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ORIGINS OF OSTOMY SURGERY
TRUST YOURSELF
IS IT ALWAYS NECESSARY TO USE A SKIN SEALENT
VITAMIN B-12 FOR ILEOSTOMATES
ELECTROLYTES AND WHY WE NEED THEM
WHEN SHOULD YOU CALL THE DOCTOR
Keryln Carville RN BSc(Nsg) STN, Silver Chain Nursing Association, Perth, Western Australia
"And Ehud put forth his left hand, and took the dagger from his right thigh and thrust it into his belly. And the haft also went in after the blade: and the fat closed upon the blade, so that he could not draw the dagger out of his belly: and the dirt came out" Judges 3:21-22 (King James Version). Ehud's mortal attack on King Eglon of Moab appears to be the first recorded observation of a traumatic opening into the bowel.
The origins of ostomy surgery are entrenched in the antiquity of surgery. The earliest reports of openings into the gastrointestinal system described rupture or perforation as a result of trauma rather than surgery. This is not difficult to comprehend when one considers the history of violence and wars that has accompanied man's journey down through the ages.
Hippocrates 460-377BC
It is appropriate that the word 'stoma' has its origins in the ancient Greek language for they were often at war and appeared to have had considerable experience in perforating injuries of the abdomen. Ancient Greek physicians such as Hippocrates (460 - 377BC) and Celsus (53BC - 7AD) wrote that wounds of the large intestine were not deadly, where as wounds of the small intestine and bladder were (Richardson 1973).
Another ancient medical figure was Galen (130 - 200AD), who was surgeon to the Emperor Marcus Aurelius and the Roman gladiators, and one presumes very experienced in traumatic perforations of the abdomen. In his prolific writings he discussed surgical management of the large intestine and abdominal wall following penetrating injuries, however, he believed little could be done to save the person with a rupture of the small intestine (Haeger 1989).
Throughout the ages, military surgeons have been presented with great challenges in caring for traumatic wounds. These challenges were exacerbated from the 14th century onwards, for it was in 1346 at Crecy that artillery was first used in battle (Leavesley 1996). Those that survived traumatic injuries to the abdomen, it seems, did so largely as a result of human endurance rather than on account of surgical skill. Cromar (1968) reported that a soldier, George Deppe, who was wounded at Ramillies in 1706 lived for 14 years with what appeared to be a severely prolapsed double-barreled colostomy.
Acute bowel obstructions and perforations occurred not only within the realm of the military but royalty has been sorely effected. King Stephen of England died in 1154 with what was termed "iliac passion", a Saxon term described in 923AD as: "a disorder in which a desire cometh upon a sick man for discharging his bowels, and he is not able, when he is out in the outhouse" (Brooke 1980, p1). The first recorded royal, though not the last, who had an ostomy was Queen Caroline, wife of George II, who died in 1736 from a strangulated umbilical hernia. She endured 7 days of suffering before her gut ruptured, but alas to no avail, for she died 3 days later (Leavesley 1996).
William Cheselden (1688-1752), a British surgeon, had a 73 year old patient, Margaret White, who ruptured her abdominal wall following severe vomiting. Cheselden removed the gangrenous portion of prolapsed gut and left the sound portion, thought to be small intestine, hanging through her umbilicus (Richardson 1973). Although she lived for some years we are left to ponder how she may have managed her ostomy.
Surgeons of that period were reluctant to operate on the bowel for fear of peritonitis and inevitable death to the patient. This was not only harmful to a surgeon's reputation but the major stimulus for what is considered today, some bizarre medical practices. These included purging with laxatives and enemas, attempted dilatation via the anus, blood-letting and the consumption of large amounts of mercury in the hope that the heavy weight of the substance would push through the obstruction. Death due to mercury poisoning ws a common side-effect (Leach 1986). Thomas Sydenham, a noted London physician during the mid-1800's, recommended horseback riding as a means to assist the passage of stool through obstructed gut and his treatment for paralytic ileus was to keep a kitten on the distended abdomen, presumably for the warmth (Leavesley 1996). Failed treatments such as these usually resulted in the death of the patient.
