And that kids, is how I ruptured my appendix

This post originally existed in my _2017 in Review blog post, but has moved into its own post so it can be found more easily.

Content Warning: I have attempted to make this section fairly safe, but this is a content warning for some mild discussion of bodily fluids, needles, and medical procedures.

TL;DR - a week before Christmas my appendix ruptured, we didn't catch it for some time due to it presenting non-traditionally, and the area was quite infected. I am recovering well, with no complications and am looking to return to work in early March once I have physically healed.

The below sections describe in a bit more depth the full timeline of my diagnosis down to where I am now, far through the healing phase and into recovery. Below I've been trying to explain the levels of pain I've been in. However, that isn't really helpful as pain is very subjective, and if there's one thing I've definitely learned, it's that I have a very different pain threshold to others. Hopefully the below examples will help share the levels of pain I experience:

• a 2-3 pain level is quite a dull ache, enough to ignore fairly easily, but remains
• a 7 pain level is blinding, very intense, and is to the point where I am unable to very easily take my mind off it for long, if at all. It seems to causes nausea due to intensity, and requires strong pain refief such as morphine to reduce the pain
• a 8-9 pain level would be expected to reduce my mental and motor functions to the point I'm unable to do anything
• a 10 pain level would be expected to instantly knock me out from the pain, for instance

I haven't experienced above a 7 pain level, and I really do hope that I do not have to.

Another point to note is the use of the term "the wound" below. Because my surgery did not happen under keyhole, the area that had been operated on was left open. This is a common occurrence that leads to the final scarring being more minimised than would be if I were sewn up, as well as reducing the chance of needing to operate again in the case that post-operative infection was discovered. Another reason it's referred to as "the wound" is because it draws attention to the gravity of it - even after a week of healing, it was the size of a fist, from above my belly button to my waistline. The fact that this is actually a pretty big area to heal has meant that the recovery has had to be a lot longer than it would have been for an otherwise routine appendectomy.

I want to say a massive thank you to both my family and to Anna for all the incredible moral, physical, and mental support I've had over the last couple of months. I honestly would not have been able to get this far without any of you, and it means so much for you to have put so much of your own lives on hold to help me recover.

I'd also like to say a massive thank you to everyone who took care of me at Queen's Medical Centre E15 ward in Nottingham, the care there was really good, and helped me recover more positively with so many friendly and helpful faces around.

One of the most problematic issues with this happening was timing. As I was in hospital over the Christmas period, it's resulted in us having to postpone Christmas until I've been well enough to be able to (over)eat a hearty Christmas meal. We've recently given our presents to each other, but the actual "Christmas day" will be coming a bit later in the year. Fortunately I didn't quite ruin New Year's for everyone, although I was asleep relatively early and missed midnight, but got to see everyone around two minutes past midnight, so I felt like I'd been able to celebrate it a little with them.

I've also found that over this period, maybe one reason I've been reacting so positively to everything is because I haven't really been thinking about how bad it could get. I guess if you don't confront the issues, they can't get you, right? (sarcasm) That being said, there have been a few places where my ignorance and unwillingness to consider the effects has not been the most ideal way of coping, especially when looking at how I didn't think about complications of the surgery, and how my life would be affected afterward.

In the past I've not really found I've had to think about my independence as a person, but this period of time has really made me think, especially about old age and the loss of independence due to frailty. For the best part of a month, getting in and out of bed required help from my parents, which meant that at any point during the night if I needed to go to the loo, I would need my parents' help. Additionally, for the first five or so weeks, I required a hand from my dad drying off after a shower, as I wasn't physically able to dry my back or bend to dry my legs. Feeling like an imposition on my parents has been a really awful feeling, knowing that you're ruining both your parents' sleep just because you can't get out of bed, but also knowing there's nothing that can be done about it. Loss of control over yourself and being able to perform even basic tasks is a really humbling experience. But knowing I would get better and would be able to look after myself soon helped me stay positive, whereas I know there are many who have no such luxury and unfortunately have to rely on others for many things. I am honestly thankful that generally I am physically healthy and am able to be self-sufficient.

