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March 2009
Last
Month’s Meeting
Just to
remind you . . . after over thirty years of conducting our general meetings
at Lutheran General Hospital, we have moved four blocks away. We now meet at Sunrise of Park Ridge (an extended
care facility), just north of Dempster St. on Ballard Rd—drive across the
street from the hospital north three blocks then west one block. In addition, we meet on the third Wednesday
of most months instead of the fourth.
The
featured program for our February General Meeting was a Panel Discussion
moderated by our Association Treasurer, Tim Traznik. This format is always interesting and
especially tonight when Tim provided some introspective questions for our
panel members to discuss resulting in a deeply emotional experience for us
all. Our panel members included Sheryl
Crook, Wayne Kraus, Craig Niemeyer and Jerry Schinberg. It takes a special person to sit on one of
our panels and express one’s most intimate feelings, which are shared by our
audience.
Tim told
us that before he had surgery, he worried that nobody would ever be
physically attracted to him. He
thought that he would never marry or have children because he had an
ileostomy. Of course, that worry never
materialized. Tim did find true love
with a beautiful intelligent woman, and he and his wife currently have two
wonderful healthy boys.
Sheryl
told us about how as a 22-year old woman, she often cried about her
ileostomy, with many of the same concerns that Tim shared. Whenever a small issue would arise, like a
little skin irritation due to a minor leak, she said that she would just be
crushed. This is the paraphrased
version. Today, she tells us that
these feelings are just a memory to her.
She is very grateful to be healthy once again. Sheryl, who could easily be mistaken for a
model due to her good looks, married a handsome and successful man about
three years ago. Her husband tells us
how fortunate he is to have found her.
Craig
comes to us with an issue that is unique to our Association. He had a 40+-pound tumor removed from his
abdomen just a few months ago. He has
a temporary colostomy due to the 18-hour surgery he miraculously
survived. He had a high probability of
not waking up after surgery . . . thankfully, he did. Regardless, Craig was upbeat and
inspirational. He told just a bit
about his battle with cancer and the ongoing emotional support he receives
from his wife and family. This life
and death struggle with cancer never really ends.
Wayne,
always positive and cheerful, shared his battle against bladder cancer along
with a plethora of medical issues that challenged him the last three
years. Wayne was a business executive before he
retired; during this tenure, he developed excellent communication skills and
a sophisticated vocabulary. Through
these skills, he offered us a more complete verbal picture of the life he
leads.
Jerry,
who has been a mentor of many of us who have had ostomy surgery, dramatized
his struggle with ulcerative colitis, contracted when he was a boy. For over 30 years, he overcame the
overwhelming challenges of living with this humiliating disease. He tells us of the tremendous support he
has received from his lovely wife Sally and their two girls. After developing colon cancer, he finally
had ostomy surgery. Jerry is one of
the best role models for a person who embraced life completely given the gift
of a new ostomy.
These
are rather inadequate descriptions of the actual conversations of our panel
members. One really had to be there in
person to feel the power and courage our panel members’ exhibit dealing with
ostomy surgery in their lives.
We would
like to offer a special approbation to Judy Svoboda for offering to fill our
vacant Membership Chairperson position.
Sue Oldham, RN, was our Membership Chairperson for years, performing
her duties with dedication along with exceeding our very high goals and
expectations. Sue worked diligently
with Jane Michnik to completely refurbish and rebuild our office procedures
after the collapse of UOA. Thank you,
Sue, so very much for all the work you have performed for our Association for
so many years.
If you
have a talent that you would like to share by participating in one of our
many diverse committees, please let us know.
Some invest as little as an hour a month. If we all pitch in, it makes the burden
lighter for all of us.
Be sure
to bring some bakery goods for our Hospitality Table for everyone to share
whenever you have a special day you want to celebrate.
A featured article in this March 2009 edition of The New Outlook . . . Low Yield of Repeat Colonoscopy is being published to commemorate the
month of March, which is being dedicated to
National Colorectal
Cancer Awareness
New Meeting Location
Sunrise of Park
Ridge
1725 Ballard Road
(General Membership Meetings are now held on
Wednesday at 7:30 PM on the third week of most months.
OAGC Meeting Dates for
2009
March 18—We will each have the opportunity to share the
innovations, inventions and options we individually have implemented while
managing our ostomy. Tonight is an
open discussion on ideas from both new people with ostomies and those with 50
years experience. Show and tell is
encouraged.
