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SqueakyandLiza
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December 9, 2019 8:06 pm  

I have been having very bad problems with my skin around my stoma lately.  The area right around the stoma (which is recessed) has been very red and on occasion sort of blistery.  And the skin under the wafer has also been itchy and red.

Today I had an appointment with an ostomy nurse.  I'm pretty sure it is never a good thing when the ostomy nurse seems thrown off by the condition of your skin.  I mean, they have seen it all, right?  

The beet red skin around my ostomy, she is guessing it is from stool getting on my skin.  She agrees with the other nurse that my stoma was not created well - the surgeon created it in such a way to make reconnection easier for him when/if it happens.  The way the stoma opens to the side instead of straight out, in addition to it being recessed, causes a ridiculous amount of leaks.  So she put me in a deep convex one piece (they were out of two piece deep convex).  

Before putting the new appliance on, she used silver nitrate to burn down a bunch of bumps on my stoma, and she put marathon skin protectant on the very red skin around the stoma.

She thinks I may be having a reaction to the material in the wafer, and wants to try one for sensitive skin, but was more concerned about the skin immediately around the stoma, so wants to get that looking better and then will try a wafer for more sensitive skin, which she did not have in a deep convex.

She also recommended using nasal spray on the skin under the wafer that is itchy and irritated.  She said it is a steroid that might clear up that irritation.  She said not to use it for a long time--maybe just a week or two to see if it helps.

She set me another appointment to follow on on Dec 30th to see if things are any better.

I just wanted to put this out there to see if anyone has similar skin problems, either to see what worked for you, or to let you know what my ostomy nurse said.  Probably all ostomy nurses have different tricks or tools.  


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Tony
 Tony
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December 9, 2019 8:44 pm  

Hi liza,

I transcribed a report on an ostomy patient with fairly irritated skin in which the doctor stated that the ostomy nurse put a thin layer of maalox on before putting on the appliance. I'm not telling you dogmatically that you should do this, but perhaps it's worth looking into.. I suspect that it's the magnesium in the maalox that helps protect the skin, but that's just off the cuff hypothesizing on my part. Maybe it would be worth asking your nurse about it..


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SqueakyandLiza
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December 9, 2019 10:25 pm  

I forgot to mention also, my skin is so dry and flaky, especially the area between my ostomy and my wound. When I put the wafer on, it doesn’t take long to start pulling away where the skin is so dry. The dry skin flakes off onto the wafer, taking away the stickiness. I have been using some of the leftover drape from when I had my wound vac to hold it in place, but my skin really doesn’t like the drape. So far though, it stays stuck longer than anything else.  

Any suggestions for dealing with dry skin when you can’t use lotion?


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LK
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December 10, 2019 3:13 am  

@squeakyandliza

Oh Liza, I am so sorry your skin is having such a brutal time!  That has to be so annoying for you.  I know when mine is dry and irritated, I apply a tiny bit of eczema cream. It is a Hydrocortisone Cream and you can buy it on the shelf now in a tube at a 1 or 2 % form.  Do not buy the  OINTMENT.  the ointment is greasy and will slip your wafer right onto the floor! The cream is great for itching, and I find almost instantly! Use it sparingly and rub it in but it should dry up pretty quickly,  and then put some stoma powder on that and blow off the extra. I use a straw to direct it where I want it the extra to go.  Give it a minuet in the air,  a little goes a long way, buy a small tube to start.  It has only taken one or two applications for my skin to heal up and feel better all around. Did the nurse check for a fungal infection at all?  I have never had one but I know we need to be careful about them.   I hope this helps to some degree.  You have been thru so much already, you are so much tougher then you think you are.  I hope you heal up well soon Liza.

Tony, wasn't this talked about in another forum where someone used it to heal there skin too? Apparently it worked well for them.  It is something I should have made a note of and kept in my helpful hints pages under skin irritations.  Thank you for the reminder.  


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john68
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December 10, 2019 4:18 am  

Hi Liza, hopefully the deeper convex will help with the leaks, Seeing a dermatologist would also be a good idea 


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Tony
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December 10, 2019 4:54 am  

Hi Liza,

A fungal infection could be the problem from the sound of it, though going by this article makes this a bit ambiguous, as different causes of skin irritation have similar appearances. It's something else to ask your ostomy nurse about.


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SqueakyandLiza
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December 10, 2019 5:31 am  

Thanks everyone. 

The ostomy nurse first thought it was a yeast infection before she even took the bag off, and suggested antifungal stoma powder, but then as she took the old bag off and time went on, she was less convinced that it was fungal and more likely allergic. And irritation from stool right around the stoma. I’m glad she scheduled me a follow up after Christmas!!


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VeganOstomy
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December 10, 2019 10:52 am  

My word! Liza, I truly wish this was not happening to you, but I'm really glad that you've got a nurse to help you with this. 

