January/February 2014 Volume 40 Issue 3 - marylandostomy.orgmarylandostomy.org/uploads/file/newsletters/JanFeb2014.pdf · January/February 2014 Volume 40 Issue 3 METRO MARYLAND OSTOMY

January/February 2014 Volume 40 Issue 3

METRO MARYLAND OSTOMY ASSOCIATION, INC. How to contact us: Phone: 301-946-6661 Fax: 800-543-5870

E-Mail: [email protected]

Web: www.MarylandOstomy.org

In this Issue

It “Guts” Better …………….......1 Upcoming Meetings & Raffle .. .2 40th Anniversary Celebration....3 2013 Year-in-Review …..………4 40th Anniversary Sponsor …….5 Membership Form .................... .5 Hospitals & Clinics ................... .6 Stoma Dermatitis………….,,,,...7

Metro Maryland Ostomy Association, Inc. is a registered 501(c)(3)

tax-exempt, non-profit organization dedicated to the education, rehabilitation, and Assistance of those living with an Ostomy.

It “Guts” Better – by Scott Bowling Dear Friends: Happy New Year! I hope that you and your family had a happy and healthy holiday season. As many of you know, the last two months have been quite turbulent for me health wise. It began in late October with an admission to Anne Arundel Medical Center and a subsequent transfer to Georgetown University Hospital. The night before Thanksgiving I was re-admitted to Georgetown for an issue with my central line catheter and what was later diagnosed as endocarditis and pneumonia. Within days, I was admitted at Anne Arundel Medical Center to clear a minor clot at the end of my central line catheter. So, from October 28 until December 20th, I was in what unfortunately at times felt like my second homes. I must tell you that the cards, e-mails, and visits that I received from members of Metro Maryland were simply unbelievable. I can never thank you enough for the love and support so many of you showed during this time. I am happy to say that things are much better now, and I am getting stronger each day. IT “Guts” Better – I am sure many of you are asking, what is “It “Guts Better”? While hospitalized many people encouraged me to set-up a website blog to keep everyone updated and to share my 30+ year journey with Crohns Disease and resulting Short Bowel Syndrome. This proved to be not only helpful for all who read it, but also for me. If you would like to visit the site, the address is www.ItGutsBetter.org I hope to see you all at our January Meeting, and don’t forget our 40th Anniversary Brunch on March 9, 2014 at the Sheraton Silver Spring.

***In case of bad weather, listen to

WTOP News Radio 1500 AM or 107.7 FM or WTOPNEWS.com for

Cancellation news of our meeting. ***

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THRIVE – Metro Maryland Ostomy Association, Inc. January/February 2014

Upcoming Meetings:

SUNDAY, JANUARY 12, 2014 at 12:00 Noon

RAFFLE DRAWING And

Guest Speaker Gwenn Herman, LCSW-C, DCSW

“Making the Invisible Visible: Treating Chronic Pain”

SUNDAY, FEBRUARY 9, 2014 at 11:30 am

Guest Speaker Linda Adelson, RN, CWOCN

“The Types of Ostomies”

* * * * * * *

Monthly Meetings held at: Holy Cross Hospital

Community Education Center 1500 Forest Glen Road

Silver Spring, MD 20910 __________________________________________________________

____________

Raffle Prizes

1st – an iPAD 2nd - $200 cash

3rd - $50

Missed a Meeting? **Due to bad weather we unfortunately had to cancel our Holiday party in December. We will have our Raffle at our January meeting. If you have any raffle tickets left you can sell them until the meeting on January 12th. The November meeting’s presentation by Alison Ehrlich, MD MHS and Research Fellows, Jack short, MD and Samah Hajjar, MD (Dermatology) of George Washington University. We have printed this presentation herein.

MMOA Board of Directors and Volunteers

Past President …….…………………………………………….…Paul M. Vogel President Emeritus & Founder ……………….……………………………Horace Saunders President ………………………………………………………………………. Scott Bowling Vice President …………………………………………………………………..Michele Gibbs Secretary……………………………………………………………………….Bonnie Richburg Treasurer……………………….………..…………………………………….Verland Erntson

Board of Directors: Chairman ……………...……………………………………………………….Marty Noretsky Scott Bowling Mildred Carter Cary Dawson Noel Eldridge Verland Erntson Michele Gibbs Paul Hudes Rosemary Kennedy William King Yolande Langbehn Bonnie Richburg Sue Rizvi

