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Need pointers before I get my colon removed

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Ostomies
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Lady Vicodin
Regular Member
Joined : Feb 2010
Posts : 40
Posted 11/21/2012 10:56 AM (GMT -8)
I am meeting with a colorectal surgeon in a few days to discuse removing my colon and getting the bag.  After I talked to several nurses at Cleveland Clinic they said they now have a department exclusively for people with the J-pouch since there are so many people having problems.  They also said they are finding some people are getting cancer in their J-pouch and that if it was them they would just go with the bag.

Since I'm just going with the bag is there anything anyone can tell me to make this transition easier?  Any pointers about what to ask the surgeon to do regarging stoma placement or such I would really appreciate.

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suebear
Veteran Member
Joined : Feb 2006
Posts : 5698
Posted 11/21/2012 12:22 PM (GMT -8)
There has always been a cancer risk with jpouchers, since there is a bit of rectal cuff left for continence. The last time I checked the percentages were less than 1% for the chance of cancer post surgery. I think you misunderstood the nurse; they don't have a ward in the hospital for people with jpouch problems, they have a ward for people who choose to have jpouch surgery. Yes, there can be complications post jpouch surgery, there are complications post any surgery. Jpouch surgery is very complex and depending upon how ill the patient is, the risk of complication is higher.

There is no perfect surgery for UC but there is a perfect surgery for you, and that's the one you're willing to live with. Jpouch surgery has a satisfaction rate of over 90%. I've been one of those happy jpouchers for almost 12 years.

Sue
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toughenough
Regular Member
Joined : Dec 2010
Posts : 180
Posted 11/21/2012 1:40 PM (GMT -8)
If it was me I'd have a longer discussion with my surgeon about it. Write down your questions before the appointment. I had my surgery 2 years ago and have never heard of anyplace close to that amount of problems. I go to the Mayo Clinic and they have no such thing there and they are ranked #1 and Cleveland Clinic #2 in the country. Good Luck with whatever you decide.
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desertsun01
Regular Member
Joined : Oct 2011
Posts : 106
Posted 11/21/2012 2:33 PM (GMT -8)
I am two weeks post op from my total Proctocolectomy with a permanent end ileostomy and anal closure.

I had 5 months to do dozens of hours of research to educate myself and get comfortable with my decision. I highly encourage you to go to YouTube where you will find lots of videos on things like bag changes, emptying your bag, all the various ostomy supplies, dealing with skin issues, etc. I learned more there and more here on this board than any other resource.

Other people on this board have commented on the fact that they woke up from surgery feeling free of the UC and I can say this is absolutely true. Though you are in a great deal of discomfort right after surgery, there really is a sense that something magical has happened.

Also, its so important that you have a good gut feeling about your surgeon. I hit the jackpot with my surgeon who it turns out is known for her ability to do procedures that are least invasive. Another surgeon told me my surgeon is one of the rare ones that can think on her feet and deal with any situation that comes up immediately. Right before surgery, I asked her to please give me the prettiest, the best, the greatest stoma she's every created. And guess what.....she did. Everyone who's seen it that knows about these things has said I've got the Cadillac of stomas.

If by doing your research, you can take the fear out of the unknown, you will be so much better off. There is no such thing as asking too many questions and be sure to focus on a good outcome because though many people do experience some difficulties, most ostomites do just fine.

I know I am very new to this, but I feel very optimistic about my future and am excited about getting my life back once I am fully recovered. Keep us posted as you go forward. I have a slogan that I have adopted just for my situation.......Trust Your Journey.....and I do.
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desertsun01
Regular Member
Joined : Oct 2011
Posts : 106
Posted 11/21/2012 2:34 PM (GMT -8)
I am two weeks post op from my total Proctocolectomy with a permanent end ileostomy and anal closure.

I had 5 months to do dozens of hours of research to educate myself and get comfortable with my decision. I highly encourage you to go to YouTube where you will find lots of videos on things like bag changes, emptying your bag, all the various ostomy supplies, dealing with skin issues, etc. I learned more there and more here on this board than any other resource.

Other people on this board have commented on the fact that they woke up from surgery feeling free of the UC and I can say this is absolutely true. Though you are in a great deal of discomfort right after surgery, there really is a sense that something magical has happened.

Also, its so important that you have a good gut feeling about your surgeon. I hit the jackpot with my surgeon who it turns out is known for her ability to do procedures that are least invasive. Another surgeon told me my surgeon is one of the rare ones that can think on her feet and deal with any situation that comes up immediately. Right before surgery, I asked her to please give me the prettiest, the best, the greatest stoma she's every created. And guess what.....she did. Everyone who's seen it that knows about these things has said I've got the Cadillac of stomas.

