After all the complications that arose from my Total Colectomy and Rectopexy surgery, I am determined to be more prepared for my upcoming K Pouch and Proctectomy surgery, which is an even bigger surgery, with higher complication rates.
As I outlined in my previous article Total Colectomy and Rectopexy, I suffered Ileus after that surgery. Ileus is when the intestines stop pushing through food, liquids and gas, which causes a blockage that can be both painful and dangerous. In my case it meant that anytime I ate or drank anything I would throw it straight back up, which was awful and I had horrible discomfort in my abdomen. In the worst case scenario, it can cause a life threatening tear of the intestine and/or an infection in the abdomen.
The doctor’s became concerned about dehydration and malnutrition and as a result I had NasalGastric Intubation (NGI) & Total Parenteral Nutrition (TPN) put in after some time.
What is NasalGastic Intubation?
If you are unable to eat or drink, a nasalgastric tube will be inserted, a tube that goes in through your nose and down into your stomach. This process is known as nasalgastric intubation (NGI). During NGI, the doctor or nurse will insert a thin plastic tube through your nostril, down your esophagus, and into your stomach. Once this tube is in place, they can use it to give you food and medicine. They can also use it to remove things from your stomach. I had this done while I was awake last time and it’s not a pleasant experience! I should also tell you that having a NGI tube in is SO UNCOMFORTABLE, whilst it’s really helpful it’s terribly unpleasant.
What is Total Parenteral Nutrition?
Whilst the NGI will help me ingest some nutrients it is unlikely to meet all my nutritional needs. Therefore I will also have Total Parenteral Nutrition (TPN) which is a form of nutritional support given completely via the bloodstream, intravenously with an IV pump. TPN administers proteins, carbohydrates, fats, vitamins, and minerals directly into the blood stream. It aims to prevent and restore nutritional deficits, allowing bowel rest while supplying adequate caloric intake and essential nutrients. I had my TPN connected to a vein in my chest, I had to be very careful moving and it was quite uncomfortable but again very much worth the discomfort!
I explained my experience of having Ileus after my previous surgery to the surgeons performing my upcoming surgery and they believe I have a high risk of getting it again. Therefore, they are going to give me NGI & TPN immediately after my upcoming surgery (I will wake up with them – thankfully I won’t be awake again while they’re put in) to try to avoid the horrible discomfort I experienced last time. Whilst NGI & TPN are unpleasant, they are significantly better than Ileus and I am grateful that my new surgeons are prepared to be proactive.
Psychiatric Care & Emotional Wellbeing
As I discussed in my article Total Colectomy and Rectopexy, I have Bipolar Disorder; I also have Generalised Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD). If you’re interested in finding out more about my mental health experiences you can read my other blog My Bipolar Life.
Stressful events can certainly be a precursor to a depressive or manic episode and of course increase anxiety levels. For this reason, in the lead up to my surgery I will be in regular contact with my psychiatrist and with the help of my husband, family and friends, I will be keeping a close eye on my mental health.
Having said that, at the moment I am experiencing a plethora of emotions. I’m anxious one minute, excited the next, I’m optimistic then pessimistic, I’m relieved yet concerned, I’m proud of myself yet I doubt myself constantly, I’m afraid yet determined to be brave, I’m overwhelmed yet I’m coping, I’m frustrated with having to wait until February yet I want time to slow down, I’m still depressed about my current quality of life but I’m hopeful for the future and I’m lonely yet my support network grows by the day. I think all of these emotions are completely normal and not necessarily related to my mental illness.
For the surgery itself and my recovery period I will be being cared for by the resident psychiatrist at the hospital where I am having my surgery. That psychiatrist is going to liase with my psychiatrist before my surgery and throughout my recovery to ensure I get continuity of care. I am very lucky that these specialists are happy to communicate with one another for my benefit.
Also as discussed in my article Total Colectomy and Rectopexy I discovered during my recovery from that surgery that a combination of opiodes and ketamine works best for managing my pain post surgery. I also have been advised by a number of patients who have had this surgery previously, that getting an Epidural for when you wake up can help dramatically. To arrange these pain management strategies, my Surgeons have arranged for me to meet with a Pain Specialist prior to my surgery, who will order my Epidural and manage my pain medications post surgery. It’s fantastic that these arrangements are being made prior to my surgery, I’ve never had pre-care like this before.
Also prior to my surgery, I will be meeting with the Stoma Nurse again so that she can give me much more thorough information about what to expect during my recovery. I know for example that my new stoma site, or valve site, will be (temporarily) intubated constantly for at least the first few days post surgery, but I’m not yet certain when that will be removed and how I will be taught to intubate myself. The Stoma Nurse is going to tell me everything I need to know in my pre-surgery visit. She will also tell me more about what to expect in the future and any warning signs I should be aware of for complications such as Pouchitus. She is also a ward nurse and is going to discuss with me my dietary requirements and preferences for when I do begin to eat again.
On the topic of diet, I actually follow a whole foods plant based diet. This means I avoid animal products, carbohydrates and processed foods. Whilst I don’t expect to be able to follow this diet strictly in hospital, they have assured me that they will do everything possible to accommodate my preferences, which is greatly appreciated. In the lead up to my surgery, I have been ensuring that I am getting solid and varied nutrition, trying to boost my body as much as I can and be as strong and healthy for surgery as possible. This has included doing a very nutritionally packed juice cleanse which includes more than 40 different fruits and vegetables in my juice daily.
On top of following a healthy diet I also take a number of supplements, some are for vitamins and minerals normally absorbed in the large intestine (which I don’t have anymore), some are for stress and anxiety, some are to help alleviate my spasmodic pain and so forth. This is in addition to my prescribed medications.
Arrangements for my husband & My Aftercare
Finally, in the lead up to my surgery my husband and I need to arrange to be able to be in Melbourne for somewhere in the vacinity of 5-7 weeks. My husband is taking carers leave from his work; our pets will be cared for by his parents and we are currently working on booking accommodation and travel. After I am discharged from the hospital we will need to remain in Melbourne for an additional three weeks to ensure that I have no post surgery complications and that I am intubating without incident, before we can head home. I will be seeing my Surgeon and the Stoma Nurse regularly throughout this time, to ensure everything is progressing as planned. Incredibly, the accommodation and travel component of this adventure are going to be almost as expensive as the surgery itself! So that’s it! Bring on February!