For Publication in the January 2002

October 2005

Last Months Meeting

Long awaited rain accompanied our first meeting of fall. We had a full agenda that began with updates about our group by our president, Gayle Gilchrist. Joan Loyd discussed some of the extraordinary activities FOW was involved in doing to help the victims of Hurricane Katrina. Dave Rudzin told us the exciting news of the newly reorganized United Ostomy Associations of America.

We had guests from two manufacturers represented, Mike Cherry from Hollister and Dick Guggenheim from Cymed. Connie Kelly, WOC nurse gave advice on what we should do as people with ostomies if we go to the hospital. Of particular interest was her advice to people with urostomies. Make sure you bring your nighttime adapter. This makes it much easier for the nurses taking care of you to hook your pouch up to a hospital collection unit.

Our featured speaker was Cathy Anton, a claims representative from the Prospect Heights District Office of the Social Security Administration. Cathy gave us a pervasive overview of all the benefits we are entitled to through the federal government along with the updates relating to current law. In addition, she went into some detail about how those eligible for Social Security will benefit from the new Part D—the Prescription Drug Plan. We are very grateful for the wonderful explanation of benefits most of us have never heard of before from such a knowledgeable speaker.

We would like to thank Mike Cherry from Hollister; Joan Loyd—congratulations on your granddaughter going to college; Vera Miller—Happy Birthday; and Sally Schinberg for bringing treats to our Hospitality Table. The lucky winner of our 50/50 was Kathy Kenney. The consolation prize was awarded to Peggy Bassrawi. We are considering our new name to be the United Ostomy Association of Chicago, what do you think? We are deciding soon. In October we will have a Rap Session, be sure to come.

President’s Message:

Hello Chapter Members,

Lately, have you thought about your ostomy? How would you manage without any supplies? So much has happened since last month including two visitors whom we could have done without—Hurricanes Katrina and Rita. We have been thinking about our fellow ostomates who have been impacted and how we may be of help to them.

The Friends of Ostomates Worldwide (FOW) has been in contact with local ostomy associations in the devastated area to provide assistance communicating the vast resources mobilized especially for them. ConvaTec and Hollister have both utilized their expert logistic systems to set up special distribution points in the South so that ostomy supplies can be delivered to hospitals and suppliers within just a few short hours. This is an incredibly amount of effort and resource allocation provided by them. It demonstrates the generous showing of help and support by the leaders of the ostomy business community.

On another note, I am celebrating my two-year stomaversary this month. In reflecting on this, I went to our Internet site at www.uaochicago.org and found a well-written description of how I felt. I would like to share it with you.

Having any type of surgery, especially one, which alters your body such as ostomy surgery does, is traumatic. It is ok to be upset, grieve, get angry, scared, feel as though you are the only person in the world with this type of surgery—I dare you to find a person with an ostomy who has not had these feelings. Yes, it will take time to adjust to your surgery, but from my experience, the more you learn about ostomies and ostomy surgery, and the more ostomates you can talk with before, during and after your surgery, the easier it becomes to accept your stoma.

The best tools a person with an ostomy can have are a sense-of-humor and willingness to laugh at oneself ... even if leaks and accidents happen in public. It may not seem so funny at the time, but as long as you can look back later and think "Oh well, at least it is not the worst thing that can happen to me", then you are fortunate indeed.

This will lead to a very positive outlook on life. Remember, people will always react to your emotions. If they sense that you are unhappy or uneasy with your surgery, then they are going to act the same way. If, on the other hand, you have a positive and confident outlook on life and do not let your stoma bother you or control your life, then usually other people are not going to worry about your stoma either. You own your stoma and not the other way around.

This time is a good opportunity for us to reflect on the progress we have made for ourselves as people with an ostomy. Please use your personal talents to assist other people with ostomies by becoming more involved with our ostomy support group. We look forward to seeing you at the next meeting on Wednesday, October 26. Oh, and by the way, we think that our new name will be “The United Ostomy Association of Chicago” just like the tag line on our Internet site has been for years.

Gayle

Coming Events

October 26—Bernie Bailey, WOC nurse from Resurrection Hospital and one of our favorite speakers will visit us and offer some special ostomy advice. The feature for this evening will be a long overdue “Rap Session”. People with ostomies, as well as their loved ones, have the opportunity to share with others their successes and struggles coping with the challenges of ostomy surgery. We invest the entire meeting on ostomy issues most important to you.

A Doctor was addressing a large audience in Tampa. "The material we put into our stomachs is enough to have killed most of us sitting here, years ago. Red meat is awful. Soft drinks corrode your stomach lining. Chinese food is loaded with MSG. High fat diets can be disastrous, and none of us realizes the long-term harm caused by the germs in our drinking water. However, there is one thing that is the most dangerous of all and we all have, or will, eat it. Can anyone here tell me what food it is that causes the most grief and suffering for years after eating it?"

