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pageVolume 33, Number 3 December, 2005
CONTINUE YOUR SOCIAL LIFE WITH AN OSTOMY
Via: The Pouch, N. Virginia & GB News Review
Your social life can be as active as it was before surgery. You can enjoy all activities: meeting people, attending concerts, sporting events, civic and social club meetings, parties, religious occasions, or whatever you enjoyed before. The first time you go out of the house after surgery, you may feel as if everyone is staring at your appliance, even though it is not visible under your clothing. You can feel your appliance on your body, but no one can see it. Keep these questions in mind: Did you know what an ostomy was or where a stoma was located or what it looked like before you had surgery?
For those with colostomies or ileostomies, you may also worry about your pouch filling with gas and sticking out under your clothing. A quick trip to the restroom can take care of this problem. If you are worried about your pouch filling up immediately after eating at a social event, remember, people without ostomies often need to go to the restroom after eating, and nobody will think it is unusual if you do the same. You probably will find that you need to empty your pouch less often than you need to urinate.
You may be wondering about your relationships with others. Now that you have an ostomy, you may feel that it will change your present relationships and decrease new opportunities for friendship and love. True friendships and deep relationships on any level are built on trust and mutual understanding. These qualities depend on you and other persons. You have the same qualities you had before surgery, and your ability to develop friendships is unchanged. If you care about yourself, others will feel your strength and will not be deterred. If your ostomy does cause a break in friendship, a relationship, or even marriage, this relationship was not built on trust and mutual respect and probably would have crumbled some time in the future anyway.
POINTERS FOR THE NEW OSTOMATE
Via: Big Sky Informer & Hemet-San Jacinto, CA
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There is no answer for “Why me?” but it is normal to ask the question and you do need to work through the answer to this.
* Each person’s ostomy is different, even as our fingerprints are different.
* Support and information received from someone who has an ostomy can be helpful. Ask your doctor or ET nurse to arrange an ostomy visitor.
* It is your ostomy; learn to manage it and don’t let your ostomy manage you. In the beginning, it is normal for your ostomy care to be the center of your existence; however, with time and practice your ostomy and its care will become just a normal part of your life.
* Basic management skills can be learned, new experiences;
* Any problems that develop must be met and managed as they occur. With time and experience you will become comfortable with your ostomy care.
* You are alive! You will get better and stronger. Give yourself time to get over ostomy surgery and to adjust to this body change and adapt to your ostomy.
URINARY DIVERSIONS Or What Does One Do Without a Bladder?
Via: Metro Halifax & Lee County, FL
Basically, the bladder is a hollow muscle which performs two important functions. It acts as a storage device for the accumulating urine, relaxing as the volume increases. But it also acts as a pump as it contracts, squeezing out the urine through the urethra to the outside of the body. Accident or illness may dictate the removal of the bladder, thus necessitating the introduction of alternate methods or devices to dispose of the urine.
Such devices (or substitute bladders) should provide the following:
A low pressure system to assure continence and prevent damage to the kidneys.
Be continent, preventing leakage and associated physical and social problems.
Be non-flexing, thus preventing recirculation of urine to the kidneys.
Be easily emptied.
Should avoid certain metabolic/electrolyte salt chemistry problems that configurations of intestines can
impart.
Prior to 1950, the removal of a damaged or diseased bladder allowed relative few alternatives. One procedure brought the ureter out to the skin individually. Since the ureters are very small in diameter, often no larger than the thickness of the lead of a pencil, problems with narrowing of the ducts, even occlusion, as well as infections were frequent occurrences.
Furthermore, the employment of appliances to collect the urine was difficult and generally inefficient.
In 1950, the ileal conduit was devised by a Dr. Bricker in a procedure which attached the two ureters to a section of the small intestine and then brought the intestine out through the abdominal wall into a stoma. The procedure had the advantage of assuring unimpeded flow of urine through the stoma as well as the more effective and practical use of an appliance to collect the urine. Bricker’s ileal conduit has remained a favorite procedure throughout the years, even though it is still subject to infection and reflux to the kidneys and requires that a prosthesis be worn at all times.
TYPES OF COLOSTOMIES
From Friends Together, Baltimore Ostomy Association
There are four main types of colostomies. They are named after the portion of the bowel where the colostomy is located.
A Sigmoid Colostomy is located within the sigmoid colon. Output has a normal, formed consistency, since the water has been absorbed as the waste passed through the remaining large bowel.
An Ascending Colostomy is located within the ascending colon, on the right side of the colon as it exits from the ileum. Output will be liquid to semi-liquid, rich in digestive enzymes and therefore irritating to the skin surrounding the stoma.
A Transverse Colostomy is located within the transverse colon, the part of the colon that transverses across the abdomen, above the small intestine, and connects the ascending colon with the descending colon. Output is usually liquid to semi-formed because digestive enzyme content decreases as the contents moves further down the colon, therefore, the further away from the ascending colon, the less irritating the output will be to the peristomal skin.
