The following excerpt is taken from Chapter 10 of
Colon & Rectal Cancer: A Comprehensive Guide for
Patients & Families by Lorraine Johnston, copyright 2000 by
O'Reilly & Associates, Inc. For book orders/information, call
(800) 998-9938. Permission is granted to print and distribute this
excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
Not everyone who has surgery to remove colorectal cancer will
need to have an ostomy. When it is possible to do so, your surgeon will
remove all of your cancer and reconnect your remaining intestine to the
rectum or anus so that you can continue to eliminate solid waste as you
always have. Newer surgical techniques permit preservation of the anal
sphincter, for instance, in rectal cancer patients who would have had to
have an ostomy in the past.
At times, however, surgery for more extensive disease requires removal
of rectal and anal tissue as well. This absence is remedied by a manmade
opening in the abdomen through which solid waste can exit.
I fly a lot for my job. Traveling is a lot easier now than it was before
when I was dealing with ulcerative colitis. I'd get on an airplane and
something would happen, and they'd end up sitting on the runway for 45
minutes or an hour. The flight attendants didn't want anyone getting up and
walking around, much less locking himself or herself in the bathroom,
because they can get a call at any time to take off.
I flew down to a business convention in New Orleans about eight weeks after
my surgery, though, with no problems. (Unfortunately, I didn't realize I'd
be too tired to do much carousing.)
As far as how an ostomy under clothes looks to others, it looks--unless you
know exactly what you're looking for--maybe just like somebody's shirt is
bunched up wrong on one side. If someone is staring at your pants that much
to start with, they've got other issues to deal with, so I wouldn't worry
about it anyway!
When I went to a vacation spa, I questioned the nurse there about
restrictions. She suggested the only thing I shouldn't do was the thing
where they use a hose to squirt you from a distance, a water massage. She
didn't think it would be a good idea to pound the stoma with water. She
also suggested I skip the seaweed wrap, which might dehydrate
me--dehydration can be a problem for ileostomates. I did it anyway, but
they kept the seaweed away from the stoma. I did the algae whirlpool baths,
too. I just left my appliance on, just like I do when I'm swimming.
There are people who are so hung up on body image and looking like
supermodels--they can't deal with it. I knew somebody who was a nurse who
died of colon cancer basically because she knew her husband--and therefore
her life--couldn't deal with it if she had an ostomy.
Ostomy is the surgical creation of an opening through the abdominal wall
to allow feces or urine to exit. During colorectal cancer surgery, part or
all of the colon or rectum is removed in order to remove the cancer. If
there is not enough intestine or rectum left to reconnect the remaining
tissue, or if the anus is removed, an ostomy will be created in the
abdominal wall so that waste can exit. The surgeon will make an opening and
attach the end of the intestine to that opening. See
Figure 1 (click here).
A person who has had an ostomy is called an ostomist or ostomate.
Most ostomies involve surgical creation of an open stoma. Waste passes
out of the open stoma and is collected in a pouch. However, in some cases a
continent ostomy can be performed.
For colorectal cancer, ostomies are further divided into colostomies and
ileostomies, depending on how much of the colon must be removed.
During a partial colectomy, only part of the colon is removed and the
remaining colon is reattached to the ostomy. Because part of the colon
remains to remove moisture from waste after it passes through the small
intestine, the waste will be more or less solid.
Removal of the entire colon (total colectomy) necessitates an ileostomy.
The ileum, the portion of the small intestine nearest the colon, is what
remains to create the ostomy.
Because the colon is not present to remove water from feces, the waste
that passes out of an ileostomy will be more liquid.
Sometimes one's colon and rectum need to heal before they can safely
process waste. Surgery for colorectal cancer has advanced beyond the point
of performing colostomies or ileostomies on all colorectal cancer patients.
Today, many alternatives exist, such as creation of internal ileorectal
pouches, and stapling surgeries to reconnect the remainder of the intestine
to the anus within the narrow bony space of the pelvis that rules out
traditional suture surgeries.
For some surgical procedures, a temporary ostomy will be used. This
might also be true, for instance, if pre- or postsurgical chemotherapy or
radiation therapy is planned, as these treatments can slow healing, or if
an obstruction or perforation was caused by the tumor.
If you receive a temporary ostomy, you might have two closely positioned
stomas instead of just one:
- One from the top portion of the intestine, which will remain active in
the digestion of food, and from which waste will exit.
