United Ostomy Association, Inc.
Evansville, Indiana Chapter
Re-Route

 
Contents:

GO WITH YOUR 'GUT INSTINCT'
WHAT KIND OF OSTOMY IS THE BEST
GETTING A NEW DOC!
COMPARING THE ILEOSTOMY AND COLOSTOMY
CANCER RISK WITH ULCERATIVE COLITIS
A NEW DRUG FOR ULCERATIVE COLITIS
CENTERING YOUR POUCH
ASK THE ET NURSE
CARTOONSVILLE

Re-Route Archive

Volume 27, Number 8  April, 2001

GO WITH YOUR 'GUT INSTINCT'
By: Jerome Groopman, MD, author of Second Opinions from: Old National Bancorp “Healthy Thoughts” April 2001
Jerome Groopman, MD, is a believer in gut instinct, or intuition. And he believes people facing any kind of serious or chronic illness will find this “sixth sense” a powerful tool as they navigate the world of medical technology and busy doctors. Dr. Groopman, a Harvard Medical School researcher and physician, says it’s crucial for both patients and their doctors to use every tool available when making a diagnosis and figuring out a treatment plan—including nonscientific ones like communication, trust, teamwork and intuition. Unfortunately, says Groopman, “Intuition is not given an opportunity to grow in the current (health-care) system.” Doctors and patients alike are not encouraged to “think out of the box.” Too often, doctors just don’t have the time. Groopman encourages patients to speak up when they sense something is not right. “Intuition is a vital force in terms of guiding both diagnosis and treatment,” he says.

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WHAT KIND OF OSTOMY IS THE BEST
Via: Hemet San Jacinto CA, UOA
Have you ever noticed that everyone thinks their own ostomy is the best? The colostomate says, “I couldn’t stand to wear that pouch all the time. It would drive me crazy”! The ileostomate says, “I couldn’t stand having to irrigate or wonder when my pouch would get full. I’d rather just wear my pouch all the time and not have the bother.” The continent says, “I’d rather catheterize than have to wear a pouch all the time.” The pull-through says, “I couldn’t stand having a stoma. I’d rather go to the bathroom several times a day.” The urostomate is strangely silent, but is thinking to themselves, “I’m so lucky, because I only have to use the bathroom once a day.” What kind of ostomy is the best? Why mine is of course!!!

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GETTING A NEW DOC!
Bill Capman, Worcester Ostomy Association, Via: “The Optomist”, Greater Seattle Chapter, UOA
Changing doctors is always an uneasy time and is especially difficult for someone with an ostomy. Many primary care physicians do not have much experience with ostomy care and are not familiar with the different kinds of problems that can occur, ie: skin irritations, blockages, proper appliances, diets, and emotional problems. If you are joining an HMO for the first time, it is very important, after choosing an HMO primary-care doctor, that you set up a “get acquainted” appointment. You should ask how much experience he/she has treating ostomy patients and most important, how readily he will refer you to a specialist. This, of course, applies to any chronic ailment not just to ostomies. Trust your instincts—if you don’t have confidence in a doctor when you’re healthy, odds are you won’t like him/her when you’re sick. Most HMOs will pay for the appointment.

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COMPARING THE ILEOSTOMY AND COLOSTOMY
Via: Macomb CO, MI Chapter & Hemet San Jacinto CA, UOA
If I am a stoma, my color should be a healthy red. I am the same color as the inside of your intestine. If my color darkens, the blood supply might be pinched off. First, make sure your pouch is not tight. (It should fit 1/16th to 1/8th inch larger than your stoma.) If this is not a solution, call your ET nurse or physician. If it should turn black (very unlikely, but it happens occasionally), seek treatment at once. Go to an emergency room if you cannot locate your doctor. Be sure to remove your pouch for them to examine your stoma. Take extra pouches along. I might bleed a little when cleaned. This is to be expected. Don’t be alarmed. Just be gentle, please, when you handle me. If I am an Ileostomy , I will run intermittently and stool will be semi-solid. If you notice that I am not functioning after several hours and if you develop pain, I might be slightly clogged. Try sipping warm tea and try getting in a knee-chest position on the bed or on the floor. Have your shoulders on the floor and your hips in the air. Rock back and forth in an attempt to dislodge any food that might be caught. If I do not begin to function after about an hour, call your physician. If you cannot locate him readily, go to an emergency room. In the meantime, I might have begun to swell. Remove a tight pouch and replace it with a flexible one cut slightly larger. If I am a Colostomy , located in the descending or sigmoid colon, I should function according to what your bowel habits were before surgery (daily, twice daily, three times weekly, etc.) I can be controlled, in most cases with diet and/or irrigation. This is a personal choice. There is no right or wrong to it as long as I am working well. My stool is fairly solid. If I am a Urinary Diversion, I should work almost constantly. My urine should be yellow, adequate in amount and will contain some mucous. If my urine becomes too concentrated or dark, try increasing your fluid intake. If my mucous is much more excessive than usual, I might have an infection. Please seek help. This cause needs evaluation and correction.

