The Newsletter of The Winnipeg Ostomy Association


March/April 1999


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Does Having An Ostomy Limit My Physical Activities?


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NOTICE

Articles and information in this newsletter are not necessarily endorsed by the Winnipeg Ostomy Association and may not apply to everyone. It is wise to consult your E. T. or Doctor before using any information from this newsletter.

Does Having An Ostomy Limit My Physical Activities?

I WOULD LIKE TO DO SOME SWIMMING AND GOLFING THIS SUMMER

Since a person with an ostomy is, first of all, a person, his or her reason for choosing any kind of physical activity is basically that of anyone else, to feel good, to be healthy and to enjoy the activity.

After recovery from surgery, an ostomy is no hindrance to physical activity. You are free to consider running, jogging, swimming, sailing, skiing, bowling, golf, cycling and tennis, to name a few. There are people with ostomies participating in gymnastics, fencing, football, skydiving, skin diving and hockey. Name the sport and there is no limit Not everyone, though, is meant to be this active but physical activity is encouraged. Even the simplest exercise does wonders for firming the abdominal muscles, boosting one's appetite and keeping the digestive tract in good order. Walking and swimming are among the best activities.

When returning to an activity or first trying a new sport, here are a few suggestions.

  1. Check with your doctor. Your physician can advise you on any limitations imposed either by your surgery or your general condition.
  2. Pick a sport that is fun. Exercise should be relaxing, comfortable and fun! Exercise is not meant to punish the body.
  3. Take it easy at first. Building muscles and endurance happens slowly. You need to take it easy during the first few months after surgery. This may mean slower hiking pace or only a lap or two of the swimming pool.
  4. Use the right equipment. You may add a belt to your appliance system to make it more secure. Close fitting jockey shorts may help hold the pouch against the body. Start your exercise with an empty pouch. Picture frame the appliance with paper tape to reinforce toe edges of the skin barrier. Replace fluids lost in perspiration by drinking extra fluids.
  5. Keep at it. It takes time for the benefits to show. Regular activity pays far more dividends in terms of health, looks and energy than intense sports.
For additional information about physical activity, contact your ET nurse.

Claire Westendorp, RNET, Kingston. ON Chapter.

Via Metro Halifax News May 1998, & Halton-Peel Counties.

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From the President's Desk

It is early March (the 5th) and I am reminded of the old saying "in like a lamb, out like a lion". In the Winnipeg area we have had the Lamb, let's hope the Lion stays away. Having said that we, will probably receive 200 or so centimeters of snow between now and the beginning of May!!

I do hope all who read this have wintered well and that you are looking forward to the warmer weather.

Now to some business.

Notice is hereby given that the Annual Election of Officers for the Winnipeg Ostomy Association will be held on Wednesday April 21, 1999, in the Auditorium of the St. Boniface General Hospital during the monthly chapter meeting, which begins at 7:30 p.m. All executive positions are open and those elected will assume their positions on September 1, 1999.

Helmut Friesen has agreed to act as chair of the Nominating Committee. Should you wish to volunteer for any Executive Committee position please give Helmut a call either at work, 786-7352 or at home 888-1404. I have indicated to Helmut that I will be standing for reelection as President.

I would ask all of you to seriously consider volunteering. We normally have 9 executive meetings a year along with eight chapter meetings. We need people who make attendance at meetings a priority. It can be very frustrating when, because of other commitments, executive members miss meetings. An executive committee member must make the Winnipeg Ostomy Association a priority in order to best serve their fellow members.

Enough of the soapbox. Somewhere else on this page you will read of a recommendation from the executive pertaining to the National Conference in August. We hope to encourage a good attendance from the W.O.A.

The May Chapter meeting will be in the form of our Annual Wine and Cheese. Forms will be available at both the March and April meetings for those who wish to donate for the Wine and Cheese Party.

See you at the meetings,

Dave


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If Odor and Gas Are Problems

Many ostomates find that controlling odor and/or gas is their greatest challenge. In addition to pouch deodorizers and air fresheners, you can help to control odor by eating regularly and by avoiding certain foods if they cause you problems. Gas production is reduced when you eat three or more times a day. Skipping meals may actually increase gas production.

