Hollister Newsletter September 2019naomineethling.co.za/sites/default/files/Hollister... · Wound, Ostomy and Continence Nurses Society. (2014). WOCN Society and ASCRS Position Statement

September 2019

Hollister Newsletter

All around us we can see new life as Spring arrived early in some parts of the country.

The West Coast is showing off

at the moment, with its beautiful

flowers. Some people are very

excited about summer approaching

and others are still holding on tight

to the last bit of winter. Seasons

come and seasons go.

Everybody is different, but one thing

most people have in common is

the desire to make their lives easier.

With this thought in mind, Hollister

is constantly developing products

to improve the quality of life for

people with ostomies. One of these

major improvements is the Lock ’n

Roll Microseal Closure for drainable

pouches.

The design of the closure is based

on feedback from both clinicians

and users, to ensure enhanced

security, ease of use and comfort.

This patent-pending new design

utilizes technology that you will only

see with Hollister drainable pouches.

Over a thousand tiny microseals on

the Lock ’n Roll Microseal Closure,

securely engage when pressed

together, creating a water-, weight-,

and pressure-resistant seal. One

new feature on the closure is a

transparent flap designed to give

the user a visual indication that

the pouch is indeed closed. And

it conveniently stays out of the

way when draining and cleaning

the pouch, which helps prevent it

from getting soiled. This closure is

designed for ease of use — easy to

open, drain, clean and close. This

is important for anyone who uses a

drainable pouch.

When it comes to emptying, the Lock

’n Roll Microseal Closure is built for

absolute ease. Flexible ribbed strips

reinforce the tail, making it simple to

hold open. In fact, minimal pressure

on the outer edges releases the

contents of the pouch. Then, pinch

the pouch tail and wipe clean. For

those who desire a slim profile, the

Lock ’n Roll Microseal Closure is

ideal. The ergonomically curved

closure rests comfortably against the

body’s natural curves. The neat, flat

interlocking microseals and curved

design, make it virtually undetectable

under clothing. And the best part is

that it’s comfortable.

Try it, and seal the deal on a whole

new way to move, play, and live.

Regards,

Yolandi VosNationals Sales & Product Manager

The Importance of Stoma Site MarkingAnatomy Positions

Physical Considerations• Age

• Diagnosis

• Posture

• Contractures

• Obesity – may require siting in an upper quadrant

Areas to Avoid• Scars / wrinkles / incision lines

• Skin folds / creases

• Bony prominences

• Under pendulous breasts

• Suture lines

• Umbilicus

• Belt / Waist lines

• Hernia

• Mobile abdominal tissue

• Radiation Sites

Other Considerations• Type of Ostomy

• Occupation

• Impairments (e.g. visual, physical)

• Sports activity levels

• Prosthetic equipment

• Location preference (surgeon, patient)

• Multiple stoma sites (consider differing levels)

Principles of Good Stoma Site Selection

References:Wound, Ostomy and Continence Nurses Society. (2014). WOCN Society and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Colostomy or Ileostomy Surgery. Mt. Laurel: NJ. Stoma Siting Procedure. www.wocn.orgJ.E. Carmel, J.C. Colwell, M.T. Goldberg (Eds.), WOCN Society Core Curriculum Ostomy Management (Chapter 8). Philadelphia: Wolters Kluwer. 2016.

The Hollister logo is a trademark of Hollister Incorporated. © 2016 Hollister Incorporated. 907469-1016

Desirable stoma locations:

Ileostomy or Urostomy

Sigmoid/Descending Colostomy

Transverse Colostomy

Ribs

Internal and External Oblique Muscle Groups

2

3 Rectus Abdominal Muscle

Umbilicus

Rectus Sheath

Should the ideal sites not be availabe as suggested for various reasons, (see sites to avoid), positions above belt line within the rectus abdominal muscle may be more appropriate.

The Importance of Stoma Site Marking

Stoma site marking has emerged as best practice in the medical and nursing fields and has demonstrated that patients sited preoperatively have fewer ostomy-related complications such as leakage and peristomal dermatitis.

Marking the optimal location for a stoma preoperatively also can enhance the likelihood of a patient’s independence in ostomy care, predictable pouching system wear times, and resumption of normal activities. Preoperative stoma site marking is crucial for improving a patient’s quality of life.


