April 2010

 

Last Month’s Meeting (our 397th)

 

  On the best weather we had on St. Patrick’s Day in years, we had our March General Meeting.  This was a unique meeting inspired by the creativity of Judy Svoboda, Membership Chairperson.  Judy hosted a Conversation about Food. 

     Judy moderated a discussion about the effects from eating various foods after ostomy surgery explored the following topics

·               Gas-producing foods

·               Foods that change our output color

·               Odor-producing foods

·               Foods that increase stool (diarrhea)

·               How to relieve constipation

·               Stomal obstructions (food blockage)

·               Blockage control and relief

·               Foods that balance urine pH levels

     One interesting discovery was that many of us have very low odor fecal output.  We thought that we were just fortunate individuals.  It turns out that we actually have something in common that Judy mentioned; we all drink cranberry juice.  It seems that cranberry juice is one of the foods to reduce output odors.

     We would like to thank Joan Loyd, representing FOW USA and Dave Rudzin, President Elect of UOAA, for providing an update on the events and activities of these outstanding organizations serving the ostomy community.  In addition, Judy represented our association at the annual CCFA (Crohn’s and Colitis Foundation of America) Symposium held in Rosemont.  At the Symposium, people have the opportunity to talk to Judy one-on-one about life after ostomy surgery.  Many of the attendees will face ostomy surgery and need our positive and realistic view of it.  Seeing and talking to someone who has experienced this trial and come out of it living life to its fullest is an inspiration that these people may not have the opportunity to obtain anywhere else.   

     Our April meeting celebrates the 35th anniversary of the establishment of our ostomy association.  Rhoda Gordon, one of the founding members, will host this evening’s event.  We have obtained a very special guest speaker for our celebration, Jan Colwell, M.S., WOCN, from the University of Chicago and President of the WOCN Association.  Jan’s presentation is titled “Ostomy Management over the Years.”  We expect a large turnout.  Our room only holds 124 people, so come early to secure a good seat.   

     If you have a talent that you would like to share by participating in one of our many diverse committees, please let us know.  A list of our officers and committees are listed in our bylaws, which anyone may view via www.uoachicago.org and following the link to OAGC (Ostomy Assn. of Greater Chicago).  

     We are updating our mailing/e-mail list every month.  Please complete the form on the last page of this newsletter if your home or e-mail addresses change.  Are you parking in the underground garage for our meeting?  Ask us for a pass to reduce your fee to $2.00!

     “Nearly all men can stand adversity, but if you want to test a man’s character, give him power.” 

                                                 —Abraham Lincoln

 

OAGC Meeting Dates for 2010

 

April 21—Our 35th Anniversary Celebration featuring Special Guest Speaker Janice Colwell, M.S., WOCN, President of WOCN Society

May 19—“How Do You Tell People You Have an Ostomy?” hosted by Joan Loyd with Connie Kelly, WOCN.

June 16—Visitor’s Training moderated by Peggy Bassrawi, RN, Visiting Chairperson

July 21—Nancy Chaiken, WOCN Swedish Covenant Hospital, “Hot Weather Management”

August 18—Ostomy Surprises

September 15—Bernie au dem Graben, WOCN

October 20—Jennifer Dore, WOCN

 

Southwest Suburban Chicago

 

     The Southwest Suburban Chicago Ostomy Support Group is an entirely volunteer ostomy association dedicated to the mutual aid, education and moral support of people with ostomies and their families.  Meetings are held at 7:30 PM on the third Monday of each month throughout the year, except July, August, December and January.

     For information regarding this special ostomy group serving Chicago’s greater southwest side, please call Edna Wooding, WOC nurse and association president, at 708-423-5641. 

 

           All meetings are held at          

Little Company of Mary Hospital,

 Evergreen Park, Mary Potter Pavilion,

 Lower Level, 2850 W. 95th St.

 

Northwest Community Hospital

 

     An ostomy support group formed in 2008 at Northwest Community Hospital, 800 W. Central Road, Arlington Heights.  They wish to extend a welcome to all of our readers to visit them.  The WOC nurses at the hospital lead the group.  For more information, please contact Diane Davis-Zeek, RN, at 847-618-3215, ddavis@nch.org .

     They meet at 1:00 PM in the Busse Center, B1 level, Room LC7-8 of the Learning Center.  This building may be accessed from the garage at the west end of the Busse Center.   

