Its been a couple of weeks and quite a bit has happened since my last post. Unfortunately I've been in a great deal of pain and discomfort and really have not felt up to sitting at the computer to write until now. Today marks two weeks since I underwent abdominal reconstructive surgery. This coming Monday I have my follow up with my surgeon to remove over thirty staples from my midline incision as well as the JP drain, which still two weeks out is draining about 45 ml or an ounce and a half of bright red blood daily.
Two days leading up to the surgery I was quite concerned as I had contracted my son's sore throat, which had turned into a cold the day before surgery. Concerned of course I immediately called the surgeon on call to make my surgeon's office aware of the situation. With nothing in the chest and just clear nasal drip, they did not believe there was cause for alarm. To be on the safe side the day of the surgery I was to call the anesthesiologists to get their take on the situation. The day before the surgery in addition to coping with a cold I also learned that day that my surgery would not take place in the morning but instead two o'clock in the afternoon. The thought in my head at the time was great, I'd be going 3 days or so without eating, given I'd already fasted a day before the surgery. That would turn out to be a very minor concern, as once out of surgery with the significant amount of pain, food was the farthest thing from my mind.
I was given the go ahead for surgery from the anesthesiologist despite my cold. Before going under an epidural was inserted, this would control the pain much better than the PCA pump and control it immediately. I was glad this was an option this time. Before I knew it I was waking up from surgery and while the pain was managed a bit better than it had been in the past something was still not right. The right side of my body felt no pain, while the left side was writhing in it. The epidural catheter was not in straight so the anesthesiologist attempted to tinker with it a couple of times to see if they could straighten it out, unfortunately the attempts wer unsuccessful and in a short matter of time the catheter was removed leaving me to fend for myself with the PCA pump. The post-surgical pain was much greater this time than in any of the previous three surgeries. I could feel the mesh and anchors that stretched across my abdomen. Even today two weeks later I can see the bruised and raised areas where the mesh anchors are causing me so much discomfort. This is the first place were plans deviated.
By the following evening the doctors gave the ok to begin eating. Unlike in my previous experiences where I was started slowly with clear liquids, followed by full liquids, and following a natural progression to ease my digestive system back to work the doctors at DUKE preferred the shock and awe method, explaining that there were no limitations and I could immediately have whatever I desired. I was a bit more cautious however and limited myself to liquids for starters. With the first sip of juice I immediately became nauseous and sent the nurses scrambling for anti-nausea medicine as I braced myself with a pillow and bucket and prepared for the worst. Fortunately, the anti-nausea medicine was administered quickly and I was saved for the moment. The day after surgery, the same day I attempted to consume food and battled nausea I also attempted to get out of bed with my wife's help but could not must the strength to do so. Sunday, two days out of surgery I was finally able to get out of bed and walk to the end of the hall and back, but that was it. The pain was so much greater than anything I had experienced before. Just as with my previous surgeries, I got the feeling I was being rushed out of the hospital, whether the accelerated dietary plan or the surgeon's resident pushing to get me home almost on a daily basis. I probably would have felt more comfortable with an extra day in the hospital but Tuesday I was sent home. I was sent home with a walker too, that I have yet to use more than once, that initial day.
Aside from the parastomal and ventral hernia repairs, a prolapsed stoma was also repaired. It was explained to me by my surgeon that they would simply remove "chop off" the prolapsed portion and bring new intestine through creating a new ileostomy. When I changed my appliance in the hospital I was a little startled by what I saw. First off, my stoma was not perfectly round as it had been in the past. It appeared almost as if the new stoma was simply placed on top of a stump of the old stoma. A little funky looking to say the least. When I asked the WOC nurse there at the time about it, I was told that it was nothing to worry about and it would fix itself over time. The second point of concern is that it did not appear to be protruding nearly as much as one would expect. In everything I've read and learned about stomas I was expecting it to protrude by at least half an inch but it looked like a little nub of a stoma that could easily be covered up by some stoma powder and a barrier ring. The stitches at the base of the stoma visibly protruded and it appeared as if the skin around my stoma was being eaten away. After a few appliances changes and several days at home saw the skin condition around the base of my stoma worsen and put in a call to my surgeon's office and in turn DUKE's wound ostomy nurse, Stephanie. I explained the situation to Stephanie and even emailed her several pictures and she diagnosed the condition as "mucocutaneous separation", explaining that it was normal and while it may get worse before it gets better assured me that it would get better. Stephanie was very helpful and agreed to meet me this coming Monday at my post surgical appointment with Dr. Mantyh to change the appliance in the office and take a look at it, offering any help that she can provide.
Since coming home a little over a week ago, I have done nothing but rest. Oh, I've gotten up and moved around the house to do a load of laundry, empty the dishwasher, etc. I've done my best though to make sure I do not over do it. I had a few instances post recovery where I've had to splint with pillow braced against my abdomen while coughing, which was extremely painful as one may imagine. Beyond that I have made certain that I do not jeopardize my recovery this time around. That being said I still feel as if something is just not quite right. Perhaps what I'm experiencing is still post surgical pain and swelling around the repaired stoma. Nevertheless I have a sinking feeling that the parastomal hernia hasn't been fully repaired. I still notice a bit more unevenness on that side of my abdomen and maybe its because of the more extensive Sugarbaker method used to repair the hernia. I've also felt some discomfort similar to what I felt leading up to the surgery but maybe its just post-surgical pain that I'm experiencing. There also appears to be some minor swelling when eating, though nothing like before. Finally my output was vastly improved the first few days post surgery, no more watery output but once the familiar symptoms set in the quality of my ileostomy output seemed to decline while the frequency increased. I will be certain to mention this to Dr. Mantyh as well on Monday.
Two weeks out and I'm still in a great deal of pain and discomfort. I'm unable to sleep through the night or sleep on my side. Getting up and laying down is something I do still very gingerly. The first major drawback of having an out of town surgeon is when it comes to pain medication and pain management. I was sent home with a prescription for 5 mg of Oxycodone, which works much better than Hydrocodone, however oxycodone can not be called into the pharmacy but only filled with a written prescription. Realizing I was running dangerously low I called my surgeon's nurse on Monday the 29th. When we spoke yesterday I was told that the prescription for Oxycodone was more than likely mailed on the 30th. Unable to go without I had the doctor's office call in a prescription for hydrocodone in case I did not receive the prescription soon enough. Its a good thing I did because I picked up the Hydrocodone yesterday and after today's mail was delivered on Friday November 2nd I still have not received the prescription for the Oxycodone. If I don't receive it by tomorrow I'll be able to pick it up in person when I see the doctor on Monday.
On the bright side my midline incision, which became quite ghastly after the infection and wound vac experience early in the year has been cleaned up. I also no longer have Gonzo's nose protruding from the right side of my abdomen. I am also eating three meals a day again, although my weight is still down at 145 and while recovering finding it difficult to add it back on because my appetite has shrunk with all the swelling and discomfort in my abdomen. The future with my ileostomy looks promising and hope to have a clearer picture on the direction of my recovery after meeting with Dr. Mantyh again this Monday.