While I was waiting for the day of the gastrografin enama test, I called my colo-rectal surgeon's office to find out what kind of surgery I would need if the fistula had healed itself. The nurse called me back and left a message that the only surgery I would need would be taking down the colostomy. This was great news, even though I was worried about how long it might take my "plumbing" to start working again. The only way you can leave the hospital after a colostomy is reversed is to poop. You know that old saying, "The proof is in the pooping."
After the test showed the fistula had healed itself, I met with the colo-rectal surgeon, and we discussed when the reversal surgery could take place. I wanted it as soon as possible. She spends a lot of time traveling the world doing research and teaching, but she had an opening right before Derby, on the last day of April, so I took it.
I had to be at the hospital at 6:00 AM, and my brother took me there and stayed while I went through pre-opp. The nurses and I had the same discussion that I have every time with them about using my port and not giving me an IV in my arm/hand. For the exploratory surgery when my doctor sedated me to probe around for the fistula, which was done in an outpatient area in the basement of her office building, they used my port until they sedated me, and then they put the IV in. They also took it out, before I went into recovery. In fact, I didn't know I'd had it, except for the bandage over the area where the needle was. This was ideal. However, the pre-opp nurses at the hospital would have none of that and insisted on poking me near my hand. They didn't seem the type to be swayed by tears, so I just went with the flow. I admit, she did a good job, and she did numb it first.
We are now at another part of the story that I don't remember big chunks of. I know my brother had to leave to go to work, because he was the only one in his office that day, but I don't remember when he left, or when my sister-in-law showed up. Apparently, the amnesiac they put in the sedative works well. I do remember some of the dilaudid block (GI block). From what my sister-in-law said, I was in a lot of pain, and the morphine wasn't working well. I don't remember being in pain, but I remember the doctor being there with the ultrasound equipment. I think I had to lie on my side while he administered the block. After reading the description of it, I'm glad I don't remember it, because it was a 4 inch needle administered subcutaneously. Subcutaneously means in a fatty layer just under the skin where there is not much blood, so the medication can be absorbed slowly.
I guess once I was out of pain, I could concentrate better on making comments like "Let the poop begin" and offering ice chips to my sister-in-law and telling her it was bacon. I also told the nurse who said I should push the call light if I needed anything, that I would "let my love light shine." That dilaudid block was great!
According to my sister-in-law, I didn't get into a room for many hours. I don't remember this either. I did go to the floor where I had been when I got the colostomy, and my room had a decent view of the Pegasus Parade. My walking buddies from work showed up either Thursday or Friday and that was a nice surprise. I didn't end up with any visitors the night of the parade, because no one could get through the traffic maze downtown.
As expected, I was given clear liquids for a few days, and I couldn't get much of them down, because they was disgusting and were foods that I don't like, like jello. Who wants to eat chicken broth and jello for breakfast, lunch, and dinner? I wasn't worried about not being able to produce poop, because I'd read that you still do or doodoo, even if you don't eat for a while. At some point, they switched me to a full liquid diet, which was a little better. I was able to have things like cream of chicken soup.
Friday, I felt good enough to work on my laptop, which saved me from losing another vacation day. After having to stay in the hospital 6 extra days for the colostomy surgery, and after my doctor said I should plan on about a week for the take-down, I figured I'd be there at least a week. But on Friday, a little before the fillies were set to run at The Kentucky Oaks, this nag was sprinting to the bathroom in a bid for the real home stretch. When the deed was done, I was so excited. I pulled the help button next to the toilet, and as luck would have it, the CNA who opened the door was the cutest, 20 something year old male CNA I've ever seen. He said "Can I help you?" and I said, "I pooped." He responded, "Do you need me to help you?" and I said, "No, just tell the nurse I pooped, because that's what I have to do to go home." If I'd known they weren't going to ask for proof, I would have told them I pooped on Thursday after the surgery on Wednesday. By the way, without knowing the odds or who was the favorite, I picked Untapable for The Kentucky Oaks, just because of her name.
Because it was so late in the day, I stayed in the hospital another night and was released around noon on Derby day. My neighbors came to take me home. It was so nice to leave the hospital without the waste around my waist. I felt good and strong and happy to have gotten over the latest hurdle. The next test would be whether I would recognize the signals to head to the bathroom, and whether I would make it on time. My first day home, the answer was "the old grey mare, she ain't what she used to be, many long years ago."
Thursday, May 22, 2014
Saturday, May 17, 2014
Unexpected good new
Almost a month has passed since I last posted here. A lot has happened and most of it was really good.
When I went in for the gastrografin enema, I told the tech that I was concerned that it would hurt because of the radiation I'd had. He went and talked to the doctor, and the doctor decided to use a much smaller apparatus instead of the longer one with the balloon. I found out the balloon is inflated after the apparatus is inserted to hold the cannula in place, while they fill up the area with the liquid. The smaller apparatus didn't hurt at all, and the doctor told me while he was viewing my insides that he didn't see the fistula. He said he would need to review the x-rays, but from what he could see, the fistula was gone. The tech later told me that all the liquid went straight to the ostomy bag. Plus, I was told that I should wear a pad, because I was going to leak all day, but that didn't happen either, because the liquid went to the ostomy bag.
