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Volume 33, Number 10 August, 2006
A BIG DEAL OR NOT
By: Mary Jane Wolfe, OA Boston
After undergoing major bowel or bladder surgery such as an ostomy or alternate continent procedure, we all need to decide whether this surgery is going to be a bid deal to us or not.
The first year after surgery is an important one. During this year, we need to remember the following items, among others.
We have gone through major surgery and any surgery demands recovery time. In fact, many healthcare professionals will state that it takes about twelve months to recover physically from major surgery.
During this time we must learn new techniques and procedures in order to perform our routine bodily functions. We will experience failure, especially during the first few months, but if we seek advice from healthcare professionals and our peers who have experienced similar surgeries, these failures should become rare.
We must decide whether we are going to let the surgery change our lifestyle or let our preferred lifestyle change our attitude toward post-surgery daily functions.
We will make individual decisions regarding with whom we will choose to share or not to share this information.
It may take a whole year, but we must decide whether our surgery will be an event in our past.
Don’t get me wrong, I am not trying to trivialize our surgeries. I am merely trying to say that we have the choice of making our surgery a big deal or not and our family and
friends will probably follow our lead. If we make a big deal out of it, they will; if we do not make a big deal about it, they will not. It is your decision, but I for one have more important matters on my mind than my past surgeries.
ACETAMINOPHEN POISONING
From Intelli-Health News
A popular over-the-counter painkiller is the leading cause of acute liver failure in the United States. A recent study that tracked 662 people treated for acute liver failure at 22 transplant centers found that overall, almost half of the cases were related to acetaminophen poisoning—some were suicide attempts, but even more were accidental, the Associated Press Reports. Broken down by year, the researchers found that the rate of liver failure cases that could be blamed on acetaminophen is rising, from 28% in 1998 to 51% in 2003, the AP says.
Acetaminophen—the active ingredient in the over-the-counter pain reliever Tylenol—is very safe when taken in recommended doses. But many people take too much of the drug, either believing it is harmless, or unknowingly taking multiple products that contain acetaminophen at the same time, such as a flu medication and a painkiller, the researchers say.
Experts recommend that adults take no more than 4,000 milligrams of acetaminophen per day from any source, the AP says. The researchers warn that doubling of this maximum daily dose could kill you. Their recommendation: Read all prescription and nonprescription drug labels before taking them, and add up all the acetaminophen to be sure it is no more than 4,000 mg. People who are already more vulnerable to liver problems because they regularly use alcohol or have hepatitis should take less—no more than 2,000 to 3,000 mgs daily, according to one of the study’s authors.
HEALTH CORNER
By Jennifer Rippy, NP Via: Rose City Ostomy News, Tyler, TX
“Can I go swimming with an ostomy?” Many adults suffer from fatigue on a daily basis.
Although there are a multitude of problems associated with fatigue, one of the most common causes of tiredness during the day is a poor night’s rest.
I venture to guess that all of us could benefit from getting enough sleep at night.
Your performance at work, interaction with your family and friends, and your energy level can get a boost by following some general guidelines for sleep.
* Go to sleep when you are tired.
* If unable to fall asleep, get out of bed and go somewhere quiet to read a book or listen to music. Return to bed when you are drowsy.
* Never fall asleep outside of your bedroom.
* Maintain the same sleep schedule daily—even on weekends.
* Use your bedroom only for sleep.
* Never take afternoon naps.
* Avoid caffeine
* Avoid strenuous activity at least six hours prior to bedtime.
* Do not eat large meals prior to bedtime.
* Minimize light, extreme temperature changes and excessive noise in your bedroom.
* Do not have a television in your bedroom.
* Try taking a warm bath, drinking decaffeinated hot cocoa or tea for relaxation prior to bedtime.
* Use a firm mattress.
* Exercise regularly but not late in the day.
* Write down your worries on paper to clear your head and avoid mulling over them in bed.
Hope these ideas will help you get some Zzzzzzzz!
ABOUT ILEOSTOMIES
Via: Metro MD & Rose City Ostomy News, Tyler, TX
There are occasions when the ileostomy does not function for short periods of time. This is normal. However, if such cessation of flow lasts four to six hours and is accompanied by cramps and nausea, the intestine could be obstructed and a doctor must be called. An obstruction (or blockage) may be partial, that is, some liquid may pass through. Call your doctor in either case. At the first sign of obstruction, remove the appliance. Wear a disposable one with a slightly larger opening so the stoma will not be constricted if it swells. Obstruction can be caused by high residue foods such as Chinese vegetables, pineapple, coconut, and corn; it can also be caused by internal changes beyond your control.
When diarrhea occurs, the intestinal contents pass through the small intestine too quickly for the absorption of fluid, salts, and minerals to take place; in fact, the illness may cause the tissues to pour out needed fluid, salts and minerals. You must quickly replace these electrolytes to avoid becoming ill from dehydration and mineral deficiency. On the other hand, loose stool can come from eating certain foods and is usually temporary. Raw fruits and vegetables, milk, fruit juice, prune juice, or strange drinking water are examples. Loose stools can be caused by emotional stress. Some people with ileostomies may always have “watery discharge” and this is normal for them. Diarrhea has these characteristics: the intestine discharges great quantities of watery stool; it comes on suddenly and may be accompanied by cramps. Diarrhea can be caused by intestinal flu. Gastroenteritis may be accompanied by fever and vomiting, causing partial obstruction. Odorous discharge, cramps and watery squirts and noises from the stoma accompany partial obstruction. It can be caused by food or other factors. You should seek medical attention if this occurs; antibiotics, penicillin, and other prescription medications may be needed or a change of your medication may be needed.
