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  TV Shows That Never Were - 6
136  Lucky I Live South Maui
137  The Rest of South Maui
138  The Family Birdman
139  TBD

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CC REATTACHMENT

 

NOTICE:  There are two versions of Ponogram #130.  This version OMITS actual photographs of incisions for any who are sensitive to such things.  The other version contains all the same text and graphics but includes actual photos and is available online – click here.

 

 

Reattachment after Colon Cancer Surgery

 

The goal of this second operation was reattachment of the colon to the rectum, closure of the colostomy, and implantation of a port to be used later for introduction of the chemicals associated with chemotherapy.  

Preparation for this surgery was extensive.  It included
    o blood tests
    o x-rays
    o EKG
    o pre-op visit to primary care-giver
    o pre-op visit to surgeon
    o forms, forms, forms, forms
    o diet, diet
    o antibiotics (flush)

The operation was scheduled for a Friday.  On Tuesday I was allowed what is called a full liquid diet, characterized by such things as ice cream, cream of rice, and tomato soup.  On Wednesday and Thursday I was on clear liquids - broth, jello, and ginger ale.

Thursday afternoon I had a whole cocktail of antibiotics over a few hours.  Intentional or not, the result of the diet and the antibiotics was a pretty complete flush of my digestive system.  Through the evening and night, I'd guess two quarts of fluid came out through the colostomy.  By the end of that session, I think I presented a pretty clean system to the surgeon.

The surgeon made the new incision in virtually the same place as with the original surgery, although I think he may have started 1 1/2" lower and finished about the same amount lower.  A close examination of the staples in the following pictures shows some scar tissue above the top of the new wound.  This sequence was taken soon after I was discharged from the hospital.

Actual photos can be seen in the other version of this Ponogram – click here.

This picture shows the implanted port on the upper chest, the entry wound down the middle of the abdomen, and the colostomy closure.  The port is covered in detail in a separate section below.

Actual photos can be seen in the other version of this Ponogram – click here.

From left to right on the left picture, see the ancient appendectomy scar with the newer cecostomy scar on top of it, the entry wound closed with staples, and the colostomy closure closed with staples.

Actual photos can be seen in the other version of this Ponogram – click here.

This right picture focuses on the colostomy closure.  The redness beneath the wound is probably skin reaction to the ever-present adhesive (but may also be the surgeon's initials).

As I understand it, the stoma was removed from its attachment to the abdomen, appropriately trimmed back to viable material, the same was done with the dormant section of colon that had been sutured, and the two ends were connected with staples.  The connection was tested with air pressure for any leaks (yeah, this is not a joke).  Both the entry wound and the colostomy closure wound were closed with sutures on the inside and staples on the outside.

The port was implanted and its catheter was threaded through minor vessels into the vena cava.  The end of the catheter is trimmed to dump very near the heart where blood quantity will quickly dilute the chemicals.  Those wounds were closed with stitches.

The surgeon scheduled several hours for all these procedures, but accomplished everything including his signature in less than two hours.

 

Recovery from Reattachment Surgery after Colon Cancer

Again I came to in a fog from the second operation.  However, this time I knew what I should expect my condition to be.  Artificial support consisted of
    o IV for nourishment, hydration, pain medication and other meds
    o catheter for urine drainage
    o that's it!

Just like the first time, the IV 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 was a tube that led to a plastic bag and was gravity-operated.

I learned that the colon had been reattached to the rectum, the colostomy had been closed, and a port had been implanted for later chemotherapy.  The operation had been a success and was completed in less than two hours.

Basic longer term directions to me were to do everything possible to regain my strength so that I could begin chemotherapy.  Immediate directions were to pass gas through the new attachment, then loose material, and finally solid formed material.

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

I was allowed nothing by mouth for a short time after the surgery.  The IV supplied nourishment, hydration, and medication.  In quick steps, a clear liquid diet, full liquid diet and finally a normal diet were introduced and the IV was removed.

