Colostomy Day – Superstoma: Laura’s Story

This ostomy day, to help increase awareness and understanding of living with an ostomy, Laura, a young woman with experience of both an Ileostomy and (later) a Colostomy, shares her inspirational story…

In 2009, at 29 years old, I was diagnosed with severe endometriosis after my bowel closed in four places.  In December, I had to have a loop ileostomy created after a low anterior bowel section.  My ileostomy was meant to be for two to three months.  Seven years later, in 2016, my loop ileostomy was converted into a permanent colostomy.  Most people I have spoken to, including the medical profession, struggle to understand that I have a colostomy for this reason.  Most people tend to have theirs due to colitis, crohns or bowel cancer.  I guess there are many people who have stomas for all sorts of reasons.

My experience with both is mainly positive.  I view my surgery and my stoma as something which has saved my life.  Would anyone choose to have one?  Probably not but this view will be based on a stigma which still exists about ‘bags’.  Although not totally problem free, my stomas have allowed me to have my life back.  I am no longer worried about where the next toilet is, what I am eating and how it may affect me.  The knock-on effect before my surgery was immense.  I was worried about long day trips without access to a toilet, my bowels at the time of my period was almost unbearable and it affected both my social life and personal relationships as well.  So, in many aspects, I could argue that having a stoma has improved the quality of my life.  Yes, I have to do things a bit differently now but it’s my new ‘normal’.  It is amazing how quickly things become ‘normal’.

My journey hasn’t been without its trials.  The surgeries have been tough and the two major ones have been quite eventful.  My body doesn’t react on the way that it should and there have been several minor and serious complications.  Time is a great healer and slowly my memories of the difficult times are disappearing.  I developed a recto-vaginal fistula which prevented me having my ileostomy reversed.  After several surgeries to try and fix this, we decided on a final major surgery in 2016 to try and address it.  However, the surgery wasn’t easy and I woke up with a permanent colostomy and you know what?  I was okay with it.  I have always been petrified of a reversal and the inability to control my bowels as well as the frequency of which I would have to go to the toilet.  I also developed a parastomal hernia which I found upsetting as it affected my confidence.  Thankfully, it has been addressed now and hopefully I won’t get another one, although I know that I am at high risk of this.  I still have some issues that I deal with on a daily basis but I try to tackle things in a positive way, when I can. Again, these side effects are my new ‘normal’.

I will now have a colostomy for life.  I have eight years experience of a stoma now although only a year with my colostomy so I am a relative newbie when it comes to that.  Although I have learned a lot, I also have a lot still to learn.  My stoma and I are well.  I am fortunate enough that having a colostomy which has improved the quality of my life.  I have a full-time job which is demanding but my new plumbing doesn’t affect me too much.  Yes, I have had the odd leak and had to deal with this but no more than anyone who may have to dash to the toilet with a funny tummy.  I do worry about some issues like pancaking and smells when I’m at work.  In some ways, I can also hold off going to the toilet until I can make it.

My life is ‘normal’ or as normal as anyone’s life is!  I socialise, swim and exercise.  I can be self-conscious if I am in a changing room or with people I don’t know but I am gaining more and more confidence every day.  Sometimes my confidence is knocked but I try and get on with it all again.  At the moment, I still worry about airport security and body scanners although I have been through a few times now and staff have been sensitive and understanding.  I have recently had some negative comments about using a disabled toilet.  I am hoping to start commenting back on this one – not all disabilities are visible and sometimes I need to use the disabled toilet and I am entitled to.  I would never be rude but I would like to have a phrase ready that gets my point across and empowers me.  A comment was made to me only two weeks ago at the airport and I was surprised at how much it upset me.  I won’t allow it to again though.  However, on the same trip, I saw a man sunbathing on the beach with his bag on display.  I find this very empowering and motivating so I am gaining in confidence every day.

Due to the nature of my job, I keep my stoma personal.  I’m not embarrassed by it at all as it saved my life and is now a part of me, but I wouldn’t want my wider work community knowing.  Others don’t talk about their toilet habits so why should I.  This does annoy me a bit as I would like to be a part of trying to remove the stigma of having a ‘bag’.  The way I see it, I have some more control over my bowel movement as well as being a survivor, for want of a better phrase.  A friend has recently being diagnosed with bowel cancer and had a colostomy created.  I am finding the opportunity to discuss my stoma with someone else is not only helpful for her (so she has said) but also quite cathartic.  I like having a positive impact on someone else’s life and helping them with lots of tips and hints which I have gathered over the eight years.  I have been trained as a visitor although never been used and I plan to approach my stoma nurse soon about offering to talk to people who are about to embark on surgery to listen to their concerns and try and show them that they can live a normal life.  I know that things may change in the future and that I may have other issues to deal with in relation to my stoma, but I will address and try to overcome them when they happen.

