The meeting was requested to discuss concerns about the Manitoba Ostomy Program being adversely affected by the regionalization of health services in Manitoba, to introduce the Minister to the Winnipeg Ostomy Association and inform him of ostomates' special health needs.
We were assured that the central distribution of ostomy products and services would not be dismantled upon the implementation of the Regional Health Authorities on April 1, 1998. Some changes in administration and financing will be required to accommodate the regional system but these should not affect the delivery of services by the Manitoba Ostomy Program.
A good exchange of information took place and we felt that the Minister has a better understanding of the special requirements of ostomates within the health care system. He was open and forthcoming during the meeting and told us to contact his senior policy advisor directly if we had any further concerns.
The delegation felt that the meeting was worthwhile and productive. We appreciated the time and attention given to us by the Minister and his aides. We feel confident that any future concerns that we have about the Manitoba Ostomy Program will be reviewed by the Minister and judged on merit.
Most of us have benefited from the excellent visiting program of the WOA. In the month of January 1998, nineteen visits were made and the need is ongoing.
An increasing area of activity is advocacy. Over the past 5 or 6 years, the WOA has been quite active in lobbying the provincial government. Without this activity it is quite apparent the Manitoba Ostomy Program, which is advantageous to us all, would be in serious jeopardy. Elsewhere in this newsletter you will read of the recent meeting between representatives of the WOA and the Hon. D. Praznik, the provincial Minister of Health, concerning the effect of the Regional Health Authorities on the Manitoba Ostomy Program. We will be monitoring this issue very closely. That is the plan provided we have enough active bodies and support to maintain our lobbying efforts.
Last year, two members of the executive stepped down. One position was filled at the elections in April, but the other remained vacant until September. This year more of our executive will not be standing for reelection. Our Treasurer, Betty Friesen, has indicated the need to identify her successor for some time, indeed this is mentioned as far back as the September 1996 newsletter, however, most graciously she has carried on. The need is urgent! Now!!!
Two years ago I responded to an appeal similar to this (I had only attended 3 meetings in the 4 = years since my surgery in 1991) when my predecessor stepped down. Two years have passed very and have been enjoyable and fulfilling, so much so, that I have indicated to the executive and now to you that I am standing for reelection.
There are also various committee positions that need to be filled. One in particular, Chair of the Library committee, has been vacant since 1996.
Election of Officers for the coming year will be held during the monthly chapter meeting on April 15th, 1998. Mike Leverick is chair of the nominating committee and he would appreciate hearing from you. Ostomate or not, please volunteer.
One fork in the road leads to a dead end, the other toward and beyond our 30th anniversary in 2002. Which road will we follow? It's up to YOU!
Dave Page,
President, WOA
1. Peristomal skin reactions
a. Stomatitis - small ulcers may appear on the stoma as on rest of gastrointestinal
tract (for mouth ulcer treatment, use = strength peroxide rinses. 4 to 6 times
daily).
3. Increased need for hygiene due to low white cell counts - peristomal skin may be more prone to infection. If wearing permanent pouches, it may be necessary to change to wearing disposable pouches, to help increase cleanliness.
1. Diarrhea - possible reaction to chemotherapy. Monitor amount of stool output; inform physician if increased significantly above normal.
a. Drink adequate amounts of fluid - at least 10 to 12 glasses a day: may be difficult
due to nausea medicine taken prior to meal times.
b. Eat foods to help thicken stool, i.e. applesauce, cheese, white rice, bananas,
peanut butter, plain tea and boiled milk.
c. Stay away from fatty foods, highly spiced foods and foods are beverages which
cause gas or cramping.
d. Potassium is lost in diarrhea and needs to be replaced. Foods high in potassium
are bananas, fish, potatoes, apricot or peach nectar, meat and Gatorade.
Physicians may order potassium supplements.
2. Constipation - an occasional reaction to chemotherapy (may also be a reaction to some pain medications, such as codeine.)
a. Drink adequate amounts of fluid - at least 10 to 12 glasses of water daily. Prune
juice daily may be helpful.
b. Eat foods with a laxative effect, i.e. raw fruits and vegetables, chocolate, coffee,
fried foods, cereals, bran, whole wheat bread, dried fruit and nuts.
c. Try to stay away from strong laxatives.
Nervous diarrhea is very common and usually mild, often showing up briefly when we face stress, and causing little more than a day away from work and a few minor discomforts.
