larry

United Ostomy Association, Inc.
Evansville, Indiana Chapter
Re-Route

Contents:
PLANNING FOR SUMMER WITH A STOMA
GOODBYE GoLYTELY!!
HAVING SKIN PROBLEMS?
DEALING WITH SKIN ULCERS
ILEOSTOMY ABSORPTION CONCERNS
ORIGINS OF OSTOMY SURGERY
LACTOSE INTOLERANCE
OSTOMY PEN PALS
Volume 32, Number 8 May, 2005


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PLANNING FOR SUMMER WITH A STOMA
by: Diane Kasner, RNET, from Baltimore (MD) Bulletin
As thoughts turn to warm swimming, and summer fun, here are some hints for
maintaining a trouble-free ostomy:
1) Don't expect to get the same pouch wear time as you do in the fall,
winter, or spring. If your flange or ring skin barrier melts out faster,
change the pouch more frequently. If wear times are very poor, have your ET
nurse recommend a different skin barrier.
2) If the plastic pouch against your skin is uncomfortable or causes a heat
rash, sew or purchase a pouch cover.
3) If you are wearing a two-piece system and are participating in VERY
ACTIVE sports, use a 10 inch strip of 2 or 3 inch tape to secure the pouch
and the barrier to your abdomen to prevent the pouch from "popping off" the
barrier.
4) Be sure to drink plenty of liquids (unless contra-indicated because of
other health problems) so that you don't get dehydrated or constipated.
5) For extra security during swimming and water sports, use waterproof, I.e.
"pink" tape to secure your pouch.
6) Monilia is a common summer problem. This raised itchy, red rash on the
peristomal skin is uncomfortable and keeps pouches from holding well.
7) If you suspect a monilia rash, contact your physician as soon as possible
for a prescription or anti-monilia powder.

GOODBYE GoLYTELY!!
By: Barb Barrickman, RN BSN CWOCN
Are you planning on having a colonoscopy soon? We all know that this is an
important screening examination to detect any abnormalities in the colon
which could lead to cancer. It is highly recommended that anyone age 50 and
over have a colonoscopy, with follow-up colonoscopies on a schedule
determined by the results of the first exam and the person's medical
history. The procedure itself isn't usually a problem. We usually don't
remember that part. It is the preparation for the procedure that really
sticks in our minds! The usual preparation includes a clear liquid diet for
at least 24 to 48 hours prior to the procedure as well as taking a
preparation to clean the bowel thoroughly. Often, this is GoLYTELY. This
preparation produces diarrhea, which rapidly cleans the bowel, usually
within four hours. It has proven to be very effective in cleaning the bowel.
The problem with it is the amount that needs to be consumed and the taste.
Although it is available in flavors now, it still involves drinking
eight-ounce glasses every ten minutes until you get the recommended amounts
down. Approximately 50 percent of people taking the preparation will
experience some common side effects including nausea, abdominal fullness,
bloating, and cramping. One alternative to GoLYTELY is magnesium citrate
liquid. This is usually a ginger-lemon preparation that is mixed with a
small amount of water. It is taken in two doses. Although it is a much
smaller amount of liquid, it does not taste good and is difficult for some
people to drink at all. Finally, there is a new product that is in
pharmacies now. It is called Visicol. This medication is in pill form. No
more drinking endless gallons of fluid! It does mean taking 40 pills,
however. The usual routine starts the day before the procedure. That day,
you take 20 pills within an hour and a half. The pills must be taken with
eight ounces of any clear liquid (water, clear carbonated beverage, or clear
juice). Then the remaining 20 pills are taken three to five hours before the
exam. These are taken in the same manner as before. The directions conclude
with this reminder: remain close to toilet facilities. There are some
contraindications for the use of Visicol. If you have congestive heart
failure, unstable angina , unstable angina pectoris, or kidney disease, it
should not be used. All of the preparations mentioned above should be used
with caution in patients with severe ulcerative colitis. There are also some
new products being introduced that might even eliminate the clear liquid
diet prior to the examination. There is one company starting to market a
meal kit for the day before the examination. It includes shakes, chicken
noodle soup, stroganoff, and even potato chips in a special low-residue diet
plan, which supposedly cleans out the bowel even more thoroughly. So, when
planning your next colonoscopy, be sure to ask your physician if you can say
goodbye to GoLYTELY!

