In a Bit of a Panic - Not sure what to think

[jjsmiles 3]

Hi everyone,

I will try to make sense, although not sure if I can.

I have diverticular disease, an ileostomy, and a couple of large hernias (belly button and peristomal). I met with my bowel surgeon yesterday, who told me last year he wouldn't touch me until I had lost 100 pounds. Well now that is done and he wants to operate. I went into the appointment thinking about having a bowel resection (take the diseased part of my bowel out) with the thought of a second surgery down the line to reverse my ileostomy and repair the hernias. Plastic surgery was only a very distant thought (dream).

Anyways, he says to me, if all went extremely well with the bowel resction (he needs to take out about a foot of bowel and then reattach the pieces), he would like to try to reverse my ileostomy and repair the hernias at the same time (YEAH!!!!). Then he goes on to say, with my excess skin and fat in my belly, there is a very large risk of infection and other complications because of the bowel surgery (which has to be open surgery, not laproscopic), which he would like a consult with a plastic surgeon to consider doing a panni.....(sp?) or Tummy Tuck at the same time as well. At this time, I am not likely looking at surgery before August at the very earliest.

OMG - all of a sudden I have gone from one serious surgery to a 3 for 1 :frown:. Of course nothing can really be determined about plastics until I have my consult. Although I am incredibly excited (and petrified), I have some concerns/questions:

1. Won't know if can do 2nd and 3rd procedure until the middle of the actual surgery - will a plastic surgeon agree to be "on hold" for a day for something that may never happen?

2. PS for massive weight loss is a new and relatively untried field in my city and province in Calgary, Canada. WLS surgery (and only lapband - NOT gastric bypass) has only been offered in my community for the last 1 and 1/2 years and to my knowledge only performed on about 100-150 people in total. My bowel surgeon has admitted that the ps he will be referring me to will not have done many (if any) plastics on massive weight loss patients. What can I ask/ say to the ps to make sure he is competent to do my surgery? Obviously I am not going to be able to rely on his vast experience as a recommendation. From what I can tell about politics, and hospital priviledges etc, I also will not have a real choice about my ps. The good news is that I wouldn't have to pay for it either.

Any advice or support you all could give would be greatly appreciated.

[Kat817 19]

Well, in your current situation, I think the main thing to concentrate on with the PS is his overall abilities, and his record as far as infection etc goes.

I am not meaning this to sound horribly mean----I truly don't---I said something very similar to my DH last night concerning myself.

Right now things are not pretty......so to get the reversal done, hernias repaired and the excess skin removed is going to be a massive improvement, even if it does not leave you looking like a bathing suit model.

My DH said something about some before and afters on here---I told him mine might look nothing like that, but if he can love me with this hanging bag of skin, whatever the PS does will be an improvement!

I understand the multiple surgeries would reduce your infection risk.

Will he be talking to the PS as well as you? Seems they are more willing to do the wait and see standby when ask by another Dr!!!

How exciting! You are almost half of what your high weight was! I can imagine that finishing the weight loss with this huge life changing surgery is like the cherry on top!!!

Congrats and good luck to you, I will follow your story to see how it develops! Best of luck!

Kat

[jjsmiles 3]

Thanks Kat,

I really enjoy reading your posts, you always tell it like it is, but in a very kind, supportive way. I know you are looking into ps yourself and I am sure looking at your pictures that you will be a fabulous success!

I am the first to admit that nothing about my body is pretty :thumbup: and I am ok with that. After all I was the one who carried over 400 pounds on my body at times, and I knew going in that there was no way my skin was going to "bounce back" (I didn't know how bad it would be though).

My list of things I would like to change, now that I am losing so much weight grows (the biggest are the arms, the breasts and the tummy), but I wasn't even thinking in the now. My understanding is that in Canada, Dr's are reluctant to look at ps unless you have been at goal for at least a year and considering I am far away from goal (and the goal I have posted here isn't a normal BMI), it wasn't more than a wish and a future dream.

My understanding is that my bowel surgeon will be talking to the plastics guy and arranging for the referral and my role is just to show up, be evaluated and they will take care of the rest if they decide it is feasible. The plastics guy is one who operates out of the hospital I would be going to and the bowel guy is the chief of surgery at the hospital, so hopefully he has confidence in the dr. he is referring me to.

I have been obese and have hidden my body my entire life, so I have no expectations of being a bathing suit model, but I would like to be able to wear a 1 piece without shame or a big cover up :biggrin2:

Thanks again, I appreciate the support!

[Kat817 19]

That is similar to what I told my DH last night! I told him, he can accept me nekkid looking like this----so I fully expect him to be able to accept me post PS---whether it looks great or not. But mainly I can walk around in clothes looking normal---right now I don't so much!

The thing about your surgeon speaking with the PS that I see, is that they may see this as a middle ground. You might in a couple years time want to tighten the stomach up some more or something but in the meantime, there will not be the huge (if it is anything like mine) pannus hanging there, hiding a breeding ground for infection underneath it.

