So what is obstructive sleep apnea? When you’re awake, the muscles around your airway are stiff and keep your airways open so air can easily flow to your lungs. When asleep, these muscles relax and allow your airway to collapse or narrow and block the flow of air. When these muscles relax, the airway narrows and the air rushing through it vibrates, causing you to snore. This relaxing also reduces the amount of air entering the lungs and reduces the oxygen level in the blood. The reduced oxygen level triggers your brain to disturb your sleep causing you to awake tightening the muscles and restoring airflow. This cycle of apneic events may happen 20 to 60 times per hour reducing your ability to get the restorative sleep you need.

Figure 1

Normal airway. The soft palate and uvula are normal in length and total size. The tongue is normal in size and is angled forward. – Courtesy aafp.org

Figure 2

Abnormal airway during sleep. Multiple sites of obstruction often occur in patients with obstructive sleep apnea. – Courtesy aafp.org

Sleep apnea can be a dangerous condition if not treated. The frequent drops in oxygen triggers the production of stress hormones that raise your heart rate and increases your risk of heart attack, high blood pressure, stroke, obesity, impotence and diabetes. Just because you snore doesn’t mean you have sleep apnea. But if you have early morning headaches or excessive sleepiness during the day, your doctor should test you.
This 4 minute video contains some good information on sleep apnea. http://www.youtube.com/watch?v=bzjlaQWWnhU&feature=player_detailpage

What are the treatments for sleep apnea?

The first steps in correcting sleep apnea are lifestyle changes that you can make. Some tips are:

• Avoid alcohol and medicines that make you sleepy. These can help cause the muscles around your airway to relax.
• If you’re obese, loose weight.
• Nasal sprays or allergy medicines may help keep your airways open at night.
• Quit smoking.
• Sleep on your side instead of your back.

If these tips don’t help, your doctor can recommend the following treatments.

Breathing Devices

A CPAP (continuous positive airway pressure) system is a common treatment for severe to moderate sleep apnea. A CPAP system gently forces air into the throat through a mask that is worn at night. The air pressure helps keep the airways open and will restore a good nights sleep.

Mouthpieces

A mouthpiece or oral appliance is fitted by your dentist or orthodontist and is used to treat mild sleep apnea. The mouthpiece readjusts the lower jaw and tongue to help keep the airways open during sleep.

Surgery

Surgery is used to remove the tonsils, reset the lower jaw or remove or shrink excess tissue in the throat. This will help open the airways during sleep.

For more information on sleep apnea check out the following links:

• National Institute of Health
• American Family Physician
• American Family Physician

There are primarily three types of catheters:
• Indwelling or foley catheters
• Intermittent catheters
• External catheters.

Indwelling or foley catheters are flexible tubes placed into the bladder to drain urine. Patients who require long-term catheterization use them. These are inserted into the bladder and might remain inside for a relatively longer period of time. One use could be after a Prostate Procedure; the catheter helps keep the urethra open during healing. The catheter is anchored in place by a soft, water filled balloon at the tip

Intermittent catheters are the most commonly used catheters. These catheters are best suited for those patients who need to empty their bladder once in a while.

External catheters are male-specific and are worn on the penis like a condom. External catheters are safer than intermittent or foley catheters because they are not placed inside the body. One reason for using a male external catheter is to assist in control of incontinence or for patients that have restricted mobility

A Urinary drainage bag is placed on the outside end of the catheter to collect the urine. The bag will be fixed to the leg, When it gets filed, it is simply changed out or emptied into the toilet. Changing a urine bag is much easier than trying to raise a person off the bed to change their adult diapers. Many caregivers prefer the male external catheter because of this.

If you just had surgery, you have chemicals temporarily in your body that will cause you to itch, especially skin covered by a barrier. Although there are situations where one has an allergic reaction to a product, most of the time it is our own bodies causing the problem. You will probably notice sensitivity to certain products at various times, this is normal.

It is very rare to have a reaction to your ostomy products as they are constantly tested and evaluated for skin friendliness. If you have suffered from a skin reaction the first thing you should do is check that you have not used something different in your normal routine i.e. change of soap or barrier wipe
. If there is no difference in your normal procedure, you may have to change your product and see if the problem goes away.

