Pseudomyxoma Peritonei and Other Words Too Hard To Explain

To begin, for reference, PMP =Pseudomyxoma Peritonei. There, now at least I don't have to type it any more!

As promised, I am following up last nights blog post with a sequel version tonight. I am still lacking much emotion about the whole thing still, so it's probably a good time to write, before I get too keyed up. Also, my lack of emotion also probably stems from the fact that I don't have many details yet, and I may just be rolling things out of proportion. That is something we will find out when I finally speak with the specialist though.

So, for now, let's work from the standpoint that I don't have this condition, and my risk for developing it is extremely low. Working from there, maybe you can set aside your grave worries for my well being (which I'm sure all of you have! Just kidding!) and let's learn what the small group of people in this world who are dealing with PMP have on their plates.

PMP is an orphan disease, it's pathological origins and best modes of treatment are shrouded in a veil of medical journals and published articles that only the most highly skilled Google searchman could find. I don't profess to be a genius on the subject, but I will attempt to paraphrase some of the probably 60 published research articles on the subject that I have read over and over.  So keep in mind this is my interpretation of the facts.
An orphan disease is one that is so rare, no one really knows about it. It's sort of forgotten. Only a handful of doctors in the country are considered specialists.
Let's go from here on out in chronological order.
The appendix is connected to the cecum.  The cecum is connected to the right ascending colon.  (think of the child's song)  The beginnings of PMP start when the pathway between the appendix and cecum becomes blocked.  The appendix makes a thick gelatinous mucus (think soft jello) and fills itself up.  This process can be benign, malignant, or somewhere in between.  If malignant or somewhere in between, the bad cells mix in with the mucus.  Given enough time or a heavy handed surgeon, and the thin walls of the appendix can break.  This causes this thick mucus stuff to spread into the peritoneal cavity (that is the bag that holds most of your abdominal organs in it.)  If the mucus has any malignant or pre malignant cells in it, that is bad because it spreads those cells around the abdomen.  But even if the mucus is clean as a whistle, it is still bad because the mucus continues to multiply and grow in your abdomen until it squeezes your digestive tract shut and the result is less than ideal...
The "Pseudo" in PMP comes from the fact that it doesn't act like most other cancers by spreading through lymph nodes and blood vessels to other organs and parts of the body.  It stays in the peritoneal cavity for the most part.  But, it is much more difficult to deal with because unlike other cancers, it doesn't have a solid tumor that can be cut out or dealt with.  It is jello like, and if only one cell is left behind in your abdomen, it can start the whole process over again.  You cannot just wash it out with saline.  That would be like trying to wash jello out of a cup by filling the cup with water and sucking the water out.  The jello would just sit there.  The commonly accepted treatment for this diagnosis is cytoreductive surgery (scooping out the bad stuff) and then giving your abdominal cavity a heated chemo bath where they take chemo medicine, heat it up, and then wash out your insides.  That is how they get the bad cells out of there.  The folks who have had to have this surgery lovingly call it MOAS (Mother of All Surgeries), because it is very difficult to go through.  I feel very much for anyone who has dealt with this disease because it is apparently not a breeze to deal with.

Now that we have all of that mumbo jumbo out of the way, I will state again for the sake of anyone's worries, we are not sure that I even have this.  I am waiting on an actual conversation with the specialist.  His voicemail only said that I was at risk for the disease because of what happened during surgery with my appendix.  Many times doctors will suggest a simple wait and see attitude.  The disease can be slow growing and could take 10, 20, or 40 years to show up.  No one really knows (remember orphan disease).      Keep checking back here for any updates, and as soon as we have more info I will post an update.
Thank you all for your concern and for reading these blog updates.

Feel free to comment, and if I messed any of the information up and you know more about it, please comment and correct me.
-Ryan

The Voicemail

Well,
Today I got a voicemail that I was hoping I wouldn't get.
After my surgery at the beginning of April, I sent all of my records to two specialists that specialize in a type of abdominal cancer that is very rare. The reason is because, well let's just say there was a possibility that I was at risk for this cancer after my first surgery.
Guess what the doctor said in the voicemail... "Mr. Jenkins, you are clearly at risk for pseudomyxoma peritonei. We can discuss any further surgery when we speak."
Yup. I knew I was probably at risk because a bunch of "non-specialists" had told me I was. These "non-specialists" were people that either have, or are caring for someone with the disease. So "non-specialist" means "not doctor", because they probably have just as much knowledge about the disease as any docs.
I can get more into the disease in another blog, since it would take a book to explain, and especially since I haven't actually spoken to the specialists yet.
Reality is that I may not have anything, but most that I have told my situation to have agreed that it is likely. I don't have any feelings about things yet, but I tell you what... I have for sure listened to that message about a hundred times so far. It'll probably sink in at some point.
Now I have at least a weekend, probably more, to mull over what he meant by surgery, and what he meant by certainly at risk.
I tried calling him back as soon as I got the message, but the number just forwarded me to the hospitals main number, and it was well after business hours. I sent him an email to contact me again, so hopefully he won't leave me hangin like a crane fly on a spider web for too long.
Oh yeah, and I forgot. The doctor said "Have a great weekend!" at the end of the message. Umm, ok. Will do.

