Cath Lab Digest

There is nothing past for which one may yearn, there is only an eternal newness which is shaped by the wider elements of the past and true nostalgia has always to be productive to create a new excellence. — Johann Wolfgang von Goethe

A few weeks ago, my husband and I were driving back to Canada after visiting our family in the US. As usual, we tuned into talk radio. After listening to a lecture on “modernity” — a completely new term for me — I began to ponder how the term could be applied to ostomy supplies and the way individuals with an ostomy live in the 21st century.

Hooker¹ defines modernity as the sense or idea that the present is discontinuous with the past. Due to a process of social and cultural change (either through improvement or decline) life in the present is fundamentally different from life in the past.¹ This is the opposite of tradition, which is simply the sense that the present is continuous with the past, repeating its forms, behavior, and events.

We experience modernity as a “proliferation of alternatives”¹ which may be associated with changes in lifestyle, social mores, or technology. This vast menu of alternatives creates an enormous sense of anxiety that can lead to social attempts to restrict alternatives. Hooker¹ states, “It is not the alternatives themselves which create this anxiety — it is the sense that the proliferation of alternatives has become unmanageable.”

The Past

Before 1960, only 25 companies (mostly small, entrepreneurial ventures) manufactured ostomy supplies.² In 1920, the Koenig-Rutzen rubber pouch was introduced.² Another 20 years elapsed before disposable plastic pouching systems, skin-friendly adhesives, and skin protection became available. By 1950, more companies had entered the market and innovation took flight. However, extensive use of “permanent” (re-usable) heavy rubber pouches, rigid faceplates, and glue remained the norm. Vinyl re-usable pouches were introduced in the early 1970s but were ineffective at odor management. Karaya’s capabilities as a “skin barrier,” discovered in the mid-1960s, quickly moved it into a position of dominance in the US ostomy market.^2,3 Later that decade and early into the next, larger manufacturers entered the field, producing more advanced skin barriers and disposable, light-weight, odor-resistant pouching systems.

Not so many years ago, ostomy surgery was considered the only alternative to death for many patients.⁴ Surgical techniques were fraught with postoperative complications, hospital stays were weeks or months long, and patients were left mostly on their own to find solutions to managing themselves if they survived the surgery. In the early 1950s, ostomy surgery techniques took an enormous leap forward. No longer considered the last resort, ostomy surgery became a cure or at the very least a way to improve a person’s quality of life. However, it remained “the secret surgery” because society was not yet ready to discuss it openly. Surgical options remained limited (ileostomy, colostomy, urinary diversion), however, until the “continent ileostomy” was developed in Sweden in the 1960s.⁵

Until 1958, physical and emotional rehabilitation of the person with a stoma was pretty much left to the patient or another person who had undergone the same type of surgery. But in that year,³ the first Enterostomal Therapist was trained at the Cleveland Clinic. Still, patients remained in the hospital for weeks and months after their surgery. The cost of care had no boundaries and no regard for financial or clinical outcomes data.