Index: Ostomy Wound Manage. 2013;59(5):26–32.

Abstract

  Ramadan fasting is an Islamic obligation for healthy Muslims after the age of puberty. Persons with an acute or chronic disease may be excused from this obligation; the degree of the disease is an important parameter for not fasting. Little is known about the effect of fasting on persons with a stoma. A prospective study was conducted among 56 patients with a cancer-related fecal stoma (33 [58.9%] male, mean age 55.9 ± 13.1 years) over two periods of Ramadan to analyze the effect of fasting 15 to 16 hours on nutritional and metabolic status and quality of life. Eligible patients were divided into two groups: fasting (n = 14) and nonfasting (n = 42). Demographic and stoma information, as well as disease and treatment-related variables, were evaluated. Participants completed cancer patient and colorectal cancer patient quality-of-life instruments and rated their religious orientation. Laboratory tests (blood urea nitrogen, creatinin, cholesterol, prealbumin, albumin, and transferrin) were performed 1 to 3 weeks before Ramadan, and questionnaires and tests were repeated 1 to 3 weeks after Ramadan in people who fasted. Demographic parameters, including religious orientation scale scores, were similar between fasting and nonfasting groups. Patients in the fasting group had significantly higher albumin levels (4.6 ± 0.2 versus 4.1 ± 0.4, P = 0.001), prealbumin levels (27.6 ± 7.4 versus 21.3 ± 8.5, P = 0.018), and global health status scores (81.5 ± 16.7 versus 68.3 ± 20.1, P = 0.030) than patients in the nonfasting group. Patients who fasted also had their stoma for a longer period of time than patients in the nonfasting group (average 9 months [range 3–87 months] in the fasting versus 4.5 months [range 3–36 months] in the nonfasting group, P = 0.084), and the proportion of patients with a permanent stoma was higher in the fasting group than in the nonfasting group (P = 0.051). Ramadan fasting had almost no influence on quality of life. Fasting lowered prealbumin levels (27.6 ± 7.4 versus 21.2 ± 4.4; P = 0.046), but did not adversely affect other nutritional or global health status variables. Most patients in the fasting group (13, 92.9%) stated they would feel sad if they were not fasting. The results of this study suggest that although fasting may decrease prealbumin levels, persons with a stoma and good nutritional status may decide for themselves whether to fast.

Keywords: prospective study, surgical stoma, fasting, Islam, nutritional status

  Not unlike scientific research, investigative journalism takes time, perseverance, and pursuit of the evidence. While pressure to follow a 24-hour news cycle and the number of ways to access that information has grown, the size of the medium we use to read about it — and our time to do so — has shrunken, literally, to pocket-size. Emphasis on the short story that fits on a small screen has increased, leaving readers with the mistaken impression they know the whole story.

  The real story and a real understanding of complex problems or research require much more screen (and print) space and much more time to tell and read. OWM readers are accustomed to (and deserve to be presented) the fullest picture possible on any topic we cover. Original research reports are never truncated for the sake of time or space because doing so would greatly reduce the value of the work and negatively affect its potential contribution to future studies. In the nonscientific press, however, the short story reigns supreme.

  In the February 2013 “Continence Coach,” Nancy Muller discussed pelvic floor pain syndrome in chronic pelvic pain (CPP).¹ Pelvic muscle pain has several aliases and implies a pain source from the myofascial structures of the pelvis that sometimes goes undiagnosed. It can exist alone with no concomitant medical pathology or as either a precursor or sequela to urological, gynecological, and colorectal medical conditions or other musculo-skeletal-neural issues.² Due to the phenomenon of somatovisceral convergence, primary pain generators can be elusive. Pathology in the viscera can refer pain and symptoms to somatic structures and vice versa.³ It is also well documented that chronic neuropathic and musculoskeletal pain are related to abnormal restructuring of the body’s somatosensory and motor cortices, as well as other areas of the brain.⁴ This makes treating the CPP patient more challenging, because clinicians must acknowledge the brain’s role in chronic pain.

  The following is a case in point. The patient’s complex symptom presentation included both visceral and somatic dysfunction, a highly sensitive nervous system, and biopsychosocial factors that needed to be addressed over the course of her treatment. As the research⁵ suggests, a team approach was necessary for a successful outcome.

2013 AAWC Board of Directors election results

  The AAWC thanks members of its Board of Directors and congratulates those newly elected or re-elected. These newly elected board members will serve a 2-year term from 2013–2015. All board members attended the Annual Board Meeting on May 1 and officially took office on May 3 at the Annual AAWC Membership Meeting held during SAWC Spring in Denver, CO.