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Volume 29, Number 10 July, 2002
DON’T RISK A NASTY SURPRISE About Pepto Bismol
By: Rodney Crick, Editor, The “Re-Route”
The Saratoga Herald Tribune column “People’s Pharmacy” by Joe Graedon, recently contained some interesting information important to ostomates.
Someone had asked a question about Pepto Bismol. This person had always considered it a helpful, harmless, household, medicine for stopping diarrhea and settling a queasy stomach. Recently the reader had taken a bigger dose for a few days of upset, and had hemorrhaged for nearly a week, until the physician asked her about the use of the pink liquid.
The reader had been on Coumadin, a blood thinner, for four years. When prescribed, there was a warning about aspirin, because the combination could thin the blood too much, but nothing had been said about Pepto-Bismol. The reader was wondering why the label hadn’t carried such a warning.
The answer was, that the active ingredient in Pepto Bismol is bismuth subsalicylate, which acts very much like aspirin once absorbed into the body. In fact, if you were to take the full dose, as directed on the label, it would be like swallowing 8 aspirin tablets.
People taking Coumadin or any other blood thinning medications aren’t the only ones who should avoid Pepto Bismol.
Check with your doctor if you are on gout medication, or undergoing cancer chemotherapy.
ILEOSTOMIES & QUALITY OF LIFE
Excerpted from article by Kevin McHugh, MD, Hamilton,
ON, Via: S. Brevard FL Ostomy Newsletter
I have postulated for some time that both medical professionals and, to some extent, people involved with ostomy associations have some wrongly-skewed impressions about living with an ostomy. I have heard a young gastroenterologist say, “Ostomies are fine, as long as you never want to go to the beach”, and a member of the executives of IOA said to me: “I don’t believe a person with an ostomy can ever feel truly normal.” These are only two examples of a prejudice that I believe is pervasive. My contention is this: Medical professionals and, to some degree, people involved in ostomy groups interact far more with people who have difficulty adapting to life with an ostomy than with those who adapt well. I would go so far as to opine that the majority of people who have the surgery adapt well, have few problems, and do not interact with either the medical or ostomy communities, thus leading to the false perception that there are many more problems associated with the procedure than found in reality.
The term, “quality of life” is used in medical research to define a person’s ability to participate in and enjoy their chosen activities of daily life. A quick search of “Medicine”(a catalogue of all medical publications), reveals over twice as many articles in the last ten years on “mastectomy” and “quality of life” than “ileostomy” and “quality of life.” Moreover, the articles on ileostomy often compare the surgery only to people who have alternative procedures (I.e. Pelvic Pouch) and not to the general populace. This discrepancy is also found with regards to publications on colostomies and mastectomy, which is remarkable in that both are generally performed in the same age group and for cancer, albeit in a different anatomical location. Further investigations will reveal if this reflects a higher incidence and prevalence of breast cancer over colon cancer or if there is another explanation.
A recent publication in the “Journal of The Royal College of Surgeons of England”, by Brennan and Steele, of Dundee, Scotland, entitled: “Objective Assessment of Quality of Life Following Panproctocolectomy and Ileostomy for Ulcerative Colitis”, is some of the first research comparing the “quality of life” of people who have undergone ostomy surgery to that of the general public. While the fact that this study only examined people undergoing ileostomy for ulcerative colitis, limits its applicability to other ostomy surgeries, some extrapolation is possible. The study compared forty-nine patients who had a permanent ileostomy for ulcerative colitis with population norms of similar age and genderin the UK. The study found that not only is “quality of life” good after surgery, but it is similar and in some ways, better than that of the general population. Patients with an ileostomy reported less body pain, more energy and vitality, and higher social functioning.
This research finding stands in stark contrast to the attitudes I described having encountered in the medical and ostomy worlds. I hope that this research spurs more and larger studies of this kind. Moreover, I would urge all people with ostomies to discuss with their surgeons and ETs if they are actively involved in ostomy research. The United Ostomy Association of Canada could be a significant resource for this research and would benefit from having better knowledge of the number and status of people with ostomies in the country. Some Canadian surgical centers are already leaders in this area and others should be prompted to follow their example.
While some may wish to view their ostomy with the attitude, “it is better than death”, this report clearly demonstrates that a significant cohort of people undergoing ileostomy surgery have little or no negative impact due to their stomas. I think the research underscores the importance of the ostomy association fulfilling its mandate of assisting people in adjusting to their ostomy. With this demonstration of the successful adaptation of a group with ileostomies, the importance of addressing the needs of those who are having difficulty in adapting, is reinforced. Clearly, research of the nature described here is criticalcal to improving the lives of all people with ostomies.
CAUTIONS FOR UROSTOMATES
Via: Metro Maryland & Kankakee Ch.
People with urinary surgery generally do not need to be too concerned with diet unless they have some other health problems like diabetes or heart disease.
