The Newsletter of The Winnipeg Ostomy Association

September/October 1995

Inside This Issue

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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.


Forgive Our Trespasses

by Anne M. Lecot.

It seemed like a nice clear day - windy and cool, but my brother and I set off for our usual "no place in particular" drive. We got over to the south western area of the city and drove until we saw a mud road that was dry and smooth, so off we went. After a few miles we came to a dead-end fronting a huge field of stubble. In the distance we thought we saw a gravel road cutting through - it appeared firm and dry. Undaunted, we set off. Of course somewhere in the middle we hit a wet spot and were soon deeply imbedded! We struggled for a long time - only going in deeper. My brother got out his shovel and tried to dig up a piece of sod to fill in the hole behind the wheel. The soil was wet gumbo and impossible to dig.

Finally, we assessed our situation - not a soul or building or farm for miles. Way off in the distance reflecting in the sun we saw a group of buildings like a mirage in the desert. There was not a choice - we set out across the fields. The stubble was not easy to walk on, a cold wind impeded our progress. It took over 2 hours to make it but we finally arrived at the Sturgeon Creek Colony. We are not young, 82 and 74 years respectively, so we were exhausted upon arrival.

We were greeted by a very kind women who on hearing our plight, led us into the community dining room. Within minutes bowls of hot soup were placed in front of us followed by a delicious meal consisting of smoked turkey, sautied potatoes, hot rolls, rice pudding and a cup of tea. One could never describe their hospitality. One of the men came over to talk to us, to get the location (approximate) and colour of the car, etc. Two young men came and asked for the keys. They told us to just rest and not to worry. They had a tractor and a truck - the car would be out and back in no time.

Emma, our hostess, stayed to visit with us. We learned some of their ways and customs. She took us to her home to clean up and us the bathroom, etc. We then went back to the dining hall to await the arrival of our car. When we left the car it was plastered with mud - huge chunks thrown up all over the roof and sides, (the car is white). The front wheels were solid mud and deeply buried.

Over an hour later the lads arrived back. We couldn't believe what we saw! They had washed it to a clean sparkle. Not a speck on mud anywhere, the had to take off the wheels to clean under the fenders, etc. It was beautiful! They did the inside as well, cleaning the floor mats, etc. Well, when asked how much we owed them they said "Nothing". Of course we insisted they take something for their trouble.

It was such a good feeling to meet these people. They are surely a credit to our society. There was no criticism or mention of how foolish we were, after all we were trespassing on their land! To sum it all up it was a great experience. What a blessing to meet such kind people and get to know them and their ways. We are certain we will never forget them and we hope to visit them again soon (using the conventional roads!).

Emma phoned me the next morning to see if we had arrived home safely and to find out how we were. We were very grateful for their genuine concern.

Anne Lecot is a member of the Winnipeg Ostomy Association.


Visitor's Report

By Christel Spletzer

Patients with the following ostomies were visited in May, June, July and August:
Colostomy - 15
Ileal Conduit - 1
Ileostomy - 6
Pelvic Pouch - 0

When You Know You've Got Trouble

Ostomates in general, as individuals, are not happy and healthy due to their surgery. They are no longer in trouble due to illness. So there should be a way to know when they are in trouble. . . .

You know you've got trouble when you:

Sunrise, Medford, Oregon via Kenosha-Racine, 1/90

Pouchitis

Joan Blair, RN, Research Nurse,
Disease Centre Pelvic Pouch Newsletter, November, 1994

In the past patients with ulcerative colitis or familial polyposis faced the prospect of either having their entire colon removed and being left with a permanent ileostomy or persevering with their persistent ill health with the risk of developing a malignancy in the diseased colon. With the development of the Kock and pelvic pouches, patients have new options when surgical removal of the colon is necessary. For a majority of patients the pouch procedure is the procedure of choice. Construction of the pouch involves making a reservoir or pouch from the small bowel and either emptying the pouch with a catheter (Kock Pouch) or connecting the pouch to the remaining 1 to 2 cm of rectum (Pelvic Pouch). For most patients this reservoir functions satisfactorily with 4 to 6 bowel movements in a 24 hour period. One complication of these new procedures is the inflammation of the pouch or pouchitis.

