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September
2010 Last Month’s Meeting (our 402nd) By Nancy Cassai We had a pretty big turnout at our August general meeting. Tim Traznik hosted the evening and Joan Loyd spoke about Friends of Ostomates Worldwide for some of the new people. Judy Svoboda told us about the upcoming product fair October 2 at Northwest Community Hospital. Alan Sears of Mark Drugs was our guest speaker. He started with a joke, “Why don’t super models have ostomies?” “They can't find shoes to match their bags.” His presentation featured a discussion about what could happen in this every changing world of insurance and healthcare. We are now in the age of health care reform. The health care and insurance benefit providers and trying to understand the mountain of new regulations and requirements the law enacts. These changes will affect people with ostomies and therefore reimbursements received from insurance companies or Medicare when purchasing supplies. Here are some highlights: Physicians must be registered in PECOS—Provider Enrollment Chain and Owners System. If your doctor is not enrolled by next year, he/she may not be able to write prescriptions for supplies that will be covered by insurance. The new health care plan targets fraud. This means that we may be required to obtain a new prescription every year proving our need for ostomy supplies. In addition, if we want to try new products, we may have to obtain separate documentation proving that a benefit would actually result. Alan mentioned that many states are practicing competitive bidding. This results in fewer providers for medical supplies, such as, wheelchairs, diabetic and ostomy supplies. People who are covered medically under a government health insurance plan, like Medicaid, may have to use generic supplies offered by the lowest bidder. Many changes are coming to Medicare, which may affect the amount of supplies allowed by a patient each month. If you receive the benefit of a home health care provider, you may lose your ostomy benefits. Alan noted that Medicare would not pay for ostomy supplies while a person has home health care. Medicare says that it is expected that the home health care provider will bring any ostomy supplies that are required. He touched on private insurance companies like United Health Care that does not cover ostomy supplies. Humana is now limiting the quantities of ostomy supplies that they will pay for a patient. 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 is listed in our bylaws, which anyone may view via www.uoachicago.org and following the link to OAGC. 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 limit your
fee to $2.00! OAGC Meeting Dates for
2010 September
15—Bernie au dem Graben, WOCN October 20—Jennifer Dore,
WOCN December 15—Our Gala
Holiday Celebration 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
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 was 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. 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. It is easiest to enter from Central Road. 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 .
NW Comm Hospital Meeting Dates for 2010 August 12 October 7 December 9 Northwest
Community Hospital Ostomy
Support Group Ostomy
Vendor Fair And Stoma
Clinic Saturday, October 2, 2010 9:00 AM until 1:00 PM Rooms 1-6 and 1-7 (across from the
auditorium) Free parking in the visitor-parking
garage Use the main entrance to
hospital 800 W Central Road,
Arlington Heights Program offerings planned! To schedule a free
consultation with a certified ostomy nurse,
call: 847-618-4YOU (4968) For further information or questions,
contact us at 847-618-3215 Lake County
Ostomy Association The Lake County Ostomy Association (LCOA) meets on the third Saturday every other month. Meetings begin at 10:00 AM and end around noon. The LCOA meets at the corporate headquarters of Hollister, Inc., 2000 Hollister Drive, Libertyville (about one mile north of the Vernon Hills Shopping Center on the east side of Milwaukee Avenue., Route 21). For more information, call Carol Rhodes 815-459-2691 or Judy Gaughan, Hollister, Inc., 847-918-3451. LCOA Meeting Dates for 2010 September 18 November 20 Join
UOAA on Facebook at http:// www.facebook.com/#!/pages/United-Ostomy- Associations-of-America/169475247090?ref=ts Follow
UOAA on Twitter at http:// Chewing Gum after Bowel Surgery