Laura, Glasgow

For more information about Colostomy day and living with a Stoma, check out Colostomy UK –  #Superstoma, and the Ileostomy Association (IA). For links about other types of stomas, check out our links page.

If you would like to define what your ostomy means to you, check out our Lived Library, click on your ostomy type and tell us your experience.

HAN 2017 – The Lowdown

The Lowdown on Enteral and Parenteral Nutrition – Supporting PINNT HAN Awareness 2017

Ever find yourself scratching your head about the terms people use in relation to feeding? New to it and confused? On one type, but not sure of the other? We’ve put together this table to help drill down some specifics… Click on the highlighted terms to read the definition as well as our lived library entries. Lots more info can be found at PINNT too.

Enteral Nutrition Parenteral Nutrition
Definition Passing through the intestinal tract Occurring outside of the intestinal tract
Acronyms / Alt Names Used EN, HEN, Tube Feeding PN, HPN, TPN
Device(s) NG/NJ tube (short-term)

G tube

G/J tube

J tube

Hickman line (or alternative Central Venous Catheter (CVC)

Portacath/PORT

PICC (short-term)

Term for Site on Body Stoma Exit Site
Where on Body Abdomen (except naso-tubes) Chest
Type of Nutrition Formula Infusion
Delivery System G tube: Pump / Bolus

J tube: Pump

Pump
Procedure / Technique Clean / Sterile Aseptic Non-Touch Technique (ANTT)

Home Enteral / Parental Nutrition – A Personal Perspective

In support of PINNT’s Home Artificial Nutrition Week, we wanted to write about the different ways and means a person can get their nutritional needs fulfilled, when they cannot get enough to sustain them otherwise. Such experiences require one or many of the different devices listed in our library. This is a chance to increase awareness of what they can be used for. What better way to describe the process than a personal perspective…

Enteral Nutrition (EN)

Nasogastric (NG) Tube

Nasogastric (NG) tubes are probably the type of device used for feeding that people are most familiar with (though they can be used for other purposes as well) .Probably because it can be seen externally, so most of us have either seen someone in person or through media with one. This was the first type of tube I had, it’s inserted through the nose, down the back of the throat through the oesophagus until it enters the stomach.

Enteral Formula and Pump

I was fed formula through a pump. (I will talk about pump feeding here for all the tubes I had, as that was the method suitable for me). There are lots of different types of formula, the dieticians choose the formula based on the calorie, nutrient and other medical requirements you have. The formula gets connected to a pump through some tubing know as a ‘giving set’. The end of the giving set would then attach to the end of my tube. The pump would be programmed to the rate of delivery. I don’t remember how long my schedules for NG feeding were exactly, but they took most of the day.

Gastrostomy (G tube)

After a little while with the NG tube, I was given a Gastrostomy. This is where an incision is made on the abdomen through to the stomach wall. The stomach wall is pulled up against the abdominal surface to make a stoma. A tube is then inserted through the stoma. The tube (often called a G tube or PEG) has either a plastic bumper or a balloon on the inside (of the stomach) to be prevent it from falling out. It also has a flange to secure it externally. The advantage of a gastrostomy is that it cannot be seen and the stoma can potentially last a lifetime. The process of feeding was otherwise the same; formula delivered via a pump over a long period.

Jejunostomy (J tube)

Enteral syringe and extension tube

Unfortunately for me I wasn’t able to get enough calories and nutrients through being fed this way. The next step was to try feeding further down the GI tract to see if my intestines would tolerate it better. This meant having a Jejunostomy. The jejunum is the second part of the small bowel. Once again, a tube is placed through an incision on the abdominal surface, but this time it led to the small bowel. With a J tube feeding has to be via a pump and it is slower compared to feeding to the stomach. The bowel does not have the same kind of capacity, so feeding can be up 24 hrs a day.

It all sounds straightforward, and it’s certainly true that it quickly becomes the new normal. I felt overwhelmed for maybe the first fortnight or so, when I was first at home with each new stoma/device, without the support of the hospital staff, but after that my confidence in the actual process and troubleshooting built quickly. Nonetheless, it is challenging; ordinary activities from the mundane to the social have to be reconfigured. They can be achieved for sure, but a lot also depends on your overall health. For me, I was still very sick and unfortunately all the methods of tube feeding that I tried were just not tolerated by my body, so I was not getting the much needed calories and nutrients throughout all the many many months of different types of tubes and stomas. My weight and health ended up at a critically low point, at that point I started TPN.

