Bad Spots Dealing With Colon Cancer
Very few of the experiences associated with colon cancer can be thought of as bright spots, and I don't suppose anyone will be surprised to hear that there are some bad spots. Here are a few of the latter.
The NG Tube
As soon as I was scheduled for the exploratory surgery, nurses descended on me with preparatory procedures. One that I will never forget is the nasogastric (NG) tube. My digestive system was blocked from end to end and in fact the intestine was returning material back into the stomach. To remove this material it was necessary to insert a tube into the stomach and apply a pump. The tube is inserted through the nose and swallowed so that the end reaches the stomach. The process is aided with a little numbing and lubrication in the nose and a few bits of crushed ice in the mouth for swallowing. The major force for insertion is a quick and effective push by the nurse at just the right time.
I was warned that the procedure was a "nightmare" and it wasn't much fun, but later experiences with it were even worse.
The NG tube is very carefully and securely fastened to the nose with adhesive tape. It leads to a pump that keeps the stomach clear. A bag accumulates the material removed. In the evening a day or two after the operation, the tube became partially dislodged. A nurse (bless her soul) spent what seemed like an hour removing some of the tape, repositioning the tube and retaping it. The discomfort was excruciating!
Next morning the surgeon came in, said why do we still have this on, and proceeded to rip off the tape and pull out the tube. Bad side - lots of hurt. Good side - over in two minutes.
The leftover adhesive, nose chapping, nasal passage damage and throat damage took many days to return to something near normal. Going in to the second surgery I begged everyone who would listen not to use an NG tube. Guess I got the right guy cause I had an OG (mouth to stomach) tube and it was inserted and removed while I was sedated.
The Vacuum Bandage
I'm pretty sure that some inventions of the medical community are viewed as wonders by doctors and nurses and as horrors by patients. An example has to be the vacuum bandage!
I was totally blocked going in to surgery and I'm pretty sure the operation that cut into this blockage was not a "neat" one. In fact I was told as much by the surgeon. One of the mitigations for the contamination situation was to leave the large access wound "open". As I understand this, the peritoneum was sealed, but the flesh and skin were left without staples or stitches. Attempts at sealing contaminated wounds regularly result in infections, so I guess it makes sense.
A day or so after the operation, a nurse who specializes in dressings spent an hour and a half or more with an audience of six or seven people installing a vacuum bandage on me. She started with a sponge and trimmed it and trimmed it until it just exactly coincided with the shape and size of the entry wound. A perforated tube was placed over the sponge. A non-porous bandage was installed over this and carefully affixed to my abdomen with (what else) adhesive tape. A vacuum pump was attached to the tube and gradually a partial vacuum was achieved inside the bandage.
The idea is to draw off material sluffing from the wound and with it bacteria and contamination left over from the operation. The invention is a wonder. When the bandage was removed, a line of people examined the results and oh-ed and aw-ed about how beautiful the color and granularity of the wound was. But...
A day after the bandage was put on, I was taken for a walk by a therapist. We took a Christmas tree along to hold the bags and bottles and the vacuum pump attached to me. The pump supposedly had battery backup and was portable. After the walk I got back in bed and the pump was again plugged into the wall outlet. I thought my abdomen was on fire.
Turns out the pump went off when it was unplugged for the walk and my wound returned to normal air pressure. When plugged in at the appropriate pressure it was too great a change. We had to start over and build up to the right psi and then all was well.
As it is in hospitals, after a couple of days it became necessary to change the vacuum bandage. Now I leave it to the reader to imagine what happens when you put a porous sponge over raw flesh and apply suction. Apparently the two become as one. Removal of the adhesive was horrible, but removal of the sponge was indescribable. No amount of the morphine I had access to with an automatic button was enough to mask the discomfort. Every square mm was agony!
Paranoid as I am, I can't help but wonder if the aforementioned oh's and aw's were designed to convince me that the vacuum bandage was worthwhile. I begged the nurse not to replace the vacuum bandage and I pleaded with the surgeon not to use that method after the second surgery. I was spared on both counts.
The IV Connector
IVs were an integral part of both surgeries, and although they are painful when inserted and generally uncomfortable to deal with, they become a way of life. However, one of them was the proverbial sore thumb due to what I consider an engineering flaw.
The IV was inserted on the back of my left hand just an inch or so from the knuckle. It had a V shaped connector. One leg of the V was parallel to my hand and connected to the major IV tube. The other leg of the V stood away from my hand at a 30° angle. The connector was securely fastened with lots of adhesive tape. The piece sticking up (like a sore thumb) was tipped with a rubbery end and used to push the odd order for an additional medication.
That rubbery end was insidious. It caught on the blankets, it caught on the sheets, it caught on the pillows, the gowns, towels, nurses, doctors, and anything else that came close to it. It is inconceivable to me that anyone would design such a device. Even if they did, they should add a cover made of teflon or mylar or some substance that doesn't grab everything in sight. The grabs never did dislodge the IV due to the masses of adhesive tape, but it was a constant irritation.
Insult to injury? The sore thumb was never used for a push!
The Roller Coaster
I'm pretty sure doctors don't do it on purpose, but sometimes they don't think of the effect on patients before they start talking or revealing information. The result is some pretty violent valleys and peaks.
Right after my first operation, the hospitalist probably said "the cancer is out, the lymph nodes are negative, and you may not even require chemotherapy". I heard the "not require chemo" phrase, but didn't parse the rest of the statement. I spent about a week thinking no chemo (Peak.) before the oncologist set me straight. Valley.
Prostate specific antigen (PSA) measured at 4.0 or higher is an early warning of prostate cancer. PSA is non-linear, however and seems to be an undependable indicator. One of the blood tests just after the first operation showed a PSA spike to over 21. The surgeon said it was unlikely to be related to the operation. Valley. The oncologist said it probably was related to the operation. He ordered additional blood tests and the PSA returned to close to pre-operation level. Peak.
The evening before I was to leave the hospital after the second operation, a doctor whose role was never quite clear to me popped in to say she had been going over x-rays from the first operation and saw a white spot on one lung. We discussed the possibilities (postpone release, biopsy, cancer) and she ordered an immediate CT scan. Valley. The CT scan showed the lung was clear and the x-ray was probably flawed. Peak.
A double dip involved liver numbers. After the second operation I had a blood test leading up to an appointment with my primary care giver. He was shocked by liver numbers out of range. A second test was even worse. A third test and a liver ultra-sound was ordered. Valley. Doctor called after the third test and said the numbers were back close to in range and I could cancel the ultra-sound. Peak. However, the oncologist saw the numbers and had a long discussion with me about the liver being a filter that might be gathering any cancer cells that escaped the surgery. We talked of surgery to remove anything that might be starting there. He ordered a liver CT scan. Valley. The CT scan showed a tumor-free liver. Peak.
And not really a valley, but more of a parting shot. After announcing the CT scan showed a tumor-free liver, the oncologist said, "Oh, by the way, you have a kidney stone". Zing!