Expect More – Take Control of Your Health Care

Part 5 in Series

By Jeanine Gleba, UOAA Advocacy Manager and Sue Mueller, CWOCN

In Part 5 of the Expect More – Take Control of your Health Care series, we tackle the sticky subject of health insurance and the importance of knowing what you’re getting in your policy. How many people plan on getting an ostomy? It’s one of those things that happens in life. So you learn to live with it and then adding insult to injury you discover that the health care insurance you had proves to be inadequate to cover the costs of your ostomy supplies.  You are stunned to discover that ostomy supplies cost $300-$600 a month. Suddenly you’re expected to adjust to your new circumstance and also cope with a significant cost as you scramble to find solutions.

Every year individuals have an opportunity to re-evaluate their health care needs and insurance coverage, and if need be, during that window of opportunity, change health care plans or increase coverage.  

How do YOU get your health care insurance?

First step is to know exactly where your coverage is coming from so you know where to get information from and ask questions.

You get health care insurance:

  1. Through your employer (usually you and your employer share costs)
  2. When you buy your own healthcare insurance from your state Health Insurance Marketplace
  3. You qualify for Medicare by age and work history
  4. You qualify for Medicare by disability and work history.
  5. You qualify for Medicaid because you are a dependent child,are a parent of a dependent child, or by low income.
  6. You qualify for military health benefits because you or your family are active US military, or have retiree benefits.
  7. You qualify for veterans benefits because of your military service and honorable discharge.
  8. You qualify for American Indian/Alaska Native healthcare coverage.

What are your medical needs?

You can begin to determine your needs by calculating your medical risks. What is your medical history and your family’s medical history?  What are your lifestyle health behaviors (i.e., diet, exercise, smoker etc.)? As you age, your medical risks increase, so take this into consideration when planning health insurance coverage. If you have several medical diagnoses/pre-existing conditions (e.g.., colostomy, urostomy or ileostomy), take prescription medications, and require visits with specialist physicians you have different needs and risks than someone with no diagnoses and no prescriptions.

So what is the best employment and financial strategy for you? If you can’t afford marketplace healthcare insurance can you or your spouse become employed by a large company with comprehensive benefits? What is your age? You might make one choice at your present age and another choice at a later date. Ask around, educate yourself, every state has a number to call to get healthcare insurance information (ask for SHIP- state health insurance assistance plan).  For example, some people don’t understand that they need to sign up for Medicare Part B insurance (where ostomy supplies are covered) when they are first eligible or simply don’t because of the additional premium due. Others have been misinformed and thought the VA would cover all their healthcare needs; however, they actually need to sign up for Medicare A and B AND use the VA. Also many people don’t realize that there is a penalty for not signing up for Medicare B and D when you are first eligible.

Once you calculate your medical risks, examine your finances and are choosing a healthcare policy, you need to know:

Your health insurance policy is an agreement between you and your insurance company, a contract. The policy lists a package of medical benefits such as tests, drugs, and treatment services. The insurance company agrees to cover the cost of certain benefits which are listed in your policy. These are called “covered services.” Your policy also lists the kinds of services that are not covered by your insurance company, and circumstances that are not covered (exclusions). You have to pay for any uncovered medical care that you receive. Don’t confuse what your policy covers with what is “right”, what your neighbor’s policy covers or what you think you are “entitled to”. What is covered is what is stated in your policy. If you understand this key concept it will save you a lot of stress down the road. This concept is true for Medicare, for Medicaid and all other health insurances who set the terms (rules) of the insurance policy agreement that you have made with them.

Insurance Basics

Some other items you need to know about your health insurance are these basic terms:

Plan Types- HMO (Health Maintenance Organization, managed care), PPO (Preferred Provider Organization ), POS (Point of Service). They all have different rules.

Premium- If you have employer sponsored insurance this is the amount you or your employer pays for your insurance coverage. Frequently you pay part and your employer pays part. If you are buying the insurance independently this is what you pay for your insurance. This is paid even if you don’t need to go to the doctor or use your insurance. Insurance costs vary by state.

Deductible- What you need to pay before your insurance kicks in. (Original Medicare and many companies have an annual deductible which must be met. Some people save money on the cost of insurance premiums by buying high deductible policies). You may get denied for supplies or a service because you have not met your deductible for the year. For example, someone with an annual deductible of $4,000 will have to pay for all of their supplies or health services until they reach that $4,000.

Coinsurance- The percent of the cost that you are responsible to pay for covered services after you meet your deductible. (ex. Original Medicare pays 80% of the Medicare approved amount of a covered service you pay 20% unless you have a supplemental policy which picks up the remaining 20%). Medicare Advantage Plans/Type C insurances set the costs of the copays which are covered in their benefit booklets. Some people have purchased insurance through the Affordable Care Act (Obamacare) Marketplace and tried to save money on premiums but found that they are responsible for 30% of the costs with insurance paying 70%.

Copay- This is the fixed amount of money you pay for certain services such as prescriptions or MD visits. Usually, visits at urgent care or the emergency department have higher copays. These rules are all listed in your insurance policy and/or benefits book. For example, a plan might indicate that you pay $20 for each doctor visit.   

In-Network versus Out-of-Network Benefits- An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. Typically, when you see an in-network provider you receive 100% coverage.  An out-of-network provider is one not contracted with the health insurance plan and you will need to pay a percentage of the cost of the services (usually insurance covers 80% and you pay 20%).

Accepts Medicare assignment- Means your doctor, provider or supplier agrees to accept the Medicare-approved amount as full payment for covered services.

Non participating providers have NOT signed an agreement to accept an assignment. They can charge you more than the Medicare approved amount up to the “limiting charge”.

Maximum Out of Pocket Expense- This is the maximum amount that you pay for in-network services and prescriptions in a calendar year. This includes the deductible, coinsurance and copays. It is wise to keep track of what you have paid for and be aware of the amount of the maximum because after this amount is reached the services are covered 100%.

For a more complete list of insurance term definitions visit this website.

All of the above can change, so it’s important to annually review your plan and see if it still meets your needs. This can greatly affect the cost to you for your health care, so it’s always a good idea to compare plan options, estimate the costs of your care and consider all of the insurance costs (premium, deductible etc.). How well does your insurance cover your needs?  For example how much do your supplies cost each month and how much will you pay out of pocket until your plan coverage starts paying the bill? UOAA gets many calls from people who are looking for help with paying for their ostomy supplies because they can’t afford their high deductibles or copays.

Are your ostomy medical necessities a covered benefit?  

Is a medical necessity the same as a covered benefit? A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy. Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug, or service you need isn’t covered by your policy and then you will need to pay for that service or item. It’s important to know what is covered by your insurance policy such as your ostomy supplies, so you will need to consult the summary plan description and evidence of coverage, (ex. benefits booklet, Medicare and You publication). The customer service agent may be able to tell you how to document your need or what they require if you have a medical reason to need more or different supplies.

Knowing what you need and being able to explain it is vitally important. Don’t expect people who don’t have an ostomy or experience with an ostomy to understand what you need. An example of this is the gentleman who had a new ostomy and went to an insurance broker to choose a Medicare C /Medicare Advantage Plan. He was assured that the plan he chose was an excellent plan and certainly covered all the bases. What resulted was that he had very high copays for his supplies and it was not a good plan for him at all. He also was not aware that if you join a Medicare Advantage Plan for the first time and you aren’t happy with the plan, you have special rights under federal law to buy a Medigap policy if you return to Original Medicare within 12 months of joining (Medicare and You- section 5).

Today the vast majority of health insurance plans do cover ostomy supplies, but how they are covered varies.  Make sure you ask if the plan will cover what you need and how they will cover it. As you compare plan options and shop around ask yourself these 10 Questions to Ask Before You Choose a Health Plan.

Final thoughts

It is critical that as an ostomate you be your own patient advocate and ensure your health plan covers your medically necessary ostomy supplies. Insurers should not determine your medical treatment plan.  That should be between you and your medical professional.

Really, there is a logical structure, rhyme and reason to all this health insurance business and if you approach it with that in mind you will be more successful. For more information on insurance reimbursement check out this webinar.