The stoma site should be located within the rectus abdominis muscle to reduce the potential problem of parastomal hernia in the future.

Abdominal stomas are best sited on the upper infraumbilical roll (the apex) approximately two inches away from the central suture line and umbilicus below the belt line. Abdominal contours are not expected to change significantly in this area even with a loss or gain in weight.

The pouching system should be able to be positioned on the abdominal wall in a site that provides secure skin barrier adhesion.

The stoma should be clearly visible to the patient when either standing or sitting or lying to facilitate better management and pouch placement.

a. Lying

b. Sitting

c. Standing

d. Bending

Ostomy Care Tips

Hollister Ostomy. Details Matter.www.hollister.com

Header: 20/21 Helv Neue Black FR OstomyCare Tips

Lock ,n RollMicroseal Closure

Purpose • A drainable pouch is open at the bottom to allow emptying. It requires a closure on the bottom to keep it closed.

• A pouch should be emptied when 1/3 to 1/2 full of stool or gas.

• The Lock ,n Roll Microseal Closure is an integrated closure on a drainable pouch.

Using the Lock ,n Roll Closure

1. Roll the pouch tail up three times towards yourself until the strip of interlocking fasteners is facing upwards.

2. Align the strip of fasteners and press to the outer edges to seal the interlocking fasteners.

1. Lift the security flap towards you.

3. Pinch the pouch tail open and allow pouch contents to empty into a toilet or receptacle.

2. Unroll pouch tail three times.

4. Clean pouch tail with a tissue or moist towelette.

To Open and Empty the Pouch

To Close the Pouch















To Close the Pouch


Purpose– A drainable pouch is open at the bottom to allow emptying. It requires a closure on the

bottom to keep it closed.

– A pouch should be emptied when 1/3 to 1/2 full of stool or gas.

– The Lock ,n Roll Microseal Closure is an integrated closure on a drainable pouch.


Using the Lock ,n Roll Closure To Open and Empty the Pouch

To Close the Pouch




















To Close the Pouch















To Close the Pouch















To Close the Pouch















To Close the Pouch

Distributed by:HARTMANN-Vitamed (Pty) Ltd, Unit

15, Northlands Production Park, Epsom Avenue, Northriding 2169,

Johannesburg, South Africa

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FAQ’s

Q: How do I know my pouch is securely fastened?

A: Aligning and pressing the centre of the security flap to the outer edges will allow you to feel the interlocking fasteners seal and ensure your pouch is securely closed.

Q: Will the closure work when it is wet?

A: The material used on the closure is water-resistant and can be securely closed even when it is wet.

Q: Will the closure show through my clothes?

A: The closure is designed to be discreet with its slim profile that is not noticeable underneath most clothes.

Q: Is the closure comfortable against my body?

A: The slim profile of the ergonomically curved outlet is designed to conform to the body’s natural curves, providing the utmost comfort.

Q: Will the closure open accidentally?

A: Laboratory testing has shown that the interlocking fasteners are secure when closed properly.

Q: My output is very liquid. Are there any suggestions to make emptying easier?

A: With the closure’s unique design, you may want to control the draining of the liquid contents by unrolling the pouch tail two times and holding the last flap up. You then can unroll this flap slowly.

Q: Will people hear me open the pouch when I need to empty it in a public rest room?

A: The material used on the closure is quiet and will not make a “ripping” noise when the security flap is opened.

Ostomy Care TipsThe Importance of Stoma Site MarkingAnatomy Positions


• Diagnosis

• Posture

• Contractures






• Suture lines

• Umbilicus


• Hernia


• Radiation Sites


• Occupation













Ribs


2


Umbilicus

Rectus Sheath










a. Lying

b. Sitting

c. Standing

d. Bending

20 miles this week

2 successful mergers

0 irritation around her stoma

We know how much is at stake for YOU as the nurse and YOU as the patient

That’s why we are dedicated to developing products that deliver the right fit to help prevent

leakage, combined with the best formulations to help support healthy peristomal skin.

Backed by science and clinical evidence, the Hollister Ostomy Care portfolio aspires to be your

go-to source by allowing both you and your patient more time to focus on things that really matter.

