My Sigmoid Colon and Choosing The Right Surgeon

Peter_S
Peter_S Member Posts: 109
in Colorectal Cancer #1

Hi Folks,

 

Hope all is well with everyone here and that fighting the good fight continues.

 

I had a CT scan which showed that the middle of my sigmoid colon has gotten very narrow and this more than the cancerous tumor is what's causing the constipation and making it so difficult when I actually do try and get something to pass through.

 

I see the surgeon this Tuesday he's got great credentials and practices out of Yale where he heads their colorectal surgery group. It's far from where we live and I worry about being so far from home (an hour there and an hour back) but the surgeons reputation and credentials outweigh my anxiety.

 

I do have an appointment with another surgeon on Thursday who also has a good reputation, excellent scores on Healthgate and Vitals.com and he practices out of a hospital 10 minutes from were we live which would make it awfully easier on my husband and family - but my gut instinct is to go with the guy at Yale because then I can tell people I went there (j/k) anyway if anyone wants to weigh in about this, I'm all ears.

 

A few questions:

 

* Am I right in assuming that the entire sigmoid colon will be removed?

 

* Is it more than likely that I'll have a stoma and some sort of appliance like a colostomy or ostomy bag?

 

* I know pain is relative but what level of pain should I be ready for, please let me know of your own experience if you care to share it.

 

Thanks in advance for any feedback

 

Peter   
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Comments

  • abita
    abita Member Posts: 1,135 Member
    #2
    I think we are all different.

    I didn't get a bag

  • abita
    abita Member Posts: 1,135 Member
    #3
    Important to do what they say

    Important to do what they say.

  • Trubrit
    Trubrit Member Posts: 5,643 Member
    #4
    Questions I can't answer, but...

    I had to travel 360 miles round trip for my surgeries, and treatments. When I did radiation, five days a week for six weeks, I was lucky to have a friend offer her home. 

    It was hard travelling during the winter months, but thanks to my husband, we made it work.  While it is a consideration, travel should be the least of your worries. 

    Good luck in your decision. 

    Tru

  • Peter_S
    Peter_S Member Posts: 109
    #5
    Trubrit said:

    Questions I can't answer, but...

    I had to travel 360 miles round trip for my surgeries, and treatments. When I did radiation, five days a week for six weeks, I was lucky to have a friend offer her home. 

    It was hard travelling during the winter months, but thanks to my husband, we made it work.  While it is a consideration, travel should be the least of your worries. 

    Good luck in your decision. 

    Tru

    Thanks Tru

    My post was poorley written, travel isn't the deciding factor - I'm glad you didn't let distance determine your treatment and went where you needed to go for your treatments. I'll be going to the Surgeon at Yale New Haven and will keep everyone here postd with my progress, best always, Peter

  • Peter_S
    Peter_S Member Posts: 109
    #6
    abita said:

    I think we are all different.

    I didn't get a bag

    That's great news

    Abita - that's good to hear and thanks for the reply, Peter

  • SandiaBuddy
    SandiaBuddy Member Posts: 1,272 Member
    #7
    Intuition

    My only advice would be to go with the surgeon you feel best about.  He or she will be able to answer the questions about how much will be removed.  As to the pain after surgery, it was not at all bad for me.  I was up and walking the day of surgery and I recovered fairly quickly.  The one thing I was not ready for was needing some help sitting up in bed when I got home--those muscles you have depended on for so long will be compromised.  One step at a time, and you will be able to handle it all.

  • JanJan63
    JanJan63 Member Posts: 2,478
    #8
    See both surgeons and choose

    See both surgeons and choose who you feel more comfortable with. My surgeon got good reviews for his work but not for his personality. People called him arrogant. I saw it as confident. My first oncologist gets great reviews because she's so 'nice'. I found her to be wimpy and not confidence inspiring at all. The one I changed to doesn't get the greatetst reviews but I think she's great. She thinks outside the box, she had the forsight to have my tumour checked for it's vulnerability to the chemo that I go on. 

    For me the situation was that I had to have an illeostomy right away due to the size of the tumour and the possibility of it completely blocking me off. Then I had the surgery to remove the tumour several months later. I have the option of having the ostomy reversed but I never will. I had IBS and the ostomy has given me so much better quality of life that I don't want to not have it. I loathed it at first and couldn't wait to get rid of it. It made me feel like a freak. Now it's just part of life.

    I hope you'll find a surgeon that you like and the surgery won't be too bad. If you end up with an ostomy of some kind know that there are plenty of us with one and it's not so bad. 