Everybody reacts to foods differently. You'll have to experiment to see how foods affect you.

Foods that may increase the odor of your stools include:

Avoid eating too many of these foods in a 24-hour period if they cause a problem for you.

Foods that may HELP to DECREASE the odor of your stools include:

Certain fluids tend to increase gas production. You may wish to avoid them before certain situations where increased gas may cause embarrassment. Some possible gas producers include: If you have a urostomy, be aware that some foods may increase urinary odor. These include asparagus, fish, onions and certain medications. A WORD OF CAUTION: urinary odor may be the first sign of a urinary tract infection. Contact your physician if odor lasts for more than 24 hours.

REMEMBER: There's no need to limit these foods if they don't cause you problems. But if they do, odor and gas can be minimized if you eat the foods listed above in small quantities and chew them well. If you continue to have problems with odor and gas, see your physician, enterostomal therapy nurse or dietitian.

Reprinted from a NUTRITION HANDBOOK FOR OSTOMATES,by Diane Drasnew, RN, MD,ET and Diane Arculus, RD

Via Akron Ostomy News & GB News Review

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Controlling Leg Cramps

If you have been jolted awake by a leg cramp, you know how sudden and intense the pain can be. Several factors, including dehydration, the use of diuretics or overuse of your muscles can trigger leg cramps, which usually occur during rest or sleep.

For relief, straighten your leg and point your toes upward while you gently rub the cramp to help the muscle to relax. For a calf cramp, stand up and put your weight on the cramp, keeps both legs straight and lean forward at the waist. Use a cold pack to relax tense muscles. Use a warm towel or heating pad later if pain or tenderness persists. To prevent cramps, stretch daily. Before bed, stand 2-3 feet from a wall, placing your hands on the wall. Keep your heels on the floor. Lean toward the wall and bend one knee, hold ten seconds, straighten your leg. Repeat with the other knee. Stretch each leg 5 to 10 times.

Drink 6 to 8 cups of water daily. Fluids help your muscles contract and relax. Try not to sleep with your toes pointed (as people tend to do when sleeping on their back or stomach). Sleep on your side, don't tuck your sheets and blankets too tightly as then can bend your toes down.

Your doctor may prescribe a muscle relaxant for frequent leg cramps.

Source: Mayo Clinic Health Letter; S. Nevada's Town Karaya, Snohomish, Metro Halifax News, Sept/98

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What You Should Know About Blockage

By Henry C. Finch, M.D.

The small and large intestines are as different in function as are the arm and leg. The primary function of the small intestine is to take nutrition from digested foods. The function of the large intestine is to absorb water out of the food residue. Consequently, there is a difference in the discharge from ileostomy, colostomy or rectum.

The discharge from the small intestine, which functions on liquid material and moves contents forward quickly, is liquid and soft.

In the large intestine, the contents are changed from liquid to solid (through the process of absorbing water). The movement is much less rapid, and the discharge is solid or even hard.

Movement of the food mass through the small intestine is never more than a few hours. Movement through the large intestine frequently takes from 48 to 72 hours. Thus, when anything blocks the forward motion of the stream of the small intestine, an immediate chain of events is set up. There is pain, then gripping and cramping. Later if there is no forward motion, a backward motion of fluid occurs, involving vomiting.

The most frequent cause of the onset of this chain of events is blockage at the ileostomy stoma. Usually this is precipitated by undigested food - a bean, pea, peanut, corn, pulpy- type foods or something similar to those.

The best way to handle a blockage is not to allow it to occur in the first place. This is done by chewing foods well. However, if symptoms of blockage occur, notify your doctor and follow his or her advice. As blockages may arise from other causes than undigested food particles, observe these two cautions:

DO NOT take any kind of laxative without your doctor's order. Any laxative may cause additional difficulty.

DO NOT take any medication for pain without your doctor's order. It may mask a symptom that the doctor needs to know about.

