I turned 43 years old this month and brought in my next year with an overnight camping trip on the wide-open expanses of the Pawnee National Grassland in northeastern Colorado. Unlike last year when I was too stressed out to even celebrate, this birthday was full of calmness (other than the wind which nearly blew us off the prairie.)
All year, I worked hard to re-prioritize various aspects of my life so that I could stop feeling so overwhelmed. This meant saying no to a lot of projects and requests and sometimes disappointing people. It meant spending less time on activities I enjoyed a little in order to make room for things I loved a lot. It meant that, yes, I would miss out on some opportunities and activities, but the reward would be a life that felt closer to my heart and less stressful. Activities like yoga, art and adequate sleep were back in my weekly routine. Pulling into our campsite, I felt light and free knowing that I had rid my life of many of the distractions that had been weighing me down. How wonderful it felt to have no agenda other than to relax and take in this new place with Doug.
We pitched our tent, set up camp and drove the desolate dirt roads that make up the Pawnee’s 21-mile birding tour. With no agenda, we let curiosity be our guide–stopping our car and getting out to explore whenever we saw something that caught our eye. We watched horned larks and McCown’s longspurs devour huge meaty grasshoppers and a saw a green, algae-filled pond that bubbled with squirming salamander tadpoles in its soon-to-evaporate water. Doug took photos of windmills and the landscape while I stopped to sketch.
When we returned to the campground, the winds died down and we made madras lentils from scratch on the camp stove, ate birthday cake and watched the abundant bird life singing from the cottonwoods around our site. As the temperatures tanked, we burrowed into our sleeping bags in the tent, but not before gazing into the vast night sky. With little light pollution, the stars were so bright that it was hard to pick out some of the usually prominent constellations.
The blazing morning sun belied how cold it was when we woke up the next morning, but soon hot drinks were on the stove and we were ready to start the day. After packing up camp, we drove to the popular Pawnee Buttes hiking trail. On the way there, we stopped to scan a prairie dog town along the road for burrowing owls. Much to our amazement, we spotted one in less than a minute! I couldn’t believe how lucky we were to see one of these birds. It was a first sighting for us and a big birthday treat for sure!
Though I will always be a mountain girl, it was wonderful to be visiting the plains for a change. When I was a child, I was captivated with Laura Ingalls Wilder and the Little House on the Prairie books. My family went on many a road to trip to visit the places she lived. It had been a long time since I had been back to exploring a prairie landscape and the wide-open spaces surrounding the Pawnee Buttes Trail were awe-inspiring.
When we reached the trail’s terminus, Doug spotted a horned lizard at the side of the path. I took out my sketchbook and sat down to record the shape of its head, curves of its tail and spiny body. Had the creature not run off after ten minutes, I could have drawn it for hours. Here I was taking this little moment to sketch this little lizard, yet the peace I felt was as boundless as the prairie surrounding me. I could not think of one thing that would have made my birthday more special. I was in heaven.
It was time to head back to the city. We bounced down the washboard dirt roads and then finally made it to the smooth pavement of bigger highways. Soon we saw the familiar cityscape of Denver. It was hard to believe we had only traveled 100 miles to get home–the grassland was a different world.
In the days of bucket-lists full of exotic trips, it is easy to think you aren’t living life to the fullest if you aren’t voyaging to far-off locales. It’s not that one shouldn’t dream large, but family needs, lack of money, medical issues– including surgery recovery– and other things can make that safari to Africa or a climb of a Mexican volcano hard to manage.
Instead of feeling bad about what you are unable to do at a certain time, make it a priority to get out on some local excursions. Who’s to say that living fully has to happen in distant lands? I found a treasured moment hiding in six square inches of grass on a vast prairie only two hours from my home. I wonder what other incredible things are to be found right outside my front door?
The main room of our condo during a recent vacation with Doug’s parents looked a bit like an outdoor gear store. Snowboards and skis of all sorts lined the wall and a plethora of boots sat in front of the fireplace. Closets, dressers and duffel bags overflowed with Capilene, fleece and Gore-tex clothing. During a week in the mountains near Winter Park, Colorado, we took part in two days of biathlon racing, and one day each of skate skiing, snowboarding and telemark skiing. I also managed to squeeze in some hiking and sketching in my nature journal in Rocky Mountain National Park. With so many activities on the schedule–some of which required an early start–it was hard to know when to fit in my appliance changes.
