL PROFESSIONAL, not an internet forum. This, Jax, is the best advice I, or you, could ever offer to pomerv and I suspect that he himself knew this before he even started this thread.

First, a bit for pomerv.

"Eventually you won't need these strong medications and that will help your bowels."-This is only partly true. It will help them to empty more frequently, if the problem is lack of function in the upper part of the colon. If the problem is that the bowels are emptying too often already (which indicates flaccid sphincter, and at least some upper colon function), then the lack of those medications could actually make the accidents happen more frequently.

"High fibre things like All-Bran, wheat cereals and certain types of fruit will help." High-fiber foods will not necessarily help. With flaccid bowel, consuming high-fiber foods can actually increase the frequency of accidents. Again, the effect is partly dependent upon how much function is present in the upper part of the colon versus the amount of tension present in the sphincter.

"Some medicines like Lactulose, which they seem to use a lot in hospitals, may actually work against you." This is definitely a good piece of advice. The lactulose can have a very negative effect for people with flaccid bowel. Lactulose, like many other products meant to promote water intake to the bowels can cause dehydration if overused or used when one is not constipated. It will also generally cause more bowel accidents in those with flaccid bowel.


Karl,

You made no error in not understanding the full idea of a flaccid bowel, but rather in offering advice without that understanding. There are plenty of doctors, nurses, and OTAs (all medical professionals) that do the same thing every day. "Less than sage advice?" You had one point about lactulose that was a good warning. Just wish you made a point of how bad the lactulose effects could be. Most of the rest of your original response was all about your reflex bowel experience and contained nothing useful for someone with flaccid bowel.

"So- experiment and it'll come in the end." WTF kind of advice is this? It is obvious that pomerv knows it will come out. It already comes out too much and likely too often.

From what I read on the Queen's University School of Nursing and Midwifery website, it seems that SCI bowel issues are not even part of the focus of the postgraduate program. Nursing and midwifery? Wow. Nursing barely even scratches the surface of a select few issues related to SCI. (My wife just completed her RN. I can give you the names of the books they used if you would like to see how uninformative they are to the nurses when it comes to SCI.) Midwifery has how much to do with non-pediatric SCI bowel issues? Unless you're birthing mothers with SCIs every day, I'd say not very much.

Assist in the structure of post-graduate modules within the field of specialist practice? What kind of assistance do you give to the structure of those modules? You're rather vague here, and sound a bit like a lawyer or politician trying to slip one past by using your colorful description as a distraction. What all specialist fields are included? From the information provided on the website for the QUB NMRU post-graduate research program, I have found no mention of SCI. "Investigating aspects of health and health care related to high risk pregnancy, childbirth and babies born requiring neonatal intensive care as well as children surviving with neurological impairments or cerebral palsy" is about as close as it gets. All of that revolves around babies. Where do non-pediatric SCI issues fit in there? There are 2 focal topics of research shown for the post-graduate research program. They are: 1-Maternal and Child Health; 2-Evaluation of Complex Healthcare Interventions. Is there even a SCI topic in their research?
Patient services? Sounds like a hospital version of a concierge.
Fracture trauma? That's ortho, not colon-rectal, and not OT for SCI. The cord and the vertebrae can be damaged independently, you know....

I see you must have not had the great experience of dealing with uninformative, inexperienced, or just plain quack "medical professionals." I have. As a matter of fact, you talk a lot about your experience, but I don't see how any of the experience you say you have pertains to flaccid bowels in persons with SCI.

This forum was the last place I looked! (Sorry, Simon) Logic, along with my personal experience (and several of the experiences I've read about on here), makes me think there is a pretty good chance that, since pomerv was still in hospital when posting this, there was not much (or at least not enough) help given by the types of medical professionals that you say to consult. That lack of help and information from medical professionals is what turned me to the internet to learn for myself. Until I read a lot of stuff on this forum a couple yrs ago, I didn't know just how bad the advice I got (over the 8 months or so prior to that) from those certain "medical professionals" had been. So far, this forum has proven over and over to me to have information available that is worth so much more than anyone could ever truly understand. It took me a bit to figure out which information was coming from somebody with certain issues similar to mine, but I did. That makes a lot of difference, too. I'm just trying to make it easier for someone else to distinguish.