If by doing your research, you can take the fear out of the unknown, you will be so much better off. There is no such thing as asking too many questions and be sure to focus on a good outcome because though many people do experience some difficulties, most ostomites do just fine.

I know I am very new to this, but I feel very optimistic about my future and am excited about getting my life back once I am fully recovered. Keep us posted as you go forward. I have a slogan that I have adopted just for my situation.......Trust Your Journey.....and I do.
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ddd45
Veteran Member
Joined : Mar 2009
Posts : 572
Posted 11/21/2012 5:52 PM (GMT -8)
actually lady vic is correct. There is a dept at CC totally devoted to people with problematic jpouches. Thing is.. they are the place where people with problematic jpouches from around the country AND around the world visit to get help. Also she is correct.. that they are recently discovering cancer in jpouches. The cancer they are recently discovering is NOT simply located in the rectal cuff. It is actually in the jpouch itself. This was NOT a known fact several years ago. It is VERY important to know this now as anyone with a jpouch connected or not, should be getting scoped on a yearly basis.

As for advice.. let an experienced ostomy nurse deterime the stoma placement. They will be the best at that. Only other thing I can tell you, is to be confident about your decision, and you will then figure out how to work with your new self. Good luck lady vic. UC since 2002 is a long time. You will feel so much better once that diseased colon is out of your body.
happy thanksgiving.
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bootstrap
Veteran Member
Joined : Nov 2009
Posts : 583
Posted 11/21/2012 9:53 PM (GMT -8)
As others have said, only you can know for sure which surgery is best for you, but my advice both for decision-making and transitioning would be to make sure you do your own research on all of the options available. Rather than listening to one surgeon or clinic's advice, look up as many studies as you can find on long-term results, success and satisfaction rates; spend a lot of time on this ostomy board as well as jpouch.org to see what types of issues people are dealing with; look at photos of ileostomies and stomas online; watch videos on youtube of how to change a bag, knowing you'll be doing it a couple times a week for the rest of your life if you choose that route; read blogs of people who are living it; and talk to as many people as you can who have done both options. This will not only help you be sure of your decision, but it will help with the transition as far as what to expect and how to wrap your brain around the whole idea and process it all mentally and emotionally, regardless of which route you end up taking.

Whatever you choose to do, since both options come with a small risk of serious complications, make sure you get a highly specialized and very experienced surgeon. I have heard this makes all the difference on how successful things turn out.

Good luck, and keep us posted!
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Lady Vicodin
Regular Member
Joined : Feb 2010
Posts : 40
Posted 11/24/2012 10:48 AM (GMT -8)
desertsun01 who was your surgeon?
I am having Tracy Hull at Cleveland Clinic.

For those of you stressing to do my research, just to ease your mind I have been thinking about the surgery since 2007 and have been going back and forth since then as I read & research about it. It is scary when you see some of the things that can happen but I have found that every year my disease has gotton worse and I'm to the point I just can't take it anymore. I got to the point where I believe in life after death but even if there isn't a peacefull sleep for eturnity sounds better than all this pain & bull crap.

Someone told me in another post that you will just know when you are ready and there will be know doubt and she was right, I was almost sure last month but now there is no doubt in my mind I want this.

Over the years I have foun little tricks to make getting scoped easier (about the prep) so this is what I'm looking for regarding the surgury.

I chose the bag route bcause in the end I want the least risk of further complications & I want to stop taking all drugs and the bag just seams the best idea for me. Those who have chosen the J-pouch I'm sure that was the best for you for what you wanted from your surgery. I'm glad there is options.
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ByeByeUC
Veteran Member
Joined : Feb 2011
Posts : 4592
Posted 11/24/2012 12:22 PM (GMT -8)
Lady Vicodin,

Good luck with your upcoming surgery. I'm one of those people who absolutely knew for sure when it was time to have surgery. I just couldn't go on another day living with UC and having it run my life. I opted for a j pouch and I am extremely happy with it. I think that being a woman my chances of developing breast cancer are probably much greater than developing cancer in my j pouch. I do go annually though for a scope of the j pouch as per recommended by my surgeon. It's really scary these days the amount of people I know .... Young people....getting cancer of just about every body part. Crazy. Wishing you a speedy recovery!
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80sChick
Veteran Member
Joined : Oct 2009
Posts : 1054
Posted 11/24/2012 1:37 PM (GMT -8)
I agree with others...do your research and learn everything you can...knowledge is power. Being educated about this is the best thing you can do to help yourself.

Make sure you are confident with your surgeon. Ask how many times he's done this, see if you can talk to anyone in your area at a support group, etc.

