Not quite wonder woman

Surgery post #1: Ventral Hernia Repair with Abdominal Wall Reconstruction

I am conflicted about posting medical information about myself on my blog. On one hand I am pretty private but on the other hand I have a blog, so there must not be insurmountable privacy issues that would keep me from documenting this process.

Part of the reason I decided it was a go was the lack of information about my particular problem. There is plenty of information about hernias, the different types of hernias, and even ventral hernias but just not specific. Much of what is written by verifiable medical sources is very general, which is what you would expect but when it’s you and your body and your stomach, general information is just a starting off point. Then you add the need for some abdominal muscle work whether it be strengthening your core, diastasis recti, a 6 inch separation of the center abdomen ~ anyhow things get complicated. How much work can you expect? How much do you want? How much will insurance cover? Will it cover any? (The answer is yes but it depends on a lot of factors.)

I briefly covered my problem on the health and fitness tab on my home page. It partially explains:

This is brief update 12/14/2016:

In 2009 I had emergency surgery. My colon had a perforation and the end result was a temporary colostomy and then another surgery doing a reversal.  Neither surgery was performed by a specialist. I always felt like the end result was a wonky lopsided mess but sometimes you’re just happy to be alive. So many things were happening in life the following years that I put my unease about my tummy issues on a backburner.

The past year I inexplicably gained 30 pounds very quickly and have just felt very tired. I have felt a tugging every since the surgeries but over 2016 it was more tugging, discomfort, and sometimes pain. I felt limited and like I could possibly hurt myself with too much physical exertion. I thought I just needed to work up my endurance and strength. So I started the health and weight loss Instagram account.

I still did not make any headway. In fact I felt worse. So fast forward to October 2016. I researched hernias. I suspected I had one at the site of the ostomy. The more I read the more I thought I might also have Diastasis recti caused by having 2 surgeries back to back both cutting straight up the center of my abdomen.   I decided to research and find a surgeon with an expertise in hernias and gastrointestinal surgery. My appointment was in November.

After a physical examination the Dr. confirmed my suspicions. He sent me for a CT scan and I was advised that if  it was more complicated than he was comfortable with I would be referred to a ‘plastic’. Well, my next appointment was with a plastic surgeon. Strictly from an aesthetic point of view, this doctor recommended I lose 20 or more pounds before they did corrective surgery. This make perfect sense because internal fat pushes against what the plastic man is trying to do. Internal fat exasperated and facilitated the problem. But then the plastic man looked at the scan.

I think it looked pretty bad.The hernia is not at the site of the ostomy. Diastasis recti is a gap of more than one inch between the rectus abdominus muscles that run down the center of your abdomen. The separation measured over SIX inches at places on my scan. Then there is a breach in the abdominal wall containing ‘mesenteric fat and small and large bowel loops’. So basically my stomach muscles are gapping up to 6 inches and my guts are on the wrong side.

The plastic doctor said at first that he usually performs abdominoplasty by himself. After seeing the scan he said he would probably advise a joint operation with the first surgeon. And that’s where I am on December 14, 2016. Waiting to hear from my ‘surgical team’ to schedule fixing this crazy weird tummy of mine.

Today I’m gonna add a few photos to give you an idea of the extent of the problem. I scrolled through hundreds of photos online looking for tummies similar to mine or that I could connect with and see how the before and after photos looked. There weren’t very many that I related to.

The red arrow is pointing at the largest area of intestines gathered on the wrong side of my abdominal muscles. The blue arrow is pointing to the scar created in 2009 and showing how crooked my belly button is.

So here’s a few, pretty icky but hey, that’s why I’m getting it fixed.

It might be helpful to mention here that I live close to Atlanta and as the bulge got larger and the smaller one above it started to appear, and the whole thing in general got more uncomfortable to live with, I started hunting for a doctor.

This is really the first step in getting fixed. Don’t skip on this step. I looked to Emory because we have had good results from University hospitals in the past and they tend to attract surgeons who are pioneers in their fields. You may not have the experiences I have but try to find the best doctor you can who specializes in hernias and gastrointestinal surgery.

