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Total colectomy Part 16

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Posted 9/15/2007 12:53 AM (GMT 0)
RESA - Thank you for the update on Irish - glad to hear she's doing well.  I sure do hope her a speedy recovery!!

QUESTION PLEASE:  I had my TC done 11-09-06 for Colonic Intertia.  Initially for the first six months post-op I was having anywhere from five to ten bm's daily, mostly "watery/liquid" in substance. 

 

Then I began to slow down to one or two bm's a day - then - one everyday or every other day.  I went back to the surgeon who performed a CAT scan and colonoscopy (with what little colon was left) in June.  Other than having a few polyps which he removed - he indicated that I more than likely have a "lazy" small intestine.

Prior to my TC my GI doctor did a colonoscopy which revealed internal hemorrhoids, however, I never had a problem with them.  Just this Tuesday evening when I had a bm - my entire toilet was filled with dark red blood - a lot of it too.  Then Wednesday morning during my morning bm - the same thing.  I call the surgeon's office and the first thing they wanted to contribute this to was the hemorrhoids, however, I explained that there was a lot of dark red blood in the toilet - even after flushing.  I was then advised to go to the ER if it was that bad.  I wasn't having any real discomfort so I was reluctant to go to the ER just in case it was indeed hemorrhoids.  This cycle continued thru Wednesday and yesterday so I told my husband that I would go this morning if the bleeding was still going on.

This morning when I had my bm it was "back to normal" - no blood at all and again this evening when I had my evening bm. 

In the entire time since my TC I've NEVER had blood come from my rectum - has anyone had a similar experience like this?  I do not strain, like I said, most my bm's are "liquid with small formation". 

Any comment or help is greatly appreciate!!

Posted 9/15/2007 10:09 AM (GMT 0)
Hi Robin,

I can relate to what has happened to you.  I also had bleeding and thought it was my hemorrhoids.  I went to GI and he performed a flex sig.  It showed proctitis, pouchitis of the blind segment of small bowel with superficial erosions.  I was prescribed flagyl and also mesalamine medicated enemas.  Not only did it stop the bleeding in a few days but also slowed me down from 15-20X a day to about 8 and now I am getting some decent sleep.  I am not saying you have the same thing but it is worth checking it out.  It could simply be hemorroids or not.  Perhaps a call to your GI would be a good way to proceed.

Take care

Phyllis

TC 6/2006

Posted 9/15/2007 11:10 PM (GMT 0)

I'm baaaccckkk! We just got home about 30 minutes ago. I'll answer posts that were directed to me and then I'll tell you the good news regarding the surgery.

To Everyone

Thanks for all of the 'good lucks', etc., prior to the surgery. I think they had a hand in what happened during the surgery which I'll explain below.

April

Yes, I was on a clear liquid diet two days prior to the surgery. After bottle #4 of the Fleet's, it still wasn't totally clear but that was it for me. I work at a doctor's office and he came to the office to run some labs on me. My potassium was really low so I had to go home and take eight and then three more at midnight. It was still low when I got to the hospital, so that had to give me more during the surgery. I also took eight Ducolax on Saturday.

Jaclyn

I had a manual rectal dilatation after I had my colon resection two years ago. Basically, the doctor just (sorry for the graphics) put his finger up my rectum and then pressed on my stomach so that he could feel the anastomosis and put his finger through it to stretch it out. That way only works if you have a low anastomosis. It was a little painful during it and I did have some bleeding afterwards, but I worked the next day.

Robin

Dark red blood means that it's coming from higher in the GI tract and wouldn't be from hemorrhoids. I think that a call to your GI doc is in order.

Surgery Day

Okay...well we were late getting to the hospital. We left our house at 6 am which would give us three hours to get there. All I can say is that the Bay Area traffic is horrible. I called the hospital to let them know that we were delayed. We ended up being 45 minutes late.

