First Follow-Up Appointment

July 7, 2010

I had my first follow-up appointment with the surgeon today! I saw my GI as well (they are in the same office), and she was SO HAPPY for me. She said that I looked like I actually had some color in my face for once. Thank goodness. I was tired of looking like the walking dead. It’s amazing that I can look so much BETTER than before just two weeks after having major abdominal surgery!

Once I got into a room, my surgeon checked up on all of my wounds. They are looking fabulous, by the way. You can hardly tell that the keyholes are even there except for the drain site. The drain site is kind of gross looking right now, but it’s scabbed over and healing. The horizontal scar where they took my colon out is also healing very well; I doubt you’ll even be able to tell it is there when it heals all the way.

She also wrote me a prescription for nystatin powder. I guess this is pretty much the same thing as stoma powder. It is just in case I develop a rash around the stoma. The hot weather makes it more likely for skin problems to occur, but hopefully I won’t have to deal with it. Right now, I don’t have any need for powder or barrier film or anything like that, but I have only had the adhesive on my skin for two weeks. I also have permission to drive small distances now as long as I don’t overdo it. I really just want to drive back and forth from my mom’s and dad’s, and I’m not really looking to go anywhere else yet.

Then, my ostomy nurse came in and gave me some free schwag. I had gotten a discharge pack from Hollister that gave me a bunch of free samples, but I never received anything from Coloplast for some reason. I haven’t tried any of the Hollister appliances yet, but I think that I like the Coloplast design much, much more. The opening is definitely better anyway (plus, you can tuck the Coloplast opening away into the pouch), and the Coloplast wafer doesn’t have any tape.

She also fitted me with a new appliance while I was there. I have been using the clear, one-piece Coloplast system that they sent me home from the hospital with. It wasn’t bad, but I do like the new one much more. My wafer had been buckling a little bit at my belly button like because of how my tummy is shaped, so my nurse gave me a pediatric wafer. I really like it because it is much smaller, but I’m not yet sure if that will just give me more problems yet. To me, smaller size might mean easier to leak, but maybe it will be less likely since it fits a little better. Anyway, it feels better.

This wafer was also part of the two-piece system, which I like better because I can see much better when I first apply the wafer, and I can apply pressure to it easier so that it will stick better around the stoma. I also think that the two-piece has less of a vacuum effect which was kind of annoying.

The pouch she gave me is opaque; it is a lot less gross if anyone else gets a glimpse of it, but I can’t see what’s inside it until it comes out. I can’t see when the inside of the wafer is breaking down either. Still, I think I would definitely rather have the opaque one; it is just more low profile. The pouch she gave me is also a size smaller than the one I was using before. It feels a lot more comfortable (actually I can’t usually feel it at all), because the other one was just that much too long. It’s possible that I might have to empty it a little more often, but I don’t mind that as long as the bag isn’t dangling down and irritating my thigh.

So, back to my ostomy nurse. My stoma has this weird little bump on the top side of it where it was suture down that keeps it from being perfectly round. It is also a little more pink and weird looking than the rest of it. While I was still in the hospital, my nurse had said it would slough off, but it hasn’t. So while I was there, she told me, “Oh, looks like we’ll have to burn that off!” My first reaction was “…that sounds horrific and dangerous! :O” I couldn’t feel it though, since the stoma doesn’t have any nerve endings. She basically took a silver nitrate stick (like they use to stop the bleeding when you quick a dog during a toenail trim), and she rubbed it all over the little bumpy part to cauterize it. Then, it turned grey! What the…! Let the sloughing begin!

I am supposed to go back in two weeks for more cauterizing (*twitch*) and to discuss which pouching system I want to stick with. I am almost 100% positive that I am sticking with the opaque, two-piece Coloplast appliance. I was pretty much decided on that before I even had the surgery when I was researching pouches. I am still going to try the Hollister one before I go back though, even if it is just to say I don’t like it. The only thing I am not decided on is whether I want to keep the pediatric wafer. This only depends on if I experience a leakage. I hope that I don’t, because (again) I really like the fit much better. I also want to try to use barrier rings rather than the stoma paste; it seems like I could get a better seal; the stoma paste is so hard to squeeze out of the bottle in a smooth, continuous line.

After my appointment, my stepdad and I stopped by a pit beef stand to get some lunch to take home. I hadn’t eaten anything that morning, because I didn’t want my stoma to spit up all over the nurse. That was a bad decision; I felt really bloated and gassy, and by the time we got to the place, I really just wanted to get something in my stomach to appease it. I was also extremely tired and felt like I really needed to sit down. I felt much better after I ate my sandwich, drank some gatorade (just in case of dehydration), and took a nap. Next time, I will eat an early breakfast and just chow down on some marshmallows to slow down output before I go.