When my skin is worse than normal, I often go for extended times without a wafer (we're talking hours here) and more frequent wafer changes in between. Anecdotally, I find that it helps, although it sounds like you've got several things going on at once. 

Please have them test for allergies. If you are allergic, or even sensitive to specific wafers, you won't be able to solve your problems unless you're using a product that doesn't cause a reaction. 

There are so many powders and topicals that might be helpful, but then again using powers or topicals when they aren't providing a benefit may actually be counter-intuitive. 

For drier skin, the Hollister products with CeraPlus has been designed specifically to help. It does take a little while (weeks?) before the full benefits come about, but may be an option for you. 

 


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SqueakyandLiza
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December 10, 2019 7:38 pm  

Thank you all for your suggestions!!  Eric, I never thought of leaving the wafer off for a while.  I just got home from a wound follow up appt and the wafer the ostomy nurse put on yesterday was already leaking, so I took it off and haven't replaced it yet.  I washed and dried the area around the stoma, and then put some Hydrocortisone all around the area.  Thanks Linda, for suggesting that.  Since I am leaving the wafer off for a while, I didn't worry about going easy on it, and will just clean it off before I put the new wafer on.

Eric, do all Hollister wafers have the CeraPlus on them?  I have never used Hollister, but I have a couple samples they sent me after I talked to someone at the Ostomy walk back in October.  It is a convex one piece, but not deep convex.  So far I have only used coloplast products, which I really like, but if I am allergic to them, I will need to find something else.  My skin has always been very sensitive.  At my wound follow up, they commented on how hard the wound dressing tape is on my skin.  I really feel like a bit of a mess right now.  But I'm trying my best to stay positive!!

As long as Squeaky behaves, I think I will have him go "naked" while I do one of my CPA continuing education online classes and then put on my Sample Hollister bag.  Wish me luck!!

 


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Dona
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December 10, 2019 9:04 pm  

Liza,

 SO sorry to hear you are having the skin issues. Its so crucial to our well being that we get a good seal around the stoma and the skin stays healthy.

I use the Hollister line ( all I have ever used) and have been happy with them . I did switch to convex a couple of years ago when my stoma sort of flattened out.

Not all the kinds of wafers they make are CeraPlus, but that is the kind I use.

Here is a link to their web site ( I put it on the wafer page):

https://www.hollister.com/en/products/ostomy-care-products

Good luck! And enjoy the naked stoma! I am sure air helps healing. Squeeky should love that.

FYI... I use the New Image skin barrier convex CeraPlus.


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SqueakyandLiza
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December 10, 2019 10:41 pm  

Thanks Dona!!

Well, the new Hollister wafer is already pulling away from my skin.  I put the crescent brackets on, but they are pulling away too.  And they are no longer sticky at all.  Ugh.

So, at my wound follow up today, they told me that removing the rectal stump would for sure allow the wound to heal, because the Crohn's is going from the rectal stump through the fistula to the wound.  In theory that makes sense, but these are the same doctors that told me the wound would heal with enough time, which it didn't.  Then they told me if they went back in and cleaning things up, it would heal, which it hasn't.  They also told me the only way for it to heal was with plastic surgery.  But the plastic surgeon I met with said that wouldn't help.  So, I feel like I can't just believe them when they say this will help my wound heal, and let them do surgery, only to have it not heal again, right???

Thanks for letting me vent.


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VeganOstomy
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December 11, 2019 10:15 am  
Posted by: @squeakyandliza

Eric, do all Hollister wafers have the CeraPlus on them?

No, only the ones marked "CeraPlus" do. I've been wearing the "non-Ceraplus" wafers over the past several months because I'd prefer that my skin is on the drier side and the Ceraplus worked too well for me to keep my skin from getting dry. 

Posted by: @squeakyandliza

Well, the new Hollister wafer is already pulling away from my skin.  I put the crescent brackets on, but they are pulling away too.  And they are no longer sticky at all.  Ugh.

Let's take a step back for a sec. Have you changed your soap/shampoo/conditioner/body wash in the last little while? Have you added anything new to your skincare routine? 

There could be many things that would cause these products to not stick (many, many reasons https://www.veganostomy.ca/ostomy-appliance-wont-stick/ ), but hair and soap products are often a culprit that should be ruled out. 

Of course, if your skin is actually weepy due to damage, then most things will have a hard time sticking. 

 

 

 

 


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Tony
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December 11, 2019 10:27 am  

Hi Liza,

 

It sounds like you may need to consider getting an opinion from a medical practitioner not tied to your current team regarding your rectal stump/fistula/wound, since they appear to have eroded your trust. That's what I would do after multiple failed predictions from a doctor.


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Dona
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December 11, 2019 11:37 am  

Great advise from both Eric and Tony,

It seems you have two problems.  The short term one of getting a good seal and stopping the leakage and subsequent erosion of your skin near your stoma.

