giovedì 25 giugno 2015

Colectomia totale ( EN English version )

            OSTOMY SURGERY 

Dear friends,
I am here :-) and I feel fine and so happy to be able to write again; already 10 months have passed since my first surgery. The recovery was a little bit 'hard”but on the one hand my psychologist helped me by providing talk therapy to achieve my goal (get my physical suffering over, improving my social conditions and having more successful personal relationships), and on the other hand my husband helped me to discharge my aggressive feelings by giving me constant sympathy and protection.The first thing, I would like to focus on -before doing a summary of the Ostomy surgery- is that I can not believe that I stopped the medicines. As soon as I wake up in the morning and then I prepare my breakfast I look at the place where I had all the medicine and now is EMPTY !!!
I think positive and I feel strong and determinate
( May 2015)
Now I can go out without having to go to the bathroom and I can taste everything:-)
( February 2015)
At the suggestion of my rheumatologist I am going in the swimming pool to do rehabilitation,because the long-term use of the steroids cause muscles weakness and wasting. I have also so much pain and other disorders of the joints and ligaments caused by the reactive arthritis. 
Besides, I'm doing yoga and meditation, so that I can face the second surgery (J-pouch anastomosis with a stoma protection)
                                                                        ( May 2015)
July 2014: I received the call from the assistant of the Professor five days before the surgery, by explaining everything I needed to do, and the hospitalization  would hold up ten days. I arrived in the hospital on July 23 and the surgery was scheduled for July 24. I presented myself on the morning of twenty-three of July to make various tests and control examinations and I had to be fasting from the night before, then I had the interview with the anesthesiologist to discussa about my anesthesia and the surgeon as well, who told me that the ostomy of the bowel, will be in three-part surgery. The current operation will be the total removal of the colon with a packaging of a temporary ileostomy ( loop ileostomy) , followed by two more operations.
He explain me how it works :
The first operation ( step one ) involves the total removal of colon except the rectum with a temporary ileostomy ( loop ileostomy ), since removal of the rectum can lead to complications with the anal sphincters. So the colectomy will be performed as an emergency because i was extremely ill,and then in separate stage it will be the removal of rectum and the J pouch construction will be performed.
The surgeon creates a stoma by bringing the end of the small intestine through an opening in the abdomen and attaching it to the skin to create an opening outside the body. A stoma may be three-fourths of an inch to a little less than 2 inches wide. The stoma is usually located in the lower part of the abdomen, just below the beltline. A removable external collection pouch, called an ostomy pouch is attached to the stoma and worn outside the body to collect intestinal contents or stool. Intestinal contents or stool passes through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever peristalsis occurs.
 The second operation ( step two) is performed after 7 or 10 months ( sometimes called " takedown" ) in which the ileostomy is reversed. The reason for the temporary ileostomy is to allow the newly constructed pouch to fully heal without waste passing through it, thus avoiding infection. This step consist of the remove of the rectum and the connection of the ileon to the anus by creating a J-pouch .
In a J-pouch anastomosis, a 12 inch section of the small intestine is formed into a J-shaped pouch in order to replace the function of the rectum and store stool until it can be eliminated. 
Finally after 5 months we will go on with the third operation ( step three) to remove the external ostomy pouch and keep the ileo-anal pouch .
                                                            ( July 2014-Bologna Hospital) 
On the same day, I had a bowel preparation with 2 litres of an oral laxative solution, in order to clean the colon of fecal contents and the nurse advised me that my surgery was scheduled for the 07:30 am the day after; I was the first on the list. I was psychologically ready to face this surgery, because I wanted to cure myself and get better. The day after 6:30 the nurse brought to me the compression ( anti-embolism) stocking and shirt. My sister and my husband was at my side. Despite my weakness, we have connected our hands together, so they could hand their strength and positivity on me.