Pouchitis is a well recognised condition that can involve part or all of the pouch and may sometime involve the adjacent intestine. Approximately 10 to 25 percent of patients may experience an episode at some time. Pouchitis is characterised by crampy abdominal pain, diarrhea which may be bloody, frequency and general tiredness. In severe cases pouchitis may also result in weight loss, fever and arthralgia. Episodes of pouchitis are usually short- lived and generally respond to drug therapy. To diagnose this condition the pouch is examined and biopsies are taken. Once a diagnosis is established, pouchitis is routinely treated with a 10 to 14 day course of antibiotics.

Although the cause of pouchitis is unknown, it is felt that bacteria may be one underlying factor since the condition responds to broad-spectrum antibiotics. Whether bacterial overgrowth or other factors contribute to this condition, has yet to be established.

At the present time it is our tendency to do the following, when a patient presents with ulcerative colitis requiring surgery and is not particularly ill, we prefer to do a colectomy and proctectomy, and to create a pelvic pouch with a defunctioning ileostomy. Three months later, the ileostomy is closed. If a patient is ill at the time of surgery, we do the colectomy portion first. This allows time for the patient to recover from the illness and operation, and to be off all medications. When health is restored, the patient returns to the hospital. A pelvic pouch procedure is performed, often without an ileostomy. However, when a hand sewn anastomosis is performed as opposed to a stapled anastomosis, we almost always defunction the pelvic pouch with an ileostomy.

Complications
One of the most important objectives over the next few years will be to define the cause and management of pouchitis. This syndrome characterised by inflammation within the pouch, may be similar to the actual inflammatory bowel disease that develops. Further studies in this area will certainly be useful, the surgical technique itself will not change considerably in the future. The advent of laparoscopy with technological advances may allow us to do the entire procedure using a closed laparoscopic technique. However, this still awaits further technological improvement. Early post-operative complications include an anastomotic or pouch leak with or without local infection, pelvic abscess, small bowel obstruction, and ileostomy complications. Late complications may involve bladder or sexual difficulties, narrowing of the anal anastomosis, perianal skin irritation, bowel obstruction and pouchitis. Pouchitis occurs quite frequently and is usually successfully treated with antibiotics.

Future Considerations
The answers to controversial issues still need to be determined. Whether or not it is essential or dangerous to leave anorectal mucosa needs to be studied further. The need for a defunctioning ileostomy is currently being assessed.

Via Metro Halifax News.


Ostomies and Childbearing

by David A. Morowitz, M.D.

A common concern of many female ostomates pertains to their ability to successfully conceive and bear children. For younger women, especially those who have had surgery for ulcerative colitis, this question is of particular importance.

For a long time, it was felt that women with an ileostomy or colostomy should not attempt childbearing because the loss of a rectum would in some unexplained way, render childbirth or delivery difficult.

Physicians and patients were concerned whether an enlarged uterus might compress a stoma from the inside of the abdominal wall. Fortunately, enlarging on clinical experiences of a great many courageous patients and intelligent physicians, we have concluded that the presence of a stoma with a past history of extensive abdominal and rectal surgery, is no real barrier to conception.

In ileostomates, reproductive function is normal, with no unusual alteration in the sensory of motor capabilities of the system. An enlarged uterus has not been known to interfere with the normal passage of the intestinal contents.

The contour of the abdomen will change with pregnancy and may require some modification in the appliance one uses, but this change is temporary. The major obstacle encountered by younger ostomates to the problem of childbearing is usually emotional in nature. They frequently labour under the burden of superstition and rumour and, not infrequently, inaccurate medical advice.

One former patient recalled a nurse in the delivery room insisting that she have an enema. This patient was an ileostomate. Between labour contractions, she had to convince the nurse that an enema was not only unnecessary, but impossible!

Metro Maryland via Brandon Oz-Tummy News.


How to Avoid Leakage of Your Appliance.

Article by Maria Siegi, Ostomy International

There are many reasons why ostomy pouches leak. Below are 10 of the most common problems, with suggestions for handling them. For further information, consult your physician or ET nurse.

Poor Adherence to Peristomal Skin
Make sure that your peristomal skin is "bone dry" before applying your pouch. Hold a warm hand over the pouch and stoma for 30-60 seconds after application, to warm it and assure a good initial seal.

Wrong Size of Pouch Opening
If the size of your stoma has changed (due to post- operative shrinkage or change in weight) and you have not re-measured and adapted the opening accordingly, undermining of the wafer and leakage may result.

Folds or Creases
If folds or creases develop in the skin, and leakage occurs along the crease, wafer pieces or ostomy paste can be used to build up the area in order to avoid leakage. Consult your ET nurse for proper methods.

