Pain

We all will experience pain at some point in our lives whether it stems from a physical, emotional, spiritual cause, or from something else.  As far as physical pain goes sometimes it is acute and will resolve rather quickly.  However, at other times it can become chronic, so we will have to find ways to manage it in order to cope to make the best out of our daily life.  Pain is said to be “whatever the person experiencing it says it is, existing whenever they say it does.”  This means that you or your loved ones are the only ones that can determine your level of pain, and caregivers should manage it appropriately related to your descriptions. 

All pain results from a signal cascade within the body’s neurological network and the way each person interprets the pain will be different.  Healthcare professionals with Total Home Health will strive to closely take into account a five-step approach to pain measurement as follows:

1.      Pain will be assessed and treated promptly for all clients.  Also, pain assessment along with all documentation will be clearly communicated with other professionals involved in your care.  Clear communication will allow for consistency of care and improved pain control.

2.      You, as the client will be actively engaged in the pain management plan.  This is because you are the only one that is able to describe your level of pain that you are experiencing.

3.      Healthcare professionals need to treat patients with analgesics as a precautionary measure to safely, effectively, and reasonably manage pain.

4.      Pain should be reassessed frequently, and treatment should be adjusted if the need arises in order to meet your needs.

5.      Healthcare companies and facilities should have a comprehensive quality improvement program established that monitors both healthcare provider practices and client outcomes for pain management, in order to provide the best care possible.

Pain assessment in those individuals who have impairments with communication can prove to be a very challenging task.  Healthcare professionals sometimes like to take it upon themselves to judge the pain a client is experiencing.  With Total Home Health this will not happen because it could result in not treating pain adequately, if the assessment is based on the assumption of a nurse alone.  With Total Home Health you will never have to worry about this because you are the number one focus.  We provide professional, non-judgmental care that is centered around each and every one of your needs so that you are comfortable and satisfied in order to get the most out of your daily life.

Some people may think that pain is natural with the aging process or that the elderly individual is just finding something to complain about.  Both of those views are wrong because there is almost always a legitimate reason behind what is causing the aches and pains.  Pain can also lead to other problems and interfere with everyday activities, such as anxiety and depression.  The individual may begin to feel hopeless because they can no longer do everything they used to do, and anxious at the fact that someone else has to do it for them.  Those who experience pain may be at a greater risk for falls, weight loss, poor concentration, and difficulties with relationships. 

After careful assessment of your pain, your provider will provide precise instructions to our Total Home Health nurses so that your pain can be managed as effective as possible while allowing you to enjoy life to the fullest.  If ever you feel your pain worsens, your current treatment is not working like it has in the past, or if you begin to experience a different type of pain, please do not hesitate to contact your provider so that treatment changes can be put into place quickly. 

Caring for your loved one can be taxing on your health and demand much more time and strength than you may have available to offer.  The efforts and sacrifices you provide to your loved one are vital to extending their quality of life.  However, caregivers need to actively care for their own physical, emotional and mental well-being too.  This is because caring for yourself is the best way to give quality care to the ones you love.  Although as a caregiver to your loved one it may sound simple enough, you should realize at what point you could use extra help, then do not be reluctant to ask for it, and finally, accept it when offered.  Everyone can use a break every now and then.  Total Home Health has a program designed with your needs in mind.  We are here for you when your loved one begins to require more assistance, do not wait for help…enroll today!

Foley (Indwelling) Catheter

You may have heard Foley catheters also be referred to as indwelling catheters.  A Foley catheter is a hollow, flexible tube that is placed into the body to drain and collect urine from the bladder; it can be made from rubber, silicone, or latex.  Urinary catheters come in many sizes and types.  When the drainage system is connected properly, the catheter tube will lead to a drainage bag that will hold the urine that is eliminated from the body. 

