Episode 4: Unpacking Ostomy Care

Joy Hooper (00:34.148)
okay. Okay. And how do you pronounce your name? Kara. Okay.

Cara Lunsford (00:38.467)
Kara. Yes. So Joy Hooper.

Joy Hooper (00:45.828)
Hello!

Cara Lunsford (00:49.859)
you know, it was really funny. I'm going to say that yesterday when I was looking at the calendar invite, it said, ostomy, and then it said your name, which was joy. And then I was like, ostomy joy. I was like, maybe we should just call the episode ostomy joy.

Joy Hooper (01:09.444)
Yeah, man, yeah, man. And for, you know, there's a lot of joy to it. There really is, there really is. Because actually, ostomies can give people their lives back. They really can, they really can. Take somebody with Crohn's disease who has 30 bowel movements a day. The body's not even designed for that. But nonetheless, that person is living their life in the bathroom. They really are.

Cara Lunsford (01:16.707)
There is a lot of joy.

Joy Hooper (01:35.236)
And so you give them an ostomy and now all they have to do is learn to manage that pouch and they've got their life back. So yes, there is. Yes, there is. Yes, there is.

Cara Lunsford (01:35.651)
Yep.

Cara Lunsford (01:43.587)
So there is Ostomy Joy. Now we know the name of this episode.

Joy Hooper (01:52.996)
Good deal. Good deal. Good deal.

Cara Lunsford (01:57.027)
Well, Joy, tell me a little bit about yourself. Tell me, tell me like who you are, what you do, how you got started in all of this. How long have you been a nurse? All of it.

Joy Hooper (02:09.188)
I started nursing in 1992 as an LPN and I worked in endoscopy, really enjoyed it. But after a couple of years, I was ready to go back to school and become an RN. And as luck would have it for me, my very last patient had to go through ostomy surgery. I was familiar with the OR, but really my outlook on the OR was it's cold in there.

And I was used to really just bringing the endoscopy equipment down and working with that. But this would be a time that I would get to go in and watch somebody go through the surgery. Now, I was familiar with what ostomies are because I had taken care of them as an LPN. On the weekends, I would do home health. And so I got to see ostomy patients doing home health.

But watching it in the OR that day, it totally changed how I looked at ostomies and it totally changed how I was looking at my nursing career too. Because what I saw that day in the OR, I saw them wheel in this man who was literally on death store and he looked like he was on death store from a bowel obstruction. He was not an old man. This guy was in his 30s. And...

I just remember looking at him and thinking of the similarities with my husband. This guy owned a stucco business and my husband had done a lot of construction and I was thinking, how would this affect my husband if he was still out doing construction? And I realized I really didn't know a lot about patient teaching at that time. Well, I'm watching them set up the OR, I watched the doctor come in and the doctor, the surgeon was actually pretty new at the hospital.

And during the procedure, he did a lot of teaching. He explained everything that he was doing. And I remember thinking, wow, I understand ostomy so much better, you know, from this example that he's giving and teaching this from the inside out. I understood ostomy so much more. And I was starting to think about different patients that I had taken care of and why their output was so caustic to their skin because it was coming from the small intestine. And...

Joy Hooper (04:28.1)
and why other ones, their output, you know, was thicker because it was from the large intestine. And of course I knew this, but I was just thinking about it in different ways since now the GI tract was being, you know, being taken apart. I remember thinking they should be teaching us this from the inside out because I just really am understanding ostomy surgery so much more. But I watched him do the surgery and I was thinking about a teaching plan that I was going to have to do about this patient.

and really thinking, I don't understand enough about it, especially now that I have this new bit of understanding of how this thing really functions. And after the class that day, after my clinical that day, I went back to the home health office and I started looking at different supplies because back in the 90s, and this was, I think 1994, back at this time,

The companies used to send, the manufacturers used to send us notebooks with samples of the products in there. And so I went back and I was looking at these products and I was looking at closed ended pouches and these different filters. And it was like, wow, I've never really paid attention to all these supplies before. And one of the other nurses that worked at the home health company came by and she said, you know, if you like ostomy so much, you should be an ostomy nurse.

And I remember saying, well, I am, I'm going to be an ostomy nurse. And I did not know what that meant. Later that night, I found out what that meant and it meant I was going to have to have a bachelor's degree, which was not what I was working on at that time. I was finishing my associate's degree. But that night I well remember telling my husband and I started the conversation with, now I know you think I'm going to be graduating from nursing school and working full -time in two weeks. So he knew I was getting ready to drop a bomb.

And that was, I saw something today that I really feel like I'm supposed to do. I'm supposed to be an ostomy nurse and I can be an ostomy nurse if I keep going to school and get a bachelor's degree. And then when I graduate, I can go to Emory and I can take a course up there and I can learn how to be an ostomy nurse and I will also learn wound care and I'll learn continence care. And I can come back here and I can work in this area where we totally don't have nurses like that now.

Joy Hooper (06:51.524)
That's what I wanna do. That's what I feel like I'm supposed to do. And I never took my eye off the ball. I finished the associate degree, rolled right on into my bachelor's degree, and then luckily was able to take the WCN course at Emory University. I took that, came back, did clinicals, and then obtained an acute care job. And that was when I really learned.