A Re-Engineering of the Colon

The Colon is a complicated organ. Anyone who tells you it isn't is lying to you to make your procedure seem less traumatic. Trust me, any work done to this "n" shaped organ is filled with lots of crap...literally...and figuratively.
This is the story about the re-engineering of my colon. After the finding of the mucocele in my cecum, then the subsequent hasty removal of my appendix, then the pathology report calling it severely dysplastic (precancerous), and a colonoscopy to find out how involved my colon was with the whole thing, it was decided that I needed a right hemicolectomy. That means a removal of the ascending right side of my colon, from where it attaches to the small intestine down on the lower right side of your abdomen, to where it turns west (or east depending on how you look at the map) in the right side of your upper abdomen. All a very simple laparoscopic procedure the doctors say, involving two small one inch incisions and a larger 2-3 inch incision above your belly button.
I went into the hospital on a Tuesday. Kari, Wren, and my Mom were with me. River was at my In-Laws. Three year olds don't fare well at a hospital for long hours. I was slightly nervous, but I just kept telling myself that I was ready for it to be over and to be back to normal. In pre-op, they put me in a pretty light purple paper hospital gown, light blue socks, and put me in a little room. I was visited by my friend Ben, and a nurse who asked if I minded if they harvested my organs for science. Well, she didn't put it quite like that. Then the party started.

In quick succession nurses and doctors and anesthesiologists came in one by one. They all asked if I understood what they were about to do to me. I would look at Kari with each one, and then state "yah". (I was getting pretty nervous). Then a young guy, who was most likely still in college, and most likely spent most of his day in the gym based on the size of his biceps, came in with two red-capped needles. He said "are you ready?", as if I had a choice. And then, I remember nothing. Kari may remember more, but the next thing I remember is waking up in post-op, and in pain.

"Ryan, remember to breath!!". The nurses kept yelling at me from across the room as they worked with other patients. I was in a big post-op room that resembled more of a car dealership service garage than a place to care for patients. Each patient had their little bay separated by a hanging curtain. Each time I would fall back asleep I would stop breathing, so the nurses would have to yell at me to keep me awake. I guess the good sleep juice hadn't worn off yet. Over the next little while I was visited by Kari and Mom, Ben, Jim, my boss Steve, and well, I'm not sure who else. I was so out of it I don't remember much. If I forgot anyone, don't feel bad. Drugs are bad for remembering things.
The one thing I do remember is the guy coming to get me to take me to my room. He wheeled me past the waiting room, and Mom and Kari were there to follow me. It felt good to see them, to know that the worst was over, and that soon I would be in my room, watching free cable, eating applesauce, and getting visits from my friends...
I don't remember much about the next 6 days. Here are a few highlights. Pain and nausea and sleep. I don't remember so much that I don't even remember writing two blog posts that I just realized I published in my drug induced stupor.
One of the things I do remember is a couple of days into my time at the hospital. I had been on a liquid diet for at least 4 days at that point, and I couldn't touch another spoonful of jello or chicken broth. I told the nurse that I was ready for something solid, like a piece of plain toast. The nurse agreed and said she'd put an order in. At lunch that day I was surprised by a much different looking food tray than I was used to at this point. The brightly colored jello and heavily aromatic chicken broth were replaced by a plate consisting of Salisbury steak, mashed potatoes, and green beans. So what's a guy who has eaten nothing but liquid for 4 days going to do? I gobbled down the whole plate in no time flat! That was a mistake I would regret in the days to come...
I spent most of my time sleeping. I was on a pump of really good pain meds, and I had moved my way up to a nausea med that basically just put me to sleep. I would wake up nauseous and request more medicine, then I would sleep again. If I timed it right, I would wake up right before a meal, eat a few bites, get some medicine, and sleep again.
My Mom was with me most of the time. Kari would bring Wren during the day, and then take him back to the house at night. I can not give enough appreciation to those two women for being by my side the entire time.
I had some rough days and some better days in the hospital, but on Easter Sunday the nurses and doctors had done about as much as they could do to get me back on the road to recovery, and so they let me go home. I was wheeled out to my Mom's car, given a bunch of prescriptions to fill, and sent home. It was quite a relief, but up to that point, 6 days after surgery, I had not used the bathroom yet. I had been eating on and off, but nothing had come out the other side. It would catch up to me the next day.

Monday I felt horrible. I was weak, nauseous, had a headache, and couldn't eat or drink. I couldn't force anything down the 'ole gullet. I called the doctors office and they asked me to go to the ER straight away for some fluids and electrolytes. It was the last thing I wanted to do at the time, seeing as I had just gotten home from the hospital the day before, but I followed their directions and Mom drove me. I am not a fan of the ER, and this day solidified that feeling. I was as sick as I had felt the entire post-op period, and I had to sit there in a smelly, loud room with a bunch of other sick folks, waiting for a room in the ER. They eventually gave me an IV, which helped some. Then, after waiting for quite a while, they took me back, xrayed my belly to look for blockages, and then put me on a cot in the hallway.... Me and my Mom were both sitting there in the hallway of this busy ER on a cot, in the way of just about everyone. But unfortunately it was the only place they had for us, and I am glad they put me there, because it was right beside a private, one seater bathroom. While we waiting on a nurse to see us, all of a sudden, one of my surgeons ran by us. "Hey!" I said. He stopped and told me that he had been looking for me. He and I discussed what was going on and he decided that I had been putting stuff in the top chute, but that it hadn't been coming out the bottom chute, and that there was only so long you could do that before it made you sick. It was good to see someone familiar. At about the same time a guy I work with on the ambulance that also works at that particular hospital happened by and checked on me.

They gave me a bunch of electrolytes, made me drink some nasty vitamins, and then gave me the all important suppository. A short wait later I was sitting in my private, one seater bathroom, and the bottom chute began working. As painful as it was, I was very very relieved. We stayed a bit longer and then we were able to get released just before shift change.

I have been home now 4 days since that time. I feel better every day. I have been going on walks, and doing more and more around the house. After all of this, I am finally beginning to feel somewhat normal again. I am ready to be completely normal and all healed up, but it is an experience I will not forget. Over the last couple of months I have lost one and a half organs and I plan on losing no more in the near future.