I was in the pre-OR area (first stop was regular pre op area) and the anesthesiologist was attempting to get an IV started. He tried two spots and failed. They can only use my left arm because of the breast cancer and lymph node disection. Then he started talking about a central line and I told him that was fine. He finally was able to get a tiny line started that would be enough to knock me out and then he'd 'dig' around some more to find something more suitable once I was asleep. The surgeon once again told us what his plan was but he did say that he was going to do a colonoscopy first to see how things looked. I went into surgery at 11 am and he finished at 5:30 pm. The best news is that he was able to do it laparoscopically!!! He said that I had a 'virgin' abdomen meaning that there wasn't any or very little scar tissue from previous surgeries. He was so excited and so was I. As soon as I woke up, the first thing I did was feel my stomach to see which way he did it. I was plesantly surprised. He had to do the new anastomosis below the first one, so I'm now the proud owner of a two inch rectum.

I had two squirts (not even close to a BM) on Tuesday and Wednesday and then had a real BM on Friday. It was painful but it happened. The pain was more like spasms. It does smell to high heaven though. Kind of like burnt flesh/sulfur smell. Hopefully that will get better with time.

Otherwise, I'm feeling great and missed all of you.

Posted 9/15/2007 11:19 PM (GMT 0)
Irish mom

So glad to hear you are home and doing well. Keep up the good work.

April
Posted 9/15/2007 11:40 PM (GMT 0)

Welcome home, Irish Mom

So glad to hear that all went well and that it was lap...that should improve recovery time.  Just take it easy..

Posted 9/16/2007 12:00 AM (GMT 0)
Congrats on your successful surgery.  Take care of yourself, rest, and listen to doc's orders!!  Good to have you back,

 

Posted 9/16/2007 1:58 AM (GMT 0)
Welcome Back Irish Mom!!!

Glad everything went well.  tongue As for the dilation, I am told that it is not a manual and that is why he is taking me to the OR.  He has to use some kind of instrument.  I am glad to hear that it didn't hurt too bad after your dilation because I was a little worried.  Thanks!

Posted 9/16/2007 6:23 AM (GMT 0)
Irish Mom - Congratulations and best wishes on a successful recovery.

Irish Mom and Resa - Would you mind letting me know the name of your Bay Area GIs and surgeons? I'm thinking about getting additional opinions.

Peace38
Posted 9/16/2007 2:49 PM (GMT 0)
IRISH - I am absolutely thrilled to hear you're already home and things went well!!  I'm very happy that the surgeon was able to do this procedure "LAP" yeah !!!!!!  I continue to wish you all the best in your recovery process!!  Just remember to take it slow (one day at a time) and don't overdo yourself.  I just knew you would come thru with flying colors - you're such and inspiration to all of us and an optimist to boot!!!  You are definitely a "SURVIVOR"!!!!!  May God continue to give you strength!!!

Not to change the subject and if you're not feeling up to my question I totally understand.  You mentioned that the dark red blood indicates it's coming from higher in the GI tract - like an ulcer?  Could it be something from my small intestine?  The thing that worries me more than anything is how sudden it came on and how sudden it stopped.  I'm not having any "pain" anywhere - pain is something I tolerate and deal with on a daily basis, not to mention, very very well (PAIN IN OTHER AREAS OF MY BODY - NOT ABDOMEN OR RECTAL). 

Now that the bleeding has stopped, do you think I should still contact my GI?  I'm really at a loss at what to do.  I take Protonex daily as a preventative measure for an ulcer the GI found a year ago during an upper (endoSOMETHING - FORGOT THE NAME)!!

Thanks for taking the time to read and respond.

EVERYONE ELSE - I also hope those in the healing process well.  Please let us know how you're doing and if things are getting better with time!!

Posted 9/16/2007 3:08 PM (GMT 0)
Hi Robin,

Absolutely you should go to the GI doc.  Blood is not something you fool with..Even if it turns out nothing serious...you can not ignore this... nono

Posted 9/16/2007 4:57 PM (GMT 0)
Robin,

I am jumping on Phyllis' bandwagon here when I say.."Yes, contact your doctor." It may be nothing but you need to get a confirmation from a physician.

