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Volume 35, Number 6 March, 2008
POUCH FALLOFF
Via: Ileostomist, & Spacecoast Shuttle Blast, FL & Metro MD.
One of the most embarrassing situations that can befall an ostomate is to have an accident with the pouch pulling loose, resulting in soiling of clothing and an instant loss of self assurance. Multiple reasons exist to explain the loss of a pouch, such as the stoma itself, the skin around the stoma, the cement, or the pouch. The stoma may be placed too close to a scar, crease or bodily prominence, so that the twisting or bending loosens the appliance. There is no single solution for a misplaced stoma. A different faceplate may be tried, one with a soft and pliable surface to fill in irregular areas, rather than a hard faceplate that pries off with motion. A regular area may be built up with tissue and cement. The stoma may have to be moved, if leakage continues. A prolapsed stoma will push the pouch off. Conversely, a flat or recessed stoma will cause pooling of intestinal contents around the stoma eroding the adherent and eventually lifting the faceplate from the skin. Convex pouches or convex inserts help this situation.
The skin around the stoma might be too oily or too irritated. Bath oils and creams should be avoided. Liquid antacids, such as Maalox, help protect sore skin and, if properly dried, do not interfere with seal of the faceplate. The cement may be too thin. Leaving the can open for a short time will allow some of the solvent to evaporate, thickening the cement. If the can is not shaken sufficiently to mix up the dense cement that settles on the bottom, the thin mixture will not be strong enough to support proper adherence. Not enough time may be given to allow the cement to dry properly.
Finally, a well-fitting pouch that is suited to your needs and lifestyle is essential. If your pouch keeps coming off, have your entire management evaluated by an ET Nurse—No need to suffer!
CAN
RELAXATION TECHNIQUES HELP ME CONTROL MY CANCER PAIN?
Via: Cancer Information Service & Hemet San Jacinto, CA
For some people, cancer pain can be helped by relaxation techniques, imagery,
and massage. These techniques may be helpful used alone or with pain medicine.
Relaxation relieves pain or keeps it from getting worse by reducing tension in
the muscles. It can help you fall asleep, give you more energy, make you less
tired, reduce you anxiety, and make other pain relief methods work better. Some
techniques may work better than others for you, and your ability to relax may
vary from time to time. When you find a technique that works well; do it at
least 5 to 10 minutes twice a day. It may take up to two weeks of practice to
feel the first results of relaxation. Relaxation may be done sitting or lying
down. Choose a quiet spot and close your eyes. Do not cross your arms and legs.
If you are lying down, put a small pillow under your neck and under your knees.
One relaxation method you might try is imagining a peaceful, calm scene while
you or someone else gently massages near the area of pain in a firm, circular
manner. Avoid swollen or tender areas. Another technique is deep breathing while
you slowly tense and then relax groups of muscles. However, if you have any lung
problems, check with your doctor before doing deep breathing. If you have
trouble using a particular method, ask your doctor or nurse to refer you to a
therapist who is experienced in relaxation techniques. Do not continue any
techniques that increases your pain, makes you feel uneasy or causes any
unpleasant side effects.
BLADDER CANCER
Via: S. Brevard, Fl & GB News Review
Cancer appears in the bladder more often than in any other organ of the urinary
system. It is one of the more common forms of cancer among men. It occurs about
twice as often in men as women. It occurs after the age of 50 about 90% of the
time. Cancer of the bladder has one outstanding and readily detected sign —
blood in the urine. Fortunately, this sign usually appears while the cancer is
still in its early stages, when it may be treated most successfully. Most people
with blood in the urine do not have cancer –urinary infections also may produce
blood. But, it is an important warning sign that warrants investigation at the
earliest possible moment. Blood in the urine is not always a bright red color.
If it is present in small quantities, the urine may appear to be merely “smokey”
or “pink” in color. But any change from the usual appearance of urine should be
investigated promptly. Do not be misled if the bleeding occurs only once and
then stops. It often appears intermittently; therefore, a single appearance
warrants a visit to your doctor. Cancer of the bladder usually is diagnosed by
means of a cystoscope—a medical instrument with tiny lenses and a light which
enables a physician to examine the interior of the bladder. The patient is given
a mild anesthetic so that he or she is comfortable and without pain during the
procedure. A small piece of tumor is taken and submitted to a pathologist for
examination to confirm a diagnosis. A urine test is also administered, and a
microscopic examination is made. Usually, the cancer is controlled without
surgery by scrapping the cancer out of the bladder or by implanting radon. Radon
–a gas– is a cancer killing radioactive agent that has been extracted from
radium. It is enclosed in a gold capsule and placed in the bladder. Regardless
of the treatment you receive, the earlier you see a doctor, the better are your
chances for a cure.
