Towards living a normal life. Whatever that is.
I've been home from the hospital for three days now. The original estimate from my surgeon was that today was the earliest I could expect to go home after my surgery, yet I've already been home for seventy-two hours.
Seventy-two hours. It never seemed like that long a time period before.
Seventy-two hours is a long weekend, a nice break from work maybe or a chance to go somewhere close for a quick getaway, but not enough time to do anything that really matters. But in those seventy-two hours, I have done a lot of significant things.
First off, I have stayed out of the hospital. The risk of postoperative complications is greatest in the first week after surgery. Not too surprisingly, the risk of infection or worse drops off once all of the tissues that have been cut and pulled and spliced and stitched have at least mostly healed. It's not like I'm completely out of the woods yet and there are still some nasty surprises that could rear their ugly head, but staying at home without bleeding, vomiting, spiking a fever, or suffering a pain crisis are all major gold stars on my recuperation report card.
Second, I am sleeping well. While there is some controversy in the animal model literature, other human research suggests that wounds heal faster in patients who get better sleep. Even if there was no evidence to support this notion, there is little reason to believe that not sleeping well would be a benefit in any way. At the very least I would be groggy, grumpy (okay, grumpier), and at least a little bit disoriented. By having a good night's sleep I feel like my life is more normal than it was while in the hospital. It's really nice to wear my own pajamas and sleep in my own bed, on my own sheets and not have my vital signs taken every four hours overnight.
Third - and this is where I caution everyone that I'm about to talk about poop again - I have had my first bowel movements. My first one was a bit of a surprise; I thought I was just going to be unreasonably proud to release some more gas when a grape-sized lump of soft poop plopped into the toilet beneath me. Since then I have been reasonably regular if a little more frequent than my previous bowel habit, defecating 2-3 times each day. My bowel movements are definitely softer than they were before my surgery but this is hardly surprising; without most of my rectum I have none of the normal apparatus to contain stool and return it to the colon for further water absorption. Add to that anatomical reality the fact that I am so far just eating small amounts of relatively low residue foods - things like rice or white bread or pudding - so there is not that much stuff for my colon to process and I'm really not surprised by the way my bowel movements are going.
Pleased, but not surprised.
Pleased? Pleased about my bowel movements? What am I, a child?
DEEPER EXPLANATION AND PLEASE FEEL FREE TO SKIP FORWARD TO THE SUMMARY BELOW: In a very real sense my lower GI tract is like a child's. I had a set of apparatus that worked pretty well for over five decades that gave me signals I rarely even thought about that it was time to go to the bathroom. I don't remember how old I was when I first mastered using the toilet like a big boy, but it was long enough ago that having control of my bowels has essentially been a lifelong skill. The major player in that communication loop went a little haywire and grew a tumour though, and now most of my rectum is sitting in a pathology lab awaiting slicing, dying, mounting, and reviewing by a pathologist. My sigmoid colon is healthy and really good at its job, but it doesn't stretch as much as the rectum and it lacks the sensory capacity that my rectum had. I now have to pay attention to the new signs that I need to go to the toilet, signs I never had before. At the same time, the old signs that I keep thinking I should get are mostly gone. I need to learn what my sigmoid feels like when it fills with stool, and then when I evacuate my bowels I need to understand that everything is still a little watery compared to the normal range of bowel movements I have experienced for my entire life. They are about a six or maybe a five on the Bristol Stool Scale and still pretty small in volume - maybe 100 mL at a time maximum. I'm starting to learn the patterns though and to learn what gas feels like as opposed to needing to poop, but it could take up to a year for my bowels to establish their new routine. I'll just need to take each event as it happens and try to learn from the strange new world inside me.
TLDR: It feels weird when I need to poop and even weirder when I do. But I'm a smart dude and I will figure it out.
Having a bowel movement was an important milestone after my surgery. If I had not been able to have a bowel movement, I would have become obstructed and that would have triggered a return to hospital with almost definite second surgery. I did well with the first procedure but I have no desire to try a second. In my head I knew that my anatomy had been pieced together inside and that the stool that I was passing would be transiting a very fresh anastomosis site. This led to me being a little emotionally hesitant (okay, afraid) that my stool would somehow damage my fragile healing tissues. It was reassuring when I was able to move my bowels, knowing that everything was working pretty much as expected.