Peristomal Skin Irritation
Pouches will not stick well to irritated skin. So, perform meticulous skin care in order to avoid irritated or denuded skin. If any of these problems develop, consult your ET or physician at once, so that the problem can be nipped in the bud.

Improper Pouch Angle
If the pouch does not hang vertically, the weight of its contents can exercise an uneven twisting pull on the wafer and cause leakage. Ostomates must find an optimal angle based on individual body configuration.

Too Infrequent Emptying
Pouches should be emptied before they become half full. If they are allowed to overfill, weight of the affluent may break the seal and cause leakage.

Extremely High Temperatures
Wafer meltout may cause leakage in warm weather. More frequent pouch changes or a change in wafer material may be needed to avoid leakage.

Pouch Wear and Tear
Disposable wafers do wear out. If you are stretching your wear time, leakage may be due to the wafer wearing out. Change your appliance more frequently.

Improperly Stored Appliance and Ageing Materials
Store your ostomy supplies in a cool dry place, humidity may affect your pouch adhesive. Appliances don't last forever. Ask your vendor what the recommended shelf life is for your brand of pouch. Keep some extra pouches on hand.

Via Redstone Ostomy Chapter, 5/95


Being an Ostomate

What Will Happen to You? How Will You Feel and Act?

Will You Bulge? Remember, without a part of the intestine or bladder, and its contents, you should have a flatter tummy than before. You can expect to wear, with little exception, what you wore before - and this includes tight clothing and (except for bikinis) bathing suits.

Will You Smell? Those with ileostomies and urinary diversions will be fitted for appliances which are completely odor-proof. Colostomates control odor with diet and/or odor-free stick-on pouches. In addition, for all ostomates there are deodorants for external use and odor-reducing compounds to be taken by mouth, should they be needed.

Will You Make Noises? Everyone produces gas, especially if he is an air-swallowed. But you don't make noises so often that you can't pretend that your stomach is growling. Be the fastest elbow in the West, or wear a two-way stretch binder, girdle or pantyhose to muffle the sound when it is audible. Avoid gassy foods, drinking through a straw and chewing gum.

Will You Feel the Waste Discharges? Very little, for the intestines have little feeling. Colostomates, however, will probably be aware of intestinal movement when it happens. Those with urinary diversions probably will be unaware of kidney discharge. The ileostomate or urinary diversion should check his appliance occasionally to see if it is full, or he might find his bag sagging - like a cow in udder misery needs to be milked.

Will You be a Captive of the Toilet? At first you may find yourself spending lots of time in the bathroom until you become efficient with the management of your stoma. But then, your routine will not involve any more time than normal visits to the bathroom. except for changing the appliance or irrigating. And there are a great many manufacturers inventing and selling better and better equipment every year for your use. Shop around.

Will You Starve? Follow doctor's orders at each stage of your adjustment. Some ostomates will be able to eat and tolerate anything; others may find difficulty with some foods. Each person is an individual and must determine, by trial, what is best for him. A good practice for all ostomates is to drink plenty of fluids.

Will You be a Social Outcast? If you haven't met any outcast ostomates, why should you be the first one? If you don't smell bad, bulge, make noises, and dwell in the toilet, what is to make you obvious and repulsive? Only your own attitude, your morale, will affect your companions. No cheerful, brave, and triumphant person will be an outcast!

Vancouver Ostomy Highlife, 4/94


Daily Exercise for the Non-Athlete

A recent medical association report stated that "proper weight control and physical fitness cannot be attained by dieting alone. Many people who are engaged in sedentary occupations do not realise that calories can be burned by the hundreds just by engaging in strenuous activities that do not require physical exercise".

Here is a tongue-in-cheek guide to calorie burning activities that can be conducted right in your workplace, as well as the number of calories per hour they consume:

Activity: - Calories Consumed
Beating around the bush: - 60
Jumping to conclusions: - 75
Climbing the walls: - 150
Swallowing your pride: - 20
Passing the buck: - 50
Throwing your weight around: - 100-400
Pushing your luck: - 100
Making Mountains out of molehills: - 600
Wading through paperwork: - 100
Juggling deadlines: - 120
Balancing the books: - 60
Running around in circles: - 250
Bending over backwards: - 50
Opening a can of worms: - 60
Tooting your own horn: - 100
Reinventing the wheel: - 150

Vancouver Ostomy Highlife via Medicine Hat, Mar/95


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 the article. Please credit the source as well as Inside Out 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 Ill make every effort).
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Last updated June 15, 2001. Created and maintained by Mike Leverick