Take the time and effort to do some necessary research on insurance plans to find the best quality, and most cost-effective to meet your ostomy needs and financial situation. In the long run you’ll be thankful you did.

Take control of your healthcare and don’t let your health plan let you down!

Disclaimer: UOAA does not provide insurance advice or financial assistance for supplies. We do recognize there may be times for emergency supplies. Please use this list of resources which may provide assistance on a temporary basis.

Ostomy Support, Love and Giving Back

By Jeanine Gleba, UOAA Advocacy Manager

On November 11th the United States observes Veterans Day to honor all those who have served in the United States Armed Forces. This year at UOAA I’d like to shine a light on two Veterans with ostomies who now continue to serve as volunteer advocates with UOAA in the Advocacy Network. Most recently, they were able to raise ostomy awareness in the state of Texas by garnering not one, not two, but three proclamations from their town, County and the Governor!  

Dan Shockley is an Operation Desert Storm; Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veteran.  He served for 22 years in “the world’s greatest Navy” onboard 7 different ships. His last tour before retiring was after 9-11 on the ground in Bahrain in direct support of OEF and OIF between September 2001 – September 2003. In 2012 after his first and only colonoscopy revealed 100 polyps embedded in his colon, rectum and anus, he was diagnosed with a rare gene mutation known as attenuated familial adenomatous polyposis (AFAP). In July 2012 at 51 years of age, he had successful ileostomy surgery at Tripler Army Medical Center, Hawaii.

 Donna Desoto, Dan’s girlfriend, began her Military career in 1976. She was in the last basic training class of The Women’s Army Corps (WACS). She also attended the Medical Lab Assistant school at the Academy of Health Sciences at Ft. Sam Houston, TX. She was then chosen to join the medical research team at Headquarter Co Troop Command at Brook Army Medical Center under the Clinical Investigation Services. She co-invented a vaccine for burn patients and received The Army Commendation Medal for meritorious service of her research between 1976 to 1979.  While serving in the military she was diagnosed with Chronic Interstitial Cystitis. After over a year of trying to save her bladder with an experimental drug instilled in her bladder surgically, she had urostomy surgery. She also had a stroke prior to that due to an allergic reaction to an unknown medicine. It took 25 plus surgeries before removing her bladder. She was in the hospital the whole time leading up to the final removal of her bladder and then was medically retired in 1981.

I recently caught up with them and asked the following questions:

UOAA:          How did you two meet and become a couple?

Dan:            Donna and I met on the Singles with Stomas Facebook group in the summer of 2016. We commented on each other’s posts. In the following months we developed a friendship based on our commonalities. We’re both retired military, left-handed, interested in medical research, and of Scottish descent. In May 2018 she called me suggesting it was time for us to get together. At the end of July I relocated to South Texas to be with her.

UOAA:             Such a great story!

UOAA:          How did you get involved in UOAA?

Dan:           My involvement began as an inpatient at Tripler Army Medical Center, Hawaii, after my surgery. Tripler’s WOC nurse shared with me information about United Ostomy Associations of America. At that point I was eager to share my diagnosis and story with others and UOAA and become an advocate.

UOAA:            It’s so important for people to realize that they can make an impact when they do share their story whether it is inspiring someone else or making the journey a little easier for someone questioning life with an ostomy.  There is also a big need in our advocacy efforts especially legislatively because elected officials want to help their constituents who the issues directly affect and hear their stories.  We can raise so much more awareness when we grow in numbers.

UOAA:           Why do you advocate for ostomates?

Dan:               My life’s focus as a colon cancer warrior, having a rare gene mutation and an ostomy is to be a source for the importance of early detection. It’s also important to me to show that life can go on having an ostomy. I consider my diagnosis a challenge rather than obstacle. That said, there’s an old cliche you can lead a horse to water, however you can’t make it drink. I’ve heard there is a way to influence the horse to drink when it reaches the watering hole. Feed it salt along the way. Hopefully my story will serve as a source of salt for those who read it.

Donna:         The main reason I feel the importance of advocating for ostomates is because I feel increasing awareness is very important and other more well known causes get lots of awareness whereas I see that many people have little or no knowledge of what an ostomy is.  Also, I see a need legislatively for ostomates in areas that should be addressed especially one area I have experienced is the usage of restrooms and other public issues.

UOAA: Why is it important for people to get involved?

Dan:        Projecting a positive outlook is important to me. Having an ostomy is a lifesaving surgery. By sending out positive vibes I receive them back tenfold. I may have been diagnosed with AFAP but my AFAP mantra is: Always Forge Ahead with a Purpose!

Donna:   Being involved with UOAA and my other volunteer efforts (Donna founded Sav-Baby Inc.) has helped me to take my mind and focus away from my medical challenges and pain and allows me the opportunity to reach out to those struggling with their current or ongoing medical issues. Not only can I hopefully be an inspiration to others it is also an opportunity to make new friends and encourage them to get involved in some way such as a being a friend to someone else or becoming an advocate or volunteer.

UOAA:          And you and Dan certainly became friends! One of the most significant things that UOAA does is provide support through our Affiliated Support Groups.  It is one of the top reasons that we get calls into our 800 information line.  People are looking for emotional support and to meet others going through similar experiences so they can learn from each other.

Dan:       I’ve been a member of UOAA support groups in Eagle, Idaho; Carmichael, California, Honolulu, Hawaii and now both of us just started attending meetings at the South Texas Ostomy group in San Antonio, TX.

UOAA:         Do you talk about your ostomy and/or military experience with others?

Dan:        I share my ostomy and military experiences every opportunity that presents itself. As a “live case presentation” for the medical community and ostomy groups I feel it is important to show life can go on as if nothing happened. Being a source of inspiration and encouragement is important to me. It’s been said we’re unable to change the wind. However, we can adjust our sails. After 22 years in the Navy I’m good at adjusting. That’s my story and I’m sticking to it!

Donna:       I talk freely with others about my ostomy. I am no longer ashamed or embarrassed.  I am so proud to be a Canadian who became a US Veteran and citizen. I participate in both military and ostomy groups.  I try my hardest not to let my ostomy limit anything I choose to do in my life.

UOAA:            What does Veterans Day mean to you?

Dan:        Veterans Day is when I reflect on and recognize those who made the ultimate sacrifice to defend our 13 stripes and 50 stars. My father served in the Army during WWII, two of my uncle’s served in the Navy and 1 uncle served in the Marines during the Korean War. My brother served in the Air Force during the Vietnam conflict.

Donna:       Veterans Day is a very emotional day for me for so many reasons. My thoughts and prayers go out to all our Sisters and Brothers who lost their lives for our freedom, as well as those currently serving, those now retired and all of their loved ones.  The real special part of Veterans Day for me is that I was born in Canada. After college I decided to join the US Army and officially become a US citizen. I was so proud the day I became a US citizen and that same proudness was felt when I took my path to become a volunteer member of the US Army.  When my two adopted children were little and my little girl that I saved from abandonment was old enough I would tell them that I was “an Alien who wore combat boots”. They loved to share that story with their friends. My Uncle enlisted in the British Army and his submarine was lost during the war. His mother, my Grandmother, who brought me up in the United States was so sad on Veterans Day as it was forever painful losing her oldest son.

UOAA:             You are both a reminder to me of John F. Kennedy’s inaugural speech, when he said the infamous words, “Ask not what your country can do for you, ask what you can do for your country.”  You both embody “service”.

As Advocacy Manager I am in the unique position to not only hear many amazing ostomy stories of resilience but also to watch many passionate and fascinating people as they take action and work together to achieve a common good cause for our community.  It is truly an honor and a privilege for me to work alongside such dedicated, impressive and patriotic volunteers like Dan and Donna.

Thank you to all Veterans who have or are actively serving America! Happy Veterans Day!

