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Volume 34, Number 10 August, 2007
POUCH CHANGES - HOW OFTEN
Via: GB News Review, Green Bay, Wi. & So. NV Town Karaya
This question is among those most frequently asked, particularly by
Ileostomates and urostomy patients. Like any other question, there is no one answer that applies to all
ostomates
An informal survey revealed that people change their
appliances as much as 3 times a day, and as infrequently as every 2 to 4 weeks. Obviously, there must be reasons for this great variation. After pointing out that the great majority of ileostomy and urostomy patients change in the range of once daily to once a week. Let us explore some of the reasons. People on either side of this spectrum can have a skin problem or skin which is nearly indestructible. Some of the reasons for the variation in time between changes include:
Stoma length: A short stoma exposes the adhesive material to moisture which decreases wearing
time.
Amount or consistency of effluent: Profuse effluent tends to loosen the seal.
Skin Type: Moist or oily skin tends to decrease adhesion time.
Skin Irritation: Decreases adhesion. The appliance should be changed more frequently to evaluate the success of your attempts to heal the skin.
Experience: Good technique, such as allowing glue (adhesive) to dry well, increases adhesion.
Personal Experience: Preferences, convenience, and odor control.
TEN (NEW) COMMANDMENTS
FOR OSTOMATES
Via: Vancouver Ostomy HighLife & Regina
Ostomy News
1} Thou shalt allow thyself to be sad, or angry, or depressed on occasion. Who
said you always have to have a good attitude.
2) Thou shalt not let the above emotions become a way of life.
3) Thou shalt seek help, education, and support if thine unhappy emotions
overcome thee.
4) Thou shalt learn to care for thy ostomy. Letting others do it for you if you
are physically able is a cop-out.
5) Thou shalt seek out thy ET nurse if thou art notified with thine products.
6) Thou shalt not hide thyself away. Get out and do the things you used to do.
You can.
7) Thou shalt not be ashamed.
8) Thou shalt cultivate a sense of humor about thine ostomy. There are worse
things. Far worse.
9) Thou shalt set an example to the non-ostomy world. An example of triumph over
adversity, courage over pity, and pride over embarrassment.
10) Thou shalt help other ostomates. Join your local UOA chapter, donate money,
volunteer your time.
WHAT IS OSTEOPENIA AND HOW IS IT DIFFERENT FROM OSTEOPOROSIS?
Via: Mayoclinic.com., Wocester Ostomy Chapter & GB News Review
Both Osteoporosis and Osteopenia are medial terms for progressive
loss of bone density and thinning of bone tissue. Osteoporosis is a metabolic
bone disease characterized by a fracture. Osteopenia refers to milder bone loss
that doesn’t yet meet the criteria of Osteoporosis. A simple, painless bone
density test (densitometry) can detect the presence and degree of bone loss.
Bone loss has many causes. The leading cause in women is a deficiency of the
female hormone estrogen after menopause. The leading causes in men are decreased
testosterone production and use of corticosteroid medications. People with
Osteopenia can slow the progression to Osteoporosis by doing weight-bearing
exercise, such as walking, and consuming an adequate amount of calcium. If
you’re a woman, the National Osteoporosis Foundation recommends that you have a
bone density test if you aren’t taking estrogen and any of the following
conditions apply to you. You use medications that can cause Osteoporosis,
including corticosteroids such as prednisone, cortisone and dexamethasone. You
have type 1 diabetes (formerly called juvenile or insulin-dependent diabetes),
liver disease, kidney disease or a family history of Osteoporosis. You
experienced early menopause. You are postmenopausal, are older than age 50 and
have at least one risk factor for osteoporosis, such as a family history of the
disease, tobacco use or depression. You are postmenopausal, are older than age
65 and have never had a bone density test. Doctors usually don’t advise routine
bone density testing for men because the disease is far less common in men.
FAT OR FICTION? FIVE COMMON DIET & EXERCISE MYTHS
By Joy Bauer MS, RD, CDN
Myth #1: By following a proper diet and exercise program, you can turn body fat into muscle.
False. Fat and muscle are two separate entities. You must burn fat and build muscle.
When fat is burned, where does it actually go?
When you lose weight (by eating less and exercising more), an enzyme located in fat cells disassembles the fat compounds, and sends the components into the bloodstream. Liver and muscle cells take up these components and disassemble them even further, until what’s left is a compound called acetyl-CoA. Acetyl-CoA then enters the Krebs cycle, a series of chemical reactions that takes place in the mitochondria -- the cell’s “power plant.”
The end product of this dismantling of acetyl-CoA via the Krebs cycle and subsequent cellular processes is:
Carbon dioxide, which is expelled when you exhale. Water, which is lost as urine and perspiration. Heat, which helps maintain body temperature ATP, the molecule that fuels cellular activities that require energy.
MYTH #2: As you age your metabolism declines and there is nothing you can do about that.
