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January
2012 Last Month’s Meeting (our 416th) What a beautiful day for us to have our
annual Gala Holiday Party. We had, as
usual; many members come early to help with the preparations for the
evening. We especially want to thank
Judy Svoboda and her husband for their important contributions.
For the fifth year in a row, we had a catered dinner brought in for us
with desserts and appetizers provided by your board of directors and managed
by the ever-charming team of Jerry and Sally Schinberg. Renard accompanied us on the piano with
songs of the holiday season. We want
to thank everyone for coming and sharing this celebration with us.
Jerry and Sally were the masters of ceremonies. They entertained us with a musical Sherlock
Holmes game that required us to fill in missing lines in the narratives with
the titles of popular songs. It was
fun. The festive night would not be
the same without singing carols. We
finished off the evening in our traditional way by singing The 12 Days of
Christmas. This was our
best-attended party in many years.
Lutheran General changed our room at the last minute, but, mainly
through the diligent efforts of Jerry Schinberg, the evening was a great
success. We also want to thank
the store Trader Joe’s for donating the paper bags used to hold the gifts for
our members. We wish you and your family a happy and healthy new year. Happy New Year! If you have a talent that you would like to share by participating in one of our many diverse committees, please let an officer know. Our offices and committees are listed in our bylaws, which may be viewed at www.uoachicago.org. Then follow the link to OAGC. We are having election of officers in January as we do every year. Due to the death of some of our officers, our leadership team has been reduced to just a few active members. Our officer candidates are Renard Narcaroti, Vice President Tim Traznik, Treasurer Nancy Cassai, Secretary Joan Loyd, Director Due
to remodeling at Lutheran General, we have lost the storage facility we
enjoyed here for over 35 years. When
you come to a meeting, you may want to volunteer to carry some of our
supplies with you to each of our meetings.
This is an easy way to become more active in our group. As we mentioned, the hospital changed the location for our Holiday Party at the last minute. We attempted to notify everyone of this change, but many of the e-mail addresses we had were undeliverable. Make sure you do not miss an important announcement by updating your e-mail address with us at uoachicago@comcast.net. Also, to ensure delivery, make sure we are in your address book or safe sender list. Our e-mail list is private and never shared or sold. Ostomy—the
new normal Ostomy Association of Greater Chicago
(OAGC) Established 1975 Vice President/Newsletter Renard Narcaroti renard22@att.net 630-418-7127 Treasurer Tim Traznik tim.traznik@brunbowl.com 630-736-1889 Secretary/Programs Nancy Cassai ngcassai@att.net 847-767-1447 Director / FOW Joan Loyd joanloyd@sbcglobal.net 847-724-8002 Gay / Lesbian Ostomates Fred Shulak thadbear@sbcglobal.net 773-286-4005 Membership Judy Svoboda uoachicago@comcast.net 847-942-3809 Publicity Danah Melcher merdanah@sbcglobal.net 708-743-7787 Visiting Peggy Bassrawi, RN pbassrawi@gmail.com 847-251-1626 Ways and Means sallyschinberg@yahoo.com
Jerry & Sally Schinberg 847-364-4547 Welcoming jeanie12@gmail.com Dick
& Jean Hill 847-272-5646 Wound Ostomy Continence Nurses (WOCN) Bernie auf dem
Graben 773-774-8000 Resurrection Hospital Alyce Barnicle 708-245-2920 LaGrange Hospital Nancy Chaiken 773-878-8200 Swedish Covenant
Hospital Terry Coha 773-880-8198 Children’s Memorial
Hospital Jan Colwell & Maria De Ocampo 773-702-9371 & 2851 University of Chicago Jennifer Dore 847-570-2417 Evanston Hospital Beth Garrison 312-942-5031 Rush Presbyterian--St.