HAVING SKIN PROBLEMS?
Via: Metro MD, & S. Brevard, FL. Ostomy Newsletter
Skin problems are usually caused by improperly fitting pouches, leakage of
stool on the skin, hair follicle irritation, perspiration, or the misuse of
skin barriers. An important aspect in preventing skin problems is keeping a
seal. To keep a pouch on irritated skin, it is necessary that the skin is
dry. When the skin is irritated, it does not remain dry and cannot be dried
with a cloth. A basic method of drying the skin includes a warm heat lamp or
hair dryer. "Heat lamp" refers to any type of lamp with a maximum 25-watt
bulb placed at least one foot away from the stoma and allowed to shine for
only 10 minutes. You will find a desk lamp good to use. Cover the stoma with
a piece of damp tissue or cloth to prevent a drying effect directly to it.
Never use a sun lamp. This is an ultraviolet light and will burn your skin.
If you have had radiation therapy to the skin around your stoma, do not use
any lamp or light to dry your skin. A hair dryer of less than 850 watts may
be used if there is a cool setting. If you find you need to purchase any new
skin products listed under remedies, it would be advisable first, to call
your ET nurse for suggestions. You may be familiar with the use of one or
two products from your hospitalization. If you are comfortable using them,
go ahead. Rash can be located under the tape, under the face plate and on
any part of the skin where the pouch comes into contact with the skin. A
generalized reddish appearance that covers an entire area, similar to a
diaper rash, will be seen. It may be caused by a leaking appliance;
perspiration, allergies to tape or hair follicle irritation. To remedy, use
a hair dryer to the skin (low setting); sprinkle a small amount of powder
(karaya, stomahesive) on the skin, wipe off the excess, then blot with a
skin sealant to seal the powder to the skin. Make sure it's dry before
applying the faceplate. Wearing a pouch belt too tight may also break the
seal. If the rash does not clear up in two to three days, consult an ET
nurse. Ulcerated areas can appear anywhere on the stoma because the stoma
opening of the pouch was too small and/or activities were causing the
faceplate to rub or cut into the stoma. To remedy, enlarge the size of the
pouch opening. (The opening should be at least 1/8 inch larger than the
stoma.) Evaluate your activities; you may need a different size or shaped
face plate; loosen your belt; if too tight, the belt may cause the face
plate to press into the stoma. If this does not help in clearing up the
ulcerations around the stoma in two to three days, consult an ET nurse.
Infected or irritated hair follicles under the face plate, raised red areas
(similar to acne) at the shaft of the hair follicle, are caused by not
keeping the area under the faceplate shaved. To remedy this, you must let
the irritation improve before removing anymore hair by shaving or cutting.
Use a hair dryer and/or very low heat lamp to dry the skin if oozing is
present Use a skin barrier between skin and pouch adhesive until irritation
improves. If irritation doesn't clear in two to three days, consult your ET
nurse. Weeping skin can prevent a pouch or a skin barrier from adhering to
the skin for long periods. If your skin is severely irritated and weeping,
it may be necessary to change your pouch more frequently to prevent leaking
and further damage.

DEALING WITH SKIN ULCERS
Via: Rock County, WI Chapter & GB News Review
Persons with ostomies might experience some form of skin breakdown from time
to time. But "skin ulcers", which are very painful, are not common. A skin
ulcer is an open wound; it can be close to the stoma or an inch or more
beyond the base of the stoma. Many people who have experienced skin ulcers
are under the impression that they are caused by the cement or seal which
keeps the appliance adhered to the body. Up until now, we have never found
this to be true. All cases of skin ulcers that we have seen have been due
to: Belts worn either too loosely or too tightly. Belts moving away from the
original position or slipping. A poor fitting appliance disc. Although skin
ulcers are not dangerous, they are painful. If they are neglected they can
take more than two weeks to clear up. If you are having problems with skin
ulcers, see your doctor or ET nurse to find the cause and cure as quickly as
possible.

