In the tackling of every major challenge, we typically have our share of ups and downs. Battles that we win that propel us forward, and battles that we lose that temporarily set us backward. You can usually sense the overall progress forward, even in the losses, but it is the small wins that build and sustain the fortitude to push onward.
Within this obstacle of cancer and surgery, one of these early battles stands out above the rest...
The NG Tube.
The NG stands for "nasogastric." I also believe it stands for "not good."
Although, to be fair, it is only "not good" from an experiential standpoint. From a functional standpoint it is a very useful and helpful (albeit uncomfortable) medical tool.
Let's let Wiki step in here:
"Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions.
If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomach's lining. In non-emergency situations, intermittent suction may be applied giving the benefits of suction without the untoward effects of damage to the stomach lining.
Suction drainage is used for patients who have undergone a pneumonectomy in order to prevent anesthesia-related vomiting and possible aspiration of any stomach contents. Such aspiration would represent a serious risk of complications to patients recovering from this surgery."
So as you can see, it serves a very important function. And, truthfully, not one person misrepresented my need for it, nor the "suckiness" of having it in place.
Way back in June, during my first appointment with Dr. Ong in Seattle, he told me I would need an NG tube and that it would suck. Every person who I talked to since then corroborated that sentiment, including Dr. Foster, when I met with him in October. Although, for the record, I do not believe he actually used the word "suck."
It's worth pointing out that to say that the NG tube "sucks" is true on at least two different levels; a coincidence that hadn't occurred to me prior to having that constant suction sound whirling away twelve inches away from my ear, all day and night.
While uncomfortable, I didn't really dwell too much on my NG tube the first few days after my surgery. It was late Friday night (my surgery was on Tuesday), that it all set in. The nurse that evening did a flush of the tube, and something changed. I don't know if the position changed, or just my sensitivity changed, but it suddenly became very uncomfortable.
I had a number of gag responses that night and the next day, and it hurt to swallow. I knew that it was pretty standard to have it in for four days post-op, and and I knew that I was on day four.
I was determined to try to have it removed that day, and the idea had worked deeply in to my brain. There was no shaking it. I even made a public offer of flowers, donuts, and coffee to the individual who could help me make it happen.
And after I passed all of the requisite tests, it did come off that afternoon. (And the flowers/donuts/coffee offer was paid in full.)
It's one of those things, you know? Those things you don't appreciate until it is taken away from you. Breathing and swallowing and being able to quench your dry mouth and throat. Having the NG tube out made me feel like my recovery had increased by 500%. For hours afterward I just lied there and appreciated the experience of it all.
Each day in the hospital was pretty similar to the others. The surgery team typically came in between 6am and 6:30am to do rounds, my vitals were taken and my meds were given every four hours (with miscellaneous IVs and other asundry things happening in the spaces in between). The pain team came in mid-morning. Dr. Foster made his way in some time during the day, depending on his schedule. And, of course, I had my daily walks, which began with a walker and progressed to just the IV pole.
A highlight of all of those days were the nurses. I can't say enough about the staff at UNMC. Everyone was so great and helpful. If you ever have to have this surgery, I highly recommend you at least consider Dr. Foster and the UNMC team.
And speaking of the UNMC team, Dr. Foster is the Man. His numbers (complication rates, days in hospital, re-occurrence rates of disease, etc) are excellent and his bedside manner is unparalleled. He is loved and admired by so many people and when you meet him, you will understand why.
Again, if you are confronted with having to have this surgery, I highly recommend you go visit Dr. Foster.
But back to me...
On Wednesday, eight days after the surgery, I was discharged. It felt so good to not be confined to a hospital room, but as soon as I got home I was presented with other challenges. Managing three drain tubes and a wound vac is pretty easy when you are lying around all day, but it adds another level of complexity as you try to navigate life at home.
Wednesday night went decently, and on Thursday I was just trying to focus on eating and pooping; both large steps in the recovery process.
On Thursday afternoon I was feeling a little "off," and as the afternoon went on, that "off" feeling turned in to a nauseous feeling.
There are numerous reasons why vomiting is a bad idea for someone in my situation. One, the bowels get sleepy after operations like this, and it is important that you get them to wake up and start moving things downward. So vomiting is kind of a step backwards. Two, when you have a new 8 inch incision in your abdomen, the abdominal muscle contraction of vomiting can be no bueno.
