Two days before surgery: a little bit jumpy, Jenny Hayden? (StarMan reference)

 

A little nervous today, more about the hospital stay (4-7 days), not so much about the surgery (I’ve had so many) or even the urostomy. Jeff and Kristin coming over later today to go out to dinner. I like that. Earl let me beat him at pool, 3 games straight. He’s too kind..lol

Got a call from Dr. Sanford in Dr. Breyer’s office to tell me I would have to do a modified bowel prep (just two  bottles of Mag Citrate) tomorrow night before surgery. See below.

Got an email from Melissa in Dr. Breyer’s office letting me know I’ll be the first surgery of the day. Check in at 6:30AM, surgery at 7:30AM, 4-5 hour surgery plus 2 hours in recovery before Trish and Peggy and Earl can visit. Long wait for them. They are the best!

We’ll head to San Francisco tomorrow around 9AM to pick up the key from our friend Richard, who is letting us (well mostly Trish) stay at his home near the hospital. Richard is so generous and we just love his dog, Karl, too!

 

Just had my pre-op anesthesia consult phone call from Dr. Pappas at UCSF Med Center. All the usual stuff, no food or drink after midnight on Thursday. This is a new one:

Would I want an epidural in addition to general anesthesia to reduce the amount of pain meds needed during and after surgery? (see below) Sounds interesting…the fewer drugs the better. Will discuss with Dr. Breyer at my consult with him at 3PM tomorrow. Questions for Dr. Breyer:

1. Epidural anesthesia option?

2. Can Trish say in the hospital room with me the first night after surgery?

3. Continent Diversion vs. Urostomy?

What is permanent urinary diversion?

Permanent urinary diversion requires surgery to reroute urine flow to an external pouch through an opening in the wall of the abdomen, called a stoma, or to a surgically created internal reservoir. Stomas range from three-fourths of an inch to 3 inches wide. Surgeons perform permanent urinary diversion when a patient has a damaged bladder or no longer has a bladder. Advanced bladder cancer ranks as the most common reason for bladder removals. Bladder damage may result from nerve damage, birth defects, or chronic––or long lasting––inflammation. Nerve damage severe enough to require permanent urinary diversion generally occurs from multiple sclerosis, among other diseases; spinal cord injuries; and damage caused by pelvic trauma or radiation injury. The most common birth defect requiring bladder surgery is spina bifida. Chronic bladder inflammation can result from severe cases of interstitial cystitis or chronic urinary retention. Interstitial cystitis is a condition that causes the bladder to become swollen and irritated, leading to decreased bladder capacity. Urinary retention is the inability to empty the bladder completely. Read more in these publications at www.urologic.niddk.nih.gov:

What is a urostomy?

A urostomy is a stoma that connects to the urinary tract and makes it possible for urine to drain out of the body when regular urination cannot occur. The stoma has no muscle, so it cannot control urine flow, causing a continuous flow. An external pouch collects urine flowing through the stoma. Ileal conduit and cutaneous ureterostomy are the two main types of urostomy.

Ileal Conduit

An ileal conduit uses a section of the bowel—usually the small intestine—surgically removed from the digestive tract and repositioned to serve as a passage, or conduit, for urine from the ureters to a stoma. One end of the conduit attaches to the ureters; the other end attaches to the stoma. The surgeon reconnects the bowel where the section was removed so that it functions normally. The urine flows through the newly formed ileal conduit and the stoma into an external pouch.

Drawing of an ileal conduit diversion, with stoma enlarged in inset box. Labels point to a stoma, large intestine, ileal conduit, and small intestine.
Ileal conduit and stoma

Cutaneous Ureterostomy

In cutaneous ureterostomy, the surgeon detaches one or both ureters and attaches them directly to a stoma. This type of urostomy is not as common as an ileal conduit because of a higher complication rate and the need for follow-up surgery. A surgeon performs cutaneous ureterostomy when the bowel cannot be used to create a stoma because of certain diseases and conditions or exposure to high doses of radiation.

Drawing of a cutaneous ureterostomy. Labels point to two stomas and two ureters.
Cutaneous ureterostomy

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What is continent urinary diversion?

Continent urinary diversion is an internal reservoir that a surgeon creates from a section of the bowel. Urine flows through the ureters into the reservoir and is drained by the patient. Continent urinary diversion does not require an external pouch. Continent urinary diversion consists of two main types, continent cutaneous reservoir and bladder substitute.

Continent Cutaneous Reservoir

A continent cutaneous reservoir connects to a stoma. A surgically created valve keeps urine from flowing out of the stoma. The patient inserts a catheter through the continent stoma to drain urine from the reservoir several times throughout the day. The stoma is very small––less than 1 inch wide––and sometimes can be hidden in the belly button.

 

Drawing of a continent cutaneous reservoir. Labels point to the reservoir, two ureters, and a stoma.
Continent cutaneous reservoir

 

Epidural Analgesia

What is Epidural Analgesia?

Epidural analgesia is an injection of local anaesthetic alone, or more commonly in combination with pain. The injection is usually made in the lumber region at the L2/3 or L3/4 space.

Magnesium Citrate Bowel Prep


Clear Liquid Diet

  • Broth — chicken, beef or vegetable
  • Jell-O — No red or purple dyes
  • Popsicles — No red or purple dyes
  • Fruit juices — NO Orange Juice, Grapefruit juice or V8
  • Coffee — WITHOUT creamer, but Vanilla Boost does work!
  • Tea — hot or cold
  • Soft drinks — Coke, Diet Coke, Mountain Dew – No red or purple dyes
  • Gatorade — No red or purple dyes
  • Any clear drinks — water, sprite, lemonade, etc.
  • Boost — (up to six cans) the day before your procedure ONLY & Chocolate and Vanilla ONLY (NO BOOST PLUS)

Resources

You Must Purchase the following:

  1. 3 Bottles of Magnesium Citrate (clear or green ONLY)
  2. 3 Dulcolax Pills
  3. 1 Water-based Fleets Enema

You must complete ALL STEPS below to be cleaned out PROPERLY

Prep Day: Starting the day before your procedure

  • You will drink 1 bottle of Magnesium Citrate at:
  1. 1:00 p.m.
  2. 2:00 p.m.
  3. 6:00 p.m.
    A Total of 3 Bottles
  • Then take the 3 Dulcolax pills, after finishing the last of bottle of Magnesium Citrate.
  • You must drink AT LEAST 8oz. of water every 2 hours that you are awake. You may have theclear liquid diet until midnight, the night prior to your procedure. (Please see list on right)
  • If you are NOT COMPLETELY cleaned out after finishing your prep, you will need to give yourself a Water-based Fleets Enema.
  • DO NOT eat or drink past midnight, the night prior to your procedure. Doing so may result in having to reschedule your procedure, due to insufficient bowel prep.

* * * Your Bowel Movements should be CLEAR like URINE!! * * *

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