Search Engine Grab Bag: Singing in the Bathtub Edition

"Singing in d'bathtub
Happy once again
Watching all my twubbles
Go swinging down d'dwain."

-- Tweety Bird (hear it here)

I get a lot of visitors here looking for information on amputee bathing.  Query strings in recent months have ranged from "amputee rubber bath leg" to "bathtub assistance for amputee."  I have already addressed bathing with new sutures, but that's just the tip of the iceberg (or the stump, or something).  At last the day has come when I shall reveal to you all the rest of my one-legged bathing secrets -- or at least as many as I can think of right now.  I may amend this post as I think of other details.

As usual, I have to tell you that I don't know everything there is to know about this subject, that people with different amputations from mine and a different assortment of health complications probably have different issues around all this, and that it is my hope that people with different information, experience, etc., will chime in and contribute all that in the comments, even if only to provide links to other places where it's already written out.   That said, here's my illustrated two cents:

While not exactly cancer-free, I am nevertheless a reasonably healthy, middle-aged right transfemoral amputee with only one prosthetic leg, a good one but not a fancy one, no extra money, no insurance, and little patience.  I'm not frail, and I don't need to take particular care not to fall, but even when I did, when I was recovering from deathly illness and my amputation was a big new wound, simplicity and self-reliance wherever possible were keys to my successful recuperation.

They may not be keys to yours.  For your own safety, you will have to be very thoughtful about this, and very honest.  I will describe as much of my process to where I am now and the reasons for the choices I've made that I can in an effort to help you figure out what is going to be good and workable for your specific situation.  Still, no matter what equipment and/or assistance you will require, the same old rules apply for everyone:

• Be smart.
• Be careful.
• Take your time.

Even for whole-bodied people, the bathroom is said to be the most dangerous room in the house, yes, even more dangerous than the kitchen.  I have known more than one person to nearly bleed to death falling through a glass shower door.  I have heard of people slipping and banging their heads and either dying or coming close to dying just from the resultant head injuries or even drowning in a very small amount of bathwater.  Then there's the electrocution factor, a prized device in murder and suspense fiction.

All this, of course, becomes less the stuff of entertainment and more a real threat when you experience firsthand physical impairments of the sort which reduce your ability to balance, catch, or brace yourself -- impairments like losing a limb, for example.  Abject terror is a reasonable response.  A few good tools can reduce this threat significantly, as will the skill-building you will do as a natural part of your rehab, and then all you'll have to be is consistently cautious.

The first such good tool I ever heard of came to me as a suggestion I read on the LadyAmp site, and it's something I have used every single day since the week I came home from the hospital after my amputation.  It's a handheld shower head, as pictured at left.  You can find an assortment of them at every hardware store.  They are easy to install, range from cheap to expensive, come with longer hoses and shorter hoses, all of which can often be switched out to customize.  They usually have at least two and up to six different output settings, and while the standard kit seems to include a 60-inch/5-foot/1.524-meter hose, I've seen replacement hoses up to 96 inches/8 feet/2.438 meters long.

Frequently, these shower heads can be installed with holders that will keep them in roughly the same position as a fixed shower head until you want to use them.  A style called a "continental" shower head has a button to help you switch between a fixed showerhead and the handheld.  Also, these units sometimes come with holders that can affix to a wall of the bathtub or shower cabinet in a position which can be reached by a person standing or sitting.  I will get to the sitting in a minute.

Meanwhile, a cunning gadget which may be a necessity if you live with someone tall who wants to use the old, fixed shower head just where it is, thank you very much, and doesn't want to have to use up one hand to hold the shower head all the time is this little switch my true love installed.  When it points up (as shown above right), water runs through the fixed showerhead.  When it points to the side (as shown at left), water runs through the handheld shower head.  (If your shower is part of a set-up which includes a bathtub, you will still have to flick the switch on the tub's tap that sets it to shower output, as opposed to faucet output, before using either.)

My true love was supposed to install this while I was in the hospital, but the rehab hospital at which I'd reserved a space in advance was inexplicably full when the time came, and meanwhile I'd decided I really didn't need to go there and in fact couldn't stand another day in any hospital, so I came home ahead of schedule.  So it was a day or two before I could bathe myself even after I got home.  Still, getting this done while you're away is a good idea when you can manage it.  It's nice to be able to come home and just keep right on living.

