Ill fitting flange

[BowelMeOver]

Today was the second time my husband and I set out to tackle the changing of the bag. Who'd a thunk some tiny bit of intestine could be so intimidating!

Because his stoma still has the bridge in it, we are having to cut out some additional space on each end of the flange hole (the part where your stoma pokes out of) to make room for the rods of the bridge, and then we try like heck to slide the flange under those rods. Needless to say, there was alot of actual handling of the flange as sometimes one side will work fine, but then we had to lift up the flange on the other side to try and squeeze it under that rod as well.

We wound up going through three flanges total, with a few cigarette breaks in between because his stoma decided this would be a great time to expel it's goodies.

They say third time is the charm, but I have a few concerns that I hope some of you ostomy extraordinaires can help me with. After we finally got the third flange on and tucked well under the rods, we noticed there was a little area of skin still showing directly above the stoma, and the only thing we had to try and cover that area was one of those sticky barrier rings, so we tore off a little bit of one and flattened it out really well to cover the skin. It is not covering the stoma in any way, just that tiny bit of exposed skin.

Are we nuts? Are we going to suffer some ridiculous yet painful consequence for not doing it perfectly? What if this happens again? Is there an actual product just for oopsies such as this? Granted, we could have gone for flange number 4, but we were exhausted by this time, and just about out of cigarettes too! Please advise. :eek2:

 

[nogutsnoglory]

When is the rod being removed? Mine was removed before discharge. It's hard to put it on you kind of need to cut out a big area but I find lifting the flange and gently getting one rod in and then placing it down for the other.

It gets easier when the rod is out.

 

[BowelMeOver]

I've read of so many people that got theirs out before discharge, and I am so jealous! We have a grueling 7 days to go with this, as well as all the staples, but the advice and support of the lovely folks here on this forum helps take some of the anxiety away.

I hope you are doing well since your surgery. I really appreciate that you share your experiences with us.

 

[DJW]

Well I learned a neat little trick. But it works like a charm. Tampons. Being a single guy it was such an embarrassing purchase. I tried to get the small ones for young teenager. I ended up with regular. Don't put it all the way in. Have another ready just in case.

 

[BowelMeOver]

Tampons? For real? :confused2:

Could you please offer more details on this neat little trick of yours, and more specifically, just where exactly am I not to put the tampon all the way in at?

 

[DJW]

In the stoma. Absorbs little leaks.
I responded the same way.

 

[BowelMeOver]

You are one mighty brave single guy then, because I don't think I could ever ever ever be motivated enough to stick anything in that stoma. :worthy:

Thanks for sharing the trick nonetheless. It's the thought that counts!

 

[DJW]

The nurse did it the first time.

 

[nogutsnoglory]

He had staples? I still have threads under my stoma which will dissolve eventually.

 

[PsychoJane]

I'm guessing it's a loop stoma? Otherwise I don't understand the rod part :S... I never had that procedure so I am a bit confused regarding it and don't really know what kind of input I could bring. Otherwise, for what it is of the portion of skin showing up, sticking a piece for seal will mostly do for a bit but it do not remain in place long. I've done similar adjustment when I was running out of material but had cut my wafer the wrong way. If it is just a tiny bit of skin, there is not much to worry about, leak is a possibility but it is possible it won't be the case. It is not the best for skin irritation but it always end up reaching the skin a little even without exposure. I found the skin is more likely to get irritated right after surgery but get tougher with time. As annoying as it can be to change the appliance right now due to the rod, I would just suggest not to wait to long before doing the next change to avoid undesired irritation. You could also try verifying if the paste/seal you added is still in place if it is a two piece system and try adding some if it falls but usually, sticking something once the appliance is not new is pretty much mission impossible.

 

[BowelMeOver]

Nogutsnoglory, he has threads holding the rods in place as well, but staples on his incisions. Four or 5 little areas with maybe 3 or 4 staples, and then one right above the groin area that has about 15 or so.

Thanks for your response, Jane. I think 2thfairy posted a pic in that Barrier Wipe thread here in the stoma sub forum, but it isn't pretty to look at.

I appreciate your advice to take a look at the ring in a day or two, and that it would be wise to try and change it sooner than usual. I'm sure we will give that more consideration tomorrow, because right now we are just happy it's over with, and it's hard to think about changing it again at the moment.

In the event we do find the ring material faulty and have to remove it, would it be wise to add a little of that powder that many of you talk about here, to prevent skin irritation, or some other product that might be recommended?

 

[nogutsnoglory]

Mine was different I have glue on my scars and little threads attached to the bottom of my stoma.

 

[2thFairy]

Tampons? For real? :confused2:

Could you please offer more details on this neat little trick of yours, and more specifically, just where exactly am I not to put the tampon all the way in at?

