Evansville Ostomy News September Issue

Evansville Ostomy News

Volume 34, Number 11 September, 2007

CONTROLLING ODOR
Via: Pensacola FL Stoma-Gram
An important part of a new ostomate’s rehabilitation is learning to control odor; it is important to feel good about oneself and be secure in relationships with others. The osotomate can be extremely sensitive to odors and the reactions of those around him or her, especially family and friends. Colostomies tend to emit more odor than ileostomies because of the bacterial abundance in the colon. Most sigmoid and descending colostomies are routinely irrigated, so persistent odor is less of a problem than with a transverse colostomy where semi-liquid drainage tends to be rather malodorous. Ileostomates experience almost continual peristaltic waves which sweep the ileum and prevent stagnation of the intestinal contents, thereby eliminating the major cause of odor, I.e., bacterial growth. Extreme and persistent odor from an ileostomy could be an indication of a secondary problem, such as a stricture or blockage. Urine has a characteristic odor, but a foul odor could be a sign of infection due to overgrowth of bacteria. Certain foods will affect the odor of both feces and urine. Avoiding such odor-producing foods will help. External and internal deodorants are available, but two important aspects of odor control are good personal hygiene and appliance care. For fecal ostomies, use odor proof pouches. Change the pouch immediately if a leakage occurs. Eliminate from your diet such odor producers as cabbage, onions, fish, spicy foods and eggs; do eat parsley and yogurt. Internal deodorants that can be taken by mouth include bismuth subgallate tablets which help control odors by absorbing toxins. Ostomates should consult their physician before taking these tablets. Urinary ostomates should clean their pouches periodically with such agents as Uri Kleen, etc. Vinegar solutions have fallen into disfavor because they tend to damage certain manufacturer’s pouches. Avoid eating asparagus and onions; do eat parsley and drink cranberry juice. Deodorants are not used because they would mask the odor which could signify the presence of an infection. With proper care of the appliance, personal hygiene and dietary precautions, odor should not be a problem for ostomates.

BLOCKAGE, MY HOSPITAL EXPERIENCE
By: Carol Ganje, “The Optomist”, Greater Seattle Chapter
I have an ileostomy, which means that if I get a blockage I can start loosing fluids quickly, and become dehydrated rapidly. This is exactly what happened to me on a Friday evening when I ate something, probably beans, and did not chew them well. But what I didn’t expect was what happened to me when I went to two different hospitals over the next two days. Saturday morning, I knew I was in trouble, having thrown up all evening, with nothing but fluids coming through my ostomy. After first calling my doctor, my husband Barry took me to the ER at hospital # 1 at 11am. I discovered that ER personnel are not well trained in the handling of ostomy cases, something the ER nurse said she wished they had more training on. But she did have the foresight to ask how I normally handled a situation like this in the past. I said that it was imperative that I get started on an IV, in order to rehydrate me. By 12 noon, an hour later, I was hooked to an IV (before I saw a doctor), and was given pain medication to help relax me. In the past, this has also proven to help in relaxing my gut, and allowing food to pass. By 4 pm I no longer had cramps, and apparently no blockage, and was released from ER. Sunday morning, the cramps started again, but not nearly as intense as Saturday. I was still rather sore and weak from my experience the day before. By evening, I was again in so much pain from cramps, that my husband took me to hospital # 2. This time we had gotten a hold of the back-up to my gastroenterologist, and he told us to go to a different hospital. We got there at 11 pm, to find that the doctor had already alerted the ER that we were coming. I thought, great, they will get me on an IV and some pain medication right away. Wrong!! At 11:15 pm I got into an ER room, so I could lay down. At 11:25 pm, the nurse came in and took my blood pressure. I asked about getting an IV, and the nurse said that they couldn’t give me one until the ER doctor saw me. It wasn’t until 1:40 am that the ER doctor saw me, and finally at 2 am, I was given an IV and pain medication. After x-rays were taken at 2:45 am, I was admitted to the hospital at 5 am, 6 hours after arriving at the ER. It wasn’t until 2 days later, that I found out that the ER doctor had prescribed a medicine for me that slows down secretions, or liquid output, a mistake in my case. I wasn’t released from the hospital until Thursday. Lesson: Not all hospital ER’s operate the same. ER staffs need more education on treating ostomies. Make sure you have a good GP doctor, gastrointestinal doctor, and colorectal surgeon involved in your care, and communicate what you need when you arrive at the hospital.