The common two-day illness, often called "intestinal flu", is due to one of several viruses that infect the bowel, making it weep fluid. The excess of fluid in the bowel leads to liquid stools and cramping abdominal pain. Infection of the stomach can occur at the same time, producing nausea and vomiting. This can lead to dangerous dehydration, particularly in those poorly prepared to withstand losses of fluid and salt, such as the very young, the old, and the sick. Anyone with diarrhea should be given fluids containing sugar, and preferably, salt. Non- diet drinks are a reasonable start, commercial quick-energy drinks such as thirst- quenchers - Gatorade, etc - containing sugar and salt are even better. If the patient cannot take fluids by mouth and is still vomiting after 12 to 24 hours, then medical advice should be sought, especially if the person is very young, old, or otherwise weak. Even when the consequences of fluid loss are more severe, the disease will cure itself. The treatment is simply the replacement of water and salt (by intravenous means, if the problem is severe). In other words, no special treatment is needed for the cause of infection.
The simple case needs only rest in bed, plenty of fluids by mouth, and perhaps a drug to reduce the diarrhea and abdominal cramps (such as paregoric). More severe cases might need hospitalization and intravenous fluids. Only occasionally are antibiotics needed. Most examples of travelers' diarrhea are inconveniences. Travelers should be careful about non-processed water and ice, unwashed or uncooked foods such as fruits and salads, and unlicensed sellers of food. If diarrhea is mild, bottled water or soft drinks will usually maintain hydration while the disease corrects itself. Antibiotics as a preventive measure are probably useful, but not usually necessary.
Medical advice should be sought before any drugs are used.
Researchers at Johns Hopkins and other institutions are currently testing a suppository made from prostaglandin E1, which is presently available as an injectable solution. The suppository can be inserted into the urethra using a slender plastic tube. Once inside, the prostaglandin diffuses across the delicate urethral membrane toward the blood vessels located inside the penis. As a result, the blood vessels widen, more blood enters the area, and the penis becomes erect. Suppositories can probably be used more often than injections, with less risk of penile scarring, shape changes, and prolonged erections - although further study is needed to confirm this hypothesis.
Researchers have also examined the possibility of using topical creams and sprays containing prostaglandin and other drugs (such as minoxidil, the baldness remedy known as Rogaine, and nitroglycerin) but according to Richard Allen, Ph.D., assistant professor of neurology at Johns Hopkins, while these approaches may help some patients, they'll probably be less effective than the suppository, because the tough skin on the penis hinders absorption.
Patients with the following ostomies were visited in January and February:
Colostomy - 19
Ileal Conduit - 6
Ileostomy - 3
Pelvic Pouch - 0
Continent Urostomy - 0
Total = 28
1. There is a little less large intestine and storage area for solidification of intestinal
contents and absorption of water.
2. Waste is now discharged through the colostomy.
3. The number of stools and consistency will gradually return to their usual pattern.
Since the rectum is now gone, the normal urge to go to the toilet is not experienced.
However, right after the operation, patients may feel "urges" and even have some
discharges from the anal area; while it heals, the body needs to get rid of mucus and
blood, and sometimes feces still remaining from the time of operation. In time, this will
subside.
Natural Evacuation. It is possible to treat the bowel movement through a colostomy like a movement through the anus; that is, to let it come naturally as it will. Unlike the anal opening, the colostomy does not have a sphincter (muscular valve) which can stop the passage of a movement. Therefore, a receptacle must be provided to collect anything which might come through, whether it is expected or not. A great number of lightweight, practical and inconspicuous pouches are available which can easily be adhered to the abdomen around the stoma. These may be worn at all times, or as needed.
Dietary Regulation. One does not have to restrict one's diet because of a colostomy. You can eat the same foods you ate before surgery. Only a small portion of the colon has been removed. However, if you now find that any foods cause you bowel problems, such as unexpected elimination, either avoid these foods or be willing to adjust your management. Some people with a sigmoid colostomy find that, by eating selected foods at specific intervals, they can make the bowel move at a time convenient to them. After some time they may feel so certain of such a schedule that they wear a pouch only when a movement is expected. It may be possible to use this method as the only regulatory practice, or one may use it in addition to irrigation.
(GLO Contact wonders whether or not she had a visitor?)