Diagnosis

On Saturday 16th December, I felt some discomfort in my stomach, towards the lefthand side of my abdomen. Anna and I had just had a Chinese takeaway, so I had just put it down to maybe being overeating. However, the following day, the pain was getting a little stronger, and I ended up vomiting at one point. We would have put it down to food poisoning, but Anna was completely fine, and given we had eaten the same food, there was a slim chance of it being that.

That evening, I was still feeling incredibly unwell and on the Monday morning I called in sick, suffering from really bad pain in my stomach (pain level: 3-4). I was barely eating, as I was unable to keep much down, and my appetite was very little. I spent most of the day just watching TV to try and keep my mind off it while paracetamol took hold, and sleeping when the pain would let me. However, by the time Anna was on her way back from work, the pain had reached an intensity to the level of pain I'd never felt before (pain level: 7), and she helped me travel as quickly as we could make it to a nearby walk-in clinic.

Arriving to the clinic as a couple of police were responding to some disorderly patients, we were told that the wait could be up to 4 hours as the commotion had caused further backlog. The longest 45 minutes of my life passed, the intense pain barely relenting for a second, no matter the positioning on the already uncomfortable seating, at which we were seen by the triage nurse. She took my details down, and referred me to one of the nurses available. Unfortunately, there was a queue, and it took more than an hour more until I was able to see her. While we had been there, Anna did her best to distract me, which did some help to take my mind off it and reduce it to a more manageable pain, but every so often I would get a flash of very intense pain, and be back at square one. When we saw the nurse, she did a quick check of the location of the pain. After doing a urine test, it was noted there was blood in my urine which indicated a urine infection, for which I was prescribed some antibiotics. I'd also mentioned that I'd had ibuprofen fairly soon before we left, and she attributed a large amount of the pain I was feeling to having that on an empty stomach. Retrospectively, I should have mentioned that the pain was there even before that, as well as asking more about the urine infection, as I had assumed that was something you would notice a bit more if you had it.

We found the nearest pharmacy still open around 2100, which happened to be at a Sainsbury's, allowing us to stock up on large bottles of water to help flush out the infection, as well as lots of snack-y food that I'd be able to more easily reach and eat in my room, where I was pretty much bound during the day, as walking up the stairs in my flat to the kitchen and bathroom was a chore I'd rather have avoided.

Anna checked on me every night on the way home from work to make sure I was okay, bringing me some soups and other goodness through the week to help me feel better. She was an absolute star, always making sure I had everything I needed, but it was a shame my stomach wasn't really wanting to eat any of the nice stuff she had brought me.

The next two days of taking antibiotics were making me feel better, until Thursday afternoon when the pain (level 7) really came back in force. And given I hadn't had any ibuprofen, I was sure that wasn't an indicator of the issue (however, retrospectively I realise I did not tell the nurse that). There was a slightly reduced wait time of half an hour to the triage nurse, and a further hour to the nurse, but once we were in we at least had the same nurse from Monday, meaning we could more quickly start looking at the problem, instead of needing to explain all the details again. Due to the antibiotics not helping, the nurse took some blood, and referred me to a Gastrointestinal surgeon at Queen's Medical Centre, allowing us to avoid the wait in QMC's A&E department, as he would be able to better diagnose this.

When we arrived at QMC, we spoke to the surgeon and discussed the last few days of pain and how my had been reacting, such as with the vomiting. He had mentioned that the nurse had thought that it may be my appendix, but as it was presenting from the wrong side of the abdomen, be didn't think it was my appendix (Narrator's voice: But as we know, it was). He took some blood and after some time of sitting in some comfortable chairs in the waiting area, we got the results back. The surgeon mentioned that my blood was "deranged", which immediately scared me until he explained that this was a common medical term. However, he mentioned that due to the way my blood was reading, especially with a high inflammatory marker count, I would have to go down for a CT scan. Before I went down there was some more vomiting which didn't help me feel any better, but meant at least I wouldn't be doing it while having the CT. I was told that I would go to the ward after my CT, so I would have to say goodbye to Anna until the morning. I wasn't quite ready to be left alone, but she left her charger with me to make sure I was able to stay in touch with her and my family and keep them updated on the situation as it unfolded.

