In most instances, the individual will go through a period of grieving and preoccupation with the loss of bodily function as well as what is perceived to be a marring of the body. This grieving period is very similar to the period that occurs when a beloved relative or friend dies. There may be pessimism, anger, crying, depression and perhaps a profound withdrawal from the activities of daily living.
How well an individual is able to adjust is due in part to one's body image and self concept prior to surgery. If ostomy surgery follows a prolonged period of pain and suffering, such as may occur with ulcerative colitis, the ostomy may provide welcome relief. In such cases the psychological trauma may be far less.
Ostomates are faced with a unique situation. Their particular disability is not readily apparent to the outside world. No one else can see his or her stoma. Research has shown that individuals with mild disabilities may have the most difficulty adjusting, because they are "almost normal". What are some of the ways ostomates cope with this situation? One may be by maintaining a distance from other people; as long as the ostomate doesn't get too close either physically or emotionally, the disability can be hidden for the most part. If involved in a close relationship prior to surgery, the new ostomate may be fearful of his or her partner's reaction to the stoma, the drainage, or the pouch, and may become distant from that partner to avoid repulsion or rejection from the partner. One of the most effective ways of distancing others is through anger. Although a certain amount of anger is to be expected following an ostomy surgery, if an individual continues to relate to others in this manner, the motivation may be to distance others.
Another course of action one may take is to push oneself into relationships in order to find out other people's reactions or their own ability to perform. Initially the ostomate may choose the company of other ostomates both for friendship and sexual companionship. This is a healthy coping response on the part of the individual. It provides him or her with understanding and a safe environment in which to react and become accustomed to change in body image.
On the other hand, the ostomate who perhaps has a negative image or self-concept prior to surgery or who was not involved in a close relationship may use the disability as a way out, a release from the pressures of having to relate and perform. Another reaction on the part of the ostomate may be to take the focus away from the body by becoming interested in activities that develop the mind.
There is one particular bright spot in relation to sex - when individuals begin to express an interest in sex following serious illness, surgery, or trauma, they are in most cases expressing an interest in living. When this occurs, it is a time for rejoicing.
I have recently returned from the Inaugural Conference of the United Ostomy Association of Canada held in Mississauga, Ont., Aug. 20th to the 22nd, 1998. Close to one hundred ostomates from Victoria, BC to St. John's, Newfoundland and all points in between gathered at the Delta Meadowvale Resort and Conference Centre for what was a most enjoyable and informative experience. Always a highlight is the displays of the newest in ostomy supplies by the manufacturers. This year, representatives from Hollister, ConvaTec, Coloplast, Marlen and Nu-Hope were in attendance.
The opening banquet on Thursday evening had a number of highlights. The evening began to the sound of bagpipes as the head table was piped in, followed by a parade of provincial flags. WOA secretary, Bill Aitken, did the honour for Manitoba. The guest speaker, Dr. Rob Buckman, medical oncologist from Sunnybrook Cancer Center in Toronto was extremely serious but also hilarious, choosing as his topic "Communication as a Coping Strategy." The evening ended with some super entertainment enjoyed by all. Friday was seminar day with business and medical sessions running from 9:30 a.m. to 5:30 p.m. More of this day will be reported on in the next issue of Inside Out.
Saturday morning beginning at 8:30 a.m. was the National Council meeting, ably chaired by U.O.A. Canada President Di Bracken. Much of the work was routine, adoption of financial reports, next year's budget, various committee reports, etc. After much debate, we did adopt a new logo for U.O.A. Canada. It should be displayed on our pamphlets and newsletter soon. Election of officers also took place. The Executive Committee consists of: President, Di Bracken; Vice-President, Les Kehoe; Treasurer, Don Scurlock; Secretary, Ron Bartlett. Of the five people newly elected to the Board of Directors, one is from the Winnipeg Ostomy Association, our secretary, Bill Aitken. Congratulations Bill, we know you will do a super job.
There were more seminars on Saturday afternoon followed by the farewell banquet in the evening.
The three days went very quickly. It was a time to meet old friends and make new ones and finally to say "See you next year in Edmonton!" To you, members of the WOA, I thank you for sending me as your delegate to the Conference.
Dave Page
President
Pre-schoolers and young school-age children begin to develop motor skills. If children never learn about their ostomy care at this time, a dependency pattern may develop. This may be difficult to reverse in the future. It is important to assign simple tasks in order for the child to develop confidence with the ostomy care. For example, at the age for potty training, the child can be taught to empty the pouch. The child can also be taught stoma and skin care at bath time. As the child becomes more mature and dexterous, he/she learns about changing the appliance and checking for any problems. The ostomy requires more attention at this time. The stoma size changes as the child grows and the appliances need to be frequently checked for fit and security because the child is active.
