January 2021 Volume 53 Issue 5

January MeetingTues. January 19

7:30 p.m.

OSTO-INFOHamilton & District Ostomy Association

Meetings held at Sacred Heart Parish Community Centre, 24 Poplar Ave., Hamilton

Visit our Web Site at: www.ostomyhamilton.com

Serving theRegion since1968

&Ostomy Association

Pandemic Blues? Lockdown getting you down? Physically tired? Under Stress?

Are you looking for something to help get through this second pandemic lockdown?

Come to our Zoom meeting on January 19th

Join us as we welcome Stephanie MacLeod from Saorsa Living.

Stephanie began doing yoga after suffering an injury and discovered that movement and meditation offer many benefits. There are the physical benefits of strengthening, toning and aiding mobility, and there are also many psychological benefits.

Stephanie will help us discover the benefits of movement and meditation, connecting our minds with our bodies through breath while physically strengthening, toning and bringing mobility to our muscles and joints. She will explain why we are not bound by age or ability and that movement and meditation is truly for everyone.

What Stephanie will show us can bring us a sense of calm, peace and balance that will benefit us not only physically but will help with our emotional well-being during this difficult time. These benefits won’t

end when the meditation session ends, but can carry us calmly through the day and help us manage symptoms of certain medical conditions.

This is one meeting you do not want to miss!

Because of Covid-19, this meeting will not be in person but will instead be conducted remotely using the Zoom platform via your computer, tablet, smartphone, landline telephone and/or cell phone.

To Join meeting, log on to https://zoom.us/join

Meeting ID: 401 907 9004 P asscode: 731738You can also join us via telephone at (647) 374-4685

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From the PresidentsJanet and Mike Paquet

Welcome to the first issue of the Osto-Info for the year 2021In our last presidents column we focused on the events of 2020 and how it temporarily changed the look of the Ostomy Association. When the world shut down we had to drastically change how we as an association

worked and figure out how to accommodate our membership during the current world pandemic. We cancelled our March – June meetings and moved to an online format starting with our September 2020 AGM.

When Premier Ford announced mid-December

that Hamilton had entered the grey zone, and that as of December 26th, the entire province of Ontario would also be under a complete lock down, the question of how we can best serve our membership was once again brought up. Our online meetings have been poorly attended and all of our other services have been put on hold. What can we do? This latest shut down brings the question of when we will be able to have our regular meetings, when can we continue our education programming for PSW and nursing students and when can we start visiting new ostomates?

To start, we will continue with our online meetings each month using the Zoom platform. Zoom can be accessed by computer, tablet, smartphone and telephone. Although we are unable to do in-person ostomy visits to new ostomy patients, will be continue to do the visits

through telephone calls and/or online. We now have the capability to use the internet to also do virtual face to face visits using zoom or facetime. We are also focusing on increasing our online presence, adding additional information and resources to our website, postings on our Facebook page and we have opened an Instagram account and registered with Linkedin.

During this ongoing crisis many business have been struggling to survive and not for profits have also taken a hit with their services compromised and funding sources drying up. How does this present economy affect us as an association? One of our funding sources has been our door prizes at each monthly meeting, our annual December Potluck is one of the biggest fundraisers the association has. Unfortunately due to its cancelation this past year, our year end donations are at an all-time low. We have also not been able to do our annual raffle to send children to the Ostomy Canada Youth Camp in Bragg Creek, AB.

One of the ways that the BOD is looking to save money is by reducing the costs of the newsletter printing and mailing. We have been able to reduce some of the newsletter cost by delivering less copies of the Osto-Info to the local pharmacies. We are also asking members if they are willing to switch to the online version, saving HDOA on the printing and mailing costs. If you are willing to have your Osto-Info sent by email, please let us know.

Please also keep in mind that the Annual 2021 memberships dues are due, if you haven't sent your renewal yet please do so, and remember that we know accept e-transfers of membership and donations.

Many thanks and we look forward to seeing/hearing you at our next meeting on Tuesday January 19th!

Best,Mike and Janet

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H&DOA Helping Freinds of Ostomates

Worldwide!

Can you imagine having lifesaving ostomy surgery only to be told that there are slim to no ostomy appliances for you to use?

