This topic is about a 27-year-old woman who has an ileostomy, which was done to give her large bowel a rest because it was nearly paralyzed. She also has several other health conditions, including Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers-Danlos Syndrome (EDS), and Mast Cell Activation Syndrome (MCAS). Since her surgery, she has been experiencing frequent obstructions, and her output is very thick. There is inflammation around her stoma, which seems to be causing blockages and flare-ups of her POTS. She is currently using Miralax daily and has a method to relieve blockages, but it takes a long time and causes leaks. She also deals with low blood sugar and has recently gained weight. Although she is seeing multiple specialists, there isn't a clear plan for managing her issues.

Here are some pieces of advice and insights that might help:

1. Seek higher-level care:
- Consider getting second and third opinions from Georgetown University Hospital and Johns Hopkins Hospital. Complex cases like this can benefit from the expertise of multiple academic teams.
- If there are delays in getting appointments, try scheduling tele-visits for quicker triage or go to the emergency room at these hospitals for immediate evaluation by their colorectal/ostomy services.

2. Build a coordinated medical team:
- Find a knowledgeable gastroenterologist to act as the primary coordinator. A good GI doctor will involve a colorectal surgeon, stoma/ostomy nurses, a dietitian, and possibly a small-bowel transplant team.
- Keep contacts at more than one medical center so that urgent issues can be addressed even if one physician is unavailable.

3. Diet and obstruction prevention:
- Always chew food thoroughly, as not doing so can cause blockages at the stoma, especially with fibrous foods like plums.
- Reduce or eliminate sugars and processed carbohydrates, as they can provoke intestinal inflammation.
- Consider a ketogenic-style diet that includes fatty meats, fish, poultry, butter, coconut oil, cream, and mayonnaise. Avoid plant-based processed oils like canola, corn, and vegetable oils, as well as high-carb foods.
- Since individual tolerance varies, try foods cautiously to identify personal triggers.

4. Managing acute blockages:
- Be prepared to remove the pouch and manually clear undigested material if an obstruction occurs, and re-establish flow when it is safe to do so.
- Keep supplies ready for frequent appliance changes, as methods to relieve blockages can affect pouch adhesion.