But vomit I did. Over and over and over. The No Good Very Bad Day.
We finally made the call to go back to the hospital. I sat in the back seat of my parent's Jeep and continued to vomit pretty much the entire way back.
At the hospital they tried a few things via IV but nothing was working the greatest to stop the nausea. I kept wondering how it was possible that I could vomit 20-30 times. It didn't seem possible that I had that much of anything inside of me.
Eventually, the resident came in and said that Dr. Foster had told him that if I continued to vomit, they were going to have to put an NG tube back in.
My will became resolute. I was not going to vomit one more time. And thankfully, I think I had pretty much emptied myself by then. Finally, they administered Compazine, and that seemed to be the ticket. Relief. I think I fell asleep not long after that.
The next day Dr. Foster explained that this is a common occurrence. It can happen when the bowels are still a bit frozen, and everything just starts to back up. It can also be a side effect of the chemo treatment that was used during surgery.
At any rate, after a couple of bowel movements I was back on track and ready to go back home by Friday afternoon.
I've mentioned the drain tubs and the wound vac a few times. See the three photos below:
The first photo is the incision itself, with Steri-strips over top of it. You can also see two of the three drain tubes coming out of my torso.
In the second photo the wound vac is applied over the top the incision. The tube that is attached leads to a small portable vacuum type box that applies constant suction to the area. The medical adhesives that are used to apply the wound vac gave me the opportunity to experience an abdominal and upper pubic waxing two times every week. You might think that this free manscaping would be a nice little perk, but another wound vac is just applied over top, so one doesn't really gain the "aesthetic benefits" from having it done.
The third picture is just for reference. That was on my 48th birthday, in October of 2014. I was probably about 163 lbs in that photo. Right now I am in the 148-150 lbs range. This would seemingly put me in the Matt "Bear" Novakovich boxing weight class, but seeing as how I am not allowed to lift more than 10 lbs, I imagine punching, and getting punched, are out of the question.
As for the drains, they are called JP drains, and they are used to collect bodily fluids from surgical sites. The suction of the little grenade-shaped bulb at the other end is what helps pull the fluid out. Dr. Foster has, on a number of occasions, referred to this fluid as "peritoneal sweat," but frankly, I have no idea what that is. I will just trust him on that one.
I have been home now for ten days, and like in the hospital, those days are all very similar to one another. I watch sports, I read a little, I get on my laptop now and then, and I take lots of walks around the house. The weather in Omaha has been cold and off and on snowy, so outside hasn't been a really great option.
One of the (many) reasons I decided to have this surgery in Omaha was because my father has also been going through some medical issues, and it was going to be a lot easier on my family for me to have the surgery here. But a result of that is that there are numerous times throughout the day when both myself and my 74 year old father, dressed in sweat pants and long sleeve flannel shirts, are shuffling around the house with tubes coming out of our bodies. It paints a whole new perspective of the phrase "Oh god, I am becoming my father." :)
As of today, 12/1/15, I am down to two drain tubes. Yesterday, Dr. Foster decided that the incision was healing really well and took the wound vac off. It is great to not have to carry around that little satchel containing the vac system anymore, but for the first 12 hours I definitely felt more "vulnerable." As today goes on it feels better. It is likely that within a week both drain tubes will come out, and at that point I will be "tube free."
There has been one very important aspect of this whole experience that I haven't written about yet, and that is how Rose has risen up to the occasion. She is basically in a cold, flat, state, away from her friends and family, living at her in-laws house. I will give you a moment to let that sink in.
Rose stayed with me at the hospital every single night, and for a good part of the day. She read Facebook comments to me at 2:30am during "The Dark Night," and was basically there to volunteer to help out with anything that I needed. Since we've been home she has been just as helpful, while trying to fit in make-shift workouts whenever she can.
I am both grateful for her, and proud of her. She has been the champion that most of you already know her to be from Spartan Races. It has been a trying time, perhaps for her more than me, and she has held up extremely well.
Thank you, babe. You are awesome.
And a special P.S. shout out to Amelia Boone and Matty Gregg who took the time to set up a GoFundMe account to help me and Rose cover our medical expenses. https://www.gofundme.com/timandrose
Their kindness is of no surprise to those who know them. They are extremely special people, and we owe them, and all of you who have contributed, the largest thank you. We have the most amazing friends and supporters. We are truly blessed.