Another interesting day. We basically followed the plan I detailed yesterday, though the timings all got a bit scrambled.
The nurses let me sleep in, and didn’t wake me until 7am (that’s a serious lie-in in hospital!) at which point they did my initial observations, gave me all my medication and let me order breakfast. Because of the potential for surgery later in the day, that was my only opportunity for food, so I made the most of it and had porridge as well as toast & marmalade. Yum!
I made it into the MRI suite around noon, where they did the longest MRI scan I’ve had yet – about 35 minutes, compared to my usual scan of about 15 minutes. I’m not sure what exactly took so much longer, or indeed what the results were (yet) as the consultant Radiologist who interprets the results wasn’t present at the time.
I then moved on to the “Intervention Suite” (what a marvellous name!) where the consultant Radiologist re-inserted the wire into the sinus (using Fluoroscopy to guide him) again. Since this seemed to be quite an unusual procedure, several of the radiology staff seemed to be observing, and my surgeon turned up part way through too, so in the end I had a surprisingly large audience. Honestly, I would never have realised my naked bottom was such a draw!
In the end, what he did was run a long wire in through my anus into my bowel, then out of my bowel via the leak at the rectal stump, up through the sinus, and back into my bowel at the blind end of the J-pouch, before leading the wire back out of my anus again. He then threaded a catheter over the wire to protect me from the wire (think “cheese cutter” here and wince), and then used that to insert a very large balloon catheter into the sinus. By inflating and advancing the balloon repeatedly he was then able to expand the sinus to a size where the surgeon ought to be able to get access to the interior with a sigmoidoscope, and potentially insert Endosponges to help with the drainage and healing. The only drawback was that they needed to leave the wire/catheter combination in-situ until I went into surgery, and at that point they were still hunting for a free slot in the theatre schedule. So I ended up with a length of trailing wire hanging out of me, which they coiled up and taped to my leg to avoid me catching it on anything.
The consultant Radiologist then disappeared off to interpret my MRI scan (I think in conjunction with my surgeon), leaving me to be transported back to my room to wait for a plan of action, and a theatre slot to carry it out in. That was initially fine, but the embedded wire became increasingly painful as the day progressed. I suspect this was mostly due to the minimum bend-radius of the wire, and the way that the loops inside and outside of me (tied to my leg) forced the wire to pull on my tissues, especially as I moved.
In the end, an 8pm theatre slot was identified, but the previous surgical team ran into complications with their patient, and the time (quite rightly) slipped, and slipped, and slipped again. In the end I was called down around 10:30pm, and by the time we’d completed all the paperwork (consent form, anaesthesia checks, etc) I suspect I was put under sometime after 11pm. Interesting to note that this time, rather than using the normal Fentanyl I’m used to, the anaesthetist used Alpha-Fentanyl, which started out life in the USA as a designer drug analogue of Fentanyl under the street name of “China White”. Clearly you get all the “good gear” in the NHS!
The next I knew, I came around in the recovery room at about 1am. The wire (and resulting discomfort) was gone, and I now have in its place a single drain from (I assume) an endosponge, that leads to a vacuum flask / collector – so no need for a noisy vacuum pump, at least for tonight. Other than that, I have no idea what was done to me as my surgeon was already well on his way home, but I expect I’ll see him first thing tomorrow morning (this morning) when he’ll update me on both what the MRI revealed, as well as what he has actually done, and intends to do next.
So with that, I’d better get some sleep!
Updated to correct issues with clarity, spelling and grammar. Jolly good stuff, that Alpha-Fentanyl!