My name is Leslie Walker, 20 years ago I had surgery to repair a large hernia with mesh. In February 2022, I noticed a small hole on the right side of my tummy which was oozing so I put a plaster on it. The next day the hole got bigger until I had two separate openings below one another. I informed the doctor who sent district nurse’s around to see me. By the time they arrived a couple of days later, the two holes had become one big hole measuring 40mm – 30mm. The district nurses packed the wound and dressed it, but it kept on oozing and soaking my dressing. Eventually a small stoma bag was applied to capture the fluid coming out. I received antibiotics three times throughout the four months that this continued.

After four months, I was admitted to hospital for dehydration, kidney problem (Acute Kidney Injury (AKI)), and wound infection. I went to theatre and had major surgery.

I had surgery on 30.06.22 where they performed a Right Hemicolectomy with ileocolic anastomosis and covering Double Barrell ileostomy (which left me with 315cm of proximal small bowel to the stoma). I was in intensive care (ITU) for several weeks then transferred to the ward. I was on total parenteral nutrition (TPN), for seven days a week, for 18hrs a day. I had a stoma which was draining a lot of fluid each day, but I was shown how to look after and change the stoma bag by the nurses. This went on for couple of months and I remained in hospital all this time.

The Insides System was introduced to me by Mr Mubasher Shaukat (Consultant). All the information was provided to support and help me make an informed decision regarding the device, how it will impact my quality of life, and the benefits of refeeding. I was informed the company nurse would come and see me and talk me through the product.

Natalie (ward sister) was available to answer any of my question and gave me an information leaflet about the product .

27.09.2022 The company nurse Surrinder went through the model and demonstrated how everything worked and I finally had the tube placed on the 27.09.22 by the Consultant. I had an audience of doctors and nurses to watch the tube begin inserted, I felt a pushing sensation when the tube was been placed but apart from that, it was good. The tube seamed very long until Surrinder informed me it was going to be cut down to the size of the stoma bag and a pump replaced at the end . I found the plastic dome shape on the tube quite uncomfortable initially. Natalie and Surrinder came back to me 2 hours later to show me how to use the driver and refeed the fluid back inside me. I started with about 100 mls, but I felt a bit uncomfortable using the driver. Surrinder showed me how the driver worked and the different speeds. I used speed 1 and I felt better. Surrinder informed me to keep it on speed 1 today and then try to increase to 2 tomorrow.

I was informed by the doctor’s that over the next two weeks my loperamide, codeine phosphate, and TPN would reduce once my bloods showed improvement.

Over the next few weeks, I did experience reflux from the stoma when using the driver and so after asking advice from Surrinder, I reduced the speed and a refed little and often throughout the day. I also had cramping which was resolved by medication and disappeared after a couple of weeks. I was refeeding 6 – 8 times a day and using a night drainage bag at night.

The tube did fall out in the second month as I was laying on my side and moved suddenly. Once the tube was replaced, I was given a purple clip to hold the tube in place which kept popping off due to wind in my bag so I didn’t use it much. Natalie then gave me a two-piece stoma bag where I could un clip the bag and release the wind which resolved the problem for a short while only. I was changing the pump by myself every 3 days as instructed. Which was a challenge when the stoma keeps working and you are trying to put the bag back on, but after several attempts I got the hang of it. My skin around my stoma was looking better and less red as I was not getting any leakage since using the insides system.

I was eating more but was informed that I needed to chew my food at least 20 times before swallowing. I had no teeth and Surrinder told me to make sure I put my false teeth back in, but due to not having then in for several months, the teeth would not fit so I just ate slowly and chewed with my back teeth.

I am a diabetic and my blood sugars were high in the morning and low in the afternoon and I couldn’t understand why. As it turned out, I had an infection in my fistula, so I completed IV antibiotics, and my sugar level went more or less back to normal.

While using the product, I was drinking 1 litre of St. Mark's solution and 500 ml of regular drinks, which was gradually raised over the course of a couple of months. TPN was scaled back and discontinued in November because I was maintaining my nutrition by just oral feeding and reinfusing my output from the stoma bag. However, I did have a significant negative fluid balance over the course of a 24-hour period, so until I normalised my hydration, I was given an overnight IV fluid of normal saline magnesium for a few days. I was taking jelly babies when I had a hypo during the night which thankfully didn’t happen often.

Once I was completely stabilised on just using the insides system and not needing anything intravenously, I was mobilising around the ward more often with the physio and getting my energy back after several months in hospital. I really felt better in myself since using The Insides System.

As time moved on in December, the purple clip continued to keep popping off and the tube did fall out which was again replaced, I produce a lot of gas it seems, which drags the tube out. However, I was now refeeding 80% - 90% of my fluid during the day in December 2022. I thought to myself that there must be something I could invent to keep the tube in place and stop the clip from popping off. I decided to use some medical tape outside on the bag, over the clip, but it made the tube stick more which was not good for me. Then I remembered there are belt lugs on the side of the stoma bag which could hold a thin belt. If I take a baseplate with the belt lugs and place that over my stoma bag and place the belt around my body, the extra base plate, on top of my stoma bag, would not apply any more pressure but hold the tube in place and stop it from falling out. The nurse’s checked my stoma when I changed my pump and bag to ensure there was no pressure on the retention sleeve and tube. This ended up being the best thing to hold the tube in place and I continued doing this.

On average, I had my bowels open every day, mostly loose, but there were no problems which showed my redundant bowels were good. The product has benefited me from stopping TPN and having more energy to recover so I could have my reversal. The consultant informed me I would be having my reversal surgery on the 15th of December 2022 and hope fully be home for Christmas.

I would like to thank my wife and family who came to visit me in hospital, and all the support their gave me. I would like to thank Mr Mubasher Shaukat (Surgeon), Natalie Grassby ward sister, Sandra Holdstock and Surrinder Kaur from the company

Leslie Walker

Patient at Castle Hill Hospital Hull

‍