Thursday, February 21, 2008

The Person with an Ostomy shall:

  1. be given pre-op counselling
  2. have an appropriately positioned stoma site
  3. have a well constructed stoma
  4. have skilled post-operative nursing care
  5. have emotional support
  6. have individual instruction
  7. be informed on the availability of supplies
  8. be provided with information on community resources
  9. have post-hospital follow up and life long supervision and
  10. benefit from team efforts of health care professionals.

Do all of you out there know what an Enterostomal Therapist is or does?

Enterostomal Therapy (ET) Nursing is a specialty area of nursing that provides acute and rehabilitative care for people with select disorders of the gastrointestinal and genitourinary systems. The Enterostomal Therapy Nurse plays a "pivotal role" in the provision of optimum patient care. Functions of the role can include consultation, direct patient care, education, research and administration and can encompass such activities as:

  1. recognizing and describing indications for ostomy surgery.
  2. counselling and teaching patients and their significant others pre-operative, postoperative and rehabilitative phases of ostomy surgery.
  3. Stoma site selection and marking.
  4. Diagnosing stomal complications and prescribing appropriate nursing interventions.

With what is happening currently with the health care system in Ontario (once sought after by authorities throughout the world) seems to be disintegrating before our eyes. A number of ETs in Ontario have lost their hospital positions over the past few years. This puts greater demand on the ETs in the community who are already stretched beyond their capacity. One of the ways which you may be able to help not only yourself but future persons facing ostomy surgery, is to write a letter to the President or Chief Executive Officer of the hospital to which you are attached, either where you had your surgery or where you are currently living, and ask the powers that be about the ET services in the hospital, such questions as:

  • If I am admitted to the hospital for an ostomy or other problem, am I going to be cared for or helped by a qualified enterostomal therapist if I am not in a position to look after my ostomy myself?
  • How do I get follow-up help with my ostomy as an outpatient when problems arise or for routine checkups?
  • Are new people facing ostomy surgery receiving the counselling and skilled post-operative care necessary to be rehabilitated back into society?
  • Who is going to advise me as to the availability of supplies and community resources?

I am certain you can think of many other questions which you could ask. I would suggest that you telephone the hospital and get the name of the top person and address your letter as "private and confidential". It would also be of benefit to send along a copy of the "Bill of Rights for a Person With an Ostomy". Ask for details of what ET services are available and when they are available. Point out that if surgeons are qualified to do ostomy surgery then it is the responsibility of the hospital to provide the additional skilled postoperative care for those people with an ostomy. There should therefore be a full time ET on the staff and not a nurse who looks after the ostomy patients. If we are going to make any changes we are all going to have to take the matter seriously and sit down and write your own individual letter for your own special needs. When you receive a reply, (and insist on getting one) please forward a copy of the letter to the United Ostomy Association of Canada Inc. Office for their records.

Source: Dianne Garde, E.T.

Halton-Peel: via Metro Halifax News, February 1997.

Editor's note: This article is specifically about Ontario, but the Bill of Rights is applicable world-wide and the erosion of health care is happening right across Canada.

The Bionic Woman

by Beth Wagner, Editor, Cincinnati (OH) Newsletter

Recently a co-worker (who is aware I'm an ostomate) and I were at a casual work function. During some down time, we started talking about how, if we could, we would sculpt our bodies. It was fun talk, nothing serious. Just a couple of women lamenting about our aging bodies.

She wanted to trim her thighs and hips. Not too much, just enough to give her body a different shape.


I, in response, said I would like to shave some baggage off my hips and flatten my stomach. As I patted my abdomen, I realized my pouch was rather full. I looked up at her and shrugged and said, "Of course, some of this is equipment."

"That's right," she said. "You're bionic."

Bionic. Never thought of it that way before.

The "six-million dollar man," that fictitious character Lee Majors brought to our TV screen once a week, had his damaged and/or malfunctioning limbs and other body parts replaced with advanced robotics. It allowed him to continue as a vital part of (if my memory serves me correctly) the government, albeit with extraordinary power and ability.

His counterpart, the bionic woman, was equally impressive in her crime-fighting series.

But think about it. Haven't our respective surgeries given us similar, although maybe less dramatic, opportunities?

In my case, my surgery has allowed me to be much more of an active, confident person than I was during the 21 years I had ulcerative colitis. No more worrying about attending my daughter's concert and jumping up in the middle to race to the bathroom. No more several-week stretches of sick time at work. No more worrying about whether I will be well enough to go on our next vacation.

We may not be thwarting the efforts of Colombian drug lords or recovering stolen priceless museum pieces or keeping our country's arch enemy at bay.

But we're taking our kids (or grandkids) to their soccer games and watching them score their first goals. We're keeping up with the laundry and making - no, beating - the deadlines for our latest work projects. We're donning rain ponchos and riding out into Niagara Falls with our families. We're helping our daughters understand their bodies' changes in their transition into womanhood. We're teaching our sons how to drive stick shifts. We're helping our spouses through trying times at work. We're sitting on our porches and watching the sun set.

And isn't being there for our families as important, if not more so, than recovering the Hope diamond?

We're bionic.

And we're making a difference in other people's lives because of it.

From Stillwater-Ponca City (OK) Ostomy Outlook Online, August 1997: Via South Brevard (FL) OSTOMY NEWSLETTER

Tuesday, February 12, 2008

What Leads to Leakages and How to Prevent Leakages


Abruptly sitting up straight from a flat-on-your-back position can pop your pouch loose.

So can bending over to clean out the bathtub, or picking up something off the floor, or stretching high to reach something.

