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Preparing for Ostomy Surgery

Articles Included:

· Preparing for Ostomy Surgery

· Life After Ileostomy Surgery

· Phases of Surgical Recovery

· Life After Ileostomy Surgery

· Ileostomy Hints

· Pregnancy and Ileostomy

· Loves Labor Lost

· Life After Ostomy Surgery

· Life Begins with an Ostomy

· A Medical Break-Through

Preparing for Ostomy Surgery

By Rodney Crick, Re-Route

What can a person, or should a person do to prepare for having ostomy surgery? Learn as much as you can about the type of ostomy you are going to have created, where it will be located, what it will look like, how it will function, and what you will need in the way of supplies to care for it. Pamphlets that explain the various types of ostomies and how they are created are available through the United Ostomy Association by calling 1-800-826-0826.

ConvaTec and Hollister Intl. both have videos and informational booklets available that explain a great deal about the different types of ostomies and how they are cared for. They are available by contacting these suppliers direct at: ConvaTec.com, 800-422-5511; and Hollister.com, 847-680-1000.

Discuss any concerns you may have with your surgeon ahead of time. The surgeon you choose should be experienced in the number of ostomy surgeries performed. Ideally the stoma he or she will create should protrude outward from the abdomen at least one half inch for ileostomies. Patient’s that have stomas that are created flush with the skin tend to experience more skin excoriations with ileostomies and some colostomies.

During peristalsis, the skin surrounding the stoma will pull inward with the result being that discharge containing enzymes will get between the barrier and the skin causing the pouch to fail, excoriating the skin. Ask the hospital where you will be having surgery to help you arrange for an ostomy visitor. You have a right to ask for and receive a trained Ostomy Visitor through the local chapter of the United Ostomy Association.

They can match you up with a visitor that has undergone the same type of surgery you will be having and who can answer many of your questions and calm your fears and anxiety. Ask the visitor if you can call them later with any further questions you might have. Ask the hospital where surgery will be performed if they have an Enterostomal Therapist (ET nurse) on staff that you can visit to have your stoma site marked prior to surgery being performed. This allows the surgeon to place the stoma on the abdomen in the area that is least likely to be obtrusive or cause pouching problems after surgery.

Your stoma will be easier to care for if it is not created in a beltline, fold, or scar tissue crevice in your skin and will result in better adhesion of the wafer, with fewer leakages and skin problems. The ET nurse can also show you samples of the pouch you will wear during your stay in the hospital.

During this visit, make sure that the ET will show you how to change your wafer and pouch and teach you the basics of stoma care before you leave the hospital. Adopt a positive mental attitude and realistic expectations about your surgery and life afterward. Face the realization that you are not the only person this has happened to in life.

There are about a half million people out there in the U.S. alone whose ostomy surgeries have allowed them to conquer disease and lead normal healthy lifestyles filled with work, activities, play and relationships. Realize that you must give yourself time to heal following surgery; but, do expect to become one of them.

Life After Ileostomy Surgery

By Jan Madaffri

My name is Jan Madaffri and I am a 23 year old female. I only knew my future husband four months before my permanent ileostomy surgery. In January 1990, I received my first ileostomy—a temporary—due to ulcerative colitis. It was later reversed to a J-pouch in July 1991.

I wasn't in pain anymore from ulcerative colitis, but I was unable to control my trips to the toilet. This put a big damper on my social life; i.e., being a prisoner to the toilet. When I first met my husband, I only explained to him that I couldn't control my bowel movements due to a disease. I didn't go into specifics about the temporary ileostomy that I had a year earlier. I didn't feel it was important anymore since the ostomy was gone. How was I to know that I would need another ileostomy later down the line?

We weren't able to go out and eat in restaurants or go to movies or clubs because my body wouldn't allow me to be away from a toilet for very long. So, our dates consisted of watching a rented movie at my house so the toilet would be close by.