Unfortunately, appliance changes aren’t that quick for me. Due to pretty acidic ileostomy output, I have to protect my skin with several layers of products. Stoma powder, skin prep, Duoderm, Eakin Seals and paste–I use them all. My changes usually take at least 30 minutes–sometimes longer. Even when I use all those products, my output chomps through them like a piranha if I try to go longer than three or four days, and I end up with very raw and painful skin.
Those with an ileostomy know that it can be pretty hard (if not impossible) to find even a short chunk of time when your stoma isn’t pooping. Usually I try to change my appliance in the morning as that is when my stoma is the most quiet. However, on a busy ski vacation (or any time with a full schedule) that plan doesn’t always work. If I already have to wake up at 5 a.m. to make it to a race on time or catch first tracks in powder, it is hard to get up even earlier to fit in an appliance change. Also, I don’t like worrying about when I am eating and how it will impact my appliance swap. If I want to head out to a restaurant for a post-ski meal later in the evening, I go for it even if I know it will be harder to change in the morning due to the extra output. In some cases I will even switch out appliances in the evening right after a big dinner (gulp!) if that is the best way to fit it into my schedule.
If you are wondering if I have a particularly quiet and cooperative stoma, the answer is no. My stoma is a non-stop workhorse and churns out output 24/7. Fortunately, I have some tricks that allow me to change at any time of the day even when my stoma is active.
Trick number one: Marshmallows
My stoma nurse first let me in on this little secret. If I eat four to six regular-sized marshmallows about 15 minutes before a change, my stoma will usually stop outputting for about 30 minutes–just enough time to finish getting my appliance on. I can’t make any promises that it will work for you, but I recommend giving it a try. It is the only time you will get to eat marshmallows for health reasons. I have no idea why the very first individual to discover this trick was dining on marshmallows right before changing their appliance, but I sure am thankful for their sweet tooth!
Trick number two: Make a hat for your stoma
When I first got my ostomy, I absolutely dreaded changes. They were tear-filled endeavors wrought with frustration because I couldn’t get my barrier ring and wafer on without my stoma pooping all over the place and ruining the adhesives. I turned to the internet for ideas to solve this problem and discovered a post on a forum that suggested wrapping the tip of my stoma with a strip of paper towel. I gave it a try and couldn’t believe how well it worked! Plus I liked that it made my stoma look like it was wearing a cute hat.
Four years later, and I still use this method during every single change. As my stoma chugs out stool, the little hat fills up. When it has reached maximum carrying capacity, I simply pop it off, toss it in the trash can next to me, and wrap on another. Along with collecting output, the stoma hat frees up my hands to put on powder, barrier film, and all the other products that I use to protect my parastomal skin. It also keeps the base of my stoma dry as it absorbs some of the moisture from the mucous membrane.
This little trick allows me to change whenever I need to as it doesn’t matter if my stoma releases output; the hat is always there to catch it. Occasionally, if my output is profuse and watery during a change, the technique doesn’t work as well. However it is better than nothing, and if my output is watery, sometimes gulping down a few extra marshmallows will temporarily slow down the flow until I can finish the change.
I realize that making a hat for a flush stoma won’t work very well, so this trick works best if your ostomy protrudes from your belly a bit.
If you feel your ostomy controls your life and confines you to a certain schedule, keep searching and experimenting to find solutions. I’d never have guessed that something as simple as marshmallows and paper towel “hats” would give me the freedom to live with my ostomy on my terms rather than the whims of my stoma.
Welcome to 2015 everyone! While in past years I might have celebrated with a big hike, this year I felt a strong yearning to stay at home and relax, so that is what I did. Also, this year I am trying a different approach to the New Year by not setting any big goals for the upcoming 365 days. In fact, I want to do less in 2015. The pace of life lately has felt far too overwhelming for me. I want to ease up and take each day as it comes, filling it with things I enjoy without focusing so much on accomplishing x, y or z.
Part of that plan has to do with a rough end to 2014. My Dad’s health took a turn for the worse in the autumn. It is still hard for me to grasp, as Doug and I went on a trip with my parents to Portland and the Oregon Coast in August and my Dad was doing well. We toured museums, took in the gorgeous oceanfront scenery, visited brew pubs and all seemed fine. However, within a month’s time things changed unexpectedly and his health spiraled downward. I flew out for a visit in the end of October and it was heartbreaking to see the illness take such a toll. My mom has been trying her best to care for him and his doctors are working hard to find a treatment that works. My brothers and I all live far away making it hard to help day-to-day. I wish we were closer to provide more support.