Luke’s Hospital Madelene Grimm 847-933-6091 Skokie Hospital--North
Shore University Health System Connie Kelly 312-926-6421 Northwestern Memorial
Hospital Kathy Krenz & Gail Meyers 815-338-2500 Centegra-Northern
Illinois Medical Marina Makovetskaia
& Kathy O'Grady 847-723-8815 Lutheran General
Hospital Bari Stiehr & Diane Zeek 847-618-3125 Northwest Community
Hospital Nancy Olsen & Mary Rohan 708-229-6060 Little Company of Mary
Hospital Barbara Saddler 312-996-0569 University of Illinois Catherine Smith 708-684-3294 Advocate Christ Medical
Center Sandy Solbery-Fahmy 847-316-6106 Saint Francis Hospital Nancy Spillo 708-763-4776 Resurrection Home Health
Services National
UOAA Virtual Networks ·
Pull
Thru Network (Parents of
children with bowel and urinary dysfunctions): Bonnie McElroy 205-978-2930 ·
UOAA
Teen Network: Jude Ebbinghaus 860-445-8224 ·
GLO (Gay & Lesbian Ostomates): Fred
Shulak 773-286-4005 ·
Young
Ostomate & Diversion Allia. of
Amer: Eric En 714-904-4870 ·
Thirty
Plus: Kathy DiPonio 586-219-1876 ·
Continent
Diversion Network: Lynne Kramer
215-637-2409 OAGC Meeting Dates January 18—Open Discussion February 15—Bret Cromer will talk about the Youth Rally March
21 April 18 May 16 June 13 Southwest Suburban Chicago The Southwest Suburban Chicago Ostomy
Support Group is an entirely volunteer ostomy association dedicated to the
mutual aid, education and moral support of people with ostomies and their
families. Meetings are held at 7:30 PM
on the third Monday of each month throughout the year, except July, August,
December and January. For information regarding this special
ostomy group serving Chicago’s greater southwest side, please call Edna
Wooding, WOC nurse and association president, at 708-423-5641. All meetings are held
at Little Company of Mary Hospital, Evergreen Park, Mary Potter Pavilion, L
Level, 2850 W. 95th St. Northwest Community Hospital The Northwest Community Hospital Ostomy Support Group meets at 800 W. Central Road, Arlington Heights. They wish to extend an invitation to all of our readers to visit them. The WOC nurses at the hospital lead the group. For more information, please contact Diane Zeek, RN, at 847-618-3215, dzeek@nch.org. They meet from 1:00 PM until 2:00 PM in the Busse Center, B1 level, Rooms LC7-8 of the Learning Center. This building may be accessed from the garage at the west end of the Busse Center. It is easiest to enter from Central Road. Meeting Dates for 2012 February 9—Bret Cromer from the DuPage support group will lead a "show & tell.” Bring ostomy products you have discovered and tell how they are helpful. April 12—John Spegele with ConvaTec Innovations June 14 August 9 October 11 December 13 To listen well is as
to talk well and is as essential to all true conversation. Did You Know? By Colin Cooke, Consultant The total number of people in the United
States with ostomies is not accurately known but is estimated to be about
450,000. Approximately 70,000
colostomy, 15,000 ileostomy and 12,000 urostomy surgeries are performed each
year. These numbers are taken from a
hospital discharge survey carried out by the National Center for Health
Statistics and have remained constant in this decade. When you take from Peter and give to Paul, Paul seldom
complains Elgin
Ostomy Association There is a new ostomy support group starting up in Elgin having meetings at Sherman Hospital. The leader of the new support group is Ray Dolan, ray.dolan@shermanhospital.org. They meet at 7:00 PM on the second Tuesday of each month at Sherman Hospital on Randall Rd. just south of I-90. Be sure to check with Ray before you come, just in case. Recognizing Symptoms of a Stroke
Doctors say a bystander can recognize a stroke by asking three
simple questions: S—Ask the individual to smile.
If he or she has trouble with any one of these tasks, call the emergency number immediately and describe the symptoms to the dispatcher. In addition, there is a new sign of a stroke—have the person stick out his/her tongue. If the tongue is crooked or if it goes to one side or the other, this is an indication of a stroke. Neurologists say that if they can treat a stroke victim within three hours, they usually can reverse the effects of a stroke. The challenge is having the symptoms of a stroke recognized, diagnosed and treated with quality medical care within the three hours.