A study by published in the Archives of Surgery said that chewing gum after intestinal surgery could help reactivate paralyzed bowels. Most of us that have had ostomy surgery know that after abdominal surgery the bowels often become slow or even shutdown. Doctors sometimes call this phenomenon ileus. When the bowels shut down, pain results with vomiting and abdominal swelling. The patient may not even be able to eat or drink. We are required to stay in the hospital until our bowels start working again. The study was conducted using 34 patients undergoing bowel resections on the sigmoid colon for diverticulitis or cancer. It divided the groups in two, half who chewed gum and half who did not chew gum after their surgery. The gum-chewing patients had sugarless gum three times daily for one hour at a time right after surgery until they were released. All of the patients who chewed gum passed gas several hours sooner than the half who did not chew gum, and they had their first bowel movements an average of 63 hours after surgery compared with 89 hours for those who did not chew gum. Somehow, chewing stimulates nerves that promote the release of hormones responsible for activating up the gastro-intestinal systems in our bodies. The gum chewers were released from their surgery after an average of 4.3 days versus an average of 6.8 days for the other patients. Gum chewers also had fewer complications from surgery. The conclusion of the study was that gum chewing after bowel surgery helps the patient restart his/her bowels thus getting well faster. Editor’s
Note: Those of us with GERD can
greatly benefit from chewing gum. Many
people with GERD have had relief from symptoms from just chewing gum all
during the day. Many of these same
people have virtually stopped using protein pump inhibitors to reduce stomach
acid if they chew gum daily. Using
these drugs over only a few weeks is very beneficial; however, these drugs do
upset the natural flora in our body and over time induce serious side
effects. People with GERD often are
provided no other option. Chewing gum
is that better option. The benefits of
chewing sugarless gum for someone with GERD are miraculous! A Second Chance Forwarded by The Optomist, Seattle, WA
Sure, you were shocked. You were depressed. Who wasn't? You thought, "How am I going to get accustomed to this thing?" "What will my life be like?" Did we not all have similar thoughts? Monopolize the bathroom when changing our ostomy system, use up too much valuable time primping, feel embarrassed, worry about our diet, be overly concerned about how we smell and odors and what other people would think, etc. Did not we all have some of these challenges? Sure, we resent what happened to us, but we cannot be resentful and grateful at the same time. We cannot change what already happened, but we certainly can do something about the future. Living is like playing poker—it is not the cards you hold, but how you play them that make the difference between winning and losing. We are not invalids. We do not need pity, sympathy, special considerations or concessions. We are normal, capable people. The ostomy is yours to do with as you wish. You have a choice to take either of two paths, and the decision is yours alone. You can refuse to accept it; feel sorry for yourself; be bitter; be resentful; withdraw from society; suffer the loss of many of the fine things life holds for you; or you can accept it. You can develop a good attitude and go on to live a happy and productive life. You can enjoy the extra time God has granted you to continue doing the things you did before surgery. The proper training of the mind and body is not an easy job. Nature has not endowed all of us with the same ability to make correct decisions. Some people find it easy to look at a situation from all angles and decide what to do. Others, because of a lack of knowledge or because of emotions, resentments, habits, etc., find it difficult to make a correct decision. Ostomy surgery—thank you modern medical science—has provided us with a rare gift . . . the gift of a second chance, a chance to live, a chance not given to everyone. An ostomy—any type—is not a handicap, it is a new method of elimination—a life-saving device. Be encouraged. Accept your ostomy. Prove to yourself that you can adjust better than anyone else can. To find happiness, we must think about what we owe to others, the world and God rather than what life owes us. Let us give thanks for every precious moment; be thankful that we have been helped. Be thankful that we now have the opportunity to help others. Let us count our blessings. Let us thank God we are alive. The Ostomy Visitor Forward by the Green Bay News Review When working
with a new ostomy patient, the goal is total rehabilitation so that this
person will return to his/her normal activities. WOC nurses teach the patient all the basics
he/she needs to know about his/her new stoma, skin barrier, pouch and all the
other technical requirements necessary for satisfactory ostomy care.
However, the WOC nurse—unless he/she has an ostomy him/herself—cannot
understand and share the emotional part of having ostomy surgery. This
is where the ostomy visitor steps in.
The visitor is the WOC nurse’s ostomy resource. Before there
were WOC nurses, the person with the knowledge of ostomy care was the another
person with an ostomy—the ostomy visitor. At that time, visitors
instructed patients on the equipment they would need as well as daily
management. Today, the
role of the ostomy visitor has changed. However, it continues to be an
important role. Who can better share with the patient the emotional
strain of a new stoma than someone who has been through the experience?
