Update After Nov 1 Rectum Removal/Surgical Wound

[Diane C]

Update: Back from the Hospital Wound Clinic. YAY! My wound decreased 2 cm in depth and is healing. The nurses are using a preliminary dressing of Aquacel silver rope again. (I wonder if the home health nurse's measuring tool is off.) Hooray! Off to eat a protein-packed breakfast. Relieved.

Diane C.

[To Dream a Dream]

Great news, Diane! Have been concerned about your struggle. The Wound Care Team is a fine resource & your positive realistic attitude a huge plus. Keep moving onward & upward & keep us on the Board informed of your progress. A real mood lightener & inspiration for us all!

[sassie]

So happy to hear great news Diane C. You do have a great positive spirit...God Bless,sassie

[Button]

Diane:
Glad to hear that the tissue deficit where your rectum was originally housed is gradually filling in.

Healing of a wound through secondary intention and the laying of granulation tissue is a slow process, at best. You will get there. The body has an amazing ability to heal.
Karen

[Diane C]

Thank you all so much. Continuing the protein, Juven, Vit. C, etc. I get MUCH positive spirit and encouragement from you all. So thank YOU! Onward and upward... wishing you the same.

Diane C.

[Diane C]

Quick update.

Wellllll, the post-surgical wound is healing VERY slowly. I'm still eating protein. I slacked off on Juven (protein supplement that is ridiculously priced) and will get back on it. And add collagen powder. The wound is now, I think, 3.4 cm deep and slowly healing. A wonderful visiting nurse has been coming for weeks to apply the dressing. I've also been going to the hospital's wound care center. Last week, a nurse there recommended I see a plastic surgeon at the hospital for reconstructive surgery to close the wound. My appmt is tomorrow. Don't know if such surgery can be done where the rectum used to be and neither did the nurse. It's necessary to stay in the hospital at least 1 nite for this surgery. For those who don't know, I had my rectum removed due to diversion colitis when I switched over to an ileostomy from a colostomy due to slow transit time, hernia, etc. I'd twice asked the Asst. Surgeon in January to allow me to continue to use the dressing on my own when this wound was tiny and requested a prescription but he was sure the surgical wound would heal well on its own. His answer remained no. I'll try to post again after my appmt.

Unfortunately, after celebrating my mother's 102nd birthday (!) on Feb 27, I, not she, tripped in her apt. I was wearing rubber soles that stuck to her w/w carpet. Wish I had thought fast and landed on my big butt. Instead, I plopped onto my curved ankle and broke 2 bones in my left foot and stretched a tendon. I'm now wearing one of those big boots that I think are dangerous. (One can buy this gizmo for the other shoe to even out your posture but last year, when I broke a toe, I found it hard to keep that contraption on my shoe and lent it to a friend. Will get it back and try again.)

Disappointing as I'd made arrangements to start going to a physical therapy place nearby that offered great exercise and I needed a boost as I stopped swing dancing, walking, and exercising at the gym. My ab muscles are so shot after so many surgeries that my balance is off.

I'm continuing to experiment with different products because of high output (using Immodium) and I think I semi-solved the leakage challenge (my ileostomy was constructed on top of my MACE scar which causes my abdomen to sink in on both sides of the wafer) by using Convatec Stomahesive strips under the wafer along the scar line and Convatec Ease curved strips to strengthen the adhesive of the wafer onto my skin. (When did these come out???) Brava strips and Hy pink tape became itchy. I posted earlier today when I learned about the Coloplast star-like wafer although I'm not a fan of the locking mechanism on some Coloplast wafers. My abdomen remains very distended and they could perhaps help to adhere. I need to rely on the nurse to order products for me and the company from which she orders can't get Cymed Microskin products. I concur with Button/Karen -- I think they are super. When all is healed, I'll head back to Edgepark or another company and order them.

I'm still wearing an irrigation sleeve under my slacks and not super thrilled about this but soon will start using a high output pouch and hope I'm not emptying more than 20x a day.

Off to visit my mom, will be careful, and encourage everyone to exercise if they can -- and avoid stumbling!

