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Saturday, March 17, 2007

Stupid is as stupid does

Originally published March 17, 2007, in Our Town for the Tracy Press.

The word "stupid" is not one I use often. It was an "ugly word" in my childhood home, meaning it was barely better than profanity. The word still makes me cringe. I’ve even got my husband trained not to use it in my presence.

But sometimes, there is just no other word that fits.
And I’m here now to confess that when looking back on when I fell ill in late January, I am stupefied by my own stupidity.

False sense of normalcy
A lot of gastric-bypass patients talk of being normal, but most of us realize our view of normality is skewed. Normal people don’t eat whatever they want without gaining a pound, no matter what those of us who have been obese tell ourselves. I came to terms with that fact about a year ago.

What I didn’t come to terms with, however, is that I’m not anatomically normal and never will be again. That’s easy to forget after losing close to 200 pounds in a two-year period. My exterior looks normal to the rest of the world. Few people would guess I’ve been morbidly obese for most of my life, and sometimes, I buy into that fantasy.

Take that night in late January when I first realized I was seriously ill. As I mulled over whether I was in serious enough shape to warrant my best friend and husband trekking into the mountains on a work night to pick me up, I had some moments of clarity that didn’t make me feel like the brightest bulb in the drawer.

What’s the worst that can happen?
Trying to convince myself of how silly it would be to have them drive all that way for nothing, I tried to imagine the worst-case scenario. I was one of the few guests at a rural cabin resort. There were no neighbors to hear my cries for help if I were to become truly incapacitated. No phone in the room to call the operator for help. I had my cell phone but didn’t have the manager’s number programmed in it.

Then my thoughts darkened. What if I were to lose consciousness? Nobody would even consider looking for me until an hour after checkout. Looking at the clock, I realized that a lot could happen in the next 14 hours or so. I also knew I was dehydrated, having consumed only about 4 ounces of water in the previous day.

Helping those who help us
I tried to be objective. If I were to pass out, either from the pain or from whatever ailed me, what would emergency personnel think? How would they help me? I didn’t have a MedicAlert bracelet to tell rescuers I was a gastric-bypass patient. My doctors warned me to order one before I even had surgery so that in an emergency situation, it could speak for me if I could not speak for myself. But I never made the time to place the order. It seemed inconvenient to figure out what to have inscribed on it, and though it wasn’t pricey, there always seemed to be better uses of my money.

I considered typing out my medical information and symptoms on my laptop but would medics really think to look there for clues? There was no way to be sure.

I finally called my husband and told him to come get me. Though I still had no idea of the severity of my condition, I realized I was safer at home with someone to help me than all alone in an unfamiliar, isolated area.

Stupid is as stupid does
To be stupid is to act in an unintelligent manner. Ignorance, on the other hand, is to be uneducated. Ignorance is forgivable; stupidity is not.

In hindsight, here were my stupid moves:
  • Not seeking help sooner — There is no guarantee that earlier medical attention would have led to an earlier diagnosis, but I knew the dangers of dehydration and the signs of bowel obstructions long before I ever had gastric-bypass surgery. The moment I realized I could not keep water down, I should have called my husband to pick me up.
  • Staying alone in an isolated area — When I was told to choose temporary lodging for my business trip, a quiet mountain resort sounded like the perfect getaway. And in some circumstances it could have been. But it was not the smartest move for a woman traveling alone.
  • Not ordering a MedicAlert bracelet — Gastric-bypass patients have some serious limitations when it comes to medical care. NSAIDs like Aleve, Advil and Motrin can ulcerate our delicate gastric pouches. Nasogastric tubes, which are inserted through the nasal passage and into the stomach, cannot be used, since access to the remnant stomach is cut off by gastric-bypass procedures. Attempting to insert an NG tube blindly can perforate the gastric pouch — not a good thing. The other benefit to a MedicAlert bracelet is that it can list allergies. Because I’m allergic to a couple of commonly used drugs, that’s something that should be a higher priority for me.
  • Not packing my vitamins — What happened to me had absolutely nothing to do with vitamins. However, I know better than to miss a single dose. The malabsorptive nature of my altered anatomy puts me at risk of vitamin deficiencies. There are few things more important than taking my vitamins each day. I knew when I left Tracy that I had forgotten to pack them. I decided that it wasn’t worth the effort to go back home to retrieve them. After all, I was only going to be gone five days. Five days without vitamins would not kill me, but it’s still stupid to rob my body of vital nutrients out of laziness.

Saturday, March 03, 2007

No immunity from complications

Originally published March 3, 2007, in Our Town for the Tracy Press.

I’ve been fortunate since having gastric-bypass surgery two years ago. I haven’t had to deal with nutritional deficiencies, strictures, profuse vomiting or any of the other common problems post-operative patients face.

But my luck, it seems, has limits. And about a month ago, it ran out.
I woke up Jan. 23 like any other day, except I had some abdominal pain. I dismissed it, and made myself some peppermint tea to soothe me. By the time I got to work, though, the pain had increased. Every time I took a drink, I’d feel cramping low in my stomach.
Deciding it must be the stomach flu, I sipped protein drinks throughout the day and figured I’d let it pass.

