DEC BYPASS



Home Officers WOC Nurses Resources Meetings Newsletters Join Links Gallery Hints&Tips Member Mail Contact Us	Newsletter Serving Members and Friends of the Triangle Ostomy Community December 2005 In this Issue Holiday Blockage Connection How to Treat a Blockage President’s Message Calendar - Meeting Information Tips from Our Members Minutes from last Meeting In Brief Calendar December 6: Ostomy meeting 7:30pm Rex Hospital December 19: Crohns & Colitis Support Group 7:30pm Duke Health, Raleigh Hospital December 25: Chanukah begins December 25: Christmas January 1: New Year’s Day Next Meeting: December 6 Program: Holiday Social! - As the holiday season builds, wouldn’t it be nice to spend some quality time enjoying each other’s company? That’s exactly what we are planning. Bring yourself, your loved one/s, and something tasty for all to enjoy. Meetings are held the first Tuesday of each month at 7:30 PM in the Rex Surgical Waiting Room, 4420 Lake Boone Trail, Raleigh, NC. Enter through the Rex Hospital Main Entrance, which is near the Parking Garage. Reminder: In the event of inclement weather on the day of a scheduled meeting, please contact Rex Healthcare at 919-784-3100. Attention J-Pouchers: Don’t forget that J-Pouchers are always welcome at our monthly meetings. Contact Lora Edgars at 919-596-5410 for all the details. Attention WOC Nurses: As a result of the dissolution of UOA, our WOC Nurses will no longer receive statements for annual membership dues. Our chapter is extending courtesy membership status to these fine professionals in appreciation for their guidance, support, and loyal service. More good stuff in the printed edition! ...like recipes and puzzles. If you do not currently receive the printed edition of The Bypass, be sure to email us with your address! Holiday Blockage Connection With the holidays approaching, I thought this would be a good time to include information about blockages. I was told by my WOC Nurse, that ostomates tend to get blockages more often around the holidays. Personally, I have had 3 blockages, one on New Years Day (from mushrooms), one on Thanksgiving (from broccoli and green beans), and one after a party (too much popcorn!). You might ask, "why?” Around the holidays or at other events, we tend to eat more food and different foods than we are used to. Also, we might eat without realizing how well we are chewing. While you are talking to your Aunt at Christmas dinner, you just gulp down your green bean casserole without even thinking about it. Before you know it, you realize you hardly chewed your food! You may just have a rude awakening in about 8 hours.So, remember to think about what you are eating and always chew your food really well. And then, if you still find yourself with a blockage, the articles in this newsletter will be very helpful. Happy Holidays! - Jennifer Higdon How to Treat a Blockage Symptoms: Thin, clear liquid output with foul odor; cramping abdominal pain near the stoma; decrease in amount of or dark-colored urine, 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 Coke, 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 might 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/ET Nurse and report what is happening and what you tried at home to alleviate the problem. Your doctor or WOC/ET Nurse will give you instructions (ex., meet at the emergency room, come to the office). If you are told to go to the emergency room, the doctor or WOC/ET Nurse can call in orders for your care there. If you cannot reach your WOC/ET Nurse or surgeon and there is no output from the stoma, go to the emergency room immediately. IMPORTANT: CLIP AND SAVE THE INFORMATION FOR HEALTH CARE PROFESSIONALS AND TAKE IT WITH YOU TO THE EMERGENCY ROOM AND GIVE IT TO THE PHYSICIAN. IMPORTANT: TAKE ALL OF YOUR POUCH SUPPLIES (eg., pouch, wafer, tail closure, skin barrier spray, irrigation sleeve, etc.) Food that can Cause Blockages The following is a list of some of the foods that can cause blockages. Every person is different, and certain foods may affect some people more than others. Add the following foods to your diet one at a time and in small amounts, so you can identify which foods may bother you. nuts celery coconut popcorn foods with fibrous peels (like apples) mushrooms dried fruits raw crunchy vegetables (carrots, broccoli, cauliflower, Chinese vegetables) Print and Save: Information for Health Care Staff in the event of a blockage EMERGENCY ROOM STAFF: OSTOMY OBSTRUCTION Symptoms: No stomal output; cramping abdominal pain; nausea and vomiting; abdominal distention, stomal edema, absent or faint bowel sounds. Contact the patient's surgeon or