Cara Lunsford (07:15.363)
Wow.

Joy Hooper (07:18.34)
how hard it is to teach somebody about ostomy surgery after they've had it. Because after you've had surgery, you don't wanna learn about the surgery. You wanna go home and kinda just bury your head in the pillow and think everything's gonna be okay. But there's a big learning component that has to come with this to make somebody self -sufficient at home. And I was always looking for a tool that would help me explain ostomy surgery and I wanted something

that would take the person to that OR and show them how their bowel had been changed. I wanted to show them, this is your GI tract before surgery. So many people are already familiar with that. And then I wanted to be able to manipulate the bowel and say, this is how your surgery was done. And then show them how their bowel or intestine would be after surgery. And that's what I wanted to do, but I never could find a tool to do it.

And it was in, I believe, late 2003 that a man came into the hospital and he had a bowel obstruction. He had to go through ostomy surgery and have an ileostomy, the same kind of surgery that I watched the man go through, you know, years before. And this man was just so very depressed and he was so hard to reach. And I knew I had to come up with some kind of tool to shock and awe him. It was back during...

President Bush's shock and awe time. And I wanted to shock and awe him with a teaching tool. And that weekend, I devised a teaching tool and I went to Walmart and got a craft apron, some red felt, sewed it on there. Well, I actually didn't sew much of it on there. I pasted it, I stapled it and I pinned it.

And when mom got home from church, she cut the bottom of the apron off and made these little arms like on it that would simulate the front of the apron, you know, simulate the abdomen. So I could take it apart, pull that piece of intestine through and fold it over and show how it was sewn down. So I could show him, this is your GI tract before surgery. This is what they're going to do. And this is it afterwards. And that was on a Sunday that I put it together.

Joy Hooper (09:34.692)
And the next day I carried it into him. And I remember I was so excited. I was at that hospital walking in that guy's room at like 6 .45 in the morning with his bright white apron with his vivid red GI track on it. And I had gone over my explanation of what I was gonna say. And I hit the floor running that day explaining about how you chew your food and it goes down your esophagus and into your stomach.

And that poor man was laying there in that bed and his eyes were as big as saucers. But I just kept going. And I said, now I'm going to explain a colostomy to you. This isn't your surgery, but I just want you to see how this is done. Because I wanted him to see me take the GI tract apart and pull some of it through and, you know, sew it down on the front of the abdomen. I wanted him to see that so it wouldn't be so much of a shock to him when it was.

his surgery I was explaining. And so I explained the colostomy surgery and I said, now I want to explain your surgery, which is an ileostomy. And he said, well, just a minute, let me sit up. And he wanted to sit up on the side of the bed so he could watch me and take in what I was doing. And I thought, I've got him, I've got him. And I had him right there in front of me and I was able to explain his surgery. And he followed everything that I was saying. And when I got through,

I said, do you understand that? And he said, yes, I do. And I want to tell you something, lady, you have taught me something. You need to patent that apron. He said, did you make that? And I said, yes, actually, I made this just for you so I could explain this. And he said, well, you need to patent it because I understand what you're talking about now. And it was a big breakthrough. Yes, I did. I did. I patented and I actually sell these all over the world now.

Cara Lunsford (11:20.227)
Did you patent it, Joy? Good for you!

Joy Hooper (11:29.828)
And this has been, it's been the biggest door opener in my career.

Cara Lunsford (11:35.619)
Can you show me how it goes? So, okay, for the listeners who can't see this, but I'm gonna make sure that this part of it gets unsocial. So this is the part that you see inside, but you had mentioned that you bring it around the front to create a, wow. And then do you have the body? So you bring it.

Joy Hooper (11:44.388)
Hahaha!

Joy Hooper (11:51.684)
Yes!

Joy Hooper (11:57.316)
I can.

Cara Lunsford (12:01.475)
You take it apart and then you come around and you create like the outside of the abdomen. this is awesome.

Joy Hooper (12:02.276)
Yes.

Joy Hooper (12:07.396)
Yes, I can show how it's taken apart, how the GI tract comes apart, how you would pull that through. I'll send you a video of doing this procedure. I can fold it over and suture it down and then show that person what their GI tract is going to look like after surgery with a stoma. And then of course I can do that with a small intestine as well. And being able to show somebody,

Cara Lunsford (12:18.019)
This is so cool.

Cara Lunsford (12:30.019)
Wow.

Joy Hooper (12:37.604)
this can make a big difference in their understanding. And to me, it's really important for somebody to understand their surgery, especially when they've had an ileostomy. Because when you manipulate the small intestine and separate it from the large intestine, the person no longer has that large intestine drinking for them anymore. And so it's really important for them to drink extra fluids.

so they're not dehydrated. And with this, I'm able to show them that separation. And so it just makes it easier to explain this. And I've explained this to children. This little thing has helped me go to Capitol Hill. I've actually used this on Capitol Hill three times explaining to the representatives and their aides what ostomy surgery is. And I do, I do.

Cara Lunsford (13:05.059)
Right.

Cara Lunsford (13:28.099)
Do you sell this? Do you sell it to osteoimmune? How do people find it? Are you on Etsy?

