Ostomy Association
of Southwestern Indiana
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ILEOSTOMY RETRACTION
by Gail Wilhite, RN, ET from Metro MD & GB News Review
An ileostomy stoma should be at least 3/4 inch in length and some surgeons advocate a longer length of 1 to 1 1/2 inches. A spout-like stoma is necessary to deposit the effluent into the bag preventing pooling of contents at the base of the stoma. Conversely, a stoma that is too long is subject to external trauma and injury. Weighing the consequences, it is preferred to have a stoma somewhat too long than one too short. There is a difference between the creation of colostomy and ileostomy stomas. Frequently, when fashioning a left-sided colostomy, the surgeon will create a flush stoma. The contents of the left colon are relatively inert and usually regulated with irrigation, therefore, little or no functional problems occur with a flush colostomy stoma. An ileostomy stoma is never constructed as a flush stoma; nevertheless, sometimes the stoma may retract for various reasons. The common cause of stomal retraction is post-op weight gain. Prior to their operations, most ileostomates have lost considerable weight. Following surgery, weight gain can be rapid, and many times, excessive. What once was an adequate stoma, now retreats within the expanding environment. Another cause of retraction may be inadequate fixation of the opposing serosal layers following eversion. If these layers fail to adhere, healing and subsequent scarring may tend to draw the stoma into the abdomen. Problems resulting from retraction are decreasing adherence of the appliance and skin breakdown. The pooling of the excoriating intestinal contents cause the loosening of the adherent bond resulting in leakage of ileal effluent on the skin. This skin-effluent contact naturally produces breakdown. The combination of irritated, weeping, peristomal skin and continual pooling leads to an unbearable situation, which must be remedied. The treatment for a slightly retracted stoma is the use of a convex faceplate. The convexity applies pressure on the skin surrounding the stoma, thus pushing the stoma up. When using a convex faceplate, it is important not to lose the convexity by applying thick washers or foam pads, etc.. The skin and faceplate should suffice to maintain the advantages of both convexity and skin protection. If the use of a convex faceplate proves unsuccessful or if the retraction is severe, then surgery is advised to create a new, longer stoma.

FISH IS HEALTH INSURANCE AND MOST OF US LACK ENOUGH COVERAGE
Via: Hemet-San Jacinto, CA. Stoma-Life Newsletter
Eat fish! You’ve heard it before, but now the case is so compelling that you absolutely must pay attention or face overwhelming health risks. Fish’s secret is its unique oil (omega-3 fatty acids), which is essential for proper cell functioning. But most of us get only 15% of the omega-3 we need.
Here’s the latest research on fish oil’s life-saving potential:
- - Men: Drop-dead protection. More than 250,000 Americans die suddenly of heart attacks every year; half have no warning signs. Yet, eating fatty fish could stop an astonishing 80% of such deaths in men, says new Harvard research involving 22,000 male physicians. It’s the first time fish oil has been found to save lives in people with no history of heart disease. Men with the highest blood omega-3 fats had the lowest risk, because fish oil prevents the irregular heartbeats that trigger instant death in heart attacks.
Women: Heart attack antidote.
The more often women eat fish, the less likely they are to have a heart attack or die of a “cardiac event,” says other Harvard research, tracking 85,000 female nurses. Eating fish only once a week cut heart attack risk by 29%; the figure jumped to 34% in women who ate fish five times a week. Researchers credit the omega-3 fat in fish. Cuts strokes. Fish was even more dramatic in preventing strokes in the nurses. Women who ate fish more than five times a week suffered half as many strokes as occasional fish eaters. Primarily, strokes are due to blood clots. Like aspirin, omega-3 oils discourage clots and have anti-inflammatory action.
Cancer block.
New French research has found that women with the highest omega-3s in breast fatty tissue were nearly 70% less apt to have breast cancer than women with the least omega-3s. In a new Swedish study, women who ate fatty fish twice a week cut their risk of endometrial cancer by 40%, compared with women who ate fatty fish less than once a month. The same Swedish investigators found prostate cancer rates were two or three times higher in non-fish eaters than in men who ate moderate or high amounts.
