# 282 Tuesday January 17, 2007 - THE BATHROOM AND THE CATHETER:  UNSEEN
COSTS OF CURE DENIED
Ever notice those extra low urinals in the Men's rooms? Those are not for
kids or short people. They are for people in wheelchairs, so a catheter tube
can be threaded into the person's body, and the other end emptied into the
urinal.
The human body depends on a simple but marvelously effective cleansing
process we all take for granted-water in, water out-- until it doesn't work.
Without a functioning kidney and bladder system, poisons build up, and
people die.
For an able-bodied adult, urination is easy. Adjust the fabric, daydream a
moment, and let loose. Sure, there is occasional awkwardness, like
performing this function in the presence of others, as in Army barracks in
the company of several dozen others and no stalls, or in the semi-privacy of
movie theater restrooms. The trick there, by the way,  is to close your
eyes, and pretend there is not somebody breathing next to your shoulder
twelve inches away-who also probably has his eyes closed.
But when the internal workings of the body do not comply, as when a person
is paralyzed?
Catheterization is the expensive, time-consuming, and risky reality.
You need a plastic-wrapped sterile single-use kit, containing lubricating
gel, disinfectant, plastic gloves, about a foot and a half of skinny tubing,
and a bag.
The gloves are to prevent bringing outside infection into the body: either
from your own hands, or a helper's. Put the gloves on, disinfect the area,
grease up the tube and insert.
It goes way up inside the person, further than you would imagine.
At best, a 4-6-times-a-day hassle.
But what if you had to RE-USE the same supposedly sterile cath tubes again,
removing and re-inserting it, not once, but over and over and over, day
after day?
Sadly-criminally-many quads and paras have no choice but to do exactly that.
The so-called  "clean cath" system requires people on a Medicare to re-use
the same tube every day for a week.  "Clean cath" is a dreadful lie. Even
doing exactly as is recommended (boiling the tubes, soaking them in vinegar,
using gloves) still the   infections are just going to happen, and they can
be fatal.
Imagine poking something inside your body-and removing and re-inserting
it-FORTY TIMES?  Excuse me for yelling, but if we only get one cath kit a
week, and we go to the bathroom six times a day, times seven days a week-
that's 42 trips to the restroom.
When Roman was first paralyzed, our health care provider told us we only got
twelve cath kits a month-we needed six a day. Naturally, we squawked. They
wouldn't budge, so we squawked a little louder.
We called our Congressional Representative, Fortney "Pete" Stark, and his
office called our health care provider-and they had a change of heart.
(Pete Stark, by the way, is one of the great men of our time; in small ways
and large, he is fearless and caring, an example of what an elected official
should be.)
Now a similar battle approaches, but on a far larger scale.
A friend of mine, Steve Winter, is on his way to Washington right now, to
fight this problem. A paraplegic himself, resulting from a gunshot wound,
Steve used to sell cath kits for a living (he does not do so currently, so
the profit motive does not affect him) and he knows the issue inside and
out. (He also has a private insurance situation which gives him all the cath
kits he needs, so the bill he proposes will not benefit him personally; it
is just a good and needed piece of legislation.)
He is trying to pass a new law HR 6302, which would change the situation, so
people on Medicare could get more than one lousy cath kit a week.
Below is a small portion of an excellent article by John Kamman, in the
Arizona Republic, February 19, 2006.

But as you read it, ask yourself a question: what are the costs of cure
denied?
It is vital that we take care of those who are chronically ill and injured;
we can, and we must; but how much better if we could just make them well.
That is why you and I fight for stem cell research, and why the next two
weeks we must concentrate our energies on the United States Senate: two
men-BOB CASEY of Pennsylvania, and BOB CORKER of Tennessee-we need one of
them (ideally both) to vote for Senate Bill 5, the Stem Cell Research
Enhancement Act. If we do that, we can override the President's expected
veto.
Friday's column will be very important to the struggle for the Senate-please
be sure and read it, and think how you can share it with your friends.
And now, Steve Winter, courtesy of the Arizona Republic and reporter John
Kamman.
 Medicare challenged on catheters
Paraplegic, Renzi fight reuse policy
Jon Kamman
The Arizona Republic
Feb. 19, 2006 12:00 AM
The lives of tens of thousands of disabled people depend on taking a narrow
tube in hand and threading it into their bladder to drain urine.
Because urinary catheters invade the body, the Food and Drug Administration
requires that they be manufactured and packaged under the highest standards
of sterility.
The only catheters approved by the FDA for sale in this country are for
single use only. Manufacturers are prohibited from suggesting reuse.
Yet, under a policy of the nation's $340 billion Medicare program, which
serves the disabled of any age, self-catheterizing patients have no choice
but to reuse a catheter perhaps 35 to 40 times, sometimes after only
rudimentary cleansing.
Now, Mesa paraplegic Steve Winter is appealing to Congress and federal
agencies to end what the disability community and a growing number of health
care professionals condemn as a primitive, life-threatening practice.
Medicare pays for only one "single-use" urinary catheter a week. It costs
taxpayers $1.81.
The forced reuse saves roughly $65 to $75 a week in supply costs.
But if repeated use makes infections more likely, as many believe, the
consequences are soaring medical costs, disrupted family and work lives and,
not least, personal suffering.
"It's terrible administrative policy, absolutely terrible, and it needs to
be changed," U.S. Rep. Rick Renzi, R-Ariz., said after Winter and other
advocates met with him in December in Washington, D.C., for a teleconference
with Medicare and FDA officials.
Urinary-tract infections are pervasive among catheter users, and the cost of
combating one can quickly reach tens of thousands of dollars as treatments
escalate from doctor visits and antibiotics to hospitalizations and kidney
dialysis.
Winter wants Medicare, along with any Medicaid or private insurance programs
that have adopted its policies, to comply with the FDA's "single-use only"
standard by providing a new, sterile catheter for each urination, or void.
"This is not just something we want," says Winter, who is devoting most of
his time to the issue. "It's something we need."-Jon Kamman, Arizona
Republic
NOTE from Don: The entire article is outstanding, one of the best medical
articles I have ever read-urge interested readers could Google Steve Winters
and catheterization and the article will pop up immediately.
P.S. Don't forget to read Friday's column, day after
tomorrow-www.stemcellbattles.com-and share with friends!

By Don Reed, Californians for Cure   www.stemcellbattles.com

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