Judy: 1, r.*End of Part I)

c). a metal pitcher, an oblong, pliable plastic dish basin and a cup for scooping water over the head.
d). patient is placed at an angle in the bed with head extended over the side into the basin. My hair is short and lends itself to this treatment. While not the best method, I thought it was a delight for many months.
d. Chest colds - Because of my inability to cough, any chest congestion is cause for concern. My method of coping with this problem is, first, to be helped into a sitting position, then lower myself until my head touches my knees. This applies enough gentle pressure on the diaphragm to allow m to cough and clear my chest.

Judy:1, q.

c. Besides shampooing in the tub, we have evolved two alternate methods for accomplishing this activity:
1). When I am in the wheelchair it is possible, by using a special shampoo tray with suction cups to wash my hair in a sink equipped with an extension spray house. We use a sheet of plastic pinned around my neck to protect both the wheelchair and myself from suds and spray.
2). During those few times when I was unable to get out of bed, we managed to shampoo my hair satisfactorily, if somewhat primitively, while I was still flat on my back. We used:
a). the flannel lined plastic table cloth to protect the bed and several towels for mopping wet hair.
b). the bedside table lowered to bed height and placed as close as possible to the side of the bed.

Judy: 1, o.

a). Using approximately six inches of non-allergenic Dermicel silk tape, fold the middle three inches in half, stick sides together. This leaves approximately one and one-half inches at each end for sticking onto the leg.
b). Using the non-sticky portion (middle) of the tape, form a loop loosely around the catheter tube on the inner, upper thigh area. When properly positioned, secure both sticky ends to the leg. These in turn are secured by Dermicel clear tape at right angles to the silk tape. (See Appendix I, drawing 6)
4). Due to a greatly reduced bladder capacity, I cannot clamp off my catheter during the trip to the bath tub. Instead, we have another string and hook suspended from the side of the tub for hanging the drainage bag while I am bathing.

Judy: 1, n.

2). My catheter changing routine at home is identical to that used in any hospital, that is, sterile. For this we provide the nurse with a commercially prepared sterile kit containing gloves, drape, lubricant, cleansing solution, cotton balls, sterile water and syringe, along with a new catheter and drainage bag. Needless to say, care is taken to prevent damaging the wrapping of these kits. We keep a supply of both kits and catheters on hand in case the new catheter inadvertently becomes contaminated during insertion.
3). Because my legs must be moved for therapy and sitting, we have devised a way of taping the catheter securely, which allows freedom of movement and yet puts no stress on my urethra. Rather than plastering the catheter immovably to my leg, we use the following procedure:

Judy: 1, m.

3. Miscellaneous
a. Foley Catheter
1. During the past several years we have used a variety of catheters and procedures for their care. I will try to explain how we have progressed through these various stages:
a. 1968 - used latex catheter with added opening to allow for insertion of continuous antibiotic irrigation (saline plus neosporin).
b. 1969 - used normal latex catheter, which we irrigated manually with a sterile water solution. Thankfully, this procedure was discontinued immediately upon discovery that it was causing bladder spasms which were refluxing bacteria-laden urine toward my kidneys. As I regularly drink 5000 cc. daily of any non-alcoholic liquid, it was felt that this internal irrigation was every bit as effective and for me, less dangerous than the manual irrigation.
c. 1970 - changed to the then new type Foley Silastic catheter. This is a latex catheter coated with a layer of silicon which is intended to reduce the body's normal rejection mechanism.
d. 1972 - changed to an all Silicon catheter, which claims an even longer life with far less sediment build-up and irritation than even the previous Silastic type.

Judy: 1, l.

1.) An alternative to doing this during the morning routine, s to insert the suppository upon retiring in the evening. Action takes place while patient sleeps on side with Chux strategically placed and can be tied up before turning. (Night time turning will be described in Part IV.)
g. Begin bathing this day from the rear (rolling out soiled Chux), then front - following with particular care the rule of never returning a soiled wash cloth to the bath pail. Scrupulous white glove treatment of all creases of the perineal area insures protection of the skin.
h. Sit up for remainder of bed bath or prepare for tub bath.
i. Dress, arrange Hoyer sling, etc. as described previously. (Because of the above mentioned bowel impaction, have found it better for me not to use the brace this day; therefore, rather than the wheelchair, the chaise lounge is brought into service.
* * * * *