Brain food.
Fish eaters are less apt to be depressed, violent, suicidal and antisocial. Probable reason: Omega-3 boosts serotonin, the brain’s feel good chemical. Eating fatty fish also may help prevent and treat Alzheimer’s disease, says Canadian researcher Julie Conquer. She found low omega-3s in elderly people who were intellectually impaired or diagnosed with Alzheimer’s. Fish oil is essential for fetal and infant brains; in Danish research, pregnant women who ate fish once a week cut their risk of premature delivery by a third.
Tips: fish and cooking for the greatest omega-3 benefit.
Buy the fattest fish. Try mackerel, anchovies, herring, sardines, salmon, tuna and turbot. Frozen and canned are OK, the USDA says. Eat enough. Daily, if you eat 2,000 calories, get at least 650 milligrams of omega-3, experts say.
A week’s quota might be ONE of these:
* 6-ounces fresh mackerel
* 10 ounces canned sardines
* 11 ounces pickled herring
* 12 ounces fresh salmon
* 13 ounces canned salmon
*14 ounces fresh tuna
* 24 ounces canned albacore tuna
*Weigh before cooking
Cook Correctly. Deep-frying destroys the benefits. Best cooking methods: bake, broil, poach, steam, stir-fry, sauté or stew.
Cut back on bad fats. They neutralize omega-3s. Restrict trans fats (margarines, processed foods) and omega-6 fats (corn oil, regular safflower or sunflower oils, soybean oil). Use olive oil and canola oil. Get the right ratio. It’s critical that the ratio of omega-3 to omega-6 be no more than 1:4. Most Americans’ ratio is about 1:15.
Don’t eat fish? Take fish oil capsules. If you’re on medication, or taking fish oil for a specific problem, check with a doctor first. OK on your own: 800-1,000 mg of omega-3 supplements daily.
Caution. Pregnant women, nursing mothers and young children should avoid eating shark, swordfish, king mackerel and tilefish, which may contain high levels of mercury.

CROHN’S DISEASE & ULCERATIVE COLITIS
By Michael C. Brown, MD, Via: Healthy Perspectives, Prince William Health System, Manassas, VA, & Ostomy Association of Ft. Worth, TX.
Although Crohn’s disease and ulcerative colitis are complicated diseases with potentially serious consequences, with prompt and proper treatment, most people diagnosed with either of these conditions are able to lead, normal, productive lives. Crohn’s disease and ulcerative colitis are forms of inflammatory bowel disease (IBD) and are distinct from Irritable Bowel Syndrome (IBS) explains Dr. Michael C. Brown, a gastroenterologist who practices at Prince William Hospital. Crohn’s disease and ulcerative colitis are both caused by immune system dysfunction. In the case of ulcerative colitis, the body’s own immune system attacks the lining of the colon, while in Crohn’s disease, problems can develop not only in the colon but also in the small intestine “and in unusual cases”, the stomach and esophagus,” says Dr. Brown. The exact causes of these diseases, says Dr. Brown is not clear. “Both diseases are more common in developed countries, which is true with any autoimmune disease,” he notes. “There is a lot of thought and research going into the idea that the body’s immune response is triggered by a bacteria and then misdirected against the body itself.” In addition, both diseases are influenced by genetic factors. Crohn’s disease and ulcerative colitis usually develop in young people between fifteen and thirty years old and older adults in their seventies and eighties, although it is possible to develop either illness at any age. What can make diagnosis and treatment challenging is that the type and severity of symptoms can vary significantly between individuals. Bloody diarrhea, frequent bowel movements, and feelings of urgency are typical for ulcerative colitis. But for Crohn’s disease, “the symptoms really depend on where the disease is active,” according to Dr. Brown. “If it’s in the colon, it can mimic ulcerative colitis. If it’s in the small intestine you can have more problems with abdominal pain, bloating, nausea, or a combination of these.” Substantial weight loss can also occur, the result of chronic inflammation and poor absorption of nutrients. Anyone with chronic or progressively worsening symptoms of this sort should seek a physician’s evaluation. If Crohn’s or ulcerative colitis is suspected, colonoscopy