Unfortunately this is the reality of many ostomates living in third world countries. With no supplies, some of these ostomates have resorted to using plastic bags or tin cans to hold their waste.

Friends of Ostomates Worldwide Canada is a non-profit organization operated solely by volunteers. Since 1986, FOW Canada has collected and sent over

50,000 KG of ostomy supplies and literature to more than 52 needy countries. Here is a list of some

countries receiving these donations: Algeria, Bulgaria, Chile, China, Croatia, Cuba, Dominican Republic, Ecuador, Egypt, Hungary, India, Indonesia, Iran, Iraq, Jamaica, Malaysia, Mexico, Nigeria, Pakistan, Panama, Philippines, Romania, Russia-Belarus, Santo Domingo, Thailand, Vietnam and Yugoslavia.

What happens here in Canada when someone has an ostomy reversal or when they have changed brands of appliances? What do we do with our old or leftover supplies? Instead of throwing them in the trash, let us know and we can pass them on them to FOW Canada to distribute to those ostomates who are currently using unconventional and dangerous methods to collect their waste.

Just since September, H&DOA picked up extra supplies donated by our members, people in the community, and local pharmacies. Many of these supplies have passed their expiration point and cannot sold in Canada. These supplies were then delivered in mid-December to a storage area in St Catharines where they will be sorted, packed and sent to a third world country for distribution.

In the latest pack and ship to Iran, shipping costs were expected to cost upwards of $4500.00.

How can we help ostomates in need? If you have excess supplies or supplies you are no longer able to use, let us know and we will pick them up. FOW is also in need of monetary donations to help supplement the cost of shipping.

Every little bit counts.

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Our skin is the largest organ of the body and is composed of two layers. The skin acts as a barrier to harmful sub- stances, chemicals and protects us from the environment. The outermost layer of the skin is called the epidermis. The skin is part of the immune system. When it has beencompromised by foreign materials such as bacteria or allergens it will become red and inflamed. (Approximately 20-70% of people living with an ostomy experience skin complications; these can be due to multiple reasons such as leakage, allergy, and skin stripping due to the removal of the flange. Removing the pouching system too quickly can cause skin damage such as skin stripping, exposing the skin to further injury such as irritant dermatitis. As we age, our skin changes and becomes thinner and more fragile, resulting in skin tears. The additions of adhesive products to assist with a pouch seal may increase the risk of skin damage and should be used only when necessary.

In order to protect the skin from harm and chemicals, the NSWOC and WOCN Societies recommend using warm water to cleanse the peristomal skin and the stoma. Water is readily available and not harmful to the skin. A frequentquestion that stoma nurses get asked is; Should use alcohol wipes, antiseptics, baby wipes or flushable adult wipes for cleansing the stoma and the skin? In reviewing the literature, it was interesting to see what the dermatologists and biochemists are saying about the use of these products on neonates and babies’ skin. In 2016Yu et al. reviewed the ingredients in multiple baby wipes and found many ingredients to cause contact dermatitis in infants (3). Although, this study was evaluating baby wipes on infant skin, it is known that the skin beneath the flange is susceptible to injury due to frequent removal ofthe pouching system.

Contact dermatitis is when the ingredients in a

product that is applied topically cause a reaction of the skin. A reaction may not be noticed immediately but can develop over a few days, weeks or years. Once an individual develops a contact dermatitis beneath the flange, the skinbecomes red and weepy preventing the flange from adhering to the skin. When this occurs, the skin has been compromised; therefore, the natural barrier protecting you from infection has been breached, allowing for bacteria topenetrate the skin.

In discussion with Dr. Greg Schultz PhD, a well-known researcher and biochemist in wound care, “Different baby wipes have substantially different formulations. Common ingredients include acetyl hydroxyethylcellulose, a plantbased product used as a cleaning agent along with glycerinor propylene glycol that are humectants that can help other ingredients penetrate more deeply into skin. Most wipes contain a buffer like citric acid which helps with product stability and maintains the pH balance of the products. Also, preservatives like parabens can be present and these chemicals can cause skin irritation.” Not only may these ingredients be harmful, but some may prevent your flange from adhering and allowing you to achieve the wear-time you desire.

