st_mel
Century club and additional surgery
Feb 22, 2010
After a very rough (non-weight loss related) February, I have finally made it to the 100 pound loss mark! I'm just a little under 40 pounds away from goal!!
My very rough February was because I had to have emergency open abdominal surgery on February 5th. On Monday, 2/1, I ate part of an orange at work. I went home halfway through the day with dumping syndrome. A side-effect of my RNY, and while unexpected from an orange, it happens. Last Monday night/early Tuesday morning at about 1 am, I woke up with pain between in my shoulder blades and in the right upper quadrant of my abdomen. In other words, classic location of pain from gall stones. Just one problem there, I had my gall bladder removed in October 2008 following a fun two week plus period of blockage and jaundice in Sept. 08 while in Baltimore for work. I had no other symptoms at that point on Tuesday, but I stayed home from work and called the surgeon's office. They couldn't get me in for an MRCP (MRI to detect a biliary stone) any earlier than Wednesday, the 3rd. They phoned in a prescription for darvocet, and told me to have liquids only on Tuesday, and go completely NPO on Wednesday. Bear in mind, I hadn't had anything more than water and a handful of crackers since the orange on Monday morning. I went for the MRI and blood work on Wednesday, and stopped by the doctor's office since they're in the same building, for a note to take to work for missing so much time. Instead of a note, I got told to lie down in an exam room to wait for the results. I guess I wasn't looking so hot.
The blood work came back first. My bile was double the upper limits of normal. Well, crap. Nurse says she realizes that this doesn't look good, but she can't tell me what will happen now. MRCP comes back sometime later, and Dr. Sims, my surgeon, delivered the bad news. I had a gall stone blocking my common biliary duct. Now, in a normal person, this means an outpatient operation where they stick a tube down your throat, into your stomach, into the bile duct, and retrieve the stone. But, me being me, I'm not a normal person because I've gone and altered my anatomy. I cannot be scoped. The only way to remove the stone is through surgery. Dr. Sims wanted to consult with gastroenterology (GI), but gave me permission to go home, pack a bag with some personal items, and come back to the hospital to be admitted.
I head home, pack a small bag and shower, my roommate meets me at the apartment and drives me back to the hospital. I get admitted, and GI comes by for a consult as they're trying to get an IV into my nicely dehydrated veins (remember liquids to NPO?). GI says, and I agree, the stone is a primary stone. That means it's not left over from when I had my gall bladder removed and my last ERCP (the scoping procedure). It is a stone my bile ducts have formed. It's not unheard of, but it's not common, either. I joked with the anesthesiologist about being in the 2% of the population to form gall stones without a gall bladder, and he said it was less than that. GI says I have three options: 1) laparoscopic surgery where Dr. Sims cuts into my old "blind" stomach, GI inserts the scope, and they retrieve the stone, 2) open surgery to do a bypass of my biliary duct directly into my intestines which would prevent this from ever happening again, or 3) surgery through my liver into the biliary duct, with 3 being the least likely to happen or the least successful. Dr. Sims agreed, though he threw in a 4th option I can no longer remember. After much reviewing of my old medical records from the first round with gall stones and consulting with lots of other, more experienced doctors, it is determined I'm the first person in Waco to ever have to deal with this situation. No one at Waco GI has ever done an ERCP through lap surgery, and I'm the first patient Dr. Sims has seen develop a gall stone after having the gall bladder removed. The other consensus is that this is a primary stone, not one that was missed, and it WILL happen again if they don't do the open surgery with the bypass. So, surgery is scheduled for around noon on Friday. Oh, and my biliary duct was uncommonly small for one with an obstruction. It should have been dilated, but wasn't, which would complicate the surgery.
So, I had open surgery to bypass the common biliary duct on Friday, 2/5. They were not able to remove the stone. The inflammation and infection was so bad that they just had to leave it there and bypass the entire thing. They released me from the hospital on Tuesday, 2/9. Before I was released, I was advised that the cultures had come back and, if I had not started hurting when I did, I was at high risk for sepsis, so I guess it all happened in the most beneficial way possible. I went home with my parents for recovery as my mother is retired and could help me while I could not bend over or really take care of my cats. I went back to Dr. Sims to have the staples removed on 2/19, and I go back for my 6 month RNY follow up on Friday, 3/5. Six months was actually 2/17, but they were mainly concerned with the new surgery, so they didn't do lab work. Recovery is going along, but it seems slow. I'm still not back at work, and I'm very easily fatigued. I'm hoping to go back to work for half days next week.
Many of my friends don't understand that the bile duct bypass is not a result of my RNY. Even if I'd had a normal stomach, they would have discovered they'd have to do the surgery when they tried to do an ERCP because of the inflammation and infection.
