Topic Explanation
The discussion revolves around a 56-year-old woman who is struggling with depression five years after undergoing a urostomy due to a severe bladder disease (interstitial cystitis). She had her bladder removed, but continues to suffer from nerve entrapment pain. The lack of local medical expertise for her condition contributes to her distress. Additionally, her relationship with her husband has deteriorated since the surgery; they have lost sexual intimacy and other forms of closeness. She feels a significant change in her lifestyle and self-perception, noting a shift from being outgoing and meticulous about her appearance to withdrawing from social activities and self-care. She seeks advice and support from others who might have experienced similar challenges.

Advice and Helpful Insights
1. Attitude Adjustment:
- Embrace a positive attitude and act vibrant and confident, which can influence how others perceive and treat you.
- Reassure your husband that you are still the same person and capable of intimacy, addressing any fears he might have about causing you harm.

2. Seeking Medical and Psychological Help:
- Consider consulting a pain specialist if nerve pain is significant, as managing this could improve overall well-being.
- Explore options for depression through counseling or medication, and consult with a primary physician for referrals to specialists.
- A gynecological check-up might also provide insights into changes in libido and other physical concerns post-menopause.

3. Social and Emotional Support:
- Engaging with an ostomy association or support group could provide comfort and understanding from those in similar situations.
- Simple gestures, like holding hands with your husband, might help in regaining physical closeness.

4. Personal Experiences and Encouragement:
- Others have faced similar challenges and have found new relationships where their partners accept and support them post-ostomy.
- Life adjustments post-ostomy can lead to new beginnings and opportunities for happiness and fulfillment.

5. Practical Considerations for Specialist Care:
- If necessary, consider traveling to see specialists, even if it requires significant effort and resources, as managing health effectively can improve quality of life.