April 15—Our 34th Anniversary Celebration! Rhoda Gordon, a founding member of our
group and still active in its management, had the idea that we should all
come to this anniversary meeting with a sample of our pouching system taped or
pinned to our clothing. We have never
done this successfully before and expect that today is that day. I will have mine proudly on my tummy, how
about you?
May 20
June 17—Connie Kelly
July 15
August 19
September 16—Bernie
auf dem Graben
October 21
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.
SW Sub Chicago Meeting Dates
for 2009
March
16—All meetings are held at
April
20 Little Company of Mary Hospital,
May
18 Evergreen Park, Mary
Potter Pavilion
June
16 Lower Level, 2850 W. 95th
St.
Did you know that we have our own Internet site? Next time you are on your computer, check
out our site at
www.uoachicago.org .
Northwest Community
Hospital
A new ostomy support group has formed at
Northwest Community
Hospital in Arlington
Heights. They have
already been operating for about a year now and wish to extend a welcome to
all of our readers to visit them. The
WOC nurses at the hospital lead the group.
For more information, please contact Diane Davis-Zeek, 847-618-3215, ddavis@nch.org .
They meet every other month on Thursdays
about 1:00 PM at a new
permanent location, the Busse
Center, B1 level, Room LC7-8. This building may be accessed from the
garage at the west end of the Busse
Center. It is easiest to enter from Central Road.
NW Comm
Hospital Meeting Dates for 2009
April 9
June 11
August 13
October 8
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December 10
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C3Life.com, a new online ostomy Community Connection Center, is now live. And, C3Life.com
is not just live it is full of life. People
of different ages and backgrounds are beginning to connect, interact and hare
the benefits of a wealth of stoma related information helping them live their
lives to the fullest. Hollister, Inc.
invites you to be one of the first to visit C3Life.com and join the
community.
IBD Patient Symposium
On Saturday, April 4, we will once again
participate, for the 10th year in a row, in the annual Crohn’s and Colitis
Foundation of America’s IBD Patient and Family Symposium, Knowledge-Power-Action. Last year, over 1,000 people attended the
educational and support meetings.
The Symposium starts about 8:00 AM and runs for most of the
day. It is held at the Donald E. Stephens Convention Center
at 5555 N. River Road
in Rosemont, IL.
For more information about the Symposium, contact CCFA at
1-800-886-6664 or www.ccfa.org .
ConvaTec is Expanding
ConvaTec will expand its Greensboro operations
and add 30 machine operators and mechanics, the Greensboro Economic
Development Alliance said today. The
company will expand its ostomy skin barrier line and attract a new ostomy
pouch operation to its plant at 211
American Ave.
ConvaTec plans to hire 30 machine
operators and mechanics over the next three years at an average wage of more
than $44,000 adding to its 258 current employees there. The company will convert warehouse space to
manufacturing and invest $19.55 million in machinery, equipment and building.
"Securing this expansion here in Greensboro should help
keep the local facility viable and growing for the longer term," said
Dan Lynch, president of the Greensboro Economic Development Alliance.
In November, the Greensboro City Council
approved a $255,000 economic incentive for ConvaTec. The company also received an economic
incentive package from Guilford
County worth
$152,000. ConvaTec is owned by Cidron
Healthcare Limited and was previously a division of Bristol-Myers Squibb.
Coloplast Reports Higher Sales
Danish healthcare products maker
Coloplast reported first-quarter operating profit above expectations on
robust sales and kept its full-year profit outlook for 2009 unchanged.
Coloplast posted earnings before
interest and tax of 334 million Danish crowns ($57.25 million) in the quarter
ended Dec. 31, down 2 percent from the same period last year. Analysts in a Reuter’s survey expected a
profit of 301 million. Sales rose 4
percent in the period to 2.2 billion crowns, in line with analysts'
expectations.
The group maintained its forecast of an
EBIT margin of 14 to 15 percent for the 2008/09 financial year. Coloplast lowered its organic sales growth
estimate to seven to eight
percent from eight to nine percent due to the weak British pound.
"It's surprising that they are not
downgrading the EBIT margin forecast because of the weakness of the British
pound," said Rune Dahl, an analyst at Sydbank. "It's positive that they can maintain
that forecast."
Urology and continence products sales
posted organic growth of eight percent, with wound and skin care up five
percent. Ostomy organic sales growth
was four percent, Coloplast said.
