Finding Routine

Over the last month, life has found a certain rhythm, a routine if you will. My day begins around 9am, with breakfast and meds right after. By 10, I’m getting hooked up to my fluids – 1 liter of lactated ringers. By 11:30, my fluids are done and I’m ready for a nap. Some days it’s a long nap, some days it’s not. Most days though it’s a long nap. I’m usually up again between 2 & 3 and awake until 9 or 10. Bedtime is at 9 or 10, whenever I lose my first wind. Then I’m up a couple times at night to empty my bag and then the day starts all over again.

Overall I’m dealing with a lot of fatigue along with some joint issues. A few weeks ago I started having some joint pain out of nowhere, including in my fingers. I’m still having output issues and a lousy appetite.

I finally saw my oncologist today and cancer wise, I’m still in the clear. My scans all looked great. He echoed seeing an endocrinologist, so I’ll be making that appointment tomorrow. He also ordered some basic thyroid blood work that I’ll have done tomorrow. Thyroid issues would explain my issues. I also have an appointment with a nephrologist the first week of October. My next oncology appointment isn’t until 2021!

I’m beyond ready to go back to maintenance appointments. I miss feeling really good. I’ve been thinking about last summer and how amazing I felt. I had a great big party celebrating a year cancer free and then a few weeks later traveled to Utah for a friend’s wedding. I had times this spring where I felt really good, but not in awhile. Last summer I was finally starting to drop the length of my naps. Then I had my big surgery and naps were back in full force (as expected). After that, I had naps nearly every day, but I did well after the nap. These days, I have my nap and could still go back to sleep. And sleep. And sleep.

I’ve been reminded again that once you’ve been diagnosed with cancer, there’s no going back to the way things were before. Not emotionally, not physically, not medically. Even with the great strides made in cancer treatment, it’s still a bit of a scorched earth approach. And in the end, you do what you have to in order to get to NED and stay that way. But it leaves scars. It can easily leave behind additional medical issues, some more immediate and some that crop up down the way.

For me, it’s left behind an ostomy and the issues and complications it brings. It’s left me with an ovarian fragment to be dealt with one day. It’s left me with “scanxiety,” despite being pretty good at dealing with anxiety. Even once you get to NED, there’s no going back to before.

Hopefully Home Tomorrow!

Yesterday was a very rough day, pain wise. We opted to try going off IV pain meds. Any of you who have been with me from the beginning knows how bad that has gone in the past. A number of factors played in but I didn’t get the new round of pain meds my doctor prescribed until three hours after he prescribed me. By that point I was in a lot of pain. That meant that by midnight, the doc on call authorized a one time only dose of 1mg of iv dilaudid. That finally broke through all my pain and stopped the viscous cycle. Today, I am on ibuprofen, Tylenol, a muscle relaxer, gabapentin, and 4mg of oral dilaudid. I am finally comfortable. 

The hope was to talk to pain management today but it doesn’t look like that’s going to happen, so I’ll be discharged tomorrow with enough meds for at least the weekend before dealing with pain management on our own next week. The reason we’re talking to pain management is that PM has many more options to keep me comfortable than my surgeon does.

All of this has been a great reminder of how dangerous a stomach/flu bug can be to me with my ileostomy. I know people who have gotten sick with what most consider the stomach flu and wind up in the hospital for a week because they can’t stay adequately dehydrated. Dehydration can lead to low BP, which can lead to respiratory distress, so it really matters. This spring before we moved, my parents both got the stomach flu. We did a good job isolating me from my parents and I did not get it. All of this is an easy reminder of how dangerous stomach bugs are to me.

Once Again, Not the Easy Way

It’s Sunday and I’m still in the hospital. I’m still having too much output from my ileostomy and it’s keeping me dehydrated and dizzy. My blood pressure overnight was great, but it bottomed out again this morning. In general, having an ileostomy leaves you at higher risk of dehydration because out is so liquid. Mine got all screwed up with surgery and bowel prep and it’s a struggle to get it back under control. Between my urine output and my ileostomy output, I’m losing too much fluid for me to manage the dehydration risk at home. I also can’t have the good pain meds until my blood pressure gets up over 100. That is because the pain meds can send my blood pressure down too. If my blood pressure gets too low, it can lead to respiratory distress.

