JoAnne Update // In The Clear, Onward & Upward

Hi guys,

Dr. Barbosa just came by to discuss JoAnne's surgery and the outcome with us. First thing he began with "one of the more favorable things that could have happened, happened", so we immediately were able to take a deep breath of relief. See below for the details...

BASICS: JoAnne's ileostomy procedure from 12 days ago did not heal the way it should, causing an infection to spread in her abdominal cavity. The end of the colon resection that they had created during the ileostomy unfortunately opened a bit in the last week or two. Barbosa said that sometimes there is just not enough blood supply to the end and the resection fails to hold up... this happens sometimes, even when they try to preserve as much colon as possible, explained another surgeon. This opening caused bile to leak out, causing an infection. 

BACTERIA: It did not seem to be the clostridium bacteria that had ravaged JoAnne so harshly before, so that was also good news... no tissue decay, just fluids to be cleaned out. 

THE FIX: They cleaned out the infected areas, removed a bit more colon, and then instead of leaving it stapled off as he did before, they created another ostomy, essentially, which will prevent the leaking from happening again. It's called a mucus fistula, or a removal of the transverse colon. Not awesome, but they did what they needed to in order to save her colon, intestines and liver and preserve her overall health. How cumbersome that will eventually be when she recovers is yet to be determined, but we're just happy that it wasn't more serious. 

TIMING: Barbosa seems to think that if it had been found a few days later, it would be been too far gone to fix, a "disaster"... So it was lucky they discovered it when they did. Damn, her team is great.  :)

CONCERNS: There is a small concern that a portion of her bile duct (called her biliary tree) could still be at risk, as Barbosa was unable to get a 100% view. This was due to the fact that her gallbladder surgery from years ago caused the colon to be right above (basically stuck to) the liver, obscuring the connection between the colon and intestine (the biliary tree). This is why there would have been no hope if it had been a more serious bacteria (or if it had spread further/longer), as they are a bit too close for comfort. If the colon had eroded into the biliary tree it would have been disastrous, but Barbosa is relatively certain that this didn't and will not happen. We will know more in the coming days, and will proceed from there as necessary. 

HIP/LEG- They closed her hip wound after cleaning/packing it, but left a bit open so that it could drain/etc. They may close it more Monday after another cleaning, but three of the surgeons that came by marveled at how great it looks, overall. Continuous cleaning and consistent monitoring will continue to keep her out of danger, healing, etc. 

NEXT- They plan to go back Monday to clean out both her hip/leg and her abdominal cavity. They'll look then for any danger to her biliary tree, any further infection, etc., but hope to just clean and re-pack. They said her abdominal wall still didn't look ready to close, and now it definitely won't be for a while. And that's ok! As long as her stats remain stable (BP, breathing, etc) and she does not leak any bile from her wound vac (demonstrating that her biliary tree was compromised), then we can move forward! Or, as they say, onward and upward.

PERSPECTIVE- Yes, some slight back-tracking has happened with today's episode, as the wound closure won't be happening immediately, nor will they be weaning her off her sedatives/pain meds in the next few days/week. At the same time, we've been told that this is to be expected, as frustrating and frightening as it is. Onward and upward is a great way to explain it; a surgeon last night likened JoAnne's infection to a bump in the road on the way up the mountain to recovery. We must realize that JoAnne will not be magically healed (and on top of the mountain) in one day, nor will she zip quickly and easily to the top. There will be bumps in the road, and today was apparently one of those bumps. 

THANKS- Many thanks again to all of you who responded with such support today. We hate worrying you, but it frankly felt really good to know you all knew what was going on, too, and that you could be there with us in spirit, sending good vibes to JoAnne. 

Unless something else comes up today, we'll be in touch tomorrow evening, as usual (on the blog!).

See below for a few photos that Kelty snapped of Barbosa, JoAnne's brilliant surgeon. We were so grateful for his amazing skill and upbeat news that we just had to get it on film (as uncomfortable as that made him).  :)

Much love

Hannah & Fam