Day to Day Living with Your Ostomy
Articles Included:
·
Stress
and Intestinal Gas
·
Ileostomy
and the Immune System
·
Temporary
Ostomies
·
Seniors
with Ostomies
·
Ostomy
Poll
·
A
Pouch Falling Off
·
Colostomies
and Constipation
·
Living with an Ostomy
·
Life as an Ostomate
·
Drugs and the Senior
·
Appeal Denied Medicare Claims
·
The Things People Tell Pharmacists
·
Live
Longer
·
Making
a Living
·
Ostomy
Facts
·
Over
Diagnosis of Cancer
·
Set in
Your Ways
·
Choosing
the Right System
·
IBS
Survey
·
Quality
of Life Study
·
What
to do if you Lose Your Wallet
·
Blood
Pressure
·
Diet
Affects Prostrate Cancer
Stress
and Intestinal Gas
Space
Coast Shuttle Blast, Cocoa, FL
One of the most common gastrointestinal
complaints is caused by stress.
Flatulence occurs in people during stressful situations.
While under stress, breathing is deeper
and one sighs more, encouraging a greater than normal intake of air. In fact, studies show that the average
American belches about 14 times a day.
The person with a flatulence problem does not belch more often. However, they may experience the sensation of
needing to belch and get little relief from doing so. Here are some ways to relieve gas:
·
Avoid heavy fatty meals,
especially during stressful situations.
·
Reduce the quantity of food consumed
at one sitting. Eat small low-fat meals
about every three hours.
·
Avoid drinking beverages out of
cans or bottles.
·
Avoid drinking through a straw.
·
Avoid foods and beverages you
personally cannot tolerate.
·
Avoid any practice that causes
intake of air; e.g., chewing gum, smoking.
·
Drink at least eight glasses of
water a day.
·
Experiment with foods in your
diet to achieve adequate bowel regularity.
·
Avoid eating too many fiber
foods in one meal.
·
Avoid skipping meals. An empty bowel encourages small and gassy
stool.
Poor digestion can often exaggerate the
symptoms associated with flatulence.
Digestive enzymes aid in food assimilation and chemical digestion. Enzyme supplements should always be taken
immediately before or after eating. Food
coats the stomach and helps prevent gastric juices and acids from destroying
the enzyme action.
Ileostomy and the Immune System
Forwarded
By ReRoute, Evansville, IN Chapter
In response to a query about the possible
effects of ileostomy surgery on the immune system, Dr. Beck—a loyal
supporter or UOA—notes that the surgery, by itself, should have no
long-term effect on the immune system. Although
there is some transient reduction in a patient’s immune responses right
after major surgery, this usually returns to normal in a couple of days.
However, the diseases that causes patients
to need a stoma—such as inflammatory bowel disease—and the
medications used to treat these diseases (steroids) or malnutrition associated
with the diseases may affect the immune system. If you are concerned, there are several tests
that a doctor can perform to test your immune system. One of these involves placing chemicals or
allergens into the skin to see how the body responds. Others involve blood tests.
We are continually learning more about the
human immune system from our experience with HIV infections. Most efforts are
directed toward identifying and then treating the cause of the immune
dysfunction. Although good nutrition and some supplements—such as
vitamins—are necessary for the immune system to work, little has been
proven to improve the immune function.
Temporary Ostomies
By Nancy Brede, RN/ET
Temporary
ostomies are surgically created with the intent of reconnecting in the future. The anatomy of the gastrointestinal system or
urinary system is left intact.
Permanent ostomies are created with the
intent that the ostomy surgery will not be reversed; usually the surgery is
performed when disease or injury prevents maintaining the anatomical structures
needed for reversal.
A large number of temporary ostomies
involving the colon are done on an emergency basis. The colon becomes obstructed or blocked, and
stool cannot pass through. Because of
the emergency nature of the surgery, the bowel cannot be cleaned and prepped
ahead of time. Reversal, or re-anastomosis—hooking
up the normal anatomy—can be done later, when infection is not as likely
and proper healing can take place.
The most common situations and diseases
requiring a temporary ostomy are:
·
Cancer of the colon with
obstruction or other abdominal cancers affecting the colon.
·
Hirschsprung’s disease, a
disorder/malfunction in infants which prevents passage of stool. Due to lack of nerve cells in certain areas of
the large intestine, stool is not moved through, and an ostomy is necessary.
·
Diverticulitis, small out-pouchings—diverticula—in
the wall of the intestine becomes infected. The diverticula may rupture or cause
obstruction.
·
Inflammatory bowel disease or
Crohn’s disease may necessitate a temporary ostomy to allow the diseased
bowel to heal.
Persons with temporary
ostomies face many of the same problems permanent ostomates have. It is just as important for them to have
support, reassurance, and teaching as it is for persons with permanent
ostomies. They must learn proper skin
care, stoma care and pouching techniques.
Often, stomas are not ideally situated on
the abdomen because of the urgency of the surgery. Thus, pouching and skin care
can pose difficult problems. Following
temporary surgery, measures need to be taken to improve the person’s
health. He/she must be in the best
condition physically to undergo the major surgery for reconnection.
This is also a time for the person to
psychologically deal with past surgery, upcoming surgery and possibly a newly
diagnosed disease. It may be a difficult
time with all the changes and new challenges. Often, there are many fears and unanswered
questions. Other people with ostomies
and ET nurses may provide reassurance and the answers to many questions.
Indian
River Ostomy Association, FL
As baby boomers age, there are a greater
number of illnesses just waiting for them. Years of fast foods and stress make a breeding
ground for intestinal problems. When
they can no longer deny that their fast-paced lifestyles and poor eating habits
have caught up to them, they seek medical help.