NW Comm Hospital Meeting Dates for 2010

June 3

August 12

October 7

December 9

 

Test Your Ostomy Knowledge

 

Q  While washing your skin and stoma you notice spots of blood on your washcloth.  Your immediate reaction is

a. Notify your doctor at once

b. Panic!

c. Apply gauze to the stoma

d. Continue with care of your stoma and apply a new pouching system

 

The answer is d.  Do not become frightened when there are spots of blood on the cloth when wiping the stoma.  Suggestion: Because the stoma has no skin, its surface is living tissue, with blood diffusing through the cells.  Always cleanse and care for the stoma gently.  If the stoma is bleeding profusely, filling the pouch, then notify your doctor at once.

 

Q Your pouching system has been on for two days and you experience an uncomfortable burning sensation around the stoma.  You decide it is best to

a. Ignore it.  It seems to come and go anyway

b. Wait until the designated day to change your pouching system to explore the problem

c. Take a cool bath

d. Change your pouching system immediately

 

The answer is d.  It is normal for your pouching system to be able to stay on for three or four days.  However, if you experience burning or itchiness around the stoma, discomfort or pain around the stoma or discoloration of the adhesive, then change your skin barrier, regardless of the day.  These signs may indicate leakage.  Stool or urine on the skin can be very irritating.  In addition, itching or irritation under the pouch may also be due to dehydration.  If you are sure the skin barrier is not leaking and there is nothing externally wrong with it, drink a few glasses of water rather than remove it.  If the symptoms persist, change your pouching system.  Do not be a hero.  When your pouching system bothers you, you change it.

 

Q  When you remove your skin barrier, you notice the skin around the stoma is red and irritated.  How do you it?

a. Apply cool compresses for a short time before reapplying your skin barrier

b. Apply a protective powder, such as ConvaTec’s Stomahesive Powder or Hollister’s Premium Powder to red and irritated skin areas, remove any excess, and continue with reapplying your pouching system

c. Apply a soothing cream or ointment to the red and irritated skin areas

d. Use an alcohol wipe on your peristomal skin.

 

The answer is b.  It is important to observe the skin around the stoma.  Using a mirror sometimes helps observe the skin and stoma.  If the skin appears reddened, irritated or weepy, you may require a protective powder.  You may need to change your pouching system more often than usual until the skin heals.  While creams and ointments may be a reasonable solution for skin irritation in other areas of your body, they may not be useful around your stoma because your skin barrier will not adhere to moist or oily skin.  Cool compresses may be soothing but cannot heal the skin.  Alcohol will dry the skin, which may cause it to itch.  As an added note, hair growth around the stoma can be quite painful when removing the skin barrier.  Remove excess hair with an electric razor or scissors.  A straight edge or safety razor should not be used because of the risk of irritation to the skin and cutting the stoma.  Ostomy adhesive removers may help reduce hair pulling when removing the pouch.

 

Q  Your friendly neighbors invite you to a pool party.  You would like to go.  How do you respond?

a. You decline the invitation since you cannot swim with an ostomy and would be depressed to see everyone else enjoying him/herself.

b. You limit your fluid and food intake for 12 hours prior to the party so your stoma is not active.

c. Of course, you accept the invitation.

d. You go in the pool and worry that your pouching system will probably leak.

 

The answer is c.  If you enjoyed swimming before your ostomy surgery, continue to swim after it.  For extra security while swimming, some people picture-frame the adhesive part of their skin barrier with paper or waterproof tape, or apply a skin sealant directly over the adhesive.  Most of us find these extra steps unnecessary.  Printed rather than solid-colored bathing suits help to camouflage the outline of the pouching system.  Some women prefer bathing suits with skirts and some men prefer boxer-style trunks, but snug fitting suits may be worn.  A lightweight panty girdle may be worn to hold the pouching system firmly in place.  If you have an ileostomy, it will work whether or not you eat.  When the stomach is empty, the discharge is liquid, highly acidic and gassy.  Skipping meals or limiting fluid intake may lead to dehydration and/or electrolyte imbalance.