Catheters are generally used in situations when an individual is unable to empty his or her bladder.  It is important to empty the bladder completely because the excess urine left behind can lead to an increase in pressure in the kidneys.  The increase in pressure can result in kidney failure, which is a dangerous issue that could result in permanent kidney damage. 

Most catheters will be used for only a short period of time, until the individual once again regains the ability to urinate on their own.  Some catheters may be required for a much longer duration, such as in the elderly, or those with a permanent or severe illness.  Your provider may recommend the use of a catheter if you are unable to control when you urinate, if you are leaking urine (incontinent), or if you are unable to completely empty your bladder when you need to (urinary retention).

Here are some reasons why you may not be able to urinate on your own that you and your loved ones should become familiar with:

ü  Blocked urine flow either due to kidney stones, blood clots in urine, or a narrowing of the urethra (the tube that connects your bladder to the outside of the body where your urine is eliminated through).

ü  Surgery on your prostate gland or in the genital area.  This could be from a hip fracture or hysterectomy.

ü  Injury to the nerves of the bladder.

ü  Spinal cord injury.

ü  Dementia which will impair your cognitive function and decrease your ability to recognize when you have to urinate.

ü  Certain medications can result in tightening of your bladder muscles, which will cause urinary retention.  Other medications such as Lasix may cause more frequent urination.

An indwelling, or Foley catheter, is left in the bladder.  This type can be used for both short and long periods of time.  An indwelling catheter is usually inserted into the bladder via the urethra by a licensed professional who follows a sterile technique.  There are times though when a physician may insert the catheter through a tiny incision, or hole, in the abdomen.  This type of indwelling catheter is known as a suprapubic catheter, meaning that the area of insertion is above the pubic area.  After insertion, a tiny balloon at the end of the catheter is inflated and filled with up to 30 milliliters of sterile water to prevent the tube from sliding back out of the body.  Of course then, prior to removal the balloon is always deflated first in order to avoid excess discomfort, and the patient is asked to bear down to allow for a more smooth process of removal.

It is important to remember that when you have anything in your body that enters through an opening, this can allow infection to enter at any time.  Therefore, having an indwelling urinary catheter is the leading cause of a healthcare acquired urinary tract infection (UTI).  Due to this increased risk the catheter tubing and where it enters the body, along with the surrounding area are routinely cleansed to help to prevent infection.  However, the following list includes symptoms of a UTI, you should be aware of these so you can receive prompt treatment.  These symptoms include:

ü  Fever

ü  Chills

ü  Headache

ü  Burning of the urethra or in the genital area

ü  Leaking of urine out of the catheter

ü  Blood in the urine

ü  Foul-smelling urine

ü  Low back pain and aches

Having a catheter can be considered a burden.  Just like anything else, it is what you make it.  Total Home Health has a program specifically for you to help you manage your indwelling catheter and continue to function on a daily basis.  Our trained professionals will be at your side or just a phone call away should you ever have any questions or concerns.  100% client satisfaction is what we strive for on a daily basis!

Cellulitis

Cellulitis is a common, but potentially serious bacterial skin infection that you or someone you love may encounter at some point in life.  You will know you have it when you see it.  It will appear as a swollen, red area of the skin that will feel hot to the touch and will be tender.  Cellulitis can spread rather rapidly to other locations throughout the body.  Do not be alarmed though because it is not usually spread from person to person.

The area of the body that is most commonly affected by this condition are the lower legs.  Although, anywhere on your body or face is fair game for it to develop.  Cellulitis may only affect the surface of your skin, or it may extend deeper into your tissues, lymph nodes, or spread throughout your bloodstream.  If left untreated, the infection will most likely spread which can rapidly become life-threatening.  A good point of advice for you to remember is that you should always seek immediate medical attention at the slightest change in your body, because you are the one who knows it best!

There are specific signs and symptoms related to cellulitis that you should be aware of and they usually will occur on only one side of the body.  These include, but are not limited to:

·        Red area of skin that is observed to continually increase.

·        Swelling.

·        Tenderness.