They must, however, take special care not to gain too much weight, since weight gain can precipitate some special problems. The stoma may retract as the flesh grows around it. And there’s an increased chance of herniation around the stoma if there is too much pressure inside the abdomen.
Normally urine is acid and should be kept acidic. This natural defense mechanism prevents growth of bacteria and the resultant infection. If the urine becomes alkaline, raised, granular, warty areas can develop on peristomal skin which is constantly exposed to alkaline urine. Alkaline urine can even cause crystal-like encrustations or gray, plaque-like lesions on the stoma. If such problems occur, the pH of the urine should be checked to see whether it is acid or alkaline.
To help make the urine more acid, vitamin C can be taken, after checking with your doctor to make sure there are no reasons to avoid it. Vinegar soaks around the stoma can also be used for plaque encrustations or for raised tissue on the stoma.
SWIMMING UNDER COVER
Via: The Ostomy Promoter & GB News Review, Green Bay WI
Are you a beach bum afraid to go in the water this summer? Never fear, here are some ways to cover-up so no one has to know you are wearing a pouch.
First off, select disposable child size or closed end mini pouches. This eliminates the bulkiness and line of a pouch clip.
A patterned suit hides lines much better than a solid color swimsuit. Swimsuits tend to run small, so choose a size 1-2 times bigger than you normally wear. It’s easy for a man to select swim trunks. A women’s suit with more Lycra than nylon will be more slimming and keep a pouch in place.
A two-piece is not out of the question. Women may benefit from a tankini style that fits loosely over the abdomen. Make sure the bottom has a high waist. Beware of suits with high cut legs that may not adequately cover a mini pouch.
Boy leg short suits may hide more but it takes a slim figure to pull it off. Scars lighten months and years after surgery. It’s up to you how comfortable you feel baring your abdomen.
If a two-piece is not your style, try swimsuits with skirts or matching shorts. No one said you can’t go swimming in shorts! Sarongs are great cover-ups while not in the water.
Don’t let a day at the beach or pool pass you by. Swimming is great for toning all muscles of the body.
OSTOMATES RECEIVING CHEMOTHERAPY
Via: Worcester OA, Loraine County & Indianapolis
Ostomates who are undergoing chemotherapy may experience the following:
Peristomal skin reactions– Skin is more difficult to heal due to increased blood counts. Take extra care of skin when the pouch is removed—concentrate on good skin hygiene.
Chemotherapy may cause deep red or purple skin discoloration under pouch faceplate.
Small red spots may appear under pouch due to decreased platelet counts as on other areas of skin; let your physician know if this occurs.
Stoma reactions –small ulcers (stomatitis) may appear on the stoma as in the rest of the gastrointestinal tract. For mouth ulcer treatment, use 1/2 strength peroxide rinses 4 to 6 times daily.
The physician may recommend that stoma dilations and irrigations be stopped until stomatitis resolves itself.
Don’t use solvents or irritating substances on the stoma area.
Due to decreased platelet count, the stoma may bleed more than normal when touched.
There is an increased need for hygiene due to low white cell counts— peristomal skin may be more prone to infection. If wearing permanent pouches, it may be necessary to change to wearing disposable or non adhesive systems, to help increase cleanliness.
For colostomates and ileostomates—Diarrhea is a possible reaction to chemotherapy. Monitor the amount of stool output; inform your physician if the output increases significantly above normal.
Drink adequate amounts of fluid,at least 10 to 12 glasses a day. This may be difficult due to nausea medicine taken prior to meal times.
Eat foods to help thicken stool (applesauce, cheese, white rice, bananas, peanut butter, plain tea and boiled milk).
Stay away from fatty foods, highly spiced foods and beverages which cause gas or could cause cramping.
Potassium is lost in diarrhea and needs to be replaced. Foods high in potassium are bananas, fish, potatoes, apricots or peach nectar, meat and Gatorade. The physician may order potassium supplements.
Constipation is an occasional reaction to chemotherapy (may also be a reaction to some pain medications, such as codeine). Drink adequate amounts of water-at least 10 to 12 glasses daily. Prune juice daily may be helpful!
Eat foods that have a laxative effect, i.e.: raw fruits and vegetables, chocolate and coffee. No strong laxatives.
Urostomates-drink adequate fluids (12 glasses daily)
Check carefully for skin infections, especially yeast and get a physician’s prescription for Mycostatin powder.
Chemotherapy may turn urine colors. Adriamycin turns red, methotrexate turns urine yellow.
Immediately report any blood in the urine to your physician.
VISITING A PATIENT WITH A TEMPORARY OSTOMY: A PERSONAL
REFLECTION(OR..I AIN’T NO SAINT)
By: Muffy
Truscott, Via: Regina Ostomy Assoc.