HELPFUL HINT: Keep grapefruit juice in the refrigerator. Some symptoms of a blockage can be relieved with a drink of grapefruit juice. It can work wonders sometimes. Editor's note: Grape juice has also been recommended.

Via Metro Maryland & GB News Review 6/98

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Generally Speaking, The Truth About Volunteers. . . .

Volunteers aren't people who happen to have spare time and need something else to do. Volunteers aren't people who have lots of money and don't have to work. Volunteers aren't people who are set up in offices with lots of equipment and supplies to help them accomplish their tasks.

Volunteers are people who want to make a difference. Volunteers are people who are already busy. Volunteers are people who not only donate their time, but many times, also the use of their equipment and supplies. Volunteers are people who do not look for rewards or returns. Volunteers are people who have big shoulders, big hearts, and the blessed spirit of serving. Volunteers are people who truly give.

I have a dear friend who has remarked that "serving is a way of loving". He has a sign in his shop that says, "I am here to serve you." He is one of my heroes.

And I might add, I've seen glad volunteers and sometimes mighty mad volunteers, but I don't think I've ever seen a sad volunteer.

Source: C.J Avery; Dallas Area Chapter; Metro Halifax News, October 1998

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Ostomy Myth Series, Part 3

By Barbara Skoglund of Maplewood, MN
barbara.a.skoglund-1@tc.umn.edu
Pegasus
This is part 3 of Barbara Skoglund's "Ostomy Myth" series. This series began on the Internet, in the alt.support.ostomy and alt.support.crohns-colitis newsgroups. Barbara Skoglund graciously rewrote her newsgroup postings for Inside Out. Thank you Barb! Further myths will appear in future issues.

MYTH SEVEN - MISCONCEPTIONS

This one is more of a misconception than a myth.

Nurse: "How long have you had a colostomy?" Barbara: "I don't have a colostomy. I have an ileostomy." Nurse: - "What's that?"

There are many different types of ostomies and continent ostomies and internal pouches. Yet some people seem to call them all colostomies. Drs., nurses, ostomates themselves seem to lump ostomies together. One type of ostomy isn't inherently any better than another (except the loop - anything is better than a loop) but they are all a bit different. Colostomy, Ileostomy, Loop ileostomy, Urostomy, Continent Ileostomy, Koch pouch, BCIR, Indiana pouch, J pouch, S pouch, W pouch, kangaroo pouch - What are the differences?

OSTOMY

- The word ostomy signifies a type of surgery required when a person has lost the normal function of the bladder or bowel due to birth defects, disease, injury or other disorders. Such operations include colostomy, ileostomy and urostomy. The surgery allows for normal bodily wastes to be expelled through a new surgical opening (stoma) on the abdominal wall. Most persons with ostomies must wear special appliances over the stoma.

COLOSTOMY

- The most common type of ostomy is the colostomy. Depending on location and nature of the individual's problem, a stoma may be constructed in any of the parts of the colon. While there was a time when most colon cancer patients ended up with a colostomy, today they rarely do. The key is location, location, location. If the cancer is in the anus or rectum then a colostomy is probably part of the cure. Other diseases often resulting in colostomy, is diverticulitis, inflammation of small pockets in the wall of the colon that become inflamed, and sometimes cause obstruction, bleeding or perforation. There are also accident and gunshot victims who have temporary and permanent colostomies. Birth defects can also require a colostomy. Some colostomates can "irrigate," using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. Folks who irrigate can avoid wearing an appliance.

ILEOSTOMY

- An Ileostomy is a surgically created opening in the ileum. The ileum is surgically cut into two pieces, usually as close to the end of the ileum as possible. The proximal portion of the ileum is brought to the surface of the abdomen and a stoma is created. In most cases, the distal ileum and the entire colon are then removed. The greater the length of small intestine removed, the greater the loss of nutrient absorption. Over time, the remaining ileum will adapt and take over part of the absorptive capabilities of the colon. Ileostomies can not be irrigated and the flow of stool can not be controlled. We must always wear an appliance.