Of course my attitude is going to be "heavier" than most doctors and other medical professionals. That is because most "medical professionals" don't really know very much about the specifics of flaccid bowels. I've asked quite a few, and so far, the majority of ones I've asked don't really know much. I keep getting the answer of "Try to make your bowels move at the same time every day." Anyone with flaccid bowel knows that advice is useless. The lack of "medical professionals" who are experienced in dealing with SCI is quite astonishing here in America, as well as other places I would figure. What makes you think there are no medical professionals online? There is at least 1 other forum online that is actually associated with Rutgers University. I'm not fond of some of the members, but here is the link so you can check it out for yourself. I know that discerning who is truly a medical professional is difficult sometimes, but (I would figure) many of us here are pretty good at being able to tell the difference. (I'm pretty sure Simon is rather adept at making the distinction.) Maybe distinguishing quacks from those who are knowledgeable and experienced is a difficult task as well, but that's generally the case offline, too. I've been there.

You get paid to guest lecture about the NHS? From the website of the QUB NMRU, I see that the "Evaluation of Complex Healthcare Interventions" is described as "investigating the translation of complex healthcare interventions into practice and their sustainability using mixed research methods." That's interesting. So, does a lot of your work involve researching how (and how well) healthcare intervention "theories" translate into their "applications?" If so, I would think that you would know better than many that something may sound wonderful in theory, but it could still be unused/unusable/misused/unsuccessful in application. That's what I'm talking about when I say that doctors don't know much about things like SCI bowel problems. The theory you are working with is that they all should, but in actuality, not all do. If they all did, I'll bet there would be a lot less people on this forum (and others) asking questions like pomerv's.

Since many doctors are not experienced in working with patients with SCI (as we are in quite the minority), many of the treatments/equipment we may need (or be able to use) have not been done/used by very many doctors to treat/help SCI issues. Many doctors may not even have considered that certain treatments/equipment could be used for SCI issues. I have read other posts on here where other forum members have heard similar things from their doctors. So the "ask a doctor" argument doesn't hold up.

Here's some personal experience for you.
I married a nurse that worked in the rehab wing of Scott & White Hospital (one of the larger hospital chains here in TX), and neither she nor her nurse coworkers had any knowledge of the treatments for flaccid bowel when I was in rehab. I've asked them. You can ask, too, if you like. Call Scott and White Hospital, Temple, Texas. Ask for any nurse on STC4. You could even call their OT department and ask for Lauren, or call the Physical Medicine and Rehabilitation department and ask for Dr. John Schuchmann. I'll bet you get transferred at least 3 times before you find someone who will even address what a flaccid bowel is. That is if you don't get transferred to somebody's voicemail every time you call. Dr. James Albers would be about the only one with a clue. See if the others don't try to tell you some BS about how you should use suppositories for flaccid bowel. It's contradictory to the intended use of the suppositories that's written on the freaking box. If I could read the box and know better than to use those things for flaccid bowel, why couldn't those "medical professionals?"

I went to 5 different "Physical Medicine and Rehabilitation" doctors, 3 different OTs, several colon-rectal surgeons, and 2 different urologists trying to get the flaccid bowel and bladder sphincter issues figured out. I drove several trips each to Houston (Evaluation at TIRR), Temple (urologist), Ft. Worth (urologist), and Austin (colon-rectal surgeons) from the town in which I lived 2 yrs ago. No solutions came. After reading through a lot of posts on this site, I found a mentioning of the AUS. I looked it up on the web, and asked a urologist about it. Although he hadn't previously done the AUS procedure on anyone as young as I was, he still installed an AUS in me.

Finding a doctor with good knowledge and experience in the field of SCI bowel issues is very difficult if you don't meet one while you are in rehab, incidentally know somebody that knows one, or just get really lucky in the search. At least, that's the case in a good portion of TX. After a couple of colon-rectal surgeons I visited showed me they knew nothing about SCI bowel issues at all, I had to find my own doc. I got a referral from my wife's primary care doctor to a gastroenterologist. That gastroenterologist sent me to another colon-rectal surgeon. His specialty was colostomies in patients with colon cancer, so he wasn't any real help. I got tired of the run-around, driving all the time, and lack of progress, so I called more than 30 colon-rectal surgeons to see what experience each had with SCI bowel treatment. Apparently, many colon-rectal surgeons are really nothing more than colostomy doctors. 1 colon-rectal surgeon actually told me a colostomy was my only option before I even told him what all I had tried already. All I told him was that I had a flaccid bowel due to SCI, and he immediately came out with "A colostomy would be your best option, and really the only option here." One actually told me that if I wanted something to help my bowels, but didn't want a colostomy, I was "asking for a miracle, and we don't work miracles." A colostomy is not only option, I have since learned. For that matter, it's not even close to the best option for me. What good does it do to go to "medical professionals" who are themselves inexperienced and uninformed? If I had listened to those "medical professionals," I would now be living with a colostomy and the knowledge that it was unnecessary. Good thing I looked on this internet forum. Now, I have found some options, and presented them to a colon-rectal surgeon. He agrees that the ACE is a good option for me, and I'm waiting to have it done.

