Pre Operative Assessments: Stoma & General Surgery – 14.03.19
I last had a pre op for major surgery back in May of 2016 ahead of my Right Hemicolectomy. Reading it back, everything is very much the same – not long before the operation is here, pre op drinks at the ready, all vitals taken and history given. What was different this time was already having a stoma.
I initially thought my stoma pre op was a mistake – surely the hospital know I already have one and I know more than most, of what to expect? – but it was not. I met all the new Stoma Care Nurses (SCN’s) who will be looking after my stoma pre and post op, as well as getting given some more precise information about what is likely to happen.
NB: I plan on going into the details of why I am having this surgery done in a post next week, so some of this might be ‘vague’ or assumptive.
I’ve not experienced an increase or exacerbation of my symptoms in a couple weeks, so I had been thinking that maybe this wasn’t really necessary. But, considering how debilitating my symptoms can be, doing this in a controlled and planned way is going to benefit me in the long run. And whist this is happening very soon, without much time to really overthink things, it is within the time frame I was given and I will be able to return to work without too much hassle.
So, for the most part, my stoma will remain unchanged throughout the operation and recovery. My stoma is not being operated on, I am going about ostomy life as normal leading up the surgery. And whist anesthetic might cause the bowel to slow down or speed up, my size and shape of stoma should not change too much. I currently cut my own bags, so prepping my supplies will be a doddle. Changing that first bag though, that might be… entertaining.
Plans have been already been well made for pain management: I will be having a spinal block for my pain relief after the surgery. I have already been informed by several people, via face to face and letter communication, that the Acute Pain Team are already aware of my pain; they will be there in the pre op ward with me and will follow up every single day on the surgical ward until I am discharged. This part – the pain and relieving it – was filling me with dread. I had some reservations about pain relief as I’ve had good and bad experiences. The good ones, where due to my surgeon fighting for my PCA to be available ASAP on the surgical ward, following ostomy surgery and in retrospect, that helped alot.
But this time, I am in a new hospital, under a new team, seeing a new surgeon – who, despite coming recommended from other local ostomy and IBD patients alike, is spoken of very highly by all staff – everything is different. I am grateful for my antidepressants and CBT right now; I would be an anxious mess without them.
I am expected to be in theatre for 3-4 hours, coming out with a catheter in place, possibly one or two drains – pelvic and butt – but that depends on the state of my insides. We are removing my rectum, anal canal and the remainder of my sigmoid; approx 30-40cm in length. I expect to be glued and possibly stapled down my mid line incision – he will cut through old scar tissue, maybe avoiding the top part around my belly button, but definitely lower, down to my pubic bone.
The SCN emphasised the need to accurately state my pain level whist in recovery. From here, we can adjust whatever might need tweaking. This will be asked of me every day I am in on the ward round and I should not put on a brave face and struggle through; it’ll result in poor recovery, a longer stay and will be harder to come off pain meds in the long run, let alone the mental knock on effect it could have too.
I am again under Enhanced Recovery (ER). This means some specific pre op instructions – ie the day before surgery – and encouragement to get out of bed as soon as I feel able after surgery. This will be the afternoon after the operation, possibly sooner, depending on how I am. PT will come and help me, encourage me to sit in the chair and get used to my new butt. I am expecting the butt wound to be the worst pain but I am trying to not neglect the cutting through my midline as well.
I have two pre op drinks to make up – to be taken at 9 pm prior to surgery, and 6 am the morning of – as well as a anticoagulant injection to give myself. I think, despite my experience with sub-Q Humira injections for two years, this makes me nervous! But I have had plenty before so it won’t be too scary.
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Overall, I feel nervous and scared. I know this is normal but I’ve put up with my pain from my stump for longer than I planned on, and despite this being fast, it has been a long time coming. I remember the euphoria of getting my first surgery date, and I felt this again at the end of February. I feel alot of things, but my AD and beta blockers are keeping my numbed. I am being methodical at planning and preparing for time away from home, time away from my own comforts and this time – time away from my partner and I am a long way from home too.
It also feels very peculiar to think that my stoma is going to be permanent. That is the biggest thing, it is an overwhelming feeling; as I know I can’t undo this. Accepting this, despite knowing my stoma has been life changing and a giver not a taker, I still feel skeptical. I am hoping these feelings fade. Or at least, I find some time to process it all. I’m sure in my drugged state, I will find the nights in hospital a good time to reflect.
More on those feelings next week, along with why my Proctectomy is taking place.