    Jan

  • Peter_S
    Peter_S Member Posts: 109
    #9
    SandiaBuddy said:

    Intuition

    My only advice would be to go with the surgeon you feel best about.  He or she will be able to answer the questions about how much will be removed.  As to the pain after surgery, it was not at all bad for me.  I was up and walking the day of surgery and I recovered fairly quickly.  The one thing I was not ready for was needing some help sitting up in bed when I got home--those muscles you have depended on for so long will be compromised.  One step at a time, and you will be able to handle it all.

    Sandiabuddy Thank You

    Great advice and I appreciate it very much. Trying to process so much info so quickly has been difficult but at heart I'm optomistic and just have to exhale every once in a while. I look foreward to meeting the surgeon on Tuesday and I'm armed with a big notebook of questions - if you've ever seen the movie "What about bob?" with Bill Murry then you'll know what I mean when I tell you it's baby steps for me all the way.

    Thanks again,

    Peter

  • abrub
    abrub Member Posts: 2,174 Member
    #10
    I had a part of my sigmoid removed

    And then was reconnected to function "normally".  (I also had part of my right colon removed.  No stoma)  With the sigmoid, you may have to retrain muscles to push when you go to the toilet, as that part of the colon does much of the pushing out.

  • Peter_S
    Peter_S Member Posts: 109
    #11
    JanJan63 said:

    See both surgeons and choose

    See both surgeons and choose who you feel more comfortable with. My surgeon got good reviews for his work but not for his personality. People called him arrogant. I saw it as confident. My first oncologist gets great reviews because she's so 'nice'. I found her to be wimpy and not confidence inspiring at all. The one I changed to doesn't get the greatetst reviews but I think she's great. She thinks outside the box, she had the forsight to have my tumour checked for it's vulnerability to the chemo that I go on. 

    For me the situation was that I had to have an illeostomy right away due to the size of the tumour and the possibility of it completely blocking me off. Then I had the surgery to remove the tumour several months later. I have the option of having the ostomy reversed but I never will. I had IBS and the ostomy has given me so much better quality of life that I don't want to not have it. I loathed it at first and couldn't wait to get rid of it. It made me feel like a freak. Now it's just part of life.

    I hope you'll find a surgeon that you like and the surgery won't be too bad. If you end up with an ostomy of some kind know that there are plenty of us with one and it's not so bad. 

    Jan

    Thanks Jan - You're The Bees Knees

    You're the best and make some excellent points, I'll be seeing both surgeons and I'll choose where I feel most confident and secure. I admire how in control and level headed you are and how you're not letting cancer push you around it's inspirational. If I have to have a colostomy/ostomy that'll become my new normal, I'm thankful I have a life partner whose there for me every step of the way so this is just one more hurdle we have to tackle and we will. I'm loving this forum and want to give back as much as I can.

    BTW, you were 100% spot on, I won't know what stage my cancer is until the surgery and they test those lymph nodes so thanks for clearing that up. Now if only the hospital would let me bring our dogs, I can't imagine a week or longer without them  - thanks again Jan, Peter 

  • Peter_S
    Peter_S Member Posts: 109
    #12
    abrub said:

    I had a part of my sigmoid removed

    And then was reconnected to function "normally".  (I also had part of my right colon removed.  No stoma)  With the sigmoid, you may have to retrain muscles to push when you go to the toilet, as that part of the colon does much of the pushing out.

    Hi abrub and thanks

    Thanks for sharing some of your story, I'm happy for you that you didn't need the stoma and a collection device. Maybe with a little luck it'll be the same for me but if not I'll be grateful just to be alive and be able to pass waste regardless of where it's coming out of. Peter

  • abita
    abita Member Posts: 1,135 Member
    #13
    abrub said:

    I had a part of my sigmoid removed

    And then was reconnected to function "normally".  (I also had part of my right colon removed.  No stoma)  With the sigmoid, you may have to retrain muscles to push when you go to the toilet, as that part of the colon does much of the pushing out.

    oh my gosh, that explains a

    oh my gosh, that explains a lot. 

  • abrub
    abrub Member Posts: 2,174 Member
    #14
    abita said:

    oh my gosh, that explains a

    oh my gosh, that explains a lot. 

    No one explained that to me

    But when I did some research, I learned that the function of sigmoid was to move things out.  I couldn't understand why I couldn't bear down.

  • NewHere
    NewHere Member Posts: 1,393 Member
    #15
    Some Thoughts
    I am sorry you are here going through all this, and it looks like others have given you good advice.  My surgery was different than yours (location), but figured some thoughts.  Definately go with the doctor you feel comfortable.  Make sure you get all of your answers ahead of time and you feel that they listened and responded to all your concerns.  The first surgeon I met had some hesitation on certain things and I realized he was unsure of what he was doing.  

