Ostomy Association
of Southwestern Indiana
Re-Route

KEEPING YOUR POUCH ODOR PROOF
By Victor Alterescu, RNET Via: Quad City, IL Newsletter & S. Brevard FL Ostomy Newsletter
Rinsing a pouch out each time it is emptied is primarily a waste of time. For one thing, it takes longer to empty the pouch and you need more materials around you. You also leave more odor in the room since the pouch is kept open longer. The water, especially if it is warm, may open the pores of the pouch material and encourage odor permeation. Never use warm water. Also, rinsing can affect the seal of your adhesive. Rinsing a pouch after each emptying serves only an aesthetic purpose; the interior of the pouch may be clean but it does not serve a functional purpose. Frankly, it does not matter whether the interior of your pouch is clean any more than it matters if the interior of your colon is clean. The pouch is replacing an organ of storage, the colon and/or the rectum. The most important portion of the pouch that should cleansed very thoroughly is the tip of the drainable pouch. Rinsing the interior can only increase permeation but cleaning the exterior neck will avoid any odor that may be present as a result of having fecal residue on the end of the pouch. Therefore, I often recommend that a person carry an alcohol wipe (individually wrapped in foil) to clean the tip of the pouch. The pouch is emptied, the toilet flushed immediately, and the lower portion of the exterior pouch cleansed with toilet tissue and alcohol.

FEELING THE BURN
By: Jim H. Park, MD, Prince William Health System, Manassas, VA, Via: The Pouch, Northern VA
An unpleasant burning sensation or pain in the upper chest. A “lump in the throat” feeling or difficulty swallowing. A chronic cough. An acid taste in the mouth. If you’ve experienced any of these kinds of symptoms on a regular or frequent basis, you could be one of the estimated millions of Americans suffering from GERD—gastro esophageal reflux disease.
“GERD”, explains Jim H. Park, MD, a gastroenterologist practicing at Prince William Hospital, “is a common digestive disorder in which acid flows—or ‘refluxes’—from the stomach into the esophagus.” Symptoms can include heartburn as well as other discomforts. Left untreated, GERD can lead to complications, including significant erosion and damage to the esophagus and even be associated with esophageal cancer. “It’s a significant problem in the U.S. and only getting more so,” says Dr. Park.
When to see your doctor. As nearly everyone suffers from the occasional case of heartburn, how should you know when your symptoms are serious enough to seek evaluation from your doctor? According to Dr. Park, if the problem is regular and recurring, you’ll want to talk with your physician. “The type of people we are particularly concerned about are those who have severe symptoms more than twice a week and who have a history of these recurrences,” says Dr. Park. Severe symptoms include chest discomfort, night time awakenings, acid regurgitation, choking or chronic cough. Obesity, smoking, alcohol consumption and pregnancy can increase your risk of developing GERD. In addition, GERD-like symptoms deserve special notice for anyone with a family history of esophageal cancer or a condition associated with GERD known as Barrett’s esophagus, in which some of the normal lining of the esophagus is replaced by the kind of cells found in the intestine. “Those with a family history are themselves more likely to develop Barrett’s esophagus and esophageal cancer than the average population,” explains Dr. Park, noting that the particular type of serious cancer associated with Barrett’s esophagus, though still relatively uncommon, has been one of the most rapidly increasing in the U.S. “Often,” he adds, “by the time the cancer is discovered, it’s too late to treat surgically.”
Treating GERD. “In relatively mild cases of GERD, your primary care physician might start by recommending basic lifestyle changes,” says Dr. Park. These changes could include quitting smoking, losing weight, cutting back on alcohol consumption, and, of course, avoiding foods such as tomato products, fatty items and acidic juices that can trigger reflux. Over-the-counter remedies such as Zantac and Pepcid Complete may be tried if lifestyle changes alone don’t make a difference. However, those who do not respond to these basic steps or who have more frequent and chronic symptoms or more severe problems such as painful or difficulty swallowing, may require evaluation and treatment by a gastroenterologist. “If patients have had repeated episodes of symptoms for more than five years, I would recommend a video endoscope to look inside the esophagus and stomach, because those people are at risk for developing Barrett’s esophagus as well as severe injury to the esophageal lining,” says Dr. Park. Medications are the standard treatment for GERD, with the physician continuing to monitor the patient for improvement in symptoms and condition of the esophagus, but occasionally surgery might be appropriate. “GERD,” says Dr. Park, “may require treatment for a long period of time—even a lifetime.” Recognizing the importance of addressing the growing problem of GERD, says Dr. Park, Prince William Health gastroenterologists and surgeons are working together to develop a comprehensive heartburn center for treating the disease and its symptoms. “Millions of people in the U.S. suffer heartburn seriously enough to require evaluation and treatment,” says Dr. Park. “We’re creating a collaborative effort to offer patients effective and expeditious treatment of reflux and its symptoms.”

