Original Article
Click here to contribute your own article
Myself
SelfApril 25, 2004
Submitted by Cheryl L.
Following WLS I spent 9 months in the hospital and 3 months in rehab due to overwhelming complications. I am now active, at or near goal weight and an advocate for making sure pre-ops understand that death is not the only complication of WLS.
My Story:
After more than seven years of research, interviewing post ops, talking with physicians, and lots of soul searching, I had an Open RNY on June 26, 2000.
The only complication during surgery was that my blood pressure dropped to a level that was troubling for only the anesthesiologist. Following surgery, my blood pressure continued to be unstable, but was eventually transferred to my own room. No special instructions were left with the medical staff about the need to keep watch of my blood pressure. At some point during the night of surgery, my blood pressure bottomed out. A nurse's aide discovered me near death and I was rushed to ICU. It was discovered that the lack of blood pressure caused my kidneys and liver to fail and my respiratory system was compromised. I was in a comatose state for over one week. No one knows just how long I went without a blood pressure, but apparently long enough to cause major organ shutdown.
A Nephrologist (kidney specialist) was assigned to my case and immediately had me transferred to a larger hospital to be placed in ICU on dialysis. The Nephrologist told my partner that I was gravely ill and it was very likely I would die from major organ failure. The damage done to my liver during surgery and from the lack of blood flow was significant. If I did manage to live, he could not predict whether my kidneys would ever be able to function normally. I was on dialysis for three and half weeks before my kidneys finally started functioning. Obviously I was greatly encouraged. On July 19, 2000 I was discharged to home.
On July 23, 2000 I was readmitted to the hospital because I had become so weak I could not walk and I could not hold down liquids of any kind. (I would not be discharged to home again until November 6, 2000) The diarrhea was so serious that anytime I stood upright it would just run out of me. I was not able to take anything by mouth because nothing was staying down. I was unable to rid my body of fluids and I swelled up from fluid retention. The Nephrologist was concerned again about kidney failure and wanted to place me on food supplements to increase my nutrition levels. The surgeon disagreed saying that weight loss was the purpose of the surgery. The Nephrologist couldn't give me a diuretic because of the damage it would do to my kidneys. I started leaking fluid out of my pores - like a sieve - I would soak the sheets and gowns. I went into the hospital weighing 309 and by this time I weighed over 325 because of the fluid retention. My health continued to decline. After more than six weeks, I was finally given a tablespoon of TPN (food supplement) a day. The Nephrologist didn't feel this was sufficient but the surgeon disagreed. Then after many GI studies, I was told I had Croan's disease (strictures of the lower bowels). The Nephrologist questioned this diagnosis because the symptoms for this don't just show up overnight. He continued to press for food supplements. During this time I developed a pulmonary embolism (blood clot in the lungs) and sepsis (system-wide blood infection). I was being given medicine cups full of pills and expected to crush them myself and get them down before the next cup arrived. In between the pills I was expected to eat and drink. It was just too much for my pouch and I found myself having to decide if I ate or took pills - I could not do both. My kidneys had started working and the catheter was removed. I was unable to walk so I had to depend on a bedpan. The problem was that I could seldom get staff to bring one so I laid in my urine and feces most of the time. My skin was seriously broken down and infected. I was severely depressed and my health and strength continued to decline. Finally, on October 7, 2000 I spoke with my Nephrologist about my options and it was suggested that I could contact my primary care physician and get transferred to another hospital with new doctors. I was told that without substantial nutritional feedings I would die and it was unlikely I would receive the nutritional supplements without intervention. My blood pressure readings were severely low - less than 60/30 (this is the lowest the machine could register and it was too shallow to hear manually).
On October 9, 2000 I was transferred to a teaching hospital. I was assigned doctors from the medical teams of dermatology, medicine, infectious diseases, surgery, psychiatry, ophthalmology (I was unable to focus) and gastrointestinal. By this time I had lost all my hair, my body was full of open sores, my eyes were swollen shut from inflammation caused by nutritional deprivation and my fingernails were falling off. Pictures were taken of my skin because the Dermatology staff hadn't seen this serious of a case in years, GI studies showed I did not have Croan's disease, all my meds were fed intravenously, I was placed on 24 hour intravenous feedings, 24-hour blood pressure monitoring, massive amounts of antibiotics were started, I had a bladder and bowel catheter, and immediately received 13 blood transfusions. GI tests were ordered to determine why I was unable to eat or drink. Results showed that my stoma (new connection between the pouch and the intestines) was swollen with scar tissue and totally closed. Nothing was getting through, not even liquids. In addition, it was discovered there was an insufficient amount of bowel connected to my pouch resulting in a condition called "short bowel syndrome". This severely compromised my ability to absorb nutrients. During my hospital stays it was necessary to have my blood drawn every day and sometimes twice a day. While I had a PICC line for intravenous feedings, the blood draws were done from veins and from arteries for arterial blood draws (extremely painful). Because of the frequency of blood draws my veins became inaccessible and they had to draw blood from my ankles, feet and neck. The daily poking over the course of my hospitalizations was torture, pure and simple. After days of massive supplements I started to improve and physical therapy was started. I had to relearn how to sit and walk. On November 6, 2000 I was sent home.
