Recovery and Fundraising

Since my last entry, I had my surgery which went very well. There were no complications and the surgeon was able to remove all the aforementioned organs without “going open”. He did have to make the main incision a little larger which extends about three inches straight up from my belly button and curves around the belly button. There are three visible scars one up and to my left from the main incision and the other two flanking the main incision, which were used to insert the instruments during the laparoscopic surgery. The only two surprises were the need to remove 18 inches of small intestine vs. the 8 that were originally planned, and the degree of disease in my gall bladder. The larger amount of small intestine removed was solely to eradicate the entire affected portion, which appeared to be larger than originally thought. The gall bladder was swollen and slightly adhered to my liver due to inflammation, but the pathology tests were negative so there was nothing else fishy going on.

My recovery was long; in all I was out of work for five weeks. I at first thought I would return after four weeks but an unexpected sharp pain popped up at the end of the fourth week which prompted me to take it easy and stay away from the office. I was assured by the surgeon at my post-op appointment that the sharp pain was likely some slight tearing of the mesentery tissue, and not a hernia or something more serious. The pain medication that was given, Percocet, was very effective at not only relieving pain but also making me quite loopy. I definitely understand why people become addicted to that stuff!

Now I have recovered almost completely, although I am still not doing any sit-ups or other abdominal exercises because of some occasional lingering pain. I have decided to help raise funds for the American Cancer Society by participating in a fundraiser called “Climb to Conquer Cancer”. It is a fairly simple hike around Castlewood Canyon but the main purpose it to accumulate sponsors to raise funds. I hope I am successful in reaching my goal of $1000, and I hope to participate in this and other fundraisers in the future. My fundraising page is:

http://main.acsevents.org/site/TR?pg=entry&fr_id=17953

Goodbye Terminal Ileum, Ascending Colon, Gallbladder, and Appendix

I have scheduled my surgery, which will be May 4th. I learned that in order to remove the terminal ileum, my surgeon will also have to remove my ascending colon. This is due to the arteries feeding that section of my intestines and the fact that he cannot leave any portion after the feeding arteries have been disconnected. I am attaching a hyperlink to a picture of the arteries of the intestines to get an idea of how things are connected.



http://l.yimg.com/fz/ls/he/mayoclinic//images/image_popup/r7_ischemiccolitis.jpg

I am also attaching a hyperlink to the webmd.com explanation of the surgery that I am going to have. I am having a Distal Small Bowel Resection to remove the terminal ileum, a Right Colectomy to remove the ascending colon, and a cholecystectomy to remove gallbladder. It was determined that I have a gallstone in my gallbladder, which has not caused any problems, but the stones will likely get bigger and cause problems later. So, while my surgeon is "in the neighborhood" he is going to go ahead and remove that as well.


http://www.webmd.com/colorectal-cancer/removal-of-right-colon

Hopefully, these work.

Prior Foreshadowing Being Realized

In my final blog entry of 2007, just after finishing chemotherapy I mentioned the transition that I am now experiencing in going from treating cancer back to treating Crohn’s disease. This was relevant because my medications may have contributed or even caused my lymphoma, especially the immunomodulators. It has now been approximately 15 months after chemotherapy, and my Crohn’s disease has progressed to the point where the standard anti-inflammatory drugs are losing the battle. I am still within that two year window where a recurrence of Hodgkin’s Lymphoma is most likely, and if there are a few remaining cancer cells that have survived, going back on the immunomodulators could weaken my immune system enough to allow the cancer to spread once again. The immunomodulator Remicade was the only drug that I have taken during the eleven years since my Crohn’s diagnosis that has effectively controlled and prevented symptoms. My recent colonoscopy revealed that the inflammation in my terminal ileum has progressed to the point where the scope could not even safely navigate through to inspect the extent of the disease. I am at risk of a blockage induced by long fibrous foods becoming trapped through the bottleneck into my colon. Now I have to make a difficult decision. My gastroenterologist feels the best option is to have an intestinal resection surgery to remove the affected portion of my terminal ileum. I have agreed. Because my doctor was unable to physically see the entire affected portion during my colonoscopy, I had a small bowel follow-through procedure. This procedure is a fairly simple radiological procedure. I drank a barium solution and then waited for it to travel through my small intestine. After a startling short twenty minutes, the barium solution had traversed the entire 30 feet and I was ready for the radiologist to start filming. He took several pictures of my innards while I watched him prod me with a device that was invisible to the X-ray. He told me that it appeared that the affected portion was approximately 7-10 inches traveling upstream of the terminal ileum from the connection point of the colon. He said otherwise he could not see any fistulae or other affected portions.

My next step is yet to be determined. I am awaiting an appointment with my gastroenterologist who will refer me to a surgeon. I will then learn exactly what to expect from my upcoming surgery. I know that these procedures are very routine and typically are performed by general surgeons as apposed to a specialized gastrointestinal surgeon. They are commonly performed laproscopically followed by a 4-5 day stay in a hospital. I don’t know if there is an extended bed rest period following the hospitalization or how many days I will be required to use a colostomy bag. There are a million questions running through my brain and I cannot wait until my pre-surgical meeting with my surgeon, whomever that will be. In the mean time I have been ordered by my doctor to go on a low residue/low fiber diet. That means I am not allowed to eat raw fruits and vegetables or whole grains. Imagine a doctor telling you to go on a “all hostess product diet” and that is my reality! I am at risk of a blockage every day until my surgery so I have to be careful. I am preparing to fly to Buenos Aires for a 10 day vacation next week, and I am a little worried about the possibility of incurring a blockage and needing emergency surgery while I am in Argentina. Hopefully, that fear will not ruin the trip. I have been put on a large dose of Prednisone to bring down the inflammation, which hopefully will keep me out of the hospital until my scheduled surgery.

And so the struggle continues of controlling my Crohn’s disease while still not inducing a recurrence of Hodgkin’s Lymphoma or another cancer caused by immunomodulators. Fun stuff!