After several seconds of quiet, a 75-year-old man in the front row raised his hand, and softly said, "Wedding Cake".

Friends of Ostomates Worldwide

FOW is a charity made up of caring volunteers for sending desperately needed ostomy and medical supplies to people with ostomies in countries where these products are not readily available.

Our world headquarters is located right here at 4304 Regency Drive, Glenview. (Regency Drive is a block north of Central Road on the west side of Dearlove.) It is staffed with dedicated people who volunteer their time and talent to help this most worthy cause. Mario Pardo, a former warehouse superintendent, manages the facility Monday, Wednesday and Friday from 9 a.m. until noon. Joan Loyd manages it on Tuesdays and Thursdays. Mike Cherry manages a group of Hollister, Inc. employees who come on the third Saturday morning of each month.

We always need capable help. When you are able to assist—if you can come on a regular schedule or if you can give just a few hours occasionally—give Joan a ring at 847-724-8002. Visit our Internet site at www.fowusa.org .

Support Your Chapter

We are now offering free membership to our Chapter. To provide for our few expenses (mainly the printing and mailing of The New Outlook) we need your assistance. Please send a contribution to help maintain our Chapter’s viability.

Name & Address: ___________________________

__________________________________________

Send To:

Chicago’s North Suburban Chapter of UOA

Mr. Tim Traznik, Treasurer

40 Fallstone Dr., Streamwood, IL 60107-1079

A Bump on My Stoma

UOA Discussion Board

Q I have had my ileostomy for about a year now. Everything is just wonderful since my surgery. However, I notice that I have developed a small bump—about 1/8”—on the side of the stoma. It does not hurt nor does it bleed, just a bump on an otherwise smooth stoma. Is this normal or do I have a problem?

A I want to take this opportunity to clarify the often repeated, albeit inaccurate, statement that stomas have no nerve endings and therefore feel no pain.

While the stoma may have diminished sensory nerve fibers, it is not true that the bowel has no nerve endings. There are different types of nerve fibers. Some of the nerve fibers scattered throughout the bowel regulate or respond to tactile stimuli and others respond to or regulate motor (motility) and hormonal functions. Normally, the stoma has diminished sensitivity to normal touch or painful stimuli across its mucosal surface, however it still possess other (motor) nerve endings that allow stool movement via peristalsis, and the obvious wiggling so readily seen.

It is this apparent lack of sensory nerve fiber response that may "allow" a stoma to suffer injury without feeling the pain associated with the initial injury—a cut stoma is the classic example. However, the bowel, of which the stoma is a part, can feel pain when it is stretched, swollen or inflamed. Think back to those times when one has experienced an intestinal blockage or an acute flare of inflammatory disease as two typical examples. During these moments of distress the bowel will be quite uncomfortable (experience visceral pain) and the person will readily acknowledge painful distress.

I know I am drawing a fine point of distinction here; however, I do not want folks to continue to repeat an inaccurate or misleading statement that the stoma feels no pain because it has no nerve endings.

Additionally, it needs to be pointed out that some folks may well experience a painful response to a stomal injury while others may not. It is not always clear to us why this is so, however we cannot arbitrarily rule out a genuine source of the pain, be it physiological, psychological or both.

To answer your question, it depends on where the irritation on your stoma occurs. If the irritation is starting at the base of the stoma, you might have the wrong size skin barrier opening. Your stoma is still relatively new, you should consider re-measuring it. If you do not change the size of your skin barrier opening to reflect the accurate size of your stoma, the effluent may sit on your skin creating irritation, or if is too small, may rub or cut the stoma, or create bumps.

Remember: if you gain or lose weight, the base of the stoma may change in size, therefore cut-to-fit skin barriers may benefit you.

Sometimes skin irritations are caused by pouching systems that are worn too long. The key is to observe the erosion of your skin barrier after you take it off. You may need to adjust the frequency of your pouch changing routine.

There are other reasons for peristomal skin irritations and stoma bumps. If a rash is away from the stoma, it could be a yeast infection, contact dermatitis or an allergic reaction. You should consider making an appointment with your ostomy nurse. This will ensure that you receive an accurate diagnosis and find the source of the problem.

Mike D’Orazio, ET

My Change of Life—Style

By Judy Lippold, Rosebud Review

Most women go through their “change of life” gradually, over a period of years. I experienced that transition also, but the change I am describing now was quite different from the one-programmed by Mother Nature. This change in my lifestyle occurred almost overnight, because I stopped irrigating my colostomy.