Thank you to everyone who helped, visited, prayed, and thought about me and my family during this time. I am very humbled by the amount of support we received.

Me and my Purple Dress

Post Op, in my room

The nurse got cute and cut my dressings into hearts

A bonus pic of the boys

A Story About a Sore Butt

Day 5 in the hospital has been a tough one. Yesterday everyone was optimistic that I would be going home today. So, in preparation I took my nausea patch off due to the fact that it was making my vision blurry. The doctor wanted to make sure that went away before I went home. Then they put me on Lortab for pain control as a test to see if it would work for me once I got home. They kept me attached to the pain pump, but I wouldn't use it to make sure I was prepared for home.

At 9pm on Friday I took the Lortab and went to sleep. The pain wasn't touched. It got worse over the night as I promised myself to not use the pain pump. At 3am on Saturday, my nurse gave me 2 Lortab to try and curb the pain. It didn't work. At 5am I succumbed to using the pain pump. A few pumps of the pain pump and my nausea returns hard-core.

I beg for nausea meds and the nurse gave me some zofran at around 7am. Nothing. I ate nothing for breakfast besides forcing down a saltine cracker in order to get down a Percocet for pain. One step up on the pain meds.

I was miserable all morning, sweating and unable to move or open my eyes without feeling like I was going to vomit. Before lunch time my doc spoke with me and told me that he would like me to stay one more night so that we could get the mixture of pain meds and nausea meds just right while I had help available at my finger tips.

Around lunch time my nurse gave me Phenergen (sp?) for the nausea and it knocked me out all afternoon until dinner. I woke up at dinner and ate a few bites of food, took a walk around this wing of the hospital, and now I'm back in bed, taking more pain meds, ready to sleep the night away hopefully.

I don't remember if I mentioned it or not, but we got the pathology report back on the rest of the tumor they removed. The doc said it was much of the same, severe dysplasia, pre-cancerous, and that by having this surgery I was able to get clear margins, hoping that whatever the abnormal cell growth was will not spread to any other portion of my body. He said that he didn't see any signs of the mucous growth in my abdominal cavity, but that follow up appointments would be needed to make sure nothing took hold over time. Even still, we are going to gather all of my records and send them to a specialist in a type of rare cancer called PMP Syndrome and see what they say. Because of the growth that I had, I am at a higher risk for this disease.

Tomorrow will be day 6 in the hospital. I am determined to make it the last day I spend in the hospital for this surgery. As long as I can stomach the pain and nausea on the meds they give me, I just want to go home and be with Kari, River, Wren, and even my mother as she stays for a couple more days to help out. Back on the road to healing.

An Insides Story

As of Tuesday night I am lighter on my right side. The surgeon took out the right side of my large intestine and some of my small intestine. Looks like I will be confined to this hospital bed for a few more days. I am in a large amount of pain, and the pain med pump I am using only allows me to push the magic pain med button every 8 minutes. I count down the 8 minutes like I was waiting for the Megaball Millions lottery numbers to be broadcast. I have also been dealing with a lot of nausea, so I have been able to request zofran when it was needed in order for me to stomach chicken broth and water.

The surgeon said the surgery went well. I have two inch long incisions in my lower belly and a larger incision above my belly button. The reason they had to take some of my small intestines was because the incision from my appendix removal last month was sitting on top of my small intestines and had somehow fused to it during the healing process. They took the right side of the large intestine in order to make sure they got all of the associated lymph nodes and blood vessels.

We do not have a pathology report from the tumor yet. The doc said it will probably be a couple more days at least before we get the report. I may still be at the hospital by then, but, if I do good with recovery, they will let me go home earlier. I have to eat some solid food and have a bowel movement.

Thank you all for your thoughts and prayers! I am humbled by all of the people thinking about me. There are so many people out there dealing with issues much worse than mine, so I really do appreciate you. I should be back to normal sometime in the next couple of months.

A Story About A Black Cloud

In the world of emergency medical services, there is a phenomenon called a black cloud. An EMT or Paramedic is said to have it when they get a bunch of really bad calls. When they are not around everything is fine. When they show up, the poop hits the fan.
I have been lucky enough to have a white cloud over me thus far. As you can guess, a white cloud is opposite of a black cloud.
That is up until about a month ago. If you have been reading my blogs or following on Facebook, you probably can tell I haven't had the greatest of luck lately when it comes to my health. It may not be EMS related, but the black cloud continued to hover overhead.
Last night I sat down on the couch for 30 minutes or so. I sat with my leg underneath me. When I got up, my knee gave out and I couldn't put any weight on it. "No problem" I thought. It will pass after a minute.
I hobbled around on it all night. This morning I woke up and tried to walk and it was excruciating! "c'mon..., really!?". Luckily I'm already on light duty here at work because of my abdomen, but I am still relegated to hiking the lower trails with my law enforcement pack.
On goes an old knee brace that I had and off I go to work. I am hobbling like a penguin, trying to curtail some of the pain. I cannot take any pain meds because of my surgery in a few days. Ugh...
For those of you that are superstitious, (I'm too cynical to be superstitious) lets hope that bad things come in threes. That would mean its all uphill from here.