“Here’s my UOAA acronym:” ~ D. Shockley

                                                      Understand (your diagnosis)

                                                      Overcome (adversity)

                                                      Attitude = 100%

                                                      Adapt (to your lifestyle as an ostomate)

Expect More – Take Control of Your Health Care 

Part 4 in Series

By UOAA Advocacy Committee

“Details matter. It’s worth getting it right.” ~ Steve Jobs

The Buck Stops Here

Since UOAA started the advocacy campaign we have been stressing that YOU are your own best advocate.  This may be hard to believe since the whole business of insurance is so overwhelming that it feels like a David and Goliath story.  Like anything else, once you understand the rules of the game it makes it a lot easier. You actually have a bigger part in the game then you may know.  Often consumers of medical care, patients, people like you, think that everyone knows their story. You are asked a million questions every time you pass through the doorway of any hospital or doctor’s office and everyone is writing things down.  How many times do you have to tell your story? Answer: as many times as it takes to get the results you want. Unfortunately, the goal of great communication among the players in the healthcare game has not been reached, and all these computers do not talk to each other as much as you think. So what this means is that you have to make sure that everyone knows the important parts of your story and that they understand what you need.

So it goes like this, the people who pay the bills want to make sure that the money that is paid is according to their rules; that is, for a medical reason.  So the people who are asking to be paid have to explain that the service or supply is medically necessary. For example, the company that sends out your supplies (ostomy supply distributor) has to be able to say that you need the supplies because you have an ostomy, what kind of ostomy you have, why you have an ostomy, and when you had your surgery.  Then if you have Medicare they have to ask you questions to make sure someone else is not giving you supplies (like a home care agency or nursing home or hospital) because Medicare doesn’t want to pay double. The doctor or physician’s assistant or nurse practitioner has to report some of the same things plus show in their notes (your medical record) they have spoken to you about your ostomy and what you need for your care.  This is where you come in; you have to make sure your doctor knows what you need and why, even though your doctor may know very little about ostomies.

Get More Involved with your Doctor in Your Healthcare

A good suggestion is to visit your healthcare provider (doctor, nurse practitioner, physician assistant) at least once a year and provide a supply checklist which includes all the supplies you need (with the product numbers), and what type of ostomy you have. At this visit discuss what has happened in the last year; for example, you had a yeast infection around your stoma, you went to the emergency room for an obstruction or dehydration, you developed a hernia around your stoma, you gained or lost weight and had to change your type of ostomy product… This is the kind of information that needs to be in your medical record.  Your medical care provider may then give you a referral to an ostomy nurse at a wound or ostomy clinic, or a dermatologist or may just write it down in your record so when the insurance company wants to know why you now need a belt or a different kind of pouch or a greater quantity of pouches, they will know why.

Medicare has done research to figure out how many supplies an “average” person with an ostomy usually needs. If what you need is different, then your doctor must include information on your medical condition to support the need for the type and quantity of items ordered.  If you are working with a nurse who is specially educated about ostomies, the nurse may also be able to help you by writing down why you need different supplies than the average ostomate and give that information to your doctor to put in your medical record. This information in your medical record can then be given to your ostomy supply company and or your insurance. It is then the responsibility, under Medicare guidelines, of your supply company to get this information from your medical provider.  

An example of a special situation that would require additional supplies might be that your skin is irritated from frequent leakage of your pouching system due to your stoma being flush to the skin or below the skin. You require frequent pouch changes until your skin can heal. Any request for supplies more than the average amount is marked for review.  Just because a person “wants” more is not a good enough reason and those requests for supplies (claims) will be denied. You might have to have detailed notes in your medical record about why you need to use a convex wafer or pouch (such as because you have a stoma which is below skin level, or the stoma opening is at skin level).

Medicare has specific guidelines for the coverage of ostomy supplies, including that they be used exclusively for colostomy, ileostomy or urostomy management.  Ostomy pouches being used to manage fistula or wounds are not covered under Medicare guidelines.

Be aware that suppliers will not receive payment from Medicare for the items that are ordered if your physician did not provide the proper detailed information from your medical records when it is requested or if your detailed written order (prescription) is missing information like a signature. Furthermore, not providing this information may result in you, the patient, having to pay for the item yourself.  Note that your doctor’s cooperation is a legal requirement as outlined in the Social Security Act, the law governing Medicare.

To help you better prepare for your next office visit, please use this new checklist resource.

Pay Attention to the Details

The details are important, sometimes a date is wrong, the type of ostomy is wrong, the code for your diagnosis has a number missing…your insurance was not recorded or was recorded incorrectly, the doctor didn’t sign the note. Those things are minor and require a little detective work.  So if you have a request (claim) denied you may have to be a detective. You can speak with someone at the company who provides your supplies (ostomy supply distributor) and ask them to help you understand why your request (claim) was denied. Maybe together you can discover that a number was off or incomplete information was submitted.  Another example of an ostomate taking control of their healthcare is to not assume that your supplier has the proper documentation, but to ensure that your file at your supplier does include all of the necessary information. Ask your supplier for a copy of this documentation including prescriptions.

The same thing may be true with your doctor’s office, a request for supplies may have been denied because the information needed was not given to the insurance company or supply company. So then you need to speak with someone to discover what was missing. Sometimes the problem can be found, corrected and then the supply company can resubmit with positive results.

If you receive a denial, you have the right to appeal. The appeal usually has a time limit attached so follow the instructions for an appeal and respond that you want to appeal the denial.  If you have non-Medicare insurance you may be able to speak with someone at the insurance company about your denial to figure out why your request was denied as part of the appeal process. You may also contact your insurance customer service and request a case manager to assist with your supply denial.

If you have Medicare, for assistance you can contact your local representative from the  Beneficiary of Family Centered Care – Quality Improvement Organization (BFCC-QIO) or call 1-800-MEDICARE to help you understand the appeal process and determine what is still missing from your record. Your supply company may also be able to help you.

Do You Know What’s in Your Medical Records?

You have a right to request a copy. In 1996 the Health Information Portability and Accountability Act (HIPPA) was passed. It is the law that protects patients’ health information from being shared with only those who have a need to know. It also states that patients are allowed access to their health records.  Your medical record is not just your doctor’s office records, it includes hospital, nursing home, or home health agency (HHA) records, and records from other healthcare professionals including, but not limited to, nurses, therapists, and social workers. Here is a great video example of advocating for yourself and knowing what’s in your record.

Each state has its own laws about what is required to get copies of your medical records. Check with your medical provider/facility for their policy on obtaining your medical records.

Conclusion

To avoid claim denials, long appeal processes, costs to you, or the possibility of not receiving your ostomy supplies, you need to make sure that:

  1. Your supplier is submitting correct information and up to date medical records to your insurance company (or Medicare); and
  2. Your physician keeps up-to-date medical records about your health, your ostomy and your supplies in your medical record.

Just recently ostomy advocate Megan, The Front Butt YouTuber, tweeted, “Currently going through some of my medical records. Found several pieces of misinformation, which I cleared up in visits and it was marked incorrectly. Yet, they are still present on my record. Again, patients are NOT being listened to.” (9/4/18 Twitter) Kudos to her for taking an active role in her healthcare, and going through her medical records. Self-advocacy is ongoing and no doubt she will be bringing this up again until it is CORRECT!

Remember that you have the right to change physicians and the right to change your ostomy supply company if they are not working with you.

It’s time to take control of your health. You deserve high-quality care.

Expect More – Take Control of Your Health Care

Part 3 in Series

By Jeanine Gleba and Keagan Lynggard-Hysell

The Choice is Yours

Having the right ostomy supplies for your individual lifestyle and stoma type plays a huge role in the quality of your life. As a new ostomate I fell victim to the common misconceptions that daily leakage and skin irritation were normal occurrences that came with the territory of having an ostomy, when in reality I was going through unnecessary struggles due to the fact that I wasn’t using the best products for my individual situation.

For those unfamiliar with my story, shortly after my diagnosis of Crohn’s disease in 2005, I was rushed to the Emergency Department with a bowel perforation and underwent my first ostomy surgery. After the operation, I endured many complications due to several different infections and the severity of my disease. I was hospitalized for a consecutive 8 months and would face 5 more surgeries within that first year of my diagnosis, all resulting in either a colostomy or ileostomy. Being in the hospital for essentially the first year of having a stoma, I was limited to the ostomy supplies provided by the hospital. Once I made the transition home and was receiving home health care I continued using the same supplies I had been using in the hospital simply because it was all I had ever known.

