A Bump in the Road

     Last week, I had a little hiccup on my road to recovery. I had some dull pain just under my ribcage on my left side. I ignored it for a week or so, brushing it off as a sore muscle. Having sore muscles has been a common feeling since surgery. As I increased my activity level, I would have sore spots in my abs, almost as if I had done crunches or sit-ups. They usually passed with time, so I was easily able to ignore this pain. However, this time, the pain did not get better.

     I was actually off of work this entire week (President's day long weekend plus furlough days) and was able to finally sit and relax after two VERY LONG weeks at school! However, my body had some different plans! I started getting a small head cold (either from allergies or just a cold) and the pain started to intensify. On Tuesday of this week, the pain was so intense that I considered going to the ER (if you know me, I'm not dramatic... it really hurt!). I called my GI to try to get an appointment, but didn't hear back from them by the end of the day. I was able to tough it out and made it through the night (albeit with little sleep). Wednesday morning, I called my PCP to try to get an appointment, but they had no openings. Finally, I decided to go to an urgent care center to make sure I wasn't dying! On the way, my GI's office called and told me they had an appointment Thursday morning. I told them that I was on my way to urgent care, so they asked me to follow up and send any bloodwork that they did over the my GI's office. I decided to keep the appointment with my GI and continue on to the urgent care as well. 

     The urgent care doctor came to the conclusion that my spleen is enlarged and that is what is causing the pain. He drew blood and did a CBC (complete blood count?) to rule out any sort of infection. The CBC came back normal, so he told me to take some pain medication and follow up with the GI in the morning. They also told me that if I started getting a fever, chills, or the pain got unbearable, that I should go to the ER. However, he didn't seem worried about that.

    Thursday morning I went to my GI (who squeezed me in between colonoscopies - this is the 2nd time he's done this in the last year... I really like him!) who also felt that my spleen was enlarged. He agreed that the bloodwork looked OK and decided to set me up with a CT scan for Friday morning to try to find out why the spleen is enlarged. He also mentioned that I could possibly have kidney stones, but I don't think the pain is that intense or in the right location. 

      The CT scan was an interesting experience. I had to go the day before to pick up some oral contrast to drink. They gave me to bottles of barium contrast. I was supposed to drink one at 10pm the night before and the other one the next morning on my way to the office. However, I asked the radiologist about drinking both since I have an ileostomy. She said that it was unnecessary, since my transit time is so much quicker than someone with a colon (suckers!). So, I only had to drink one bottle of the contrast on my way to the appointment :) It was not very pleasant, but not quite as bad as the prep I have had to drink before my colonoscopies. Yuck!

    At the office, they had me change into scrubs and started an IV. Then they took a quick X-ray in the CT machine. The actual scans took no time at all. I have had 2 MRIs and those each took around 45 minutes to an hour. The CT probably took only 30 seconds total to take all the pictures. The whole process took around 20 minutes top! Pretty amazing how quickly they can conduct these tests!

     The weirdest part of the whole thing was the IV contrast. They took one scan without the contrast, then inject the contrast and take another scan. When the contrast enters your body, it gives you a very overwhelming warm feeling. I read somewhere that it feels like you drank a hot cup of coffee in one gulp. This was pretty accurate. Also, the radiologist warned me that it might feel like I'm urinating once the contrast is injected (strange right!), but I didn't really feel this. 

    The coolest part about the scan is that the radiologist gave me a CD of my scan. She will write a report and send to my doctor with the results, but she gave me the scans in case my GI or surgeon want to see them. Also, I can look at them at home, which is so fascinating to me! 

Here is a video of the scan. I was lying on my back so the bottom is my back and the top is my chest. Also, my right side is on the left and my left side is on the right. It starts around the bottom of my lungs (the black things) and the base of my heart, then progresses down my abdomen toward my pelvis. You can also see my ileostomy around 00:16. Pretty cool, huh!

Here is another view that goes from the base of the table up through my body (from back to front) at a different angle. It's not quite as clear, but still really cool!

Bag Change Pictures (graphic images!)