Thirty years ago, I had surgery for rectal cancer resulting in a sigmoid colostomy. Before I left the hospital, I was taught to irrigate my colostomy. “You will want to do this daily or every other day”, the ostomy nurse said. I did as I was told.

Over the years, I managed my altered elimination process as best I could, try new techniques now and then, and acquire improved equipment occasionally. I adjusted my diet as needed, and always learning, learning, learning how to communicate with and listen to my body. I made good use of one of the most common methods of learning anything: trial and error. Sometimes I mused about what it might be like not to irrigate. However, a small voice within me cautioned against tampering with success, so I continued with my usual colostomy management procedures.

Enter calcium. During an annual physical examination, it was determined that I had rather severe osteoporosis, the weak-bone disorder. I always had been conscious of needing calcium in my diet, but every time I attempted to increase the amount by taking calcium tablets, I experienced constipation extreme to put me in a “bind” and make my irrigations miserably ineffective. My simple solution was to discontinue the added calcium.

With my new diagnosis of osteoporosis came the doctor’s strict orders to, among other recommendations, ingest 1500 mg of calcium per day. I decided to do this by consuming calcium-rich orange juice, soy mike, skim milk, plus soft calcium “chews” that successfully imitate delicious candy. All this, I hoped, would skirt the constipation problem by avoiding the more obvious calcium supplements I had tried previously.

Suddenly I—a 25-year expert in my personal colostomy management—became an insecure novice needing help, advice and encouragement from my ostomy nurse and my fellow colostomates. My learning began anew, and I heard my body’s message loud and clear: “Now pay attention to my needs ... Address my issues sensibly and we will get along just fine”. As I adjusted to the physical and management changes, I was experiencing, I realized my thoughts and attitudes were changing too. I no longer had “mono-bathroom phobia,” a term coined years ago by a writer who said she was reluctant to stay in homes where there was only one bathroom—and she did not even have an ostomy.

Since I no longer had to spend two-hours or more in the bathroom while irrigating, I felt differently about early morning appointments or late night meetings. Why? Well, I could be out at 7:00 a.m. without having to arise at 4:00 a.m. to do so. I had learned early on during my irrigating years that not only could you not fool Mother Nature; you could not hurry her either. Even a covert wish for the process to go faster would usually shut down the irrigation completely—an impressive demonstration of the mind/body connection.

Having company in my home no longer posed a challenge for me. Of course, I have three bathrooms in my home. It had been awkward when I, the host, would disappear for hours at a time. Long-distance train travel, a favorite mode of transportation for my husband, and me became much more pleasant to contemplate—no more need to spend hours jostling around in than tiny tiny Amtrak restroom.

Another travel plus ... less ostomy gear to carry on. There are no longer any issues. Sharing a bathroom in a bed and breakfast, in a college dormitory or an Elderhostel is not a challenge anymore. The thought of visiting a country with questionably pure water is not so worrisome.

There were advantages to irrigating certainly ... once a day and that was that. I greatly appreciated the clean pouch condition that I experienced for many years. As I move along this new path in my ostomy life, I sometimes speculate whether I would choose to resume irrigating. Moreover, would I be able to perform it successfully? I would have to weigh seriously the pros and cons, and listen to advice from my body. I wonder what I would decide.

A Urostomy Experience

The Magnolia Ostomy News

I have been reading articles in the newsletter for a few years now. I had an unusual and awakening experience concerning my urostomy that I thought might be of interest to your readers.

I have had my stoma for four years now and have had no complications or problems. For the past six months, I have noticed that the skin around my stoma was white and irritated. I tried several different things to clear it up:

But nothing seemed to clear it up.

So, I just put up with it, hoping that once I had enough time at my new job, I could take off and then get in for an appointment.

While at work last Thursday, I went to empty my pouch, and it was full of bright red blood. I noticed two small blood clots. This got my attention, and I went directly to the phone and called the doctor who had performed my surgery four years ago.

The nurse said she would leave a message for him and he would call me back. Meanwhile, I continued to work. I started dramatically increasing the amount of water I usually drink and a couple of bottles of cranberry juice, thinking this would clear things up. After lunch, I again went in to empty my pouch and this time it was so full of huge blood clots that it would not even drain.

I became more scared than ever, and I called my doctor’s nurse and told her that I had an emergency situation. I was told to go directly to the hospital were a urologist came in to look at my stoma. When I took off the pouch, the blood had coagulated so thick that the doctor could not see the stoma.

He peeled off the barrier and blood was spurting from a severed artery next to the stoma. He said that because the skin around the stoma had such severe erosion, it caused the breakdown by the artery and broke loose. He skillfully put in several stitches to close the artery. I had lost quite a bit of blood but not enough to keep me in the hospital.