 

Q Six weeks after your ostomy surgery, your pouching system no longer fits tightly around the stoma.  There is skin showing around it after the skin barrier is attached.  What should you do?

a. Notify your WOC nurse.

b. Fill the skin spaces with one of the specially made barrier rings or with ostomy paste.

c. Remeasure your stoma using the measuring guide and then cut the barrier to the new size.

d. Figure that is just the way it works.

 

The best answer is c, although b will work also.  Immediately after ostomy surgery, the stoma is swollen due to the handling of the bowel during surgery.  It may take a few months for the swelling to subside.  When your stoma is still relatively new, you need to remeasure the stoma each time you change your pouching system.  If you live in an area where there are WOC nurses, make an appointment to see one about three to four weeks after surgery, just as a follow-up.  It is important that the skin barrier fit as closely as possible to the stoma without touching it.  This is an issue in itself.  You need to allow room for the bowel to expand as contents pass.  This is especially true for people with fecal ostomies.  To allow for bowel expansion, usually cut the opening 1/8th to 1/16th of an inch larger than the stoma size and fill any gaps with a barrier seal or ostomy paste, if using a standard wear skin barrier.  For true extended wear barriers like ConvaTec’s Durahesive and Hollister’s Flextend, cut them to the exact size of the stoma and let the barrier actually touch the stoma.  Small skin spaces may be filled with barrier seals or ostomy paste.  Barrier seals and ostomy paste are not made to fill large openings, say ½” wide.  People with urostomies need to be careful with ostomy pastes.  They may reflux into the kidneys and cause infection.  Skin barrier seals would be a better choice.

 

Q  The warm weather is coming, and you are anxious to resume sporting and physical recreational activities.  The doctor has agreed that you are ready for more activity.  However, you know that

a. Having an ostomy interferes with your ability to exercise and be physically active.

b. You can only be a spectator . . . you will live a quiet life from now on.

c. During any physical activity, it is important to increase your fluid intake, not limit it.

d. You may participate, but you will get ill.

 

The answer is c.  The large bowel absorbs water and electrolytes like sodium and potassium.  With the removal of or bypassing of part of the colon, a person with an ostomy tends to lose fluid and electrolytes through the stoma, depending on the amount of large intestine remaining.  An increase in fluid and electrolyte loss is associated with excessive perspiration, physical exercise, a hot climate or vomiting.  Loss also occurs with high ostomy output, sometimes seen with an ileostomy.  If you have an ileostomy, are emptying a full pouch more than eight times a day or your stool output is greater than 1000 cc per day (more than a quart) you have high ostomy output.  With a high ostomy output electrolyte imbalance may occur.  There is no reason why an ostomy should limit your participation in sports even rough contact sports.  Specially designed shields may be used to protect the stoma from injury.  Many individuals who have an ostomy are golfers, hikers, runners, swimmers, skiers, skydivers, weight lifters, football, baseball and volleyball players . . ..  It is important to remember that during periods of physical activity or high ostomy output, your fluid intake should be increased, not limited.  Of course, your body must be prepared in the usual ways just like any other person.

 

Q You are invited to fly south during spring break.  Of course, having an ostomy you should

a. Decline.  You cannot travel with an ostomy.

b. Readily accept, but plan ahead for potential problems, like bringing extra supplies with you.

c. Plan to purchase your supplies when you arrive.

d. Pack all your ostomy supplies in the luggage you check through baggage.

 

The answer is b.  You can travel virtually anywhere with an ostomy, but it is wise to plan for potential problems.  Helpful hints when traveling including the following

·         Take triple the amount of supplies you would normally use for that period.

·         Never check all of your ostomy supplies with airline baggage.  Put some in your carry-on luggage. 

·         Again, emergency supplies should be placed in your carry-on luggage and stored in a cool place.

·         A doctor's letter may prevent unnecessary questions during a luggage check.  TSA personnel know little or nothing about ostomy surgery.    

·         If you need emergency supplies, check our Internet site at www.uoachicago.org for sources to access ostomy supply vendors.  Many will ship by air express for next day delivery.

·         Contact the local ostomy support association in that area through the United Ostomy Associations of America Internet site at www.uoaa.org if problems or questions occur.

 

Q You come home from hospital and feel lonely and depressed.  It is wise to for you to

a. Visit, phone and talk to friends.

b. Contact your local ostomy support association and arrange to go with a new friend to a meeting.

c. Become involved busy with a hobby, actively helping someone else with his/her challenges. 
d. Plan an outing to have some fun.

