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Volume 34, Number 10 July, 2007
HERBS AND THE INTESTINE
Via: Cheers & Tears, & Greater
Cincinnati Chapter
Herbs have long been proclaimed nature’s remedy for many of our
maladies. The fact is that 40% of all prescribed drugs are based on chemicals
from plants. The following are a few examples:
* The juice of Aloe leaves is very helpful in caring for the skin around
the stoma.
* Bay leaves, added to slow cooking foods are said to “tone” the digestive
tract. They also relieve cramps and expel wind from the stomach and bowels.
* Cayenne is claimed to have such benefits as easing congestion, warming
your feet, and aiding digestion.
* Dill is an old remedy for stomach ulcers, probably because of its
calming effect. But it will also reduce flatulence when used as a seasoning.
* Garlic has long been proclaimed to be an aid to the immune system and
effective against colds, flue and bronchitis. It, also strengthens the digestive
system and helps in gastro-intestinal disorders. It works better raw than
cooked.
* Parsley is nature’s finest deodorant. It is a breath freshener but also
reduces odor in the stool. Chew a couple of sprigs of parsley, especially after
eating Garlic.
* Thyme in tea is proclaimed to be a cold remedy assist.
CONCERNS WITH THE J-POUCH
By Dr. Tracy Hull, Cleveland Clinic
Patients with ulcerative colitis (UC) who were treated surgically previously underwent a total proctocolectomy with permanent ileostomy. However, in the late 1970s, when the pelvic pouch (J-pouch) procedure was first introduced, the surgical approach to UC was revolutionized.
The pelvic pouch has now become the "gold standard" in surgical treatment. Although the operation avoids a permanent stoma and usually improves the patient's quality-of-life, it does not restore the bowel function to normal.
Patients can expect to have many stools per day - as few as two or three for the fortunate few and as many as 40 for the less fortunate, with the average being around eight - and these stools are pasty to watery in consistency. As with any bowel operation, patients experience many changes, both short - and long-term. This article will discuss some of the potential long-term problems that patients with a pelvic pouch may experience.
Diarrhea: The function of the pelvic pouch will change over the first year - improve as the pouch stretches and becomes larger after the ileostomy closure. However, there are still some people who have 20 bowel movements or more, daily. Dietary changes may help these people to decrease the number of bowel movements. Foods, which have been found to help decrease the water content of the stool, may help to reduce the number of trips to the toilet.
These foods include applesauce, bananas, rice, creamy peanut butter, potatoes, cheese, marshmallows, pretzels, toast, yogurt and tapioca pudding. Bulking agents such as Metamucil, Citrucel, Fibercon or Konsyl also help thicken the stool.
These products are ingested with little fluid to allow extra fluid in the gastrointestinal tract to be absorbed. A doctor to slow down stools sometimes prescribes medications such as Lomotil or Imodium. They should not be used without your doctor's approval. Limiting the intake of fried and fatty foods and milk products may decrease diarrhea. Reaction to foods varies with each individual, and other foods may be found to increase the amount of stool produced or change the consistency.
Bowel obstruction and emptying concerns: To construct the pelvic pouch, the small bowel is stretched, along with the blood vessels that provide blood to the pouch, in order to reach the anus. This stretching may predispose a patient to bowel obstructions from scar tissue, twisting or kinking; surgical intervention may be required to relieve the obstruction. Another concern, which may lead to problems with pouch emptying, is a narrowing or stricture at the pouch-anal joint (anastomosis). This is diagnosed by an exam of the anal area. Strictures may cause symptoms that result in a progressive need to strain more and more to move one's bowels. Usually, dilation solves the problem and rarely is an operation needed to correct the problem. Pouchitis: Pouchitis is a non-specific inflammatory condition of the pouch. The cause is unknown, but it occurs much more frequently in patients who have a J-pouch for IBD versus those who have one for familial polyposis. Patients are at risk to develop pouchitis over their entire lifetime, as long as they have a functioning pelvic pouch. For some patients, pouchitis is an isolated event, but others can experience multiple episodes or even continuous "chronic pouchitis."