FACTORS WHICH INFLUENCE OSTOMY FUNCTION
By: Liz O’Connor, R.N., E.T. Via: Metro MD & Sterling Ostomy Assoc., Sterling, IL
Quite often patients experience a sudden reversal in normal ostomy function due to medications or treatments they are undergoing. The following information might be helpful to keep in mind. Antibiotics—These often cause diarrhea, even in patients without an ostomy. Ostomates are no exception, and if the problem becomes severe, notify your physician immediately. In the meantime, keep Gatorade or a like drink on hand to maintain adequate electrolyte balance. Pain Medications—These are often constipating, extra irrigations or laxatives or stool softeners might be required for colostomates to combat the side effects of medicine. Perhaps the dosage of pain reliever can be reduced to eliminate the situation. If not, consider one of the above alternatives. Chemotherapy—Many cancer patients have follow-up chemotherapy after surgery or as an alternative to surgery. This often produces nausea and/or vomiting. Gatorade is again good to keep on hand for electrolyte balance. Radiation Therapy—This often produces the same effects as chemotherapy and should be treated accordingly. Travel—Travel can cause constipation in some patients and diarrhea in others. Be aware that these are possibilities. Altered diet when traveling accounts for some of this, plus the excitement of new surroundings. Allow sufficient time for irrigations and take along an anti-diarrhea medication. Check with your doctor if you are not familiar with what works best for you to control diarrhea. Antacids—Those with magnesium can cause diarrhea. Perhaps you will want to ask your doctor to suggest some with aluminum rather than magnesium. Drink plenty of fluids—Tea is always a good source of potassium (so are orange juice and bananas). Coca Cola also contains some potassium. Bouillon cubes are a good source of sodium. Gatorade is used by athletes for electrolyte replacement. It is better served over ice. Remember that some of the signs of electrolyte imbalance are irritability, nausea and drowsiness. Be prepared and prevent this problem when possible. Keep well hydrated with adequate fluids of all types—water included

NIBBLING
By: R. D. Somer, M.A., R.D. Via: The Internet & Hemet –San Jacinto, CA
I was raised on three square meals a day, but I am noticing that I’m starting to gain weight. Should I cut down to two meals a day? No, in fact, you should eat more frequently, not less. The nibbler’s diet has replaced the “three squares” diet as a better way to manage weight, cut heart disease and diabetes risk and curb cravings. A study from the University of Michigan School of Public Health found that women who divided their food intake into several little meals and snacks through the day were leaner, with less body fat, than women who ate the same amount of calories, but packed them into two or three big meals. Why, nibbling helps weight management is poorly understood; however, one theory is that dividing the same amount of calories into five or more little meals and snacks encourages the body to “burn” the food for immediate energy, rather than store it in the hips and thighs. Eating breakfast and eating at consistent times each day also helps curb hunger and prevents overeating later in the day. For example, researchers at Vanderbilt University in Nashville, Tennessee, found that women who ate breakfast had an easier time controlling cravings and consumed less fat throughout the day compared to breakfast skippers. In fact, if someone tells me he/she struggles with food cravings in the afternoon, my first question is “did you eat breakfast?” More often than not, the answer is “no”. Your best bet is to establish a consistent pattern of eating where you eat every four to five hours, which in the course of a few weeks, will help reprogram your body’s appetite and hunger clock. The benefits extend beyond just weight management. Nibbling, compared to gorging on big meals, helps improve cholesterol, and improves insulin sensitivity. The benefits are noticed within weeks of initiating a nibbling style of eating. The trickle-down effect on health is a lower risk of diabetes, heart disease (the number one health concern of postmenopausal men and women), and possibly even cancers of the colon and breast. But wait! Before you race to the vending machine with a license to snack, keep in mind that unplanned nibbling can make or break your weight management effort and health. The secret is not to add more snacks to your usual diet but to divide your current food intake into five or six little meals, while continuing to emphasize fiber and nutrients and de-emphasize the fat, sugar, and salt. In other words, have the oatmeal with raisins and orange juice for breakfast, but save the glass of milk and banana for the mid-morning snack. Have a sandwich, raw vegetables and tomato juice for lunch, but save the dessert of yogurt and fruit for the mid-afternoon snack. Dine on spaghetti, salad and steamed vegetables in the evening, then have a slice of French bread and a cup of nonfat cocoa for a late-night snack.

YOUR URINARY OSTOMY
By Edith Lenneberg, ET Via: Town Karaya, Ostogram & Hemet-San Jacinto, CA
The urinary ostomy requires three kinds of preventative attention: care of the stoma, care of the skin around it, and care of the kidneys. Your routine care of kidney functions includes:
1. Drinking at the very least, one quart of liquid daily like tea, coffee, juice, soup, colas, water, beer, etc. These should be decaffeinated, preferably.
2. Getting your urine tested (urinalysis) every six months.
3. Having an X-ray taken (IVP-intravenous pyelogram) of the kidneys once every two years.
Observations to be made:
1. Stoma - changes in size. After initial healing is complete (about six months), measure with paper measuring gauge every six months; change to equipment with correct opening. Appearance of stoma: Does it appear different than usual, (color, shape, little white or red spots, etc.)? Look for this at each change of appliance, show to surgeon or clinic.
2. Skin - signs of irritation: Are there pink spots, tiny pimples, reaction to adhesive, etc? Look for this at each change of appliance. Learn methods of dealing with routine minor irritations, soreness or raw or infected area: Do not delay, see (your doctor immediately; white deposits or whitish appearance around the base of the stoma. Look for this at each change of appliance; drink at least 8 oz. of cranberry juice daily. Soak the appliance in water/vinegar solution (3 parts water to 1 part vinegar). If there is no improvement in two weeks, call your urologist or GU Clinic.
3. Kidneys - nature or urine: Look at it every day. Is it dark? Drink more liquids. Is it gritty? Tell your urologist. Is there mucus? This is normal. Is there a persistent unpleasant odor? This is a sign of infection and must be treated by your urologist.