Today I had my series of pre-surgery appointments at UCSF. On the 45-minute drive, I “got” to stop at the finally reopened the Father Serra rest area on 280. Pretty nice. May I never need it again.
My first appointment was with UCSF’s PREPARE program. It should be called the “Prepare to Wait” program, because that’s what we did. Eventually, I met with a nurse who took my vitals and drew some blood for tests. We discussed my medical history, prior surgeries, current medications and allergies. I then met with a nurse from the anesthesiology department. We discussed all of the above again, as well as some additional details for my surgery prep, procedure, and recovery. All in all, pretty uneventful.
I then went to meet with the colorectal surgery nurse practitioner for my stoma marking. We discussed the surgery and the creation of the loop ileostomy. She showed me pictures, as well as several sample ileostomy bags. She walked me through how they work and what I will need to do to empty/change them. It was all a bit overwhelming and something I’m sure I won’t really come to terms with until I’m actually living with it. I know it will be fine, but it’s a big change from how I currently live (which my nurse pointed out), and it’s the part of this process I’m most uncomfortable with. The thought of a portion of my small intestine poking through my stomach and then attaching a bag to it is unsettling. There’s no two ways about it. But it’s only temporary.
We also discussed my post-surgery diet and what I can do to minimize complications such as sleepy bowels or intestinal blockages (basically nothing beyond not eating forbidden foods). We then discussed where to place my bag. Ideally, you’d want it somewhere that is easy to conceal, but also allows you free range of movement (e.g., sitting, twisting). Because I have a bit of a belly (I blame the prednisone appetite; also, my fundamental laziness), we chose a spot a little higher on my stomach, and marked it. Stoma marking is a very technical process in which you draw a dot on the skin with a “surgical pen”—which appears to be fancy name for a permanent marker. Because my surgery is not for a few days, I will have to keep darkening my spot. So I now have my very own “surgical pen.” Which is nice. Finally, we discussed belts, wraps, and various other accessories one can use to stabilize and conceal the pouch. When I actually get the thing and figure out what works well for me, I’m sure I’ll do a more detailed ileostomy post to discuss such things. In the meantime, here are a couple of pictures of my stoma marking (after the jump).
Finally, I had a Magnetic Resonance Enterogram (MRE) to check for any signs of Crohn’s in my small intestine. I’ve never shown any signs of Crohn’s, but this test will provide some additional peace of mind for me and my surgeon. However, because Crohn’s/Colitis are spectrum diseases and autoimmune diseases are unpredictable, it’s always possible that Crohn’s will pop up post-surgery even if the MRE shows nothing. All you can do is do the appropriate tests to make sure you’re not missing something obvious (which we’ve done) and then hope for the best.
The MRE was by far the most interesting part of the day. After removing all of my metal and getting into a gown, I was given a couple pints of Barium Sulfate to drink. Apparently, it fills the small bowel and gives them a better view of how things are moving through it. It was thick and sweet, and I had to drink a lot of it, but it wasn’t too bad. They then hooked up an IV, which would be used to give me gluconate (a glucose derivative that temporarily slows the bowel to give them a better look) and the contrast dye. The IV did not go in easy and I’m pretty sure I’ll end up with a big bruise. Flashbacks to my Remicade infusions.
I then entered the machine and sat there while it did its thing. They slid me back and forth and had me take and hold breaths, over and over again, while the machine made all kinds of crazy sounds (bah, bah, bah; waa, waa, waa; sirens; pops; bass drums). At one point, it sounded like I was in a club, with several competing bass lines, the deepest of which caused my dental bridge to rattle a bit. After about 30 minutes of this, the tech asked me if I had a hip replacement because the images were showing what appeared to be metal near my hip and lower bowel. I have not had a hip replacement, and my mind immediately went to thoughts of something left behind during some prior colonoscopy. Maybe it was the source of all my problems! Alas, no. It was just something quirky with the way the coil apparatus was laying on my torso, which was creating artifacts in the image. A quick readjustment and the “metal” disappeared. Eventually, they injected the gluconate and took a few more images. Finally, they injected the contrast, which hurt a bit, had me do a few more breath holds, took some more images, and we were done. I should have the results tomorrow, but no one is expecting anything exciting.
And that’s it. Surgery is Monday. I’ll be on the table for 4-6 hours and then in post-op for another hour or two before my wife and family will be able to see me. I’m sure it will be a long day for them, but I won’t remember a thing.