A Descending Colostomy is located within the descending colon. Output is semi-formed, because much of the water from the stool has been reabsorbed from the colon back into the body.
REIMBURSEMENT OF OSTOMY SUPPLIES BY MEDICARE
Via: Metro Maryland & Hamilton-Fairfield, OH
Medicare covers most ostomy supplies that are ordered by a physician and needed for the day to day care of a stoma. However, Medicare B reimbursement policies for ostomy supplies have changed. Until 1993, Medicare B reimbursement for ostomy supplies varied from one region of the country to another. Someone in Florida might be reimbursed at a higher rate for more pouches than someone in Montana, even though each one was paying the same Medicare premium. To equalize benefits, Medicare set nationwide standards for the quantities of ostomy supplies normally used in a month. Usually this means ten drainable or urinary pouches and thirty-one closed-end or stoma caps will be covered in a thirty day period.
Unfortunately, many people with ostomies have assumed that Medicare will not pay for more than the quantity of supplies listed in the policy. This is not true. Medicare is aware that all people with ostomies are not alike and has written its ostomy policy to accommodate individual needs. For example, Mrs. Smith is sixty years old with a colostomy. She uses a one-piece, closed-end system. The number of one-piece pouch and barrier combinations Medicare allows each month is thirty-one. If she has to have chemotherapy and experiences additional discharge that requires more than one pouch per day, she will exceed Medicare’s monthly limit. For her to be reimbursed, Medicare may request additional documentation supporting her increased supply need.
If your medical record contains written explanations of why you need certain types and quantities of supplies, you have a better chance of having your claim approved. If Medicare has
a question about your need for supplies, they will contact your physician.
Therefore, letters from home care nurses, ET nurses, and other health care professionals involved in your care should be sent to your physician and placed in your record in case Medicare requests them.
The letters should explain the type of ostomy you have, the pouching system prescribed, any complications and why additional pouches are necessary. Maintaining your medical record is your physician’s responsibility. Your ET nurse may fill out the order for your ostomy supplies, but it must be signed and dated by your physician. Your supplier must keep a copy of it on file. If for some medical reason you must increase your quantity or change to another type, Medicare requires that a new order is signed by your physician and given to your supplier. Make sure the health care professionals involved in your care provide a written explanation that can be placed in your medical record if your needs exceed the limits.
[ConvaTec has a free brochure—Do You Know How To Obtain Documentation of Medical Necessity For Your Ostomy Supplies?] [Oakland City, MI –N.B.: Some patients needing help in gathering the pieces for their doctor to write a “Letter of Medical Necessity” have found assistance in their ostomy support group]
DON’T SWEAT IT
Via: Rose City Ostomy News
Does sweating cause you pouching problems? If you work or live in a warm environment, and if you are an athlete or just prone to sweating, you may have problems keeping your pouch barrier on. Here are three approaches to solving your problem.
Sweat less! Some antiperspirants can be used underneath an ostomy barrier. Many antiperspirants dry after application and leave little residue that would affect the adherence of a pouch. C.C., a cyclist in Maryland, uses Tussy 5-day antiperspirant that is sold in packets. Mitchum and Crystal, among others, have been used successfully by ostomates to diminish perspiration. Do your own research and find one that works for you.
Increase adhesion! If your barrier is floating off, consider increasing the quantity of adhesive. SKIN TAC has recently been produced in a new wipe-on form. This is a thin, clear adhesive that is easily removed with alcohol. Torbot manufactures it. Hollister makes a medical spray. And for the truly needy, there are paint-on adhesives that, though more cumbersome, can make a dramatic difference in adherence. Two of these are Nu-Hope Adhesive and Skin Bond by Smith and Nephew. All of these products are available at most ostomy product dealers.
Try a breathable barrier. The MicroSkin adhesive barrier on all Cymed pouches is moisture-vapor permeable, and allows perspiration to flow through the barrier rather than being trapped beneath it. John Dermengian recently wore a Cymed pouch through the grueling Ironman Triathalon. His pouch held up through 16 hours of extreme physical exertion and lasted a total of 6 days. Christine Newberry, RN, WOCN Metro MD.
PREVENTING SKIN IRRITATION
Via: Metro Maryland & So. NV.
Town Karaya
You do not have to put up with irritated skin. A properly fitting pouching system changed as needed will prevent skin irritation in most instances. Irritation right around the stoma can be a sign of poor adhesion which permits leakage of body waste. Your skin barrier should be changed as soon as it starts to leak. The time you can wear it comfortably will vary depending on your activities. You may need to change it more frequently when you exercise strenuously or when the weather is hot and you are perspiring. Itching, redness, or rash may be caused by constantly pulling the adhesive away from the skin. It may also indicate that you are allergic to the adhesive. Report any such reaction to the doctor, nurse, or ET nurse immediately. There are several types of skin barriers available. You should be able to use at least one of these with no problem.