14 replies to this topic

[GarryB]

Sorry if this post gets too detailed - I'm not sure how else to get help unless I am descriptive.

My question concerns the depth a suppository must be inserted to be effective. In rehab we learned it must go high up and beside the bowel wall (not into stool in which case it won't work). I have done this for years with good results using the Magic Bullet. But these days I am not having good results when one of my caregivers does my routine and I'm trying to figure out why.

Here are some relevant details. I have complete C5/6 quadriplegia. I have been doing an evening side-lying bowel routine for almost 25 years (started in rehab and never switched). Take only Metamucil as a stool softener. Caregiver inserts suppository and then after 30 minutes we start with some manual removal of stool and them digital stims at intervals. The whole thing is normally done in about 1.25 hours.

I have two caregivers who do my BR. With one I have probably 99.9% perfect routines. She inserts the suppository, I wait 30 minutes for the urge to push (usually don't get the urge till then or maybe 20-25 minutes), she does a manual evacuation if needed to start, and then I empty well in about 1 or 2 waves of stool and then a few dig stims to make sure everything is out. After and the next day I feel great and I'm good for 3-4 days till the next routine.

With the other caregiver I have very different results. She will put in the suppository and I will strongly feel the urge to push within 5 or 10 minutes. The stool is not eager to come out even though I am trying to push and she ends up doing many digital stims. Stool comes out in many small amounts and the routine doesn't finish well. Usually I end the routine with small amounts of clear jelly coming out and then I'm sure I'm good and cleaned out but it takes forever to reach that point with her - if it can be achieved at all. Stool doesn't seem to really finish emptying well.

Often later that night and the next day I have a gurgly belly, gas, bloating, and sometimes feel faint. Generally I do not feel at ease and my body feels tense. I notice also my bladder wants to empty very much more than normal and I have been attributing that to it not being able to expand properly because I have stool or gas competing for space in my lower belly. I will then do the routine again in two days with the expert caregiver and will often have results when normally I would not be ready to go again in two days (I don't eat much). I believe this is because not everything came out the failure routine. Other times on this 'repair routine' I will have extra-ordinary amount of gas and not much stool. After this is over I will feel great again till the next time I need the routine with the 'non-expert' caregiver.

Obviously this is distressing since feeling terrible is no fun. We have been over training numerous times (first caregiver teaches the second) and I believe she understands well what needs to be done and is trying. The only difference between the two that I can imagine is relevant is the first caregiver has average to long fingers but the second caregiver has much shorter fingers (she is a very short person with stubby fingers). I can only reason that she is not able to push the supp in as far as the first caregiver (in fact, it's obvious that she can't because she just doesn't have long fingers).

I suspect this is the reason for poor results I experience with her and am wondering what other people with experience with suppositories think. Sorry if this got too grpahic.

Thanks for any comments,

Garry

[Tetracyclone]

Never too graphic, Garry. I cannot help really. I insert the magic bullet myself and there is no question about how far. It pops behind the sphincter and that is about as good as it gets. I usually have good results IF i wait until it feels like feces are pretty close to the end of the L. intestine. A bit of sensitivity can be useful. Also only works if I've kept my routine so that stool is fairly soft.

Being incomplete my routine is different, but I will describe incase it helps someone else. I get on the commode about 5 minutes after insertion and read for 10 minutes, then massage the large intestine systematically, or where it "feels" useful to do so. I also circle my torso to provide some internal massage.

Problems for me are most often associated with gas and bloating. In that situation it is difficult for me to perceive whether or not the load is "ready to go".

[mellowgator]

i would hate to lie in bed and do my bowels. this is how it was done in the hospital but once i got out of rehab 24 years ago i began doing my routine from my shower chair and rolling directly over the toilet. i always dilly and get any low bowel down before i add the suppository. in fact i stopped using the suppository after a year of so because i found that mini ampules work much quicker. i started using theravac and when that was discontinued i swithed to enemeez. it work like the majic bullet just quicker. results are acheived in less than 10 minutes. i also only do my program 2 or 3 times a week. as far as the different result you get when the different nurses do the routine, it probably is that one puts the suppository in a different spot than the other one.

sorry not to answer your question better. the only other method that looks promising is the coloplast enema but we don't have access to this in the us.


best wishes,

mellowgator

[GarryB]

 Tetracyclone, on 22 August 2010 - 06:45 PM, said:

It pops behind the sphincter and that is about as good as it gets. ... then massage the large intestine systematically, or where it "feels" useful to do so. I also circle my torso to provide some internal massage. ... Problems for me are most often associated with gas and bloating.

My skilled caregiver describes how she pushes the suppository past the entrance and through an 'inner opening.' I'm not exactly sure what she means by this inner opening but it think might be that she is doing something a bit different that the other woman. She has tried to teach this technique but this is why I suspect the woman with short fingers cannot quite push the suppository in far enough.

