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Volume 29, Number 7 April, 2002
PREPARING FOR YOUR OSTOMY SURGERY
By: Rodney Crick, Editor, The “Re-Route”
What can a person, or should a person do to prepare for having ostomy
surgery? Learn as much as you can about the type of ostomy you are going to have
created, where it will be located, what it will look like, how it will function,
and what you will need in the way of supplies to care for it. ConvaTec and Hollister both have informational booklets and videos available that explain a great deal about the different types of ostomies and how they are cared for. They are available by contacting these suppliers direct. Both have web sites and toll free numbers.
Discuss any concerns you may have with your surgeon ahead of time. The surgeon you choose should be experienced in the number of ostomy surgeries performed. Ideally the stoma he or she will create should protrude outward from the abdomen at least one half inch for ileostomies. Patient’s that have stomas that are created flush with the skin tend to experience more skin excoriations with ileostomies and some colostomies. During peristalsis, the skin surrounding the stoma will pull inward with the result being that discharge containing enzymes will get between the barrier and the skin causing the pouch to fail, excoriating the skin.
Ask the hospital where you will be having surgery to help you arrange for an ostomy visitor. You have a right to ask for and receive a trained Ostomy visitor through the local chapter of the United Ostomy Association. They can match you up with a visitor that has undergone the same type of surgery you will be having and who can answer many of your questions and calm your fears and anxiety. Ask the visitor if you can call them later with any further questions you might have.
Ask the hospital where surgery will be performed if they have an Enterestomal Therapy (ET Nurse) on staff that you can visit to have your stoma site marked prior to surgery being performed. This allows the surgeon to place the stoma on the abdomen in the area that is least likely to be obtrusive or cause pouching problems after surgery. Your stoma will be easier to care for if it is not created in a beltline, fold, or scar tissue crevice in your skin and will result in better adhesion of the wafer, with fewer leakages and skin problems. The ET nurse can also show you samples of the pouch you will wear during your stay in the hospital. During this visit, make sure that the ET will show you how to change your wafer and pouch and teach you the basics of stoma care before you leave the hospital.
Adopt a positive mental attitude and realistic expectations about your surgery and life afterward. Face the realization that you are not the only person this has happened to in life. There are about a million people out there in the U.S. alone whose ostomy surgeries have allowed them to conquer disease and lead normal healthy lifestyles filled with work, activities, play and relationships. Realize that you must give yourself time to heal following surgery, but do expect to become one of them.
THE FOUR PHASES OF SURGICAL RECOVERY
By: Dr. Albert G. Wagoner, Via: Sonoma, CA & Hemet-San
Jacinto, CA
Each patient, along with the family, usually goes through four phases of recovery, following an accident or illness that results in loss of function of an important part of the body. Only the time required for each phase varies. Knowledge of the four phases of recovery is essential. They are:
The Shock Phase—The period of psychological impact. Probably, you remember nothing of this phase after your operation. Nevertheless, it is a phase that requires a lot of support.
The Defensive Retreat Phase—The period in which you defend yourself against the implication of the crisis. You avoid reality. Characteristic in this period is wishful thinking or denial, or repression of your actual condition. For example, an ostomate believes that his/her entire colon is still there and will be connected later.
The Phase of Acknowledgment—In this period, you face reality. As you give up the existing old structure, you may enter into a period, at least temporarily, of depression, apathy, agitation, or bitterness and of high anxiety. You hate your stoma, yourself, you cry a lot, pity or condemn yourself. You may not eat, be unable to sleep or want to be left to die. In this phase you need all the support that can be mustered.
The Phase of Adaptation—Now, you actively cope with the situation in a constructive manner. You adapt, during a shorter or longer period, the adjustments that are necessary. You begin to establish new structures and develop a new sense of worth, with the aid of an
Enterostimal therapy nurse and an ostomy visitor, you can learn about living with an ostomy. Aided by your physician, social workers, ostomy association and family, you go about rebuilding and altering the life that brought about the condition. Sound familiar?
MEASURE YOUR STOMA
by Alice Bowman and Bob Baumel, June 1997, Stillwater-Ponca City (OK) Ostomy Outlook
One of us recently visited a patient with a two-year-old colostomy. The patient was suffering from severe skin irritation caused by using appliances with pre-cut stoma openings of the same size as originally measured in the hospital.
Immediately after surgery, the stoma is quite swollen; it then shrinks for about the next six months--sometimes for a year or longer. During this initial period, it is best to use a cut-to-fit appliance and measure your stoma every time you change the barrier. Once your stoma size has stabilized, you may switch to a pre-cut appliance if you wish; however, you should continue to measure your stoma occasionally, to see if you should switch to a different size appliance.
