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Volume 35, Number 5 February, 2008
SHARING AND CARING
PARTNERS & SPOUSES
Via: 2002 UOA Annual Conference & Northeast Iowa Ostomy
Chapter Newsletter
Many times the roles we had been accustomed to playing in our relationship
are reversed or altered drastically when there is an illness—especially a
lengthy illness. Sometimes people want to return to the previous roles and
sometimes not. It can be a real opportunity for stretching and growing.
Sometimes the “patient” who was sick, doesn’t want to “burden” their partner
with needs, feelings, concerns, even disagreements as the “patient” may feel so
indebted already. Don’t forget in relationships there is “you”, “me” and there
is “we.” It has been explained by some relationship counselors that personality
and autonomy and at the same time cultivate the other special relationship of
“we”— which is not instead of “me” or “you” but in addition to. Realistic
assessment of oneself is healthy, so is taking responsibility for your own
feelings. Likewise, the partner has a responsibility to take care of herself or
himself. This doesn’t mean protecting the other out of worry or fear of
upsetting them. There is also a responsibility to “we”. Spouses/partners need
support too. Sometimes they can be forgotten while everyone is attending to the
“sick” one. The partner may be waiting for you to give the cues on how you wish
to be treated. Others can “pick up” on your attitude and this may influence
theirs. If you have a positive attitude it will be difficult for your partner to
have a negative one.
LEAK PRODUCERS & PREVENTERS
Via: Southern Maryland Counties Chapter
Abruptly sitting up straight from a flat-on-your-back position can pop your
pouch loose. So can bending over to clean out the bathtub, or picking up
something off the floor, or stretching high to reach something. Learn to
get in and out of bed on your side. Get in bed by sitting far onto the bed and
going down on your elbow while holding the mattress with the other hand, and
swing your legs up. To get up, roll over on your side and use your elbow to push
up, while holding the mattress with the other hand and swing your legs sideways
off the bed. Get a clamp-type reacher for reaching down and a stool for reaching
high shelves. Learn to lift and carry on the side of your leg, carry things
high, or drag it, or get someone to help. Ostomates get hernias easier than
anyone else.
WHAT IS A REVISION?
Via: Sherman Area Ostomy Association
We often hear people asking, “What is a revision?” The term applies to a
surgical correction of the stoma. This may be a small procedure done in
out-patient surgery, or it may be a procedure requiring hospitalization. Four
common reasons for revisions are listed below. But, before we begin, please bear
in mind that these conditions may be present without causing much trouble—in
which case a revision is not needed.) Revisions are most frequently done to
correct: 1. A tight stoma, 2. A prolapse (when the stoma becomes very long and
large), 3. A retraction (when the stoma becomes so short that it is below the
skin level), or 4. In the case of a hernia, so near the ostomy that it
interferes with management. (copied from Coos Bay, Oregon)
STOMA COMPLICATIONS
From: North Texas Ostomy News Via: Sherman Area Ostomy Assoc.
Many pathological conditions can necessitate the need for some type of
bowel or urinary diversion known as an ostomy. For the most part, ostomies are
well managed by the patient, and/or caregiver. Sometimes complications can
occur. A list of basic stoma complications follows:
Necrosis— A dark, black stoma due to inadequate blood supply. This can be
caused by excessive tension on the mesentery, too thick of an abdominal wall for
the intestines to pass through, too tight a suture line, or interruption of
blood flow (clot). Management is based on the extent of necrosis.
Superficially—– continual monitoring: it may slough off and can be managed with
a modified pouching system. If it is below the fascia level, it often requires
stoma reconstruction.
Detachment — The stoma separates completely from the adjoining skin. This
is caused by too much tension on the mesentery and requires surgical revision of
the stoma.
Recession—Retraction — Sinking of the stoma below the skin level. This
can be caused by scar formation secondary to mucocutaneous separation, necrosis,
peristomal skin problems, weight gain, radiation, recurrent malignancies, or
excessive tension on the suture line. This can be medically managed with a
modified pouching system. Severe cases may require stoma revision.
