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Volume 31, Number 2 November, 2003
HINTS FOR NEW UROSTOMY PATIENTS
Via: Ostomy Association of Long Island
Train yourself to shut the pouch valve as soon as you have emptied the pouch! If you forget, the resulting disaster within the next 10 minutes could ruin your day. Be sure to take the plastic washbasin and clean measuring container home from the hospital. They are very helpful as you establish a daily routine of washing your nighttime equipment. Gallon bottles of white vinegar and cheap liquid detergent make the daily washing-up an inexpensive chore. If you change the pouch first thing in the morning, there is less chance of the stoma misbehaving as you do the change. Irrigate the pouch daily with a solution of 4/5 water and 1/5 vinegar. The hospital plastic washbasin is an ideal container for supplies when traveling and can be used to hold the night drainage bag. In the morning, it is handy for washing-up wherever you are. It fits nicely into most carry-on bags and is not heavy.
In most cases, urostomy patients enjoy a completely normal diet. Cranberry juice, yogurt, or buttermilk will help combat urinary odors. Asparagus should be avoided by urostomates as it produces a strong odor in urine.
POWDER YOUR STOMA?
By: Schwankweiler, RNET
Powder is normally not required during the routine servicing of a stoma. As a matter of fact, most modern disposable barriers are designed to adhere to the skin by themselves.
Powder is used to treat irritated skin or a fungal infection. Yeast (fungal) infections are very common, especially during summer or when one perspires during regular exercise.
Micro granulated anti-fungal powder is used only when there are signs of a yeast infection, i.e. an itchy rash and raised red bumps. Use the powder until the infection clears, then discontinue.
Pectin-based powders, like Hollihesive, or Stomahesive, or Karaya type powders, are used to treat irritated skin.
To apply any kind of powder, clean the peristomal skin well with plain water and then dry. The skin should be completely dry before applying the powder. Dust the skin with the powder, gently rub it around and then brush off the excess.
The barrier can be applied directly over the powder. You may also seal in the powder by applying a skin sealant over the powder and allowing it to dry. Be careful: skin sealants retard the adhesion of the extended wear barriers and are not recommended! The barrier is applied over the sealant covering the powder.
WHY ARE SOME PATIENTS TOLD TO IRRIGATE THEIR COLOSTOMIES?
Via: Augusta Area, OA, Stillwater—Ponca City OK, & Worcester MA.
Bowel control after colostomy depends in part on the nature of the person. Patients with right-sided colostomies do not have as much remaining colon as those with a left-sided colostomy. Because of this, there is usually
too little colon to absorb enough water to make a solid stool. This type cannot be controlled by irrigation, but instead behaves very much like an ileostomy with a fairly continuous discharge. The sigmoid, or left-sided colostomy, is often described as a dry colostomy because it discharges formed stool. One has the choice of attempting to manage this type either by trained control or irrigation control. Only one-third of the people who attempt to train themselves to control their colostomy without irrigation are successful in doing so.
This type of training relies very heavily on diet and medications to achieve regularity. Most physicians in the country feel that control is more easily and satisfactorily achieved by irrigation. However, there are some patients who cannot achieve irrigating control because they have “irritable bowel”. This problem has nothing to do with the colostomy. It’s just part of some people’s makeup. Some people, even before they had their colostomy, may have had irregular bowel habits. They may retain these habits after their colostomy is performed so that regular irrigation does not assure them regularity. When this condition exists, physicians will sometimes suggest the patient dispense with irrigation since it will not produce the desired regular pattern and the person may become frustrated trying to achieve this.
ARTHRITIS AND THE INTESTINES
Via: Northern VA.
Arthritis is the most common non-intestinal condition associated with Crohn’s Disease and
Ulcerative Colitis. Although most people with these diseases do not develop arthritis, three primary kinds may develop, namely:
1) rheumatoid-like arthritis,
2) ankylosing spondylitis and
3) large joint arthritis.
The first form of arthritis mimics rheumatoid arthritis in many ways. It usually involves the wrists and fingers and may improve or worsen without regard to the course of the bowel disease. Sometimes people with this form of arthritis have an antibody in the blood called
rheumatoid factor which is found in persons who have rheumatoid arthritis. Not all people with the rheumatoid-like arthritis have this antibody, however.
Ankylosing Spondylitis is a condition that involves the lower part of the spine and adjacent joints. In addition to pain, it may cause stiffening of the spine, hips, neck, jaw and rib cage. Its course is independent of the course of the underlying bowel disease. As time goes on, the condition may get better or worsen and on occasion, it may develop even after the bowel disease has been removed or has improved. The disease usually commences before age 30.
Large Joint Arthritis usually affects the knees, ankles, hips and occasionally the elbows and shoulders, The small joints of the hands and feet and the spine are not usually involved. Unlike other kinds of arthritis, this form often worsens as the bowel disease worsens, and improves as the disease improves. It sometimes worsens before the bowel activates. This kind of arthritis does not leave permanent joint deformities.
We do not know what causes these three forms of arthritis that develop with either Crohn’s Disease or Ulcerative Colitis. Many physicians have attributed the arthritis to some immunologic process which may accompany the intestinal disease, but convincing evidence for this is still lacking.