- A second for the temporarily inactive lower portion of intestine,
called the mucus fistula, from which only mucus will emerge. (A fistula is
an abnormal tubelike body tissue that erroneously connects two organs, or
one organ and skin, usually developing as the result of disease. In this
instance, it is manmade.)
I still wear a colostomy bag. I tried to have the ostomy reversed back in
November after wearing the bag for more than fourteen months. However,
because of lack of muscles, the operation did not go as planned and I am
still wearing a bag.
The surgeons were going to try to reverse it again, but due to CEA levels
climbing from being off chemotherapy so long while recovering from surgery,
my oncologist said that I have to wait.
J-pouch (ileoanal anastomosis with reservoir)
In this surgical procedure, the small intestine is folded back onto
itself to form a J shape, then stitched together to create a wider reserve.
The sphincter muscle and the anus are left intact. The end of the
constructed pouch is connected to the anus.
Certain patients who have had most or all colon tissue removed may be
candidates for a type of ostomy called a continent ileostomy. This
variation on ostomy surgery involves creation of an abdominal stoma
implanted with a valve that remains closed until the patient opens it to
drain the intestine.
The advantage of this implant is that no pouch is needed for
collection--just a stoma cover, a sound awareness of body function, and
reasonable manual dexterity. The disadvantage is that continent ileostomy
works well only for ileostomy and the liquid waste that results--not for
sigmoid colostomy's more solid waste.
Most patients realize quickly that a colorectal tumor that's found very
low in the colon, or in the rectum itself, might require surgery that
entails removal of all rectal and anal tissue along with creation of an
ostomy. It's sometimes difficult, though, to comprehend why a tumor that's
farther up in the colon requires what seems like drastic surgical
treatment, including an artificial opening. The answer depends on several
- Healthy tissue must be removed along with diseased tissue to ensure
that no microscopic cancer remains. If several tumors or a very large tumor
that has invaded deeply are found, a great deal of healthy tissue,
including many lymph nodes and blood vessels, must be removed. The
relatively small portion of healthy intestine that remains after radical
surgery might not heal or function if it were reconnected to the anus or
- Tumors that are associated with certain diseases, such as ulcerative
colitis, or that occur in family members at risk for inherited colon
cancer, often are best treated by removing all colon and rectal tissue to
avoid recurrence of disease.
- Severely inflamed colon and rectal tissue, such as that crushed by a
nearby tumor or affected by the body's inflammatory response to the tumor,
will not heal if surgically cut and repaired. Thus, in some cases, a
temporary ostomy is created to allow the intestine to heal, after which the
remaining pieces of intestine are rejoined, and the opening in the abdomen
is surgically reversed.
The ostomy's exit through the skin of the abdomen is called the stoma, a
Greek word meaning mouth. The most visible portion of the stoma is actually
a portion of the inner lining of the intestine. When healthy, the stoma is
pliant, painless, red, and moist. It has these characteristics because
centuries of surgery and research--colostomies have been performed since
ancient Egyptian times--have shown that the most workable, infection-free
ostomies are made by pulling intestinal tissue through the abdominal
opening and rolling it outward to form a ridge.
Although directly after surgery the stoma may appear large and swollen,
in time the healthy stoma will shrink, protruding a bit past the skin of
the abdomen and developing a puckered appearance. Ileostomies will protrude
farther than colostomies, because ileostomy must accommodate more liquid
waste than colostomy, as the removal of the entire colon changes the
ability of the body to remove water from the stool. This liquid waste is
more likely to "travel" and irritate nearby skin than solid
waste; the protruding stoma is intended to be a larger barrier between
waste and skin.
Where the ostomy is positioned on the abdomen is determined by several
- The location of the tumor
- The extent of disease
- The kind of surgery performed--that is, how much of the colon is
- Certain physical characteristics of the patient, including weight,
posture, and skin folding
The typical stoma location for an ileostomy is a little below and to the
right of the navel. For a colostomy, there is more variety in location, but
often it is on the lower left side of the abdomen.
If time permits before surgery, you should discuss with your surgeon any
preferences or concerns you might have regarding the proposed position of
the stoma, such as your desire to remain active in a certain sport, and the
subsequent possibility that the position of the stoma might interfere with
this activity. Most surgeons will do their best to accommodate their
patients' concerns, but the overriding consideration must be the
positioning of the stoma to facilitate proper functioning of the intestine
after removal of all cancer.