Hollister.com




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FAQ’s

















• Diagnosis

• Posture

• Contractures






• Suture lines

• Umbilicus


• Hernia


• Radiation Sites


• Occupation













Ribs


2


Umbilicus

Rectus Sheath










a. Lying

b. Sitting

c. Standing

d. Bending

IntroductionAdjusting to life with an ostomy takes time. The process is easier if you have education and support as well as the right ostomy products for your needs. Appropriate products can help prevent some of the most common challenges faced by people with ostomies. Problems such as leakage and skin irritation are more easily prevented if you have an appropriate and well-fitting ostomy pouching system.

Sometimes, despite proper ostomy care and products, problems develop involving the stoma or the skin around it. This sheet was designed to help you learn more about some of these problems and provide some suggestions about how to manage them. This information is intended to support the information you receive from your nurse or doctor. Be sure to talk to your healthcare provider about any problems that occur with your stoma or skin.

Skin IrritationIf the skin around your stoma is damaged, it will look irritated and feel sore. Skin damage around a stoma can be hard to manage because you need to place the ostomy pouching system over the irritated area. The most important part of dealing with skin problems is to learn what caused the irritation. Below are some of the things that can create irritated skin.

Improperly FIttIng SkIn BarrIer (Figure 2) If the opening on your pouching system is too large or does not adhere well, the drainage from the stoma can damage the skin.

SuggeStIonS:• Measure the stoma using the stoma measuring guide before every barrier application

• Apply the skin barrier, making sure it fits where the skin and stoma meet. Verify that no skin is showing between the skin barrier and the stoma

• Apply stoma powder to any open skin before applying your new pouching system

• Discontinue use of stoma powder after the skin has healed

• Contact your Stomaltherapist if the skin does not improve

Healthy Stoma and Peristomal Skin (Figure 1)While stomas come in a variety of sizes and shapes, the healthy stoma is pink or red in color and slightly moist. A stoma bleeds easily when rubbed or bumped (for example, when washing). This minor bleeding should resolve quickly.

The skin around the stoma (peristomal) should be intact without irritation, rash or redness. A properly fitting skin barrier protects the skin from being irritated or damaged by the stoma drainage. It doesn’t really matter whether your stoma is large or small or whether it protrudes or not, as long as the drainage can come out of the stoma and go into your pouch without leaking under the skin barrier.

Skin Irritation Under Tape (Figure 3)Irritated skin that develops only under the tape of your ostomy pouching system can occur for a variety of reasons. Your skin may have become damaged from incorrect or frequent tape removal. The skin may be itchy, blistered or open and weeping. This problem can develop at any time even if you have worn the same type of product for months or years.

SuggeStIonS:• Try a pouching system without tape. These products are adhesive but use a skin barrier instead of tape


• Contact your Stomaltherapist if you are having difficulty keeping your pouch on

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1

3

Peristomal Skin Care

OStOmy Care tiPS

151611CT_r1_HOL_OS_CareTips_PeristomalSkinCare_r3.indd 1 11/22/17 8:39 PM


For product questions/sampling needs in South Africa, call 011 704 7420 or send an email to [email protected]

Skin Irritation Due to Leakage (Figure 4)Stoma discharge can be irritating to the skin, causing redness that can progress to open raw skin that weeps or even bleeds. This type of irritation is often very painful. People with ileostomies are at the highest risk. However, for anyone, a change in your stoma or the shape of your abdomen can make your pouching system not fit as well as it used to, leading to leakage.

SuggeStionS:• Change your pouch promptly if drainage is leaking under the skin barrier

• Change your pouch on a regular schedule before it leaks


• Consider use of accessories (convex skin barrier, paste, barrier rings) to help prevent leakage under the skin barrier

Rash Under Ostomy Product (Figure 5)Sometimes a rash is caused by a skin infection or sensitivity or even leakage. The area may be red or red with bumps. Itching may also be a symptom. It is important to get assistance in determining the cause since the suggestions for treatment will vary.

SuggeStionS:• Contact your Stomaltherapist if you are having difficulty keeping your pouch on

• If an antifungal medication is recommended for treatment, make sure it is in a powder form, not a cream

RemembeR:• Don’t ignore skin problems around your stoma

• Do seek help for skin irritation or pouch leakage

• Don’t use home remedies

• Do call for samples if you need to try something new

4

5

The Hollister logo and “Healthy skin. Positive outcomes.” are trademarks of Hollister Incorporated. © 2017 Hollister Incorporated. 923085-1117 US-00185

Routine follow-up with your healthcare professional is recommended.