( July 2014 -  2 hours before  Ostomy surgery - Bologna Hospital )
My operating room nurse greeted me and went with me into the operating room. I prayed !!
I felt calm, thanks to drops of valium they had given me before; my anesthesiologist Emanuela was very capable. The day before during the interview I said to her that I am afraid and she told me that it was better to take Valium drops before come under general  anesthetic. The surgery lasted only two hours; the surgeons were very capable and fast. It was removed the entire colon except the rectum with a temporary ileostomy ( loop ileostomy). I woke up after the operation with no pain because I was under morphine and I was attached to the intravenous drip in both my hands and I had also gastro nasal tube, anal and urinary catheter and I had also two drainages in the belly to take away the blood. The surgery went very well and the next day the physiotherapist forced me to get up and sit up but it was so difficult and painful because I felt dizzy and then  the wound was so large in vertically  position just below the sternum to just above the pubic bone, stitched up internally and externally. During the visit of the surgeons, they wanted me to walk up and told me that I should not stay in bed; the physiotherapist came every morning to help me and sit up in a chair and then to walking.
( July 2014 - Bologna hospital) 
After surgery and because of the morphine, the small intestine stops working; when it starts to work again the pains are very strong; It feels a movement and the ostomy pouch begins to fill up with bile and air. At this point the nurse removed the gastro nasal tube and I started to drink only water and then eating step by step. After 5 days the nurse removed the anal and urinary catheters and in the end the most painful was the remove of the two drainages that i had in my belly.I was under morphine for five days, starting from 1.5 up to 0.5 and then to stop. When I stopped the morphine I felt so bad but the next day I was back completely normal. I also had a little bit of fever, because of the absence of cortisone but after getting cortisone I came back completely normal. While I was recovering in hospital, the stoma nurse teached me how to care the stoma, including how to empty and change the bag, also how to keep the stoma and the surrounding skin clean and free from irritation. She explain me the different types of equipment; I choose the COLOPLAST supplier. The first approach with the stoma was terrible but then my psychologist helped me to accept the temporary ostomy pouch, because it gave me my life back.
                                             (  August 2014 - February 2015 - in my home )  
For the first 3 months, I followed the necessary changes to my lifestyle and to a diet a low residue(no fibre), because the food with fibres increase the activity of the small intestine, by causing the frequency and amount of the faces . My large intestine ( a site of fluid absorption) is no longer a part of my digestive system and the fecal matter that exit from the stoma has a high water content. That's why I have to drink 2 litres of water a day. Now I resume a normal diet and I returned to my normal activities. My day starts with a juice of fresh fruits and vegetables (beetroot, carrot, celery, lemon, apple) and a cup of barley coffee with goat's milk and a piece of homemade cake with emmer flour and my homemade jam; At mid morning, I have my homemade yogurt, then for lunch I eat the pasta with ground beef, interchanging with the fish or the escalopes and then for snack I have a banana and I drink a lot of fresh water between my meals. Then in the evening I prepare a soup with homemade vegetable stock cubes and Parmesan. Following this nutrition my weight increased in nine kilos and my analysis are perfect; I digest everything and I do not have vitamin deficiencies. I also take the Vit D to treat osteoporosis caused by steroids. I'm doing a normal life, even though it is not easy to live with the ostomy pouch because it limits you in so many things, but as I have always said:
 I am back :-)
                                                                  ( May 2015)
During this period I am in relaxing and I live every single day like it is a gift, because  IT IS !!! 
I attend also some online course related to my job in order to be updated  when I return to my office that I miss  so much .
This terrible disease, suffering and surgery has made me a stronger and positive person.
I am waiting for the call  for the second operation (step two) of anastomosis with J-pouch with a stoma protection;  A BIG thanks to my manager, his assistant and my colleagues for their support during this period of convalescence.