I decided that I wanted to record an account of me changing my bag at least once before I get rid of it! I figured it could be a good memory for me (yeah right!) and a possible help to anyone who is going through the same surgery. While I was preparing for surgery, watching these videos really helped me know what to expect, what questions to ask, and helped desensitize me to the "ick-factor" involved with an ileostomy. By the time surgery came around, I had watched just about every ostomy video available on the internet and felt relatively prepared to tackle my own ileostomy.
The video that I took ended up not being great quality. The sound is very hard to hear since my bathroom fan was running and I was talking very quietly (first thing in the morning with a cold!). So, instead of posting the video, I extracted some stills that will hopefully show the process a little better. At some point, I may try to record again with better video/audio quality. Seeing video is much better than pictures! I also edited out any "output" from the shots, but you can see my stoma through most of the video. If you are squeamish and don't wish to see it, then don't scroll down :)

Before starting the bag change, I typically gather all my supplies on my counter in my bathroom (see previous bag change post). Occasionally, I don't have everything I need which results in a trip across the hall with my stoma hanging out!

First, I place a plastic grocery bag in my pants to both catch any output from my stoma (occasionally happens) and to use as a trash bag while changing the pouch.

Next I check my bag and skin barrier to make sure they fit together correctly. I use Hollister bags with the "Lock 'n Roll" closure. I have found that there is a small bit of extra material on the end of the pouch closure tail. I usually take a pair of scissors and carefully remove the extra flap. This helps make emptying the bag much easier and much cleaner!

Next, I close the bag and make sure that the bag and the skin barrier attach together correctly. I've never had one that didn't fit, but I always make sure!

Then, I take some small curved scissors and cut out the opening where my stoma will go in the skin barrier. I cut just outside the 1 inch line and this fits my stoma very nicely. After I cut the hole for the stoma, I typically take my index finger and rub it on the inside of the hole I just cut. The warmth from my hand does a nice job in smoothing out the cut surface and gets rid of any rough edges.

Once I cut out the opening, I begin the process of taking the pouch off. I start by pulling up the tape border on the very edge of the skin barrier. Once this is done, I peel the entire barrier off from top to bottom.

Next up, I use 4X4 Gauze that I've wet with warm water to clean off any output on my stoma and the surrounding skin. I also do my best to get any left over adhesive off using the gauze

TA DA! Here's Johnny!

After cleaning the stoma and skin, I usually check the fit of my skin barrier around the stoma. This used to be more important when my stoma was still changing size. However, it has stayed the same size for a few weeks, so now I'm fairly certain it will fit on the first try.

Next, I spend a good bit of time shaving the area around my stoma. I usually start with a regular razor, then use electric clippers to get closer to the stoma (sometimes I even use tweasers to get any stray hairs). My belly is VERY hairy, so if I didn't shave, there would be no chance for the skin barrier to adhere to my skin.

Once my skin is shaved and clean, I prepare the skin barrier (some people call it a wafer as well). I remove the plastic backing and pipe out a ring of paste around the opening in the skin barrier. This is not really paste, but is like caulking that helps fill in any gaps in your skin near the stoma. This way, there is no leakage of output onto my skin. 

After there is a nice "bead of caulk," I usually wet my finger with water and mold the paste around to flatten it out and fix and spots that were messed up. It is normally VERY sticky, but the water helps make sure it doesn't stick to my fingers. If one side ends up being thicker than the other, that is usually the side that ends up on the bottom side of my stoma, since that is the most likely place to have a leak.

Next, I set the skin barrier aside so the paste can set for a few minutes. While it is drying, I prepare the skin around my stoma. I use stoma powder layered with a skin prep wipe. The stoma powder removes any moisture from "weepy" or raw skin and the skin prep creates a film over my skin to reduce irritation from the adhesive or any output that may leak. I usually do two layers of each (powder, wipe, powder, wipe) always making sure to get rid of extra powder and making sure the skin prep has dried before moving on. 

Next, it is time to put on the skin barrier. If my stoma is not very active, I usually do the next few steps all in a row. I place the skin barrier over my stoma, remove the paper backing from the edges of the barrier, and then put the bag on. 

Always press around the inside of the plastic flange ring
to make sure you have a good seal.

Removing the paper backing.

While putting my bag on I usually fold it in half while pressing the flanges together. This is to make sure that no output, stoma powder, paste, or skin barrier gets on the bag. If any of this drips onto the grocery bag, there is potential for this to get on the pouch while clicking it into place. I avoid this by folding it in half and then clicking it into place. 

Lastly, I place my hands over the stoma and new skin barrier to activate the adhesive and make sure there is a good seal. The heat from my hands helps the adhesive stick better and results in a much better seal. I usually only do this for about 30 seconds or so. 