When tests confirm intestinal problems
that require surgery, their whole world seems to explode around them when the
doctor says, “You need an ostomy.” If the patient is fortunate enough to have a
doctor who is aware of the local ostomy association, he/she will ask the ET
nurse managing the pre-surgery examination to arrange for a visit.
It is only when an ostomate talks to other
ostomates that the problems that seemed insurmountable are gradually chipped
away. That is what the UOA and local chapters
are all about — ostomates helping other ostomates. And where is the best place to find this
information and help? Why, at a monthly
chapter ostomy meeting, of course.
Ostomy
Poll
What is the best thing
you’ve found about having ostomy surgery?
Results
from 148 people
I’m free from all
medication and pain 23%
I’m free from looking for
nearest toilet 17%
I can mostly do what I want,
when I want 13%
I have freedom 14%
I’m free of my disease 10%
There is no good thing about it
... I hate it 6%
I’ve only just had surgery 6%
No surgery but am contemplating
it 11%
Who have you told?
Results
from 757 people
Nobody—It’s my own
business 4%
Only those who need to know 20%
Only close
family 5%
Only close family and friends 27%
Anyone who cares to listen 44%
A Pouch Falling Off
Adapted By The New Outlook
One of the most embarrassing situations
that can befall a person with an ostomy is to have an accident because the
barrier or the pouch pulled loose.
Multiple reasons exist to explain the
falling off of an ostomy system:
·
The stoma
·
The skin around the stoma
·
The barrier
·
The pouch
The
stoma may be placed too close to a scar, crease or bodily prominence so that
the twisting or bending loosens the barrier.
This is no single solution for a misplaced stoma. A different barrier may be tried; e.g., one
that is softer and more pliable like the new and improved version of
Hollister’s New Image Ostomy System.
An irregular area may be built up with the
new seals—like ConvaTec’s Eakin Seals—or with paste. Using these products will usually solve most
challenges.
A stoma may require surgical intervention
if one has a prolapsing stoma that is pushing the pouch off. Conversely, a flat or recessed stoma may
cause pooling of the effluent around the stoma eroding the adherence and
eventually lifting the barrier from the skin.
Fortunately, manufactures have developed ostomy systems with curved
barriers that put minor pressure on the skin around the stoma. These convex ostomy systems are a growing
product line of retailers as more and more people discover the advantages of
wearing a convex barrier.
The most stubborn falloff problem can
usually be solved by using a seal with a convex barrier held on with a
belt. Your ET nurse is expert in solving
these types of issues.
The skin around the stoma might be too
oily or too irritated for the barrier to hold satisfactorily. Bath oils and greasy creams should be
avoided. But, there are products that
may be put on the peristomal skin to treat skin irritation problems. Ostomy product manufacturers all carry skin
care products that will treat peristomal skin and yet at the same time allow
your barrier to adhere firmly to your skin.
There are many different producers of many
different barriers. They offer you a
large choice of products that may work for you.
You need to try different products if you are having problems. One barrier will not work for everyone in the
same way. For instance, one urostomate
in our Chapter had a problem with falloff using a flat, Stomahesive
barrier. He saw an ET from our Chapter
and she recommended he try a Durahesive barrier with convexity along with a
belt to gentle hold it in place. It
worked! Our member was so pleased that
he could resume his life doing the same activities he did before surgery.
A well fitting pouch that is suited to
your needs and lifestyle is essential.
If your pouch keeps coming off, have your entire ostomy system evaluated
by an ET nurse. Do not settle for less
than excellent service from your ostomy system.
There are solutions to most any problem with ostomy management. Invest the time to talk to a professional
ostomy nurse—at a hospital, through your retailer, at a Chapter meeting
or even by calling one of the manufacturers themselves. There is no need to suffer!
Colostomy
and Constipation
Vancouver
Ostomy High Life
Way back before surgery, did you go to the
bathroom after a hot cup of coffee, milk, cold juice, whiskey or beer? Well, whatever made you feel that need then,
can make you feel the need now. Check it
out.
See if your irrigation can be helped by
some of the things you used to do. Of
course, if you have had your colostomy for a number of years, your previous
habits may not be the same now. Your
body can, however, be trained as it was before, and you can adapt yourself to
certain habits which can help you to be in control.
A glass of hot water or juice, or a cup of
coffee before a morning irrigation may initiate gut reaction. Also, a glass or two of water, after the water
return starts, is usually helpful. If
you irrigate before going to bed, a glass of ice water or a cup of hot coffee
should get you started. If you have not
drank much water during the day, it would be wise to drink an extra glass or
two to make sure your tissues will not absorb so much, or you may be left with
little or no return.
But what if you don’t irrigate? Part of the difficulty in elimination of waste
matter experienced by colostomates is due to lack of bulk in the diet. Consumption of white bread, pastry and highly
refined foods does not provide the roughage and bulk necessary for proper
evacuation of the colon. The deficiency
can be overcome in part by the simple addition of bran to the diet.
Bran can be made into muffins adding
raisins and molasses to taste. Diet ...
there is no such thing as a colostomy diet. A colostomy is not an illness, so try to eat
the same foods you have eaten and enjoyed in the past. If you are on a diet for a condition such as
diabetes or high blood pressure, of course you should stay on that diet.
Foods can be acidic or alkaline, bland or
spicy, laxative-like or constipating. Individuals react differently to food. Try to return to your former, normal diet. Those foods which disagreed with you in the
past may still do so. Chew well and see
the effect of each food on your colostomy output.
