6. Better the devil you know

A couple of days ago I received a standard letter from the department of surgery saying that my operation would be scheduled for a maximum of 12 weeks from the date I agreed to go ahead. By my reckoning that means it must be on or before Fri 15th March 2013. Over the festive holiday period I had decided that it was sooner-the-better for me and therefore I have also indicated that I would be willing to go on the cancellations register. This could speed up the process a bit.

There seems to be a lot of time for me to think about things at the moment. I go between wanting to learn everything there is to know about colorectal surgery and just wanting to forget about it; for the operation to be over and done with. My inquisitive mind tends to dominate though, and I have found myself scouring the internet for information and I'm going to share some of my findings here.

Better the devil you know

Here is a quote from a fellow ostomate's blog, which I stumbled across the other day:

"Ostomies are a bitch, but they're a devil you know...one we understand."

This sums up the ileostomy surgery for me. As I've explained before there is a high degree of certainty that I can achieve a manageable solution to my Crohn's. Yes, I will have a new and life-long "problem" to deal with, but one for which there are known solutions to any complications which may occur. This cannot be said for Crohn's disease itself. It seems like a good time to be thinking about the complications that can occur. I figure that by understanding the risks of complications I might be able to take positive actions to reduce the chances of them occurring.

By far the most concerning (and most common) is the 'paristomal hernia', which occurs in up to 50% of ostomates (although for ileostomy the rate is lower at 20-30%). Whereas the intestine is normally concealed behind the abdominal muscles, it must be brought through them and the skin in order to form the stoma. This creates a potential point of weakness in the abdominal muscle. A hernia can occur if the muscle collapses, allowing more than just the end of the small intestine through the hole in it. The picture below explains it better than I just have, basically the hole in the muscle should only allow through the bit of intestine leading to the stoma.

Paristomal hernia (taken from reference 1)

Whilst there seem to be no guarantees against parastomal hernia, the advice is to maintain strong abdominal muscles post-surgery. This includes various limitations such as no lifting for 3 months, but also doing exercises including sit-ups etc. Maybe this ileostomy is just the stimulant I need to get that ribbed "six-pack" look I've been longing for all these years!

Regarding other complications, one study (Reference 2) into 180 ileostomy patients showed the following rates:

• Skin excoriation (due to stool irritation) 21.1 %
• Stoma retraction (where the stoma recedes back inside the body) 6.6 %
• Prolapse (opposite of retraction) 4.4 %
• Stenosis (narrowing)  4.4%

What else can I expect?

Complications aside I've been trying to understand what else will be involved in this process. I think I've  figured out a rough plan:

• Meet stoma nurse to decide stoma location and discuss other pre-op requirements
• Confirm surgery date
• Bowel preparation (lots of laxatives for 2 days)
• Admitted to hospital
• 6-8 hours on the operating table (thankfully I'll be asleep!)
• 5 days in hospital
• Further 5 weeks off work to recover

I'm not sure when my next blog post will be -  I'm not really convinced I'll have anything interesting to write before surgery, but many thanks for your continuing support, it really does make this journey easier to embark upon.

“Life is 10% what happens to us and 90% how we react to it.” - Dennis P. Kimbro

References:

1. "Parastomal hernia: incidence,prevention and treatment strategies" Mary Jo Thompson,
British Journal of Nursing, 2008 (STOMA CARE SUPPLEMENT), Vol 17, No 2

2. "Frequency of complications of ileostomy: experience of 180 cases at Chandka Medical College Hospital Larkana."  Rawal Med J Jan ;35(2):198-200.