Joe Gregorio
This colostomy takedown surgery is the second in the pair of surgeries I have had this year. If you would like to read the story of how I came to need a colostomy takedown please read A thing that happened.
As opposed to the first surgery which was done as an emergency procedure, this was a planned surgery, which made a world of difference. We were able to research and hire a patient advocate to stay with me a few nights, apply for short term disability before the surgery, etc.
Day of surgery
I was told to arrive at 11 AM for a 2 PM surgery, but when I got there at 11 they told me that both the surgeon and anesthetist had arrived and were ready to start, so my prep was actually pretty quick, they brought me back without Lynne to get me dressed and an IV started before Lynne was allowed to come back to see me, by the time they allowed her to come back and see me we only had 5 minutes together before they wheeled me off to the operating room.
The prep for the surgery went well. I have deep and abiding issues with getting IVs, a leftover from a previous surgery years ago when I was traumatized with an awful IV experience. This time, instead of just sucking it up, I talked to the anesthesiologist before hand, they added notes to my chart about my issues with IVs, and I also, on their advice, talked to the nurse giving me the IV. She was very understanding and gave me a Lidocaine shot before giving me the IV. This turned out to be a much better strategy than sucking it up, and the IV was painless and easy.
Compared to the first surgery, which was an emergency surgery, I was awake for much more of the process leading up to the surgery, even helping to move myself onto the operating table and watching them apply straps to hold me in place. I was also woken up in the operating room at the end of the surgery, I remember moving off the operating table and being rolled into PACU.
Going into the surgery the goal was to do the whole thing laparoscopically, but if that didn’t work they would have to re-open me up in same dramatic fashion that they had for the first surgery. Also, if there was still too much swelling or scarring on my large intesting they might also have to give me an ileostomy that I would then need to wait yet another three months to have taken down. Luckily all went well and when I woke up I was glad to hear that they were able to to do the whole thing laparoscopically, and I didn’t have an ostomy of any kind.
When coming out of surgery you initially have no pain medication in you, so they need to judge how much pain you are in and how much pain medication to give you. This is always a point of confusion post-op for me because I do this thing where I shake when I’m in extreme pain, not a little shaking mind you, I’m talking full-racking-body-swaying-the-hospital-bed shakes. This, unfortunately leads the nurse to believe I’m cold, and not in pain, so they start wrapping me in more and more layers of blankets. By the time they let Lynne into the PACU I was under 10 blankets, 6 over my body and 4 around my head. She explained that I wasn’t cold, but in pain. The nurse gave me my first dose of pain medicine, but having just come out from under anesthesia I was a little incoherent:
Nurse: Did that help? Me: Yes. Lynne: You are still shaking, are you still in pain? Me: Yes. Lynne: So that last set of pain meds wasn't enough? Me: What pain meds?
As you can see from this exchange that both the nurse and Lynne are saints.
After they had my pain under control they set me up with a pain pump and moved me to my room.
The doctors and nurses told me that the more I walked the better I would heal and I took them very seriously. I was out of PACU and in my room by 5pm and took my first walk an hour or so later, with Lynne pushing IV pole and me with a walker. Lynne then had to leave to take care of the kids for the night, so I took another walk with the help of the nurse at 8PM. That exhausted me and I took an hour nap, but that got me behind on the pain pump and I felt it when I woke up at 9PM.
My pain was mostly in area where colostomy was closed, except for the hiccups, which caused intense pain right below the rib cage. My Dr. explained that they were the result of the CO2 they pumped me full of for the laparoscopic surgery and that they should go away as my body absorbs the rest of the CO2.
I actually slept pretty well that first night, sleeping in solid blocks of 2-4 hours and then waking up to use the pain pump.
Day 2
I was serious about my walking and if I was awake and had my pain under control I would try to get out for a walk. I was also serious about keeping hydrated, as I had been since the first surgery, as becoming dehydrated and constipated with a colostomy was something I dreaded. So as the day wore on I kept drinking and walking, but after a while it felt like I couldn’t drink any more and my stomach was getting sore. The Dr for that shift suggested I stop drinking, that my bowels probably hadn’t woken up and that everything I was drinking was just accumulating in my stomach. I did hold off on the liquids for the rest of the day, and then asked my Dr. when I saw her later in the day and she agreed with his prognosis. At this point I suggested that if I wasn’t going to drink maybe they should increase my rate of IV fluids above the KVO (Keep Vein Open) level so I didn’t get dehydrated. She agreed and actually changed me to IV Lactate. I don’t think anyone would have thought of this on their own, just pointing this out that no matter how great the care, you really need to be your own advocate.