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4 Responses to “First Follow-Up Appointment”

  1. Paul said

    Hi Piper,

    It’s me again from “Meet-an-Ostomate.com.” Thanks for telling me where to find your blog. It sounds like you’re doing great! Regarding your appliance, have you tried or considered Convatec? I’ve had my ileostomy for over 30 years and I’ve been using the Convatec as far back as I can remember. And the good thing is I’ve never had any skin problems after all these years. It’s a two piece system with an opaque pouch. My technique for keeping the skin protected is after a shower I take four 1 1/2″ pieces of Stomahesive strips and place them on my clean, dry as close to the stoma as possible, kind of like a picture frame. You could probably skip this step, but my stoma is mushroom shaped (wider at the top than the base) so for me, it protects the skin and keeps it dry. Without these strips the skin would get wet immediately as I pull the wafer over the stoma since the hole in the wafer is slightly smaller than the widest part of the stoma. (Are you taking notes?). Next I place the wafer over the stoma and, using tissue, I press it onto my skin and onto the stomahesive strips that I already put on in step one. To make make it really moisture (and poo) proof, I take another piece of Stomahesive strip, (about 3 1/2″ long) and fold it in half the long way to make something like what you’re trying to achieve with the paste. It’s sort of like if you could take the paste, squeeze out a 3 1/2″ length of it, and then pick it up without it falling apart. I then take this doubled over strip and then wrap it around the base of the stoma over the wafer I put on in the previous step. So now I have thre protective layers..The 4 small pieces of Stomahesive strips, the wafer and finally the long strip wrapped around stoma. Take that moisture! I have found that the strips are much longer lasting than any paste or seals. The final two steps are taping on the wafer (probably not neccesary) and popping on the pouch which is like putting on a Tupperware lid. Oh…don’t forget the clamp on the pouch. It could get messy otherwise :).

    Before I get back to work, I just wanted to say I loved the pictures and your blog. Does it gross you out seeing pictures of your own colon? I don’t think it would bother me. Those pictures are pretty graphic…a lot dfferent than the drawings in my father’s copy of “Grays’ Anatomy.”

    Paul

  2. Piper Lee said

    Wow! Thanks for the tips! I will probably stick with Coloplast, just because I really, really, REALLY like the velcro closure that you can hide away. 😛 I will have to check out the strips though. Are they like the barrier ring but just strips instead of a ring? I am going to try that next because they came with the free samples Hollister sent me. I’ll also try putting it on my skin first and molding it to the base of the stoma rather than molding it to the hole I cut in the wafer.

    I think my colon pictures are pretty awesome. Haha. I don’t get grossed out easily (I work at an animal hospital, so I see some pretty gross stuff). I was interested in seeing how diseased it looked.

    • Paul said

      Hey Piper,

      After sending that long message yesterday I was thinking to myself that I’m probably scaring this poor lady! The bottom line is that, over time, you learn to improvise and find out what works best for you. Just recently I stopped using Skin Prep (because I ran out of it) and I found I get better adhesion without it.

      Regarding the Stomahesive Strips I guess they are like a barrier ring for me. I had used barrier rings once (I think they were called Colley Seals) but they broke down so quickly, especially in the heat. The strips are much more durable. They are about 1/4″ X 4″ and come in a box of 15. One side has adhesive and the other is plain. Since they don’t come shaped like a ring, that’s why I need to place the four small pieces around the base of the stoma. Basically, I’m trying to make my own barrier ring. I put the adhesive side against my skin and then the Convatec wafer goes on next and it adheres to the non-adhesive side of the strips. If Convatec made barrier rings out of this material it would be great. What kind of barrier rindg do you use?

      You’ll also find Piper that, in moderation, you can eat most anything. I had a friend with an ileostomy and she used to eat popcorn. I never would have done that for fear of blockage. And eating salad again after my surgery (without having to see it floating around the toilet an hour later) was and still is a great pleasure. Chewing well and moderation are the keys.

      Anyway, it’s back to work for me Piper. Have a great weekend and I look forward to your next story.

      Paul

      P.S. If you have a free minute, take a look at http://www.dancingdreams.org. I’m a contributor, and seeing the inner strength of these little girls always reminds me how minor my problems are.

  3. Piper Lee said

    It seems like a lot of people use skin prep, but my nurse told me that I shouldn’t use it unless I have a rash or some other skin issue, because it does break down the adhesive.

    I haven’t actually tried the barrier rings yet, but the ones I have came from Hollister. I have been using the Convatec stomahesive paste. It actually seems to work well, but I think that it would be easier to use the rings or strips.

    I think the pediatric wafer is what I’m going to continue to use as well. Since it is smaller, it is on a flatter piece of skin, so it hasn’t buckled like the regular size wafer did.

    Thanks!
    Piper

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