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Surgical staples and iliostomy  

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FancyKittySews
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May 19, 2019 12:42 pm  

Hi, I am at 8 days out from debulking surgery and new iliostomy. The hospital sent me home with Hollister 2 piece appliance. My first two tries at changing the appliance on my own resulted in leaking.

My stoma is less than an inch away from my surgical incision and staples. I tried trimming the wafer/skin barrier so that it lay right next to the staples but it didn’t stick. Next one I applied the adhesive seal so the edge goes over my staples. It’s pulling on the staples and it won’t seal.  I’m worried because the staples are supposed to be open to the air and now they aren’t. I also worry about leakage getting onto the incision.

My skin is loose from weight loss and has lots of stretch marks so it’s really tender. I’ve had a very difficult time getting the appliance off because it pulls and hurts my skin.

I’m wondering if there is anyone out there who has been thru this who can give me ideas, support, assurance? I desperately need help finding the right pouch system that will work for me. I do have home health coming this week. 

FancyKittySews


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LK
 LK
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May 19, 2019 4:25 pm  

FancyKittySews...Welcome! I am glad you found us early on. Leaks are a frustrating part of this life with a stoma, but they do eventually get under control and that comes with experience and finding what works for you. It would be helpful if you could tell us what products you use. A few tips, if your using a lotion or perfumed type cream soap, in the area, you may not want to anymore. My skin is dry all the time, but I can moisturize around the area of the wafer. Your skin will toughen up. If the hole you cut is too big, it can cause a leak. Too small can hurt the stoma. When you cut the hole, cut on the other side of the circle and turn the bag not the scissors. I use the Skin Barrier Wipes and the Spray. I use less cloths this way, and always fan dry the area with your hand or the plastic part that comes off the wafer. The stoma produces a fair bit of fluid. You can touch it and it won't hurt you or it. When applying the wafer, any liquid from the stoma will help to make a leak. I wrap a few layers of toilet paper (gauze is better) around the stoma to make it as dry as I can get before slipping the wafer over it. For baggy skin, stand up to apply the wafer, and carefully push your tummy out as comfortably as you can to help put the looser skin back where it had been, or close to it. Do not hurt yourself doing this. You do not want to tear anything new. I used stoma powder in the area of my incision, it helped to to protect the incision, it helps keep the area dry and the wafer did not stick to it too much. First applying the lower half of the wafer, folding the wafer away from you so you can see just where you are going to put the first half is a good idea. Then I dry the top part of the stoma and slip it the wafer over that. Once on, make sure to apply gentle pressure to the opening hole you cut in the wafer, rubbing gently a few min. and then work your way around all of the wafer. A square or two of TP helps your fingers slip around. I have found that paying close attention to the hole I cut and right after the wafer has eliminated leaks all together for about a year for me. Ofcourse, now that I said that out loud, I will likely get a leak. LOL. I should knock on wood. Done. I take about three min. to make sure that the wafer is pressed on enough to feel sure about the seal. Also, after the pouch is on, I take a "warm" hot water bottle and lay down for about 5-10 with it on the area of the wafer on top of the plastic. PROTECT the tender skin and your stoma, do not make it too hot and place a wash cloth on before the bottle. For some, the heat of your hands may be enough. Others will chime in here to give suggestions also, but if you can tell us what your routine is and what products you use, right down to lotions and soap, it may help. You are doing so well so far. Don't let leaks get you down and the sooner you catch them the better. You will figure this whole thing out yet. Can you tell me what debulking surgery is? Was this a planned surgery? If you want to try some of the products I use, ask your stoma nurse if she can bring some, or call the companies as Eric has provided a list of suppliers here too, and ask for samples. They are very willing to help too. stay hydrated, and rested, do not push yourself too hard just yet. Be well! :D.

Linda


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FancyKittySews
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May 19, 2019 5:41 pm  

Thank you so much for the advice. I appreciate your response. Just knowing there are people out there who will help me makes this easier. 

So the hospital sent me home with:

Hollister bag 18003, 2 1/4 inch

Hollister New Image 14803 Wafer

Hollister Adapt 7805 ring ( it’s like a wax gasket)

Only using Dial soap.

they also provided skin prep wipes and powder but I haven used it yet. 