That morning they removed both the catheter and pain pump, I apparently didn’t use the pain pump very much, and they moved to oral pain meds, falling back to IV injection for breakthrough pain, which didn’t happen very often. I was still having hiccups, which were still painful, and would be triggered by coughing, laughing, or most annoyingly, just saying the word “hiccups”.
I walked 6 more times, now without the walker since without the pain pump I was very stable on my feet. As the day went on my stomach got better and towards evening started to pee a lot more, around 700ml every hour or two. The IV fluids were only coming in at 75ml/h so that wasn’t the source and I hoped that my digestive tract had started to wake up.
I had a total of four bowel movements during the day, but they were entirely blood clots, and each one was progressively smaller than the previous one, and since I didn’t pass any gas they didn’t “count”. What the staff were waiting for was me to pass gas, at which point I would be allowed to transition from “clears” to solid foods. I know they were blood clots and not “blood” because I dragged a nurse into the bathroom each time to inspect them and confirm that it wasn’t “blood”.
I took 3 more walks through the evening for a total of 10 walks for the whole day.
Day 3
Early in the morning I saw the other Dr and he said I had urinated over 3L during the night, in addition the nurse listened to abdomen and said it sounded very active, so I was hopeful that would be enough evidence that my bowels had woken up.
The majority of the day was again more walks, keeping on top of oral pain meds, and napping between walks. The only change was that it was now beautiful and I upgraded to walking around outside.
The hiccups are gone at this point, and the pain at this point is mostly in the site of the former colostomy and only during transitions to/from walking/lying down.
I saw my surgeon at 3 PM and she wrote me up for solid foods, and I immediately ate one Ritz cracker, from a sleeve I had squirreled away in my travel bad for just such an occasion. Later they deliver the hospital dinner, which I nibbled at, and then went for another walk and then back to sleeping. I woke later that evening and had another small bowl of chicken noodle soup they prepared at the nurses station, got my pain pills, and went back to sleeping.
Day 4
I took my first walk at 6 AM and had a bowl movement with real stool and a small amount of blood clot. I also had a lot of gas coming out both ends of my digestive tract.
Later that morning I walked down to Au Bon Pain in the hospital lobby to get a croissant for breakfast, and I also went back down there for lunch. Yes, the hospital food was that bad. The folks working at the Au Bon Pain seemed oblivious to me wearing a hospital gown and pushing my IV pole as I ordered my lunch, but some of the other patrons gave me wary looks.
I was released later that day.
Day 5
I didn’t realize that when they released me I was still on 10mg of oxy every 4 hours, but they wrote a prescription for 5mg of oxy every four hours. It took me some time to coordinate my pills and get on an overlapping Motrin/Tylenol shift with just oxy for the breakthrough pain.
At this point I am home and walking 2-3 times a day, where each walk is about a mile long. A new symptom appears at this point, occasionally I will get a muscle cramp in my abdomen around the old ostomy site, and that will slowly spread across my entire upper abdomen. It usually only lasts a minute or two, but it is fairly painful when it happens.
Day 7
I am no longer using the oxy for breakthrough pain.
I did have a bit of a panic this day, I had been regular and stools were beginning to become more formed, but then I “missed”, or really just went a few hours over when I was due for a BM, so I tried lots of things, taking a stool softener, drinking apple juice, etc. A few hours later I had a normal BM, but unfortunately all the things I had tried to loosen up my stools were still in my system working away and I ended up giving myself diarrhea and re-irritating my bowels. Fortunately that died down over the next 24 hours.
Day 11
No longer taking Motrin or Tylenol on a regular basis. At this point I am fine if I am standing, walking, or lying down, but sitting gets uncomfortable, and if I sit too long then when I stand up the area just under my ribs feels uncomfortable, it’s hard to describe, bit it almost feels like my intenstines stiffen into one position when I sit and then when I stand up they resist, in a painful way, moving back into the standing position.
Day 12
Stopped wet packing the former colostomy site as it was almost completely closed.
Day 14
Actually had enough brain power to do some real programming, but that only lasted for about 30 minutes; it is shocking how much pain and healing will take out of you and turn your brain to mush.
Day 30
First day back to work. I am still taking Motrin occasionally, usually if I just try to do too much. I can now sit for much longer periods of time, and I don’t get that stiffness in my abdomen when I stand, but I will still occasionally get a muscle spasm around the old ostomy site. All my wounds are closed at this point, but my abdomen is covered with scars, swollen in some areas from the last surgery and distened from where the colostomy was; in summary I look like my stomach was run over with farm equipment.
At this point I am 20 lbs lighter than when I went into the emergency room for that first surgery. I lost 15 lbs from the first surgery and another 5 lbs from this latest surgery. I’m fine with the weight loss, just not what I had to go through to get here.