I don’t know what to expect going into the next 365 days, but do any of us really? I do know that finding happiness in the present moment, taking things day-by-day and leaning on others for support is a good way to live in general and has gotten me through other hard times. This seems like a good approach as I head into 2015.
Yesterday morning while perusing Facebook, I saw a post by Brian Greenberg, founder of the Intense Intestines Foundation, regarding the four-year anniversary of his ileostomy surgery on November 9th. I was thinking about how awesome it was that he had accomplished so much since his operation and how happy I was for him. Then I came to a sudden realization: if Brian was celebrating his stoma’s birthday, it meant that I had completely missed the anniversary of my own surgery. You see, when I first discovered Brian’s website a few years ago, I found out that it wasn’t only a love of the outdoors that we had in common: our surgery dates were only one day apart. When I was getting used to my first day as an ostomate, Brian was being wheeled into the operating room. I remember wishing I had known him then. We would have had much to talk about as we prepped for and recovered from surgery.
Now, four years later, I couldn’t believe I had actually forgotten about my stomaversary. It was a date I always ardently celebrated. My surgery had given me my life back and had allowed me to do all the things I loved again. To think I had let my stoma’s birthday pass by without notice made me feel sad and disappointed.
However, I soon started to look at my forgotten stomaversary differently. The reason I had my ostomy surgery was so that I could return to all the things I love and lead a normal life again. I wanted a life in which my family, friends, hobbies and career were at the forefront and health issues faded into the background. Yet in those initial weeks after surgery, my stoma dominated my world. More than anything, I just wanted to get to point where it felt like my ostomy was part of me and not something I had to think of at every moment. On November 8th, I gave my ostomy nary a thought. Perhaps forgetting about my stoma really was the best way to celebrate how far I have come in the past four years.
That said, I don’t intend to let the date slip by again. Wilbur, my stoma buddy, we will definitely celebrate your 5th birthday with a bit more fanfare next year!
Very occasionally, I take the opportunity to share someone else’s words on OstomyOutdoors.com when I think it will be of particular interest to you, my dear readers. Thank you for your ongoing support and please enjoy this article and photos from my guest author, Matilda.
International Travel with an Ostomy: Following the Druk Path By Matilda
I’m really an iPhone photographer; my husband is the one who takes great photos and happened upon the brochure for a two-week photographic tour to Bhutan. We are both in our mid 50s, and though we had little outdoor adventure experience in our earlier years, have now discovered trekking holidays, so we added a six-day supported hike to follow on from the small group photographic tour.
Once I had found Bhutan on the map (between Tibet and India) I remembered Bhutan is recognized for its worthy goal of “Gross National Happiness,” which measures quality of life in more complete terms than just the material GDP.
Having chosen a total proctocolectomy and permanent ileostomy for Crohn’s colitis just over a year ago, I was both excited and apprehensive about the trip. We had taken a couple of independent supported walks since the surgery, including the Cape to Cape walk in Western Australia with its stunning coastal views, but the isolation of Bhutan is both a major appeal for travel there while at the same time posing additional risks.
The first two weeks of the trip would be fine–hotels with en suites, a couple of day hikes to Tango and Flying Tiger monasteries, and some early morning starts to arrive at scenic spots such as the Dochu La Pass for dawn low-light photography. These early starts were so much easier for me than they would have been pre-ileostomy.
When I chose surgery, I naively believed I could now make travel plans without worrying about a relapse or the timing of infusions interfering. I discovered that was overly optimistic thinking, as I needed a stoma revision six weeks before departure. When finally starting to train again for the trip, I sprained my ankle with associated aggravation of an old Achilles tendon injury. I iced and exercised it for two hours a day while my husband did some weekend training up and down nearby hills without me. Even when we left Australia for Bhutan, I wasn’t sure if I would be able to follow through with the trekking part of our plans and wondered if we would take a meditation retreat instead!