Who can better convince a person with a new ostomy that life will get back to
normal than an experienced person with an ostomy who has returned to work and
recreation? Who can offer people with new ostomies the best advice
about the little everyday things that really make life easier? Yes,
the ostomy visitor can do it. The ostomy nurse plays a large part in a
new patient’s rehabilitation, but the ostomy visitor plays an equally
important part for most patients. A Pouching Alternative by Cymed
This article will be most valuable to someone with a lower colostomy or a urostomy. It will also serve someone with an ileostomy who is having leakage issues. We will discuss a revolutionary product that uses a completely different philosophy in addressing ostomy care. At a recent WOCN conference in Chicago, we had the opportunity to talk at length to a marketing executive from Cymed. Now, we always looked at the Micro Skin product as being one with an excellent tape, but one that needed attachment to a hydrocolloid skin barrier in order to protect the peristomal skin. They told us of an alternative application that you need to know about. Some Background Urine from a urostomy is sterile and not very irritating to the skin. If urine sits on the skin, it will not burn it. However, it is never advisable to allow urine to pool around the stoma because of many other maladies that may result. Therefore, an ostomy system that never leaks is vital for good skin care. Stool from a lower colostomy is about half bacteria, and it does not burn the skin. Otherwise, all regular people would have burning butts. Nobody advises people actually to have stool ever sitting on the skin because it leads to disease, odor and other problems. The peristomal skin must be protected and stool completely contained to prevent these issues from occurring. Effluent from an ileostomy is in part composed of liver bile and pancreatic fluids, digestive enzymes that can dissolve a steak. It will do the same to one’s delicate skin. A strong barrier is required to protect the peristomal skin so it is not eaten away. This is the reason, people who have a j-pouch’s experience terrible burning in the rectum. The effluent comes in physical contact with the anal area and the patient is miserable. Something to Try Cymed makes a one-piece ostomy system, in which the entire skin barrier is made out of Micro Skin. There is no other barrier attached. This means that one can cut the barrier opening—made up of only Micro Skin—right up to the stoma so that it will be actually touching it—and then apply this flat, thin and very flexible ostomy system over the stoma. This means no barrier rings, no convexity, no rigid wafers, no belts . . . and no leaks. Micro Skin “breathes”, that is air moves through it and the skin underneath is healthier. Urine does not melt the Micro Skin. People with urostomies that have had issues with leaking in the past have said that this system works for them. People with lower colostomies may use this same technique, although they would use a two-piece closed system. This would be especially useful for people with flush or recessed stomas because this product will generally work without convexity. Just cut a Micro Skin barrier right up to the stoma, it may even touch it. It is so thin that no matter what contours or folds one has on ones tummy, it molds around them. This is also an excellent management method for people with large oval stomas not easily serviced with hydrocolloid barriers. People have told us that this technique has provided better system performance. A little information for someone with an ileostomy: Although, Cymed sells a Micro Skin barrier with a washer attached, most of us obtain only mediocre results from it, no matter what the advertising claims may be. However, there is a masterful new application that can benefit us. ConvaTec and Hollister, Inc both make true extended wear barrier rings using the brands Durahesive and Flextend respectively. These are two of the best hydrocolloid barriers ever made and have proven and effective results. A Micro Skin barrier may be cut right up to a stoma and then have one of these barrier rings attached right to it. Then one would put the attached ring and barrier right over the stoma. This would provide the skin protection from the effluent needed, yet yield the benefits of Micro Skin tape. This application could also be implemented when convexity is truly needed because the barrier ring provides convexity. Summary We are so happy to be able to inform our ostomy community of a brand new alternative in ostomy care through use of a Cymed Micro skin barrier without a washer . . . a barrier of only Micro Skin. This is especially useful for people with urostomies that currently have a leaking issue. Half of the total sales of Cymed Corp. are to people with urostomies that previously used other brands but had leaks that were difficult to stop. Note well, we are not suggesting you stop using your current ostomy system. We only want to present a new alternative to people who have had less than satisfactory performance with the options they currently use. We repeatedly tell our members never to accept less than satisfactory results from one’s ostomy system. There are many resources for assistance including your WOC nurse, manufacturers, suppliers, our local ostomy association, etc. An ostomy provides us the opportunity to continue our lives in a wonderful way. Sometimes we just need information on a new way of ostomy management.
