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Volume 33, Number 11 October, 2006
WHAT CAN YOU DO?
Via: The Innermost News, Monterey City & the G.B. News Review
Your ultimate goal is to take personal charge and live a happier life—despite
having ostomy surgery. Here are a few strategies that can help you to better
handle your ostomy and improve your overall health, happiness and productivity.
Be a person, not a patient. Make this the foundation of your thinking. You are a
person who has had ostomy surgery, not an ill person. The only time you are a
patient is when you’re in the doctor’s office or in the hospital. The way you
see yourself living with an ostomy is an essential part of coping successfully.
Understand the unique way that your ostomy affects you and your life -
Identify the ways that your ostomy causes problems for you. You’ll want to
identify them and then determine how you’re going to deal with them.
Set overall goals for improving your life: Improve your ability to adapt
to your situation. Improve your coping style. Set reasonable, realistic,
achievable goals. Aim to regain control of your life. Do things that you like
and spend less time with things you dislike. Enhance positive relationships.
Improve participation in your social network. Improve your life satisfaction and
quality of life.
Pinpoint what you need to help improve your life. Think about all the
difficulties that you are having living with your ostomy. Write these down on
the left side of a folded piece of paper. On the right side next to each item,
write down things you can do to improve each one. Note as many alternatives as
you can. Ask others for additional ideas, especially if you’re not sure what to
do about certain things. Keep adding to your list and plan how you will use
these ideas to improve your life.
Anticipate the negative. There are negative things that can happen
during your life with an ostomy (leakage, skin irritation, depression, fear,
sexual concerns) but some of these could also happen if you didn’t have an
ostomy. The more you anticipate and prepare—the better you will cope.
PATCH vs. POUCH vs. PLUG
Via: Jacksonville, FL Mail Bag, Via: SW Arizona ICU Bulletin & S. Brevard
FL Ostomy Newsletter
There has been much discussion over whether colostomates should wear a patch
over their stomas, a pouch or the plug (a pouchless product). The controversy
behind the three Ps dilemma is whether or not the person with a colostomy should
irrigate. No two ostomies are alike and irrigating is not for everyone. The
colostomy has to be in the descending or sigmoid colon to irrigate. A colostomy
in the ascending or transverse colon will produce stool too watery for
regulation. People who had a very unpredictable bowel schedule before surgery
may continue to do so despite efforts to achieve regulation with irrigations.
Some people have work schedules or lifestyles that don’t permit them to irrigate
at a consistent time each day and this, too, can cause irrigations to be
unsuccessful. Other people simply don’t like to irrigate. The thing you need to
know is this: YOU DO NOT HAVE TO IRRIGATE YOUR COLOSTOMY FOR IT TO WORK. Your
bowels will work anyway, irrigation or not. The purpose of irrigating is to
achieve regulation of the bowel. The reason for regulating the bowel is for the
individual’s comfort and convenience. If irrigating is not accomplishing
regulation and if it is making you more uncomfortable trying to fit in your
personal schedule, you should not be doing it. FIND OUT WHAT WORKS FOR YOU AND
STICK TO IT.!
ALL POUCH WEARERS
Via: Coos Bay Oregon & Greater Cincinnati Ostomy Association
Avoid letting your appliance get too full, either of waste or gas. Although one
of our members says he likes his pouch to “balloon up” because it makes him
lighter on his feet, it’s not a good practice. Normally, you should empty your
pouch when it becomes 1/3 to 1/2 full, and before trapped gas makes it feel
firm. As the pouch becomes fuller, it places a greater strain on the snap
fastener holding the pouch onto the flange, for two piece wearers and increases
the tendency for the adhesive part of the appliance to pull away from the skin
around a stoma for even a one-piece pouching system. If it is not convenient to
empty a “filling” pouch, get somewhere you can discreetly “pop” the seal,
releasing the gas pressure. This trick can buy you a little more time before
emptying is absolutely necessary. Also, for ileostomates, if you know that you
are going to be traveling or in a situation where easy access to a rest room is
not available, adjust what you eat to avoid high residue food. Instead of eating
two bran muffins and a bowl of Raisin Bran for breakfast, consider pancakes,
which have much less residue. Be aware of how fast your body responds to eating.