After this, I collect any remaining trash, tie up the grocery bag, and take it out to the trash can (outdoor trashcan!). All together, this all takes about 20-25 minutes for me. I am a perfectionist and I have had good luck with all my pouch changes. I've never had a true leak or "blowout" since surgery (I've had minor leaks just around the stoma, but not bad enough to change the pouch). All of my bag changes have been scheduled and I attribute this to my perfectionist approach to bag changes!

Please let me know if you have any questions about my bag change. I would be more than happy to help!

Say Cheese :)

     Yesterday I went down to Wellstar to have my "pouchogram" at an imaging center near the hospital. This is basically a way to check the integrity of my J-Pouch and ensure that it is safe to proceed with the second surgery in March.

     Upon, getting to the clinic, I filled out the normal paperwork and made sure to mention that I DON'T HAVE A COLON! This is important in a procedure like this, because they have to tailor the procedure to make sure they don't hurt you or damage the pouch. First, they took a few normal x-rays without the barium. I explained my surgery and the fact that I don't have a colon to the x-ray techs and they seemed genuinely interested and wanted to make sure they did things right. 

 Fluoroscopy Machine

    Next, they took me back to a different room. This had a slightly bigger machine with a table. I think this is either called a fluoroscopy machine or dynamic x-ray. It is basically a moving x-ray as opposed to just one single picture. It uses x-rays to get several images very quickly at different angles and positions. One of the techs was filling up a LARGE bag with warm tap water. He pointed to several bottles of the contrast sitting on the counter. The contrast was actually clear! I was thankful for this since I was expecting the nasty, thick, white barium that I have had before (I had to drink it though... not pleasant either way it enters your body, I'm sure!). Also, the techs comforted me saying that they were using much less than they typically would on someone with a colon (suckers!). Also, they used the smallest catheter tip that they had. The techs were VERY nice and responsive. I kept reminding them that I didn't  have a colon, and instead of ignoring this (like I'm sure some medical professionals might do), they listened and made sure they were doing things correctly based on my specific circumstances. Kudos to that crew! It made the whole process a little easier! 

    After getting into a couple of robes and sliding up onto the (hard) table, they inserted the catheter and began to infuse the contrast into my pouch. It was a little painful when they first inserted the catheter and once the contrast began to flow. It felt like my pouch had small spasms when the liquid entered and this was a little uncomfortable. Once enough contrast was in, they made me roll onto my sides and roll around in some very uncomfortable positions (all of this while one of the techs was holding the catheter in my butt... poor guy!). Finally, they removed the catheter and asked me to hold in the contrast. This is the part I was the most worried about! I wasn't sure if I was going to be able to, since I originally did not know how much liquid they would use. Luckily, I had no issues holding it and after a few more pictures, they let me use the restroom to get rid of the contrast. Then, they took a few more x-rays to see how well I got rid of the contrast. 

     Finally, I got dressed and was on my way! Overall, the procedure was not terrible. Certainly not a picnic, but much less terrible than I had pictured it in my head! I tend to create these horrible scenarios in my head. Perhaps, it's because I always look stuff up on the internet. It seems that most of the time, people only post their experiences on the internet when they have BAD experiences. Hopefully, my posts will be refreshing to those who may be going through the same thing and are looking for reassurance. So far, I've had no complications (**knock on wood**) and love sharing my stories!

10 Week Follow Up - Appointment with Surgeon

     Today I had my 10 week follow up with Dr. Liberman in Marietta. The purpose of this check-up was to make sure that things are going well (which they are!), do an exam of the anastomosis site (where the pouch is attached to the "rectal cuff"), and to discuss and schedule surgery, round 2.

     Dr. L asked how things were going and to be truthful, I feel pretty good. I've been back at work since Christmas Break for about a week and I feel great! There are actually days where I have left school and thought to myself, "Wow! I don't feel like I got hit by a truck today!" Certainly a good feeling! 