     

    Of course there are great doctors everywhere.  But Yale is a teaching hospital (I think), so you are probably getting state of the art.  It is on Top Cancer Center lists.  

     


     

     


    A few questions:

     

    * Am I right in assuming that the entire sigmoid colon will be removed?

     

    * Is it more than likely that I'll have a stoma and some sort of appliance like a colostomy or ostomy bag?

     

    On the top two questions, ask the doctor what they think.  My approach for all of this was prepare for the worst and hope for the best.  Meaning I found myself better off being in the mental headset of thinking the less acceptable outcome (to me) was the probable, be geared for that as much as possible and adjust accordingly on good news.  (My worst times during the last four years were when I thought I was finally about to get a good scan, etc. and being disappointed.)

     

     

     

    * I know pain is relative but what level of pain should I be ready for, please let me know of your own experience if you care to share it.

     

    It was relatively painless.  Waking up always kind of stinks for me.  I hate the feeling. In terms of pain, I had a morphine pump and hit the button more as a matter of being told to get ahead of the pain.  I had a couple of spasms which was the worst.  Ativan cleared it up quickly.  I was up and walking with my IV holder the day after the surgery.  The faster you are up and walking, the quicker you get released.   Overall there was discomfort and coughing kind of stunk, so pillows to the stomach helped.  The one thing I do know, the pain was quickly in the rear view mirror for me.  I was sore and maybe not a happy camper, but I was discharged after four days and did not take any pain killer they gave me when I was at home.  

     

    As I told people, I had a buddy who had a hernia surgery about 25 years.  He was a misrable wreck for quite awhile.  I had a ton more taken out 25 years later for a more serious issue.  I recall his pain and misery to this day and would never have a hernia surgery if I could avoid it.  Some colon being popped out, no biggie Cool

     

    Try to relax and take care of yourself as much as possible.  You got this.

     
  • tootsie1
    tootsie1 Member Posts: 5,044 Member
    #16
    abrub said:

    I had a part of my sigmoid removed

    And then was reconnected to function "normally".  (I also had part of my right colon removed.  No stoma)  With the sigmoid, you may have to retrain muscles to push when you go to the toilet, as that part of the colon does much of the pushing out.

    Interesting

    This is interesting to hear. My cancer was in the sigmoid colon. I was fortunate to have Stage 1 and not do chemo or have a stoma. However, ever since the surgery, I have had chronic constipation issues. I will be 11 years cancer free in Nov.

  • JanJan63
    JanJan63 Member Posts: 2,478
    #17
    Peter_S said:

    Thanks Jan - You're The Bees Knees

    You're the best and make some excellent points, I'll be seeing both surgeons and I'll choose where I feel most confident and secure. I admire how in control and level headed you are and how you're not letting cancer push you around it's inspirational. If I have to have a colostomy/ostomy that'll become my new normal, I'm thankful I have a life partner whose there for me every step of the way so this is just one more hurdle we have to tackle and we will. I'm loving this forum and want to give back as much as I can.

    BTW, you were 100% spot on, I won't know what stage my cancer is until the surgery and they test those lymph nodes so thanks for clearing that up. Now if only the hospital would let me bring our dogs, I can't imagine a week or longer without them  - thanks again Jan, Peter 

    Aw Peter, you're so sweet.

    Aw Peter, you're so sweet. Thank you for the kind words. I just hate being the person with cancer. I hate the idea of anyone pitying me and I hate that I'm no longer able to work or do many things because of it. It's changed my life so much and not in good ways. I have no choice in that but I do have a choice in how I respond to it. I'm here and will likely be here for years longer. I'm grateful for that. I've only ridden my horse once this summer due to the issue I had before the surgery last month. I'm sad but my daughter is giving lessons on him and she rides him to keep him in shape. I've had him for almost twenty years, there's no way I'd give him up, ever. I'd like to walk my dogs more but I can't. Today I'm having a miserable day but three days ago I was able to wash the bedsheets and blankets and make the bed myself. Two days ago I painted the new steps my husband built on our deck. On the good days I'll enjoy myself and do whatever I'm capable of. On the bad days I lie in bed and try to rest for the afternoon. It's not the life I'd choose but it is what it is.

    Tomorrow I'm hoping to get the dying plants out of the garden before winter. Last year I was in the hospital with sepsis in September. My colon had gotten irritated and had made small perforations that leaked out into my bloodstream. They identified 4 diferent colon bacterias in my blood. My point is that we got an early winter and the dead plants stuck up through the snow all winter. It drove me nuts thinking about it. 

    Jan

  • Butt
    Butt Member Posts: 352
    #18

    my cancer was in a sigmoid colon. get it laparoscopically if you can. No bag. Released after 2 days in a hospital. Went to work shortly. You can walk on a day of a surgery.