Maintaining the skin around your ostomy and beneath your flange is extremely important. When considering which products to use, it is important to recognize that many products that are not designed for ostomy care do not have the research to support their use and may put you at risk of injury to your skin. See your ostomy nurse to discuss which products are safe to use and to help you with a skin assessment.

If you have further questions, contact the author at lauren@macdonaldsrx.com

People don’t talkabout catheters— they’re icky,urological, andbelow-the-belt

Care and Management of the Skinbeneath your Ostomy Appliance

by Lauren Wolfe RN, BSN, CWOCN; Macdonald’s Prescriptions Fairmont Bldg; via Vancouver (BC) Ostomy HighLife; via Jan 2021 UOAA Ostomy Outlook

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Viruses can be active outside the body for hours, even days. Disinfectants, liquids, wipes, gels and creams containing alcohol are all useful at getting rid of them – but they are not quite as good as normal soap. When I shared the information above using Twitter, it went viral. I think I have worked out why. Health authorities have been giving us two messages: once you have the virus there are no drugs that can kill it or help you get rid of it. But also, wash your hands to stop the virus spreading. This seems odd. You can’t, even for a million dollars, get a drug for the coronavirus – but your grandmother’s bar of soap kills the virus.

So why does soap work so well on the Sars-CoV-2, the coronavirus and indeed most viruses? The short story: becausethe virus is a self-assembled nanoparticle in which the weakest link is the lipid (fatty) bilayer. Soap dissolves the fat membrane and the virus falls apart like a house of cards and dies – or rather, we should say it becomes inactive as viruses aren’t really alive. Putting it another way, Soap works so effectively because its chemistry pries open the coronavirus’s exterior envelope and cause it to degrade. These soap molecules then trap tiny fragments of the virus, which are washed away in water. Hand sanitizers work similarly by busting apart the proteins contained in a virus. The slightly longer story is that most viruses consist of three key building blocks: ribonucleic acid (RNA), proteins and lipids. A virusinfected cell makes lots of these building blocks, which then spontaneously self-assemble to form the virus. Critically, there are no strong covalent bonds holding these units together, which means you do not necessarily need harsh chemicals to split those units apart.

When an infected cell dies, all these new viruses escape and go on to infect other cells. Some end up also in the airwaysof lungs. You can’t, for any price, get a drug for the coronavirus – but your grandmother’s bar of soap kills it When you cough, or especially when you sneeze, tiny droplets from the airways can fly up to 10 meters. The larger ones are thought to be the main coronavirus carriers and they can go at least two meters.

These tiny droplets end on surfaces and often dry out quickly. But the viruses remain active. Human skin is an ideal surface for a virus. It is “organic” and the proteins and fatty acids in the dead cells on the surface interact with the virus.When you touch, say, a steel surface with a virus particle on it, it will stick to your skin and hence get transferred on to your hands. If you then touch your face,

especially your eyes, nostrils or mouth, you can get infected. And it turns out that most people touch their face once every two to five minutes.

Washing the virus off with water alone might work. But water is not good at competing with the strong, glue-like interactions between the skin and the virus. Water isn’t enough. Soapy water is totally different. Soap contains fat-like substances known as amphiphiles, some of which are structurally very similar to the lipids in the virus membrane. The soap molecules “compete” with the lipids in the virus membrane. This is more or less how soap also removes normal dirt from the skin. The soap not only loosens the “glue” between the virus and the skin but also the Velcro-like interactions that hold the proteins, lipids and RNA in the virus together.

Alcohol-based products, which pretty much includes all “disinfectant” products, contain a high-percentage alcohol solution (typically 60-80% ethanol) and kill viruses in a similar fashion. But soap is better becauseyou only need a fairly small amount of soapy water, which, with rubbing, covers your entire hand easily. Whereas you need to literally soak the virus in ethanol for a brief moment, and wipes or rubbing gel on the hands does not guarantee that you soak every corner of the skin on your hands effectively enough. So, soap is the best, but do please use alcohol-based sanitizer when soap is not handy or practical.

Paul Thordarson is a professor of chemistry at the University of NewSouth Wales, Syd Vancouver Ostomy HighLife - May / June 20

The Science of Soapby Paul Thordarson, The Guardian

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Dentions of

an Ostomy....via Ostomy Canada January 2021 Newsletter

Colostomy: The surgically created opening of the colon (large intestine) which results in a stoma. A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. It may further be defined by the portion of the colon involved and/or it permanence.