I wouldn't try this, especially not this early in the process. It would be way too easy to damage the new stoma and it's never a good idea to block the flow of output. No one should ever stick anything inside a stoma except a trained physician and even those are difficult to find. Many ER personnel don't even know what to do when someone presents to the hospital with a stoma obstruction or prolapse.

After I get the old gear off, I use gauze squares to wrap around my stoma. This soaks up any output and also allows me to move the stoma around as I put the new gear on. You may go through a lot of gauze in the process, but it is much safer.

 

[nogutsnoglory]

Putting anything into your stoma sounds like a recipe for disaster. Although it would be nice to stop the damn flow when changing appliances.

 

[DJW]

Putting anything into your stoma sounds like a recipe for disaster. Although it would be nice to stop the damn flow when changing appliances.

I've always been of that opinion until the stoma nurse suggested it. Just the end goes in the stoma.

 

[nogutsnoglory]

I'm going to try to remember and ask my nurse. I got a pamphlet from Hollister and under the intimacy section it says dont use your stoma for sex. First of all yuck and second how crazy are people? Why would that be at all enjoyable? Shakes head.

 

[annawato]

Haha, I remember reading that bit about sex and a stoma. I was like Really? REALLY?

It is not advised to put anything in to your stoma. That said, I did consider using a tampon in desperation the other day. I'll let you all know if I'm ever brave enough to do it.

And back to the original question, I assume you are using a two piece? Stoma paste should fill the gap nicely but until you get some bits of the rings will be fine. Just replace them as they fall off or dissolve. You would probably have to replace the stoma paste too as the output will dissolve that too. Much easier than replacing everything though.
If you are using a onepiece then all you can do is replace it all if you want to avoid skin irritation and possible leaks.

 

[BowelMeOver]

Thank you all for taking the time to respond to my questions, even with some of the really gross answers. Tampons? blech! Sex with a stoma? Yikes!

The little bit of ring material that we used seems to be holding well. When we applied it, we also made sure some of it was also stuck to the wafer area. I'm not sure if this is what is allowing it to hold, for now at least.

I did order a few different products prior to this mishap, and although paste wasn't one of them, the visiting nurse is bringing some by today after her visit to her office. Even if we don't wind up using it, it will be nice to have for future ooopsie moments at least.

As far as nurses go, she is very helpful and knowledgeable in regards to giving him his Lovanox injections, and checking his blood pressure and temperature, but when we start talking about the stoma, it seems a foreign language to her. Unfortunately, according to our insurance, because we have the visiting nurse, we can't also go and see the stoma nurses that we saw in the hospital, for help in putting the flange on, at least until the bridge is removed. Six more days!

Another product that we have samples coming in of are the Hollister Formaflex wafers, which you can actually mold to the stoma without the need to cut. This will also, hopefully, be something we can rely on until the bridge is removed.

Thanks again for taking the time to advise me. This place has been like a lifeline for me, even prior to the surgery.

 

[2thFairy]

After hospital discharge, my insurance company arranged for a visiting nurse to come by twice a week. She also was very good at general stuff, but didn't really know much about stomas. At my colorectal surgeon's office, however, there was a stoma nurse on staff who was able to fix all of my other concerns. You might check with your surgeon's office for an actual stoma nurse in your area that you can get hooked up with that is not part of the hospital...maybe even be able to count that as part of your doctor visit so that insurance will cover it?

Six days and counting....

 

[nogutsnoglory]

After hospital discharge, my insurance company arranged for a visiting nurse to come by twice a week. She also was very good at general stuff, but didn't really know much about stomas. At my colorectal surgeon's office, however, there was a stoma nurse on staff who was able to fix all of my other concerns. You might check with your surgeon's office for an actual stoma nurse in your area that you can get hooked up with that is not part of the hospital...maybe even be able to count that as part of your doctor visit so that insurance will cover it?

Six days and counting....

My insurance does cover a visiting nurse but I declined? I'm not sure what good they will be? In what ways did you find that helpful?

 

[BowelMeOver]

Six days and counting....

Actually, after the nurses visit this morning, what she initially assured us was just normal skin irritation around the staples is now thought to be a mild infection, so we get to go see the surgeon this afternoon for him to have a look at things. I hope he will also decide that the bridge can go too. Fingers crossed! :dance:

 

[2thFairy]

My insurance does cover a visiting nurse but I declined? I'm not sure what good they will be? In what ways did you find that helpful?

I needed monitoring of unexplained heart issues that sprung up coming out of surgery and I also had a lot of dehydration while in the hospital. My surgeon insisted on the home healthcare.

I think most people with new stomas are recommended to have a visiting nurse for whatever reason--I think it is an automatic recommendation.