 

All these solutions may help you feel better.  You may be going through a profound period of grief and may be experiencing a tremendous amount of stress.  It is not unusual or unexpected to have days when you feel sad or depressed.  These feelings are normal and pass with time for most of us.  It is important to express your feelings.  You may cry, be hostile, angry, nasty and react in ways that are unusual for you.  Remember you are not alone.  Family and friends, as well as other individuals who have an ostomy can be a great support.

 

For our liability disclaimer and privacy policy visit

http://uoachicago.org/liability.htm.

 

Gas in the Digestive Tract

Resourced from the National Digestive Diseases Information Clearinghouse

 

     Everyone has gas and eliminates it by burping or passing it through the intestines.  However, many people think they have too much gas when they really have normal amounts.  Most people produce about one to three pints of gas a day and pass gas 15 to 30 times a day.  Gas is made primarily of odorless vapors—carbon dioxide, oxygen, nitrogen, hydrogen and sometimes methane.  The unpleasant odor of flatulence comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.  Although having gas is common, it can be uncomfortable and embarrassing.  Understanding its causes and ways to reduce symptoms and treatment will help most people find relief.

What Causes Gas?

     Gas in the digestive tract, that is, the esophagus, stomach, small and large intestine, comes from two sources: swallowed air and normal breakdown of certain undigested foods by harmless bacteria naturally present in the large intestine.

     Swallowed air.  Air swallowing—aerophagia—is a common cause of gas in the stomach.  Everyone swallows small amounts of air when eating and drinking.  However, eating or drinking rapidly, chewing gum, smoking or wearing loose dentures can cause some people to take in more air.  Burping or belching is the manner most swallowed air, which contains nitrogen, oxygen and carbon dioxide, leaves the stomach.  The remaining gas moves into the small intestine, where it is partially absorbed.  A small amount travels into the large intestine for release through the end of the digestive tract.  The stomach also releases carbon dioxide when stomach acid and bicarbonate mix, but most of this gas is absorbed into the blood stream and does not enter the large intestine.

     Breakdown of undigested foods.  The body does not digest and absorb some carbohydrates (the sugar starches and fiber found in many foods) in the small intestine because of a shortage or absence of certain enzymes.  This undigested food then passes from the small intestine into the large intestine, where harmless and normal bacteria break down the food producing hydrogen, carbon dioxide and—in about one-third of all people—methane.  Eventually, these gases exit through the end of the intestine.

     People who make methane do not necessarily pass more gas or have unique symptoms.  A person who produces methane will have stools that consistently float in water.  Research has not shown why some people produce methane and others do not.  Foods that produce gas in one person may not cause gas in another.  Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce.  The balance of the two types of bacteria may explain why some people have more gas than others do.

Which Foods Cause Gas?

     Most foods that contain carbohydrates can cause gas.  By contrast, fats and proteins cause little gas.

     Sugars.  The sugars that cause gas are raffinose, lactose, fructose and sorbitol.

     Raffinos.  Beans contain large amounts of this complex sugar.  Smaller amounts are found in cabbage, brussel sprouts, broccoli and asparagus, as well as other vegetables and whole grains.

     Lactose.  Lactose is the natural sugar in milk.  It is also found in products such as cheese and ice cream.  It is also found in processed foods such as bread, cereal and salad dressing.  Many people—particularly those of African, Native American or Asian background—have low levels of the enzyme lactase, which digests lactose.  As people age, their enzyme levels decrease.  As a result, over time people may experience increasing amounts of gas after eating foods containing lactose.

     Fructose.  Fructose is naturally present in onions, artichokes, pears and wheat.  It is also used as a sweetener in some soft drinks and fruit drinks.

     Sorbitol.  Sorbitol is a sugar found naturally in fruits, including apples, pears, peaches and prunes.  It is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums.

     Starches.  Most starches, including potatoes, corn noodles and wheat, produce gas as they are broken down in the large intestine.  Rice is the only starch that does not cause gas.

     Fiber.  Many foods contain soluble and insoluble fiber.  Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines.  Found in oat bran, beans, peas and most fruits, soluble fiber are not broken down until they reach the large intestine where digestion causes gas.  Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas.  Wheat bran and some vegetables contain this kind of fiber.