And after my last change I bought adhesive remover wipes because I had such a hard time getting the old ring off . Haven’t used yet.

I know this is an IBD board but this is where I found the best ostomy advice so far.

i have ovarian cancer so the debulking surgery is where I had a full hysterectomy, dissected diaphragm, removed omentum, and removed large intestine. So I have a surgical incision from my sternum to pubic bone and it’s stapled shut. And it’s close to my stoma. I don’t like that the edge of the wafer goes over the staples because I worry about them healing, contamination, and adhesive pulling them out. 

Where the edge of the wafer goes over my staples I don’t get a seal  with outer fabric tape part but I guess as long as that sealant ring part doesn’t leak I’ll be ok .

I’m going to call some of the companies to see which products they recommend to work with the staples. If you have any suggestions that would help me narrow it down and point me in the right direction I’d appreciate it! 

All the above advise is really appreciated and will help me get more comfortable with the process. 

 

FancyKittySews


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Dona
 Dona
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May 19, 2019 10:31 pm  

Welcome Fancy Kitty,

It is good you have the home heath coming soon to help you find a practical solution.

It will all get better over time. While you still have the staples in it will be problematic especially since they are so close to the new stoma..

Hopefully soon, when your wound is healed and your skin is smooth again you will get a good seal. The wafer needs to stick properly. Also ask the nurse about barrier rings, stoma powder etc. Read about those on this web site.

Hang in there. I use the Hollister two piece and am very happy with it. Others here use other brands of appliances . There will be a right one. I kept getting better at this for at least a year. Your stoma may also change shape as it heals, so be aware of that.

ASK QUESTIONS!

Onset of severe Ulcerative Colitus Oct.2012. Subtotal colectomy with illiostomy July 2015; Peristomal hernia repair ( Sugarbaker, mesh, laparoscopic) May 2017.


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sjlovestosing
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May 20, 2019 7:31 am  

Welcome Fancy Kitty,

I agree with Dona, you are only a few days out of your surgery with staples to boot, so the best thing is to keep in touch with your ostomy nurse to see if you can try other appliances which may work better for you. As Dona said, your stoma will change size over the course of about 6-8 weeks and as you put back weight. Be patient with yourself as this is certainly a time for learning. (I've been doing this for a little over a year and I am still learning new things!) Wishing you the best in your journey. Keep on coming here for info and support.

God bless,

Stella


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LLNorth
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May 20, 2019 10:54 am  

Hi, Fancy Kitty. I am so sorry you are having this trouble, and I hope things resolve and heal for you very soon. I have been doing this for a little over a year, and I found the trial-and error of those first weeks helpful in getting acquainted with the basics of living with the pouching system. Once things heal and settle down there is some ongoing learning and decision-making about the supplies and your ways of using them - this is rather empowering as one learns to “own” and “take charge”. Best of everything to you. LLNorth

I love the smell of coffee in the morning. It smells like .... victory.


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IleosTony
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May 20, 2019 6:34 pm  

Hi Fancy Kitty,

 

First of all, welcome. We're excited that you found this one-of-a-kind and marvelous resource. Eric is the man, putting this together to help us all to live better.

 

Leaks are going to be a challenge for a while, most likely a short while as you work with your stoma nurse and your wounds heal and your stoma shrinks. No matter how miserable you feel about them, how mortified, how frustrated, how hopeless, don't let yourself feed those feelings. This part of your life as an ostomate will get better as you apply yourself to learning what works best for your skin chemistry, body shape, etc.

 

Your ostomy nurse is the best person to ask about how to manage things with your staples still on. As you no doubt well know, it's temporary, and once they come out, things will get easier.

 

I've only had my ostomy a few months, but I do find that my skin is becoming a bit less sensitive to pulling off the pouch at changing time. Part of that is finding a pouching system that will minimize or hopefully eliminate skin irritation. For me it's the Brava barrier ring #12037 from Coloplast, the Coloplast SenSura Mio Click #10502 skin barrier, and the #18620 pouch. Don't be afraid to try something new if you find you're jus tnot satisfied with your pouching system, and be patient with the process. Finding what works for you is a matter of when, not if. If you're interested in Coloplast products, call and ask for samples. The website sample request form works, but it takes them weeks to get back to you if you go that route, so use the phone number. They will ask you questions and recommend something that they think might work for you based on your answers.