     After discussing how things are going, Dr. L performs an "exam". This involved me rolling to side and bringing my knees to my chest, and... well, you probably know what came next. Not pleasant at all! After shoving his finger in my ass, Dr. L says something to the effect of, "Yep... if you don't use it, you lose it!" Not exactly what you want to hear during an "exam" like this! He then proceeds to manually stretch my pouch from the inside. This might be one of the most painful things I've felt during this whole process! I couldn't help but let out a few audible groans to hopefully let him know that I was in pain! It probably lasted no more than 30 seconds, but it was awful and felt like so much longer. I guess the size of the pouch can shrink during the healing phase. I am assuming that this will get better once there is "output" through the pouch. After cleaning me up, he sat me back up and it was time to discuss surgery dates.

     I had hoped that I would be able to wait until school gets out (end of May) to do surgery 2, but Dr. L said I had to have it sooner. He wanted to do it in February, but I told him with my school schedule, this would not work. We finally compromised and settled on mid March as an ideal time. March 20th to be exact! I asked him why I couldn't wait longer, and he basically said that the longer you wait, the harder the recovery/adaptation process is. I guess this makes sense. I'll also be out for only 2-3 weeks this time, so I figure I won't miss too much school again.

    Also, today I set up an appointment to have a "pouchogram" done at the end of the month. I'm not sure exactly what the official name for the procedure is, but I've heard others call it a "pouchogram", so that 's what I'm going to call it! This is basically where they will give me a barium enema and take x-rays to make sure that the pouch is healing properly and there are no leaks. Once this is done, I'll get the official OK to proceed with the second surgery. 

     After leaving the appointment, the pain from the exam lingered for the rest of the day. I passed a little blood and mucus this evening, but they told me to expect that.

     I will update again after my "pouchogram". Until then, I finally get to focus on school for a little while and not worry about my health! 

8 Week Update - Happy New Year!

Since I haven't updated since the end of December, Merry Christmas and Happy New Year! As of Wednesday of this week, I was 8 weeks post-surgery and I am feeling GREAT! I had the realization last week while running some errands that I no longer have much abdominal pain. Until now, getting in and out of my car always gave me a reminder that I was still healing, but finally, this little reminder is gone! Being on a two week break after working for 2 weeks has been very good for my body and I am glad that I finally feel mostly back to normal. Here are few updates on how things are going:

Bag Changes:

Changing the bag is still going OK. After trying out 2 new skin barriers, I have discovered that I still like using the Cut-to-Fit skin barriers (Hollister #14603) with tape border. I tried a pre-cut barrier that I think ended up being a little too big. I still cut my barriers at 1 1/4", but it usually is just a little smaller than the pre-cut barrier. This gives me a better seal and more security in the skin barrier. I also tried a skin barrier without the border tape and I eventually decided that I wasn't a fan. While it was more flexible than I thought it would be, it still did not allow enough flexibility to survive moving around for 4 or 5 days. I eventually got nervous about it leaking and had to change it.

Also, my bag change times have not gotten much faster. I attribute this to two things. First, I am a perfectionist, so I have to make sure that everything is clean, dry, and properly prepped before I can put on the wafer. I think this has made a difference as I have still yet to have a true leak (knock on wood!). The other reason it takes me so long is because my abdomen is very hairy. A lot of the time I spend while changing the bag is devoted to shaving the hair around my stoma site. I even have to resort to using tweezers to get rid of hair right up next to the stoma. Again, it is a little bit of a process, but I think it gives me longer wear time on my skin barriers. I changed my bag this morning and it took me about 25 minutes. The bag that I took off had been on since Sunday morning for a grand total of 5 days with no leaks and no fear that the bag would leak!

I also recently tried using a barrier ring instead of stoma paste (just to try it... it seems easier to use than the paste, which can be a little messy). Unfortunately, I did not like the ring. I don't think it gave me a good enough seal and I had some very irritated skin right next to the stoma (I guess it's possible that I may have been allergic to the ring, but most likely not... I'm not allergic to anything!). The paste, while messy to apply, definitely gives me a much better seal and causes no skin irritation.

After trying some of these new products, I did have some issues with irritated skin right around my stoma. It was very red, bled much more easily than normal, and had a stinging/burning feeling while changing and wearing the pouch. After switching back to my stoma paste and normal wafers and using a technique that my stoma nurse taught me, I have been able to keep it under control and begin the healing process. The technique I used is called "crusting" and involves layering stoma powder and skin barrier prep. After cleaning, shaving, and dying the skin, I use stoma powder on the wet, weepy areas right around my stoma. After brushing the extra powder off, I apply a layer of skin barrier prep (I use the 3M Cavilon No-Sting Barrier Wipes... No-Sting is an absolute must!) right next to the stoma, then all around the area where the skin wafer will sit. After allowing the barrier to dry, I repeat the same process which effectively creates a double layer of protection. I have noticed that doing this for the last few changes has cut down on the burning/stinging sensation and the skin looks less irritated during bag changes.

