Surgery Round 2!!

I did it!  I went through with surgery step 2/3 - "J-Pouch Construction and Loop Ileostomy"!

I was terrified right up until the drugs kicked in.

My surgery was on a Tuesday morning at 8 AM.  I took a Xanax and some Zofran Monday evening, to help me deal with the tired/hungry/scared nausea and nerves leading up to the surgery.  Xanax is pretty great, I actually managed to sleep!!  We left the house at about 5 AM to make our 6 AM check-in at hospital registration.

Waiting was agonizing.

I left all of my belongings and cell phone and glasses with my husband, and they wheeled me away before we got to talk to the doctor... which was a little surprising, but Mount Sinai is such a busy place that I guess the doctors don't see patients until they're literally prepped and ready.  When I finally saw Dr. Steinhagen before surgery, I tried to remember all of my last minute questions (my list was on my cell phone, with my husband...) and found out the surprising news Dr. Patricia Silla would be assisting again and that they were going to try to do everything laproscopically!!!  AND THEY WERE SUCCESSFUL!!!  I think it's incredible that they were able to do this major surgery through 5 tiny incisions, my ileostomy site, and believe it or not, my butt.  They literally stuck a stapler up my butt.  It's been a little sore... but worth it to not have any big incisions to recover from!  When my mom had surgery 15 years ago (same surgeon) they opened her up breastbone to pubic bone.  I didn't get opened up.  That's amazing!!

For this surgery they make an incision around your stoma, since that's the end of your large intestine and they need to free it up to make the J-Pouch.  They pull out a length of small intestine so that they can create the J-Pouch, by folding it over on itself.  Meanwile, they remove the "rectal stump" (several feet of large intestine that was just hanging out in there, not being used), leaving about a 1-inch "cuff" of rectal tissue.  Then they slide it back in, and attach the bottom of the pouch (the fold) to the rectal cuff.  My understanding is that they used to remove all of the rectum since it is diseased with UC, but they found that the walls of the small intestine weren't strong enough and would collapse and have more issues.  The 1" may get colitis (and later on rectal cancer) but it's worth keeping it for now to reinforce the pouch/anal connection.  We'll just keep an eye on it, and if it gets sick it's easier to medicate 1" of sick rectum than it is to heal an entire colon.  Anyway, I think this is where the stapler comes into play... to help attach the pouch.  I don't think they do much sewing, mostly stapling.  Lastly, they pull a loop of your small intestine higher up out of the old ileostomy hole, cut it part way open, fold it back, and sew it in place - this is called a loop ileostomy, and serves to divert the poop out into the bag upstream, while the new J-pouch downstream has a chance to heal.
The doctors later told me that the surgery went great, and that it is generally much easier to do things laproscopically on thinner people.  They did, however, mention that I had a big ovarian cyst that got in the way and "a piece fell off" so they sent it to pathology.  WHAT???  (I haven't heard anything and it's been over a month, so I'm pretty sure that means it wasn't a problem.  Ovarian cysts are common).

I don't remember much about the first day of recovery, except ridiculous nausea, and constantly feeling like I needed to pee.  Thanks catheter.  They told me I had to leave the catheter in for at least 2 days post-op, because some people have some kind of bladder nerve trouble after this kind of deep pelvic surgery.  Walking with a catheter = not fun.  It was kind of funny when the person changing the sheets somehow spilled my box/bag of urine all over the floor though.  Whatever, pee on my feet.  At least it was my pee!

One of the more shocking things after this surgery was the drain.  I've never had a drain before...it's a little hose that disappears inside of you, and somehow transparent red fluid comes out and fills up this little ball you have to empty occasionally.

Since my incisions (other than my new loop-ileostomy) were all tiny, my abdominal muscles recovered pretty quickly, and I could sit up without help within a couple of days!  Unfortunately, although I looked better on the outside, I had another system-shut down on the inside.  Paralytic Ileus I think it's called?  Basically, I tried eating and my body was like, "wait, WHAT?  We have to process food after what just happened?  We're not ready!!!" and then my small intestine passed out for 48 hours, just like last time.  The good news is that the combination of me puking with new residents sucking at their job meant that I never got the NG tube the doctor ordered, HOORAY!  Avoided repeating the worst discomfort I've ever experienced in my life!

But then.  I was starting to feel better, moving around, walking and getting less nauseous... and I started having fleeting severe pain on my right side, kind of like where appendix pain would be (if I still had one - it comes out with your large intestine!).  It started off as a fleeting (but severe, 10 out of 10) pain, and over the next couple of days became less fleeting, more frequent, and harder to get rid of.  We suspected gas pain or some kind of tight spot in my intestines, but it started getting worse when I moved my right leg.  WTF.  It seemed to be worse overnight, and I spent a couple of evenings freaking out.  We thought perhaps it was related to a drug I had stopped taking, so they put me back on it and the pain backed off (good drug!). 

Unfortunately, the next morning I woke up feeling like I was passing gas out of my bottom... but it turns out I was bleeding.  A lot.  And I couldn't hold it in!  We think it was "old" blood, ie, the clotting and whatnot from surgery was shedding and passing out the rear.  My butt was so traumitized from the surgery that I couldn't control it, but after a day or two it backed off, and I no longer leak :) 

Because of the bleeding, they took me off the good (NSAID) drug again, and I had a horrible night, where I cried hysterically and basically did a pull up on my hospital bed all night long, trying to literally get away from the pain.  A 12 on a scale of 1-10.  The poor overnight on-call nurse practitioner!!!  They finally drugged me up enough that I fell asleep, and I woke up to my surgeon pulling out my drain.  As he pulled it out I felt the awful pain for a second, and then IT WAS GONE!  Apparently, the drain was poking or squishing or somehow generally irritating something, and once the drain was out, the pain never came back.  What a frustrating fluke! And what a relief!!!

When I eventually woke up out of my drug haze, I ate some food, it came out without too much trouble, and I got to go home!!