As a certified visitor with the local ostomy chapter, I have had many occasions over the years to visit patients who have just undergone surgery, leaving them with a temporary ostomy. Usually a temporary ostomy is done on an emergency basis, as the result of a blockage or obstruction in the colon, where stool cannot pass through. This may be the result of diverticulitis or cancer of the colon and sometimes inflammatory bowel disease or Crohn’s Disease may necessitate a temporary ostomy in order to allow the bowel to heal. The intent is to reconnect the bowel at a later time and many patients are told by the attending physician to expect to have an ostomy for anywhere from 3 to 9 months.
My first thought as I headed off to visit a patient with a temporary ostomy was that this would be a piece of cake and the visit would involve lots of questions about management of the ostomy. I also figured that the patient would be greatly relieved knowing they would not have to deal with an ostomy on a permanent basis. Boy, was I wrong! This particular patient was angry beyond all belief, upset with what had happened to her and definitely not prepared to deal with anything as disgusting as a colostomy. To be sure, she wasn’t angry with me but the medical profession as a whole suffered her wrath and it was quite evident that the nursing staff gave her a wide berth. She was NOT going to like this ostomy thing! Not having encountered this kind of reaction before, I wasn’t exactly sure how to proceed but I found myself listening to her frustration and empathizing with her situation. This calmed her somewhat and she toldme that I was the first person who had not treated her fears about the ostomy lightly. She felt people did not take her seriously because hers was only a temporary situation. The visit actually went fairly well after that and although she was still angry with many things, I left feeling that she would manage her colostomy quite well in the short period of time she would have it. It impressed upon me that people with temporary ostomies struggle with the same fears and anxieties that all of us who have permanent ostomies do. In addition to this, because the surgery is done on an emergency basis, they have absolutely no time to prepare themselves for the eventual outcome, the ostomy.
Do I sound like an all-knowing and understanding saint? Well, I don’t feel like one on some of these visits. In general, I find most of those who have just had surgery resulting in a temporary ostomy to be very upset and unusually angry. They just hadn’t expected this.! I am sympathetic, as mentioned before, but the thought also crosses my mind, “Deal with it!!” Recently, I paid a visit to a woman after her emergency surgery who asked me how I could tolerate having a permanent ostomy! At that moment it seemed bizarre that I should be counseling her when I am the one who has to live with this thing on a full time basis. She could look forward to a reversal. On the other hand, hard as it may sound, her comment actually helped me and I didn’t have to hesitate a second for the answer. I know I cope with it because I wouldn’t be here if it weren’t for my surgery for Colorectal cancer. I was 37 at the time and I suppose I had every reason to be angry but I wanted so desperately to live. The surgery and colostomy gave me a second chance at life, for which I am grateful.
I would like to remind some of the people who have to live with temporary ostomies that their surgery likely saved their lives too and that a few months is really not such a long time to live with an ostomy. But I also have to remember how very frightening this surgery is and how it is still considered such an awful thing to have an ostomy. Despite our attempts to educate the public about the normal lives we lead, who among us wouldn’t choose not to have an ostomy? So, I internalize my thoughts and sympathize and try to make the patient feel better about coping with their new situation. But a question still lingers, why do some people marvel at their good fortune while others retreat into anger and disgust? We humans are truly a complex lot.
SUMMER HEALTH TIP
By: Goergene Whiteway, Tulsa OK. Via: Metro Halifax News & Regina Ostomy News , Canada
Now that summer is here and the sun is a more constant companion for most of us, you should aim to get at least 15 to 20 minutes of sun on your skin every day (a little more if you are very dark-skinned) before you apply sunscreen. Vitamin D is important for strong bones and the prevention of some cancers. Apply sunscreen after you’ve soaked up your 15 minutes of sun. Skin that’s overexposed will wrinkle, spot, and for many people, develop cancer.
MUSCLE SPASMS OR NIGHT CRAMPS
Via: North
Wind News & “The Ostomist” Greater
Seattle, Chapter UOA
Ostomates with vomiting or diarrhea who have cramps in hands, feet, or legs, might ask their doctor about electrolytes. Losing lots of body fluid, at any age, from any source, can cause muscle spasms. Hot sweaty weather may cause cramps and charley horses.
Loss of body fluid causes a shortage of the main electrolytes, sodium and potassium, minerals that help the nervous system activate muscles. When electrolytes are in too short of a supply, the muscles may spasm.
Orange juice, honey and apple cider vinegar in water, bouillon, tomato juice, or other high sodium drinks help. Gatorade, other sports drinks, Pedialyte drink and freezer pops from the grocery store, and powdered electrolytes from sport shops are commercial drinks that help stop cramping from electrolyte loss.
OSTO HINTS & TIPS
Avoid drinking from small mouth bottles or through straws which can cause intestinal gas.
A new ileostomate should wear a transparent appliance so they can check on the stoma until everything has been healed.
To avoid intestinal gas, chew food thoroughly, eat slowly and leisurely in a quiet atmosphere, don’t gulp liquids.
Coffee can often bring about bowel activity, it tends to loosen the stool. Tea is an intestinal anti-spasmodic. It stimulates kidney action and is good for diarrhea or excessive perspiration.
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