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Volume 31, Number 11 September, 2004
TEN (NEW) COMMANDMENTS FOR OSTOMATES
Via: Vancouver Ostomy HighLife & Regina Ostomy
News
1}
Thou shalt allow thyself to be sad, or angry, or depressed on occasion. Who said you always have to have a good attitude.
2) Thou shalt not let the above emotions become a way of life.
3) Thou shalt seek help, education, and support if thine unhappy emotions overcome thee.
4) Thou shalt learn to care for thy ostomy. Letting others do it for you if you are physically able is a cop-out.
5) Thou shalt seek out thy ET nurse if thou art notified with thine products.
6) Thou shalt not hide thyself away. Get out and do the things you used to do. You can.
7) Thou shalt not be ashamed.
8) Thou shalt cultivate a sense of humor about thine ostomy. There are worse things. Far worse.
9) Thou shalt set an example to the non-ostomy world. An example of triumph over adversity, courage over pity, and pride over embarrassment.
10) Thou shalt help other ostomates. Join your local UOA chapter, donate money, volunteer your time.
WHAT IS OSTEOPENIA AND HOW IS IT DIFFERENT FROM OSTEOPOROSIS?
Via: Mayoclinic.com., Wocester Ostomy Chapter & GB News Review
Both Osteoporosis and Osteopenia are medial terms for progressive loss of bone density and thinning of bone tissue. Osteoporosis is a metabolic bone disease characterized by a fracture. Osteopenia refers to milder bone loss that doesn’t yet meet the criteria of Osteoporosis.
A simple, painless bone density test (densitometry) can detect the presence and degree of bone loss. Bone loss has many causes. The leading cause in women is a deficiency of the female hormone estrogen after menopause. The leading causes in men are decreased testosterone production and use of corticosteroid medications.
People with Osteopenia can slow the progression to Osteoporosis by doing weight-bearing exercise, such as walking, and consuming an adequate amount of calcium.
If you’re a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren’t taking estrogen and any of thefollowing conditions apply to you.
You use medications that can cause Osteoporosis, including corticosteroids such as prednisone, cortisone anddexamethasone.
You have type 1 diabetes (formerly called juvenile or insulin-dependent diabetes), liver disease, kidney disease or a family history of Osteoporosis.
You experienced early menopause.
You are postmenopausal, are older than age 50 and have at least one risk factor for osteoporosis, such as a family history of the disease, tobacco use or depression.
You are postmenopausal, are older than age 65 and have never had a bone density test.
Doctors usually don’t advise routine bone density testing for men because the disease is far less common in men.
ARE YOU GETTING THE NUTRIENTS YOU NEED?
From ConvaTec’s Health & Vitality, Fall 2003, Via: Hemet-San Jacinto, CA.
Everybody has trouble eating right. When you have an ostomy, though, the challenges can be even tempts to control diarrhea, fluid balance, gas, and odor can stop you from eating enough healthy foods. And even if you do eat right, you may worry that your intestines don’t absorb the vitamins and minerals you need.
The first thing to know: people with an ostomy usually don’t have any absorption problems unless significant portions of the small bowel have been removed. If you’re not sure, ask your surgeon (if possible) or physician about the location and extent of your surgery. And listen to the experts. They say nutrient deficiences (in people living with an ostomy) are often self-inflicted.
FOOD CHALLENGES:
“If people living with an ostomy have deficiencies, it’s because they’re afraid to eat, and they impose too many restrictions on themselves,” says Claudia Mueller, RD, a colorectal dietician at the Cleveland Clinic Foundation in Ohio. Trying to help each other, people with an ostomy often share war stories about the foods that bother them, creating a “do not eat” list of foods that can limit nutrient intake and compromise health. But it’s important to try out these foods for yourself, since each digestive system reacts differently. Keep a food diary, testing one suspected food every 3 days. A registered dietician can help expand your food choices.
Following are the two most common food concerns:
Fear of Fiber
Fear of a fiber-clogging stoma is big. But fiber is usually only an issue for people who don’t chew their food very well, Mueller contends, although corn, popcorn, and nuts may always
may always be a problem for someone with an ileostomy.
The solution: Take your time, and chew, chew, chew—at least 25 times with each bite of food you take.
Fear of Odor
The challenge: “Six to 12 months out, most people with an ostomy have achieved a good comfort level,” says Leslie J. Bonci, RD, author of the American Dietetic Association Guide to Better Digestion, “and they’re more concerned with odor”. Fish, coffee, onions, garlic, chives, asparagus, and sometimes even poultry are the culprits.
The solution: Try smaller portions, suggests Bonci, and include buttermilk or yogurt at the same meal to counter the odor-causing foods. Fresh parsley and spearmint help too—a reason to eat your garnishes.
EXTRAINTESTINAL COMPLICATIONS OF IBD
From the research news bulletin of the C.C.F.A., Via: Loraine Co. OH
A recent study suggests that once surgery is performed for ulcerative colitis, it may be more effective at relieving certain complications than medication. Patients who have pancolitis, the type of ulcerative colitis that affects the entire colon, often experience numerous symptoms that seem unrelated to their condition. These “extraintestinal complications” often include arthritis. A study by Basu and colleagues from the Cleveland Clinic in Florida showed that, of 46 patients with pancolitis who had surgery, 58% had an improvement in extraintestinal manisfestations, compared with only 14% of the 22 patients who received medication. Arthritis and arthralgia were the most likely extraintestinal complications to improve, but other symptoms that improved were: erythema nodosum (red sores on the legs); pyoderma gangrenosum (ulcers on the legs); uveitis (inflammation of the uvea of the eye); oral ulcerations; and ankylosing spondylitis, a type of arthritis affecting the joints of the spine.