"Unpaid consultancy?" That sounds remarkably similar to what is done by almost anybody who posts any kind of advice on a forum, no matter what experience the person may or may not have regarding the particular topic. Does your definition of "unpaid consultancy" mean "volunteer" work? Generally, volunteer work is to be respected. As I have said before, I have been volunteering since last December at a SCI rehab center. I have learned a lot over these months, and I have recently been offered a paying job (which I am accepting) as a therapy assistant. So, I have actually done work (and soon will be paid for doing that work) directly with people with SCIs, helping them with SCI issues. Does your work involve dealing with SCI issues? You go feed someone else your "let me re-iterate strong." Although I'm at the bottom of therapy for now, I am at least working and studying to become a "medical professional." (Who knows, maybe I'll even get a PhD. After all, it is one of my little goals.) The issue of flaccid bowel is part of not only my area of study, but also my life (especially considering I actually have flaccid bowel). Since having all my issues dealing with so-called "medical professionals" post-SCI, I have dedicated my studies and life to helping people with SCI through occupational therapy and better, more available information regarding SCI and SCI issues. (Those are the big goals. Too bad Simon beat me to starting a good forum for the second big one. Now I have to find a different way.)

I'm glad you found the QUB website informative. As a former student (Politics, BA, 2:1) I can tell you right now you'll find nothing of any use there unless you enter Queen's Online (QOL) where you'll find the teaching modules, but you aren't a student or teacher there so that's a moot point.

You also won't find any information on the modules I'm helping develop as they are for commencement in September and are not yet ready to go 'live' as they call it.

I also think the way you refer to nurses and their expertise in the field of SCI a total and utter disgrace. I spent five months at Musgrave Park and the nurses there were, for the most part, stellar and were experts in SCI. The doctors were, on the other hand, virtually non-existent. If you wanted advice, you went to a nurse, its that simple and if you don't understand that nurses are the footsoldiers then I can't help you see that forest for those trees.

My consultancy at QUB is mostly to do with the political/bureaucracy/practice side of medicine. I am not interested in the nitty gritty of the human body beyond my own, which I must understand, obviously. It is my belief that the NHS, as a system, is totally broken and inept and places patients at great risk from bad practice and, as you have pointed out, misinformation. My experience in hospital galvanized my belief that government healthcare does not work and needs root and branch reform if it is to survive at all. What my consultations do is cut through the BS that has been handed down by bureaucrats and little hitlers within the system, and to give it to nurses straight from the patients mouth about what is needed.

I understand what you mean about doctors and nurses having no clue about bowel and bladder functions. I spent three weeks at Belfast's Royal Vic after my accident and they had no idea what to do about my bowels beyond giving me suppositries and laxatives that didn't work. Only in specialist wards does the knowledge about such things exist. This is exactly the problems I hope to try and alleviate in my time at QUB- to say and show that bowel and bladder problems should be in the general knowledge of all nurses and doctors (they should especially know what self-catheterization and DRE is) and not the preserve of a brief few. (Especially when considering the fact that bladder and bowel problems are also not simply present in those with SCI, but can appear as defects in otherwise healthy people or can come as a result of injury, disease or stroke.)

So sue me if I tried to help someone out in need, I mis-understood their situation but my intentions were only to try and help them.

I see by the statement below that I forgot for a moment you are in Ireland. My apology. Please, let me clarify. I'll do my best to remember that you're in Ireland this time.

"I also think the way you refer to nurses and their expertise in the field of SCI a total and utter disgrace. I spent five months at Musgrave Park and the nurses there were, for the most part, stellar and were experts in SCI."