Parenteral Nutrition (PN)

Hickman line ®

I had a Hickman line placed so that I could receive parenteral nutrition. The PN goes straight to the bloodstream via the central veins and the heart, thereby avoiding the gastrointestinal system altogether. For people like me with Intestinal Failure, it allows enough us to gain enough nutrition to survive.

Hickman Exit Site and Line

My Hickman line was placed via an incision in my jugular vein, through which the line was inserted, one half threaded down the superior vena cava to the top of the right atrium of my heart, the other half threaded out through another incision about half way down my chest wall. This is where the external section of the line sits. The PN (sometimes refered to us Total Parenteral Nutrition (TPN) or Home Parenteral Nutrition (HPN)), is also administered through a pump system, set to deliver at a particular rate. The initial hospitalisation was lengthy. Unlike formula, PN infusions are compounded to individual requirements. It takes some time to get the prescription right for each person. All connections must be carried out using aseptic technique, as introducing microorganisms has serious and potentially life-threatening consequences. This meant that the process of connecting and disconnecting takes a long time. Even longer at the beginning when I was having to be taught to do the process myself. Added to this, I needed to be treated for refeeding syndrome, having been underweight and deprived of nutrition for such a long term.

Lipid (fat) and protein PN infusion bags

Coming home with PN was scary. I was concerned about the risks of a line in my heart. In the beginning, I was fearful of making a mistake in the process. It certainly felt like a lot of responsibility to shoulder. I was used to being responsible for my own life of course, but not for running the gauntlet with it on a daily basis. Initially my homecare company sent nurses in everyday, to oversee my training with it and to check how I was doing, which was helpful. There was also a huge amount of supplies to find space for and a full size pharmacy fridge for the TPN (which has to be kept refrigerated). There were a lot of changes to get used too, even figuring out how to shower with 30cm cable in the middle my of chest that cannot get wet! Like with the EN though, I’d did get used to it over time. Also, the fear of sepsis and the other serious complications that can occur, although still present, became less dominant.  I think it’s a good thing to be a little afraid still. It means I am never complacent about my PN routine. I never rush even when I’m tired and very sick, I just say to myself which would you prefer, a few more minutes ensuring everything is fully sterile or sepsis? A no brainer obviously.

Clichéd though it may be…PN saved my life. I wouldn’t be here today, if some great medics had not persisted in finding an alternative way, to get vital nutrients into people like me who’s intestinal tracts had given up altogether. I was malnourished, severely underweight and very sick. I’m still very unwell – my underlying disease has not left – but my weight and nourishment have improved substantially. It isn’t easy, it requires a great deal of time and commitment, it curtails my freedom, and being tied to a machine all day can be very hard. Going away from home is like a military operation! However, if there is something that is really important to do, then with patience, creativity, planning and a little more patience, it can generally be realised, even if it’s just the once. As with enteral feeding, a lot depends on the rest of your health. PN isn’t a one size fits all thing. The best way to find out about the life of someone you see on enteral or parenteral nutrition is to ask. To those who developed PN and those who have helped me and continue to help me live on it now, I would like to say thank you.

For further information visit PINNT

What Lies Beneath Campaign

We are launching our What Lies Beneath campaign to increase awareness about the medical accessories people live with and care for day to day. It is allied to the Not All Disabilities Are Visible movement associated with multiple charities and individuals.

We’ve put together a double sided information card to promote awareness about the existence of hidden  medical accessories, as well as basic information about the different medical appliances and devices, that people may have. Its handy business card size, means single or multiple cards can be carried around in a bag or wallet and used if and when an occasion arises. We’ve also produced an A4 poster with the same information, for places where a static sheet or leaflet would be useful. Both can be downloaded by clicking on the relevant PDF below.

The card and leaflet are particularly aimed at those situations where those of us with hidden accessories can be negatively appraised, challenged or simply misunderstood. Using disabled facilities is a frequent context where this can occur, but there are also many other times when greater understanding and awareness would be helpful. It can be difficult in the moment to know what to say. Sometimes it is just a shake of the head and disapproving look we receive. Those with medical accessories should not have to feel they need give personal information to explain themselves, unless they want to. The recipient will not know which medical appliance / device you have. The card quietly asks others to reappraise the situation, while you go on your way. The front side of the card can also be used alone if preferred. We hope that the recipients understanding will then be carried forward to future situations.

