Surgery Number 4, eighteen years later – post 2/3 in a series

Surgery | J Pouch | Ulcertative Colitis | Colitis | Crohn's | Recovery | Hospital | Ileoanal Anastomosis | Colectomy | Colostomy | Trauma | Abdominal | Scars | Medical | healing | adhesions | bowel | obstruction | ileus | peristalsis

WARNING: THIS POST CONTAINS GRAPHIC PHOTOS OF SURGICAL INTERVENTIONS.

The first time I had surgery, when I was 21 years old, I had been smack dab in the middle of taking an EMT course. Fortunately, when my surgery was done and I had the chance to heal for a few months and gain some strength back, I was able to jump into a subsequent course, finish my training and go on to take the National Registry test and become certified. This was in late 1999. I was working, at the time, for a small local bank in Thomaston, CT and so I volunteered for the Thomaston Ambulance Association once or twice a week and was able to get a little bit of experience under my belt. Soon, life and school and work got in the way and after the first three years of my certification, it hadn’t made sense for me to renew it and it fell by the wayside. I had always missed it, however. I loved the adrenaline rush of an emergency call, the unpredictable nature of what you might be thrust into and of course, the ability to help and make a difference. And driving the ambulance was fun.

Fast forward eighteen years. I had been jumping from job to job, trying to find my lot in life. Trying to find a good employment fit after nine years of running my own business that had shut down. As I struggled, I thought, being an EMT has been in the back of my mind for eighteen years, I had always enjoyed it and though it would never pay very much, perhaps I should take another course, get re-certified, and then if all else failed, I could fall back on something I know I would enjoy and always be able to find employment. I made it more palatable in my mind by thinking that I could even go on, eventually, to become a Paramedic, be that much more trained and that much more employable at a higher rate. I’ve always enjoyed the medical field, ever since my first surgery. So, this is what I did. I enrolled in an EMT class this past September and was having a great time getting to know my new classmates as friends and eating up the knowledge that the course provided. I absolutely loved the idea of being able to help, not just as a member of an ambulance crew, but as an everyday citizen. In my excitement, I bought a jump bag to keep in the trunk of my truck, and loaded it up with every piece of trauma and medical equipment you would ever need…I turned my personal vehicle into an ambulance in itself. I had c-spine collars, trauma dressings, splinting materials, BP cuff and stethoscope, tourniquets, a bag valve mask and even an OB kit, in case I ever needed to deliver a baby! I loved the idea that if I ever came upon a scene, I knew I could help. I decorated my truck with a star of life and a bumper sticker that reads, “My other ride is an ambulance.” I was all in.

Well, again, God had different plans. Just as He had done during the first EMT class I had took, luck would have it that I wouldn’t finish this one either. I had been doing some ride time for my course at the local Winsted Ambulance Association on the Sunday night before Thanksgiving in 2016, the holiday which also happened to land on my birthday this year. I arrived at 6:00 pm and inhaled a Quarter Pounder with Cheese and some fries. At exactly 6:15, I started to experience what I thought was the most intense bout of indigestion and acid reflux than I had ever before. The pain started right below my sternum and stayed there throughout my shift. We had one call that night and drove in the snow up to Colebrook for a motor vehicle accident that was nothing serious. I was done by 9:00 and went right to bed when I got home.

By 11:00 pm, I was awoken by some serious pain that had radiated down into the lower quadrants of my abdomen. It was a pain that I was not used to and it immediately concerned me. I kept saying, “30 more minutes, 30 more minutes,” to see if it was going to get better. Well, when 1:00 am came around and it hadn’t, it was time to get to the hospital. Over the past 18 years of my condition, I had experienced periodic pain before, but it was generally much lower…down in my J-Pouch, which was referred to simply as pouchitis. An inflammation of my pouch, causing pain that was usually handled quite simply with some antibiotics and anti-inflammatory agents. I could tell, however, that this pain was almost certainly a blockage of some sort.

So, against the will of my wife, who wanted to wake up the two boys and package them up for a trip in the snow to the hospital, I demanded to drive myself. I explained to her that while it was painful, it was not the kind of pain that was going to drive me into a tree. I could handle it and let’s not disturb the boys. I’d call her as soon as I got there and again as soon as I knew something. So, I arrived and they got me right into CAT Scan rather quickly. It was confirmed by about 4:00 am or so that I indeed had a blockage. The scan showed a constricted area just South of a rather bloated area…a clear sign that something was not right. So, I was admitted and sent upstairs, luckily to a private room that turned out to be one of the best rooms in the hospital. Two windows and the quiet end of the hallway. I was scared, but content that they would figure out how to fix me up.