Office Manager………………………………………Mildred Carter; & Volunteer Staff – Jan Erntson, Sue Hoover Newsletter Editor & Volunteers …… Sue Rizvi; Don Ball, Jan Erntson, Rosemary Kennedy, Yolande Langbehn

Meeting Greeter/Registration ……………………………………………………………………………….Yolande Langbehn Appliance Chairperson ……………………………………………………………………………………………William King

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Join us for our 40th Anniversary Brunch and

Celebrate our inaugural “Founder’s Award” recipients

WHEN: Sunday, March 9, 2014 12:00 pm – 2:00pm WHERE: Sheraton Hotel - Silver Spring 8777 Georgia Avenue Silver Spring, MD 20910 (301) 589-0800 TICKETS: $40. – MMOA Members (advance purchase) $50. – Non-Members (advance purchase) $60. – At Door HONOREES: Liz O’Connor, WOCN (retired) Holy Cross Hospital Carol Pettis, WOCN (retired) Washington Hospital Center Joyce Newmyer President Washington Adventist Hospital

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2013 – A Year-in-Review – by Scott Bowling Each January, I usually deliver my year-in-review at our meeting, but given the opportunity to have such an outstanding guest speaker this month, I wanted to provide you with some highlights of 2013.

• Successfully advocated along with CCFA and others for a new law under consideration by the Maryland General Assembly in 2013. This new law expands the use of public bathrooms, even if marked employee only, for those with ostomies, and various forms of IBD -- even if bathrooms are marked “emloyee only”

• Updated our website with a fresh look and design as wel as increased functionality and resources.

• Re-designed our award winning bi-monthly newsletter, THRIVE! and began distributing via e-

mail to as many members and outside sources as possible. This increased efficiency and was a major cost savings to MMOA in the areas of postage and printing.

• Provided over $10,000 in ostomy supplies to those in financial need due to unemployment or

no medical insurance. Supplies that our members and ostomates within the Greater Washington Metropolitan Area could not use, we shipped to Friends of Ostomates Worldwide (FOW). This was possible because of the generous donations of many who no longer had a use for these particular supplies.

• Participated in numerous health fairs throughout the state.

• Continued our visitor program to assist and support new ostomates as they adjust and return to an active and regular life.

• Attracted new guest speakers from different practices and specialties.

• Began video taping our meetings with guest speakers, and with the speakers consent, post them to our website.

• Began planning for our 40th Anniversary and inaugural “Founnders Award” Brunch this coming March.

• Successfully worked to increase funding sources via grants, individual contributions, and

sponsorships, and will continue to do so in 2014. While many ostomy support groups throughout the country struggle or make the decision to close, your Board of Directors at Metro Maryland Ostomy Association is committed to the future of this organization and above all else ensuring that we continue to serve the patients who need our help, the same way most of us were helped in our time of need.

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Membership Request for Metro Maryland Ostomy Association Today’s Date __________________________

Name __________________________________________________________ Birth Date _______________________________

Street Address ___________________________________________________ Occupation ______________________________

City ______________________________ State _____ Zip Code ___________ Spouse Name ____________________________

Home Phone _______________________ Cell Phone ____________________ Email __________________________________

Type of Ostomy: Colostomy___ Ileostomy ___ Urostomy ___ J-Pouch/Pull-thru ___

Continent Ileostomy ___ Continent Urostomy ___ Urinary Diversion ___ Other ____________________________

Date of Surgery __________________________

Reason for Surgery: Crohn’s ___ Ulcerative Colitis ___ Cancer ___ Birth defect ___ Other _________________________

Donations are needed and gratefully accepted. All contributions are Tax Deductible.

Send Check to: Metro Maryland Ostomy Association, 12320 Parklawn Drive, Rockville, MD 20852 www.marylandostomy.org Email: [email protected]

Telephone: 301-946-6661 ~ Fax: 1-800-543-5870

THANK YOU METRO MARYLAND OSTOMY ASSOCIATION, INC.

extends our sincerest thanks to Capital Digestive Care

for being the first Gold Sponsor of our

40th Anniversary Brunch Celebration

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HOSPITALS AND WOC NURSES OUTPATIENT OSTOMY CLINICS

REMINDER: A doctor's referral is required to take with you or to be faxed to the clinic before your visit. Be sure your

referral covers additional visits with the nurse if that might be needed. This will help with your insurance coverage.