Learn to get in and out of bed on your side. Get in bed by sitting far onto the bed and going down on your elbow while holding the mattress with the other hand, and swing your legs up.

To get up, roll over on your side and use your elbow to push up, while holding the mattress with the other hand and swing your legs sideways off the bed.

Get a clamp-type reacher for reaching down and a stool for reaching high shelves.

Learn to lift and carry on the side of your leg, carry things high, or drag it, or get someone to help.

Ostomates get hernias easier than anyone else.


Via: Southern Maryland Counties Chapter

STOMA COMPLICATIONS



Many pathological conditions can necessitate the need for some type of bowel or urinary diversion known as an ostomy. For the most part, ostomies are well managed by the patient, and/or caregiver. Sometimes complications can occur. A list of basic stoma complications follows:

Necrosis— A dark, black stoma due to inadequate blood supply. This can be caused by excessive tension on the mesentery, too thick of an abdominal wall for the intestines to pass through, too tight a suture line, or interruption of blood flow (clot). Management is based on the extent of necrosis. Superficially—– continual monitoring: it may slough off and can be managed with a modified pouching system. If it is below the fascia level, it often requires stoma reconstruction.

Detachment
— The stoma separates completely from the adjoining skin. This is caused by too much tension on the mesentery and requires surgical revision of the stoma.

Recession—Retraction
— Sinking of the stoma below the skin level. This can be caused by scar formation secondary to mucocutaneous separation, necrosis, peristomal skin problems, weight gain, radiation, recurrent malignancies, or excessive tension on the suture line. This can be medically managed with a modified pouching system. Severe cases may require stoma revision.

Stenosis—Strictures
—– Extreme narrowing of the stoma that can threaten the normal function of stool evacuation. Multiple causes can include inadequate suturing at the fascia level, mucocutaneous separation, edema, and disease conditions which may cause scar formation that compress the stoma causing ribbon-like stool or obstruction. This may be medically managed with stoma dilation or require surgical intervention.

Prolapse
— Telescoping of the bowel out through the stoma. Poor abdominal wall support and increased abdominal pressure from coughing, sneezing, laughing, or tumor formation are common risk factors. Conservative management of a prolapse includes reduction of protrusion by gentle pressure, cool wash cloth and even sugar (acts as an osmotic diuretic) on the stoma, then applying a binder or prolapse belt. In some cases, prolapse is medically managed if the patient is considered a surgical risk.

Hernia
— Protrusion of the bowel into the subcutaneous tissue around the stoma. This is characterized by a bulge in the abdominal wall or tension on the abdominal wall or on the abdominal muscle. This is medically managed by wearing a binder and/or modified pouching system. If herniation leads to a blockage, surgical intervention is required. To aid in prevention of a hernia, wear a binder especially when lifting heavy objects, or guarding the stoma with a hand pillow when coughing or laughing. One noted entertainer places a hand over his side, guarding the stoma when laughing.

Obstruction
— Blockage of a stoma from recurrent disease process, or twisting-kinking of a loop of bowel in the abdomen. Surgical intervention is required.

Impaction
— (In colostomates). Stoma clogged by hard stool requiring stool softening with enema or a small amount of oil prior to stoma irrigation. Impaction may be prevented by drinking 8 to 10 glasses of fluid per day, attention to diet and regular use of stool softeners.



From: North Texas Ostomy News Via: Sherman Area Ostomy Assoc.

Friday, February 8, 2008

OSTOMATES IN THE PHILIPPINES

Ostomy, stoma, colostomy, ileostomy and other terms may be new words for our readers but they are in daily use for the growing thousands of people mainly affected by cancer of the colon, rectum or bladder and the people and health professionals who care for them.

In medicine, the stoma is a surgically made opening in the abdominal wall. Ostomates are the persons who have a surgical opening specifically the stoma. Usually, they would have a belt and bag contraption around their waste to care for their stoma. You may also see these words being spelled as ostoma and ostomates. Stomas can be temporary or permanent. But surgeons create stoma as a life-saving or life maintaining method to allow the outflow and inflow of substances to and from the intestines, bladder or lungs.

In the Philippines, the most common causes of stomas are cancers of the colon, rectum and bladder. Colon cancer is the sixth most common site of cancer among Filipinos with nearly 3,000 new cases found yearly with another 3,000 cases of rectal and bladder cancer. Cancer of the colon and rectum has been linked to high fat diets and diets rich in red meat. So if a member of your family, whether near or distant, has colon or rectal cancer, you are advised to keep yourself in peaceful harmony with people and the environment. Go to places that are relatively secure and safe. Ride a vehicle always with a seat belt; avoid alcohol while driving and keep cool despite the heavy traffic.

The real key is prevention. However, government and society as a whole has not invested enough in the prevention of diseases and the promotion of health. At the same time, more action and funds are needed to match or double the efforts in the curative field.

As ostomates ourselves, we continuously adjust and learn our new lifestyle. We need to give encouragement to other ostomates across the country and build our own ostomy groups encouraging people with the same situation to move out of their fear, anxiety or depression in returning to the rudiments of daily living.

For families and relatives of ostomates, they are encouraged to give more support and understanding. Ostomates do need to continue with their social life and occupations.

For care givers and health professionals, there should be greater effort to expand ostomy clinics not only in hospitals but also in polyclinics and ambulatory care clinics. Greater concerns can be placed on how to increase access of stomates to care near their workplace and residence. There is a need to tie up with Filipino business community to manufacture our own ostomy contraptions in the future.