A Story of Children, Pain, and the Never Ending Cough

After my appendix removal at the beginning of March, I was placed on some antibiotics. During the two weeks following, my family ran through a little cold, each of the boys and Kari were affected. They were all better when I took my last antibiotic pill. As soon as it wore off I could feel my throat swelling and my nose running.
Crap, I thought. Three days of a cold were in the cards. Not a big deal. I've had quite a good deal of colds in the past. Then, on day three of my spat with the germs, I helped work a controlled burn forest fire at the park. I spent all day in the smoke. And the cough began...
For the last 8or9 days, I have had a ferocious cough. Bad enough at night that I have had to sleep in the other room while Kari sleeps in our room with the boys. A sleeping arrangement that we will have to utilize for a while after my surgery next week.
I went to our doc yesterday and she said I was not infected with anything still, but that the cough was just lingering from the irritation. She prescribed some major cough medicine/knock you out at night syrup. It doesn't even touch the cough, and if it indicates it's "knock you outness", it is 10pm and I took it 3 hours ago and I am typing this blog at about 300 miles an hour.
Earlier tonight, when I laid River down in our bed so he could go to sleep I laid down beside him for a minute. He wanted some kisses, then, as he pulled up his covers and made himself comfortable, he reached over and grabbed two of my fingers with his little three year old hand. He whispered "hand", and proceeded to not let go. He laid like that until he started to fall asleep and couldn't keep his grip.
Moments like that are more than special. They are precious and fleeting. We have to enjoy them completely while we have them and keep them tucked away in our memories for when we don't.
I have surgery again next week. I hope to be rid of this cough, and I hope to be rid of the abdominal pain and precancerous cells soon. I hope to be back to normal ASAP! I know there are a lot of people out there much more sick than I am, but only one month in and I am sick of being the sick guy. I can't sleep in bed with my family, I can't throw my kids around or wrestle with them. I'm not supposed to even be picking them up, but I do it anyway. I have been over doing it at home and at work the last week or so in a desperate attempt for some normalcy before next week. The cost has been more pain than I expected. But it is all worth it for moments like tonight with River.

Out of the Woodwork - A Quaint Story About Irregular Cellular Division

Let me begin this short (long) story by saying that it is not over yet. Only just recently did Kari and I actually have some answers that we were someone satisfied with. And yes, this is a non-fiction story. I have been on and off pain meds while writing this, so I apologize in advance for any jumping around or dry paragraphs. It is hard to be creative while on pain meds!

In the end of February I began having some light abdomen pain. It wasn't in any particular spot, just all around, although it did spend a majority of it's time down the middle of my stomach. At first I suspected gas pain. I saw a doctor a couple of days in, and he said it was food related and to call if it gets any worse. After 5 days or so I was worried it was something else, but I kept it to myself. My Mom happened to be in town during this time.

Now, my mom has never been the nagging type, and neither has Kari, but in this instance I can definitely say it was a good thing. They both pushed me to go see a doctor a second time and get a second opinion. So I did, and I am glad I did. The Urgent Care Doc noticed I was tender when he pressed on my right side. He decided to send me to get a CT Scan that night to see if anything interesting showed up. He told me that if everything was alright they would let me go about my way, but if they found anything they would meet with me.

On to the CT Scan that I was surprised to be getting that night. I sat on the table that moved in and out of the big expensive donut and then it stopped moving. I waited.....and waited, and finally a nurse came in the room. She asked me to wait in a secondary waiting room. There I waited....and waited, and a doctor walked around the corner and said "Mr. Jenkins, I have your doctor on the phone, we would like to have a conversation with you." I walked to his office and the Urgent Care Doc was on speaker phone.

He told me that I had what looked to be a mucocele of the cecum and appendix, and that I needed to have it operated on the next day. After getting off the phone, the Doc I was with tried to explain it more to me. It is an extremely rare disease process in which a growth in the beginning section of the large intestine (where the cecum and appendix is located) fills with a mucus type substance. (The appendix makes a mucus substance, which fills the area behind the growth.) This shows up in something like 0.3% of appendix cases. I've read one in a million chance. I was surprised, but not worried or scared of anything at this point.

The next morning the Urgent Care Doc's Office called and said the surgeon needed to see us in his office something like two hours ago. So Kari and Wren and I rushed to the surgeons office while my Mom took care of River. (She was supposed to have left that day, but decided to stay a couple more days.) The surgeon said he was going to remove my appendix via lapendectomy that day and sent me off to the hospital to get admitted and to receive an IV of some antibiotics before surgery.

Kari's parents ended up taking River to their house and my Mom was able to come to the hospital to hang out and help Kari. Kari rushed out to take care of some last minute things before getting back to the hospital just before a rush of tornado warnings came through the County. The nurse even had to come in and move my bed and the chairs in my room away from the window for most of the afternoon. My surgery was delayed, and then delayed some more as thunderstorm after thunderstorm passed through the area. We had a nice birds eye view from the 5th story of the hospital.

At around 7pm that night they surgeon came and got me from my room. They told us that they couldn't do surgery while there were tornado warnings going on. I politely agreed, as I wouldn't want them to be poking around inside my belly and the power to conveniently go out or the roof to happened to blow off or something. They put me to sleep shortly thereafter, and the next thing I remember is being wheeled back into my hospital room. Our friend Melanie Sams was there with Kari, Wren, and my Mom. I don't remember much, but apparently I said "Hey Mel" about 100 times or something.

Early the next morning the surgeon came to my room to update us on the surgery. He said the surgery went well, and that he was able to remove my appendix. Then he uttered the statement that started our worrying.... "I have never seen anything like this before. It is highly unusual, so I sent it to pathology to see if it is malignant or benign." In a moment, I felt a rush of feeling flow through my veins that I had never expected to feel. I thought, "What? I am 31 years old. I am not supposed to be dealing with any type of cancerous stuff. I am a completely healthy guy, and my family history is spotless. As far as I know, my family is a race of super humans because I have never been told that there were any genetic health concerns to be worried about." As the surgeon left I was in a state of disbelief. Kari showed up with Wren shortly thereafter and I had to pass along the news to her. I could see the worry show up in her eyes at that moment as well.