Joy Hooper (13:35.492)
It's, I'm not on Etsy. I have my own website. It's apronsbyjoy .com and I sell them to nurses. I sell them to a lot of nursing schools. I sell them to a lot of hospitals and...

Cara Lunsford (13:50.083)
This is the best thing I've ever seen. I've been a nurse for 17 years. I'm like, and I did home health and I've done ostomy care. And I'm like, this is maybe the best thing I've seen in a long time.

Joy Hooper (14:00.388)
Well, thank you. Thank you. You know, I had been thinking of creating something like this on a poster board and because I was doing different sessions, different in services at a lot of nursing schools. And the only thing that stopped me from doing that is whenever I would visit the nursing school, I usually had to park in a parking lot way away from wherever I was going. And I didn't want to have to walk across that campus with this big poster board blowing in the wind.

And that really was what stopped me making it. But that day I realized, hey, I've got to, or that weekend I realized, I've got to create something to help this man understand this. And what I did, actually that morning I thought, you know what, I'm going to bake some cookies because I'm really more creative when I cook. And I put on an apron and it was my aunt's old apron, my aunt that was a nurse. She had passed that apron down to me and I put that apron on. And when I was tying it,

I looked down and I thought, my, I could put an apron on a GI, you know, a GI track on an apron. And wow, I think I could, my hands would be free and my mind just started racing. And I took the apron off and I told my husband, no cookies, man. I am headed to Walmart because that, I live in a very small rural area. We don't have a Hobby Lobby or a Michael's or we didn't have a Joey and Fabrics at the time. And I wish I did. The story would have just sounds so much more.

classy if I didn't have to say that I would.

Cara Lunsford (15:30.019)
No, this story is great. Like this is exactly where people need to understand and learn is like how to harness those innovative ideas and work with what you've got. Like you just, you basically took an apron and then you took felt and I'm sure like the V1 of this, the version one of this was not nearly as built out as what I'm seeing here. But I'm sure.

Joy Hooper (15:49.164)
Mm -hmm.

Joy Hooper (15:56.996)
no, no, no, no, no. And prototype number six, nobody saw because I sewed over my finger and blood was all over the apron. So nobody saw that. And I couldn't sew well at the time at all. I've learned to sew now because I have had to do some in between, but we found a sewing contractor and I did a worldwide search for a sewing contractor and found one 33 miles from me.

And he made my first several thousand, my first several hundred aprons. But I went back to get another larger quantity of them and he had this big contract with the government at that time. And he was just too busy for me. And so I had to find somebody else. And I was talking to one of the other vendors, his name is John Newton with PolyMEN, at one of the conferences. And he said, Joy, you need to find the Mennonite women and get them to help you.

And lo and behold, I did. And I've got a couple of them that have been sewing these aprons for me since I think around 2016 or 2017. And they can sew like nobody's business. And they sew them for me and I just give them the parts. I get the parts from a sewing contractor up in North Georgia whose wife had ostomy surgery a couple of years ago.

And it's so weird how ostomy is just all through this apron because the first sewing contractor, the head seamstress, her sister had just been through ostomy surgery. And so seeing this apron, I mean, to her, it was like, my gosh, now I understand the surgery that my sister had. And so it's just weird how ostomies have just really, really, yeah, been woven through this.

Cara Lunsford (17:41.667)
It's amazing. It's amazing.

Joy Hooper (17:45.284)
But it has been such a blessing in my life. It really has. I totally enjoy working with ostomy patients. Explaining the surgery is probably my favorite part of it. But I really have a passion for it. And it's a passion that was born in the OR that day, watching Dr. McKeechan do ostomy surgery in Tifton, Georgia back in 1998. And I still get goosebumps thinking about that life saving surgery that he did on that guy that day.

And for that man, it was a temporary surgery, but for me, it was permanent. It was permanent. The fire that it put in me to be passionate about this. And there's room for passionate ostomy nurses out there. There is a lot of room. We need so many more ostomy nurses. We really do. There's a shortage of them. And we've got certifications for all nurses, LPNs, RNs, nurse practitioners.

The certifications are out there and we need more nurses doing this. We really do.

Cara Lunsford (18:49.475)
That's amazing. So what are your, so I'm thinking back, you know, as I listen to you, I'm thinking about the patients that I've had over the years, the home health patients that I've had. It's, I always felt like it was such a satisfying thing to be able to do. I think it was because,

I felt like I was able to actually fix something. There was something so satisfying about, you know, taking care of the skin, making sure that if there was a problem that I knew, you know, maybe like how I could make it better, especially if the person's having a lot of discomfort. I also love the psychology of talking to people through difficult things. It's a tough thing having...

your stool outside of your body, you know, that there's a lot of psychological effects that patients have when they have to deal with that. And so it was just a satisfying thing for me as a nurse to feel like I could take care of patients like that. How did you, like when you're teaching people, like once it's done,

and you're teaching people how to care for their own, for their own sight. Can you, cause I know that nurses who are, are newer nurses who are listening to this, who maybe don't have any experience or thinking like, okay, how, you know, if I have a patient who has an ostomy, what are like the top five things that I really need to have at the forefront of my mind when I'm taking care of an ostomy patient?