Ileostomy: A surgically created opening in the small intestine, usually at the end of the ileum. The intestine is brought through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent, and may involve removal of all or part of the entire colon.

Urostomy: The surgical procedure which diverts urine away from a diseased or defective bladder. The ileal of cecal conduit procedures are the most common urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine(cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder.

Sleeplessness, loss of appetite, feelings of guilt or worthlessness, irritability are some of the symptoms of depression. It can be triggered by the inability to participate in normal daily pleasurable activities, by a sense of helplessness and lack of control over your body. Medications, stress, malnutrition, anesthesia, chemotherapy or metabolic imbalance can also cause depression.

Patients who base their self-esteem on their physical appearance, their “always in control, take charge” character, or their good Samaritan (always the helper or solver) behavior, have a harder time dealing with cancer, their ostomy, their lack of control over their bodies, and their need to depend on others for help, even if only temporarily.

Constantly tired from efforts to cope with daily household or work routines, while learning to adapt to physical requirements this unpredictable new addition to your body, leaves little energy for enjoyment of leisure activities or romantic involvement. It takes us some time to return to our normal lifestyle. To gain acceptance of your new body image. So relax—do what you are capable of doing at this time, and do not try to rush things. You have had enough pain and misery and deserve the vacation. Vacation? You do not want to return to the hospital if you can help it. Give yourself a year for a good recovery and if it should happen to take a lot less time, consider yourself a very lucky person. In the meantime, do what you have to do in whatever way you are capable of doing it, but do not give more than a passing thought to the things you cannot do right

January 2021 Page 11now. You might have to take some shortcuts, do some improvising, or indulge in some healthy neglect. Do not be bashful about asking for and accepting help. You would do the same for someone else if they needed help.

Some patients conceal their ostomy from their spouse, families or lovers because they fear rejection, feel shame or embarrassment, are modest or have noticed evidence of disgust. This results in feelings of isolation, depression and chronic anxiety. Most ostomates need a few months before they feel secure about being accepted. Join the crowd!! You are not alone! We all go through this. Editor’s Note: There are some cases of depression which can benefit most from professional help. Do not hesitate to ask your doctor

Ostomy Surgery and Depression

via UOASL 2021, via Southern New Jersey

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Allergy or Fungal Infection?

via UOASL 2021 Newsletter, via Mary Ann Brooks, CWOCN, Singapore, via OSGNV the Pouch

Do you ever have a red itchy rash around your stoma when you remove an old wafer? The rash could be an allergic reaction. You may develop an allergy to new products or new adhesives, preservatives or artificial colors in the products.

Most allergic reactions occur on the second exposure to an allergen. But people can develop a new allergy to products that never bothered them before. An allergic reaction would exactly match the area that was covered by the wafer. The skin may be dry or weepy, itchy and/or splotchy. Hives may develop. Generally, the rash would respond to the use of Benadryl if it is an allergy. You should try a different wafer and maybe some hydrocortisone cream and see if the rash resolves.

But maybe the rash is really a fungal infection. Fungal infections are most common in the summer months. The symptoms are similar. The red itchy rash under the wafer may look like the allergic reaction described above. Fungal infections are caused by the overgrowth of any number of fungal spores that are in our environment every day. If you have fungus on one part of your body for instance, it can easily be transferred to the peristomal area. Athlete’s Foot is a fairly common example of a fungal infection. Ringworm is another. When fungal spores land on our skin, they usually don’t harm us. But, if you give them a nice warm, dark area like under your ostomy wafer, they may start to grow and multiply.

A fungal rash will generally be about the same size as the wafer, but it may grow outside the boundaries of the wafer. It may also occur under the pouch part of the appliance or extend out even further into the skin folds of the groin area. A fungal rash may have small red dots around the periphery of the central rash area.

This rash will not improve with a different type of pouch or wafer. Fungal infections will not respond to Benadryl. They may improve a little with a hydrocortisone cream but won’t go away entirely. What you will need is an antifungal powder. If it is a fungal rash, it should respond well to the powder. It is important to continue to use the powder after the rash is gone for a full two weeks to prevent it from coming right back.

