Home Editorial My 18-month experience with intestinal obstruction

My 18-month experience with intestinal obstruction

…I lived with stomach bag for six month

Florence  UDOH

My experience with ill health began a week after I learnt about my fathers death. That was in February 2014.
Soon after my father’s death, I started having severe abdominal pains which was so bad. I was rushed to Lagos State University Teaching Hospital (LUTH) where I was operated upon and the operation landed me in a COMA state for 6 weeks. Then at LUTH I was bed ridden after the COMA and eventually I was discharged after 5 months at LUTH.
Then in September 2014, I was flown to India where I was told that I will have a colostomy surgery.
The realisation of having an emergency colostomy surgery was one of the saddest days of my life. Well, that’s what I thought then.
Indeed  if  you  hear   that  you  are  going  to  get  a  stoma  and  will  have  to  use  your  stomach  to  pass  stool,  it  can  be  a  real  shock.
That’s  how  I  felt  in  September 2014  when  the  surgeons  in  Apollo  Hospital  India told  me  I  would  be  operated  upon  and  might  be  given  a  stoma because  of  the  extent  of  damage  done  to  my  intestines  at the Lagos University Teaching Hospital( luth) Lagos  during  the  month  of  March  2014.
I  had  gone  to  LUTH  hospital  in  February  ending  due  to  intestinal  obstruction   and  operated  upon  in  March  in  LUTH  and   ended   up  in  the  Intensive  care  unit   and  also  in  all  spent  5  whole  months  on  admission  in  LUTH.
The preparation  for the Stoma  Surgery  in  India.
Normally there are investigations done at the clinics first: blood tests, heart checks (ECG), a general physical examination and sometimes an x-ray of the lungs. I   also  had  an interview  with  the anaesthetist,  the   surgeon  and  the   stoma  nurse.   During   this   consultation   the anaesthetist   informed    me  about   the   anaesthesia,   ,  gave   me   an    estimate   risks   of   the operation .
The  doctors  and  nurses  in  Apollo  Hospital   India   welcomed  me  in  September  2014  to  their  hospital  and   did  series  of   test  on  me  and  also  counselled  me  in  details  of  what  kind  of  surgery  I  was  going  to  undergo.
The  nurses in  particular  spoke  compassionately  with  me  and  assured  me  I  would  be  fine,  however  I  was   feeling  very  self-conscious  and   wondering   if  people  were  looking  down  at  me  because  I  arrived  INDIA  with  a  very  protruded  large  stomach   as  if  I  were  pregnant  with  triplets.  My    stomach  was  swollen  so  badly  due  to  complications  from  the  LUTH  Surgery.
In order to be sure that  my  stoma bag will be in a good place after the operation and sits comfortably when  I   stand, sit or move, the surgeon and stoma nurse   did   carefully try to find the best place to site the stoma. The place can depend on the shape and folds of your stomach. It is very important that the stoma is formed in the “correct” place otherwise you can have problems with leaks. They take into account your bone structure such as the hips and ileum and also the navel, scars and the contours of your body. The stoma is often placed at the top of the “fatty roll” level with the navel.
I   was    told   then  when you go under the   knife ,  you must be ‘empty’. This means that your stomach must be empty when you are operated on. So  I  have  given  a  laxative   to  completely  empy  my  stomach  the  night  before  the  surgery.
In the operation room   I   was  moved from my   own bed to the operating table. Then   I  was  connected to the monitoring equipment. During a anaesthetic the anaesthetist monitors continuously the most   vital  body functions, such as breathing, blood pressure and the heart beat. That is why stickers   were   stuck   to  my  breast which monitors  my  heart rhythm during and after the operation.  I   also get a peg on  my   finger which monitors the oxygen level in my blood and a blood pressure monitor on my  arm.
A drip is inserted in the back of my  hand. This is a thin tube that is placed in a blood vessel and whereby other medication and fluids can be administered during and after the operation.
With an operation on the gastro-intestinal tract an epidural in the back is often used to regulate the pain during and after the operation.. With an epidural (Thoracic Epidural-Anaesthetic, TEA) a very small thin catheter (tube) is inserted just inside the spinal cord outer skin, between 2 vertebrae. Epidural means ‘the space just outside the hard spinal cord’. The injection therefore does not go into the spinal cord. The medication goes immediately to a good place meaning less pain killing medication is needed. By means of a pump pain relief is administered via the tubing. An epidural catheter also often has a beneficial effect on the oxygen levels if the heart and the coronary arteries which regulate the blood delivery of the heart.
