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Volume 31, Number 5 February, 2004
ASK THE ET PANEL
Via: Southern Maryland Counties Chapter
Question. What are skin ulcers?
Answer. Skin, like every other organ of the body, requires nourishment which means a blood supply. If the blood supply is cut off, the skin starts to die and if prolonged, the skin can ulcerate. If you have an ulcer under an appliance, it is an indication that this localized spot is getting more pressure than the area around it; so correct the unequal pressure problem.
Question. What causes warts to form on the edge of the stoma?
Answer. A poorly fitted appliance can cause nodules to form around the edge of the stoma. They are benign and will do no harm. If they get in the way, they can be removed by cauterization.
Question. When a colostomate who wears a pouch gets a blockage from eating improper or too much food, should a laxative such as prune juice be taken? Should heat be applied? Would it be a good idea to irrigate?
Answer When a colostomate gets a blockage, in most cases it is due to constipation. There are a number of things that could lead to a person becoming suddenly constipated, such as eating constipating foods, lack of physical activity, use of pain medication, etc. It is quite satisfactory for a colostomate to take a mild laxative. The use of prune juice is an excellent suggestion. Foods with fiber, like bran, make the stools less constipating. For a person who has not irrigated, the other methods should be tried first.
Question. I have a hernia on one side of the stoma which was once repaired by surgery, but it reoccurred. I use a 4-inch wide elastic belt to keep the hernia in place during working hours. At night, when taking off the belt, I notice the stoma is swollen, but by morning, the stoma is back to normal size. Is there any long term danger in this procedure?
Answer When the stoma goes down overnight and there is no marked change in the color, we see no long term danger. There would be far greater danger in not wearing some form of support during waking hours if you are an active individual. Some ostomates with recurring hernia problems have taken steps to have the stoma relocated. If this is done at the navel, which is the strongest part of the stomach muscle, make sure you have a protruding stoma because this is an uneven sunken area.
Question. Does the appearance of my stoma change over time? Does it age?
Answer. The size and shape of a stoma generally changes within 6-8 weeks after surgery. This is why it is not recommended to purchase precut pouches immediately after surgery. Alterations in the abdominal contour related to weight gain or loss or abdominal muscle weakness can result in a change in the size and shape of the stoma. If the size and shape do change, the size and type of pouching would need to be adjusted. The stoma doesn’t “age”, but a healthy stoma is always pink or red and moist.
Question. Should an ostomy be a consideration when taking medications for other conditions?
Answer. Patients with inflammatory bowel disease, multiple small bowel resections, or radiation enteritis require special consideration for medication regimes because of the decreased absorption capacity. Some forms of medications are not completely absorbed with patients who have an ileostomy. Examples of such medications are enteric coated tablets, large tablets, and time released capsules and spanules. Liquid forms will ensure the best absorption.
LEARNING MORE ABOUT DRUG REACTIONS
by: Council on Family Health, Via Indianapolis Chapter
There are more opportunities today than ever before to learn about your health and to take care of yourself. It is also more important than ever to know about the medicines you take. If you take several different medicines, see more than one doctor or have certain health conditions, you and your doctors need to be aware of all the medicines you take to avoid potential problems, such as drug interactions.
Drug interactions may make your drugs less effective, cause unexpected side effects or increase the action of a particular drug. Some drug interactions can even be harmful to you. Reading the label every time you use a non-prescription drug and taking the time to learn about drug interactions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.
Drug interactions fall into three broad categories:
*
Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery
dangerous
*Medications result from drugs reacting with foods or beverages. For example, mixing alcohol with some drugs may cause you to feel tired or slow your reactions.
*Drug-condition interaction may occur when an existing medical condition makes certain drugs potentially harmful. For example, if you have high blood pressure, you could experience an unwanted reaction if you take a nasal decongestant.
Remember that different over-the-counter (OTC) drugs may contain the same active ingredient. If you are taking more than one OTC drug, pay attention to the active ingredients used in the products to avoid taking too much of a particular ingredient.
Under certain circumstances, you should talk to your doctor before you take any medicine. Also, make sure to know what ingredients are contained in the medicines you take to avoid possible allergic reactions.
