1.12.2022

Dr Emma Carrington (Colorectal surgeon) and Sylvia Turner & Sushma Paudel (Lead Stoma Care specialist nurse’s) explained The Insides System to me, a device that could be used to refeed chyme from my stoma bag back into my bowels to help with my high output stoma. I was draining 3 – 4.5 litres per day. They explained the benefits of The Insides System including that it would reduce my total parenteral nutrition (TPN) and restore my bowel before the stoma is put back. The Insides System would help me retain all the vitamins and minerals I was losing out of the stoma bag, start eating more food, hopefully gain some weight but most importantly, help me to go home to my wife and new home.

Before The Insides System, my fluid restriction was 1 litre of St Marks solution and 500mls of any other fluids. I was on TPN 7days a week for 12 hrs per day.

09.12.2022

Before starting the system, I met with Surrinder Kaur the company nurse with Sylvia and Sushma, she went through The Insides System and showed me how it worked on their demonstration model. I understood the clinical benefits and was given a patient information leaflet with more information to read, which further helped me understand how the system would work. The team also informed me that I would be taught how to change the pump every three days when changing my stoma bag and would need to come to the outpatient clinic once a month to have my tube change at St Marys Hospital. Dr Carrington asked if I was happy, and that she would place an order for the system to try for insertion the following week.

The date was scheduled for the 14th of December, to insert the tube and commence chyme reinfusion.

14.12.2022

The Insides System was placed at my bed side by Dr Carrington and Sylvia with the company nurse present, who explained step by step what was being done and helped me relax.

Two hours after the setup, I had chyme in my stoma bag and the stoma team and Surrinder showed me how to reinfuse using the Driver. I was given a plan for the next 7 days for reinfusing daily. I reinfused 100mls, three times on my 1st day on speed 2, with minimal issues.

15.12.2022

All was going well and I increased the amount reinfused to 150mls each time on this day. I did get some reflux which is where the fluid flows back into the bag. It happened when I increased the speed to level 3, however, this was resolved straight away by decreasing the speed back down to 2.

19.12.2022

I was eating more and making sure I chewed my food before swallowing to help with the reinfusion. I was reinfusing about 55 – 60 % of my fluid daily with no issues and my bowels opened twice during the week.

I changed my stoma bag with the stoma nurse who showed me how to change the pump. On the second change of the pump, I did it myself with minimal help. The pumps needed to be changed every 3rd day when changing the stoma bag to help prevent the blockage of the pump, which would cause it to stop working. My wife was able to help me once I go home. I continued to reduce my TPN and dropped another three days, so I was only receiving TPN twice a week.

26.12.2022

I was now reinfusing 80 – 90% of my chyme & had completely stopped my TPN after 8 days of using the Insides System which was great. I was eating and drinking 1.5 litres of fluids which included St Marks Solution. I was reinfusing my chyme on either speed 2 or 3 and had no issues. I was feeling well and was informed that I would be able to go home in a few days. I continued to write everything down including how much I was reinfusing and how much I was discarding down the toilet. Here are a few days from my log book:

• 25.12.22 – total output 4.300L – reinfused 3.100L and discarded 1.200L

• 26.12.22 – total output 3.650L - reinfused 3 L and discarded 0.650L.

• 27.12.22 – total output 3.750L – reinfused 2.900L discarded 0.850L.

• 09.01.23 – total output 3.650L – reinfused 3.050L and discarded 0.600L.

• My bowels opened once daily.

28.12.2022

I was discharged home 14 days after commencing The Insides System.

02.01.2023

My loperamide and codeine phosphate decreased as the chyme in my stoma bag was getting thicker and harder to reinfuse. I was now reinfusing 90% – 95% of my chyme and only discarding about 600mls of chyme in the morning.

Summary

The Insides System has had a positive impact on my life, and it’s been an amazing way to ensure I am getting proper nutrition. My bowels have opened every day and I haven’t lost functionality. The Insides System chyme reinfusion device has been great for my weight gain and general health, and I have nothing negative to say about the device.

The Insides System has provided me with the benefits of being able to reduce my stay in hospital, stopped my TPN, and allowed me to be home with my family.

I still return to the hospital once a month to have my tube changed and collect a new set of pumps for the month.

Dr Emma Carrington is aiming to reverse my stoma between May – June 2023.

I would like to say thank you to Cristiane A. Scaldaferri (My Wife), for her support while I have been ill in hospital. Dr Emma Carrington, Sylvia Turner and Sushma Stoma Care Nurses at Charing Cross Hospital who have supported me and educated me on the Insides System. Surrinder Kaur (Company Nurse) for seeing me when I was discharged home.

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