 

[2thFairy]

Actually, after the nurses visit this morning, what she initially assured us was just normal skin irritation around the staples is now thought to be a mild infection, so we get to go see the surgeon this afternoon for him to have a look at things. I hope he will also decide that the bridge can go too. Fingers crossed! :dance:

How did it go? Are you guys bridge-less now??

 

[nogutsnoglory]

I needed monitoring of unexplained heart issues that sprung up coming out of surgery and I also had a lot of dehydration while in the hospital. My surgeon insisted on the home healthcare.

I think most people with new stomas are recommended to have a visiting nurse for whatever reason--I think it is an automatic recommendation.

I am chronically dehydrated, did the nurse hook you up to IV and give you saline? Do you have the saline ready or they bring supplies?

 

[2thFairy]

I am chronically dehydrated, did the nurse hook you up to IV and give you saline? Do you have the saline ready or they bring supplies?

Fortunately, by the time I was released from the hospital, I was able to keep up with the dehydration issues with fluids by mouth and dietary means (LOTS of salty foods), and the nurse just monitored my weight and skin turgor along with the other indications of dehydration. No IV fluids needed after I was home. My heart issues were just a mystery, but did need someone other than myself to monitor that, so her service was still necessary.

 

[BowelMeOver]

How did it go? Are you guys bridge-less now??

We are bridge-less and a few staples lighter!

It seems he was developing a little bit of cellulitis along his biggest incision, and while it wasn't draining or anything as yet, they did remove a few of the staples there, and by the time we left the doctors office and made our way out to the parking lot, the front of his pants were soaked. All clear liquid so far, and the draining is giving him a good bit of relief.

There was on small 4 staple incision right above his stoma that drained just a little bit yesterday, then stopped. Today, it started up again, just clear liquid drainage, but no redness at all. Yet, there is a little teeny tiny hole that appeared where one of the 4 staples was. (they removed 2 of the 4). Is this normal, and should I just have faith that the antibiotics will do the job? I've sent a message off to the doctors office, but I'm sure some of you have had some experience with this?

 

[2thFairy]

Hooray on being bridge-less!! As for the draining, I'm not sure if I can be of much help. Since it is clear, that sounds good. I had only a tiny bit of draining after staple removal from about 4 spots. I did have a 1-inch space of separation that looked evil to me, but was reassured by 4 different health professionals was normal. It was draining and a little bit red. That spot did heal normally and without additional meds. Hopefully that is the same scenario for you guys.

 

[nogutsnoglory]

Glad you got those obstacles out of the way. It's going to be so much easier and less painful putting on the barrier now. As for the hole I think it's smart to check but if nothing is coming out of it, it's probably a wound from the staple.

 

[BowelMeOver]

You all are truly awesome for taking the time to answer my questions. I know a stoma bridge and a few issues with the incision area are small beans compared to what many of you have had to deal with, but each little bump in the road makes me a little nervous, and who better to alleviate my fears than those that have lived through some of the same ones as well!

The larger incision area is healing amazingly well now that he has started the antibiotics. Still a bit of clear drainage, but all the angry red skin around the staples has all but disappeared. The smaller incision that had developed a little hole yesterday is also looking good, and appears to be almost closed.

So now we are back to celebrating the removal of the bridge, and our first bag change without it tomorrow. Weeeeeeeeee! I am also happy to report that, although they did do a bag change in the doctors office, when the doctor removed the bridge, he said that the bag didn't really need to be changed just yet, and this was the assembly that took my husband and I three flanges and a few cigarette breaks, as well as a little chunk of barrier ring to cover some exposed skin in the final set up. It's been exactly 2 weeks since the surgery, and we haven't had a leak yet. :dusty:

Again, thank you all for your support. I hope that one day, I can help new members with our story as well.

 

[annawato]

Yippee on getting rid of the bridge!
To the best of my knowledge the clear fluid draining would be serrous fluid which is a normal part of the healing process. My last op I had a wound vacuum attached to the wound and it used to suck out an amazing amount of fluid. The community nurses assured me that this was normal and ok. The main thing to watch out for is greenish or yellowish discharge - slightly red tinged is ok so long as its not a lot of blood obviously. Also redness around the wound can signify cellulitis so needs to be followed up on. A small amount of redness is ok but if it starts spreading see the doctor.

NGNG, re dehydration, make sure you are sipping (not gulping) fluids all day and as 2th fairy said salty foods are really good. In the sticky about stomas , good advice for you there is more about dehydration and a particular drink that is readily absorbed by the bowel. Make sure you keep on top of it as it can cause kidney damage as well as lots of other problems.

:heart: anna

 

[nogutsnoglory]

Red discharge would be of concern. I'm told green discharge is just bile and normal. I had it a few days ago and freaked out.

Yikes about the kidneys. I need to be on top of my fluids.

 

[2thFairy]

I'm told green discharge is just bile and normal.

Green discharge from skin is bad. Green output from stoma is normal.