Diane C

[ot dave]

My experience with surgical wound healing is that you have to give it time. I got an infection in the hospital after my hernia repair, and actually had to have the wound opened up the day I left the hospital. I spent the next 8 months visiting a wound care doctor every Monday morning. I started with a wound vac, progressed to wet to dry dressing changes, to all the fun silver dressings, and even ended the treatment with a pneumatic wound vac that he just got and wanted to try out!
There were times that the wound would get deeper, and then heal up. Unless you are completely still, you will have periods where the wound will get bigger, and then get smaller again. You can consult a surgeon, but unless the wound is not changing/getting smaller, they will likely recommend giving it more time. Never hurts to get another set of eyes on it... I can empathize with wanting that thing to heal, it is just a pain!

David

[To Dream a Dream]

Diane: Sorry to learn of your recent spill after your ongoing struggles to heal. Enough is enough! What a resilient spirit you must have to continue on as you do. Hoping the plastic surgeon will have some good news for you. My best wishes for your mother. 'Think I can guess where your courage comes from.

[Diane C]

Thank you, Dave and To Dream,

I'm usually resilient and was so angry that I was ready to fight yesterday. Today, I am tuckered out but will revive.

Saw the plastic surgeon. She wants to make 2 incisions -- each about 6 inches in length in my inner thigh and use part of the thigh muscle to cover the wound on my "posterior." My colorectal surgeon and she would work together. The thigh will require a drain. Recuperation will be difficult -- again, no sitting or sleeping on my bum for at least a month -- but even more important than before apparently. Unsure if I can drive even with the pillow that Karen/Button recommended to me. Forgot to ask. The thigh surgery should not affect the function of my thigh or leg. I am NOT in the mood for more surgery now.

My preference is to continue for at least 2 months to dress the wound and consume MUCH protein, including adding Juven and collagen to my diet. The plastic surgeon was unhappy with the current dressing. When removed, it's wet and sometimes (esp now) bloody. She said the moisture will NOT help at all and I need the dressing changed daily -- not every other day to dry the wound. She's not a fan of Aquacel silver and gave me a bottle of small dry strips. A home health nurse can't come daily. She IS coming tomorrow but was not told what to apply as the head nurse of the wound clinic at the hospital was out today. She will use what the plastic surgeon gave me.

On Thursday, I have an appointment to see this wound care nurse at the wound clinic so that she can teach me how to insert the right dressing and cover it with a pad or plastic or rubbery material that keeps it in place. That last part has been a problem. The covering has been coming off. I can't easily see the wound but I can feel it. Can get a better mirror. Or -- IF my mother is dexterous enough, I can sleep at her apartment in Maryland for 2 months and she can insert it and I can commute home to Arlington, VA. I'm not working these days because of all this. She's not queasy but IS 102. I don't know if Medicare/insurance will pay for a skilled nursing center just to dress a wound. I doubt it and don't especially want to go.

Today, I met with an ostomy nurse about ongoing leakage and will research some products. She is a "less is more" nurse. I'm wearing a belt on my Convatec high output pouch right now. She suggested the Convatec Esteem Flex pre-cut drainable: https://www.convatec.com/ostomy/patient ... ilter_hcp/. She's also a fan of the SenSura® Mio Convex Flip Fitl which was mentioned in another discussion and does look nifty so I need to compare those. Am not used to 1-piece systems. My abdomen is still bulging (she thought I had a hernia but I left the hospital this way... hmmm) and it's convex and concave now in various places so one of these may be best. The visiting nurse must order supplies and can't order Cymed MicroSkin which is VERY flexible and which I used to love except for the adhesive irrigation sleeves which I guess I no longer need despite much output.

She also recommended a Safe n Simple "Security" support belt -- which seems far more costly than those offered by Comfizz but I think the latter company is out of stock. http://sns-medical.com/wp-content/uploa ... ocrops.pdf I iwonder if Medicare or insurance pays for this...?

She applied half of a seal -- the thinnest possible -- where my MACE scar was below the wafer. She prefers seals to Stomahesive strips which don't bend enough. Seems to be working.

I'm to measure my output and report back. Obviously, she didn't like the idea of my wearing an irrigation sleeve instead of a pouch. So we'll see how much I'm spurting and I'll try to get used to a 1-piece system. With my colostomy, I changed wafers after 7 days. Changing after 3 days will be new for me but given the leakage, I've been using up my supplies at a rapid pace. And doing endless laundry.

Pleased to report that suddenly my left foot (preferred the movie!) has been feeling MUCH better today. Think it is healing if nothing else is. Yay!

Thanks for your recommendations and support.

Diane C.

[Button]

Diane:
It can take the better of takes 6-8 months (or longer) for the tissue deficit created by resection of the rectum to fill by tissue granulation through the healing process of secondary intention.