Once the CT had been completed, I was wheeled to the ward, where I awaited the results. After some time, the surgeon came to inform me that I had a ruptured appendix, and that given the amount of infection I had accumulated I would be needing to have surgery as soon as possible. However, given the fact it was 0200 at this point and it would be possible to hold out until an early surgery in the morning, they decided not to rush me into the operating theatre.

However, there were a number of pre-operation preparations to get underway, so I needed to sign my consent form, taking some time to consider the real worst case of potentially having a stoma bag when I woke up. Although this was a real worst case due to the fact that the infection had been underway for a number of days at this point, there was only so much the CT scan could tell them about how bad it would be until I was on the operating table. This meant that they had to prepare for every eventuality, and obviously they wouldn't be able to ask me for consent when I was knocked out with anaesthetic. He also explained that due to the amount of infection, there was a very high chance of the operation not happening under keyhole, which would result in a bigger scar. I wanted to chat to my parents because this was the first major, potentially life-changing surgery that I'd had had, and as well as keeping them updated, I just wanted to talk it through with someone. We later spoke about logistics as they wanted to make sure they were with me on the ward before I went off to theatre, so would have to drive up from London. Given it was getting close to 0300, this didn't give them much time to prepare and jump in the car, to then make the journey and see me as soon as visiting hours were available at 0700, with hopefully an hour or so before I needed to go down to theatre. They also organised with my sister Catherine in Southampton, who'd be leaving for the first train around 0500, but would have an almost four hour journey to get to Nottingham, and who unfortunately missed me by about half an hour.

Once I'd had my initial chat with my parents and signed my consent form there were preparations that they needed to perform, like checking blood pressure and vitals, as well as inserting an IV drip and catheter. With the preparations complete, I was given an hour to try to sleep before I'd need my blood pressure taken again. I managed to drift off for a little bit of very poor, and pain-filled, sleep, though, which meant that it was around 0600 by the time I woke up. Not long after, my parents and Anna arrived and tried to help distract me from the pain and thinking about the surgery, which fortunately was very soon.

Operation + Recovery at QMC

I got wheeled down the morning of the 22nd, and had to wait for what felt like at least half an hour to an hour before having the final pre-operation preparation. It was at this point that I was given the choice about pain relief post-surgery - I would either be given an epidural, which could continuously be administering pain relief, as well as giving me an option every half an hour to provide an extra dosage if required, or to just keep with IV administered pain relief. I opted to go for the epidural for the extra control, and maybe also because "constant pain relief" sounded good in my state, although maybe not quite realising it was a going to be a long needle literally poked into my spine. That being said, it wasn't an uncomfortable experience being administered, it just felt a little weird. Once complete, I was ready to go under.

Waking up in the recovery room, I was drifting in and out of sleep while they worked to get my pain management under control. At one point I asked to call my parents just to let them know I was fine, worrying they hadn't been told I was out of surgery. Fortunately they had been kept fairly updated, and therefore weren't frantically worrying about what was going on. They took the time I was in recovery to book accommodation for the next week, as they'd rushed to Nottingham but not really planned anything around what they'd do after I was out of surgery. Fortunately, they found an [amazing flat][lenton-view] that was close by, very spacious, and, from what I've heard, had a really comfy sofa for napping on!

Once I made it back to the ward, I was incredibly drowsy as I still had the effects of the anaesthetic and pain medication I was on. My family and Anna stayed for about ten minutes or so, and left me as I couldn't really stay awake, but am told I was much better in spirit than before the surgery. My family also will have needed a bit of time to rest and recuperate and pick up the keys for the flat, but more importantly, think about what they would be doing for dinner!

My IV was hooked up to a bag of fluids to ensure I was as hydrated as possible. As I would be immobile for the first few days, the catheter would made the fluid intake much easier. However, being so used to drinking water while at work, I was finding my mouth would be getting very dry, and so the nurses allowed me to drink a little water myself, although they made sure I knew that I would get all my required fluids via IV. I wasn't physically able eat until Christmas morning, my first meal being vanilla ice cream, as the doctors felt I was getting to a good stage. We've also decided that having ice cream for breakfast definitely has to join the Christmas traditions in the future.