Ostomy Supplies


After trying out a few new supplies, I ultimately decided that I like the supplies I originally ordered and set-up a reorder of supplies. Since I met my deductible and out-of-pocket maximum for the year, I knew I wanted to order as many supplies as my insurance would allow (since I would not owe anything out of pocket). Luckily, my insurance allows a 3 month supply to be ordered, so this is what I did! It was like Christmas for ostomy supplies!! Somehow, it is strange that I was so excited about this (but these supplies are worth around $1000 without insurance help, so if I can get them for "free", I'm happy!). So, now I have enough supplies to hopefully last through my next surgery (depending on the date, of course).

60 Bags and Wafers, 6 Tubes of Stoma Paste,
3 Boxes of Barrier Wipes, and 3 Bottles of Stoma Powder...
Yahtzee!!

Food

Since the last update, I haven't had any major food breakthroughs. I ate pretty normally at Christmas dinner(s) and enjoyed every bite. On New Years Day, I did try a couple new food items and seemed to have no problems. In the South, it is traditional to eat collard greens and black eyed peas for good luck and money! I couldn't resist not trying this out on New Years, so my mom cooked a meatloaf, some cornbread, and mashed potatoes to accompany the veggies. My new pipes handled the peas and collards beautifully (Both were canned, which I think helped. Plus, they were just as good as fresh in my opinion!). This gave me a little bit of confidence and I plan to start slowly adding some foods I haven't been able to eat back into my diet now that I'm 8 weeks post-op.


I go back to see Dr. Liberman in a couple weeks for a check-up and to possibly discuss the date for surgery #2, so until then, Happy New Year!

Six Week Update

I can't believe it has already been six weeks since surgery. I have been back at work for a week and a half and am so glad to be back. I am still getting tired very easily, but that is to be expected for a little while. Luckily, I have a two week Christmas break starting next week :)

Life has been getting progressively more normal and I feel like I've come a long way since surgery. Taking a shower no longer feels like a workout, I am able to sleep normally on my side, and the bag has slowly ended up in the back of my mind most days. These are things that seemed really far away right after surgery. I am still a little sore, especially around the incision site. There are times when I'm especially active that I notice some soreness in my abdomen (not just at the incision site). Sometimes, it feels like a "stitch" in my side, or like a cramp when running. I'm not sure if this is because I've lost so much muscle tone in my abdomen, or if it is the tissue on the inside still healing and readjusting to the new plumbing. Today, I was trying to be agile while hopping over rain puddles in the parking lot at school. Later on, I realized that my body wasn't ready for my ninja-like puddle evading skills. I'm definitely sore after that!

I've had a couple of very small speed bumps this week that were a little frustrating, but things could always be MUCH worse! First, I found a bunch of gift cards to restaurants that my students got me at the end of last school year. I used one on Saturday to get a steak from Longhorns (so good!) and decided on Monday of this week to get something from Chilis. I ended up getting some little slider burgers that I have eaten before and enjoyed. I was starving when I got home, so I promptly dug in. I knew the burger had onions (on the list of foods to be cautious about) but I have eaten onions since surgery and had no issues. I wasn't too worried and continued to engorge myself. About 3/4 of the way through the burgers, I suddenly realized something about the burger that was not good: The bun had sesame seeds! Seeds of any kind are on the "do not eat" list, especially for the first couple of months after surgery. I freaked out a little and got mad at myself for not realizing it sooner. I have been so afraid of having a blockage and have been pretty careful for the most part, so I was mostly upset with myself. I quickly drank a lot of juice, to hopefully ensure that the seeds would flush themselves out. Later that night, I ended up getting what I think is my first bout of diarrhea. I had to empty my pouch very frequently and it was very watery (much thinner than normal). I was able to see individual sesame seeds and realized too that the ground beef must have been very gristly (sorry if this is too graphic, but I am no longer phased by talking about my bodily functions or fluids!) because I could see the remnants of that as well. Overall, I made a poor choice for dinner that night, and I paid for it in lack of sleep and peace of mind. Luckily, I did not get a blockage and learned to be more careful about watching what I eat!

