Thursday, 16 August 2018

Follow-Up Hospital Appointment

This morning I had my long-awaited follow-up appointment with the surgeon, after my operation at the end of March and subsequent major infection in April. At the time, he said he wanted to see me a fortnight after my discharge, but NHS timing being as it is, for them, two weeks = three months!

I had been having trouble with Kermit, my ileostomy, for weeks after the operation wound had healed, with many leaks and frequent bag changes. I kept hoping for an early appointment so that I could see the stoma nurse at the same time, and during this time, I was dealing with the problem myself and getting more and more frustrated with it. I suddenly remembered I’d had exactly the same problem after my original operation in 2015, and after trying various solutions, the stoma nurse had given me convex bags to try, which act by pressing on the parastomal area and making the stoma protrude more into the bag, and this solved the problem. I had been using the normal flat bags since the operation because initially, you have to let the area heal before using convex bags, and also, because Kermit Mk II was longer after being remade during my hernia repair surgery, I thought it would no longer be necessary. Anyway I decided to try, and hey presto, it worked, and the problem was solved.

I phoned the stoma team a few days ago to ask if I could see someone during the surgeon’s appointment, and was told that they were very short-staffed, with two on leave, and one with a broken wrist, but they would do their best. The HCA (complete with cast and sling) did manage to come, and she and the surgeon saw me together.

They agreed that I should have new support garments. The last ones I had were in January 2017 and they should be replaced every year as the elasticity tends to diminish, and I had also lost weight since then, so my current garments are probably not providing adequate support. The stoma nurse will arrange for a representative from the company to make an appointment with me, and she will come and see me at home.

I told the surgeon that I had a suspicion that my hernia had returned. He examined me, but couldn’t be sure, so he is booking me in for a CT scan to see what is going on. He said that if I had got a hernia again, it would be very much more difficult to repair, firstly because I have already had two repairs done, and secondly, the mesh that he inserted in March would make things a lot harder. I said that I realised this, and that I was most unwilling to have Kermit re-sited on the other side of my abdomen, which is what they often do under these circumstances. Not only would I have to get used to managing Kermit on the other side, but it would also introduce another weakness in the abdominal wall and a potential site for herniation.

Anyway, we shall have to wait and see what the scan reveals. If it has herniated again, I am going to suggest that we leave well alone, and try and manage it without further surgery, and I have a feeling he will agree. There is always a risk of it causing another obstruction, which would again involve major emergency surgery, with the added complications listed above. Meanwhile, we will try and get new support garments as soon as possible.

I told him that I was feeling better than I have felt for years, and my hubby agreed that I was much better these days. I told him I had decided to try and restore my gut microbiome by drinking kefir when I came out of hospital and was still on the strong antibiotic cocktail to combat the last of the infection. In hospital I had three different combinations of intravenous antibiotics and came home with the oral version of the last, and this was playing havoc with my gut. I knew my friend had had great success in dealing with her long-standing gut problems, by consuming kefir and other fermented foods, as well as some radical changes to her diet, excluding certain foods that were causing her problems. She came round, armed with some kefir grains and a lot of very helpful information. Since then, I have been immersing myself in this whole new world of fermentation and the diversity of the gut microbiome. My surgeon didn’t say anything in reply and he probably thinks I’m a weirdo, unless he’s kept up to date with the latest research in this area! Anyway, the proof of the pudding has been in the eating, literally, in my case! (A little aside: I do hate the way this expression has been adulterated recently – I keep hearing people on TV saying, “The proof is in the pudding.” This is nonsense!!!)

We also discussed my anticoagulant treatment. Up until my recent operation I’d been taking rivaroxaban, because some time previously, a CT scan had revealed numerous small pulmonary emboli. I was told to stop the rivaroxaban before surgery, and resume it immediately afterwards. This became a problem a few days after I was discharged, with profuse bleeding from the stoma, and I was readmitted overnight until it settled down. I remained off it during the following couple of weeks, during which time I was brewing up with the infected haematomas in my abdomen which led to the early stages of sepsis and my emergency readmission. When I was discharged, I asked about going back on the rivaroxaban and they said no, but to have the daily fragmin injections for several weeks (horrible – like bee stings!). Once these were finished, I spoke to my GP on the phone and asked again, and she said she had had a letter from my surgeon saying that I should not start again until I had seen him in the outpatient clinic. We all thought my appointment would be a lot sooner than it was, so all this time I have been without them. He said that I really should be taking them, and would inform my GP accordingly. It is a relief at last to know where I stand on this.

All in all, it was a good appointment. My surgeon is so expert and experienced, and speaks with authority but without being patronising, and is friendly and charming. He is always ready to listen to my point of view and we have fruitful discussions, and informed decisions are made. I am extremely blessed to be cared for by such a man. I always know I am in very good hands with him, and that he always acts in my best interest, and gives a lot of thought as to how to deal with the various problems I have had. I have the greatest confidence in him.

So now we wait and see what result the CT scan brings.

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