I'd bet they do it!!! How exciting! Imagine what changes this surgery will be for you! Yay!!!

Kat

[jjsmiles 3]

Huge pannus hannging there only just begins to describe it :redface:. One of my worries is putting too much hope into getting it all done at once, only to wake up from surgery with "only" a bowel resection. I know, I know - selfish thoughts - keep positive.

Thanks!

[StephC 0]

JJ - I think you are very fortunate to be getting it all done in one surgery. Thats wonderful. I also agree with Kat, its gotta be better then what it is now.

[jjsmiles 3]

You are right Steph. My life has been so complicated for such a long time, that I am hoping my karma has finally changed for the better and it can all happen and I can get my entire life back!!!

I know that I am very fortunate if I can get this surgery covered, because in Canada, with universal health care, plastics aren't usually covered, unless you can prove medical necessity, and most surgeons won't deal with the hastle. You can't buy (to my knowledge) private insurance to cover it, so most Canadians have to foot the entire bill (as I have seen is the same for most of everyone else) :thumbup:

Sometimes I wonder if this was all meant to happen, in the nightmare way it went down, as I was also able to get my lapband covered by health care, which is almost impossible in Canada at this point.

Thanks. I will count my blessings. :crying:

[StephC 0]

You are right Steph. My life has been so complicated for such a long time, that I am hoping my karma has finally changed for the better and it can all happen and I can get my entire life back!!!

I feel the same way. Last night while walking with my niece I was telling her that it all seems so surreal. I remember years ago when my sister had her tt, I was so envious - but yet I knew it was something that I'd never be able to have done, definitely not something I would spend money on at this point in my life, but here I am with insurance paying for it. I feel so blessed! I still feel like I'm going to wake up and it'll all be a dream.

[jjsmiles 3]

You are so close. Your dreams are coming true and I am so excited for you. I am guessing, but I think that this is likely a pretty emotional time for you. You have achieved SO much, probably more than you thought was possible, and now you are about to see a tangible reward of a newer body to match your achievements (I guess if you can call it a reward to have your body basically cut in half ).

You are almost at goal, you have been so successful in your journey and now your outside person will soon match your incredible inside person.

I am looking forward to hearing how it goes for you. Remember to take lots of pain meds and look after yourself.

Thanks for the thoughts and words you have given me.

Jacquie

[jjsmiles 3]

Update:

I have a date for the potential 4 in 1 surgery!!!!! September 9 - whoo hoo! :cursing:

Of course I may wake up from surgery with only a bowel resection, but if the gods are with me I will also have hernia's repaired, ileostomy reversed and a Tummy Tuck. The plastic surgeon was pretty sceptical (he was concerned it was too much surgery at once), but I guess my bowel surgeon talked him into it.

The bad news is that I will likely be in hospital between 5 day and 2 weeks :biggrin:.

Wish me luck!!!!!

[amsderb 1]

My prayers are with you...and be glad they want to take care of you for the days you won't feel great....much better than lying at home thinking something might go wrong and then what?....Keep us updated! Shelley

[Jachut 487]

I agree with Kat, you want to know the surgeon is a competent surgeon, but they are not exactly offering you a work of art, its a functional panniculectomy. You're looking at a big change, which you can always fine tune later on I would assume, and one would think, all risks of surgergies aside, a panniculectomy is not the most complex or difficult of procedures, you're going to be opened up anyway and I would guess you've got your bowel surgeon's choice of anaesthetist etc.

I would think as long as the surgeon has a reasonably good reputation, and your bowel surgeon is happy to work with him, then I'd feel comfortable, I just wouldnt be expecting anything more than a lot of belly gone. That's going to give you a huge boost for the rest of your journey, it will be so much more comfortable.

Good luck with it, that's a lot to get fixed up at once, but its a good opportunity for you too.

Edited June 19, 2008 by Jachut

[jjsmiles 3]

Thanks Jachut

I am not expecting miracles, but I have a lot of extra skin and fat in my belly area (well actually everywhere) that is not going to bounce back and so anything they can do to make me more comfortable, hygenic and make clothes fit better is a great big bonus. I am also curious to see how much gets taken away!

With my gigantic peristomal hernia, it is really difficult to see how my body looks with all the weight loss (I am basically wearing my intestines in a gigantic bubble on the right outside of my body). I have to buy my clothes at least one size (maybe even bigger) too big so my oddly shaped body isn't too noticeable.

It is interesting that wls is fairly new and uncommon in my community and so there isn't a lot of experience in dealing with the after effects of the skin. The plastic surgeon I am using does some public stuff, but mostly works through the hospital doing reconstructions and such. I am told he is very "thorough", whatever that means :confused_smile:. My bowel surgeon is the head surgeon at the hospital, so I figure he wouldn't refer me to someone he didn't trust.

I also figure there must be a threshold of pain and discomfort in the abdominal area - as long as they are in there I might as well have it all at once, if possible.

You are right amsderb - at least at hospital I will be in a hospital bed that I can raise and lower and have people take care of me :crying:.

Thanks!!!!