LOOP ILEOSTOMIES

are temporary ileostomies where a loop of small intestine is pulled through the abdominal wall to create a stoma. From my experience it can be very difficult to find a properly fitted appliance for a loop ileostomy.

CONTINENT ILEOSTOMY

- Here a reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch that is brought through the abdominal wall. A catheter or tube is inserted into the internal pouch several times a day to drain feces from the reservoir. Koch and BCIR are the most commonly performed continent ileostomies. They are named after the Drs. who designed them. The BCIR is a revision on the Koch and is only performed in a few facilities in the US. Continent folks don't wear an appliance.

UROSTOMIES

result when the bladder is removed or the normal structures are being bypassed and an opening is made in the urinary system to divert urine. A piece of ileum is used to create a urostomy stoma from which urine flows. Birth defects can also require a urostomy. Urostomies can not be irrigated and the flow of urine can not be controlled. They must always wear an appliance.

CONTINENT UROSTOMY

- There are two main continent procedure alternatives to the ileal or cecal loop (others exist). In both the Indiana and Koch Pouch versions, a reservoir or pouch is created inside the abdomen with a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir. In the Indiana Pouch version, the ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch that is made from the large bowel. With a Koch Pouch version the pouch and a special "nipple" valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted. Continent folks don't wear an appliance.

J POUCH, S POUCH, AND W POUCH

are internal pouches formed from the terminal ileum and connected to the anus. The j-pouch has become the surgery of choice for people with severe ulcerative colitis or familial polyposis. These procedures are not done on folks with Crohn's Disease since Crohn's disease can pop up anywhere. This procedure is done in 1, 2 or 3 steps. Folks who have the 2 or 3 step procedure have a temporary loop ileostomy while their internal stitches heal. These internal pouches are named for their shapes. They are also called ileoanal anastimosis, pull through, endorectal pull through, pelvic pouch, or a combination of these terms. I lived for 3 years with a straight ileoanal anastimosis - I also frequently refer to it as a straight shot. Straight shots are rarely performed (because they rarely work.)

KANGAROO POUCH

- where baby kangaroos nourish and grow.

(Thanks to UOA and Convatec's Web Sites for some of the more technical definitions.)

MYTH EIGHT - "I'VE NEVER MET ANYONE WITH AN OSTOMY."

HA! That's what you think.

There are only two ways you can "tell" if someone has an ostomy: 1. They tell you. 2. You see them in the nude.

Believe it or not you have met many ostomates in your lifetime. You just don't know it because they haven't told you.

I used to think I'd never met any ostomates. The week before my surgery to install my permanent ileostomy I was in a union meeting at work. I was sitting next to the president who was also taking leave during Christmas for surgery. She was having glaucoma surgery and asked me what I was going in for. Although I'd made up my mind to have the surgery, I wasn't going to tell anyone. So I mumbled something about intestinal surgery. She said, "Oh, do you have Crohn's?" I said, "No, colitis." "Oh, are you having an ileostomy?" asked Susan. "Umm. yes." uttered honest Barb. "Rob (her partner) has Crohn's. He's had an ileostomy for years." Oh, my. I'd outted myself for the first time and lo and behold it was to a woman whose partner had an ileostomy. I still wasn't going to tell anyone. Well - I told folks on the internet, but it's a lot easier to tell people via a computer than in person. It was nice that Susan understood, but I sure wasn't going to say anything to anyone else. Then my health insurance company told me that my ostomy supplies were unnecessary convenience items. Mind you if I was a man who needed a penile implant or if I wanted a bedpan they would pay for it. So out I came in full force. I told everyone - my legislators, all of the state employee unions (I'm a state employee,) the newspapers, any and everyone who might be able to put pressure on my insurance company. It worked and after 5 months I won ostomy supply coverage for all State of Minnesota employees - no matter what insurance company they had chosen. (4 of our 6 plans covered supplies - just mine didn't.)

