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Volume 30, Number 5 February, 2003
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.
UNDERSTANDING INSURANCE COVERAGE FOR OSTOMY SUPPLIES
By: Glenda Motta, RN, MPH, ET, Via: Hemet San Jacinto & Worcester MA Ostomy Association Newsletter
There is a considerable amount of paperwork associated with filing health insurance claims, especially Medicare. This paperwork is used to establish medical necessity. Simply stated, this means that the supplies must justify medical necessity to an insurer in order to receive payment. Here is some important information that may make it easier to understand insurance for ostomy supplies.
Medicare
Medicare Part B pays for ostomy pouches, accessories, and other items directly related to ostomy care. However, there are certain rules that every supplier must follow. For many supplies, Medicare only allows a predetermined maximum quantity each month. Medicare also limits how much payment a supplier receives for each item.
How does Medicare determine the maximum quantity of supplies each month? The Medical Director and other personnel at each Regional Carrier (the insurance company that pays for the supplies) establishes the policy. They confer with other experts, such as ET Nurses, to determine a reasonable amount.
What information does Medicare consider to determine the maximum quantity of supplies allowed each month?
The quantity of supplies needed by a person with an ostomy is determined by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. For example, a person with a flush stoma may experience leakage more often than someone with a stoma that protrudes. That person would need a greater quantity of supplies each month and Medicare MAY approve the extra number.
What information does Medicare require to approve a quantity of supplies over the usual maximum quantity?
Medicare requires documentation in the medical record of the reasons the additional supplies are needed. For example, if chemotherapy causes skin changes and the pouches leak more frequently, Medicare MAY consider this a justification for more supplies. However, there is no guarantee that a greater number
will be approved for payment.
Are there any types of ostomy pouches that Medicare will not pay for? Yes! Medicare rarely pays for closed-end-pouches—rather than drainable pouches. (This has changed as of September 2000)
How many supplies can I order at a time?
Medicare permits you to order a 3-month supply if you reside at home and a 1-month supply if you reside in a nursing facility.
Other Healthcare Insurers Each policy is unique. Some cover supplies when necessary; others exclude such supplies. It is important to read your policy and determine the coverage the policy provides. If you have any questions, it is a good idea to contact the insurer directly or discuss the policy with your healthcare benefits manager where you work to obtain your insurance.
How can I improve my chances of getting paid for ostomy supplies if my policy provides coverage?
Be sure that the claim forms are complete and accurate. Include all requested information and double-check that the name matches the beneficiary and the numbers are all correct. If the supplies are purchased for a different calendar year, file on separate claims. Also remember that you probably have an annual deductible. This means that you must pay a certain amount of out-of-pocket before your insurance will begin to pay for supplies.
What if my insurance denies my claim? Some items, such as skin care products, may not be covered by insurers. Check first to see if the supplies are a covered benefit. Then, file an appeal. Determine the procedure for this. File as soon as possible. Ask what additional information would help to determine the medical necessity for the supplies that you need. Your doctor, ET Nurse, or other healthcare professional can provide a statement to help justify the supplies. The majority of times, if you submit an appeal, the claim will be paid.
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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