To maintain good health, the body requires
carbohydrates, proteins, fat, minerals and vitamins. Water is not nutritious but is absolutely
necessary. Having a balanced diet is a
fitting way to maintain good nutrition and keep bowel activity normal. Every day your body needs meats or fish, dairy
foods, vegetables and fruits, cereals and bread, and liquids. And always, talk to your physician or ET nurse
if you have problems.
Living with an Ostomy
By Florence Weber-Javers, RN, CETN
Remember when
you were in the hospital, and you were told you would have to live with an
ostomy? When you looked at your stoma
for the first time, what was your reaction?
Most likely, you were
shocked, depressed,
seared. You could not imagine how you were going to live with "this thing."
How far have you come since then? Do you
still call your stoma "the thing," or have you given it a special
name? Do you sometimes even forget that
your stoma exists? Everyone's adjustment is a bit different, but
hopefully you've accepted your stoma. I tell my patients,
"You don't have to like the stoma, but you do have to learn to
live with it."
You rule your stoma
You need to take the time to take good care of your stoma but not let it rule your lifestyle.
In other words: "You rule the stoma. Do not let it rule you." After all, you're the same wonderful person you were before your surgery.
Help is available
You need to know some basics to reach a satisfactory point of control
over your ostomy. You
need to know how to take good care of your stoma and surrounding skin, and what information is available to help you and where to obtain sound advice. You also need to take
that information and assimilate it to
fit into your own lifestyle. One reason you see so many products in ostomy catalogs is not to confuse you, but to help you find the right products so you may personally choose the best way to
get on with living. Your local UOA chapter
is an excellent source of information, advice and support. Use this resource for the benefit of
yourself, and also for the benefit of others.
You know, we want to hear about your story, and about your successes.
Does it hurt?
First, you need to know about your stoma itself. It's red and looks as if it ought to hurt. But the stoma is actually your intestine,
which does not have any
nerve endings. Reassure your spouse about this. Your mate may be afraid of hurting you if the stoma is touched. An ostomate may feel
rejected because of the mate's fear to touch him/her. If your spouse understands the stoma has no
feeling and will not hurt you, he/she will
be more at ease.
Learn to live
with it
Your attitude is also important. If you can't
accept your stoma, how can you expect
someone else to accept it? Remember, you don't have to like it, but you must learn to live with it. I'm sure there are other parts of your body that you would like to change. Maybe you think your nose is too
big or your thighs are too large.
Or maybe your eyesight is not the greatest. These are all
unique characteristics we learn to live with. Your stoma is just a new part of you that
you learn to live with.
Remember the symbol of the United Ostomy
Association is the Phoenix. The Phoenix
is the mythical bird that was risen from
the flames. Ostomates are "risen
from the ashes of
disease." You don't have to like your
stoma, but
you do have to live with it. There are
people who said, "I could never live with one of those." And you know what, they didn't.
Should I worry
about bleeding?
The reason your stoma is red and your stoma
bleeds easily is that the blood vessels in your intestinal lining, which is
what your stoma is made
from, are very close to the surface.
This is why it's important for you to be gentle in cleaning your stoma.
A small amount of bleeding is normal
and nothing to be concerned about.
Excessive bleeding should be reported to your doctor or ET nurse as
needed. Excessive bleeding means more then a drop or
two. If you touch it with a tissue, you
may notice some red on the tissue. This
is what is normal. If you have much
more of this, meaning you actually witness bleeding, see someone
immediately. This is not normal. Anytime we are bleeding it is not usually
good. Check with a health professional
about it.
Make sure nothing constricting is riding over your stoma, reducing the blood supply needed to keep this vibrant
tissue alive. Elastic belts over your
stoma are usually okay, but a
leather belt doesn't give enough to ride
over your stoma if it is on your
beltline. Ideally, your stoma is located below the beltline, but sometimes it cannot be surgically
positioned in the ideal site.
Isn't is
supposed to be round?
Stomas come in all sizes and
shapes, just as all of us do. If you are
worried that your stoma does not fit exactly into one of those cute measuring
guides with the perfectly round holes, don't be
discouraged. Most stomas are not perfectly round. The measuring guide is just that, a
guide. You customize it to fit your personal
need. This is a vital point. The correct size for your equipment is
extremely important. Always
measure your barrier to the correct size, no matter how it is built. Just like us, stomas come is all shapes and sizes.
The Right fit
Initially after surgery, your stoma is probably swollen. It will decrease in size. Your nurse
should show you how to
measure your stoma
correctly. Measuring is an ongoing concern. Most of the problems I see after surgery are created by incorrect sizing of the
stoma. You want the opening in your
pouch or adhesive to fit as closely as
possible without touching the stoma, leaving
a 1/16" to 3/16" border from your
stoma. This is to allow for your stoma
to change size and shape. Yes, your stoma does move and change size slightly with the normal peristaltic waves of your intestinal tract, of which it is, after all, a part. A soft pliable substance is usually used directly around the stoma, such as a paste or a washer, to fill in this 1/16" to 3/16" gap
around the stoma. It acts as a washer
or caulk to protect the skin directly around the stoma, and to protect the seal of the pouch to your body. The more liquid the discharge from your stoma, the more important the
caulking compound is. Liquid effluent
usually break down adhesives faster than solid.
Which pouch?
Now that you know what size your stoma is
and the importance of skin protection, let's discuss what type of pouch you'll
be wearing. Maybe you're still wearing the same type you had
when you were discharged with from the
hospital. This is perfectly okay if you
are comfortable with
it. If you are not really happy with
that type of pouch, by all
means decide what it is that you don't like and try finding another type that is more compatible with
you. Take advantage of the great variety of products on the market.