George Washington University Hospital Main Level

Tuesdays & Thursdays, 12:30-3:00 pm By Appointment Only - Call 202-715-5302

Georgetown University Hospital Thursday mornings, 8:30 AM to 12:30 PM.

4th floor, Pasquerilla Healthcare Center For appointment, call 202-444-5365.

Holy Cross Hospital Tuesday, Wednesday and Thursday

By Appointment Only - Call 301-754-7295

Washington Hospital Center Surgical Clinic - Ostomy Care, Ground Level, Rm GA48

Wednesdays, 12:30 PM to 4:30 PM By Appointment Only - Call 202-877-7103

!Memorials and Tributes

A generous donation in memory of or in honor of a loved one or friend will aid in the continuation of

Ostomy rehabilitation. Make your tax-deductible contribution to: Metro Maryland Ostomy Association, Inc.

12320 Parklawn Drive Rockville, MD 20852

□ In Memory of □ Honoring □ Other/Donations

Name: ______________________________________ Amount: $ ____________________________________ From: ________________________________________ Address: ______________________________________ ______________________________________________ Telephone & Email: _____________________________ ______________________________________________ Send Tribute to: ________________________________ Address: ______________________________________ ______________________________________________!

!

MARYLAND: ANNE ARUNDEL - Annapolis – 443-481-5508 Irene Repka, WOCN or Michelle Perkins, RN DOCTORS’ COMMUNITY - Lanham – 301-552-8118 x8530 HOLY CROSS - Silver Spring – 301-754-7000 Page WOCNs: Theresa Emmell, Rezia Lake, Toli Stopak HOWARD COUNTY GENERAL - Columbia - 410-740-7890 MONTGOMERY GENERAL - Olney - 301-774-8882 Wound Ostomy Consult Line: 301-774-8731 NAT’L INSTITUTE OF HEALTH - Bethesda - 301-451-1265 CWOCNs: Tye Mullikin, KC Chandler Axelrod, Ashley Buscetta PRINCE GEORGES - Cheverly - 301-618-2000 Barbara Smith, CWOCN, CWS, 301-618-6462 SHADY GROVE ADVENTIST – Rockville - 301-279-6000 WOCNs: Lyndan Simpson, Linda D’Angelo, Barbara Copenhaver Cancer Care Navigator – Jan Tapimeister, RN 240-826-6297 CHESAPEAKE-POTOMAC HH AGENCY, Clinton; 1-800-656-4343 x227 or 301-274-9000 x227; SUBURBAN - Bethesda - 301-896-3050 Melba Graves, WOCN WASHINGTON ADVENTIST - Takoma Park - 301-891-7600 Barbara Aronson-Cook, CWON – 301-891-5635 FOR MILITARY ONLY: MALCOLM GROVE MED CTR, ANDREWS AFB – Suitland, MD, Phone 240-857-3083 BETHESDA NAVAL/ WALTER REED NATIONAL MILITARY MEDICAL CENTER - Bethesda, MD - 301-319-8983 or 4288 Paz Aquino, WOCN & Sharon May, WOCN V.A. MEDICAL CENTER - Washington. D.C., 202-745-8000 page Erlinda Paguio, WOCN; RNs Leslie Rowan, Natalie Tukpak WASHINGTON DC: CHILDREN’S NATIONAL - 202-476-5086 June Amling, CWON GEORGE WASHINGTON UNIV- 202-715-4000 Debbie Sears, WOCN GEORGETOWN UNIV - 202-444-2801 Page WOCNs Dot Goodman, Kelsey Skeffington HOWARD UNIVERSITY - 202-865-6100 Page 769 Faith Winter, RN NATIONAL REHABILITATION - 202-877-1186 Carolyn Sorensen, CWOCN PROVIDENCE - 202-269-7548 or 7000 Page Beverly Styles, WOCN SIBLEY MEMORIAL - 202-689-9931 WOCNs: Dorothy Shi, Helene Hemus, Marie Newman SPECIALTY HOSPITAL of WASHINGTON (formerly Capitol Hill Hospital) is a nursing home with long term acute care beds. Wound Care Dept. 202-546-5700, ext. 2140 UNITED MEDICAL CENTER (UMC) - 202-574-6150 Donna Johnson, WOCN

WASHINGTON HOSPITAL CENTER - 202-877-7000, page WOCNs Joseph Kisanga, Robert Ebeling, Michael Kingan, Donna Stalters, Debra Engels

“It is one of the most beautiful compensations of this life that no one can sincerely try to help another without helping

himself.” ~ Emerson

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Stoma Dermatitis; Part I - by Allison Ehrlich, MD MHS and Research Fellows, Jack Short, MD and Samah Hajjar, MD of George Washington University gave this presentation at the MMOA meeting on November 10, 2013.