ILEOSTOMATES
From: Snohomish County (WA) Via: S. Brevard FL & UOA Insider
Can an ileostomy be controlled with strict diet or irrigation? A definite “NO” to both questions. Occasionally, a doctor may irrigate an ileostomy with a lavage set for food obstruction. This procedure should be done only by your doctor to prevent perforation of the small bowel and further surgery. An ileostomy cannot be controlled by any diet.
It is vitally important, that everyone with an ostomy eat at least three nutritionally balanced meals a day. If your doctor has given you a special diet, remember that when your stomach is void of food, it will fill up with gas. Excess gases result in a noisy ileostomy. It may also increase the activity of the small bowel, causing the ileostomy to discharge very liquid feces.
Diet is an individual matter. Some people can eat all varieties of food, including foods with skins, without affecting the consistency of the stool or the activity of the bowel. Others find that any violation of a low residue diet leads to frequent and watery movement
leads to frequent and watery movements. Each person must discover his own dietary pattern through trial and error.
A WORD TO ILEOSTOMATES… If you are ever depressed, just think of all the ailments you no longer have to worry about: rectal cancer; colon cancer; hemorrhoids, Diverticulitis;
appendicitis, constipation—sometimes, it’s amazing that anyone can survive with
the colon intact!
MANAGEMENT OF A FLUSH OR RETRACTED STOMA
By Gloria Johnson, RN, BSN,CWOCN, Via: Charlotte, NC Cheers & Tears & Hemet-San Jacinto, CA
The ideal stoma is one that protrudes above the skin, but this is not always possible and a flush (or skin level) or retracted (below the skin level) may result. The surgeon may be unable to mobilize the bowel and mesentery adequately or be able to strip the mesentery enough without causing necrosis or death to the stoma. Some causes of stoma retraction after surgery may be weight gain, infection, malnutrition, steroids or scar tissue formation.
Stomas that are flush or retracted can lead to undermining of the pouch by the effluent (drainage). This continued exposure can lead to irritated and denuded skin as well as frequent pouch changes. These problems can be very stressful and expensive.
The inability to maintain a pouch seal for an acceptable length of time is the most common indication for a product with con
with convexity.
Shallow Convexity may be indicated for minor skin irritations and occasional leakage.
Medium Convexity may be indicated for a Stoma in a deep fold, with severe undermining and frequent leakage.
Deep Convexity is used when medium convexity is not sufficient, stoma is retracted, in deep folds or leakage is frequent and the skin is denuded.
Ways to Achieve Convexity:
Convex Inserts: can be applied to a 2-piece system by snapping a convex insert into the ring of the flange. Outer diameter must match the flange size. This can be cost effective as this insert can be removed, cleaned and re-used.
Pouches designed with Convexity: are available in both one and two piece systems. These can be shallow, medium or deep. They come as either pre-cut or cut-to-fit.
Addition of skin barrier gaskets around the stoma: Can be cut or purchased pre-cut. You can use one layer or several layers. Products like the Eakin Wafer/Coloplast Strip Paste, which can be pressed into shape around the stoma to protect and seal.
Other Ways to Increase Wear Time and Prevent Leakage: An ostomy belt may be helpful. Opening should clear the stoma 1/8” only, to give skin maximum protection.
Ostomy Paste for “caulking”. Always read and follow manufacturer’s directions for product use.
Product Information
Most ostomy companies make appliances with convexity and carry convex inserts as well as belts.
ConvaTec uses a product called “Durahesive” which has a turtleneck effect around the stoma. Hollister has the “Premier” series which does not erode. Nu-Hope makes barriers which are oval as well as round which have deep convexity.
If you have questions, make an appointment with your ET nurse.
FREQUENTLY ASKED QUESTIONS
Excerpted from Diet & Nutrition Guide, UOA 2002, Via: Cleveland, O.A., OH
Question: How soon after ostomy surgery can I return to a normal diet?
Answer: Physicians and ostomy nurses suggest that you begin slowly, depending upon your recovery and/or other medical complications. Add back one new food at a time. If you experience any problems, discontinue for a few weeks and try again.
Question: In the past, certain foods caused me some trouble with digestion. How will they affect me since my ostomy surgery?
Answer: Check them out. You may find that some of those foods will continue to be troublesome and others may not.
Question: Will my ileostomy continue to produce output even if I do not eat?
Answer: Yes, the small intestine will continue to produce gas and digestive juices. An empty digestive tract seems to produce excessive gas. Eat small meals to
keep something in the gut. Peristalsis happens!
Question: After ostomy surgery, I have gained excess weight. What happened? What types of food should I eat?
Answer: The relaxation of dietary restrictions, freedom from debilitating illness and malabsorption promotes a rapid gain in weight. Follow the same weight reduction diet as recommended by nutritionists and dieticians. Eating small quantities of a well-balanced diet and increasing water/fluid intake will assist with weight reduction.
Question: What is meant by “low residue” diet?
Answer: Low-residue refers to a dietary regime which eliminates bulk-forming, hard-to-digest or high-fiber foods.
Question: Will spicy foods cause any damage to my stoma?
Answer: If you can tolerate spicy foods through your digestive system, the output through your stoma should not cause any harm. The stoma is formed from the lining of the bowel and it is tough and can tolerate those spicy foods.
Question: What effects will oral odor control medications have on my ostomy?
Answer: Some individuals who have a colostomy report that they experienced some constipation from bismuth products found in oral odor control medications. Individuals who have an ileostomy have more benefits and fewer side effects from oral preparations (chlorophyll tablets, bismuth subgallate and bismuth subcaronate). Most foods do not effect an individual with a urostomy. A strong urine odor may be an indication of dehydration and the need for in-
creased fluid intake. Check with your doctor or ET nurse about oral preparations and don’t exceed the recommended dosage.
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