The rectum is a dense, deeply placed muscle. Its excision leaves a profound empty space that is NOT as easily closed as sewing two tissue layers together as may be the case with other surgical incisions that you may have had. The wound bed fills as granulation tissue is laid down, in what is a nortoriously slow, slow process.

It was a good 10-11 months for my backend to heal. The would get a bit better . . . Then the wound bed would open wider with drainaged . . . Followed by a period of more evidence in healing . . . Then a few steps backward, more drainage . . . Then a few more steps forward, tissue depth lessening as the wound filled from the inside-up and from the outside edges-in.

Hang in there,
Karen

[Diane C]

Thanks for your post, Karen.

Having computer issues. I used Preview and Full Editor but my post SEEMED to disappear twice. Sigh, I think it was above but I went "back" when I didn't see my draft so it vanished.

I only have time now to post that I am reassessing surgery of the wound by using the inner thigh muscle. Can go into more detail another time. May, in fact, ask re MORE surgery to support the many sutures but given your post, that doesn't sound wise as the whole area is still healing, I suppose. The plastic surgeon indicated that the skin there is extremely thin. Am worried it can tear in the future. Did not ask her about added surgery but will. She would work with my colorectal surgeon.

At 8 AM, I see the wound care nurse AGAIN -- I think I've been to the Wound Care Clinic 6x in 2 wks. Postponed other appmts. PLUS the home health nurse has been coming every other day if I've not just had the dressing changed at the Clinic. I can't change the dressing alone. I help the nurse.

Many issues. My abdomen is so puffy and distended that an ostomy nurse for whom I have little respect asked if I had a hernia. Told her I left the hospital after surgery this way. Watching my diet. That is not causing the continued swelling. Scar tissue? Adhesions? Lightly massaging it w/ Vit E. Trying to strengthen abs by inhaling, holding -- and repeating per GI doc's advice. Need exercise! No can do with sprained ankle and 2 broken bones in one foot tho could do mild crunches, lift light wts, etc.

I saw this ostomy nurse re leakage. She used 2 halves of a thin seal under my wafer on both sides where my MACE scar is located and the skin caves in. She did not like the firmness of Stomahesive Strips. By 2 AM the next morning, the itching was so intense, I removed the seals and wafer -- cleaned my abdomen -- and put on a flexible 1-piece that adheres closer to my skin. Thinking of using a 1-piece. Pls see previous post for the products that seem super helpful. I also found Cymed's January email reply to my request for samples and asked the company to expedite. As long as I am using a home health nurse, she has to order my products and can't order Cymed MicroSkin. I spent 3 hrs in the wee hrs researching products, including a support belt.

My mother, age 102, really needs to move to Assisted Living from Independent Living. I can't help her given my current condition and it's causing immense concern. She cancels appmts with an aide. She is falling and her increasing memory loss is causing much confusion, I can't be there altho can be with her when I recuperate from more surgery. We agreed to discuss when the wound issue abates.

I realize FULL well that I must live with the consequences of further surgery. In fact, I emailed my Asst Colorectal Surgeon. Rec'd a polite, comprehensive, caring reply covering every detail I mentioned. My colorectal surgeons, wound care nurse, and plastic surgeon have conferred but I'm now changing my mind about avoiding the surgery. I am aware of your challenging condition and sympathize to the max. Admire your persevance so very much. But I need my life back. I want and need to work. A change must occur somehow. I need more info first before any surgery -- and even more about the dressings which the plastic surgeon and wound care nurse do not agree on.

My sleep hours are now way off... not helping. Need zzzz before I see the wound care nurse this AM.

Wondering if anyone has had reconstructive surgery to close a wound. Pitfalls aside from infection and 1-2 mos of recuperation (my guess is FAR more)?

Btw, Juven powder is NOT for protein. It helps to heal very expensively-- and only has 2 grams of protein. Does contain collagen but I'd bought collagen powder. I looked online and was impressed by this protein powder although it contains coconut oil which can increase output with an ileostomy. Consuming 120 grams of protein is incredibly hard and I'm eating more of it than ever. I am not a fan of Ensure or Carnation Instant Breakfast when I must lose 30 lbs. Gaining weight will adversely affect my emotional state and throw things off although I intellectually understand when people say worry about the weight later. See https://www.biotrust.com for Harvest Vegan Protein. Sounds good.

Grateful for support. Sorry for any typos.

Diane C

[Jimbob]

I always say we have a very wonderful Hobby, we learn something new everyday. And the best part is we share with others...….