For the first few years of living with my ostomy I was isolated by the insecurities fueled by daily pouch leaks, chronic skin irritation, and the fear of experiencing a leak or unexpected odor in public. It wasn’t until I got to the point where my peristomal skin was so excoriated and I could no longer keep a pouch on for longer than a few hours that I finally made an appointment to see a WOC nurse.

During my appointment, not only were my skin issues addressed, but my WOC nurse introduced me to a new ostomy appliance and accessories that would work best for my individual stoma and lifestyle. I was given a product catalog which my WOC nurse had marked with tabs on the new products we used that day so I could order them for the upcoming month as well as any samples of other supplies I was interested in trying in the future. That day, I left my appointment feeling comfortable and confident in my new ostomy appliance.

As time went on, I no longer experienced the daily leakage or skin irritation that I had with my previous appliance, and this drastically improved my quality of life. I was no longer worried about odor, or ruining my clothes, I felt more confident in public and was able to participate in the activities I had once restricted myself from doing out of fear that my ostomy appliance would not stay on properly.

As ostomates, we are fortunate that manufacturers continue to improve our ostomy supplies. For the last 13 years that I have been living with my ostomy I have benefited greatly from product innovation and feel confident in the ostomy appliance I wear today.

As an ostomy patient advocate, I am often invited to share my story with nursing students, WOC nurses, as well as other health care professionals. By providing the patient perspective, I encourage them to educate their patients on the supply options available and that a patient’s ostomy appliance plays a huge role in their everyday life.

It’s important to remember that our stomas may change, our bodies may change, and more often than not- our ostomy supplies may change- and that is okay! The most important thing to remember is to seek out the most optimal pouching appliance for you so that you may live the life you love and want to live.  The most important thing to remember is, whatever works best for you and your individual stoma.

Know that you have Ostomy Product Choices

As listed in the UOAA Patient Bill of Rights, ideally before patients are discharged from the hospital they should be informed of the pouching  system that has been prescribed to them as well as have an understanding of the ostomy supply ordering process.   In addition to the pouching system prescribed, patients should be provided with information on the supply choices available to them once they are home.

When in the hospital, your ostomy supplies are included as a part of your treatment of service. To keep costs down, the hospital only has a small selection of ostomy products from a particular manufacturer vendor that they contract with.  As a result patients are initially limited to whatever ostomy supplies the hospital uses. Know that you are not locked into any pouching system and that you have many choices to find the ideal system for your stoma and lifestyle.  (It should be noted that many patients stay with their initial hospital brand and are very satisfied with these supplies.)

Before you leave the hospital be sure to get the product codes for the specific ostomy supplies used while in the hospital. Request that extra ostomy supplies be sent home with you upon discharge to ensure you have enough on-hand until your first order arrives at home, or until your first home nurse visit if you will be receiving home health care. Don’t forget to ask about being enrolled in one of the discharge programs that are sponsored by ostomy manufacturers.

It is completely normal for your stoma size to change in the weeks following surgery, so what was initially prescribed in the hospital might need to be altered.

As always it is strongly encouraged that you work with an ostomy nurse to find the best products to meet your needs and particular situation. Manufacturers’ also have WOC nurses available to discuss any issues or answer your questions if you do not have a WOC nurse/OMS available in your area. Their services are free of charge and they are dedicated to helping you.

When you are ready, feel free to experiment with different manufacturers  or different types of products. It may be helpful to order a product catalog from your medical supplier, so you can see the different products available and what assortment you have to choose from. Also, either you or a family member can call the manufacturer’s toll free 800 number and request product samples, or ask your supplier for a sample.

Know Your Pouching System

In the ostomy world, it is wonderful to know that there are many different styles and types of pouching systems available, and that manufacturers are continually improving their styles and selections.  Manufacturers listen to ostomy nurses and to patients as they seek to improve the lives of ostomates.

It is good to understand the basics of pouching systems and then advance your knowledge as you become familiar with your own system. Once you gain confidence in the terminology, you can begin to explore options for yourself.  Please use this link to learn about the different types of options available. Another excellent resource is here.

Know Supplier Options

The major manufacturers do not sell supplies directly to ostomates. Furthermore, ostomy supplies are rarely available for purchase in chainstore pharmacies such as CVS or Walgreens. Before you begin ordering ostomy supplies, itis important to do your research (read online reviews too) and carefully consider your options when choosing your supplier (Under Medicare these are known as Durable Medical Equipment providers.). Some things to consider when choosing your supplier: affordability (reasonably priced), reliability (on-time delivery) and reputation (quality service).  You should also know the answers to these questions before deciding on your supplier:

  • Do you want to shop at and support a small local medical/surgical supply house or order from the convenience of home through a large mail-order house (aka national online vendor)? There are pros and cons to each but typically national vendors carry a wider range of products, many (but not all) accept Medicare assignment and due to higher volumes can offer lower pricing.
  • Do they accept your health insurance?
  • What are the prices before and after your deductible is met?
  • Do you have to submit the claim for reimbursement to your insurer or do they directly bill the insurance company for you?
  • Do they carry all of the products that you need for your unique pouching application system?
  • Do they stock and keep current with the latest available in ostomy technology and do they suggest new products?
  • If you are on Medicare, do they “accept assignment”?
  • What is the return policy or how do they handle product issues such as defects or incompatibility?
  • Do they only ship in quantities for 30 days (1 month) or also offer 90 day (3 month)?
  • Do they charge shipping?
  • Do they impose their own quantity limits on supplies?
  • How long does it take to receive orders?
  • Do they help rectify insurance denials and work on appeals?
  • Do they work with your doctor to renew your prescription or if you need a change to your supply order?
  • Do they have personalized customer service with helpful reps knowledgeable about ostomy supplies?
  • Do they offer free ostomy nurse consultations to give you tips and guidance?

Tip: Be sure to have a back-up supplier in case your normal provider has a disruption in service or is waiting for your type of supplies on back-order.

Know what Information is Needed to Order Supplies

It’s helpful before you place an order to have all of the information about your pouching application system ready. The most important thing to know when placing an order is the order number for your particular supplies and accessories. The order number will tell the supplier what kind of pouch and accessories that you use. If you are ordering for the first time or switching suppliers,  be sure to know the type of ostomy appliance and any other accessories that you use. Include the pouching system product, size, and product number. Download the UOAA Know Your Pouching System (Appliance) Checklist tool to have handy.

 

Conclusion

Knowing your current ostomy appliance and accessories, where and how to purchase them, that options are available in product selection, and that you have a choice in all of these decisions helps to make you in control of your ostomy health care.  In addition, utilizing the resources available to you through your ostomy manufacturers, suppliers, and ostomy nurses will help provide the best experience with your supplies.

It is important that you are able to advocate for the right ostomy supplies that work best for you and your individual stoma so that you can feel confident and live well with your ostomy.

Please note: UOAA does not endorse particular products, manufacturers, or suppliers, and is not responsible for any content expressed in sponsor websites.

By Jeanine Gleba, UOAA Advocacy Manager

“Awareness is the greatest agent for change.” ~ Eckhart Tolle

It’s coming!  As I write this there are 50 days 9 hours and 41 minutes until World Ostomy Day on October 6, 2018!  (Current Countdown) Then you will have to wait another 3 years for the International Ostomy Association to sponsor it again.  UOAA is thrilled to join our national efforts with the rest of the world and we want ostomates across the country to join us from big cities to small town America to make this day a pretty big deal.

In both my professional and personal life as an “advocate” I know first-hand that the key to success for any advocacy cause is awareness. Simply put the more people talking about something the more attention it will attract (e.g., a video gone viral or hot issue on the political radar in the media). Unless you are personally affected not only do most people not even know what an ostomy is but they certainly don’t know how much this surgery can change lives for the better. A prime example of this is a person suffering for years with an irritable bowel disease such as ulcerative colitis who finally finds relief by having ostomy surgery. This is why it is crucial that we heighten consciousness around the globe to increase understanding of “ostomy”, remove feelings of embarrassment and eliminate fears so that ultimately when all other medical treatment options have failed more people will choose this surgery. Then more lives will be improved and saved.