To insert this,  I    had   to sit on the edge of the operation table in a position known as the ‘cat position’; chin on your breast, nose towards your knees, shoulders sagged/relaxed and my   feet   were  supported on a bench.      The  place of the epidural   is first numbed with a small injection.    With the  epidural,  my  legs felt l different; warm tingling and heavy and  became  numb.
My  whole body   was  numbed   and  I  became  unconscious. But  before  I  went  to  sleep,   I  was  given   a mask with 100% oxygen on my  mouth and nose.  I  learnt   that   gave  my  blood cells and body an extra “boost” of pure oxygen. This helps  my  sure  recovery. Then the anaesthetist injects the anaesthetic via the drip.   I  fall into a deep sleep within  a half minute. It can feel as if a warm glow spreads over my  body.
On  waking up
After the   operation   which  lasted   4  hours   I   was   brought to the  recovery   room. This is a separate room near the operating room. Here a good look is taken at the pain relief and my  blood pressure, breathing and all sorts of other functions are monitored closely.
I  spent  the  night  in  the  recovery  room  and  when  my  condition  stabilised,     I   was  brought    first   to  intensive care   section   where  I  spent  2  days  before  I was  moved  to  my  room in  the  ward.
When    I  OPENED  MY  EYES  Clearly  and  saw  all  the  tubes,  one  in  my  mouth/throat,  two  tubes  on  each  side  of  my  body  and  then  the  hole/stoma  on  my  belly  with  stool  coming  out,  I  felt  so  depressed  and  wept  my  soul  out.
I  was  glad  to  be  alive , but  the  thought  of  having  to  watch myself  pass  stool  from  my  stomach   was  quiet  a  shock  for  me  and  I  felt  so  depressed  and  all  alone  inspite  of  the  fact  that  my  bosom  friend  with  me  Lady    IFREKE  who  came  with  me  to  INDIA,  really  consoled  me,  I  still  felt  my  life  had  no  meaning  anymore,  my  worry  was  how  will  I  survived  using  my  belly  to  pass  stool  for  many  months?  HOW?
Also   I  was  shocked  at  the  size  of  the  stoma  hole  in  my  belly,  it  looked  so  big.  The  nurse  with  me  was  friendly  and  asked  me  to  refer   to  the  stoma  as  my  rose  bag,   I  ask  her  why  rose,  and  she  said  all  women  like  rose  flowers.
The drip in my  hand ,  I  learnt  was  very important. The first few days after the operation ,  I  got   a  fluid/saline solution (saline 0.9%)  via  the  drip  in  the  hand. The saline content in this solution is the same as that in our body cells enabling the water content in our body to be replaced as soon as possible.
I   felt  so  much  pains  in  my  stomach  and  all  over  my  body  and   the  nurse  told  me  to  endure  that , the pain is mostly worse immediately after the operation and gradually reduces. The aim of the doctors and nurses is that 72 hours after the operation you have a pain number of less than 4  measured  with  a  special  instrument. The difficulty with pain is that it is subjective; pain is very much a personal experience.
Apart from the drip and the pain pump when   I   woke up,   there will be a tube in my  nose for oxygen.
I   also  wake up with a bladder catheter. This is a flexible tube which is pushed along the natural ureters into the bladder. The urine can drain away by itself and is caught in a bag which hangs on the bed. As a result of the   surgery  so   I  could  not  pee by   myself.
The Recovery
I   was  not   worth much the first days after the operation.  I  was  so  depressed,  but  the  nurses  and  doctors  did  their  very best  to  cheer  me  up.  Also  their  medical  care  was  excellent,  they  attended  to  me  with  much  love  and  dedication .
My  temperature, heart rate , blood   pressure  and  oxygen  level  was  checked  every  day.  I  was  so lean  and very  week  and  very  emaciated.  I  was  100 percent  dependent  on  the  nurses  for  everything,  they  cleaned  me  up  each  day,  brushed  my teeth,  wash  my body,  change  my  clothes  and  stoma  bag.

