Ostomy Page List

Learning Ostomy Changes
Our fluids now move more quickly so timing and its effects need attention. This is caused by a shorter path, controlled with food types and fiber, along with some specific meds.
Your bladder shares some space with your colon and other organs, and now you have some changes. Several muscles in this area may need toning-up to make-up for change. See the following links about 'Kegel' for info. And remember - muscles work on protein and exercise.

Parastomal Hernia
"One of the most common complications following stoma creation ..."

Get all the details you can from your G.I. Doctor, discuss some things you shouldn't do and for how long.
Why?   Your abdomen muscular wall is weakened by that puncture where the stoma passes through.

That surgery must heal before trying usual strength. Otherwise that area around your stoma can be pushed outward by those muscles and/or organs behind. A bulge can be tricky to fit a skin barrier without it leaking, and abdominal pressure from that barrier around the stoma can help treat a hernia. Only surgery can solve it.
Few of us are alerted to this until after it occurs. See this link for some history and methods used.

Many stoma hernia belts can be found. They're wide and many have an opening for the entire ostomy device. The belt should maintain abdominal pressure to help prevent a hernia without interrupting the ostomy device functions.

A pouch belt is usually available with two-piece ostomy devices to help secure that pouch to avoid it separating from barrier. Sometimes that belt can also apply abdomen pressure and help avoid a hernia. Incorrect angle for belt pressure against a seal can cause leaks, break the adhesive, irritate skin, or tear skin at stoma junction.

A belt for the one-piece ostomy device is not common, so we are working on a belt attachment for the one-piece device.




Timing & Alkalinity
After eating, we need up to 3 hours to pass 1.5 — 4 pH stomach fluid (Chyme) going to the Duodenum.
The Duodenum connects our stomach to the small intestine, and is the beginning of where 90% of nutrient and medicine absorption occurs while waste products are passed along.
      The flow & mix regulator.
The Duodenum secretes alkaline to blend with stomach fluids. Its secretion goes on till that blend hits 7.0 — 8.5 pH for it to quit. Before Ileostomy this could need up to 1 hour. Pathway is shortened from Duodenum to Stoma which used to take 1—5 hours.
Ileostomy's faster travel moves alkalines away from Duodenum before full blending, but that alkaline secretion is still set for target pH.

Fluid travel time can be improved and regulated for anyone by using Fiber, and Anti-Diarrheal meds may be essential for an ileostomy or other changes.

Metamucil type fiber supplement or equivalent produces a gel that can interfere with usual medicine absorption, and the amount of that fiber found sufficient may offset proper medicine dosage.
Anti-Diarrheal meds (if taken) should be at least an hour before or after the gel producing fiber.
Interval timing is important for meds taken between doses of that fiber.

Try Metamucil® or note that some pharmacies have their own brand.
Example: equate

Another favorite is Chia Seed. Its soluble fiber content is absorbed by fluids and is very nutritional. It is sometimes sprinkled on salads, ice-cream, yogurt, as examples.

You can make your own capsules of either of these fibers and have less calories than brand name versions.
Diets low in saturated fat and cholesterol that include 7 grams of soluble fiber per day from psyllium husk, as in Metamucil, may reduce the risk of heart disease by lowering cholesterol. One serving of Metamucil has 2.4 grams of this soluble fiber, while capsules have at least 1.8 grams.

Learn your own system
    with some pH Test Strips.
First, find your own scale by occasionally reading output. That pH level will vary and can help show the effects of travel time helped with Fiber & Anti-Diarrheal meds.
Having an ileostomy, Stomach Acid Reflux (GERD) meds can affect stoma output alkalinity.
Check pH of Your Output to Verify
  Before Ileostomy:      4.0  —  7.0 pH
  With the Ileostomy:   7.0 — 10.0 pH
Typical Exterior Skin:  4.5  —  5.5 pH

Now our skin is exposed to more alkaline (8—10 pH) fluid than tolerable. Muscles can't limit output as before. Device Leaks beneath the barrier are painful, and even with no leak visible outside, replacement is required. So we try more devices for fit and comfort.

Absorption
Some medicines and nutrients need more time and might be passed along before fully absorbed.

Consider that liquid and gel meds may absorb faster than solids, and Consider that delayed-release meds may be washed away before time to dissolve & absorb.

For nutrition, foods we eat have always required proper chewing (Mom said). Nutrition labels help you get maximum protein and nutrition from smaller meals and daily supplements. Eat less volume per meal and have more meals in a day to accomplish better intake.
Good eating style doesn't require ileostomy, just practice. Pass that on!
Vitamins, Minerals and Protein need attention, liquids and gels give better absorption. Most of us need > 60-80 grams Protein/day. Fiber is now more important.
Click these to see:

There are several drinks with added Protein and other nutrition, try to balance cost with your food for the day.
Click for Nutritional Drinks Ensure, Boost, Resource, Nutren, Pediasure, Nestle, online.


Sleeping
Naturally you should sleep lying on the side appropriate for your stoma pouch to hang down. The stoma defines that side.
BUT if you also have stomach acid or esophageal issues, like ACID-REFLUX or GERD for example, that requires your body on a slope with your head and esophagus several inches above your stomach. Lying on your left so your stomach is positioned hanging down is also desirable.
If you need a stoma pouch hanging down on right side and stomach down for sleeping, your best sleep may need experimenting. Propping up and twisting body with a reclining chair to aid testing has been a start for some. Special firm sloped bed pillows are available for this upward positioning.
Some 2-piece pouch systems may allow special positioning of the pouch for sleeping. Any pouch must be returned to its hang-down walking position when you're awake. See more about 2-piece details. Beware that some pouches are limited to attachment once, others are allowed removal & reuse over again.



Shopping List
Metamucil, Benefiber, Imodium*, wipes, toilet tissue, anti-bacterial-hand-soap, paper towels, protein+nutrient drinks, pH Test Strips, etc., etc.
 *names shown may be generic. Consumables may combine Prescription types.


 
 Author's visit details:  AdventHealth
A faith-based non-profit group hospital has GI doctors unaware of Ostomy devices, and a Nurse refusing to save patient from medical adhesive on any Ostomy device.
That Nurse blames this on . . .

    being taught to use water . . .
to breakdown water-proof adhesive.

Admittedly relying on anesthesia to hide the painful injuries they cause, the Nurse will tear this barrier from a patient.

A Hollister 8925 window cover needs a one-time tug at its perforated tear-line to open if ever to view the stoma.

At AdventHealth they attach the new barrier with its firm plastic & pre-cut opening, to cover half the stoma. It will BLEED with every normal, natural motion of the stoma, obviously!
This window cover serves evidence the window was never opened. This evidence means the Nurse Never looked at the resulting stoma device.

With their assumptions the new pouch drain is already closed, they don't close the new pouch drain. Any pouch will drain itself when you leave it as it was new.

Finally, this was explained as a nurse that never, ever saw Hollister products before mine. Four steps here tell us (with Ostomy criteria) to avoid AdventHealth at any cost.

I've never experienced such nursing with
No procedural steps in play.

They demonstrate patient mishandling before Covid-19 arrival, no excuses allowed.
See a related link:   "marsi"
medical adhesive-related skin injuries



Patrick Mullins
2018

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