In the hospital, I used the shower that came with my private room, and I don't remember it having a handheld head.  I do remember it was tricked out with all kinds of grab bars.  If you find these convenient and useful -- and some people find them necessary -- you or someone who loves you can also have these installed in your home.  You or the person managing these details for you should consult with your team of caregivers about what kind and how many.  In my experience, physical therapists, physiatrists, prosthetists, occupational therapists, rehab nurses and social workers all know something about this, or can guide you to someone who does; surgeons not so much.  Also, some places which sell them have people on staff who are well-versed in their safe installation.

What happened to me may also happen to you.  Before being released from the hospital, a case coordinator type of person was sent to consult with me to assess my needs generally.  She is the person who called the one local home health care outfit that had a contract with my health insurance company of the time and ordered things to be delivered to my home that I would need, things like a walker, a reacher, a wheelchair, and a bath chair.  She couldn't order everything, like ace bandages for stump wrapping, because this company didn't carry those things and none local that would deal with my insurance company (United HealthCare) did.  But she ordered what she could.

Things proceeded to get F-ed up from there.  It was not her fault.

There are many, many kinds of bath and shower chair and support.  A common, basic bath or shower chair is a chair with the same kind of adjustable legs that you see on a standard walker or standard metal crutches:  aluminum tubes, rubber stops on the ends, little buttons you push in until the legs are the right length and then they pop into a hole to hold the chair at that height.  The chair portion is hollow plastic with holes molded into the seat and back so that water can drain through.  A bath or shower chair chair might have some kind of rail to keep the user from sliding off one or the other side, and to provide extra places to grab onto for balance.  A bath or shower chair is an appropriate choice if you have had at least one leg amputated and will be bathed or bathing yourself in a shower which is only a shower.

A bath bench is just like a bath chair except that it has an extended seat.  Of course some simple bath chairs are called bath "benches" by their manufacturer, for no reason I can determine, and that makes things a little confusing when ordering.  You might also see this kind of setup called a "transfer bench," "bath chair with transfer bench" or "bath chair with transfer extension."  There is also a kind called a "sliding transfer bench" where the chair part slides along rails from over the floor to the middle of the tub.  I'll say a little more about those in a minute.  Meanwhile, you can see how all these variables make for such a fun adventure in shopping while sick and drugged!  Okay, it's not fun.  That's why there are care coordinators, but even they get it wrong sometimes because there are so many choices and so much confusing terminology.

Regardless of what you end up calling it, the extension on a true bath bench is a flap of molded plastic that is meant to extend over the side of a bathtub.  The extension is either one continuous unit with the chair seat or hooks onto it to create one continuous unit, but either way, it has its own pair of legs which support the end that hangs out of the tub and over the floor.  This allows the user to enter the tub by seating herself on the very safe, very stable extension and then sliding herself over into the chair seat situated in the center of the bathtub.  This is far safer than having either to launch herself off one or fewer feet onto a chair sitting in the middle of a bathtub or transfer herself from the side of the bathtub onto the chair, especially if she is still weak and ill after whatever happened to take her leg(s).

There are also bath transfer systems involving sliding extensions.  These are appropriate for people whose shower unit is part of a bath/shower combination unit and who for whatever reason need or want a little more help getting in and out.  I won't go into them here because I have no experience of them.  My sole point in mentioning them is to give you an idea of the range of choices that exist, devices and prices for every level of ability and every kind of bathroom architecture.  Any web search you run for "bath chair" or "home health" or "assistive devices" will locate dozens of varieties, new and used.

Our shower at the old house, like this house, came as part of a bath/shower installation.  Thus after amputation I wanted a bath bench, a true bench, the kind with the extension over the side of my tub.  I had been very sick, I was weak and wobbly, and this balancing on one leg thing was new and scary, not to mention the fact that for awhile I was still having to do the bathing thing without getting my sutures and dressings wet.  Also, we had a tiny bathroom (and now we have another tiny bathroom), and no one was going to be around to help me every time I wanted to get clean.  I needed an extremely simple, clean solution I could use by myself safely.  My case coordinator type person ordered me a bath bench with a transfer extension.   I don't know what exact language she used while ordering, but that is what we agreed I would need.