The   nurses   were   so  caring    and  if  I  needed   anything,  all  I  needed   was   to  press   a   bell   to call   a   nurse  and  immediately   a  nurse  will  come  to  assist   me.
Every day step by step things get better   for  me    and   I  could  do a little more.  I  Started   to  brush   my  mouth  by  myself  after  2  weeks,    but   that  only  became  possible   after  the  nurses  had  helped  me  out  of  bed  many  times  so   that  I  could  sit  on  a chair.   It  felt  like  a  journey  around  the  world  for  the  first  time.  Indeed  I   cannot  forget  the  grim  fact   that   the  operation  was  another  blow  to  my body indeed my body   will  need  time  to  recover  again.  I  felt  so  overwhelmed  with  the  whole  surgery  saga   and  I  prayed   for  GOD  to  sustain  me  and  keep  my  spirits  high.  I  looked  at  my  stomach  and  the  stoma  and  remembered  that  it  was  the  same  stomach that  LUTH Operated  me  in  the  month  of  March  and  that  was  what  sent  me  to  coma  ,  and  now  again  this  same  stomach  of  mine  was  opened  again  at  the  same  position,   and  even  more  that  it  would  have  to  opened  again    so  that  one  day  this  stoma  will  be  closed.
I  slowly  learnt  to  drink  fluids  and  eat  again.  In  the  first  days,  only  liquids,  soup,  porridge,  e.t,c,   and  then  light  food  like  mashed  potatoes,  mashed  rice  ,  fruit,  e,t,c,   next   ,   building  up  gradually  until  I  was  able  to  eat  semi  –  solids    before  I  left  India  to  return  to  Nigeria.
There   in  India,  dieticians   came   each   morning  to  see  me   before  breakfast,  and  they  often discuss the impact of  the  menu   on  my   newly formed stoma. The surgeon   often  came   often   to  visit   me    and  to    tell  me    how the operation went and to see how things are going with me now.
In the first days after the operation ,  I  was   being  taught how to care for my stoma. A ward nurse looks after the basic care, the stoma nurse deals more in depth..    In the beginning ,   I    just watch and the stoma nurse explains everything. This is called bed-side teaching. There seems to be a lot happening all at once and   I  had  the feeling that  I  will  never remember    all  this  processes  of  caring  for  my  stoma  to  prevent  infections.
Just  before  I  was  discharged  in  India,  the  stoma  nurse  came  and  emphasized   that  I  watched  carefully  and  learn  everything  well and  learn it  well  and  she  also  added  that “  you  may  not  get  anybody  to help  you further back  at home, so  prepare  your mind  to be  cleaning  up yourself  properly  on your own”.  I  was  told  that  in  3  months  time, my intestines  would  have  healed  enough   for  me  to return  to India  and  undergo  the  final  operation  to  push back inside  my stoma  and  make  me  normal again  to  pass  stools  via  the  anus.
Indeed  , after  6  weeks  in  the  hospital  I  was  well  enough  and  discharged   to  return  back  to  my  country  Nigeria.   I   was   warned   that  in  the  first   6  weeks  after  the  operation,  I  should  not  lift anything in order to prevent a   stoma hernia. That  my  stomach muscles will grow back together after a month or more,   so   chores   like   fetching   water,  sweeping,  e.t.c   were  unadvisable   during the first weeks after the operation.
I  was   warned   also  that   my  appetite   will    change after the operation; more or less, and   other changes.    I  was    told.  :   “  Your body can for example crave specific foods like salt, fibre or proteins. Listen to your body, because protein (meat, fish and dairy products) are good for the recovery of your body. Watch and try gently to see which foods you can tolerate, and which not. For a handy food list with products which can cause an obstruction, air etc, click on the page FOOD on this website. What you can and cannot eat varies person to person and also on the opening of your stoma. The narrower, the harder it is to digest difficult products. Try everything quietly, not at the same time, and if something doesn’t appeal try it again later”
Upon leaving hospital, after being on admission for colostomy surgery for 6   weeks, it seemed that I was confident about managing my colostomy, taking care of my stoma and changing the colostomy bag.
On arriving home, the confidence seemed to dissipate slightly. No more nurses round the corner to cry on their shoulders. No more pep talks about how easy it will become to live with a colostomy.
