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Volume 34, Number 5 February, 2007
CONTROLLING ODOR
Via: Pensacola FL Stoma-Gram
An important part of a new ostomates rehabilitation is learning to control
odor; it is important to feel good about oneself and be secure in relationships
with others. The ostomate can be extremely sensitive to odors and the reactions
of those around him or her, especially family and friends. Colostomies tend to
emit more odor than ileostomies because of the bacterial abundance in the colon.
Most sigmoid and descending colostomies are routinely irrigated, so persistent
odor is less of a problem than with a transverse colostomy where semi-liquid
drainage tends to be rather malodorous. Ileostomates experience almost continual
peristaltic waves which sweep the ileum and prevent stagnation of the intestinal
contents, thereby eliminating the major cause of odor, I.e., bacterial growth.
Extreme and persistent odor from an ileostomy could be an indication of a
secondary problem, such as a stricture or blockage. Urine has a characteristic
odor, but a foul odor could be a sign of infection due to overgrowth of
bacteria. Certain foods will affect the odor of both feces and urine. Avoiding
such odor-producing foods will help. External and internal deodorants are
available, but two important aspects of odor control are good personal hygiene
and appliance care. For fecal ostomies, use odor proof pouches. Change the pouch
immediately if a leakage occurs. Eliminate from your diet such odor producers as
cabbage, onions, fish, spicy foods and eggs; do eat parsley and yogurt. Internal
deodorants that can be taken by mouth include bismuth subgallate tablets which
help control odors by absorbing toxins. Ostomates should consult their physician
before taking these tablets. Urinary ostomates should clean their pouches
periodically with such agents as Uri Kleen, etc. Vinegar solutions have fallen
into disfavor because they tend to damage certain manufacturer’s pouches. Avoid
eating asparagus and onions; do eat parsley and drink cranberry juice.
Deodorants are not used because they would mask the odor which could signify the
presence of an infection. With proper care of the appliance, personal hygiene
and dietary precautions, odor should not be a problem for ostomates.
THE FOUR PHASES OF SURGICAL RECOVERY
By: Dr. Albert G. Wagoner, Via: Sonoma, CA & Hemet-San
Jacinto, CA
Each patient, along with the family, usually goes through four phases of recovery, following an accident or illness that results in loss of function of an important part of the body. Only the time required for each phase varies. Knowledge of the four phases of recovery is essential. They are:
The Shock Phase—The period of psychological impact. Probably, you remember nothing of this phase after your operation. Nevertheless, it is a phase that requires a lot of support.
The Defensive Retreat Phase—The period in which you defend yourself against the implication of the crisis. You avoid reality. Characteristic in this period is wishful thinking or denial, or repression of your actual condition. For example, an ostomate believes that his/her entire colon is still there and will be connected later.
The Phase of Acknowledgment—In this period, you face reality. As you give up the existing old structure, you may enter into a period, at least temporarily, of depression, apathy, agitation, or bitterness and of high anxiety. You hate your stoma, yourself, you cry a lot, pity or condemn yourself. You may not eat, be unable to sleep or want to be left to die. In this phase you need all the support that can be mustered.
The Phase of Adaptation—Now, you actively cope with the situation in a constructive manner. You adapt, during a shorter or longer period, the adjustments that are necessary. You begin to establish new structures and develop a new sense of worth, with the aid of an
Enterostimal therapy nurse and an ostomy visitor, you can learn about living with an ostomy. Aided by your physician, social workers, ostomy association and family, you go about rebuilding and altering the life that brought about the condition. Sound familiar?
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
Aden carcinoma (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 esophageal 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.
TIPS FOR THE UROSTOMATE
Via: Ostomy Outlook, Stillwater, OK
Check the pH of your urine about once a week to be sure the urine is
acidic, with a pH of less than 6.0. Always wash your hands before working with
your appliance or stoma, to avoid introducing bacteria into the stoma. Reusable
or disposable appliances that are not cleaned adequately or are worn for long
periods of time can cause urinary tract infections from bacterial growth in the
pouch and urine. Signs and symptoms of a urinary tract infection include fever,
chills, bloody urine, cloudy or strong-smelling urine, and pain in the back and
kidney area. If you experience these symptoms, see your physician!