"Like everyone else, we are also
impacted by the financial crisis, one of the reasons being the fluctuation of
the British pound," said Chief Executive Lars Rasmussen. "But fundamentally Coloplast is a
sound business no matter the state of the international economy, as we sell
medical devices which are in daily demand.
Low Yield of Repeat Colonoscopy
At Five
Years in Average-Risk People
By Douglas K. Rex, MD, Published in Journal Watch
Gastroenterology, November
7, 2008
New data support existing
recommendations for a 10-year interval between normal colonoscopies.
How often should patients undergo screening colonoscopy if their initial
exams revealed no polyps or only small distal hyperplastic polyps?
Current guidelines recommend a 10-year
interval, even though this interval is not supported directly by any
observational or clinical trial data (Gastroenterology 2003; 124:544). Instead, the recommendation is based on
case-control studies showing 10- to 16-year protection after a single
negative sigmoidoscopy and on observational studies showing at least 10-year
protection after a negative colonoscopy in a symptomatic patient.
In addition, three studies of
colonoscopy performed five years after an initial negative examination all
found the yields to be very low. Now,
a fourth study, which is six times larger than any of the previous ones were,
finds the same.
A total of 2436 average-risk,
asymptomatic individuals who had negative baseline colonoscopies; i.e., no
adenomas, were offered repeat exams at five years; 1256 accepted—mean age at
baseline, 57; 57% men. The repeat exams
took place an average of 5.3 +/- 1.3 years after the initial exams. No serious complications occurred during
either set of exams. The cecal
intubation rate was 94.4% at baseline and 96.6% at follow-up.
No cancers were found during the repeat
exams. A total of 201
patients—16.0—had one or more adenomas, including 16—1.3% overall—who had at
least one advanced adenoma. In total
19 advanced adenomas were detected, including 10 distal to the splenic
flexure.
This large study puts existing
recommendations for 10-year intervals in average-risk people on firmer
ground. An essential element of
effective protection against colorectal cancer is the quality of the baseline
examination. Today, all colonoscopists
should be measuring their rates of adenoma detection. Not measuring such rates and continuing to
insist on 5-year intervals is illogical and a disservice to patients.
Colonoscopists with high measured rates
of adenoma detection can feel fully confident recommending 10-year intervals
to patients with normal colonoscopies.
Those colonoscopists with low adenoma detection rates should take
steps to improve.
Why Does My Stool Smell Worse After
My Ostomy?
By Michael D’Orazio, CWOCN
This is a concern and question
commonly expressed by fecal ostomates, and their observations are not without
solid physical foundation—in other words, it is not in their heads,
only. It is fair to say that all who
poop, no matter the route taken, stink at times!
The traditional or
non-ostomy way of evacuating the stool in many developed countries is
relegated to a well-accepted and orchestrated routine of sitting upon the
commode. By doing this, one seals the
rapid escape route of smell with the butt or derriere plastered against the
toilet seat. The only exit port is the
space between the legs, where one has the urinary tools mounted and which
space opening can be regulated as desired.
Ok Ok, I know it sounds hokey to phrase it this way, but I am trying
to make a visual point here. As the
turd, stool, fecalith or poop exits the anal canal and drops into the water
below it is engulfed by the water as it sinks. This action surrounds the stool and traps
the odor causing gas, struggling to escape from the sides of the stool mass,
from immediately reaching the nose; thereby mitigating the smelly
offense. Of course, if a fart or gas
escape occurs simultaneously with the deposition of the stool then the odor
offense will be more readily detected by all noses in the immediate
vicinity.
Now, with a fecal ostomy,
the stool character and surface area are changed and the laws of physics and
chemistry reveal the true reasons why a fecal ostomate tends to smell more so
when emptying the pouch. In this case,
as one approaches emptying of the pouch, whether seated upon the throne as
before or standing or kneeling before it, the surface area of the stool is
much greater than the fecalith that previously exited the anal canal. In the case of the ileostomate and high
colostomate, whose stool character is softer or looser, the surface area is
greatly increased. As the pouch is
emptied of its contents, the stool—be it liquid or pasty—is plopped into, the
water and often times will float a while before sinking. Because the stool is softer and slower to
sink it allows for greater amounts of gaseous diffusion or escape of odor
offending molecules to occur. The
greater number of offending odor molecules bombard the nose at a given time
and the bystander(s) recognizes the greater degree of smelly offense.