I found two Doctors at Emory who seemed to be what I was looking for. I decided to email Dr. Scott Davis. This is the email in it’s entirety sent Sept 27, 2016:

Dear Dr. Davis;

 I am a 48 year old female, I’m about 5’6″ and weight about 218. I have been married 30 years and have 3 children. I work for Bartow County School Dept. as a school bus driver. We moved to Cartersville, GA in 2010 from north Alabama.

 In October 2009 I had a gastrointestinal perforation (colon rupture). I had to have emergency surgery, a colon resection and a temporary colostomy. I was uninsured at the time this all happened. 11 weeks later I had the colostomy reversed.

 At the time my mother was having bone metastasis issues with her breast cancer, that made taking care of myself not top priority. Along with family circumstances, the lack of insurance caused me to get what I consider sub-par care. My follow up was sporadic. The doctor who did the reversal surgery took non insured patients at a discount rate as long as we paid part up front and set up payments. I am grateful for that, I had a real anxiety/fear of not being able to get the reversal but I did not like the doctor, he was neither kind nor reassuring. I feel like I got the very minimum care required. The scarring on my stomach is very bad and my bellybutton is very off center.

 In 2008 (before the rupture) my weight jumped from a steady 168 to about 215 within about 6 months. From that time I have fluctuated from a low of 185 to a high of 224. Most of the past 8 years have been spent over 210. (I’m including weight history because I know it can effect post surgery hernias and abdominal healing.)

 My concern now is that I look pregnant, I feel tugging in one spot, and physical activity sometimes makes me feel like I am damaging my abdominal area. I have read quite a bit about diastasis recti. This seems likely with 2 major surgeries opening up my abdomen. I also have a bulge on the lower left side under the area directly under the repaired stoma. I’m pretty sure it is a incisional hernia.

 I do read a lot about these things but I don’t want to diagnose myself. What I want now that I have insurance is to go to a professional who will give me up to date care, help me with a long term plan, and preform needed treatment including surgery if necessary. I understand if it is a hernia that weight is a factor. I am willing to follow whatever regimen recommended to accomplish results.

 Basically I do not want to live another 6 months worrying that my intestines are going to explode, or get tangled, or tumble out of a hole in my stomach muscles or any one of the terrible scenarios that I could think of.

 Up until my 40’s I have been active, had periods of a little too much weight but was usually between 135-155. I could run 7 miles in less than an hour without total exhaustion and hike and do pretty much what ever I wanted. I feel like this is hindering me and now that I have insurance and can focus on me for a bit I would love to see a specialist and work my way back to being fit and active.

 I did contact my insurance and I do not need a referral from my GP to see a specialist. I’m not sure who in your department or on your team I need to see first but I am looking forward to any information your office can give me.

 Thank you for your time.

It wasn’t until October 21 that I heard back. The personal email had gotten sent to the doctors junk email and when he found it he immediately contacted his patient liaison and she contacted me. I ultimately wound up with the soonest possible appointment which was with Dr. Davis’ partner Dr. John Sweeney.

During my visit with Dr. Sweeney I was sent for CT scans and told that if he felt like the surgery was too complicated or needed the help of a plastic surgeon that he would refer me to the one he worked with. By this time I had set up a patient portal which I highly recommend they notify your personal email and from there you can click into you portal and see notes from your visits, reports from test, upcoming appointments, directions to the offices, and and bills and accounting.

Here is part of the CT report that was on my patient portal:

Diastases of the ventral abdominal wall musculature measuring up to 16.5 cm (series 2, image 57) and eventration of the abdominal wall fascia containing mesenteric fat and small and large bowel loops.

Now that’s a very short sentence but when you lookit up it means there is up to a 6 inch gap in my abdominal wall and intestines and belly fat are escaping from the cavity that they belong in.

Red arrow is again pointing to the largest bit of hernia/intestinal mass. the blue arrow is pointing at the location of the temporary colostomy, and the pink arrow is highlighting the weird wonky scar that runs from mt breast bone to my pubic bone.

The largest area of separation of my stomach muscles, the diastasis recti is as large as 6 inches. So before I go any further I will let you know that this abdominal wall reconstruction, the suturing together of the separated abdominal muscles, the ‘tummy tuck’ is covered by my insurance. There really would be no way of repairing a large ventral hernia without making a sturdy solid wall of muscle to hold it into place.

