Minor Set-Back

Aug 10, 2011

Well, I'm in the hospital again.  At around 9:30 Monday night I started getting some pretty painful cramping in my abdomen that would come in go in waves.  It would come every few minutes and last about 20 seconds.  It reminded me of labor contractions, oddly enough.  At the time, I thought that it was gas pain; I had never had problems with gas before my bypass and so I reasoned with myself that maybe I was experiencing gas pains, since I had tried some cooked vegetables for the first time since surgery for dinner earlier that evening.  I stayed up a little late trying to post my 2-week update video on YouTube, but for some reason it wouldn't post, so I gave up and went to bed around midnight.  I was still having the pain, but somehow managed to fall asleep around 1am.  I took some Gas-X strips before getting into bed as well.

However, I awoke at 3:30am because the pain had gotten worse.  I got up and used the bathroom and decided that I should call my bariatric center.  The on-call doctor called me back and told me he wanted me to check into the emergency department.  I live about 15 minutes from the hospital I had my surgery at, so that's where I went.  My husband and I didn't want to have to wake our daughter up and frighten her by taking her with us, but we have no family near by or friends that would be able to watch her at this time of night, so I drove myself in.  I had about three or four of my "contractions" on the ride in, but they were not so bad that I felt I needed to pull over or anything.

I work at the hospital that I had my surgery in as well, and occasionally work in the ED.  So when I got there, my co-workers were worried to say the least.  It was a comfort knowing exactly how the ED works and what to expect.  The timing of my arrival couldn't have been better; there was only one other person waiting for a bed in the ED when I got there, and they were able to get me into my bed within ten minutes after triaging me.

I explained everything to the ER docs and they told me that they would be ordering lab work, a urine test, and a CT scan to try to find out what was going on.  The hospital staffs one of my surgeon's residents 24/7, so the one on duty came down and talked to me about what was going on as well.  We talked about the possibility of three things that could be the cause of my pain; I could have had some food stuck in my intestines (the pain was lower than my stomach), I could have an internal hernia, or it simply could have been irritability from the vegetables.

At 6:30am I started drinking that lovely (not) drink for the CT scan; the scan was scheduled for 7:30.  At that point they had given me some Morphine for the pain, because it had gotten more and more intense, and subsequently some Zofran for the nausea that the Morphine caused.  I'd never had a CT scan done before, and no one explained to me that I didn't have to drink the entire jug!  The nurse had said, "Try to have it in by 7:00"; I assumed she meant the entire thing.  Well, as you all know, I can't drink very fast since the bypass, but none-the-less I tried my best to sip, sip, sip as quickly as I could.  The problem was that the pain seemed to get worse the more I drank.  So at 7:00 I called for the nurse and kept drinking while I was waiting for her, because I wasn't anywhere near finished the jug, and I was worried I wouldn't be able to finish it before they took me for the scan.  Before the nurse got there, a CNA came in to check my vitals again.  I told her my worry and she said, "Oh, you don't need to drink the whole thing!"  Gah!  LOL...problem solved.

The radiographer came for me at 7:30 and explained the process.  I was nervous; as I said I'd never had this done before and the process honestly sounded a little scary.  She had me lie on the flat table and propped my knees up on a big cushion.  It was actually quite comfortable.  When she had me all prepped and was ready to do the scan, she had me put my arms above my head.  I suddenly felt the most intense pain I'd had yet, even with all the Morphine, and then just as quickly it went away.  After the scan was over, I realized that I hadn't had another cramp after that really intense one.  Turns out I didn't have any pain following that and didn't need any more Morphine after that.

While I was waiting for the scan to be read by a radiologist, my husband arrived to keep me company.  He called out sick from work and came as soon as he could drop our daughter off at day care.  The hospital also has a nurse practitioner who specializes in bariatrics.  She came in and talked with me.  Two of the things they tested my blood for were elevated.  I can't remember the name of the first, but I remember that the second was liver function.  The radiologist read the scan and didn't see any issues, but the nurse practitioner explained that one of the bariatric surgeons would be looking it over soon, just in case.  In the meantime, they were going to admit me into the hospital, because they wanted to keep me overnight to observe me regardless of the scan because of those two things that were slightly elevated from my blood work. 

There are two bariatric surgeons - my surgeon, who happened to be out-of-town for the week, and his partner, who would be taking a look at the scan, Dr. Wolffe.  Dr. Wolffe and her team came and talked with me about an hour after I got up into my new room on the floor I would be staying at.  She explained that there was some inflammation around my intestines, but it was not too concerning.  She also said that she found a tiny hernia (a whole in my abdominal wall) by my belly button.  She said it likely had been there since childbirth (which is apparently something common, because my dad had to have a hernia by his belly button repaired when he was six months old).  It was so tiny that it was not visible on the ultrasound that was done prior to my bypass, and they did not see it during my bypass, but now that she knew it was there, she didn't want to leave it because it could cause issues later down the road when I lose a significant amount of weight.  It's possible that while I lose weight, some of my bowl could get stuck in that hole, which would be a big problem and I'd need to have surgery if that happened.

