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Volume 36, Number 2 November, 2008
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!!
TAKING YOUR STOMA FOR A HIKE
By: The Honorable Ross Foot, New Orleans, Louisiana
Having just finished an eleven day hike through the mountains with my scout troop and an 18 month old stoma, I offer the following suggestions. Take lots of supplies (pre-cut appliances, adhesive remover, skin gel and cleaning gauze in individual disposable bags. (I mean a lot, there are none on the trail.) Grabbing one complete package is easier than finding all the pieces in the pack and setting up a changing station. In bear country, these are “smellables”, even before they are used, so they need to go up in the bear bag. Make sure you know where they are and keep one package with you during the day. Except the one you are wearing, they all go up at night. Check carefully before climbing into your sleeping bag. Consider a small bear bag with just the supplies so if you need one in the night, you do not have to drop all the crew gear.
I suggest one piece drainable pouches with tape. Hip belts run close to the appliance and the chance of accidentally opening a two piece worried me. Make sure its drainable because you can leave the contents in the woods, but you have to pack out the appliance and you don’t want the extra weight. Did I mention bring extra supplies?
Depending on stoma placement, you will have to experiment with packs and hip belts. With a 45+ lb. pack, you need to get substantial weight to the hips. A placed stoma may require building a bridge. I tried with built up padding on each side of the appliance, but getting the belt tight enough to bear weight was hard. I found a lower cut belt on an external frame pack that fit under the stoma. This meant the pouch had to ride outside of the clothes. The solution turned into salvation. I sewed a green bandana into a pouch shaped envelope with the front piece an extra 4 inches tall. I then wore a cloth belt above the stoma and tucked the flap over it tying the two corners to each other. This cover would hang out under the shirt, but over the hipbelt. After explaining to the kids they never gave it a second thought and no one else knew what it was. This puts the hip belt against bare skin. Next time, I will wrap the touching part of the belt with cloth or sheep skin.
The cover turned out to save the day. I planned two days per pouch with a few extra. The first failed at 30 hours. Quick math let me know I was not going to have enough. Did I say take lots of supplies? With heat being the culprit and sweat under the appliance causing adhesion failure, I found periodic soaking of the cover would create an evaporation based air conditioner. (We were over 11,000 feet so evaporation was very effective.) Appliances lasted up to three days, or until I forgot to wet the pouch cover. This was July, so cooler weather should lessen the problem, but you still have great exertion.
Make sure to carry a headlamp style flashlight. Affixing an appliance is a two handed job and at night with bears and mountain lions around,you want to be as quick as possible when standing out alone. We hiked Philmont Scout Ranch and there was no activity I could not do. I chose to skip one strenuous rock climb. One section involved a rock hugging technique described as a “smear” and I was concerned with redefining the term.
Two years earlier, we completed a wilderness hike three weeks before my cancer diagnosis. There was a great psychological benefit for my 14 year old son to see Dad as well as before. The scouts now know what we need to remember, an ostomate is not limited in any way. If you have any doubts, go take a hike!
About the author: Ross Foot was diagnosed with colo-rectal cancer at age 47. He had colostomy surgery at age 48 at Oschner in New Orleans. He has been a judge for 12 years and was just reelected to another 6 year term. He teaches at the National Judicial College in Reno and handles the training of new judges in Louisiana and runs the La. Judicial Retreat Program. He snow and water skis, plays tennis and hikes. He is active with the Boy Scouts and has served as an adviser to scouts with ostomies. Next year, he is planning a canoe trip to Canada.
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.
UROSTOMY CARE
Via: Metro Maryland & Rose City Ostomy News, Tyler, TX
The urostomate should keep in mind that the stoma may shrink for several months following surgery. It is important that your appliance fits well so that the skin around the stoma does not become thick and white due to contact with urine. This crust may rub against the stoma, causing bleeding. To cleanse the pouch of crystals, soak it in a solution of 1 part vinegar to 2 parts water. Several glasses of cranberry juice each day will help restore the acid level in your body and there is less crystalization.
The urinary pouch should be emptied often. There is no odor when the pouch is kept clean. The portion of the intestine (the ileum) that is used to form the “conduit” is mucous forming, thus it is not unusual nor abnormal to see some mucous in the urine. Before attaching the night drain, leave sufficient urine in the pouch to fill the entire length of the tube. This eliminates air bubbles which prevent a flow through the tube and causes “back-up” problems.
Please remember that for best results, you will want to change your appliance first thing in the morning before you eat or drink anything. This may give you some breathing room for a few minutes (when your stoma will not be so active) to get the skin dried off and the new appliance in place.
If you bend over and try to be sure all stored liquid is forced out before you begin the change it may also help give you a few minutes of inactivity to complete the change.
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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