It was at this point I was really gaining massive admiration for the human body and the fact that it could survive for another two days without any food, after a week of eating at most two slices of toast a day and a huge surgery. It's also helped me realise that major surgery is a great way to lose weight! As of mid February, I've lost 14kg (2st 2lb) of my previous weight, although this loss is slightly unfair as I wasn't exactly in the best shape of my life. Over the next few days, I started being able to have a soft diet, such as rice pudding and mashed potatoes (no, not as a pairing), and one of the most impactful, being able to drink tea!

Speaking of Christmas, this year it was a little different than I'm used to. Although I was able to spend some time with my family, it wasn't quite the joyous occasion that we're used to, but there was definitely excitement for me eating ice cream. I did also get to see Anna, which I wasn't expecting this year, so that definitely helped keep my spirits up. But given the night before had been quite interrupted sleep for monitoring blood pressure and oxygen levels, as well as running other tests, I was rather tired during the day, and pretty much slept through the afternoon. I saw my family again in the evening, but again it was a short visit because I needed to sleep.

The first few days were spent in a state of sleeping and sleepily chatting when the family and Anna. As I was having very interrupted sleep, for instance to checking my blood pressure throughout the night, combined with flushing the anaesthetic out of the system, and the body's reaction to the trauma it had been through, I would be trying to get sleep where possible. Given I was in a shared ward, too, there was the inevitable noises of the hospital as well, although I am very glad I wasn't in a private room because having nurses constantly around to be able to look in on me or call for if needed was invaluable.

As I was starting to gain a bit more brainpower, my days were being spent pretty much glued to my phone. Fortunately I have a self-hosted app called [Wallabag][wallabag] which [I have been meaning to blog about][wallabag-issue] which is a great way to save links to read later. Over time I've accumulated quite a few, so I was able to make decent headway through them, as well as trawling Twitter and reddit for new content and just to do something. I'd also spend time trawling through Twitter, reddit and [Hacker News][hacker-news] for further links or interesting conversations my still recovering mind could try to digest.

Every day I had visits from my family and Anna, making sure that I had time to see them and chat about how they were and catch up on how I was, too. My family would arrive earlier to make it in time for the doctors' rounds, and Anna would join a little after so we'd get some time just to ourselves. It definitely helped, because there's only so much you can spend reading and sleeping! Having some human interaction, even if it was just knowing they were near while I was asleep, was nice.

Unfortunately over the first day or two post-surgery, I was suffering fairly often from vomiting, even with anti-nausea tablets. Not only was this not fun (because hey, who likes to vomit when you've got literally nothing in your stomach?) but it was also also incredibly painful, not helping due to the act of throwing up occurs in the area that had recently just been re-oriented when undergoing surgery, the muscles themselves had either been cut through or weakened, but also due to the fact that I would be doubling over on myself, which given my stomach was still open from surgery, would hurt further. There was an attempt to place a tube through my nose that would help pump the fluids from my stomach, but the attempts to place it were painful (level 3 with epidural) and unsuccessful. After another day or two of lots of vomiting, we tried again with the tube, which after a fair bit of pain (level 3 with epidural) did place correctly, which helped to ensure the stomach remained at a level that was comfortable, only vomiting once while it was in.

On the 26th, we were able to start disconnecting the various tubes and needles from me, starting with the tube down my nose to help with nausea, and my IV drip.

Very early on the 27th, they removed my epidural so they could then very carefully monitor my pain levels over the course of the day and night. It was a little shock as I was used to there being a constant baseline of pain relief, whereas I now had to specifically ask for oral medication and then wait for it to take action. However, there weren't too many times this happened, as I seemed to be coping a little better with the pain. We'd also removed the catheter to give my body time to ensure everything was still working. After seeing the doctors, they felt that as long as the pain team were happy with my body's reaction to the epidural's removal, I would be able to go home the next day!

With that in mind, my parents decided to take me out for a celebration (and more importantly, a test of my strength) to the large Costa a seemingly endless walk and a lift ride away. The previous few days I had been doing a little walking, but not quite enough to prepare me for the journey. When we arrived at Costa I was very tired, but a nice cup of Earl Grey and a little cake sorted me out, and I was able to make it back to the ward okay, too.