·        Increase in pain.

·        Increase in warmth compared to other areas.

·        Fever.

·        Red spots.

·        Blisters.

·        Dimpling of skin.

It is important to be attentive to the signs and symptoms as mentioned above to intervene early in your treatment of cellulitis to avoid other problems that it can easily cause if left untreated for too long.  Do not hesitate to seek immediate medical attention; Total Home Health professionals will be ready to take control of your condition.

Now that you know what to look for, you may be wondering what causes this condition.  Cellulitis occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in your skin.  MRSA is commonly heard of, as it is one of the more serious staphylococcus infections. 

To result in cellulitis, bacteria most likely will enter through an area of your skin that is compromised, such as where you have had recent surgery, have cuts, puncture wounds, ulcers, athlete’s foot or dermatitis.  Other factors can lead to cellulitis, such as certain types of insect or spider bites that can transmit bacteria and start infections.  Skin that is also just dry, flaky or swollen can also allow the infection to enter.  Basically, you just never know when you may become infected and it is a good idea to maintain strict hygiene.  Always take care of your skin, even more so if it is compromised, or if you have a condition such as diabetes that results in poor circulation, which delays healing.

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Treatment of cellulitis usually will include a prescription for an oral antibiotic.  Some cases may require intravenous (IV), depending upon its severity.  Within three days of starting an antibiotic, you should start to notice if your infection is responding to the treatment.  It is important to take the full course of the antibiotic treatment in order for it to exert its full effects, you should never stop your antibiotic just because you feel better.  Generally, the course of antibiotic therapy lasts up to 14 days.  Elevation of the affected extremity is also a general rule of thumb to aid in relief and recovery.

In most cases, within a few days, the once apparent signs and symptoms of cellulitis will disappear.  However, if your specific course of cellulitis does not respond to oral antibiotics, if your signs and symptoms are extensive, or if you have a high fever, you may need to be hospitalized to receive IV antibiotics.

Usually, providers will prescribe a medication to you that are effective against both streptococci and staphylococci so that your treatment will have a better chance at success by killing all the bacteria.  The professionals at Total Home Health cannot reinforce enough of how important it is to finish the entire course of your antibiotics so that further complications do not arise or your condition continues.

Total Home Health has a program that is right for you and all your needs that may arise if you are burdened with a condition such as cellulitis.  This infection may hinder your abilities to perform daily routines while it runs its course, which is where our staff comes into play to get you through your daily routine.  Our professional staff will also be available to assess your course of cellulitis and prevent it from worsening or developing into a more serious condition.  At Total Home Health, we are ready for whatever may be thrown at us next!

Melanoma

Melanoma is the most serious type of skin cancer; it develops in the cells (melanocytes) that produce melanin.  Melanin is the pigment that gives your skin its color.  Melanoma can also form in your eyes and, rarely, in internal organs, such as your intestines.  The exact cause of all melanomas is not clear.  Exposure to ultraviolet (UV) radiation from sunlight or by tanning beds increases your risk of developing melanoma.  Therefore, limiting your exposure to UV radiation can help to reduce your risk of melanoma.

The risk of melanoma seems to be increasing in people under 40 years of age, especially in females.  Knowing the warning signs of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread.  Melanoma can be treated successfully if it is detected in its early stages.  Melanomas can occur anywhere on your body.  Most often, they are known to develop in areas that have had more exposure to the sun, such as your back, legs, arms and face.  Melanomas can also occur in areas that do not receive much sun exposure too, such as the soles of your feet, palms of your hands and fingernail beds.  These “hidden” melanomas are more common in dark-skinned people. 

Normal is what we all hope for and normal moles are generally a uniform color such as tan, brown or black and they have a distinct border that separates them from the surrounding skin. They are oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter, approximately the size of a pencil eraser.  Most individuals have between 10 and 45 moles. Many of these develop by age 40; although moles may change in appearance over time, and some may even disappear with increased age.