I’m particularly excited this year’s theme is “Speaking Out Changes Lives”. What better way to raise awareness than to “speak out”?   What better way to improve lives and make concerns known such as when a person has received poor quality of care, than to “speak out?” What better way to advocate for a dedicated national day of ostomy awareness than to “speak out”?   

Do you know how to raise awareness? Think of the causes that you support. Look around you.  Everywhere you turn there are reminders of one cause or another keeping issues alive and on people’s minds (e.g., Breast cancer started out as a simple pink ribbon symbol in 1982 and has now turned into a global sensation with all of the pink anything and everything that is available for purchase to raise research funds. Not to mention all that is done during the month of October and all year long for breast cancer awareness).  There are many ways to raise awareness such as having a car bumper sticker or the widely popular Twibbons, but the best and simplest way is just….you got it…. “speaking out”. The growth of ostomy awareness is realized each time a person living with an ostomy shares his/her story. Each and every one of us has a powerful voice and together we can make a big impact.  Learn more ways to raise awareness in UOAA’s toolkit “Be an Ostomy Champion”.

Get Involved

Here’s some of the ways UOAA is raising awareness for World Ostomy Day: 

  • Expanding our annual family-friendly Run for Resilience Ostomy 5k events across the country now in nine states (AL, AZ, ID, MI, NC, NJ, OR, PA or TN) as well as well as a worldwide Virtual Run/Walk. Hundreds of people will attend these events and even more will witness the event as people run the course.
  • Promoting ostomy awareness year-round with a free “Ask Me: What is an Ostomy?” sticker for all those that register for the Virtual Run/Walk.  This sticker can be put on cars, laptop covers, water bottles or any where you want to raise awareness. Help UOAA teach the world what an ostomy is!  
  • Encouraging more people to use our sample proclamation to get one passed in towns, counties and states across the country officially declaring Ostomy Awareness Day. In addition, NJ Congressman Donald Payne, Jr. has agreed to be the Primary Sponsor of a Congressional Resolution nationally recognizing Ostomy Awareness Day for the first-time ever!
  • Sharing our special logo for World Ostomy Day and the use of dedicated hashtags for social media recognition: #WorldOstomyDay2018 and #OstomyDayUSA.
  • Coordinating our very own 1st Annual Virtual Day on the Hill competition to raise ostomy awareness with lawmakers!
  • Producing a very motivating “Speak Out” Campaign call to action video!

Please keep visiting our dedicated and frequently updated webpage to find more ways you can get involved in the celebration this year!  And make a mental note to yourself that it doesn’t end on October 6th. Awareness can happen every day. We’re counting on to you to make it happen.

Expect More – Take Control of Your Health Care

Part 2 in Series

By Joanna Burgess-Stocks, BSN, RN, CWOCN, UOAA Advocacy Chair

Good communication skills are the key to problem-solving.  This became clear to me when, as an ostomy nurse, I found myself having to unravel what people were trying to tell me when facing a problem.  I realized I was speaking a medical language that was not always understood, and my patients were trying to work with that language the best that they could, but miscommunication often happened, resulting in unresolved problems. One day it dawned on me that I needed to do a better job in teaching my patients ostomy language. Sometimes a change just takes a moment of truth.

My moment of truth!

I was excited and determined as a new ostomy nurse to make a difference in people’s lives and knew that I could, after having lived with an ostomy most of my life; since age three.  My responsibilities in the hospital setting were to teach people how to care for their ostomy after surgery. I would make sure my patient or their caregiver knew the basics of ostomy care. On the last day before discharge home, I would focus on how to order supplies.  I would then say my goodbyes with a simple “call me if you need me”. I realize now, as an experienced nurse, that this was only part of the story. It was not until I became involved with my local UOAA Affiliated Support Group (ASG) and started following online support groups that I became aware of the challenges people experience once they are home and face ostomy care on their own. My moment of truth came one day as I was lying on my bed with my laptop reading story after story on the online support group Inspire of people and their loved ones trying to problem solve skin and stoma issues and difficulties with trying to keep a pouch in place. There I was, an ostomate and nurse who had every resource available to me yet all I could do was offer words of encouragement and some basic information. I realized that I could not adequately offer advice because it was very hard for people to describe what was happening and I didn’t always understand what they were describing to me and sometimes they did not understand what I was saying to them.    

Changing my Approach

I started to pay closer attention to what my own patients would say to me when they called with a problem and realized that they too had difficulty describing the issues. I had taken for granted that ostomy medical language was second nature to me, but not for them.

Because the patients were not able to tell me the problems they had with managing their ostomies in a way that I could use, I was often left with more questions. I could only offer limited answers and my efforts to help often felt useless. Being a medical professional for most of my life, I felt humbled realizing that medical language can be difficult for people to understand.  Unless you have worked in or been around hospitals, you might not have learned medical words. It is mind-boggling just to know the words to use for ostomies. To get the true feeling, it would be as if I were suddenly thrown into having to build my own house and had to understand all the words involved with building. I would be lost!

The challenges that ostomates face at home motivated me to start an outpatient ostomy clinic connected with my hospital so that my community of people had somewhere to go for help.  After seeing patients in the clinic I learned that many ostomates had no idea how to describe the problems they were having with their stoma or skin. Some did not know the type of ostomy they had, some could not describe their stoma and most had difficulty describing their skin problems other than using the words:  red, painful and hurting.

Gaining Wisdom:

What I have found over the years, is that the better my patients are able to describe the problems they are having with their ostomy, the more I am able to help them come to a successful solution; whereby, they are able to help themselves. These patients also feel more confident to explore different pouch choices on their own because they have the confidence to tell vendors ( ostomy supply companies) their own stoma and skin problems. Thus the right pouching  system “match” is more likely to happen, resulting in a positive result and better quality of life. I now know that just as important as teaching someone ostomy care, it is also important to teach the language that is a part of that care.

As you read these tips on ostomy language, be patient with yourself. It takes anywhere from 6-12 months to speak the language of ostomies according to some ostomy nurses!

Know your Ostomy Type (and whether it is permanent or temporary)

Know How to Describe your Stoma:

“Stoma” an opening created by ostomy surgery.
It is located on the abdomen and is red/dark pink in color, moist and shiny.
Some describe it as looking like a rosebud.

Take a look at your stoma. In front of a mirror, look at how the stoma changes when you are standing still, twisting from side to side, bending over, sitting, and lying down. Once you have done that, you can ask yourself the following questions about your stoma:

What Does the Skin Around your Stoma Look Like:

  • Flat and no wrinkles/creasing
  • Skin folds/wrinkles  (describe where and when you see wrinkles and folds; for example “ when I sit I have creasing on the right and left side of the stoma”)

Shape:

  • Round
  • Oval
  • Irregular
  • Smaller at the top, larger at the bottom
  • Larger at the top, smaller at the bottom
  • Has one opening
  • Has two openings

Color:

  • Red
  • Pink
  • Brown (not normal)
  • Black (not normal)
  • Maroon, Blue/Purple (not normal)

Stoma Position and Level:

  • Below skin level ( in a skin fold or sunken)
  • Flush to skin level/at skin level
  • Above skin level

Know your Stoma Location:

  • Right side of the abdomen above the belly button
  • Right side of the abdomen below the belly button
  • Left side of the abdomen above the level of the belly button
  • Left side of the abdomen below the level of the belly button
  • In or near a skin crease
  • In or near a skin fold
  • On a flat skin surface

Know your Stoma size:

  • Use measuring guide to match the size
  • Round stomas are measured by diameter
  • Oval stomas are measured by widest length and width
  • Learn how to measure your stoma here

Know where the stool or urine comes out of the stoma ( this is called the “os” meaning mouth or opening)

  • On the top of the stoma and centrally located
  • Located on the side of the stoma (left or right)
  • Located on the underside of the stoma
  • Located level with skin

Know How to Describe your Effluent (output from stoma)

For a stoma that drains feces/stool

  • Color: brown, green, black, red and black
  • Consistency: thin and watery, loose, thick, soft, formed, pasty
  • Odor: no odor, mild odor, offensive
  • Amount: High output and loose, High output and thick/formed, no output, low output
  • Number of times a day you empty the pouch.