and biopsy are used to properly diagnose these illnesses. “During colonoscopy, inflammation and ulcers can typically be seen”, says Dr. Brown. “It can be quite severe.” Dr. Brown notes that Crohn’s and ulcerative colitis are typically chronic illnesses requiring “a specific balance of medications and sometimes surgery at some point.” How these diseases are diagnosed and treated is very individualized, explains Dr. Brown. “It’s not one disease, and for each patient, it’s very different.” Dr. Brown stresses the importance of early and proper diagnosis to prevent long-term complications of these diseases. “Malnutrition can be very serious. For children, that malnutrition can affect future growth and development. Chronic ulcerative colitis can lead to an increased risk of colon cancer. And Crohn’s disease can lead to the formation of intestinal strictures.” Developing a good relationship with a physician who will closely monitor symptoms and adjust treatment accordingly is one of the most important steps a patient can take to manage these illnesses, says Dr. Brown. Fortunately, he adds, “Most people are able to go about their lives relatively normally and deal with the disease and its symptoms as needed.”

ILEOSTOMY AND SALT
Via: UOA Resource Library & Ostomy Support Assoc. of Ft. Worth, TX. New Directions
The salt output from an ileostomy is very high, around one teaspoon per day, as opposed to almost none in the feces of a person with an intact colon. Therefore, the proper intake of salt by the person who has an ileostomy is very important. The body, however, seems to compensate for the salt and water loss by discharging less salt than normal through the urinary tract and through perspiration. The intake of too much salt is avoided, in that it increases ileal output. Urine output is generally less with an ileostomy. Therefore, it would be advisable for the person with an ileostomy to increase their water intake above normal so as to increase urine output. In this way, the possibility of kidney stone development can be kept to a minimum.

COMMON COLOSTOMY DIFFICULTIES & THEIR REMEDIES
Via: S. Brevard (FL) Ostomy Newsletter
Painful Cramps During Irrigation
This is usually caused by too-rapid flow of water or too much water. The flow of water can be checked by clamping the tube. The height of the container can also be lowered. Inability to Secure Successful Results from Irrigation This usually results from constipation. Excessive fatigue, nervous exhaustion, or emotional strain can also be causes. Trying to hurry may also be a cause. Relax and take it easy. It will help.
Evacuation Between Irrigations
This usually means that the irrigations aren’t regular or thorough enough. If the irrigation has produced an adequate movement of the bowel, then spillage between irrigations will be reduced to a minimum. Some mistakes or incomplete evacuation with diarrhea can cause evacuation several hours after irrigation.
Worry and Anxiety
If you have reason to think that something is not right, don’t brood about it. Consult your ET nurse or doctor. Most of the time you are worrying about nothing. Remember that your doctor and ET nurse are vitally interested in your welfare and also about your successful return to a “normal” life. They also want to know about any tricks you may have discovered which will help others.
Slow Evacuation
You can stimulate bowel activity by either hot or very cold drinks. Massaging the abdomen or lifting the knees to the chest a few times for that final bit of evacuation will help.
One Trap to Avoid
One trap you must avoid is to let your whole life revolve around your ostomy. Preoccupation with managing an ostomy can sometimes make us fail to realize how important it is to other people. Our families and friends are only concerned that we join them again in our usual activities of work and play. Certainly, we had problems at times, and if we think back, we can remember when we had more than our share. Now we can enjoy a freedom not possible before our surgery. We will continue to have upsets from time to time, but so do those who never had an ostomy. Our own experience, together with the shared knowledge of our fellow members and the advice of our doctors and ET nurses will also see us through these infrequent and unpleasant episodes.