False. While it’s true our metabolism naturally slows down by about 2-5% per decade after age 40…. There are plenty of things we can do to fight back.
Exercise is key.
Engage in aerobic exercise - 4 to 5 days/week: It’s obvious that aerobic activities like running, brisk walking, swimming and bike riding burn calories and increase metabolism while you’re working out. But interestingly enough, several studies show that aerobic activities cause your metabolism to stay increased for a period of time after exercising.
Work your muscles: Lifting weights and/or other strengthening activities like push-ups and crunches on a regular basis (at least 2-3 times each week) will boost your resting metabolism 24/7. That’s because these activities build muscle, and muscle burns more calories than body fat. In fact, if you have more muscle, you burn more calories—even sitting still.
When it comes to food, keep your metabolism revved with these three tips:
Eat enough food – at least 1000 calories: Your body and metabolism thrive on food - when you fast, crash diet, or restrict calories below 1000, your metabolism will SLOW down in a response to conserve energy.
Eat every 4-5 hours: Because our bodies work hard to digest and absorb the foods we eat, your metabolism revs in response. This is called the thermic effect of food. Take full advantage and schedule meals and snacks every 4-5 hours.
Incorporate lean protein with every meal: Eating all foods creates a thermic effect and will boost metabolism after consumption. However, the consumption of protein has the absolute greatest metabolic boost when compared to carbohydrate and fat. PLUS, eating the appropriate amount of protein will ensure you’re able to maintain and build muscle mass (the more muscle mass you have, the greater your metabolism).
Daily Protein Requirements: 50% of your weight = daily grams of protein
Some of the best protein sources include: fish, chicken, turkey, lean sirloin steak, skim milk, yogurt, eggs and egg substitutes, tofu, and beans.
Myth #3: It's better to eat 6 mini meals versus 3 squares.
False. This entirely depends on your personal lifestyle and food preference. …and as long as your food choices for the entire day are healthy and not too high in calories, either eating style can work. I find many people prefer to eat more volume less frequently because of hectic schedules and/or heartier appetites. If that sounds like you, just be sure your collective daily calories are in check and try not to go longer than 4-5 hours without eating. That’s because your blood sugar may drop causing low energy, headaches, and unnecessary eating in response to feeling blah. Also, be sure to always keep small emergency snacks on hand in case you’re running late for lunch or dinner - perhaps a fruit, non-fat yogurt, or baby carrots.
The bottom line: it’s about choosing an eating style that fits with your lifestyle and you can live with!
MYTH #4: It's OK to sub a fattening dessert for a meal now and then
True. Call me a disgrace to my profession, but I say, YES!
As long as “now and then” means no more than a couple times a month, I think it’s OK to enjoy a Ben & Jerry’s dinner, or a Krispy Kreme breakfast. Chances are, if you deny your craving, you’ll end up eating your regular meal plus the fattening dessert. Better that you cut your caloric losses by allowing yourself to indulge once in a while.
MYTH #5: Health professionals recommend people eat 5 to 9 servings of produce a day. It is incredibly hard and unrealistic to work in 9 servings of produce a day!
False. Nine servings may seem like a lot, but a serving isn’t all that large. In the vegetable category, one cup of leafy greens, ½ cup raw or cooked veggies, or 6 ounces of juice count as a serving; for fruit, it’s one medium piece, ½ cup fresh, frozen or canned, ¼ cup dried, or 6 ounces of juice.
EXTRA INTESTINAL
COMPLICATIONS OF IBD
From the research news bulletin of the C.C.F.A., Via: Loraine
Co. OH
A recent study suggests that once surgery is performed for ulcerative colitis,
it may be more effective at relieving certain complications than medication.
Patients who have pan colitis, the type of ulcerative colitis that affects the
entire colon, often experience numerous symptoms that seem unrelated to their
condition. These “extraintestinal complications” often include arthritis. A
study by Basu and colleagues from the Cleveland Clinic in Florida showed that,
of 46 patients with pan colitis who had surgery, 58% had an improvement in
extra intestinal manifestations, compared with only 14% of the 22 patients who
received medication. Arthritis and arthralgia were the most likely
extra intestinal complications to improve, but other symptoms that improved were:
erythema nodosum (red sores on the legs); pyoderma gangrenosum (ulcers on the
legs); uveitis (inflammation of the uvea of the eye); oral ulcerations; and
ankylosing spondylitis, a type of arthritis affecting the joints of the spine.
ILEOSTOMATES
From: Snohomish County (WA) Via: S. Brevard FL
& UOA Insider
Can an ileostomy be controlled with strict diet or
irrigation? 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 your doctor 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 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. Excess gases result
in a noisy ileostomy. It may also 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 movement leads to frequent and watery movements. Each person must
discover his own dietary pattern through trial and error. A WORD TO
ILEOSTOMATES… If you are ever depressed, just think of all the ailments you no
longer have to worry about: rectal cancer; colon cancer; hemorrhoids,
Diverticulitis; appendicitis, constipation—sometimes, it’s amazing that anyone
can survive with the colon intact!