Joy Hooper (20:43.012)
you need to have good understanding of the surgery so you know what you're talking about. If you're talking about small output, if you're talking about output from the small intestine, or if you're talking about output from the large intestine. You know, really also if you're talking about output that's coming from the urinary system too, because there's your urostomies and what a lot of people don't understand when you're dealing with a urostomy patient is that,

had substantial surgery on their GI tract as well. Because when they make a urostomy stoma, they don't make it out of the ureter or the urethra. Those make horrible stomas because they're such small little structures. What they actually do is go to the small intestine and rob a piece of the ilium. And then they take the ureters and connect them to that little conduit of ilium that they've robbed from the small intestine.

They have them going down into it and then they bring that piece of the ileum out and that's what they make the stoma out of. That's why the stomas for ileostomies and urostomies look so familiar is because they're from the same thing. But what people don't know is the small intestine secretes a lot of mucus and that mucus is going to end up in that urostomy pouch because it sloughs off of that little conduit and then the urine brings it right on out into the pouch.

So as an LPN, I never understood why is all this stuff in this urine and how can this be okay? It's clearly not okay for all this stuff to be floating around, but it is okay because it's just coming right off of that little conduit.

Cara Lunsford (22:26.467)
So when you say off of the conduit, so when you're having, when they're pulling through that ilium, that small intestine, so essentially if you have a urostomy, you also have an ileostomy, or you don't.

Joy Hooper (22:42.148)
No, no, no, you don't have that. But what it is, is they separate this. Let me put some kidneys on here so I can show you this, okay?

Cara Lunsford (22:54.371)
This is like, this is the best thing ever. See, this is just goes to show you that even if you've been a nurse for over 10 years, it doesn't mean that you know everything there is to know, especially when it comes, I mean, I've had patients who have had a Urostomy and I was, and I obviously I noticed that it's coming through some form of an Ilium.

Joy Hooper (23:05.988)
Ha ha.

Cara Lunsford (23:20.067)
of some kind. I was like, I can't imagine they're taking the ureters and pulling this through.

Joy Hooper (23:25.924)
No, no, what they do is most of the time, say with bladder cancer, they're going to remove the bladder. Now they could bring the ureters out, but you would have two, you'd have a ureterostomy. And then they could connect one on the inside and bring the other one out. That's a uretero ureterostomy. But again, they make really horrible stomas because they're so small. So what they usually do is they separate a piece of the ileum.

and then put the GI tract back together. Now they don't take the piece of it out and wave it around like a freak flag like I'm doing right now. It has got to stay connected to that blood supply. So the surgeon is just manipulating this around in the abdomen, but they isolate this section of small intestine from the ilium, close one end of it off, and then they bring the ureters down and connect them.

Cara Lunsford (23:58.371)
Joy Hooper (24:22.372)
to this little piece of ilium and it's going to be a conduit. It's going to be a conduit. Let me get the front of it right here. It's going to be a conduit and they're going to bring the end of it out and this is where the urine is going to exit the body. And since it was from the GI tract, that little section, it's going to be secreting mucus that is gonna end up in the pouch.

Cara Lunsford (24:32.131)
Fascinating.

Cara Lunsford (24:38.659)
Yep.

Cara Lunsford (24:52.131)
I love that when you fold over that felt, it looks exactly like a stoma.

Joy Hooper (24:57.316)
Doesn't it though? Doesn't it? It looks like the stomas we want to see. That's what it... Yes.

Cara Lunsford (24:59.171)
It looks, well, it looks like that beefy, the beefy red stoma that you want to see. So like for people who are just listening to this, it's like you're folding it over and it literally like inside out, kind of like how you would do with a sock, right? Like when you're making, when you're like cuffing, you're cuffing it over, it literally, you pull it through the apron and then you cuff it over and it looks exactly like a stoma.

Joy Hooper (25:06.98)
yes.

Joy Hooper (25:16.804)
Yes, yes, cuffing it over.

Joy Hooper (25:26.82)
Yes, it does. Yes, it does. Yes, it does. Thank you. Thank you. I've enjoyed working with it. I just, I love working with it. I do. I love explaining the surgery because most people, I would say like 99 % of the people have no idea what's happened in their body and they don't know what that red thing is. And not only the patient, unfortunately, many nurses don't. And to be honest,

Cara Lunsford (25:28.099)
That's amazing. I love it. I love it. I...

Joy Hooper (25:54.308)
I really thought, I made good grades in nursing school, both for my LPN and associate degree, but I really didn't understand what was going on with an ostomy until that day in the OR. And that's why I was just so fascinated with it. I was like, more people would like this if they knew what was going on in here. And I can't say that I fully understood everything about where that stoma had come from.

Cara Lunsford (26:12.035)
Yes.

Joy Hooper (26:20.452)
Not as much as I did until I saw the surgery. And so that's what I'm trying to replicate with this apron.

Cara Lunsford (26:24.035)
Yeah.

This is so, it's just so cool.

So, okay, so knowing the origin, right, of that ostomy, really understanding, like you said, coming from the large intestine, coming from the small intestine, or is it coming via a conduit of the small intestine via your ostomy? I'm not even going to attempt to say the words that you said if you're using two ureters versus one ureter. Let the listeners, you can rewind and listen to her.