I was told my urine would clear up later that evening ... which it did. I took several days for me to become myself after the panic of what had happened. Because of this ordeal, I made an appointment with a WOC nurse. She told me that she recommends that people with urostomies wear a convex barrier. It is better able to keep the urine from pooling around the peristomal skin area. In addition, she showed me how to use barrier seals and powders to complement my barrier.

I have also scheduled an appointment with my doctor to have him follow-up on the excellent care provided by the ER urologist. The urologist told me that he rarely sees an artery burst like mine did. Obviously, he does not see many urostomy stomas.

Dealing with Skin Ulcers

ReRoute, Evansville, IN

People with ostomies might experience some form of skin breakdown from time to time. However, “skin ulcers”, which are very painful, are not common.

A skin ulcer is an open would; it can be close to the stoma or an inch or more beyond its base. Many people who have experienced skin ulcers are under the impression that the cement or glue on the barrier causes them. Up until now, we have never found this to be true.

All cases of skin ulcers that we have seen have been due to

Although skin ulcers are not dangerous, they are painful. If they are neglected, they can take more than two weeks to clear up. If you are having problems with skin ulcers, see your doctor or WOC nurse to find the cause and cure as quickly as possible.

Latent Risk of Cancer

By Patricia Murphy, WOC nurse, Chicago

There have been clinical reports on adenocarcinoma of the ileostomy after surgery. This is a brief overview of an interesting case of this subject that came to my attention after researching cases involving, "the latent risk of cancer after colectomy for ulcerative colitis and familial polyposis".

There was a person who had an ileostomy done for mucosal ulcerative colitis 29 years ago. She called and made an appointment to see me regarding some sore on her peristomal skin. When I saw the patient, the stoma looked almost like a double-barrel type instead of an ileostomy.

There was red, healthy looking mucosal tissue forming what looked like an extra stoma and smaller spots of this near the real stoma. I was surprised that she was able to use a barrier over all of this and that it stayed on for four days, even though this tissue was wet. I thought that perhaps leakage under the barrier had caused this condition; however, most of the skin looked fine.

I referred her to a surgeon who thought it might be excess granulation tissue. He treated the problem by cauterizing it with silver nitrate. The next week it looked worse and appeared to have a necrotic center. He biopsied it and it turned out to be adenocarcinoma of the ileum.

This is an extremely rare cancer. We could find only about two dozen cases that had been reported. They all had something in common: All of the people had their stomas for a long time—an average of 24 years. They either had a history of ulcerative colitis or familial polyposis. Most of these cases have been discovered over the last fifteen years. This may mean that there is a growing population of patients who have had their stomas for a long time. They may be at risk to develop cancer of the ileum.

It was suggested that it develops in this way: First, the ileal mucosa changes to colonic mucosa, then to colonic dysplasia, and then to adenocarcinoma. These changes resemble those that occur when a patient who has ulcerative colitis for a number of years and develops colon cancer. It is recommended that there be an annual evaluation of the stoma, looking for changes in the mucosal cells of the stoma—colonic metaplasia—inflammatory lesions consistent with ulcerative colitis and dysplasia.

The surgeon removed my patient’s entire stoma and the involved skin. He made a new stoma on the other side of her abdomen. This wide excision of the tumor should result in a complete cure. The patient did very well and went home at a stay of only a few days in the hospital.

A very good outcome for these cases can be expected with early detection and resection. The moral of this story is

Is It an Ileostomy or What?

Q I have a question that I think is self-explanatory; however, I had a discussion with a “professional” about this. I have an ileo-conduit loop—a urostomy—and a colostomy. Well, she kept calling the urostomy an ileostomy. I told her it is a urostomy, and she then said I should not say it is an ileo-loop ... that it is just called a urostomy. She said I could confuse medical staff because they would just assume I have a colostomy and an ileostomy.

I questioned her on how a person can have a colostomy and an ileostomy, and she that it is possible. Is this possible? I am just confused by all of this.

A The use of medical terminology or jargon can be more subjective than necessary. Medical folks are not immune from using sloppy language or abbreviations to describe outcomes of certain procedures.

The term ileal loop or ileal conduit or Bricker's Loop all mean the same thing surgically. They define or describe the surgical procedure you have whereby a piece of isolated small bowel, in this case the ileum is removed from the fecal stream and where the ureters—now disconnected from the bladder—are attached to one end, the proximal one, of this isolated bowel segment. This allows urine to flow through this isolated segment of small bowel as it exits from the stomal orifice onto the abdomen.

