The best time for self-study – the first week after the end of menstruation. The mammary gland during this period is in most softened state.

Women in menopause, you must select BSE is one of the days! month, remember (and it is better to write down) the date of the survey and its results. It is convenient to examine the breasts, standing in front of a mirror.

Skills Training includes the following:

• inspection of linen in contact with milk! glands. Slight discharge from the teat leave traces on the bra in patches of yellow, brown, reddish, or greenish colors watery;
• Inspect the nipple. Pay attention to their shape and color. To see if they are extended, do not get wet whether, whether cracks or sores;
• Inspect the skin of the breast: for redness entire surface or selected areas, rashes, diaper rash, “lemon peel” skin. It is necessary to determine whether there is bulging, retracted, ulcerated and shriveled breast track. Attention is drawn to the shape and size of breast (whether increase or decrease in size, surface roughness) on the symmetry (one if they raised the level of­toil at the institution hands behind his head, whether to fix one of them, to tighten up and b side). Inspect the gland when turning right and Nala­in.

Feeling.

Feeling (samopalpatsiyu) is carried out three or four pads serried fingers (in dependenceing on the size of the breast), standing before the mirror methodically penetrating circular movements. Beginning with the probing of surface. This makes it possible to identify formations located directly under the skin. Then comes a deep probing] fingertips when moving in a circle gradually reach the surface of the ribs.

Samopalpatsiya.

A woman is on a bed in a supine position. If the surface is soft, under the right shoulder blade puts a firm pillow or cushion of towels (Figure 6). Right arm extended along the body, the left hand is carried out probing­of the right breast. Then, the position of­menit palpation for the left breast.

Samopalpatsiya squares method.

Mentally entire surface of the anterior chest wall­ki from the collarbone to the costal margin and the right breast is divided into squares. Palpated consistently each square, down from top to bottom as if the stairs, do not forget to test the armpit and nipple.

Samopalpatsiya spiral method.

Probing the anterior chest wall lactic­hydrochloric gland being spirally concentric circles converging starting from the armpit (the right arm is placed under the head) to the nipple, without missing any portion of the breast.

When samopalpatsii breast say what they feel and remember those feelings. Because breasts are lobed Straw­ix, under your fingers will feel a certain graininess or tyazhistost, but it is not at­signs of the disease.

When samopalpatsii, as mentioned, be sure examined axillary region where the possibility but swollen lymph glands. front piles­Naya wall is palpable breast due to the possible presence of additional lobes, in which the same changes may occur, as in the mammary glands.

It is necessary to test the nipple and about podsoskovuyu­domain, as under the nipple may occur OPU­Chol. Most tumor is detected in that quarter of the breast, which is located above and outside.

Survey complete, carefully taking pain­PWM index fingers nipple and pressed on it – so check that there are no selections, and if any say characterized­ter selections.

The procedure is repeated and carried out his right hand for the left breast. Then examine both mo­mammary gland described­hydrochloric procedure in position standing. Better to do it in the shower, lathered obsl­when the wind blows area. Skills Training for menstruating women must be conducted in the first week after the windows­Chania menstruation. For women in menopause – in fixed­Bathing day of the month.

Samopalpatsii main goal – to get proof­of the nonexistence of the disease. In the presence of pack­lotneny in the mammary gland is necessary to pay­Xia to the expert.

Condition after mastoektomii

Thanks to the progress made in the last decade in the treatment and early diagnosis of breast cancer, thousands of women live after the operation for more than 5 years. Statistics in oncology abroad highlights the five-year survival rate when the most likely to relapse. The woman lived­Shaya more than 5 years, it is considered cured.

Unfortunately, diagnosis and treatment of it awareness­NVIRONMENTAL of breast accompanied by high levels of suffering women. after SET­Lenia diagnosis develop severe psychological stress, most of the women in a state of duality. On the one hand, the need to pass through a difficult treatment, transfer crippling operation (removal of the breast), but remain­Xia live, despite the consequences for work and family life; on the other – it is impossible to reconcile with the operation, makes you a “monster.” Sometimes this leads to the disintegration of the family, if the husband or loved one is not as strong in spirit, and dealt with a difficult situation in life at a time when women are especially needed their love and support.