Sometimes it makes a
difference where your stoma is located to determine the best pouching system
for you. Remember, you're trying to
find what will best f it into your lifestyle.
You can listen to your doctor's
and nurse's advice as a guide, but you're the
one wearing the pouch. You should be as
comfortable as possible. Find what will best
fit into your lifestyle.
Most people wear a drainable pouch, which
comes in different lengths, shapes
and materials. Shorter pouches are
better for shorter people so
the end of the pouch doesn't rest
in an uncomfortable position. Most
people prefer an opaque pouch
material or color, one you can't see through.
Also available are pouch covers or "necessities" which are actually
underwear to conceal
the pouch, and prevent it from adhering to
your skin or causing perspiration underneath it. Some people swear by pouch covers. Others have no use for them. Take the time and trouble to find what is
most comfortable for you.
Some people like
to wear closed end pouches. These are closed off at the bottom and are usually disposed of when half full. Closed
pouches may be supplemented with liners which reduce the cost of using
them. Some find it convenient to wear a disposable pouch or mini pouch for special occasions or intimate moments. Unless you have good control of a colostomy via irrigation, a mini pouch is designed for short term use, e.g.. for swimming,
sexual relations or working out in the gym. A new development has taken place
over the last few years. More and more
people are using the smaller pouches on a regular, daily basis. They have a sporty look to them, and are
less intrusive to wear.
Can I switch
appliances?
A two piece system is available. These enable you to change the type of pouch you are wearing without
removing the adhesive each time. You would also be able to see the health of
your stoma more easily. In addition, a
two piece ostomy appliance utilizes a small flange that protrudes from the
barrier. This helps protect the stoma
from being smashed too much. Remember,
you want to select equipment that
best fits into your lifestyle. You want it to be compatible with your
activities. Some people use one and
two piece system. They change between
these because of different activities in which they are engaged, or just for
something different. In fact some people
even change between manufacturer to keep the peristomal skin from becoming
allergic to one brand. In addition, if you are able to use more than
one system, you are not as dependent on a particular manufacturer making your
particular system. They do change
product lines ever so often. You want to
anticipate this.
Do I need a
support belt?
Any abdominal surgery cuts through abdominal muscles and may weaken them. Peristomal surgical support belts are available in different widths to accommodate different needs. Some people like to wear a support belt for physical activity such as
bowling, gardening, working out in the gym or performing physical labor on the job. Such a belt can help prevent complications, provide support for a peristomal
hernia, or provide abdominal support just for comfort. Support belts come in 1-, 3-, 4-, 6- or 9-inch widths. They are elastic,
fasten with Velcro, and have an opening cut to fit around the ostomy pouch. Most ostomates do no wear belts
anymore. They are still made for
special situations and needs. Discuss
this with your ET. She will be able to
help you determine if a support belt will be of benefit.
Peristomal
hernias
A few words about peristomal hernias.
Developing a hernia around the stoma is a common complication because of the necessary weakening of the abdominal muscle.
This occurs when the surgeon cuts these muscles during surgery. Even with the newer laproscopic procedures,
the stomach muscles are weakened. The
area particularly vulnerable is where the surgeon pulls the intestine through
the abdominal
wall. Such a hernia is characterized by
a large bulging around the
stoma. If in doubt about whether you've developed a hernia, check
with your doctor or ET nurse. Remember,
after any type of surgery, the best way to avoid complications is to
exercise. When you are able, begin
walking two or three times a day. Start
out slowly under the advise of your doctor.
Gradually build up the distance you walk. Six to nine months after surgery, start other
abdominal, arm, leg and body muscle building exercises. Never stain yourself. You will not only gain strength, look good
and feel healthy, but you will reduce the risk of hernias. Muscles repair faster and better than fat
does. There are health professionals to
advise you in this area. Use their
help. This is a very important issue. Many problems are caused from lack of
physical activity. Eliminate
them… exercise.
Stomal prolapse
Another complication is a prolapsed stoma. This happens when the stoma keep protruding more and more from the
abdominal wall. It looks like it is
actually growing. It is falling out of
the body. It does not hurt because the
stoma has no feeling. It is harder to
manage because the pouch must be maneuvered more carefully to be applied. As with a peristomal hernia, a prolapse
can be cured only by
surgery. It may be contained where additional damage is slowed and is less uncomfortable by
wearing a peristomal support bell. Usually, wearing such a belt does increase your comfort.
The surgery requires the doctor repair the tissue around the stoma and
to rebuild it. This sometimes is able
to be done at the same site. Very
often, the stoma must be moved to the other side, lower, or in extreme cases,
higher. There are stoma almost to the
rib cage. These are very difficult to
manage.
Summary
It is test of character. Having an ostomy in not easy, yet it is not
really hard. The most difficult part of
the surgery is psychological adjustment.
If you are able to muster the strength of character to accept your body,
then you will have the best attitude to attack the physical issues with more
success. Be happy. You've been given a new life.
Life as an Ostomate
--Vancouver Ostomy Highlife
Will you
bulge?
No. Actually, without a part of the intestine or
bladder, and its contents, you should have a flatter tummy than before. You can expect to wear, with little exception,
what you wore before—and this includes tight clothing and bathing suits.
Will you
smell?
No! Those
with ileostomies and urinary diversions will be fitted for appliances which are
completely odor-proof. Colostomates can
control odor with diet. Or, just like
ileostomates, use an odor-barrier type ostomy appliance—like virtually
all that are now sold.