What Are Some Symptoms and Problems of Gas?

     The most common symptoms of gas are belching, flatulence, abdominal bloating and abdominal pain.  However, not everyone experiences these symptoms.  The determining factors probably are how much have the body has produced, how many fatty acids the body absorbs and a person's sensitivity to gas in the large intestine.  Chronic symptoms caused by too much gas or by a serious disease are rare.

     Belching.  An occasional belch during or after meals is normal and releases gas when the stomach is full of food.  However, people who belch frequently may be swallowing too much air and releasing it before the air enters the stomach.  Sometimes a person with chronic belching may have an upper GI disorder, such as, peptic ulcer disease, gastroesophageal reflux disease (GERD) or gastritis.  Believing that swallowing air and releasing it will relieve the discomfort of these disorders some people may unintentionally develop a habit of belching.  Frequently, the pain continues or worsens, leading the person to believe he or she has a serious disorder.

     Two rare chronic gas syndromes are associated with belching, Meganblase syndrome and gas-bloat syndrome.  The Meganblase syndrome, which causes chronic belching, is characterized by severe air swallowing and an enlarged bubble of gas in the stomach following heavy meals.  The resulting fullness and shortness of breath may mimic a heart attack.

     Gas-bloat syndrome may occur after surgery to correct GERD.  The surgery creates a one-way valve between the esophagus and stomach that allows food and gas to enter the stomach but often prevents normal belching and the ability to vomit.

     Flatulence.  Another common complaint is passage of too much gas through the intestine.  However, most people do not realize that passing gas 15 to 30 times a day is normal.  Although rare, too much gas may be the result of severe carbohydrate malabsorption or overactive bacteria in the colon.

     Abdominal bloating.  Many people believe that too much gas causes abdominal bloating.  However, people who complain of bloating from gas often have normal amounts and distribution of gas.  They actually may be unusually aware of gas in the digestive tract.  Doctors believe that bloating is usually the result of an intestinal motility disorder such as irritable bowel syndrome (IBS).  Motility disorders are characterized by abnormal movements and contractions of intestinal muscles.  These disorders may give a false sensation of bloating because of increased sensitivity to gas.

     Splenic flexure syndrome is a chronic disorder that seems to be caused by trapped gas at bends, flexures, in the colon.  Symptoms include bloating, muscle spasms and upper abdominal discomfort.  Splenic flexure syndrome often accompanies IBS.

     Any disease that causes intestinal obstruction, such as Crohn's disease or colon cancer, may also cause abdominal bloating.  In addition, people who have had many operations, adhesions, scar tissue, or internal hernias may experience bloating or pain.  Finally, eating much fatty food can delay emptying the stomach and cause bloating and discomfort, but not necessarily too much gas.

     Abdominal pain and discomfort.  Some people have pain when gas is present in the intestine.  When gas collects on the left side of the colon, the pain can be confused with heart disease.  When it collects on the right side of the colon, the pain may feel like the pain associated with gallstones or appendicitis.

What Diagnostic Tests Are Used?

     Because gas symptoms may be caused by a serious disorder, the symptoms should be evaluated.  The doctor usually begins with a review of dietary habits and symptoms.  The doctor may ask the patient to keep a diary of foods and beverages consumed for a specific time.  If lactase deficiency is the suspected cause of gas, the doctor may suggest avoiding milk products for a time.  A blood or breath test may be used to diagnose lactose intolerance.

     In addition, to determine if someone produces too much gas in the colon or is unusually sensitive to the passage of normal gas volumes, the doctor may ask patients to count the number to times they pass gas during the day and include this information in a diary.  Careful review of diet and the amount of gas passed may help relate specific foods to symptoms and determine the severity of the problem.

     If a patient complains of bloating, the doctor may examine the abdomen for the sound of fluid movement to rule out ascities, buildup of fluid in the abdomen, and for signs of inflammation to rule out diseases of the colon.

     The possibility of colon cancer is usually considered in people 50 years of age and older and in those with a family history of colorectal cancer, particularly if they have never had a colon examination, sigmoidoscopy or colonoscopy.  These tests may also be appropriate for someone with unexplained weight loss, diarrhea or blood not visible in the stool.  For those with chronic belching, the doctor will look for signs or causes of excessive air swallowing.  If needed, an upper GI series (X-ray to view the esophagus, stomach and upper small intestine) may be performed to rule out disease.