Any travel with an ostomy needs some planning. I had heard plastic bags were banned in Bhutan, which would make the practical aspect of disposing of soiled pouches potentially more complicated. This especially concerned me when a friend, who had only been transiting through Rwanda airport, had the plastic bags holding her toiletries confiscated. When trekking, I considered packing out my used pouches in a tube made of plumbing pipe as suggested in the book How to Shit in the Woods, and also ordered an odor-barrier zip lock bag. Ultimately, I heard from our tour guide in Bhutan who advised that though plastic bags are banned, I could still use them (!) and they would be packed out with the other rubbish when we left camp. Biodegradable ostomy bags would be great, but so far are only available for those using a closed pouch.
Sadly, it turned out, plastic bags are far from being unavailable in Bhutan and though mostly a clean, welcoming and astonishingly picturesque country, plastic bags were to be found along the roadsides and in rivers. Though nights were bitterly cold for someone who lives in tropical Australia, the snow made our hike more aesthetically pleasing as it covered up the yak and mule excrement and rubbish some left behind at camp sites on this very popular route, the Druk Path, between Paro and Thimpu. Our team packed all our rubbish out with us, except food scraps, which were shared with the birds and stray dogs that followed us.
I experimented with some biodegradable baby wipes before departure, knowing I may not have ready access to clean water on trek, or on the minibus, especially if I needed to make unscheduled changes. It was important to know that my skin would not react to the wipes and adhesion of the flange be unaffected. I had also read a horror story about a trekker having difficulty with pouching at high altitude in cold conditions, so when weather conditions were cold, I carried a base plate underneath an inside layer of clothing day and night so that it would be flexible if I had to repouch. I discovered a couple of things, re-pouching sitting in the tent, rather than standing next the bathroom basin: the base plate fit my contours better when applied sitting down, and my skin was happier without soap.
I am always impressed when I hear of people who can wear their appliance for 3-4 days, or even a week at a time. I have never managed more than two days, and since my stoma revision just before the trip, felt lucky to make a day and a half without a leak and un-scheduled change needed. This meant carrying a lot of ostomy equipment with me–double what I expected to need–was the advice. I divided my gear into four uneven piles, spreading them between my husband’s and my own carry-on bags and checked luggage. I still hoped that as the stoma settled down post op, I would be able to extend the wear time, but after several leaks leading to showering and washing out clothes in the middle of the night, luckily while staying in a hotel, I decided it would be best to plan on a daily change. From then on, I only had one leak, the first day on trek, when fortunately conditions were warm and sunny and I was able to wash out my clothes in the Sea to Summit “kitchen sink” I carried with me.
Our “private” trek, for just the two of us, included the company of a guide, cook, assistant cook, mule driver, and six mules! It is compulsory for most visitors to travel with a guide in Bhutan, and our guide and his staff thought of everything; they even supplied hot water bottles at night! I didn’t have to worry about carrying a heavy pack as the mules carried food, cooking equipment, tents, and even our personal gear.
I found the hip belt of my daypack obstructed the outflow of my stoma, so I took Heidi’s suggestion of padding out the belt to take pressure off the site. I found my “kitchen sink,” using its attached belt loop with the bulk of the sink on the inside (body side) of the belt rather than the usual outside, very effective without adding extra weight or equipment. When the temperature dropped and I had to wear more layers, the padding was no longer necessary.
Water was boiled for our drinking bottles, and I advised the company in advance that I needed to drink more fluids than most people due to my stoma, in case this required they carry extra fuel supplies. I gave up on my hydration bladder due to the hygiene risk of the open mouthpiece, and swapped to water bottles with a lid over the mouthpiece instead.
Here are some additional hints for traveling overseas with a stoma.
Remember to declare pre-existing health conditions in your application. In the past, I was able to get Crohn’s disease coverage, by paying an excess fee.
Ironically, post op and off immunosuppressants, though I am much healthier, I now am unable to get cover for Crohn’s disease in the Americas, though I still can in Europe, Africa and Asia. Because I had a stoma revision operation planned, I didn’t seek insurance on this trip for Crohn’s disease (as I didn’t want the rejection on my record). Though there was a small chance of forfeiting the trip due to Crohn’s disease, the biggest risks were not related to my inflammatory bowel disease but to road trauma, altitude, accidents and infection, especially gastroenteritis.
Airports and security:
My stoma nurse suggested wearing a clear pouch (a post-op bag) for airport security. This seemed overly cautious but she told me of a woman asked to remove her pouch at a European airport to show what was underneath.