Prior to using any ostomy products/accessories be sure to read all product inserts and labels.

Peristomal Skin CareOStOmy Care tiPS


IntroductionAdjusting to life with an ostomy takes time. The process is easier if you have education and support as well as the right ostomy products for your needs. Appropriate products can help prevent some of the most common challenges faced by people with ostomies. Problems such as leakage and skin irritation are more easily prevented if you have an appropriate and well-fitting ostomy pouching system.

Sometimes, despite proper ostomy care and products, problems develop involving the stoma or the skin around it. This sheet was designed to help you learn more about some of these problems and provide some suggestions about how to manage them. This information is intended to support the information you receive from your nurse or doctor. Be sure to talk to your healthcare provider about any problems that occur with your stoma or skin.

Skin IrritationIf the skin around your stoma is damaged, it will look irritated and feel sore. Skin damage around a stoma can be hard to manage because you need to place the ostomy pouching system over the irritated area. The most important part of dealing with skin problems is to learn what caused the irritation. Below are some of the things that can create irritated skin.

Improperly FIttIng SkIn BarrIer (Figure 2) If the opening on your pouching system is too large or does not adhere well, the drainage from the stoma can damage the skin.

SuggeStIonS:• Measure the stoma using the stoma measuring guide before every barrier application

• Apply the skin barrier, making sure it fits where the skin and stoma meet. Verify that no skin is showing between the skin barrier and the stoma


• Discontinue use of stoma powder after the skin has healed

• Contact your Stomaltherapist if the skin does not improve

Healthy Stoma and Peristomal Skin (Figure 1)While stomas come in a variety of sizes and shapes, the healthy stoma is pink or red in color and slightly moist. A stoma bleeds easily when rubbed or bumped (for example, when washing). This minor bleeding should resolve quickly.

The skin around the stoma (peristomal) should be intact without irritation, rash or redness. A properly fitting skin barrier protects the skin from being irritated or damaged by the stoma drainage. It doesn’t really matter whether your stoma is large or small or whether it protrudes or not, as long as the drainage can come out of the stoma and go into your pouch without leaking under the skin barrier.

Skin Irritation Under Tape (Figure 3)Irritated skin that develops only under the tape of your ostomy pouching system can occur for a variety of reasons. Your skin may have become damaged from incorrect or frequent tape removal. The skin may be itchy, blistered or open and weeping. This problem can develop at any time even if you have worn the same type of product for months or years.

SuggeStIonS:• Try a pouching system without tape. These products are adhesive but use a skin barrier instead of tape



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FAQ’s

















• Diagnosis

• Posture

• Contractures






• Suture lines

• Umbilicus


• Hernia


• Radiation Sites


• Occupation













Ribs


2


Umbilicus

Rectus Sheath










a. Lying

b. Sitting

c. Standing

d. Bending

At Hollister Ostomy Care, we balance product effectiveness, patient safety, and environmental responsibility.

In the pursuit of improving the performance of our products and minimizing environmental impact, we’re happy to announce that we’re making the following improvements to our pouch film, designed to achieve both of those goals, and deliver added peace of mind and confidence for you and your patients.

Chlorine-free. Our pouch films will no longer contain chlorine, which means the disposal of the pouches is easier on the planet.

Improved odor control. Odor-resistant properties of the new pouch film enable the film to contain gas longer.

More discreet. White pouch film will be replaced by beige film, helping make the pouch less visible under clothing.

Better visibility. Translucent pouch film will be replaced by a more transparent film, which can help with application and improve visibility during use.

These improvements only affect the pouch film. Our products will continue to be of the same high quality you have come to expect from Hollister.

Improvements are being made to our ostomy pouch films

Dedicated to You and the Planet

The Hollister logo and “Healthy skin. Positive outcomes.” are trademarks of Hollister Incorporated. ©2019 Hollister Incorporated. Not all products are CE marked.

The Importance of Stoma Site MarkingAnatomy Positions


• Diagnosis

• Posture

• Contractures






• Suture lines

• Umbilicus


• Hernia


• Radiation Sites


• Occupation













Ribs


2


Umbilicus

Rectus Sheath










a. Lying

b. Sitting

c. Standing

d. Bending

Hollister Ostomy. Details Matter.