You and your loved one should be aware of some of the first warning signs and symptoms of melanoma, which include:

·         An observed change in an existing mole

·         The development of a new pigmented or unusual growth on your skin

Keep in mind that melanoma does not always have to begin as amole.  It can also occur on otherwise normal-looking skin.  Generally, health professionals follow the ABCDE acronym when deciding whether or not an unusual area of the skin indicates melanoma.  Here is what to look for when assessing your moles:

·         A = Asymmetrical Shape.  Melanoma lesions are often irregular, or not symmetrical, in shape.  Whereas benign moles are usually symmetrical and nothing to be concerned about.

·         B = Border.  Melanoma lesions usually have irregular borders that are difficult to define.  Whereas, non-cancerous moles typically have smooth, even borders.

·         C = Color.  The presence of more than one color (blue, black, brown, tan, etc) or the uneven distribution of color observed on the skin can sometimes be a warning sign of melanoma that should be taken seriously.  Benign moles are usually a single shade of brown or tan.

·         D = Diameter.  Melanoma lesions will often appear to be greater than 6 millimeters in diameter (approximately the size of a pencil eraser).

·         E = Elevation.  The elevation of your mole(s) means that it is raised above the skin surface and is uneven.  The mole will also appear to look different than the rest, or will have appeared to change in size, shape, and/or color.

Other signs that may indicate suspicions with a mole would be itching, oozing, or bleeding.  Or those skin areas that you can peel off, but they consecutively return over a short period of time.  In order for a mole to be malignant moles they do not have to exactly match all of the characteristics that were listed.  In fact, they may only have a couple, so it is a good idea to become familiar with each and every one in order to seek immediate treatment.

The topics mentioned are generally the most important factors to consider when it comes to diagnosing melanoma.  In general we should all know our own bodies, so this means that by knowing what is normal for YOU could save your life.  If a mole has gone through recent changes in color and/or size, bring it to the attention of your provider immediately.  

Total Home Health has a program for you.  Our highly professional and compassionate staff can provide you with information regarding any questions or concerns you have regarding melanoma, and we will be with you along the way to provide care for you during what could be your most vulnerable time.

Depression

Not every day will be filled with rainbows and butterflies.  There will be some days in our lives when all we want to do is stay in bed.  At one point or another we will all have a feeling of sadness that creeps up on us for some reason, but usually it is short-lived and will go away in a day or two so it really isn’t a big deal.  However, these sad feelings can linger for months and we will start to notice that maybe we no longer get our daily tasks done as we should anymore, and it may start to cause our loved ones to become concerned.  It is at this point that an individual can be diagnosed with depression.  This illness is both common and serious. 

Many people suffering from a depressive illness may never seek treatment, simply because they think their routine is normal.  However, if they do seek treatment, the majority of individuals will get better.  Treatment can be provided in many forms including medications and psychotherapy.  Generally, it is a good idea to start with treatment that does not involve medication in order to see the depth of the condition and to escape the effects of the medication.  Some individuals just need someone they can count on to listen to them and provide one-on-one communication in their times of need. 

There are several types of depressive disorders.  Typically, depression is caused by a combination of genetic, environmental, and psychological factors.  Depressive illnesses are disorders of the brain.  There are diagnostic tests, such as a magnetic resonance imaging (MRI) that will produce images of the brain in order to help determine what is going on in a depressive illness.  MRI’s have shown that the brains of individuals who have depression indeed do look different that those of individuals without depression.  The parts that looked different are the ones involved in mood, thinking, sleep, appetite, and behavior.  However, MRI’s reluctantly do not give the answer as to why the depression has occurred, and they cannot be used to diagnose depression either.  Diagnosis in part generally stems from what behaviors an individual is exhibiting, and for how long the behaviors have been going on.

