Monday, January 28, 2013

Nepal 2012 Ostomates Only - Cold 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 flange failures without cleanup facilities, while living in sub-zero temperatures 24 hours a day, can certainly consume some mindshare. I had solved Heat-Induced ostomy challenges earlier in this journey and was thinking I was better-built for cold conditions. Apparently cold also offers challenges.  This is a log of my Cold-Induced ostomy experiences while trekking and climbing 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 28 ... The temperature is well below freezing every night, and we sleep in unheated lodges or tents. As we continue to gain elevation, it gets progressively colder each night, and the 'accommodations' get progressively rougher. In 2 days we will be at Island Peak BaseCamp. It is day-4 for my flange, and I prefer to avoid changing a flange in a very cold tent at Island Peak BaseCamp, or while climbing Island Peak Mountain. So I decide to change flanges early and have a 'new flange' in place for the Island Peak adventure. In a sub-zero temperature lodge, I wash with cold water, and place a cold flange on cold skin with cold hands.

Day 29 ... Next day, while trekking from Dingboche to Island Peak BaseCamp I had Seal Failure by noon. 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, hoped it would last until we arrived at BaseCamp that night, and continued trekking. I had Tape Failure during the afternoon, so a cleanup was due by the time we reached BaseCamp that night. Temperature in my tent was -15C (5F). At home I would have a hot shower, then place a hot flange on hot skin with hot hands... but of course that wasn't practical here. Heat would be nice, but it's not available. There is also the dilemma of my clothes (wearing multi layers of bulky warm clothes)...  If I take off my clothes I will be very cold very quickly and the flange won't stick when cold. But if I leave my clothes on... well I already have a mess to clean up, and I know that dealing with a Failed Flange will mean sh*t smears on my clothes. So I compromise, leaving most of my clothes on, and open up the midsection enough that I can see what I am doing. Then I wipe the smears with a damp sock, knowing I will have a cold night drying damp long-johns and socks with body heat. I rigorously slap the area around my stoma, bringing heat to both my hands and the stoma area. I heat the flange under an armpit. The flange-change seems good, so I zip up all my clothes and get into my sleeping bag to warm up.

Day 30 ... Did local-climbing near Island Peak BaseCamp, and ostomy gear seems ok.

Day 31 ...  While on Island Peak Mountain yesterday, I had a challenging Total Flange Failure under extreme conditions,  and descended 5 hours with extreme exertion
without ostomy gear
See Skipping Stones
I was totally exhausted after 16 strenuous hours on the mountain, consuming just 1 litre of water and 3 Mars bars, living on 50% oxygen, and physically drained from the effort. All I wanted to do was sleep. But I had a serious cleanup to do, and a cold-induced ostomy problem to solve. I had sh*t and smears from belly-button down to mid-thighs and everything in between (if you get what I mean :)). On my skin and on my clothes.  Fortunately, and common at high altitudes, appetite and stool production declines, and stool thickens, so the 5 hours without ostomy gear was not as bad as it could have been. I laid out my cleanup and ostomy gear and pre-thought how I would get this job done without exposing too much skin too long to the below-freezing temperature, and without leaving my clothes wet as I would have to dry them with body heat. At home I would just toss the dirty clothes in the laundry, have a hot shower, and put on clean dry new clothes, but of course none of this exists here. I again used flat stones as scrapers, and semi-cleaned my skin and long-johns.

While this may seem crude and gross, it needs to be put in context with our local conditions ... these clothes have already been worn 24 hours a day for weeks without washing ... I have no other clothes ... there are no practical washing/drying/showering options ... and we have all adapted to this lifestyle we have lived for the past month.

As I crawl into my tent, our camp-cook hands me a bottle of boiling water, simply saying 'you need this'.  I am humbly pleased with this rare luxury, and with the thoughtfulness shown by our Nepalese team (Ganesh or Sanjay must have told our cook about my ostomy-gear-failure on the mountain).  I first use this hot water with a damp sock to wash my skin and "reasonably" clean my clothes, inside and out. Then I wrap a new flange around the water bottle  and hold the water bottle on and around my stoma... heating my skin, my hands, and the flange. When all is hot (and uncomfortably burning my skin) I place the new flange and add a pouch. 

Then I slip back into my sleeping bag, holding the hot water bottle over my stoma to heat-seal the new flange in place. The hot water bottle heated the inside of my sleeping bag, and I immediately fell asleep, exhausted from climbing Island Peak Mountain, pleased I had solved my cold-induced ostomy gear challenges, and still thinking about the Nepalese kindness shown by bringing me hot water.

Some will imagine this to be an awful or humiliating experience. But it wasn't.
This entire journey has been about challenges, adaptability, acceptance, and grit.
The details of easy-times are soon forgotten.
The most vivid memories are of adapting to the harshest events.

Read about more Ostomy challenges at Ostomates Only - Disposals

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  1. Necessity is the mother of invention - you will overcome anything life throws out you if you try hard enough - you are amazing!!

  2. Loved this story so much I just had to share it with a Facebook ostomy group that I am a member of!!! Kudos to you for even having the courage to climb a mountain with an ostomy.....and it was awesome to read how you dealt with your flange blowout and quick thinking!!! Flange blowouts are difficult under normal circumstances, never mind on the side of a freezing mountain!!! Glad to see you aren't letting your ostomy stop you from doing things you want to do, it is really inspirational!!! Thanks!!!