At Hollister, we understand security and

comfort are priorities when it comes to your

ostomy needs, and we are committed to

providing leading-edge solutions for

ostomy care.

To learn more about Hollister ostomy

products, visit www.hollister.com.

Request your trial sample today!

Adapt Barrier Rings

• Shapewithoutflakingorcracking

• Fitsround,ovalandirregularlyshaped stomas

• Helpspreventleakageandgivesyou greater security

• Easytoapply—evenforthosewith limited dexterity

Get security and flexibility without the flakes. Feel the

Flex.

Forget the Flakes from Your Ostomy Accessory.

Try Adapt barrier rings today

Hollisterandlogo,andAdaptaretrademarksof Hollister Incorporated. “Hollister Ostomy. Details Matter.” isaservicemarkofHollisterIncorporated.©2012Hollister Incorporated.PrintedintheUSA.921902-212

To request samples call

011 704 7420 or mail a

request to

[email protected]

Experience Improved Security

Adapt barrier rings offer technology designed

to ensure comfort while maintaining a secure fit.

Adapt barrier rings:

• Holdtogetherwhenwet,soskinisless

likelytobeexposedtostomaoutput

• Are fast and easy to apply

• Areconvenientlypackagedinsingle-ring

trays(10perbox)foreasierhandling

The Clear Choice for Comfort and Protection— Try Adapt Barrier Rings.Someostomyaccessoriesmayerode,flake,or

crackduringnormalwearorwhenstretched—

causingunwantedleakage,frustration,and

discomfort. If you’re searching for an alternative

to provide improved protection and more reliable

coverage, Adapt barrier rings could be the right

solution for you.

Feel the Difference for Yourself!To request samples dial 011 704 7420

or send a mail to

[email protected]

FAQ’s

Q: What is the skin barrier on the Adapt barrier rings?

A: The barrier formulation of the rings is the Flextend M™ skin barrier, which is an extended wear skin barrier.

Q: How do these barrier rings compare to other rings on the market?

A: Some barrier rings from other manufacturers are made of standard wear skin barriers. Others are made of extended wear material. The Adapt barrier ring is made of extended wear barrier material that’s flexible and moldable.

Q: How do I know if I should use a 2” or a 4” barrier ring?

A: Because the barrier rings stretch so well, most people find the 2” barrier ring works best. The 4” product suits people who need substantially more coverage from a ring.

Q: IIs there a top or bottom to the barrier ring?

A: No. Either side may be applied to the skin.

Q: Can the Adapt barrier ring be used if the stoma is not round?

A: Yes, Adapt barrier rings can easily be stretched and formed for a customized fit. To form to the shape needed, simply remove the ring from the plastic tray and then remove both film release liners.

Q: Is paste needed in addition to the barrier rings?

A: No. There are many advantages for using barrier rings instead of paste. When using barrier rings, paste is usually not necessary.

Q: Can Adapt barrier rings be used if the skin is irritated?

A: Yes, Adapt barrier rings are alcohol-free and will not cause stinging when applied to broken or irritated skin. Irritated skin near the stoma should be evaluated by a qualified healthcare professional who can help determine the cause of the skin problem and help prevent further injury.

Q: How do you apply an Adapt barrier ring?

A: Adapt barrier rings may be applied to the back of the skin barrier or directly on the skin They can be stretched and molded to provide a customized and comfortable fit. They need to be removed from the tray and the plastic liner removed from both sides before application. There is no designated top or bottom so either side can be applied to the skin.

Adapt Barrier Rings

Hollister Secure Start Services eNewsletter Q1 2019

8

The skin around your stoma should be intact without irritation, rashes or redness. But skin complications aren’t always visible. Peristomal skin itching is a common occurrence. People living with a stoma and otherwise healthy peristomal skin often complain that “need to scratch” sensation.

“We recognize that skin health is so important to the people we serve,” explained Elina Yufa, Associate Digital Manager at Hollister Incorporated. “Evidence has shown us the negative impact of peristomal skin complications on quality of life.”

As a resource to you, we have devoted a website page with an interactive quiz on Hollister.com that uncovers the facts, addresses common misconceptions, and offers ways to help with peristomal itching.