An additional cause for
increased odor offense is that the exit point for the stool from the pouch is
now directly under the nose; unless an attempt is made to empty the pouch by
tucking it beneath the butt or between tightly closed thighs and magically
opening it only when fully seated on the toilet. However, I think this approach would be
impractical, don't you?
A simple analogy of this
“smelly” phenomenon, before the ostomy, is to compare episodes of diarrhea
and the enhanced odor offense. I think
it is safe to say that most people would acknowledge that their watery stool
tended to smell worse than their formed stool.
So, there you have it. Gaseous diffusion is the underlying
principle that allows the nose to perceive a greater quantity of offending
odor molecules from the increased surface area of softer or liquid stool, as
is typically found with fecal stomas.
Take heart in knowing that you are not stinkier because of the ostomy,
merely that gaseous diffusion is finally being recognized as the phenomenon
underlying a very normal process, previously hidden or impeded. Fortunately, many of the aids for ostomy
odor management work quite well in this new potty environment.
Hospital Stays
Many older people view
hospitals as places from which their contemporaries have not returned. So, it is no wonder they are loath to check
into them. But, identifying and
dealing with illness earlier rather than later still gives a person a much
better shot at recovery.
Another challenge to getting the most out of
the health-care system is that some seniors view doctors in awe and may be
reluctant to ask questions. However,
doctors are not superhuman, and any medical “miracle” that may occur comes
because of the hospital staff and the patient working together. Therefore, it is incumbent upon patients
and family members to be as detailed and as educated about an illness as
possible.
This is not easy because
relatives may not be forthcoming about their health. Some simply learn to cope with pain or
discomfort. Some even try to salve
wounds and solve problems with home remedies.
Patients and family members
should not be afraid to request a formal consultation with hospital
staffers—doctors, nurses, social workers.
Write down questions ahead of time, do research and ask them to reword
answers if you do not understand them.
Your good health is your responsibility.
A Polish immigrant went to
the DMV to apply for a driver's license.
First, of course, he had to take an eye test. The optician showed him a card with the
letters 'C Z W I X N O S T A C Z.'
'Can you read this?' the
optician asked. 'Read it?' the Polish
man replied, 'I know the guy!'
Surgery to Cure Stoma Problems
By Arthur J. Vainer, Jr., M.D.
There are many people with
ostomies that have a “problem stoma” that may obtain improved efficacy
through a surgical intervention. UOA
estimates that about 10 percent of all ostomies require surgical intervention
for complications associated with the stoma.
The first, easiest and best
step in treating the problem stoma is to create a stoma correctly. The foundations of stoma construction are
similar to the old real saying, “Location, Location, Location”. Location is important so that the patient
may properly care for the stoma. Skin
folds and irregular surfaces are avoided, if possible, and the stoma should
be visible to the patient, avoiding placement too low on the belly wall. Placement should also pay regard to
wardrobe consideration, such as the belt line.
·
Location through the rectus
abdominus muscle: Placing the
stoma through the rectus abdominus muscle—the one used to do sit-up
exercises—takes advantage of the strongest muscle of the belly wall and
minimizes the chance of developing a hernia.
·
Location of the “spout” above
the skin: An ileostomy should have
a long spout—about an inch—to keep the caustic small bowel effluent off the
skin. A urostomy or colostomy should
have a smaller sized “bud”.
Despite proper construction, any of
several complications may develop that require surgical correction. Retraction of the stoma is apparent as the
“budding” disappears. The most common
causes of stoma retraction are technical problems at stoma creation and
post-operative weight gain. Stoma
retractions occur in about three percent of ostomy patients.
Therapy for stoma
retraction can involve weight loss, if weight gain is the culprit. Often times this approach is not practical
since many patients had weight loss from their disease—notably Crohn’s
Disease and ulcerative colitis—and go back to their normal weight after the
disease is removed. Most commonly, the
stoma will need to be revised operatively.
An intra-abdominal procedure is needed. Therefore, surgery for correcting a stoma
is major.
Stricture of the stoma (a
narrowing of the intestine) will first show up as difficulty with evacuation
at the stoma—like constipation—and possible cramping abdominal pain. The combination of a tight stricture and
hard stool can result in impaction when the stool truly blocks the stoma and
cannot come out.