The straightforward goal of this surgical procedure is to allow urine to flow unimpeded through the piece of isolated small bowel outside the body into a collection pouch.

Now, here comes some technical correctness. The term "urostomy" is a somewhat sloppy generalization of any urinary diversion. The term "ileostomy" is also a bit of a sloppy catch all term. To be most accurate, one should specify what type of ostomy they have. For example, an ileostomy, if meant to describe the classic one related to stool diversion onto the abdomen, should be more accurately termed a fecal ileostomy. Conversely, if one uses the term ileostomy to mean a urinary one, then it should further clarify or describe an ileostomy for urine or a urinary ileostomy. To leave the term ileostomy hanging out there all alone is, unfortunately, an invitation to subjective interpretation by the listeners.

I believe the origin of the sloppy use of ileostomy to mean a urinary diversion arose from the ranks of urologists themselves. To them any ostomy they do, involving the small bowel or ileum, invariably meant that of the Bricker's loop procedure. So, credit the urologists with causing this bit of confusion and sloppy use of surgical descriptive language. I can tell you from many years of experience with many urologists that the majority falls prey to this less than accurate way of depicting their urinary diversion handiwork.

Had the urologists not become sloppy in ascribing or appropriating the term "ileostomy" as a shortcut word for their urinary diversion procedures none of the current word and meaning confusion would have ensued?

Onto your other point, let us talk about having a functional stool ileostomy and colostomy. If the fecal stream is not completely diverted within the small bowel—whether it be ileum or higher up—and this person has some fecal continuity with an ileostomy stoma and a colostomy stoma then it is possible for stool to emerge from both.

There used to be a technique employed partially to decompress the bowel without necessarily intending completely to divert the downstream fecal stream that was called a "blowhole" colostomy or even ileostomy. The intent was to relieve some of the excessive tension or pressure on the bowel, and this was often done in the presence of a significantly distended bowel. Again, the "professional's" attempt to explain this unusual situation offers a less than an adequate explanation. Perhaps he/she should have taken the advice to be more specific or accurate in describing it to you.

Now as to why the term ileum is used to describe anatomical locations of organs, it is probably rooted in very early conventions used by the ancient practitioners of anatomy and surgery. The hipbone is technically/anatomically defined as the ileus. The terminal small bowel tends to reside within the abdominal or pelvic cavity of the body in the general region of the hipbone. Thus, it is not much of a stretch to call that portion of the terminal small bowel the ileum. In fact, we ascribe other geographic bowel segments according to where they lay or how they are contoured or shaped or in which direction the fecal stream travels.

The ascending colon is termed such because the stool stream at this point in the bowel is traveling upward or ascending up the right side of the colon. The transverse colon is received its name because the stool is now crossing over or across the horizontal segment of the colon. I suppose had another chap decided to call this portion of the colon the horizontal colon it might have stuck, but someone else beat him to it and named it the transverse. The sigmoid colon received its name because it appears as an "S" shaped curved segment of bowel and the Greek term depicting this orientation or shape is "sigmoid".

To add some interesting information, removal of the rectum and anus, via abdominal and perineal surgical approaches, with formation of an end—descending or sigmoid—colostomy is typically called and abdominoperineal resection (APR) of the rectum. Normally, this is done for cancer of the rectum, however any time the rectum is removed and a permanent ostomy diversion is created then it is more likely that the APR name is suitable. Another surgical term for removal of the rectum is proctectomy.

Another example of surgical jargon for folks who have permanent end ileostomies would be "pancoloproctectomy”. If one dissects the word groups used in this term, one sees that "pan" refers to complete or total; "colo" refers to colon; "proct" refers to rectum and "ectomy" refers to removal. Put all these terms together and you have the total or complete removal of the colon and rectum.

A compound word ending in "ectomy" refers to the removal of the organ or body part identified by the front part of that word. Hence, your ileum removal would be accurately termed an "ileectomy”. If the jejunum were to be removed then it would be called "jejunectomy, and so forth.

When one has multiple segmental resections of the small bowel the terminology protocols change a bit, and it is more appropriate to state that one has had multiple small bowel resections involving the (here you fill in the blanks of the exact location and amounts of bowel segments removed).

Mike D’Orazio, ET

One-Stage Procedure Favored for

Ulcerative Colitis

Reuters Health, via DuPage County Chapter of UOA

One-stage proctocolectomy with ileal pouch—anal anastomosis (IPAA)—is associated with better operative outcomes than a two-stage procedure in ulcerative colitis patients who are candidates for either, according to a report by German investigators.