Talk to your doctor or pharmacist about the drugs you take. When your doctor prescribes a new drug, discuss all OTC and prescription drugs, dietary supplements, vitamins, botanicals, minerals and herbals you take, as well as the foods you eat. Ask your pharmacist for the package insert for each prescription you take.
Before taking a drug, ask your doctor or pharmacist the following questions:
*Can I take it with other drugs?
*Should I avoid certain foods, beverages or other products?
*What are possible drug interaction signs I should know about?
*How will the drug work in my body?
*Is there more information available about the drug or my condition (on the internet or in health and medical literature)?
Know how to take drugs safely and responsibly. Remember, the drug label will tell you:
*What the drug is used for
*How to take the drug
*How to reduce the risk of drug interactions and unwanted side effects.
If you still have questions after reading the drug product label, ask your doctor or pharmacist for more information.
UROSTOMY TYPING
by:Victor Alterescu, RN, ET, Via:UOA Resource Library
Urostomy is the general word for any type of urinary ostomy. There are, however, several types of urostomies. Some people have
Ileal conduits. In those cases, a piece of ileum (the third portion of the small intestine) is removed from the intestinal tract and the two ureters (tubes that carry urine from the kidneys to the bladder) are attached to the portion of the
ileum. One end of the ileum is stitched closed and the other end is brought out into the abdomen as a stoma. Very often, people who have ileal conduits think that they have an “ileostomy” because health-care personnel often incorrectly call this surgery an ileostomy. Remember that if the urine is coming through your stoma, you do not have an ileostomy.
Sometimes the ileum is not used, and instead, a piece of the large intestine is used, usually from the sigmoid colon. In this case, the surgery is called a colon conduit.
Urostomies are formed for many reasons. In adults, the surgery is most often done to remove a cancerous bladder. For people with spinal cord problems, a urostomy of one sort or another may save someone from irreparable kidney damage. Sometimes after urostomy surgery, a bladder may be left in place, but if the bladder is diseased, it is usually removed.
Drinking fluids is essential for urostomates. Kidneys are happy when they have lots of work to do. Show me someone who does not produce much urine and I’ll show you two unhappy kidneys! Drinking water may be the single most important thing that a person with a urostomy can do.
Urostomies are the most complex of the three major types of ostomies. They can be found in all age groups. They are performed for more varied reasons than the other two categories, and they can present incredibly complex problems, but when they work right, they are winners! Remember, an ostomy is a cure, not a disease!
IRRIGATION CHALLENGES WHEN TRAVELING
by: Hank Thill, UOA St. Louis, MO
Before proceeding into this subject, let me first describe how I do my irrigation at home. This procedure is optional for each individual colostomate, and is directed to those of you who do choose to irrigate. If you’re like me, you all have a “standard arrangement” for how you’d like your bathroom accommodations to be, and how you conduct the procedure.
My bathroom isn’t large, but it does have a sink, toilet, and shower stall, plus an exhaust fan. I have a hook on the wall across from the toilet to hang the irrigation bag. I attach the irrigation sleeve to the flange on my wafer, and put a clip on the bottom of the sleeve. I sit on the toilet with the bottom of the sleeve on the floor and direct the flow of water through the tubing to the cone inserted into my stoma. I smear KY Jelly on the tip of the cone to facilitate insertion. I’ve previously filled the bag with a little over one quart of tepid water. Regulating the flow with a finger control, it takes me about 10 minutes to introduce the water into my colon. When that step is completed, I seal the sleeve at the zip-lock on the top. Then my routine is to brush my teeth, shave my face, comb my hair, etc. while the waste comes out into the irrigation sleeve. The sleeve, of course, gets heavy and pulls down on the wafer, so it must be emptied at intervals into the toilet, and the end of the sleeve washed off before putting the end clip back on. When you open the sleeve to empty it, there is...ODOR., but my exhaust fan gradually gets rid of it.