Stenosis—Strictures—– Extreme narrowing of the stoma that can threaten
the normal function of stool evacuation. Multiple causes can include inadequate
suturing at the fascia level, mucocutaneous separation, edema, and disease
conditions which may cause scar formation that compress the stoma causing
ribbon-like stool or obstruction. This may be medically managed with stoma
dilation or require surgical intervention.
Prolapse — Telescoping of the bowel out through the stoma. Poor abdominal
wall support and increased abdominal pressure from coughing, sneezing, laughing,
or tumor formation are common risk factors. Conservative management of a
prolapse includes reduction of protrusion by gentle pressure, cool wash cloth
and even sugar (acts as an osmotic diuretic) on the stoma, then applying a
binder or prolapse belt. In some cases, prolapse is medically managed if the
patient is considered a surgical risk.
Hernia — Protrusion of the bowel into the subcutaneous tissue around the
stoma. This is characterized by a bulge in the abdominal wall or tension on the
abdominal wall or on the abdominal muscle. This is medically managed by wearing
a binder and/or modified pouching system. If herniation leads to a blockage,
surgical intervention is required. To aid in prevention of a hernia, wear a
binder especially when lifting heavy objects, or guarding the stoma with a hand
pillow when coughing or laughing. One noted entertainer places a hand over his
side, guarding the stoma when laughing.
Obstruction — Blockage of a stoma from recurrent disease process, or
twisting-kinking of a loop of bowel in the abdomen. Surgical intervention is
required.
Impaction — (In colostomates). Stoma clogged by hard stool requiring
stool softening with enema or a small amount of oil prior to stoma irrigation.
Impaction may be prevented by drinking 8 to 10 glasses of fluid per day,
attention to diet and regular use of stool softeners.
THOUGHTS FROM A COLOSTOMATE
Via: Greater Cincinnati Chapter
I’ve had a colostomy for more than seven years, but I can still remember
that day when I thought my surgeon’s visit was only to ‘rescue me from that bowl
of salt-less mushroom soup’. That was until he said something like “I’d like to
do some exploring”. Before I could get off my “Dr. Livingston, I presume” line,
he explained the bad news/good news features. Even though surgery was indicated
there was a possibility he might find nothing. Because I am a person of much
faith, he proceeded with my carte blanche surgery and about three days later I
realized I had a “rosebud” for life. Now one of the mixed blessings about this
scenario was that there was no time for a pre-op education about that brand new
word to my vocabulary—colostomy. But then the REAL good news came, my E.T. nurse
and my ostomy visitor from Metro Maryland, Margaret Proctor, bless her soul,
undoubtedly labeled me her worst patient, and with just cause, I might add. I
was a slow learner, wallowed in all kind of self pity, and physically felt as
badly as was my comprehension of this whole new system. BUT, she didn’t give up
on me, thank goodness! And though my role as host left a lot to be desired, the
visitors from the Ostomy Association didn’t give up on me either. They tolerated
me, sympathized with me, and left me some very helpful literature. Now it took
me a while to feel comfortable talking with others about a colostomy. But
finally, I felt quite good about visiting other patients, offering support,
extending an open ear, and sharing information I’ve gained from experience. You
know, there seems to be as many different colostomies, and how to handle them,
as there are persons who have them. No two of us are the same, although we are
so much ALIKE we can learn a great deal from sharing with each other. There’s a
perspective that only “one who’s been there” can convey. AND SHARING IS CARING.
A few hours of my week are volunteered to help out in the Ostomy Association
office which our Metro Maryland volunteers are so dedicated to running well.