NOTES FOR NEW OSTOMATES
Via: Grand Rapids, MI & The Right Connection, San Diego Area Chapter
Do you ask “Why me?” You are very lucky to live in a time when doctors are able to perform ostomy surgeries. Did you know that rectal bleeding was one of the leading causes of death 100 years ago? If you and I lived back then, we would probably be dead. We have been given a great gift—a new life. It is natural though to grieve over loss of important organs.
Stomas change in size and shape during the first few months. The initial stoma swelling will lessen and the diameter will decrease. It is prudent to check the size of the stoma each pouch change until the size stabilizes.
Each person has a different ostomy just as our fingerprints are different. We have more similarities than differences. Attending UOA meetings gives us the opportunity to explore with others, seek support and information from someone with an ostomy to ease the transition time. UOA has experienced visitors who are generous in helping people who had or are about to have surgery. They will assist with concerns about this new phase of life.
It is your ostomy. Learn to manage it and do not let it manage you. It is normal for your new ostomy to be the center of your existence; however, with time and practice, your ostomy and its daily care will become just a normal part of your daily life.
You are not alone. About 500 ostomies are performed daily in the U.S. Some are permanent and some are temporary. Help others along the way. Be happy you have been given a second chance.
LIVING WITH YOUR ILEOSTOMY
By: Lawrence R. Davis, M.D., Via: Spacecoast Shuttle Blast, & Metro Maryland
This article is from a talk about “The Surgeon’s Responsibility to You and Your Responsibility to the Surgeon.” My talk will be on what a physician expects of an ileostomy patient. Being an ileostomate myself, I have jotted down things I experienced and what I (as a physician) expect of you as you learn to cope.
1. Immediate post-op care, the most important thing the doctor expects is the patient’s acceptance of the change in body image: One of the biggest hurdles with patients who will not even look at their stoma is to let him or her take care of it. This is the beginning of the road to recovery and complete recuperation. This patient should and must be independent by the time he or she leaves the hospital.
2. Get the patient to look at the positive effects of their operation. They are free of the disease, cancer, diarrhea, pain. Most
Ileostomates say they are so happy to be rid of 20 trips to the bathroom and sometimes getting there too late. The new ostomate should be made aware that he has not been mutilated but changed for the better.
3. The next big obstacle is “bagging the stoma,” or finding the right appliances for the patient. The patient needs to know that their stoma is going to change. With weight change, the need will change.
It is very important to understand the problems a surgeon faces. Keep in mind that the individual’s problems dictate the surgeon’s techniques. Individual problems dictate different stomas and locations. You do not swap dentures for eyeglasses, so don’t compare stomas. Go to your ostomy meetings and learn all you can about ostomy care. The caring and sharing will help more than anything else.
Usually, the ileostomate has been on diets for years, and after surgery, does not want to talk about diets. However, there are foods that may cause problems, gas or odors. The patient should be aware of possibilities that the doctor waits until some of the problems occur. This way, the patient is not overwhelmed with so many “iffy” things to think about.
“ASK US”
Via: Los Angeles Ostomy News, Niagara Frontier O.A. & OA of Long Island, NY
An ileostomy study was conducted by Dr. Philip Kramer of MA Memorial Hospital,
BU School of Medicine, attempting to answer the following questions: Which foods eaten by an ileostomate change the ileal output and which do not? What is the function of the small intestine? What do people without a colon miss, or what effect is the function of the large intestine?
The following are some of the conclusions after 224 studies: The average output per day for an ileostomy is about a pint. It is composed of 90% water and 10% solids. The fat and nitrogen content of the ileal discharge is normal, which indicates that the food absorption in an ileostomate is normal.
The salt output from an ileostomy is very high (around one teaspoon per day), as opposed to almost none in the feces of a person with an intact colon. Therefore, the proper intake of salt by an ileostomate is very important. The body, however, seems to compensate for salt and water loss by discharging less salt and water than normal through the urinary tract and through perspiration. The intake of too much salt is to be avoided in that it increases ileal output. Urine output is generally less in an ileostomate. In this way, the possibility of kidney stone development can be kept to a minimum.
Some of the foods which were tried and caused no increase in ileal output were: dark rye bread, cottage cheese, pork, apple and grape juice, milk, watermelon, and cantaloupe. Some foods which increase output were: prunes, raw figs, dates, bananas, grapes, beans and cabbage.
An interesting study involved the intake of huge quantities of water, up to 31/2 quarts a day. Ileal output was not affected, but urine output was increased
IS YOUR APPLIANCE SHOWING?
Via: The Right connection, San Diego Area Chapter
Are you worried about your appliance showing under your clothes? Or your stoma protruding enough to show? People today lead busy lives at a fast pace. Everyone is concerned with his or her happenings. Aren’t you?
By the way, what is the color of your bus driver’s hair? Did the sales clerk wear a dress or slacks today? What color was the bank teller’s tie? Give up?
Forget about the uncalled for worries and enjoy each day. Remember that your attitude about your image will affect the attitude of your family and friends.
HELPFUL HINTS AND BORROWED BITS
It is important that you be aware of the symptoms of kidney infection: elevated temperature; chills; low back pain; cloudy urine (ileal conduits normally produce mucous threads in the urine, which give a cloudy appearance, but bloody urine is a danger sign); and decreased urine output.
It is a good idea to avoid alcohol when taking any drug, but be particularly cautious with: pain medications, tranquilizers, antidepressants, antihistamines, and muscle relaxers.
Rice Krispies can help slow the amount of stool; a great breakfast choice with skim milk or eaten dry.
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