On the morning of the 28th I was OK'd to be discharged, and prescribed, among other things, morphine sulphate syrup for the pain and anti-nausea tablets. We drove home, giving me extra blankets to ensure I would be warm and that I wouldn't have as much of an issue if the seatbelt needed to tighten around me, as well as one behind my head to make sure I'd be able to sleep more comfortably. And fortunately, sleep I did - for all but the last 20 minutes of the non-stop journey.

Recovery in Harrow at my Parents'

Being very tired after the journey, the rest of the afternoon was quite quiet, and mostly involved napping. In fact, the majority of the first week of my recovery was spent reading and sleeping, with a little time downstairs watching TV with the family. However, my Dad had also set up an old TV in my room, meaning I'd be able to at least watch Freeview in my own room which helped a lot with having a sense of normalcy. It also helped, because we found the old Wii and I've been able to have some very nostalgic times re-playing [Super Mario Galaxy][mario-galaxy], one of my favourite Mario games.

Over the New Year's weekend, we had to travel to Mount Vernon Hospital to get the dressing on my wound redressed, as our local GP surgery was not open. Often, the wait was no longer than twenty minutes, and we would then have the wound redressed in another half an hour. One thing we found through the shift patterns over the weekend was that we wouldn't have any consistency, resulting in us seeing three nurses over the three days, where each nurse had their own techniques for cleaning the wound, which were sometimes a little more painful than others. The wound then needed to be repacked with gauze, meaning that dependent on their technique and appreciation of my pain, it'd not be the best experience for me. And because we saw different one the next day, they would now not have the knowledge of the wound and my pain thresholds.

This inconsistency persisted to the 3rd January where we found at our GPs' we were also having issues where there wasn't necessarily the same appreciation of what the wound was. Fortunately, we had decided to start taking photos of the wound on our second visit to Mt Vernon, so we could start to at least compare ourselves, even if the nurses wouldn't remain consistent. This helped with nurses who weren't quite aware of what was under the dressing so would perhaps be a little more heavy handed than they knew, giving them appreciation of the fact that right now, Content Warning: hover to view you were able to see my bowels. This was also something that I didn't realise until I saw the first photo, as my perspective didn't quite Content Warning: hover to view let me see the depth of the wound itself.

As we were getting the dressing redressed that day our GP popped in to look at the wound, and after seeing it, put some time aside for us after our redressing so we could discuss further. He recommended that we speak to one of the local tissue viability nurses about [negative pressure therapy][negative-pressure-therapy], and left a message for them to call us back, and to get us on the much better treatment path.

Unfortunately, that call never came, but by this time we had managed to get all my details for Aviva, and therefore were able to start visiting the BMI Clementine Churchill Hospital. On the 3rd January we saw Mr G, a Gastrointestinal specialist for our first visit, who agreed with the recommendation for negative pressure therapy, as it has the best healing capabilities of all the options, as well as often causing a 2-3 times speedup in the healing process, and that we should be able to secure the unit a little more easily than on the NHS, as they usually have a pool of them to use, whereas we would be procuring our own. After seeing a photo of the wound from a few days earlier, Mr G was shocked the very fact I'd managed to walk into the hospital, let alone all the way around to his office. It was at this point, he managed to catch the Clementine Churchill's tissue viability nurse, M, before she left for the day, who was able to remove the dressing so they could see for themselves what they'd be dealing with.

M explained that as well as the fact that the traditional dressings required being redressed daily, the leakage of some of the fluids that was happening almost every morning should not be exposed to the skin due to it being internal enzymes and fluids (also called exudate) which could cause damage to the surface of the skin. Although not a problem with the dressings themselves, it was more a matter of there being quite a lot of exudate therefore needing it to be extracted, which the pump would be able to do.

