Incontinence Management

I have made many drafts of posts as this chart grew; each had a different ending. This post tells a summary of an interesting and frustrating story.

Provision Living at Columbia used MoliCare incontinence pull-ups for almost two years. Their novelty was the control of pH that controlled skin irritation and odor. Attends stretch tabbed briefs are easier to change in bed than pull-ups. Attends pull-ups are less expensive than MoliCare pull-ups.

The hot summer of 2018 came without a spring. My wife likes the outdoors. She sweats. Nystatin powder requires dry conditions to work. We never achieved the necessary dryness until November; leaving her to endure five months of irritation to the point she was scratching in her sleep.

[She cannot talk. She also suffered a concussion at the end of August; with partial recovery of the use of her fingers at this date.]

The chart begins with my return from a week trip to San Antonio, TX. A one-hour conference in our apartment with the Director of Nursing and the Director of Memory Care, with two other family members, set the time for Nystatin treatment “at 12-hour intervals at the same time each day”: 8 AM and 8 PM. The effect was immediate (lower blue line).

The 1:00, 3:00 and 5:00 am (actually 6:00 am) dry checks found at the start of the chart continued for the next three weeks. After meeting with the dermatologist, December 11^th, , a toileting schedule was delivered to our apartment. Again the effect was immediately evident. In a few days the 12:00 and 4:00 am dryness checks were in place.

We found that my wife was dry at most of the checks at 10:00 pm and again at 12:00 am. These were dryness checks made at night.

Toileting was defined as placing the person on the toilet; and leaving them there for the time they needed to toilet. My wife comes from a family that has a small library in their bathrooms. Toileting needs 10 to 20 minutes.

To rush this invites a fight and a wet pull-up shortly after it is put on. Getting up in the morning takes about 15 minutes; combined the two is 25-30 minutes. Skilled and experienced caregivers leave our apartment after a few minutes to work on another resident for 10 to 25 minutes.

Curiously, all of this variation seems to have little to do with my wife’s abdominal skin condition. What does have an effect is what happens during the daytime toileting, that is not captured by the Arlo video clip camera in our apartment; that I am learning to use when the monarch butterflies return in the spring.

From the 13^th to the 15^th of December her abdominal skin condition was consistently GOOD and after the 23^rd of December totally CLEAR. The dermatologist determination that the infection was over by the 11^th of December was correct. Separating yeast and wetness irritation is another story summarized in the next post.