Dr. Sweeney did in fact send me to a plastic surgeon that he confers with and it was agreed that my condition is too complicated for one or the other doctor to to handle it alone and that a joint surgery would give the best outcome.

Because those appointments were so close to the holidays and because both doctors have busy practices the first available date for surgery after they had a consult with each other on how to proceed was February 22, 2017.

About 9:30 am I should be on my way to having a somewhat normal stomach.

So this is my journey- if you are looking for real life experience information I hope it helps you. If our problems are not identical maybe it will at least reassure you that there are good caring medical professionals out there who will help guide you through the process.

Until then:

  • Keep a journal
  • Know dates and specifics of your problem
  • Put them in writing for your team of medical professionals
  • Ask that it be put in your file so they can refer to it
  • Do your research and contact doctors who specialize in the field
  • Contact your insurance provider to make sure the doctor you want is in network if you have it
  • Contact your work human resources and let them know what’s going on
  • Make and keep your appointments
  • If you don’t hear back make a follow-up call, never think that you are being a bother, it’s your quality of life at stake
  • Keep a list of questions to ask at your visits even ones you think are silly
  • Activate you patient portal if one is available, it maybe the best means of communication
  • Follow all instructions
  • Make sure your work leave is in place and approved
  • Don’t smoke or quit smoking
  • Start practicing good health routines by eating well and stating active
  • Find out if there are any vitamins or supplements recommended to prepare your body to heal

Here’s one more picture collage for the record.  I would like to thank all my Instagram friends who encouraged me to blog about this surgery. It is a big deal and hopefully it helps someone along the way.  Have a good day and hopefully if you are reading this I am already out of surgery and happily in a drug induced rest. 🙂

Different angles and views of my herniated stomach, scars from previous surgeries, and lopsided bellybutton.

 

 

 

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6 thoughts on “Surgery post #1: Ventral Hernia Repair with Abdominal Wall Reconstruction

    1. April Post author

      You might have helped other people stay sane too.A lot of info I found was not practical. It was either clinical or emotional. And that’s not what I was looking for.

  1. Kelli Gray

    Thank you for real world blogging and advice. My tummy muscles are herniated badly and stick out in a straight line down my front. It tugs and hurts . After my last surgery my gastro doc told me it was a bad hernia. I am currently trying to lose some weight to be a better surgical repair candidate. Your photos and blog were the closest realistic scenario and look to mine that I could find. Thanks for the encouragement.

    1. April Post author

      You are welcome. I had the same problem finding someone close to the same problem as mine. My plastic surgeon told us that he normally wouldn’t do the surgery before weight loss but that with some medically necessary conditions he would. His reasoning was that he could put off an obvious needed surgery for three months to give me time to lose 15-20 lbs but that three months could pass and I might not lose weight and in the meantime I could have a complication. So ahead with the surgery. So I think there is a balance to discuss with surgeon because he might feel like my doctor did.

      I actually have lost about 12 pounds and surgery has decreased my appetite dramatically for the moment. The knowledge that getting my weight down will prevent the past three weeks from ever happening again is a big motivation. Hope it goes well, please let me know. Don’t get discouraged and my saga took from the first visit to surgeon around of November 2016 til February with the surgery. So it maybe a long process and you can be losing weight the whole while.

  2. Michelle Schumacher

    This could be me! Pictures are me with my scar except my belly button was taken during second emergency surgery that resulted in removal of infected tissue, my appendix which was infected, portion of my intestinal tract, and the newly Implanted 10 day old mesh that got infected when my first surgeon perforated my small bowel while doing Laproscopic umbilical hernia repair (routine). That second surgery caused a bowel blockage that took five months to diagnose after $2,400 of tests and the first surgeons advise to wait as long as possible to remove my gallbladder (which wasn’t the underlying issue). I watched the hernia grow from tangerine size tomgrapefruit to basketball size PLUS fought to get the DR recognized. Dr told me I was a candidate for abdominal reconstruction with two surgeons (general and plastics). After cat scan they decided that they didn’t want to do the surgery based on current mesh products on the market. This blog is a lifeline. My quality of life is drastically altered.

    1. April Post author

      Wow, you’ve been through the ringer! I didn’t have those drastic complications but just not grear doctors and follow up care.

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