And, the long term problem of getting an overall solution to the fistula, stump/wound issues.

Definitely time to get more help from different Medical people.

 


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Cyrisse
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December 11, 2019 8:02 pm  

@dona
it is a mystery for my irritated skin by the prolapsed stoma with the parastomal hernia issue. This irritation just started in the last 3 weeks. The stoma nurse did not think it was yeast, more likely due to the tape on the Hollister wafers. Have been using Hollister products since the ostomy was done. It’s not gone yet. The irritation is by the tape borders. Trying Convatec products now. The weird thing is the irritation starts around the same time every day ! After 6 pm wafer was on since 9 am. Will have to keep having faith that this will b ok soon. Sorry to hear that u r having problems too, we will have some relief soon I hope 


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sjlovestosing
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December 11, 2019 8:45 pm  

Oh Liza,

I am so sorry to hear about your issue! I wish I could pass along more advise, but it seems the others are covering the bases. Regarding getting another opinion, I thoroughly agree. Too bad you don't live here in VT. My surgeon, Peter Cataldo, who is at UVM and literally wrote the book (in fact two) on ostomy surgery. He is known all over the world for his expertise and is a caring man who listens to his patients.

I'll be praying 🙏 for you.

Stella


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UCtoOstomy
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December 11, 2019 9:49 pm  

@cyrisse

I get irritation on the tape border of the coloplast flange often. Eric did a video and article about the cuts that can occur on the border.  I use a 'Tegaderm' product a few times a year to protect the skin at the tape border. I found the article

https://www.veganostomy.ca/protect-ostomy-skin-from-cuts/

Hope you all resolve your issues quickly and pain free. And as always thank you Eric!

Mike


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SqueakyandLiza
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December 11, 2019 10:15 pm  

Thank you all so much for taking the time to reply to me. Eric, your video and accompanying article were great and very comprehensive. You definitely touched on some things that may be causing part of my problem. I haven’t really changed anything about my skin care. I’ve had problems from the beginning with keeping my wafers stuck to my skin and that is why I started using the leftover drape from my wound vac because that has stuck better than anything else, but it is really rough in my skin. The skin around my wound was pretty mascerated after 11 months with the wound pump. But my skin is so sensitive that even the regular medical tape is irritating the skin. Ugh. 

Tony, I am waiting for a call to schedule my second opinion appointment. I am hopeful that they have another idea other than the rectal stump removal. 

Stella, I wish I could see your doctor. Actually, we are to the point where I wouldn’t completely rule it out. Our frustration level is pretty high and I’ve been getting more and more discouraged. I’ve never been to Vermont. 😀

Mike, do you know if tegaderm is the same as duoderm?  We have a little bit of that left over from when I was on home health care. My husband puts it on the skin around my wound when the skin gets raw from the tape. I was worried it wouldn’t stick well enough to keep the wafer in place, but I might give that a try. 👍

My sample Hollister appliance only lasted 2 hours, so I went back to the coloplast, but didn’t use the drape to secure it. I just used some medical tape instead. It isn’t sticking as well, but so far it is just the outside of the wafer pulling up. The part around the stoma is still sticking so far, 24 hours later. 

Thanks everyone!!


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LK
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December 12, 2019 3:56 am  

Liza,  knowing all these issues and what you  have been told would frustrate anyone. You did wash off that cortisone cream right? Of course you did! lol. When I use it, and sparingly I do leave it on with the stoma powder but it sounds like  your issues are  almost out if control here. 

I waited for a good long time to see the Internest  and when her receptionist called to book an apt. for 7 months down the road, I asked what my doctor wrote on the form. Turns out all he  said was "fevers!!!"  All I  could do was laugh and then I literally burst into blubbering  tears.  I told her about the pain, the almost passing  out on standing, the heart palpitations, the bowel issues, dehydration and the anemia, she said she would get back to me.  They are the doctors gate keepers. A bull dog of sorts and I say that respectively, but they are trained to know  when someone needs a better appointment.    The next day she called back and said there was an envelope in the mail with blood work to be done. I was told  to get it done the day I rec'd the forms and I did. She also gave me an apt. for  three weeks away. That doctor is in that office one day a week, so it was like 3 days away from the actual phone call. They took 17 vials of blood if I remember right. They used both arms to get it too. I think you know what  happened from there, but some times we have to appeal to the receptionist booking the apt. by putting ourselves out there and baring our soul. I would suggest you do the same. Its over due! I hope all things settle down for you and your issues get solved. Note...I have  had up to 9 specialist referrals to solve one issue. It was the 9th who said...I know what this is! He as right on with his diagnoses and the surgery was the fix! Trust your instincts! All the best!!! 


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Cyrisse
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December 12, 2019 7:06 am  

@uctoostomy

TY Mike 😉


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