Identification – The prevalence of skin problems in ostomy patients is wide range from 6 to 80%. This breaks down in to one third of colostomy patients and two thirds of Ileostomy and urostomy patients being affected. Urine having a higher concentration of enzymes means the urostomate’s skin often can be irritated. Though these statistics cover a large population of ostomates in 2008 Nybaek reported just over one third of stoma patients visited their WOCNs for related skin complications. The main reasons for seeking clinical help for skin problems either with a WOCN or a dermatologist include pain or discomfort, issues involving leakage, odor or social isolation for a better quality of life. When recovering from surgery dermatoses can slow the healing process and may lead to a more severe complication or infection. An important consideration is the cost of care when more frequent changes of equipment to avoid discomfort or to attain a better seal of the skin barrier and can be a costly misuse or overuse of medical resources. Bilious content of small bowel leads to more complication in an ileostomy verses the large bowel with the risk of leakage often due to a poorly created surgical stoma or improper sizing to the stoma equipment. The abdominal wall is often compromised in surgery, warm weather and increased perspiration during exercise and diarrhea during a sickness all can cause your flange to loosen. As we age our skin’s layers of keratine or epidermis become thinner. After surgery weight gain is a good thing but a gain that is not healthy will also compromise the ability of the flange to stay in place due to crevices and gullies in the topography of our stomach. Risk factors - Bilious content of small bowel leads to more complication in an ileostomy verses the large bowel with the risk of leakage often due to a poorly created surgical stoma or improper sizing to the stoma equipment. The abdominal wall is often compromised in surgery, warm weather and increased perspiration during exercise and diarrhea during a sickness all can cause your flange to loosen. As we age our skin’s layers of keratine or epidermis become thinner. After surgery weight gain is a good thing but a gain that is not healthy will also compromise the ability of the flange to stay in place due to crevices and gullies in the topography of our stomach. Leakage - The primary culprit for peristomal skin irritation is leakage of effluent. Leakage prevents formation of a proper seal leading to a lack of skin integrity that in turn prevents adhesion leading to further irritation. Wearing a pouching system beyond the suggested wear time of 3-7 days may compromise the seal leaving the skin unprotected. A 2006 study conducted by Herlufsen found of 202 ostomy patients, 45% were diagnosed with a peristomal skin disorder. Of these patients, only 38% recognized any skin issues on their own revealing patients seem to have a “higher threshold” for identifying skin issues. Because these patients may have a constant peristomal irritation which they consider normal for them, their quality of life is negatively affected. Another possible cause of peristomal irritant dermatoses is abdominal stoma remodels or changes after surgery. The stoma becomes smaller and a portion of skin may be exposed to effluent. Another cause is post surgical weight gain resulting in a buried (retracted or flush) stoma producing a larger area of skin irritation due to trailing under the equipment. Peristomal Moisture-Associated dermatitis (MASD) is inflammation and erosion of the skin caused by prolonged exposure to various sources of moisture and its contents. Leakage of urine or stool, perspiration, wound exudates, mucus or external water source when bathing or swimming leads to either partial or full pouch failure. MASD treatment may include: increase hospital stay of proper patient learning of pouching techniques, pouch change schedule may be too long, skin barrier powder containing hydrocolloids to absorb the moisture, steroid spray for inflammation and diet modification may be addressed. Peristomal dermatologic conditions can have chemical (irritant contact dermatitis, pseudoverrucous lesions), mechanical (mechanical dermatitis, mucocutaneous separation, stripping injury), infectious and bacterial (candidiasis, folliculitis), immunologic (allergic contact dermatitis), or disease-related (pyoderma gangrenosum, malignancy, Crohn's disease) etiologies or causes.

Continued on page 8

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Continued…

Irritant contact dermatitis is caused by the contact of substances with the skin or by the improper placement of stoma equipment. Chemical irritant dermatitis arises from the patient's reactions to substances that come into contact with the peristomal skin; these include gastric secretions, mucus, solvents, or cleansing materials. Fecal or urine irritant contact dermatitis is common with ostomies because of leakage that can occur around the stoma. The majority of irritant dermatitis cases involve the inappropriate placement and sizing of the ostomy equipment, resulting in constant exposure to the irritant.