Depression may also tend to run in families, but it can still occur in those without family history.  In addition, a stressful situation in an individual’s life may predispose them to experiencing depression.  Examples of these situations could be trauma, loss of a loved one, a difficult relationship, loss of a job, financial struggle, etc.  Any of those could spark an episode of depression.  However, some episodes may occur without a specific spark.

The signs and symptoms of a depressive illness will most likely vary; no two people will experience the exact same symptoms.  The severity, frequency, and duration of the symptoms will vary depending on the individual involved and what their current situation is.  Following is a list of common signs and symptoms that are observed in someone who is experiencing depression including, but not limited to:

ü  Persistent sad, anxious, or feelings of emptiness

ü  Feeling hopeless or relaying pessimism

ü  Feeling worthless, guilty, or helpless

ü  Irritable, restless, fatigue, decreased energy

ü  Loss of interest in what they once considered pleasurable

ü  Difficulty concentrating and making decisions

ü  Not being able to sleep, or sleeping too much

ü  Overeating or loss of appetite

ü  Suicidal thoughts, suicide attempts

If you begin to notice any of the signs and symptoms listed above, either in yourself or a loved one, please try to intervene and reach out to the individual.  Seek out medical help as soon as possible in order to prevent chronic health problems to get your life back on track and enjoy it.  The earlier you get treatment, the more effective your treatment will be. 

An important fact to remember is that another illness may have been present before the depression set in.  Therefore, the underlying illness could have caused depression to occur just because of the toll the illness was taking on the body.  It is always important to make sure that any underlying illness is addressed and treated before treatment is initiated for depression.  This is because if the underlying illness is treated and the individual begins to feel better and normal again, the depression may have just been a consequence of the illness and will also have ceased once the illness was treated.

Depression will exert its effects on each individual differently whether you are male, female, elderly, young, pregnant, etc.  

Total Home Health has a program that is right for you to help cope with your depression.  The treatment you undergo for depression will be specific to your situation and will involve you in every step of the way.  Our professional staff will be there for you to provide continued support throughout your journey.  We will be there to establish realistic goals for your care in order for you to continue your normal daily routine.  Plus, we hope that you will be able to demonstrate effective ways to cope if you are ever faced with depression again with the help of our professional staff.  Don’t wait, enroll today!

Alzheimer’s

Alzheimer’s disease is the most common form of a neurocognitive disorder (NCD).  A neurocognitive disorder occurs when there is global impairment of cognitive functioning that is progressive and interferes with social and occupational abilities.  Generally, a NCD is classified as either mild or major and the distinction is primarily the severity of the symptoms that are present.  The prevalence of Alzheimer’s disease doubles for every five year age group beyond age 65.  It is important for you to recognize characteristics of Alzheimer’s disease, because it could affect you or your loved ones at some point in your life.

Neurocognitive disorders can be classified as either primary or secondary.  Alzheimer’s disease is a primary NCD, meaning that it is the major sign of some organic brain disease and it is not related to any other illness.  On the other hand, a secondary NCD is caused or related to another disease or condition, such as HIV.  In a NCD such as Alzheimer’s, impairment is evident in abstract thinking, judgment, and impulse control.  The common rules that we all normally follow in social situations are no longer taken into consideration, plus communication may become impaired.  Behaviors may become uninhibited and inappropriate, and neglect will be noticed in the individual’s personal appearance and hygiene as compared to their norm. 

There are seven stages to Alzheimer’s disease as listed below.  It is important for you to become familiar with the characteristics of each in order to intervene early to help slow its progression.  The seven stages are:

o   Stage 1:  No Apparent Symptoms

o   In the first stage, you will not be able to notice any apparent decline in memory.

o   Stage 2:  Forgetfulness

o   In this stage, the individual involved will begin to lose things or forget the names of other people.  Short-term memory loss is common.  The individual will realize and become aware of their forgetfulness and they may become ashamed, anxious, or depressed, which may continue to worsen their symptoms.  In this stage it is a good idea to begin to organize a structured routine and create lists for daily tasks.  Others generally do not observe decline in this stage, only the individual.

