The Dreaded BOWEL OBSTRUCTION post. Had one? Post here!

Lots of questions about this lately here...so if you have had one-- or know someone else who did-- and wouldn't mind, can you share your story so people know what to look for and expect? Thanks!!!
_____________________________________________________

My story (reposted for the ten billionth time) from June 2008:
-----------------------------------------------------------

If you are suffering an intestinal blockage, all the noise in the world may not save your life. Or better said, if you think you're being loud enough, BE LOUDER-- and arm yourself with knowledge so you recognize it beforehand.

My story: 3 days after having my gallbladder out in June, I started feeling very nauseous and suddenly could not keep food down. (That'd be hard for some to note because they have trouble keeping food down anyway.) I hadn't had gas or a bowel movement in 7 days, but having just had surgery suspected it was just slow in coming.

After 6 hours of this nausea and pain not passing I paged my surgeon and his assistant. I was told that neither were answering their pages. I was able to get in some water eventually and went to bed.
 
The next day the nausea and pain intensified. By 6pm I could take no more. I was home alone, and so instead of driving to the metro hospital where I had my RNY, I could only drive as far as the local ER. This choice almost cost me my life.

I was sweating and crying when I went in. I explained to the triage nurse that I had an RNY and a gallbladder removal just days before and suspected I had an intestinal blockage, and that the pain was excrutiating. An emergency. I could die. 

But It was a holiday weekend, and people who cut their fingers on beer pull tabs were taken back, women who were upset over boyfriends, the general ER riffraff BS that takes place on a holiday-- and I was left standing (couldn't sit) in the waiting room for FIVE hours-- even though I returned several times to triage to say, "I can't take this much longer-- I am very afraid I have had a blockage and need a doctor NOW."

When I was finally seen, the CAT scan was "inconclusive"...the doc told me he saw a lot of fluid in my belly but thought it might be from the gallbladder surgery, and I should follow up with my surgeon in the morning. I was discharged at 6 am with nausea meds and pain pills.

When I called my surgeon, I read him all my tests-- enzyme levels, etc. He said he didn't hear anything alarming-- but he was listening for something gallbladder related-- a bile duct blockage etc. would skew the numbers. When it didn't, he more or less said, "You'll be fine." This was Monday.

By Wednesday the pain at night was unbearable. I cried and screamed into a towel. Wednesday morning I had my regular scheduked check up with my  RNY surgeon. Luckily, his assistant knows me very well and said, "Shari, you don't look right. Seriously." The surgeon said, "I don't know what to do-- want us to admit you and run some tests?" I think he expected me to say no, but I said, "PLEASE!"

So I was admitted around 4 pm. By 7 pm the pain was back, but they wouldn't allow me pain meds until after I had a CAT scan. I didn't have the CAT scan until 3 am. They left me on a gurney in the hallway for an hour and a half  afterward, sobbing in pain, because they didn't have anyone in transportation to come get me. By the time I finally received pain meds at 5 am, I would have shot myself if I'd had access to a gun.

I finally fell asleep. At 7 am, my surgeon breezed in, threw open my curtains and said, "You're having surgery today. You have a bunch of fluid backed up in your belly, and we need to find out why." He explained he'd use the lap incisions he'd made for the gallbladder and go back in.

By noon I was in surgery.

At 4 pm, I awoke in the worst pain I had ever felt in my life. I focused on a spot on the ceiling. I could not talk. I had tears streaming . The dilaudid wasn't even touching it. 

He explained to me, "You're a lucky woman. Your bowel (intestines) had twisted and actually permeated the wall of your excluded stomach. Generally when this happens, and days pass, we find a bunch of dead bowel which we have to remove. But for whatever reason when we reconnected you, you pinked up right away. Now we just have to see if it works-- if you can move your bowels or pass any gas." I was told that the lap procedure went open-- suddenly-- when they couldn't locate the source right away-- I had a large, jagged open incision now from my sternum to my navel. I'd been gutted and beat up pretty badly in the process. But I was alive.