I
asked God for all things that I might enjoy life. He gave me so much
more. He gave me life so that I may enjoy all things. Walk Yourself to Better Health
Although recovering strength after surgery or an illness can be a challenge, walking is one of the best and simplest ways to build stamina, according to Margi Morris at Stanford University. Begin by deciding on a manageable amount of walking. Plan to walk for a short amount of time, and walk slightly more briskly than is comfortable, in order to increase the heart rate slightly. Increase the time walked by five minutes each week. Ignore the idea of distance walked; the amount of time spent in exercise is more important. Work up to a walk of about an hour and do it six or seven times each week to maintain stamina. You may also take your one-hour walk in smaller increments during the day, like two half-hour walks. Walking is a common and automatic activity; almost everyone can do it to some degree. It makes you breathe deeply, which pulls oxygen into your lungs making you feel energetic. It improves circulation, lowers blood pressure and generally strengthens your cardiovascular system. In bad weather, try walking in a shopping mall. Some malls have formal walking programs. If you do not want to be part of a group, pick your own time and walk at your own speed. If you cannot walk, do something else to increase your heart rate. Water aerobics classes are another good form of exercise, although the usual one-hour sessions are too long for many older people. If you take part in such exercise and are exhausted when you get home, you are overdoing it and should try something less strenuous. Some additional thoughts on walking: We are built for walking. Sitting contributes to back end spread and puts strain on the wrong places. Standing is exhausting and can be bad for the circulation. Walking moves everything correctly and helps our body fully. Medical and health authorities endorse walking for an astonishing variety of benefits. Physical fitness expects say it is one of the best exercises. Cardiologists say it is a preventive for heart problems. According to obesity experts, walking is a first-rate weight controller (One big mistake is to think that walking an hour a day is going to result in a massive weight loss. Walking is a great help in that direction, however, weight loss is directly proportionate to food intake). Walking is an aid to digestion, elimination and sleep. Walking is an antidote for tension. In fact, walking and breathing freely so helps the circulation that every part of the body benefits. A one-hour walk can reduce blood pressure. Maintaining a steady pace while walking keeps the circulation flowing freely, the lungs breathing, and the eyes taking in sights they never noticed or appreciated before. In twenty minutes, you can comfortably do a mile and smile. Urinary Ostomy By Edith Lennebery, WOC Nurse
The urinary ostomy requires three kinds of preventive attention: · Care of the stoma · Care of the skin around the stoma · Care of the kidneys Your routine care of kidney functions should include: · Drinking two quarts of liquids daily · Testing urine (urinalysis) semiannually · Testing kidneys (IVP-intravenous phelogram) every two years
You should make the following observations: Changes in size of the stoma After initial healing is complete—about six months—measure with a paper-measuring gauge every few months; change to a skin barrier with the correct opening if necessary. Appearance of stoma Does it appear different from usual; e.g., color, shape, little white or red spots? Look for this at each change of your skin barrier. See your WOC nurse to determine if the change needs some action to repair. Skin . . . signs of irritation Are there pink spots, tiny pimples, reaction to adhesives, etc.? Look for this at each change of your ostomy system. Learn methods of treating routine minor irritations. If the skin area around the stoma is sore, raw or infected, do not delay; see a WOC nurse if you have difficulty treating this yourself. If there are white deposits around the base of the stoma, soak your pouch in 3:1 water: vinegar solution. If there is no improvement within two weeks, see your doctor. Kidneys Look at your urine every day. Is it dark? Then drink more liquids. Is it gritty? See your doctor. Is there some mucus? This is normal. Is there a persistent unpleasant odor? This is a sign of infection see your doctor.
