Monday, May 9, 2011

Phlegmon and Fistula


Phlegmon and Fistula - no, they're not characters from a Baroque opera by Haydn, a Commedia dell'Arte farce, or an ancient Greek poem. Phlegmon and Fistula are brand new words in my vocabulary. They put the "complicated" in complicated diverticulitis.

I've thought a lot about whether to write about my medical adventures. Is it interesting to anyone but me? Who wants to bore friends and relatives with endless details about an illness?

Plus, my complaint is not a pretty one.No major illness is, when you get down to the details. Although Puccini and Dumas transcended the horrors of tuberculosis to make it the romantic stuff of novels and opera, I can't see how to pretty up colon disease.

But I have reasons for writing.

One reason is to let people know about it. Lots of people in my generation may face this situation. Colon disease, and particularly diverticulitis, is mostly caused by the way we choose to live - diet.

The other reason is - writing is just how I deal with things.

So - fair warning. I'm writing about it. If you don't like it, don't click on the "Read More" link.
Working without a net
After my CAT Scan in the Emergency Room, the doctor explained to me that the images showed infection in the colon wall and a phlegmon in my lower abdomen. "What's a phlegmon?" I asked. "And how do you spell it?"

I'm sure ER doctors try to deliver bad news in language that's as sanitized as possible, especially when speaking with their patients on a gurney in a public hallway, rather than in a private room. I had only just met my doctor under the awkward social occasion of emergency treatment, so it's understandable she was still being polite. "It's an infectious mass," she explained.

The next doctor I spoke to, representing the Internal Medicine team, was a little more descriptive. "It's a big ball of infectious matter," she said.

The representative from the General Surgery team was a little more forthcoming. "It's a collection of pus."

The second morning, I was visited by the rest of the Surgical team, led by Dr. C.

As he explained my condition and listened to my questions, Dr. C. sat down in the chair beside my bed, pulled aside the coverlet, and, with his ball-point pen, drew a detailed diagram of my innards on the bedsheet.

The darkly cross-hatched mass at the center represents the location where the infection set in, forming a phlegmon.

Phlegmon is a very generic term - referring to a mass of infection no matter where it occurs. But one can imagine if the inflammation occurs in one's critical plumbing - your "blackwater" system, as it were - this is going to be pretty nasty, indeed.

Dr. C. used blunter language than the other doctors - the phlegmon, he said, was "a big ball of pus and fecal matter."

I have no doubt that as we become more acquainted, he will dispense with the euphemism and revert to the simple Anglo Saxon four-letter word in current common usage.

What are the possible outcomes of having a glob of really nasty infectious goo inside your gut?

One thing that can happen is peritonitis. The peritoneum is the lining of the abdomen. As with produce on a styro-tray in the grocery, the peritoneum shrink-wraps your organs to protect them from outside contamination and hold them in place.

If something bad happens inside the shrink-wrap, it can infect the whole package.

Since the era of modern surgery, there have been several notable deaths recorded from peritonitis, but the one that strikes me as rather poignant is that of the American writer Sherwood Anderson. who died in 1941 while on a cruise ship to South America. An autopsy revealed that he had swallowed a toothpick - from an olive in his martini - which perforated his colon, causing peritonitis.

What a way to go
Other famous people - Rudolph Valentino, Enrico Caruso, and Harry Houdini - died of peritonitis from complications of appendicitis.

Another bad thing that can happen is that the infection can spread beyond the area enclosed by the peritoneum, infecting another bodily system. Just like mold spreads from one orange in a bowl to another, the inflammation can spread to another organ.

What does the laundry service think of this?
The breach, or passage between the two areas is called a fistula. Infection in your bowels can contaminate the urinary tract, the reproductive organs, or even pass outside the body through the skin. Dr. C's drawing shows scarey passages reaching toward the bladder, the ascending colon, or the skin.

Sorry, are we grossed out enough yet?

But it's not really gross when you think about it. Phlegmon and fistulae are the defense mechanisms of our bodies. Pus is just a bunch of white blood cells dispatched like soldiers to the battlefield of infection. A fistula is just our body trying to move that junk outa there however it can.

The good news is that none of these bad things happened to me.

Like these heating ducts encased in insulation, a layer of membrane, blood supply and nerve cells encased the part of my gut where perforation occurred, containing the phlegmon and preventing its spread.

I was also lucky they caught it in time - no fistulae or abcess formed for me.

Now, I'm undergoing antibiotic treatment to reduce the infection. I have to follow a strict diet temporarily to avoid stressing out my system. Once the area is "cooled down" (as the surgeons say), they will perform a surgical procedure called a colectomy, which means cutting out the damaged part of the colon and re-attaching the good parts together.

Yes, I'm in for an education, and my vocabulary is going to expand - it will probably be pretty gross, too.

But I'm a fortunate person, really.

Phlegmon and Fistula are the complications of serious infection, and haunt every critically ill person. But some people are more vulnerable than others. If you google "fistula" the first thing you'll find is heartbreaking. The most common incidence of fistulae today is among third-world women who are victims of brutal rape or untreated complications of childbirth. What I'm going through is nothing compared to these victims.


Janet said...

Welcome to the wonderful world of colon surgery! I know what you're going through is serious, but this statement cracked me up: "What does the laundry service think of this?" Good luck!!!

Lynda said...

Will be sending those healing thoughts your way.

ifthethunderdontgetya™³²®© said...

Dr. C. used blunter language than the other doctors - the phlegmon, he said, was "a big ball of pus and fecal matter."

This makes me think of our government.

Big Bad Bald Bastard said...

You're handling a difficult, disgusting topic with class, and you are imparting good information about a topic which all of us should be aware of.

In short, don't change your game, Aunt Snow!

Albug said...

You go girl! I had stage four colon cancer thirteen years ago. I am healthy and happy now. I believe I survived to spread the word to anyone who will listen to get screened and not to shy away from the subject because you think "ewe". Ignoring the symptoms can be deadly. Thanks for the creative way in which you have described your journey so far. I so enjoy your blog no matter what you are writing about, so I will continue to stop by.

Smut Clyde said...

We are fortunate that you had your camera there, ready to photograph the bedsheet before the laundry service got hold of it.
I'm assuming you didn't scan it.

I can't see how to pretty up colon disease.

Potential Michael Nyman opera.

Karen (formerly kcinnova) said...

Not gross at all -- fascinating!
I'm still trying to wrap my mind around my mother's cancer, and since she doesn't want to talk about it and I can't be there to question the doctor (and I can only pick my SIL's brain so much before driving her crazy), I'm grateful for any and all insights into the weird workings of our bodies.

Keep writing. I'm still working up the nerve to schedule my colonoscopy.

materfamilias said...

In Paris while we were there, right below the Montparnasse station, there's a huge plastic balloon-type (the same sort of material as those kids' bouncy castles)model of the colon for people to walk through as a way of educating and raising consciousness. Clearly, it's time for us all to push delicacy aside in order to save lives.