After surgery and other treatments at home, a woman with a “sick” and hand stitch on breast place, poor, deprived of the opportunity to perform many household chores, overtaking­a second psychological shock, depriving as it seems to be no hope of a return to the pre­bo ttom life. Oncologists call this situation psi­hologicheskim collapse since transferred mastoektomiya “knocks out” the majority of women from social habitual and social environment and ve­children to major changes in their mentality and way life. This crisis requires a change­Nia position in life, a woman revising itsof attitude to the world, words and deeds relatives and acquaintances.

Help a woman cope with these difficulties – the main task of doctors, friends, family, colleagues, because in this period the further life of the women in the family and society. Oncologists believe that the climate in the family depends on the attitude of the patient to their slaughtering­Levan: the smaller woman dramatizes situa­tion, the more likely it is to get support from his family. First it is necessary to analyze their old life and try to identify the factors to­torye contributed to the emergence of her cancer slaughtering­Levan and, if possible, eliminate them.

After surgery, the body having anatomical and physiological disorders that may instill­STI to partial disability. The question arises: how to live, to live for a long time, have a happy family, to work actively?

So, what should be done to avoid re­tsidiva diseases to boost the body’s defenses, to feel good, to work on the floor­hydrochloric power to enjoy life?

To do this:

• change the mode of the day;
• Change the diet;
• lose weight and stabilize it;
• engage in physical therapy;
• learn how to make the physical and psycho-emotional overload;
• take care of their appearance;
• do what he likes; h “to undergo regular medical examination.

To restore physical strength, strengthen the nervous system is necessary:

• sleep for 7 – 8 hours with an open window or pane;
• before bedtime take a warm shower, directing a jet of water in the first place on the sore spots;
• the patient’s hand in bed to lay on the pillow, the hand located on a hill (this is the norm­lizuet lymph circulation and its outflow);

sleeping on your back or on the side opposite to the operated side to their weight in the BPE­sleep on me not to squeeze the hand vessels by about­operated seats;

in the event of pain simple­Lebanon nature in operation, your hands, nadplechevoy area should see a doctor (it can be a symptom of bronhopleksita – Sun­Singe brachial plexus);

• Do not lift or carry heavy weights, if possible, not to overtax his hand. When the load increases, the muscles need more oxygen, which increases blood flow to the hand and the already congested venous blood and lymph in the BPE­mja like outflow therefrom is difficult;
• It is recommended to limit the load on the hand from the operation – up to one kg for one year, up to two kg for four years and up to 3 – 4 kg for a lifetime. Better to wear a bag on the Tribes­Th good hand;
• Avoid any work related to the long inclined position with his hands down. Such restrictions are necessary to obstacles­Vat stagnation of lymph in the lymphatic vessels of the hands;
• After the physical work required to do exercises, self-massage of the hands (by stroking fingers to armpit), giving it an elevated position at an angle of 10 ° – 15 °.
• when working near her house, laundry, washing dishes, especially with the use of strong detergents, it is recommended to use protective gloves;
• sewing with thimble;
• Avoid mosquito bites, bee by using insect repellent for protection;
• Do not give injections, take blood for analysis to measure arterial PRESSURE­of the arm from the operation;
• Do not expose the clamping arm: eliminate the tight cuffs on a blouse and a nightgown, monitor, clothes to armhole were too narrow bra straps should not crash into the Tribes­cho. Rings, bracelets and watches should be kept on hand, free, without the girth;
• Avoid burns while cooking, to prevent sunburn. Summer wear shlya­pu, long-sleeved clothing (to protect from the sun);
• Do not use hot water when washing MSRP­dy, taking a bath. Contraindicated in sauna, steam bath, and washing in the bathroom shower is recommended to replace;
• Protect the arm from the operation of the on­cuts, burns, abrasions, cracks, scratches, caused­GOVERNMENTAL animals and plants. these precautions­STIs are important for the prevention of erysipelas are inflamed­Nia. Erysipelas leads to increased swelling and hands;
• when receiving the injury must be rinsed with running water and wound doubly treat antiseptic solution (iodine, 0.01% chlorhexidine bigluconate 70-degree alcohol solution). If the arm at the site of injury flushed, there was a pain at­towered body temperature, increased swelling of the hands, you need to see a doctor;
• After work, remove the bra with a prosthesis, to relax your body, put on its­Bodnya cotton clothing;
• protect the area of ​​the second operation, the healthy hand in the transport market, in crowded places.