If you know that you can expect lots of stoma activity about two hours after
eating, time your meal so that you won’t have to deal with a pouch approaching
its capacity at an inopportune time. Similarly, urostomates may want to consider
temporarily adjusting their rate of fluid intake for a short time. The caution
here is that urostomates should consume plenty of fluids during the day. This
technique is not advisable for periods of more than a couple of hours. Ostomates
shouldn’t skip meals before going out socially. In general, the less an ostomate
eats, the more gas, he or she will produce, with its attendant problems.
Actually, a quick arm across the stoma will usually silence if it is operating
at the wrong time.
THE FUNGUS AMONG US!
By Kathy Dahn, RN, Riverside HealthCare Via:
Kankakee Ostomy Association
My patients frequently tell me how good it feels when I remove the ostomy
appliance and bathe the skin around the stoma with warm soapy water. A bit of
itchiness at that point is normal. What is not normal is to have severe itching
under the appliance while you are still wearing it. There can be several reasons
for this but one of the most common is a fungal infection. This is not a cause
for panic!! Many people worry that having a fungal infection indicates they are
not clean and that is simply not the case. Fungus thrives where it is warm and
dark and moist—a great description of the environment under an ostomy appliance!
The peristomal skin (the skin around the stoma) will usually be a “hot pink” or
strawberry-red when a fungal infection is present. The skin may be intact or
there may be places where the top layer of skin is missing, leaving an open
wound which is red and moist (and tender). The fungal infection can be treated
in different ways with the main difference being the use of a powder versus a
cream product. Regardless of whether you use a powder or a cream, your appliance
will probably not adhere for as long a period of time as you are used to, so
beware! (My sixth grade teacher used to say, “Fore-warned is fore-armed”, so
consider yourself warned!) Nystatin (Mycostatin) powder is a product that will
combat the fungal infection. Powder is especially helpful when there are many
areas which are open and moist. To use the powder, clean and dry the peristomal
skin well, then apply a light “dusting” of the powder to the affected areas. You
can place your appliance directly over the powder or you can apply a skin-prep
over the powder to help achieve a tighter seal. Another method (which Karen and
I frequently use) is to apply Lotrisone to the entire reddened area. Lotrisone
is a combination product with clotrimazole to fight the fungus and betamethasone
(steroid) to decrease the itching. By the time patients come to see us with a
fungal infection, they are frequently so miserable with the constant itching
that we elect to use the Lotrisone to give relief. At this point, I’m sure
you’re probably thinking….but Lotrisone is a cream and the appliance will just
slip right off...and you’re right! To help achieve a tighter seal, we then cover
the Lotrisone with a “second skin” - Extra Thin Duoderm. Extra Thin Duoderm is
just what it says it is—it is very thin and it adheres to the skin when the body
heat softens the Duoderm. Skin prep can be applied over the Duoderm to increase
adhesion, then the ostomy appliance can be placed in the usual fashion. The
edges of the Duoderm can be secured with tape as needed. One little hint about
using the Extra Thin Duoderm: if you are cutting a hole in the center to
accommodate your stoma, you will need to cut the hole smaller than usual as the
Duoderm tends to stretch somewhat when you remove the paper backing. There is no
special amount of time that you will need to use the antifungal products. They
can be discontinued once the peristomal skin looks and feels completely normal.
If you have had your ostomy for years and never had a fungal infection before,
you may wonder, why now? One reason is that our immune system becomes less
efficient as we age. In addition, increased use of antibiotics not only kills
the “bad germs” but wipes out our normal flora– the “good germs” that normally
live in our body. Our normal flora help to keep the “bad germs” in check so when
the normal flora is decreased; the fungus can take over—sort of a “when the cat
is away, the mice will play” scenario
And of course, summer heat can cause moisture under
the appliance through perspiration. I hope this helps to clarify some of the
confusion about “the fungus among us”.
EXERCISES AFTER SURGERY
by Barbara Hiser RNC, MBAs Via: S. Brevard FL & Heart of Iowa Support Group
When a patient has surgery, he becomes a candidate for several complications.