Stoma stricture will occur
in about two percent of ostomy patients.
The stricture is made up of scar tissue and can be at the level of the
skin or fascia—the tough muscle covering—for skin strictures. This repair is simpler and may be done as a
local procedure. Fascia level
strictures may require the relocation of the stoma.
Since the bowel is a
contaminated organ, a relatively common problem after surgery is the
development of an abscess or fistula.
Patients with Crohn’s Disease are most prone to this complication,
since fistulas tend to develop commonly in Crohn’s Disease anyway. Stoma abscess or fistula will occur in
about five percent of ostomy patients.
If such an infection occurs, it needs to be drained. Drainage of the infection should be done
either right next to the stoma or well away from the stoma to allow proper
care of the ostomy system. Making an
incision to drain an abscess that will be covered by the skin barrier will
either doom the attempt at drainage or the proper seal for the ostomy
system. Complicated infections may
require relocation and/or revision of the stoma.
Prolapse of the stoma
is evident as the bowel telescopes out into the pouch, resembling an
elephant’s trunk. Prolapse will occur
in about three percent of ostomy patients but is rare in those with a
urostomy. If a prolapse is bothersome
or causes symptoms, the stoma will need to be revised.
People
with Ileostomies
Via ReRoute, Evansville, IN
Can an ileostomy be
controlled with strict diet or irrigation?
The answer is a definite “no” to both questions.
Occasionally, a
doctor may irrigate an ileostomy with a lavage set for food obstruction. This procedure should be done only by an
experienced doctor or ostomy nurse to prevent perforation of the small bowel
and further surgery. An ileostomy
cannot be controlled by any diet. It
is vitally important, that everyone with an ostomy eat at least three
nutritionally balanced, but small, meals a day.
If your doctor has
given you a special diet, remember that when your stomach is void of food, it
will fill up with gas. Excessive gas
will result in a noisy ileostomy.
Fasting may increase
the activity of the small bowel, causing the ileostomy to discharge very
liquid feces. Diet is an individual
matter. Some people can eat all
varieties of food, including foods with skins, without affecting the
consistency of the stool or the activity of the bowel. Others find that any violation of a low
residue diet leads to frequent and watery stomal activity. Each person must discover his/her own
dietary pattern through trial and error.
Another word to people with an ileostomy ... If you are ever depressed
about your surgery, just think of all the ailments you no longer have to
worry about: rectal cancer; colon cancer; hemorrhoids; diverticulitis;
appendicitis; constipation. Sometimes,
it is amazing that anyone can survive with the colon intact!
Dehydration with an Ileostomy
By Terry
Gallagher, UK
When we had our ileostomy surgery, our colon
was removed. In a normal person; i.e.,
a person with a full, working colon, the colon is responsible for absorbing much
of the water we drink and that is contained in our food. In addition, electrolytes such as sodium
and potassium, essential to maintaining good health, are absorbed there.
Removal or disconnection of the colon
immediately causes an initial problem because of the removal of the
ileo-cecal valve. This valve is
between the ileum or small intestine and the colon where the appendix is
attached. Its purpose is to dispense the
contents of the ileum into the colon with a measured response to maximize food
absorption.
When we lose this valve, food and water
pass through our digestive system without a regulator, for a short time
anyway. The body does adjust quite
well to our new plumbing, and soon our transit rate slows to about a third to
a quarter of that of people with normal colons to help make up for this
loss. The ileum begins to absorb more
water to compensate for the loss of the colon but still absorbs much less
than a normal colon usually would.
Effluent from the ileum normally has about
30% of the original water taken into the body remaining, while normal stool
from a colon has about 10% remaining ... quite a difference. In addition, we lose ten times as much
sodium and potassium as someone with a colon.
Because of all this, anything that upsets this balance in our bodies
has a faster and more dramatic effect.
A typical example is
gastroenteritis. A normal person with
this infection may be sick and have diarrhea for a couple of days, whereas we
could end up in the hospital with exactly the same symptoms as these because
of the loss of fluids and electrolytes.
This may apply to other problems that upset the digestive system’s
balance. When these occur, a normal
person may experience nausea, vomiting, fever, abdominal cramps, bloating,
bloody diarrhea and signs of dehydration—including the veins on the back of
the hands and elsewhere becoming invisible.
