How To Treat an illeostomy Blockage

 

HOW TO TREAT AN ILEOSTOMY BLOCKAGE
UOAA Patient Reference Card, UOAA Update 3/12

Symptoms: Thin, clear liquid output with foul odor; cramping abdominal pain near the stoma; decrease in amount of or dark-colored urine; or abdominal and stomal swelling.
Step One: At Home:

  • Cut the opening of your pouch a little larger than normal, because the stoma may swell.
  • If there is stomal output and you are not nauseated or vomiting, only consume liquids such as sodas, sports drinks, or tea.
  • Take a warm bath to relax the abdominal muscles.
  • Try several different body positions, such as a knee-chest position, as it might help move the blockage forward.
  • Massage the abdomen and the area around the stoma as this may increase the pressure behind the blockage and help it to pop out. Most food blockages occur just below the stoma.

Step Two: If you are still blocked, vomiting, or have no stomal output for several hours:

  • Call your doctor or WOC Nurse (ostomy nurse) and report what is happening and what you have tried at home to alleviate the problem.

∙Your doctor or WOC Nurse (ostomy nurse) will give you instructions
(e.g., meet at the emergency room, come to the office).
∙If you are told to go to the emergency room, the doctor or WOC Nurse (ostomy nurse) can call in orders for your care there.

  • If you cannot reach your WOC Nurse (ostomy nurse) or surgeon and there is no output from the stoma, go to the emergency room immediately.

Important: Take all of your pouch supplies with you to the Emergency Room (pouch, wafer, tail closure, skin barrier spray, irrigation sleeve, etc.)

 

Seeking Medical Assistance-Colostomy

SEEKING MEDICAL ASSISTANCE – COLOSTOMY
Edited by B. Brewer, UOAA Update 3/12

The most common problem after colostomy surgery is the development of a hernia around the stoma site. This is manifested as a bulge in the skin around the stoma, difficulty irrigating and partial obstruction. Heavy lifting should be avoided immediately after surgery.

You should call the doctor or ostomy nurse when you have difficulty with:

  • Severe cramps lasting more than two or three hours
  • Unusual odor lasting more than a week
  • Unusual change in stoma size and appearance
  • Obstruction at the stoma and/or prolapse of the stoma
  • Excessive bleeding from the stoma opening, or a moderate amount in the pouch
  • Severe injury or cut to the stoma
  • Continuous bleeding at the junction between stoma and skin
  • Watery discharge lasting more than five to six hours
  • Chronic skin irritation
  • Stenosis of the stoma (narrowing)

Your ostomy nurse is helpful in managing complications should they arise.

POUCH CHANGES – HOW OFTEN
via Green Bay (WI) GB News Review, Edited by B. Brewer, UOAA Update 3/12

This question about pouch changes is among those most frequently asked, particularly by ileostomates and urostomy patients. Like many other questions, there is no one answer that applies to all ostomates.
An informal survey revealed that some people change their pouching system as much as 3 times a day, and some as infrequently as every 2 to 4 weeks. Obviously, there must be reasons for this great variation. After pointing out that the great majority of ileostomy and urostomy patients change in the range of once daily to once a week, let us explore some of the reasons. People on either side of this spectrum can have a skin problem or skin which is nearly indestructible.

Some of the reasons for the variation in time between changes include:
Stoma length: A short stoma exposes the adhesive material to moisture which may decrease wearing time.
Amount or consistency of effluent: Profuse effluent tends to loosen the seal.
Skin Type: Moist or oily skin tends to decrease adhesion time.
Skin Irritation: Decreases adhesion. The pouch should be changed more frequently to evaluate the success of your attempts to heal the skin.
Experience: Good technique, such as allowing paste to dry well, will increase adhesion. Personal Experience: Preferences, convenience and odor control.

Just For Laughs

 

JUST FOR LAUGHS

UOAA UPDATE 11/12

 

An elderly gentleman had serious hearing problems for a number of years.  He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100%. The elderly gentleman went back to the doctor and the doctor said, “Your hearing is perfect.  Your family must be really pleased that you can hear them again.” The gentleman replied, “Oh, I haven’t told my family yet. I just sit around and listen to the conversations. I’ve changed my will three times!”

____________

 

Morris, an 82 year old man, went to the doctor to get a physical.  A few days later, the doctor saw Morris walking down the street with a gorgeous young woman on his arm.  A couple of days later, the doctor spoke to Morris and said, “Wow, you’re really doing great aren’t you?” Morris replied, I’m just doing what you said Doc: “Get a hot momma and be cheerful.” The doctor said, “I didn’t say that! I said, you’ve got a heart murmur, be careful.”