How is Gas Treated?

     The most common ways to reduce the discomfort of gas are changing diet, taking medication and reducing the amount of air swallowed.

     Diet . . . Doctors may tell people to eat fewer foods that cause gas.  However, for some people this may mean cutting out healthy foods, such as fruits and vegetables, whole grains and milk products.  Doctors may also suggest limiting high-fat foods to reduce bloating and discomfort.  This helps the stomach empty faster, allowing gases to move into the small intestine.  Unfortunately, the amount of gas caused by certain foods varies from person to person.  Effective dietary changes depend on learning through trial and error how much of the offending foods one can tolerate.

     Nonprescription medicines.  Many different types of nonprescription, over-the-counter medication, including antacids with simethicone and activated charcoal, are available to help reduce symptoms.  Digestive enzymes, such as lactase supplements, actually help digest carbohydrates and may allow people to eat foods that normally cause gas.  Antacids such as Mylanta II, Maalox II and Di-Gel contain simethicone, a foaming agent that joins gas bubbles in the stomach so that gas is more easily belched away.  However, these medications have no effect on gas in the intestines.  The recommended dose is two to four tablespoons of the simethicone preparation taken one-half to two hours after meals.

     Activated charcoal tablets may provide relief from gas in the colon.  Studies have shown that when taken before and after a meal, intestinal gas is greatly reduced.  The usual dose is two to four tablets taken just before eating and one hour after meals.

     The enzyme lactase, which aids lactose digestion, is available in liquid and tablet form without a prescription under the brand names Lactaid, Lactrase and Dairy Ease.  Adding a few drops of liquid lactase to milk before drinking it or chewing lactase tablets just before eating helps digest foods that contain lactose.  Lactose-reduced milk and other products are available at many grocery stores.  Beano, a safe over-the-counter digestive aid, contains the sugar-digesting enzyme that the body lacks to digest the sugar in beans and many vegetables.  The enzyme comes in liquid form.  Three to 10 drops are added per serving just before eating to break down the gas-producing sugars.  Beano has no effect on gas caused by lactose or fiber.

     Prescription medications.  Doctors may prescribe medications to help reduce symptoms, especially for people with a motility disorder such as IBS.  Promotility or prokinetic drugs like metocopramide (Reglain) and cisapride (Propulsid) may move gas through the digestive tract quickly.

     Reducing swallowed air.  For those who have chronic belching, doctors may suggest ways to reduce the amount of air swallowed.  Recommendations are to avoid chewing gum and to avoid eating hard candy.  Eating at a slow pace and checking with a dentist to make sure dentures fit properly should also help.

Conclusion

     Although gas may be uncomfortable and embarrassing, it is not life threatening.  Understanding its causes, ways to reduce symptoms and treatment will help most people find some relief.

     Points to remember

·         Everyone has gas in his/her digestive tract.

·         People often believe normal passage of gas to be excessive.

·         Gas comes from two main sources:  swallowed air and normal breakdown of certain foods by harmless bacteria naturally present in the large intestine.

·         Many foods with carbohydrates can cause gas.  Fats and proteins cause little gas.

·         The most common symptoms of gas are belching, flatulence, bloating and abdominal pain.  However, some of these symptoms are often caused by an intestinal motility disorder such as IBS, rather than too much gas.

·         The most common ways to reduce the discomfort of gas are changing diet, taking non-prescription or prescription medications and reducing the amount of air swallowed.

·         Digestive enzymes, such as lactase supplements, actually help digest carbohydrates and may allow people to eat foods that normally cause gas. 

Foods that may cause gas include:

·         Beans

·         Vegetables, such as broccoli, cabbage, brussel sprouts, onions, artichokes and asparagus

·         Fruits, such as pears, apples and peaches

·         Whole grains, such as whole wheat and bran

·         Soft drinks and fruits drinks

·         Milk and milk products, such as cheese and ice cream, and packaged foods prepared with lactose; such as, bread, cereal and salad dressing

·         Foods containing sorbitol, such as dietetic foods and sugar-free candies and gums

 

Fat or Fiction? 

Five Diet and Exercise Myths

By Joy Bauer MS, RD, CDN

 

     Myth 1: By following a proper diet and exercise program, you can turn body fat into muscle.