IrishMom,

Welcome Home! I am glad that your bowels are moving and things are getting better. How long where you in the hospital? By my calculations, you were there less than a week...is that correct? The shorter the better, I think. You can recover so much faster in a "normal" enviornment and NOTHING about the hospital feels normal...not even the three squares a day.

I'm off for a bike ride...I'll check back later.
Posted 9/16/2007 5:57 PM (GMT 0)

Jaclyn

Since my anastomosis was so low, that's why he was able to do it manually. In fact, he did it right in his office. I'm assuming for you that they'll either use a balloon or a metal dilator. I had a balloon dilatation done during a recent colonscopy. As far as I know, it's a same-day procedure.

Peace

My GI is in the Central Valley, but I can give you the names of the doctor's that our office refers people to. We send people to a group that is in Redwood City. There are three doctors; Dr. Yang, Dr. Rengstorff, and Dr. Torosis.

My surgeon is Dr. Kieturakis and he's also in Redwood City. He's a general surgeon that is very good at what he does. In fact, he has invented a lot of the instruments that are used during laparoscopic procedures across the nation. As as example, the sister of the doctor I work for had a severe problem with her peritoneum (the membrane that holds the abdominal organs in place) and went to several doctors that said there was nothing they could do and that she would need to wear an abdominal binder the rest of her life. She was sent to Dr. K and he said he could help her and did. He put in a large piece of mesh to hold everything in place and she is one happy camper.

Robin

Dark red is usually from the stomach, i.e., bleeding ulcers, but can also come from the beginning parts of the colon. Just because you can't see the blood anymore, chances are that you could still be bleeding. The ulcer you mentioned that was found was probably during an endoscopy. Sometimes they do a colonoscopy at the same time. My mom had some bleeding back in October 2006 that I told her to get checked out. Some weeks later she told me that it had stopped but I still told her to go to the doctor. Being stubborn, she didn't go. Well, during a recent physical her blood count was low because of the continuing GI bleed and she had to have blood transfusions. You really do need to get it checked out. The doctor can do a hemocult right in the office that will look for blood in the stools. Please go, okay?

Amey

You're right about it being less than a week; it was six days. I'm doing well and continue to have BM's which makes me happy. They do hurt though. It's not rectal pain during them but internal pain. I'm sure it's where my anastomosis is. I just bite onto my robe that hangs on the wall and let her go.

Posted 9/16/2007 9:07 PM (GMT 0)
Thank you Irish mom! I really appreciate it!
I like my GI who suggested that i have TC, but just in case, it is helpful to know other doctor/surgeons who have done surgery around this area.
Posted 9/16/2007 11:47 PM (GMT 0)
PHYLLIS/AMEY/IRISH - Thank you all for your input and adivse.  I guess I will call my GI first thing tomorrow morning!!

IRISH - You're correct, it was an enoscopy and yes I had a colonoscopy (my first) done at the same time.  Although the ulcer he found during the procedure wasn't bleeding it was very red and irritated - thus - prescribing me the PROTONEX.  You mentioned "the beginning part" of the colon - is there such a thing having a TC or are you referring to the small intestine?  I do have a very small portion left of my colon (which the surgeon says isn't much at all) but wouldn't that be down toward the bottom?  I'm just so confused at this point.

I know I've said it before and I'm gonna say it again - you inspire and amaze me!!  You're a trooper and a survivor!!!  If I remember back correctly, it was a bit painful for me as well during a bm.  I contributed it to all the moving around they did in the abdomen with all the laparoscopic equipment.  I just think things are very irritated at the moment and I'm sure it will get better each day.

AMEY - You are another one who continues to amaze me!!  Off on a bike ride - WOW!!  I'm truly happy that you're doing so good, especially after all you went thru prior to your last surgery (you were really sick, weak, and frail)!!!  Thank you too for being such an inspiration!!

JACLYN - Good luck with the dialation and I hope it isn't too painful for you and recovery is quick and solves your problem.