Now for CHALLENGE #1...I’m on the road, away from the friendly confines of my bathroom arrangement at home. We’re checking into a motel. The first
The first thing I look for obviously is a bathroom that is self contained. However, more often than not, the sink is in a counter and located outside a smaller room that contains just the toilet and tub/shower and an exhaust fan. How do I keep the clean-out ODOR from offending my wife! To go out where the sink is to wash off the sleeve brings the smell with me. Solution...don’t open the door...wash off the end of the sleeve using the tub faucet. But, remember the sleeve is attached to me, and I have to lean out over the tub and this is awkward to say the least! Plus, I’m stuck in this little room until it airs out.
The plot thickens as we move to CHALLENGE #2. Where’s the best place to hang the irrigation bag? Remember, the bottom of the bag (where the tubing starts) should be at shoulder height when you are sitting down. A door hook is great if it will allow the bag to be hung so that the tubing and attached cone will reach me comfortably and I can control the water flow. Where there’s no door hook, I’ve found that the shower curtain rod is the next best place.
How do you attach the bag to the rod? Where the rod is metal and sturdy, I use a “C” clamp and hang a piece of chain with a hook on one end that can be adjusted to the proper height. Where the rod is plastic and/or flimsy, I use string to secure the chain. A little over a quart of water in the bag is heavier than you think and you don’t want the bag to fall.
I’ve failed to mention filling the bag with tepid water. Again, this is also best done at a sink in the same room as the toilet/tub, but it can be filled elsewhere. Newer homes and some motel/hotel locations have the toilet recessed into an alcove and some distance away from door or shower rod bag mounting locations.
CHALLENGE #3 will require you to use a chair, and hopefully, it will fit through the bathroom door. However, now you’ve got a chair in the bathroom and things can get crowded!
Foreign travel adds another dimension to irrigation. Let’s call this CHALLENGE #4. Let me relate the following experiences: In Scotland, our tour guide warned us about “wee” rooms at an older and the only hotel in the coastal town of Oban. (This small town is known for a famous Scottish distillery that produces 14 year old single-malt Scotch Whiskey which we visited. Samples were free. What a great stop!) If the guide described the rooms as very small, you should have seen the bathroom. When I stepped out of the tub, I had to be very careful not to put my foot in the toilet! An equally small sink was close by, but had no mixer valve. Getting tepid water into the bag was pure guesswork, whereby, alternating hot and cold was the only solution. I need to also mention that the door to the bathroom was not solid, but louvered. Exhaust fan….what exhaust fan??
On a boat trip down the Rhine, our cabin was even smaller than “wee” and contained a tiny shower stall two feet away from the toilet and an itty-bitty sink.
On both of these occasions, I asked my wife to leave our room for an hour. I burned matches to mask the ODOR, but she’s not too fond of that mixed smell either!
Finally...CHALLENGE #5. Security screening at airports where my carry–on luggage is X-ray scanned will invariably bring questions. “Is this a “C” clamp? Is that a piece of chain? What’s that tubing and that cone thing?” Few scanners know about ostomies, much less the stuff we have to personally carry with us. No doubt, you’ve encountered similar questions at these checkpoints even if you don’t irrigate.
The option to irrigate or not is certainly mine. But since I irrigate each morning, I like the freedom of wearing a small closed-end mini-pouch under my shirt and not worrying about waste coming through during the remainder of the day and night.
So bottom line...for me, the aggravation is worth it.
WHY DO YOU COME?
This article via Metro Maryland and GB News Review is a testament to every ostomate as to why they should consider attending an ostomy support group meeting such as are provided by countless hundreds of United Ostomy Association Chapters in communities (both large and small) throughout the United States. Ed.
*Our presence is an encouragement to others.
*No matter how long ago your surgery, no matter how many meetings attended,
there is always information to be gained. *To keep up on newer developments pertinent to ostomates.
*We may have problems and questions that can be asked and answered at the meeting.
*To give support and encouragement to the volunteers (leaders and trained visitors) and to each other.
*To be role models for new ostomates to show an active life can continue.
*To see that many of those who were in trouble are now helping others.
*To learn what’s new in ostomy management equipment.
*To “feel good” with our peer support group.
*To experience a sense of accomplishment and renew a positive attitude for life and fulfillment.
As an ostomate, you owe it to yourself and your “good health” to attend a
chapter meeting and become an active part of the group. You’ll find your life as
an ostomate, “enriched” by the experience.
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