Elina added, “People living with a stoma don’t have to live with the cycle of unhealthy skin, and we want to be a part of making life more rewarding and dignified for them.”

Sometimes You See It, Sometimes You Don’t Check your knowledge of peristomal itching

NEWS FROM HOLLISTER INCORPORATED

“People living with a stoma don’t have to live with the cycle of unhealthy skin...” —Elina Yufa

Start touring the page nowhollister.com/ditchtheitch

Check out the Peristomal Skin Assessment Guide for Consumers

How much do you know about peristomal itching?

Click here to take the interactive quiz.

https://www.hollister.com/en/ditchtheitch?utm_source=ss-newsletter-pdf&utm_medium=direct&utm_campaign=uso-itching-190215&utm_content=ditch-the-itch-main-page

http://psag-consumer.wocn.org/#home

https://www.hollister.com/en/itchinguncovered?utm_source=ss-newsletter-pdf&utm_medium=direct&utm_campaign=uso-itching-190215&utm_content=itching-uncovered-interactive-quiz

Hollister Secure Start Services eNewsletter Q1 2019

12

WHAT’S SO FUNNY?

I Can’t Stop Itching! Brenda scratches right where it itches with humor

I’ve had my share of itching. I have a wooded backyard, and if I see a wood tick, I have a psychological urge to keep scratching. In my early Camp Fire Girl days, I once climbed into a patch of poison ivy and the pink splotches on my legs soon turned into an itchy mess.

It seems the more you feel that mosquito bite, the more you are compelled to scratch it. Unfortunately it never helps. I did some very thorough “research” through friends and family to ask for their remedies for a never-ending itch. Here is what my limited market research pulled up: Rub coconut oil or the tops of strawberries on the itch. Basil, peppermint or aloe vera leaves work for some folks too. Apple cider vinegar got a couple of nods, along with drinking several beers. Eat bananas and watermelons and then rub their skins on your itches. In a pinch, oatmeal paste or clay will do too. And there you have it.

Of course, none of these proposed home remedies would work well for itchy skin underneath an ostomy barrier. Putting any of these on the peristomal skin could interfere with the barrier’s ability to stick to the skin – and the outcome of that could be worse than the itch!

Early on with an ostomy, I used to have terrible itches under my pouch and I hated changing it so I just left it. This was not a great plan. My skin suffered a lot from my irregular stoma, cutting my pouches too big, and products that didn’t agree with me. It was trial and error for a very long time. After I had a couple more surgeries, the combination of antibiotics gave me a yeast infection around the stoma to contend with. At that time, I used a lot of paste, but there

are so many better products these days. It’s been a long time since I had an itch around my stoma. The best thing to do if you have an itch is to probably check out your flange to see if it’s been compromised. Once stool or urine gets on the skin it can wreak havoc.

I’ve also found that having your hands down your pants in public is just not a good look. People will wonder about you.

I’ll leave you with one last tip I read about on the internet—press a charge card along the itch and it will go away. I have my own theory about that. I went shopping while suffering from an itchy sunburn, took the charge card out, bought a new purse, some makeup and a cute dress and forgot about the itch all together. That card tip really worked!

Brenda Elsagher is a loud and proud member of the ostomy community and a good friend of Hollister Incorporated. She is an international keynote speaker, author and comedian. Her books include: If the Battle is Over, Why am I Still in Uniform?; I’d Like to Buy a Bowel Please!; Bedpan Banter; It’s in the Bag and Under the Covers; and Your Glasses Are on Top of Your Head. you can find out more about her at livingandlaughing.com.

Financial Disclosure: Brenda received compensation from Hollister Incorporated for her contribution to this eNewsletter.

*Please note: The content of this article is not meant as medical advice. If you have peristomal skin itching, please consult your ostomy care nurse or healthcare professional.

Being a stomaltherapist was a career choice that I never envisaged in my future when I started my nursing training many years ago.

Circumstances showed this pathway (first working part-time for Sr Naomi Neethling), and needing to decide to continue in Primary Health Care or go forward with Stomaltherapy was one of the easiest decisions I have ever made, particularly as I wanted a complete change , and more patient contact.

I now work full time in the practice of Naomi Neethling Health Services in Pretoria.