you never know how 
you are 
until being strong is the 
choice you have 
Chara F.

mercoledì 24 giugno 2015

Colite Ulcerosa ( EN English version )


July 2013 (during my lunch time - Italy) 
Dear Friends,
About five million people in thirty-six countries are diagnosed with Crohn's disease  and  ulcerative colitis. We need to talk about our disease with the hope that we can help  each other  .
I decided to write my story and publish the pictures, after I saw the model Bethany Townsend suffering from Crohn's disease posing in bikini with her colostomy. In a few days I' m going to make the surgery of Ostomy in the Department of Surgery of S. Orsola Hospital in Bologna, Italy. It is the center of excellence, the third in Europe, for Crohn's disease and Colitis ulcerative, directed by the Professor Gilberto Poggioli . I have to do the total remove of the colon with a temporary ileostomy packaging.I can not wait that time, to get better and give an end to this nightmare .....
Everything is started 26 years ago, after the birth of my daughter; I was 27 years old. I remember I had a lot of pain, blood  and diarrhea but no doctor had understood what I had, they said maybe it was the appendicitis, hemorrhoids, stomach. I had to go immediately to Greece, in order to control myself, I trusted my country. As soon as I arrived  my dad brought me to our family doctor; the results of the analysis of feces were terrible : only blood, on the other hand the result of the blood exams was : iron almost zero , hemoglobin at  level six. The doctor immediately said: ulcerative colitis .. bring her to the hospital .... it was a general doctor but very competent. I have been  hospitalized to the University Hospital of Ioannina , and it was diagnosed the IBD ( ulcerative colitis). The colonoscopy did not exist at that time, I had a so painful proctoscopy, I still remember it. The doctor put me  on treatment with mesalazine, cortisone and transfusions ( I also have the thalassemia minor and this is a complication with this disease), then the doctor told me that it was a chronic disease that I had brought with me, along my life. I was non able to understand what it was exactly, I thought that I had a bad meal in the past, my bowels had got ulcers?I felt so confused and scared, but 26 years ago the doctors had not explained to me, that this is an autoimmune disease. They told me that this illness , it was a matter of a chronic disease  and I had to stay calm, I do not get excited.  I was so young, I had 2 children and I wanted to play with them, to have fun and to be able to eat everything, but I could not. I had to always be careful about everything I did. I was missing the energy and the quality of my life was horrible.
However I was able to understand that the IBD was an autoimmune disease in these last years 
What does it mean??
The inner working of the immune system is based on the ability of its various components to recognize on the one hand what is part of the body (self) and on the other hand of what is foreign (non-self).  To do this, it is necessary that our defense system learns not to attack their own cells but  to recognize them as harmless. But sometimes when  this ability is lost, our defense system becomes crazy and starts to attack his own cells and tissues of itself.
In these cases we speak of inflammatory and autoimmune diseases IBD ( ulcerative colitis and Crohn's disease), rheumatoid arthritis, ankylosing anchilosante, the systemic lupus erythematosus, psoriasis and type 1 diabetes.
I remember that for about 15 years I was always sick and for four times a  year I  had a worsening  during seasonal changes ; at the beginning I prefered to be hospitalized in the hospital in Greece, but lately my father found a professor at the hospital of Ancona in Italy, who he take care of me for a long time. I was tired all the time and completely worn out; I felt weak because of the Mediterranean anemia  and I had low hemoglobin, tachycardia, iron deficiency, lack of vitamin B12 and folate, pains in the joints, periodontitis, osteoporosis; I had to eat more meat, potatoes, rice, crisp brad and some banana and I was on medication with steroids and mesalazine. I was exhausted ! I had a poor quality of life ( depression and no energy ) and I was compelled to be assisted by my husband, during the worsening. I desired to carry out my daily activities and tasks but it was not possible with the pain and depression. I had no friends, no wish to talk with the others and go out to have fun. I prefered to stay alone with my pain. My husband had helped me a lot during these years with our children. 
Then the disease is gone by making a treatment with l'azathioprine. The professor had told me about this medicine but I do not remember if I have well tolerated it. I remember that I took it for about 6 months and later the disease has calmed down. I did a proctoscopy (I had never done a colonoscopy yet ) my intestine was normal without the disease. I DID NOT BELIEVE IT, but I was wrong, the disease always was there and he was sleeping peacefully and the worst is still to come.
The professor told me that I should continue through all my life the mesalazine and every two years to make a colonoscopy. All the years from 2004  to the present, for almost 10 years, I have never been checked and I had stopped any medications.:-
I believed that I recovered of a IBD, but I did not. There are only moments of seeming wellbeing but the disease is always there. The Mesalazine is taken for all the life for support, even if we feel well and we think that it is get over. The mesalazine prevents the cancer and it needs to be making a colonoscopy every year!!
                                               July 2013 ( Germany Metzingen) Hugo Boss Run ) 
I spent 10 years of well-being, I have eating  very healthy and well, much more organic and natural  food, fruits and vegetables; I created also this site with my recipes. I have started the gym 4 times a week and I have had a very active life, travels, fun and never failed to appointments with my friends to get away to the SPA during the weekends. I was so happy and I no longer thought  about this disease, but one day the month of April 2013 I had a very strong worsening and since then, the acute disease has not stopped. I was so afraid that it was something else, because I had never checked through these years but thankfully after many colonoscopies, biopsies and analysis , he was  my old friend, the ulcerative colitis. She began to destroy the first part of the rectum and sigmoid and then the descending and traverse and then walked up through the entire colon. The doctors have said it is not my fault .. it is the disease itself ... I got back to the hospital in Ancona ( Italy ) and the head doctor Lorenzini and his team, took care of me, great center and excellent doctors . A big Thank you to all of them for their support. They have done the impossible to save my intestine, which already has been destroyed. I have been hospitalized 5 times, within 12 months.The hospital had become my second home. The colonoscopies were made with the pediatric tool in Radiology Dept. because of my intestine has also  a stenosis and it was not possible to be controlled by a normal tool. 