Challenges – The First Few Weeks At Home
The emotional stress experienced was expected   even  though   I have been well tutored about what to expect and this is a normal post surgery feeling. I was thinking about my stoma all the time. And worrying about how life will be like, with a colostomy.
It took me a few weeks to adapt to life, living with a stoma. With the benefit of hindsight, it really was a passing phase.
The first weeks found me learning and researching more about a living with a colostomy, and my stoma, whilst discovering better and more efficient ways to use my colostomy pouch and other ostomy supplies.
And in a matter of a month, I was in full control of my colostomy and was always able to tackle any unexpected situations.,  however   I  still  felt  depressed   every  now  and  then  at  seeing  my stools  coming  out  of  my  body   and  worst  still  as  I  had  been  warned   it  often  came  out  un  controllably,   like  a  running  tap  that  you  cannot  close  up.   Once  I  eat  any  food,  40  mins  after  the  stools  came  running  out,  it  was  awful  indeed.  But  I  thank  my  husband,  MY  3  CHILDREN  and  all  my  siblings  ,  my  colleagues   and  all    my  friends    and  church  members   and  neighbors  for  all  their  emotional  support
Ostomy, Major Issues Initially Encountered:
Initially, wearing colostomy bags, and managing the colostomy was a great challenge at home. It really took some getting used to, but eventually, we all got along fine, colostomy bags, stoma and   I. The seemingly major issues initially encountered by being a colostomy patient at home includes:
Knowing when to change an ostomy bag.
Dealing with the odour left behind, every time a bag has to be changed. The ostomy deodorants never seemed to work well enough!
Worrying about how to handle colostomy bag ‘ballooning’
Knowing when a colostomy bag blow out is about to occur, and dealing with it before it gets out of hand.
Making sure that colostomy supplies NEVER run out.
Bleeding around the stoma.
The loudly audible sounds of expelling wind.
Disposal of used colostomy bags  and  worst   the  burning  and  peeling  off  of   skin  around  the  stomach  area.
The  experience  made  me  appreciate  the  fact  that  stool  is  acidic  in  nature,  it  was  so  awful,  the manner  my  skin  around  the  stoma  burned  and  hurt  so  much.
Never before has the feeling of self consciousness been so profound! My emotions were in a turmoil. This was going to be a long    3    months. If only time could fly.  And   worst   that  3  months  became  6  months.
How to Change Your Colostomy Pouch
Managing A Stoma At Home
The first week at home was scary.   I   was, ‘in and out’ of the bathroom, checking on the colostomy bag. And because the stool was still fairly fluid and scanty,  using the drainable colostomy bags was easy. But  as   I  begin  to   eat   well,    it  became   more  cumbersome   changing   the   pouches.
Eating
I barely ate any food, hoping that eating much less will ensure the stoma bag has as little stool as possible. But I had to eat because I was just out of hospital, and needed to build up my body mass, strength and stamina, and I needed to put on some weight. I has lost about 10 kilos  during  and  after  surgery  and I  looked  so  emanciated  and  skinny.   I eventually stuck to a simple colostomy diet that ensured waste in form of excreta was expended with ease and with a reduced quantity.
Clothing
My change of clothing style was another bothersome issue. I packed away my tight fitting clothes and opted for looser fitting apparel, especially those that are loose around the waist. Wearing    gowns  posed a problem initially,    until I opted for low-rise    gathered  gowns , allowing my colostomy bag to hang out unhindered or squashed by a waistband.
Sleeping
Sleeping soundly at first, wasn’t easy. There was the horrible thought that lying on my stomach with burst the colostomy bag, spilling its contents all over the sheets. I had to learn to sleep on my side, and eventually inculcated that way of sleeping within a few days at home.   Yet   still,  sadly  I  wake  up  each morning  with  all  the  bed  sheet   stained  with   feaces.
At the hospital, it was a different ‘kettle of fish’ in that the nurses were always around to help you out of nasty situations that may occur. When you are in bed with your husband, the last thing you wish to happen is a burst ostomy bag occurring in the middle of the night,  but  I  had  no  choice   because  it  happened  most  nights  that  the  bed  was  soiled.
Travelling
I   did  the  stoma  surgery  in  September  2014   and  by  December  the  same  year  I  was  determined  to  travel  by  plane  from  Lagos  to  Benin  to  see  my  mother  who  had  not  seen  me  all  the  while  I  was  sick  in  LUTH  and  in  coma   and  almost  dead.
