Well, just two months after his last round of chemo and John's getting out of hospital today (Thursday 8th Aug) after a four day stay due to another complication with his digestive system. The output of his stoma had gradually been decreasing for some time compared to what it was at the beginning, 6 months ago, and it has been playing on my mind for a few weeks. We finally had confirmation that something wasn't quite right when he had an episode of vomiting early last week. This is an immediate red flag because it means his stomach isn't emptying, probably because there is no space in his small bowel for the food to go to. He felt too full to eat much and for the next two days was cold and clammy if he did try to eat. A couple of days later (Thursday) he was sick again, with no stoma output and the beginnings of abdominal discomfort. He went to see the GP, having tried all the home remedies that had worked previously (laxatives, stomach massage, Coca-Cola, gentle walking). We could still hear a lot of gurgling going on, which is a good sign, and the GP said don't worry, focus on having plenty of liquids and give it a couple more days. He felt slightly better when he wasn't eating but on Sunday had terrible abdominal pain and on Monday morning, when it was still sore, he took himself off to hospital to see what was going on.
As usual, not a lot happened on the first day. He bumped into his original surgeon, Mr Alwahid, in the lift and told him why he had come in. Mr Alwahid very kindly popped up to the ward to see John the next day and give him some reassurance that there were options available, which really improved John's spirits as he'd been very anxious. Another of the surgeons in John's original operation came to see him to work out an approach to the problem. She remembered him too, and when John told me I realised it was the lady who had broken the cancer news to me on that night after his surgery. We wonder what it was about John's surgery that had been so memorable. She decided that the stoma hole had shrunk too much and was probably causing an obstruction, so the plan was to stretch the hole under a general anaesthetic (due to the pain expected) and then for John to use a 'dilator' at home to keep the hole from shrinking again.
On Wednesday morning they did a CT, which they had yoyo-ed on whether to do or not. The stretching procedure was done just after lunch, and the surgeon came to see John at about 5pm while I was there visiting. He explained that the procedure had worked and he had flushed the gut out a bit. There had been some tearing to the skin as predicted, which explained the soreness John was experiencing. He also said that some of the bowel had come away from the skin around the stoma opening and so he had had to put some stitches in place to hold it all together. The stoma nurse would come round the following day to bring the dilator and show him how to use it.
Then came the slightly less good news. The CT scan had shown some evidence of a blockage in the small bowel, but the surgeon still maintained that clinically John was not presenting as having a blockage, so he was happy for John to go home that evening if he wanted to, and to see what happened when he got back to eating more normally. We decided that it was better if he stayed in one more night for any pain relief and to see if the stoma might kick into life overnight, because the next step would be a gastrograph with contrast agent, which works like an industrial strength laxative, and that would have to be done in hospital anyway. We thought that perhaps that would happen the next day if needed.
And then the bad news. The CT had thrown up some other findings regarding the cancer. There was some fluid in John's abdomen that hadn't been there on the last scan just six weeks ago, and the lymph nodes of the mesentery (the membrane that holds your guts in place) looked enlarged. He had called Dr Storey, John's oncologist, who was on holiday but kindly took the call, and she had requested John's case be discussed at the MDT meeting on 19th August and then she would see John in clinic after that. Essentially it possibly/probably means that the cancer is already starting to grow back and spread just two short months after stopping chemotherapy. The surgeon said that the suggestion would most likely be to restart chemo soon, hopefully giving us more time, but bringing with it all the side effcets and medical appointments and the inconvenience of having the PICC line put back in his arm permanently.
The care John is getting is really good and so many of the staff recognise him from earlier visits - not quite sure whether it's John that's memorable or his medical condition that jumps out off the page!
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