________________

 

Marriage is a relationship in which one person is always right, and the other is a husband.

__________________

 

Fifty-one years ago, Herman James, a North Carolina mountain man, was drafted by the Army. On his first day in basic training, the Army issued him a comb.  That afternoon the Army barber sheared off all his hair. On his second day, the Army issues Herman a toothbrush.  That afternoon the Army dentist yanked seven of his teeth.  On the third day, the Army issued him a jock strap.  The Army has been looking for Herman for 51 years.

____________________

 

Is it my imagination but do buffalo wings taste like chicken?

_____________________

My weight is perfect for my height which varies.

____________________

I used to be indecisive but now I’m not sure.

____________________

One thing nice about egotists: they don’t talk about other people.

_____________________

What is a “free”gift? Aren’t all gifts free?

______________________

If swimming is so good for your figure, how do you explain whales?

 

The Most Powerful Prescriptions

 

The Most Powerful Prescription

UOAA UPDATE 11/12

A positive attitude toward negative situations is one of the most powerful forces in the world. It not only affects how we respond to hardships and difficulties, it can actually help to change the outcome. This can be seen first- hand in many ostomates and other people who have overcome potentially devastating diseases and gone on to lead full, productive, happy lives.

The physical aspect of life may be compromised greatly by illness or surgery, but with a positive mental attitude and a willingness to let go of self-pity and bitterness, life goes on and can even be enriched by a painful traumatic experience.

Stoma and Skin Stuff

 

Stoma and Skin Stuff

Edited by Bobbie Brewer UOAA UPDATE 11/12

Stoma…

  • Your stoma should be rosy red.
  • Use a hand mirror for a better view of your stoma
  • Don’t allow anything to be put in your stoma without your doctor’s personal supervision. Question any procedure that intrudes upon the stoma including suppositories.
  • Re-measure your stoma to ensure the correct size of pouch and skin opening. The stoma will shrink in the first few months after surgery.
  • Spot bleeding often occurs during cleaning and pouch changing.  Tiny capillaries are easily damaged and just as easily repair themselves. This is common to all ostomates.  Prolonged bleeding, increased amounts of bleeding, or very easy bleeding may indicate another problem and should be reported to your doctor.
  • If you participate in contact sports, cover your stoma with a “cap or shield” that are available from national manufacturers.

Skin…

  • Make sure your peristomal skin is clean and dry before applying the pouch.  It is not necessary to use sterile supplies.  Your peristomal skin is not steril.
  • Keep the skin clean with water.  If necessary, use mild soap (avoid oil based soap or soap containing lotion) and rinse very well.  Pat dry before applying the skin barrier or pouch.
  • Skin must be perfectly dry to receive and hold the pouching system. If your pouch doesn’t stick well, are you applying it right after showering in a high-humidity bathroom?
  • Skin rash or itchy skin may need to be checked out by your ostomy nurse.  It may be a fungal rash or allergic reaction that needs topical medication. Allow your skin to be perfectly dry before applying your new pouching system. You might want to use a hair dryer on cool setting.
  • If you are prone to fungal infections, don’t use antibacterial soap as this will alter the flora on your skin in favor of the fungus.
  • Many times any skin irritation will clear up under the pouch but prolonged wearing may cause the skin to break down again.  Change the pouch regularly.
  • If you cut your center holes, save the leftover pieces and use them to fill in any skin indentations around the stoma underneath the wafer.
  • Some men find it necessary to shave around their stoma.  They find that electric razors are better for the skin.  Protect the stoma when shaving.

Pouch Stuff

 

POUCH STUFF

Edited by Bobbie Brewer, UOAA UPDATE 11/2012

Paste…

  • A skin barrier paste is used to “caulk” around the stoma or to fill in uneven skin surfaces. Not everyone needs to use it.
  • A little dab will do you.  Use only a small bead of paste (not toothpaste size.)
  • When using paste around the stoma, apply to the pouch rather than the skin and allow it to dry for one minute before touching so it will not stick to your finger.

Pouch Security…

  • If your use a 2 piece system, the pouch may not be totally secured when you snap it on and could fall off when it’s half full.  Make sure the pouch is snapped to the flange securely by snapping it together at the bottom and working your way to the top. Give a little tug on the pouch to test its lock, but make sure you hold the wafer so you don’t break the seal.
  • Don’t be afraid to take a shower without your pouch.  Soap cannot hurt the stoma, however, rinse well (and rinse again).  After bathing with the pouch off, pat dry and allow a few seconds to close the pores before putting on a new wafer.
  • Wear your pouch inside your underwear for support. FOR MEN: try jockey-type shorts. FOR WOMEN: try brief panties with some lycra (light stretch) to the material.