While you are still in the hospital, the nurses, and especially a nurse
trained as an enterostomal therapy (ET) nurse, will help you learn to care
for your stoma, the skin around it, and the health of your altered
If your hospital does not have an ET nurse, contact your surgeon or
medical oncologist for a referral, or contact one of the ostomy
associations, such as the United Ostomy Associates, and ask a volunteer to
visit you to discuss up-to-date tips and techniques. Often the regular
nursing staff haven't time to keep abreast of new advances in ostomy
appliances and care. You'll save time, money, and peace of mind by learning
the best ideas as soon as possible.
Issues with which these professionals can help you include:
- How to clean and care for the skin around the stoma. The stoma itself
is relatively tough tissue compared to the skin nearest it, which must be
protected from intestinal enzymes, bacteria, and potentially irritating
- How to choose, empty, and clean appliances that attach to the stoma to
- How to select clothing that will not injure the stoma or interfere with
- How to eat to avoid constipation and diarrhea, and how to choose foods
to cause bowels to move at your convenience.
- How to irrigate your bowel through the stoma, if you have a sigmoid
colostomy and choose to irrigate instead of using a collection pouch.
Irrigation, which is similar to an enema, is a means to remove waste from
the remaining colon on a schedule that's convenient for you.
Before I was discharged, an ET nurse helped me learn to care for my stoma
and showed me various ostomy appliances. I spoke with a few people about
this and it still was a shock for a while. I haven't had too many problems
caring for my new body part. I did do some shopping around and
experimenting to find things that would work best for me. Finding the right
combination of appliance skin preps is very important.
I heard an older couple, obviously retired, talking about how they take
care of things. They irrigate every 48 hours, and spend four hours doing
it. The first thing I thought of was, "Man, you are wasting a lot of
time." They say "we" do it, so his wife has to be there to
take care of him, so every two days ...
A young man in my Ostomy Association group was talking about his colostomy.
He irrigates and still puts on a closed-end pouch in case it leaks. He
irrigates every night and changes his bag every day, so that's one way to
do it. One of the first things I thought of was that my equipment costs
about five or six dollars every time I change it. I've gotten so mine lasts
seven or eight days without skin irritation or problems. But if people are
changing these things daily, even if they're two or three dollars a day,
that mounts up pretty quick. To change it every day is expensive.
One of the things the Ostomy Association points out is that just because
one guy says irrigation works for him and he's been doing it for five years
doesn't mean that you should also start out doing irrigation if your system
is working fine and things are moving through. You need to figure out
what's best for you. Just because someone else does it doesn't mean you
should switch your style to do it.
An ostomy appliance consists of two parts: a collection pouch and a
positioning plate that surrounds but does not touch or enter the stoma.
If you've had an ostomy for years, you may remember how few products
used to be available in the past, and you may note happily how many are
available now. The era of the leaky rubber pouch that smelled odd even when
clean and didn't accommodate gas episodes is over. Today's options
- Disposable pouches.
- Reusable pouches that empty from the bottom, or from the top, while
still attached. These are the most practical choice for ostomies that
produce liquid waste.
- Pouches with filters to control odor.
- Pouches that hang sideways instead of down for use when jogging or
playing tennis. This might be a more suitable option for sigmoid
colostomates who will manage solid waste rather than other colostomates and
- Small patches similar to Band-Aids to cover and protect the stoma
during swimming. These are suitable only for sigmoid colostomies or those
with continent ileostomies. An ileostomate with a traditional stoma and
many colostomates with liquid waste would have the patch pushed away from
the body by the constant flow of diarrhea from the small intestine.
- Ornamental stoma covers for romantic interludes.
- Pouches that glue in place.
- Pouches that are held in place with a belt, for those who are allergic
to some adhesives.
- Hypoallergenic gluing and skin-sealing products made from vegetable
- Neoprene pouch belts for use during sports activities.
- Irrigation tubes (catheters) for those who prefer to empty the bowel by
irrigation (enema) instead of collecting waste in a pouch. This applies
only to sigmoid colostomates; many other colostomies as well as ileostomies
produce continuous liquid waste.
- Catheters for opening and draining the continent ileostomy.
