Melvin & Me, Part 17: Skin

**Please note that there are some #nofilter pictures of my stoma below,  Squeamish may wish to skip past some parts today.

Melvin has been kind of quiet on this blog as of late.  As expected, Melvin has become more and more a fact of life and less of a novelty.  Or, more accurately, I am aware of my colostomy, but it's a quieter awareness.  I think about when I need to go to the bathroom to empty out the bag; I plot out when I need to do bag changes to fit my schedule best; I ensure that my supplies are well-stocked and ordered as necessary; and all of these elements are routine.

However, I am immensely grateful that these pieces are so routine.  I have not (knock on wood) had any major leakage in months.  I know that it is an inevitability, that something is bound to fail sometime, but that it is not a frequent thing for me, right now, that gives me a great deal of confidence, that a leak will still momentarily shatter parts of that confidence but that I will bounce back from that cleaner and faster.  It's the most that I could ask for, truly.  From where I was last year, I am in a much better state of health and my mental health has been positively reflecting aspects of that in glimmers.

The reason right now that Melvin is behaving so nicely is in no small part because my skin has been tolerating the situation well.  Three cheers for the integumentary system, the unsung hero of the body!  Yay for skin and hair and nails!  Hurrah for oil and sweat glands!  Sebum number one!

Thumbs up for skin!

...and, yes, I'm aware of the irony of that given that I've just gotten a tattoo recently.

Taking care of the skin around my ostomy site is incredibly important.  I'm relying on this area to stay more or less permanently covered, possibly slightly covered in escaped bits of poo for a few days, if the seal leaks.  If the skin starts to break down in any way, the bandage part of the flange is less inclined to stick, increasing the likelihood of a leak.  More leaks mean more poop against my skin, which causes the skin to deteriorate further in a reinforcing cycle of blah.

When the skin gets to this point, I have a few practices that have in my pocket to help out.

1. Change the bag more frequently--more bag changes mean that I have more opportunities to clean and treat the area, allowing the space to breathe a bit more than usual.  This can be difficult for those that only have so many bag changes available from their insurance company per month; in my case, I have slowly built a back-up supply by stretching changes out when components were going well to prepare for the circumstances as necessary.
2. I have a different kind of flange and adhesive that are gentler--these contain ceramides, which are ingredients in a few brands of gentle soaps (specifically such as Cera Ve).  My skin had responded well to these soaps with my first ostomy experience.  I know that this flange option had not been offered previously--new developments are continually happening in ostomy care!
3. Gentle soaps and consideration when cleaning the site itself--treating the area with warm water and, in my case, either CeraVe soap or Hibiclens soap
4. Let air dry as much as possible--for as long as I dared, I would leave the ostomy open to the air, uncovered and able to breathe.  With no sphincter control, eventually the site will need to perform its function, but the longer I could let the skin absorb a product I had put on it to help heal the skin or otherwise just be uncovered for a bit was a kindness to the affected area.

If the problem persists, then it's time to reach out for some professional help and schedule an appointment with the ostomy nurse.  We may discuss some different interventions, such as using some additional putty adhesive to bolster up a particular side that is leaking or use some additional bolsters on the flange to add some additional pressure around the stoma.  Once Melvin had healed enough, we did end up switching to a more convex flange, so that there was a constant pressure around the ostomy site to help push around it and prevent leaks from underneath it.  

However, the best thing that I recommend for myself is to prevent it from happening in the first place.  Whenever possible, I still use the gentle soaps around my stoma and wash it gently with warm water for each bag change, debriding off any remaining adhesive as necessary.  After drying it off, I apply some stoma powder.  This powder I specifically apply to anywhere that has been oozing or weeping to help dry the area in question at least a little bit.

Dusted around with my preferred powder brand

And remembering that sometimes Melvin

sticks out a bit further on any given day

Then, I open up the small, foam rectangle of the skin protectorate solution and swab that generously over the area under the flange with particular attention to any of those angry spots.  I always ensure to cover well the area immediately around the stoma, since this area is most likely to be affected by leaks.

Powder is still there, under a thin layer of the solution

Between these treatments, my skin has been healthy and happy in this area, all things considered.  The convex flange around my stoma means that I always look a little bruised in that area, but it has been a good solution for me for the long run.

A closer angle of that convex flange

The rest of my skin, I take care of that with a little less caution, but still a good deal of care, since this is my first line of immunological defense (amongst other functions) and I appreciate preventative care.  Taking care of my body means taking care of Melvin.  Taking care of Melvin means taking care of the surrounding areas.  I recognize and appreciate the specific needs that I have, honoring my body's needs as best I can and adjusting as patiently as possible when they change.  It's not easy--I know that there will be leaks and issues that come up--but I am more confident in my ability to adapt to them, even if it involves maybe a little good natured grumbling.