In addition,
for all ostomates there are deodorants for external use and odor-reducing
compounds to be taken by mouth, should they be needed. I have never met a smelly ostomate.
Will you make
noises?
Everyone
produces gas. Normal people release gas
about 15-20 times a day. Air-swallowers
produce even more.. But you don't make
noises so often that you can't pretend that your stomach is growling. Be the fastest elbow in the West, or wear a
two-way stretch binder, girdle or pantyhose to muffle the sound when it is
audible. Avoid skipping meals, gassy
foods, drinking through a straw and chewing gum.
Will you feel
the waste discharge?
Sometimes,
very little. The intestines have no
feeling, but fecal ostomates will on occasion feel the peristomal skin move
because of peristalsis. Colostomates
usually are aware of intestinal movement when it happens.
Those with
urinary diversions probably will be unaware of kidney discharge. The ileostomate or urinary diversion should
check his/her appliance occasionally to see if it is full, or he/she might find
his/her pouch sagging—like a cow in udder misery needs to be milked.
Will you be a
captive of the toilet?
At first you
may find yourself spending more time than usual in the bathroom. Soon you will become efficient with the
management of your stoma. Then your
routine will not involve any more time than normal bathroom visits, except for
the few minutes used in changing the appliance or irrigating. Plus, there are a great many manufacturers
inventing better equipment every year.
Make sure you stay informed about the state-of-the-art in ostomy care.
Will you
starve?
No. In fact, make sure you don't get too
fat. Follow you doctor's orders at each
stage of your adjustment. Some ostomates
will be able to eat and tolerate just about anything. Others may find difficulty with some
foods. Each person is so individual in
his/her tolerance of foods that he/she must determine what is best by trial and
error. All ostomates must drink plenty
of the proper fluids.
Will you be a
social outcast?
No. I have never met any outcast ostomates and
don't know anyone who has. Why would you
be the first one? If you don't smell
bad, bulge, make rude noises and dwell in the toilet, what is to make you
obvious and repulsive? Only your own
attitude—your morale—will affect your companions. No cheerful, brave and triumphant person will
be an outcast just because of an ostomy.
Drugs and the Senior
--Town Karaya
Changes in
the body caused by age or disease make seniors three times more likely to
experience reactions to drugs than younger people. Since many elderly often take medications for
more than one condition, there is also the potential for drug interaction. Taking medication without a clear
understanding of what, when, how and why, often significantly reduces the
effectiveness of the medication and may cause other problems. Here are some actual statistics:
·
About 25% of all prescriptions
are written for patients 65 years or older who also receive an average of 13
prescriptions drugs per year.
·
About 7% of the patients never
get their prescription filled.
·
The cost of failure to take
drugs properly is estimated to exceed $15,000,000,000 a year.
·
About 11% of all hospital
admissions are related to failure to take drugs correctly, resulting in some
125,000 deaths annually; another 4% of the admissions are due to drug-induced
toxicity.
·
About 15% of senior patients do
not complete a full course of their prescribed drug therapy.
·
Studies have shown that better
than 80% of the elderly take prescription and over-the-counter medications with
little knowledge of dangerous effects or potential interactions.
·
About 23% of nursing home
admissions result from the inability to manage medication use in the home
environment.
·
Often elderly people suffer
from speech defects or have hearing problems, are absent minded, or experience
other problems attributed to aging which are really reactions to drugs.
Appeal Denied Medicare
Claims
via—ConvaTec and
Internet Sources
In the majority of cases, Medicare claims are developed and processed
without problems. If the claim is denied
or payment is reduced, you may have the right to an appeal. In many instances of denial, the original
claim should be reviewed for accuracy and completeness before proceeding with
the appeals process. You should know
that:
·
There will be a letter notifying you of a denied Medicare claim, explaining
the appeal process and what options you have to pursue.
·
If your claim for ostomy supplies is denied by Medicare, you have a
right to appeal the claim whether or not the supplier had accepted assignment.
·
Only two percent of denied claims are appealed, but that 75% of those
which are appealed are successful.
·
Appeals may be submitted by your supplier or by a representative you
designate.
·
Based on DMERC Supplier Manuals, there are five levels in the Medicare
appeals process.
The following is the information you will
need to appeal a denied claim:
·
A brief statement explaining why you are requesting a review of the
claim.
·
A copy of the claim and its remittance notice.
·
You and your supplier's Medicare number.
·
Letters from your doctor or ET nurse; or information from your medical
records not previously provided. There
should clearly document your medical need for the ostomy supplies which have
been ordered by your doctor and for which the claim is question was submitted.
There are publications available to you
from AARP to assist you with reimbursement issues: When Your Medicare Bill Doesn't Seem
Right, and How to Appeal Medicare Part B.
Things People Tell Pharmacists…
--Hope Health Letter
·
What do you mean there's no
more refills? This is a forever
prescription.
·
I know I'm late getting this
prescription refilled, but I figured that if I took my pills every other day,
they would last longer.
·
I know I just got this
prescription the other day, but I need more because my cousin has the same
problem.
·
I can't take generic
drugs. I tried generic potato chips once
and they were just awful.
·
I got these pills back in
1975. What are they for—just in
case I need to take the rest of them?
·
Did you have to go to school to
get this job?
·
I was seen at the Mayo Clinic
for two years, and they couldn't find out what was wrong with me. What do you think it is?
·
My doctor switched medications
on me. Can I return these leftover pills
for credit?
Live Longer
--Orange Oasis
A new Haven
University study reveals that social activities; e.g., playing bingo, cards,
etc., increases one's life span by as much as 20 percent.