If you fail to adjust your appliance size as your stoma shrinks, you'll eventually be using an appliance with an opening much bigger than your stoma. This leaves a large area of unprotected skin around your stoma, making you a prime candidate for skin irritation.
If you've had an ostomy for many years, perhaps you've forgotten that initial period while your stoma was shrinking. However, if you find yourself visiting a new ostomate, this is a topic you may wish to discuss if you have the chance.
How big is the optimal appliance opening? For most types of barriers/faceplates, the opening should provide clearance of a millimeter or two all around the stoma. On the one hand, you should minimize the area of unprotected skin around the stoma; on the other hand, some clearance is usually necessary because many barriers contain hard materials (including plastic films) that can damage the stoma if they come in direct contact. Please note, however, that some of the newer barrier materials, such as Hollister's Flextend® and ConvaTec Durahesive®, are more protective and contain no hard materials, so they don't require any clearance.
WARNING ON LAPAROSCOPIC COLON SURGERY
Via: The Ostomatic News, Dallas TX.
Laparoscopic surgery for colon cancer may not be a better option than more invasive surgery. A study published in the Journal of The American Medical Association suggests that laparoscopic, or keyhole, surgery does not necessarily mean a quicker recovery for patients. In the study, researchers looked at 428 colon cancer patients who were randomly assigned to have either laparoscopic or open surgeries to remove their tumors. They found that the laparoscopic patients required almost as much pain medication as patients who had larger incisions and were able to go home an average of only one day sooner. The researchers are continuing their study to see whether there are any differences in long-term survival and quality of life between the two surgeries, the Associated Press reports. In the meantime, they say their findings suggest no reason to recommend laparoscopic surgery for colon cancer.
A TRUE STORY THAT PACKS A POUCH—UH PUNCH!
By: Goergene Whiteway, Tulsa OK. Via: Metro Halifax News & Regina Ostomy News , Canada
After years of struggle, I finally faced the inevitable and had surgery which resulted in an ileostomy. I endured the same fears, depression and hopelessness common to anyone undergoing this type of traumatic procedure. With the total support of my family, I faced each day of my hospitalization. Finally, a milestone—I would get to see my 10 year-old daughter! It meant walking all the way to the visiting area, but , rolling my IV stand and holding on to my sister-in-law, I knew I would make it.
My nurse placed a fresh ileostomy bag on me and I started my “journey”. Within a few minutes, I felt fluid draining down my leg and knew the bag had broken. Back to my room. Call the nurse. Replace the bag. Start again.
Halfway there, the bag broke again. Is this what my future was to be? Was there something about me that caused the breakage? I was in tears as the nurse placed a new bag on me.
When the third bag broke, my morale was completely destroyed. My daughter was still waiting, crying now to see her mom.
A new nurse came in and in a matter of seconds was able to turn disaster into a quick and happy reunion with my badly shaken daughter.
What magic did this new nurse perform? None. But she did know that drainable pouches require a clip at the end to hold liquids in!
Yes, the first nurse had been “exposed” to ostomy care, but her skill was so minimal that she could not identify the various forms of pouches. As a result, she inadvertently put me through 60 minutes of sheer hell.
Will I help promote familiarization training in our hospitals? You bet!!
OSTOMATES AND SEXUAL FUNCTIONING
From “Sexual Counseling for Ostomates”, By: Ellen A Shipes, RN, MN, ET, & Sally T. Lehr, RN, MN, Via: Metro Maryland & Hemet-San Jacinto, CA.
Fear and misunderstanding often result in the assignment of unnatural or supernatural qualities to that which is unknown. This article will present factual information about ileostomies and urostomies that will dismiss the fear and dispel the misunderstanding.
Ileostomies do not possess the extensive attributes of colostomies. They are more uniform in size and shape. Like the individuals they are a part of, however, no two are exactly the same.
Ileostomies are usually permanent. They are most often performed to remove disease such as ulcerative colitis and occasionally cancer. Since ileostomies are made in the small bowel, they are usually smaller than colostomies but have the same red color.
Urostomies are the most varied of all the stomas in name, location, size, and color. Urostomies are done because of trauma, congenital defects, or disease, but the ultimate reason is to protect the kidneys by removing or bypassing the damaged, effective, or diseased portion of the urinary tract. The urine is diverted to the abdominal wall by various methods. Location of the urostomy in the urinary tract determines the name.
Stomas formed from part of the urinary tract will be pink, not red, due to a difference in tissue structure between the intestinal and urinary tracts. Bowel conduits will be red because they are constructed from a portion of the intestine.