If possible, complete independence is the goal. A parent is not normally needed to assist a 6-year old with toileting, therefore, the child with an ostomy requires the same minimal amount of help. If ostomy care is treated as a normal party of the child's daily routine, the child is more likely to adapt.
As children grown, they strive for independence. Just like going to school and crossing the street, caring for an ostomy is a step on this path. The parent who continues to care for a child's ostomy past a reasonable age because it is faster, easier or better that way, gives the child the message that the child can't do it. Tying a shoelace may be a challenge when a child is five - and so is changing an appliance - but well worth doing. Parents can help by simplifying the procedure (e.g. using a pre-cut skin barrier) and gathering equipment in a place the child can reach. Beyond that, their greatest contribution is in teaching patiently and lovingly. Parents can then step back so that the child can assume responsibility and the pride that comes with it.
An ostomy in a child is scarcely a catastrophe. Instead, it is the path to health and in some cases, to life. To learn more about children with ostomies, contact your local ET nurse or Parents of Ostomy Children (POC) at 1-800-826-0826 (United Ostomy Association Inc.)
I would rather treat an injured stoma in a live patient than look at a healthy stoma in a dead one. There is no question in my mind about the value of safety belts in autos. Anyone arguing that such a belt should not be worn is making an excuse, not giving a reason. Inevitably, the failure to wear a safety belt is sheer laziness and stupidity. Any further discussion of the matter is irrelevant.
Moles have no known purpose and scientists don't know why they develop. Most moles
are harmless. You don't need to remove them unless they're irritated or unattractive. But
you do need to monitor them. Skin changes are signs! Melanomas often become visible
at an early stage, so examine your skin carefully on a regular basis. Any of these changes
may be an indication of melanoma:
SIZE - Melanomas tend to be the diameter of a pencil or larger.
COLOR - Individual benign moles usually have one color. Multiple colors require
evaluation.
SHAPE - Harmless moles typically have smooth edges. Look for irregular borders.
HEIGHT - Benign moles tend to be flat or dome shaped. Be wary of moles that are
partially flat and partially elevated.
TEXTURE - Scales, shedding of skin, oozing or mild bleeding can signal melanoma so can
hardening or softening of the colored area.
SENSATION - Is there itching, tenderness or pain?
NEARBY SKIN - Pay attention to swelling, redness, or other coloring that spreads into skin
near the pigmented area.
Here are five suggestions to make life easier.
SMILE - You'll find this costs you nothing. It is perhaps the first pain free motion you've made recently. It is exhilarating. It not only improves your face - it's contagious.
THANK GOD - You're alive Count your blessings. You're bound to resent your surgery. We all do -but we cannot be grateful and resentful at the same time. We cannot change the past experience, but we can make the future what we want it to be.
OVERCOME - Your fear of being different. It doesn't show. Everything else is normal. In no time at all, you will be back in the swing of things. If you don't think so, come to a meeting. Look around the room and try the guessing game - which one has the stoma?
MAKE - SOME ONE HAPPY! Your show is over. The curtain has come down on the starring role. Consider those who have been waiting breathlessly in the wings. They need loving too.
ACCEPT - Your new way of life. It's not really a change. It's just in a different place and it takes a little time to orient yourself. Don't give up - there will come a day when you will have to agree it's far more comfortable than it used to be.
Any of the following may be the cause:
You have been eating too fast, with your mouth open, or trying to talk while you eat. Your mother always told you it was rude, but she didn't mention that you would swallow air, which grumbles and growls as it is moved along the digestive tract. Prevention -- Eat a snack of fruit or vegetables between meals if you're hungry; eat smaller, more frequent meals; eat slowly. Don't gulp.
Diverticular disease of the colon refers to a condition where there are small "pockets" or outpouchings of the bowel wall. These pockets form along the edge between the muscles that run along the bowel, perhaps at what might be considered a "weak" point. The exact cause or causes of diverticulae are not known, but it seems likely that long-term increases in pressure within the bowel might predispose to diverticulae. There must also be some familial factors since diverticulae do seem to run in families. The reasons for the increased pressure inside the bowel may relate to our low fiber, Western diet. In countries where there is a naturally high fiber diet, such as many places in Africa, diverticulae almost never occur. If there is inadequate bulk in the bowel, the bowel tends to become more spastic, thus increasing the inside pressure. People with the so-called "Irritable Bowel" or "Functional Bowel Syndrome" also have an increased occurrence of diverticulae, again because of the persistent increased pressure in the bowel. Diverticulae are more common in the left side of the colon, (the last part of the bowel) since the bowel contents here are solid, whereas, the contents elsewhere are liquid. Thus, more pressure is required to propel solids along the bowel than to propel liquids.