By Debra
Rooney, Vancouver Ostomy High Life I have travelled much since colostomy
surgery nine years ago but never anywhere as challenging as South
America. I would not go so far as to
say that South America is ostomy unfriendly, for it is not, but it is not a
place that a person with an ostomy should take lightly if considering the
kind of trip I took. Our itinerary
included Machu Picchu in Peru, the cloud forests of Ecuador, the city of
Quito and the amazing archipelago of Galapagos. The first thing one learns, as any person
with or without an ostomy does in such a country, is to have a bathroom
map. Restaurants do not necessarily
have bathrooms and those that do may frown on you asking to use the
facilities if you are not eating or drinking there. Public restrooms, which are few and
sometimes far between, not to mention difficult to locate for tourists with
no guide or ability to speak Spanish, usually require the payment of a few
coins to enter. These buy you the
toilet and a small amount of weapons grade toilet paper. Lesson One: Carry small coins, carry your
own tissue and take note of anything that looks remotely like a public
bathroom. Tip: Churches usually have
free bathrooms that will usually be cleaner than public ones. If you are
in South America it is a given that you are going to tour churches. Lesson Two: Carry water. If it is being handed out on a tour, take
as many bottles as you can carry. Any person with an ileostomy already knows enough to
carry water when travelling, but I had to learn this the hard way. Once I spent a long bus ride staring
longingly at others’ bottled water until our guides handed out water at the
next stop. I do not normally drink
much water, but the minute it was not readily available, I was thirsty. Lesson Three: Do not irrigate in a strange
country, especially if you do not feel well. Seriously,
you will be sorry because you must not drink or irrigate with the tap
water. Americans are not used to the
bacteria in the water in South and Central American countries. I had to ride all the way back to Quito
lying down in a taxi. Lesson Four: Pack many extra ostomy
supplies, usually double or triple the amount you would usually use during
this time. OK, I was prepared, but even so, it was a bit worrying to
see how fast I could run through closed-end gear when I became sick. I had drainable pouches too, but I brought
them specifically to donate in Quito.
Therefore, it was with alarm that I realized that I might have to
start using them if my diarrhea did not clear up. Lesson Five: Water sellers are your friends. I used
much water to irrigate and became skilled at finding street vendors to sell
me the required number of bottles. Tip: Check the caps on the bottles to make
sure they are not just refilling old bottles with tap water. This was never a problem in the
city, but I imagine that in remote locations it might be an issue. Agua,
por favor, or, quatro, por favor,
did nicely. At the Galapagos Islands,
I had to rethink irrigating. We were
on a small ship, 70 feet in length, which tossed and rocked with great vigor
when underway. When anchored, it was
reasonably stable, but anchoring meant all of us were scheduled for land
tours and sometimes snorkeling twice a day.
Irrigating at any time of the day when at anchor meant missing out on
something, which I was loathe to do, and irrigating at night when underway
and being tossed around was out of the question. One needed two hands at all times just to
avoid being thrown against the walls.
Since one needs two hand to irrigate, I had to suspend this practice
for eight days. Those of you who do
not or cannot irrigate will laugh at my consternation at having to reorient
myself about monitoring, emptying and changing ostomy gear. I developed the hang of it quickly. I did manage myself this way during the
first year after all, but dear me, did I run through supplies! Even the one-piece drainable pouches did
not last long in this environment. I
worriedly counted down the dwindling supply that would be left to donate. Lesson Six: Be flexible. So I
could not irrigate. I adapted just
fine. Food in South America Many of us must be vigilant about what we
eat due to the risk of having a blockage at the site of the stoma. I found that there were many safe choices
in restaurants for those who must take care to limit the amount of high-fiber
foods. However, if one has an
ileostomy, special care must be taken, especially when touring Galapagos. I can speak only for our ship, but there were
no menu choices. Everyone was served
the same fare, which tended to be vegetable- and fruit-heavy, with a
surprising lack of starches. It was
decidedly un–North American, but very healthy. I wondered how people with ileostomies
might manage such meals. Probably by
eating smaller quantities, I did notice one fellow traveler who avoided many
of the dishes. I simply assumed at the
time that he did not like strange vegetables.
Perhaps he had an ileostomy. It
seems like he left the table hungry a few times. For those of you with no food worries, such
a ship would offer some interesting gastronomical experience like tree
tomatoes. Oh yes, and corn is a major
staple in South America. All of your
corn needs will be met. Donating Supplies It was my intention from the get-go to
donate whatever drainable and closed-end pouches I had remaining before
leaving Ecuador and going home. Astrid
Graham of Friends of Ostomates Worldwide (FOW) had advised me to donate them
to any hospital I could find in Quito.
We hoped that they might find their way into the hands of those who
needed those most. This proved to be more
difficult than expected due to the language barrier. What is the word for hospital? How should we explain what our mission is
once there? A solution was found,
entirely by chance. This is how it
came about: We had also brought school supplies to donate and set out one
afternoon in Quito to find a school.