In the recovery period (7-8 days after surgery) recommended set of therapeutic exercises to restore maxi­mal range of motion in the hand operated with­Noah side, maintain the correct posture, coordinate­ordination of movements, complete respiration, normalization of the general condition. Exercise better vypol­nyat twice a day – morning and mid-afternoon. Very effective for the recovery of motor Fung­ktsii hands with the operated side sessions in the pool. They can start in 2-3 months after surgery.

Lymphedema – a swelling of the tissues due to limfostazom. In most cases, lymphedema times­Viva after surgery for breast cancer, pelvic cancer, as a result of post-operative infections, radiation therapy, recurrence of cancer in the axillary, inguinal and pelvic areas.

Unlike other types of lymphedema swelling svya­linked to changes in the skin and subcutaneous TKA­nyah, especially when the surface lymphatics heavily overloaded or clogged. The re­result of these changes, the patient has the following symptoms:

• tumor limb (upper or lower);
• feeling of tension in the limbs;
• feeling of heaviness;
• pain and discomfort due to the pressure on the joints and ligaments.

visually:

• lymphorrhea (leakage of lymph fluid);
• keratosis (skin roughness as a consequence of protein fibrosis and infection);
• formation of deep wrinkles in the skin;
• sign Stemler (inability to take the skin of the limbs in the fold);
• cellulite.

A patient experiencing psychological difficulties, associated with changes in shape of the body, an increase in the volume of the upper or lower limbs.

Lymphoedema can not be completely cured, so the sooner treatment starts, the positive result will be achieved soon. effectiveness­ciency of treatment depends on the degree of swelling of the limb, and general physical condition of the patient.

The range of therapeutic measures in lymphedema include psychological support for the patient (training, consulting), skin care, Exercising, gentle massage, lymph drainage.

Chronic lymphedema skin becomes dry and discolored. Microcracks skin spo­Property ingress of bacteria into the ideal for their breeding environment – fixed lymph. Accuracy and compliance with the rules of hygiene can reduce the risk of infection:

• Wash, dry (blotting motion­niyami) swollen limbs, the area between the thumb­E and the folds of skin (to prevent fungus­postglacial infections);

“Lubricate the skin washed limbs softening cream – to moisturize the skin and prevent the appearance of cracks (Remember: the cracks – the entrance gate for infection!).

* Apply a cream, water-based (ointment as emulsions). It is not recommended to use creams

and lotions containing lanolin (warning contact dermatitis), perfumed creams and lotions that cause irritation;

• Wear gloves when working at home or at­manor portion;
• Use a thimble when sewing;
• Take care when trimming nails;
• to protect the skin on the affected limb from sunburn;
• Use an electric razor when shaving hair in the armpit;
• Protect the edematous arm of injection, blood sampling for analysis of pressure measurement;
• treating cuts and abrasions antiseptiche­medication available in a timely manner.

If the skin on the edematous limbs reddened, appeared burning, soreness, a local increase in temperature, swelling, should like to see a doctor as soon as possible. In this case, the prescribed antibiotics, rest, elevated polo­voltage for swollen limbs (pillow under the arm or leg). Unfortunately, cases of acute inflammation ^ is the inevitable consequence of chronic congestive lymphedema.

Special exercises will help improve the core­nazh lymph prevent fibrosis, increase the effect of the contraction, to expand the range of motion swollen limbs, prevent stiffness su­pose. Requires regular systematic motionvoltage swollen limbs, as the contraction of the muscles and stimulates the flow of lymph and blood circulation. If the execution of active movements difficult, the patient should be twice a day to perform sparing exercise.

It must be remembered that too vigorous, requiring effort, exercise can sometimes be at­incur damage as cause dilation of blood vessels and increases the flow of lymph. Patsien­there with swollen feet should not sit or stand for a long time, to move heavy objects – is reducible­dit to stagnation of blood and lymph. Not recommended for­Niemann arms at an angle greater than 90 °. Such a provision reduces the space between Clue­chitsey and the first rib, circulatory disturbance­Nia and leads to increased edema. Avoid at­standing use of support bandages for hands. Use them only during walks.

