How much margin for stoma with cut-to fit?

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NHMike
Posts: 689
Joined: Fri Jul 21, 2017 3:43 am

Re: How much margin for stoma with cut-to fit?

Postby NHMike » Sun Dec 03, 2017 6:39 pm

Aqx99 wrote:
NHMike wrote:I haven't had leakage problems - just irritation.


Irritation typically means a leak. When I first started, I had a red ring all the way around my stoma because my output was seeping under the wafer.


Mine is a spot directly below the wafer. Not sure if I'm not doing the barrier paste right or I was wearing the bag for too long. If there is a leak, it's well contained by the wafer.

When I think of a leak, I think of something getting outside the wafer.
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).

Aqx99
Posts: 279
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: How much margin for stoma with cut-to fit?

Postby Aqx99 » Sun Dec 03, 2017 7:18 pm

NHMike wrote:
Aqx99 wrote:
NHMike wrote:I haven't had leakage problems - just irritation.


Irritation typically means a leak. When I first started, I had a red ring all the way around my stoma because my output was seeping under the wafer.


Mine is a spot directly below the wafer. Not sure if I'm not doing the barrier paste right or I was wearing the bag for too long. If there is a leak, it's well contained by the wafer.

When I think of a leak, I think of something getting outside the wafer.


Sounds like you have a minor leak. Make sure you aren't getting paste under the wafer. Paste is not meant to be an adhesive, it is more like caulk to fill cracks. You might need to add an Eakin ring or something like that to help contain your leak. Your ostomy nurse should be able to help you with that.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
2/21/17 Diagnosis, Age 39
2/21/17 CEA 0.9 ng/mL (Siemens Chemiluminescent Method)
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR w/ temp loop ileostomy, ovaries & fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Diagnosed w/ precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
11/27/17 CEA 2.6 ng/mL (Roche ECLIA Method)
12/5/17 CT showed NED
12/13/17 CEA 2.9 ng/mL (Roche ECLIA Method)
1/23/18 Reversal

MissMolly
Posts: 444
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: How much margin for stoma with cut-to fit?

Postby MissMolly » Sun Dec 03, 2017 8:59 pm

Mike:
Ann’s (Aqx99) comments in her post above are Spot On and wise.

I suspect your irritation and minor leak correlate to your use of a ring of ostomy paste on the wafer. Cease and desist this practice.

Ostomy paste is not like Elmer’s glue. Ostomy paste is NOT an adhesive. It is meant to fill dips and creases in the skin to make a level skin surface for placement of a wafer. But even that role is questionable. A better option is to use portions of a barrier ring (ex. Ekin cohesive ring or Brava adaptic ring) to fill divots and creases in the skin. Long term/permanent ostomates almost never use ostomy paste. A well-known motto: “Paste is a waste.”

The problem with applying a ring of paste is that it provides a ready conduit for liquor ileoaromy output to seep through, resulting in devestating leaks and embarrassing wafer failure.

I do not know why it is that almost every individual with a new Ostomy is issued a starter or welcome ostomy kit that contains a tube of ostomy paste and stoma powder. Neither product is an essential accessory and both contribute to wafer leaks.

A visit with a competent and up-to-date ostomy nurse can be a God Send where you are in your discovery and product
experimenting stage. You have had several weeks getting to know the individual characteristics of your stoma and its output frequency and to become familiar with ostomy-specific vocabulary (i e. a “one piece” is not a bathing suit but rather an ostomy appliance where the wafer and pouch are a single unit).