- Skin barrier creams to protect the skin nearest the stoma, which must
be shielded from bacteria and digestive enzymes (to which the stoma itself
- Appliances geared either to the continual liquid waste of ileostomy or
the more solid and periodic waste of sigmoid colostomy.
- One-piece appliances, or two-piece appliances with a stoma-surrounding
attachment that stays glued in place, but a bag that's detachable.
- Appliances in different sizes to accommodate individual stomas and more
copious flow overnight or during travel.
Many of these products are preferred by some people, but disliked by
others. Some people say, for instance, that certain pouches with built-in
filters that are intended to allow gas to escape without odor don't work as
advertised. The best way to find what works for you is to contact a local
branch of one of the ostomy associations and talk to a volunteer (many of
whom have ostomies), to join a support group for colon cancer survivors or
ostomates, and to try various products. Products can be purchased by mail
until you feel comfortable talking about your needs with your
It took me a while after both operations to find the correct bag that fit
properly. The last operation left me with an open wound near the new stoma
and that caused the bag to keep coming loose. I had problems for about a
month with that, but eventually it cleared up and everything is fine
The stoma will clean itself by producing and shedding intestinal mucus,
but the skin near the stoma, called peristomal skin, must be kept gently
and scrupulously clean. There are several reasons for this:
- Its juxtaposition to both feces and digestive enzymes makes it very
likely to become infected, as digestive enzymes are capable of breaking
down skin, which is then very likely to be infected by fecal bacteria.
Fecal bacteria are common, abundant, and necessary for digestion, but not
at all healthy for skin.
- The peristomal skin is more likely to be scratched or scraped owing to
the amount of activity it sees in its new role: pouch attachment, cleaning,
removing adhesives, and so on. These scratches and scrapes make it more
likely to become infected or to develop allergic reactions.
Most people find it easiest to clean the stoma and its surrounding skin
when the digestive tract is least active. For many, this is in the morning
The stoma can be rinsed with water and patted dry, if you wish, although
it is not necessary to clean it: as mucus-shedding intestinal tissue, it
will clean itself. Exposing the stoma to the spray from a shower will not
hurt it. A stoma should never be scrubbed.
Peristomal skin should be cleaned gently with very mild soap and patted
dry--never rubbed. If you use a skin barrier or a skin sealant, cleaning is
done every few days to once a week, dictated by your own skin's tolerance
for the barrier substance. If a bit of skin sealant or barrier remains
after washing and rinsing, leave it until the next cleaning, provided the
skin beneath looks healthy. Rubbing away residual barrier or sealant is
more likely to harm your skin than leaving the residue in place.
If your stoma was placed amidst body hair, trim it regularly so that
removing the pouch or adhesive will not pull hair, causing pain and opening
the skin to infection.
Peristomal skin should look just like the skin anywhere else on your
abdomen: not red, wrinkled, grey, or chapped. Changes in peristomal skin
should be discussed with an ET nurse and reported to your oncologist.
A skin barrier or seal is a liquid, powder, paste, or membrane that
rests between your skin and the stoma attachment in order to protect the
skin from bacteria, moisture, and the irritants in adhesives. These are
excellent products that truly save the skin; many varieties are available,
and should be used no matter what model appliance you prefer. Each comes
with its own instructions and precautions for use.
People normally gain weight after surgery, especially if they've had
ulcerative colitis, because they feel better. They warn you not to gain too
much weight because then the stoma can pull inside, it doesn't protrude
like it's supposed to, and it makes life interesting. But they have
appliances that will work around that. The barrier spray goes on to protect
the skin from any irritation.
I had trouble with yeast infections under the wafer. I got little blisters
and it was irritated all the time. I had to change the wafer every couple
of days because it got itchy, and I had to spray cortisone on it. Basically
once I got the rhythm down for the combination of products I use, I haven't
had any trouble like that for a year or longer. How much you sweat and what
kind of food you eat can also come into how well the appliance stays
Even if you've never had a skin allergy before, you should assume that
these products might cause an allergic reaction because:
- Humans develop more allergies as they age.
- Skin that is repeatedly injured is more likely to develop
- Chemotherapy and radiation therapy are known to cause skin to become
more sensitive to a variety of substances.
When trying a new product, it's wise always to do a patch test first on
a part of the abdomen well away from the stoma. The instructions packaged
with the barrier or seal will explain how to do a patch test.