Verbal and mental exclamations of “Gross!”, “Ugly!”, “Monstrous!”, “I can’t stand it!”, “It’s a sore!” and the like may be expressed by ostomates and their partners following surgery. Indeed , only members of the medical profession can truly gaze upon a stoma and its accompanying incision
and state, “How Nice! It looks great!” Although the ostomate and partner may react poorly to the initial results of surgical intervention, the stoma itself should produce no physical change in sexual functioning once the individual has recovered from the surgical procedure.
Since the stoma is often bright red and appears sore, it is commonly thought that sexual activity will cause stomal damage and pain. Because the bowel and stoma have no nerve endings, even vigorous sexual activity should not result in pain. Slight stomal bleeding may be noted following an especially energetic lovemaking session because of the fragile nature of the stomal blood vessels. There is no cause for alarm as long as the bleeding remains minimal and does not persist for several hours.
The maintenance of sexual functioning varies widely following surgery. In men, the scope of physical change depends solely on the degree of damage to the nerves controlling erection and ejaculation. Radical resection required for removal of malignancies of the bladder and rectum imparts a high degree of erection difficulty (impotence). In regard to surgery performed for colon cancer, studies cite the frequency of impotence as ranging from 24 percent to 75 percent. Since a major part of sexual functioning depends on the desire, expectation, and motivation of the individual and partner, it is unwise to assume that erection failure is a foregone conclusion.
For women, the physical damage is not so extensive. Removal of the vagina or persistent coital pain are the only physical conditions that should preclude Each ostomate must be considered individually and all ostomates and their partners should have sexual counseling incorporated into their pre-and postoperative teaching. This will aid in reducing both fear and the psychological difficulties which frequently accompany ostomy surgery.
GO BANANAS!
Via: Battle Creek Chapter, Straits Area Ostomy Assn., OAB Farmington, MA & Indianapolis, IN Chapter
Bananas are nature’s drug store...much more than just a delicious fruit. They consist of substances which contribute to health just as if they were a medicine obtainable in prescription. They have become notable for their rich supply of potassium.
Most diuretics are given to get rid of surplus fluid in the tissues, relieving the burden on the heart, lowering the blood pressure and reducing the swelling of the ankles as well as puffiness in other parts of the body. But they get rid of potassium, resulting in muscular weakness and other distressing symptoms. The doctor prescribes drugs and food rich in potassium, and bananas are highly recommended.
There is no cholesterol in bananas. For persons who have cardiovascular conditions and must be on low cholesterol diets, this is important. Bananas contain little sodium. Low sodium diets are often used with diuretics to get rid of surplus fluid. This combination helps to reduce weight.
Weight watchers find that eating a ripe banana half hour before meals greatly suppresses the appetite. As a bonus, the banana supplies vitamins A B-Complex and C and twelve minerals.
ONE WORD OF CAUTION: The day before urinalysis, don’t eat bananas! They contain a chemical, norepinephrine, which could interfere with certain tests.
More on bananas…..
Have you ever suffered agonizing chest pains after taking medications? Medical experts say that drug-induced esophagitis can result when capsules and pills linger in the esophagus for lengthy periods of time if swallowed with small amounts of water. This is particularly true if the patient is lying down. According to experts, the solution to this problem is to drink a lot of water (a cup full ) and remain standing for a few minutes after taking the pill. “These suggestions are not always easy to follow,” states Dr. Hans H. Neuman of Wilton, CT. in an article in “The Journal of The American Medical Association.”
Dr. Neuman further states that, “a simple method that is… useful for recumbent patients is to swallow a few bites of banana.” It will melt and provide a smooth coating that adheres to the tablet or capsule with the bulk of the banana.
OSTOMY HINTS & TIPS
Colostomates: To make inexpensive stoma covers, use Job Squad Paper Towels, which are soft, thick and feel almost like velvet. Cutting the sheets in half and folding them will make 100 stoma covers for less than $1.00. If you need to make them really moisture proof, put a piece of plastic wrap between the fold.
Ileostomates: If you have irritated skin around your stoma, you may want to use a powder with a pectin base (Stomahesive) According to Karen Schankweiler, RN, WOCN, the correct way to apply the powder is first of all to clean the skin well with water and then dry the skin thoroughly. Dust the skin with powder, rub in well and brush off excess. The wafer can be applied directly over the powder or you can seal it by patting a sealant over the powder and allowing it to dry. The wafer is then applied. Powder is not needed routinely, as the new barriers are designed to adhere to the skin.
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