Miscellaneous…

  • If you are staying overnight, consider carrying a “chuck pad” with plastic backing for your piece of mind. Put it on the bed and now you have no need to worry about night time leaks.
  • Always carry an extra replacement pouching system in case you spring a leak while away from home and always carry extra clips in case you drop one in the toilet.
  • Some men with excessive hair find it painful to remove the wafer/barrier. Shaving with an electric razor or trimming hairs with scissors is helpful.
  • If you do not use pre-cut wafers try using a seam ripper (for fabric) for cutting the size you need for barriers/wafers.
  • Put skin prep (spray or wipe) around the inner edge of the wafer to help prevent the wafer from “melting” away too quickly.
  • Don’t expect to get the same pouch wear time in the summer months.
  • Sew or purchase a pouch cover if the plastic pouch against your skin is uncomfortable.
  • If you participate in very active sports, use a 10” strip of 2 inch tape to secure the pouch and barrier/wafer to your abdomen (picture frame).
  • Ziplock sandwich bags are useful and odor-proof for disposing of used ostomy pouches.

Self-Acceptance: A Must for Restoring Intimacy

 

Self-Acceptance: A Must for Restoring Intimacy

Edited by B. Brewer, UOAA UPDATE 11/12

Frequently, among the first things to enter a recovering patient’s mind after major surgery is: “Will I be a whole person in the eyes of my spouse/partner?

Accepting one‘s self is the first step toward a happier marriage and sex life (at any time, for that matter!). By accepting one’s self, one appears as an emotionally well-balanced and relaxed person appealing to his or her spouse/partner. When one has fear of rejection, fear of being unable to perform, fear of being loved, these fears can be self-fulfilling.

A healthy, mutual, emotional caring for and about each other’s well-being, always plays the most important role in a loving relationship. Another most important ingredient is openness,

a comfortable attitude that accompanies self-acceptance and invites acceptance by the spouse.

If you are concerned about how your spouse will react to the change in your body that is normal. The hardest part is accepting what you cannot change, but you must for a healthy outlook. Once you manage to banish fear of rejection and the anger of “Why me”? You can work toward rebuilding emotional health and toward becoming comfortable with your new image.

Your spouse may have greater emotional hang-ups than you, concerns that may be magnified by concerns for your emotional health. Your own positive attitude goes far in rebuilding the relationship, rekindling the “old spark”.

Ostomy Surgery and Depression

 

Ostomy Surgery and Depression

Edited by Bobbie Brewer, UOAA UPDATE 11/12

Sleeplessness, loss of appetite, feelings of guilt or worthlessness, or irritability are some of the symptoms of depression. It can be triggered by the inability to participate in normal daily pleasurable activities, by a sense of helplessness and lack of control over your body. Medications, stress, malnutrition, anesthesia, or metabolic imbalance can also cause depression.

Patients who base their self-esteem on their physical appearance, they’re “always in control”, take charge character, or their good Samaritan (always the helper or solver) behavior, have a harder time dealing with their disease, their ostomy, their lack of control over their bodies, and their need to depend on others for help, even if only temporarily.

Constantly tired from efforts to cope with daily household or work routines, while learning to adapt to physical requirements this unpredictable new addition to your body, leaves little energy for enjoyment of leisure activities or romantic involvement. It takes us some time to return to our normal lifestyle. So relax—do what you are capable of doing at this time, and do not try to rush things. You have had enough pain and deserve a vacation.

Give yourself a year for a good recovery and if it should happen to take a lot less time, consider yourself a very lucky person. In the meantime, do what you have to do in whatever way you are capable of doing it, but do not give more than a passing thought to the things you cannot do right now. You might have to take some shortcuts, do some improvising, or indulge in some healthy neglect. Do not be bashful about asking for and accepting help. You would do the same for someone else if they needed help.