Keeping a sense of humour, but still with compassion, is essential. Seeing the patients “insert” themselves back into their families, and society, makes this work very rewarding.

Choice of product, whether a one piece or two piece, is a priority for me, bearing in mind the factors of cost, body shape, type of stoma, effluent volume/type, and whether or not there is someone to assist etc. The goal is independence by getting the patient back to as “normal” as possible and as quickly as possible. Teaching the patient to “own” their stoma and not passing responsibility.

Chew, chew, chew.........!! Patients are delightfully wilful and try new things (yippeeeee) and then phone wondering why “the stoma hasn’t worked for 3 days”.....”I am nauseous”...... “is it normal to have bad cramps and tummy bloated”..... We all give advice regarding diet especially for the first 4 weeks postop, and asking a dietician to see the patient before discharge from hospital encourages a patient to recognise the importance of food guidelines.

Keeping in contact with the patients is important. Emphasis should be made that when they notice any changes, to make contact. To come in at least every 6 months for follow-ups, especially as patients are not always aware of developing parastomal hernias. Regular checks postop should be the norm until the stoma has settled and the patient is managing well. The quantities of visits vary greatly according to individual patient needs.

Just taking time with the placement of the appropriate base/product usually ensures a good wear time.

LISTEN to the patient.

LEARN from the patient. (They usually solve their own problems)

To travel and explore the World still awaits me.... as well as Darling and Sutherland (but only in the summer) in our beautiful country.

Sr Tandi EllisNaomi Neethling Health Services952 Justice Mohammed Str, Brooklyn, 01810123460709

Letter to Hollister

By: Dr Robbie de MuelenaereI have been a radiation oncologist for 30 years and have gone through the trauma of cancer and the fairly frequent resultant colostomy with many patients.

I was often reminded of the disastrous effect of colostomy in my student years as the technology around stomas and the paraphernalia was in its infancy so many years ago. I was privileged to observe the improvement and see the positive influence on quality of life as the technology improved. We have counselling support in our practise and have also seen how patients’ lives stabilise over time.

I was diagnosed at the end of April 2017 with a silent but fairly advanced cancer of the rectum, and underwent an anterior resection on 7 May 2017. Immediate re-anastomosis was technically impossible and I had a colostomy.

Learning to live with a stoma was quite an experience and I frequently had to remind myself of my message to patients that a stoma saves our lives every day! The support from the stomatherapy team was invaluable and they contributed immensely to the process of adjusting my life. They have a deep understanding and their availability was incredible. Even as myself and my doctor team had a good working knowledge about stomas there were many aspects

where the stoma team had to help and I’m deeply indebted to them.

After successfully completing Chemo-radiation and a further 3 courses of Chemotherapy we waited another 6 months for a reversal operation in April 2018. This was technically difficult after the previous surgery, chemo- and radiotherapy but successfully completed. Unfortunately I suffered multiple complications including two near-fatal ‘superbug’ infections. The long term effect was the final operation on 8 March 2019 – a ‘loop colostomy’. Since this procedure I have never looked back! ‘Sakkie’ and I have a good relationship and live together in harmony (most of the time! :) ).

I am back exercising and jogging/walking 30+ km per week. I’m feeling excellent and have needed little change to my diet. When I enjoy food I know will cause more difficulty with ‘sakkie’ I deal with the consequences with a smile!

The most important message is that there is good quality life with a stoma with good support from the stomatherapy team. They also have an excellent supply system in place and help dealing with the medical aid side of things.

I’m more than 2 years cancer free and have every expectation of being cured of the disease. Here’s to many years of healthy good quality life!

Living with a colostomy

People with ostomies have experiences that others can learn from. Won’t you share yours? Whether you run marathons or just stay busy running your normal life, we’d love to hear from you. If you are willing to share your story with others, please email Yolandi Vos at [email protected]

QUESTIONS TO ET’S

Being involved in people’s lives so intimately, forces me to value the honest moments in life. Also to evaluate what is true in my own life. I love the simple and uncomplicated things in life. I am loyal and dedicated in my relationships, but my trust is earned. I am comitted to my passion as a wife, a mother, grandmother and a Nurse.

When time lends itself, I do in-depth research on various subjects. I love knowledge and new insights resulting in regular reading on various subjects. I enjoy crafts and embroidery, being creative and making things with my hands.