Previous study findings have suggested that a two-stage procedure, which includes diverting ileostomy, is safer. However, many of these studies were flawed by their retrospective design of the inhomegenity of the subject’s disease, pouch design, or the technique for IPAA. To overcome these problems, Dr. Udo Heuschen and colleagues, from the University of Heidelberg, performed a matched-pair analysis of the two procedures that included only ulcerative colitis patients. Furthermore, a J-pouch was constructed in all patients and the IPAA technique was standardized.

The study included 57 patients who underwent the one-stage (single surgery) procedure and 114 who underwent a two-stage (two surgeries) operation.

Patients who underwent the one-stage procedure were significantly less likely to experience early and late postoperative complications than patients who underwent the two-stage procedure. In addition, anastomotic strictures were less likely with the one-stage operation. The one-stage procedure is clearly superior to the two-stage operation in UC patients suitable for either. “This finding is of great clinical relevance both for the subjective interests of the patient and from an economic point of view,” the investigators concluded.

Adhesions

www.healthcentral.com, via DuPage County Chapter

Definition

An adhesion is a scar tissue that binds together two anatomic surfaces, which are normally separated from each other.

Description

Adhesions are most commonly found in the abdomen, where they form after abdominal surgery, inflammation or injury. Lysis (destruction or dissolution) of adhesions is a surgery performed to free adhesions from tissues. Although sometimes present from birth, adhesions are usually scar tissue formed after inflammation. The most common site of adhesions is the abdomen, where they often form after peritonitis (inflammation of the abdominal lining) or following surgery, as part of the body’s healing process.

Abdominal adhesions infrequently bind together loops of intestine resulting in intestinal obstruction. The condition is characterized by abdominal pain, nausea and vomiting, distention and an increase in pulse rate without a rise in temperature. Nasogastric intubations and suction may relieve the blockage. If there is no relief, an operation is usually required to cut the fibrous tissue and free the intestinal loops.

Although scar tissues within the abdomen can occur after any abdominal operation, they are more common after a ruptured appendix. Most adhesions cause no problems, but they can obstruct the intestine in about two percent of all patients. These obstructions can occur several years later. The adhesions can also block the ends of the fallopian tubes, possible causing infertility.

Questions to Ask Your Doctor

Be Your Own Advocate

Forwarded By Cathy Tomasik, DuPage, IL Ostomy Assn.

Most hospitals encourage patients to be advocates of their own health care. To help you, they offer the following suggestions

© Bring a list of all medications you have been taking at home. When it is time to go home, ask about and understand the normal or abnormal side effects of your procedure.(For example, how much pain should be expected.)

© Ask about your expected recovery time. Find out when you can return to work. If you or your loved ones do not feel you are ready to return home, state your concerns to your caregivers and ask for some time to discuss these concerns in detail.

The Other Story

By Lynne Rich, Ph.D.

If anyone walked a mile in the shoes of a person with an ostomy, how would he/she feel? Maybe a little tired, but his/her ostomy would work just fine, thank you.

What does having an ostomy mean to you? Survey’s says ... good health, no pain, belonging to a group of strong, caring and compassionate people—ostomy people, perceptive individuals who have learned how and where to get and share knowledge, help, humor and hope. Okay, there has not yet been a comprehensive survey.

Are you living as actively as you would like to? If not, Why? An ostomy is merely tissue that is been surgically relocated and designed to function smoothly. If even temporarily an ostomy does not work correctly and trouble free, it may only need a little extra attention and care. You and your ostomy deserve the time necessary to be taken care of really well. After that, let your heart and brain take charge.

Living through health problems that led to ostomy surgery, you no doubt gained strength and fortitude. Your ostomy will not break and neither will you. You might develop feistiness and greater determination. You may also discover more bad hair days are likely than bad ostomy days especially in a tropical, humid climate, during blustery winters or in the windiest rainstorms.

If you are not sure whether an activity is medically or physically all right for you to do, before you stop yourself from trying ask your physician and WOC nurse if actual medical or physical restrictions prevent you from participating in or learning to: water ski, play the guitar, swim, play canasta or poker, scuba dive, speak Spanish, French or Italian, dance, (ballet, tap, waltz, samba), eat Cajun, sushi, or Greek foods, hike, canoe, kayak, take a trip by car, bus, ship, plane or train, ride a horse, run a marathon, walk 90 minutes, do yoga, golf, garden, sing or laugh.

Ostomies do not prevent working, traveling, living anywhere, swimming, scuba diving, hiking, or water skiing. Do not allow inaccurate information or a negative attitude to prevent you from doing what you want. Adjust your attitude with realistic information. Just as you adapted to the ways your body changed as you were growing up and as an adult too, you can adapt again and resume living as millions of other people with ostomies have done.