Some patients conceal their ostomy from their spouse, families or lovers because they fear rejection, feel shame or embarrassment, are modest or have noticed evidence of disgust. This results in feelings of isolation, depression and chronic anxiety. Most ostomates need a few months before they feel secure about being accepted. Join the crowd!! You are not alone! We all go through this

Signs of Depression:

  • Physical – aches or pains, or other physical complaints that seem to have no physical basis. Marked change in appetite; change in sleep patterns, and fatigue.
  • Emotional – pervasive sadness; anxiety; apathy; crying for no reason and indifference.
  • Changes in Behavior – neglect of personal appearance; withdrawal from others; increased use of alcohol/drugs; increased irritability and restlessness.
  • Changes in Thoughts – feelings of hopelessness/worthlessness; inappropriate or excess guilt; forgetfulness and inability to make decisions to take action.

(Note: There are some cases of depression which can benefit most from professional help. Do not hesitate to ask your doctor.)

Flu and an Ostomy

 

FLU & an OSTOMY

By Anne Marie Knudsen, CWON,MN,CNS,CFCN,  UOAA UPDATE 11/12

FACTS about the FLU:

The Flu is caused by a virus spreading from an infected person to the nose and throat of others.

Symptoms usually appear within 2-3 days after being infected and  a person with a fever  is considered contagious for another 3-4 days.  Here in the US the flu season generally run from November to April. Flu symptoms include chills, fever, dry irritated cough, nasal congestion, a sore throat, muscle aches, pain and a headache. For a frail susceptible and elderly person complications can lead to hospitalization related to pneumonia and rarely death can occur.

 

Who should get the Flu shot? All over 65, women pregnant or breastfeeding, healthcare givers and patients with chronic medical conditions like asthma; immune deficiency; heart disease. It is also recommended that students get the flu shot. It is a myth when people state they got the flu from the flu shot. Why do we need the flu shot every year? For the simple reason that the flu virus keeps changing and the vaccine must be replaced. Flu shots only protect for 1 year. Flu vaccine contains NO LIVE VIRUS which means it is impossible to get the flu from the flu shot. The flu shot is 90% effective against type A & B Influenza; but remember there can be different strands which means if one does get the flu the symptoms will be milder compared to not having gotten the flu shot.

THINGS TO DO IF YOU GET THE FLU:

First of all drink plenty of fluids and rest. Take some Ibuprofen or Tylenol for fever and pain. Wash your hand frequently and use Kleenex versus a handkerchief. Keep your hands off your face except for eating and daily hygiene. Rinse the nasal cavities with warm salt water or a steam bath with chamomile since these are soothing and will open the nostrils and bring down the viral population.

Boost the immune system with foods rich in vitamin C. You should take at least 1000 mg daily and supplement Zinc 15-20 mg. to boost the absorption of vitamin C. Finally drink as many many warm liquids as possible as the warm liquid will produce a wash off,  proliferating the virus from the throat to the stomach. Because of the high acidic content of the stomach the virus will not be able to survive.

 

WHAT to do as an Ostomate with the Flu:

Ostomates must take special care not to take any medication including laxatives without being

prescribed by a doctor as they have no effect on viruses and can change the balance of the gut and cause severe diarrhea.  For the Colostomate the diet needs to change while recovering from the flu. Eat a fiber free diet and then gradually move towards a regular normal diet.

DO NOT IRRIGATE WHILE HAVING DIARRHEA AND DO NOT TAKE LAXATIVES.

Some drugs and specific foods can cause constipation in colostomates. This can be prevented by

increasing your fluid intake.

Ileostomy Absorption Concerns

 

Ileostomy Absorption Concerns

UOAA Diet  and Nutrition Care Guide, Edited by Bobbie Brewer, UOAA UPDATE 11/12

Due to the absence of the colon and often altered transit time through the small intestine, the type of medication taken must be carefully considered when prescribing for the person with an ileostomy. Medications in the form of coated tablets or time-release capsules may not be absorbed and therefore, no benefit received. A large number of medications are prepared this way. Before the prescription is written, the patient with an ileostomy should inform the physician of his concern.

If the medication required is available only in a certain form, and the coating would not be destroyed by stomach juices, then the tablet may be crushed between two spoons and taken with water. (Note: check with your pharmacist to determine if the pill should be crushed).

The best type of medication for the person with an ileostomy is either in the form of uncoated tablets or in liquid form. Although these are not the most palatable treatments, these dosage forms ensure that the medication prescribed will be absorbed.

After ileostomy surgery, never take laxatives. For a person who has an ileostomy, taking laxatives can cause a severe fluid and electrolyte imbalance.

Transit time varies with individuals. If food passes through undigested, be aware that this may be a sign that the nutrients are not being absorbed properly. Prolonged incidences of decreased absorption may lead to various sub-clinical or clinical nutritional deficiencies.

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