By Lynn Rhoades

Most patients initially balk at the idea of having an ostomy,
and Travis Felder was no exception. But three years ago, at
age 22, Felder had little choice.

Paralyzed from mid-chest down following a 2001 automobile accident, Felder had been flat on his back for months. He had developed a serious skin infection that required surgery, but his doctors told him that he would have to undergo an ostomy first.

An operation that makes it possible for waste to leave the body through an abdominal opening is not something most 22-year-olds ever have to contemplate.

“It was really difficult at first,” Felder says, “but I’d already been through some really tough stuff, so in some ways, the ostomy was a walk in the park compared to what I’d already gone through.”

Today, at 25, Felder is an engaging, outgoing college student, well adjusted to life both in a wheelchair and life with an ostomy.

Recovery and adjustment didn’t happen overnight, but Felder believes that life after ostomy is definitely do-able. You just have to be willing to educate yourself and keep trying to see what works best for you.

The nurse who helps
For patients at FirstHealth Moore Regional Hospital, the person to provide that education and assistance is Ann Poplin, R.N., a certified wound, ostomy and continence nurse. Poplin firmly believes that education is the key to a patient’s success.

First, it helps to understand basic anatomy. The body’s gastrointestinal tract begins with the esophagus and continues down through stomach, small intestine, large intestine (colon), rectum and anus. When a medical condition significantly interferes with the function of the small intestine, an ileostomy is done. When the problem is in the large intestine, a colostomy may be needed.

Both of these surgeries may be reversible, depending on the medical condition involved.

Ann Poplin, R.N.

“What happens in an ostomy is that a piece of intestine is brought out to the abdominal wall, to the outside, and more or less turned inside out and sutured so the patient will have an opening, called
a stoma,” Poplin says.

An ostomy pouch can then be fitted over the stoma. In some colostomy cases, a patient can be taught to irrigate and a cap covers the stoma between eliminations.

There are several different types of ostomies. “There are GI or digestive ostomies, which can be from the small or large intestine,” says Poplin, “and there are also urinary diversions where the patient’s bladder has to be removed for whatever reason and those patients will wear a pouch as well.”

Raymond Washington, M.D., a general surgeon with Pinehurst Surgical, performed Felder’s ostomy. “Whenever you have an inability to move yourself, you can develop skin breakdowns,” Dr. Washington says. “An ostomy can help allow the skin to remain clean and dry and heal properly.”

When an ostomy is recommended
A variety of medical conditions can lead a doctor to recommend an ostomy. “Rectal cancer, for example, is very painful,” Dr. Washington says, “and an ostomy in that situation can bring great relief to the patient.”

Other situations that may call for such surgery include malignancies in the GI or urinary tracts, Crohn’s disease, ulcerative colitis, diverticulitis, interstitial cystitis, radiation damage, infection or trauma.

“Acute emergencies also occur,” says Dr. Washington, “such as a perforation of the colon. A temporary colostomy will allow the area to heal.”

Patients admitted to Moore Regional Hospital for ostomy surgery receive an initial visit from Poplin. “The best case scenario is when patients come in for their preadmission visit and I can give them some ostomy information,” she says. “I will show them an ostomy pouch, and I will mark the preferable site for the surgeon to place the stoma. You don’t want it in the beltline or in a skin crease. You want patients to have the best experience they can have, and if the stoma isn’t placed well, the patient may have leakage issues. That’s why we troubleshoot before they have surgery.”

Felder remembers meeting Poplin after his ostomy surgery. “She was really helpful,” he says, “and she has the biggest heart I’ve ever seen.” “Ann Poplin does a great job educating patients,” Dr. Washington agrees.

“It was tough that first week,” Felder recalls.

“Anyone going into it needs to know that for the first seven days it is very uncomfortable, but it gets better.”

Felder was in and out of the hospital frequently during this period. “I was in the hospital 18 months of the three years following my car accident,” he says, “so I couldn’t do any normal things during this time, and I didn’t really have a chance to deal with the ostomy.”

Poplin taught him how to empty his pouch and how to change it, just as she does with all ostomy patients. But Felder’s real test came later on.

“When you’re in the hospital, everyone knows about it,” he says. “It is once you’re out of the hospital that you have to learn how to handle this in public. It would’ve been real easy to let someone else take care of me, but I didn’t want to be one of those people who regresses. I was determined that, every day, I was going to do something to better myself.”

For Felder, a high school athlete who had dropped out of school to work in construction, something his father told him began to take on a special meaning.

“My Dad said, ‘It’s OK to fail, but you don’t quit,’” Felder recalls. “I realized that I could have died in that wreck, or I could’ve been completely paralyzed. But I was blessed with a strong upper body, and I can use my arms and hands.”

Felder asked Poplin to teach him how to irrigate his colon so he wouldn’t have to wear a pouch. Today, he gets up at seven every morning and spends about 35 minutes in the bathroom performing his irrigation—“That’s as long as many people take anyhow,” he says—before getting ready to start his day at Sandhills Community College.

He has discovered that he has a talent for numbers and is considering a career in either accounting or statistics.

Meanwhile, he isn’t letting either his disability or his ostomy get in the way of life. He has traveled to Florida and Arizona to watch his cousin play college football, and he recently attended a family wedding in Minnesota. He also enjoys playing with his 3 1/2-year-old son during weekend visits.

“We play catch or shoot basketball,” Felder says. “We play cars, or I read to him—all the normal things that any parent would do. He loves to get on my lap and go for a ride.”

According to Poplin, an ostomy patient can carry on normal activities. “You just have to plan for them,” she says.

“Ann has been very supportive in helping me learn how to plan,” says Felder. “She’s very resourceful.”

“How a patient deals with an ostomy has a lot to do with the support system the patient has and what his coping mechanisms are generally,” says Poplin. “The best way for someone to cope is to make himself an expert on whichever type of procedure he had and the available products and appliances on the market once he goes home. Sometimes you have to do a little trial and error to find out what you like and what works best for you.”

“A lot of people have reservations at first before they have an ostomy,” says Dr. Washington, “but once it is in place and they learn to care for it, their quality of life is improved.”

Dr. Washington points out that while 75 percent to 80 percent of the ostomies he performs will be reversed, “Many people live out their whole lives very well with an ostomy, and no one even knows they have one.”

“It’s not the end of the world,” Felder says, “I promise you that.”