In fact,
playing these games are as good for senior citizens as exercise, according to
the research. "Social and
productive activities that involve little or no enhancement of fitness lower
the risk or mortality as much as fitness activities do", says Thomas Glass
or Harvard University School of Public Health.
Socializing
is good for your health because it reduces the effects of stress and boosts the
body's immune system, researchers suggest.
What this means to you is that coming to our monthly General Meetings
will help you live longer. Please
attend, we need you.
Making a Living
--Orange Oasis
Shortly before
his retirement, Charles Hendrickson Brower, Chairman of the Board of Batten,
Barton, Durstin and Osborn, circulated a memo to his staff which included these
lessons learned during 43 years in business:
·
Honesty is not only the best
policy, it is rare enough today to make you pleasantly conspicuous.
·
The expedient thing and the
right thing are seldom the same thing.
·
The best way to receive credit
is to try to give it away.
·
You cannot sink someone else's
end of the boat and still keep your own end afloat.
·
If you get a big kick out of
your job, others will bet a big kick out of working for you.
·
It is not important that you
come to work early and work late. The
important thing is why?
·
Chicken Little acted before her
research was complete.
·
A man of stature has no need
for status.
·
Many people know how to make a
good living. Few know what to do with it
when they have it made.
Ostomy Facts
·
There are about 500,000 people
with ostomies at any one time in the U.S.
·
Ostomy surgery is increasing
about 3% per year worldwide.
·
There are now more temporary
ostomy surgeries being performed than permanent ones.
·
The most common flange size is
45 mm.
·
More people wear two-piece
systems than one-piece.
·
Pouches have no expiration
date, per se, depending on how they are stored.
·
Skin barriers should be stored
in a cool, dry and dark place.
Over Diagnosis – Over Treatment
The Hidden Pitfalls of Cancer Screening
This article by Maryann Napoli, Associate Director, Center
for Medical Consumers
appeared in the
April 2001 issue of American Journal of Nursing.
This year an estimated 182,800 women will be diagnosed with
breast cancer, and about 40,800 will die of the disease. Every time I come across that ubiquitous
statistic, I mentally add this missing
one: And at least 32,000 women will be treated for a cancer that never would have killed them. The 32,000 figure represents over diagnosis,
an under appreciated byproduct of
mammography screening. In fact, over
diagnosis is the risk of any screening
procedure.
Subject
a large group of symptom less people to mammography, computed tomographic (CT) scanning, or a Pap smear, and then
biopsy the tiny abnormalities identified by these tests identify--in many
cases, the cells will look like cancer under the microscope. But most would never have invaded other
organs and become life-threatening, even if left untreated. Widespread acceptance of mammography
screening, for example, has caused a dramatic increase in the diagnosis of
ductal carcinoma in situ, which usually shows up as micro calcifications on a
mammogram. Before the advent of
mammography screening, this microscopic lesion within the milk duct was rarely
seen beyond the autopsy table. Shockingly,
DCIS was routinely treated with radical mastectomy in the 1970s when mammography
screening first became available. Women
were usually told by their
surgeons,
"Be grateful your cancer was found early--your life is saved."
Providers
now recognize that treating DCIS with a radical mastectomy was a form of
therapeutic overkill. But over treatment and uncertainties persist, as most of
these lesions are currently treated with lumpectomy plus radiation or simple
mastectomy. Research now indicates that
about 80% of all DCIS will never become invasive even if left untreated. Hence my 32,000 statistic, which represents
80% of the nearly 40,000 women diagnosed annually with DCIS. No test can
accurately distinguish the DCIS that would become invasive; what's more,
invasive is not necessarily synonymous with fatal. For example, invasive breast cancer developed
in a small percentage of women whose DCIS was treated either with excision plus
radiation or excision alone in a large ongoing clinical trial. Thus far, eight-year results from this trial
show a breast cancer mortality rate of 1% in both groups. This is the same rate of mortality shown in
much longer follow-up studies of women whose DCIS had been treated with
mastectomy in the past. What's more,
early detection of DCIS provides no advantage, according to 13-year follow-up
results from the
Canadian
National Breast Screening Study.
Pick
a body part--lung, prostate, cervix, thyroid--look hard enough, and you'll find
a "precancerous" abnormality. But not always to the benefit of the patient.
In the not-so-distant past, precancerous cervical lesions were almost always
treated with a hysterectomy because it was assumed that all would eventually
become malignant. Now it is known that
nine out of ten regress spontaneously. And widely publicized findings from a
1999 study showed increased lung cancer survival due to screening with the
spiral CT scan. But this study has yet
to prove a reduced rate of lung cancer mortality--the ultimate test of screening's
value. Some doctors caution against premature acceptance of lung scanning
because it may lead to unnecessary lung surgery; furthermore, the increased
survival might be artificially inflated by the inclusion of scan-detected
cancers would have never become invasive.
The
PSA screening blood test for prostate cancer may be causing more harm than
good. The majority of men diagnosed as result have the type of early prostate
cancer that is so slow-growing, the majority will die of other causes. Most are
treated with either prostatectomy or radiation therapy, each with a substantial
rate of impotence and incontinence.
Cancer
always kills, we are told, and early detection virtually guarantees cure. Simplistic half-truths--many of them
emanating from the American Cancer Society--are at odds with research showing
cancer to be heterogeneous, encompassing a broad spectrum of diseases that
includes everything from permanently noninvasive to rapidly fatal.
Screening
does save lives, but at a far more modest rate than the public has been led to
believe. Whenever you find yourself telling your patients to be screened, don't
forget to give them the whole story.
Set in Your Ways?
