Apr 16, 2017
I want to share my recent and very scary experience in case it may educate or otherwise be helpful to anyone.
I had RNY Oct. 10 2016. Everything has been perfect since my surgery other than my weight loss has been a little slow for my preference. I have followed all the rules ( I thought) and have taken every vitamin, supplement, etc. that has been recommended.
Early morning Saturday March 11 I woke up to a severe sharp pain in my neck/clavicle area and a pain ,not quite as severe but definitely a pain, under my ribcage. I had just returned from a very very long flight (I had flown straight to Miami from Kathmandu Nepal And right back from Miami to Kathmandu! (long story). So, my initial fear was I had an embolism or clot from that ridiculously long flight. I woke my husband and told him I needed to go to the Emergency Room. As my husband went to get local transportation to take us to the hospital I started walking around and thought maybe the pain was just severe bloating from the flight and took a gas reliever just in case. When my husband returned with the taxi, I actually considered waiting and not going to the hospital. Thankfully I did decide to go. The ride in the taxi to the hospital was so painful. I prayed I would not die for about half the trip and then the pain was so bad I started praying I would die! We reached the local travel clinic in Kathmandu that most ex-pats go to. They saw the terrible pain I was in and started giving injections for pain. The first two things they tried did not touch the pain. It did not subside at all until I got morphine. I explained to the doctor in the clinic that I had RNY 5 months before. My fear that became my reality was that the doctors trained in Nepal had very little understanding of weight loss surgery and did not know post RNY anatomy at all. Thankfully they sent me from the ER to get a CT scan (at a location several miles away. I had to go by ambulance). When I returned to the hospital they sent me straight to ICU. I got a catheter for monitoring my urine output and a NG tube to empty anything out of my stomach. An ICU doctor explained t me that there was a leak in my gastrointestinal track and air and fluid was filling my abdomen. Several local doctors including a surgeon came in and talked with me. I called the practice that did my surgery (in North Carolina). The American surgeon advised that it sounded like an ulcer had ruptured at the anastomosis site causing the perforation in my jejunum. He recommended I have surgery right away. The ICU doctors told him they do not do laparoscopic surgery In Nepal and are not familiar with the surgery I had in October. All agreed it would be best if I could be evacuated to a country near by that could handle my needs.
This is where is gets bad. At this point I am about 20 hours from the start of the pain. I have very little urine passing, and what is passing is dark brown. My abdomen is swelling, my bowel sounds have stopped and my White Blood Cell Count is climbing fast. We are trying to make arrangements to get to a hospital in New Delhi India as soon as possible. However, because it is a major Indian holiday, no one is answering phones in India!
It is now Sunday morning and the small hospital ICU realizes that I am sick beyond their capabilities and transfer me to another hospital. In my opinion the hospital they moved me to was far worse, but that is not terribly relevant here. We were all just focused on getting me out of Nepal for surgery as soon as possible. I was continuing to deteriorate, but my pain was managed my morphine. By Sunday night I was septic and had trouble breathing. The surgeon there had decided I was too sick to travel and said he would operate Monday morning. I was terrified because I knew this was a very much less than ideal situation.
Monday morning we got word that an evacuation team was coming form Dubai to take me by air ambulance to a Dubai hospital. They could not get there until Monday afternoon because India could still not be reached to approve the flight over their airspace!!!! The surgeon was very anxious and told me point blank I would never make it to Dubai! My white count was so high and my kidneys were starting to fail and my abdomen was continuing to fill with infection. My husband and I had a good argument over this. He wanted me to listen to the doctor and I was certain having surgery there was a bigger risk than trying to get to Dubai.
When I saw the med-evac team walk in the ICU I felt like the Calvary had arrived!
We reached the Dubai hospital Monday evening. I was put in ICU and assessed.
The new surgeon told me he did not know what he would find when he got inside. He warned me I may have bowel gangrene. It was decided, however, that I could be maintained until morning and a day time surgery is always safer than a nighttime one. So Monday morning I had surgery. It was in fact a rupture at the anastomosis site. The surgeon said my abdomen was “full of so much pus”. I was told by everyone involved that it was not common for someone to live through that kind of septic infection for 3 days and the fact I never lost conscious was especially unbelievable. I must say here that I am a Jesus follower and I feel convinced in was prayer and the hand of the Great Physician that spared me!
However, the issues did not get better right away. Both my lungs had collapsed from the pressure on them from my abdomen. I had gained THIRTY POUNDS from fluid and infection! I also still had a very high white count. Post-op I had seven tubes--4 drains, a central line, a catheter, a NG tube. I remained in ICU 12 days. I had to get my lungs drained by tube because they filled with fluid. It took an additional 8 days on the regular hospital floor before I was well enough to leave the hospital. Because of my lungs, I was not permitted to fly so I had to remain in the UAE for another two weeks before I got the clearance to fly. A total of 5 weeks away from home.
What I learned form both my UAE surgeon and my US surgeon is that I had an ulcer at the jejunum site and it ruptured. I thought that coffee in moderation was ok post op and an ibuprofen once in a while for cramps was ok. Not for me. I now must be on Nexium for the rest f my life and get endoscopic scans every 3 months to monitor for ulcers. It is frightening to think this can possibly happen again!
Pay attention to any pain that you have. Do not let things just go. Do not be like me and think some things in moderation are ok. If your doctor said no coffee, no ibuprofen- listen. I wish I had!
a few weeks post surgery
and ready to go home!