  • Annabelle41415
    Annabelle41415 Member Posts: 6,715 Member
    #19
    Opinions

    If you have appointments with two different surgeons, I'd listen to what they can tell you.  My first surgeon told me I'd definitely have an ostomy and after seeing my second surgeon he gave me hope of 50/50 and ended up having a temporary ostomy with reversal.  It's good to get a second opinion, especially when it comes to something permanent.  Wishing you the best - it's a scary place to be in right now and can truly relate.  Thanks for keeping us so informed about your journey right now.  It's a whirlwind of appointments, tests, surgeries, etc and you seem to be up on getting all the ground work down great.

    Kim

  • plsletitrain
    plsletitrain Member Posts: 252 Member
    #20
    Mine was an emergency resection....

    ...so I did not have full liberty of having to choose which surgeon nor was I able to research what to expect.  All I knew was when I was admitted to the ER because of abdominal pain, in the next 48 hours I would be resected.  I haven't heard of the bag before, heck I don't know any single thing about cancer except that it can kill you.  (No one in the family had it).  It is important to choose a surgeon you're comfortable with, and of course, competent in his field.  Trust your instincts (and word-of-mouth about the surgeon's expertise).

    As to your questions:

    I was put on temporary illeostomy but I haven't had it reversed and probably won't.  I'm more comfortable with the bag (although it could get expensive) than what I encountered pre-bag.  Having the bag is much easier to me than before (it was hell--I can't control my bowel movement, had to go every 15 minutes).  As to pain, I can't remember exactly because my abdominal pain before resection was so painful I think after the operation I was ready to face any sort of pain.  But aside from the needles, I think removal of the drain tube or something gave me some painful sensations but they were all tolerable.    

    I'm sensing you're going to do just fine during and after the surgery.  You're mentally and physically prepared for the surgery, you'll do fine. Best wishes.

  • steveja
    steveja Member Posts: 41
    #21
     
     

    >>* Am I right in assuming that the entire sigmoid colon will be removed?

     Pretty much.  About a foot of colon is typically removed. They 'drop' the splenic flexture (the upper left corner of colon)  so the left-colon is then much straighter.  They alway try to take at least 12 lymph nodes and remove the entire tissue as one unit - as this helps the pathologist and reduces the chance of any spread.   

     

    >>* Is it more than likely that I'll have a stoma and some sort of appliance like a colostomy or ostomy bag?

     

     An excellent question for your surgeon, but probably not.   Unless there are complicating issues, or they get close to the rectum, they usully do an anastamosis (connect the pipes) during surgery.  If they did need to do an ostomy it's extremely probable they'll 'reverse' it after a couple months, but from what you say an ostomy is unlikely.

     

    >>* I know pain is relative but what level of pain should I be ready for, please let me know of your own experience if you care to share it.

     

    Modest.   I had laparascopy surgery taking my sigmoid & the upper edge of rectum - so I have a ~5 inch horizontal scar a couple inches below my navel,  and two small 'port' holes for instruments on either side. Felt like a wet dishrag the day of surgery - zero energy.  I had a button with some opiod dose available, but only used it twice.  Just tylenol after that.   Was walking around the floor (they recommend getting up & walking) the next day every few hours - sort of a stiff/crampy feeling but nothing harshly painful. They released me after 2 days, tho' 3 is more common.   So honestly, the two most painful things were the catheter, and the heparin shots.  After any abdominal surgery they give you heparin (a blood thinner) shots several times a day - and it burns during the injection and make your arm sore.    When sitting or standing still - the abdomen muscles just felt a bit 'tight', or stressed/sore like the day after too much exercise.   When getting up or otherwise flexing stomach muscles there was a some pain, but nothing serious.

     

    At home I found it more comfortable to sleep in a recliner with few extra pillows for a few nights. It's very convenient to gather your stuff (tv, controller, laptop , phone, book, magazines, pills, something to drink) on a tray/side table, near a comfortable arm-chair and camp out there during the day.   You want the chair-arms so you can use stand using your arm muscles.   Just plan to take it very easy the week after you get home.   

     

    My opinion is that you should select the facility and doctor that do this procedure ferequently and is a member of one of the professional societies - like


     

    Ask if it's laparascopic surgery vs open (vs robotic).

    Ask about the anastamosis vs ostomy (if ostomy, then permanent vs temporary?).


    Ask how often he/she does this procedure recently (a hemi-colectomy).


    Ask about the expected time of hospitalization & home recovery.

    How long after surgery till you get the pathology report.

    Ask about followup schedule after surgery.

     

    - best wishes

     

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