Ann, you’ve learned a lot as you approach 6 months with a loop ileostomy. You’ve mastered the material suma cum laude and will be a valuable asset to this forum in the months to come, helping newcomers and continuing the cycle. Kudos to you and best wishes for a successful and uneventful take-down and reversal in January.
Karen
Devoted daughter to my father, diagnosed with stage 2 colon cancer Nov-2014.
Dear friend to Bella Piazza, former CC member.
I have a permanent ileostomy and offer advice on living with an ostomy.
I have been on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression and recurrent infection x 4 years. I transitioned to Hospice Sept-2016, but it was not yet my time. I am back on Palliative Care and live a simple life due to frail health.

rockhound
Posts: 55
Joined: Fri Jul 14, 2017 5:00 pm

Re: How much margin for stoma with cut-to fit?

Postby rockhound » Sun Dec 03, 2017 10:00 pm

A partial brava ring was so helpful for me - had a constant leak at 9'clock (looking down) where a crease is located. That was like a highway to my bellybutton for output, until I used the partial ring on that side. I also found using an ostomy belt with a convex wafer to be really helpful; pushed my stoma out and keep output directed as best as possible, down into the bag (rather than just around the stoma itself).
42 yr old male
Diagnosed December 2016, age 41
Stage 1/IIA rectal cancer - T2/3N0M0 via MRI (MRI indicates stage 1; onc/surgeon = stage 2a)
Lynch syndrome, MSH6 mutation, MSI-H
2 to 3/2017 Xeloda + Radiation
5/10/17 - Robotic LAR with temp. loop illeostomy, 0/20 lymph nodes
6 to 7/2017 - Six cycles Folfox @ full strength
9/20/17 - Ileostomy takedown
10/17 - Clear CT

hawkowl
Posts: 64
Joined: Sun Dec 14, 2014 5:29 am
Location: MN/FL

Re: How much margin for stoma with cut-to fit?

Postby hawkowl » Mon Dec 04, 2017 6:48 am

I am a huge fan of the moldable barriers rather than cut to fit. I use convatec natura convex, apply adapt stoma paste where there is a small divot on my skin (and where leaks usually started), then apply an eakin slim ring, and then the barrier. Almost never have leaks or even itching or irritation, and only need to change the barrier every 7-10 days or so (and I'm very active and live in a hot climate most of the time).
Dx 12/2014 T3N2MX (iliac nodes) low rectal
12/2014-4/2015: FOLFOX (8 cycles)
4/2015-6/2015: 28 cycles of chemoradiation with xeloda
8/2015: Robotic APR with iliac node dissection; path showed ypT0,ypN0 (complete pathological response).
11/2015 scans clear, CEA 2.1
11/2015 parastomal hernia repair
3/2016 CEA 1.7
10/2017 CEA remains in normal range (1.4), scans stable.

Totally disabled due to oxaliplatin induced neuropathy and dysautonomia

NHMike
Posts: 689
Joined: Fri Jul 21, 2017 3:43 am

Re: How much margin for stoma with cut-to fit?

Postby NHMike » Mon Dec 04, 2017 1:01 pm

Aqx99 wrote:
Sounds like you have a minor leak. Make sure you aren't getting paste under the wafer. Paste is not meant to be an adhesive, it is more like caulk to fill cracks. You might need to add an Eakin ring or something like that to help contain your leak. Your ostomy nurse should be able to help you with that.


The instructions that I received had me using the paste. I meet with the Ostomy nurse on Thursday and I have a list of questions for her. I will probably call her today to ask about the paste issue. I suspect that I may have returned to work from Short-Term Disability too soon. I'm basically doing all of my work and household responsibilities while researching some of the cancer stuff. The stoma stuff that I did worked for a couple of weeks but I need to address the irritation.

I still think that the process for stoma supplies is pretty poor. I find that product discovery and sourcing to be challenging. Maybe it's a lot easier once you get the first one down. But the stoma stuff has bubbled up to my second priority (first is meeting with the oncologist to get adjuvant chemo started).
6/23/17: ER rectal bleeding; Colonoscopy+Biopsy
7/13: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8. 11/30: 0.6
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV
10/30: Surgery: LAR, Temp Ileostomy
Path report: Tumor regression grade: 0 (complete response).


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