Self-massage and lymph drainage

Massage is performed in order to lymph flow was starting from (irreducible) lymph vessels to the deeper muscle (abbreviated­schimsya) lymphatic vessels.

The majority of patients with lymphedema after mastektomii have swelling, extending from the fingers to the upper torso. Swelling of the lower part of the body is observed in patients with lymphedema of feet.

Massage – the only way to cope with the swelling of the body, allowing more freely lymph drained from the swollen limb. Methods wt­black: stroking straight, bowing­Suitable strokes in the direction from the hands to the armpit or groin to the foot of­domain. Massage axillary carried slow circles for one minute.

Tracheotomy (incision of the trachea) is carried out in cases where the natural airflow through the trachea is not possible – for tumors of the larynx, vocal cords.

Patients who undergo surgery, both before and after surgery, fear to choke. It is therefore very important to prepare the patient’s tracheostomy. Both the patient and his relatives must realize that after the operation he could not talk because of cough and breathing strifroznogo. The patient will need care for tracheostomy tubes­Coy, so the patient and his family members have to learn to take care of a tracheostomy.

A patient in a permanent tracheostomy The necessity­ma metal tube (Fig. 24). It consists of three parts:

• the outer tube (cannula) having a side opening for ribbons which it is attached wok­pyr patient’s neck;
• guide (guiding unit) from the closed end, which puts the tube in place; Apply­out only with the introduction of the tube;
• inner tube (cannula), standing in traheo­stoma with an outer tube, can be removed for washing.

Models of the inner tube somewhat, but better use a metal tracheostomy tube having a lock-box, allowing to­reliably hold the inner cannula. Constipation-FLA­Joc must always be closed, or on coughing or even during washing, the inner tube may fall out of the outdoor. The outer tube fic­siruetsya ribbons around the neck, so you need to make sure that the ribbon untied Yai, otherwise­ruzhnaya tube may pop out of the tracheostoma when sudden movement or coughing, resulting asfik­these (suffocation) as tracheostomy immediately closed without tubes.

The outer tube can be removed or replaced only by a doctor, an inner tube – at home whisker­loviyah trained member of the family or the patient himself. For the care of a tracheostomy patient must “cook: with sterile cloth bag­mi vial with 70-degree solution of ethyl alcohol, brush, roller, bottle with sterile glycyl­Rene, a container with two percent soda sol­rum (1 teaspoon to 120 ml of water);

• Remove the bandage covering the hole pipe­ki;
• Wash the hands;
• stand up in front of a mirror;
• turn lock-box outer tracheotomy­cal tube to the “up”;
• take the “ears” of the internal tracheal tube between thumb and forefinger and firmly secure them in his hand;
• lock plate outer traheoto­nomic tube on both sides with the other hand (so­the thumb and forefinger)
• extract of the “ears” in the direction of ourselves Dugo­shaped movement of the inner tracheotomy tube from the outer tube;
• lower inner tracheal tube into the container with two percent soda solution, preheated to a temperature of 45 °;
• treat the inner tracheotomy tubes­ku a brush in a container with two percent soda ra­the shots from the crusts and mucus (until you remove all the peel);
• Rinse the inside tracheotomy tubes­ku under running water;
• dry the inside tracheotomy tubes­ku sterile cloth;
• handle doubly inner tracheotomy­ical tube cloth moistened with a solution of 70 -gradusnym ethyl alcohol;
• Moisten a sterile gauze sterilenym glycerol and lubricate the outer surface of the inner tracheal tube;
• Shake before you enter it into the outer tube to her left drops of glycerine \ (drops remaining on the tube, can cause coughing); j
• lock plate outer tracheal tubes thumb and forefinger of the left hand;
• take the “ears” of the internal tracheal tube between thumb and forefinger of his right hand and put into the hole of the outer tube;
• fix the inner tracheotomy tube by moving the lock-box to the “down”;
• remove the container with water, ruff and drugs;
• Wash the hands.