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CANCER RISK WITH ULCERATIVE COLITIS
By: Steve P. Bensen, MD, Assistant Professor of Medicine (Gastroenterology) Dartmouth Medical School, Via: “The Ostomist” Greater Seattle Chapter, UOA
People who have had ulcerative colitis for more than seven to ten years are at increased risk of developing colon cancer and need to be screened aggressively for the disease. The risk depends on the duration of illness and how much of the colon is involved. Patients who have had the disease longer and have had pancolitis are at higher risk. Those who have had the disease for a decade may have a 5 percent to 10 percent higher chance of developing colon cancer. After thirty years, this increases to a 15 percent to 40 percent chance. The severity of the symptoms and the number of flare-ups over time do not appear to influence the risk of developing colon cancer.

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A NEW DRUG FOR ULCERATIVE COLITIS
Source: Crohn's-Colitis Foundation of America, Via: The Ostomatic News, Dallas, Area Chapter
COLAZALTM(balsalazide disodium), manufactured by Salix Pharmaceuticals, Ltd is now available in the United States for patients with mildly to moderately active ulcerative colitis. Shipments of this new IBD medication were sent out to drug wholesalers in late December, ready to be ordered by local pharmacies in January. COLAZAL, a sulfa-free 5-ASA product, is the first entity approved by the FDA for the treatment of ulcerative colitis in seven years. It treats ulcerative colitis by delivering the active anti-inflammatory medication directly to the colon, where it appears to work topically. A number of drugs that contain 5-ASA are currently used to treat IBD. 5-ASA is the active ingredient of sulfasalazine, which has been a standard IBD medicine for many years. Sulfapyridine, the portion of sulfasalazine that carries 5-ASA to the intestine, is responsible for most of this drug’s side effects. To reduce these side effects, several drugs have been developed that deliver the 5-ASA molecule without the use of the sulfapyridine carrier. Examples are olsalazine (Dipentum TM) and mesalamine (AsacolTM, PentasaTM). COLAZAL, which has been available in Europe for some time, links 5-ASA to a carrier molecule that is less toxic than sulfapyridine. COLAZAL is approved for up to a 12-week course of therapy. During the course of clinical investigations, the most common side effects were headache and abdominal pain was formerly known as Colazide in the United States prior to approval by the FDA in July 2000). If you or your physician would like more information, please visit Salix’s Web site or call Salix at (888) 802-9956 ext. 4099.

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CENTERING YOUR POUCH
Via: Indianapolis Chapter
A well-fitted pouch does not allow for much margin of error. Consider this: the correct opening size is determined by measuring your stoma’s diameter with a measuring card and adding one eighth of an inch. This means your pouch must be centered exactly and carefully each time. How do you do this? Good lighting is important, preferably from both above and the side. Stand sideways to the light source for better visibility. A wall mirror is a great help to see that the appliance hangs straight. A crooked pouch exerts uneven pressure on the skin and stoma and can only lead to trouble. Don’t rush! Take time to check placement carefully before allowing your skin barrier to make contact. No time is saved if you have to do the whole thing over again because the pouch is crooked or uncomfortable. Remember, if your pouch feels out of place or uncomfortable, TAKE IT OFF! Don’t wait for an injury to occur. It is better to change unnecessarily than to risk damaging the precious stoma. You have to live with it for a long, long time.

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ASK THE ET NURSE
Answered by Karen Schankweiler, RN,WOCN , Via: Harrisburg Ostomy Association, PA.
What is the difference between Stomahesive and Durahesive wafers? All skin barriers are alike, varying widely in durability and resistance to breakdown by feces and urine. Basically, there are three skin barriers. Karaya is a polysaccharide gum from the Sterulia tree. It melts in high temperatures and burns denuded skin, and dissolves with urine. Pectin-based barriers (Stomahesive) are composed of sodium carboxymethyl cellulose, pectin and gelatin covered with a polyethylene film.They don’t melt at high temperatures or burn denuded skin, but they do dissolve in urine. Newer synthetic barriers, called extended-wear barriers (Durahesive—Convatec, Flextend—Hollister) have synthetic components that are more resistant to erosions by enzymes, high liquid volume and alkaline or markedly acidic output. This permits them to remain on the skin for longer periods of time than conventional skin barriers. I have an ostomy, but my rectum is still intact. Can I remain like this indefinitely? Yes. If you have a colostomy the surgeon may have removed only the diseased portion of the bowel, such as diverticulitis, and left the rectal stump intact. This is done so the bowel can be put back together at a later date. The inner walls of the rectum will continue to secrete mucous, so at times you may pass thick gray mucous rectally. A person with a permanent ileostomy usually has the rectum removed at the time of surgery.

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