o   Stage 3:  Mild Cognitive Decline

o   Interference with work performance occurs in this stage and it is also noticeable by other co-workers.  In addition, the individual may get lost when driving.  Concentration may be interrupted and a decline is evident in the ability to plan or organize.  There is increased difficulty recalling names or words, which is now noticeable by family and close associates.

o   Stage 4:  Mild-to-Moderate Cognitive Decline

o   At this point, the individual involved may forget major events in personal history, maybe something such as a birthday of his or her child.  There will be a continued decline in the ability to perform tasks, such as managing personal finances or being unable to understand current news events.  Confabulation may occur in order for the individual to cover up their memory loss.  Confabulation is the creation of imaginary events to fill in memory gaps, like blaming someone else for putting the keys in the drawer.  Depression and social withdrawal are often noticed in this stage.

o   Stage 5:  Moderate Cognitive Decline

o   Here, individuals lose the ability to perform some activities of daily living (ADL’s) independently.  They may need ongoing assistance with their hygiene, getting dressed, and grooming.  Forgetting addresses, phone numbers, and names of close relatives will most likely occur.  They will maintain the knowledge about themselves, but they may become disoriented regarding place and time. 

o   Stage 6:  Moderate- to-Severe Cognitive Disorder

o   In this stage of progression the individual may be unable to recall recent major life events or may not even be able to recall the name of his or her spouse.  Disorientation continues and they may not be able to recall the day, season, or year.  The individual will be unable to manage ADL’s without assistance.  Incontinence of bowel and bladder is common in this stage and sleeping becomes problematic.  The individual may begin to wander, become obsessive, easily agitated, and possibly even aggressive toward others.  There is generally an increasing loss of language skills and most individuals will be placed in institutions for 24/7 care.

o   Stage 7:  Severe Cognitive Decline

o   In this end stage of Alzheimer’s the individual is unable to recognize his or her own family members.   Commonly this person will be bedfast and non-verbal, which may result in compromised skin and contractures due to decreased mobility.

The exact cause of Alzheimer's disease is unknown.  There are various medication treatments that can be put into place to help slow its progression, it is not fully reversible.  It is very hard for family members to see their loved ones go through Alzheimer's disease.  Ongoing support is needed in these difficult situations and that is where Total Home Health comes into the picture.

Total Home Health has a program that is right for you or your family member that is affected by Alzheimer's disease.  Our compassionate, patient, and professional staff are ready to provide ongoing assistance to your loved ones in such a life-changing and vulnerable time.

Ostomy Education

During your life or in the life of a loved one there may come a time when your provider suggests that the next point in your treatment plan involves creating an ostomy.  An ostomy is an opening in the body that is surgically created to allow for discharge of bodily wastes that cannot assume the normal elimination pattern.  You may also hear the word “stoma.”  A stoma is the actual end of the ureter or small/large bowel that can be observed protruding through the abdominal wall.  The words ostomy and stoma are sometimes used interchangeably.

An example of an ostomy is a colostomy which could possibly be created due to having sections of the colon removed, possibly due to colon cancer progression.  It does not matter where your ostomy is located, the care that it will require should be a top priority of your treatment plan to avoid infection, skin breakdown, etc.  Total Home Health will provide you with professional staff trained in this area that will come into your home to take care of your ostomy exactly as prescribed.  Plus, our staff will be available to provide you with education related to your ostomy and answer any questions that may surface.

As a client with a stoma you should be familiar with techniques used to clean the area, signs and symptoms of possible infection or complications, and how to apply and manage the pouching system of your ostomy.  Important educational points are explained as follows:

ü  A healthy stoma appears pink or red and moist.  It should protrude (stick out) from the abdominal wall about ¾ inch (2 cm). 

o   If you see that your stoma appears dusky, brown, black or white you must immediately notify your provider.  You most likely have circulation problems that should be addressed as quickly as possible. 