People with an ileostomy may experience
these signs differently. When I had
flu, my ileostomy produced enough output to fill my pouch in just a short
time. I felt nauseous and developed
abdominal discomfort. I rapidly began
to experience the symptoms of dehydration, which include a dry mouth, decreased
or virtually non-existent urine output, heart irregularities and dry skin.
In my case, I could see my urine output
had ceased as I have a urostomy as well.
This is a medical emergency! In
less than a 15-minute trip to the hospital by ambulance, the driver remarked
that I had visibly deteriorated during the trip, even with a saline IV being
administered. If hospitalized for
dehydration, you may expect IV solutions to be given. The fluid given will be saline, potassium,
or potassium and glucose to replace those essential electrolytes lost through
diarrhea. Expect an EKG to check for
heart problems, bloods to be taken, and stool and urine samples, to check for
infection, and chest and abdominal X-rays.
Dehydration is a serious medical
emergency that can lead to shock, unconsciousness and death if not treated soon
enough. Delaying treatment can also
lead to kidney damage, which may be permanent, requiring lifelong dialysis or
a transplant. If you become ill with
diarrhea, have vomiting and fever that persist, find yourself with a pouch
continuously filling with fluid, and have little or no urine output, seek
emergency treatment immediately.
Normal people may sneer that we are
making a lot of fuss for a simple “tummy bug” — we are not! It is much more serious for us than for
people with a normal colon.
A Rabbi's son had just received his
driving permit, and approached his father about the use of the family
car. His father said, "I'll make
a deal with you. You bring
your grades up, study your Talmud a little better, get your hair cut,
and then we'll talk about it."
After about a month, the boy came back and again asked his father
about his use of the car.
The rabbi said, "Son, I am
very proud of you. You have
brought your grades up, you've studied the Talmud diligently but you
still didn't get your hair cut."
The young man replied, "You know Dad, I've been thinking
about that too. You know
Samson had long hair, Moses had long hair, Noah had long hair and even
Jesus had long hair." The Rabbi
said, "Yes, son, and everywhere they went, they walked.
My Stoma Changes So Much
UOAA Discussion Board
Q I've had my
stoma for a year and a half and my stoma protrudes between ¾” to flat with my
stomach. One day I can hardly see it
sticking out and the next day it seems huge.
I talked with this to my doctors and they tell me it is
peristalsis. I am not so sure. I know what peristalsis is—the wavelike
motion the intestines have in order to propel the contents from the stomach
to the outside. Is it normal not to be
able to see your stoma? It shrinks
down in so far there's almost nothing there, making it hard to put a barrier
around so it doesn't leak. Then at
other times, it gets big and protrudes just fine. What so you think?
A I would be cautious about dismissing the physicians'
reply so readily. One can have a stoma
situation secondary to peristalsis similar to what you describe—it is not all
that unusual. Without knowing the
nature of your bowel motility and stoma location as it relates to your bowel
anatomy, it would be difficult for me to say anything more certain than the
general comment that peristalsis is quite variable among the general and
ostomy population.
This being said, let me try to explain
why your stoma appears to disappear at times.
Stomas are typically "fixed" in place after a period of time
and the overall appearance and size do not change all that much once all the
post op healing takes place—several months post surgery, on average.
However, in some cases, a stoma can be uniquely influenced by
peristaltic motions, and then it can become quite "mobile" in
position, length and width, and give the appearance of disappearing at
times. When this occurs, it does
challenge one's abilities to ensure a leak-proof seal at times. Of course, if you are not having leaks or
skin irritation then nothing further needs to be done from a pouching
management perspective. If, however,
you were experiencing reduced wear time and/or skin irritation you may want
to consider adding washers, pastes or strips, which are designed especially
for this need, to help fill in the immediate peristomal skin zone, especially
when the stoma is in its small or "disappearing" mode.
Appreciate that you should size the barrier opening for the largest
diameter of your stoma and allow these specially designed pieces—like an
Eakin Seal or a Hollister Flextend Barrier Ring—to fill-in and protect the
skin when the stoma narrows.
Hope this helps your understanding
somewhat.
Mike
D’Orazio, ET
The Final Word on
Nutrition
It's a
relief to know the Truth after all those conflicting medical studies and
misleading TV ads:
The Truth . . .
·
Japanese
eat very little fat and suffer fewer heart attacks than Americans suffer.
·
Mexicans
eat a lot of fat and suffer fewer heart attacks than Americans suffer.
