Expectations after radical cystectomy & neobladder

Mike and anyone else interested in B 12..here is the discussion from some time ago on this forum.
www.bladdercancersupport.org/index.php?option=com_kunena&Itemid=114&func=view&catid=5&id=27632
pat

Carol,
Has he had a bowel movement in the past few days?
Nausea is pretty common after this surgery...i periodically had it for about 6 weeks. My appetite was very small but i did get down some pretty high calorie things...a little trick is to make a milk shake with lots of icecream and throw in a protein drink to disguise the taste(I had to find one without iron as i have a very high hemoglobin anyway)..soft soups..and i managed an egg a day in one form or another.
But throwing up could be a sign of ileus. Is it green? Mine was. Linda Blair had nothing on me...nothing would go down plus the vomit was actually projectile and i also had a pain in my left flank. I knew something was very wrong. I did have to have a second surgery as my ureter trapped part of my small intestine which, of course, they said they had never seen before!!
I'm sure they will do blood work and another CT.
Pat

Checking for leakage might be in order though. That is one of the more common complications. They should probably ask the doctor about that one.

Carol,

It's probably not a blockage if he's been having bowel movements. He would have had to have bowel movements prior to being let out of the hospital. I did say probably though and they will likely be doing a lot of checking to see what the problem may be.

Sounds like they are doing the right thing by getting him back in the hospital. Fever could mean there is an infection and they will want to get that under control right away.

Mike

Wow! Very interesting article. Thanks Pat.

I didn't realize the B12 issue also occurs with aging.

The MSK stats are pretty incredible. Going to try to find the study they referenced for that one. Seems like they should all report that information on a regular basis and list the incidences of each particular complication. If that is what it is at MSK, I wonder what it is at other places.

I know I had a few complications just post-op. Had ileus for a long time but I am convinced that it was made even worse by an obstruction at the intestine resection site. I remember getting scans and xrays while still in the hospital and they were a day away from going back in to clear the blocked area when it finally pushed through. If we had done that back then, it would have saved me a lot of pain and trouble. When I finally had it fixed, it was badly kinked in that area that the upstream intestine had considerable thickening from constantly working so hard to try to push past the kinked area where the staples were. The downstream side was apparently stapled in a smaller diameter than the upstream row of staples. That got worse and worse over time. Now that they cut out that whole piece and put it back together with sutures instead of staples, things have been great! I was the first person that my surgeon had that problem with.

It appears in the article like that complication rate is JUST post op and doesn't take into consideration things like hypercontinence or incontinence, etc. that are potential complications down the road.

I would imagine ilius happens in a lot and once that resolves its ok. So the question becomes the severity of the complication.

More studying to do now...

Mike

Hi Pat & Mike,

Pat, I forgot to mention that he has not had an appetite. The doctor actually prescribed something in the past couple of days to try to stimulate his appetite.

I found out last night when I went over that he had been nauseous and had vomited a couple of times and had a fever of 101.7. They called the doctor who sent out a home health nurse last night. His fever had gone down a bit by that time (to 100.4) and he was given a Phenergan suppository to help with the nausea. That did seem to help and he was able to eat some strawberry yogurt and drink an A&W. The nurse called his surgeon and he has an appointment this morning. The surgeon spoke with my mother and told her that, most likely, they will need to put him back in the hospital.

The home health nurse also discovered that the antidepressant that was called in for him can cause stomach upset, including nausea. That may possibly explain that part of it, at least.

I spoke with my mother this morning. He woke up with a degree of fever and, although he had not vomited, was very nauseous.

I tried to call them when I read your messages this morning to ask the doctor to test his serum level for B12, just in case. They have already left home and have both - believe it or not - just lost their cell phones. (My father accidentally left his in the pocket of his hospital gown when he was in the hospital. My mother lost hers the day they came home from the hospital. They were pretty worn out.) I did call and leave a message with the receptionist at the doctor's office asking them to have them call me when they arrive, so I hope they get the message.

I am wondering about a possible problem with the surgery on the small intestine that was used to make the neo-bladder. Perhaps there is a blockage or perhaps it may be leaking???

Pat, the surgery was not done at Vanderbilt. It was done at Centennial Medical Center. His cardiologist cleared him for the surgery - with the warning, of course, that he was very high risk for any surgery, must less one as extensive as this. His cardiologist has jokingly referred to him as Lazarus. My father underwent a special procedure a couple of years ago to decrease angina symptoms that had just been approved by the FDA. It went so well the company that makes the robotic machinery used to do this asked to interview him and his surgeon now has a poster with his picture on it in his hallways that the company uses to promote it.

The surgeon that did the neo-bladder has a lot of experience and was very confident that my father would have the strength and motivation to do well with it.

I will let you know what I find out.
Thanks,
Carol