It quickly became apparent that we had little idea of where to go, so
I decided to ask a passing nun where a Catholic school might be located. After much sign language and the words escuala por niños, she happily grasped
the concept and led us to a school near the main square. More translating of our mission was
required and we were then led to the outer office of mother superior. Sister, alas, was in conference with
another petitioner and after giving us a suspicious glare through the window
to her office, continued to debate at length with her guest. We waited.
It became apparent that we were not high on their list of priorities,
so we left. By a great happy chance we found them,
our receptive waters that is, in the form of an outdoor school for street
children. A tall woman who looked like
she might speak English seemed to be in charge. I approached her with our offer of crayons,
paper, chalk and the like. Her name
was Emma Barthles, and she was half-Canadian.
Emma and her organization, DeBartolo
Social y Hábitat were happy to take our school supplies. Best of all, when I asked where I might
find a hospital (after all, it is prudent to seize upon the chance to obtain
as much information as possible when encountering a fluent English-speaker),
she collaborated with the Director of the local health center, Unidad Municipal de Salud Centro,
which would see that our donation went to the best source. The deed was done and done right. I thank you again, Emma for working with
us. Emma may be contacted at
www.dsh-ecuador.blogspot.com If You Go Besides the
obvious precautions people with ostomies should take when travelling, I would
strongly recommend that if planning a trip to either Ecuador or Peru you
visit a local travel clinic for specific advice on the immunizations
needed. These will vary according to
the regions visited. You can count on
needing immunizations for hepatitis, tetanus and yellow fever. Some areas recommend polio vaccines, which
many of us had when we were young, and definitely malaria medication. I would also strongly recommend the
altitude medication acetazolamide (Diamox), which I took on the clinic‘s
suggestion. I had no issues with the
high altitude while taking this drug.
All these immunizations will run you around two to three hundred
dollars depending on the areas you visit.
Travel immunizations may not be covered by insurance/Medicare but are
well worth it. To Whom It May Concern I regret to
say that my mom, Lorraine Goldman, 85, has died. Therefore, you may remove her name from
your newsletter’s mailing list. I know that she looked forward to reading
the newsletter. On more than one
occasion, she told me so . . . mentioning some article she had read. I believe your newsletter did indeed help
mom have a new outlook toward managing everyday life better. Thank you. Sol Goldman November Product Fair at NCH
About 75 people attended the Northwest Community Hospital Vendor Fair
and Stoma Clinic this past November.
Many people traveled from all over the Chicago area for the opportunity
to attend this educational event.
There were overwhelmingly positive comments from new people with
ostomies, as well as many veterans of ostomy surgery. Some people who had not yet had surgery
came just to find out that life could be wonderful after ostomy surgery. Even family members, caregivers and
long-term care nurses attended.
In addition to providing assistance and new product information,
workers at the fair were able to dispel misconceptions among those new to the
ostomy community about living with an ostomy.
We all want to offer a hardy thank you to all the manufacturers,
vendors and volunteers who generously gave their time. We especially want to thank the Northwest Community
Hospital WOCNs who ran the stoma clinic and answered so many of the attendees'
concerns. The Newest Health Research We thought
we would share with our readers some of the newest research on popular health
topics. Migraine Headaches A recent
study in the journal Cephalgia
found that exercise was as effective at reducing the frequency of migraine
headaches as medication or relaxation training. Researchers divided 91 people with
migraines into groups that cycled indoors three times a week for 40 minutes,
practiced relaxation techniques or took the anti-migraine drug topiramate. Blood Pressure and Strokes This new
anthology reviewed 12 studies involving over 500,000 adults in the October 4,
2011, edition of Neurology. Those with systolic readings of between 120
and139, and a diastolic number between 80 and 89 were 55% more likely to have
a stroke over a median of 10 years than those with normal blood pressure. Saw Palmetto According to
a study published in the September 2011 edition of the Journal of the American Medical Association, saw palmetto
is not effective in relieving male urinary symptoms. They evaluated 306 men with symptoms of an
enlarged prostate who took either saw palmetto or a placebo pill each
day. After 18 months, the urinary
problems reported by both groups stayed the same or improved very slightly. Multivitamins Almost half
of all American adults take multivitamins.