The symptoms are similar to a mini-attack of UC. Patients report increased bowel movements, pelvic pain, abdominal cramps, malaise, fevers or blood in their stools. However, it is common for patients with a pelvic pouch to notice blood on the toilet paper with normal function of the pouch and yet not have pouchitis. The most common treatment is Flagyl (metronidazole) 750 to 1500 mg daily for 7 to 14 days. This is effective about 85% of the time. Improvement is usually seen within 48 hours.
WHAT IS THE
RIGHT WAY TO USE SKIN BARRIER PASTE
Via: www.convatec.com &Hemet-San Jacinto, CA.
There are a variety of types and brands of skin barrier pastes,
so check with the manufacturer of the brand you’re using for specific
instructions. Skin barrier pastes are used as “caulking” to fill in the space
between the stoma and the opening in the skin barrier. Skin barrier pastes are
not “glue”, and should not be used to keep the pouch on the abdomen. The pastes
fill in gaps or uneven areas, protect the skin around the stoma, and can
increase wear-time. Generally, this is the procedure you should follow if skin
barrier paste has been recommended to you.
1. Remove the soiled wafer and gently clean the skin around your stoma in the
usual way. Pat the skin dry.
2. Apply a bead of skin barrier paste around the stomal opening on the body side
(sticky side) of the skin barrier/wafer or apply the paste to the skin
immediately surrounding the stoma.
3. Let the paste air dry for about one minute.
4. Gently place the wafer over the stoma and on to the skin. Hold in place for a
few minutes, allowing the warmth of your hand to mold it to your abdomen.
5. Attach your pouch to the flange on the skin barrier.
STOMAL STENOSIS
Via:Ralph Kaye Chapter, San Antonio, TX
Stomal Stenosis is a narrowing of the lumen of the stoma as
it passes through what is referred to as the fascia (located an inch or so below
the ostomy opening) or a narrowing of the ostomy opening due to a tightening of
tissue about the ileum or ostomy. The peristomal hernia is a widening of the
defect of the abdominal wall through which the ileum passes to reach the
surface. If this defect becomes too large, then more ileum can move into the
space between the skin and the lining of the abdominal cavity. The ileum in this
space can then twist or kink on itself and cause a blockage. Any type ostomy can
become stenosed. Your doctor can help resolve this by several methods. Stenosis
that develops right after surgery is usually attributed to mucocutaneous
separation—the stoma separating from the skin to which it is sutured. Stenosis
that develops later may be caused by disease (Crohn’s or tumor), excessive scar
tissue formation at the skin or fascial level, trauma resulting from improperly
fitting equipment, hyperplasia or chronic irritant dermatitis or peristomal
skin. Preventive measures include maintenance of a secure pouch seal to prevent
peristomal skin breakdown, urine acidification measures, prompt treatment of
hyperplasia and awareness of signs and symptoms of partial stoma obstructions.
DEHYDRATION AND THE
ILEOSTOMATE
by: Terry Gallagher, UK (Edited & Excerpted)
When we had our ileostomy surgery, our colon was removed.
In a normal person (that is a personwith a working colon), the colon is
responsible for absorbing most of the water we drink and that is contained in
our food. In addition, electrolytes such as sodium and potassium, essential to
maintaining good health, are absorbed there. Removal or disconnection of the
colon immediately causes the first problem because of the removal of the ileo-valve.
