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Volume 30, Number 10 July, 2003
SUMMER SUN BULLETIN
By: The Marketing Communications of Cole Managed Vision, Via: Indianapolis Chapter
Sunglasses provide both the “right” look for those sunny summer days, and important protection from two dangerous types of invisible ultraviolet (UV) radiation. Exposure to both UV-A and UV-B light for even short periods of time can cause damage to the surface of the eye (cornea & sclera), similar to sunburn on the skin. Sunglasses reduce sun glare, but can also protect the eyes from these dangerous UV rays.
“While glare from the sun is typically cited as the primary reason people wear sunglasses, many people do not realize the medical impacts that the sun’s ultraviolet rays have on the eyes,” according to Dr. Ken Clanton, Medical Director for Cole Managed Vision. “Not only can sun burn our eyes, but intense or prolonged exposure to the sun is also linked to cataracts, macular degeneration and some forms of carcinoma of the eyelids.” When choosing a pair of sunglasses, you should always select one that gives you maximum protection from the sun (larger size, wrap-around lens, etc.).
For optimum protection, sunglasses should block 99 to 100 percent of UV rays. Technological advances in lens materials and sunglass design not only protect the eyes from the sun, but also provide wearers with fashionable and functional style.
Polarized sunglasses— Enjoy the sun without the dangerous glare. Polarized lenses reduce glare and improve vision when driving or enjoying both summer and winter outdoor activities.
Adjustable tints—Not only do adjustable tints protect you from the sun’s harmful rays, they also enhance vision in the sun or in the shade.
Fashion Tints—Choose a tint that complements your facial tone with a UV coating to protect your eyes against the sun’s harmful rays.
Magnetic Clips—Add a polarized magnetic sunglasses clip to your prescription eyeglasses for enhanced versatility and maximum protection.
UV light is most intense between 10 a.m. and 2 p.m.; however, UV rays exist when it’s gray and overcast.
UV rays don’t take breaks during winter. In fact, reflected sunlight from water, ice or snow can be even more dangerous due to the reflective effects of the sun.
Watch out for other UV light sources including welding lamps and tanning booths. Don’t look directly into these light sources and always protect your eyes.
YOU MAY HAVE SEEN THIS BEFORE
Reprinted from Metro MD and Delene St. Clair’s Archives, Via: “The Right Connection, San Diego Area Chapter
The Ostomates’ Most Often Asked Question: What is the correct way to empty your appliance (regardless of what type of ostomy you have)?
So many ostomates want to make this so complicated and so unnatural! Some kneel on the floor in front of the toilet, others stand facing the toilet bowl; others take off the pouch and empty and rinse in the toilet bowl; Some remove the pouch, empty it in the toilet and then wash it in the sink; still others fill the pouch with water, swish it around and then empty it again. We could go on and on about the way pouches are emptied. Name it, and its been done before!
Why not make life as easy as possible and make pouch emptying as easy, natural and stress-free as a normal trip to the restroom. When the pouch is 1/3 to 1/2 full, empty it, as the weight will cause tension and loosen the adhesion of the appliance, resulting in leakage.
Throw out the syringes, plastic bags, tin cans and whatever else it is that you use. Maybe the nurse at the hospital told you that you had to wash it out, that you had to kneel or face the toilet. But think about an easier system; Sit on the toilet with the pouch between your legs; Lean forward; With the closure clip on, turn the contents upward, away from the body; Remove the clip; Carefully aim the end of the pouch into the toilet and empty; With toilet paper, wipe off the end of the pouch; Refasten with the clip and presto, you’re ready to go!
COLOSTOMY NOISES
Via:
OAB, Birmingham, AL & Greater Cincinnati Chapter, UOA
Colostomates are somewhat embarrassed by noises emanating from the stoma. There are two kinds of noises, those caused by the escape of gas and some due to the movements of the intestines.
The latter is the “growling” stomach and nearly everyone experiences such noises at times. It is usually a good idea to have a little something to eat before going out because it is the empty stomach that growls. The escape of gas comes from the air we swallow without food, or that which we gulp when we are nervous.
Gas can also enter the intestines from the bloodstream and even less common from fermentation of food. This is not common because usually the food has been very disappointing in the control of gas.
Pure charcoal seems to absorb gas better than any other preparation. Tablets containing bicarbonate of soda can cause gas to be emitted from the mouth but some may also be expelled from the stoma.
WHO ARE OSTOMATES?
Via: The Courier & GB News Review & Hemet San Jacinto, CA
Men and women, rich and poor, all races, creeds and colors. No one is exempt, from a new born babe to the very elderly.
Some have felt alone with their ostomy, apart from the rest of the world. Nothing could be further from the truth since there are over one million ostomates in the United States and Canada alone. And, our numbers are increasing at an annual rate of more than a hundred thousand. When we add the millions living in other parts of the world, we find that we are far from being alone.