Learning how to take care of an ostomy is not as difficult as originally learning—earlier than you remember—to walk, or later, perhaps, learning to drive a car, to wear contact lenses or bifocals. Ask questions. Terrific at sharing information, people with ostomies are resilient, inventive, practical and creative. At ostomy association meetings, notice how well people look. That is due to deliberate effort and an optimistic attitude. Give yourself the same quality of care you expect from your doctors.

Do not ask less of yourself. Having an ostomy might mean better health now, and living longer. Decide each day what you would like to do. Socialize with other people or spend time alone. Count on the people most important to you to remain living and supportive. Call people you would like to see. Let your family and others know when you want them to join you in various activities. Do not think or expect the worst from anyone, including you.

An ostomy gives you health and options. Consider the Spanish proverb: Living well is the best revenge. Live well! Two recommended books provide valuable information. In The Ostomy Book, Barbara Dorr Mullen and Kerry Anne McGinn, R.N., present basic information about all three types of ostomies—colostomy, urostomy and ileostomy—and tips about best ways to return to good health following surgery and continuing to feel well. After ileostomy surgery, Maureen Bender wrote A Secret No More about her experiences as she resumed working, dating and started an exercise program for people with ostomies.

Be a Total Person with an Ostomy

By Albert Lyons, M.D. forwarded by ReRoute

The person with an ostomy as a total person includes the worker, the family member, the social being, the sexual being and the physically active being. To achieve this totality after ostomy surgery, a person needs doctors, WOC nurses, friends, family, and his/her own individual will to become a more total person.

A proper mixture of optimism and realism is needed. Some modifications may be needed in one’s lifestyle. It is all right to be upset by this drastic change, but it depends on how well this mixture is worked out, whether the person adjusts well or not. Ostomy support groups can help with this. Right after surgery, most people feel like a small person attached to a large stoma. Everything seems to revolve around this stoma—daily cares, adjustments, even the simplest of movements.

As days go by, the person with an ostomy begins to feel once more like a person, this time with a stoma. Adjustment has begun. This may take a long or a short time, depending on the person. Anger and depression after ostomy surgery is perfectly natural. Becoming a trained visitor is one of the best ways after ostomy surgery to adapt to his/her own surgery, as well as being helpful and providing support to someone else. Each visit helps reinforce the visitor’s own attitude toward his/her situation, while providing positive reinforcement for a new patient.

During explanations to the patient, the spouse, or another family member, can be present. They will all be involved and should be included. The family also requires some adjusting to the ostomy surgery. Answer questions in private if needed. Most people have some difficulty in making changes in lifestyle or body image. This is to be expected. However, if progress is not made in a reasonable timeframe, then psychiatric help may be needed.

If a relationship can be established with a counselor before surgery, it can help the person with an ostomy make a smoother transition to his new life after surgery. Of course, this situation is not always possible, as some surgeries are done in an emergency with no prior knowledge of the illness.

Different types of ostomy surgery may result in impotency and/or sterility. One’s sexuality need not depend on one’s capacity to perform sexually. There are many forms of sexual expression. One’s sexuality depends on how one views him/herself. Ostomates want to share and help others as well as maintain their own personal space. They may not wish to discuss their surgery with everyone. It is up to each person to decide who knows about his surgery.

In the beginning, a person with an ostomy may feel that “everyone knows”, but this is not the case. Participating in an ostomy support group does not need to invade the individual patient’s privacy. The group will respect his /her wishes. It is perfectly all right not to tell everybody he/she has had ostomy surgery, as long as this does not progress into hiding at home to avoid facing reality. Remember–every day there are new people having ostomy surgery who could use your help.

Food and Your Ostomy

Forwarded By ReRoute, Evansville, IN

There used to be, and to some extent still are, some out-dated theories about what foods people with ostomies should and should not eat. Mushrooms, onions and fresh vegetables were considered troublesome, along with some meat. Today, we find that the old food “taboos” do not necessarily apply.

In moderation, most foods need not be avoided. If you have any questions about food and the way your body reacts to it, consult your doctor. Here are some common foods and hints on how to enjoy them without causing excessive gas, irritation or stoma blockage.

Fibrous vegetables—Vegetables like celery, asparagus and broccoli have long, fibrous strands running through them. Onions can produce odors in the stool. Such strands are hard to digest and can form a “ball” behind the stoma. When eating celery choose the hearts. These are tender and the fibers are not as thick as those on the outside stalk are. If you must eat the other stalk, peel down the outside strands. Always chew, chew, chew and drink lots of water.

Asparagus—Medium stalks are usually the most tender. Start at the tip and work down. As soon as the spear gets tough to cut, go down to the next one and you should have no blockage concerns. Asparagus causes odor in the urine, which may be a bit bothersome to a person with a urostomy.

