My procedure will be a laparoscopic LAR. My surgeon spoke of a 10-15% chance of temporary stoma. I appreciate your response. I am eager to conquer surgery and see what I am facing in regards to staging, biomarkers, etc. It has been twenty-five days since diagnosis. Nine days until surgery.
Jacques, The link above will be very helpful!
With peace & gratitude,
Lee, no worries at all!
Our situations are very similar - I had a ULAR by lapro (robot) to remove a 3.5cm tumour which was around 10-12cm high. The only different is I was guaranteed a temporary ileostomy, due to prior radiation to the area. I’ve put some of my tips below - I have more but I’m a bit of a nut with these things (my hospital didn’t have a formal ERAS program so I had to run my own...), so I’ll stick to the big ones here.
I’ll include my stoma tips below, but of course we all hope you won’t have to worry about that!
- You may have a consultation with a stoma therapy nurse before the surgery to mark up where it will go. Wear your favourite pants to this appointment to make sure it doesn’t interfere with them.
- Ask the surgeon not to place port sites too close to the stoma! This makes healing and wound care way harder.
- It’s not an overly painful surgery, but I suggest asking your anaesthetist about a regional (spinal) block (morphine or long-acting fentanyl) to help minimise pain/inflammation and reduce need for opiates.
- You’ll probably have to do a bowel prep first, but if you have a 6 hour fast make sure you get some decent calories before the six hour mark (eg bone broth, jelly, etc). Also ask your anaesthetist if you can have a clear carbohydrate drink 2 hours before surgery (like Dex or Gatorade).
- Walk walk walk walk - small amounts frequently. The latest enhanced recovery guidelines target 1,000 steps within 24 hrs of surgery, 4,000/day after that, then 8,000/day by discharge. I didn’t quite manage this much, but I got pretty close. The key is to do small amounts, frequently.
- Take pain meds before walking if you need to. Progressing to oral Tramadol is good when you can to avoid the heavy opioids (eg oxycodone, morphine). Fewer opioids means less risk of ileus means earlier discharge. Also being off IV painkillers means fewer observations and earlier discharge.
- Start out by taking your meals sitting out of bed as soon as you can. Progress to spending the days sitting out of bed, only using the bed for naps or sleeping. You’ll recover a lot quicker this way, with less risk of complications.
- Start soft proper foods as soon as you can without nausea. Earlier eating = earlier discharge.
- Stoma nurses are directly descended from angels. Ask every question you have and don’t be afraid to ask more. Don’t stop until you’re satisfied with how your new friend is behaving.
- I slept propped up on pillows for about 2 weeks as lying flat was uncomfortable.
- Stomas or resected bowels tend to be quite “active” once they wake up, so foods that slow it down are good. Rice, bananas, mashed potato, banana bread, fish/chicken. Avoid raw fruit/veggies, mushrooms and any nuts for a while. If you have a stoma, stock up on Imodium too as most folk stay on this for some time.
- Plain water doesn’t do much to rehydrate ileostomates. Pick up some oral rehydration salts from the pharmacy, mix yourself up some St Marks Solution, or in a pinch use Gatorade (though the sugar levels may contribute to high stoma output).
Best of luck with it - it’ll all be over before you know it.