The day after the operation I was up and walking.  From that day on I was up walking every day.  The incentive for activity was to get the bowel working again.  I don't remember the day, I think it was three days after the surgery, but the time was 3:58p.  I felt an urge and made a noise from a place that had missed that action for more than three months.  I called my local angel with a report of the report and the word went out far and wide.

Now it became necessary to get food in the stomach to exercise the rest of the function.  A normal diet came fairly soon and before I left the hospital I had passed unformed, loose stool and six days after my return home my #1 solid formed #2 occurred.  Although I do have a picture, I decided to spare you that thrill.  Initial "formed" stool had an interesting cross section, somewhat like Saturn, a circle with two horns.  Eventually the cross section became more oval or circular.  Interesting stuff, huh?

I had a thick protective covering over the entry wound and the colostomy closure immediately after the operation.  When the surgeon came in the day after, that covering was removed and not replaced.  The next day the entry wound was drying up nicely, but there was significant drainage from the closure.  It was necessary to keep gauze and a bandage on that wound.

I was released from hospital on the seventh day.  By that time I was on a regular diet, I was passing gas and unformed loose stool, the entry wound was dry and fine but the closure was draining, I had found a way to wiggle myself out of bed, but I was using regular pain relief.  My son Stuart had arrived.  He brought me home from the hospital and provided the help required until I was able to drive and take over again.

Stitches and staples were removed ten days after the operation.  The drainage from the closure was due to an infection.  The surgeon reopened one side of the wound, cleaned it out and packed it with gauze.  Nurses taught me how to maintain the packing and that was an uncomfortable chore.  It only lasted a few days though.  Fresh flesh filled in the hole at a remarkable rate!

Since then I have continued to regain strength and flexibility.  I'd like to think that improvement is still going on, but it's hard to distinguish between leftover operation issues and new chemotherapy side effects issues.  I guess I'll know if I've recovered from the second operation when the chemo is done.  Chemotherapy started just 31 days after the reattachment surgery.

 

Port for Chemotherapy after Colon Cancer

During my second operation for reattachment of the colon to the rectum, the surgeon also implanted a port to be used for introduction of the chemicals associated with chemotherapy.  The device consists of a wafer that seems to be about the size of three dimes stacked together on a quarter with a tail of several inches. 

Port diagram Port chest position

The picture here in the full version of P-gram #130 may be upsetting to some who are sensitive to such things.  If you want to see the actual photos you can click here.

Left is a diagram of typical ports.  While earlier ports had metal parts, mine is entirely plastic.

The port is implanted in the upper chest (mine was on the left side) in a little "pita pocket".  The "tail" is actually a catheter that is threaded through minor vessels into the superior vena cava, a large vein that feeds directly into the heart.  The center diagram shows where the port is implanted.  The picture was taken soon after the operation.  Stitches and yellow sterile wash are still present.  The heart diagram below shows the superior vena cava.  The end of the catheter would be just about where that label is on the diagram.

Heart diagram 

 

In use, a needle is inserted into the port and affixed with a clever plastic transom and, of course, quantities of the ever popular adhesive tape.  The issue of body hair vs. adhesive quickly becomes a non-problem as the hairs are systematically removed by the roots. 

Port in use

This is a diagram of the port in use.  The diagram does not include the transom which protects the portion of the needle just outside of the skin and its connection to the IV tube.

Although I focused on the value of the port for chemotherapy, I found that any time I drew a nurse who was port certified, blood tests came from the port as well!

 

  

 

 

AFTERWORD

This P-gram is the second of a set of four that cover my experiences from the end of 2004 through much of 2005.  This one covers the second surgery to reconnect the colon, close the colostomy, 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.

It may be that you have visited my website and read this in a slightly different format.  That info will remain online until I have finished reformatting it and sending it out as Ponograms, 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 online version instead of waiting until I send it out as a Ponogram.  (If your browser can handle it.)