Friday, 26 October 2012
Observations-MOAS I vs MOAS II
I thought it may be of interest to summarise the differences that I observed between having the first MOAS in Feb 2010 to the second MOAS in August 2012.
Obviously there were some fundamental differences between the two operations that mean that you can’t really directly compare them. For example there was far more done in the first operation in terms of the number of procedures that took place within the operation itself with a greater number of organs being removed and a total of twelve hours in surgery. The second operation was far shorter; only six hours with no organs being removed and PMP being removed from the Pylorus and Duodenum. However the second operation still required a laperotomy (incision down the front of the tummy) and followed the line of the original scar. There was a large amount of time spent unpicking scar tissue from the first operation to mobilise up the bowl in order to gain access to the affected areas. Finally toward the end of both procedures HIPEC (Heated Intraperitoneal Chemotherapy) was applied where Mytomycin C heated to 42 degrees was poured into the abdominal cavity and the whole area washed with the treatment. So the second operation was still pretty invasive!
From the start though I did observe changes in the procedures on C2 ward from the first time around. The first day was pretty similar in that it’s about getting settled in and is fairly relaxed. Day two is a bit more full on with visits from the medical team and the Picolax starting to take effect. The discussion with the specialist nurses regarding the drugs used for pain relief was invaluable. As you will be aware if you have read all of my story I suffered badly with hallucinations the first time around and this was largely down to the drugs used and how they affected me personally. The fact that I suffered so badly allowed for the drugs to be changed slightly which definitely helped me the second time around. I suffered only with minor effects. There also seemed a more pro active approach toward the whole area of the hallucinations and its effects on the mind from the team this time around. We talked about what could be done to focus the mind on the here and now rather than letting it wander where hallucinations seem to then be able to creep in. The use of a black spot drawn on the back of the hand allows the patient something to focus their attention on if they think they may be experiencing a hallucination. Similarly, objects in the room can be focussed upon. I personally found music played quietly through the speaker of my phone or laptop again focussed the brain on the real world.
On the day of the operation things were different too. Rather than the pre op that I had first time around where I was already rather sleepy by the time the theatre staff came to take me down for surgery this time around there was no pre op. I was fully awake and walked down to theatre with the theatre staff. I’m not sure if this is the usual procedure nowadays or just because I am a seasoned patient. Personally it didn’t bother me as I knew exactly what to expect and it was one less drug being added to my system. However I can see that perhaps some more nervous patients may prefer to be under the effects of a sedative when faced with such a large surgery ahead of them.
After the operation there were some changes here too. I seemed to be moved through the intensive care unit far more quickly and into the new high dependency ward. Throughout the couple of days that I was in ITU and HDU I was very out of it and only remember small amounts. My first real memories post op really start from the point that I was moved onto C2.
From this point onwards I noticed fairly quickly that I felt stronger the second time around. Granted the operation was only half the time of the first and far less was done but I still came out with the same attachments minus the stoma. I think the fact that I knew what to expect and also what was expected of me made a big difference. I felt more confident.
One of the things that I didn’t really appreciate was that although I was very pleased not to have a temporary stoma this actually presented its own challenges to a bed bound patient attached to several machines and pipes once the bowel began to work again! I’ll leave the rest to your imagination!
The final change that I noticed was a dedicated physio on the ward. Jade, had put together a number of leaflets that could be used to help the patient. Initially this was a list of breathing exercises, this proved very helpful to me especially having picked up pneumonia. We followed this programme religiously on the hour every waking hour for a number of days and these made a huge difference to me. I often had to push myself to do them but the effort was worth it. The second set of exercises I was given came with a resistance band and could be done in the chair or on the bed. The other change was that a physiotherapy room/gym was available for use. This is in the process of being developed fully but already has a number of machines that can be used by patients to help with their recovery.
I found that second time around my stay on the ward was easier. I believe this to be down to a number of factors; the changes listed above, the fact that second time around I was in familiar surroundings and knew what to expect and obviously the fact that it was a slightly smaller procedure. The fact that having done this once before I knew I could do it again and was more confident. I also struck up a great relationship with a fellow patient-Robin and we spent much time talking and comparing progress which undoubtedly helped us both along. We bounced off each other and made light of situations wherever possible, keeping the nurses on their toes and generally created havoc; laughter is a great healer. Luckily Tracey also hit it off very well with Robin’s wife Karen who also stayed on site and I know this helped her too.
This week saw my return to work. Initially just half days and then gradually increasing it until I'm back to full time. It's just like I have never been away!