Later that afternoon they let me go home with some pain pills and a nice pair of grippy bottomed socks. (They are grippy topped to, so I am not sure what that is for, unless you are spiderman.) During my time at home I did a lot of research on mucoceles of the appendix and cecum. They are so rare, that the only thing I could find were scientific papers in which doctors were trying to figure out the best way to remove the growths without spreading the possibly cancerous cells into the abdominal cavity. We waited a few days before going back to the surgeon for a report update. On the way there Kari and I told each other that we hoped it was nothing, but that knowing our luck, something else was going on.

I knew when we got there that something weird was going on, because we were the only people in the waiting room and I could hear the office workers saying "Where is his path report? Have we gotten it yet? I can't find it?". We get in the exam room and the surgeon comes in and reiterates to us how unusual the growth was. He said that he does over 300 appendix removals a year and has never seen anything like this. Then the nurse comes in and hands him a phone. It was the pathology department. They were calling about my path report. It was quite interesting sitting there listening to the doctor have a conversation with someone on the other line about me. The first wave of sickness hit me when he said to the person on the other end of the phone, "I know I didn't get the entire growth, because when I cut through it, I released some of the mucus inside of it." (According to all the research papers I had read, this was mistake numero uno when it came to removing these things. Releasing any of that mucus into the abdominal cavity created an interesting type of cancer in which the mucus keeps multiplying and filling the abdomen. Mistake numero dos was cutting the growth in half, exposing the edge of the growth.)

Once the surgeon got off the phone, he proceeded to tell us that the growth was called a cystadnoma with severe dysplasia. Severe dysplasia, he continued to tell us, was a pre-cancerous type of cell multiplication. There are different levels of dysplasia, and mine was the worst kind. Basically, if there is a line drawn in the sand between not cancerous and cancerous, the growth was sticking it's tip toes over the edge of the line. He said that due to the size of the tools he had available to him at the time, he was unable to remove all of the growth. He said either a cecotomy (removal of cecum) or complete right hemicolectomy (removal of right colon) would be needed to have clear margins and to make sure all of the growth was out of me before it turned cancerous. In order to see how involved my colon was he needed to schedule a colonoscopy.

So, at 31 years old I was preparing to do a colonoscopy. I had to watch a video instructing me on how to prepare, and it started with, "Now that you are 50 years old..." When colonoscopy-eve arrived, I began the prep. It was lovely, and that's all I will say. When I woke up from the procedure I had a horrible headache. The doc sat down and told us that a right hemicolectomy was definitely needed, and that it was probably needed sometime very soon. Prior to this procedure I had already began the process of getting an appointment with a GI surgeon at Vanderbilt Medical Center.

The next day, my headache had grown into a full blown migraine and was causing me to vomit. I took some pain meds left over from my appendectomy and we headed to the specialist at Vandy. Boy, was I glad we were urged to see a specialist. (When my boss first heard about what was happening, he strongly suggested that we see someone who only does colon surgery because any messing around with your colon affects your entire body system. He said that you do not want a general surgeon messing around with surgery in your colon.) We sat down with the specialist, handed him my remaining records and pictures from my colonoscopy, and he calmly described exactly how the next phase of the process would go. When I asked him if he had ever seen anything like this, he said that it was rare, but that yes, he had seen this before. He calmed some of our fears about the previous surgeon releasing mucus into my abdominal cavity by saying that while he was doing surgery, he would check to see if he saw any evidence of remaining mucus. He described my next surgery in detail. He will put me to sleep and then give me an "on the table" colonoscopy. He will get an inside view of the growth, then proceed with a laproscopic surgery using 4 incisions, each one for a special tool and a camera. Once he can figure out how much of my colon is involved he will either do a cecotomy or a full right hemicolectomy. All of this will take place on April 3rd. He was very confident that this will take care of the issue, and that the only follow up I needed was to get a CT scan in one year to make sure there was nothing else growing in my abdomen.

Now, such a long story all leads me to the title of this blog post. People have come out of the woodwork to help in any way from meals, to babysitting, to mowing our lawn, to movies to watch while I am laid up in bed. People that I didn't even think knew who I was have offered the statement "If you guys need anything, just let me know". We have been in so many people's prayers and thoughts that it blows my mind! My only worries are related to the mucus cell release in my abdomen, but in all reality I should be well on the way to recovery by May and this adventure will pass like so many others. But I want all of you to know that your kindness will not be forgotten. I want to say "thank you" to all of you from the deepest part of my heart. I do love all of you.

A photo from earlier in the day that my Mom and Kari pressed me to go get a second opinion and the CT scan found the growth in my cecum. I had been on a hike at work and took a photo of this tree inside the park. It is a landmark for those of us that hike the trails regularly. It is a tree that at some point in it's growing history, it was damaged or got some sort of disease, and instead of dying, the tree has developed a massive growth around the damaged section.

A Day At The Park

Here is a quick video update, mostly with River. Wren doesn't have much action footage yet. He's getting there though!

The Boys' Cousin Mallory, Uncle Derek, and Aunt Mandy are in a few of the shots.

Enjoy!

Ms Piggys Big Getaway

Kari and I decided that it would be a fun way to play with River by making a movie with him. Of course I went a little overboard and made a full length motion picture. Uncle Jim (Rivers Godfather) and River save the day from the crazy Miss Piggy!