ü  Only certain cleansing agents should be used to provide care around your stoma.  These include things such as mild, pH balanced soap or no soap at all, just water. 

o   Other products such as Betadine, alcohol, or oil-based soap can interfere with the adhesion of the skin barrier and could cause skin breakdown.

ü  You should see that your Total Home Health staff nurse is measuring your stoma with each change of your pouch for up to 8 weeks following surgery.  This will ensure that the stoma is the correct size.

o   Pouching system must fit so that the skin at the base of the stoma is covered.  It should never constrict or put pressure on the stoma. 

o   If a size difference is observed related to your stoma, your provider will be notified to decide what will happen next.

There are several other indications that should alert you to immediately contact your provider.  These reasons include, but are not limited to:

Ø  Increase in abdominal pain or pain at surgical site.

Ø  Fever, redness, or drainage of the incision site.

Ø  A change in bowel habits.

Ø  Skin irritation that continues even with the correct pouching system and application.

Ø  A bulge around the ostomy site.

Ø  Separation of the stoma from the surface of the abdomen.

If at any point you observe the above characteristics related to your ostomy, never hesitate to contact your provider.  The quicker you contact someone, the better your chances will be at escaping complications that could occur and be life-threatening.

Total Home Health has a program that is right for you when it comes to caring for your ostomy needs.  Our main focus is your well-being and maintaining your most optimal health to allow for the best quality of life for you.  Enroll today to have someone by your side that cares for you like your one of their own!

  

Ileostomy Education

There may come a time in your life when caring for an ileostomy is a part of your treatment plan.  Your ileum is the lowest portion of your small intestine.  An ileostomy is an opening in the wall of your belly that is made during a surgical procedure.  This opening is used to move waste out of the body when the colon or rectum is not working properly.  Basically, the waste and urine your body produces will exit your body and be visible in a pouch that hangs at your side.  In comparison with a colostomy, an ileostomy also can also be short-term or long term.  It will take time for you to become comfortable with any type of ostomy, so allow Total Home Health to assist you with this transition. 

If your ileostomy is short-term, it usually means all of your large intestine was removed but you still have at least part of your rectum.  You will need it long-term if a more serious condition exists that result in all of your large intestine and rectum being removed.  Many different problems may lead to the need for this procedure, including:

ü  Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

ü  Colon or rectal cancer

ü  Birth defects involving the intestinal area

ü  An accident that causes damage to your intestines

Just as with any other surgical procedure there are risks involved.  As far as after the procedure itself, there are various ways you can adjust to now having an ileostomy.  A bland diet is usually recommended by providers.  This type of diet includes foods that are soft, not very spicy, and low in fiber.  You should avoid spicy, fried, or raw foods and also alcohol and caffeinated beverages.  You should be prepared to follow this type of diet until otherwise notified for diet progression by your provider and dietitian, if one is involved.

Being familiar with caring for your stoma and knowing what to look for that should alert you to notify your provider should be a priority for you.  After surgery, your stoma will no doubt be swollen.  It will shrink over the next several weeks.  The skin around your stoma should appear like it did before your surgery; it should be warm, dry, and pink.  The drainage pouch should always be the correct size to fit around your stoma so your elimination does not leak and compromise your skin.  Your Total Home Health nurse will assist you with caring for your stoma and changing your drainage system.

Being aware of the abnormal findings related to your ileostomy is very important as a client who receives care in the home.  You are not in a 24/7 facility where there are healthcare professionals available at all times, so being aware of the following findings and not hesitating to consult your provider will decrease any complications you may have.  You should immediately notify your provider if you observe any of the following characteristics of your ileostomy appearance and/or function:

ü  Increase in swelling

ü  Bleeding more than normal

ü  Stoma appears black, white, or purple

ü  Frequent leaking or draining fluid

ü  Ill-fitting drainage system

ü  Discharge from the stoma that has an odor

ü  Signs of dehydration (dry mouth, urinating less, weakness)

ü  Persistent diarrhea, or decrease in output

ü  Fever or pain

Having an ileostomy can prove to cause many changes in your life and how you go about your usual activities.  You may experience feelings of sadness, become discouraged, ashamed or alone.  If you have any of these feelings you should consider talking it over with someone you feel close to or maybe even your healthcare provider.  As far as continuing to work, you should be able to resume working once you provider releases you to return.  Being open about your ileostomy and having a good support system will help you through this situation.  Total Home Health professionals will be at your side for continued support. 

