Friday, 25 June 2010

The Planned Operation

So I am currently undergoing surgery to resolve the Colitis issue once and for all: the following is my best attempt at a layman's terms summary with 'the right medical words' used where I can remember them (and because I find entymology interesting in its own right). If I find time I will try and hunt down some useful links in particular for illustrations which are reallly helpful if you start as ignorant about biology as I did.

  • The purpose of the surgery is to remove my colon (the large intestine) and rectum ie. everything from the end of my small intestine down to my bum. This is about a metre long and is the last bit that mainly extracts fluid from your faeces and provides a storage chamber until you are 'ready to go'. The technical term for this is a proctocolectomy: procto = rectum as in proctologist + colon + ectomy = surgical removal as in, well, all those -ectomies)
  • The Good News: this definititely works! In fact, it definitivley works: Ulcerative Colitis is defined as a disease of the colon; you can't have a diseased 'something you don't have'
  • The Bad News: those attentive kids at the front will have already recognised that the rectum and colon serve some pretty useful functions. Fortunately a rather nifty surgical process has been developed whereby they take the top part of the bit that's left (the end of the small intestine; the ileum) and use it to construct a replacement 'pouch' inside you and connect this to your bum to 'plumb you back in'. The technical terms for this are an ileul pouch (a pouch formed from the tail end of the ileum) and an ileoanal anastomosis (joining the ileum and the anus, 'anastomisis' = connection of two structures)
  • The alternative to this ileul pouch solution is also commonly used (including in my case) as a transitional procedure to allow the pouch to heal undisturbed; a Stoma and bag. [Stoma from the Greek, 'Stomata' = mouth, which kind of makes sense if you think about it]. This is generally achieved via an ileostomy as the Stoma is created from the Ileum; when used transitionally as in my case then they use a loop ileostomy (as a loop rather than the end of the ileum is bought to the surface because it will be 'replumbed in' in a few months). I think most people have a vague mental image of what this means -- the ileum is brought to the surface through your skin at the abdomen (below and to the side of your belly button) and you discharge directly into a bag stuck to your side which you manually empty and change. I think most people are intuitively repulsed by this idea (and I include myself in that, initially); for me it is a transitional issue only so I won't attempt a full defense of the practicalities of dealing with this, suffice to say for anybody who faces this as the end-state ... like so many things in life, when it comes down to it its not actually that bad and technology and care techniques have moved on a lot; I am sure I would be a more roundedly functioning individual sans-colon but avec-pouch than with Chronic Ulcerative Colitis

So in my case I am undergoing surgery intially for the removal of colon (Proctocoloectomy) formation of pouch (ileal pouch) and a temporary external bag (loop ileostomy). In a few months I should be back in to get the loop ileostomy reversed and effectively be plumbed back in. I won't have fully 'normal' bowel function after all of that but I will be a far healthier person than I have been and my quality of life should be transformed. Apart from a big old operation scar, I should be externally 'normal' and able to resume my outdoor / sporting / fitness activities that most of you know I enjoy.

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