First of all, I'm in Texas... The USA. There is a vast difference between the education of nurses here and nurses in many other countries. Nurses here are generally not well trained or experienced in SCI issues unless they happen to be married to a person with SCI, work in a SCI rehab center, or actually have SCI. As I said before, my wife is a nurse here, at HealthSouth Rehabilitation Hospital, and she has even told me before that there is so much about SCI that she never knew until she found it out in the course of being with me. (Incidentally, she was one of my nurses in rehab at Scott & White.)

I do not mean that nurses are stupid, or incapable of learning, or unintelligent, or uncaring. Quite the opposite is actually the general case here in my experience. However, few nursing schools here teach anything more than just the basics of SCI as they fly through the books, therefor, the nurses can only learn more through their own research, or through firsthand experience with people with SCI. As for the nurses at Musgrave Park, I've no experience, but I'm glad your experience with them is good.

Second, you were at Musgrave Park for five months? My "rehab" was LESS THAN FOUR WEEKS at Scott & White hospital in Temple, TX. My entire hospital stay was 5 weeks to the day. I went in on 16 DEC , had spine surgery on 17 DEC, had IVC filters placed on 18 DEC, transferred from ICU to med/surge on 20 DEC, transferred to rehab on 23 DEC, and was discharged on 20 JAN.

They keep 3-4 SCIs per year in their rehab, although their spine surgery unit sees between 20 and 30 SCIs per year at that campus. The rest are sent to SCI rehab centers, such as TIRR in Houston, TX. I was one of the 4 total that Scott & White kept in their "rehab" during the time from December '06 through February '08. Their rehab focuses mainly on ortho patients (knee and hip replacements mostly) and elderly people (falls, "small" strokes, etc.). A young SCI patient doesn't get much of anything there really. The physical therapist I had was good, but the occupational therapist and the doctor I had were worthless.

To give you a bit of an idea how ridiculous it was there-
Scott & White's "rehab" is 1 floor of 1 small wing of the hospital, comprised of 20 patient rooms (With tiny bathrooms that a 40cmX40cm manual chair won't fully fit into. The back wheels were outside the door, and I was as far in as I could go...). There is also 1 nurses' station, 1 doctors' charting room, and a "case worker's" office. The Physical therapy department is 1 room measuring about 9 meters by 12 meters, and has 1 elevation mat, a set of parallel rails for those who can walk, a small set of steps for those who can walk, 2 stationary bicycles, 1 stationary handbike, and a small weight-workout machine that will sort-of fit some manual chairs into a couple of the stations.

I didn't get any kind of wheelchair evaluation in rehab. I had no chair to go home in until I called a med supplier that I had looked up on the web and bought a cheap hospital-style chair (the evening before I was supposed to be discharged). I actually didn't get a wheelchair evaluation until the state rehab service set me up for one in September '08, almost 2 yrs post-injury. I had figured out wheelchair fitment pretty well by then, as I'd fitted my second chair, and just told the med supplier rep what I wanted and how I wanted it. So far, the only issue is the Jay3 backrest sucks for everyday use for me, but the chair fitment is great otherwise.

I was never given a bowel or bladder function evaluation. I was not given a urology consult or a gastroenterology consult. I had to go through other primary care doctors to get those referrals. I first saw a urologist in late July/early August '07, and first saw a gastro doc in February '08.

I got about 30 minutes with the "OT" each day (no weekends or Christmas day, so that cuts it down to about 9.5 hrs total with OT), and about an hour with PT.

I learned more about my SCI from internet forums and medical journal papers online than I ever did from all of the doctors and nurses I've dealt with together. Sadly, even in rehab, I learned more online than the entire rehab wing staff knew about lower motor neuron injury. And all I learned was the bit about avoiding laxatives and the like. The staff didn't have a clue. I was fed stool softeners and laxatives and suppositories daily for the first 2 weeks post-injury (then I started refusing them after reading an article online about their effects on flaccid bowel). The doctor I had was a total loon. When I first refused the suppository, he came into my room and asked me why I'd refused it. I told him that I was crapping too much, and he said "You should be going all the time. It means the bowels are working." I was sitting there thinking "WTF??" When I asked the head of the rehab department to get me another doctor, I got to see another doctor once. After that, the head told me I had to stay with the quack. Well, actually, the head wouldn't talk to me again. He had his secretary tell me.

Doesn't sound much like a SCI rehab, does it? Yeah, it doesn't to me either.