For five days, nothing passed. My urine was dark brown, I was losing kidney function. Then it started to lighten, and returned. And finally on the fifth day, while walking in the hall, I passed gas. Sounds stupid, but I was so happy I cried. I gained 25 pounds in fluid and unpassed stool in 3 days--but within two weeks lost 40. My recovery took many weeks, but I finally feel better now. I am grateful for the opportunity to live, and feel obligated to warn anyone who will listen.

Blockages like mine are 100% fatal if not caught in time-- usually within 72 hours. Why mine didn't take me down in the FIVE days that had elapsed, I am not sure. Lucked out.
 
I wanted to make sure you know what we're really discussing-- how it feels, what it looks like, how you might be treated. Your local ER will NOT be able to help you. You need to educate loved ones so that they can speak FOR you-- a medical alert bracelet will not help you. The beloved posters who've passed away may have done all of the above, and still they missed their blockages until it was too late.

You need to do everything you can to make sure it doesn't happen to you-- and this sort of herniation-- sometimes called a Petersen's hernia-- allegedly happens in about 5% of post bypass patients. Five out of one hundred. One in twenty. Could be anyone.

Symptoms in an RNYer include nausea, vomiting, abdominal pain and distention, inability to pass stools or gas. (Apparently in DSers, gas will still pass.)

Know the signs and symptoms. Don't allow anyone to dismiss you. Do NOT ignore pain that will not pass. Insist on prompt and appropriate treatment, and train your family to know how to help you if it should happen. You may save your own life.

WOW, what a story!  I'm so happy that everything turned out ok for you!  Thanks for sharing!

Thank you so much for sharing your story.  I just had RNY surgery one month ago and wondered what to watch out for just incase... I'm thankful for you taking the time to share your story so I know what to look for incase that ever happens to me.

Thanks, Jena! Worst part for me was that I KNEW what it was-- my brother's co-worker went out on a stretcher with the same deal just weeks before (which scared him half to death!) so I was very conscious of it-- next time, I'd show up at the ER with a copy of an online article about Petersen's Hernia actually in my fweakin' pocket, and if no one listened, I'd educate them with my shoe!

I agree... it's important to have documentation of what you think it is.... be persuasive... know that proactivity might be a percursor to ANY activity... as in it might keep you alive.

My mum was always obese, and when I was 8, she was super morbidly obese and went on a huge diet.... losing quite a bit of weight. Then one day she began to have a lot of extreme pain one day, and it wouldn't go away, no matter what. Finally they hospitalized her, did exploratory surgery, and found that her small intestines had knotted themselves. They had to remove a huge section of her intestines because of this. I never tied the two facts together but I realize now that she was only "obese" for most the rest of her life... probably due to malabsorption.

She almost died. She never had WLS. It happens.

I remember that time from the perspective of someone who was EIGHT.... .dad not knowing how to brush my hair.... feeding me oatmeal and demanding I fini**** before leaving the table... and staying at the table all day.

I try to be aware of myself, of how I feel... and be proactive about my care. I had some serious abdominal pain last fall AFTER a hospital stay, and my surgeon, who is AWESOME about taking care of postop issues... got me a CT scan.... found my intestines and colon were all inflamed quite drastically. he put me on some antacids, and wanted me to call/come in if it didn't get better quite quickly. I got better, and it seems it wasn't a blockage. What I did find out was that in spite of telling the hospital I couldn't have NSAIDS, they pumped me full of them while I was there for a serious almost fatal virus. (Now I say ALLERGIC, instead of not supposed to have).

Whenever I feel WRONG inside... I make an appointment and then surf this site and medical sites to see if I can figure out what is going on inside. I make an appointment as my first plan of attack.

It was about 10PM on July 11th.  All was going good for me.  I had just gotten a cold bottle of water out and planned to drink it before I went to bed.  As I took the first sip, I felt like I had just been kicked in the groin.  I also couldn't decide if I wanted to throw up or have a BM more.  I hadn't had any complications eating, and I did try something new that night, so, I figured that I may just have a piece of food lodged in my pouch.  I went through the process of trying to rid myself of the offending food, but that didn't relieve the pain.  At this poin****er wasn't even wanting to stay down.  At about midnight, I realized this was something really beyond what I was able to handle without calling my surgeon. I called him and to my surprise, he answered and told me I could go to the nearest ER if the pain was unbearable,  I decided I'd take some Lortab and deal with it on Monday since I wanted to deal with my surgeon and not whatever doctor happened to be on call at the ER that night.