God bless each and everyone here!!  You're all like family and the best bunch of people I've ever met in my life!!!!

 

Posted 9/17/2007 1:28 AM (GMT 0)
Hi Peace38,

I do not mind giving you my surgeon's name but I am a Kaiser patient. If your insurance allows you to use Kaiser, I will provide you with his name.
Posted 9/17/2007 1:34 AM (GMT 0)

Robin

The general rule of thumb is the the brighter the blood, the closer to the anus/rectum it is. Bright red is usually from the anus, rectum, or sigmoid colon. The darker blood will usually come from the transverse or descending colon, or at a higher area such as the stomach. This is because bleeding from these areas causes the blood to remain in the body for a longer period of time. However, in some cases you can still have bright red blood from the area that would normally cause darker blood due to the severity of the bleeding.

The TC thing is kind of iffy. Some people who had a TC had everything removed and the small intestine then reconnected. Then there are others, like myself, who had what is considered to be a subtotal colectomy just due to the fact that a few inches were left. Those few inches would be at the beginning of the colon which is/was located on your right side - where your appendix is located if you still have one.

The pain with the BM's gets a bit better each time. My doctor told me that he did this anastomosis different than the last one, so maybe that has something to do with it. He used a different instrument and this one is larger. You're also right about them moving your innards around during the surgery. I'm sure things are still settling into place. I have six port sites and two drain sites, so I have a total of eight holes.

Posted 9/17/2007 2:09 AM (GMT 0)
IRISH  Thank you so much for all of your input - it's greatly appreciated!!  Yes, those ports and everything around them are very tender.

You know - I did indeed have my small intestine attached to my rectum and from the mouth of the surgeon he left in "very" little colon - yet he still calls it a Total - this is all so confusing at times - I remember asking here why they leave some of the colon.

I'm pretty much a hollowed woman LOL - I have absolutely NO female organs nor my appendix, and of course no colon now (with the exception of the small amount he left).  What's a woman supposed to do, LOL!!!!

Again, thanks so much for all your help!!

Posted 9/17/2007 3:06 AM (GMT 0)
Hello all,

I had my colectomy surgery on 9/5, but am still in the hospital. I am not yet able to take even clear liquids at the moment, because every time I've tried, I've become very nauseated later that day, and so I currently have an NG tube in place, my third since 9/8/07. My doctors are calling it Ileus which I guess is some sort of blockage(either mecanical or functional), but they are waiting 'til tomorrow to start running additional tests. They don't think that it is a mechanical blockage because I'm not having any pain. I've had 2 sets of abominal x-rays that both showed everything distended from the stomach down, and that nothing is moving yet. Hence, the NG tube to keep me from vomiting. They tried to discharge my on Friday, 9/14, and removed my staples, but while in the hospital lobby rest room, I began vomiting bile and pulled part of my incision open. So my wife brought me back up to my room. That's when they put the 3rd ng tube in, lightly packed the open wound part of the incision with sterile gauze and then put a bandage on top of that.

I'm still hoping that this will resolve itself in the next couple of days, but am really concerned that it might not.
Anybody out there heard of the intestines taking a full 2 weeks to 'wake up' from the this surgery. My surgery was actually a sub-total colectomy with ileo-sigmoid anastomosis, because the surgeon opted to leave a little of the bottom of the sigmoid colon to re-attach to. My surgery was done because of high-grade dysplasia found in my ascending colon during my last colonoscopy(which the post-op biopsies did show a very small occurence of colon cancer), so it was not done for colonic inertia.

So I'm very grateful that I had the surgery when I did so the cancer hadn't had a chance to spread. They also told me that it had not crossed over into the lymph nodes yet.