Note:boil in a special emkos­ti 2 ruff (one – substitutes) within 30 minutes of boiling water. Drain after boil­Niya, ruffs dry and wrap in a clean cloth, where it is stored until the next use.

Patient while walking in the winter period is necessary to impose on the tube hole bilayer gauze bandage and bandage should moisturize the water (Fig. 25) in the summer.

 

Eating the patient should be in a calm state, not talking, no laughing. It is recommended to wear a scarf, scarf or kerchief around the neck. When is it addictive Paci­cient to the tube and appear confident, you can pore­recommended active cover tube collar, tie. In some cases, put an inner tube with a valve that allows you to talk. This tube can be worn during the day as long as there is a need to communicate. On her night­necessity to change an ordinary handset. patient mo­Jet learn to talk, covering the opening of the tracheal cannula finger, wrapped with a sterile cloth. We can use this technique­but short conversation.

To prevent drying of the mucous about­span of the trachea into the trachea poured into 2 – 3 drops of sterile vaseline oil or glycerol. Thinning mucus poured by pipette 0.9 ml of 1-pro­percentage of sodium chloride solution or 1 ml fer­mentha-trypsin.

When intestinal tumors when allocation of IP­EXERCISE through the rectum is not possible, in the or other intestine make an artificial opening. Ileostomy – an opening in the area under­vzdoshnoy intestine. During surgery – ileostomy- the end of a healthy ileum is displayed on the surface of the abdomen and fixed there with forms­tion of new holes for removal’s contents­direct intestine. Usually, it is placed in the right lower abdomen.

Colostomy – a hole in the ascendant about­zling or sigmoid colon. gut hemming­added to the opening in the abdominal wall and form a height­Tupa mucosa in the form of “roses”. On this artificially created back proho­du, and depart stool. Thus pischevari­tion path as well as dri ileostomy, continues to operate normally.

It is important to properly care for the skin around the ka­lovogo fistula to prevent maceration. when the correct­Mr. avoiding the patient does not have an unpleasant smell, ca.­Rouge fistula skin is not irritated.

Discharge from the intestine is most convenient to collect in spe­cially disposable colostomy bags and mnogora­zovogo use. It is important to define the mode of the GRO­bowel rozhneniya since isolation masses are periodically come about in large chunks, usually – postprandial.

Well selected Colostomy bags protects the skin, it placed a bowel movement, it corresponds to the curves of the body, allowing interference-free to bend, do not miss the smell.

The frequency shift is dependent on the type of stoma bags, used by the patient. For example, one component adizivny Colostomy bags should be changed, coh­but the content level reaches half or when the patient begins to feel discomfort from the pouch. Colostomy bags should not be changed without a real ‘need, as this can cause irritation and damage to the skin.

When using the two-component system ,; Clay plate allowed to stand for 3 – 4 days. Kalopriemnik easier to change in the bathroom. one­to learn to change Colostomy bags in toilet Paci­entu is also necessary, as it is most welcome­lemoe place outside the home. All necessary for the care of stoma items should be stored together in a container with a lid and ready for use. To replace the stoma bags should:

• Net Colostomy bags of the appropriate typeand size;
• measurement (stencil) to check – whether the stoma size has changed (Merck gives sister at discharge Hospital);
• Additional materials, which benefit­etsya patient: pasta “Stomageziv ‘, deodorant, etc .;
• paper towels, napkins, soft sponge, soap, scissors, adhesive tape;
• paper bag, plastic bag or newspaper for used stoma bags;
• Cooper scissors (one end is rounded, the other sharp);
• a small mirror.

It is desirable to have a second set of the same, but in a smaller volume and number of components, koto­ing can take with you and wear a small sum­ke (leaving home).

Before beginning the procedure make sure that the container with the material to change contained everything you need. Then you need the following:

• Prepare a clean Colostomy bags;
• Increase scissors central opening of the plate so that it accurately BME­schalo a stoma;
• Separate gently used kalopri­emnik, starting from the top (try not to thee­pull the skin);
• remove Colostomy bags used in the gas­that, in a paper or plastic bag;
• Clean the skin around the stoma using a dry gauze or paper towels;
• rinse with warm water and wipe the stoma and the skin around her blotting movements;
• get wet wipes skin around the stoma dry (do not use cotton wool – it leaves on the skin of the villi);
• apply a protective cream and massage until complete absorption;
• stick to clean the stoma Colostomy bags using manual.