I got a bath chair.  No extension.

I sent it back and got a true bath bench, with extension.

I was billed approx. $86.00.  I was expected to pay this out of my own pocket.  My insurance company, you see, the one with the $50,000 lifetime cap on all prosthetic devices, would fully cover a bath chair, but not cover one dollar of a bath bench with a transfer extension molded into its shape.  Since it had a contract with the provider, I would be offered the bench at a reduced price, because that's how insurance works, but I would still have to pay for it myself.  None of this, of course, was spelled out in the multi-hundred-page description of specific coverages and limits my HRA had to photocopy in its entirety for me because no copies were available for individual employees covered under the plan, and no one would budge.  United HealthCare's representative told me United HealthCare would not pay one dollar, even though I had already exceeded my combined annual out-of-pocket limit including deductibles, because it would only cover a bath chair.  The home health care provider told me I had to pay out of pocket or they would take it back.  I paid out of pocket.  I kept getting bills anyway.  The home health care provider moved offices in the middle of all this, you see, and lost some of my paperwork, including but not limited to any record of having delivered an approximately $500 wheelchair to me, so that neither I nor United HealthCare, to my knowledge, was ever billed for that wheelchair (which I still use every day), but I was billed repeatedly for this vershtinkine bath bench that really should have been paid for by UHC.  I mean, please, what was I supposed to do, hop over the bathtub wall onto my bath chair?

Grr.

I know; I've digressed.  I've done it to rant, to get this off my chest, yes, for my own sake, but also as a cautionary tale to you. 

Be careful what you ask for.  Be very specific.  If someone is ordering for you, make sure s/he understands exactly what it is that you need and are requesting.  Make sure everyone knows who is going to pay, how much, and for exactly what in advance.  Even with all these elements being clean and equal, you may still end up with extraneous billing crap due to unforeseeables such as incompetent billing staff and companies that move their offices messily.   So make sure you get exactly what you need, and that you only pay for it once.

Moving right along...

Sitting in your shower chair or on your bath bench, it is a simple matter to take a lovely, refreshing and thorough shower with a handheld shower head (assuming you have hands available to you and a long enough hose).  If you move carefully and/or have careful assistance, you will be perfectly safe and get perfectly clean.  You may like this arrangement so much that this is the arrangement you will always use.

Now, as I mentioned, our last bathroom was tiny, and this bathroom that we use now is tiny.  Each was or is our only bathroom, for both of us.  There is not room in the current bathtub for my true love and my bath bench, nor was there at the other house.  There is also nowhere good to put the bath bench while my true love is showering.  Like much of the amputation experience has proven to be, this part of the bath chair experience was a gigantic pain in the ass.  And then there was the billing crap, which filled me with wrath and hatred.

Then there was the fact that I eventually got "all better."  My sutures healed.  My strength and skills built.  I got sick of taking only showers all the time; I've always been more of a bath person.  Moving that bench around was an even bigger pain in the ass for me on one leg than it was for my true love.  Besides, somehow somewhere water had gotten into the hollow plastic parts, and every time it moved it made a sloshing noise, and I had no expectation that this water was clean water that would remain smell-free indefinitely.

And finally there was the fact that the chair was oriented non-modularly for a bathtub with the faucet/showerhead placed in front of someone entering from right to left, and our new bathtub is oriented for someone entering from left to right.  Which meant I'd have to get another bath bench.  Somehow.

Frankly, I couldn't face it.

So I did a bad thing.

Well, maybe it was a good thing for someone else.

While we were in the process of moving from the old house to the new, I left the bath bench -- which I had paid for once but damn if I was going to pay for it again or have a single other phone call about it with anyone, ever -- out by the curb, as a free donation to whoever would take it.  Yes, I did.  It disappeared in about five minutes.  Also, I did not give the people from whom I bought it once, under protest, and damn if I was going to do it again, my forwarding address.  So that was that.  I am sure I have wrecked my credit over this bath bench.  Of course, I am sure I have wrecked my credit over a bunch of other as yet unpaid bills leftover from my amputation experience and the hideous way I was treated by United HealthCare, but that's another story for another day, a day in some distant future after my PTSD over insurance and billing has subsided to the point where I can talk about it without lapsing into inchoate rage.