I then explained to her the strange episode I had while on the CT scan table, and she said "A-ha!", lol.  She theorized that there was a possibility that part of my bowl, or intestine, had gotten caught in that hole and that when the radiographer had me stretch out, it popped back out, relieving the pain.  She said she was going to look at the scan again with that possibility in mind, and then decide if they would operate the next day.

Well, the next morning my nurse told me that I was on the OR schedule for the day as an add-on, which meant that I didn't have a time yet, but it would likely be in the late afternoon or evening, after all the previously scheduled surgeries were completed.  I felt a little miffed at that, because I felt someone from Dr. Wolffe's team should have come and talked with me sooner, but it turns out that they came and talked with me shortly after that and explained everything.  They explained that there was no evidence from the scan that anything had been caught in that hernia, but Dr. Wolffe felt most comfortable in repairing the hernia, even though it was really tiny, to prevent any further problems down the road.  They explained that they would also be able to take a good look inside me before repairing the hernia to make sure everything with my bypass was okay.  So, although I was nervous about going under the knife again, this made sense to me.

My mom had driven up to Maine from Massachusetts to be with me because my husband couldn't miss another day of work on Wednesday, so I felt comforted in having family there with me.  I forgot to mention that my husband had picked up our daughter at day care Tuesday afternoon and brought her to see me in the hospital.  I wanted to see her, but I also wanted her to see that I was okay because my husband had to tell her that morning that I had gone to see the doctor because my tummy hurt, because she was wondering where I was when she woke up.  She is five years old and seemed to understand everything very well.  She is familiar with hospitals because at one point my husband and I were both working there, and one of us would occasionally would bring her in to "swap off" with the other when we worked opposite shifts.  We would sometimes take her to eat dinner in the cafeteria when this would happen, and she has visited a friend with me in the hospital before.  At any rate, I felt better seeing her and seeing that she didn't seem worried.  I told her that they wanted me to stay in the hospital just to watch me for a little while, to make sure I was getting better.  I had no pain, so she saw that I was acting my normal self.  We played a round of go-fish.  :)

Back to Wednesday.  They ended up taking me to surgery at 4:30pm on Wednesday.  My mom was still with me, and my husband had just gotten out of work at 3:30, and had picked up our daughter to come visit me, not knowing at what time they were going to take me into surgery.  They got there while I was in the prep room, and I was worried about my daughter being frightened, but she didn't seem so.  I made sure to smile at her a lot and let her see that I was okay.  I asked her about her day like I normally would.  When they were ready to take me to the operating room, I gave her kisses and told her that I probably wouldn't be able to see her again that night, because she would need to go home and go to bed, but that I would definitely see her the next day.  She seemed to do well with that and was smiling.

The surgery went well.  It took about 45 minutes, and I actually came out of the anesthesia much better than I had the first time, during my bypass.  I felt more alert and in less pain than with the bypass.  I still haven't felt any gas pain from the surgery, although they said they filled my abdomen up with air just like they did during my bypass.  They didn't need to make any new incisions - they re-opened three of my existing incisions from the bypass and made a very small puncture hole on the inside of my belly button with the tool that was used to sew up my hernia.  The three re-opened incisions were closed up with some stitches and steri-strips, which is what Dr. Wolffe prefers to use.  The surgeon that did my bypass had just used dermabond to close the original incisions.  The small puncture in my belly button just had some gauze and a band-aid over it.

After the surgery, they told me that in addition to repairing the hernia, they had found and removed some adhesions on my intestine where that inflammation had been found on the CT scan.  I was too loopy from the anesthesia to think to ask more about it at the time, but later one of the residents came to visit me back in my room and explained that they found those adhesions, removed them and "cleaned everything up", and packed some of my fatty tissue from the fold in my stomach around that area to help protect it (which I found out is something that they regularly do).  I asked if they knew what had caused the inflammation and adhesions.  She said that there was no telling why that had happened and that it was nothing that I had done wrong and nothing that I could have done to prevent it.  She said that Dr. Wolffe had said that the bypass looked like it was performed excellently and that everything should heal just fine.  I think Dr. Wolffe is going to visit me Thursday morning, so I plan on asking her more about that and the chance of it happening again.

I am feeling fine!  The pain is much less than the pain I had after the bypass.  They are giving me morphine right now to control the pain because I am not allowed to have anything by mouth until Thursday morning.  The plan is to give me a liquid breakfast, soft food for lunch, and if everything goes down well and stays down, they will discharge me.  I haven't had anything to eat since dinner Monday night, but I do not feel hungry.  Love my bypass!  LOL.  I haven't had anything to drink since midnight before my surgery, but they've been pumping me full of fluids and I'm now allowed to swab my mouth with a tiny sponge on a stick.  I also forgot to mention that they did more blood work Wednesday morning and those things that were elevated had gone back down.

So, I'm feeling and doing well.  I'm going to go for a short walk around the floor and then try to get some more sleep.  As I finish writing this, it is 5am Thursday morning.  I wanted to get this all down so I would remember it all later.

Thank you all for your support and well-wishes!

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