The pouch should be changed when it's about one-third full. Accumulating
excessive material increases the pouch's weight and may cause it to pull
away from the skin. Leakage, odor, and infection of nearby skin may
Many pouches are what is termed "drainable," or open ended. The
"open" end hangs down. There is a plastic clip that folds the
pouch end back and keeps it closed. The seal created by the clip is water/
liquid- and gas-proof. I couldn't change the appliance every time it starts
to fill. It would cost a fortune and take a lot of time. Drainable pouches
come in one- and two-piece models. Most appliances are designed to be left
on for up to two weeks. I change mine about every seven days or earlier if
it starts coming loose.
One man in our ostomy support group was using a two-piece system that had a
drain. He was not told to leave it on and just open the bottom to let out
the waste. He was very pleased to hear there was a faster, cleaner way to
deal with the equipment.
At times, the pouch should be emptied before it's one-third full:
- If you're traveling and won't be able to empty it easily en route, it
should be emptied first. Some ostomates report that air travel in
particular may cause the pouch to expand as the cabin is unevenly
pressurized during takeoff and landing.
- If you're having a spell of diarrhea.
- If you've prepped for a colonoscopy.
- If you're about to engage in sports or any physical activity.
Gently remove all pouch models, but especially the one-piece models, to
avoid damaging the skin beneath the attachment plate.
As far as wearing the bag is concerned, it does get better. However, I find
that I empty my bag still about eight times a day some days, and usually at
least four or five times. However, after a while you learn to live with it
and you are able to go out and do things.
If you are using disposable pouches, you can empty the pouch into the
toilet first, then wrap it and put it in the trash, or you can dispose of
it, well wrapped, while it's still full. What you choose to do depends on
how well you're feeling, what trash collection facilities are available,
and the sensibilities of those you live with.
If you have a reusable pouch, you can empty it while sitting on or
standing in front of the toilet. Put some toilet tissue into the toilet
bowl first to act as a cushion for the material you're discarding--this
helps prevent splashback. For emptying, some reusable pouches open from the
top, some from the bottom. All come supplied with directions for
A reusable pouch must be carefully cleaned and deodorized. Fortunately,
this is easy today, as many very good products are available for these
purposes. A few points to remember are to avoid hot water, as this will
cause the pouch material to expand and hold odors, and to dry the pouch
thoroughly. Empty the pouch into the toilet (you might need to squeeze the
outside of the pouch to get all material out); give it a good rinse; soak
it for a spell; then scrub the inside gently with a bottle brush. Add a few
drops of mineral oil to the bottom of the bottom-opening type to make the
next emptying easier. It might be useful to purchase three reusable pouches
at once: one for wearing, one for washing, and one for emergencies.
If you share a bathroom with others, take an extra minute to clean
splashes and stow away supplies and trash.
How the pouch is attached or reattached depends on which model you're
using. Most people find it easiest to reattach any pouch while seated.
For either the two-piece or one-piece pouch, you may need to adjust the
stoma opening in the skin plate to match the size and shape of your
stoma--they differ among people, and may change as age and weight change.
Some appliances come with a template that you can match to your stoma to
choose the correct size opening. The skin plate then can be cut carefully
to match your needs.
If you're using a two-piece pouch, you can simply continue to reattach
fresh pouches to the skin plate for several days or a week until it's time
to change the skin attachment.
Your own body will dictate the schedule for changing the skin plate,
based on your skin's sensitivity. In general, the skin should be left
undisturbed by plate changes for as long as possible in order to avoid
irritation by too-frequent changes.
One-piece pouch or pouch plate
The skin plate of a one-part pouch that's glued in place must be changed
whenever the pouch is changed. A skin barrier is a must in this instance;
otherwise, skin layers are stripped away whenever the adhesive is removed,
leaving exposed newer, more tender skin that's increasingly likely to
become irritated or infected.
Most people find that placing the bottom of the skin plate under the
stoma and "rolling" the plate upward provides a better fit around
the stoma, because visibility is better using this method.
The improved pouches available today hardly ever emit odors. When odors
exist, they are identical to the odor of gas and feces of those who have an
There are steps you can take to be very certain that odors will not
become a problem:
- Use deodorant tablets or liquids in the bottom of the pouch, as
recommended by the manufacturer.
- Clean and dry reusable pouches carefully.