Joy Hooper (26:45.284)
Yes.

Joy Hooper (26:55.108)
Mm -hmm. Mm -hmm.

He's like, ha ha ha ha ha ha.

Cara Lunsford (26:59.013)
say that. But then the output that's coming from each of those, okay, so what if it's coming from the large intestine, what are your biggest concerns?

Joy Hooper (27:13.188)
If it's coming from the large intestine, that's the stool that's thicker. With that, the person is usually more concerned about gas and odors. Since the stool is formed most of the time, or at least semi -formed, it usually can be easier to get that stool in the pouch, and it can be easier to manage, as long as the person has somewhat of a protruding stoma.

And a lot of people think that if I had a stoma, I would want it flat on my abdomen so you couldn't see it. No, you would not. You want it to protrude a little bit and you want it to protrude so when you put your pouch on, your output drops into the pouch. So I explained it to the patient like a faucet.

I said, you know the faucet on the front of your house, it projects the water outward. It's not that you have a cork in your wall and you go and pull the cork out and the water runs right down the front of your wall. If that was the case, it would be undermining your foundation. And with a protruding stoma, like that water is being pushed away, this is going to propel the stool outward so it can drop down into your pouch.

really you have to sell somebody on that protruding stoma because especially a woman, she's gonna think, I don't want that. Where I can honestly say, no ma 'am, you do. If I had an ostomy, I would want one just like yours that sticks out because it's going to make pouching so much easier for you. It's not that it's going to be terribly difficult for that person that has that flush or retracted stoma to pouch. I mean, we do have convex products.

But usually it is just going to be easier to manage one that has some protrusion there.

Cara Lunsford (29:05.411)
I think if it were me, and this is just because I'm a tattooed person, so you can't tell because I have a sweatshirt on, but I have a lot of tattoos. And I was thinking to myself, if it were me and I had to get a stoma, I would ask the surgeon, okay, where are you going to do it? And then I would get a rose. I would get a tattoo.

Joy Hooper (29:29.732)
Yes!

Cara Lunsford (29:32.291)
of a rose in the area, like probably like fairly large so that the stoma could be like at the center of my rose. This is what I would do. So for anyone who's listening who's like, you know, because a lot of women like, like they have to have mastectomies because of, you know, there's just things that are changes or alterations to your body. And I know that a lot of women who have had mastectomies, for example, they,

Joy Hooper (29:41.028)
yes.

Joy Hooper (29:49.572)
Mm -hmm.

Joy Hooper (29:54.116)
Mm -hmm.

Cara Lunsford (30:01.091)
have had tattoos, you know, like across their chest, you know, that they feel beautify them in some way, you know, so, you know, if you're a tattoo like person, like me, maybe that's an option.

Joy Hooper (30:04.484)
Mm -hmm.

Joy Hooper (30:14.148)
I have seen some of those. One of my favorite is this guy on social media had an outhouse tattooed and it looked like plumbing from the outhouse went to the stoma. That's one of my favorite all time ones. As soon as I saw that, I had to reach out and say, can I have permission to use your photo? This is just too good. Yeah, I've seen some good ones. I've seen a lot of like blue ribbons because blue is the color for.

Cara Lunsford (30:36.451)
That's amazing.

Joy Hooper (30:42.372)
colorectal cancer awareness. So I've seen a lot of the blue ribbons. I've seen a lot of birds. I've seen a lot of hummingbirds and many, many dragonflies.

Cara Lunsford (30:44.355)
Okay.

Cara Lunsford (30:52.995)
Yeah. And I'm just going to say, like, I don't know if you agree with me, Joy, and feel free to disagree, but I think that you should do the tattoo and let it heal first. Then have, don't, don't do it around your stoma. Or I guess you could. Yeah.

Joy Hooper (31:03.62)
I would think.

Some people have, now they don't go really close because I mean, you could have output during the time. So I would think it could be a messy, messy tattoo for a while. But you know, whenever...

Cara Lunsford (31:17.667)
Yeah. Yeah. And just like from a cleanliness perspective, like you don't want it to get infected and you're like penetrating like the area around. So I'm just telling people like, hey, if it's something you're going to do, you might want to do it ahead of time.

Joy Hooper (31:35.684)
Yeah, that's true. That is true. That is true. And you know, we usually cite stomas. I'm not sure if you know that, but before somebody has ostomy surgery, many times the surgeon is going to have that ostomy nurse cite the person for the proper placement. So what we do is we have the person get multiple positions. We have them bend over, you know, we have them sit down, we have them lay down.

and we look at their abdomen in these different positions and as they're going from one position to another, looking for folds in their skin or creases that happen when they change position because you want the stoma to end up on a flat plane, you know, for good pouching. So we're usually citing them before whenever we get the chance. Not everybody has. Yes, yeah.

Cara Lunsford (32:18.243)
Yes. Yeah.

Cara Lunsford (32:23.875)
Yeah, if it's not an emergency, yeah, if it's a bowel obstruction, I'm sure like that, you know, sorry, probably don't have time for. Yeah, but but yes, agreed like that. There's a lot of prep that goes into that. So so. Gas smell odor.