I also do my best to massage by belly where it seems useful although to be honest I don't think this does much good for me if the supp hasn't been inserted well. I don't have to do this with the skilled caregiver.

Funnily, for me the gas and bloating come after the failed routines and disappear when I have successful ones.

Thanks a lot for your help.

[GarryB]

 mellowgator, on 22 August 2010 - 09:12 PM, said:

i swithed to enemeez. it work like the majic bullet just quicker. results are acheived in less than 10 minutes. ... it probably is that one puts the suppository in a different spot than the other one.

Thanks for this advice. I've been thinking of giving the Enemeeze a try. I would think people would not be able to administer this in many different ways. Results should be consistent with that product.

As far as putting the supp in a different spot, I'm sure that's it. It is just hard to imagine how many different places there can be in there for people to put the suppository. The fact that I have no way of telling how they are actually inserting it makes it very difficult to give any direction.

I've also thought about the Coloplast product but never looked into it enough to find out if we can get it in Canada. I'm very surprised you cannot get it in the U.S. since I find access to medical supplies is much more open there than here.

Thanks again,

Garry

[benok]

deep breathing until it goes deep way way down done in a sidelying position.

[GarryB]

 benok, on 23 August 2010 - 12:45 AM, said:

deep breathing until it goes deep way way down done in a sidelying position.

I'm going to try the breathing thing. Thanks.

Garry

[qbounce]

Even those spring loaded suppository inserters will only push it up so far. My point is, it doesn't have to go up that high to work properly. It may take longer, but I'm not so sure. The fact is, sometimes stool gets impacted, and especially while on antibiotics.

Let's see, maybe you could figure out a way to side step the other carers bowel routine all together. The night before she starts her shift, have the first carer clean you out again. I'm not sure how their shifts go, but you said your bowel routine is done as few as every 4th day, so I can't see why the second carer even needs to your BP.

[GarryB]

 qbounce, on 23 August 2010 - 08:22 AM, said:

Even those spring loaded suppository inserters will only push it up so far. My point is, it doesn't have to go up that high to work properly. It may take longer, but I'm not so sure. The fact is, sometimes stool gets impacted, and especially while on antibiotics.

For me impaction isn’t a problem. It's caregiver specific.

 qbounce, on 23 August 2010 - 08:22 AM, said:

Let's see, maybe you could figure out a way to side step the other carers bowel routine all together. The night before she starts her shift, have the first carer clean you out again. I'm not sure how their shifts go, but you said your bowel routine is done as few as every 4th day, so I can't see why the second carer even needs to your BP.

I've been doing this especially if I'm going away for a few days and need to be confident. Problem is I cannot completely avoid have the second caregiver doing the routine at times. Also, I'd like to solve this issue so I have two people who can do it well instead of just one.

Thanks much

[tyvin]

It's real simple here; have the one caregiver teach the other how it's done. Pooh hoo on egos it's your butt and you're paying them.

[Maltese Cat]

If its just a matter of fingers too short, there must be some form of applicator (bit like a tampax applicator) that gives your second caregiver a bit of extra length? From what you are describing it seems as though this is the only major difference between routines.

[GarryB]

 tyvin, on 23 August 2010 - 08:29 PM, said:

It's real simple here; have the one caregiver teach the other how it's done. Pooh hoo on egos it's your butt and you're paying them.

That's for sure. I've done initial training where the experienced one trained this new one and when things weren't going well I had her undergo more review. We'll repeat this process as long as needed! In the meantime I think it's about time to try the Enemeez product. I can't imagine how one person could apply this differently than another.

[GarryB]

 Maltese Cat, on 23 August 2010 - 09:25 PM, said:

If its just a matter of fingers too short, there must be some form of applicator (bit like a tampax applicator) that gives your second caregiver a bit of extra length? From what you are describing it seems as though this is the only major difference between routines.

Good idea. I am inventing a suppository inserter to give extra length. I want to make sure it's safe so have been searching for materials that are soft and supple enough to be safe in the lower rectum yet firm enough to allow proper placement. I think I'm getting close in the material search and the preliminary designs are looking good. If it works well it would make for very consistent suppository insertion.

Because I'm not rushing this build and the material search is not completely done I'm going to try Enemeez in the interim. It might be a good product.

Thanks

[4wheelz]

does one have to have a script for this Magic Bullet? I've never seen them where I live (USA) but I hear they do wonders.. is that true? My BR just isn't a good R.. I'm still having issues.. living and learning..
thanks

[GarryB]

 4wheelz, on 25 August 2010 - 05:48 AM, said:

does one have to have a script for this Magic Bullet? I've never seen them where I live (USA) but I hear they do wonders.. is that true? My BR just isn't a good R.. I'm still having issues.. living and learning..
thanks

You can buy them online directly from the manufacturer without a prescription.
http://conceptsinconfidence.com/