WOC/ET Nurse to obtain history and request orders. Pain medication should be initiated as indicated. Start IV fluids (Lactated Ringer's Solution/Normal Saline) without delay. Obtain flat abdominal x-ray or CT scan to rule out volvulus and determine the site/cause of the obstruction. Check for local blockage (peristomal hernia or stomal stenosis) via digital manipulation of the stoma lumen. Evaluate fluid and electrolyte balance via appropriate laboratory studies. If an ileostomy lavage is ordered, it should be performed by a surgeon or ostomy nurse using the following guidelines: ---- Gently insert a lubricated, gloved finger into the lumen of the stoma. If a blockage is palpated, attempt to gently break it up with your finger. ---- Attach a colostomy irrigation sleeve to the patient's two-piece pouching system. Many brands of pouching systems have Tupperware®-like flanges onto which the same size diameter irrigation sleeve can be attached. If the patient is not wearing a two-piece system, remove the one-piece system and attach a colostomy irrigation sleeve to an elastic belt and place it over the stoma. ---- Working through the top of the colostomy irrigation sleeve, insert a lubricated catheter (#14-16 FR) into the lumen of the stoma until the blockage is reached. Do not force the catheter. *Note:* If it is possible to insert the catheter up to six inches, the blockage is likely caused by adhesions rather than a food bolus. ---- Slowly instill 30-50 cc NS into the catheter using a bulb syringe. Remove the catheter and allow for returns into the irrigation sleeve. Repeat this procedure instilling 30-50 ccs at a time until the blockage is resolved. This can take 1-2 hours. Once the blockage has been resolved, a clean, drainable pouch system should be applied Because the stoma may be edematous, the opening in the pouch should be slightly larger than the stoma. Message from the President Happy Holidays to all my valued members and friends! I hope we all will take a few moments this holiday season and give thanks for all the many wonderful blessings that have been bestowed upon this past year. We have so much to be thankful for; such as the medical professionals who worked their magic to enable us to lead exciting and productive lives; our care givers who stood by our side through some pretty rough times and helped nurse us back to good health; and lest we forget our wonderful membership who helped us understand that we have just begun to realize what a great life we have ahead of us. Let's also remember those less fortunate and hope that some day soon they will realize the benefits that we have been blessed to receive. That their misfortune will be short lived and they will once again be able to realize the great life they so richly deserve. Our meeting is going to be a time for socializing and connecting with one another. It's a good time for us to just relax and enjoy this time of year and share our stories with each other. Please bring a finger food/snack of your choice for everyone to enjoy. Also, please bring a loved one or other significant member of your family. Thank you so much for a great year and I look forward to seeing you on Tuesday, December 6th, at 7:30 pm. Yours in service...........................................Dan Hints, Suggestions, and Tips from our Members The By-Pass offers us a wonderful vehicle to share our ostomy tricks with the rest of the community. If you have an idea you’d like to have included, please contact Jennifer Higdon or Dan Wiley. If you find suggestions posted here helpful, be sure to tell the person who contributed them. I was taught by my ET nurse to take care of a blockage on my own. I always carry my "blockage supplies" with me on vacations. I haven't had to use them while traveling, yet, but at least I have them handy. -Jennifer Higdon I’ve had a couple of blockages. They’re not pleasant to say the least. One of the things I can do myself is massage my abdomen - I can usually feel if there is a blockage there. My mother taught me to rub and massage my belly when I had digestive cramps/difficulties, and it works with an ostomy - at least mine - as well. -Anke Gassen We REALLY want your input! Next month we’re looking for suggestions regarding your favorite appliance manufacturer and ‘model’ - tell us why you like it and how it benefits your lifestyle. Send your comments and suggestions to Anke - email anke@intrex.net or call 968-8461. Famous Ostomates Dwight D. Eisenhower 34th President of the United States Bringing to the Presidency his prestige as commanding general of the victorious forces in Europe during World War II, Eisenhower obtained a truce in Korea