I'm now very OUT about my ileostomy. No, I don't walk up to strangers and say, "Hi, I'm Barbara and I have an ileostomy." But I don't hide it. I mentioned it in my annual holiday letter when I had my surgery. When a co-worker lost her dad to colon cancer I offered my condolences and noted that I understood a bit how difficult it was since I had started developing cancer and had to have my colon removed. "Oh, how can you live without your colon?" I said - "I have an ileostomy." When it's appropriate I discuss it. I'm open to share my experiences with others and share how much better my life is now. I'd speculate that I'm much more "out" than many of my fellow ostomates. I felt forced into that situation when I had to fight my insurance company and I'm also a very self- disclosing person to begin with. Some ostomates only tell intimate family members, others are out like me. Most probably fall somewhere in between.

I'm sure everyone has met an ostomate - they never even knew it. We are everywhere.

For Next Myth, Click here


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Things to Keep In Mind

  • Be nice to your kids. They'll choose your nursing home.
  • 2 kinds of people: those who can count and those who can't.
  • Why is "abbreviation" such a long word?
  • Don't use a big word where a diminutive one will suffice.
  • For people who like peace and quiet: a phoneless cord.
  • The beatings will continue until morale improves.
  • Mental floss prevents Moral Decay.
  • Madness takes its toll.
  • Please have exact change.
  • Proof read carefully to see if you any words out.
  • I'd explain it to you, but your brain would explode.
  • Ever stop to think, and forget to start again?
  • A conclusion is simply the place where you get tired of thinking.
  • I don't have a solution but I admire the problem.
  • Don't be so open-minded, your brains will fall out.
  • If at first you DO succeed, try not to look astonished!
  • If one synchronized swimmer drowns, do the rest have to drown too?
  • If things get any worse, I'll have to ask you to stop helping me.
  • If I want your opinion, I'll ask you to fill out the necessary forms.
  • It's not hard to meet expenses, they're everywhere.
  • Help Wanted: Telepath. You know where to apply.
  • Look out for #1. Don't step on #2 either.
  • Budget: A method for going broke methodically.
  • Shin: A device for finding furniture in the dark.
  • Department of Redundancy Department.
    Via Rambling Rosebud, Via Ostomy Toronto September 98.

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    Infections In Urostomates

    Germs are all over the world. When they are in the urinary tract, either in the conduit or ureters of the kidneys, they are in an abnormal location, and that is what causes an infection. Infection of the kidneys is the most common long-term complication.

    What causes infection? Mostly, the reasons are unexplainable. Why do some people get more colds than others do? Infection can be caused by an obstruction, kidney stones, tumours, cysts, or scar tissue. Almost synonymous with obstruction is infection. And then, too often comes stone formation. Once you have stone formation, you can't get rid of the infection. It's kind of a cycle that goes round and round. Obstruction is a cause of kidney damage, not just infection.

    Infection can be caused by urine being forced back to the kidneys through the conduit. This could happen if a person fell asleep with the appliance full of urine and accidentally rolled over on the bag, causing urine to be forced back into the stoma through the urinary tract with tremendous pressure. Invariably, the urine in the appliance is contaminated. Germs are not healthy to have in the kidneys.

    Town Karaya, South Nevada, via Niagara Frontier Ostomy Assn., via Brantford 1/96

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    Visitor's Report

    By Anne Lecot

    Patients with the following ostomies were visited in January and February 1999:
    Colostomy - 9
    Ileal Conduit - 2
    Ileostomy - 6
    Pelvic Pouch - 0
    Urostomy - 0
    Total = 17


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    Editor's Comment

    This is the electronic version of The Winnipeg Ostomy Association's newsletter, Inside Out. The newsletter includes articles from other United Ostomy Association chapter newsletters and these are credited at the end of each article. Please credit the source as well as Inside Out Online if you wish to use any of this newsletter.

    LETTERS TO THE EDITOR & SUBMISSIONS

    Submissions and Letters to the Editor can be mailed to:
    The Editor, Inside Out,
    130 Woodydell Ave,
    Winnipeg, Manitoba,
    Canada. R2M 2T9.
    All submissions are welcome, may be edited and are not guaranteed to be printed (but I'll make every effort).
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    Last updated June 15, 2001. Comments to: Mike Leverick