- Pretest pouches that contain charcoal filters to be sure they work as
- Ask a sensitive, helpful, honest person if he or she notices any
- Eat yogurt, parsley, and other foods known to ameliorate odors in the
- Avoid foods such as cabbage that increase gas if you'll be with people
who object to tummy rumbles and possibly an aroma.
- Ensure that the skin attachment fits well and is firmly attached. Most
people don't have the ideal flat tummy that allows no gas to escape; firm
attachment can remedy this.
- If your pouch has a "burp" valve, engage it in the bathroom
or use a room deodorizer.
I've never had a problem with gas in my bag when on an airplane, as some
ostomates report. It depends more on what you eat first: you'll only have
gas in your bag if you've eaten something that causes gas to form ... and
you can take care of releasing it from the bag in the
Passage of waste material and gas through the stoma can create wheezes,
sighs, rumbles, or gas-like noises. Do try to be gentle with yourself when
assessing these: are they really any worse than the stomach noises your
body made when you had an intact colon?
But suppose one of the "healthy unaware" notices and is rude
enough to comment? You might explain that it's just your intestine, that
your digestive tract has been noisy all your life, which is a true
statement for many of us. As Miss Manners says, those who ask nosy
questions deserve to be lied to.
If your stoma regularly makes noise as gas passes, you may be able to
anticipate it. If the setting is less than ideal for such noise, you can
suppress it temporarily by subtly moving your forearm over the stoma and
holding it there.
You will undoubtedly have other observations or will note other
- You may see the pouch expand as material, especially gas, pass into it.
It's unlikely anyone else will notice this unless you point it out to
- You may feel warmth against your skin as waste material collects in the
pouch. At first, you may think this is a leak.
- Your remaining gastrointestinal tract will continue to behave as
before, with sensations of movement or mild gas pains. Any pronounced pain
should be reported at once to your oncologist, even if it's transient.
Everything you enjoyed doing before surgery can continue to be done
after ostomy. Sunbathing, swimming, dancing, sexual activity--all of these
are still possible; all have appliances and techniques developed to allow
the gastrointestinal tract to go about its healthy business while you have
Shelly Weiler describes his way of dealing with his ostomy:
I carry an emergency kit with me, which includes a towel, a fresh bag, a
new wafer, scissors, remover pads, skin prep pads, and a roll of paper
towels. I am very open about my "emergency kit" and take it
anytime I'm going anywhere that is too distant from my house to get back
quickly. No need to worry about odor. The modern appliances are tighter
than crazy glue and no odor escapes unless the wafer is broken.
I'm happy the surgeon didn't put the darn contraption on my forehead.
Of course I can't wait to have it reversed, it is a pain to have to think
about it, clean it, and be prepared for that inevitable
For activities that require lots of skin to be bared, a sigmoid
colostomate might consider a stoma plug and a patch that can be used. For
ileostomates who have a continent ileostomy, this might also be an option;
for other ileostomates and for colostomates with liquid waste, however, the
constant flow of diarrhea from the small intestine would push the patch
away from the body. For strenuous physical activities, pouches with special
capacity and belts that wick away sweat have been developed.
I'm an RN who had ulcerative colitis for years and knew my risk for colon
cancer increased with each year. I swore I would never have a colostomy. I
even had it written into my living will at one point. But when it came to
the point of having it done or dying with a bowel obstruction, I chose the
And it really isn't all that bad. It hasn't stopped me from doing anything
I really want to do. I swim, hike, go to social functions, whatever. No one
outside my immediate family and a few close friends even knows it's
For the best tips and news of advances in ostomy care, join a local
support group. In addition to learning of new products, you'll likely find
it an immense relief being able to share feelings with others who know
exactly what you're going through.
After a few months I found out about and started going to monthly United
Ostomy Association meetings, and I still do. The meetings range from
presentations by doctors, presentations by appliance manufacturers,
discussions about problems and solutions. We compare stories and share what
we've learned about cleaning the skin, using different moisture barriers
and glues, special appliances for sports, and the like. My local group also
has an additional meeting to discuss quality-of-life issues. I've met a lot
of good people, and also some people who aren't as lucky as I am: people
who were much sicker, who had no partner and can't seem to find one now.
Two women in the group from vastly different cultural backgrounds have had
partners divorce them. In my case, my wife has been great throughout this
ordeal. We've taken up ballroom dancing and are basically doing everything
we did before, and more.