As usual we would like to hear from you, so please contact us if you would like to give feedback about your use of the card.

WhatLiesBeneathCard

WhatLiesBeneathPoster

Decoration

ivpole

Living with a medical accessory means undergoing changes to the body we are used to living in. It can affect not only the way we see ourselves, but also our perception of how we are seen by others. Whether these changes are welcome, whether or not they are planned, they invoke a process whereby the individual adapts to the new way they look. The way in which each person comes to terms with and goes about living with their accessory is an individual choice.

At MAST we believe it’s important to know options that are out there.

gcatFor some people, in addition to choosing the right medical appliances, accessorising in some way can help bring them a sense of ownership, personalisation, incorporation, reclaimation, humour, individuality, beauty, or style, (to name but a few), to their body and accessory. The links and features here explore how others have done this, including those who offer a service to make accessories for other ostomates and tubies.

As usual if you have a way to decorate your medical devices that you would like to share, we want to hear from you. Get in touch here.

Securing IV or Enteral Tubing / Giving Sets

Living with a Central Intravenous Line (CVC), stoma that has a tube for feeding / venting, or a naso-tube, can mean dealing with considerable lengths of tubing. This is particularly the case when the appliance is in use with extension sets running to a metre or so. Even when disconnected, it is not unusual to have approximately 30cm of tubing just hanging around on a chest, abdomen or face! Regardless of mobility and activity level, these things – though greatly beneficial to our health – aren’t always practical. They can get caught, tangled or pulled, get in the way of personal care and get dirty.

There are lots of securement devices around. It’s worth doing some investigating, as it may take some time to find what works best for your own set up. Especially if you have more than one accessory to deal with, you may find you need to get creative with it. Don’t be afraid to look further afield if you need too; you may find the product that works for you was initially developed for a different type. Ask your specialist nurse what might help you.

Below are a couple of basic approaches that can help to secure extra tubing in a simple way, should you want something less clinical. Please note they are not intended for the CVC, ostomy or catheter site itself, which should be secured using medical products as you have been advised by your team.

If you need to secure it to the skin, then simple plasters can work well. img_20151123_150200Just line it up so the pad is over the tubing and stick either side as normal. It will allow a small amount of give, so that the tubing can move with your movement. img_20151217_023930-2The plasters that work best for this are ones where the pad covers the whole of the centre of the plaster. Other than that, you can choose whatever you like, from plain colours, to patterns, characters, words and sayings.

img_20170126_011816If you’re having trouble with lengths of tubing externally then a simple clasp with a piece of ribbon or material, will achieve the same effect; securing it while still allowing a little natural movement. There is no sewing involved, just cut the ribbon or material to size. Push it through the clasp, and put a piece of stick on Velcro on the ends so you can bring them together.img_20170126_012700 The clasp will clip to your clothing and then you can place the IV or enteral line between the material and close. It can be removed quickly and easily as necessary. Again, you can choose whatever material or ribbon that suits you.

 

Accessorising a Stoma Pouch

The number one priority for ostomy pouches is clearly their functionality, but once a reliable set up is in place, they can be decorated to reflect your own personal style and needs. It can also help out those of us using clear pouches, for those times when we would prefer and feel more comfortable to have the output covered up. Pouch covers are a great way to achieve this. They can be slipped on and off and washed as needed. You don’t even have to have any sewing skills, as the more proficient ostomists among us make them for all!

stomacoverswithcopy-2

Shelley Davey is one such lovely lady, an ostomist herself she has designed a range of pouch covers (pictured). Stomacovers has options available for different ostomies; ileostomy, colostomy, urostomy and gastrostomy, using a wide range of templates. Custom orders can also be arranged if you have specific requirements. There are a range of different designs to choose from, you can check them out here (opens new window).

 

Using Tubie Pads

These pads are great for stomas that have a tube or low profile (button) device in situ. They sit around the stoma (with a opening for the device) and clip in place. They have the practical purpose of absorbing leakage from the stoma site, helping it keep dry and protecting the skin from gastric / intestinal effluent which can cause granulation. They also protect the stoma, providing a cushion. Materials vary, but they are usually very soft and have multiple layers, given them better absorbency than gauze pads.

groovypadsIn addition to their practically purpose, they come in a huge variety of different designs, colours and even shapes. Making it another great way of personalising your stoma. Once again, you don’t need sewing skills of your own as folks in the tubie community sell them online. GroovyTubies hand-make a range of tubie pads (pictured) here in the UK. They even make glow in the dark pads! Different types of backing material are available. You can find them here (opens new window).