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).