Diverticulae may be present with no symptoms at all or they may present with the symptoms of an irritable bowel with cramps and alteration in bowel movements, either diarrhea or constipation. Since the diverticulae are "blind pouches", bowel contents may lodge in the diverticulae and set up an irritation. This irritation may lead to bleeding from small blood vessels, and thus, blood may be seen in the bowel movements. If the irritation is marked enough, there may be a degree of inflammation. When this occurs there may be a fever, pain and discomfort, particularly over the left lower abdomen. Occasionally, there may be enough inflammation that a diverticulae perforates. This may result in an abscess around the bowel, or sometimes a generalized infection of the abdomen.
Diverticulae are diagnosed most commonly with an X-ray, the standard barium enema. The diverticulae are usually easily seen as small pouches extending from the bowel wall. The other method of diagnosis is with a flexible sigmoidoscopy or colonoscopy. With these methods, the diverticulae can be seen as little openings along the bowel wall. The condition of having diverticulae without any infection is referred to as "Diverticulosis", and, if inflammation is present as "Diverticulitis". The treatment of Diverticulosis is basically dietary with the use of a modified fiber diet. This diet removes irritating substances such as small seeds, nuts, corn, and popcorn from the diet, but increases the bland bulk in the form of bran and root vegetables. Bulking agents such as psyllium may be helpful and sometimes anti-spasmodics may be used. The presence of Diverticulitis usually requires the addition of an antibiotic and sometimes a very low fiber diet until the inflammation has subsided.
Generally, surgery is not required for Diverticulosis and infrequently for Diverticulitis. The main reasons for surgery are 1. profuse bleeding 2. infection with abscess around the bowel, or 3. infection with the abdomen infected. These are usually acute situations with surgery being semi-emergent. Sometimes, if infection is present, a temporary ostomy may be necessary, but most patients can have this taken down at a later date with normal bowel movements.
Although diverticulae may cause bleeding in the bowel movements, there are other causes of bleeding, and anyone with blood in the bowel movements should see their physician to have the condition checked and the exact diagnosis made.
With our increased awareness of the importance of a good diet and the trend to increased fiber in our diet, diverticular disease may be less prevalent in the years ahead.
by Mary Lou Thomas, RN, EU, North
Arundel Hospital Hi! I'm a STOMA!! I am great when you think about it. I must admit I have upset many people, some even consider me crude, rude and socially unacceptable. Well, excuse me!! Just about everyone gets bent out of shape when their doctor says it may be necessary to create a stoma. They make it sound like a dirty word. Listen, it isn't the greatest for me either. I'm usually created from a piece of your intestines. I guess you know all about that and then maybe, just maybe you don't so I will tell you.
Becoming a stoma wasn't my original function or job. No siree!! I used to just lay there in your abdomen, minding my own business. Then boom! Some surgeon decided - let's make a stoma. He has his nerve! Why?? How could they consider such a thing? Well, I guess it was because you hurt so much, because you were awfully sick from disease, like cancer, or from a trauma, like from that automobile accident, or from a birth defect. Your surgeon knew that by putting me to work, you could be free of discomfort and problems. In truth, so you could get on with living which is YOUR main function. Well, you know, because you are a people.
If that is why I was created, then why do so many complain about me? Did you know I am NOT given to just anyone? You see, there is a lot of planning and evaluation of each human being before I am created. So, I know you can say only a "chosen" million or so are lucky to have me. That's a relief. You see, my people are special. My people are not like the normal run of-the mill people. I must say, it takes them a while to recognize that fact. And, sad to say, there are a few who never do.
It isn't easy being a STOMA! Some of you just don't understand what a miracle I am. Listen, before creation, I just laid quiet (sometimes not so quiet) and generally content in your abdomen.. Now I've been put to work! It's rather easy when fecal waste comes through because that's what I'm used to, but some dude decided, why not water waste as well? Come to think of it, that dude was very wise because that works well also. You think YOU have problems adjusting! Phooey!! Did you realize that I am a delicate mucous membrane? Yet I'm durable, but some people think I am asphalt tile. Thank God I don't have feelings, but my friend the skin does. You want complaints? Give a listen to her sometime. She really gets upset because of ulcers, fungus, irritants, barriers, etc. We are a team, and a darn good one! I'm moist; she is dry. I'm pink-red; she is natural. I'm smooth; she is a little bit bumpy.
One of my biggest problems is my size. I am not always the same size from one human to the next. I am not always round. I don't always protrude nicely. Then, why do some of you insist that my pouch opening is always the same? You need to check my size once in a while and fit me appropriately. Your shoes fit don't they?
Some of you complain because I'm not pretty. Well, your anus wasn't exactly Miss America! I think I am attractive. I am light red like a rose. I am always moist if I am healthy, and I don't smell. My discharge can't help but be what you put into your mouth. If you care for me with thought and keep my equipment clean, that just about takes care of it. In closing, let me say that you can live a good life, a productive life. It's up to you. I'm just part of you, trying to do a job.