I am not a “Bucketlist-kind-of-girl” – I’d rather spend time traveling with my best friend, who is my husband, or practicing bee-keeping. Participating in community outreaches in Africa and Indonesia is something I still want to do.

After working in community development, my path crossed Sr Naomi Neethlings and inevitably, stoma care. As General Surgery was one of my favorite fields, stoma care came naturally. I thought it was just a pause with a short life span and comitted for 5 years. Almost 8 years later, I fell in love with the job and learned to deal with all the challenges that comes with being a Stomaltherapist. It really is a service of love!

The reward is found in working closely with patients, being suddenly and directly involved in each of their lives in their most vulnerable and fragile state as a human being. This is profoundly life changing for me as a nurse, but also as a person.

Working in the private sector does not make it easy for the patient or stomaltherapist to justify regular visits. I have a regimen which I try to stick to.

For New patients I recomend 2-4 consultations in the first 2 weeks post-operatively with a follow up consultation at 6 weeks post-op for

product adjustment, problem solving and stitch removal.

Thereafter the patient and family will have sufficient information, counselling and product training to transition into this new life with a stoma. Patients and family will have gained the self-confidence to take over full responsibility for care and regular product changes.

A 6 month to yearly visit helps with product script and medical aid requirements and allows us to pick up issues before they cause problems .

I do however have patients that come for weekly clinic visits to change products. Always let the patient guide you, and be a responsible health care worker by putting the onus back on the patient and not keep them dependent on you as a stomatherapist. They have to be able to cope in a crisis, and this sense of being in control empowers each ostomate!

To choose the correct product depends on various aspects, including but not restricted to the following factors:

1. Type of stoma: do you need access to stoma? For example, with a Urostomy we need access to the stoma the first 4 - 6 weeks, with stents in place. Once a patient is

Sr Francis PienaarNaomi Neethling Health Services952 Justice Mohammed Str, Brooklyn, 01810123460709

settled on the product they do not want to chop and change.

2. Location on body surface. Also, available protrusion of Mucosa is vital in product choice. A little pout always makes things easier.

3. Patient specific preferances are included to help with compliance in stoma care and product choice. This include, activity, personality, body image, illness profile and resulting treatment and life style requirements.

I need to emphasise that with regards to diet, we as Stomaltherapists are not Dietitians. We can, however, provide guidelines in conjunction with lifestyle adjustments and advice to prevent life threatening consequences, like dehydration and malabsorption with, for instance, a patient with an Ileostomy. We should do the bit that we can and remember that we can refer patients with challenges to competent dietitians. Being to specific and jotting down to many rules and guidelines can become an obstacle in a well-balanced diet plan. We all have to deal with the consequences of what we put in our mouthes. For ostomates everything happens where it can be seen and heard. This should not be to much of a deterrent to find the midway between a balanced diet and being afraid of eating certain foods. Just guide the patient to keep track of what is on the menu. Mindful eating is key.

Stoma patients tend to isolate themselves from social interaction, even daily tasks like shopping is neglected, as to not come into contact with other people. Looking

inward and focusing on recovering from

surgery, life changing treatment and just

coping physically is first on their minds.

It is important to provide counselling and

information on the ajustment period of

about 3 months to 6 months. This time

frame is set aside for dealing with the

stoma, care, treatment, recuperation and

adjustment.

Then we need to re-integrate the

patient back into society. This is often a

challenging and difficult process. Patients

need proper support and guidance

from everyone involved. We should

always keep the door of counselling and

emotional support open. I refer patients

to professionals to assist them in their

process of adjustment.

The best advise I give patients is to not

not let your stoma dictate your life. Let it

become one of the things you attend to in

your daily routine. Caring for your stoma

should not become more important than

caring for yourself. Always give correct

and current information to your patient.

Use the technology at hand to create a

video diary of each specific patients stoma

care regimen. The patient and family

can refer back and have time to absorb

information on their own time.

Also, bombarding the patient with this

flood of advice could be overwhelming,

so remember to keep this in mind.

QUESTIONS TO ET’S




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Documents

Hollister Newsletter September 2019naomineethling.co.za/sites/default/files/Hollister... · Wound, Ostomy and Continence Nurses Society. (2014). WOCN Society and ASCRS Position Statement