Garden oh Eden

Our home is much like the garden of Eden from the old testament. Take away the nudity and fig leaves and we have a paradise here... Well, add the nudity back in because with two little boys there is plenty of that going around.
This week, possibly to our demise, the fall of man has commenced. River, obviously tempted by the talking snake we keep inside our house, climbed onto the kitchen counter and ate the fruit of the tree of good evil.
We feared the worst! Curses upon our household for sure! But nothing happened. No lightning or thunder. No animals eating each other. Not even any shame of nakedness! (they're little boys, they aren't ashamed of anything!).
Then we realized, it was just a tomatoe, that River thought was an apple. And as far as I know, even modern science can't figure out if the tomatoe is a fruit or veggie! (another argument for another day). So we wee saved by the skin of our teeth again here in the Jenkins adventure, and River learned the differences between a tomatoe and an apple!

A Jenk Adventure Christmas 2011

Zombies

I know Halloween was a couple of months ago, and at our house, Christmas is in full swing, but there are a couple of Zombies walking around this house right now! Raised from our slumber every night, or kept awake late, we are slowly learning how to keep two children happy on very little amounts of sleep.

The mad scientist who is responsible for the Zombies creation is this small, one month old little boy. Wren doesn't look the part of a mad scientist. Mostly he just lacks the white lab coat, but besides that, he is a perfect match for a Dr. Frankenstein type. He has worked in his secret lab, concocting up any and every way to stay awake or to wake up as many times as possible throughout the night. Also, while asleep, he likes to growl and grunt and snore and coo as loudly as possible to prevent any Zombies from changing back to their normal human form throughout the night.

As Zombies, our only weakness is a pouty, jealous two year old lip from a child who doesn't always grasp that the attention is not fully on him and that he is having to learn the virtue of sharing the Zombies time with the person who created the Zombies in the first place. A rough lesson for a two year old, no doubt, but one that River is taking with apparent grace beyond his age.

The twist in this classic Zombie tale, is that the Zombies are head over heels in love with both the one month old Mad Scientist and the two year old Zombie Slayer. We are loving every minute of this new adventure and we really don't care walking around the day like two of the un-dead. We keep our identities as Zombies hidden by scheduling a shower every once in a while and putting on a clean outfit. Most Zombies eat people, we just eat snacks at weird hours of the night and morning. The world is kept in the dark as to the true nature of the dangerous Zombie creatures that leave our house every day to walk amongst the public. You know the truth now though! So keep your eyes out, we may be nearer than you think!

Some photos for the update:

Donuts

The Musician in the family

Sleep

More sleep, just usually not when we are able to!

River likes to help out now

This is not usual, but sometimes he likes to gives Wren kisses

Pretending to be asleep

Playing with the Christmas Train

It's a family affair

River emulating his Uncle Choyer cutting hair at our friends house

Yes! My Amazing Afterbirth.

A print of my placenta. You can see where the knot was located about half way down the cord.

Yes! You read it correctly, My Amazing Afterbirth. I'm so bummed we didn't get a picture of it. I always take pictures of everyone else's but forgot to take one of my own. It was a beautiful placenta, bright red with lots of capillaries and veins. It was pretty dang sexy if I may say so myself. Even my midwife and her assistant commented on how good it looked.

My dried umbilical cord. The knot is at the top left.

Here's my umbilical cord story...

When Wren came out, the cord was wrapped around his neck twice, his body once, and there was a perfect knot in it. Around his neck not too much of a deal to me, it happens often. But it was the knot that was so amazing to me. At the time, I was just so happy he was here. But over the few days at The Farm we talked about it with Stacie. She said that she had only seen a knot 6 times in 15 years. And one time it didn't turn out well. There were other issues going on, but the knot didn't help. Wren must have tied the knot early on in the pregnancy when he could swim a lot more. He would have had to swim in one direction and then back through the cord again. From what I remember my midwife sharing with me, she had done some research on knots after the one didn't turn out well. Some research suggests that women with low blood pressure tend to have more "cord accidents." Women who have low blood pressure and get a knot in their cord (which isn't that common) are more likely to have the knot tighten down. There is less blood being pushed through the cord making it easier for the knot to tighten and slow down the oxygen.

I've always had low blood pressure but with this pregnancy it was even lower. I was mainly in the double digits. But here's what is so interesting...Yes, this is speculation from Stacie and me but interesting nonetheless. I started seeing Lyle, an acupuncturist at East Nashville Community Acupuncture. At first I went for Moxa trying to turn Wren from breech. Well, that worked after one or two treatments. I continued going to acupuncture because I wanted help with regulating my gestational diabetes and raising my blood pressure. YES! I wanted to raise my blood pressure. Something inside me told me to do it. A mother's intuition is so freaking wise!!! With Lyle's help, we got my blood pressure into the triple digits. It was an accomplishment. I kept going for those reasons because not only had Wren turned vertex but now I was having success with my diabetes and my blood pressure. Speculation....Receiving acupuncture throughout the pregnancy to raise my blood pressure might have saved Wren's life. Because raising it may have pumped more blood through the knot keeping it loose. Thank you, Lyle, my Life Saver!!

Placenta Encapsulation....

Here's a photo of my tincture. I haven't delved into that yet. I could save it and use it for menopause.

With River I had a little more than the normal Postpartum Blues off and on. I had a bit of depression that didn't completely clear up until around 8 months to a year. In all honesty, I absolutely love being a mother and I have been since Day One. I couldn't quit kissing either of my Sweet Babies when they come out, even if they are covered in amniotic fluid, blood, and vernix. It was the sleep deprivation, not having much extra time for cooking meals and showering, topped with a gassy baby who cried a lot and being self-employed. I found it difficult at times to relax into my new role as a a mother. I didn't talk much about it because of the work I do. I was embarrassed. It's the weirdest thing...to be absolutely in love with this little creature and struggle meeting your own needs. This time I knew I needed to make some changes.