There is no proof that they prevent chronic diseases or premature
death. A large 2011 study published in
the American Journal of Epidemiology
found no decrease or increase in cardiovascular disease, cancer or death
among multivitamin users. Another
study published in the Archives of
Internal Medicine suggested that multivitamins, other vitamins, and
mineral supplements, particularly iron, might actually increase the risk of
death among older women. People are
advised to avoid supplements in favor of a diet rich in fruit, vegetables,
whole grains and legumes. Consult your
doctor about vitamin or mineral use for your particular circumstances, particularly
if you have reduced calorie intake, are a vegetarian, have a digestive
disorder or are pregnant. Feed a Cold and Starve a Fever? There is no
scientific basis for this adage, according to the Board of Regents of the
American College of Physicians. With a
fever, one should certainly be well hydrated since there is often excessive
sweating or gastrointestinal illness that can result in fluid loss. Starving would stress one’s body, which is
already under stress. For the flu, The
American Lung Association emphasizes good nutrition and adequate liquids to
speed recovery and prevent dehydration.
For colds, they recommend drinking plenty of water and/or juice to
keep the lining of the nose and throat from drying out. Studies have found that chicken soup
reduces symptoms by loosening nasal secretions, easing throat soreness and
preventing the inflammatory responses that make having a cold so miserable.
World Ostomy Day Saturday,
October 6, 2012 "LET’S
BE HEARD" Growing Old with an Ostomy Forwarded by
The Green Bay Ostomy Support Group Aging has
become a 21th century phenomenon.
There have always been a few people who have lived to an old age, but
having masses of people living to old age is new. In the U.S., 25 million people are now 65
years or older—the fastest growing group in the population. By the year 2030, one in five Americans
will be elderly. Among these fast-growing groups are the
“old old” . . . those over 85. By the
end of this year, the over-85 population will have doubled, and the
population 65 and over will have increased by 39% from just a generation
ago. However, the elderly are not the
nursing home crowd. Most live in the
community, with only 5% in extended care facilities. The biological clock stands still for no
one. While the aging process brings
wide individual variations, aging is a universal process. It is the second law of thermodynamics that
everything becomes old. Aging can
present particular challenges for people with ostomies—be they older people
with new ostomies or those whose ostomies have grown older with them. A New Ostomy at Senior Age Because the population as a whole is
living longer, greater numbers of people are suffering illnesses that require
ostomy surgery. Challenges the senior
with a new ostomy may face, which all of us can help with, include the
following: Fear of Increasing Dependence
and Non-acceptance by Family Family acceptance and support are
essential for complete rehabilitation. Unpreparedness for a Stoma Surgery may often be done as an emergency
procedure, with little time for the older person to adjust to this change in
body image. It is common for an older
person to be confused after surgery because the hospital routine is
unfamiliar. Bed rails are up and
he/she is confined as though a child.
It is in this condition that he/she first becomes acquainted with his
ostomy. A Hard-to-Manage Stoma Particularly if created in emergency
surgery, the stoma may be adjacent to a wound or done in haste and poorly
positioned. Ostomy visitors and
caregivers can and should teach the senior with a new ostomy acceptance and
self-care. It might take extra
patience. The ability to learn does
not diminish with age, but speed of performance and reaction time decline. It will take longer to learn new
tasks. A word of advice to those
working with seniors: Allow your student to learn one task very well before
proceeding to the next one. The Person with an Aging Ostomy
Different challenges can arise with the individual
who had an ostomy created in his/her middle years and is now older. Some of the common concerns experienced by
people in this category include the following: A peristomal hernia that requires new
skills to manage may develop. Most
doctors do not recommend revising a peristomal hernia unless the hernia
interferes with normal bowel function.
Loss of muscle and skin tone, coupled with weight change, can cause
the pouch to leak or fit poorly and skin may become excoriated. If one has a colostomy and irrigates,
irrigations may take longer, become unsuccessful or may no longer be
needed. Try to increase fluids and
make dietary changes so irrigation is not required. Common Challenges One common problem affecting the older
person with either a new or an aging stoma is impaired vision, which may be remedied by using visual aids,
magnifiers, better light, and large-print instructions for ostomy care. Another
result of growing old is decreased sense of touch and smell. The older person with an ostomy may not
sense a pouching system leaking or smell the odor. When we are older, we lose
skin elasticity, and our skin becomes dry.