That Friday (5th January) M was able to fit a slightly newer version of the negative pressure therapy unit than was currently available, with the assistance of a representative at Smith and Nephew, the company who manufacture it. Although I'd found going to have my dressing changed potentially a little painful due to the cleaning of the area, it was nothing to prepare me for the first time with the pump. For the pump to work, M had to cut pieces of sponge (effectively the same as is used to protect hard drives in transit) and then place into the wound so once the suction dressing is applied, the sponge will be flush to the skin. The sponge has two main uses, the first being aiding granulation of the tissue to promote the healing process and secondly to allow the passage of any fluids from the wound into the pump. However, in order to make sure that the healing process is maximised, the sponge must be packed fairly tightly, which was an very painful process (pain index reference: 4 the first time, when dosed on Oramorph). It was only the first few dressings that this was uncomfortable, and as the body healed there was a lot less sponge that could even be used, so packing it tightly wasn't required.

However, the real pain was dealt each time the dressing came off due to the way the sponge promoted granulation of the skin, and how sometimes the sponge would stick to the skin of and around the wound, resulting in an extremely painful process (pain index reference: 5.5 the first time, when dosed on Oramorph) which required my dad's hand/arm to become my stress relief. Unfortunately this pain was similar every time the dressing was taken out, until only the last week and a half of the pump's time with me, meaning it was never a fun affair, although M and my parents did their best to distract me while it was happening. For the first few weeks, I needed a nap very soon after the visit as my body was really quite exhausted from both leaving the house and the walk around the hospital, and the trauma of the dressing changes.

That being said, I wouldn't have wanted to not be using the pump - the incredible healing it helped promote, even after the first few days with it, made the pain worth it. Although we'd been told just how good the pump was, I don't think we really appreciated just how fast the healing would occur, and how noticeable it would be in the pictures we had taken over time.

One of the most life-changing things about the pump was that on the days I would be seeing M to get the dressing changed I was able to disconnect the pump and go for a shower. Although this may not seem like such a big event, I had spent my time since the 21st December only having a washbowl, which wasn't even always daily, given how I was feeling. And not only was washing weeks of hospital and general grime out of my hair liberating, but being able to wash myself a little more normally was a big step and helped me mentally feel like I was already on the path to healing.

The other, less fun, change was that I'd have to carry around this pump wherever I went, meaning a little bag (of non-negligible weight) wherever I went. I'd have to sit it down such that I'd be able to reach the carry handle, otherwise I'd not be able to get up in a hurry if I needed to pop to the loo, but also to just generally being a little more independent. The pump also was constantly humming which added background noise to anything going on, so although I'd personally been getting to the point of it not even registering to my hearing, the family and Anna would be aware of it when we would be sitting watching TV, or when we were eating.

A couple of weeks later, there were evenings where I started to have some really intense back pain (pain index reference: up to a 7 before taking any pain relief), where I was getting pain directly under my shoulder blades, either just on the right side, or in a clear straight line running across both sides. I managed to find that sitting in one specific type of chair helped a little more, but it wasn't without the strength of morphine and applying wheat heat packs that I was able to get the pain under wraps. Another fun side effect of the pain I was suffering in evenings was also that it would often cause me to vomit, which although not as painful as when the wound was still very fresh, it wasn't much fun adding on top of the back pain, as well as making me hungry. Over time, the pain was holding out against the morphine where it would instead be reduced to a pain index of 2-3 rather than it completely dissipating. We found that it may potentially be caused, if not being exacerbated, by the carrying of the pump on my right hand side. As a method of looking to reduce the effect of this, I switched the pump to being on my left hand side where possible, so I'd rest my muscles. I'd also found that posture when sitting (especially when there was no back support) would greatly impact the chance of having the pain that day. Unfortunately for me, my posture has always been awful, but this has at least been forcing me to better it.

But as these were getting more common, we decided to get it checked out, and scheduled an appointment with Dr L, who wasn't quite sure about the pain, but took some blood to be safe. Returning the next day, we found that my liver was working a little harder than usual, and there were some inflammatory markers. He recommended we get an ultrasound, and we managed to get that booked for the evening. Unfortunately, due to me being unable to move onto my side, the ultrasound wasn't conclusive so we were booked into a CT scan, which happened about half an hour later. After waiting for results for the around an hour, we were told that we'd get a call tomorrow with results, as there was some communication that had to go between the radiologist, Mr G, and the Urologist. On our way home, however, Mr G called us up, and told us that there seemed to be a collection of fluids, following the surgery, that seemed to be pressing on the left ureta, which travels from bladder to left kidney, and that it was causing a bit of inflammation in the kidney. Oddly, this is usually something that would present itself in the first 1-2 weeks after the surgery, rather than 4 weeks later, but it could have been there for a while and it just wasn't causing any impact. In order to resolve this, the Urologist would place a JJ stent placed into the ureta, which would help move any fluids from the kidney to the bladder, unaffected by the collection pressing on the ureta.