HELPING PATIENTS ADJUST
Via: GB News Review
The patient with an ostomy is apt to foresee a life of ostracism. Even though he/she may have been ill and limited in activity for a long period, it will be difficult for him/her to acknowledge the inability to voluntarily control his/her bowel or urine function.
As his/her family doctor, you may be able to handle the patient’s questions and emotional difficulties better than the consultant, a stranger to the patient. But, the best medicine is a visit by a healthy, happy, fellow ostomate. It is also important that the patient is associated with an
Enterostomal Therapist.
If the patient is a woman, the sight of an ostomate in a slim sheath without a telltale bulge can provide assurance. And, the visitor will answer the type of questions the patient might be reluctant to ask others. The following are typical questions new ostomates ask, and the answers a fellow ostomate can provide.
CAN I HAVE INTERCOURSE? When the patient asks about the potential for sexual intercourse, it’s a harbinger of a successful adjustment. A man will be concerned about his ability to perform; a woman about her ability to attract and satisfy. All too often, the subject is skirted or, even worse, is handled negatively with, “What difference does it make at your age?” or “This operation is going to save your life—isn’t that enough?”
According to the United Ostomy Association, it is estimated that approximately 10-20 percent of male ileostomates suffer impairment of sexual function and potency. But fortunately, this is only temporary in most cases.
Males who have had urinary ostomies early in childhood can usually perform sexually, but they may be sterile. More than half of the males who have urinary surgery as adults for bladder malignancy are impotent. The average age for this surgery is 74.
Male colostomates vary in their degree of potency from full potency to complete impotency. In many instances, potency is retained, but in these cases the patient is sometimes sterile. In some patients, potency is lost due to the extent of the surgery. In a few cases, regardless of the type ostomy, it may take as long as two years to regain potency.
IS MARRIAGE POSSIBLE FOR ME? Many ostomates have married. An ostomy is not a barrier to getting married. The first ET nurse, Norma Gill, was married after her ostomy surgery. And usually, no marriage breaks up solely on the basis of the ostomy, although it may put added pressure on an already weak relationship as will any serious illness or emotional event. In fact, a remarkable 82% of ostomates are still married to the same spouse a year after surgery. This compares to 76% of the normal population.
CAN I HAVE A CHILD? A patient contemplating pregnancy should consult her physician for evaluation of her individual situation, but an ostomy in a woman does not preclude a successful pregnancy. In addition, an ostomy is not an indication for a caesarean section. Many ostomy women have normal vaginal births.
There is a need, however, for close medical care during pregnancy. The ostomy may tend to enlarge or protrude. This may require a temporary change in her ostomy management system to permit modifications to the size and location of the stoma. An ostomy woman may also require more careful monitoring of her diet and fluid needs. But, on the other side, ostomy women never worry about constipation or hemorrhoids like their continent friends.
CAN I TRAVEL? The patient can go anywhere in any type of vehicle. An ostomy alone does not stop someone from climbing mountains; riding horseback; flying in airplanes; driving in autos; riding bicycles; taking cruises; etc.
All ostomy patients should buy a copy of the book, “Yes, We Can!”, by Barbara Kupfer. It is currently the best resource on traveling and offers all types of valuable advise on traveling with an ostomy and tips for everyday living.
WILL I BE ABLE TO SLEEP AT NIGHT? Any comfortable position may be assumed with a correctly applied ostomy appliance. Having an ostomy will probably improve the sleep of a patient who had previously been sick.
CAN I PARTICIPATE IN SPORTS? Ostomates report enjoying many types of sports-water skiing, body surfing, skin diving, tennis, golf, baseball, football, hockey, weight lifting, running, bicycling, hiking...you name it.
Rough contact sports require special protection for the stoma, but, there are professional athletes in all types of sports with stomas. An ostomy alone, is not a reason not to participate in sports. You can assure your patient that he/she will be back on the golf course, hitting them as good as always. The ostomate’s desire is to return to his/her normal way of life and there is every reason he/she will do just that.
STOMA SURGERY: TRYING TO GET IT RIGHT!
By: Joshua Katz, MD, Cleveland Clinic, Florida, Via: Broward Ostomy Association
Creation of a stoma (Ileostomy, Colostomy, or Urostomy) represents a major, immediate, and sometimes permanent change in the life of a human being. This can have profound effects upon lifestyle, intimacy, employment, recreation, and travel. Fear, misunderstanding, loss of self-image and social isolation can compound the situation.
Colorectal surgeons and nurses who care for patients with a stoma must recognize that to save someone from a life threatening condition means little if the life the person returns to is made miserable by a poorly functioning stoma. The objective of any operation involving a stoma is to create a stoma that the patient can care for with simple routine using an appliance that fits reliably, comfortably, and protects the surrounding skin. Time between faceplate (wafer) changes should be at least three, and preferably five to seven days. There should be no leakage of feces around the appliance.
