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Volume 32, Number 3 December, 2004
LET YOUR CANDLE SHINE
Via: So. Nv. Town Karaya
The question is often raised as to how new ostomates find out about our chapter support group — it is up to all of us to get the word out. When you visit your doctors, be sure to mention that you are a member of a support group that is available for all ostomates. Another way to get the word out, is to be very open in the discussion with anyone who asks about our group or ostomies in general. We should all be very proud we have gone through the life saving surgery and we are still here to let everyone know that an ostomy is not the end but just the beginning of a new and better life. As an old Sunday School song goes—”Let your candle shine; hide it under a basket—no! Let it shine, let it shine!”
OSTOMY CARE TODAY
By Lolly McClure, RN, BA, CWOCN
Having started in nursing in the 1960s, I have seen many changes in ostomies and ostomy care.
There is a history of colostomies being done in the generally as a last resort. One doctor performed a colostomy on a 3 day old infant with imperforate anus and reportedly this person lived to age 45. In the 1900s, surgeons began to treat rectal cancer with resection and permanent colostomy.
Today, we see a sharp decrease in permanent colostomies and more primary reconnections of the intestine. Loop ileostomies are frequently done temporarily to protect lower surgical sites. Newer surgical techniques and the intestinal stapling device have enabled surgeons to resect lower in the rectum and reconnect the bowel.
Today, many continent procedures are done. Several attempts were made to make colostomies continent without success. A magnetic method was used with mixed success and numerous complications. Irrigation and diet are used now to regulate temporary continence of the colostomy. There is also a plug system used by some ostomates for temporary continence.
Surgeons began performing ileostomies in the 19th century, and today we have several continent procedures for certain individuals. These include the Koch Pouch and the Barnet Continent Ileal Loop. These are internal systems which require catheterization. In the scope of urinary diversions, several procedures were tried including hooking ureters directly to skin. The most success has been with intestinal conduits, called various names including Bricker’s Loop, ileal conduit, or colon conduit. Many people improperly call them ileostom
them ileostomies.
Also, many today, opt for continent urostomies which need to be catheterized every 3-4 hours. These include the Kock urostomy, Gilchrest, the Indiana, Miami, or Florida pouches. Surgeons have created a neobladder with fairly good success in men.
Today, we have seen a proliferation of laparoscopic surgeries. The first laparoscopic colectomy was done in 1991.
The development of interostomal therapy nurses (Ostomy nurses) has enhanced the lives of most ostomates. Most hospitals, some nursing homes, and home care agencies have specialists to help patients manage their ostomies.
What are the biggest concerns I hear for persons with ostomies?
1. Can I still do everything I did before? Generally, yes. You can play, shower, bathe, swim, play sports with few restrictions.
2. What about odor? Modern pouches are odor proof. Hand in hand with odor, people ask about gas. Certain foods are gas producing, as well as using straws, gum and smoking.
3. What about sex? The risks and options should have been discussed before surgery. Communication with your partner is the key to a successful marriage.
4. Can I do everything? There may be some restrictions depending on the type of surgery. Those with ileostomies have to be careful of dehydration and of possible food blockage, especially from high fiber foods. Major rules are, chew your food well and drink plenty of liquids, unless restricted.Certain foods may discolor feces or urine.
5. Will medication affect my ostomy? Many medications not only color feces or urine, but may affect the output. Some, such as pain meds, tend to constipate, while others will loosen. Some ileostomates may see time-release capsules or enteric coated tablets come through the pouch.
6. What appliance should I use? There are one piece and two piece pouches to choose from and there are close ended pouches, generally for colostomies. There are urostomy pouches with a spout which can be attached to drainage bags or bottles. There are high output pouches, convex pouches, and wafers, solid wafers or those with flexible tape. If you wish to try samples of pouches, call the company or check with your ET Nurse.
THE SKIN YOU’RE IN
Via:
Rose City Ostomy News, Tyler TX
Skin problems can be the most frustrating problem encountered by individuals after ostomy surgery. Whether you have a new stoma or are experienced with stoma management, sore skin can really get your attention.
When evaluating peristomal skin irritation, the WOC Nurse first tries to determine the cause of the irritation. Just treating the symptoms often does not prove to be a long-term solution.
What, then, are some possible causes of peristomal skin problems?
1. Incorrect size of the opening in the skin barrier: remember to allow 1/8” —1/16” between the edge of the stoma and the opening in the skin barrier: Too large an opening may expose skin to stool or urine contact. Too small an opening may cause lacerations due to rubbing of the pouch or skin barrier.
2. Incorrect contour of pouch/skin barrier. Flush or retracted stomas often require convexity in the pouching system. Individuals with peristomal hernias will usually require very flexible skin barriers that will mold around the herniated area.
3. Rubbing of ancillary equipment. Sometimes belts or hernia supports may rub around the area, causing abrasions.
4. Peristomal skin infections: Superficial yeast/fungal infections (key word—itch!) may require a physician’s prescription. Individuals with psoriasis and/or eczema may find that the condition “flare” under the ostomy skin barrier. The physician should be consulted for proper Rx.