For a stoma that drains urine:

  • Color: Clear, cloudy, amber, straw, blood tinged
  • Odor: no odor, musty, fishy, fecal ( stool smell)
  • Volume: No output, low output, high output
  • Substances other than fluid (e.g., grit, crystals, mucus).

Know Your Peristomal Skin ( the skin around the stoma):

  • The skin is intact, not raw – no skin breakdown
  • The skin has sores – blisters, or looks like a blister without the skin on top
  • The skin is discolored (red, pink, purple, bruised)
  • Skin sensation (normal, itching, burning, painful)

Normal peristomal skin does not have sores, discoloration, pain, itching or burning.

Final Thoughts on Ostomy “Lingo”

Learning a new language can be difficult. My hope is that you will take the time to understand and know ostomy language so that you too will be an expert. The more you know and understand, the better you will be at expressing your needs and be able to find the best pouching system for you. Use this Know Your Ostomy Checklist the next time you need to talk about your ostomy, and see how much it helps!  

49% of Respondents Report they Received Inadequate Information and Communication From their Provider at the Hospital

By Leslie Riggle Miller, M.A.

My name is Leslie Miller and I am a 25-year cancer survivor and a former ostomate. I had a partial colectomy at age sixteen in 1993 resulting from a cancerous tumor attached to the rectum. I was given a colostomy, for which I had never heard of before I woke up with one! Nine-reconstructive surgeries later, I received a takedown (reversal of colostomy) in 1997. Now, three lives later I am doctoral student at the University of Oklahoma in the Department of Sociology. My primary research area is Medical Sociology.

I am excited to share with you some preliminary results of a very important study on the lives of ostomates. I began this research project in the summer of 2017 called Peoples’ Experiences With Pouches (1.) (P.E.W.P.) Study. I am interested in the difficulties ostomates face in their everyday lives, as well as the level of supportive care they receive in current medical practice. Long-term goals include improving hospital processes and nurse training with respect to ostomy care and instruction.

Background: An important component of our healthcare system is when patients and providers meet and interact together. During this interaction, patients are able to explain their ailments and tell their story, and providers are able to provide care, instruction, and diagnoses. There are positive and negative outcomes for patients based on this interaction, such as patients feeling heard, respected and cared for, but also there can be patient dissatisfaction, lack of trust, and misdiagnoses. Effective communication from providers is not only critical for all patients, but possibly more so for patients who receive a life-changing surgery, such as an ostomy.

The communication from providers when ostomates first receive their appliance is critical. Provider communication not only needs to be effective for ostomates’ ability to go home and take care of their appliance, but also it needs to be efficient given the short turnaround time in release from the hospital. As such, in my study, I examine provider communication and information when ostomates first receive their appliance.

Study Background and Results: Currently, there are 391 ostomates from the U.S. and abroad included in the study. 89% reside in the U.S. with 11% residing outside of the U.S. (predominantly from the United Kingdom and Canada).

The research questions that I have addressed are based on ostomates’ initial experiences at the hospital when they first receive their ostomy. The research question that I will address in this post is, “Do ostomates receive adequate information and communication from providers while at the hospital?” The answer to this question is “no.” I found that almost half (49%) of the ostomates felt that they received inadequate information and communication from their provider at the hospital. Below are the areas of provider care that ostomates reported that they either did not receive or an inadequacy in care that they experienced:

  1. Attitude. The provider said something that hurt the patient’s feelings or acted in a way that dissatisfied the patient, such as the provider was arrogant or rude.
  2. Ostomy Nurse. The patient wanted to see an ostomy-specific nurse sooner than they did or have follow-up appointments with an ostomy nurse but did not get to.
  3. Providers Lacked Knowledge. Patients felt that providers were not educated enough about ostomy care or were lacking in their knowledge on ostomies.
  4. Products. Patients were not told that there were other products on the market that may work better for their type of stoma or situation.
  5. Preoperative Information. Patients did not receive pre-op information or wanted more preparation before surgery.
  6. Fixing Issues. Patients were not told how to fix issues that arose once at home.
  7. Supervise Pouch Change. Patient wanted to be supervised on how to change the pouch or more practice with changing it with an ostomy nurse or more practice changing it, in general, before going home but did not get to.
  8. Wrong Information. Patients were told the wrong information from providers.
  9. Missing Information. Patients were not told all of the information that they needed or wanted on how to care for their ostomy or other options available.
  10. Lacked Support Information. Patient wanted to be told about ostomy support groups or links to support information or meet with a current ostomate, but did not receive this.
  11. Lacked Emotional Support. Patient did not receive any emotional support from their provider and they wanted to.
  12. Questions. Patients had questions that were not answered at the hospital, or they wanted to call to ask questions.
  13. Hurried/Dismissed. Patients felt like the nurse was hurried, or the patient did not receive overall basic care, making them feel as if they were dismissed.

A majority of ostomates felt that they did not receive all of the information that they wanted or needed, with lacking product information as the second highest category for inadequacy.

Additionally, I examined whether provider communication and information were better or worse for ostomates who received their ostomy years ago versus more recently. The years of ostomy surgery ranged from having had surgery in 1953 to 2017. I found that the further back in years the ostomate had their surgery, the more likely they were to report adequate information and communication. This finding leaves us with additional questions, such as whether the quality of hospital provider care has decreased over time? What is driving this decrease in adequate information and communication for ostomates? I plan on determining the answers to these questions in future studies.

Closing Remarks: The main takeaway is that there is much work to be done with regard to ostomy care when people first receive their pouch. We hope our study (and future studies on this topic) will help in this endeavor. Finally, I encourage all of you to be active participants in your medical encounters when you meet with providers. It is important to ask questions and have an open dialog with your provider. The UOAA offers vast resources for new and seasoned ostomates. In particular, the UOAA has a “patient bill of rights” so that ostomates have the tools they need to advocate for their care. Please visit https://www.ostomy.org/bill-of-rights/ to see this great resource. You are welcome to reach out to me if you have any questions

1. Miller, Leslie Riggle and B. Mitchell Peck. 2018. Peoples’ Experiences With Pouches (P.E.W.P.) Study: Examining Whether Ostomates Receive Adequate Information from Hospital Providers. Presented at the Oklahoma Sociological Association Annual Meeting, Norman, Oklahoma, November 2017

Leslie Riggle Miller, M.A. is a former ostomate and a doctoral student at the University of Oklahoma in the Department of Sociology. 

After eight years of not responding to western pharmaceuticals, at the age of thirty, I found myself facing a colectomy. While I had anxiety about the ostomy surgery and fear of the unknown, my overall emotion was relief. This surgery was hopefully going to be the end of many years of pain and suffering. Thanks to the encouraging words of other ostomates I was wheeled into surgery with a smile on my face, excited about what the future would hold for me–I saw endless possibility!
The support I received from the local ostomy support group along with many wonderful bloggers inspired me to be vocal about my story. I started my own blog and instagram account to raise awareness about life with an ostomy and provide support to fellow ostomates. There is so much value in people who are facing an adversity to come together and lift each other up.
I’ve been on a rollercoaster ride with my permanent ileostomy (I named her Rita) for the past two years. Life is full of ups and downs, however, I am proud to say that Rita and I have traveled to Hawaii to snorkel in the ocean and hike through the cliffs of the Napali coast. We wore a bikini on the beaches of Maryland’s eastern shore, danced our way through weddings, explored new foods at restaurants with friends and worked our way through a graduate degree in acupuncture!
Philosopher Wayne Dyer once said, “When we change the way we look at things, the things we look at change.”  When diagnosed with ulcerative colitis it was easy to fall into a mode of feeling isolated and alone during periods of flares. I forgot what life was like as an energetic and healthy young professional. The expectation of a healthy life and the unfair reality caused a lot of unnecessary suffering. What I learned is that we all have the option to dance with life. Crisis can open a door to a new opportunity, a loss can be seen as a gain, and a breakdown can turn into a breakthrough.

You can follow Rena’s story on Instagram @myintestinalfortitude or her blog www.myintestinalfortitude.com

Expect More – Take Control of Your Health Care

Part 1 in Series

By UOAA Advocacy Committee

This first article is about finding your voice as you take the initiative to speak up, or act on your own behalf, to encourage change that will bring improvements in your quality of ostomy care, and ultimately, your quality of life.