Rick
Posted 9/17/2007 4:41 AM (GMT 0)

Robin

If your surgeon left in a small piece of colon, then it's your colon that was reattached not the small intestines. I know it can be confusing, so let me try explaining it this way. Food goes in your mouth, down the esophagus, and into the stomach. From the stomach, it goes through different parts of the small intestine and then enters the ileum which attaches to the colon on the lower right area of the abdomen. This beginning part of the colon is where the appendix is. From there it goes up your right side which is the ascending colon, then across the transverse colon that runs vertically to your left side, and finally goes down your left side which is the descending colon and then out it comes. LOL  My doctor also left some colon. He said he left about six inches which would keep me from having the diarrhea that so many people suffer with.

I know what you mean about feeling empty. I had a hysterectomy at 33 and then the ovaries came out the following year. They were fine at the time of the hysterectomy, so I had the doctor leave them in. Then I had that stubborn right ovary that liked growing back that I had out four more times. Gallbladder is also gone. The funny thing is that I still have my appendix!

UCRick

I'm so sorry to hear that you're having problems after your colectomy. I had mine on 9/10. Do you have any bowel sounds at all? I'm assuming that you do if they're giving you liquids. I was on ice for three days after mine. The intestines are always the last thing to wake up after surgery. Maybe with the UC, yours are extra tired and taking some time off. I did have some problems when I was finally able to move to the clear liquid diet. I also got nauseated and distended/bloated, and my surgeon did say that he might have to put the NG tube back in. One of the nurses had me lay on my left side with one of the heated blankets laying across my stomach and things returned to normal. The next time I tried eating, they had me eat a little at a time and wait for about twenty minutes before eating more. I tried this and I didn't get the distention! Whether it worked or was a coincidence, I don't know. Please keep us posted on what the additional tests show. I'll be thinking of you and send you my best.

Terri

Posted 9/17/2007 7:00 AM (GMT 0)
Resa,
Thank you very much!
Please pm me the info at [email protected].

Peace38
Posted 9/17/2007 2:06 PM (GMT 0)
Rick,

What were your bowel habits like prior to the surgery? I have some postive information to share and some ...well, not so pleasant information as well. I had a TC and I never had bowel sounds while in the hospital. I was not able to have any water, clears, or food for 9 days. Finally, on day 9 they gave me clears and sent me home. I began to vomit and was constipated from the moment I was sent home. I went back to see the surgeon 3 days after being sent home and he said I was not being patient with the surgery. He said, "Amey, I fixed you, now go home!" Needless to say, I left in tears. Now, nearly seven years later and after lots of sickness, I have a bag. Ok, so that does not sounds so good. However, here is some positive information...you are in the hosptial and your doctors are working on the problem. This problem will be resolved and things will get better. I know it is hard to be without food and water. I know you are thirsty and tired of having the NG tube stuck and restuck up your nose. It is no fun...I have been there four seperate times. Please do not let your doctors send you home until your bowels are moving. This time in the hospital will pass and you will get to go home. I spent 9 days in the hospital in July and 15 days in the hospital in August. This forum was GREAT for encouragement and venting. Keep posting your comments and we will help you get through this time.

Best Regards....

Robin,

Thank you for your kind words! I want to start teaching at the gym next week so I have get my butt in gear (litterally).
Again, thank you for your complements! I am sure you will be feeling stronger and better very soon. I am just so grateful YOUR surgery was a success.

Take care,
Amey
Posted 9/17/2007 5:44 PM (GMT 0)
Thanks Amey and Terri for you encouraging words.

I talked to the surgeon this morning and he let me know what the plan is now.
They've clamped off my NG tube for about 4 hours this morning. If I'm still feeling ok after that, he wants the NG tube pulled and let me try some clear liquids today. If I can't tolerate the clear liquids this time around, they will do a CT scan and a barium enema study tomorrow. His concern now, with as long as it's been, that there might be a mechanical blockage that isn't resolving on its own, so pending the outcome of those tests, he has already put me on the OR schedule for a Wednesday surgery. He did say that if nothing showed up on these tests, he would just give it more time.

Amey, my bowel habits were normal before the surgery. Even with a 28 year history of UC, my symptoms were almost always controlled with the medications; Asacol most recently and Azulfadine before that. So this has all been a shock to me.

Terri, last week they thought they were hearing bowel sounds, but this morning everyone has pretty much said they're not hearing anything.