This valve is between the ileum or small intestine and the colon where the
appendix is attached. Its purpose is to hold back the food in the ileum to
enable it to be absorbed better. When we lose this valve, food and water pass
through our digestive system faster, so less is absorbed, often accounting for
weight loss when a person first recovers from the surgery. The ileum does absorb
more water to compensate, but still absorbs much less than the colon did. Waste
from the ileum normally has about 30% of the water remaining, while waste from a
colon has about 10% remaining-quite a difference. In addition, we lose ten times
as much sodium and potassium as someone with a colon. Because of all this,
anything which upsets the balance in our bodies has a much faster effect, as
well as happening much quicker than in a person with a colon. A typical example
is gastroenteritis. A normal person with the same degree of infection may well
be sick and have diarrhea for a couple of days, whereas we may well end up in
the hospital as an emergency. This may apply to other problems which upset the
digestive system’s balance as well as gastroenteritis. When these occur, a
normal person may experience nausea, vomiting, fever, abdominal cramps,
bloating, sometimes bloody diarrhea and signs of dehydration (including the
veins on the back of the hands and elsewhere becoming invisible). Ileostomates
may experience these signs differently. My ileostomy filled up very rapidly with
fluid. On emptying, the pouch refilled in minutes. I felt nauseous and developed
abdominal discomfort. I rapidly began to experience the symptoms of dehydration
which include a dry mouth, decreased or virtually non-existent urine output,
heart irregularities and dry skin. In my case, I could see my urine output had
ceased as I have a urostomy as well. This is a medical emergency! In less than a
15 minute trip to the hospital by ambulance, the driver remarked that I had
visibly deteriorated during the trip, even with an iv of saline being
administered. If hospitalized for dehydration, the ileostomate may expect iv
solutions to be given. The fluid given will be saline, potassium, or potassium
and glucose to replace those essential electrolytes lost as mentioned earlier.
Expect an EKG to check for heart problems, bloods to be taken, and stool and
urine samples (to check for infection) and chest and abdominal X-rays .
Dehydration is a serious medical emergency that can lead to shock,
unconsciousness and death if not treated soon enough. Delaying treatment can
also lead to kidney damage, which may be permanent, requiring life long dialysis
or a transplant. If you become ill with diarrhea, vomiting and fever that
persists and you find yourself with a pouch which is filling and refilling with
fluid and start to develop a dry mouth with abdominal pains, seek emergency
treatment immediately. Normal people may sneer that we’re making a lot of fuss
for a simple “tummy bug” — we’re not! It is much more serious for us than for
people with a colon.
SOME OF THE BEST BASIC
OSTOMY HINTS
Via: The Right Connection, San Diego
Don’t believe as if having an ostomy makes you less of a
person or some freak of nature. There are lots of us and most of us are glad to
be alive. Build a support system of people to answer questions when you have a
problem. Consider our ETs and your officers who are listed in this newsletter.
Don’t play the dangerous game of making your appliance fail by over taping or
putting off a change. There aren’t any prizes given for the longest wear time
except accidents. Don’t wait until you see the bottom of your supply box before
ordering more. Always count on delays in shipping, holidays, etc. when
calculating what is needed. Zip-lock sandwich bags are useful and odor-proof for
disposal of used ostomy pouches. Don’t get hung up on odors. There are some
great sprays and some internal deodorants...Remember— everybody creates some
odors in the bathroom. Don’t feel you are an exception. Hydration and
electrolyte balance is of vital importance. Be sure to drink enough fluids to
maintain good hydration, ileostomates especially. Read and learn all you can
about ostomies. You never know when you may find an opportunity to educate
someone about the life-saving surgery that has extended so many lives. Learn to
be matter of fact about this and never embarrassed. Few folks get out of this
life without some medical problems and unpleasant situations with which to cope.
You may be amazed at how people will admire your adaptability and courage. In
the beginning after surgery, almost everyone experiences some depression. If you
fit into this category, you are certainly not alone. But it need not be a
lasting condition. Try something as simple as walking….long walks. If the
depression seems to linger, don’t be afraid or ashamed to seek help. There is
help out there! The bottom line is— We are alive! In other times, in other
countries, we might not be. Medicine and techniques today have given us an
opportunity to experience this second chance. It is certainly an opportunity
worth accepting and exploring. The most important part of you as a human being
has not changed.
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