Application of the adhesive (adhesive) stoma bags (single-component):

• Remove the wrapping paper;
• Position the center of the hole over the stoma, Execu­Zuya mirror to check the correct position;
• press down evenly and make sure that the plate is smooth and has no wrinkles, folds;
• check the correct positioning of drainage­of the bag opening (bottom);
• Make sure the latch is in the closed position,

Two-component Colostomy bags worn differently. Adhesive (sticky) plate can remain on the patient for several days, untilyet provides comfort. The plate has a flanged ring of different sizes. To select op­optimality size of the patient is necessary to remember, that the diameter of the flange ring should be approximately 12 mm larger than the diameter of the stoma.

Your actions should be as follows

• determine the contour of the stoma;
• draw the outline of your stoma on the included template;
• cut the corresponding hole;
• apply a pattern on a support plate;
• paint over holes and contour cut (up responsesstiein the plate should match the size of your stoma);
• remove the plate protects its boom­gu holding plate for the flange ring;
• apply it to the stoma;
• press and smooth the first plate about the flange ring, and then – at the edges;
• Make sure that the bag walls are not stuck together before you put it;
• align the lower flange portion of the plate and the bag, and, starting from the bottom, gently presses­those on the circumference of flange rings, until they snap in the right place and will not­reliably fixed;
• Pull down the bag to make sure to­Connection reliability flanges.

In the care of stoma patients admit typical­nye errors leading:

• mechanical irritation when changing stoma bags;
• skin irritation chemical substance­E;

“A rapid peeling plate holes due to rinsing under the shower plate;

• an incorrect closing of the clamp when one uses­mations drainage bag;
• When gluing the bag is loosely at­Mounting by a plate, which can cause it to sweat­re.

If a patient – an elderly man and is reusable ileostomy, you must otre­gulirovat the act of defecation, and dress him roofingto the period of defecation. Colostomy bags freeing­content of dissolved, washed, and stored in polyethylene­tion package. Between acts defecation mozh­but wearing times sew oval four-six-layer cloth to sew her waist with one hand, and on the other – buttons or hooks.

After defecation with a soft cloth should wash the skin around the stoma with warm water and we­scrap. Dry dry with a soft towel. greasethe skin around the stoma paste “Stomageziv” and on the intestinal mucosa apply Vaseline, warning drying of the mucous membrane bleeding and the appearance of cracks. Then apply to the area of ​​the stoma napkin, folded in four layers and lock her belt. From top to put on underwear.

Currently it offers a wide range of products for skin care around the stoma. Pasta “Abutseya” is designed to protect the skin and scarring of tissue around the stoma. The paste has healing properties. “Statin” – poroshkoob­misc dressing means is used for treating the skin around the stoma as ranozazhiv–governing means.

The patient and his family should be aware that the nature of power has a decisive influence on the hour­Tautou his chair.

Anyone with a stoma bowel eating­a balanced diet at regular intervals, and slowly, carefully chewing on it. Patients should be warned that by­from the point, and other indigestible food components will be visible in the stool.

People with a colostomy does not require restrictions on food, although many products may cause IU­teorizm. Most ileostomy not Propus­cabins smell and some (bicomponent) have the valves for the release of gases, in some way solve the problem of flatulence.

People with iliostoma for 4 – 6 weeks pos­le operation is necessary to avoid the rich tartan­Coy and giving in feces much indigestible hour­particles products. In the following high-fiberproducts can be added in small amounts. Beli person can not tolerate such food, after two or three attempts to exclude it from the diet.

During the day, should be separate from the solid food use of at least 1500-2000 ml liquid and 6 – 9 g of salt. The patient should know that ileostomy results in a shutdown function of the colon. The small intestine is only partially compensated capable­Rowan opportunity colon to absorb water and mineral salts to produce some wi­Tamino. Ability to accumulate and regularthe contents of the allocation is lost completely. But by the end of the second month after the surgery the small intestine is adapted so that the majority of patients can restore the old regime and ha­rakter power. Food is better to take regular­but in small portions. Fasting or restricting food intake leads to throughdimensional formation gases and diarrhea. dining beam­Chez early and eat a small Included Quantity­, an initiative which will lead to fewer vyde­tions through the stoma in the night.