My new ostomy supply organizer

The next "setback" I had happened yesterday while changing my pouch. It was the first time I changed the pouch in the morning before going to school (last week I did it right before dinner, so there was very little activity). I was up a little earlier to give myself plenty of time, so I was pretty tired and my brain was not firing on all cylinders. I was testing out some new wafers/bags that Hollister sent me last weekend. I am trying out a pre-cut wafer (as opposed to the cut to fit ones I've had since surgery since the stoma can change) since my stoma has stayed right at 1 1/4" for the last few pouch changes. While preparing the wafer, I applied the paste like I usually do, set the wafer aside, and started working on cleaning/prepping my skin. At some point, I managed to knock the wafer on the ground and it landed adhesive side down (of course!). Fortunately, after some swearing and picking hair off of the adhesive, I was able to salvage the wafer. I set it aside again and continued skin prep when I managed to RUIN this recently salvaged wafer. Last weekend, I bought a small countertop organizer to keep my ostomy supplies easily accesible (up until then, I was using a small, cluttered Coloplast bag provided in the hospital. It was also my "emergency bag" that I take to work in case I have a leak at work. Now, I have a supply that stays at home, and an emergency bag that stays in my car. This way, I don't have to worry about taking the bag to and from work every day). Unfortunately, I managed to open the bottom drawer right on top of the wafer which effectively smeared stoma paste all over the wafer. At this point, there was no chance of rescuing the wafer, so I threw it out and opened the other wafer that Hollister sent (thank goodness they sent 2 - probably for newbies like me!) and applied it with no further hitches.

Writing about these two very trivial things makes me realize that I am really in a pretty good place. I have read horror stories about the complications that people have after a surgery like this (abscesses, fistulas, tons of leaks, etc.), so I am thankful that my biggest concerns are a little diarrhea and a ruined wafer (that I didn't even pay for). God is good and He is definitely helping me through this!

Regarding the new wafer, I think I like it so far. Not having to cut the opening saves a good bit of time while changing the pouch. The other thing about this wafer is that it is a little smaller. Since my stoma is 1 1/4", the wafers that Hollister makes with this size opening have a smaller flange (the plastic tupperware-like ring that holds the bag to the wafer). I'm still not sure yet if this smaller flange is a good thing or bad thing. Because it is smaller, it doesn't get caught on my pants as often. On the other hand, the smaller ring means there is slightly less adhesive between the stoma and the flange. I can't tell yet if this means the seal is not as good, but hopefully I'll be able to tell by my next pouch change.

Finally, I realized the other day that I have not posted any pictures of my incision or scars. I need to find some post-op pictures that my folks took while I was drugged up in the hospital and post those as well. For now, here are some six week pictures of my scar and the ostomy pouch (The little scar on my left side is where the JP drain was placed during my hospital stay). Overall, the incision is healing very well and starting to itch (which is a good thing, I think... it means the nerves are starting to heal as well). I am using Mederma, as recommended by a dermatologist, to try to reduce the size and darkness of the scar (my skin scars really easily, so I hope this stuff helps!).

Part of the scar is always covered by
my pants line

The Whole Scar

Back To School...

Back to school, to prove to dad that I'm not a fool...

Not really, but every time I say "back to school", that song comes to mind (from the movie Billy Madison if you're not familiar... YouTube it!).

I went back to school for the first time last Monday after only spending 4.5 weeks at home after surgery. It felt good to be back and be back into a normal routine. I was very tired, especially toward the end of each day, but I felt like it will help me get closer to 100% sooner. I did end up leaving school early on Thursday afternoon in order to take a nap and recover before coming back for our concert on Thursday night. Being at the concert was so refreshing. Not only did I get to see all the band families for the first time since surgery, I also got to make awesome music on stage with a bunch of teenagers. This night definitely confirmed the fact that I love my job and was so happy to be back (even if I was worn out!).

Other than returning to work, not a whole lot has happened since my last update. The bag changes are going well and I have still had no leaks (knock on wood) since the big blowout in the hospital. I am supposed to be receiving some samples from Hollister so that I can try out some new products (pre sized skin barriers and some without the cloth border, just to try something different). I am also going to order my second set of supplies before the end of the year. Hopefully, I can get enough supplies to last for a while since my deductible resets at the beginning of the year.