At times, I would be in the bathroom for hours at a time. By the time I could come back out and join him, he would be asleep on the couch. He didn't seem to mind, but I hated losing that time to be with him.

After we had been dating for about four months, I needed another surgery. Basically, the J-pouch was failing and I needed a permanent ileostomy to save my life. I was ready to have the ostomy back; I was tired of living on the toilet. When I was in high school, I only attended my freshman year in the physical school building. I finished the next three years being home schooled because of the severity and complications of the ulcerative colitis. I didn't want to be a prisoner any longer.

When I recovered from the surgery, I was scared he would leave me once I told him what the surgery involved. I showed him a brochure that would best explain the surgery, what an ileostomy was, and what it looked like.

He simply said, "OK". A little over two years later we were married. He later said that when I was explaining the surgery to him, he realized just how much he loved me. He said it didn't matter that I had an ileostomy, he just wanted me to feel well and to be with me.

Now, we were able to go out in public and enjoy being with each other and our friends. I swim, go out to clubs to dance, exercise; nothing is "off limits" because I have an ileostomy. In fact, without the ileostomy, many activities had previously been off limits to me.

I would still be grateful for my ileostomy even if he had left me because he couldn't handle it. But, I am much happier that he loves me and decided to stay. He has proven to me that there are people out there who will love you for you. Anyway—the way I see it—if anyone doesn't, then he/she doesn't deserve your love.

The Phases of Surgical Recovery

By Dr. Albert G. Wagoner

Each patient, along with the family, usually goes through four phases of recovery, following an accident or illness that results in loss of function of an important part of the body. Only the time required for each phase varies. Knowledge of the four phases of recovery is essential:

The Shock Phase—The period of psychological impact. Probably, you remember nothing of this phase after your operation. Nevertheless, it is a phase that requires a lot of support.

The Defensive Retreat Phase—The period in which you defend yourself against the implication of the crisis. You avoid reality. Characteristic in this period is wishful thinking or denial, or repression of your actual condition. For example, an ostomate believes that his/her entire colon is still there and will be connected later.

The Phase of Acknowledgment—In this period you face reality. As you give up the existing old structure, you may enter into a period, at least temporarily, of depression, apathy, agitation, or bitterness and of high anxiety. You hate your stoma, yourself, you cry a lot, pity or condemn yourself. You may not eat, be unable to sleep or want to be left to die. In this phase you need all the support that can be mustered.

The Phase of Adaptation—Now, you actively cope with the situation in a constructive manner. You adapt, during a shorter or longer period, the adjustments that are necessary. You begin to establish new structures and develop a new sense of worth, with the aid of an ET nurse and an ostomy visitor, you can learn about living with an ostomy. Aided by your physician, social workers, ostomy association and family, you go about rebuilding and altering the life that brought about the condition. Sound familiar?

Life After Ileostomy Surgery

By Jan Madaffri

Ileostomy Hints

--Internet sources

· If you are on chemotherapy and your mouth is sore, gargle with one teaspoon of baking soda in half a glass of water. It is also reported that some people obtain relief from drinking carrot juice.

· The following foods may cause loose stools. Do not stop eating these, but you may wish to avoid them when diarrhea occurs: green beans, broccoli, prune juice, spinach, raw fruits, rhubarb, beer and spicy foods.

· To help firm up a loose stool, some have tried a large teaspoonful of bulk gelatin dissolved in water or lemon juice once a day with success.

· The following foods often help firm up stool: bananas, applesauce, boiled rice, boiled milk, tapioca pudding, creamy peanut butter, buttermilk and yogurt.

· Two or three tablespoons of applesauce may help firm up a liquid stool which may result from eating pizza or other spicy foods.

· When diarrhea occurs, potassium and sodium are lost rapidly. An easy way to replace them is by drinking a quality sports drink; like Gatorade, some orange juice or a salty broth in proportion to the fluids lost.