On November 30, 2000 I was called and told to readmit myself to the hospital. Blood tests two days prior confirmed that the blood infection had returned and it was now resistant to conventional antibiotics. I needed to be placed in ICU. After several days of intravenous drugs I was sent home again on December 4, 2000.
On December 6, 2000, my infection returned with a vengeance and I was rushed by aide car near death back to the University of Washington and placed in ICU. The malnutrition, kidney and liver damage I had experienced following surgery had depleted my ability to fight off infection - I now had what is called immune deficiency (not AIDS). The doctors decided I needed a more aggressive form of treatment. I returned to surgery to have a feeding tube threaded into my main stomach. I received another 14 blood transfusions and was started on experimental drug therapies to fight the infections. Anything going into my system would either be given intravenously or by feeding tube. I was having my stoma opened by esophageal dilatation every two weeks. I was finally starting to feel some strength. I was still unable to sit or walk on my own, but I was eating food and able to drink liquids. On January 4, 2001 I was discharged to a rehabilitation facility for inpatient rehabilitation. The experimental drug therapies continued, as did the dilatation every two weeks.
On February 6, 2001 I was readmitted to the hospital with complications from the experimental drug therapies. After a medication adjustment I was returned to rehabilation
on February 8, 2001.
On March 29, 2001 I again was admitted to the hospital with liver failure. My albumin level had dropped so low it was not measurable. Blood transfusions and albumin were started. I developed another pulmonary embolism and an embolism in one leg and one arm. I was told that my condition was critical and they were doing everything they could to try and find a solution. The damage caused by the initial malnutrition was more than my body could overcome. I again developed sepsis and this time it did not respond to conventional drug therapies. I agreed to start a new drug that had not been fully tested, but thought to be promising in fighting drug resistant infections. It was pure hell. However, my infection cleared up, my liver began functioning and I was getting stronger. I was discharged to rehab again on April 27, 2001. On my last day at the UW Hospital the medical doctors and nurses presented me with a sugarless cake and one candle to symbolize my new life.
On June 12, 2001, after weeks of agonizing physical therapy, I was finally able to walk and allowed to go home. After more than a year of nighttime tube feedings, the doctors agreed to discontinue my tube feedings and let me try to maintain my health and weight with regular eating. On August 21, 2002 my feeding tube was removed.
Today, I have regained my strength, my liver function is near normal levels, my fingernails have returned and my hair has grown back. My blood pressure routinely measures 120/70. Unfortunately, the lack of blood circulation during and after surgery caused nerve damage to my feet and I have constant tingling, like they are waking up from a "sleep". It can be excruciatingly painful at times, but I feel very fortunate that this is my only lingering disability. Today, to maintain my nutritional levels, I have to eat in excess of 1200 calories knowing that only a small portion will ever be absorbed. I see my Internist once a month and we go over my lab tests and adjust my intake accordingly. I no longer have dilatation. I do have difficulty with my thin skin on occasion and I have a difficult time fighting infections. I am at my goal weight of 170, down from a high of 325.
While hospitalized, my 9-year relationship ended and for financial reasons, I was forced to sell my home. Today, I live in an apartment and enjoy my new life.
The question I am constantly asked is whether or not I would do it again. This is not a question that I can answer. I am extremely pleased with my weight loss. Obviously, had I known about the complications beforehand I would not have put my family, friends and myself through a year of worry, torture and separation. Not having the services of a crystal ball, I placed my faith in God and the medical staff. I went into the procedure with my eyes wide open and my homework done.
What concerns me the most are the recent TV ads and articles about weight loss surgery. The news is either reporting the miraculous success or the untimely death of WLS patients. I believe there is an obligation to make sure that individuals investigating the surgery understand that complications, other than death, can and do occur far more often than is reported.