POUCH FALLOFF
Via: Ileostomist, & Spacecoast Shuttle Blast, FL & Metro MD.
One of the most embarrassing situations that can befall an ostomate is to have an accident with the pouch pulling loose, resulting in soiling of clothing and an instant loss of self assurance. Multiple reasons exist to explain the loss of a pouch, such as the stoma itself, the skin around the stoma, the cement, or the pouch. The stoma may be placed too close to a scar, crease or bodily prominence, so that the twisting or bending loosens the appliance. There is no single solution for a misplaced stoma. A different faceplate may be tried, one with a soft and pliable surface to fill in irregular areas, rather than a hard faceplate that pries off with motion. A regular area may be built up with tissue and cement. The stoma may have to be moved, if leakage continues. A prolapsed stoma will push the pouch off. Conversely, a flat or recessed stoma will cause pooling of intestinal contents around the stoma eroding the adherent and eventually lifting the faceplate from the skin. Convex pouches or convex inserts help this situation. The skin around the stoma might be too oily or too irritated. Bath oils and creams should be avoided. Liquid antacids, such as Maalox, help protect sore skin and, if properly dried, do not interfere with seal of the faceplate. The cement may be too thin. Leaving the can open for a short time will allow some of the solvent to evaporate, thickening the cement. If the can is not shaken sufficiently to mix up the dense cement that settles on the bottom, the thin mixture will not be strong enough to support proper adherence. Not enough time may be given to allow the cement to dry properly. Finally, a well-fitting pouch that is suited to your needs and lifestyle is essential. If your pouch keeps coming off, have your entire management evaluated by an ET Nurse—No need to suffer!

IMPROVISING...or fixing a leak in a hurry
Via: The Right Connection & Southern Nevada’s Town Karaya
If you do spring a leak, especially when away from home, it can be a cause of panic. Being prepared can help you keep your cool. Wearing an appliance cover provides extra protection. One person noted that when they had a leak near the seal he was able to stuff several folded tissues between the pouch and cover. This absorbed the leakage and kept him going for 90 minutes until he was able to get back home and change. A pouch cover has the advantage of soaking up perspiration on a hot day. Perspiration can quickly undermine the best adhesives. A good ostomy powder can help soak up moisture too. Lacking this, corn starch or baby powder is equally effective. Some people always carry Band Aids with them. She said she used the tape to mend a small tear in the pouch. It worked so well that she forgot about the makeshift repair until her regular time to change pouches! One ileostomate told about his pouch filling with gas while he was hurrying to catch a plane and he didn’t have time to stop in the restroom. He used a pin to poke a hole in the top of his pouch. By pressing his arm against his body, he was able to avoid an emergency until he could safely use the restroom on the plane. Another ileostomate told about Using a disposable diaper to wrap around her appliance. It kept her safe until she could get home and change. Individually packaged alcohol wipes or towelettes are easily carried and are great helpers in cleaning up an emergency. Best of all though, take precautions to try to avoid having an emergency.

I’VE HAD MY POUCH SURGERY….NOW CAN I EVER HAVE A BABY?
By: Scott A Strong, M.D., from the Cleveland Clinic’s Pouch-O-Gram
Ulcerative colitis and familial adenomatous polyposis are diseases that most commonly afflict young adults with 50,000 individuals requiring operative treatment of their disease annually. In recent years, the ileal pouch-anal anastomosis procedure (internal pouch) has emerged as the operation of choice for many of these individuals, even though some patients are understandably concerned whether the ileal pouch operation will affect intimacy with their partner or the ability to have a family. The majority of men and women report an improved sexual life following restorative proctocolectomy because of better overall health. However, approximately 2% of men will have difficulties with sexual dysfunction while nearly 25% of women complain of painful intercourse, although this discomfort is usually improved over the pain experienced preoperatively. We also understand that most women with an ileal pouch-anal anastomosis can successfully conceive, yet the infertility rate among these patients is nearly tripled. Women who do become pregnant will often complain of increased stool frequency and worsened control over bowel motions as the pregnancy progresses and the enlarging uterus compresses the ileal pouch. These symptoms are usually tolerable and bowel habits typically return to normal within three months after delivery. Lately, many surgeons and obstetricians share the patients’ concern about which mode of delivery should be utilized. While vaginal delivery would possibly benefit the health of the infant or mother, cesarean section might avoid irreparable damage to the ileal pouch, the sphincter muscles, or the nerves that control these muscles. Fortunately, studies from three large centers, including the Cleveland Clinic Foundation, report that bowel function is not significantly altered by the mode of delivery. We are unsure, however, if these short-term similarities will continue to be comparable decades later when delayed effort of vaginal delivery combines with other detrimental factors to cause worsened bowel function. Therefore, we generally suggest delivery by cesarean section unless this approach introduces excessive risk to the infant or mother.