Placenta Encapsulation is supposed to help your hormones balance, give you energy, and help with milk production. It does a lot more, but those are the ones that stick out to me. I contacted Heather Crandall with Beautiful Dawnings. She came out within 24 hours and picked up my placenta. She dried it and encapsulated it for me. She also made a liquid tincture, a print of my placenta, and dried my umbilical cord. She kept the knot in for me. I didn't even have to ask. She knew it was special. I've been taking my "mommy pills" everyday. And I SWEAR by them. For the most part, my hormones haven't been wacky (with the exception of the unavoidable sleep deprivation crankiness), and I have more energy. Ryan can tell if I've missed taking them for a day or two. I've always promoted the idea, but now I will even push it harder for women. It has changed my life and my postpartum journey thus far.

Cheers to the Placenta!!

Our Chimney Sweep

We were on The Farm for Halloween. Neem, Pappy, and Ryan were going to take River to Spring Hill for trick or treating, but he had a melt down as they drove away from the birthing house. He wasn't sure why everyone was leaving Mommy and Baby behind. Ryan turned the car around, and we decided that he would go trick or treating on The Farm instead.

River's favorite movie is Mary Poppins, so he was a chimney sweep for Halloween. River doesn't like dressing up, so we had to trick him. Ryan got him ready in the car, told him he was putting "lotion" on his face, and he thought he was wearing his favorite hat. When they got back to the birthing house, we showed him a mirror and he was startled.

Jamina came down and stayed with Wren and me while everyone else went trick or treating. It was nice to have a friend to come and hang with me while everyone loaded up on candy.

Our Time At The Farm

We stayed at The Farm for 6 days after Wren was born. Stacie came and checked on us everyday. We just took our time. We say it's like our Disney World or our own Little Eden.

Ryan's parents drove down from Virginia, and my parents helped us out a ton! My parents cooked us meals every night. How lucky are we?!

We spent our time getting River acquainted with a new family member. Honestly, he didn't like it at first. And that was hard for Ryan and me. He's adjusting now, but those first few days were rough. His break through came when he saw Wren laying in the sun without any blankets wrapped around him and with his hat off. River had an epiphany, and said "baby feet?" Once he realized that Wren was just like him, only smaller, he has been into Wren ever since.

River also had lots of playmates between Daddy, Neem, Pappy, Grandma, and Grandpap. He played outside and went on walks and adventures to see the horses and chickens and play at the playground.

Jim came down to meet his new godson, and Jamina came for a visit too. My friend, Jen, who lives near the Farm stopped by for a visit as well.

Here are some photos from our first few days as a new family.

Wren's Birth Story

**This is a very condensed version from my 7 page handwritten account.

Enjoy what I recount from Wren Outlaw Jenkins' special day!

I started getting emotional the week of October 23rd. Everyone thought baby would be here by now. "Bed Rest" since mid-July was wearing me down. We didn't have a certain due date. I had been measuring small the whole time, and a couple of the midwives had said in passing that they thought I would go into November. Ina May mentioned Thanksgiving. I never thought I would think Ina May was full of it. I had been doing more research on gestational diabetes for a friend, and my emotions were running high. Nonetheless, the power of words were taking a toll on me. Ryan woke up on October 26th and found me in the living room crying. I couldn't even explain why, but I started fearing that something might be wrong with our baby. He secretly called Stacie, our midwife, and told her what was going on with my emotions. I had an appointment that day, and he wanted her to know where I was at emotionally. She arranged a ultrasound to ease my fears. Everything looked good! We did find out that baby was posterior, meaning that the back of his head was facing my sacrum instead of the most optimal way of being face first. Being a doula, I know that that usually means longer harder labors. Stacie checked me that day, and I was already 2-3 cm and baby was VERY LOW, 0 station. My mom ran me a bath at her house and suggested that we all get out of the house the next day.

When I woke up on the 27th, I noticed some bloody show. I thought maybe I lost my plug. We met my parents at Loveless Cafe and rode the Natchez Trace for awhile. During our ride on the Trace, I started feeling "something" but I couldn't put my finger on it. I kept quiet about it and would look at the clock periodically; it was about 10:30 a.m. I noticed that my "something" was happening every 7 minutes. When we got back to Loveless, I told Ryan that I might be having contractions. We all ended up back at our place since it was raining for an indoor picnic. I got a shower and the contractions stopped. There was more bloody show though.

I laid River down for a nap at 1:30 and we crashed together. Those feelings woke me up a few times during our nap. At 3, I got up to let Ryan know that they were back. We decided to contact Stacie. I knew she would suggest we come down. She did. She said the worst thing that could happen would be to come down, be checked, and stay the night.

Once we made the decision to go down to The Farm, the contractions started coming anywhere from 2-7 minutes. They were a little more intense and mainly in my back since baby was posterior. They began to require me to stop and focus on breathing. I would point to Ryan as he packed the car up, and he would keep time. I remember him saying, "Kari, some of them are 2-3 minutes apart. We need to get a move on it." I still kept my slow, steady pace. We all got in the car, River and Chaco, included and headed out.

It was about 4 or 4:30, and Stacie called to check on our location...only to find us sitting in traffic on the interstate. She wanted to let me know that Laura, her cousin, was going to assist her and let me know what other midwife would be there too. I was pleased. Stacie and Laura are a hoot together. And all the while we all weren't still sure I was in true labor. We dropped River and Chaco off at my parents. We started our birth music and drove the rest of the way. I was never so happy to get to The Farm. My low back was so uncomfortable.

We got to the birthing house around 6:30p.m., and Stacie and Laura were waiting for us. I thanked Laura in advance for being my official butt wiper. We all laughed! Stacie checked me and I was 4 cm and a lot thinner from the day before. We all agreed that we "thought" this might be labor. Stacie and Laura went to the Farm store to get us all some soup and give us some privacy to unpack and get settled.

