This topic is about exploring different options for people who have had a total colectomy, which means their colon has been completely removed. The discussion focuses on alternatives to a conventional ileostomy, such as the BCIR, K-pouch, and J-pouch, and weighs their pros and cons.

- BCIR (Barnett Continent Intestinal Reservoir) is an updated version of the K-pouch with a unique valve system. However, it's not widely available in the U.S., with only a couple of surgeons performing the procedure, and many insurance companies do not cover it. The re-operation or failure rates for BCIR are reported to be between 30-50%, which sometimes leads to reverting to a standard ileostomy.

- The K-pouch is now rarely offered and has mostly been replaced by the BCIR, especially if the rectum and anus have been removed.

- The J-pouch is an option only when the anus is intact and is technically not considered an ostomy. Some people are hesitant about the J-pouch due to potential issues like chronic urgency, incontinence, and the need to stay close to a toilet.

- Many people and surgeons prefer the conventional ileostomy due to its reliability and ease of care, especially in hospital or nursing home settings. Some individuals express satisfaction with their ileostomy, finding it provides peace of mind.

- Despite the challenges, there are success stories with the BCIR. Some long-term users have found it to be the best decision, enjoying life without external bags or skin irritation.

- Access to BCIR surgery is becoming more limited, with the closure of facilities like Olympia Medical Center in Los Angeles. Community members are seeking updated information on available surgeons and centers.

- For those with a BCIR, practical questions arise, such as which catheter brands or models are most effective, though specific recommendations are not yet provided.

- New innovations like the TIES implant are being studied, but they are still in early clinical trials and not widely endorsed.

- A note on medication: one patient mentioned developing an allergy to Azulfidine, a drug previously used for ulcerative colitis, highlighting past treatment challenges.