Joy Hooper (32:28.964)
Mm -hmm. Yeah, we gotta get you in the OR. Yes. Yes.

Joy Hooper (32:41.86)
Gas and odors would probably be the biggest thing for somebody with a colostomy. They're not going to have that many dietary changes with theirs. The output is not really that caustic on the skin. You don't want it on the skin any longer than possible, but it's not as caustic to the skin as the output from the ileostomy. Now, the person with an ileostomy, they're going to have different dietary changes.

Cara Lunsford (32:47.587)
Okay.

Joy Hooper (33:10.788)
We've got to watch out for bowel obstructions. So we're going to tell them you can still eat fibrous foods But you need to chew chew chew really well You need to space those fibrous foods throughout your day. Don't sit down to a great big high fiber meal Space them throughout the day and drink plenty of fluids drink plenty of fluids because you no longer have your large intestine drinking for you anymore And another thing so that's you know with their diet

But with their pouching, if this person feels any weird sensation around their stoma, any itching or any burning, it's important that they change their pouch right away because it could be leakage. And when you have leakage coming out from the ileostomy stoma, it is very, very caustic because I said the large intestine drinks for you, the large intestine eats for you. That's where your food is being broken down. So it's a very, very caustic environment.

So I mean, goodness, if the small intestine can break down steak and cabbage, it's gonna melt my skin down like butter. And that's what it does. And so we've got to teach that person about pouching, about the importance of getting the output off of their skin when it gets on there just as soon as possible. So for them, there's going to be dietary changes, and then we really have to emphasize on pouching as well. And then,

somebody's stoma can come with its own complexities depending on if it's a long stoma or if it's a short or retracted stoma even.

Cara Lunsford (34:49.219)
So sometimes like even if it starts out more, like if it's protruding more in the beginning, it can retract and start to become more flush or against the skin or even further.

Joy Hooper (35:01.7)
It can and during the first six weeks, the stoma is going to shrink down in size, usually six to eight weeks, something like that. It's going to shrink down into size. So you usually lose some of the size there. Hopefully not all the protrusion is going to be lost, but some of it may be.

Cara Lunsford (35:21.763)
Okay. So.

Joy Hooper (35:23.332)
But some people start with a flushedoma to start with, and it's not like the surgeon is setting to create a flushedoma. You know, the surgeon's gotta work with what he's got. And this might be somebody that's got short bowel, but nobody knew it because they never had surgery before. But they have short bowel, and it's all the surgeon can do to get that piece of intestine up to their skin.

Cara Lunsford (35:40.483)
Right.

Joy Hooper (35:48.452)
And you know now we have a lot of people with increased adiposity on their body and this piece of intestine is gonna have to come up through all of that adipose tissue. So short bowel, increased adiposity on the abdomen, those can tend to make that stoma end up being a shorter stoma as well.

Cara Lunsford (36:10.947)
Yeah, that makes sense. And then when you're so I know that I always used to get a little stressed out when I was measuring, you know, and and trying to make sure that the hole that I was creating wasn't too big, wasn't too small, wasn't restricting blood flow to the stoma like the I always was just

Joy Hooper (36:25.828)
Hmm?

Joy Hooper (36:29.316)
Mm -hmm.

Cara Lunsford (36:31.331)
especially as a home health nurse, if I knew that I wasn't gonna be back for a week or if I wasn't gonna be, I was like, my gosh, what if I make this too small? I come back and it's all gray and you know, like what if I do something and I restrict the blood flow to it? Like I was always really nervous about that when I was first learning. And so what are some good like tips and tricks for that?

Joy Hooper (36:36.452)
Hmm?

Joy Hooper (36:49.22)
Mm -hmm. Mm -hmm.

Joy Hooper (36:59.332)
Well, it used to be that you wanted about an eighth of an inch in between the stoma and the edge of your skin barrier. The skin barrier's the wafer. And we used to have to have space in there because the skin barriers were rigid. The hydrocolloid, you know, was really rigid. But over the years, these things have evolved. And they make skin barriers now that have elasticity to them.

Cara Lunsford (37:09.699)
Yes.

Joy Hooper (37:26.724)
And so even though they've got that little tiny small starter hole, you can ram your finger through there. And I mean, it's not like cutting off the circulation on your finger. And so now most manufacturers, pretty much all of the big three here in the United States, the instructions are cut the opening to fit the stoma. And they can be up closer to the stoma now because of this increased pliability to them. And then,

Cara Lunsford (37:52.003)
Yeah.

Joy Hooper (37:53.54)
The accessory products that we use, like the moldable rings, those can touch the stoma. And we've got so many different accessory products to make somebody's life easier with an ostomy. For instance, if you've got an ileostomy or a urostomy, your output is almost steady when you're changing your pouch. But there's little tools now, like this little tool right here. This is an absorbent capture cartridge.

that you would put over the stoma to capture the output that's coming out of it during your pouch change. So now you're free to clean around the stoma and your output is gonna go into this capture cartridge. And when you get through, you cap it and throw it away. Isn't that amazing?

Cara Lunsford (38:41.571)
That's great. Yeah, because it would always like, you're like racing to try and like get this and cleaning and trying to make sure that it doesn't get on your clean and your dry site and your it's because you know that it's not going to adhere right. And I'm also I haven't.