Juldy: 1, k.

b. Insert Dulcolax suppository as first step in program, using a well lubricated rubber glove. (We wrap and save the glove for use later in this routine.)
c. Spread underpad (Chux). This is necessary in my case, as I cannot be placed on a bedpan or commode for a variety of reasons 0 the main one being to prevent undue prolonged pressure to critical spots on my skin.
d. Breakfast is fed to me this morning while I am still flat on my back. (Hot coffee stimulates action of the suppository.)
e. Range of motion exercises. These also aid action of the Dulcolax. (See Appendix III)
f. Finish program by using the well lubricated rubber glove for gentle stimulation of the rectum, which pretty well insures two day free from accidents. Using the middle finger for this procedure is also a good way of detecting an impaction. (An enameled porcelain container lined with paper towels is used for collecting refuse and toilet paper which is then flushed into toilet. Lysol is used liberally as a disinfectant during the process of cleaning up this container. Needless to say, all this involves much hand washing - we still use pHisohex.)

Judy:1, j.

2. Bowel Program Day - The aim of this day is to get me up and functioning in much the same manner as we previously described for a work day, but with some necessary variations in procedure as dictated by this day's priority - the bowel program.
a. Preparation for the success of this function has been incorporated into our daily life style, i.e., diet, medication, etc.
1. Medication - Uricoline (a smooth muscle relaxer) which was prescribed for me as a result of an earlier bowel impaction and Colace (a stool softener).
2. Large quantities of fluid - I drink approximately five quarts daily. This serves the dual purpose of thoroughly flushing the urinary system.
3. At least three servings of fruit and fruit juice daily - I prefer to use a small jar of strained baby fruit as one serving and dried apricots or my allowance of dried prunes as a second serving. Fruit or vegetable juice makes the third serving. (Appendix IV)
4. A salad or fresh vegetable is included in at least one meal daily for bulk.

Judy: 1, i

g. Begin dressing which includes:
1.) Surgical elastic stockings with flared thigh. (Mine are by Kenlon and are quite expensive, $35.00 a pair, but they last about a year.) Their function is to prevent blood from pooling in my feet and legs and to permit me the security of sitting with my feet lowered without fainting.
2.) Hoke Polio Sitting Corset with rigid metal uprights. This glamours looking garment of sturdy canvas is custom made with metal uprights shaped ot fit my spinal curves. Its purpose is to make breathing easier and to add stability to my sitting position in the wheelchair - I must sit at a slightly reclined angle.
3.) the remainder of dressing includes a bra, panties, dress, etc. (See Appendix V)
h. Even though most of the above procedure is accomplished with me in a prone position, it does not require as much brute strength as would seem likely. The necessary turning is done by using body leverage which enables the nurse to accomplish her tasks without undue tugging and pulling on my arms and legs.
i. Arrange the nylon Hoyer sling with patient carefully centered to insure a comfortable sitting position and proper balance. Time and practice in the use of the hoist gives confidence, but we usually have an extra person present for learners. Hurrah! Hours later, I am up in the wheelchair and ready to go.
* * * * *

Judy: 1, g

B. The actual morning's work breaks down into two distinct programs which occur on alternate days.
1. Work day - My goal on this day is to be mobile in my motorized wheelchair and usually this is a day when I go to work. To accomplish this we use a routine similar to the following:
a. Count the day's medication into individual pill cups to prevent any later mix-up.
b. Coat feet and ankles moderately with Dermassage, stroking (never messaging) lightly upwards from the toes to the calf. This is to keep the skin from drying or cracking as we do not bathe my feet and legs daily.
c. Do passive range of motion exercises on legs. (See Appendix III) The purpose of these is to keep my tendons and muscles limber, but they also have a very relaxing effect on my back and help to unwind any muscle tension that may have built up overnight.
d. Sit up in bed for breakfast, using a foam rubber wedge pillow behind my back. This upright position is a refreshing relief after lying down all night, but it also serves the purpose of stabilizing my blood pressure, as I am often quite dizzy when I first sit up. In this position, gravity allows me to feed myself from a bedside table which is placed in front of me. Feeding myself breakfast on this day is my only active participation in the entire morning's schedule. (See Appendix IV)