In February '07, I went to see my spinal surgeon due to immense pain in my back and poor posture. I found out from the x-rays that L4 had broken (the lowest vertebra they put screws in), and the screws were no longer in place. On 22 MAR, I went in for my second (9hr) spinal surgery, which extended the fusion from being T10-L4 all the way into T10-Pelvis. After that surgery, I was in hospital for just over 72 hrs prior to discharge. No offering of therapy at all was made by the hospital. I got a scrip for 20 Vicodin and 2 yellow pieces of paper they call discharge papers. That surgery really changed my balance and took away my flexibility. I balance like a bowling pin with a narrow bottom. Nobody even asked me if I would like a referral to a therapist. Hell, I asked the attending doctor for a physical therapy referral, and he told me I didn't need it. Luckily my brother knew a good PT/OT and got me in to see her. It was amazing the difference she made.

I apologize for having been an ass to you (and for the lengthy posts-another bad habit of mine). I understand your intention to help. I hope you will understand that I am not angry at you specifically, but rather with the generally accepted practice of rapid, high-volume distribution of misinformation. I should not have taken that frustration out on you.

Your work at QUB sounds incredibly frustrating. I must say I have respect for you for doing it. I couldn't do it. Not without ending up in trouble/jail for telling somebody to "Shut the hell up and f***ing listen, you f***ing moron!" I hate bureaucracy BS. It too often gets in the way of patient care over here, too. It's awful.

"This is exactly the problems I hope to try and alleviate in my time at QUB- to say and show that bowel and bladder problems should be in the general knowledge of all nurses and doctors (they should especially know what self-catheterization and DRE is) and not the preserve of a brief few."

Please, please, tell me you're not serious. Self-catheterization? How could anyone in the medical field not tell from the name of it what it is? DRE? Really? There are doctors who have no clue about DRE? I don't get it. What do they teach medical professionals nowadays? It would make sense to me that these things should have been learned at some point in the yrs of schooling it takes to become a doctor. But then again, it's not much different here in that aspect.

Geez! How much information is thrown out between the bits and bytes of what is taught? Here, there seems to be a much shorter list of what is covered than of what isn't.

I only speed-read the long posts and may have missed some detail, but from your description of your shabby treatment, Jax, it does sound to me as though you would benefit immensely from our NHS over there! It may not be perfect, but I cannot imagine you being treated like that anywhere in the UK.

Jax, sounds like you've been through hell and my apologies if I came across as a jerk, there was no malice intended. I understood some of the US rehab centres before your post there as I have a bud in ND who lost his leg in a car accident and only got 2 weeks rehab- I was well shocked when I found out and I feel for you guys out there. Your system, like the NHS, needs a total overhaul, although its not like the politicians are going to help us, right? Gotta do it ourselves.

As for rehab- it was good in parts and hell in others. I spent two extra months in because I had no house to go to afterward. I was homeless until my family, in a last ditch effort, put an advert in a paper and someone called about a suitable place. I'm also a big guy and for some reason the people in rehab believed I couldn't do certain things and they were proved wrong. Chair wise, I was given the musical chairs treatment and was at the end of my tether and still kind of am as I still don't have my own chair- I'm in a company chair currently (bureaucracy).

I know what your saying about keeping your anger in check over bureaucrats- I've had several run ins with them thus far and I reckon there'll be a few more.

To be honest, I took it as granted that all nurses and doctors knew about self-catheterization and DRE. They'll know what a catheter is- but they always think its the indwelling variety that most patients have fitted in the ER and during ops. They usually have no clue what an intermittent cath is and its a total disgrace. Only those who have urology or SCI experience will likely know about ISC. As for DRE, I thought this was general knowledge aswell but take this as an example: Before I was permanently discharged the district (local) nursing team where I live had to be informed about my needs as they help me with my bowel routine every morning. None of them had ever done DRE before and had to be taught and certified. Things like this are the main problem with patient care and they are problems that we all face, unfortunately.

I've heard that from some others as well, and I've also heard the opposite opinion from some regarding the NHS. I'm pretty sure that no system is perfect. It seems that the issue really comes down to the particular hospital and that hospital's staff and focus, more so than just the single-payer versus private-insurance-type healthcare system.

The healthcare system here is broken, but what's really broken is the way our educational system thinks as a whole. In nursing, as well as many other fields of study, there is too much apathy, to much acceptance of lowered standards of curriculum, and too much trying to push out all the students they can in as short a time as possible, rather than taking the time necessary to educate them better in many areas.

