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Sep 22, 2012 - 12:16 AM |
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The Knife |
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So many of you know about my condition.
Many of you know that since I was diagnosed with Ulcerative Colitis way back in 2005 I fought a difficult battle. I had good times. I had bad times. Colitis turned out to be the most difficult battle I have ever had to fight. It dominated my life and dictated what I could and could not do. I had more trips to the ER with a life-threatening bleed than I can count a single hand, and the last time led me to a surgical procedure called a Subtotal Colectomy that resulted in 90% of my large intestine being removed. That was in 2009, and I've spent the better part of the last three years enjoying freedom from this crippling disease. I traveled across the globe. I met with friends in Maine. Shit, I was able to drive to the office without worrying am I going to make it in time.
But, I did say that the surgery only removed 90% of my wretched colon. The rectum was left behind. By all estimates, the disease had left this small piece of tissue mostly unscathed, but not without its own problems. I had no worry of suffering from the terrifying flares wrought by the disease, but this little stump was still a pain in the ass in its own way. Proctitis is common in post-surgical patients such as myself, and from time to time it reminds me of the desperate urgency to use the bathroom that once plagued my daily existence for so many years.
Further surgery was always a given; left alone the bit of rectum lends risks of the disease recurring or a new disease wherein the disconnected tissue becomes necrotic as it is starved of necessary dietary nutrients. Oh, let us not forget the elevated risk of rectal cancer, especially poignant given that I have a family history.
Yesterday I consulted with my surgeon on just what do about this. She outlined three options for me: Do nothing, treat the proctitis with anti-inflammatories, and have regular exams to ensure nothing ornery is going on with the tissue; Do a straight 'take-down' in which the distal end of the small bowel is simply reconnected with what is left of the rectum; remove the majority of the rectum and use a portion of the small bowel to construct a new internal pouch; or simply remove the entirety of the rectum outright, leaving the ostomy as-is albeit permanent.
I have made myself familiar with all of these options over the course of years following surgery. I have weighed the costs and the benefits. Doing nothing leaves a number of risks. The disease can suddenly rear its ugly head, and I'll wind up back in the ER. The tissue can become necrotic beyond saving, and emergent removal would be required.
Take-down surgery has its own drawbacks. The capacity of what remains of the rectum is a small fraction of what my current ostomy supplies can hold now. I would be required to use the bathroom twice as often at the least, and God help me if I am suffering from a spell of diarrhea. I spent too many years letting the urgency of getting to the toilet dominate my day-to-day routine to go back to this, and there is the remaining problem of the Ulcerative Colitis returning. This would cause the take-down to fail, necessitating another emergent corrective surgery.
Pouches constructed from the small bowel remove the risk of the disease, but suffer from the same limited capacity and continence problems as a straight take-down. Pouches also require a minimum of two surgeries, not one: The first to construct the pouch, the second once the tissue has healed enough to handle digestive functions. Each surgery is a full-open abdominal and requires six to eight weeks of recovery. Pouches also carry their own risks of failure.
The last option is the most attractive to me. The surgeon simply removes what is left of the rectum. I remain with the ostomy that I currently have. There is zero risk of the disease recurring. There is zero risk of colorectal cancer. There is zero impact to my current quality of life. I really have nothing to lose and much to gain.
My decision to have the remaining tissue removed and live with a permanent ostomy, and my surgeon agrees. December 14th is the most likely date that the surgery will occur. Recovery will be six to eight weeks, just as the first operation. However, this time I will be walking into the hospital not on death's doorstep, but healthy and invigorated. I figure that realistically I'll be up and about in just a few weeks. I'm looking forward to being on Vallium and Morphine. I'll try to liveblog the whole thing if I can.
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