So  stoma  or  no  stoma  on,  I  was  determined  to  go  to  Benin  and  I  dared   it  indeed  and  travelled.  All  the  way  from  lagos  to  Benin,  I  took  nothing,   not  even  water  in  the  plane   but  even  at  that  I  arrived  Benin  still  soaked  in  my  pants   with  my feaces,  but  my  joy  was  that  the  stain  did  not  show  on  my  clothes,  I  thanked  GOD  in  my  heart.  My  mother  was  so  delighted  to  see  me  and  she  thanked  GOD  I  was  alive  and  she  assured  me  that  soon  I  will  no  longer  wear  a  stoma  bag.
In  the   plane,   in  my  hand   luggages   I had my colostomy supplies in my hand luggage, the deodorant, wipes, ten colostomy bags (I laugh when I look back now!), disposal bags, etc. all neatly packed in a designer colostomy supplies zippered bag. I had to pre-cut the stoma holes on the colostomy faceplate because scissors were not allowed in hand luggage.
Any ostomy patient will know what its like changing a colostomy pouch in any toilet. Now changing a pouch in an airplane’s toilet is something else entirely. The odour was consuming and the deodorants couldn’t ‘tackle’ the smell. Oh well, it was just too bad. I had to change three times before arriving my destination. One thing was for sure, I was getting more adapt at this and spent less time than I would have, sitting on the loo.
Settling Down To My Normal Lifestyle With A Stoma bag
After settling down and fully accepting having a colostomy, I must say that it beats having to use the toilet the normal way. There were a few times when the urge to go the normal way occurs, and at first it was alarming. After talking to my doctor, I was assured that it was normal. Because of the accumulation of mucus, the urge to expel something happens. At this time I was advised to try to expel it by sitting on the toilet and bearing down lightly. If it doesn’t pop out, then using a very mild suppository will aid its expulsion.
In no time managing my colostomy became second nature. I had come to terms with having a stoma, and my initial reaction and shock after my colostomy surgery had been replaced by happier thoughts  of  still  being  alive.  . And still only a couple of people knew I was walking around with a colostomy stoma.
Because I watched what I ate, keeping to a simple colostomy diet, I hardly experienced colostomy blowouts. In the spate of   6    months, I only experienced blowouts about three times. Whenever I consumed fizzy drinks  I expected some colostomy gas build up and stoma bag ballooning. I just sneak into the toilet and open up the drainable colostomy bag to release the gas. All done in two minutes.
Stoma prolapse
However   there  was   one  sad  fateful  day  I  witnessed   the  length  of  my  intestines  from  my  inside  stomach  come  out  through   my   stoma   hole ,  this  is  called   stoma  prolapse   and   the  length  was  so  long  it  reached  my  knees,  I  was  so  alarmed   and  only  I  and  my  little  8   year  old  son  was  at  home.
I  was  so  scared   that  I  would  die  that  day,   but  thanks  be  to  GOD  I  survived  it  and  I  thank  my  little  son  because  he  showed  much  bravery  that  day.
How  the  intestines  went  back  inside  is  that  I  santinised  my  2  hands  in   saline   water  and  use  my  own hands  to  push  my  intestines  back  into  my  stomach,  it  was  really  frightening.  But  I  survived  it  and  all  went  fine  and   later  when  I  was  able  to  reach  the  Indian  doctors  via phone,   they  advised  me  on  some  mild  pain  killers  to  take  and  asked  me  to  rest  adequately  and  reduce  house  chores   to  avoid  another  stoma  prolapse.
Closure  of  stoma   hole  and  return  to  Normal  life
In  the  month  of  March  this  year  I  returned  back  to  Apollo Hospital,  India  for  the  final  corrective  surgery  which  lasted  2 hours  and  eventually  my  stoma  hole  was  closed  up  and  my  intestines  reconstructed  back  normally  again  so  that  I  could  use  my  anus  to  pass  stool  normally.
Since  after  the  final  surgery  in  march,  I  have been  fine  living  a  normal  life  again  and  I  am  really  thankful  to  the  expert  doctors  and  nurses  in  Apollo  Hospital,   India   and   also   to  everyone   here  in  Nigeria  who  stood  by me.

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