Testing for skin allergies

Some ostomates can use anything on the skin and get away with it. Others have to search for just the right combination of products for satisfactory use. If you are experimenting on your own, consider the following information for using different products. Patch testing is recommended before proceeding to use any new product. The skin on the inner surface of the arm or leg or the opposite side of the abdominal area from the stoma are good areas to use for a simple test. Cut a piece of the washer, tape, disc, etc., and affix it to the chosen area. Secure with a strip of Micropore tape and leave it for 48 to 72 hours. Any burning sensation or itching during the testing time could signify sensitivity to the material being used and therefore, should be removed immediately, washed and dried well. After 48 to 72 hours, remove the patch and if there is no redness or irritation, it is safe to assume that the product can be used.

Stoma skin care

A good time to check your stoma and the skin around it is when you change your pouch. The stoma is always pink or red and moist, looking wet. Because your stoma has many small blood vessels, it may bleed when it is cleaned and wiped. You should not worry about a little bleeding unless the bleeding does not stop.

Gently remove the ostomy pouch. Clean the skin under the pouch with water. Make sure the skin is dry, today’s modern barriers will not stick to moist skin, try an ordinary hair dryer set to blow cold. Cold air should dry the skin and close the pores leaving you ready to apply the skin barrier. Sprinkle ostomy protective powder on the skin and then blot it off. If your skin is moist due to an irritation, ostomy powders like Hollihesive or granulated Stomahesive powder Stomahesive are made to dry the skin so the skin barrier will stick. Stomahesive Paste or Powder may be used to fill the crevices around the stoma to give added protection. Reattach or replace the pouching system.

Treating skin irritation

The stoma is normally pink to red. Call your doctor if your stoma:

• Develops a pale color.
• Becomes dusky or blue.
• Swells.
• Bleeds.

If there are red dots on your skin, you may have a fungus infection usually Monilia or yeast infection, similar to diaper rash. We all get these. Your doctor or pharmacist can recommend a micro-granulated anti-fungal powder and show you how to use it. This will usually clear up the infection.

My best friend thinks it has less to do with all of the above and more to do with the daily stops at my favorite coffee shop! I disagree. She also suggested that I wear a pedometer to get me up and moving. She was concerned that my sitting in a car for so long during the day was not helping my health. I now have a slim pedometer attached to my inside waistband and am working towards the ubiquitous 10,000 steps a day. Walking from my car to the inside of the coffee shop counts, right?

Mrs. Franco’s house is two blocks from another client, Mr. Morchauser. She is a new patient who is considered to be a fragile diabetic. I have been asked by her family doctor to make sure that the rules for compliance are listened to as this seems to be a huge problem. As I am waiting at her porch, I send myself a quick reminder email to check in on Mr. Morchauser when I finish. I want to see how the trapeze mobility arm worked for him and just to see how he handled his diabetes after the Thanksgiving holiday.

As the door opened, I dropped my messenger bag and looked down to see two swollen and painful looking ankles sticking out from red fluffy holiday slippers. Entering the home, I immediately realized that Mrs. Franco was extremely clean and organized and there was no apparent clutter. I find this to be important for patients because if a patient keeps themselves or their house together, they tend to want to follow the regimen of medicinal treatments. Doing one thing one way is how they do things all the time. I now wondered why listening was a big problem with her?

Thirty –five minutes later, she told me all about the alternative therapies she read about on the internet, the conspiracies theories (for lack of a better word) that Big Pharma is putting out in the media about the need for insulin, et al just so they can increase profits,. She felt that her diabetes would best be solved solely by her diet and applying some type of creams sold on a shopping network on her swollen legs.

As she went into the kitchen to make some chamomile tea, I grasped on the idea of her watching programs and wanting to be “informed and entertained” I took out of my tote: 2 different blood glucose meters with varying size screens for easy visibility, test strips for both blood and urine, 3 different styled compression stockings, and a stylish yet practical diabetic medical organizer. Placing them on the table in a display fashion, I also powered up my tablet and hooked up my Wi-Fi card and put on a video from one of the social media sites. It shows a man going into diabetic shock and what his wife has to do almost every day to save his life. Brutal tactic, maybe, but I wanted my patient to comply not end up in the hospital.

