Opening New Doors After Surgery: Adjusting to the 'Next Better' Thing

Patient Expert
Jim Mielke

Living with a bag for 40 years, and with 16 major ostomy-related surgeries under his belt (so to speak) Jim Mielke has had his share of post-surgical restrictions – including having to give up some of his most cherished activities. But somehow, he has maintained a positive attitude and continues to live a full and active life with his ileostomy. Jim also happens to live in Thailand, and has lived outside of the US for most of his adult life. How does he do it? Here is some of Jim’s story:

Soon after receiving my first ileostomy (at age 19), I tore out a peri-stomal hernia while working in a physically demanding parks maintenance job. After years of poor health struggling with inflammatory bowel disease (IBD), I loved the feeling of renewed strength and a toned and tanned physique from the heavy outdoor work as my muscles swelled from tossing 55-gallon steel drums filled with trash into the garbage truck. Until then, I hadn’t considered safer alternatives to building and maintaining my physical fitness. But after getting the hernia repaired, my surgeon lowered the boom: No more heavy lifting — EVER! I was devastated.

Coming to grips with post-operative limitations on activities we are passionate about can be tough, especially when it’s clear there is no going back to the way things were before surgery. You may have been a runner all your life, or a top tennis player. Maybe it was your very identity! How can you just let it go?

Fortunately, many people not only bounce back from these challenges, but experience personal growth. Psychologists call this “post-traumatic growth” which refers to the positive psychological changes resulting from adversity or other challenges that can lead to a new and more meaningful life. Trying to hang on to the way things were will only aggravate the situation and make it worse. But with acceptance and a touch of optimism, you can become more resilient and open to new ways of living.

The hernia and weakened abdominal muscles eventually forced me to give up tennis and ice hockey, which were my top competitive sports during high school and college. I was also an accomplished trumpet player, headed for a possible career in performing arts. But that also ended abruptly as my weakened and herniated abs made it hard to blow my nose, let alone a trumpet. Amazingly, the ‘doors’ that ‘closed out’ some of my favorite activities have actually allowed for the ‘next better’ ones to open.

A particularly interesting and humorous transition occurred when I was suffering with rectal abscesses during the final months leading up to receiving my first ileostomy. It was my sophomore year in collegeand after 10 incisions in my buttocks, I had to soak in hot “sitz baths” three times a day while the wounds were healing.

It was pretty dark in the toilet stalls, so instead of trying to read during these lengthy sitz baths, I used the time to teach myself the banjo – much to the amusement and curiosity of men’s room patrons and passers-by. (As it turned out, we had another trumpet player in our dorm’s band, so when I could no longer play trumpet, I became the group’s banjo player!)

Soon after graduation in 1982, I moved to the tropics to begin my career as an aid worker in Asia and the Pacific. With no ice in sight, I hung up my ice skates for good, and took up scuba diving instead.

Another set-back came several years ago while packing for a trip from my island home in the south of Thailand, to visit friends and family in the U.S. I noticed a slight bulge in my abdominal incision and headed instead to Bangkok, where I have had most of my surgeries over the years. The longitudinal incision that runs along my abdomen from stem to sternum (and had been opened on multiple previous surgeries) was ripping apart and the muscles were separating, which meant that I was a walking time bomb. It would not have been at all pleasant if my guts had spilled out while on the plane at 30,000 feet.

In Bangkok, many of the competent and eager staff at my hospital remembered me from my previous admissions as an in-patient over the years. After 90 minutes on the table, my surgeon had successfully inserted a large mesh across my entire abdomen. It was like getting a new set of surgically implanted six-pack abs. What a deal! I could not believe my good fortune, having avoided another possible disaster, but also to be given what now seems like a gift — such a wonderful gift of enhanced quality of health and blessed freedom to continue enjoying my life!

There was a down side, however, as my surgeon imposed further restrictions on my most cherished activities and once again, I was forced to modify them — in particular, some of my favorite yoga postures (e.g., headstands and pelvic stretches) were now relegated to the past. It was a tough blow. I broke down in tears in the hospital lobby.

Fortunately, yoga offers plenty of postures, many of which can be modified for any physical condition or level of fitness. And now, as an internationally certified yoga teacher, instead of feeling regret for this loss to my personal practice, I take pleasure observing someone in a perfect headstand, and enjoy sharing in that person’s sense of achievement. I also continue to draw on my skills and experience to help others learn the art and science of yoga.

By accepting each new challenge, I have been able to adjust to new, and even more fulfilling activities, and in the process discovered something that has radically changed my life. All of my modified activities — swimming, cycling, yoga, and hiking &mdash gently and safely tone the abdominal area and promote the overall fitness and sense of well-being that I crave. Their non-competitive nature also acts as a powerful liberating counterbalance to the pressures of our highly competitive society.

Whether it’s post-surgery restrictions or just normal aging, it’s not easy to give up a life-long passion, especially when it has become a symbol of self-identity. Such a change can spark difficult, unpleasant or painful thoughts and emotions.

If we indulge in these kinds of thoughts and emotions, we simply reinforce them and cause ourselves to suffer. Practicing the R.A.I.N. exercise can help transform these thoughts and emotions into more workable and revealing experiences by expanding our self-awareness. Just stop and take a breath, and practice working with them "mindfully" by Recognizing, Accepting, Investigating and Not Identifying with whatever is present, with a willingness to be with what is – and without judgment.

  • Recognize and consciously acknowledge what is going on inside you and around you, right now. What thoughts, emotions, feelings or sensations are you experiencing right now?

  • Accept, Acknowledge and Allow life to be just as it is – just let it be – allow what is here to be here.

  • Investigate with kindness, curiosity and compassion any physical sensations, thoughts or emotions being experienced now. Are they positive, negative, or neutral? What are they trying to tell you?

  • Non-identification involves “observing” thoughts and emotions – rather than getting “caught up” with them. For example, whenever anger presents itself, instead of ruminating or 'acting out' the anger, let your attitude say “anger is present right now” or repeat silently to yourself “anger, anger, anger,” and you’ll find that you can dissolve unnecessary thoughts by simply being aware of whatever is happening at any given moment. Whatever personal problem you may have, there is no need to analyze it further. Simply be in the moment -- no past, no future, and as you slow down and clear your mind, solutions to problems present themselves clearly and spontaneously - like magic. By learning how to observe thoughts and emotions in a detached manner – objectively, without getting caught up in them, and ultimately to let them go -- we can stop creating suffering for ourselves.

If we remain attached to the past, or to the familiar, we may miss new opportunities that are right in front of us. Re-evaluate your priorities and allow yourself to become open to the new and unexpected. Discover possibilities that were not there before. When the time comes to hang up your beloved tennis racquet, consider tapering off to golf. How about replacing your running shoes with a bicycle or a pair of swim trunks? Why not give yoga a try? When one door closes, be grateful for what was, and get ready for the "next better" thing waiting for you behind the next door — and know that it’s getting better all the time!