20 August 2007

The fun, it never stops

So if there wasn't enough going on, today I received my official diabetes diagnosis. And the best part is that having diabetes makes all of the other healing more difficult. Yay Me!!

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17 August 2007

Surgery, round infinity

So much since the last post....

First, some background. In November, 2000, I developed a perforated colonic diverticulum. This required emergency surgery, a bowel resection, and a temporary colostomy. The surgery went okay, but I started my history of complications during the recovery period. My stoma died, and the colostomy was reversed early. We had planned on waiting three months, but had to perform the reversal surgery after about six weeks. What happens when a stoma dies is that the end of the bowel that is protruding through the adbdominal wall basically rots and falls off due to lack of blood supply. It's not uncommon in obese patients, but was still a bit disconcerting when pieces of me started coming off in the shower.

Everything went well for quite a while. In 2002 I went to see a surgeon because I was having abdominal pain and my abdomen looked distended under strain. It turned out that I had developed a "giant" ventral hernia. This means that there was a hole the size of a softball in my abdominal wall where the incision from the previous surgeries had been made. Because of the size of the hernia, and the thin wall over the previous colostomy site, I had two pieces of double-sided synthetic mesh implanted. We thought the surgery went well, but I developed a post-operative fever that wouldn't go away. After a week I was back in the hospital undergoing tests. On the day I was due to be released (again) because the tests had all been negative, we discovered a pinhole in my small intestine. Apparently during the surgery something had nicked the small bowel, and it was now leaking into my abdominal cavity. So back to the OR to remove the mesh, because once synthetic mesh is contaminated with bacteria, there is no way to remove the infection. Antibiotics don't work because there's no blood flow into the mesh to deliver them. The treatment for a condition like this is to allow the bowel to rest and heal. In this context, rest means no digestion. So I got my first PICC line and started on a couple of months of TPN instead of taking any food or drink by mouth. This was all actually not nearly as bad as is sounds (or as bad as it sounded at the time). So six months later (February, 2003) the hernia repair was redone, this time without complication.

Then everything was quiet for a while. I had a very minor sinus surgery to alleviate some recurring sinus infections, but it was simple and really helped a lot. Then in early 2006 I started having pain in my shoulders and elbows. It was getting so bad that I was afraid to drive. I went to an orthopaedist, who diagnosed a herniated disc. As part of the diagnostic process I had an MRI. This was the test that found the thyroid cancer, which I've talked about already. At this same time, our cat of 18 months decided she really didn't want to live with us any more and bit me. The bite got infected, which required four days in the hospital, another PICC line and two weeks of antibiotics.

The treatment (surgery and radioactive iodine) for the thyroid cancer (papillary carcinoma) all went well, and I haven't had any problems.

Now back to the present...

In March, 2007, I had surgery to repair two new hernias and remove my gallbladder. I've had some gallstones for a while, and though they weren't causing a lot of trouble the surgeons wanted to go ahead and remove it before there were problems especially given the large synthetic mesh that I have. One of the new hernias was around the edge of the mesh, and the other was were the mesh had detached from the abdominal wall. Instead of synthetic mesh, this time a new product called AlloDerm was used. This is basically connective tissue harvested from cadavers. It has advantages over synthetic mesh, especially in patients who have had more than one hernia. The surgery went well, and I was out of the hospital quickly. Of course, this quick recovery was too good to be true. As the wound healed I started developing fevers, and we discovered an infection. Antibiotics would knock it down until the wound closed up again, and it would start over. To break this cycle, I had another surgery in May, 2007. In this one, the wound was reopened and the cavity was flushed. Also, the wound itself was not closed, but was left open so that it could heal from the inside out. Everything seemed to be going good for a while, but of course there were more complications.

The wound never healed completely. The discharge continued, and after a CT scan we found pockets of infection. At this point, the surgeon feared that the old synthetic mesh had gotten contaminated. As a first step, I got another PICC line. So now I've been on IV antibiotics for over a month, and the discharge still hasn't stopped. I've now got another surgery scheduled in a month to do another "wound exploration and debridement" procedure similar to the one in May. This time it will be more aggressive, going all the way to the mesh, and he may even remove a small portion of the mesh if it appears that the infection is originating from there.

The hope is that this will finally resolve the infection, and everything will heal. If not, and the mesh is still contaminated, it will have to be removed. It is very large, about 8x11 inches. Removing any mesh is not easy, but for something this large it would effectively be taking out my entire abdominal wall, and would require extensive reconstructive surgery. But more on that later....

Oh yeah, it's also time for the radiation follow-up. I'll be having another scan a couple of weeks after the surgery, but all tests so far have been negative for any recurrence. At least that's still going good.

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