By Sharon Williand, RNET, The Pouch
There is a
risk in being set in you ways. Sometimes
it takes a catastrophe to shake us out of our complacency. It is easy to fall into the "ostrich
syndrome". This is unfortunate,
particularly when it comes to ostomy management. It is only through education that individuals
grow, learn and reach their fullest potential as ostomates.
While writing
this column, I was reminded of several examples of individuals recently seen by
our ET team. One gentleman had a sigmoid
colostomy performed many years ago and had developed a huge peristomal hernia. He irrigated his colostomy daily and had been
using what now classifies as an antique set.
The irrigator
was a latex bag with no measuring guide to gauge the amount of solution being
given. There was a hard-rubber catheter
with no shield present on the irrigator tubing.
He had been forcing the tubing in to its full twelve inch length. He poked and poked until it finally went in!
All-in-all,
it was a miracle that he had not perforated the herniated bowel. He had not been successful with irrigations,
continually losing as much water around the catheter as he was instilling. It was difficult for him to accept an
explanation of why he was flirting with danger.
After all, he
had always done it that way. Only after
a great deal of persuasion was he agreeable to trying a new system which included
a measuring guide on the irrigator and a cone in place of the catheter.
One elderly
lady called the ET office in a state of panic.
She was no longer able to obtain the rubber pouches that she had been
using for the past 25 years.
She had been ordering
these through the mail from a distant state.
She had no idea of any other pouch that could be substituted, and she
also had no idea of what supplies were locally available. She was totally amazed at the new
light-weight, odor-proof pouches now on the market.
Choosing the Right System
By Gwen B. Tumbull, BS, ET, Ostomy Newsletter
For the
healthcare professional who is caring for a person who has just undergone
ostomy surgery, the biggest challenge is selecting an appropriate ostomy pouching
system. As an ET nurse with 18 years of
experience, I can honestly tell you that I really don't know which pouching
system is right for a person.
Oh yes, I
know what type of barrier is indicated for various types of output, and whether
additional skin protection should be provided by utilizing skin barrier pastes,
powders or strips. But only
you—the person with the colostomy, ileostomy or urostomy—know for
sure what ostomy system is right for your needs.
Why do I say
this? Because my years of experience
have shown me that the right pouch for the patient is the pouch the patient
says is the right pouch. After all,
living day-in-and-day-out with a pouching system is the only true test of how
the system affects a person's daily life.
There are
many options and factors to be considered.
For example, a person whose output is frequent may prefer a pouch that
can be emptied without being removed from the abdomen. On the other hand, people with irrigating
colostomies, who are able to regulate their bowel movements by giving
themselves an enema through the stoma, may need only a security pouch, or even
a gauze pad.
The key
questions that must be answered are:
Does it help him/her feel secure when wearing a particular pouching
system? Does it help him/her feel
confident when interacting with family, friends and co-workers? Does the way the pouch appears on the body or
under clothing positively or negatively affect how one feels regarding
sexuality?
IBS Survey
A new survey of 1,000 adults shows
Americans are not aware of the widespread presence of irritable bowel syndrome
(IBS). IBS affects up to 20 percent of
all Americans, but only 1.2 per-cent of people in the survey knew that IBS is
more prevalent in the United States than depression, asthma, diabetes or
coronary heart disease. IBS is a leading
cause of school and work absenteeism, second only to the common cold.
IBS is characterized by abdominal pain, or
discomfort, bloating and altered bowel movement, such as constipation or
diarrhea. The survey was sponsored by
Novartis, maker of an investigational drug, Zelnorm, for treatment of IBS.
Quality of
Life Study
Researched By Jane Michnik
Quality of life is retained after rectal cancer surgery. A new study shows patients undergoing rectal
cancer surgery can have a good to excellent quality of life after the
operation.
While long-term survival is the key goal of any cancer surgery, the
qualify of life of the patient is important as well. "Surgeons want to
preserve bowel function and avoid creating a permanent colostomy, but not at
the expense of adversely affecting patients' quality of life," said Dr.
Kirk Ludwig, an assistant professor of surgery at Duke University Medical
Center in Durham, N.C.
The findings, presented at the 2002 Annual Clinical Congress of the
American College of Surgeons in San Francisco, show the vast majority of
patients have good to excellent quality of life after surgery for rectal
cancer. Quality of life scores were
similar whether patients underwent a procedure that creates a permanent
colostomy after surgically removing rectal cancer or one that avoids a
colostomy by preserving the anal sphincter and restoring the continuity of the
gastrointestinal tract.
There
are some 50,000 newly diagnosed cases of rectal cancer annually in the United
States. Treatment has evolved over the
last 50 years. "There was a time in the middle part of the last century
when it was a feat to get someone through an operation for rectal cancer,"
Ludwig said. "The focus of
treatment at that time became optimizing oncologic outcomes. More recently, optimizing function and
quality of life have become major issues."
What to do if
you lose your wallet
By Jane Michnik
We've all heard horror
stories about fraud that's committed using your name, address, social security
number, credit cards, etc.
Unfortunately, I have
firsthand knowledge, because my wallet was stolen last month and within a week
the thieves ordered an expensive monthly cell phone package, applied for a Visa
credit card, had a credit line approved to buy a Gateway computer, received a
PIN number from the DMV to change my driving record information on-line, and
more.
But here's some
critical information to limit the damage in case this happens to you or someone
you know. As everyone always advises,
cancel your credit cards immediately, but the key is having the toll free
numbers and your card numbers handy so you know who to call. Keep those where you can find them easily
(having to hunt for them is additional stress you won't need at that
point).