So I guess I'll keep walking today and hope things start working on their own.

Thanks again,
Rick
Posted 9/17/2007 7:13 PM (GMT 0)

Rick

So how are things going today? We're you able to keep the liquids down? I forgot to mention something in my last post to you. When I tried liquids the first time, the nurses and doctor had all heard bowel sounds right before. When the doc came in later to check on me and saw the distension, he checked again and the sounds were gone. Kind of like things turned on and then turned off again.

I was a big walker while in the hospital. I hate hospitals and can't ever get any sleep in them. The nurses used to laugh because I'd be up doing laps at 2 and 3 am when everybody else was sleeping. LOL

Terri

Posted 9/17/2007 9:10 PM (GMT 0)
Rick,

I know what you are going through.  I was in the hospital for 13 days after my TC.

I also could not hold down any thing, I would throw up. I also had ileus and distended bowel.  They put in a NG tube which I screamed through the whole thing all so I also had a pneumia.  They told me I had to start walking because there was no bowel sounds, so my plumming was not working.  the only thing is they were giving me my night meds during the day which all I wanted to do was sleep.  Finally my husband got my meds straightened out and once they put that NG tube in I said I have to get moving, which took me a long time because I was in so much pain and weak.  I have a very high tolerance to pain so they had to keep changing it, they even had pain management come talk to me.

My surgery was in Feb of 07 and still not completely happy. I go to the bathroom any where from 5-20x's a day, with alot of cramping, my doctor can't find anything wrong, I'm just one of the people that the surgery was not a complete success.

What can I say I damaged goods...............

Hope all goes well for you and keep on walking,

April

Posted 9/17/2007 10:30 PM (GMT 0)
TERRI - I want to thank you for your time and all the information you've suppied me.  It's very nice to know someone with knowlege as well as support - you're very sweet!!  You're also the one who explained the "reason" for leaving the colon - that it would keep me from having the diarrhea that so many people suffer with.  I know that whatever amount of colon he did leave wasn't much at all.  In fact he make a comment indicating it was a lot less than what he would usually leave in.  He also told me that he did attach the small intestine directly to the rectum - I'M SO CONFUSED!!  In fact, I've had a few problems since the TC and the first thing he looks for is a blood supply issue where he attached the small intestine to the rectum.  Believe me, I'm not questioning you - I'm thankful you're here!!  My surgery was also "lap" and I was on the operating table for eight and a half hours.  My surgeon told my family that it NEVER took him anywhere near that kind of time to do a TC "lap" - I was a big job!! 

For the past several months - starting around April, my bowel habits changed greatly.  The first five months post-op I was going anywhere from five to ten times a day which was mostly liquid and watery - then I wasn't going for days.  My surgeon did a CAT scan and went up thru my rectum to see about the small intestine attachment to the rectum.  Thank God he didn't find anything too serious and said it was probably a "lazy" small intestine.  He's put me back on Miralax and said we will see how that works.  Well, unfortunately I'm taking it two times a day now and the bm's I'm having are watery, however, they don't seem to have any "substance" and I'm back to feeling and looking bloated ALL the time.

OMG, you and I sound just alike with being in the hospital and NEVER resting.  I was walking those halls at all hours of the day and night.  The nurses were very impressed with my determination to get up and keep moving.  I believe it contributed to me staying only four days in the hospital.

I still haven't contacted my GI regarding the bleeding last week but I will contact his office first thing in the morning.

RICK - My heart goes out to you and I'm sorry you're not feeling or doing to good at this point and time.  Was your day any better today?  Please keep us posted.

APRIL - I'm so sorry that you're still having issues as well and that you feel your surgery wasn't a complete success.  Even though I've had issues I continue to believe mine to be a success, especially comparing it to my life pre-op!!  Best wishes to you too!!

AMEY - You're so welcome.  We know what a very difficult time you had post-op and how your situation ended up getting a bag.  However, you are doing so good now and your optimism is AMAZING!!!!

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