We watched the video first. It was harsh and scary. It took place in the middle of the night. The man featured would make guttural sounds in his throat that sounded like a wounded animal. His wife would coax him to drink some type of juice to get the glucose number up again while she is calling 911. In one hand, she is pricking his finger with a lancet so that she can give the emergency responder his blood glucose number; the other hand is holding his head up. He is staring at his contorted face in the mirror while making these sounds, tears silently stream down her face.

I told Mrs. Franco that neither her doctor nor I would want this scenario to happen to her. Diet is crucial for maintaining a healthy glucose number, but also compliance with all of the steps to manage her diabetes is equally important.

For someone as neat and fastidious as Mrs. Franco liked to consider herself, she did not want to see herself in that condition. She had never seen the ravages of diabetes in that form before and it frightened her. I now wanted to reassure her that with careful monitoring, visits by me, and oversight by her doctor, the scene we watched could be avoided. We chose a blood glucose monitor with easy visibility and blood testing strips. While she liked the idea of compression stockings, she thought the ones that I brought were too “old ladylike.” I rolled up my pant leg to show her the patterned, stylish compression stockings that I wear every day. She liked these better and wanted two pair!

Leaving her house, I checked my email and saw my reminder note to pop in on Mr. Morchauser. I completely forgot! A quick stop in to see him made him so excited! Our regular visit was not until next week and he wanted to show me how well the quad cane was working out and how his granddaughter had helped move furniture around his house for ease of walking. I checked on his blood glucose levels, which were all in the normal range and promised to see him next week.

So far my day is minus my daily coffee routine; 4,763 steps; a successful albeit questionable method to convince a patient to comply; visit to another patient and it is not even lunch yet! My Husband just emailed me to remind me to order some more ostomy adhesives for Grandpop Mickey as his supply is low.

Will do.

Illness, death of a spouse and old age did not bring my client, Mrs. Smith at age 82, down. Four times a week Zumba classes at the local gym with all the twirling and whirling while wearing the wrong type support shoes, caused her to trip during a turn and she fell on her side. Bracing herself, she shattered her right wrist. Immediately, her children descended with solutions to a problem that she did not want to have handled by them.

When Mr. Smith was alive, I was his primary home health care nurse. He initially had prostate cancer, then Parkinson’s began its slow degradation of his body, and all the while, I was there. Helping to set up mobility aids in the house, bed rails for his bed upstairs, then for the one for downstairs. All of it. Their two terriers, Rusty and Jesse, initially would tussle with each other to see who could bite me first. After several nipped ankles, I wised up and carried more dog biscuits, treats and chewies than the local pet store!

Mrs. Smith frantically called me to help. She did not want her children’s help as she treasured her independence. I arranged with her doctor that I would see her as part of my patient route. Her vibrancy was diminished by the fall and she looked tired, scared and forgive me for saying it … old. Her wrist was encased in a lemon colored plaster cast and hung at her side. After checking her vitals, propping her elbow under a pillow, and getting her some tea I settled down to ask some questions.

Thirty minutes later, I knew my plan of action to help her and I could just be feeding my ego, but Mrs. Smith looked to perk up too! Several phone calls later, I ordered a cast protector for the shower , and a children’s sling as I figured out that Mrs. Smith did not wear the sling given to her by the hospital as it was meant for an “adult” sized person. Her petite figure warranted a smaller and more delicate sling. Also to the list was an extended reacher to help grab something off of the floor. Simple adjustments to her sitting room such as detaching the phone cord from the kitchen and hooking it up next to her chair, repositioning her side table so that it was on the right side of her chair so she could rest her arm out of the sling, and ordering a back scratcher was the icing on the cake!

Care for patients is not cookie-cutter and I want my clients to be the most comfortable that they could be. In discovering how she lived her day and what was important to her, or frustrating to her, I was able to determine that these fixes would not only improve her quality of life but also improve her mood. I left her a soft stress squeeze ball that I had in my backpack and told her to gently pump it on both her left and right hands as she was watching her programs.