So, standard procedure ensued…IVs in, blood work like crazy, stool and urine samples, and constant vitals taking. Then, the dreaded GI tube! Uuuggghhh! That nasty tube up my nose and down into my stomach to suck all contents out. The idea here was to give my bowels a rest. It was explained by the doctors that almost 100% of folks who have had abdominal surgery in the past, will, at some point in their life, end up with abdominal adhesions that cause a small bowel blockage. So, that was the diagnosis. In my mind, I was thankful for what I considered a good run for eighteen years. Something to be thankful for. It was further explained that an abdominal adhesion is basically fibrous tissue that forms, often at the site of scar tissue, that binds together things that aren’t supposed to be bound together. At the same time, the hope was that with a little bowel rest, the blockage may work itself out. Apparently, the small bowel is a very mobile organ. It doesn’t just sit in one place, but moves around as it processes food – twists and molds and contorts like a small slithering snake might do if you held it in your hands. With this in mind, the hope was that it would “un-kink” itself. Because basically, the adhesion had connected two outside surfaces of small bowel, kinking itself into a loop that wasn’t allowing food to move through it. So, we waiting for a few days to see if it might naturally release. It didn’t.

I had another CAT Scan on Thanksgiving and it was confirmed that the blockage was still in place. When the surgeon, Dr. William McGeehin – a highly regarded local surgeon with an impeccable reputation – came to see me the day after Thanksgiving, it was about 8:00 am. “Well,” he said, “it looks like the blockage is still there, not getting any better and we’re going to need to go in and fix it.” I asked him what he thought about timing and he said, “how’s 10:00?” Okay, so that was a lot to digest all at once. We weren’t wasting any time and perhaps thankfully, I wouldn’t have a lot of time to dwell on it. I quickly reported the news to Sybil and she came right down.

I was comforted by the professionalism with which I was informed of the surgery and what was to take place. In contrast to my first surgery, I was fully informed of what to expect when I woke up and exactly what they were looking to do when they got a look inside. It would be somewhat exploratory, because it was impossible to predict exactly where this blockage was, which was a contraindication for laparoscopic surgery. So, yes, there would be another quite large incision, but they were going to take very good care of me. As an aside, it was a special experience to speak with one of the surgical nurses, who actually was there when I had been in that same hospital 18 years ago. Mark Dallavalle and I had a special connection the first time around and I had given him a book back in 1999, which he immediately brought up as he spoke with me and my wife before this surgery. He remembered me and how he appreciated the gift of that inspirational book I had shared with him all those years ago. He praised my strength to Sybil and I was happy he was on the team.

And so they did their thing. It was just under a three hour surgery…much easier to come out of than that eight hour one in Boston. Still the GI tube, and the big incision, but this time, no drain tube and certainly no colostomy bag. I felt some significant discomfort, but for the most part, I felt great. Happy it was over and thrilled with the report that everything had gone smashingly. And of course, my wife was soon right by my side as I recovered. The doc had actually even taken a picture of the surgery that he shared with my wife and I. I hope this doesn’t gross you out, but I’ll share it with you.

blockage

As I understand it, the section that the surgeon is holding with his three fingers at the right, was the “kinked” section of the bowel. The two holes that you see at the left, top and bottom, are the sections of the bowel that were stuck together by the adhesion. So, the surgeon had to snip the adhesion itself and then sew up the resulting holes in the bowel.

What I loved about what they were able to do, was basically give me a thorough check-up from the inside out. You would never willingly go into major surgery just to check around and see how things were going in there. But, because they had to go in to fix the blockage, the added benefit was a full review of how everything else in there was doing. Were there any places where things were festering that could leave to problems down the line? In fact, the connection of my J-Pouch to the anal sphincter got a bit of a repair job while they were in there, which cleared up some minor bleeding that I had been experiencing for a few years prior. So, a fixed blockage and an internal check-up…I was happy as a clam. For a couple days or so.

…to be continued.

Ulcerative Colitis…the extreme cure – post 1/3 in a series

Surgery 4 Recovery; post 3/3 in a series

2 thoughts on “Surgery Number 4, eighteen years later – post 2/3 in a series

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