Essential Tips—Ileostomy
· Do not fast. Fasting may lead to serious electrolyte imbalances even when adequate fluid intake is maintained. · Do not limit your fluid intake. People with ileostomies may be slightly dehydrated, due to the constant outflow of fluids, so maintaining fluid intake at all times is necessary. · Do not completely eliminate salt from your diet. Salt is also lost with the fluid outflow—about a teaspoon more a day then someone with a normal colon. Even those with high blood pressure should not eliminate salt altogether. Consult your doctor for his/her recommendations on salt intake especially when other physical conditions are a consideration. · Do not give blood. Everyone with an ileostomy—due to his/her probability of having a constant state of dehydration—has placed on him/her an enormous stress on kidneys when blood is given. Serious damage may occur. Blood donation is not a prudent practice to be exercised by most people with an ileostomy. · Do not put anything in your stoma, without your doctor’s direct supervision. Often, doctors give routine orders; i.e., for enemas, etc., that will injure you. Question any procedure that intrudes upon the stoma, including suppositories. · Do not take any medication unless you know it will dissolve before it would normally reach the colon. This is sometimes hard to find out even for a pharmacist. Be vigilant. · During your annual checkup, be sure to discuss with your doctor your vitamin B-12 level, level of hydration and bone density. He/she will order tests to evaluate these measurements. We all get
heavier as we get older because there is a lot more information in our
heads. We are not fat, we are just really
intelligent and our heads could not hold any more . . . so, they started
filling up the rest of our bodies. That is my story and I am sticking
to it. Goofy Answers You Will Never Hear About Living with an Ostomy Forwarded by that loony Portland Maine Ostomy Group (revised)
If you have an ostomy, you probably read many of those question-and-answer articles in which people ask a WOC nurse or doctor about life with an ostomy. I pretty much can bet that none of them gave these answers. Please consult with your medical professional and a local comedian before taking any of these seriously. Q. How will medication affect my ostomy? A. The general answer is . . . adversely, although the opposite may also be true. Especially important, your stoma should not be allowed to operate heavy equipment with some painkillers, and alcoholic beverages should only be introduced to the stoma through ones mouth. Do not feed booze, or anything else, directly into a stoma. Q. May I still do everything I did before surgery? A. It depends what you did before your ostomy surgery. If you robbed banks, then no you may not do everything you did before surgery. Send me a list of what you did before, and I will let you know which of them you can do. Q. What about alcohol? A. I thought I just answered that question. Nevertheless, if you are asking it again, maybe you should consider abstinence. Alcohol has the greatest influence on the brain, not the stoma. However, if you were told for years that you have your head up your ass, I guess I can understand the question. Q. Should I exercise after ostomy surgery? A. The stoma does not need any exercise, but the rest of your body does, especially the abdomen. A firm tummy reduces the probability of hernias. Plus, exercise tones the body, makes the blood flow, releases endorphins and makes one happy. Q. What foods can I eat after surgery? A. Most can usually eat virtually all the same foods after surgery as before surgery. Just remember that people with ileostomies have slower transit times, which means more can be absorbed thereby making it is easier for them to get fat. People with urostomies are thin and trim, so they do not need to be concerned. Q. Why did this have to happen to me? A. Having ostomy surgery means you are one of the lucky ones. Complaining just makes the situation worse. If you exercised more, you would be happier; just think of it as the ultimate body piercing. Q. Will spicy food cause any damage to my stoma? A. That depends. If you eat spicy foods . . . probably not. But if you smack the stoma with a jar of hot peppers, then yes. I would advise against striking the stoma with any hard object, spicy or not. Q. In the past, certain foods gave me digestive trouble. Will they affect me the same way after surgery? A. You seem to be a little obsessed with food, aren’t you? You should be more concerned about how fat you’ll become from eating all that food. To answer your question . . . my crystal ball is being repaired right now so I do not know the future. Just eat the darn stuff—one thing at a time—and see for yourself. Q. What about sex? A. The answer is yes, if you can find anyone who will have sex with you. The answer is no, if you think your going to have any sort of stoma sex. Now you are pushing the envelope, and someone from Chicago would never have asked a question like this. Care During Cancer Therapy By Kathryn Earhart, CWOCN; Vicki Mueller, RN, MS, WOCN; Denis Murray, CWOCN Reprinted through permission of WOCN Journal This article was originally intended for nurses treating ostomy patients.