·
Africans
drink very little red wine and suffer fewer heart attacks than Americans
suffer.
·
The
French drink excessive amounts of red wine and suffer fewer heart attacks
than Americans suffer.
·
Germans
drink a lot of beer, eat lots of sausages and fats and yet still suffer fewer
heart attacks than Americans suffer.
Conclusion: Eat and drink what
you like. . . . speaking English is apparently what kills you.
Make Your Skin
Barrier Stick
By Terri Pittman,
CWOCN
I often am asked the question, “Why won’t my skin barrier stick?” This is especially true of people who
actively play sports. A non-sticking
skin barrier can lead to embarrassing situations. You should know that it is usually not the
fault of the skin barrier. A skin
barrier that will not stick is usually due to operator error! Here are some conditions one should
explore.
Moisture on the skin: A
skin barrier will not stick properly if there is moisture on the skin. After removal of the skin barrier when you
wash, make sure the skin is dry, bone dry, before putting on a new skin
barrier.
Insufficient application of pressure: In order for a new skin barrier to
stick, pressure must be applied to the skin, particularly at the center edges
near the stoma. In addition, holding
one’s hand on the skin barrier after applying it allows the heat from one’s
hand and the extra pressure to help it stick to the skin. If the skin barrier does not seem to be
sticking very well, holding it on the skin for a few moments usually does the
trick. A skin barrier is not like a
common bandage. It takes heat and
pressure to make it stick and not just physical contact.
Water-soluble foreign matter on the skin: This would include residual soap, skin
preparations, dried perspiration or mucus.
Perspiration and mucus should be washed off with water. If only wiped off, a thick coating of dried
matter is left on the skin. Then,
stomal output or additional perspiration will dissolve and undermine the
adhesive.
Touching the adhesive before application: Moisture, skin cells and other material
transfer from your fingers and reduce adhesion. This does not mean that if one touches the
skin barrier that it is ruined. We
recommend handling the skin barrier as little as possible and only with clean
dry hands.
Loose solid particles on the skin:
This would include powders, flaky skin or an overabundance of dead
skin cells. Stoma powders and
anti-fungal products are usually manufactured to adhere quite well if applied
properly, as taught by an ostomy nurse.
Subjecting the adhesive bond to stress too soon after
application: It takes a few
moments for the adhesive to bond onto the skin. A quality skin barrier will flow into the
microscopic irregularities of the skin and develop total contact and maximum
adhesion.
Over stretching the skin under the adhesive area: Adhesives will release when the surface
to which they attached is overly stretched.
If one’s skin barrier always comes loose in the same place, chances
are that one’s body movements are over stretching the skin at that
point. Try to stabilize the skin by
applying a one-inch or so wide tape around the edge of the skin barrier. Most people with ostomies that perform
aerobic and stretching exercises; play tennis or golf; swim, hike, box,
wrestle etc. never have an issue with the skin barrier becoming loose.
A majority of tape adhesion issues are due to physical skin
injury.
1. The skin has the epidermis—outer
layers—and the dermis—inner layers.
Since the tape is placed on the outer layer, if this is done with
tension, the constant pull of the outer layer can cause a strain on the bond
with the other layers. Thus causing
irritation or an actual separation between layers forming blisters. The same effect will also take pace if
swelling occurs after an adhesive backed pouch is in place. To prevent this type of injury, gently place
the tape on your abdomen without tension and then press down with a firm rubbing
motion.
2. Skin damage may also be
caused by rapid removal of adhesive tapes.
To remove a skin barrier, pick up a corner of the tape and push the
skin away from the adhesive. Skin
trauma I reduced substantially if you push the skin and do not pull the tape.
3. Chemical irritants that are
trapped between the adhesive and the skin may also cause redness of the skin
and prevent the skin barrier from adhering to one’s satisfaction.
4. Usually, the irritant is residual soap—Ivory is a known
offender—skin preps that are not completely dry; deodorants, which should
never be near the peristomal skin; antiseptics and other outer layer skin
coating like lotions or sunscreens.
5. Chemical substances from
within the body may also cause irritation and reduce adhesion. When these by-products are trapped under
non-porous tape or the skin barrier itself, the increased concentration on
the skin surface may be reason for concern.
Another cause of skin irritation is small quantities of effluent on
the skin that is not removed quickly.
The enzymes present with an ileostomy do not know the difference
between one’s skin and a piece of steak—they dissolve both equally well.