I haven't written about this yet, but I was pretty concerned about developing Lower Anterior Resection (LAR) Syndrome after my surgery. It's one of the more common adverse outcomes of my sort of surgery and is associated with some things that definitely decrease quality of life. Fecal incontinence isn't something anybody wants to have, and the fecal urgency and frequency could have a significant impact on how I could live my life in the future. Going on a long motorcycle trip or even taking a relatively short flight on an airplane would be pretty difficult if I couldn't predict when I needed to use the toilet or if I needed to use one RIGHT NOW!!! I didn't want to suffer from these problems after my surgery, but as scared as I was about LAR syndrome I still went through with the procedure because the alternative - blindly hoping that my cancer would not extend or metastasize and eventually kill me - was worse.
It's still early days obviously, but it seems like I won't have any significant problem with LAR syndrome. I may still have to add a bulk-forming fibre supplement to my diet to help absorb water and create a predictable stool pattern. If that doesn't work I can use loperamide to reduce the frequency or urgency of my bowel movements, but right now that doesn't seem to be necessary.
Finally (all the poop talk is done now), I am taking things easier. Everything I do just seems to take a little longer. I have to think about my incision and how to get up without using my core very much. Every cough, every sneeze becomes a conscious act and includes holding my abdomen or pressing a pillow against it to brace. I am on day five of twenty-eight of my dalteparin injections which has given me true sympathy for all the patients I have counselled over the years on the importance of using their blood thinner shots. I stay connected with all the amazing people that matter to me - my family, my incredible circle of friends and colleagues, even my neighbours - who have all expressed their support. I accept their love and the tokens of caring that they send me, not because I need things or sympathy but because these people all feel a connection with me and reaching out in whatever way they do is something active. It's a gift and it is as much for their benefit as it is for mine; declining their gifts would at the very least be rude and would be likely to reduce the circle of wonderful people in my life. For my own part, recognizing this vast number of amazing people that care for me makes me feel like my life is so much bigger than the minor discomfort I feel or the fact that I had cancer (past tense, although it will take a year and at least two more colonoscopies before I can be considered cured).
Life is pretty wonderful. That may sound like an odd thing to say just five days after having major abdominal surgery for cancer, but it's the truth. At least, it's my truth.
Maybe that's what normal will be for me now. Seeing the beauty in the world instead of the stressors.
I certainly hope so.
Seventy-two hours. It never seemed like that long a time period before.
Seventy-two hours is a long weekend, a nice break from work maybe or a chance to go somewhere close for a quick getaway, but not enough time to do anything that really matters. But in those seventy-two hours, I have done a lot of significant things.
First off, I have stayed out of the hospital. The risk of postoperative complications is greatest in the first week after surgery. Not too surprisingly, the risk of infection or worse drops off once all of the tissues that have been cut and pulled and spliced and stitched have at least mostly healed. It's not like I'm completely out of the woods yet and there are still some nasty surprises that could rear their ugly head, but staying at home without bleeding, vomiting, spiking a fever, or suffering a pain crisis are all major gold stars on my recuperation report card.
Second, I am sleeping well. While there is some controversy in the animal model literature, other human research suggests that wounds heal faster in patients who get better sleep. Even if there was no evidence to support this notion, there is little reason to believe that not sleeping well would be a benefit in any way. At the very least I would be groggy, grumpy (okay, grumpier), and at least a little bit disoriented. By having a good night's sleep I feel like my life is more normal than it was while in the hospital. It's really nice to wear my own pajamas and sleep in my own bed, on my own sheets and not have my vital signs taken every four hours overnight.
Third - and this is where I caution everyone that I'm about to talk about poop again - I have had my first bowel movements. My first one was a bit of a surprise; I thought I was just going to be unreasonably proud to release some more gas when a grape-sized lump of soft poop plopped into the toilet beneath me. Since then I have been reasonably regular if a little more frequent than my previous bowel habit, defecating 2-3 times each day. My bowel movements are definitely softer than they were before my surgery but this is hardly surprising; without most of my rectum I have none of the normal apparatus to contain stool and return it to the colon for further water absorption. Add to that anatomical reality the fact that I am so far just eating small amounts of relatively low residue foods - things like rice or white bread or pudding - so there is not that much stuff for my colon to process and I'm really not surprised by the way my bowel movements are going.
Pleased, but not surprised.
Pleased? Pleased about my bowel movements? What am I, a child?