The only time I have been pulled aside was when the bag showed up on x-ray in the USA and I was simply asked to wipe my hands on my shirt, over the area. My hands were then tested for explosives, and I was waved through.
Remember, you can’t take sharps onboard, so make sure you pre-cut any flanges that you will carry on the plane (more than you think you will use, in case of problems on the plane or delays), and pack the scissors in your checked baggage.
See your medical practitioner in plenty of time, ideally three months before you go, to make sure you are fully immunized. This is important for everyone, but especially for those of us who are immunosuppressed due to medications (ideally we should have had the opportunity to update our immunization status before starting immunosuppressants, but there may be additional travel vaccines indicated). If you are immunosuppressed, you are unable to have live vaccines, such as Yellow Fever, and will need a certificate to enter some countries, explaining why you are not immunized. Though this documentation does not guarantee entry, there were no issues for me crossing from Argentina to Brazil a few years ago.
Your doctor can also give hints on food and water safety and general travel health, and supply an emergency pack of antibiotics and rehydration solution if you do become ill. If you irrigate, remember it must be done with potable water. Ask the doctor to write a brief health summary and a list of your medications, stating they are for personal use. Keep the medications in their original packaging with labels attached. Like your stoma gear, you may want to divide medication between bags. Consider having your stoma nurse or doctor discuss how to handle obstruction before you go. I self-managed this issue a year ago (remember, I said I couldn’t get health insurance in the Americas!), using “Dr. Google” as a guide, but there is better internet access in Boston than on trek!
I use a “FRIO” bag for medications that need to be kept cool when there is no access to refrigeration. These work by evaporation and only need water to re-charge them.
Take twice as much as you would normally use and spread it out between your pieces of luggage. I also keep a little kit with everything I need for a pouch change within reach on the plane. I find I can’t drink carbonated drinks when flying as the extra gas plus the altitude blows up my bag. If I empty my pouch in the plane, I leave a little extra air in it, as descent seems to depressurize my bag. The exception is when landing at a higher altitude than you took off from, as I discovered landing at Paro airport, necessitating a quick trip to the loo at the arrivals hall to empty my stoma bag of air!
The most important thing to avoid altitude sickness is to choose a trek that does not climb too high, too fast. A slow ascent (400 meters or 1,300 feet per day) and a rest day every three days is recommended to allow you to acclimatize.
Finally, don’t be put off by the idea of traveling with an ostomy. Though your trip may not be incident free regarding stoma issues, don’t miss the opportunity to discover other places and cultures; you will manage, and the change in routine may even help you learn something new about managing your stoma, your health and living life.
When I haven’t blogged in a while, it is hard to know where to start. I had a wonderful summer filled with a lot of fun activities and it would be impossible to cover all the happenings in a single post. Last summer I focused on the singular goal of climbing Rainier. This year I spent time doing a lot of different things including camping, rock climbing, hiking peaks, backpacking, bicycling, fly fishing, making art and visiting with family and friends. This was not the summer to get in shape or work on any specific fitness goals; it was a time to let myself bounce from paint brush to climbing hold on a whim and let go of some of the overwhelming feelings that I had been experiencing in the spring due to having too many things on my plate. I even fulfilled my dream of spending an afternoon sketching in my mother-in-law’s beautiful backyard flower garden with a glass of iced tea at my side. While I moved forward in feeling less stressed, my performance in a few sports definitely took a hit. One of those was running.
That was not a good thing with a September biathlon race on the schedule. Last winter, Doug and I started this sport and fell in love with it. Our last race was six months ago. In preparation for the upcoming season, we signed up for our local biathlon club’s late-summer event. This warm-weather race would be done by running or cycling rather than by skiing. I absolutely love biathlon and was excited to get out there with my running shoes and rifle. The course was only 5K, so I wasn’t too worried about my lack of training. Certainly I can run a few miles, I figured. It wasn’t like I had been a couch potato all summer. I had done a little bit of running and had still been active with climbing and hiking.
Unfortunately, I was in for a rude awakening on race day. The event was tougher than I anticipated and I huffed and puffed my way through the course. I couldn’t glide down the hills as I was used to doing on skis so it felt like my legs never got a break. Each lap of the race route ended with a small uphill into the range and I was so out of breath during the shooting bouts that I missed most of my targets. That meant a lot of extra penalty laps. Forget about trying to make a certain time–I decided mid-race that my goal would be to simply run the whole course without walking. I succeeded, but was completely wiped out by the time I reached the finish line.