Mechanical dermatitis results from the physical abrasion that can occur because of the movement of stoma support belts or the hard plastic components of the ostomy pouch system across the skin. The affected skin is often characterized by erythema (redness) and possible abrasion. Stripping injuries, which occur when adhesives are forcibly removed from the skin, constitute another form of mechanical injury.

Infectious/bacterial complications of stoma dermatitis can be Candidiadis or Folliculitis. A bacterial Infection may be treated sufficiently by cleansing with antiseptic. Systemic treatment with appropriate oral antibiotics may be necessary. For Candida Albicans, Miconazole nitrate 2% powder or Nystatin powder can be used.

Irritant Treatment Options - Topical ointments are often too oily affecting adhesion of the ostomy equipment. Hydrocolloid dressings over ointment can be used, followed by equipment placement. Avoid lotions containing propylene glycol as it affects adhesion. Sucralfate powder provides a physical barrier on skin and the basic aluminum salt polymerizes in moist or acidic conditions. The powder prevents further irritation and may promote mucous or bicarbonate secretion due to increase in prostaglandin production. Other treatment options are surgical revision, changing Ostomy equipment, treating pre-existing skin conditions and patch testing for allergic contact dermatitis.

Part II of Dr. Ehrlich’s presentation will be included in the March/April issue and deal with “Irritant vs. Allergy.”

⪻⪼

!What To Do as an Ostomate With the Flu - by Anne Marie Knudsen, CWON, MN, CNS, CFCN, DOAA, Update 11/12 Via Ostomy Assn o f West Texas. Excerpt by Metro MD. Ostomates must take special care not to take any medication including laxatives without being prescribed by a doctor. Eat a fiber free diet and then gradually move towards a regular normal diet. Colostomates : DO NOT IRRIGATE WHILE HAVING DIARRHEA AND DO NOT TAKE LAXATIVES. Some drugs and specific foods can cause constipation. This can be prevented by increasing your fluid intake. Coughing or sneezing may cause a peristomal hernia. A support belt can make a difference. lleostomates: Diarrhea in addition to causing excessive discharge, can risk an electrolyte imbalance. Most importantly POTASSIUM must be kept within safe levels. If vomiting and dehydration becomes an issue, the Ileostomate must go to the ER as an ileostomate cannot hydrate oneself fast enough. Don’t wait. It is recommended to drink Ginger Ale, bouillon, and either Gatorade or Pedialyte. Urostomates: Follow the same special care and make sure to protect the kidneys. Prompt attention of distress from the Flu will make a difference. General Information: Imodium plain and Imodium ES (extra strength) is available. Imodium is by far the better choice than Lomotil as it does not contain Atropine or Anti-cholinergics which can have ramifications with many medications as well as side effects. Pouch Options with the Flu: If you have a closed pouch, switch to a drainable one and finally, if you do get excoriated or raw peristomal skin, use Milk of Magnesia, Mylanta or Maalox and dab it onto the raw skin areas and blow dry on low until a white dry crust is seen. One can pouch on top of the white crust and the raw skin will be healed within 24 hours. Always try to have a variety of pouches available at all times. Simply contact your vendors and ask for free samples. Get your Flu shot – it is worth it. �

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MMOA Uses Social Media to Reach You

We appreciate and depend on your support for Metro Maryland. We have only one fund raiser each year; our annual raffle. This year we are planning a celebration of the 40th Anniversary of Metro Maryland on March 9, 2014.

We recognized it was time to make our small corner of the world more available through social media to those who are in need of our assistance or know someone who is. We continue to be there for ostomates either by telephone or in person. At MMOA’s meetings we have experienced the generosity of our members sharing themselves and their experiences with ostomates, not only to gain confidence in ourselves, but to reach out to new ostomates who just need a little word of encouragement. MMOA wants to continue to be there for ostomates… for YOU.

Please visit us on Facebook and follow us on twitter @MarylandOstomy

MMOA, Inc. 12320 Parklawn Drive, Suite 241 Rockville, MD 20852

Documents

January/February 2014 Volume 40 Issue 3 - marylandostomy.orgmarylandostomy.org/uploads/file/newsletters/JanFeb2014.pdf · January/February 2014 Volume 40 Issue 3 METRO MARYLAND OSTOMY