Here the result;  the worst form of PANCOLITIS and then all the various analysis and exams Entero TAC, RM etc.... I was scared of the yellow shirts,employees that they bring you to do several tests, when they were coming into the room, then the white shirts with all these infusions bottles of all the colors, then the blood bags, then the doctors dressed in green, but during the morning I was happy with the OS, I called them the red shirts, always so kind to take parameters, help you to take a shower, wash your hair, make up the bed.
                                                     February 2014 ( Ancona hospital) 
This acute worsening has brought me in a deep depression and from then I have been on medical-treatment with psychotropic drugs, mesalazine, steroids and  azathioprine but nothing to do... every time I went back home, I had to return to the hospital with a acute disease stronger than before.
After all the medications  I have tested, I received a treatment with a biological agent anti-TNF ( Remicade). I was so afraid to try it, because I had read on the forums, possible side effects, but at the same time I was happy because it was perhaps the cure for this disease. The head doctor  of the Hospital had told to my husband that the BIological agent ( Humira and Infliximab) works at 70% of cases, but in my case I had a chance that would work only 40%, if I had  have no allergy.
FRIENDS IF  THE anti-TNF WORKS  ON YOU  ... DO NOT EVER STOP!. HAS NO SIDE EFFECTS. The first treatment worked immediately without any reaction, every five weeks I went to the hospital for treatments and I was fine.  I arrived  at 9:00 am,  and then the nurse got the parameters, blood etc. and then while waiting for the preparation of the medication, she made me a intravenous feeding of cortisone and another one of antihistaminic, then the infusion of Remicade going on for 4 hours. The infunsion had to go very slowly, every 30 minutes the nurse came into the room to check how it  proceeded; I always slept and dreamed. By the end  I had another intravenous feeding to clean the vein, and then about the 17.00 the therapy was over . My blood test were very bad even if the diarrhea , mucus and blood  were gone. The calcoprotectina test was at the 500 level and the  hemoglobin weekly test was lower. After the third anti-TNF treatment, I had diarrhoea mixed with blood again, and  was worried about it, because I was aware  that after the anti-TNF therapy the only solution was the surgery. The leader of the division of  Gastroenterology suggest  to anticipate  the  fourth therapy in order to check if my body gives an response to the treatment but nothing to do. Maybe my immune system has made antibodies against the biologic agent, who knows ??? No one knows; the doctors have said that the anti- TNF does not work on about 30% of patients and I was in that 30% . I had the worst relapse of my life ( the symptoms of diarrhoea at 25 times a day along with the blood, mucus, nausea and intense pain). I have hospitalized urgently, I could not walking, talking,eating,sleeping. I immediately had two blood transfusions just to get over and walk ; at this point the only medication was the high-dose of steroid, that caused me the hair loss  at 50% and the muscle loss. I will not go into details because at this point, I can be understood only by people suffering from IBD. I look at the mirror and see myself, I was not me; 
                                                         ( May 2014 -in my home)
I started to cry, I was puffy with few hairs and depressed. My husband was very upset for me, he was day and night very close to me, he suffered along with me, he wanted to take away my pain,my illness.I asked my doctor if it was possible to try  a new therapy  called : granulocyte/monocyte apheresis . I had read on a scientific journal  INFORMA A.M.I.C.I , about  the therapy discovered  in Japan with great success. My doctor told me that I could not do it, I also wrote to a scientific newspaper and a competent doctor told the same thing; to leave aside this therapy and go ahead with the total colectomy. At this moment, I am on medication with very high doses of cortisone, mesalazine and intravenous feeding, in my home, trying to stop the bleeding.Unfortunately I can not take other medicines. The fever does not stop, every night increase up to 38,5. I feel so suffering, the level of PCR increased to 92 and I am in risk of bowel perforation, which would kill me, but missing only a few days to arrive the time of surgery. I was a bit scared and worried for this surgery,I was terrified of having an ostomy pouch, it seemed to me the end of the world, but after speaking with il Prof Poggioli, my surgeon,he has made me feel more relaxed and calm, in order to face this experience with optimism.  He reassured me that everything will be fine and i will feel immediately better.
                                                             ( July 2014 -in my home) 
How it will be the things after surgery ??
I do not know yet, you will be updated after my surgery, when I will get  back home and I will be able to sit in front of  my Mac. How it will be my life with the ostomy packing and for how long ?? I do not Know yet , I hope not more than  five months. 
Do you know what I think ???
I do not want this organ in my body, that gave me all these problems and  then all these treatments  and medications  could destroy other organs and carry many side effects.
Now I feel so Positive and Hopeful.
No  more medicine, my body will start to  detoxify, I will begin to eat everything, get out, go to the restaurant, super market, take a walk, go to the SPA  with my husband , that has always been my passion.  
I am sure , that I'll get it over  and I 'll get back to my old self , smiling as before.

I  will get back in shape, it will take some time ...but it will be.

                                                     ( March 2011 my 50th B-Day)

                                                                    ( April 2013) 

because things will get better
it may be stormy now, but it never 
rains forever
Chara Filippa