Joy Hooper (38:53.348)
Yes.

Cara Lunsford (39:01.187)
done it in a while. So there's new and exciting things that obviously are being used. When you showed that, you know what made me think of? I have a boy and so they had this thing, these cups where you could put it over your child's penis while you're changing them so you don't get shot in the face. Yeah, so you don't get like pee in the eye, you know, because that's boys, they just like pee at you when you're changing their diaper.

Joy Hooper (39:07.908)
yes.

Joy Hooper (39:19.3)
-huh.

Joy Hooper (39:22.692)
Yes! Yes!

Joy Hooper (39:29.796)
Mm -hmm, mm -hmm.

Cara Lunsford (39:30.755)
So there was like this little like kind of cup you can put over the top of it so that you don't that doesn't happen So when you were showing that I thought this is kind of like that

Joy Hooper (39:41.188)
It is, it is, it is. And they have helped so many people and not only can they help capture the output, you can actually use this as a guide if you can't see your stoma and see if somebody has an abdomen that has a contour that goes down and their stoma is down here, they're not going to see it low on their abdomen. So you could use this as a guide to seek that skin barrier down. And that's just an example of one of them.

Cara Lunsford (40:02.947)
Yeah.

Joy Hooper (40:10.692)
many, many tools that we now have for ostomies. No, there's actually just one manufacturer here in the United States. It's Stomagenics, and this would be called the Stomagene. It's been out since around maybe 2018 or something like that. They make these in multiple different sizes, and you know what, Medicare covers these.

Cara Lunsford (40:13.923)
Is that made by several manufacturers?

Cara Lunsford (40:30.659)
Tomagenics.

Joy Hooper (40:36.164)
They can get like 30 of them a month and I think they're in 13 different sizes. So very, very cool product. Very cool product. Yes it is.

Cara Lunsford (40:44.035)
That is cool. my gosh, I had never heard of it before. I was kind of assuming, well, there's probably a few manufacturers, but so interesting that it's just stomagenics.

Joy Hooper (40:54.02)
And you know, it really to me has helped me bring other nurses into the fold because a lot of nurses think, that's going to be dealing with stool or that's going to be dealing with urine if I'm working with ostomies. No, no. With tools like this, you don't come into contact with it. You've got something there to capture it. And you know, we as nurses, as individuals, we've got what we like and we've got what we don't care for.

Cara Lunsford (41:23.491)
Yeah.

Joy Hooper (41:23.62)
And we need more nurses doing this. So tools like this that can get over the yuck factor, which ostomies tend to bring for many people. gosh, it's so beneficial, so beneficial.

Cara Lunsford (41:39.139)
Well, and it's probably for like patients too. I mean, like a lot of, I mean, nurses sometimes are kind of like, whatever, poop, like I deal with it, you know, like stool, you know, for, I'm like poop, like I'm 15. But we're used to dealing with a lot of, you know, output of different types, vomit or stool or.

Joy Hooper (41:47.012)
Mm -hmm.

Joy Hooper (41:51.268)
Yeah.

Joy Hooper (42:01.988)
Yes, yes, yes.

Cara Lunsford (42:06.947)
But patients are not necessarily and they do get grossed out by their own stuff. And so I think like, you know, even if like they needed help from their, their spouse or someone like that, it makes it a little bit more like, could you help me with this, but you feel comfortable that you could ask for help maybe because you could just put this over the top kind of covers it makes it seem like, you know, I just need you to do this, this and this and

Joy Hooper (42:32.484)
Mm -hmm.

Cara Lunsford (42:36.259)
People don't necessarily have to see even the stoma and they don't have to see the output that's coming from the stoma.

Joy Hooper (42:42.5)
You know, it's really embarrassing for the person when they're working with the nurse. It's not embarrassing for the nurse at all, but for the patient, when they have output, when they have these surges of output and we're trying to assess the stoma or the peristomal skin, or maybe we're trying to do crusting on an area that's irritated and we need to keep that area clean and then out comes more stool or out comes more urine. It's embarrassing for the patient.

It really is, and I guess you can't help for it to be, but it is. And if it can come out and go into a capture cartridge like this, there goes the embarrassment at least of that part of it.

Cara Lunsford (43:23.171)
I sound like I'm doing an ad for Stomagenics, but I'm really not. Like, I was like, it totally sounds like I'm doing an ad for them, but I'm just really pleasantly surprised to see that there is an option for this because I'm thinking...

Joy Hooper (43:26.148)
no.

Cara Lunsford (43:38.531)
all those things in my head, everything you just said about how when you're just trying to do your job and then you're feeling like you have to comfort your patient, you're like, it's okay. I see this all the time. This is not a big deal. I'm always up to my elbows in shit every day. When you're trying to lighten the mood and...

Joy Hooper (43:57.156)
Ha ha ha ha ha ha ha ha ha ha

Joy Hooper (44:03.46)
Yes.

Cara Lunsford (44:05.347)
kind of bring some humor into it and stuff like that. Sometimes that's all you can do. And it's nice if you can just kind of take that out of the conversation a little bit. And you can just really be able to focus on what you're doing is really amazing. So yeah, I had no idea that a product like that even existed. So that's very cool.