· Drinking tomato juice will help eliminate odor, and is a good way to retard dehydration and keep the electrolytes in balance. But, be careful. Tomato juice is full of salt, and you don't want too much salt. It may increase your blood pressure to unsafe levels.

· Eating a sprig or two of parsley daily works wonders to combat odor.

· Cinnamon can be used in the pouch for odor control.

· If you wash out your pouch, always use cool water. Hot water seals in the odor.

· Keep some grape juice on hand. If you eat something that causes a blockage, just drink a glass of the juice; it works wonders.

Pregnancy and the Ileostomy

By Marcus Setchell, FRCS, Ottawa Ostomy News

Pregnancy

Before embarking on a pregnancy, it is important to check with your doctor or surgeon as to whether you are now fit to go ahead. You may be asked to visit a gynecologist for pre-pregnancy counseling to discuss any possible difficulties before pregnancy occurs.

Most women with ileostomies sail through their pregnancies with no particular problems, but some commonly asked questions and less common problems will be discussed.

Will my ileostomy work normally?

Usually the ileostomy works perfectly normally during pregnancy. But, you may need to increase fluid intake because the developing fetus and the changes going on inside your body require extra fluid.

Occasionally during pregnancy, women get episodes of intestinal obstruction when the enlarging uterus causes a hold-up in the passage of intestinal contents. The ileostomy stops flowing into the pouch, and the abdomen may become distended and colicky pain is felt. Restricting the diet to fluids only and resting may resolve the problem. But on very rare occasions, hospital admission and an intravenous IV will be needed to rest the intestine.

During pregnancy, changing of the ileostomy system is not usually difficult. When the abdomen gets very big in the later stages of pregnancy, it may be necessary to use a mirror—of course most use mirror regularly anyway.

Sometimes the stoma enlarges due to stretching of the skin and muscle, and there may be some prolapse of the intestine into the pouch. That is more of a situation to manage instead of concern to ones health.

What about diet during pregnancy?

Nobody needs to eat for two in pregnancy. Some increase in certain foods may be desirable. Plenty of protein and vitamins are needed. It may be sensible to eat more meat, eggs or cheese, and some vegetables or salads.

Iron tablets will usually be prescribed and possibly some vitamin tablets. Pregnant women should avoid all but small quantities of alcohol, and, of course, smoking is very harmful for the developing baby.

Is natural childbirth possible?

Caesarian section is certainly not the rule for ileostomy patients; indeed, most obstetricians will try to avoid this because previous surgical scars may make the operation slightly more difficult. The vast majority of women with an ileostomy are able to have a vaginal birth. But, there are a few factors which can affect details of the birth.

If the rectum has been removed and there is scar tissue in the perineum—the area between the vagina and the original site of the anus, it may be necessary to do an episiotomy—a small cut to enlarge the vaginal entrance—in order to make the birth easier and prevent an ugly tear.

If there has been considerable damage to the nerve supply, the woman may not get the urge to push her baby out, and so may require a forceps delivery.

None of this matters because local anesthetics are used; or an epidural—a special injection near the spine which takes away all the pain of childbirth…it is wonderful. If the midwife or doctor are not familiar with ileostomies, do not worry. They will listen to your needs and work with you on any of these small issues.

Breastfeeding?

There is no reason at all why an ileostomate should not breastfeed. Remember, a breastfed baby may drink several pints of milk a day, and so fluids must be taken in greater quantities. There is no evidence that beer is better than any other fluid for breastfeeding mothers.

Infertility

There has been much discussion and disagreement as to whether infertility is more common in people with an ileostomy. Approximately 10% of the population has a problem in achieving pregnancy. It is possible that some causes of infertility are a little more common in people who have had one of the conditions leading to an ileostomy.

If women are in a very poor state-of-health; are grossly underweight—as sometimes happens to people before an ileostomy, then their periods may stop, and they will not ovulate—make an egg. Once health is restored, and their weight reaches normal levels, the periods and ovulation resume. Occasionally, a drug is required to stimulate ovulation.