EX-For my wife to get her RN (she was already a LVN), she went to 1yr of school, passed one final, and has a state board exam soon. Their clinical rotations consisted of 4 shifts in pediatrics, 4 in oncology, 4 in cardiac, 5 in med/surge, and 4 in ICU/emergency. I can't believe how much stuff they didn't even put into clinical rotations, much less how uninformative the study materials (books, college internet study guides, etc.) were regarding many areas of nursing. It's no wonder I've encountered so many with so little experience and knowledge about SCI-they don't even get a 4-day rotation in a rehab center. It's rather sad.

I'm trying not to focus on my anger as much now as I did initially. I'm rather trying to use it as motivation to help others to not receive the same treatment I received. I can't get too angry anyway, really. I did meet my wife in that rehab...

Two weeks after traumatic amputation?!! That's insane!! They should have kept him in rehab longer than that just for the monitoring of the leg alone. (Keeping infections out, etc.)

Musical chairs sucks. I've a friend who had that done to her for a couple years before she got her own. The chairs she used were generally secondhand. Her first was one that her grandmother (who passed on a year or so earlier) had used, and it was way too big.

I've proven my "OT" wrong on quite a few things as well. It's sad how even OTs don't have a clue what can be done by someone in a chair.

Incidentally, my first transfer was without assistance, on Christmas day. My dad had gone to get coffee, and when he came back, I was using the board to get into the chair. There wasn't a therapist in the building. But there was coffee on the floor. When they came back the next day, I went to morning PT on my own before the assistant came to get me. The OT director saw me along the way and made the statement "Wow, Lauren (OT) taught you to transfer already?" I asked him "Who's Lauren?" I hadn't even met her yet. When I did finally meet her later that day, she asked me if PT had put me in the chair... Again, I thought "WTF?!" Then, on the following Saturday, I transferred without a board. Again, no therapist and no help from anybody. The OT wouldn't teach me, and kept telling me "You're not ready." And here I was thinking that they were supposed to help and encourage people that get injured... I later learned that she had no idea how to manage transfers without the use of a board. The PT, however, could transfer floor-to-chair, chair-up to mat, chair-down to mat, and into my mom's four-door pickup without using her legs. (She's very fit.) I held my hands against her calves a couple times-no tension. I was quite amazed. She even taught me to dress on the floor, just for grins. But, the focus of her studies was not in the "nitty gritty" parts of SCI, either, so not much help there.

Here's a sad circumstance-I learned more watching Murderball than I did in rehab. It's where I learned to get dressed in the chair, how to put the chair behind the seats of the truck, the basic requirements of everyday manual chairs, how to use escalators, and how to flip someone else over in a chair. That's just what I learned the first time through.

Escalators eh? I want to learn to do those too. I also wanted to learn in OT how to get up and down stairs with the assisstance of one person but they were having none of it...all this health and safety BS, red tape basically. They teach you to back-wheel balance but won't let you out of their sight without putting your anti-tips back on! One day they forgot mine and they came running down the corridor and put them back on. Next time they forgot I kinda forgot aswell ;). By the time I left I was backwheel balancing with one hand, and a cig in the other!

Sometimes I think getting on with things on your own can be a good thing- although transfers, at least the first few, really need to be taught and monitored closely...this seems like common sense to us...but not them, how so? I got fed up waiting on a nurse to come 'watch' me transfer into bed so I just went ahead and did it and was already dressing for bed when he arrived. He gave me that whole 'that was a careless thing to do, what if you fell' etc etc. I just stared at him and said 'I got tired of waiting'.

I always liked the PT's way more than the OT's, they worked harder and pushed you to do things you never thought you could, whereas the OT's just came up with excuses most of the time.

Using escalators will usually get some really fun reactions. Of course, sometimes there's the idiots who just won't leave you alone when you get on one. They think you're lost or mentally retarded or something, and just won't get the hell away. They keep insisting you don't know what you're doing and call security and stuff. Then you have to explain to security that you've been doing this a while, and the elevator is at the other end of the mall, and try to convince them that you're not retarded, drunk, or on drugs, etc. It's really a pain sometimes. But here's the link to a video of a guy showing escalator use basics.

Funny thing, I've even seen some stair navigation on youtube where the guy did it himself in a manual chair. Really cool.

PT taught me the wheelies (along with most of what little I learned in rehab) too.