TENDER LOVING
CARE - YOUR STOMA NEEDS IT TOO!
Via: Boston (MA) OAB BULLETIN, & S. Brevard (FL) OSTOMY NEWSLETTER
Most ostomy patients would agree that there is no substitute for TLC. That is
one of the reasons that the specialty of ET nursing exists. It ensures that
nurses with a special sense of caring and with special education are taking care
of the ostomy patient’s needs. Once you are discharged, remember that your stoma
needs TLC also. A few pointers might be helpful. Generally speaking, it is good
to set aside a time for giving priority to stoma care. It might be during your
morning shower, after breakfast, or at bedtime. It’s important to make it fit
into your routine. Don’t change your schedule for the stoma. Make it change for
you. Having a regular time for pouch changing, etc. helps put some order into
your schedule. It will also ensure that leakage or other problems can be kept to
a minimum. If you know that your pouch always leaks on the fourth morning for
instance, then begin changing it on the third night, if that time is convenient.
Don’t be rough with your stoma. It’s not unusual for it to bleed a little when
washed. Just be careful not to be too brisk with the washcloth or whatever you
use, as that might cause excessive irritation. Eat a well-balanced diet;
following special instructions from your physician, dietician, ET, etc. Drink
sufficient water and fluids unless you are medically restricted. Persons with
ileostomies and colostomies should chew their food very well. Avoid eating too
many hard to digest and gaseous foods at one meal. Urostomy patients need to be
sure to have sufficient fluids, unless told otherwise by the doctor, as fluids
help prevent infections. Rinsing the pouch daily with a solution of 1/3 white
vinegar and 2/3 water helps prevent crystals from building up on the stoma, and
the wash will also keep the inside of the pouch acid. Acid conditions prevent
growth of bacteria. Patients can usually shower with the pouch off or on unless
instructed otherwise. Water will not hurt the stoma. Peristomal skin especially
needs TLC. A properly fitting pouch, changed regularly, usually accomplishes
this. Never tape the pouch if it is leaking. Change it!! If you have frequent
leakage and have to change too often, call your ET to make an appointment for
re-evaluation. Perhaps another type of pouch would be better suited, or perhaps
your stoma and peristomal skin need re-assessment. There might be some new
products that will work for you. Don’t hesitate to make an appointment.
IS IT ALWAYS
NECESSARY TO USE SEALANT ON MY SKIN?
Via: The Right Connection & Southern Nevada’s Town Karaya
Skin sealants such as Skin-Prep by Smith & Nephew, Skin Gel Wipes by
Hollister, Allkare by ConvaTec and Bard Skincare Protective Film are available
in different forms, such as small wipes, sprays or applicator bottles. These
products contain a plastering agent as their main ingredient and are used to
provide a thin protective film on the skin surface. This film helps prevent
injury to the surface layer of the skin during appliance removal. It also acts
as a moisture barrier. For people with dry skin, the film actually improves
appliance adhesion. Skin sealants also contain variable amounts of isopropyl
alcohol. Because of the alcohol content of the sealant, burning and stinging
often occur when the sealant is applied to damaged skin. Therefore, skin barrier
powder should be used rather than a skin sealant on irritated skin. It is also
important to know that skin sealants may not be recommended for use under
certain skin barriers. The protective film may reduce the adherence of the
barrier.
TESTIMONY OF A NEWSLETTER SUBSCRIBER
Hi, My name is Mavis Barclay and I live in Australia.
I had an Ileostomy performed on October 28, 2002.
I wish to thank you for your endless helpful articles which I receive every
month.
I pass many on to my Specialist.
I am by no means out of the woods, but find so much helpful information in
your Ostomy Newsletter.
My thanks never ends. I have made a file which gets much use not only to
Ostomates but also those who just cannot get their head around our
situation.
A sense of the ridiculous is a necessary requirement. My ability to see the
humour in situations I find myself in are countless.
Keep up your excellent support. Mavis Barclay
OSTO - TIP
If you find your stoma gurgles a lot, try this: At meals, eat the solid foods
first, then take your beverages. Do not eliminate your beverages. Daily intake
of fluids is needed to prevent dehydration.
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