TAKE TIME TO ENJOY
By Dr. Dale E. Turner, Hope Healthletter Via: Ostomatic News, Dallas TX
Many people fail to enjoy life because they take on more than they can reasonably handle, leaving little time to pause, reflect and enjoy. Ghandi reminded us that there is more to life than increasing its speed. No good point is served in running all the way to the grave. The art of living is not merely to look, but to see; not merely to listen, but to hear; not merely to experience, but to enjoy.
Few of us have many great days in life. Most of our days are commonplace and routine. It's not by the great thrill of an occasional triumph that we live most, but by the appreciation and enjoyment of the little joys that come and go almost unnoticed.
Little joys like the fragrance of pastry baking, a brilliant sunset, a swiftly moving cloud, the hug of a child, or an unexpected call or letter from a loved one.
Henry David Thoreau once wrote a deliberately shocking letter to a friend, advising him not to worry about his health. "For, he wrote, "you may be dead
already". Thoreau's bold remark was simply a conviction that many people aren't really alive, because they do not sense the joy of each passing moment. Take
time to enjoy.
COLONOSCOPIES—HUMOR
Via: Seattle WA & Stillwater –Ponca City OK & Hemet
San-Jacinto, CA
A physician claims these are actual comments from his patients made while
he was performing colonoscopies.
1) “Take it easy, Doc. You’re boldly going where no one has gone before.”
2) “Find Amelia Earhart yet?”
3) “Can you hear me NOW?”
4) “Oh boy, that was sphincterrific!”
5) “Are we there yet? Are we there Yet? Are we there yet?”
6) “You know, in Arkansas, we’re now legally married.”
7) “Any sign of the trapped miner, Chief?”
8) “You put your left hand in, you take your left hand out. You do the
Hokey Pokey….”
9) “Hey, now I know how a muppet feels!”
10) “If your hand doesn’t fit, you must quit!”
11) “Hey, Doc. Let me know if you find my dignity!”
12) “You used to be an executive at Enron, didn’t you?”
13) “Could you write me a note for my husband, saying that my head is not, in
fact, up there?”
CREATION OF A STOMA
by: Joshua A. Katz, M.D. Dept of Colorectal Surgery, Cleveland
Clinic Florida
The creation of a stomaurostomy-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
ostomy changes should be a least once a day, and never longer than seven. There
should be no leakage of feces around the appliance. Creation and utilization of
a stoma is a team approach involving the patient, the ostomy nurse 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. So be sure to list current
medications, physician’s names, addresses and telephone numbers. If a relative
or friend has power of attorney or is a health proxy, or if there is a living
will, this should also be recorded. 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-usually more than a 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. The ostomy
nurse also plays a critical role in the preoperative and postoperative
management. Prior to surgery-in elective or non-emergency cases–the surgeon and
nurse sit down to 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 like ribs, hips, scars and creases.
* Making sure the patient can see the stoma.
* Placing the stoma so it is not in the midline abdominal incision.
* Keeping the stoma within the rectus muscle to prevent peristomal hernias.
* Preventing stoma tension and assuring an adequate blood supply
* Budding the stoma so that it is inverted to permit proper pouch placement.
This is particularly important for ileostomies so that the
pouch can be placed right next to the stoma with no exposed underlying skin and
thus prevents skin irritation, ulceration and breakdown.
An ostomy nurse can help patients adapt post-operatively to living with their
stoma by assessing the quality of the ostomy system and its fit, and modifying
the pouching method. Particularly in the several months following surgery,
patients may gain or lose weight depending upon their disease and may undergo
several different pouching methods before developing a regimen with which they
are comfortable. The ostomy nurse can facilitate and direct the process.