The degree of risk depends upon the exact type of surgery, its location, how
long the surgery lasted, how much pain the patient is having after surgery, how
much movement the patient is able to perform after surgery, and other factors.
Immediately after surgery, most patients don’t move about very much. This might
be related to pain from the surgery, sleepiness from medications, the presence
of tubes and dressings that make mobility difficult, and other factors. As a
result, blood flow slows down, especially in the legs, and a blood clot can
form. If not treated, the blood clot can become dislodged and travel to other
parts of the body. Your nurses and doctors will be checking regularly for blood
clots. Let them know immediately if you have any tenderness in your legs,
especially in the calves. If a blood clot is suspected, special tests will be
performed to confirm the diagnosis and special medications will be started to
help reduce the size of the clot. This treatment complicates the hospital stay,
delays the discharge, and adds additional discomfort to the patient. The
following things will help to prevent blood clots. Each patient will benefit
differently, depending upon the type of surgery.
1. Your doctor might order elastic stockings. The nursing staff will remove
these daily for a short period of time, and then replace them.
2. Your doctor might order inflatable stockings or “booties”. They apply
alternating pressure to the legs or feet to encourage blood flow. The nursing
staff will remove these daily for a short period of time, then replace them.
3. You can help prevent blood clots by performing special exercises while in
bed. Tighten and release the buttocks for several seconds frequently throughout
the day. Move the feet up and down, as if working the gas pedal on a car.
Pretend you are writing your name or leading an orchestra with your feet. Do
this frequently throughout the day.
4. Call for assistance to get out of bed and walk as much as possible, and
change position in bed.
Lung Complications
Immediately after surgery, most patients don’t breathe very deeply. This
might be related to pain from the surgery, sleepiness from medications, the
presence of tubes and dressings, all of which make breathing difficult, and
other factors. As a result of slow, shallow breathing, lung complications can
develop. If not treated, the lung complications can progress to pneumonia or a
type of collapsed lung. Your nurses and doctors will be listening regularly to
your lungs, measuring your breathing, and checking your temperature. Let them
know right away if you have any trouble breathing, excess mucus, or pain in your
lungs. If lung complications are suspected, special tests will be required to
confirm the diagnosis and special medications will be started. This treatment
complicates the hospital stay, delays discharge, and adds additional discomfort
to the patient. The following things will help prevent lung complications by
expanding your lungs and eliminating any after-effects of the anesthesia. Each
person will benefit differently, depending upon the type of surgery:
1. The nurses will encourage you to take deep breaths every hour while you are
awake, 5-10 times each.
2. The nurses will encourage you to cough several times after each series of
deep breaths. Depending upon the location of your surgery, this may be
uncomfortable. It will be made a bit easier by placing a pillow or folded
blanket over the surgical incision and pressing gently during the cough. This is
called “splinting” the incision.
3. You might be given a small plastic device to help you take deep breaths. The
nurses will show you how to use it, and will encourage you to use it every hour
while you are awake, 5-10 times each. Keep it near you at all times.
4. Call for assistance to get out of bed and walk as much as possible, and
change position in in bed. This promotes deep breaths and allows any secretions
in the lungs to be coughed up more easily.
Patient Reminders
1. Practice your leg and foot exercises every hour while awake, 5-10 times
each.
2. Practice your breathing exercises every hour while awake, 5-10 times each.
3. If you watch TV, an easy way to help you remember to do your lung and leg
exercises is to practice them each time a commercial comes on!
4. If you are having pain, take your pain medication regularly, because if your
pain is well-controlled you will be better able to do your exercises and move
about.
PAT YOURSELF ON THE BACK
Via: Snohomish Cty Insight
Have you ever had the experience of having someone, learning about your ostomy
for the first time, express amazement at your ability to live a normal life and
admire your ability to carry on despite your “infirmity”? Then, have you asked
yourself if you have really accomplished some miracles and overcome such
difficult obstacles? We, who have been through trying times, sometimes do not
realize our mettle was tested. So...lift up your chin with pride and give
yourself a pat on the back once in a while. Those who have not been tested,
wonder about their own ability to stand up under severe adversity, and so admire
us. We have proven our ability, so we ought to occasionally take personal pride
in this accomplishment.
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