When you have the stoma nurse mark you, make sure she observes you sitting, standing, laying, etc. and wear pants with the waistband where you like it.

You sound like you're in the same place I was when I had my surgery...totally ready and doing as much research as possible. I think those two things were the key to my good attitude. Two and a half years later I'm still having "firsts" where I see another benefit of having had the surgery, and I'm so thankful for my ostomy.

Let us know if you have any other questions and I hope you can start feeling better soon!
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ddd45
Veteran Member
Joined : Mar 2009
Posts : 572
Posted 11/24/2012 3:09 PM (GMT -8)
lady vic.. wanted to assure you that you are at the best colorectal surgery facility in the country AND your surgeon is one of the top rated there. I am a CC patient myself, and though Dr. Hull is not my surgeon, I am more than aware of her expertise and her ratings among the CC colorectal team and beyond. I also have a few friends she cares for and they are extremely happy with her skill and bedside manner. You are definitely in good hands with the surgeon and facility you have chosen.
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Blueheron
Veteran Member
Joined : Feb 2010
Posts : 720
Posted 11/24/2012 4:08 PM (GMT -8)
Lady Vicodin,

I too chose a permanent ileostomy even though I was a candidate for the j-pouch. I felt that the permanent ileo would be a better fit for my lifestyle and the results have been everything I had hoped for. I am now two years out of surgery, and most of the time I hardly even notice my ostomy. It just feels like it is part of me and it has not stopped me from doing anything. I hike, rock climb, backpack for multiple days in the wilderness, run, swim, travel, wear all my normal clothes and eat most foods. Life is very good and I am thankful for my ostomy every single day.

In my opinion, these are the three things that have led to me to be very happy with the results of my surgery.

1. Get your surgery with a highly recommended surgeon. Sounds like you already have this one covered.

2. Get a good stoma placement. Wear your favorite pants to your placement meeting. My stoma nurse recommended having a stoma placed below the belt line so that my pants waistband would not press on the stoma or cut off flow to the pouch. Mine is about two inches below my belly button and two inches to the right, but it is going to be different for everyone depending on their build. I love to backpack and rock climb too, so I brought my harness and backpack to that meeting too. I know another person who is really into biking and brought their biking clothing. Do whatever you can to get a good placement for your clothing and activities. This is super important because your stoma will be permanent.

3. Do not get a flush stoma if it can be avoided. My GI nurse and doctor really emphasized this when I decided I wanted surgery. So, I asked my surgeon to make sure to create my stoma so it stuck out over an inch. He confirmed that he always tried to make stomas that length as it helped prevent leaks and skin issues, but it felt good to ask him anyway just to make sure. My stoma ended up being just shy of 1.5 inches tall when the swelling went down. My stoma works really well at this length. Stool never gets pumped under the wafer and the longer length points my output towards the bottom of the pouch. Due in large part to my stoma length, I have only experienced one leak in 2 years, and that was a week after surgery due to wound drainage compromising the adhesive on my wafer.

Best wishes for your upcoming surgery!
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ENIGMAWRAP
Regular Member
Joined : Nov 2010
Posts : 424
Posted 11/24/2012 5:27 PM (GMT -8)
Lady Vicodin,

First, cool name! :-)

2nd, gratz on making this decision! Not sure how long you've had your condition (UC or chron's)?
en it
As far as deciding, there is really nothing a Dr. or nurse can tell you unless they themselves have an ostomy. Not sure how good/bad your health is right not, but if you can contact a local UOAA organization (United Ostomy Association of America) and talk face-to-face with human beings that have an ostomy, j-pouch, other, and get there information on life in general, and the daily challenges of living with each, that would help your decision, and your spirit now and later on.

As for me, my short story is if I had considered surgery earlier, when I was younger, i would have tried the j-pouch. However, since i didn't really feed bad enough (LOL! - there's a whole 'nother story there) to have surgery, i lived on Budesonide and Prednisone for another 7 years before i wised up) to have surgery, i pushed it off. Well, when if finally came time to act, even though i had two surgeons tell me i was a good candidate for the j-pouch, i decided on a pouch because 1) - it would have taken 3 surgeries and time on the calendar i didn't have, 2) it would have involved potentially more surgeries if things did not go right (like a surgery to give me a permanent stoma anyway), and 3) the prednisone had really weakened me (i knew it, Dr.'s didn't realize 'til later, well after my surgery)...i knew that was correct because my surgery was in 4-11-2011, and I just now feel "normal" again..no prednisone, no pain killers, no nausea medication..no medication at all....clean!

Congrats again on making this decision for yourself, and for your family....6 months after, you will be happy you did...

God bless you!
jimmy
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