Ultimately, as always if you have any general questions or concerns regarding your ileostomy you should never hesitate to contact your provider.  Total Home Health has a program for you, either if you have a brand new ileostomy or have had one for years.  Our experienced staff nurses are ready to join you in your journey.

Colostomy Education

A colostomy is a surgical procedure that will bring one end of the large intestine out through an opening (stoma) that is made in the abdominal wall.  Any stool that accumulates in the intestinal tract will drain through the stoma into a pouch that is attached to the abdomen.  A colostomy can either be short-term or long-term. 

A short-term colostomy for instance may be present after you have surgery on your large intestine.  The colostomy will allow the other parts of your intestine to rest while you recover.  Then once your body recovers, another surgery will be performed to reattach the ends of the intestine and reverse the colostomy.  An instance where a colostomy may be long-term and unable to be reversed is if colon or rectal cancer has progressed to where the individual will have no other choice for elimination.

As an individual with a colostomy there are some helpful hints to make dealing with your situation easier, such as:

ü  Eat a well-balanced diet with fruits and vegetables.  Eat on a regular schedule and try to drink 6 to 8 glasses of fluids each day.

ü  To reduce gas, minimize the amount of air you swallow, so try to avoid chewing gum, smoking and drinking from a straw.

ü  Remember to empty your pouch when it is 1/3 full to make it less difficult.

ü  You may shower/bathe with your pouch on or off, your stoma will function regardless.

ü  If your weight changes, either you lose or gain up to 10 pounds, the size of your pouch may need adjusted.

There are several tips our professional staff at Total Home Health can share with you related to your colostomy.  Our nurses are trained to provide the best quality of care to you with your colostomy.  If you are motivated to learn, we are always ready to educate you on how to care for your colostomy in the event of our absence.

Warning signs related to your colostomy are also extremely important to become familiar with.  The following list includes signs and symptoms that if you observe you should immediately notify your doctor no matter what time it may be, these include:

ü  Purple, black, or white stoma.  This could indicate circulatory problems.

ü  Severe cramps lasting more than 6 hours.

ü  Severe watery output from the stoma lasting more than 6 hours.

ü  No output from the colostomy in 3 days.

ü  Excessive bleeding from your stoma.

ü  Severe skin irritation or deep ulcers.

ü  Bulging in your abdomen.

There are also some indications listed below that may not be as quite as severe.  In these instances you should just notify your ostomy nurse.

ü  Your pouch system frequently leaks.  You want your pouch system to fit well around your stoma in order to prevent the leaking that could occur and result in skin breakdown.

ü  The size/appearance of your stoma changes, causing discomfort or problems with your pouch. 

ü  If you notice a skin rash or if your skin is becoming raw.  This could lead to further skin breakdown and increase risk for infection.

ü  Any drastic weight gain or loss that may cause your pouch to not fit as well.  This should be addressed as soon as possible to prevent leakage.

If you have a colostomy or are supposed to undergo the procedure to get one soon, it is normal to experience negative feelings related to the colostomy itself and how others may perceive you.  Remaining open about your colostomy and able to talk to others about your situation would be recommended in order for you to express your feelings to feel more comfortable with yourself.

All in all, the professional Total Home Health staff is eager to care for you in your unique journey by being your teacher, friend, and caregiver to make your situation as easy and comfortable as possible.  We have the program that is right for you and all your colostomy needs.