and worked incessantly during his two terms to ease the tensions of the Cold War. On June 8, 1956 Eisenhower developed vague, ill-defined discomfort in the lower abdomen at 12:30 am. His physician arrived at the White House 30 minutes later and found moderate distention and tympany, but no particular point of abdominal tenderness. The President slept fitfully for the next few hours. Tap water enemas in the morning gave no relief. The pain became colicky and centered on the umbilicus and right lower quadrant. Without surgery, Eisenhower's bowel obstruction could easily have killed him. Even so, the decision to operate was contentious. Eisenhower had had a serious heart attack just nine months earlier, and this made surgery risky. As you might expect, it is difficult to decide to operate on the President of the United States when he might not survive the operation. At operation, the terminal 30 to 40 cm of the ileum had the typical appearance of chronic "dry" Crohn's Disease. An ileotransverse colostomy (internal ostomy) was performed, bypassing the obstruction. The post-operative course was smooth as well. He began conducting official business on the fifth post-operative day. Meeting Minutes from the November 1, 2005 Meeting of the Triangle Ostomy Community Dan Wiley, President opened the meeting by welcoming the visitors who introduced themselves to the group. Ruth Rhodes, Treasurer reported that the response to the payment of dues has been wonderful. Ruth Rhode’s mother needs our prayers as she is 91 years old and in the hospital with Pneumonia. The presenters for this meeting were Ed Withers (who maintains the Raleigh UOA website) and Stephanie Yates (the Rex Hospital WOC nurse). Ed used a computer projector to explain the use of search engines to obtain information on the internet. He then demonstrated how to maneuver around the Raleigh UOA website which can be reached by using Internet Explorer and typing in the address www.raleighuoa.org. Ed reviewed the website links that lead to general medical information, ostomy supply vendors, ostomy education and ostomy support services. He also reviewed access to the chapter newsletter via the Raleigh UOA website both in PDF form (printable version) and in HTML (faster, text version). Stephanie Yates provided the handout “Criteria for Evaluating Health-related Web sites”. She encouraged members to use caution when obtaining information over the internet. Medical information should be verified by visiting multiple sites and comparing information from different sources. It is important to recognize that anyone can post anything they wish on the Internet, so just because it is posted on a web page does not make it factual. It is also important to clearly distinguish between fact and someone’s views/opinions on an issue. Stephanie Yates then used the computer projector to show pictures of her recent trip to Moscow and St. Petersburg. This was an educational trip designed to allow nurses from the USA the opportunity to share information and compare healthcare systems with Russian nurses and other medical staff. Stephanie related to the group that the healthcare system in Russia is much as it was here in the 1960’s. There are signs of poor infection control, poor sanitation and the lack of antibiotics to treat infections. The life expectancy is much lower in Russia averaging in the mid 50’s. Stephanie found the Russian medical staff to be very friendly and eager to share information with the USA team. The Russian doctors and nurses are quite aware of the medical technology as it is developed, but since they do not have access to all of the technology, they improvise and make the best out of what they do have to treat patients. They are proud of their accomplishments and continue to improve their healthcare system. Stephanie showed pictures of the ostomy nurses that number as only a few for the millions of people that they serve. She was able to meet the leaders of an ostomy support group in Russia. The group provides education and emotional support to the members. The medical system in Russia is supported by government funds. The exact process of medical reimbursement/payment of services was complicated and not clear to Stephanie and the other nurses who visited Russia. However, it was interesting to note that ostomy supplies are free to those who have ostomies and Stephanie shared pictures of the supplies and the display boards that the Russian WOC nurses proudly displayed. Dan closed the meeting by reminding everyone that the December meeting will be one of fellowship and visiting as we approach the holiday season. Members are welcome to bring food if they wish.