Surgery: the nitty gritty

So, I keep mentioning my upcoming surgery.   Lots of people are asking what it is for and how long I’ll be recovering.  All that good stuff.    I haven’t elaborated a lot, because frankly we weren’t certain of the details until very recently.

When I had my surgery back in March, the reason it turned into a septic disaster is because the stitches in my intestines didn’t hold due to both active Crohn’s Disease and prior damage from Crohn’s activity.   We knew I had Crohn’s Disease (have for 18 years), but I was not having any symptoms to suggest it was active and there’s no real way to know this if you are me (or the surgeon) since you don’t see inside the colon in a surgical procedure.  So, they had to divert things to an ileostomy and leave my colon to heal.

If you aren’t familiar with what an ileostomy is, or an ostomy in general, and you have interest, you can learn more here:  http://www.ostomy.org/ostomy_info/factsheets/facts_ileostomy_en.shtml

Most people don’t even realize I have one, and even people who know I do wonder if they misunderstood because they can’t tell.  Basically, an ileostomy offers someone who can’t keep their colon an alternate way to “poop”, which is all you really use your colon for anyway.   It’s a little difficult to wrap your head around the idea if it’s new to you, and there’s definitely a learning curve that comes with having one, but in general, it’s not a big deal.   It restricts very little (for me, I have to be careful not to eat much lettuce/cabbage or difficult to digest foods like apple skins or celery).    I have to drink lots of water and chew well.   No activity restriction or anything.  No big deal, really.

Originally, we planned to “undo” the ileostomy and “put me back together” during this upcoming surgery.  However, despite me otherwise feeling great, my colon has continued to be very inflamed due to my Crohn’s Disease.   Inflammation is bad for anyone, and is especially bad in a place you can’t see it, and especially bad for someone who has already had a cancerous tumor removed.   It basically leaves a breeding ground for more cancer in your body.  Not what I’m interested in.

So, my colon comes out.     This means I keep my ileostomy, but if that means my likelihood of a cancer recurrence is reduced, it’s not a difficult decision.  That colon has done little but cause me trouble for a lot of years.    People live perfectly normal healthy lives with ostomies, some people even getting them in their teens, twenties, or even as children.  I’ll take mine happily at age 42 if it gives me a healthier rest of my life.  You tend to look at things a little differently if you consider the alternative!

So, that’s Part 1 – remove my diseased time bomb of a colon that I’ve not used since March anyway.   Okay, but why go all the way to Maryland for this?

My tumor was in the cecum, right up against the appendix.    The tumor had a “mucin” component.    There is some question as to whether the tumor was traditional colon cancer, just blocking the appendix (fortunately, since the pain from that is what led to its identification), or if it originated in the appendix and is a more rare (though not as rare as some would lead you to believe) appendix cancer.

Frankly, at this point, it’s a bit academic.  Either way, I had an abdominal cancer with a mucinous component.   Usually, we hear about the spread of cancer through lymph nodes or blood.    But, abdominal cancers, especially mucinous ones, can also spread through the abdomen by seeding the organs and linings of the abdomen with more tumors.

My surgeon from March is confident he got the tumor and all the cancer.  He believes nothing had ruptured, no mucin was spilled.   I mostly believe him.   He is a general surgeon, not an Oncologic Surgeon.  He is awesome, and frankly did an amazing job helping to save my life.   I am forever grateful to him.  However, everyone makes mistakes.   And, I had a rupture of stitches that spilled my guts all over my abdominal area before they had removed the entire right side of my intestine.   If there was any leftover cancer in there it had a chance to mix in with everything else.   I am 42 years old and have 2 little boys at home.  I’m not willing to “mostly believe” someone when we are talking about life.   I want to be as sure as I can and to know that I have had the best people in the field check me out and say they agree I’m good.   There are no guarantees (for anyone about anything), but for peace of mind, I want to know I did all I could to get as close to one on this as possible.  AND, if there’s something in there, I want a top of the line expert dealing with it.

So, Mercy Medical Center in Baltimore, MD.   Dr. Armando Sardi.   Dr. Sardi is one of the major experts in a surgery – the cytoreduction / HIPEC procedure.    Cytoreduction is the surgical process of the doctor searching the abdominal cavity for any tumors, which are then carefully removed.    This is followed by HIPEC, which is the process of applying heated chemotherapy to the abdominal cavity to help ‘kill’ any microscopic cells that might still be left.     This is a major life saving surgical operation for many who have experienced spread in the abdomen.

More information about the surgery can be found here (including a great 3 minutes video segment):

http://mdmercy.com/centers-of-excellence/cancer/treatments-we-offer/surgical-oncology/treatments-we-offer/hyperthermic-intraperitoneal-chemotherapy-hipec?sc_lang=en

And, more information on Dr. Sardi can be found here:

http://mdmercy.com/centers-of-excellence/cancer/treatments-we-offer/surgical-oncology/our-doctors/armando-sardi-md?sc_lang=en

So, this is Part 2 and the reason for going to this hospital.  All my scans and blood work look good.  I feel great.   We are very hopeful that I may not need “Part 2”, but I want this doctor to look around in there and tell me that.   And, should I need it, I want THIS doctor doing the procedure – and doing it asap.

So, I will be checking into Mercy on Wednesday morning for a pre-surgical test/prep/meeting day.   My surgery will be first thing in the morning on Thursday, January 23.   It will probably last at least 4 or 5 hours since the doctor has to go through and investigate whether there is any cancer hiding as well as taking care of the colon removal.  Should he find cancer to remove, the surgery will last many hours – can easily be upwards of 12 hours (hopefully not too long since the time increases with the more they have to remove).   Nathan and my mom will be at the hospital with me and will be updated periodically by an OR nurse on what is happening.    Keep them in your thoughts.   I’ll be ‘napping’.  Their job of waiting is likely the tougher one.  We will let everyone know what is happening as soon as possible.

The length of my stay depends on what ends up being done.  It could be as short as 3 nights after surgery, or it could be an average of 2 weeks should I need the longer procedure (and if I need the longer procedure, I will need to stay in the area for an extra week after in case of complications).

As you can imagine it’s difficult to “plan” for a stay when you don’t know how long it will be.   I feel you need to plan on the ‘long haul’ and hope for the short one.  So, that’s where I’ll be.    For those of you in the area who have inquired, I’m sure once I’m awake and aware, I will be happy for visitors – but no way to tell you until then how long I’ll be in there.  We will keep you posted!   Feel free to email my personal account, FB, text.   I will be wired once awake!

As you might imagine, being away from my little guys doesn’t thrill me.   Technically they aren’t even allowed  on my floor (under age 12), so if my stay is long, I will be less than happy about that and will be sure to figure out a way to see them.  While Nathan is with me, his parents will be with our little guys.   I am very grateful for all their help.    During the week, they will keep their normal routine – I am so appreciative of their teachers and staff at school for giving them a little extra love and watching out for them, especially during the rough moments we have had this year.

As always, we appreciate your good thoughts and prayers!  They have seen us through one heck of a year.  Hopefully just a little bit further here and we can return to our regularly scheduled programming.  : )