     False.  Fat and muscle are two separate entities.  You must burn fat and build muscle.  When fat is burned, where does it actually go?  When you lose weight (by eating less and exercising more), an enzyme located in fat cells disassembles the fat compounds and sends the components into the bloodstream.  Liver and muscle cells take up these components and disassemble them even further, until what is left is a compound called acetyl-CoA.

     Acetyl-CoA then enters the Krebs cycle, a series of chemical reactions that takes place in the mitochondria, the cell’s “power plant.”  One product of this dismantling of acetyl-CoA via the Krebs cycle and subsequent cellular processes is carbon dioxide, which is expelled when you exhale. Other products of the breakdown of fat are water, which is lost as urine and perspiration, heat, which helps maintain body temperature, ATP, the molecule that fuels cellular activities that require energy.

     Myth 2: As you age, your metabolism declines, and there is nothing you can do.

     False.  While it is true that our metabolism naturally slows down by about two to five percent per decade after age 40 there are plenty of things we can do to fight back.  Exercise is the key.  Engage in aerobic exercise, four to seven days a week.  It is obvious that aerobic activities like running, brisk walking, swimming and bike riding burn calories and increase metabolism while you are working out.  Interestingly enough, several studies show that aerobic activities cause your metabolism to stay high after exercising.

     Work your muscles by lifting weights and/or other strengthening activities like pushups and crunches on a regular basis at least three or four times each week will boost your resting metabolism 24/7.  That is because these activities build muscle, and muscle burns more calories than body fat.  In fact, if you have more muscle, you burn more calories—even sitting still.  When it comes to food, keep your metabolism revved with these three tips:

     Eat enough food at least 1000 calories a day.  Your body and metabolism thrive on food.  When you fast, crash diet, or restrict calories below 1000, your metabolism will slow down in a response to conserve energy.

     Eat every four to five hours.  Because our bodies work hard to digest and absorb the foods we eat, our metabolism revs in response.  This is called the thermic effect of food.  Take full advantage and schedule meals and snacks every four to five hours.

     Incorporate lean protein with every meal.  Eating any food creates a thermic effect and will boost metabolism after consumption.  However, eating protein has the greater metabolic boost than eating carbohydrate and fat.  In addition, eating the appropriate amount of protein will ensure you are able to maintain and build muscle mass.  The more muscle mass you have, the greater your metabolism.

     Daily Protein Requirements: 50% of your weight in pounds = daily grams of protein.  Some of the best protein sources include fish, chicken, turkey, lean sirloin steak, skim milk, yogurt, eggs and egg substitutes, tofu and beans.

     Myth 3: It is better to eat six small meals than three squares.

     False.  This entirely depends on your personal lifestyle and food preference.  As long as your food choices for the entire day are healthy and not too high in calories, either eating style can work.  I find many people prefer to eat more volume less frequently because of hectic schedules and/or heartier appetites.  If that sounds like you, just be sure your collective daily calories are in check and try not to go longer than four to five hours without eating.  That is because your blood sugar may drop, causing low energy, headaches and unnecessary eating in response to feeling blah.  Be sure always to keep small emergency snacks on hand in case you are running late for lunch or dinner, perhaps a fruit, nonfat yogurt, or baby carrots.  The bottom line: Choose an eating style that fits with your lifestyle and you can live with!

     Myth 4: It is OK to substitute a fattening dessert for a meal now and then.

     True.  Call me a disgrace to my profession, but I say, yes!  As long as “now and then” means no more than a couple times a month, I think it is OK to enjoy a Ben & Jerry’s dinner, or a Krispy Kreme breakfast.  Chances are, if you deny your craving you will end up eating your regular meal plus the fattening dessert.  Better that you cut your caloric losses by allowing yourself to indulge occasionally.

     Myth 5: Health professionals recommend people eat four to nine servings of fruit and/or vegetables a day.  It is incredibly hard and unrealistic to work in this many servings a day!

False.  Four to nine servings may seem excessive, but a serving is not very large.  In the vegetable category, one cup of leafy greens, one-half cup raw or cooked veggies, or six ounces of juice count as a serving.  For fruit, it can be as little as 15 raisins, a small apple, one-half cup fresh, frozen or canned or one-fourth cup dried, etc.  This means that if you have your glass of juice in the morning, a sweet potato during lunch, a banana or pear as a snack during the day and a nutritious salad and side vegetable with your dinner and you are fine.  No, those oily fries with your greasy hamburger do not count.  