Something serious
By 8 p.m., I was doubled over in pain. I wasn’t at home, though. I was on a business trip in the Santa Cruz Mountains. So I was alone in a rural cabin and determined to stick it out.
I was up most of the night, fighting both pain and nausea.

I called in sick Thursday and dozed most of the day. I seemed to do OK lying on my right side, and the pain would come and go, allowing me to sleep between spasms. On a scale of 1 to 10, the pain varied from a 7 to 10. I couldn’t get any water down, and I had uncontrollable belching.

By Thursday evening, I could no longer walk and had taken to crawling.
In the previous 24 hours, I had only consumed four ounces of water. Looking at the veins bulging in my chest and upper arms, I realized I had become dehydrated. On top of that, my stomach was distended and felt as if it were in flames.

Finally, I let my husband and best friend drive to the mountains to get me so I could see my local doctor the next day. It took them a few hours to reach me, and my condition continued to worsen. One look in my best friend’s eyes when she saw me told me I looked as bad as I felt. They packed my things while I laid in the bed, barely able to speak without sending myself into spasms of pain.

To get to the car, I had to bend at a 90-degree angle and shuffle the few yards outside. My husband asked why I was walking like his osteoporitic grandmother.

"This is the only way I can walk," I mumbled.

The ride to Tracy was miserable. Instead of going home as planned, we went straight to the hospital. Addressing my dehydration was the first priority. It took three nurses to get an IV in my arm. After that, I was led to radiology for a CT scan. Having to lay flat, even for 10 seconds, was the most excruciating experience of my life.

Afterward, I was hooked up to a bag of fluids and dilaudid, a painkiller 25 percent stronger than morphine. It didn’t do a lot for the pain but it allowed me to sleep.

The diagnosis
The CT scan showed I had a kink in my intestines. I was so happy to have a diagnosis that I didn’t fully process what that meant. I was admitted into the hospital for the night and scheduled to see a surgeon the next day.

After talking with the surgeon, it became clear that I would need a specialist. Unfortunately, there are no bariatric surgeons in Tracy. Finally it dawned on me that Dr. Prithvi Legha, who performed my gastric bypass, was now in private practice in the Bay Area. I had the surgeon contact him for advice.

Everything happened so fast from that point that there wasn’t even time to contact family.

I was transferred to El Camino Hospital in Mountain View the evening of Jan. 25. I didn’t know it at the time, but I was going on three days with an obstructed bowel — a dangerous problem.

Emergency surgery
I arrived at the hospital via ambulance at 9:30 p.m. Dr. Legha was already there and told me his assumption was that I had a bowel obstruction and at least one internal hernia. In laymen’s terms, my intestines had tangled into a gigantic knot and then started to twist inside out. Surgery was the only answer.

"I’m going to try to go in laparoscopically," Dr. Legha told me, "but I think you’re too far gone. I may have to open you up."

I nodded and told him to do what he had to do.

"When are we going to do this?" I asked, thinking I’d be scheduled for surgery the next morning.

Instead, he said, "now," and with that, I was wheeled into the operating room. I hadn’t even been at the hospital 30 minutes.

During the three-hour operation, Dr. Legha first tried a lap procedure, puncturing my abdomen six times. However, my bowels were so swollen and inflamed, he was afraid they would fray and break open. He cut me about five inches down the middle. He discovered two intestinal hernias in addition to the bowel obstruction. My intestines were purple from lack of blood. But I was lucky. As soon as the knot was untangled, they pinked up. I had no infection, no tissue death.

Dr. Legha is not one to mince words. He has let me know numerous times in the past month how close I was to death. Another 12 hours, and somebody at the Tracy Press would have had to write my obituary.

The road to recovery
This is one of the toughest surgeries to recover from. Not only are there incisions to heal, but the intestines must be retrained. It seems they forget to do their job after being shut down for a few days.

I was in the hospital about a week. I had nothing by mouth the first five days, but I wasn’t complaining. The thought of eating at that time seemed an impossible feat. Once it became apparent that my intestines were still asleep on the job, I was given intravenous nutrition to preserve my muscle mass and body weight. I was released from the hospital after moving from clear liquids to pureed food with little problem.

A month later, I’m back at work but still recovering. I’m slowly introducing solid food into my diet, and my body is learning to process it all. Earlier this week, I had to go home early one day after my intestines protested the chicken I had for lunch.

I tire easily, and I struggle with dizzy spells caused by low blood sugar. I’m eating between 6 and 9 ounces of food per day, not nearly enough to fuel my body. At Dr. Legha’s suggestion, I’m trying to consume most of my required protein through supplements. This will prevent my muscles from cannibalizing themselves, and it also keeps the dizzy spells at bay.

The future
This experience has taught me a variety of lessons, many of which I’ll share in upcoming columns. But for now, my focus is on building my strength and improving my health. Can’t expect much more than that.