We are all unique individuals and regardless of having a medical condition such as an ostomy some people by nature are outgoing while others are more naturally shy and timid. Some people are overly confident while others lack self-esteem. We are who we are; however, when it comes to your health and well-being, if your gut is telling you “this isn’t normal” or something is wrong or you just don’t plain “get it”, don’t be afraid to speak up. There is power in your words. Yes, this can be easier said than done for many, but realize there is no shame in asking for help. It can be a challenge to balance being assertive while not being overly demanding.

Ask yourself the question – do you think you are capable of producing a change? How do you create change in your life? For example, if you are experiencing pain and sores on the skin around your stoma – are you accepting this as normal and trying the best you can to manage it on your own because you don’t want to bother anyone? In contrast, are you someone that would call your doctor, seek resources to find help and not accept this as normal? It is good to try to be self-sufficient but if you are still suffering and in pain then a positive change has not happened. What can you do to strengthen your voice, and be a participant in your self care? The belief that you can make a change is called self-efficacy. It is a little different than being self-confident in that you truly believe a change will happen and you won’t stop seeking help until that change has happened.

Some people also fear that by speaking up and questioning their healthcare providers, that they will find them annoying, stupid, needy or unlikeable. Healthcare professionals are held to high medical standards and they want to help their patients. They understand that this is new to you and that you are trying to understand your medical condition. They also need you to understand your treatment plan, so that it can be a success. There is absolutely no reason to feel embarrassed. Remember, if you do not ask your questions or express your concerns, you remain uninformed and that is a fearful place to be. You want things to get better not stay the same.

FIND YOUR VOICE: 10 Questions To Ask Yourself

When it comes to medical situations, many people become tongue-tied or have difficulty expressing themselves. UOAA recognizes that it is not enough to just tell ostomates to self-advocate, but rather we need to provide you with the tools to do so. Self-advocating can be a positive experience.

Below are 10 questions and simple solutions that will help you find your voice:

1) Are you nervous, anxious or confused about your medical condition?

People who do not feel confident in their understanding of their medical condition feel fearful. Once they are educated about their condition, they are more confident to speak up. The information in this blog post and UOAA’s ostomy information and educational resources can help you gain confidence and if you are just starting your ostomy journey it can give you a sense of control in a time of uncertainty. “Knowledge is power.” ~ Sir Francis Bacon

2) Do you just defer to the expertise of medical professionals or do you participate in decision making?

Many people assume they have no role in their care. They just leave it in the professionals’ hands. In reality, you play a very important role. Medical “lingo” is very new to people – people who don’t understand it do not feel confident in speaking up and feel intimidated by medical professionals. Most people are afraid to say – I don’t understand what you are saying. Make a list of what you do and don’t understand to generate the proper questions to ask.

3) Do you think you are the only one in the world having these issues and concerns?

People who feel alone do not speak up – once they find others such as with a support group – they feel more confident and less isolated and alone. Here you can get a role model or peer to guide you along the way. It’s comforting and insightful to hear from people who share similar experiences. Chinese proverb: “To know the road ahead, ask those coming back.”

4) Do you have low self-esteem and sometimes feel that your life doesn’t matter?

People with low self-esteem tend to not speak up. They tend to remain silent or let other people do the speaking for them. When someone has low self-esteem, it is hard to see his/her own worth or recognize that his/her opinion matters. Self-esteem is further affected by a life-altering/body altering illness such as ostomy surgery. Take steps to feel better about yourself or if needed, seek counseling.

5) How can advocating for your healthcare needs (or other things in your life) really change your life in a positive way?

Consider the impact on your life. Make a list of pros and cons for speaking up. If the pros outweigh the cons, it may be worth it to speak up and improve your life in a positive way.

6) Do you have a concern or health issue with your ostomy, but your doctor or nurse pushes it aside and tells you not to worry about it?

Are you the type of person if you are worried about something, but your doctor doesn’t mention it, then you assume it must not be a concern so you remain silent? If you are unsure or disagree and it is affecting your quality of life, then get a second opinion by another expert. Listen to your gut. It’s important for you to feel safe and secure in your own body, and you certainly don’t want the problem to get worse (or it might truly be nothing to worry about!). It always feels better to have your concerns addressed in a way that makes you feel that you have been heard.

7) Do you find yourself rushed or brushed off when you are at an appointment with a medical provider?

We all agree that medical professionals are busy and are often running behind schedule. The good news is that often this occurs because other patients were asking questions during their appointment! They were speaking up! You deserve their time too. Write down your questions before you arrive and be sure to take out your list and go over every single question you have. Remind yourself – this is your visit, this is about YOU, not the doctor. Also, the next time you call to make your appointment tell the office staff that you will need some extra time to discuss all of your concerns and evaluate your situation especially if it is a complicated issue.

8) Do you feel like you are just another ostomy patient in a long assembly line and feel that there is no real care for YOU, a unique and individual person?

If you consistently leave the office feeling worse than when you entered and with unanswered questions, then it is time to consider finding a new provider and seeing someone else who will make you feel comfortable to ask questions and take the time to listen and respond. This holds true even if it’s a referred provider who is supposedly the “best” in the field. It’s important to have a good relationship with your provider. Quality ostomy healthcare is a team effort and communication is critical.

9) Have you ever looked back and kicked yourself for not saying something?

It’s better to speak up, than have regrets later, especially when it might be something as serious as your health and well-being. Your doctor has many other patients and concerns on his/her plate so don’t run the risk that they will remember everything about you or what was discussed at your last visit together. You know your health history. You are the person experiencing the symptoms or whatever the issue is. It is absolutely your place to express your concerns.

10) Do you sometimes draw a blank or choke under pressure and miss out on speaking up?

Keep an ongoing list of your questions and concerns prior to meeting with your medical professional. Practice the conversation that you want to have by role-playing with a family member or friend acting as your doctor or nurse. Practicing will help instill confidence in what you want to say. You can also decrease stress by bringing your questions with you and reading them from your paper. That way you are sure that nothing is forgotten. “Asking for what you need, what you want, and what you’re worth requires practice. So practice self-love and start asking.” ~ AnneMarie Houghtailing

FIND YOUR VOICE: Expect More Examples of when you or your Advocate should speak up!

IF YOU CAN’T FIND YOUR VOICE; BE SURE TO GET AN ADVOCATE

We realize that having major surgery can be overwhelming. Be sure to find someone who can help you along the way. Sometimes you might “lose your voice” especially after surgery, from medications, or just being overwhelmed. Your advocate should be someone close to you, whom you can share your deepest fears and concerns with, and HAS A VOICE, and can speak up for you when you can’t. Your advocate can ask questions for you or simply listen and take detailed notes so you can recall and understand later.

SPEAK UP!

If English is not your primary language, you have a right to an interpreter. All hospitals are now required to have interpreter services either in-person or via web connections provided for you.

In conclusion, we know that ostomy healthcare is not perfect and inconsistent in our country. When it comes to your healthcare, don’t be shy. You must harness the power of your own voice and share your concerns, desires, and opinions; because if you don’t, who will? Remember that you matter! You are important! Self-advocacy isn’t a “one and done” deal. It’s an ongoing process from before you have your surgery thru the ongoing continuum of care of your ostomy or continent diversion.

Speak Up! Ostomy and Continent Diversion Patient Advocacy Resources:

(Note – Although we focus on finding your voice with regards to healthcare, you can use these self-advocacy tips in other areas of your life as well.)

By Heather Brigstock MSN RN CNL

On Sunday, October 7th 2017, my family and I went to bed just like we do every night. School lunches were packed and sitting on the counter ready for the next day. A load of laundry sat in the dryer ready to be folded. Our community of almost 200,000 people was going about its usual routine. We had no idea our world was about to be turned upside down.