Make a list today of
all you credit card accounts and telephone numbers to reach them. File a police report immediately in the jurisdiction where it was stolen, this proves
to credit providers you were diligent, and is a first step toward an
investigation…if there ever is one.
But here's what is
perhaps most important: Call the three national credit reporting
organizations—listed below—immediately to place a fraud alert on
you name and social security number. I
had never heard of doing that until advised by a bank that called to tell me an
application for credit was made over the Internet in my name.
The alert means any
company that checks your credit knows your information was stolen and they have
to contact you by phone to authorize new credit. By the time I was advised to do this almost
two weeks after the theft—all the damage had been done—there were
records of all the credit checks initiated by the thieves' purchases, none of
which I knew about before placing the alert.
Since then, no
additional damage has been done, and the thieves threw my wallet away this
weekend—someone turned it in. It seems to have stopped them in their
tracks. The numbers of the credit reporting agencies are:
·
Equifax 1-800
525-6285
·
Experian (formerly
TRW) 1-888-397-3742
·
Trans Union
1-800-680-7289
Social Security Administration also has a fraud line at
1-800-269-0271. Pass this information
along…it could help someone else.
Blood Pressure
--The Johns Hopkins Medical Letter
Physicians in the past diagnosed high blood pressure (BP) based on
diastolic pressure. The bottom number in
a BP finding—the diastolic value—is the pressure in the arteries as
the heart relaxes between beats.
Elevated diastolic BP is strongly associated with increased risk of
death from heart disease and stroke.
However, beginning at around age 60, diastolic BP often begins to
plateau and may even decline.
Simultaneously, systolic BP often starts to rise. The top number in a finding—the
systolic value—is the pressure of the blood in the arteries when the
heart contracts. BP is expressed as
millimeters of mercury (mmHg).
Until recently, rising systolic BP was considered normal. But research shows that systolic elevations
are strongly linked with death from stroke, heart attack, congestive heart
failure, or kidney failure—even when diastolic BP is relatively low. The phenomenon is so widespread that it is
recognized as a bona fide medical condition known as isolated systolic
hypertension (ISH).
About 5% of adults develop ISH by age 60, and about a quarter of those
in their 80's have it. Recognition of
the importance of ISH began to emerge in 1991 with completion of the landmark
Systolic Hypertension in the Elderly Program.
When researches used low-dose diuretic medications to control ISH in
more than 4,500 elderly patients, the incidence of stroke dropped 35% and the
risk of heart failure was cut in half.
For subjects who had experienced a heart attack before entering the
study, heart failure risk fell by 80%.
Other research has borne out these results—notably, a study of
3,600 hypertensive patients published in the journal Hypertension.
ISH is diagnosed based on established categories similar to those used
when both diastolic and systolic values are elevated (stages 1, 2 and 3
hypertension). Like all types of
hypertension, ISH should be treated more aggressively when coronary heart
disease (CHD) or CHD risk factors—smoking, high cholesterol, diabetes, or
a family history of early CHD—are present. Age is also a factor—more aggressive
treatment is required for men after age 60 and for women after menopause.
Treatment usually begins with diuretics such as hydro-chlorothiazide
(Hydrodiuril) and ferosemide (Lasix).
Other medications that may be considered include:
Beta-blockers,
which are often used for people who
have had a heart attack, as well as for stage 2 and stage 3 hypertension;
·
Angiotensin-converting enzyme
(ACE) inhibitors, which are
especially appropriate for patients who also have diabetes or heart failure,
and often for those who have had a heart attack;
·
Angiotenin II receptor
blockers, which can be used if ACE
inhibitors have to be discontinued because of a dry cough or other side
effects:
·
Long-lasting calcium channel
blockers, which are often
particularly effective for ISH—short-acting formulations can cause heart
damage and should not be used.
Most people who require drug therapy can be managed with one medication,
but about 40% need combination treatment.
Lifestyle measures—not smoking, limiting alcohol consumption,
exercising, maintaining a healthy diet and losing weight—are also
important.
A Blueprint for Treatment
Optimal blood pressure is 120/80 mmHg or below. Though values of around 130/85 are still
considered normal, they are classified as "high normal" and should
not be ignored. ISH is diagnosed when
systolic findings are consistently 140 or above and diastolic findings are
consistently below 90.
Isolated systolic values between 140 and 159 are considered mild to
moderate; values over 160 are considered moderate to severe. Treatment should be guided by the following
criteria, established by the Joint National Committee on Prevention, Evaluation
and Treatment of High Blood Pressure for state 1 (140-159/90-99), stage 2
(160-179/100-109), and stage 3 (180/110 and above) hypertension. When systolic and diastolic values fall into
different categories, the higher finding should generally guide treatment.
Diet Affects Prostate Cancer
Fred Hutchinson
Cancer Research Center researchers have found high fat and high calcium
consumption may fuel prostate cancer from a localized to an advanced
disease. Researchers examined intake of
calories, fat, calcium and vitamin D among 1,200 Seattle-area men ages 40 to
64. More than 60 percent of the
participants were under age 60. Half of
the men recently had been diagnosed with prostate cancer while the rest were
cancer free.
Researchers found the men whose fat intake
accounted for no more than 30 percent of their daily calories had half the risk
of late-stage cancer than men who consumed more fat. There were no associations
of fat intake with early-stage disease, however. The researchers also found the risk of
advanced prostate cancer was 112 percent higher among men who consumed the most
calcium—more than 1,200 milligrams per day, equivalent to four or more
glasses of milk—compared to those who got fewer than 500 mg. It did not
matter whether the calcium came from food or supplements, researchers said.