Stones in a sock - and other news

Street sculpture at my hospital

Friday, I visited my surgeon's office the last time before my colectomy surgery. I'm in pretty good shape, and everyone is optimistic.

The surgery takes place on Wednesday. Tuesday I have to prepare my body for the surgery. If you've ever had a colonoscopy, the preparation is similar. You drink an enormous amount of a laxative solution, and spend the entire day within running distance of the toilet.

In addition to that, I have to take some powerful antibiotics to kill off all the helpful bacteria that normally aids digestion. Part of the recovery process is having the bacterial environment in my gut come back to its proper ecological and functional balance.

And that's all before I even get to the hospital.

Do I look fat in this?

I was delighted that Dr. C agreed to send me the image from my CT scan of two weeks ago. This is me, as vertically split from top to bottom. You can see the pattern of my ribs on either side, near the top of the picture. The round shape way up is my stomach, the lobed shape below and to the left is my liver. The white V-shape at the bottom of the picture is the bone at my pubis. I'm not sure about the rest of the jumble - the garland-like blobs must be my intestines, but what are the solid black shapes? Dr. C noted in his message the hazy, ameoba-like shape of the phlegmon of infection - it's centered right between the two white shapes that are the iliac crests of my pelvis.

Although I've read a lot already about the procedure I'm about to undergo, a member of the surgical team took the time to fill me in on some details that brought the reality all the more closer.

They will make three incisions, she said. One will be larger than the other, but they will all be small, because the surgical technique will be laparascopy - which means they snake little teeny tiny instruments and little teeny tiny video cameras inside you to do the work.

The main incision will be at the "bikini line," she said. They'll cut crosswise on the surface, for cosmetic reasons, but part the muscle fibers that run up and down vertically, to get inside the actual abdominal cavity. There will be one incision a little higher up on my abdomen, so they can snip the tissue that attaches my descending colon.

If we hearken back to the idea of the stage prop Cadillac with fog hoses run through its works, it's kind of like snipping the tie-wrap that snugs the hose up to the steel frame, and furling out some slack to complete the run.

I"ll have an epidural catheter for regional anesthesia and to manage the pain of the incisions. She kept assuring me it would be just like what I had for childbirth, only I pointed out to her that I didn't have an epidural when I had my son. So I have no frame of reference for this.

I'll also have a catheter to my bladder, and be nourished by IV fluids only. All this means to me that I won't be moving around much when I first wake up. The two catheters will remain in place "as long as necessary" - probably a couple days.

The tricky part is how fast the two rejoined sections of my colon will heal. Dr. C talked about "leakage rates" - leakage rates are low if the bowel is in good shape, as we hope mine is after a two-week antibiotic regimen.  Leakage rates are not so great if there's infection present - and here's where they gave me a sobering disclaimer.

If - IF - they discover, when they get inside, a lot of infection still present, they may opt to perform an ostomy. This means, basically, that they want to get the whole mess out of a dirty environment, close it up, and wait till later. They create an opening, or stoma, in the skin of the abdomen. 

Like a button-hole, or eyelet, you could imagine. After cutting out the damaged section, they attach the up-stream end of the colon to the stoma, and this - Wikipedia puts it delicately - "provides an alternate channel for feces to leave the body."

This would be "temporary," said the doctor. After the infection goes down with further treatment, they'd schedule another surgery to go back in and stitch the whole thing back together.

"How long would be 'temporary'?" I asked.

Six to eight weeks.

Hmm. That could sure put a damper on the summer. Do they make little designer covers for the collection bags?

But both doctors said, given my general health and condition, this is only a remote possibility. Well, okay. Please think good thoughts for my internal environment! Or, alternately, send nice fabric swatches.

Stone

Another piece of news is that while they're in there, they'll remove my appendix. My CT scan two weeks ago showed that there were a couple of what are called "appendecoliths" or little calcifications lodged in there. As irritating as a couple of little stones in a sock, these appendecoliths can develop into appendicitis. And why not take it out now, while they're in the neighborhood?

After all, I'm not using my appendix, anyway.

It was a good visit, yet sobering.This shit is for real. I'm in their hands. Whatever happens, I'll deal with it.