There’s such a volume of paperwork—membership information, mailing lists, the
many steps in preparing the newsletter for distribution, preparation for
conferences, such as this one, and many, many more details that are necessary to
the efficient operation and ultimate usefulness of the whole operation. It
requires a lot of time from a lot of people. Another helping hand is most
welcome. My message is, I suppose, that when you see a ‘Dr. Livingston type’
approaching with a scalpel and magnifying glass in hand and exploration in his
eyes, check out his back-up facilities (E. T. nurse) and the follow-up and
follow-on support (Ostomy Association visitor) because they’ll probably help you
as much as the surgery itself. And then YOU in turn can help others—and so on.
That’s what the Ostomy Association—and indeed, life, is all about.
GASTRIC REFLUX
By: Bob White, Via: S Brevard (FL) Ostomy Newsletter
A recent article in the Annals of Internal Medicine purports to deal with the possible association between certain drugs and the incidence of esophageal adenocarcinoma (cancer in the esophagus) as a result of gastric reflux. It is, unfortunately, more likely to confuse the layman than to educate him.
First, incidents of esphageal cancer demonstrably are on the rise among men in America and Western Europe. It has a 5-year survival rate of 11%. Gastrointestinal reflux—the backward flow of stomach fluids into the esophagus—is a risk factor in this cancer.
Second, the research group, from Sweden and the Harvard Center for Cancer Prevention, theorizes that certain drugs may loosen the sphincter at the base of the esophagus, making reflux more likely.
Third, the drugs include nitroglycerin, asthma medications such as albuterol and aminophylline (a bronchodilator), and Valium.
The research considered the cases of 600 people with the cancer, between 1995 and 1997, as compared with a control group of healthy men who had taken the medicines in question. The rate of cancer was almost four times more common in those who had taken the drugs daily for more than five years.
Then, the researchers concluded that the findings “could be seen” as “reassuring” for users of the drugs, because “our data suggest that persons who use these drugs (for short periods) may be at little increased risk. A logical rebuttal might hold that, if you use these drugs on anything approaching a daily basis, and you are experiencing the symptoms of gastric reflux (they’re hard to miss!) be sure your physician knows about the situation.
AN
OSTOMATE LOOKS AT SPORTS: PRACTICAL ADVICE FOR ALL
By: Barbara Hurewitz , Via: UOA Northern Virginia
Chapter & Green Bay,WI Chapter
Sporting activities are some of the most exciting things for any ostomate
to participate in. Good muscle tone and increased strength are important for
anyone who has suffered a prolonged illness, but for ostomates, there is the
added pleasure of doing something which, because it is a challenge, adds to our
emotional strength. When I was ill, I had no desire to do any kind of vigorous
physical activity. After my operation, while I felt better, I was still worried
about taking part in any activities, especially athletic ones. I was afraid that
my appliance would fall off, that I would strain my abdomen, and that I would
feel inhibited from really throwing myself into a sport. But, by starting to do
various exercises, and by taking a certain number of precautions, I not only
have enjoyed vigorous activity, but have also found myself doing many sports I
had never done even before my illness. This successful activity has in turn
increased my courage and made it easier for me to accept my ileostomy. It has
certainly brightened my outlook many times over. Swimming is one of the first
sports an ileostomate should try. It is a gentle form of exercise which uses all
your muscles and should get your body into good enough shape to start any other
sport. I would suggest to ostomates to wear waterproof tape around the edges of
the appliance. No water will seep under it to loosen the appliance. (I have worn
a temporary appliance to the beach and found this perfectly satisfactory.) I
also suggest wearing some sort of reinforcer (A stretch panty, the panty part of
pantyhose, or a gentle support belt) under your bathing suit. This will keep
your appliance from moving around, loosening, or causing discomfort.
OSTOMY HINTS
Via: New Directions, Ft. Worth, TX Area Chapter
Be sure to re-order supplies before they get too low. Your supplier may
be out of your particular brand and will need time to notify the company. When
you travel and fear that you may have an accident during the night, buy the
small pads in the baby department and take them with you to place them under you
when you sleep. If you have a leak, no one will be the wiser.
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