ILEOSTOMY ABSORPTION CONCERNS
Via: Marshfield, WI, Chipewa Valley, WI & S. Brevard, FL
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 in this way.


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. This often results in an evil-tasting mixture, but absorption is
ensured. 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 paletable treatments, these dosage forms ensure that the
medication prescribed will be absorbed. A pharmacist can assist in choosing
the form of a medication that will be best absorbed. After ileostomy
surgery, never take laxatives. For a person who has an ileostomy, taking
laxatives can cause severe fluid and electrolyte imbalance. Transit time
through the digestive system varies with individuals. If food passes through
undigested, be aware that this may be a sign that nutrients are not being
absorbed properly. Prolonged incidents of decreased absorption may lead to
various nutritional deficiencies.

ORIGINS OF OSTOMY SURGERY
Kerylin Carville, RN, BSc, (NSG) Silver Chain Nursing Assoc. Perth, Western
Australia
And Ehud put forth his left hand and took the dagger from his right thigh
and thrust it into his belly. And the shaft also went in after the blade;
and the fat closed upon the blade, so that he could not draw the dagger out
of his belly, and the dirt came out. Judges 3:21-22 (King James Version).
Ehud's mortal appears to be the first recorded observation of a traumatic
opening into the bowel. The origins of ostomy surgery are entrenched in the
antiquity of surgery. This is not difficult to comprehend when one considers
the history of violence and wars that has accompanied man's journey down
through the ages. Hippocrates 460-377 BC it is appropriate, the word 'stoma'
has its origins in the ancient Greek language for they were often at war and
appeared to have had considerable experience in perforating injuries of the
abdomen. Ancient Greek physicians such as Hippocrates (460-377 BC) and
Celsus (53-7 AD) wrote that wounds of the large intestine were not deadly,
whereas wounds of the large intestine and bladder were (Richardson 1973).
Another ancient medical figure was Galen (139-200 AD), who was a surgeon to
the Emperor Marcus Aurelius and the Roman Gladiators, and one presumes very
experienced in traumatic perforations of the abdomen. In his prolific
writings, he discussed surgical management of the large intestine and
abdominal wall following penetrating injuries, however, he believed little
could be done to save the person with a rupture of the small intestine
(Haeger 1989). Throughout the ages, military surgeons have been presented
with great challenges in caring for traumatic wounds. These challenges were
exacerbated from the 14th century onwards, for it was in 1346 at Crecy that
artillery was first used in battle (Leavesley 1996). Those that survived
traumatic injuries to the abdomen, it seems did so largely Survived
traumatic injuries to the abdomen, it seems, did so largely as a result of
human endurance rather than on account of surgical skill. Cromer (1964),
reported that soldier George Deppe, who was wounded at Ramillies in 1706,
lived for 14 years with what appeared to be a severely prolapsed
double-barrelled colostomy. Acute bowel obstructions and perforations not
only within the realm of the military, but royalty, has been sorely
affected. King Stephen of England died in 1154 with what was termed "iliac
passion", a Saxon term described in 923 AD as "a disorder in which a desire
cometh upon a sick man for discharging his bowels, and he is not able, when
he is out in the outhouse (Brooke 1980, pl)." The first recorded royal,
though not the last, who had an ostomy was Queen Caroline, wife of George
II, who died in 1736 from a strangulated umbilical hernia. She endured 7
days of suffering before her gut ruptured, but also to no avail, for she
died 3 days later (Leavesley 1996). William Cheselden (1688-1752), a British
surgeon, had a 73-year old patient, Margaret White, who ruptured her
abdominal wall following severe vomiting. Cheselden removed the gangrenous
portion of prolapsed gut and left the sound portion, thought to be small
intestine, hanging through her umbilicus (Richardson 1973). Although she
lived for some years, we are left to ponder how she may have managed her
ostomy. Surgeons of that period were reluctant to operate on the bowel for
fear of peritonitis and inevitable death to the patient This was not only
harmful to a surgeon's reputation, but the major stimulus for what is
considered today, as bizarre medical practices. These included purging with
laxatives and enemas, attempted dilation via the anus, bloodletting and
consumption of large amounts of mercury in the hope that the heavy weight of
the substance would push through the obstruction. Death, due to mercury
poisoning was a common side effect (Leach 1986). Thomas Sydenham, a noted
London physician during the mid 1800's, recommended horseback riding as a
means to assist the passage of stool through the obstructed gut and his
treatment for paralytic ileus was to keep a kitten on the distended abdomen,
presumably for the warmth (Leavesley 1996). Failed treatments such as these
usually resulted in the death of the patient.