Mr. Morchauser is my first client to visit today. He is diabetic and beginning to experience problems with his balance and walking. I am bringing him a rollator . The doctor ordered one and based on his measurements, he is considered “petite” so this is what I am unloading from the car. As this is my first visit, I have already contacted BPI Medical Supply to inquire about returns and the possibility of exchanges. In the past, I have learned to never trust first measurements taken or given.

After being assured of a “no hassle return” policy, I am so glad that I inquired! Mr. Morchauser could no way use a rollator in his home as the hallways were narrow and the loop brake was difficult for him to figure out. I showed him how to use it but there is definitely an unwillingness to use the rollator as my client sees this as him being an “invalid” to use his words. “One step away from you putting me into a wheelchair,” he told me – over and over.

Am I to be surrounded by older, stubborn men? Yes, it appears so.

My goal is to help my client so I suggest for him to demonstrate to me exactly how he moves about his day in his home. His mobility issues seemed to stem from his inability to lift himself from a chair, get himself steady and then walk forward. The struggle to stand appears to either tire him out or he just gets so frustrated that he gets winded. There are several mobility aids that may function better for him as he gets out of a chair.

I need to call the doctor first, but I am recommending a trapeze mobility aid, then possibly a quad cane, along with the removing the small area rug between his chair and the doorway. Mr. Morchauser complained about this as he does not like to get his feet cold. I told him that slippers or socks are an easy fix versus him tripping over a rug and ending up with a broken leg … or worse, a hip!

No, redesigning his house is not part of my job description but my clients’ care is very personal to me and I am sometimes the only outside visitors that they get. It is no big deal to move a small rug.

Immediately called over to BPI Medical Supply after getting confirmation to change out the rollator to inquire whether or not they even had the items in stock. Thankfully, I am okay with a sampling of the trapeze mobility aids and the quad cane that are available and will be delivered directly to him tomorrow.

Six calls on my cell phone from The Home. Upon consideration, they would like me to find arrangements for Grandpop Mickey sooner rather then later. Back on the phone to BPI Medical Supply for a full house consultation to set up a bedroom, adequate bathing, a transport chair of some sort and whatever else may be needed.

My husband is well aware of issues with Grandpop Mickey – just not that it would be so soon. I called him to let him know of the new arrangements and he said, among other things, “You know Viv, the veterans’ cemetery on across the street needs volunteers. Maybe he would enjoy doing that, what do you think?”

I think he is crazy. Grandpop Mickey refuses to believe he has life left in him after the cancer diagnosis and the need for an ostomy bag. Work with people who are dead? My Husband lost his mind and I do not have time for this. Still have three patients to go today.

BPI Medical Supply helped me take care of Grandpop Mickey’s endless changes and complications that arose with his ostomy bag and supplies. Through emails back and forth, I came to wonder why BPI Medical Supply did not hire someone like myself who works in the field to report on what products and services work and which ones do not. Including my experiences with working with BPI Medical Supply.

After many acts of persuasion, they agreed to hire me to write this blog. The writings are my personal opinions and my clients’ personalities, disease states and characteristics are a melding of many of my clients’ and do not represent any particular person real or otherwise.

Since we are introducing ourselves, Grandpop Mickey is my paternal grandfather who is a widower, former Army veteran and a survivor of colon cancer. Fast forward to today, and while the cancer is in remission, Grandpop Mickey is missing part of his intestine and now must use an ostomy bag system.

His case worker at The Home initially ordered the Coloplast Assura One-Piece system for him thinking that the ease of the clicking lock would be best suited for his needs due his recent diagnosis of Rheumatoid Arthritis. Also, since the one-piece system does not include the plastic ring or flange – it should make removal and replacement easier. The locking mechanism could be easily put into place with little bodily twisting or contortions. I wanted something for him that if his RA were acting up, he would still be able to change his ostomy bag with little to no help from the caseworker.

Grandpop Mickey insisted that he was hurting his back when he tried to connect the One-Piece system. I called the customer service rep at BPI Medical Supply who listened to my problem and suggested a different position for Grandpop Mickey to be in when he locks the device. This was simplicity itself and I wonder why I did not think about it but myself. Sometimes I get so wrapped up in his personality that I forget the easy solutions.

Maybe they can help me to convince him that this was a life-saving surgery and that through proper care and management, he can still work, live and even play in his current state. I will take one step … and one success … at a time.