Broccoli—the same principal applies as to asparagus. Vegetables like broccoli, cauliflower and turnips are considered “gas producers” and may require an extra trip to the restroom to relieve the pressure. However, they are worth the trip.

Fresh fruit—in moderation, fresh fruit can and should be included in a well-balanced diet. If you have trouble digesting oranges and grapefruit, then try squeezing the juice and discarding the skin. Apples, pears and peaches are great without their skins if you find them hard to digest. Fruit is a natural cathartic. Keep this in mind when you are eating a picnic or the beach or anywhere bathroom facilities are not readily available.

Oysters, clams and mussels—though delicious treats, mollusks can be more difficult to digest than other types of seafood and can cause a minor blockage behind the stoma. Be sure to chew them well, and avoid tough mussels the major offenders. Seafood of all kinds can cause odor in the stool. Pouch deodorants are most helpful in controlling this problem.

Nuts—the most difficult nuts are the hard ones, such as peanuts, almonds and hazelnuts. Chew them well, and be careful not to overindulge, no more than a handful at a setting. Even non-ostomate nut-lovers can experience discomfort after enjoying more than a reasonable share of nuts.

Meat—most meat and poultry do not present any concern, however, those with fat content or heavy casings can be somewhat more difficult for the bowel to handle. Try sausage patties instead of links or hot dogs with the skin removed. When eating fatty cuts of pork, lamb or beef, cut it into small pieces, do not eat the gristle, chew well and limit your intake.

Corn on the cob, popcorn, dried foods and coconut—When it comes to obstruction behind the stoma, these are the major offenders. In fact, even people without ostomies can suffer major tummy aches after indulging. Chew, chew, chew and remember to limit your intake.

Spices and carbonation—heavily spiced foods and sauces can act as cathartics for people and can produce gas. Carbonated beverages are gas producers, too. One great way to get the bubbles out of the carbonated drinks is with a dash of sugar. It will cause a frenzy of fizz and leave the beverage safely flat.

Pain from Effluent

Q Apologies in advance, I know this is gross to read about, but I am desperate. I am having problems with my output being so thick and paste like that it sticks the sides of the ileostomy pouch together. It also stays up around the stoma without falling down into the pouch. This happens especially at night and wakes me up with excruciating pain every few of hours.

It happens during the day when I am standing up, too, but at least then, I can keep more of a watch on it so it does not get quite as bad. I am disabled and at home all the time. The stoma cannot push the effluent down into my pouch. I have to move it manually. What am I doing wrong?

A We will assume that your stoma is not blocked, tight—stenosis—or twisted by strictures. If this is so, then a few techniques you may wish to try are

1. Leave a little air in your pouch after each emptying cycle so that the walls of the pouch are separated enough to allow the stool not to become readily "trapped" between the flattened walls of the pouch. However, this may not be as helpful as it sounds because of the very sticky nature of your stool, what we professionals call an inspissated stool.

2. Have you considered using a larger capacity pouch? Some of the major manufacturers have larger capacity pouches, typically targeted for high output stomas, on the market now.

3. Hollister makes a combination pouch deodorant and lubricant (Adapt brand) that may allow the stool to slide down with greater ease.

4. Make sure your clothing and sleeping postures are not causing undue impingement or entrapment of the stool at the stoma level.

5. Finally, you may want to review with your medical providers whether some dietary or medicine regimens might ease the passage of the stool out of the stoma. It may still be worthwhile pursuing additional strategies with GI specialists and or pharmacists to figure out better ways to help ease the stool out of the stoma.

Mike D’Orazio, ET

Back in 1905

Here are some of the U.S. statistics for the Year 1905

· The average life expectancy in the U.S. was 47.

· Only 14% of the homes in the U.S. had a bathtub.

· Only 8% of the homes had a telephone.

· The maximum speed limit in cities was 10 mph.

· The tallest structure in the world was the Eiffel Tower!

· The average wage in the U.S. was 22 cents per hour.

· A worker averaged about $300 per year.

· A competent accountant could expect to earn $2000.

· A dentist $2,500 per year

· A veterinarian between $1,500 and $4,000 per year

· More than 95 % of all births took place at home.

· Ninety percent of all doctors had no college education.

· The five leading causes of death in the U.S. were:

· Pneumonia and influenza

· Tuberculosis

· Diarrhea

· Heart disease

· Stroke

· Two out of every 10 U.S. adults could not read or write.

· Only 6 % of all Americans graduated from high school.

· Marijuana, heroin, and morphine were sold retail.

· One fifth of all households had 1+ full-time servants.