PONOGRAMS

 

Ponograms:

1-24  The First Twenty-Four
25-48  The Second Twenty-Four
49-72  The Third Twenty-Four
73-96  The Fourth Twenty-Four
97-120  The Fifth Twenty-Four
121-on  The Sixth Set


121  TV Shows That Never Were - 3
122  Genealogy Kicks - 2
123  TV Shows That Never Were - 4
124  From Land to Lindbergh
125  Pono In Dreamland - I
126  Pono In Dreamland - II
127  Licensed to Drive
128  TV Shows That Never Were - 5
129  Colon Cancer Surgery
130  CC Reattachment
131  CC Chemotherapy
132  CC Personal Review
133  A Trip to Maine - 1
134  A Trip to Maine - 2
135  TBD

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COLON CANCER SURGERY

NOTICE:  There are two versions of Ponogram #129.  This version OMITS actual photographs of incisions for any who are sensitive to such things.  The other version includes all the same text and graphics but includes actual photos and is available online – click here.

 

Symptoms of Colon Cancer

 

I was fat, dumb, and happy - literally.  I hadn't the smallest clue that anything was going on in my belly.

After a lifetime of regularity, on approximately November 8, 2004 I became constipated.  During the first week I tried mineral oil without results.  On the 8th and 11th days I used Fleet enemas with minimal results.  On the 13th day I called my HMO's advice line and they recommended a trip to the emergency clinic.

I saw a doctor at the emergency clinic and told him the history.  He ordered a set of abdominal x-rays taken standing, looked them over and said my bowels were blocked.  He went over the details with me again and ordered another set of abdominal x-rays taken lying down.  He prescribed a laxative and sent me home.

I took the laxative as directed on the 13th, 14th, and 15th days with no results.  On the 15th day I called and made an appointment with a doctor at the clinic.

The appointment doctor was new to me.  I told him the history.  He ordered a set of abdominal x-rays, looked them over and said my bowels were blocked.  He directed his nurse to administer two Fleet enemas.  They produced minimal results.  He prescribed an industrial-strength laxative and sent me home.

When I got home I took one dose of the laxative, but was unable to keep down that or anything else.  Thanksgiving Day I was unable to eat, drink, sleep, or anything else.  By about 3am on the 18th day of constipation I gave up and called 911.

I was evaluated by a surgeon and scheduled immediately for exploratory surgery.  The operation revealed extreme blockage caused by a circumferential colon cancer.  The surgeon tells me that another day or two might have resulted in a rupture.

 

Discovery and Removal of the Colon Cancer

 

Since I came to the hospital as an emergency, preparation for the exploratory surgery was jammed into a very short period.  I'm confident that everything necessary was done, but it was done fast.  I barely remember some of the steps, I know I just initialed some of the myriad forms, and I know they didn't have time/take time to shave my abdomen.

Now, I'm not an MD and it's been a LONG time since I took biology, so if I happen to use the correct words in describing this operation, it will be sheer luck.

Having done every noninvasive thing possible, the surgeon elected to do an exploration.  He made an 8" or 9" slice starting about two inches below the sternum, right down the middle of the abdomen with just a slight detour around the belly button.  He found blockage of the small and large intestine (surprise!) and followed it to the cause.  It was a tumor that surrounded the colon and gradually shut down its function.

 

 

Organ Diagram

 

The surgeon removed a 7 cm segment of the colon including the cancer and with it the associated lymph nodes.  On the diagram above, the segment removed would be between the labels "Descending Colon" and "Sigmoid".

I can only guess that backed up material was removed from the colon and maybe even the small intestine, since I saw very little of such material output just after the surgery and there must have been a large quantity.

I had had an appendectomy back in the dark ages when medicine was not very sophisticated.  The resulting scar is large and ugly.  The surgeon went right through that scar to puncture the cecum and insert a tube.  This cecostomy provided drainage of material from that end of the colon.

A 2" or 3" horizontal incision was made through the abdomen and peritoneum, just above the top end of the removed colon segment.  The upper end of the healthy colon was redirected through this incision, turned back on itself like a sock, and attached to the skin.  The lower end of the healthy colon was sealed with sutures to await reattachment.