[Diane C]

Jimbob -- Very positive attitude.

Returned to hospital wound clinic this week. Wound care nurse said wound had gotten smaller (3.3 cm in depth) and changed type of dressing (forgot to get the name of it). Today home health nurse came and changed dressing. Wound dimensions the same. Back to my waiting game. Will see how it goes with the new dressing. Wound definitely is painful now and was NOT before. Maybe that's a sign it's healing? NOT itching. I return to the plastic surgeon in a couple of weeks to discuss.

Enjoy wkend. SUN is out.

Diane C.

2000 MACE irrigation procedure due to non-synchronous relaxation of anal muscles + non relaxing puberactalis resulting in chronic constipation and distension
2002 Colostomy
2018 Removal of colostomy and MACE tube; creation of Ileostomy;removal of rectum and anus due to diversion colitis

[Diane C]

Good news update on my post-surgical wound! It seemed to have a sudden spurt of healing. It decreased in depth from over 4 cm to 3.8 -- where it stayed for weeks -- to 3.4 -- and this week at the Wound Care Clinic of the hospital was 2.4 cm. Wonder if they measured correctly but hope so. Always seems deeper when the home health nurse measures it but it could be the method of measurement or the instrument used. Other dimensions are .5 cm X .5 cm. Still taking Juven powder for wounds which is mostly collagen, Vit C, zinc, B-!2 and other good healing ingredients. It's impossible for me to ingest 120 g. or protein daily via food. I am eating fish, hormone-free chicken and now beef, peas, beans (chew well), eggs (no cholesterol issue), quinoa cooked in bone broth (actually good!), etc. to the hilt. And hydrating.

I searched online and FINALLY found a protein powder I think I'll like. It's costly but it has stevia, no sugar, no dairy, no gluten, no corn syrup, etc. A bit leery of the coconut oil (promotes output). BiotTrust Harvest Protein powder with pea, pumpkin, and hemp protein. 2 flavors -- chocolate and vanilla caramel. Ordering with a subscription from the company costs less than at Amazon and Biotrust has phenomenal customer service but you pay for shipping. 20 grams of protein per serving. Hope it arrives today. https://www.amazon.com/BioTrust-Harvest ... ZTQJV?th=1

Using a Drawtex dressing with healing Prisma. Unfortunately, the covering to keep it all intact in my butt has caused chafing and something akin to diaper rash so nurses added Clobetasol proprionate cream (what about Desitin?!) to the "cheek."

For now, reconstructive surgery is off and I need to get a protein-packed lunch. More patience ahead...

Diane C.
2000 MACE for pelvic floor disorder and attendant constipation/distention
2002 Colostomy
2018 Removal of hernia, MACE, colostomy; ileostomy creation; removal of rectum/anus due to diversion colitis

[Button]

Diane:
That your perianal wound has decreased in depth is certainly encouraging news. Horray ! Your personal compass is pointing in the right direction.

The rectum is a dense, thick muscle. Its excision leaves a large wound deficit. The laying of new granulation tissue to fill the wound deficit takes an abundance of time. You are making progress. And that is Good News, indeed.

I know that you are paying particular attention to your intake of dietary protein. A+.

It can also be the case that some/many of us who have struggled with any number of intestinal issues are found to have co-existing micro-nutrient deficits. Ex. Eating a low fiber diet of easy to assimilate foods (white bread, pasta with sauce, saltine crackers). Food choices may be low in nutritional benefits.

While protein is important, do not forget about basic vitamins, minerals, and micro-nutrients. B complex vitamins (B6 and B 12), zinc, selenium, vitamin C are a few of the nutrients that play a key role in healing. A high quality multi-vitamin would be an advantageous addition to your healing arsenal.

I am not a good pill taker. I gag on most oral pills/tablets/capsules. Chewable multi-vitamins are popular with adults as well as children. Multi-vitamin gummies are also formulated for adults. A faithful regimen of vitamins and minerals may substantially aide your healing if you are micro-nutrient deficient.

Hyper-baric oxygen therapy would be an option to look into if your perianal wound healing detours or regresses. Concentrated oxygen has sound clinical benefit in healing complex tissue wounds. In my opinion, hyperbaric oxygen should be considered before any reconstructive surgery.

Ok . . I just wanted to give you a few ideas to consider that might help keep your new progress moving in a favorable direction.

Celebrate your healing and Good News !
Karen