Even though the race was tough, I still had an absolute blast. It rekindled my desire to train for biathlon. Maybe not at a super intense level (I still want to leave time in my schedule to work on art), but enough that I see some personal improvement.
Another thing that made race day challenging is that I was experiencing watery and profuse ostomy output. I have no idea why—it just happens to me on random occasions. The hard part is that there is no restroom near the biathlon range and the hectic race-day schedule makes it tough to hike back to the lodge to use the facilities. When I am not racing, I am usually helping with scoring or other tasks. My ostomy hadn’t been a problem at other races because I can usually make it six hours between empties. With the higher output, I knew I would have to somehow deal with it out at the range. I thought about taking Imodium, but sometimes that medication makes me feel nauseated, and I didn’t want to feel sick during the race.
To solve the dilemma, I brought closed-end pouches for my two-piece appliance and OstoSolution Seals. When my pouch filled, I dashed off to a secluded spot in the nearby woods to swap it out. The OstoSolutions Ostomy Pouch Disposal Seals made it easy to pack out the full pouches. During the hour I was actually racing, my output slowed down and I didn’t have to worry about it out on the course.
Though it can be frustrating, I really do appreciate it when my stoma acts up and throws me an unexpected challenge. It teaches me to be resourceful and is a good reminder that even on those less-than-ideal days, I refuse to let my ostomy slow me down. Now if only that were the case with my lung and leg power! They are definitely holding me back. In the upcoming months I am going to be busily training for the winter biathlon season so that I won’t get so tired on all those penalty loops.
Today is the one-year anniversary of my Mt. Rainier climb. I can’t believe 12 months have gone by since I stood on the summit. When I returned from the climb, I blogged about the adventure. However, I had intended to write a couple more posts related to the trip. The weeks sped by and I never got around to it. What better time to revisit the topic than on this anniversary?
As someone who has a big passion for spreading ostomy awareness, I viewed my trip to Rainier as a great opportunity to share information about ostomies with others and show that anything is possible with a stoma. In fact, as I walked into our pre-trip meeting at the guide service, I had all the things I wanted share with my teammates during introductions neatly figured out in my head. The problem was, things didn’t go as planned.
As we sat in a circle and got ready to meet each other, the lead guide threw out some questions to break the ice and get us started: Tell us who you are, a little bit about your climbing experience and something weird about yourself, she said.
Something weird about myself? That wasn’t the introductory question I had hoped for. Everything I planned to say about my ostomy didn’t fit at all with the concept of weirdness. If anything, I wanted to talk about how normal life with an ostomy was. I came up with another silly non-ostomy-related answer for the question and scrambled to think of another way to bring up my surgery.
As I shared a little bit about my climbing experience in my intro, I did mention that I had been severely ill with ulcerative colitis three years prior and had gone through major surgery to remove my colon. I talked about how much it meant to me to be healthy enough to climb Rainier. However, I didn’t mention any details about the surgery or the fact that I had a stoma or wore an ostomy appliance.
As I left the meeting, I felt disappointed in myself for being vague about my surgery type and not talking more openly about my ostomy. How could I have let such a good opportunity to spread awareness slip by?
That is when it hit me. I didn’t feel like talking about my ostomy in this situation– not because I was ashamed, but because I didn’t want it to define me on the climb. After all, my stoma was really such a small part of me in the bigger picture of my life.
As it turned out, I did succeed in spreading the word about ostomies on my trip–it just happened a little more quietly and gradually than I had originally planned. I ended up having many great one-on-one conversations about my ostomy with most of my teammates when the topic of surgery came up. These small chats with individuals did just as much to spread awareness as a bigger announcement would have. I have also formed lasting friendships with some of my Rainier co-climbers and they continue to learn more about my life with an ostomy as time goes on.
Most importantly, my ostomy made its way to its rightful place on my climbing adventure–in the background. It didn’t become too much of a focus, and my thoughts and energy were left to more important things like cheering on teammates, taking in the beauty of the landscape and feeling the strength of my body making its way up the mountain.
So worry not if you are shy when talking about your stoma. Ostomy awareness comes in many forms: from a grand campaign to a small heartfelt conversation with a friend.