Friday, November 23, 2012

Nepal 2012 Ostomates Only - Heat Induced

Only Ostomates are likely to relate to this post. The experience is all real but if it makes you uncomfortable then quit reading and move on to other stories that are less-revealing.

Most days we are unaware of our ostomy except for a 3-minute bag change. But daily 'flange failures' without cleanup facilities can certainly consume some mindshare. The following is my experience log while trekking in Nepal.
I use Convatec Durahesive flanges (normally good for 6 days) with closed-end pouches. 


My terminology:

  • Seal Failure - stool seepage past the seal and into the tape adhesive.
  • Tape Failure - stool seepage outside the tape adhesive and stool now exposed.
  • Total Flange Failure - more than 50% of the flange is not attached to the skin and stool spreads well beyond the flange area.


Day 6 ... We trekked a hard and hilly 11-hour day in +31degree Celsius (87.8 degree Fahrenheit) carrying a loaded backpack with hip-belt. By noon of the next day I noticed Seal Failure. With no cleanup facilities it was impractical to change flanges so I just added a band of micro-pore tape around the perimeter of the flange hoping it would last until we arrived at our campsite that night, then just continued trekking. I had Total Flange Failure during the afternoon so a cleanup was due by the time we reached camp that night. No shower. No hot water. In my tent I used a cup of cold water, liquid soap, and the top of a wool sock for cleanup. Stoma didn't cooperate as it was active at the time, prolonging the cleanup and re-flange procedure. This was no problem, just a minor inconvenience that was easily fixed.



Day 7 ... Total Flange Failure at noon. Toughed it out all afternoon on a gruelling 855m or 3000ft climb. When we camped I discovered the worst mess in my ostomy lifetime. From a full belly-button, down to mid-thighs and everything in between (if you get what I mean :)). I removed the flange that was holding by only 1 corner, washed in a cold mountain stream, then rushed back to my tent to dry off and apply another flange.

Day 8 ... Very similar to day 7, with Total Flange Failure and a nasty cleanup. My best theory now is that I am not rinsing the soap well enough and the soap film residue is causing the premature Flange Failures. I must solve this soon - not only for the innconvenience of mid-day Flange Failures but also at this pace I will not have enough flanges for this 34-day trekk, and there is absolutely no opportunity to re-supply. I mentally designed a zip-loc bag and duct-tape contingency plan that would be uncomfortable to our entire team, but would allow me to complete our trekk. While I acknowledge this daily Flange Failure is an inconvenience, I remain positive and thankful. Without the Ostomy I would not be in Nepal, as my cancer and colostomy was the wake-up call that made me LIVE my bucket-list rather than just dream my bucket-list. Without the ostomy I would not be alive.

This is my perspective for my life and it works for me.

Day 9 ... Total Flange Failure by noon again. I really must resolve this very soon. Trouble-shooting skills, developed over 35 years in the computer business, need to be deployed. I start by identifying all potential causes then eliminate all those potential causes ... immediately.

  • No more soap when washing to eliminate possible soap film.
  • No more Karia Powder as that may start to break down the skin-seal near the stoma.
  • Eliminate many of the vegetables in my diet as they add to the volume of stool and gas.
  • We are working hard carrying a load in a hot climate. Sweating under the flange is a problem. I can't control the temperature nor the 11-12 hour trekking-days but I can reduce the weight of my pack, walk slower, and stay in T-shirt and shorts even during the cool mornings and evenings.
  • I know the backpack hipbelt is tight (to put weight on my hips rather than shoulders). The rubbing and pressure of the hipbelt combined with 1000s of deep knee bends and the slight rotating force with every step... all contribute to the peeling effect. So tomorrow I will loosen the hipbelt and carry my load entirely on my shoulders.


Changing everything worked. I had a quiet smile on my face for the next 5 days as the flange held in place and did it's job. With cooler weather and a loose hipbelt I am back to 5-6 days for a flange and my ostomy reverts back to virtually no mindshare. Nepal and its people are far too beautiful to allow such ostomy inconveniences to detract. I am so happy to be back to my ostomy-normal!



Read about my other ostomy-related challenges on this adventure.

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3 comments:

  1. Sometimes Stomahesive works better in high humidity or heat...I know it may be too late...but for next time...

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    Replies
    1. Thanks for the suggestion. Since returning from Nepal, i have done some research on flanges, perimeter tapes, and pre-flange glues. But its tough to do conclusive experiments without recreating the harsh conditions experienced in Nepal.

      Delete
  2. Wow, what a challenge that must have been!

    I enjoy reading about how methodical you are with testing and reporting your experiences.

    ReplyDelete