At the same time, patients should know how way certain foods affect oporozh­nenie intestine.

Products that accelerate intestinal emptying­ka: sweeteners (sugar, honey, fruit); god­Tide table salt – pickles, smoked­obtained; spicy food; rich plant checkered­Coy – black bread, some raw vegetables and­you, fat (including vegetable oil), green F­salt, spinach; milk, fresh yogurt, fruit-flavored water, juices, cold dishes and drinks, ice cream,beer. Spicy food should be consumed carefully, in small amounts, combine them with rice, Ma­Karon or potatoes.

Accelerate gastric emptying excitement, then­roplivaya food and lifting weights.

Thickener content coming from the small intestine, it is possible to make rice, blueberries, ter­Tide apples, jelly.

Products that delay emptying ki­shechnika,They include astringents and legkousvai­Vai dishes, including white crackers, cereals, cheese, mucous soups, corn, pureed oatmeal, raisins, dried fruit, rice, warm pureed soups, jelly, strong tea, coffee, cacao, natural coloring­Noah wine (nekreplenoe).

Constipation also leads a sedentary lifestyle, a limited amount of fluid (less than 1.5 liters per day) as well as some medicinal fluids­CTBA (analgesics, antidepressants and others.).

Products that do not affect gastric emptying:Steam and chopped meat, fish, eggs,­grinding the fruits and vegetables without skin and bones­check, wheat bread.

Peel tomatoes, apples and corn, Ore­chi, cucumber or citrus pulp cause SIS­we bowel, leading to abdominal pain.

However, be aware that the response to the received­May of individual foods, Conse-­quently, each picks up a diet self parking­tion.

Calm and lax lifestyle with length­tion exposure to fresh air and mind­rennymi physical activity as a way to­exists a satisfactory function thin quiche­ki. ”

For choosing the right diet Paci­entu with iliostoma, upon returning home after the operation, you need to keep a diary, where he will be employed to record their food, their number and the reception, as well as the time of bowel movements, the consistency of secretions, odor, and if­honors flatus (subjective oschu­scheniyam) through the stoma. Be sure We mention­chat appearance of pain and the amount of urine. Maintaining such a diary during the first 4 – 6 no­del after surgery the patient will accurately yc­thanes, what foods and how much more acceptable to him. Form diary could be next.

When it is clear the effect of different foods on the activities of the stoma, on the future conduct of the diary can be dispensed with.

Due to the fact that the same products can have different effects on the composition and volume of discharge ileostomy, strict instructions on diet can not be given. You can give the patient a recommendation that the best return to the pro­ucts that are more likely to use them to the opera­tion figuring when administered diary those to­torye bad influence on the activities of the stoma, and­gradually abandon them.

Below is a list of foods developed in the State Research Center of Coloproctology MZRF, which can serve as a shout­entirom in formulating the diet with ileostomy.

The drinks: tea, herbal tea, broth from rosehips, cocoa, coffee weak, mine­tral gas without water, fruit juice (after meal), beer, wine.

Grain mill products: wheat bread white or gray yesterday’s batch, buns and Pec­Nya, white croutons of bread, sponge cakes.

snacks: mild cheese, low-fat herring, caviar payusnaya or grain, meat pate homemade.

fats: butter, ghee, vegetable.

eggs and dishes from them: boiled egg, boiled (not more than one egg per day), scrambled eggs as part of other dishes.

Milk and milk products: milk in Natu­eral form is strictly individual, because most people cause bloating and­nose. To maintain the correct composition of micro­the intestinal flora is recommended every morning to drink kefir. Suitable cottage cheese and processed cheese.

soups: Different loosely on meat, fish or chicken broth with different cereals, pasta, noodles, mucous broths; vegetables, pureed soups.

Meat and fish dishes: various products of low-fat beef, veal, lean Petit­tzu and fish (roasting when not rolled in su­haryah not to form a rough crust).

Cereal and pasta: cereal, pudin­Ki-baked patties from cereals without gross shorter­ki, boiled pasta, vermicelli. Cereals before­respectful rice and semolina.