I am now on both Metamucil and Imodium to bulk up my stool and slow it down. Bulking it up means I lose less liquid. I’m also getting two bags of fluid this morning. Unfortunately, the first bag only sent my blood pressure up by a point.

Since surgery itself went so well, I figured I was in the clear and that for once, I’d done things the easy way. As it turned out, I spoke so soon. I’ve had post surgery issues no one expected. My mind is all muddled and I hate it. The nurses won’t let me walk the halls with my dizziness, in case I were to fall. It’s like trying to think through molasses. That’s more disconcerting that my pain level. I can’t wait until I can go home and sleep in my own bed.

Still Here

The hope yesterday had been that I’d get to go home today. Turns out that was a pipe dream. While my BP got better yesterday after fluids, it’s back to struggling to get over 100. This morning it was under 90 and only got a couple points better when I sat up. It did get high enough for my nurse to be comfortable giving my the dose of dilaudid.

The bigger issue is that my ileostomy output yesterday was more than 2 liters. That’s way too much for the doc to be comfortable discharging next. In doing a little research, normal output for an ileostomy should be 800-1000 ml/day. Pharmacy screwed up with they input my medications into the system and didn’t put in that I take Imodium and Metamucil at home. So until this morning, I had had either. I’ve now had a dose of Metamucil and at some point will have a dose of Imodium. Together, they slow down the passage of fluids & nutrition through my small bowel. That gives it time to properly digest things and absorb the things it needs to. Those two meds also help thicken up my stool so I’m not constantly losing fluid. One of the functions of the colon is to remove the liquid from stool and put it back into the body. That is one of the few functions the small bowel cannot take on following a total colectomy. Between the very liquid stool and urinating, it can be difficult at times to stay hydrated and then when you become dehydrated, it’s difficult to fix without medical intervention.

My technician came in and checked my blood pressure. Even after a full bag of fluids (1 liter), my blood pressure is still low. It was 95/54. Normal for me is around 115/60. It got that high after heater’s round of fluids but today it’s been in the tank again.

My mom will be here shortly and we’ll see if I can walk the halls. I haven’t seen people walking the halls the few times I’ve had my door open but wouldn’t surprise me if we’ll not allowed to walk the halls. If that’s the case, the next best thing is to sit in the big chair in my room.

I did get a look at my new stoma last night when I changed my bag. It took a good chunk of the day to get someone to help me change it. I literally just needed another set of hands while I changed it myself. With the pain, I don’t have quite the range of motion right now. So I needed someone to help me make sure everything made it in the garbage and to hand me things that might end up on the floor or just too far to reach. I had all my supplies and changed it myself with that extra pair of hands. Initially, the nurse and tech didn’t understand why I’d want to change it, mostly because they assumed I’d simply be putting on the same appliance. It took them a few minutes to grasp I was going to put on a bag Id brought from home. My stoma right now is pretty ugly and somewhat bloody. It’s also very big and my usual bags are just barely big enough to accommodate it. It’s hard to know right now how the stoma is pointed, but I’m hoping my current bag system will work with it long term. I know for sure though that I’m not interested in a two piece system. There’s too much hard plastic that can dig into my skin (this wasn’t my first run in with a two piece system). My own bag has some plastic of course, but it’s so much softer and pliable that by a few hours after a bag change, I don’t even notice it. The bag change went well and so far no leaks. While it heals, I’ll be much more prone to leaks as the stoma itself will shrink as it heals. While I don’t know how big my stoma will be when it heals, it won’t be as big as it is now.

To end, I’ll be praying I get out of here tomorrow, but that’s largely determined by whether we can get my stoma back on track. Right now it’s in overdrive.