 

Finally, in these early stages, things are changing in the region of your stoma, so something that works for you in the beginning might not work later. That's probably not what you want to hear, but I think it's better not to be surprised about that. You might need to change systems at least once at some point.

 

Again, welcome!

Tony
Crohn's diagnosed in 1995.
Spontaneous colon perforation and emergency end ileostomy surgery in 2018.
No colon - still rollin'!
No eyesight - life still bright!
Stomaversary - December 4th


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john68
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May 21, 2019 3:27 am  

Hi Fancy Kitty, welcome You have lots of great advice from the posts above, seems like a lot to take in but it pretty straight forward. Trimming the wafer will cause a fail. The wafer also does not have to be worn as a square it can be moved ie as a diamond. Maybe that may get passed the staples out 

ileostomy 31st August 1994 for Crohns


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LK
 LK
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May 21, 2019 10:17 am  

John-I am beginning to feel  tab wee bit envious of our newbies these days. The different topics and ideas being touched on are incredible for them not to have to figure these things out thru trial and error and as often as I did. It is all right here. I for one had never thought to turn the wafer to the diamond and when I read that Eric wore has pouch on sideways, I was mesmerized and determined to give it a try and I found it works so much better for me. Not completely on a diamond but more a 75 degree turn. When the bag fills with air or fluid, it no longer is as embarrassing to me as it was for all those 8 years. It also makes a difference in where the fluids land at night,  and I believe it has eliminated the night time leaks...at least so far!  Even a change in clothing style helped, another good video to watch ladies and gents. The pouch hanging more off my right side at night,  I sleep on my back, it does not allow the fluid to float around the hole I cut in  my pouch. Other then a pouch wear and tear area, I have also never had issues with a bag being the cause of a leak, it was usually something I had to re-learn or a tip to pick up on. Thank you all. 

IleosTony- I don't think I would be the only one here interested to learn from you or our other blind ostimates how you felt and what it was like to for as a blind person when you got your ostomy. How long had you had your gut issues, what they were, and when you were told, and so forth. I can not imagine being told that news and blind to boot. A support system is so important, I am sure you appreciated yours even more, and I am glad that so many have  Eric site for them. Tho  my system was bigger at the time, they still have no idea what it was really like for me. Your struggles must have been many! Please share your story on a new forum if you are okay sharing it. Newbies, my favorite saying is..."I am okay so far." I tell myself this often and try not to be overwhelmed by all the issues some may have, as not one of us has the same body and because one has certain issues with health or whatever, it certainly does not mean you too will have these issues. Take some deep breaths. You have landed. Be well! It took many different roads for us to reach Erics site and I am so thrilled I found it also! Thank you again Eric! Be well everyone, today is  new day.  :D.

Linda


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john68
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May 21, 2019 10:34 am  

Hi Linda, As long as the wafer has a good flat as possible surface it can be in many shapes. For me a little of the square (just like me) works well. 

ileostomy 31st August 1994 for Crohns


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FancyKittySews
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May 21, 2019 1:37 pm  

Thank you ALL so much for your advice, kind words, and support! It’s comforting knowing there are complete strangers out there willing to help me and guide me through this. ❤️

I called ConvaTec and Coloplast this morning. They were both supportive, asked me a lot of questions, gave advice, and are sending me samples. I think that since my staples are healing up nicely I may be worried about nothing. As far as leakage, I’m going to try the samples and see what works best for me keeping in mind all the great advice I’ve received. Again, thank you from the bottom of my heart kind internet friends! 

I’ll be back to ask more questions as time goes on. 

All of you have a great week!

FancyKittySews


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VeganOstomy
(@veganostomy)
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May 21, 2019 4:09 pm  

FancyKittySews, I think many of us have issues with our surgical wounds and/or staples interfering with our appliance at first. I know I did and it was a challenging time for sure! 

You may be able to trim the wafer a little bit to accommodate the incision/staples - however - I would caution you not to cut too much of the wafer or it will not hold (I've had too many instances of appliance failure because of that). 

I hope that things will continue to improve as your skin heals up!

Just your friendly neighborhood ostomate.

~ Crohn's Disease ¦ Ileostomy ~


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