5. Using certain products under the barrier: Salves and ointments will cause the barrier to loosen and leakage may occur. Trying over the counter skin products for hair removal may be quite irritating. Certain soaps may be irritating if not rinsed completely off the skin prior to the application of the pouch.
6. Shaving of peristomal hair in individuals who are prone to develop ingrown hairs and folliculitis (inflammation of the hair follicles) may cause very irritated skin. In these individuals, trimming the hair with blunt tipped scissors is preferable to shaving.
7. Individuals with very dry skin may find that the flaking skin
caused causes adhesion problems. Itching and scratching due to dry skin may create further irritation. This problem may be treated with skin lotions that are completely absorbed prior to pouch application.
8. Very oily skin may also present problems with adhesion. Individuals with very oily skin
may need to “prep” the skin with alcohol to dry up excess oil prior to pouch application. Skin barrier wipes that provide a protective coating may also be helpful.
9. Sometimes, allergic reactions to the pouching system may be the culprit. It is possible to develop an allergy to the skin barrier or any part of the pouching system. If this is suspected, the WOC Nurse can provide skin testing with comparable products to select possible alternative systems.
Unfortunately, once the skin irritation starts, it may result in the dreaded “vicious cycle”.
If you are unable to determine the cause of the skin problem and break this cycle, see your physician or WOC Nurse for evaluation and suggestions. Your skin will thank you.
A POUCH FALLING OFF
Adapted by “The New Outlook”, Via: The Right Connection
One of the most embarrassing situations that can befall a person with an ostomy is to have an accident because the barrier or the pouch pulled loose.
Multiple reasons exist to explain the falling off of an ostomy appliance:
The stoma
The skin around the stoma
The barrier
The pouch
The stoma may be placed too close to a scar, crease or bodily prominence so that the twisting or bending loosens the barrier. This is no simple solution for a misplaced stoma. A different barrier may be tried; e.g., one that is softer and more pliable like the new and improved version of Hollister’s New Image Ostomy System.
An irregular area may be built up with the new seals—like Conva Tec’s Eakin Seals—or with paste. Using these products will usually solve most challenges.
A stoma may require surgical intervention if one has a prolapsing stoma that is pushing the pouch off. Conversely, a flat or recessed stoma may cause pooling of the effluent around the stoma eroding the adherence and eventually lifting the barrier from the skin. Fortunately, manufacturers have developed ostomy systems with curved barriers that put minor pressure on the skin around the stoma. These convex ostomy systems are a growing product line of providers as more and more people discover the advantages of wearing a convex barrier.
The most stubborn falloff problem can usually be solved by using a seal with a convex barrier held on with a belt. Your ET Nurse is an expert at solving these types of issues.
The skin around the stoma might be too oily or too irritated for the barrier to hold satisfactorily. Bath oils and greasy creams should be avoided. But, there are products that may be put on the peristomal skin to treat skin irritation problems. Ostomy product manufacturers all carry skin care products that will treat peristomal skin and yet, at the same time, allow your barrier to adhere firmly to your skin.
There are many different producers of many different barriers. They offer the ostomate a large choice of products that may work for you. You need to try different products if you are having problems. One barrier will not work for everyone in the same way. For instance, one urostomate in our Chapter had a problem with falloff using a flat, Stomahesive barrier. He saw an ET from our Chapter and she recommended he try a Durahesive barrier with convexity along with a belt to gently hold it in place. It worked! Our member was so pleased that he could resume his life doing the same activities he did before surgery.
A well fitting pouch that is suited to your needs and lifestyle is essential. If your pouch keeps coming off, have your entire ostomy system evaluated by an ET Nurse. Do not settle for less than excellent service from your ostomy pouching system. There are solutions to most any problem with ostomy management. Invest the time to talk to a professional ostomy nurse—at a hospital, through your provider of supplies and equipment, at a Chapter meeting or even by calling one of the manufacturers themselves. There is no need to suffer!
POTASSIUM HAS ITS UPS AND DOWNS
Via: Loraine County Ohio Ostomy Assoc.
The body leans heavily on potassium. It’s a busy mineral. Potassium is essential for a normal heartbeat. Without it, nerves cannot send messages to muscles. Low potassium levels weakens muscles.
People who take a diuretic over a period of time may show a low potassium count. Other conditions that deplete potassium are adrenal gland problems, kidney diseases and diarrhea. Once the body has depleted its potassium reserves, the doctor almost always has to prescribe a potassium supplement. It’s nearly impossible for potassium-rich foods to restore body potassium levels. Once potassium levels are replenished, then foods help keep the levels in the normal range.
Bananas, extolled as a potassium gold mine, are good; but not a great source of the mineral. A baked potato tops the list. Other food sources are dried figs, yogurt, avocados, water melon, oranges, cantaloupes, soybeans, peas, squash, spinach, tea, bouillon/broth, molasses, raisins, dates, fish and apricots.
HELPFUL HINTS FROM HERE AND THERE
Emotional pressures and over-fatigue can cause bowel upsets, especially when traveling. Do not allow yourself to become over-tired.
For hard-to-deal-with itchy, irritated skin due to tape burns, scar healing, pouch friction on the skin, etc., doctors often recommend a cortisone cream or ointment. Two products of this nature are available without a prescription: Cortaid or Dermolate.
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