Vegetables and herbs: Puree a variety of vegetables, ny­Ding, vegetable patties, baked without a crust, cauliflower boiled with butter, early kabach­ki and pumpkin stew. Finely chopped, early, raw herbs (dill, parsley) can be added to various dishes.

Fruits and berries: puree, jelly, jellies, mousses of different fruits and berries, dry and fresh. Jam in a limited number.

Sweet dishes: sugar, sweets and biscuits in a limited number.

Sauces and spices: in a very small amount of meat and fish sauces, tomato sauce, mayonnaise, a bay leaf, onions in moderation.

Salt: 6 – 9 grams per day.

Food is recommended to take four times a day at the same hours.

Not recommended:

products from fancy and warm dough, fatty meats, poultry and fish, smoked, marinades, meat, fish and other oils and concentrates, sausage, cold drinks, ice cream, vegetables and­you’re kind, fried eggs (fried), sharp cheeses, overheated fats, fat dessert, drinks, mustard, vinegar, saffron.

Sample menu for a person with iliostoma:

8.00 – 9.00 – Steam fish cutlets with maps­felnym puree sauce. Vermicelli with oil. Butter, tea, white bread.

13.00 – 14.00 – soup of carrots and POTATO­A meat broth with croutons. Meatballs meat with bechamel sauce and noodles. Apple mousse. Bread gray.

19.00 – 20.00 – semolina pudding, baked with grated cheese, and sour cream. Carrot Cutlets­nye, fried without flour and breadcrumbs. Tea, white bread.

22.00 – jelly, biscuit yesterday.

The patient should know that no closing apparatus in colostomy does not allow to hold the intestine gases. However, gassing can try to adjust. Their abundance and expectoration observed in colitis and gastritis with reduced­Noah acidity before the imposition of colostomy. In these cases it is advisable to consult a doctor and treat these diseases.

Excessive flatulence is also observed in the use of milk, especially boiled, potatoes, cabbage, cucumber, radish, beer, peas, beans, nuts and other products. The use of activated carbon significantly reduces to­amounts of gas in the intestines.

Part ostomy patients Decrease the mark­shenie gases in the formation decreases ratsio­not bow.

Some products give excessive feces­but the putrid smell. This is – cheese, eggs, fish, F­salt, onion (different), cabbage (any), as well as the neko­torye vitamins and medicines.

Reduce the unpleasant odor of feces: cluck­Gov. juice, cranberry juice (after a meal in the afternoon), yogurt, kefir (in the morning).

When the malodor accompanied­guide gassing, it is recommended to use a special, odor absorbing pads. In Colostomy bags can add a special pore­shock, neutralizing odor, tablets, activated­bathrooms coal or aspirin. Deodorant will not design­nyaet smell but only mixed with it, giving it a sharpness that can attract the attention of okra­zhayuschih.

As with an ileostomy, it can be argued that the spe­Hoc diet for a patient with a colostomy is not su­exists. The ideal is to return after the operation to the usual diet and regime pita­Nia in steady regular emptying.

The possible development of constipation is topical­theme in an in patients with colostomy. Preference should be given such products: pshenich­Nome and rye bread, wholemeal Pomo­la, dough; soups with meat is saturated­Mr. broth with plenty of coarsely chopped vegetables (beets, cabbage, beans); dishes lean meat, fish, poultry; dishes and garni­frames made of flour, cereals, legumes and pasta; mushrooms; fresh fruits and vegetables in natural form or slaboprovarennom; milk (at endure­Bridge) and various milk products; not­strong tea or coffee with milk (cocoa excluded­chit); juices and mineral water cooled. Meals may be prepared in any form, salt is added to taste. The volume of consumption of the Jew­bone – at least 1.5 liters per day. It is recommended for­Nima eat at least 3 – 5 times a day, at one and the same time.

It must be remembered that the right food in the presence of an ostomy although not completely solve all problems, however, it is a prerequisite for conducting a full zhiz­no.

In addition to the diet for the regulation of the chair by a doctor can use some drugs that affect the function of the intestine. If constipation is possible with­Menen laxatives, but it is also necessary to coordinate with your doctor as to the pain­shinstvu of them comes highly addictive.