What to do about diarrhea; take one cup of sweetened tea or one glass of orange juice, or one cup salty broth, alternately every hour. Continue as long as diarrhea persists. There are also glucose drinks available which will help replace these losses. Most important—call your physician and take medications as prescribed.
SIZE DOES MATTER
by Kathy Dahn, RN, Riverside Healthcare, Via: Kankakee Ostomy Association, Kankakee, IL
It is not unusual for Karen and I to get calls from new ostomates (and by new, I mean within the first year or two after surgery), telling us that the skin around their stoma is irritated and painful. While there are several reasons that this may be happening, one of the most common has to do with size: the size of the stoma versus the size of the opening on the ostomy appliance.
Many ET nurses send the patient home with a template—a pattern of the size and shape to use in cutting the opening in the flange. This would be fine if the stoma never changed size or shape! However, as most of you folks who have been dealing with the “rosebud” for several years know, the stoma usually changes a great deal in size and shape, particularly during the first few months post-operatively. It is quite normal for the stoma to shrink in size and retract downward toward the
abdominal wall. The end result is that frequently, that first template ends up being much too large compared to the size of the stoma. If the person continues to use the template to cut the opening in the appliance, the skin around the stoma will be continually bathed in urine or stool.
Continual contamination of the skin with urine can cause a gray “warty” appearance and even a crystal-like shine from the deposits of uric acid crystals left by the urine. Allowing the small bowel contents from an ileostomy to be continually touching the skin around the stoma can lead to actual breakdown of the skin with open, moist, painful areas (remember that the small bowel is where digestion takes place so the output from an ileostomy is full of the acids and enzymes that digest our food). As a rule, colostomies don’t tend to “work” as often as an ileostomy (although there are exceptions). This can help to keep the skin from becoming so irritated—however, many people tend to have very sensitive skin and only a short amount of time in contact with stool is needed to cause the peristomal skin to be reddened.
The answer to this problem is proper sizing of the stomal opening in the appliance. Karen and I teach our new ostomates to use the measuring guide (that comes with each new box of wafers) to measure their stoma EACH TIME they do a wafer change. This is particularly important over the first couple months after surgery when the largest changes are taking place. After the first few months, only periodic re-measurement will be necessary. BUT…. (Why is there always a “but” in life?) If the ostomate has gained or lost weight, this can also affect the size and shape of the stoma as the “geography” of the abdominal wall changes. So re-sizing the stomal opening is important in this instance, even if it has been many years since the original ostomy surgery.
So, you see…..size IS important!!
FOOD ADVERTISING: SEPARATING FACT FROM FICTION
Reprinted from Mayo Clinic Health Letter, Via: Northern VA, Pouch
The food industry is like any other business—its main priority is to make a profit. To do so, it will attempt to make products fit whatever the market happens to demand at the moment. To get the most nutrition in your grocery cart, you need to be an educated consumer. You need to be able to figure out what’s actually in a product—not just what it’s advertised to contain.
Common Misconception
It’s important to realize that big, bold claims made on the front of a package are designed to get you to buy the item, not necessarily to be an accurate representation of the item’s nutritional content. For that, you need to look at the Nutritional Facts label and the ingredient list. Here are some common examples of misconceptions that may arise from food advertising.
* Reduced-fat products—Reduced fat doesn’t necessarily mean a product is low in fat.
* One ounce of reduced-fat mild cheddar cheese, for example, still has six grams of total fat and four grams of saturated fat. This is less than the ten grams total and six grams saturated fat in regular mild cheddar, but it still provides a fair amount of total and saturated fat.
* Whole Grain Products— The packaging of bread and pasta products often indicates that the product is made with whole grain. This aims to capitalize on advice from nutritionalists to eat more whole grains, which are a good source of fiber. But even though the product may contain some whole grains, the total amount of whole grains may be very low. Meanwhile, other ingredients may still provide plenty of fat and sugars. Look for the words “100 percent whole wheat.” Or look for products with whole grains in the first listings on the ingredient list. Primary ingredients are always listed first. Also, look for products that contain at least three grams of fiber per serving.
* Natural ingredients — The word “natural may have a healthy ring to it, but there’s no standard definition for the term. And natural doesn’t always mean nutritious. An orange is a natural product, but the same may be said of butter. Nutrition depends on the ingredients. For example, the label on a juice container may indicate its made with natural ingredients. But if you look at the ingredient list, the natural components may be near the bottom of the list while water and high-fructose corn syrup are at the top.
* Food additives and preservative — Food advertisers like to capitalize on the perception that natural products are better. But just because a product is advertised as having no additives or preservatives, doesn’t mean that the item is healthy. An item advertised as having no additives or preservatives may be high in sugar or fat, as well as low in overall nutritional value.
* Light or low-salt— If you compare regular soy sauce to light soy sauce, you’ll find both have large amounts of salt. Light means, by definition, 30 percent less than the standard product. However, if the standard product is extremely high in sodium content, the light version still contains a very large amount.
* Savvy Shopping — Discerning what’s good for you and what’s not can at times seem like a monumental task. So keep it simple: Disregard claims made on the front of packages and instead pay attention to Nutrition Facts labels and ingredient lists. These will carry the real information.
At first, it may take some time to evaluate food products, but once you find your nutritional favorites, Your shopping will be a breeze.
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