Sunday, August 31, 2008

Hutt Hospital

This is to say thank you to the General Surgery staff at Hutt Hospital for their treatment of Geoff's latest twisted bowel. The stay in the General Surgery Ward was a miserable time; I imagine it is for most patients. After abdominal surgery, the drugs take away most but not all of the pain. The anti-nausea drugs are only effective some of the time. And you feel pretty much like you've been run over by a bus. Things pick up when the body is eventually ready for food again.

But the staff do an excellent job. The doctors are informative and friendly. The nurses never stop working; their workload is very high. Yet they take the time to do a thorough job: they don't rush things. They are patient and kind, and many of them work hard to find creative solutions to every challenging problem a patient has.

Geoff had a room to himself when he first came out of surgery but was moved into a four-bed room a few days later. At one point the ward was so full that there weren't single rooms available for all the most seriously ill patients and one gentleman returned from major surgery to a bed opposite Geoff. Some hours later, when the doctors did their rounds, he was given the news that they had found a tumour, probably cancerous, and that chemotherapy was likely to be recommended. The news was given behind curtains but with three other patients, and me, in the room, which I'm sure added to the awfulness of it. I think of the gentleman often, hope he's doing okay.

Monday, August 25, 2008

Intestinal Malrotation

An obscure heading for a blog post perhaps but, for the last hectic fortnight, our lives have revolved around Geoff's intestinal malrotation. Between the fourth and twelfth weeks in utero, our developing intestines undergo a rotation, positioning themselves in the abdomen. For unknown reasons, in some cases the intestines do not rotate into the normal position. Usually in these cases the small intestine positions itself on the right of the abdomen, the large intestine on the left. As a result, the base fixing the small intestine to the abdominal wall is narrow rather than broad (represented by the dots in the diagram below), predisposing the person to volvulus (twisting of the bowel). Also as a result, bands form connecting the caecum (part of the large intestine) to the abdominal wall, which cross and can obstruct the duodenum (the top of the small intestine).

Most cases of intestinal malrotation manifest, and are surgically treated, in the first month of life, and almost all in the first year. Geoff wonders if he did show signs at the age of one month but his symptoms eased on their own and were put down to having been introduced to solid food at too early an age, Plunket in all its wisdom recommending in those days that babies start solids at one month of age.

In a few cases, symptoms do not appear until late childhood or adulthood or not at all. Geoff's experience of intermittent abdominal pain throughout his adult life is fairly typical of those.

Two years ago, Geoff had his first twisted bowel, a caecal volvulus. Geoff underwent urgent surgery, as is usual for volvulus because of the risk of ischaemia (restriction in the blood supply) leading to necrosis (death of cells) of affected intestine, and death. We were told after that first surgery that Geoff had intestinal malrotation but we didn't understand that he was therefore at a heightened risk of twisted bowel in the future.

Just over two weeks ago, Geoff had a second twisted bowel, this time a midgut volvulus. He is recovering well now. Good news is that this time, as well as correcting the volvulus, the surgeons performed a Ladd's Procedure which corrects some aspects of the malrotation, minimising the risk of further twists or obstruction.

With his belly all distended, I thought Geoff looked 5-6 months pregnant. Here he is ten days after the surgery.