With a
urostomy, alkaline high pH urine does the most damage. Certain foods like cranberry juice will
usually lower the pH and minimize the issue.
If skin prep is used for protection, be sure it is non-water
soluble. Never use a skin preparation
with an extended wear barrier like ConvaTec’s Durahesive or Hollister’s Flextend
brand. Extended wear barriers are
manufactured to be applied directly to the skin, where they bind with
it. A skin barrier prevents this
binding by blocking the process
Stenosis of the
Stoma
UOAA Discussion Board
Q
I was wondering, could anyone
tell me what the signs and symptoms are for stenosis of an ileostomy
stoma? In addition, what is the term
when the stoma is too big in diameter for the abdominal opening it protrudes
through?
A
When the stoma becomes congested
or swollen secondary to stenosis it is termed edematous. In essence, the blood and lymph supply to
the stoma is now becoming compromised secondary to the tightening effect of
the stenosed or narrowed stoma at the skin and or fascial levels. The skin around the stoma may look as if it
has “puckered” due to the peristomal skin and associated tissue shrinking
around the stoma and strangling it.
The stoma will look like a soft balloon like when you would squeeze to
obtain a little globe between your fingers.
The effluent may come out in spurts as if it has trouble getting out
of the stoma. You may actually feel
your belly move when you have stoma flow because the skin around the stoma is
so tight. If the blood and lymph flow
is not allowed to remain normal in both directions then some backing up or
retention of the fluid in the blood or lymph networks will occur and present
itself as a swollen part of that organ, in this case the exposed part of the
stoma.
Mike D’Orazio, ET
Growth on Stoma
UOAA Discussion Board
Q I recently noticed a small growth on my stoma. It is like what is called a skin tag, a
small barely attached mole. The one on
my stoma is about the diameter of a strand of cooked spaghetti, just over
1/8” long, perpendicular to the stoma and very near the base. It is the same color as the stoma and so
far has not been a problem. Does this
little critter sound like a granuloma and if so, is it a cause for any
concern?
A The term granuloma pops up regularly enough in the ostomy
lexicon, and perhaps it is useful to differentiate granuloma from many other
peristomal processes, especially the most common description of any bump or
lump that is typically called a nodule.
Appreciate that "nodules" themselves can have many unique
identifiable traits and arise from many different causes as well as be
related to concurrent diseases throughout the body or arise alone.
For example, your written description of the small growth, which
mimics the stoma appearance or coloring, emanating from the stoma edge outward
may be mucosal cell proliferation or migration and not a true granuloma at
all. Often times when a stitch is
placed along the mucosal edge and skin, as occurs when the stoma is created,
the direction the surgeon uses to pull the suture through the skin and stoma
edge could influence the occasion of the mucosal growths which are often
times characterized generally, but inaccurately, as granulomas.
Another type of "granulomatous" appearing peristomal skin
lesion occurs around colostomy stomas when too much skin is left exposed to
the less irritating stool as found in a left sided colostomy. Years ago, many ostomy nurses used the term
acanthosis to describe the unsightly appearance of skin exposed to urine around
a urinary stoma. As the years went by,
we changed the term to pseudo/epitheliomatous/hyperplasia (PEH). Now, we call the same skin process a
pseudoverrucous lesion. Each change in
terminology was an attempt to better clarify and define the state of the
exposed skin changes.
No doubt, I have not made the issue of "granuloma" at stoma
sites clearer but my hope is that we will appreciate the greater complexity
of skin changes that can occur around a stoma from many different causes.
On a related subject, when I referred to a left-sided colostomy, I was
referring to the left side of the colon, be it a descending or sigmoid part
of the colon, and not to the left side of the body or abdomen. Appreciate that any stoma can be placed on
the left or right side of one's abdomen or body, and this placement of the
stoma would not necessarily determine the functional location of the opening
or stoma within the bowel or urinary tract.
For example, one could have an ileostomy stoma positioned on the left
side of the body or along the upper portion of the abdomen, and conversely
one could have a descending colostomy stoma placed along the right side of
the abdomen. The factor that
ultimately determines how the stoma will function—when we discuss output or
frequency—are a number of factors other than where the actual stoma end is
positioned on the body surface. A
common consequence of stomal revision is to have a stoma moved from one side
of the abdomen to another without any significant change in stomal behavior
or output properties.
Mike D’Orazio, ET
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