The thing was, how would I get in and out of the bathtub from then on?  And how could I safely shower?  We cannot install any kind of rails or hand holds here because the shower/bath cabinet is one of those nasty plastic-walled jobbies that cannot be punctured without causing permanent damage.

Well, actually, it hasn't proved to be a big deal at all.  We have another handheld showerhead on a very long hose, so I can in fact reach everything I have to using that and just sitting in the tub.  And getting in and out, because I am strong and able and do my yoga, is a snap, no hopping required.  I just have to be careful in a couple of very simple ways.  I will demonstrate.

Demonstrating means photos.  In these photos, I am going to show you my naked leg and a half.

Mothers who flock to this site in ones and twos, rest assured that I am not naked in these pictures, it's just my leg-and-a-half and foot.

People who think stumps are icky and gross and that this is horrible but you just can't look away, grow up and run along.

People who will see the stains on my bathtub and become interested in criticizing my housekeeping skills, read this and either suggest something useful, nontoxic and fast or shut your pie hole.

Freaks who have come to this site for impure reasons, you should run along now, too, but if you don't, if you find yourself having impure thoughts upon the mere idea of these photos even though that's not what they're for and feel you just have to look no matter what, please allow me to direct your attention here.  Take a good look at that.  Swap out the red t-shirt for a tie-dye blue and purple one and the anti-fume ventilator for a double-chin with a big zit right in the middle of it, and that, though with much better hair, is pretty much what I looked like today while taking the following photos, some of which reveal in all its glory my naked, fat, hairy leg-and-a-half.  Not sexy.  Not exotic.  Also not accessible, vulnerable, frail, or victim-y.  (Also not to be linked to individually or copied without my express written permission.)  Get it?  Good.  Now seriously, run along unless you need this information to bathe yourself safely and just can't help all that other stuff, in which case I suggest you make your bathwater very cold indeed.

Okay, now the rest of us can get on with it.

I don't know about you, but before my amputation, when I thought about getting into a bathtub, I always assumed I'd do it facing the faucet.  It makes plain, natural sense; you don't want your back to a potentially still-hot piece of metal, and also you might want to adjust the water level or water temperature, and you can't do that easily if you're not facing the controls.

If your bathtub is oriented like mine (as seen in above photo) and all you are missing is your left leg, you can probably still do this.  If, like me, you are now missing your right leg but still have your left leg, you will be better off facing the other way both entering and exiting the tub.  You can turn around once you're in the water, and then turn back around again when it's time to get out.  (And if you have opposite stuff, opposite bathtub orientation and leg amputation, just switch everything I just said around in your head 'til it makes sense, okay?)

See, for maximum safety, you want your healthy, strong, and still existing leg to control your entrance into -- and eventually out of -- the water.  It will control the speed and the angle of descent.  If you plop yourself into the water on your amputated side, what if the water is scaldingly hot and you don't realize it until you're deep in it?  Even if the water's okay, how do you control your landing?  You could go in fast, at a bad angle, and seriously hurt yourself, even drown under the right combination of circumstances.

To avoid this, when I get into the tub, I first seat myself facing outward on the side of the tub, which I first make sure is completely dry so that I won't slip.  I make sure dry towels and my wheelchair are within easy reach.  Then I turn to the left, balance on my residual right thigh and right buttock, and bring my foot up at the same time to brace myself, like so:

When I feel firmly situated and stable, I swing my left leg over the side of the bathtub and test the water with my foot.  If it's a good temperature, then I put my foot down --

-- and, using my leg to lever my weight, gently slide myself into the water, slowly flexing my existing knee and ankle, bracing myself on the tub wall and side.  Of course, I couldn't really demonstrate that while photographing it, and didn't want to get my clothes wet anyway.  I really think from here you can get the idea, though.