It is best to use only water to clean around the
stoma. It really does not become very
dirty under a skin barrier. Daily skin
barrier changes can traumatize the skin, if you use a standard wear
barrier. Pouching systems should fit
well enough to be worn for two, three or four days. Under ordinary circumstances, it is not
advisable to wear a pouching system more than four days. Belts should be avoided as they may cause
skin friction. Arthritis, which makes
handling the pouching system difficult, is another common challenge. A one-piece
pouching system or one without a clip may be easier to apply. About 41% of all people over 65 are
physically impaired because of a chronic medical condition. You have to learn how to live with a broken heart. What is Colon/Rectal Cancer? Forward
by The Green Bay Area Support Group, written for The American Cancer Society Colorectal cancer is cancer that starts in
the colon or the rectum. These cancers
can also be referred to separately as colon cancer or rectal cancer,
depending on where they start. Colon
cancer and rectal cancer have many features in common. They are discussed together in this
document except for the section about treatment, where they are discussed separately.
The normal digestive
system The colon and rectum are parts of the
digestive system, also called the gastrointestinal (GI) system. The first part of the digestive system, the
stomach and the small intestine, processes food for energy while the last
part, the colon and rectum, absorbs fluid to form solid waste (called fecal
matter or stool), which then passes from the body. To understand colorectal cancer, it helps
to know something about the structure of the digestive system and how it
works. After food is chewed and swallowed, it
travels through the esophagus to the stomach.
There it is partly broken down and then sent to the small intestine,
also known as the small bowel. It is
called the small intestine because it is narrower than the large intestine,
the colon or rectum. Actually, the
small intestine is the longest segment of the digestive system—about 20
feet. The small intestine continues
breaking down the food and absorbs most of the nutrients. The small intestine joins the large
intestine or large bowel in the right lower abdomen. Most of the large intestine is made up of
the colon, a muscular tube about five to six feet long. The colon absorbs water and salt from the
food matter and serves as a storage place for waste matter. The colon has four
sections: The first section is called the ascending colon. It starts with a small pouch (the cecum) where the small bowel
attaches to the colon and extends upward on the right side of the
abdomen. The cecum is also, where the
appendix attaches to the colon. The second section is called the transverse colon since it
goes across the body from the right to the left side in the upper abdomen. The third section, the descending colon, continues
downward on the left side. The fourth and last section is known as
the sigmoid colon because
of its S shape. The waste matter that is left after going
through the colon is called feces or
stool. It goes into the rectum, the final six inches of the digestive system, where it
is stored until it passes out of the body through the anus. The wall of the colon and rectum is made
up of several layers. Colorectal
cancer starts in the innermost layer and can grow through some or all of the
other layers. Knowing a little about
these layers is important, because the stage (extent of spread) of a
colorectal cancer depends to a great degree on how deeply it invades these
layers. Abnormal growths in
the colon or rectum In most cases, colorectal cancers develop
slowly over several years. Before a
cancer develops, a growth of tissue or tumor usually begins as a
non-cancerous polyp on
the inner lining of the colon or rectum.
A tumor is abnormal tissue and can be benign (not cancer) or malignant
(cancer). A polyp is a benign,
noncancerous tumor. Some polyps can
change into cancer but not all do.
Whether cancer develops depends upon the kind of polyp. Adenomatous polyps
(adenomas) are polyps that can change
into cancer. Because of this, adenomas
are called precancerous. Hyperplastic polyps
and inflammatory polyps, in general, are
not precancerous. However, some
doctors think that some hyperplastic polyps can become precancerous or might
be a sign of having a greater risk of developing adenomas and cancer,
particularly when these polyps grow in the ascending colon. Another kind of precancerous condition is
called dysplasia. Dysplasia is an area in the lining of the
colon or rectum where the cells look abnormal but when viewed under a
microscope do not look like true cancer cells. These cells can change into cancer over
time. Dysplasia is usually seen in
people who have had diseases such as ulcerative colitis or Crohn's disease
for many years. Both ulcerative
colitis and Crohn's disease cause chronic inflammation of the colon. Start and spread of
colorectal cancer If cancer forms in a polyp, it can eventually
grow into the wall of the colon or rectum.
Then the cancer cells can grow into blood vessels or lymph
vessels. Lymph vessels are thin, tiny
channels that carry away waste and fluid.