Patients with ostomies should consider a yearly visit with an ostomy nurse to
reassess pouching methods and to assess for problems. While these principles of
preoperative assessment and operative management are considered standard of care
by colorectal surgeons, there is as yet no data that prove the validity of these
principles. Also, there are some patients with optimally constructed structed
stomas who function well. For this reason, Cleveland Clinic Florida is
conducting the 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. The Cleveland Clinic gratefully acknowledges the participation of UOA
and its members and is always pleased to participate in UOA activities. Those
seeking care, a second opinion or information from colorectal surgeons in the
United States and Canada may contact:
* American Board of Colorectal Surgery—734-282-9400 or
www.abcrs.org
* American Society of Colorectal Surgery—847-290-9184 or
www.fascrs.org
* Department of Colorectal Surgery—Cleveland Clinic Florida —954-659-5251
YOU ARE AS YOUNG AS YOUR
CONFIDENCE
Via: Charleston Area OA & Great Falls, MT &
Greater Orlando, FL Chapter
Youth is not a period of life, it is a state of mind, it is the vigor
of the will, the agility of the imagination, the strength of feeling, the
victory of courage over cowardice, the triumph of the spirit of adventure over
inertia. Nobody becomes old because he has a number of years behind him. One
becomes old when one says good-bye to one’s ideals. With the years, the skin
becomes wrinkled, but the renunciation of enthusiasm wrinkles the soul. Sorrow,
doubt, lack of self-confidence, anxiety, and hopelessness are like long years
that drag the head down to earth and bend the upright spirit into the dust.
Whether seventy or seventeen, within the heart of every person lives the longing
for the wonderful, the uplifting amazement at the sight of the eternal stars.
Within every heart lives a fearless venture, the insatiable child-like tension
of what the next day will bring. Within lives the frolicsome joy and gaiety, the
joy of life. You are as young as your confidence, as old as your doubt, as young
as your self-confidence, as old as your fear, as young as your hopes, as old as
your despondency. As long as the messages of beauty, joy, boldness, the
greatness of men and of infinity reach your heart, you are young. Only when the
wings hang down and the inside of the heart is covered by the snow of pessimism
and the ice of cynicism have you become truly old.
NOT EVERYONE KNOWS
By Sharon Williams, RNET, Via: The Triangle,
Abilene TX & GB News Review
The experience of having a new ostomy can be quite frightening if one does not
understand what is normal in stomal appearance and ostomy function and what is
not normal. Although each ostomate is uniquely individual, there are some basic
generalizations which can be cited in the postoperative period. For example, the
normal, healthy stoma is bright red in appearance, resilient to the touch and
may bleed slightly if rubbed stoma is bright red in appearance, resilient to the
touch and may bleed slightly if rubbed when the peristomal skin is being
cleansed. A marked change in stoma mucosa color or appearance should be reported
to the physician or enterostomal therapist. Also, bleeding from inside the stoma
(whether urinary or fecal) should signal a call to the physician for further
testing. It is normal for an individual with an ileal conduit or sigmoid conduit
urinary diversion to have some mucus in the urine. Drinking sufficient amounts
of water (8-10 glasses per day minimum) will help to keep the urine and mucus
diluted. It is normal for the skin surrounding the ostomy to be in the same
condition as the skin on other portions of the abdomen. Redness, rashes, urine
crystal build-up etc. are not normal and should be reported to the enterostomal
therapist or physician. In individuals with colostomies and ileostomies who
still have a rectum intact, it is normal to expel mucus through the rectum. The
mucus membrane lining the rectum will continue to produce mucus, even though an
individual is “re-routed.” It is normal for the stoma to change slightly in
shape and size due to peristalsis (the contracile motion of the bowel which
propels contents through the intestinal tract). However, marked swelling,
prolapse, or shrinking in size of the stoma, should be checked by a
professional. It is normal for some colostomates and ileostomates to feel as
though they still need to have a bowel movement (phantom rectum sensations) even
though the rectum has been removed. The sympathetic nerves responsible for
rectal control are not interrupted during surgery and therefore the sensations
are still present. Knowledge of this fact may alleviate anxiety. In summary, get
to know your stoma and what is normal for you. Only by recognizing the norm can
one know when and if a problem develops.
HELPFUL HINTS FROM HERE AND
THERE
If your pouch doesn’t stick well there may be an easy solution: Are you
applying it in a high-humidity bathroom right after showering? Skin must be
perfectly dry to hold the appliance. Oily skin care products, such as vitamin E
and Dove Soap, can cause the wafer to loosen and slip. If you change your
appliance before a shower, wait 15 minutes or so until the appliance seal is
secure. Pre-warming of the tube of appliance paste will make it easier to apply.
The tube can be held under hot water. When taking a new medication, keep a close
eye on your appliance to see if the undigested pill appears there. Contact your
doctor immediately if you suspect the medicine is going straight through. To get
the most out of your supplements, take vitamins with meals. That will boost your
absorption and lessen your chances of getting an upset stomach. Thirst is a
great indicator of liquid needs. If you are thirsty, drink up!!!
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