These rashes may look alike, but they have different causes and different treatment. If you ever have a question or concern about your stoma or your peristomal skin, make an appointment to see your local NSWOC Nurse.

DO YOU NEED AN OSTOMY VISITOR? We have trained and certified visitors who are available to help you with practical advice. We even

make house calls if you wish! Call 905-389-8822 or email ostomyhamilton@gmail.com

The Osto-Info is published ten times a year by the Hamilton & District Ostomy Association and is sent to all of its members. Opinions expressed by authors are entirely their own and do not necessarily represent the opinions of the Hamilton & District Ostomy Association. All medical advice expressed in articles should not be followed without consultation with an NSWOC Nurse or physician. Hamilton & District Ostomy Association disclaims all liability relating to the accuracy of the advertisements contained in the Osto-Info. Inquiries by contributors as to the suitability of articles can be made by contacting the editor at 905-389-8822 or at Articles may be ostomyhamilton@gmail.com.re-printed by member associations of the International Ostomy Association, provided that an acknowledgment is given.

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Disclaimer

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The Evolution and Innovation of Ostomy Products!

via UOASL 2021 Newsletter, via Tulsa Ostomy Association

Most of us who have been in the field of enterostomal therapy for some time are familiar with an etching that appears in a 1750 surgical textbook. A middle-aged woman is peering down at her abdomen — the rags she had wrapped around her midsection removed to expose her stoma. Amazingly, this woman (who had the first colostomy of record) lived for many years with nothing more than rags or tree moss to absorb and manage her output. As late as 1900, no manufactured appliances were available, and patients had no other recourse but to invent their own collection devices — inner tubes, tuna fish cans, and bread bags.

Concoctions of vanilla and peppermint extracts, aspirin tablets, mouthwash, perfume, parsley, and bicarbonate of soda utterly failed to control odor. Omnipresent peristomal skin problems were treated ineffectually with cornstarch, talcum powder, and aluminum paste.3 Most ostomy patients were relegated to their homes as social outcasts, afraid to venture out into society because of odor, a lack of security, and the fear of embarrassment. Due to the resulting decrease in the quality of life for the patient, ostomy surgery remained the “secret surgery” of last resort for many years.

It was not until the early- to mid-1950s that a cycle of innovation of ostomy pouching systems appeared in the medical device marketplace, literally transforming the life of the ostomy patient. Bulky, heavy rubber products yielded to aesthetically pleasing odor-proof plastics and other modern materials that quickly found their way to ostomy manufacturers’ research benches. At about the same time, peristomal skin care made a quantum leap forward with the introduction of karaya. The “skin barrier” was born.

Over the next few years, skin barriers became the impetus for startling advances, not only in ostomy care but also for incontinence and wound care. However, it was not long before karaya’s limitations became evident. Watery or copious

output washed karaya away. It was thermally unstable, had poor adhesion, and many patients developed allergic dermatitis or complained of burning when it was used on broken skin. In 1965, in conjunction with recommendations by noted colorectal surgeons of the day, a material used to treat oral ulcers (Orahesive® Paste and Orahesive® Powder, developed by J.L. Chen of E. R. Squibb and Sons, Princeton, NJ) was launched in the UK for peristomal skin care. Eight years later, Stomahesive® wafers were introduced by E.R. Squibb and gained rapid acceptance by clinicians and patients due to a decrease in allergic reactions, increased thermal stability, low moisture absorption, increased wear time, and fewer skin problems. These wafers were sandwiched between the skin and a commercially available pouching system to prevent peristomal skin breakdown.

A decade later, ostomy management took another leap forward when ConvaTec, a Bristol-Myers Squibb Company, introduced a two-piece pouching system with a low-profile body-side Stomahesive® wafer incorporating a snap-lock flange. This system afforded the patient the freedom, security, and ability to remove the pouch, empty or rinse it, and reapply it without removing the body-side wafer from the skin. With this freedom and autonomy, people with a stoma gained a sense of security and were able to live more normal lives. Since that time, many versions of the flanged coupling system on two-piece pouching systems have been developed by a variety of manufacturers.