Mr G also diagnosed the back pain as the paravertebral muscles going into spasm, which is something he has experienced in the past too. We were prescribed Diazepam, a muscle relaxant, which he recommended we take an hour before the pain would usually start, allowing for the Diazepam to kick in before the pain would have taken full effect. This mostly helped curb the pain I was experiencing in the days leading up to the stent operation, but there was still sometimes discomfort, even when the Diazepam was in full effect, leading us to our working theory being that that was just the muscles being sore after use for the first time in a while.

Whether by coincidence or by cause, as soon as I had had the stent put in, my appetite has come back in force, to the point I had assumed I would have been, given the body requires three times the amount of energy when healing these large wounds. Additionally, since it's been in, I've really been feeling better, my strength has been coming back a lot better, and when we last saw Mr G on 7th February, he mentioned I am most likely entering the "anabolic phase", where I had turned a corner in the healing process, and although mental and physical tiredness would persist for some time, my major functions would be returning and I would be getting much stronger and closer to being all healed up.

I would say that it also wasn't until around the time that I had the surgery that both mentally and physically I started to really feel better. It was more obvious to see on weekends when Catherine and Anna were visiting, I would find I needed some quiet time to myself, sometimes part way through a conversation, as I was mentally tired and needed a bit of a break. Up until this point, too, I was still requiring a nap every afternoon, otherwise I wouldn't be able to make it until the evening. This was mentioned to be normal, partly due to the amount of energy I'd be expending on the healing process, and also because there would be the extra overhead of me being awake and mobile. By making me go to sleep, the body could save some energy that it would then be able to dedicate the saved energy to the healing process. Mr G mentioned that this would also be true for my mental state - as the body needs to focus itself on healing, the brain would be working at lower capacity to conserve some more energy.

In preparation for the stent insertion and overnight hospital stay, we decided to move me to the [Pico dressing][pico], a much smaller and more convenient dressing, especially as the previous pump was having diminishing returns. I feel this has definitely contributed to my overall well-being, due to the fact that it is silent, fits in my pocket, and is generally out of my way all of the time. It's also been helping promote healing at a great rate, although from the 19th February we may be looking at moving to conventional dressings as the Pico's effectiveness may be reduced as there is very little for it to work with now.

One surprising factor that has helped with my recovery has been having one of my [Philips Hue][hue] bulbs in my bedroom lamp. Given my reduced mobility early on in the recovery phase, being able to get up to turn on/off the light hasn't exactly easy, especially if it were in the middle of the night, or if feeling unwell. Before Anna brought a Hue down from Nottingham, we had positioned the lamp closer to my bed to make it easier to reach, but it still wasn't ideal. Additionally, I found that the light could be quite harsh during the middle of the night, so being able to move it to a softer tone (or even colour) helped when I needed to wake up in the night.

Lessons Learnt

• if you're in pain, and traditional pain relief doesn't help, immediately go and see someone! You're not helping anyone by postponing, and are potentially harming yourself by not getting checked
• just because you have certain symptoms does not mean they point to a certain diagnosis - ensure that the examining medical professional does explore some non-traditional causes
  • since having a non-traditionally presenting ruptured appendix, the number of people I've found out about who have had similar is very high
• if you're in a lot of pain, tell them!
  • also explain your pain intensity levels, such as how I have outlined in the beginning of my [Ruptured Appendix section][anchor-appendix], because your "a lot of pain" is someone else's stubbed toe
• ask questions, such as "if I had (diagnosis), what other symptoms should/would I have?"
• know your family medical history roughly well, or at least have handy access to it
  • even if it's i.e. that somewhere in the immediate family has had heart disease, it's better than nothing
• needing to go to hospital is scary, let alone going under for major surgery - but having a strong support network helps better than anything else