Surgery – round one

I’d taken the plunge for surgery, though in the end I didn’t really have many other options. Although surgery was a daunting and somewhat unknown prospect, it was in someways a relief to have made a decision and to have something to look forward to: hopefully getting better.

So, in July 2010, after having a pre-operative assessment in which “X marks the spot” was drawn onto my tummy diagonally down from my navel, I went under the knife. The (temporary) loop ileostomy was a relatively straightforward operation that took just 45 minutes. It involved making a small hole through my abdominal muscles to bring a loop at the end of my small intestine (ileum) through to the surface and securing it in the skin with an opening in the intestine to form a stoma through which my stool would pass, into a removable bag stuck around the stoma.

I find all aspects of these types of procedures fascinating and one of these is general anaesthetic. Once you have put on a hospital gown (which rather disconcertingly opens and ties at the back) you then walk in your slippers through the corridors of the hospital that you don’t normally see and into the operating theatre (or it could be a pre-operative room because you don’t have a clue what happens next!). Everything is cool, peacefully quiet and clinically pristine. You have some friendly chit-chat with the anaesthetist discussing anything from where you’re from, what career you have, where you’ve been cycling to recently, to the impressive birthmark I have running the length of my right arm, while the nurse inserts a cannula into a vein your arm (I am very fortunate to have good veins which are easy to locate).

The anaesthetic is then connected and starts flowing. I always imagined that there would be a gradual feeling of drowsiness and then being overcome by the anaesthetic but it’s not like that at all. At one point you’re fully conscious and then, boom – you’re not. The period until you’re brought round is (probably thankfully) completely lost from your life – you know and can recall absolutely nothing from this time and have no conception of how long it lasted. It’s a very strange (absence of) feeling; very different from sleep which, for me, is a fairly interactive process with vivid dreams (though thankfully not normally as heightened as those I had while on post-operative painkillers).

I woke, rather slowly and groggy, after the operation in the recovery ward. I remember a slightly confused conversation with the nurses about what I was doing there and the fact that one of my sisters was also a nurse. Eventually I was wheeled back onto the main ward where I was lucky to have my own room. After I had been made comfortable and was (sort of) sitting up, I plucked up the courage to peek at my newly formed stoma. Although I am not squeamish and would normally take pleasure in poking at a wound to see how it is developing, actually seeing my stoma made the reality of what had just happened hit home. I had this painful looking large, blobby, red “thing” poking out of my body which was discharging “stuff” into a large transparent bag. This was going to take some getting used to…

A lot of how alarming my stoma looked was down to the trauma from the surgery and I was reassured that this would subside over the next few weeks. However, it was still a very strange feeling every time something came through my stoma in my still tender abdominal muscles (now I feel very little when things pass through). A stoma nurse soon came to show me how to change my bag and talk me through the various options I would have for different types of bags – I could try a few to find which I found most comfortable. The nurse also made it clear that I could be discharged as soon as I could demonstrate that I could change my bag competently myself. Game on!

I stayed only a couple of nights in hospital and was glad to return to the comfort of home. Although the surgery had gone well and only involved creating a small hole in my abdominal muscles, it felt like they had all been ripped apart. I was very tender and couldn’t stand up straight. I had two months off work and it took the first few weeks just to gain the strength and stamina to walk more than a few hundred metres. Running was a long way off…

Over these weeks, as predicted, my stoma healed and shrunk in size (to approximately comparable to a 50p piece), though initially the skin around it didn’t want to go with it and a worrying gap opened up. This was solved by some magic powder and filler paste the stoma nurse gave me; in time this healed nicely and my stoma was functioning nicely. I got into the routine of changing my bag daily and gradually built my strength back up.

Although my recovery from the operation took some time and my stoma took some getting used to, I was soon feeling much better and started putting some weight on (at times when I was ill my weight would drop to close to 50 kg; now, even when marathon training, I am over 60 kg). With food no longer passing through my colon, my symptoms subsided in a number of ways: there was less inflammation in my colon, I didn’t have the pain of food passing through my colon and out through my narrowed and scarred rectum and anus, and I didn’t have the trauma of very little control over when I needed to go to the toilet (often at very short notice).

This latter improvement was the best: I had total control over going to the toilet for the first time in many years. It was a very liberating feeling! Although my stool would come out of my stoma and into the bag by itself, I could empty the bag whenever I chose (they have a folded velcro opening at the bottom). I could go out without having to think about where the nearest toilet was and if it might have enough toilet paper to clean up the mess I had made. I could feel vaguely normal.

I was also much less fatigued which was a wonderful thing. For years I had been exhausted for much of the time but this wasn’t a feeling of not getting enough sleep and being able to catch up. It was the opposite – I would feel tired all the time and sleep would not cure it. I would also suffer badly the next day if I didn’t get an adequate night’s sleep which unfortunately happened fairly regularly because I would often have to go to the toilet in the night. Finally I had some energy that I could put towards something that I enjoyed, maybe training for something in earnest? It was great to be able to look forward to things and dream!

Mark

Marathon training got serious this week: four runs with a total distance of 68 km. We did one of the toughest runs of the training plan yesterday: 32 km (20 miles), with the last 9 km at marathon pace (4:10/km). This was tough but manageable, which is encouraging for a good time in what is now 8 weeks (and so the training is half complete).

Monday: 12.6 km in 57 minutes

Wednesday: 14.3 km in 63 minutes

Thursday: 8.8 km in 41 minutes

Saturday: 32 km in 2 hours 21 minutes

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