MANAGEMENT OF A FLUSH
OR RETRACTED STOMA
By Gloria Johnson, RN, BSN,CWOCN, Via:
Charlotte, NC Cheers & Tears & Hemet-San Jacinto, CA
The ideal stoma is one that protrudes above the skin,
but this is not always possible and a flush (or skin level) or retracted (below
the skin level) may result. The surgeon may be unable to mobilize the bowel and
mesentery adequately or be able to strip the mesentery enough without causing
necrosis or death to the stoma. Some causes of stoma retraction after surgery
may be weight gain, infection, malnutrition, steroids or scar tissue formation.
Stomas that are flush or retracted can lead to undermining of the pouch by the
effluent (drainage). This continued exposure can lead to irritated and denuded
skin as well as frequent pouch changes. These problems can be very stressful and
expensive. The inability to maintain a pouch seal for an acceptable length of
time is the most common indication for a product with con with convexity.
Shallow Convexity may be indicated for minor skin irritations and
occasional leakage.
Medium Convexity may be indicated for a Stoma in a deep fold, with
severe undermining and frequent leakage.
Deep Convexity is used when medium convexity is not sufficient,
stoma is retracted, in deep folds or leakage is frequent and the skin is
denuded.
Ways to Achieve Convexity:
Convex Inserts: can be applied to a 2-piece system by snapping a
convex insert into the ring of the flange. Outer diameter must match the flange
size. This can be cost effective as this insert can be removed, cleaned and
re-used.
Pouches designed with Convexity: are available in both one and two piece
systems. These can be shallow, medium or deep. They come as either pre-cut or
cut-to-fit.
Addition of skin barrier gaskets around the stoma: Can be cut or
purchased pre-cut. You can use one layer or several layers. Products like the
Eakin Wafer/Coloplast Strip Paste, which can be pressed into shape around the
stoma to protect and seal.
Other Ways to Increase Wear Time and Prevent Leakage: An ostomy belt may
be helpful. Opening should clear the stoma 1/8” only, to give skin maximum
protection.
Ostomy Paste for “caulking”. Always read and follow manufacturer’s
directions for product use.
Product Information
Most ostomy companies make appliances with convexity and carry convex
inserts as well as belts. ConvaTec uses a product called “Durahesive” which has
a turtleneck effect around the stoma. Hollister has the “Premier” series which
does not erode. Nu-Hope makes barriers which are oval as well as round which
have deep convexity. If you have questions, make an appointment with your ET
nurse.
FREQUENTLY ASKED QUESTIONS
Excerpted from Diet & Nutrition Guide, UOA
2002, Via: Cleveland, O.A., OH
Question: How soon after ostomy surgery can I return to
a normal diet?
Answer: Physicians and ostomy nurses suggest that you begin slowly,
depending upon your recovery and/or other medical complications. Add back one
new food at a time. If you experience any problems, discontinue for a few weeks
and try again.
Question: In the past, certain foods caused me some trouble with digestion.
How will they affect me since my ostomy surgery?
Answer: Check them out. You may find that some of those foods will continue
to be troublesome and others may not.
Question: Will my ileostomy continue to produce output even if I do not eat?
Answer: Yes, the small intestine will continue to produce gas and digestive
juices. An empty digestive tract seems to produce excessive gas. Eat small meals
to keep something in the gut. Peristalsis happens!
Question: After ostomy surgery, I have gained excess weight. What happened?
What types of food should I eat?
Answer: The relaxation of dietary restrictions, freedom from debilitating
illness and malabsorption promotes a rapid gain in weight. Follow the same
weight reduction diet as recommended by nutritionists and dieticians. Eating
small quantities of a well-balanced diet and increasing water/fluid intake will
assist with weight reduction.
Question: What is meant by “low residue” diet?
Answer: Low-residue refers to a dietary regime which eliminates
bulk-forming, hard-to-digest or high-fiber foods.
Question: Will spicy foods cause any damage to my stoma?
Answer: If you can tolerate spicy foods through your digestive system, the
output through your stoma should not cause any harm. The stoma is formed from
the lining of the bowel and it is tough and can tolerate those spicy foods.
Question: What effects will oral odor control medications have on my ostomy?
Answer: Some individuals who have a colostomy report that they experienced
some constipation from bismuth products found in oral odor control medications.
Individuals who have an ileostomy have more benefits and fewer side effects from
oral preparations (chlorophyll tablets, bismuth subgallate and bismuth
subcarbonate). Most foods do not effect an individual with a urostomy. A strong
urine odor may be an indication of dehydration and the need for in- creased
fluid intake. Check with your doctor or ET nurse about oral preparations and
don’t exceed the recommended dosage.
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