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By: Robert Eisman, RN, ET
Regardless of the type of ostomy you have, your prime concern must be placed on getting to know yourself. Any advice you are given should coincide with you as an individual. Lifestyle, activities, weight, all play an important part in determining which product will work best for you .... but
jumping from product to product without being aware of the differences, the advantages, or the disadvantages of each can be costly and dangerous practice. Assuming that you have been taught how to care for your ostomy, how to use your appliance, and where to purchase your supplies, you should become thoroughly familiar with the recommended procedure and equipment before experimenting with a new product. After you've gained the confidence that comes with experience, thought can
be given to exploring other products and procedures. Learning new and better ways to care for yourself can be fun and very rewarding but guidelines should be set and observed with safety being the paramount concern. Remember, the ostomy has not changed you individually. You still have the same strengths and weaknesses, the same needs and desires as before. So, walk slowly at first, but increase the steps and strides as you gain more confidence in your own ability and get back into the mainstream of life as quickly as
possible.
Via: S. NV's Town Karaya
Skin sealants such as Skin Prep by Smith & Nephew, Skin Gel Wipes by Hollister, ALLKare by ConvaTec and Bard Skin Care Protective Barrier Film are available in different forms, such as small wipes, sprays or applicator bottles. These products contain a plasticizing agent as their main ingredient and are used to provide a thin protective film to the skin surface. This film helps prevent injury to the surface layer of the skin during appliance removal. It also, acts as a moisture barrier. For people with dry skin, the
film actually improves appliance
adhesion.
Skin sealants, also contain variable amounts of isopropyl alcohol. Because of the alcohol content of the sealant burning and stinging often occur when the sealant is applied to damaged skin. Therefore, skin barrier powder should be used rather than a skin sealant on irritated skin.
It is, also important to know that skin sealants may not be recommended for use under certain skin barriers. The protective film may reduce the adherence of the
barrier.
Via. Orange Oasis
If a large section of the last portion of the small intestine (terminal ileum) has been removed, you will require Vitamin B-12. The vitamin deficiency may not show up for several years, so if you have had several feet of the terminal ileum removed and have not had Vitamin B-12 injections, it might be a good idea to check with your physician.
Your body can store B- 12 for about three years; then you start to become deficient. The symptoms tend to come very slowly and may not always be easily associated with Vitamin B-12 deficiency, particularly in older persons. They include anemia and neurological symptoms, such as numbness in the feet and difficulty in walking. If the deficiency continues too long, some of the symptoms cannot be reversed, leaving the patient
severely impaired.
The treatment consists of B-12 injections (relatively inexpensive). See your physician. Since the section of the intestine which absorbs B-12 is no longer available, taking Vitamin B-12 tablets won't work.
Via: Ostomatic News, Dallas Chapter
Everyone needs to be aware of the fact that they need electrolytes in their life. If you have ever noticed football players slugging down Gatorade or some other concoction when they return to the bench, it's because they need
to replace the electrolytes they lost with their perspiration.
For the ostomate particularly those with ileostomies, replacing electrolytes is very important. The purpose of your colon is to store food waste and to return the liquid portion of the stool to the body, When you no longer have a colon, that liquid is lost directly into your bag and is gone forever from your body. With that liquid, you also lose a good portion of your electrolytes.
When you have:
1. Cramps lasting more than 2 or 3 hours.
2. A deep cut in the stoma.
3. Excessive bleeding from the stoma opening (or a moderate amount in the pouch in several emptyings).
4. Bleeding at the junction between the stoma and the skin.
5. Severe skin irritations or deep ulcers.
6. Unusual change in stoma size and appearance. A change to a purple or blue color may be an indication of trouble.
7. Severe watery discharge lasting for more than 5 or 6 hours.
8. Severe odor lasting more than a week.
9. Any other unusual occurrence regarding the ostomy.