Living with an ostomy—whether it is newly created or long-standing—might present a number of daily challenges. An oncology diagnosis may necessitate radiation and/or chemotherapy in addition to stoma surgery. Adjuvant therapy may be required immediately postoperatively, based on tissues pathology or tumor staging, while tumor recurrence can initiate further oncology treatment. Notable stoma care challenges can result from cancer therapy or tumor progression. The WOC nurse can provide education and evaluations to minimize any difficulties that may arise. Steps that the WOC nurse can take once chemotherapy or radiation have been prescribed include the following ® Schedule an appointment to examine the stoma and peristomal skin, and review the patient's stoma care procedure to establish a baseline. ® Discontinue the use of any of the older ostomy systems with metal in the barrier or zinc oxide, either of which can interfere with radiation therapy. The ostomy system should be emptied and moved out of the radiation field if possible to prevent a bolus effect. ® Discontinue stoma dilatations or colostomy irrigation during treatment. Infections may occur in immunosuppressed individuals through traumatized mucosal surfaces. Additionally, diarrhea is a common side effect and negates successful colostomy irrigation. ® Discontinue the use of soaps, solvents, ointments or sealants near or in the area receiving radiation if any skin reactions are noted. ® Teach the patient how to remove the skin barrier gently. Gentle cleansing of the stoma and surrounding skin with warm water is allowed. Pat dry and avoid any vigorous rubbing or toweling. A hairdryer set on cool may be used. ® Skin reactions related to either radiation or chemotherapy can occur. Instruct the patient to report any changes in the stoma or peristomal skin to the medical staff. ® Neutropenic patients—those with a white blood cell count below 2000—should be fitted with a clean, disposable ostomy system. At times when the immune system of such patients is dangerously suppressed, some centers utilize a sterile ostomy system. A sterile urine culture may be required for the septic urostomy patient. The patient's usual ostomy system can be resumed when his/her white blood cells have normalized. ® Stomal edema—swelling from an excessive accumulation of an excessive amount of watery fluid in cells or tissues, ulcerations, and less frequently necrosis, which is death of a portion of tissue resulting from irreversible damage—can be observed. An enlarged barrier opening may be needed to protect the stoma from trauma. Stomal edema can result from direct contact with the mucosal lining. Any stomal ulcers that develop require gentle cleansing and should resolve quickly when treatment ceases. ® Counsel patients to monitor fluid intake and output if nausea, vomiting or diarrhea develop. The ileostomy patient is particularly at risk of dehydration and medical intervention may be required to treat symptoms and/or dehydration. ® Constipation can plaque certain colostomy patients taking narcotic pain medication, some chemotherapy drugs or having tumor progressions. Caution patients to obtain professional medical/nursing instruction if their bowels have not moved within 48 hours. Other, less common complications of the oncology patient include hemorrhage due to suppressed blood platelets or peristomal varices—caput medusa (veins radiating from around the stoma). Peristomal varices present as a bluish or purple discoloration of the peristomal skin that blanches when pressed. The skin remains intact, though upon initial examination it appears damaged. This condition of the liver is related to metastatic disease—shifting from one part of the body to another, hepatitis and cirrhosis resulting in portal hypertension—a vein that is obstructed in the liver. The dangerous stomal complication is hemorrhage at the mucocutaneous junction—where the stoma meets the abdominal skin. To minimize the risk of hemorrhage, the barrier opening should not touch the stoma. Enlarge the opening of the barrier ¼" larger than the stoma. Soft barrier rings or stoma pastes can minimize rubbing and fill in any gaps. Gentle stoma and peristomal skin cleansing is imperative, as is avoiding aggressive adhesives or excessive pressure from belts. Pressure from a soft cloth or gauze can be applied to bleeding sites. If the bleeding does not stop, the patient should be instructed to seek medical assistance. Topical treatment includes cautery, suturing and the application of homeostatic agents. Surgical treatment and blood transfusions may be indicated. Candidiasis—fungus or yeast infections—occurs more easily in