They first drain into nearby lymph nodes, which are bean-shaped
structures containing immune cells that help fight against infections. Once cancer cells spread into blood or
lymph vessels, they can travel to nearby lymph nodes or to distant parts of
the body, such as the liver. Spread to
distant parts of the body is called metastasis.
Types of cancer in the
colon and rectum Several types of cancer
can start in the colon or rectum. Adenocarcinomas: More than 95% of colorectal cancers are adenocarcinomas. These cancers start in cells that form glands
that make mucus to lubricate the inside of the colon and rectum. Most colorectal cancers are adenocarcinomas. Other, less common types of tumors may also
start in the colon and rectum. These
include the following: Carcinoid tumors: These tumors start from specialized hormone-producing
cells in the intestine. Gastrointestinal
stromal tumors (GISTs): These tumors
start from specialized cells in the wall of the colon called the interstitial cells of Cajal. Some are benign (noncancerous); others are
malignant (cancerous). These tumors
can be found anywhere in the digestive tract, but they are unusual in the
colon. Lymphomas: These are cancers of immune system cells that typically
start in lymph nodes, but they may also start in the colon, rectum or other
organs. Sarcomas: These tumors can start in blood vessels as well as in
muscle and connective tissue in the wall of the colon and rectum. Sarcomas of the colon or rectum are rare. WOCN Certification We thought it might be interesting to our
readers to read four of the test questions that were recently published in
the Journal of WOCN as examples in
the WOCN certification examination. We
will try to translate some of the more obscure technical language. 1. A patient with an end colostomy for rectal
cancer is discharged on the eighth day post-op. The next day he goes to the emergency room
with abdominal distention, nausea, vomiting and weakness. What complication is the patient most
likely experiencing? A. Ileus B. Anastomotic leak C. Stomal necrosis D. Hemorrhage 2. A complication that may occur
if the stoma site is not within the rectus muscle or if there is a large
fascial opening is A. Stomal retraction B. Peristomal hernia C. Stomal stenosis D. Peristomal fasciitis 3. A patient with portal
hypertension and a colostomy is found to have peristomal skin with a purple
hue and varices. Instructions to the
patient should include A. Change the two-piece pouching system every
three to four days. B. Use a pouching system that will
not apply direct firm pressure. C. Lubricate the stoma with saline
gel to prevent bleeding. D. Use Stomahesive powder on the
peristomal skin at every change. 4. If the peristomal skin is erythematous,
macerated, has satellite lesions and the patient complains of itching and
burning with each change of the skin barrier, the most likely complication is A. Folliculitis B. Candidiasis C. Contact dermatitis D. Herpes simplex Answers 1. (A) This is an application question, defined as the ability to comprehend, relate or apply knowledge to new or changing situations. An ileus is an obstruction of the intestine due to paralysis of the intestinal muscles. The paralysis does not need to be complete to cause ileus, but the intestinal muscles must be so inactive that they prevent the passage of food and lead to a functional blockage of the intestine. On listening to the abdomen with a stethoscope, few or no bowel sounds are heard because the bowel is inactive. It is also called paralytic ileus. Anastomotic leak (B) symptoms include abdominal distention but also signs of peritoneal irritation, high white blood cell count and signs of sepsis. Stomal necrosis (C) is indicated when the stoma is black, and hemorrhage (D) is massive bleeding. 2. (B) This is a recall question, requiring the ability to recall or recognize specific information. Bringing the stoma through the fascia (a flat band of tissue below the skin that covers the underlying tissues and separates different layers of tissue) of the rectus muscle (also called the "six-pack," a paired muscle running vertically on each side of the anterior wall of the human abdomen) stabilizes it, preventing possible hernia or prolapse. An overly large fascial opening may allow loops of intestine to protrude into the area of weakness, creating a hernia. Stomal retraction (A) results from tension on the stoma during surgery. Stenosis (C; a narrowing or stricture of a tubular organ) occurs because of ischemia (insufficient blood supply to an organ). “Peristomal fasciitis” (D) is a made-up phrase. 3. (B) This is an application
question. Portal
hypertension is an increase in the pressure within the portal vein, the vein
that carries blood from the digestive organs to the liver. The increase in pressure is caused by a
blockage in the blood flow through the liver.
