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Volume 33, Number 2 November, 2005
YOU ARE THE CUSTOMER!
Via: Green Bay News Review, Green Bay, WI
The oft-used phrase, “The customer is always right”, has been around for as long as any of us can remember. In fact, each one of us may
have had to remind a store clerk or two of the age-old adage.
But have we ever thought of the doctor-patient relationship as one between a service provider and his or her customer. If you step back and think about it in the proper context, the patient is, in fact, the customer and, as patients, we need to be treated accordingly.
The doctor-patient relationship is used for illustrative purposes. The concepts apply in all medical personnel and hospital situations.
As the customer group in medical situations, we too have responsibilities. We need to be “good” patients. We need to follow established procedures. We need to take prescribed medications, etc. But, we also have the right and need to understand clearly what is being proposed and why, what our options are; and what are the likely (and unlikely) consequences/results of a particular procedure or treatment. To insure our complete understanding, we must insist on clear and concise explanations and we must be prepared to ask questions (hint: write the questions out ahead of time) and to have the questions answered to our satisfaction. A very simple rule to follow is “if you don’t understand it, then it is wrong”. If a verbal explanation or anything in writing is unclear, don’t accept (or sign) it until you, the patient/customer are satisfied.
Remember….It’s not “right”, unless you understand it. Hopefully, the foregoing “food for thought” will lead to a more comfortable relationship between you and all medical personnel. Best of luck!!
POSSIBLE DRUG FOR COLON CANCER
This article was reported by Ivanhoe. COM, Via: The Pouch, Northern VA
Researchers from Johns Hopkins University are now analyzing data from a phase II trial to determine if a specific drug can help slow or stop colon cancer before it starts.
The Epidermal Growth Factor Receptor is a protein located on the surface of a tumor cell. Mutation of EGFR has been linked to characteristics of cancer such as metastasis, growth and dissemination of cancer. Researchers have been studying this receptor for 20 years.
Investigators gave 20 participants the drug Iressa to determine if it can target and inhibit EGFR in colon cancer. Oncologist Manuel Hidalgo, M.D., Ph.D., led the study at the University of Texas, San Antonio. He says, “We have been measuring not only toxicity and efficacy, we’ve been incorporating pharmocodynamics.” He is now conducting the lab component of the trial at John Hopkins University.
Phase I of the trial tested the safety of Iressa on a variety of tumors. Results show it was well tolerated. Side effects included skin toxicity and diarrhea. The FDA is currently reviewing Iressa for lung cancer.
MANAGING A COLOSTOMY
Via: Metro MD & Hemet-San Jacinto, CA
The type of output produced by a colostomy varies according to the site at which the colostomy was constructed. Since the colon absorbs water from the bowel contents, the more colon left intact during surgery, the more solid and predictable the discharge is likely to be. An ascending colostomy is likely to produce frequent, soft stools with unpredictable timing. A transverse colostomy usually produces soft to pasty stools, still somewhat unpredictable but less frequently than the ascending. A descending or sigmoid colostomy can be expected to produce one or more firm, well-formed stools a day on a fairly regular schedule.
With all types of colostomies, the use of a skin barrier around the stoma is recommended in order to protect the skin and provide a leak-proof seal with the pouch. Most often, an ascending or transverse colostomy requires a drainable pouch because frequent pouch emptying may be necessary. With a descending or sigmoid colostomy, a closed-end or drainable pouch can be worn since the stool is usually well formed.
Colostomy irrigation is simply an enema through the stoma. Irrigation is optional for the person with a descending or sigmoid colostomy who wishes to empty the bowel at a certain time each day.
OSTOMY OBSERVATIONS
By: Renard Narcaroti, Via: Philadelphia Ostomy Assoc. & Greater Cincinnati Chapter
It is very common from our experience at the chapter that when people come home from having ostomy surgery that there will be a brief period of grief and mourning. However, you should only have this feeling for a short period...it should only be temporary. As you once again return slowly to an active lifestyle, you will be transformed to the person you once were before the surgery or the disease/circumstances that brought you to this point. If depression lingers or is severe, this is not normal. You should see your doctor. He/she can help you with these feelings. Often they are caused by the shock of surgery to your system, the psychological adjustment to being well or a chemical imbalance. Your doctor has ways to help you so that you may be back to yourself once again.