I waited for the results and took them to my colo-rectal surgeon. She was very pleased that the test confirmed the fistula had healed itself and got up from her chair to give me a hug. She said she was so happy to be able to give good news for a change. I asked if it was very common for a fistula to heal itself, and she said it was very unexpected. While fistulas can heal themselves, they tend to grow even larger from radiation, and my radiation oncologist had told me early on that he was 100% certain that I would have the colostomy for the rest of my life. While I was discouraged from his statement, I decided to believe my colo-rectal surgeon who had told me that she would do whatever she could to reverse it. And she was true to her word - more about this in the next blog.
She and I had had a previous conversation about other surgeries that she could perform if the fistula were still there, and they were not easy surgeries or easy recoveries. One type of surgery was possible if the fistula were small enough and low enough in my vagina. This surgery is called graciloplasty and the gracilis muscle is a little used muscle on the inside of the thigh. "It can be turned upwards to be used as a living transposition muscle flap to cover or repair damaged tissue." The other type was even worse and involved two surgeries. First, I would have switched from a colostomy (large intestine) to an ileostomy (small intestine) and that would have had to be in place for two months while the area of the second surgery healed. The second surgery, called a colo-rectal anastomosis would have meant removing some of the rectum where the radiation had done damage, then pulling the colon down and creating a J-pouch out of the colon where the waste would go. Then the colon would have been sewn to the remaining part of the rectum. Fecal incontinence is not uncommon after anastomosis surgery and exercises to strengthen the anal muscle are needed. Dehydration is somewhat common with ileostomies. Also, with anastomosis surgery, because the J-pouch is where the waste goes, and the construction of the colon is different from the rectum, I would have had to learn new signals that I needed to poop. The rectum has a very sophisticated collection of nerve endings in it which send signals to the brain letting you know that you have gas, poop, or liquid. (Apparently, this collection of nerves isn't so sophisticated as you age, because sometimes, we seniors think we have gas, but it's poop. Surprise! Are you wearing your Depends?)
Luckily, I got to avoid those surgeries, because the fistula healed itself. The unexpected good news of the fistula's departure balanced out the unexpected bad news that I had cancer, which I might not have discovered in time had it not been for the appearance of the fistula. Maybe it knew it was no longer needed and went away. I don't know what caused it to close up, but I admit to doing some visualizations of it closing, and I know many of you were saying prayers, sending good vibes, and healing thoughts my way, too. Whatever the reason it healed itself, I'm grateful.
When I went in for the gastrografin enema, I told the tech that I was concerned that it would hurt because of the radiation I'd had. He went and talked to the doctor, and the doctor decided to use a much smaller apparatus instead of the longer one with the balloon. I found out the balloon is inflated after the apparatus is inserted to hold the cannula in place, while they fill up the area with the liquid. The smaller apparatus didn't hurt at all, and the doctor told me while he was viewing my insides that he didn't see the fistula. He said he would need to review the x-rays, but from what he could see, the fistula was gone. The tech later told me that all the liquid went straight to the ostomy bag. Plus, I was told that I should wear a pad, because I was going to leak all day, but that didn't happen either, because the liquid went to the ostomy bag.
I waited for the results and took them to my colo-rectal surgeon. She was very pleased that the test confirmed the fistula had healed itself and got up from her chair to give me a hug. She said she was so happy to be able to give good news for a change. I asked if it was very common for a fistula to heal itself, and she said it was very unexpected. While fistulas can heal themselves, they tend to grow even larger from radiation, and my radiation oncologist had told me early on that he was 100% certain that I would have the colostomy for the rest of my life. While I was discouraged from his statement, I decided to believe my colo-rectal surgeon who had told me that she would do whatever she could to reverse it. And she was true to her word - more about this in the next blog.
She and I had had a previous conversation about other surgeries that she could perform if the fistula were still there, and they were not easy surgeries or easy recoveries. One type of surgery was possible if the fistula were small enough and low enough in my vagina. This surgery is called graciloplasty and the gracilis muscle is a little used muscle on the inside of the thigh. "It can be turned upwards to be used as a living transposition muscle flap to cover or repair damaged tissue." The other type was even worse and involved two surgeries. First, I would have switched from a colostomy (large intestine) to an ileostomy (small intestine) and that would have had to be in place for two months while the area of the second surgery healed. The second surgery, called a colo-rectal anastomosis would have meant removing some of the rectum where the radiation had done damage, then pulling the colon down and creating a J-pouch out of the colon where the waste would go. Then the colon would have been sewn to the remaining part of the rectum. Fecal incontinence is not uncommon after anastomosis surgery and exercises to strengthen the anal muscle are needed. Dehydration is somewhat common with ileostomies. Also, with anastomosis surgery, because the J-pouch is where the waste goes, and the construction of the colon is different from the rectum, I would have had to learn new signals that I needed to poop. The rectum has a very sophisticated collection of nerve endings in it which send signals to the brain letting you know that you have gas, poop, or liquid. (Apparently, this collection of nerves isn't so sophisticated as you age, because sometimes, we seniors think we have gas, but it's poop. Surprise! Are you wearing your Depends?)
Luckily, I got to avoid those surgeries, because the fistula healed itself. The unexpected good news of the fistula's departure balanced out the unexpected bad news that I had cancer, which I might not have discovered in time had it not been for the appearance of the fistula. Maybe it knew it was no longer needed and went away. I don't know what caused it to close up, but I admit to doing some visualizations of it closing, and I know many of you were saying prayers, sending good vibes, and healing thoughts my way, too. Whatever the reason it healed itself, I'm grateful.
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