LACTOSE INTOLERANCE
By: Dorothy Vaillancourt, RN, CETN,
Many people are bothered by this problem, some to mild degree, others to a
great degree, and still others who may even become incapacitated by it. What
is Lactose Intolerance? Lactose intolerance develops when the body has
difficulty digesting whole and skim milk and other dairy products. Lactose
is a milk sugar and like most sugars, it is broken down by enzymes in the
intestinal tract so it can be absorbed as an energy source. The enzyme that
breaks down lactose is 'lactase'. When the intestine does not contain
lactase, then lactose intolerance can occur. Who has lactose intolerance?
Infants and children have the enzyme lactase so they can digest mother's
milk. However, lactase begins to disappear in many people. Some ethnic
groups are more likely to develop lactose intolerance. Seventy-five percent
of African-Americans, Jewish, Native Americans, Mexicans, and 90 percent of
Asians are apt to develop the condition. When undigested lactose reaches the
colon, it is broken apart by bacteria. Lactic acid and other acidic
chemicals result. It's these products that create the symptoms of lactose
intolerance. The symptoms include nausea, abdominal cramps, rumbling,
bloating, rectal gas and diarrhea. They usually occur 30 minutes to two
hours after eating lactose-containing foods. The severity of symptoms
usually depends on the amount of lactose ingested and how much of the enzyme
lactose remains in the intestinal tract. Diagnostic Tests;
To make a definitive diagnosis, one of several tests may be needed:
* Lactose Tolerance Test: A test dose of lactose is ingested and blood
sugar determinations are made over several hours. If no lactose is present,
the blood sugar does not change.
* Hydrogen Breath Test: When lactose is broken down by the colon's
bacteria, hydrogen is released which then passes out through the lungs. The
amount of hydrogen after a lactose meal can indicate a problem.
* Stool Acidity Test: When lactose breaks down to lactic and other acids in
the colon, the resulting acidity can be detected by a simple measurement of
stool acidity.
* The Home Do-It-Yourself Test: You may want to do a test of your own at
home. First avoid milk and lactose-containing foods for several days. Then
on a free morning, such as Saturday, drink two large glasses of skim or
low-fat milk (14 oz). If symptoms develop within four hours, the diagnosis
of lactose intolerance is fairly certain. Treatment: Therapy is dependent on
whether a patient is willing to tolerate the symptoms. If the symptoms are
mild, just avoiding large amounts of dairy products may be enough. If
symptoms are more intolerable, there are two options. First, all food should
be carefully checked for lactose. This can be a chore and you may have to be
quite a detective, since foods such as bread, bakery goods, cereals, instant
potatoes, soups, lunch meats, salad dressings, pancakes, biscuits, cookies
and candy may contain hidden lactose. Even prescription and over-the-counter
drugs may contain lactose. You must become a label reader, looking for and
avoiding milk and lactose. Buying products, such as milk, which have had the
enzyme added to them and buying over-the- counter lactose tablets that can
be taken with meals to replace the enzyme the body no longer has, is a good
way of controlling symptoms.

Evansville Ostomy Chapter Monthly Newsletter Archive:
http://www.ostomy.evansville.net/menunews.htm

rob hooper

Hi Larry,

Thanks for posting the newletter diirectly to the newsgrouop.

Rob

sean

I second that. A direct posting is going to attract more readers than a
link to an external website.

The only disadvantage with this is that Larry can't see how many people are
reading the newsletter Sean
<snip />

bonnie

Great info Larry

Bonnie

ron g

Hi Larry---

Glad to see you continuing.
As a previous webmaster, I understand how many people you help.
Best to you---
Ron

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