If you have an ostomy, you should learn all you can about it, not only for your own sake, but also for the sake of setting a good example and being able to advise others with an ostomy. You will at sometime have the opportunity to educate someone about this life-saving surgery and alleviate his/her fears. Never, ever, be embarrassed about having an ostomy. You will be amazed at how many people will truly admire you for the courage you show in adapting to the ostomy. Remember, there are very few, if any, people who never have any medical problems during their lifetimes.
While you are learning about your new life, know how to change your ostomy system. New people regularly come to our meetings and tell us that they have someone else change their pouch...this always surprises us. This may be acceptable for a brief time, while one recuperates, and it is good for a family member to know how to change it in an emergency. Nevertheless, not doing it yourself is equivalent to a normal person not wanting to sit on the toilet and do his/her business by himself/herself. This habit needs to be changed in order to have a better quality-of-life and to adapt to changing circumstances, ie., when nobody else is around.
Be proud of your ostomy. Do not act as if by owning an ostomy that you are less of a person or somehow a less complete person. You are just one of the sporty new front-end exhaust models.
Develop a support system of people you can count on to assist you with ostomy issues. Your ostomy nurse, your friends and relatives, and your local ostomy support group are proven ways that work. There are over a half-million of us in the United States, you are far from alone. Most importantly, we are very glad to be alive. For most of us, the alternatives for not choosing ostomy surgery would have resulted in our deaths.
Another observation from talking to our members is that we Americans seem to like to compete with ourselves to wear our ostomy systems as long as possible. Why do we do this? There is no prize given for the longest wear time. We have one member who would wait until he had a leak before he changed his ostomy system. We vigorously tried to persuade him that it is better to have a regular routine, e.g., using the best practice of changing one’s ostomy system every three to four days. Having one accident is so much worse than changing it at regular, responsible times that this should never even be considered an option.
The number one concern with people about to have ostomy surgery is odor, according to multiple surveys performed by ostomy nurses. Know this; we have less of a problem with odor than normal people do. Modern pouching systems are completely odor-proof when closed. Under clothing, people with ostomies absolutely have fewer parts exposed to make odors than normal people. Everybody creates some odors in the bathroom-just like you and me.
Another observation published by recent medical studies is that we will stay healthier when we exercise regularly-that means at least a half-hour every single day as long as this is safe for your to perform. We must also consume a low fat diet and drink at least 64 ounces of water a day. If you have an ostomy and do not drink enough water, you are asking for trouble.
Advances in surgery and drug therapy have provided us an opportunity to experience a “second chance” at life. If we lived in many other countries, or before WWII, we would probably be dead right now. However, we are not. We are alive and well. Be happy, you have been given a new life.
NON-OSTOMY USE FOR OSTOMY PRODUCTS
Via: Cleveland Ostomy Association
For quite a while now I have thought we ostomates had an advantage over other mortals: In addition to all the uses for our myriad of ostomy products, I seem to be finding quite a few unconventional ones.
For instance, nothing seemed to take off the goo left after removing a bumper sticker until I thought of my ostomy adhesive remover. It worked like magic! It’s also good for removing tar from feet when your at the beach, and it takes off the sticky goo left by price stickers-or stickers left on the windshield-or cleans off Band-Aid goo from kid’s knees. What would I do without it?
Many times, I have lent mothers my tape for kid’s bandages. It is so much less “ouchy” than ordinary adhesive tape. My waterproof tape worked very well for a friend who needed to keep a bandage on his finger but didn’t want to miss swim practice. Then there’s the dial on the TV that needed to be stuck back on, not to mention the plastic rear window on my old convertible.
Whenever I lend my tape for human kinds of repair, I also lend my Skin-Prep (or similar product) to be sprayed under it. This makes peeling off the tape much easier and less ouchy for the kids. Did you know that spraying Skin-Prep on our hands before gardening can help prevent blisters? Also, in nursing homes, when sprayed on the skin under leather brace straps, Skin-Prep helps prevent chafing.
One ostomate reports sticking an extra pouch on his wife and hiding their money in it. Another ostomate told of using tubing from his irrigation kit to siphon gas when his auto’s fuel tank ran empty...Oh Well!
