Posted tagged ‘nasogastric tube’

My Journey with NETs: Part Five

September 14, 2016

An Exercise in Perseverance: the Hernia Repair and subsequent events

In South Africa, March is the start of Autumn so we travelled to Johannesburg with little in the way of warm clothes expecting to be there a maximum of three weeks; little did we know that we would be there three months and that I would be in hospital for around two and half months.

The start was straightforward, we travelled to Johannesburg by car on the 27th March (Easter Sunday) and I booked into hospital at 6am on the day of my hernia repair operation on Tuesday 29th March 2016. Professor Botha said that the hernia was larger than he had anticipated, but that he had successfully put it back using a ‘biological’ mesh.

After the operation I ended up in ICU for a few days and was then sent to a general ward for my recovery. I was familiar with the hospital routine, with nurses doing regular BP, Glucose levels and temperature checks at regular intervals, and of course Clexane injections in my stomach area to limit the risk of deep vein thombosis; I was alsso of course having daily physiotherapy. There were some issues namely the development of cellulitis on the left side of the wound and a reaction to the Clexane in the form of red patches which developed at the sites of the injections. The other issue was that I did not feel like eating and was picking at my food. The Doctors were anxious that my bowel should work, and with the help of a daily dose of Movical this started happening but in a somewhat limited way.

Then one afternoon I felt incredibly sick and vomited green bile (engine oil colour) several times. One of the surgeons on the team Dr. Anders Grotte, who was on hand diagnosed a blockage of the bowel which was confirmed by ultrasound and CT scans. Then, (probably my worst experience) , a young nurse came in to the ward to administer what in medical terms is known as a Nasogastric Intubation involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and down into the stomach as a sump tube to remove the bile. I don’t think the nurse was experienced in this procedure and I ended up with blood coming from my nose before I literally shouted for her to stop. Fortunately Anders appeared and with the help of local anaesthetic spray in my nose and throat, gently managed to insert the tube without further trouble.

Scans revealed that a section of bowel was stuck to the mesh and I was wheeled into theatre for a second operation to unblock the bowel which involved a new vertical cut following the route of the first op I had in 2009. Fortunately they were able to free the bowel without cutting a section away.

Back in ICU, I had a central venous port inserted into a vein under the collarbone and was fed intravenously with a carefully prepared formulation from a plastic bag on a stand above my bed. This continued for several days and I think I had a total of six bags of the formula.

Then I contracted a gram negative infection: Klebsiella, and was put on antibiotics. The days that followed are something of a blur of medical personnel changing drip lines and continuous monitoring of vital signs, blood tests, ultrasounds and CT scans. It was suspected that I had a mesh infection and there was a fluid build-up below the mesh.

The other issue was the fluid leaking from the new wound for which a wound specialist Sister Jane Hoole, attached to the Hospital administered what is known as vac therapy involving a special foam dressing on the wound attached to a pump which using negative pressure draws fluid from the wound into a canister; she visited me in hospital every second day to check, and where necessary replace the dressing and remove the collected fluid.

In the period of this hospital stay, I was visited every day by Prof Botha, Prof. Britz and/or other members of the surgical team, including Dr Anders Grotte. They were I think  dismayed at my situation and concerned that unless the situation improved, I might well have to be taken back into theatre for the removal of the mesh.

Fortunately this was avoided, and after a number of weeks in hospital, I was eventually discharged with the caveat that I needed to watch for evidence of further infection when I would need to report back immediately.  I departed with a portable vac pump and vac dressing with a commitment to visit Sister Jane Hoole twice a week.

During our time in Johannesburg we were fortunate to have been able to stay with Colleen’s sister Pauline and her husband Mike in their home in Chartwell. This is where I returned after this long stay in hospital, and was grateful for the support given to us by the family and their graciousness in allowing us to stay for such a protracted period.

In the meantime, autumn was changing to winter and Colleen was obliged to buy warm clothes for us both, as we had only brought up summer gear expecting that our visit would last a maximum of three weeks.

I checked in with Professor Botha on one day and we discussed the possibility of our returning back to Durban. He was not too concerned but emphasised the need to watch for infection and to immediately book myself into our local hospital in Hillcrest if this occurred and get the local Doctors to phone him or a member of his team for background and advice.

On the question of the timing for the PRRT treatment, Prof. Botha felt that I needed to have a clear month with no infection before proceeding with the motivation.

Sister Hoole was also happy for me to return to Durban and agreed to contact a colleague of hers based in Durban who I could visit for follow-up treatment.

I agreed to wait another week for my next visit to her rooms before leaving for Durban. But this was not to be.