Can You Help?

Can You Help will post patient and clinician questions regarding wound, ostomy, and continence care for comments and advice. Please send your queries to the Editor: bzeiger@hmpcommunications.com.

I have a colostomy, about 1" opening, and for 8 years I had no problem with my pouches. Then for 3 or 4 months I can't seem to have a bag on for more than a day, and there is leakage. What is deep convexity and should I have different kind of pouches that have a deep convexity? Would that help? Thank you.

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My mother has an ostomy bag on her abdomen covering a deep fistula that opens to the skin. The bag successfully collects fluid for short periods of time (2-3 hours) before it begins to leak. There is a deep depression in the skin around the hole from a surgical incision created for pancreatic surgery that she fills with the karaya paste, but leaks still develop. The doctors and nurses that have been caring for her in the last several months have exhausted their known resources with no significant improvement in the dressing's ability to retain the fluid. We are looking for any advice/ suggestions you may have. Thank you.

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NOTE: This is an update to the previous Can You Help. Two weeks ago, my wife was hospitalized due to bacteria. She was released after one week, but is very weak and taking antibiotics. These are causing nausea and lack of appetite. She is also experiencing back pains and vomits about 2-3 times at night (she doesn't vomit during the day). Prior to these health problems, she received 2 rotations of chemo (Taxol). Is there anything she can take to relieve the back pains and nausea?

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My wife had surgery (total abdominal hysterectomy, bilateral oophorectomy, and omentectomy) for Stage II ovarian cancer in December 2004. She underwent chemotherapy in 2005 (CARBOPLATIN+TAXOL) that caused peripheral neuropathy in her fingers and toes. The cancer recurred in 2009 (liver and left pelvis), so she underwent chemotherapy again (CARBOPLATIN+TAXOTER) in 2010; her CA-125 levels dropped then increased and in late 2010, she suffered stomach pains. She subsequently was put on a course of Doxil and Avestin, and her stomach pains resolved. In October 2012, she again had stomach pains, diarrhea, nausea, and vomiting, and was found to have a partial bowel obstruction, which was treated. An amoeba parasite was also found and treated. After the amoeba parasite was treated, my wife suffered a second partial bowel obstruction, with more stomach pains, diarrhea, nausea, and vomiting. I would appreciate any opinions or treatment recommendations to prevent future bowel obstructions. Thank you.

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I am a layperson. My family member has a tunnel in their pressure ulcer that gets better and then goes back again. It seems to gyrate between certain points. What are possible causes of this? Are tunnels in wounds ever debrided? If so, what are the most common methods? Thank you.

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I am a CWS/FACCWS and FAPWCA certifed wound care RN/BSN and am looking to see what exactly defines what I can do in the hospital setting. More specifically, is there a written standard, sort of like a job description, which sets my limits of what I can and cannot do with these certifications? I work in Florida and have a RN license here and in NJ and Maine. Thanks so very much.

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Which certification is best for working in a hospital? I've been doing wound care for almost 4 years and would like advice on whether to take WCC or CWS. I am also interested in WOCN, but I have no time as of now to go to the east coast for a month and take off from work. Thank you.

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Hello, I am a layperson. I had surgery one week ago to treat an abscessed infection on my umbilicus. The wound was left open, packed with a dark kind of foam, and I was placed on a wound vac. I have a home health nurse coming 3x/week to change the dressing. I am wondering if anyone has advice on how to make this process less painful. Removing the foam rips the outside skin which adheres to it, and it is very bloody and excruciating. I am on an oral pain medication, which I take before my dressing is changed. I am wondering if there is anything else that can help. I know this is not going to be a pain-free experience, and luckily I have a fairly high tolerance for pain in general. Perhaps this level of pain is just to be expected the entire length of treatment, which I am told will be at least 8 weeks. This is the second time this wound has occurred. The last time I did mechanical debridement on my own at home, which was also extremely painful. I was able to learn a couple of tips that made it more tolerable, but that was for a wet/dry dressing, and those don't seem to apply to the wound vac dressing. Thank you so much for any input.

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I am a layperson. My wife has a non-healing ischial pressure ulcer that is currently being treated with a wound vac set at continuous therapy of 120 mmHg. However, I recently read that a literature review indicated that continuous therapy should not be standardized and may not be as effective as intermittent and lower pressure therapy (Christian Willy, The Theory and Practice of Vacuum Therapy). In addition, I was informed by a highly experienced wound care professional that a low diastolic blood pressure reading (118/50) suggests the need for a lower setting on the wound vac. Before discussing these topics with my wife’s doctor, I would like to be reasonably well-informed. If anyone would share their experience or knowledge of the literature on these two issues, such feedback would be much appreciated. Thank you.

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I am looking for a wound care facility, preferably in the New England area, to help my wife with a persistent, open, nonhealing wound on her head above the brain as the bone flap was removed. Thank you.

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