The variety of quality of products available today has come a long way since the first recorded colostomy 253 years ago. The past 53 years have been a time of incredible innovation and shared dedication to the ostomy patient by researchers, clinicians, and manufacturers. Each step forward in technology, as well as advances in the operating room, has furthered the quality of life for a person with an ostomy to a higher level that could never have been imagined many years ago. It has taken an enormous investment of time, research dollars, and dedication. If past decades are a model for medical innovation, people with an ostomy can eagerly anticipate future technological advances that will positively impact the quality of their daily lives.

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Name: ______________________________ Address:__________________________________________City:______________________ Province:____ Postal Code:____________Tel #_____________________Email:__________________________________________________

Date of Birth:(d)______(m)______(y)______ New Member Renewing Member

Membership is open to all ostomates, family members, medical and health care professionals, ostomy equipment suppliers and other interested persons.Membership dues are $30.00 per year. Dues include one year’s membership, ten newsletters, and two issues of Ostomy Canada magazine. If you want your newsletter sent to you by email, check here

CHECK ALL THAT APPLY Colostomy Ileostomy Urostomy Male Female Continent Ileostomy Continent Urostomy Ileoanal Pouch Spouse or significant other I am unable to pay at this time but would like to be a member

How did you learn about the Hamilton & District chapter?_________________________________________

ENCLOSED: Yearly Membership Dues: $_________ Donations are gratefully accepted to support any of the following Chapter services: Youth Camp $______ Education Fund $ ______ Community Outreach $ ______ Total: $_________

Make cheques payable to: Hamilton & District Ostomy Association And mail to: Mrs. Karen Lindsay, Box 729, Waterford, ON, N0E 1Y0

Tax Receipts will be issued for all donations

“An affiliated Chapter of Ostomy Canada Society” A Non-Profit Canadian Charitable Organization. Registration Number: 118951417 RR0001

Hamilton & District Ostomy Association

Meetings of the Hamilton & District Ostomy Association are held on the third Tuesday of every month at 7:30pm, except for July and August, online via ZOOM until further notice

Juravinski Hospital Sarah Suresh, RN NSWOC Cheryl Marzoli, RN NSWOC Andrea Gambale, RN

McMaster Hospital Stephanie Furtado, RN NSWOC Tracy Dowds, RN NSWOC

Hamilton General Hospital Enza Browne, RN NSWOC Melanie Martin, RN NSWOC Kelsey McIntyre, RN NSWOC

St. Joseph’s Hospital Suzanne Sandhu, RN, BScN, NSWOC

Joseph Brant Hospital (through Acclaim Health) Kim Vuksan, BScN, RN NSWOC

Hamilton Branch V.O.N. Kelsey McIntyre, RN NSWOC

St. Elizabeth Health Care Vicky Polak, RN NSWOC

Medical AdvisorsCo-Presidents Janet & Mike PaquetVice-President vacantSecretary Joelle PaquetTreasurer Candy Boily

Newsletter Editor Alex ThabaneVisiting Coordinators Janet Paquet, Candy BoilyMonthly Programs Janet & Mike PaquetFundraising Mike PaquetHospital Liaison / SASO Candy BoilySocial Media Janet Paquet, Candy BoilyGreeter/Meeting Recorder George Menzies

Membership Karen Lindsay Hospital / Visiting Packages Candy BoilyYouth Camp Coordinator Janet PaquetMailing Suzanne & Wayne ClarkResource centre Gail MenziesTelephone Candy BoilyPhotographer Ed Herman

Ostomy Canada Society: www.ostomycanada.ca E-mail: info1@ostomycanada.ca Tel:1-888-969-9698

Board of Directors

Mission StatementThe Hamilton & District Ostomy Association provides support and information services to ostomates - persons who have had a

colostomy, ileostomy or urostomy operation - who therefore must wear an ‘appliance’ (or pouch),and to persons who have had alternate ostomy procedures. The agency’s mission is to be of service and assistance to all

ostomates, families and caregivers in the region by visiting them in hospital or home, holding monthly information meetings, publishing a monthly newsletter and operating an Ostomy Information Center.

Renewal and New Membership Application -Hamilton & District Ostomy Association

2-558 Upper Gage Ave., Suite 116Hamilton, ON, L8V 4J6Phone: 905-389-8822

H&DOA Web Site: www.ostomyhamilton.comE-mail: ostomyhamilton@gmail.com