In 1996, some 317,000 new cases of prostate cancer were diagnosed, with about 41,400 deaths directly attributed to it. Although it is a very slow disease, and while, in some men, we don't treat it after diagnosis, it is a lethal disease, and it's not a particularly pleasant way to end one's life. It is a curable disease, however, and, if found early enough, can be taken care of.
The increased incidence of new cases is due to several reasons. First of all, increased media attention tends to make more men concerned about the disease. Second, the use of the blood test for PSA prostate-specific antigen is more common. Third, the population is aging and it is a fact of life that, as men get older, they will develop some form of cancer in the prostate - a natural result of aging. The trick is to determine in whom the cancer is significant and in whom it is completely insignificant.
The prostate gland sits right under the bladder. Through it passes the urethra, which leads from the bladder to the penis. The role of the prostate itself is quite minimal - its sole function seems to be to provide a small amount of fluid to the male ejaculate during sexual activity. If you were to remove the prostate in a young male, it would have no effect upon his physiological well being, with the exception that his ejaculate volume would be a little smaller.
There are three well-known risk factors involved in disease of the prostate. One of these is age. Second is family history; if there is a first-degree relative in your family who has had prostate cancer, you have a two- to three-fold risk of developing the disease. Third, there is the race factor. We don't know exactly why, but blacks have a higher incidence of the cancer than Caucasians, and their cancers are relatively more aggressive. Other than these, there is no medical proof at this time that there are any other risk factors.
How can you be aware that you have prostate cancer? It's unfortunately true that, if you have a small tumor, confined to the inside of the prostate, you will have no symptoms. If the tumor grows larger, typical symptoms are difficulty in urinating, perhaps some blood in the urine. If the cancer has spread outside the prostate (metastatic cancer), it typically spreads to the bone - the spine, the hips, the ribs, or the long bones of the legs. As you can imagine, then, pain in the bones might be a symptom of disease that has already spread out of the prostate.
One problem with the rectal digital examination is that only about 80% or 90% of prostate cancers occur in the accessible side. A small percentage will be in the interior of the prostate, not available to a digital examination. Digital examinations, too, are subjective in nature. What is significant to one physician may not necessarily be important to another.
The PSA test has been used for about the last ten or twelve years. It is a good test, in that it is specific for the prostate; the antigens come only from the prostate. An elevated PSA level does not necessarily mean that you have prostate cancer, but it is a warning signal. If a patient has an elevated PSA, I look at not only cancer, but other causes as well.
The PSA test is rated in fairly familiar numbers. A reading of from 0 to 4 is considered "normal", from 4 to 10 is a gray area; from 10 to 20 is regarded as suspicious; over 20 is highly suspicious. We know that if you have a PSA of over 20, and don't have an active infection in your prostate, there is a very good chance of there being cancer. For the physician, the tough area is that from 4 to 10. Although not everybody in that zone has a prostate cancer; there is a 20% to 25% chance that cancer is present. Of course, this also means there is a 75% to 80% chance that the PSA reading is due to some other cause.
Any of several things can falsely elevate your PSA when no cancer is present - infection in the urine; infection in the prostate; stones in the prostate (not uncommon as we grow older); and quite commonly, an enlarged but benign prostate, which will leak PSA into the blood stream.
The third tool used in diagnosis is the ultrasound, which we use as a tool in performing a biopsy of the prostate. Biopsy is the only sure test for presence of a cancer, and in obtaining this sample the ultrasound is of vital assistance. The ultrasound procedure consists of the insertion of a probe through the rectum to the prostate. The probe has a very sharp needle that rapidly and repeatedly penetrates the prostate, giving us our biopsy. We take biopsies from as thorough a sampling of the entire gland as possible. This can provide us with a valid diagnosis of cancer in the prostate. Most patients undergoing the procedure agree that it's uncomfortable, but not horribly painful. We do not use anesthesia for the procedure.
In the case of persons who have no anus, such as ileostomates we must, unfortunately, rely primarily on the PSA test. There is no other way that I know of to diagnose the cancer. It was recommended at one time that the prostate be removed at the time of the surgery to remove the colon and close off the rectal area. However, it proved to be too much of a shock to the body to do additional surgery at that time. Removal of the prostate is a major operation, and has substantial risks of its own.
(This is the first part of a two-part article. The second part will be printed in the next issue)