Sometimes, the underlying condition, or the operations for it, cause damage to the Fallopian tubes either by causing kinking and adhesions, or rarely, by blocking the tubes. Where this is suspected, tests will be done by x-ray to check the tubes, and it may be necessary to have an operation to improve the tubes.

If this is not successful, or if the tubes are very badly affected, in vitro fertilization (IVF) may be considered. This treatment is perfectly possible for women with an ileostomy. Nowadays, the eggs are usually collected through the vagina or bladder so there is no danger of interfering with the ileostomy. It is, however, important to remember that IVF is still a relatively unsuccessful form of treatment, and not everybody gets their "miracle" baby.

Love's Labor Lost

By Marjorie Kaufman, Los Ileos News

The surgeon probably doesn't have a stoma; the ET doesn't have one either; but the patient has a stoma he/she didn't want, is having a struggle accepting it, and is in a tailspin over all the paraphernalia and rigmarole of putting ostomy equipment together.

Eight days post-op and it all seems like a bad dream. The doctor and the ET have made a quality attempt to reassure their patient that all is well, and he/she is ready to go back to the world. The patient is not so sure about this him/herself, and doesn't know what "doing fine" really means. Not that he/she doubts the words of the professionals, but he/she has a strong desire to see one of those people, who have licked this thing. He/she wants to be convinced that there may be a better tomorrow.

The ET, who believes he/she has given him/her the best care possible, calls for a visitor only to satisfy his/her whim. The ET knows that he/she him/herself will take care of the mechanics, and the visitor will provide a glimpse of the patient's future—the picture worth a thousand words.

A scenario: The visitor arrives to find the patient in mechanical trouble. The ET, not on staff at this hospital, has left the patient "appliance perfect". The unforeseen happens—as it does with most new ostomates—a leak. Written instructions are clear and concise and the materials are ready for application, but the nurses' hands are tied. Orders are "hands-off" until the visiting ET returns tomorrow. Padding is applied.

The visitor? He/she know what that leak is doing to the tender and unaccustomed skin. He/she can feel the itching, the burning and the discomfort. He visualizes the inflammation building up while the patient waits for relief that may be a whole day away.

Where once he/she could have helped, he/she now is rendered impotent. By ET standards, he/she must ignore the mechanical failure. The visitor is limited to conversation only. He/she is just there to appear healthy…not to help medically.

Dare we then return the criticism professionals have voiced against experienced visitors on occasion? Is our first obligation to the professional rather than the patient? We are forced to stand idly by sacrificing the patient's skin to save our own.

Note: We have copied the above article because we think it is of value. If you're an ostomy visitor, you already know that we are not allowed to touch the patient in a medical fashion. We don't give medical advice; that's the way it has to be to avoid personal liability and medical licensing issues.

We don't think any volunteer ostomy visitor wants to give medical advice, but it's possible that a visitor might help a patient change an appliance in an emergency, or even offer tips on irrigating a colostomy. But we don't. We make our visits, try to look as nice and healthy as possible, and assure the patient that better days are ahead. We've all been there.

Life After Ostomy Surgery

By Muriel G. Greenspan, Metro Maryland

When I was diagnosed with colon cancer and faced surgery for a colostomy, I was completely devastated and thought my life was over.

It took quite a while for me to come to acceptance—thanks in part to unforgettable discussions with Horace at meetings of the Metro Maryland Ostomy Assn. After a time, I also began visiting patients who recently had the same surgery—trying to reassure them that life does go on, if you are determined to be a survivor and not wallow in self-pity.

Since I was a widow with both of my children married, living out of state, I was on my own and had to make a life for myself. As I gained confidence that I could operate basically as a "normal" person, thoughts of travel came back to me. I had always loved to travel from the time I was a teenager.

During my marriage, my husband and I had taken several island cruises and two extensive European vacations. I was determined to try and travel again with my new situation—being an ostomate. I am happy to report that I have successfully traveled to Israel, Greece, the Orient, Turkey, Scandinavia, St. Petersburg, Alaska, England, Scotland, France and Costa Rica.