Colon Diagram

 

At this point you can see an actual picture of Pono’s abdomen taken soon after the surgery.  Since the major incision and the stoma may distress some viewers, to see it you must click here.

 

 

This diagram shows the colon configuration after the surgery.  The picture shows the wounds and the stoma.  The cecostomy (the + in the diagram) has pretty much healed and is in the fold of the appendectomy scar.

The surgeon tells me that while I was open he did a thorough search for any other organic problems and found none.

 

Recovery from the Colon Cancer Discovery/Removal Surgery

 

I came to in a fog after the first operation.  With the help of nurses, the hospitalist, the surgeon, and personal "exploration" I pieced together my condition.  Artificial support consisted of
    o IV for nourishment, hydration, pain medication and other meds (e.g., antibiotics)
    o catheter for urine drainage
    o colostomy for feces removal
    o cecostomy for drainage of contamination from the cecum
    o NG tube for drainage of contamination from the stomach

The IV (intravenous) was controlled by a pump that regulated the speed of the various drips.  It also provided a "happy button" for the patient to add a shot of morphine at any time up to every 10 minutes as required for pain.

The catheter and cecostomy were tubes that led to plastic bags and were gravity-operated.

The colostomy (detailed below) was effectively a plastic bag that caught anything that came out of the colon.

The NG tube (naso-gastric - nose to stomach - detailed later under "Bad Spots") was attached to a pump that applied gentle suction.

I learned that a colon cancer had been removed and that my colon had been redirected at the upper point of the removal to and through my abdomen.  At the lower point of the removal the balance of the colon leading to the rectum was inactivated by suture.

Directions to me were to do everything possible to regain my strength so that I could have a subsequent operation to reattach the colon to the rectum.

The catheter was very quickly removed and the urinary system immediately returned to normal.

The object of the NG tube is to drain off material in the stomach that was left over from the original blockage.  That tube was removed as soon as it was determined that nothing further was being discharged.  Of course while that was in place, I was allowed nothing by mouth.

The object of the cecostomy is to drain off material in the cecum that was left over from the original blockage.  That tube was similarly removed as soon as it was determined that nothing further was being discharged.  A simple bandage was placed over the tiny hole in the abdomen and that healed quickly.

The object of the colostomy is to give the patient's digestive system time to recover from the blockage and from the removal operation.  The colostomy stayed with me until the reattachment surgery.

I was allowed nothing by mouth for several days after the surgery.  The IV supplied nourishment, hydration, and medication.  After removal of the NG tube, a clear liquid diet, full liquid diet and finally a normal diet, with the added ability to take pain and other meds orally, obviated the need for the IV.

I think it was two days after the operation that therapists had me up and walking.  It was quite a scene with two attendants, my Christmas tree with all the bags and bottles, a wheelchair in case I needed it and a walker for stability.  From that day on I was up walking every day, but shedding "ornaments" made it less of a spectacle each day.

The initial dressing on the big wound was replaced with a vacuum bandage (detailed later under "Bad Spots") for a couple days and then it varied between a wet-dry bandage and wound gel, depending on the preference of the RN on duty.  The wet-dry consisted of gauze saturated with saline solution covered by dry gauze covered by a less porous dressing and then adhesive.  The other option consisted of a liberal covering of a sterile material called wound gel with gauze, etc. as with the wet-dry.  I preferred the wound gel approach, but both of them were better than the vacuum bandage.

I was in hospital for thirteen days.  My middle son JR arrived in time to collect me from the hospital, take me home, and provide the care and assistance I needed for nearly a month.  My youngest son Stuart arrived a couple days later and helped out with the first few days of adjustment.  In addition, my HMO provided home health nurses who dropped in to check vitals, help out with wound and colostomy care, and advise.  I was well cared for!

Both of my sons managed to keep working during their stay in Maui nei.  They each had their laptops and cell phones.  The only bottleneck was the three of us sharing dial up.