the immuno-suppressed patient. A white coating appears on the stoma and can be scraped off. Peristomal yeast infections can be seen as erythematous skin—redness of the skin due to capillary dilatation—with scattered satellite lesions that may cause pruritis—itching. If the culture is positive, topical anti-fungal powders or creams can be effective. However, immuno-suppressed patients may require systemic anti-fungal therapy. Drug-induced skin reactions are a common side effect of chemotherapy agents. Drugs reported to cause skin reactions include 5-fluorouracil, bleomycin, methotrexate, doxirubicin, actinomycin, taxol, taxotere, thiotepa and melphalan. Gentle removal of the barrier and cleansing are indicated. A non-adhesive ostomy system using a belt and silicone or karaya rings may be necessary during acute skin reactions. The skin will improve post-treatment; however, recall skin reactions have been noted during active radiation treatment. There is the potential for tumor recurrence in the stoma mucosa or peristomal skin, the 5-10 per cent of malignant recurrences appearing cutaneously—at the base of the stoma. Direct examination and biopsy can confirm tumor development. Treatment may or may not be indicated. Gentle removal and cleansing, plus the use of non-adherent and absorbent dressings over friable—a dry and brittle culture falling into powder when touched—peristomal tumors, will reduce trauma. Barrier openings may have to be enlarged due to stomal tumors. Surgical resection or radiation may be necessary if there is a risk of stomal obstruction by the tumor. Preventive stoma care, education and evaluation can minimize the side effects of oncology-related treatment. With the increasing number of therapies for cancer, more stoma patients are undergoing such treatments. The role of the WOC nurse as a member of the oncology treatment team is therefore increasingly important. What to Say By Georgia Photopulos What should
one say to someone who is sick? There is not a set of guidelines for
being a good friend. However, if you would like a few simple tips,
well, here they are—direct from the patient's mouth: §
Do not
be afraid to ask me what I have, how I am doing or what my treatment will
be. At worst, I will say I do not want to discuss it. At best, I
will welcome the opportunity. §
Are
you worried about what to say? What did we talk about before I became
ill—politics, art, religion, children? I am still interested. §
Do not
try to cheer me up by telling me things could be worse; that I am lucky my
spouse has not left; that I could have been hit by a truck. It does not
help. In fact, do not try to cheer me up at all. What I need most
when I am depressed is a compassionate comforter and listener. §
I do
need a sensitive, empathetic listener. Do not assume you know how I
feel. It is not even important. A husband will visit his wife
after she has given birth to their child, and yet, the
man has no real frame of reference for what his wife has just
experienced. Regardless, the wife is always happy to talk to the
husband about everything that has happened. §
If I
look horrible, do not tell me I look great.
Your lie will hang between us and undercut anything else you
say. You do not have to comment on my looks at all. §
Remember,
I chose my doctor and unless I say otherwise, I am probably satisfied with
him/her. Do not ever bring articles about doctors, hospitals
or treatments unless I ask you. §
I
really like it when you bring flowers, books, games—whatever you know that I
like. Most of all . . . bring you. Illness interrupts so much; do
not let it interrupt our friendship. § If anything about my illness trouble you, if it makes you upset, sad or nervous, tell me. Your silence may hurt me. Adhesions By Health Central
An adhesion is a scar tissue that binds together two anatomic surfaces that are normally separated from each other. They 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 intubation 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 tissue 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, possibly causing infertility. Adhesions can occur elsewhere and can be the cause of other disorders—for instance, they can lead to glaucoma when located in the eyes and when located around the heart can result in pericarditis. Here are some questions to ask your doctor: ® How do you know the problem is the adhesions and not some other growth or condition? ® Is surgery recommended to remove the adhesions? ® What is the procedure? ® Will the adhesions redevelop? “Being well intentioned and doing good is not enough, it must be done well.” Vincent
De Paul
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