Creation and utilization of a stoma is a team approach, involving the patient, the Enterostomal Therapy Nurse (ET), and the colorectal surgeon. Patients must assume responsibility for their own health and well-being. They need to learn about their disease and understand what operation is being performed and why. They need to know whether they have a colostomy or ileostomy, and whether it is permanent or temporary. An important rule to keep in mind is “WHEN YOU DO NOT KNOW, ASK.”
It is useful to keep a medical summary of one’s medical and surgical history written down. List current medications, physicians’ names, addresses and telephone numbers. If a relative or friend has power of attorney or is a healthy proxy, or if there is a living will, this should be recorded too. One may also choose to obtain copies of operative notes and discharge summaries from recent or complex procedures and hospitalizations. This record is particularly critical when traveling or relocating. It is important to know that by law, all information about a patient must be made available upon request of the patient. This means that at any time, you can request a copy of your medical record. In particular, patients planning a long journey (more than one week) or relocation, should notify their doctor, travel with a copy of their medical record, and prior to leaving, seek and obtain the name and number of a physician at their destination.
destination.
The Enterostomal Therapy Nurse (ET) also plays a critical role in the preoperative and post-operative management. Prior to surgery (in elective or non-emergency cases) the surgeon and ET sit down and review with the patient what procedure is being done and why. The patient then has his/her body examined while standing, sitting and lying down to determine the best place on the abdominal wall to locate the stoma. One or more sites are then marked so that the surgeon knows where to place the stoma during the procedure. Principles of stoma location and creation include:
Keeping the stoma away from bony landmarks (ribs, hips) scars, creases;
Making sure the patient can see the stoma.; Not placing the stoma in the midline abdominal incision;
Keeping the stoma within the rectus muscle to prevent peristomal hernias where possible, preventing tension and assuring adequate blood supply;
Everting (budding) the stoma to permit proper pouch placement.
Enterostomal therapist can help patients adapt postoperatively to living with their stoma by assessing the quality of the appliance and its fit and modifying the pouching methods before developing a regiment with which they are comfortable. The ET can facilitate and direct the process. Patients with ostomies should consider a yearly visit with an ET to reassess pouching methods and to assess for problems.
While these principles of preoperative assessment and operative management are considered the standard of care by colorectal surgeons, there is as yet no data that proves the validity of these principles. Also, there are some patients with optimally constructed stomas who are miserable and some patients with extremely poorly constructed stomas who function well. For this reason, Cleveland Clinic, Florida, is conducting research to determine if the currently espoused methods actually impact upon quality of life and stoma function. We have developed a “stoma scoring system” and have used this to assess 70 patients in conjunction with validated quality of life estimates as well as appliance wear time and leak rate. Data are currently undergoing statistical analysis and the results will be published.
OSTOMY PROCEDURES THAT CAN BACKFIRE
Via: The Right Connection
There are times when we think we are doing the right thing or taking a “logical” shortcut, but inadvertently get ourselves into trouble. Here are some instances to think about:
Using alcohol to clean the skin surrounding the stoma; Alcohol is a powerful drying agent. Prolonged contact with the skin can have serious consequences.
Wrapping the drainable pouch tail around and around the clamp before closing it; This will not make the clamp work better. All it will do is spring the clamp out of shape, which will ensure that the clamp will be less likely to work for future applications.
Snapping the pouch off the face plate ring to expel gas. This procedure
does not do much for odor control. It is better to hold the tail of the pouch
beyond the clamp with a tissue with deodorant on it. Then hold the pouch up so
that only the gas is at the clamp, open the clamp and push the gas out through
the tissue with deodorant. Then use the tissue to clean out the end of the pouch
and replace the clamp.
Wearing the appliance for as long as you can until it leaks; The object is to change the
appliance before leakage occurs. This way your skin gets the best protection and care.
Washing pouches in the washing machine and using the same pouch for months; Eventually, the plastic of the pouch is saturated with the odor of the chemicals and no amount of washing will get rid of it. Throw the pouch away when throwing the face-plate away.
Trying every new pouch and new product you hear about; Although it is fine to experiment with new appliances, especially if you are unhappy with your equipment, you will generally get the best service from the equipment you have the most experience and practice with.
Ignoring skin problems. All skin problems are easier to treat if they are
found early.
Letting the pouch get full before emptying it; Excess weight will separate a two-piece system and will put excess weight on the face plate, resulting in early failures. Empty the pouch when it is one-third full.
Not using seat belts in a car; A well-placed and adjusted seat belt should not interfere with the stoma function or damage your stoma. True, in an accident, your stoma may be damaged, but it is a lot easier to repair a stoma than a crushed skull.
It is not a good idea to try to live with a condition you can't correct
yourself. When in doubt, see your friendly Enterstomal Therapist (ET) or your
doctor.
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