See how well balanced I am throughout the process when leading with my whole leg?  That's really what I want you to understand.  Whole leg first, then stump, at least going in; then reverse going out.  That's the safer way.

Do not try this until you are completely healed or if you are not strong enough to get yourself up off the ground under normal, dry, non-bathing circumstances.   Also, if you are going to try this, you might want to try it with an empty tub first.  If you fall, it will hurt, but you will learn your limits and you won't drown.

Make sure the side of the tub is dry before sitting, then survey the area.  Make sure you have dry towels in reach.  Then find your natural hand-holds.  I am on the tall side, and my arms are very long, and you can see how comparatively narrow this tub is, so I can reach the wall across the tub very easily for extra balance.  Also the sink, which won't take my whole weight but is something I can use as a balancing point, is just about two feet from the tub.  My nearby locked wheelchair is another possible point of stability for which I can reach.  On the other hand, the tub faucet, which would seem like a natural were I facing it, is not a good choice, because it can be hot or break off under my weight.

What do you have in immediate reach?  How able are you to support your weight with your arms, hands, and fingertips, and on what secure edges, ledges, and other surfaces?  Find them all, test them all to be sure, and make sure you are very familiar with all of them before you try this with a full tub.

So you've done all that, and now you're in the water having a bath.  And now it's time to get out.  When leaving the tub, something will have changed.  Hmmm, what could it be?  Why, yes!  You will be wet everywhere!  The side of the tub will still be very slippery, though.  Very slippery indeed.

If you add water to this slick, wet surface, and then hoist your heavy, wet body onto it, you are likely to go flying off onto the bathroom floor or back into the tub, and you are likely to hurt yourself or drown if this happens.  Yucky!

So remember those dry towels you were supposed to have handy?  Now is when they come in handy.  Take one and fold it in half across the width, and then in half again across the length, or in thirds if it's a big towel.  You now have a longish rectangle of folded towel.  Drape this lengthwise over the side of the tub so that there is a large enough area of fabric to receive the bulk of your wet bottom and extended residual limb.  It should be narrow enough not to dip into the water, but wide enough to cover the edges.

Hoist yourself up onto this towel the same way you came in, facing the same direction and using the same holds you used entering the tub.  The towel will absorb water off your body and keep you from sliding off the tub side.

Holding onto your bracing points, swing your complete leg up so that your foot rests on the towel.  You can dry it off and then put it on the floor.  If your foot is nice and dry before it hits the ground, then if for some reason you have foolishly not provided yourself a bath mat on which to land, you will not go sliding all over the place on one wet foot when you stand up, nor will your foot pick up any floor crud that may have accumulated between visits from the maid.  (Ha ha ha -- the maid!  I kill myself.)

You will also be able to immediately put your nice, clean, dry foot directly into any waiting shoe or slipper.

Stably situated on your towel, with your foot on the floor, you can now stand, dry yourself using other towels you have placed in reach before bathing, and do whatever else you need to do in the bathroom as you ordinarily would.

This is just what I do, and my utter hatred of complications plus a logistical inability to punch holes in the tub cabinet walls in order to install rails have combined to make it so.  There are many other combinations of tools and techniques to use, though.

Some people shower standing up like they always did, wearing old prosthetics that they can't use for everyday activities anymore.  I'm not sure how they get their stumps clean doing that (maybe you can tell me?) and it's not an option for me anyway because I only have the one leg and no prayer of getting another without insurance coverage I don't have or charity I won't seek, but it works for a lot of people.  Some people love their shower chairs/bath benches.  The one thing I recommend above all others is to start out with the maximum amount of help you can get -- equipment and people, as appropriate to your specific case -- and assuming you get some, taper back on that only with good reason and only as you become genuinely fit enough and skilled enough.

I think that covers that topic, at least enough to give you some ideas for your own situation, whatever it may be.  As I said, I welcome additional tips others who have been through this might like to share.

Meanwhile, happy bathing!  Happy safe bathing, whatever that turns out to be for you.