While we were unpacking, Ryan very kindly asked, "Do you want me to set up the video camera?" I couldn't decide before hand, so I had told him to ask me in the moment. My response in the moment was to stop in my tracks and use a 4 letter word. I can't remember which one but we'll go with a Hell No! I apologized immediately or at least I meant to. Ryan said I used a lot of 4 letter words this time. I do know that I kept saying, "Good God." I apologized to Laura and Stacie. I found out that Laura is a preacher's daughter. It seemed like I repeatedly said, "Good God! I don't know why I keep saying that. I'm sorry."

Knowing Wren was posterior, I decided to try and turn him using a Roll Over Technique from spinningbabies.com. Back Labor was a totally different experience than River's birth. Everything was much more intense. When Stacie got back from the store, she came to check on me. She found me half way through the Roll Over Technique in a lot of discomfort. Stacie told me she didn't want me to fear a posterior labor/birth.

"Either baby will turn or you'll push him out posterior."

"But I'm only half way through the technique."

"Is it working? Are you comfortable?"

"&*%$ NO! But I'm an over achiever. I'm only half way through."

"Well, I would get up and squat and get this baby out."

I threw in the towel on the Roll Over Technique and went to the kitchen for some soup. It was about 7:30 p.m. or 8 p.m. at this point. We all hung out in the kitchen telling stories and cracking up. When a contraction would come, I would hold onto the counter and squat or get on all fours. After awhile I couldn't handle anymore Amish stories. Stacie and Laura birth Amish babies and massage their families too. So they have tons of stories. As funny as they were, I couldn't get on top of the contractions anymore.

Around 8:30 or so, I retreated to the bedroom. I wanted to be checked, but I wasn't feeling any urge to push. I started to "lose control" and panic. The intensity was growing, and the low back pain was causing me to panic internally. She checked me, and I was between 6 -7 cm. My only thought at that moment was I made some progress. I was on all fours in the bed, and Stacie offered to put pressure on my low back. That didn't work. She suggested a bath. They got the water running, and Ryan got my birth music set up. I climbed into the tub and would go back and forth from sitting up to all fours.

I requested Lady Gaga's, You & I. We all commented on how much we loved this song. During my tub time, I would stare at the tile on the floor or this button on the side of the jacuzzi tub. I would breathe and push my breath into it. Here I was using my Birthing From Within practices. Sometimes I would roll my forehead up onto Ryan's shirt and breathe deep. It felt so good to have him sitting near me, encouraging me. Stacie told me to let her know if I felt the urge to push. After 20 or 3o minutes in the tub, I felt my nether regions expanding. They felt like they were about to rip in two. Ryan asked me if I wanted to get Stacie. "No! Let me have one more." With the next one, I came up out of the tub like the Loch Ness Monster. "Get Stacie!"

They got me out of the tub and back into the bedroom. I threw myself back onto the bed, and Stacie checked me. I was 9 cm. I think it was about 9 p.m. at this point. I couldn't form thoughts or words much at this point. However, I heard Hanson playing from our play list.

"I always knew I would give birth to Hanson."

"Ok."

"IT'S HANSON!"

"Yeah. We know."

"You know, Mmm Bop."

"Yes."

I think it was Laura who actually appeased me by saying that she didn't know they had new stuff. I swear one day Hanson will give me front row seats or backstage passes for being so devoted. If you know me well, then you know how hilarious that conversation and spot on that conversation is for me to have in labor.

I started pushing my head into Ryan's abdomen with my arms wrapped around his waist, and my vocalizing took over. Moaning. Groaning. Screaming. Those powerful birth noises are indescribable. "Toilet," I said. They got me there.

Once my butt sat down, I felt Wren coming and there was nothing I could do to control or stop it. "I can't stop it. He's coming!" My water broke on the toilet. How convenient?! Stacie told me she couldn't protect my perineum on the toilet. She wanted to get me back to the bed. But once I stood up I knew he was coming out, and I couldn't go anywhere. Ryan sat down in the corner of the bathroom and helped me down too. I leaned back on him, put my arms above my head and grabbed his shoulders. My body had taken over, and I was along for the ride. I wasn't even intentionally pushing. My body was doing it without me controlling it. Stacie looked at me and with her fingers showed me an egg size shape with her hand. "I see this much head" in the midst of me screaming, "I can't stop!" And just a few moments later, she said the head is out. I gave a push for the rest of his body, and he was out. And yes, Footloose came on! The only other person I know named Wren is Ren McCormick from the movie.

I remember this with River too but it's the most amazing feeling when you're handed your baby. The feeling of their warm, wet, slippery body against yours and then your eyes meet for the first time! Wow!!! And it was 9:20 p.m. I jokingly told everyone when I got there that I wanted to be done before bed time. Ta-dah! We were...kind of.

The placenta came after about 10 minutes. I've always wanted to cut a cord, so Stacie let me cut my own cord. I thought it was fitting since Wren and I had been connected for 9 months. I wanted to be the one to cut it when I was ready. We all had some time on the bathroom floor before everyone got me up and to the bed. Since Wren came out SOOO quickly, I had some bruising and tearing. Stacie said I tore like a flower. It sounds a lot nicer than it probably looks or definitely feels. She made Ryan promise NOT to give me a mirror if I asked for it. They know me too well. In those moments, I didn't care. Just take your time stitching me (2 hours worth), give me my frozen Arnica and Witch Hazel Pads, and we'll call it a day. I had my new sweet baby, and my husband beside me. All that was missing was my River boy.

Stay tuned for more blogs on the amazing umbilical cord and life changing placenta encapsulation...