Joy Hooper (44:16.868)
Yes, it is.

Joy Hooper (44:25.508)
yes, there's some cool things in the ostomy world. It's a big world. It is a big wonderful world when you're talking about the ostomy world. And they've got conferences, you know, they've got organizations, they've got support groups. And we've got the Wild on Wounds conference coming up. I can't wait for that. I love these conferences.

Cara Lunsford (44:27.875)
There's some cool stuff.

Cara Lunsford (44:42.211)
We have the Wild on Moons conference, which is this year.

Joy Hooper (44:49.86)
And then going along with the conferences, I'll be teaching one of the ostomy management specialist classes. So we'll be bringing more nurses into the fold. But you know, we don't just certify nurses. We also certify physical therapists and occupational therapists, physicians as well in this. It really is a great course. It really is.

Cara Lunsford (45:10.211)
That's amazing.

I love it. I love it. Well, I am. I love this episode. I know I say this. I say this all the time because the listeners are like, Kara probably loves every episode that she does. I do, though. I just have I am so fortunate to be able to interview some of the most interesting people. And you have not disappointed at all.

Joy Hooper (45:25.476)
Hahaha!

Joy Hooper (45:40.068)
Yes, yes, yes. I was listening to one of your earlier podcast this morning. I was listening to the one by Tracy Rogers, who also worked for the Wound Care Education Institute and teaches wound care and the diabetic course. Yes, and I saw all the other podcasts that you did. Yeah, yeah. I bet you enjoy your job. I bet you do.

Cara Lunsford (45:49.667)
Yes.

Cara Lunsford (45:56.099)
Yes.

Cara Lunsford (46:00.003)
I have, there's, I do, I do. When my boss asked me to start a podcast and I was like, okay, because there's lots of other things I do for nurse .com, but I had no idea how much I was going to enjoy it. I mean, I love people and I love talking to people. So I guess I was a natural choice for it.

But it's really been one of the highlights of my job is that I get to have these opportunities.

Joy Hooper (46:36.228)
Good deal. Well, when I was first asked about the podcast, they asked me about the wound care. And I said, you know, I can't speak passionately about that. I'm not your girl for this one. If they want to talk about ostomies now, I am there. I am there. And I am so glad that you were willing to talk about ostomies because see, it's more interesting than you even thought it was going to be, isn't it?

Cara Lunsford (46:59.395)
It was way more interesting than I thought it was going to be. I mean, I'm, I'm always down for learning something new, but that apron, that takes the cake right there. It was apronsbyjoy .com, right?

Joy Hooper (47:08.836)
Thank you, thank you, thank you. That's it, apronsbyjoy .com.

Cara Lunsford (47:16.259)
That's an easy thing to remember. All right. So all of you, all of you nurses out there, nursing students that you're listening to this right now, I'm looking at this apron, you have to have it. I mean, you absolutely have to have it because it's just fantastic. And it's, if you are nervous or worried about working with ostomies, I feel like this is the best place to play around with it, get comfortable. And,

And I just, I love it. I love everything about this episode. And Joy, I'm just so, I'm so happy that I got to talk to you.

Joy Hooper (47:54.244)
I am so grateful that you ask and that you were willing to talk about ostomies. I just can talk about this all day long and love every minute of it. I do. I do. You know, after I teach the ostomy class, and these are long days. You go from eight until five, Monday, Tuesday, and Wednesday. Thursday's a shorter day. But even at the end of Thursday, I mean, I can just keep on going. I just...

I'm so fortunate that I have a passionate.

Cara Lunsford (48:22.979)
So tell me where they find these classes. So make sure to, anyone who's interested in taking one of these classes, where do they go to find you?

Joy Hooper (48:31.332)
WCEI .net, WCEI .net and Relias .com I believe can get you there as well. And we have a schedule there of what the classes are. And this is by the Wound Care Education Institute, also known as Relias.

Cara Lunsford (48:49.827)
Awesome. Yeah, yeah. So I'm guessing I'm going to get to see you in Phoenix.

Joy Hooper (48:57.636)
Yes you will with bells on. I know there was that old saying with bells on. Yes, I had to throw that in there.

Cara Lunsford (49:01.123)
With bells on!

Cara Lunsford (49:05.699)
Boom boom.

Cara Lunsford (49:10.531)
I love it. All right. So if you want to take the if you want to take a course with with joy wcei .net and if you want to meet joy in person you got to come to the wild on wounds conference which is in Phoenix and I'm totally blanking on the dates right now but if you're looking you just go to wcei .net and you'll find it. Thank you.

Joy Hooper (49:23.108)
yes!

Joy Hooper (49:32.452)
It is the middle of August. It is.

Cara Lunsford (49:35.907)
Thank you. You would think that I would know those dates by heart, but it's Friday. All right, well, Joy, thank you again. This has been just the pleasure has been mine. And I can't wait to see you in August.

Joy Hooper (49:40.868)
Yes it is. Yes it is. Yes it is.

Joy Hooper (49:55.332)
I can't wait to see you either. Thank you so much for having me.

Cara Lunsford (50:00.579)
Thanks, Joy. See you later. Bye.