I was weak as a kitten when I first got home.  I popped pain pills every day.  My appetite was good, but I lacked the energy to eat more than just enough to get by.  Personal hygiene (showering, cleaning the wounds, changing the dressings, dealing with the colostomy bag) took lots of time.  I had regular doctor appointments, but riding in the car was awkward and uncomfortable.  Fifteen minute walks were about the limit, but I did them.  Gradually, all of these things improved.

The recovery period actually continued right up to preparation for the second operation.  By that time, the wounds were well healed, pain had subsided, my strength had pretty well returned, I had regained a few of the 20 pounds lost, the flaming jock-itch I picked up in hospital had been tamed, I was walking 45 minutes nearly every day, I had accepted the colostomy bag as a way of life, and mentally I was ready for the next step.  The reattachment surgery was done 88 days from the discovery/removal surgery.

 

 

The Colostomy after Colon Cancer Surgery

 

Colostomy: A surgical opening of the colon brought to the abdominal surface.

Stoma: The end of the colon that may be seen coming through the skin.

This is a description of the ostomy supplies provided to deal with a colostomy.  There are lots of varieties, but this is what I used.  I am impressed with the simplicity of the devices and the relative ease of use.

 
Colostomy Wafer and Clamp
Colostomy Bag

Photo of the wafer being attached to the abdomen can be seen if you click here.

 
 

 


Photo of the bag being attached to the wafer can be seen if you click here.

 

     

 

 

There are three parts to the device.  The wafer (top left) is cut to the dimensions of the stoma and affixed to the abdomen.  The bag (middle) attaches to the wafer with an interlocking ring.  The clamp (bottom left) seals the bottom of the bag and provides a means for emptying it..

The wafer consists of a circle of skin-like adhesive material and an outer collar of adhesive tape. Both the circle and the tape are covered with release paper.  The skin surrounding the stoma is prepared with a covering of liquid that protects it from reaction to the adhesive and helps the adhesive to adhere.  When the circle has been shaped properly, the release paper is removed from it; it is placed and firmly attached to the skin.  Then the release paper is removed from the outer collar and the tape is smoothed out.  The pictures above right (not me) illustrate the wafer placement.

The bag is attached by placing bag ring against wafer ring and pressing.  If you have ever put a top on a plastic storage container, you will easily recognize the action.  The picture on the right shows the beginning of this process.

Bags can be emptied, rinsed and reused, or simply disposed of when full.  The wafer should be changed periodically "as required".  Frequent changing may cause excess skin irritation.  Three to four days is recommended.  I've heard of people who went significantly longer than that.  The main thing to watch for is infection or irritation on the skin near the stoma.  When the bag is emptied or replaced, the stoma needs to be cleaned and examined.

There is no need for "sterility" in dealing with this - simple cleanliness is quite adequate.  The colon is very accustomed to dealing with the various biota and toxins in excrement and, even though the stoma is exposed to fresh air, it remains efficient.  Showering with the bag off gives ample opportunity for cleaning the stoma.  When the wafer is changed, showering while the wafer is off gives a still better opportunity.

Living with a colostomy is something I wouldn't wish on anyone, but believe me it beats many alternatives.  The surgeon described an option that he has in colon surgeries.  It involves removal of the entire colon and attachment of the intestine directly to the rectum.  Since the colon's function is to remove liquid from the excrement, the patient with this option is left with frequent, very loose stool.  I will take the colostomy over that option every time.

 

 

AFTERWORD

This P-gram introduces a set of four that cover my experiences from the end of 2004 through much of 2005.  (Spoiler alert – I survive.)  This one covers the initial discovery and removal of the cancer.  The next covers a second surgery to reconnect the colon and implant a port to be used for the chemotherapy.  The third covers the chemo and the fourth wraps up my personal views on the process.

If this sounds familiar to you, it may be that you have visited my website and read it in a slightly different format.  That info will remain online until I have finished reformatting it and sending it out, and then be expunged.  Why?  In my uninformed youth I developed “Pono’s Colon Cancer” using frames that turn out to be unsupported by some browsers.

If you can’t stand the suspense after reading this one, you may want to jump to the old online version instead of waiting until I send it out as a Ponogram.  (If your browser can handle it.)