Increased
pressure in the portal vein causes large veins called varices to develop
across the esophagus and stomach to bypass the blockage. The varices become fragile and can bleed
easily. Portal
hypertension
can cause intermittent, profuse and spontaneous bleeding around the
stoma. Blood loss can be large and
sudden. Patients need to use a
pouching system that does not apply direct firm pressure, because this can
cause bleeding. Most two-piece
pouching systems (A) put too much pressure on the peristomal skin. (The Hollister Floating Flange is an
exception.) Saline gel (C) will not
prevent bleeding. An ostomy powder (D)
is indicated for moist weeping peristomal skin. 4. (B) This is a recall question and
describes peristomal candidiasis.
(Candidiasis or thrush is a fungal infection—mycosis—of the candida
species, i.e., the yeast infections.
It is also kn4own as candidosis, moniliasis and oidiomycosis.) A hallmark of candidiasis is satellite
lesions. (A satellite lesion is a
portion of the candidiasis rash on the outer skin. It is a beefy red plaque surrounded by
numerous smaller red patches of skin that are discolored but not usually
elevated and are located near the main lesions.) It often occurs after a patient has been on
antibiotics. Folliculitis (A) appears
as pustules around a hair follicle.
They are usually caused by friction or shaving of the skin. With contact dermatitis (C; an allergic
reaction), erythema (redness or rash) is noted in the affected area followed
by pruritis (itching). The patient
most likely is having an allergic reaction to the material of the skin
barrier. Herpes (D) causes vesicles
(small blisters) that are opened when the skin barrier is removed and can be
quite painful.
For those of you who are curious to know more, the answers to these
questions may be researched by referring to preoperative and postoperative
management in Colwell J, Goldberg M, Carmel J, eds. Fecal & Urinary Diversion, Management Principles, St. Louis,
MO: Mosby, 2004. Facts of Life ·
At least five people
in this world love you so much they would die for you. ·
At least 15 people
in this world love you in some way. ·
The only reason
anyone would ever absolutely hate you is that he/she wants to be just like
you. ·
A smile from you can
bring happiness to anyone, even if he/she does not like you. ·
Every night, someone
thinks about you before he/she goes to sleep. ·
You mean the world
to someone. ·
You are special and
unique in your own way. ·
Someone you do not
even know exists loves you. ·
When you make the
biggest mistake ever, something good will come from it. ·
When you think the
world has turned its back on you, take a look—you most likely turned your
back on the world. ·
When you think you have
no chance at obtaining what you want, you probably will not, but if you
believe in yourself, you probably will obtain it eventually. ·
Always remember
compliments you receive; forget the rude remarks. ·
Always tell someone
how you feel about him/her; you will feel much better when he/she knows. ·
If you have a great
friend, take the time to let that person know that he/she is great. Living Well with an Ostomy By Elizabeth
Rayson If you have an ostomy, you know that the
practical aspects of ostomy care are just some of your concerns. Elizabeth Rayson’s book, Living Well with an Ostomy, delves
into those practical aspects, yet provides candid coverage of the things they
may not tell you in the hospital. This comprehensive guide is organized so
you can find exactly what you are looking for, whether you are new to the
experience or a pro looking for new answers.
Rayson begins with descriptions of the various types of ostomies and
moves on to highlight what to expect before and after ostomy surgery. You will find information on basic care,
selecting a pouching system, diet, skin and medication. Rayson never leaves you guessing. Most chapters wrap up with frequently asked
questions and thorough answers. In the second edition, the new three
chapters of Living Well with an Ostomy
live up to its title, with informative conversations about how to live the
rest of your life. Rayson addresses
managing an ostomy on the job, while traveling, and playing sports. The most eye-opening chapter examines body
image, relationships and sexuality.
Rayson approaches this hush-hush subject with a blend of expertise and
compassion. She provides frank
information about what both men and women might expect after ostomy surgery
and offers constructive advice. She
covers everything from telling a new partner about your ostomy to pregnancy
with an ostomy. Just when you think Rayson has explored
everything, you will find a chapter about ostomy care and tips for the
elderly, caring for babies and children with ostomies and dealing with an
ostomy as a teenager. Sprinkled
through the pages you will also find anecdotes and advice from people who
have been there and done that. You will not only want to keep Living Well with an Ostomy for the
handy resource section and glossary at the end, but for the chapters you
might not need now but may need in the future. It is just that kind of book. For our liability disclaimer and privacy policy visit http://uoachicago.org/liability.htm.
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