I felt my wife get out of bed and assumed it was morning. The faint glow of what I thought was daylight came streaming through our open window. “What time is it?” I asked. “2 a.m. and I smell smoke” she replied. I sighed and rolled over, desperate to get back to sleep. I didn’t smell anything, but she insisted on going outside to check. She quickly returned to tell me she heard explosions outside. This news lured me out of my bed and I went outside to see what she was concerned about. The sky in front of our house was a red glow and we heard explosions in the distance. The blare of sirens reassured us that the fire department was already alerted to whatever this fire was. But something didn’t feel right. Neighbors started pouring out of their houses, some packing up their cars and leaving. Our cell phones were oddly silent despite our expectation that if we were in danger, we would have gotten some kind of alert. The bells at the Catholic Church down the street started ringing at 2:30 a.m. We decided to turn on the radio and see if there was any information about where this fire was. The explosions were getting much closer and the red glow in the sky was growing. Within a minute of listening to the radio, we learned that our town was burning down around us. Flames were surrounding our town on three sides and moving at a speed of over 200 feet per second. Cell towers were overwhelmed so none of the calls we made to alert our friends would go through. The hour that followed was a chaotic blur that is etched in our minds forever. We pulled the kids out of bed and told them to grab anything that could not be replaced. The four of us frantically ran around the house grabbing family heirlooms, photos and packing overnight bags. We crated our three cats and put our fire safe containing important documents in the car. Adrenaline was coursing through us, propelling us to grab everything that could possibly fit in our cars. We had no idea where we were fleeing, so we packed some of the emergency food and water that I always keep on hand. My fourteen-year-old was sobbing, looking for her favorite childhood blanket. My mind kept jumping from being ultra-focused to going blank. I couldn’t remember where basic things were and I kept coming back to the same thought: how did this happen?

The hours, days and two weeks that followed were a painful mix of emotional trauma, sleep deprivation and extreme stress. The National Guard and first responders from all over the country and even Canada, rolled into town. Pictures of the devastation dominated my social media newsfeed. My friend’s homes burned to the ground, with many getting out with only the pajamas on their backs. Hundreds of people were unaccounted for. For two full weeks the fires raged; the wind would shift and flames would change direction, threatening different neighborhoods. Night brought a sinking feeling since the darkness hampered the firefighting efforts, and seemed to carry with it a fear of the unknown. Two out of our three hospitals were evacuated and closed, with flames licking their walls and patients in gowns loaded onto buses. Thousands of people were living in shelters, sleeping in their cars and tent camping in parking lots. The collective grief in our community hung in the air, almost as thick as the toxic smoke that burned our throats. Entire portions of our city were destroyed.

My family and I evacuated to my parent’s house, 30 miles north of Santa Rosa. A couple of days after the fire started, I began getting messages and texts from nurses. People with ostomies were living in the shelters and they had no time to pack their supplies when they evacuated. Since hospitals were contaminated and closed, getting supplies from them was not an option. I alerted UOAA of the issue as I quickly started organizing an effort to gather donated supplies from manufacturers. Living through that experience taught me many things about disaster preparation as someone living with an ostomy.

Before the Disaster

*Prepare now-don’t wait! We have a false sense of security when we think that disasters won’t happen in our town. I never thought a wildfire would rage through my city. Preparing properly could not only save your valuables and ostomy supplies, it could save your life.

*Make a go-bag-A go-bag is a bag that is packed at all times, in an easily accessed place that you can grab as you run out the door in the event of an evacuation. It should contain extra ostomy supplies and necessary medications in addition to important documents. According to FEMA, you should pack your go bag with enough supplies for 3 days. This includes food, water, flashlights etc. Visit ready.gov to see a complete list of recommended items for your go bag. During the fires, we were evacuated for two weeks but many of my friends were evacuated for four weeks, so plan your ostomy supplies accordingly.

*Make lists and assign tasks-Have a family meeting and decide who is responsible for what in an emergency. Instead of everyone running around frantically, each person would have a list of tasks. One person should be in charge of medical supplies and medications. Make a list of family heirlooms/irreplaceable items and where they are located. Don’t forget laptops or thumb drives if that is where photos are stored.

*Make a communication plan- During emergencies, cell towers can be overwhelmed and calls will often drop. In our situation, texts would send but since it was the middle of the night, people outside our area were sleeping and never got our frantic messages. Afterward, we discovered that most cell phones have a way to allow texts/calls to alert from certain numbers even if the phone is on silent. For example, if my phone is on silent for the night but my mom calls me, my phone will ring because it is now set so that her number overrides the silent setting. Learn about the features your phone has for emergencies. Also designate a meeting place outside the area so that if there is a rushed evacuation and your family is separated, you know where to meet each other.

*Keep emergency supplies together-We discovered that all of the emergency supplies I had carefully gathered were not located in the most efficient places. I had food and water in the garage but our emergency radio and first aid kit were out in the shed. I had purchased N-95 face masks but I couldn’t remember where they were. Having the items isn’t enough, they need to be located in a place where they are fast and easy to access. The same rule applies for ostomy supplies-keep them together in a place that is accessible.

*Plan on extra water if you have an ostomy-For emergency preparedness, the Red Cross recommends planning for ½ gallon of water per person per day. However, that is for the average person. If you require more water due to your ostomy or an underlying medical condition, plan on more. You may want to purchase fluids that are enriched with electrolytes to prevent dehydration.

*Keep gas in your car and cash in your wallet- During most disasters, one of the first things that happens is everyone rushes to get gas on their way out of town. Gas stations quickly ran out of gas during the fire. Credit card machines also went down in many locations so cash was the only way to pay for gas. In this era of electronics and technology, always have a backup plan.

*Take pictures- Go through your home and take pictures of each room. This will serve as proof for your insurance company of what you own, and it will also remind you of what you own so you can claim your losses. Take a photo of your medical supplies as well. Store these pictures in more than one place; I recommend keeping them digitally on your phone and hard copies in your go bag.

*Know your insurance policy- Dust off that policy and read it. Know what coverage you have, and make sure you have enough coverage. If you are a renter, strongly consider purchasing renters insurance. If you rent and do not have renters insurance, you can lose everything.

During the Disaster

*You are not replaceable! First and foremost, do not take unnecessary risks to save material items. Your safety is more important than anything else.

*Communicate your needs- If you find yourself in a situation where you don’t have the medical supplies or medications you need, don’t wait until you run out to tell someone you need help. Shelters usually have volunteer nurses/medical staff on site. Talk to them and any other organizations who are on site to let them know you need help. It takes time to get supplies and medication arranged so giving medical staff a heads up before you run out is best. Use UOAA’s list of Emergency Supply Resources or contact a local support group in the area you have been evacuated to if you need help locating supplies.

*Know your rights- If you live in a federally declared disaster area, you are entitled to replacement prescriptions and medical supplies. Call your insurance company to find out what you need to do to replace what you lost. If you are covered by Medicare, information regarding replacing lost medical supplies in a disaster can be found on their website www.medicare.gov or call 1-800-MEDICARE.

*Register with Red Cross and FEMA- If you are impacted by a disaster, the first step in accessing assistance is to register with these organizations so they know you are among the affected.

The Aftermath

*Recognize the impact of trauma- Once the disaster is over, the news trucks leave town and the rest of the world goes back to their normal routine. In the impacted community, the devastation of what occurred remains and nothing is the same. Almost 5,000 homes were lost in my community. I have friends that are still displaced over 2 months later. Entire sections of town are gone and we drive by them every day. We drive by places where we know some of the 45 people died. Trees are frozen in time, charred but forever arched in the wind gusts from that night. The smell of smoke still lingers in certain areas. Toxic ash still kicks up into the air. Rows of chimneys are the only thing that remains in many neighborhoods. Several schools burned down along with many businesses, taking those jobs with them. Housing is extremely difficult if not impossible to find. People are still living in their cars and camping in parking lots. The people who lost homes are of course grappling with overwhelming trauma, but the trauma also impacts anyone who lived through that night. Driving through flames and watching your friends’ homes burn down are not things that are easy to forget. Once I knew our home was going to survive, the survivor’s guilt crept in. Recognize what you’ve been through and seek out professional support if you need it.

On behalf of Sonoma County CA, thank you to every first responder who came to help us fight this devastating fire. Thank you for fighting flames at the walls of our hospitals and thank you for saving the thousands of homes you were able to save.

For more information on how to prepare for a disaster, visit www.redcross.org , www.fema.gov and www.ready.gov