Alternatives to wafer or paste?

I had emergency surgery in March 2012 for perforating diverticulitis. I have been using a one-piece bag with wafers or paste. I was told to do this by the nurse in the hospital and am just wondering if the wafer/paste is really necessary. I don't really like the paste, and the wafers are too expensive (I have to pay for my supplies out of pocket). Just looking for some suggestions to keep cost to a minimum. Thanks.

Hi Justgran - The reasons to use wafers or paste are either because the opening on the flange is too big or because you need to build the area around the stoma up to keep effluent off the skin (convexity).

Do you use pre-cut wafers? If so, you might try the kind you cut the opening yourself so you can fit it exactly to your stoma size. If you need to build the area up, you can get wafers with built-in convexity. Either way, you should be able to eliminate the need for pastes/wafers (I use Convatec Eakins seals, but fortunately, my insurance covers them).

Ask your local hospital WOCN to help order the supplies right for your need.

Hi Justgran, like Pinky said, an ostomy nurse should be able to help. I use both flat and lite convex. I would look to see how flat the skin is and how close the wafer is for fit. They have you start with a two-piece so you can see how it fits and to get used to centering it. I have a surplus of the convex I may be putting in an ad. I will let you know when I do. Catman.

Yes. I have to use stoma paste, Eakin seals, and a convex wafer. As a result of the surgeon's...um...lapse in judgment(?)...I was left with a gaping, abscessing wound adjacent to my stoma that took 4 months to heal. It left a deep scar that I have to "spackle in" with stoma paste, and an irregular stoma that is difficult to shape a wafer opening, hence the Eakin seal. The stoma is lopsided and flush with the skin on the underside, which is why I need convexity. All of this is applied, as many of you know, in a game of "beat-the-clock." Properly applied, I can usually get 5+ days of wear time. It took time to develop a system, and a couple of visits to a WOCN, but I got it figured out. It's an art.

Products I use are precut Convatec Sur-Fit Natura Durahesive with Convex-It wafer and Eakin Cohesive SLIMS. I can stretch the openings of each to "fit" the stoma shape (as well as I can). The Eakin seal swells up to fill in any gaps in the seal around the stoma.

I will add just a little to the excellent replies you already have. The most economical system is the one that lasts the longest without the risk of leakage. In my experience, the Eakin rings will double your wear time. I also use skin prep wipes, but I don't think many others do. Keep in mind that since you are a newbie, a call to Convatec, Hollister, Coloplast, and any other manufacturer will get you free samples of any product that they think might be of use to you. Contact them, try them all, and see which system works the best.
In my circumstance, a flange/ring combo lasts me from 7-10 days, the closed-end medium-sized pouch 2-3 days.

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Definitely...always, always use skin prep (wipe or spray) under the wafer to save your skin. I usually "layer" it with stoma powder...I wipe the skin everywhere the adhesive will be in contact with skin, dust a little stoma powder around the stoma, then dab on another layer of skin prep. I then place the stoma paste, Eakin seal, and wafer.

When removing the wafer, always use an adhesive remover, and slowly, from the top down, push your skin away from the adhesive (rather than pulling the tape and wafer away from the skin--does that make sense?), while wiping with the adhesive remover. This is so critical to protecting your skin.

When I was treating my wound, I had to change my wafer every day for almost four months. Skin prep and adhesive remover saved my skin...particularly the fragile scar tissue over the healed wound.

Try it without and see how it goes. You need to figure out what works best for you, nobody can tell you what that is really. I also was told to use this and that and do this and that. My life was hell until I gave all that up and figured out what I REALLY needed.

The important thing is to be sure you take care of the skin around your stoma. Be sure you do not have any exposed skin. Be sure to be gentle removing the old appliance. As I believe was mentioned, push skin away rather than pull the appliance from the skin. If you want good wear time (and peace of mind) then your skin needs to be in great shape.

I normally do not use anything between my wafer and my skin. No adhesive remover, no skin prep, no spray, no powder. I remove the old, wash and dry (might even skip that if I am in a hurry), and slap on the new appliance.

Of course, if my skin looks a bit irritated then I usually dust a little zinc powder (or caldesene powder) on it and gently wipe off any excess so that you cannot really see it but you can feel it if you run your finger all over. Just enough to barely dust the skin really. If my skin is a bit itchy and irritated then I do the same but use Desenex powder instead. Anymore, I usually do not have to do either one.

If using a two-piece then I use a pea-sized blob of paste after I put on my wafer, just to fill in the minuscule gap around my stoma. Then I pop on my bag and I am good to go. If it has been a couple of days, I pop off the bag and reapply a dab of paste in the gap again.

If using a one-piece then I do use a very small amount of paste to ring around the very edge of my stoma before putting on the appliance. Once again, just enough to seal the small gap between the wafer material and my stoma. I usually will change my one-piece every other day (or third day if I am being lazy) just to be sure my skin is in good shape.

I also pay for supplies. I have tried various products and found a few different ones I like, that work well for me, and provide really good wear time. In other words, ones that provide really good value. So now I keep an eye out on eBay and even ostogroup.org to see if any of those are available. Sometimes you can even find an auction with various products and I suspect you could call and talk to ostogroup.org and probably get a variety to try out as well. Also, as mentioned already, you can usually get free samples directly from the manufacturer or even your local ostomy care clinic.

Hope this helps!

Dean

Thanks everyone for the great advice. I agree that we all need to figure out what works for us. I just don't have the money to buy different things to see if they work. I will be taking some of your advice and contacting the manufacturers to see about getting some free samples. Thanks again for the support and great comments.

Just grab as many ostomy samples as you can. Wow, you buy pouches on eBay! Amazing.

Greetings from next door in California! I hope over the months since you posted this that you have everything down to a science with doing your changes and getting good wear-time. I know it took me a few months of trial and error and lots of help from my Ostomy nurse to breathe a sign of relief on getting things squared away.