DEEPER EXPLANATION AND PLEASE FEEL FREE TO SKIP FORWARD TO THE SUMMARY BELOW: In a very real sense my lower GI tract is like a child's. I had a set of apparatus that worked pretty well for over five decades that gave me signals I rarely even thought about that it was time to go to the bathroom. I don't remember how old I was when I first mastered using the toilet like a big boy, but it was long enough ago that having control of my bowels has essentially been a lifelong skill. The major player in that communication loop went a little haywire and grew a tumour though, and now most of my rectum is sitting in a pathology lab awaiting slicing, dying, mounting, and reviewing by a pathologist. My sigmoid colon is healthy and really good at its job, but it doesn't stretch as much as the rectum and it lacks the sensory capacity that my rectum had. I now have to pay attention to the new signs that I need to go to the toilet, signs I never had before. At the same time, the old signs that I keep thinking I should get are mostly gone. I need to learn what my sigmoid feels like when it fills with stool, and then when I evacuate my bowels I need to understand that everything is still a little watery compared to the normal range of bowel movements I have experienced for my entire life. They are about a six or maybe a five on the Bristol Stool Scale and still pretty small in volume - maybe 100 mL at a time maximum. I'm starting to learn the patterns though and to learn what gas feels like as opposed to needing to poop, but it could take up to a year for my bowels to establish their new routine. I'll just need to take each event as it happens and try to learn from the strange new world inside me.
TLDR: It feels weird when I need to poop and even weirder when I do. But I'm a smart dude and I will figure it out.
Having a bowel movement was an important milestone after my surgery. If I had not been able to have a bowel movement, I would have become obstructed and that would have triggered a return to hospital with almost definite second surgery. I did well with the first procedure but I have no desire to try a second. In my head I knew that my anatomy had been pieced together inside and that the stool that I was passing would be transiting a very fresh anastomosis site. This led to me being a little emotionally hesitant (okay, afraid) that my stool would somehow damage my fragile healing tissues. It was reassuring when I was able to move my bowels, knowing that everything was working pretty much as expected.
I haven't written about this yet, but I was pretty concerned about developing Lower Anterior Resection (LAR) Syndrome after my surgery. It's one of the more common adverse outcomes of my sort of surgery and is associated with some things that definitely decrease quality of life. Fecal incontinence isn't something anybody wants to have, and the fecal urgency and frequency could have a significant impact on how I could live my life in the future. Going on a long motorcycle trip or even taking a relatively short flight on an airplane would be pretty difficult if I couldn't predict when I needed to use the toilet or if I needed to use one RIGHT NOW!!! I didn't want to suffer from these problems after my surgery, but as scared as I was about LAR syndrome I still went through with the procedure because the alternative - blindly hoping that my cancer would not extend or metastasize and eventually kill me - was worse.
It's still early days obviously, but it seems like I won't have any significant problem with LAR syndrome. I may still have to add a bulk-forming fibre supplement to my diet to help absorb water and create a predictable stool pattern. If that doesn't work I can use loperamide to reduce the frequency or urgency of my bowel movements, but right now that doesn't seem to be necessary.
Finally (all the poop talk is done now), I am taking things easier. Everything I do just seems to take a little longer. I have to think about my incision and how to get up without using my core very much. Every cough, every sneeze becomes a conscious act and includes holding my abdomen or pressing a pillow against it to brace. I am on day five of twenty-eight of my dalteparin injections which has given me true sympathy for all the patients I have counselled over the years on the importance of using their blood thinner shots. I stay connected with all the amazing people that matter to me - my family, my incredible circle of friends and colleagues, even my neighbours - who have all expressed their support. I accept their love and the tokens of caring that they send me, not because I need things or sympathy but because these people all feel a connection with me and reaching out in whatever way they do is something active. It's a gift and it is as much for their benefit as it is for mine; declining their gifts would at the very least be rude and would be likely to reduce the circle of wonderful people in my life. For my own part, recognizing this vast number of amazing people that care for me makes me feel like my life is so much bigger than the minor discomfort I feel or the fact that I had cancer (past tense, although it will take a year and at least two more colonoscopies before I can be considered cured).
Life is pretty wonderful. That may sound like an odd thing to say just five days after having major abdominal surgery for cancer, but it's the truth. At least, it's my truth.
Maybe that's what normal will be for me now. Seeing the beauty in the world instead of the stressors.
I certainly hope so.
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