Comments

[pilgrimgirl]

My shower/bath nightmare was when we renting a place that had glass shower doors on a track and there was a track filled with nasty slimy water running down the edge of the tub. I tried every way imaginable to get into the tub while avoiding sitting on that nasty track (not only was the water gross, but it gave quite the wedgie). But it was doubly hard because I had to fold my very tall self into half the width of the tub stall (because of the sliding glass doors taking the other half) as I attempted to vault across the track. It was just awful and quite dangerous.

Then one day I got out a hammer and crowbar and just completely took out the shower door thingy. It took like 5 hours and I hauled the whole unit straight to the dumpster. Wow, I've never taken a nice smooth tubside for granted since then (and btw, our landlord never seemed to notice the missing showerdoors and I can't believe I put up with that awful situation for two years before I went at it with tools!).

[Sara]

Oh, brava, Jana! Those sliding glass things are a menace.

Ironically, one of those sliding glass things in a hotel room bathroom is what first gave me an inkling I would ever be able to live without the plastic bench at all. The first summer after my amputation, my true love and I took a trip to Newport, and we did not reserve a specifically accessible room because I was in that stage where I was just getting used to be being visible, didn't want to be extra trouble, extra anything, and also, as now, didn't want to take resources from someone who might need them more. I also wanted to see how well I could do without special accommodations, sort of as a progress test.

In fact, this is the first place I used the towel trick. Since I was not going to be doing the laundry, I made no bones about getting extra towels and using one to thickly cover up that horrible track for both entering and exiting the tub. It helped a lot.

Nevertheless, I was grateful not to fall through the glass or drown. I really think those sliding glass things should be illegal.

[pilgrimgirl]

I should add that my best solution for the track thing was to buy one of those foam pads that gardeners kneel on (about a foot long, about an inch thick) and sit that over the track as I transferred to the tub. I was just too chintzy to soak (and wash) a towel everyday just for transferring. And even a well-folded up towel didn't mitigate the wedgie factor, IMO.

I've never tried a showerchair nor have I had an adjustable showerhead (though the showerhead part does sound lovely). But I have had more than my share of scary experiences in hotel bathrooms w/slippery tubs/showerstalls. Now I usually just throw a handtowel on the floor of a hotel tub just in case it's a super-slippery one.

[Sara]

Excellent tips, Jana. Thank you.

The shower head is awesome. Some are even more awesome than what we have, lovely tools for self-pampering no matter how many legs you've got.

The chair, however, though a major source of annoyance on many counts, well earned its place on the list of many stupid little things that have probably saved my life. I have always been a big klutz, and the addition of soapy water to my environment at any given time has never been seen to mitigate that. If I couldn't have sat down while showering that first year, I would probably have broken my neck.

[Axistive]

I just love your wry writing style. You have so many good tips here. I think you're completely correct; thinking about taking a bath without one of my limbs fills me with absolute terror. It takes a lot of bravery to keep going after something like amputation.

[Sara]

Axistive, I'm glad you like my writing (though I can't imagine your interest in it), but now I fear I might not have been clear.

While terror is a reasonable first response to facing the bathroom without one's original complement of limbs -- you know, a perfectly reasonable reflexive emotion -- the fact is that choosing to be ruled or controlled by that terror would be silly.

Luckily, it doesn't take courage to get past this, just a reasonable amount of smarts -- you know, caution but not panic, the right combination of tools, and conscientious strength-building practices -- and a will to be clean. And for some people it might also take a little bit of help from others. A little or a lot. (Honesty is also an important tool.)

Meanwhile, I've got to tell you as a point of etiquette, amputees, cancer patients, disabled people, and everyone who might be any combination of the three are as likely as not to punch you in the face if you call them "brave" or -shudder- "special." Many of us have gotten really, really sick of being expected to graciously serve as receptacles for other people's projections and expectations.

Naturally, this being just a blog, no one is going to punch you in the face here. But you should know that I don't welcome that kind of talk, and that I consider it delusional not complimentary. This blog is about getting on with life, all life, real life, as a real person who just wants to live, one of many real people who just want to live, and sharing conversations about that, including but not limited to honest assessments of the sucky bits and any workarounds we might have discovered along the way. If you (or any other visitor) are looking to thrill to True Tear-Jerking Tales of Desperate Courage, you're going to have to head elsewhere. Me, I've got a kitchen to clean.

Cheers!