A Neverending Cycle

Sometimes my life feels like a neverending circle of doctors. I’ve not even been in Florida six months and already I’ve had one surgery, two separate hospital stays, and parts of 17 days in the hospital. And now I’m on IV fluids at home for the foreseeable future.

My ileostomy is still dysfunctional, nearly six weeks out from surgery. My output is still too high and too thin. As a result, I was discharged from my last hospital stay (August 3rd) with orders for IV hydration at home three times a week. Last week my surgeon upped that to daily IV hydration. I saw my surgeon again yesterday and he told me at this point, it’s likely to be another 3-6 months before my ileostomy sorts itself out. Yes, that’s months. So then I’m probably going to be on home IV fluids for awhile too.

My quarterly oncology appointment is next week, with my abdomen/pelvis/chest CT scans having been completed last week. No matter how good someone might be at controlling anxiety, “scanxiety” gets even the best of us. “Scanxiety” is anxiety surrounding new medical scans of any variety and waiting for the results. My anxiety is typically well controlled, but scanxiety still sneaks up on me from time to time. Hopefully everything is normal so that I can have a relatively boring appointment with my oncologist next week.

None of this is what I expected when I moved to Florida this May with my parents. I certainly didn’t expect needing to find a colorectal surgeon or having a new medical experience (at home fluids). I sincerely miss the days when medically my life was uncomplicated. I’ll even take going back to last summer when I was feeling great and doing whatever I wanted. I had recovered from chemo & my latest hospital stay and my second surgery hadn’t happened yet. But I can’t go back. All I can do is move forward and make the best of what I’ve got.

My Hospital Stay, Explained

Now that I’ve been home a bit, I thought I’d explain how an expected hospital stay went from 2-3 days to 12 days.

Surgery was on Thursday, July 9th. The day before I had to do a bowel prep, which I expected. Bowel prep for surgery isn’t that different from the prep for a colonoscopy. Essentially, you drink a bunch of laxatives to clean out your intestines. In the case of surgery, it’s to decrease the risk of infection. Stool inside the abdomen is a recipe for infection. However, that can leave you dehydrated. That effect is worsened with an ileostomy. I was then NPO starting at midnight (nothing by mouth) until after surgery. All of that meant that by the time I was in preop Thursday morning, I was pretty dehydrated. To combat the ugly dehydration headache, they first gave me fentanyl. Fentanyl was great for the headache, but not long lasting. When it became clear that surgery wasn’t going to start on time, they gave me something more sedating. It was sedating enough that I’m one minute I was talking to the nurse and the next minute I had an IV in my hand with no recollection of how it got there. My headache was definitely gone though.

For my previous surgeries, my parents were allowed to be with me throughout preop. With COVID, my mom was only brought back to preop when it was time to say goodbye before I was taken to the OR. It made for a weird time in preop, especially as it dragged on. I did take my phone with me into preop, so I could keep her informed as things went on.

Surgery itself went well with no issues. My surgeon was able to go through my existing stoma to fix the fistula. In broad terms, he detached my stoma from my abdominal muscle, pulled out my intestine and respected it below the location of the fistula, and then attached the new end of my intestine to my abdominal muscle, using the same hole in my abdomen. This was the way we had hoped things would go. We didn’t know though until surgery whether previous adhesions (scar tissue) would inhibit my surgeon’s ability to pull out my intestine. I’ve had two open abdominal surgeries in the past and the thing about surgeries in general is that they tend to produce scar tissue. Scar tissue tends to make things inside the body stick together. There’s no doubt I have scar tissue, but thankfully it didn’t cause problems this time.

I spent a long time in recovery while I got a room assigned to me. By the time I got out of recovery, it was mid evening. I ended up on the 10th floor, the surgery, trauma, and colon & rectal surgery floor. By the time I got to my room, my mom was already waiting for me. That night wasn’t much different than any night post surgery – good drugs and innumerable nurse interruptions.

At this point, my blood pressure was lower than my doctors and nurses would like. My usual blood pressure is around 115/60. Typically when one is dehydrated, their blood pressure drops. That was initially the case with me. Low blood pressure also can cause dizziness, and for me it did.

My real problems began on Friday, though I didn’t know that until Saturday. Anytime I’ve been in the hospital, they’ve measured both my urine output and my ostomy output. Ileostomy output is very liquid. This is because stool is coming out of the small intestine, rather than the colon (large intestine). One of the things the colon does is remove water from stool and circulate it back into the body. As a result, dehydration is always a risk for anyone with an ileostomy. Normal output for an ileostomy is around 1000 ml per day. My output for Friday was 2000ml. That explained my dizziness and muddled thinking. With output that high, my doctor couldn’t release me because as a practical reality, I would struggle to drink enough fluids to remain hydrated.

Through this, there were many times my blood pressure struggled to reach 95/65. I had several days where I was dizzy and so muddle headed I struggled to text coherently. I had two sets of doctors while in the hospital – my surgeon’s group and a group of internal medicine doctors. Between them they worked to get my output under control. In general, ileostomy output is controlled in two ways. One is slowing down the gut and one is thickening output. In my case, we did both. The first was done via Imodium and the second was done via Metamucil.

Things were going well until Thursday when I had a very ugly pain day. It was a massive struggle to get my pain under control that day. My family and I have suspicions as to why it was a struggle, but that’s a story for a different day. On Friday, we talked to the resident working with my surgeon. We had the choice of trying to talk with pain management in the hospital that day, or being discharged and trying to work with pain management on our own. I opted to try and meet with pain management in the hospital. Pain management was never able to meet with us, but it turned out to be a good thing I was still in the hospital.

That Friday, my ileostomy output went nuts again, this time measuring over 2300 ml. I was all set on Saturday to be discharged until the surgeon on call came by and did his rounds. He came into my room and let me know that with that kind out output and the Florida heat, he couldn’t in good conscience discharge me. He said I’d be there until at least Monday. Thankfully, a tweak in my medication got my output back under control and I was discharged Monday morning.

That first Saturday I was in the hospital, when my surgeon told me about my increased output, he tried to explain what was going on. He said that for a small subset of people, when doctors mess with the bowel, their output just goes nuts. Apparently I belong to that small subset. Another instance of not doing things the easy way. And that’s the story of how an expected 2-3 day hospital stay turned into my longest hospital stay yet (12 days).

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.