I've had plenty of that "Got tired of waiting" experience. The OTs always wanted me to wait for them or wait for a nurse or wait for somebody else to do anything. I got fed up with waiting all the time and said "To hell with it."

I got told that I was careless, and I responded with something to the effect of "I'm careless? You're the one who didn't give enough of a shit to come in here and help me when I needed it. I've got it now, you're too late. Now, get the hell out of here." I got threatened with the "against medical advice' thing several times (insurance won't pay for anything if the doctor says you're doing things against medical advice). I told them they needed to either do it or shut up about it. I didn't care which, I just wanted to learn how to do everyday stuff and get on with life.

wat we have to see in using gloves for stim so it shouldn't have any side effects. doesn't using of gloves cause bowel cancer ? and how about the lubricating jelly we use . dose it also have any side effect or not , pleaaaase reply . thanks

There is no evidence showing that people with SCI have a greater risk for bowel cancer.

EVERYTHING I have learned so far has been through this forum and You Tube videos. I am 6 months into this now and can do almost everything I want to - go to the bathroom, dress, transfer, drive my car w/ hand controls. I have had absolutely no rehab but we are finally working on that. I should start PT and OT in a couple of weeks. I think in part, because I did not have an injury but just woke up paralyzed. They have been so puzzled trying to figure out why it happened that it's like we just can forget about the other stuff. Also, I was 5 months pregnant at the time, and maybe they were afraid to do too much because of the pregnancy. I don't know. When I had they baby 8 weeks ago, a nurse in the hospital was horrified that nothing had been done. So, she called the PT and OT dept. and they came down to see me. I was in the hospital for 8 days and they came every day and worked with me. Even though I had been doing stuff from watching online or reading what others had said, I still learned so much. Like...when I transfer to put my nose over my toes to get the weight off my bum and help make the transfer easier. I was transferring but it was hard. That little piece of advice really made it so much easier for me. So, now I wonder how much I am doing but maybe could do easier if someone could really teach me. So, I talked to them about it and we are set up to start rehab in 2 weeks. They were so great to get interested in me!! I thank God for that nurse!! Also, the rehab team hooked me up with a great wheelchair guy and I should be getting a new wheelchair very soon. Mine is okay but I got it off of Ebay and it doesn't fit exactly. So, they are getting me a TiLite Titanium chair and I am really pumped about it.
By they way, I have been wondering about this bowel and bladder routine also. I can feel pressure when I need to have a bowel movement but I have to go right then or there is trouble. Also, I take a little bit of Magnesium Citrate every day or my stool won't be soft enough for me to pass it. Before I had the baby, it felt like I would get butterflies in my stomach and I would know to go pee but since I have had the baby, I cannot feel that anymore. So...I just don't think to go. I will go in the mornings and if I push with my stomach muscles and imagine how I used to push, I will pee. But then at night, I will remember that I have not gone all day long but I don't have an accident. I got a UTI and I know it was from not going enough so now I try to remember to go in the morning and with every meal and then again at bedtime. Is this enough though? Just curious.

I'm in my 32nd year with SCI, am a C5/6 quad, my carers have been using latex and vinyl gloves, various types of suppositiores, KY and manual stimulation near the entire time. Had a colonoscopy last year, doctor said I had the colon of a twenty year old. Not one polyp, healthy and pink and no discolouration...no cancer...was a vegetarian for fifteen years, now a meat eater. I'm 52, still going strong

I understand that we are all different, we eat differently, worry differently, live differently, but I wouldn't worry to much about your bowel care regime. If you are concerned about colon cancer, look at your family's history first. If it is present in your family, ie. mom, dad, uncles aunts, etc., do get a colonoscopy when your doctor recommends to...

Here is an information sheet that I found helpful in understanding how your bowel works after spinal cord injury. This information sheet is available through the following link: http://images.main.uab.edu/spinalcord/pdff...9BOWEL-2009.pdf I have been a T-12 paraplegic for over 19 years. Hope this helps.

[/quote]


hi stillfingers. you're exactly the person i want to ask (i think). i'm 52 as well, injured 29 years, t-6, and i want to ask you some questions about a colonoscopy i'll be having in a couple of weeks. i can probably contact you through your member profile but i just found this site and don't exactly know what i'm doing. i've had one colonoscopy already but the circumstances were different, hence the questions.