THE RITUALIZATION OF APPLIANCE CARE
Via: Metro Washington By-Pass, the Oklahoma City Ostomy News & the Cleveland Ostomy News
A person who has had an ileostomy, urinary diversion or colostomy for a long time usually has experienced occasional problems with the stoma, skin or equipment. The ostomate has sought help from the ET nurse, physicians, friends and others. As advice was given, the ostomate heeded each suggestion into the routine for changing his pouching system. Changing the pouching system took more and more time. I have observed persons using several different kinds of soaps or disinfectants to cleanse the skin, applying skin sealants using several skin barriers and then affixing the pouch over all this. Often the result of this is that the person will take hours to change the pouching system and care for the stoma and skin. Periodic evaluation of the changing procedure should be done. At each step, the ostomate should ask himself: “what am I accomplishing doing this step? Can I eliminate it?” The pouching system should guarantee freedom from leakage of stool or urine; maintain normal peristomal skin, be odor proof, and be invisible when the person is dressed. The procedure should be uncomplicated with as few steps as possible. No step or use of a product should duplicate another. Care of the stoma, skin and changing the equipment should take no more than 15-20 minutes. The stoma should accommodate the lifestyle of the person who has it, and take as little time as possible.

BEING THE MOTHER OF A CHILD WHO HAS AN OSTOMY
By: Dawn Steeves, Via: Regina Ostomy News
Kale was born in 1987 with medical problems that ended up with him wearing an ostomy pouch. He was born in Humboldt Hospital, then taken by ambulance to the Royal University Hospital in Saskatoon. Dr. Rossi talked to me about his surgery. I trusted him to do what he thought was best for Kale. Kale was only a few years old when he had surgery. When I saw him afterwards, I almost fainted. There was this little baby boy, great big eyes, long eyelashes and a “pouch”. I said to the doctor, “What am I supposed to do with that?” Thank goodness for Teri and Phyllis (ET nurses) and NorDon Drugs as their help was greatly appreciated. Kale has had many, many surgeries in his short life. We moved to Alberta for about 6 years and then we moved back in 1996. Teri contacted us about the ostomy camp that Kale could attend. I was very leery about it. He really wanted to go, but I wasn’t sure. Who would look after him? Who would remind him when to empty his pouch? What would he do without me to help him? Well, I tried to phone him after he was there a day or so. They told me he was out wall climbing. I almost fainted. They asked me if it was an emergency. I said I just wanted to talk to him. They told me he was fine, he was having a great time, he was all right, to relax, and I would see him in a couple of days. I wasn’t sure I liked that, but I didn’t call again. I would like to thank the Ostomy Association for making it possible for Kale to attend camp, because without you, he simply could not go. My family cannot really afford to send him. I know he has gained a lot from camp. (Editor’s note: Both the United Ostomy Association of Canada and the United Ostomy Association, Inc. (U.S.A.) sponsor camps for ostomy children & youth annually. In addition UOA Inc. has a network for “Parents of Ostomy Children.”

HELPFUL HINTS FROM EVERYWHERE
If the stomahesive paste (karaya paste) becomes hard and will not push through the end of the tube...take a mug/glass and fill half way with water. Then place the mug/glass in your microwave for 45 seconds heating the water. Remove from the microwave and place the tube, cap down in the water, let it set for a few minutes, then remove and dry it off. Your paste is ready to be pushed out of the tube. Vitamins should be taken on a full stomach. Otherwise, they irritate the lining of the stomach and produce the sensation of feeling hungry. Try strong-brewed tea before the purchase of a “diuretic”. Hot tea twice a day will wake up your sluggish kidneys. Tomato juice is lower in cost per cup while providing as much sodium and 5 times more potassium as a low cost alternative to Gatorade. Orange juice is another alternative providing the same amount of sodium and 15 times the amount of potassium. Tea, however, contains approximately the same amount of potassium as Gatorade, but only negligible amounts of sodium. Some people find a large teaspoon of bulk gelatin dissolved in water or lemon juice once a day will firm up a loose stool. If you are taking calcium, medical experts advise taking calcium at night to obtain maximum benefits. During the night, the body depletes calcium in the bones to maintain normal blood levels. Eating Rice Krispies can help slow down the amount of stool, and is a great breakfast choice with a small amount of milk or eaten dry. Emotional pressures and over-all fatigue can cause bowel upsets, especially when traveling. Do not allow yourself to become over tired. Don’t be afraid to shower without your appliance. Soap cannot hurt the stoma. Just remember to rinse well.

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