In preparation for any trip, I see my doctor first, advise him as to where I am going and get inoculations as needed. I always take some diarrhea medication with me—just in case.

I make sure I have bottled water—even for irrigation—since many problems may be caused by bacteria in the water of the different regions I visit. Also, I take at least twice as many supplies as I could possibly need for the time I will be away. I try to be careful of what I eat and avoid ice in drinks.

In addition, I make sure to have adequate extra supplies with me in my carry-on luggage. You never know when your luggage will be lost—even temporarily. Enjoy your new life and bon voyage.

Life Begins with an Ostomy

By Dr. John Irelford, Ostomona News

Life begins with an ostomy. Crazy, you say? OK, let's analyze. Before you were told you would have to live with an ostomy, how often did you reflect on life, your family, the environment, the beauty and wonderment of a sunrise, or the magnificence and beauty of a sunset?

For the first time, you experienced the possibility that your brief visit to this life might end. Suddenly all your senses became heightened. The appreciation of living and staying alive became real to you.

Think back to all the time one wastes—sitting doing nothing, silly day-dreaming, arguing about nothing, putting off to the next day, worrying about things that never come to pass, etc. Never before does one wish that he/she could have the time for things that are important, to accomplish tasks, mend personal relationships, and most of all—make peace with God.

Life and the meaning of life come into clear focus, and the frivolous aspects of life fade out of sight. Each person reacts differently to these realizations, some positively, others negatively. Some adjust and live, others lament that which may never come to pass—and they die

Since we only visit this earth once, it is important to make every moment count. A moment wasted can never be recaptured. An ostomy gives you a second chance to assess priorities and start living the important side of life…to enjoy each day for itself…to not waste a moment. An ostomy opens the blinds…and lets the sunshine into your life once more.

A Medical Break-Through

--Hope Heart Institute, Seattle, WA

Breakthrough studies on nutrition and health are announced every day. When reading or listening to a news story, it’s important to be a critical thinker. Here are some tips.

Single Study: As a rule, do not make radical nutrition or life-style changes based on the results of a single study. Talk to your doctor if the “news” relates to a medical condition you have. In most cases, it’s best to make changes after several highly-regarded studies have confirmed the results.

Conflict: If the new findings conflict with previous studies, look for a reason why. Be aware that the media loves to play up “exciting” news.

Quick Fix: Be wary of recommendations that promise a quick fix. If something sounds too good to be true, it probably is.

Headlines & Bottom Lines: Read beyond the attention-grabbing headlines. Headlines simplify complex findings. Bottom-line conclusions are usually reported at the very end of news stories.

Verification: Read several news reports. Your local paper, USA Today, and the New York Times each may put an entirely different spin on the same research. Look up the original journal article, if possible. You can find most article summaries on the following database:

www.nlm.nih.gov/medlineplus/druginformation.html.

Method: Analyze how the study was done. Long-term studies that involve a lot of people are usually more reliable than quick, small studies. “Memory recall” studies are notoriously unreliable. Note that study results may not apply to you if the people studied differ in age, gender, race, locale, health habits, etc.

Source: Analyze the source. The best research is conducted by leading organizations, is peer-reviewed, and is published in leading medical or scientific journals. Note that publication in a prestigious journal does not guarantee that the findings are definitive or conclusive.

Interpretation: Look for expert interpretation and commentary from health and nutrition professionals.

Bias: Beware of researcher and or funding bias. Examples: Nutrition studies financed by food manufacturers should be taken with a grain of salt. Beware of health organizations that have an underlying financial issue at stake.

Specialization: Most researchers are specialists, so you’ll have to put the whole picture together by yourself, Example: a cardiovascular research study might note that one alcoholic drink a day decreases the risk of heart disease, and neglect to mention that it increases the risk of some cancers.

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