 

Remember:  You can park in the attached parking structure for $2.00 and come to our meeting by taking just a few steps to the elevators.  Valet parking and wheelchairs are also available.

 

Tips for People with Urostomies

By Ben Hoover, Metro Maryland Ostomy Assn.

 

     Your equipment is not a handicap; it is a small nuisance.  You can still do just about everything you ever did, although you might want to use an ostomy belt to hold your system if you are very active.

     Two or more pouch covers are one of the best comfort investments you can ever make.  After all, that fluid is entering your pouch at 98.6°.

     People with a urostomy should not use stoma paste.

     The vinegar you use during the day in your night bag can ruin the plumbing in your home if it is not flushed or rinsed down with water.

     You are going to have some leaks.  Do not worry about it.  It happens to all of us.  Just change your equipment and continue to march.

     Putting your night bag in a small plastic washbasin while in use will save on cleaning your rugs and floors.

     Some one-suit luggage will fit underneath an airline seat.  A small plastic washbasin will fit in half of one side of the suitcase, which will hold your supplies while traveling and is then available when you are using your night bag.

     Apply a little toilet paper to the drain on your pouch when you have drained the equipment to absorb any remanding liquid residue out of the drain.

     Do not worry about your urostomy when traveling.  You can go anywhere you want.  You just have to take a few things you did not take previously.

     Take three times as many supplies as you think you will need when you travel . . . just in case.

     If you have a leak in a pouch, put on a new pouch.  If you have a leak in a barrier, put on a new barrier.  Trying to use tape or fixing the leak will not work very well.

     Many people out there would love to trade their problems for what you and I will know only as an inconvenience.

 

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Birthing Babies out my Anus

By Barbara Skoglund, Maplewood, MN, Ostomy Myth Series

 

     As I shared in my Let's Talk about Sex series of lectures, the number one question I receive is, "Can one still have sex after ostomy surgery?"  Can you guess what number two is?  "Well, you can't have children now, can you?"  Huh?  What are they trying to imply about the conception of babies?  Since when do women give birth via their anus?  However, I have known people whom I was not quite sure of which end they came out.  Babies grow inside a woman's uterus, not her colon!  Many females with ostomies give birth after their surgery. 

     Many males with ostomies father children after their surgery.  Can ostomy surgery cause infertility problems?  Yes.  So can other abdominal surgeries, so can other issues, so can Crohn's disease.  Some men have impotence problems after surgery, from two to four percent depending on the surgery.  There will be very few from ileostomy surgery—one or two out of one hundred, twice that amount with a j-pouch and most after bladder cancer. 

     Studies have shown that the less experienced the surgeon, the more likely the problems.  It is not the ostomy that causes any physical problems but rather sloppy cutting near the rectum.  Patients can reduce the odds of these problems by finding an experienced surgeon. 

     Women may also have problems resulting from surgery.  There may be fertility issues caused by adhesions, the internal scars from surgery.  If an adhesion appears near the opening of the fallopian tube, it could block sperm from finding their way to eggs and/or eggs finding their way into the uterus.  There are surgical procedures to help clear away problematic adhesions.  In-vitro fertilization is also an option. 

     Infertility rates are higher for women with Crohn's disease, than women with ulcerative colitis or healthy women.  However, in some cases an ostomy could improve the fertility of a woman with Crohn’s disease especially if she suffers from vaginal fistulas and surgery puts her into remission and clears away the fistula problem.  I wanted to be a mother and was quite concerned about adhesions, since I had had five abdominal surgeries. 

     When I was going through all of this, I asked for feedback from other women with ostomies.  I received many notes from women who have and who have not been able to have children.  Most women reported they had no fertility problems because of their ostomy.  Of the women who discovered they were infertile, most were infertile for reasons unrelated to their ostomy.  I am looking forward to the day when I can bust this myth for myself.

     Editor’s note:  One of the active members of the DuPage Ostomy Assn., Ginnie Kasten, was featured on the front page of the Ostomy Quarterly—now the Phoenix—when she was pregnant with her baby,  after her ostomy surgery.