[jjsmiles 3]

Hi everyone,

I thought I would just give those of you who might be interested a not so quick update!!! Be warned that I have written a bit of a novel.

I had my mega surgery on September 9 and the 2 surgeons were able to do everything (yeah!!!!!). I have been told by about a dozen nurses and doctors that having everything done like that was probably as big of a surgery that could ever be done. Both of my surgeons have been positively giddy since the surgery, and I think they are very impressed with themselves :cursing:.

I had:

• Anterior bowel resection (took out about 1 foot of my diseased colon and reconnected the remaining pieces)
  
• Reversal of my ileostomy – which means reconnecting my small intestine with my large intestine (for the last 2 and ½ years I had not been connected and was managing my bowels through my small intestine which had been poked through my abdomen and I “pooped” into a pouch that was attached to my abdomen – I had no bowel control).
  
• Repair of two huge hernias (one in my belly button and the other a peristomal hernia which was as a result of my ileostomy)
  
• Panniculectomy – the plastic surgeon removed about 5 pounds of excess fat and skin in my abdomen.
  

I was in hospital for 10 days and had a wound vac for that time – special dressings attached to a type of vacuum that sucks out Fluid and guck (frangi has one) to help with wound healing. I had 3 drains across my abdomen and 46 staples. The wound line is about 28 inches from one back side of my hip to the other (the line is straight across the hips but then goes up and around my genitals – the doc said he had to take the cut a bit higher than they usually do). I believe he went higher to assist with the bowel surgery and to be able to remove the bad skin where my ileostomy site had been – I had a whole there plus some wounds that had not healed for a couple of years).

When I left hospital they removed about half of the staples and two of the drains. The other drain I was supposed to keep – it ended up coming out (with some assistance from me) about 4 days later. I was noticing a bulge on my other side (which I was worried was a recurrence of the hernia), but when I went in to see the plastic surgeon to get the rest of the staples out it was a build up of Fluid. He ended up draining 360 cc’s fluid that day, the next day 190 cc’s of fluid. I then went and saw him last Tuesday (four days later) and had 2 separate pockets of fluid (800 cc’s of fluid between them), so the decision was made to “reinsert” 2 drains again. To drain the fluid, they stick a really big needle into the wound line and start pulling out fluid – not a really pleasant experience. I was told it is not really unusual to have fluid build up, but the amount of fluid I have is unusual.

Radiologists reinserted the drains this by ultrasound. They froze the areas separately by needle, cut two new wholes and inserted the new drains, which they stitch to the skin to hold it in. This time they used industrial size tubing and drain bags (the bags can hold up to 600 cc’s which is more than 2 cups), which I strap to my leg. What can I tell you – I am a fashion statement!!!!! I will likely have these drains for a couple of weeks. Worst thing – I can’t shower now until they are out). I have lived with an ileostomy for 2 ½ years, so taking care of the drains is really simple.

My other main complication has been fluid retention in my legs. I went into surgery weighing 164 pounds and left hospital at 194 pounds :cursing:– all fluid being held in my legs (NOTE - I am NOT changing my ticker ). It is incredibly painful and uncomfortable to carry that kind o fluid. The docs finally put me on a mega dose of Water pills (80 mg per day). I have lost 17 pounds in the last 3 days – which really drains you (literally and figuratively), but at least the legs are starting to look and feel a little better. I am trying to sleep with my legs above my head - interesting position let me tell you).

I have an appetite, but can’t eat much (which is pretty ironic considering the weight gain – I mean REALLY - gain that much weight but not with anything good to eat sucks horribly :smile:). I had very little restriction before the surgery, and I didn’t get any solids (clear fluid only) for the first 8 days after surgery. My band is being pretty picky right now – for the first time since being banded I am struggling with bread and some meats- although some days I can eat quite a bit and others almost nothing. Ironically, Pasta seems to slide right on down. I have been told to load up on Protein, so I am back on Protein shakes. My port feels like it didn’t move at all as a result of the surgery (I was not unfilled for surgery).

It is hard to really say what my body looks like now, with the drains, fluid retention, etc., but the first time I put pants on I was incredibly excited because I had no extra stuff hanging in my abdomen to stuff into my pants. I could feel it was flat before, but wow it felt different and great when I put on pants :cursing:!!!!

Because I didn’t have any Lipo, my mid section is pretty square and boxy (I have never really had a waist though). I will never be able to wear a bikini (oh yeah – I also don’t have a belly button any more), but I am excited about what I can see (or not see).

Sorry for the length, but I wanted to get it off my chest (or thighs or ankles :cursing:) and I have always felt very supported here.

The first week or so after surgery was very rough - but I would gladly do it again. I hope to get my arms done in the next year (no hurry though).

Thanks for listening!!

Jacquie

[nip50 2]

jjsmiles - thanks for all the posts and I'm so glad you've made it through and they were able to do all the procedures. I hope your healing continues smoothly. You've been through so much already that you deserve a quick healing process. Please keep us all posted and hopefully after all the drains come out and the weight goes back down, you'll be willing to post some pics.