A look alike problem
I can't pass stools without finger manipulation

Last year my bowl management went haywire and I was crappig myself when I pressured my gut by vigourous moving.
ie pulling up into the chair or bending over to pick somin up.
Couldn't figure out what had gone wrong
Visited my doc and after poding my gut he sent me to the hospital for a check up
I had a hernia. One small operation later......all is as it should be
Also I suffer from hemeroids and when they get bloody bad enough to return to the hospital, the mucus they produce softens/lubricates the stools...and can produce accidents

Always cary wetwipes to wipe your hands befor you eat that burger or anything else.
Or this might happen to you

Went to Bennigans for a evening meal. Wheeled there. Herd a rustle in some bushes as I rolled by.
Had my meal. Back to the hotel, watched some TV went to sleep
Woke up smelly...........My guts had let go ...BIG TIME.....Everything had emptied out.
The bedding was fit for insineration.
Obveously, the rustling bushes were rats and I had wheeled through their area and contaminated my inards via my hands via my wheels.

One of lifes lessons

Oh..Bowl Cancer...No evedence....Then why have 3 of my wheelie colleages succomed to this insiduous .........
Remain on constant watch you wheelies.
We can't feel it growing inside us, nor will we recognise warning signs, because we always have problems with this function.
Until we are reguarly screened by the powers that be........it won't be found until it's to late.
Remain alert.

I know exactly what you mean Jax.....I'm a single mom of two, so i felt like i was unable to go somewhere too far away. I live in leesville/fort polk , LA. I was sent by heli the day of surgery to Alexandria, LA. They had the same people as you described, hip/knee replacements, stroke patients, etc. (Ironically, I did surgery for years before. Never thought I would one day be in rehab w/ them) They asked where i wanted to go to rehab at. I asked about my options and houston, dallas, and new orleans were mainly brought up. However, I had some family in Shreveport, LA and thought, "well, my parents won't have to stay in motels or travel far if i'm there..". I then asked how many SCI pts. they saw anually. LOL, 3-5 in a good year. HAH...well, it was (to me) the only option for my family. My kids had gone through enough trauma as far as i was concerned. But like you I only had about3 -4 weeks and then off to the house. I only got to SPEAK to a urologist because i "requested" to. They had kept me on a foley the whole time and then he said, "well how would you even know if your bladder is working if you haven't tried it?". Damn, i thought....does anyone know ANYTHING about my condition. I remember being at the first hospital in Alexandria. It was just a few days i think after surgery. I don't know what others go through, but my T12 was completely shattered, so they had to take out my lower left rib (whole thing) to replace my T12. They put other things in it, and then a titanium plate from my T11 - L5. I'm not gonna break that shit again....lol...anyways...when the young group of 4 came to get me for my x-rays downstairs, my mom had already had enough of nurses, doctors, and aides touching me, and hurting me due to lack of knowledge of what all was going on w/ me. lol, poor guys never knew what hit them. As soon as they walked in, they said nothing. Just walked over to me, put their clipboard under my mattress and proceded to move the bed. After bumping into everything in my room my mom screamed for them to stop! LOL, I said mom it's alright (i'm passive), she (being aggressive) said, "no april. Now, do you people know what her injuries have been? Do you know how to handle someone in this condition? Where are you taking her? And what exactly is her name???" OMG was i embarrassed, but oh so relieved all at once. I was still so drugged i knew and felt nothing but pain. Can you believe they answered they didn't know to all the questions!!!!??? Sure enough, they had to leave figure it all out, then come back w/ appologies and the answers....go mom!! Anyways...that i think was the worst part, pain wise, AFTER my surgery. The x-rays...those people didn't understand me at ALL. They just picked me up, rolled me, moved body parts rapidly...etc...it was exscrutiating pain and agony. Then when done for the x-rays i was left BACK OUT IN THE HALL WAY for someone to notice me lying there and come and get me. Just horrible. Of course when i got upstairs i told my mother that all was well....lol...anyways...the story goes on and on obviously. No one to this day knows or understands everything i'm going through that i've seen or been around. I wish i had someone here that cared enough to check on me, or check things out for me. Because instead of researching or doing other things to better myself, i just keep trying to better the life of my kids and bf and forget about myself until things get so bad or painful, i have to shut down for a bit. okay anyways...i have literally ranted toooooo much, sorry...just understand where you're coming from. We don't live far from each other, i felt your pain over here...lol, later