Adventures in Gastroenterology

You may be familiar with my adventures in colorectal surgery series, but this is an adventure that I had with my Gastro doc Dr Shen back in Nov 2006. It all started when I began to see blood coming out of my stoma. This was very unsettling for me as I'm sure you can imagine. So after watching this happen and getting some advice from my webboard at www.j-pouch.org I decided I had better notify my GI. I emailed my doctor and his response was to order me to come up to the clinic to have a scope done through my stoma. This scope is the same type device they use for colonoscopies it is a fiber-optic cable with a camera and light and they shoot you full of air to expand the intestine and see stuff. Now I had a scope done through my stoma before, it is not really painful, mostly uncomfortable because of all the air so I felt ok going up by myself. So I got checked in, had my backpack and walked back to my little pre-op area, I passed Dr Shen who was on the phone at the nurse’s station and he waved at me.
My nurse takes me to my little area and says "you don't need sedation right? Because it’s through the stoma?"
ME "right, no sedation"
There's 2 nurses, My nurse and this other nurse in training who walked up after this was stated and the N-I-T says "I'll get her IV started"
Nurse "No, she's getting scope through her stoma she doesn't need an IV"
So they close the curtain and I take of shirt and pants, just so poop doesn't get on my clothes and throw on a gown. Well I'm just tying the back and trying to shove my backpack under the gurney (in this area your stuff goes under the stretcher with you because you finish in a different place where you started).
Dr. Shen comes right outside my little area "I'm ready for my next patient. Is it Katie? She should be ready." Then to me, "Katie, are you ready?"
ME: "Yes almost, I'm just stowing my stuff. Am I gonna walk back?"
Dr Shen "No I'm going to push you!"
ME: "I'm really getting the red-carpet treatment today!"
He laughs and then he swings back the curtain and my nurse is there too with the N-I-T who says "Aren't we going to start an IV?"
to which all of us (Dr Shen, the nurse and me) say "NO"
So the nurse starts pushing me to the scoping room and Dr. Shen and I are chatting about the conference he was at and that N-I-T goes "shouldn't we start one though?"
Real Nurse "NO"
Nurse in training "Really? What if there's an emergency?"
Nurse: "NO"
ME: (giggling a little) "What kind of emergency?"
Nurse "We don't need an IV”
And at this point I'm totally rolling my eyes here. I don't think she would've been so eager to get her shot at starting one if she knew how bad of a stick I am :oP

So we get all situated in the scoping room and I ask Dr. Shen if he's going to look down towards the pouch as well as up since I think that’s where I saw the blood come from and once he confirms that I have LOOP ileo he says yes he will certainly do that.

Well he sticks the scope in and I'm totally digging this because it’s really cool to watch your insides on TV. But the amount of air is REALLY quickly making me incredibly uncomfortable and it is painful. Try to imagine the worst gas you've ever had then triple it. I'm starting to breathe harder and squeeze the bed rails.
So the Nurse comes over and she takes my hand and she's like "take deep breaths... that’s right, in through the nose..."
I feel like I'm giving birth. :oP
Dr. Shen: "I'm sorry, Katie, you're doing good. Small bowel looks really good no disease. Ok I'm gonna to try and go to the lower part."

And he does try but he's not having any luck because the lower opening of the stoma is really covered by my appliance which he cannot take off because obviously that would be a problem when I need to leave. I have an appointment to see the ET nurses an hour after my scope and I can't just sit around "au natural" (wee willy naked) until then.
So then Dr. Shen says "Ok, we're going to go through the bottom"
ME: "Um, really? Ah, because I'm a BIG CHICKEN" I realized though that I didn't have much of a choice because I can't have sedation because I have no one to drive me home.
Dr. Shen: "Its ok"
ME: "really? cause ah..."
But at this point Dr Shen has removed the scope from my stoma and I don't really have a say because I'm already being rolled onto my left side. I'm trying desperately to to not panic, And I notice the nurses DID NOT put my bag back on and now that willy is free of the scope and full of air he is spewing poo everywhere!
ME: "Hey!!!! we really need to put the bag back on!!"

Nurse "Oh yes, we need to do that"
Dr. Shen "ok, here we go"
ME: "OH, really? Umm, I…"
Enter scope - I'll spare you the detail except to say... EEK!
Actually, it really wasn't bad. I thought I would be miserable, and it was slightly uncomfortable but oddly enough NOT as bad as through the stoma ( I think he used a pediatric scope) And also I think it was largely due to the fact that now all that air had 2 exits - 1 my fistula (gross) and 2 my stoma.

Now I'm really trying to watch because this is my j-pouch which I really wanted to know how bad it looks. So I'm trying to see the TV around the nurse who has put the bag back on and is trying to clean me up. She turns around to do something at the counter and I move my hand and realize that my ostomy bag is ABOUT TO BLOW!!!!
It is completely filled with air - blown up like a balloon full to capacity and I squawk "HEY this thing is going to EXPLODE if we don't get it open now!"
Nurse "yes! I'm coming!"
I'm frantically trying to un-Velcro the stupid thing, but my left arm is pinned under my body because I'm on my side. Finally the nurse comes over with a giant pad of some sort and releases the Hindenburg.
Dr. Shen "Wow, your pouch is very narrow and constricted"
ME: "Narrow huh?" --- Relieved of the impending explosion of poo I can once again turn my attention to the video monitor.
Dr. Shen "That is because of the crohn's disease, and you have diversionary pouchitis but that is to be expected"
ME: "So just diversionary pouchitis? Pouch doesn't look too bad? So, if the fistula got closed and I got reconnected how would my pouch function be?
Dr. Shen "If you get hooked back up then pouch gets the nutrients it needs and pouchitis should go away."
Then he took a couple of biopsies of my pouch.

Then I notice out of the corner of my eye that there is a PAUSE in the flurry of activity the nurses have kept up to this point. I mean, really I'm a complete disaster, covered in poo because of the scope and the nurses forgetting to cover willy then the whole almost-exploding ilestomy bag incident. So the fact that they've STOPPED doing anything gets my attention, so I look down to see what the nurses are occupied with now and I notice something VERY ODD (Like this whole experience hasn't been insane enough already...)
I can see the light from the endoscope shining out from inside me ----- out of my stoma and into my bag!!! This is truly a stunning moment. My brain is trying to process that there is a light in my belly and I'm on the verge of hysterical laughter.

ME: "O my gosh!!!"
Nurse PAUSE "That’s the endoscope...."

DUH!! I'm not E.T. !!!

And I'm not looking at her but out of the corner of my eye I can see that her mouth is open (heh)
ME: totally laughing 'HOLY COW the endoscope!! That's hilarious!!"
Dr Shen (who up to this point seemed totally removed from every other odd thing that was happening) did seem to find this amusing too. :)

I know that this was an odd experience for the nurses even though they were VERY professional, trying to make it seem like this sort of thing happens every day there. But I know that they don't do a lot of stoma scopes maybe a couple in a month and the nurses are assigned a room and not a doctor so they cycle through upper and lower scopes. And I DOUBT very much that they do a lot of endoscopes on patients that have ileostomies! And I'm pretty sure they've never seen an endoscope light shining through a stoma!

Definitely one of my most memorable experiences!