Monday morning at promply 8AM, my Surgeon's office called and wanted to set me up with a CT Scan of my groin and abdomen.  It would be scheduled at 2:30, but they wanted me there around noon so I could start drinking barium.  I got the first bottle down with some work, but didn't have any luck getting the 2nd bottle down.   I soon atarted throwing up the barium and the water they gave me.  At 2:00 I had my first reading, and the CT tech said she didn't think I had enough barium in me.  She called the Radiologist and got his advise.  Evidently, he told her that it may take awhile for the barium to work it's way through, and to have me continue to sip and to do another scan in an hour.  At about 3, I had another scan.  The CT Tech said she still didn't see anything unusual, but the radiogist would talk to my Surgeon.

In the meantime, I called my Surgeon's office to see if I could get something for the extreme nausea I had.  His staff said they'd contact him.  Around 4:30, he called me and told me to check in to the hospital where I had my surgery because I had an obstruction.  I got there around 5:15 or so, and had to wait until about 6:30 for them to recieve his orders and get my room ready.  (It is a very small hospital, probably less then 20 patient rooms, but it is EXCELLENT.)  I was given morphine and something for nausea and was NPO.  NPO means nothing by mouth other then the "lovely" lemon glycerine swap they gave me to wet my mouth.  The morphine seemed to work on the pain though, I vaguely remember doing situps in my bed.

Tuesday was an ok day.  I was still in my own PJ's and passing time by watching TV.  I took a shower around 3:00 and got dressed in time for them to come in and tell me I was having surgery @ 5:30.  From my recollection, the surgery probably actually started around 6:15.  I was back in my room before 9:00.  I pressed the morphine pumps a few times that night, but the pain wasn't bad.  I only had 2 new small incisions.  At about 4:00 AM I was walking the halls.  And at about 11:30 AM, I was discharged feeling pretty good other then "backed up".

I stopped and got some Miralax on the way home.  I took one dose immediately and nothing really moved.  The next day, I took a 2nd dose and with in a few hours I was back to feeling somewhat normal again.

When I look back on it, I really hadn't had a significant BM in about 5 or 6 days prior to me feeling ill.  I took some MoM Saturday night, and had a small movement, but no real relief.  I track it now...I know that sounds unusual, but I figure 2 or 3 days is normal for me....anything more then that needs attention.

I go to the Surgeon tomorrow for follow up after this last surgery. 

My bowel obstruction was on July 2, 2010.  I was 10 months out from surgery and doing well. I had read on OH about bowel obstructions which is what really ended up saving my life in the end.  I woke up feeling fine that morning. I got up, let the dogs out and made myself a shake. I began to drink the shake and almost immediately I started to have pain in the lower belly. At first, it felt like gas that would not pass but grew increasingly worse.  The pain came in waves with nausea.  My stomach was distended and within a hour, the pain was so intense I could not stand straight. My SigOt took me to the ER right away.  I went to the ER and after the initial evaluation (after a 45 min to hour wait) they took me right back.  The hospital staff ran the tests (CAT scan, blood work, X-rays) and it was determined that it was a bowel obstruction.  Dilaudid helped with the pain but by the point the hospital determined the cause, the bowel had twisted and I was throwing up blood.  I was at the hospital for over 9 hours when they said that they would not do the surgery because "they would not work on another surgeon's work".  I was med-evac'd to Temple Hospital in the city and they did emergency surgery that night. I was lucky in the way that the doctors moved fairly quickly when it was determined what the issue was. I agree with you Sheri, the pain is unimaginable.  What was weird was that the pain started almost immediately after the first drink of the protein shake and intensified very quickly. 

Wow-- a TUH Surgery Sister! Who fixed your obstruction-- Meilahn or Soriano? (I have spoken at meetings for both-- Meilahn was my RNY surgeon!)

Meilahn did the bowel surgery and Soriano did my RNY. I love them both. They are great surgeons!