TOO MUCH OF A GOOD THING
By Wanda Herdzina, CWOCN, Via: The New Outlook & GB News Review
Do you need an hour and a half to change your ostomy system? Does your stock of supplies resemble the storefront of the local pharmacy? Do you need a road map to remember what product goes on first, second, etc.? If so, then you may be the victim of the “too much of a good thing” syndrome.
Occasionally, an individual will come to a stoma clinic carrying a large sack with a vast array of skin care products. He/she explains, “All these items are needed in order for me to apply my appliance”.
Unfortunately, the reason he/she usually needs assistance is due to a problem with the adhesion of the barrier-usually due to scars, skin folds or weight changes; skin irritation or skin breakdown. One particular gentleman who come to mind was utilizing a special skin cleaner and cream, two types of skin cement, a double-faced tape disc, a paste and a popular skin-barrier wafer before the pouch was
applied. He had started out with a fairly simple ostomy system right after surgery. However, in his quest to achieve what he felt should be a seven-day wearing time, he had been adding product after product. Besides the many items he was now using, he had what he described as a “closet full of products at home”.
After checking his abdomen, it became obvious that what he needed was a product change in the convexity of his barrier and not the addition of another product. He also needed a more realistic view of wearing time for his particular situation.
Practically speaking, not everyone may be able to achieve a seven day, leak-free wearing time with no skin irritations. It is much better to anticipate leakage and establish a regular changing time prior to this. You know, there are ostomy systems for colostomates designed to be changed in about 30 seconds, whenever full—even several times a day. Europeans prefer this method. Here are a few hints to remember to help achieve a successful ostomy management system:
Keep it simple– Do not use extra cement, skin-care products or whatever unless medically necessary. Usually, extra products actually interfere with barrier adhesion or create skin problems—especially with the new extended wear systems. And as far as washing your peristomal skin, plain water is still the best cleaning agent.
Do not continue to use therapeutic products after a problem has been solved. As an example: A steroidal cream and an anti-fungal micro granulated powder should not be used routinely when changing the barrier. These products are prescribed for particular skin problems. A steroidal cream is usually recommended for its anti-inflammatory effects, chronic-skin itching and systematic relief of the discomfort associated with skin irritation.
However, continued and prolonged use of steroidal creams, after the problem is resolved may lead to thinning of the outer layer of skin. This will lead to a greater susceptibility to skin irritations. Also, stop using an anti-fungal powder when the fungus is gone.
MORE HINTS FROM HERE AND THERE
If you’re stoma bleeds during cleaning and appliance change, don’t panic. A healthy blood supply is what gives your “rosebud” a bright red color. Tiny capillaries are easily damaged and just as easily repair themselves. If bleeding continues long after the appliance has been changed, check with your doctor.
Use a hand mirror for a better view of the stoma. It is about the only way you can see under it.
Sometimes a large teaspoon of bulk gelatin dissolved in water or lemon juice will help firm up a loose stool. It should be taken once a day.
When ill with a virus and diarrhea, eat pretzels, it is something which can be kept down and salt is good for you to maintain liquid balance. If you use washcloths (as opposed to sponges) and you have arthritic hands, substitute thin, inexpensive ones instead. They are easier to wring out.
Always take your ostomy supplies to the hospital with you. Designate someone else to do this if you cannot. Let this person know where your ostomy supplies are. If you have a serious medical problem, make up an emergency “bag” to be grabbed at the last minute. When the ambulance arrives there is no time to do this.
Always remove the cotton from pill bottles after opening. Once you touch the cotton, it becomes contaminated with bacteria. Place that cotton in a bottle of peppermint oil (available at the pharmacy). Make sure the bottle has a good stopper. When changing your pouch, just remove the bottle top and pull some of the cotton out. Works like an air spray and has a pleasant odor that does not pollute the air.
If it looks as if you are allergic to a certain product, try one made by another company and patch test it too. You will probably find one that works for you.
Allergies are not as common as is irritation caused by the faulty use of a product. For this reason, always read the directions that come with a product.
For colostomates, if you feel that the last of the discharge has not been disposed of after irrigating, blow your nose ten or fifteen times after you think you are through and before putting on your little pad. You will usually get rid of the last troublesome matter.
A couple of drops of mineral oil or spraying Pam on the inside of the pouch and rubbing the pouch sides together, causes the feces to drop to the bottom of the pouch, and away from around the stoma.
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