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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.

2 comments:

Anonymous said...

I am so glad to finally here of someone that has had the same issues as me, but certainly :( that you had to go thru what you did. I was really starting to believe it was just an ulcer or not chewing well enough. I have had this problem about every 6-8 months starting about 2-3 yrs following my gastric bypass. (11 yrs ago) I have been to doctors following the episodes and ct showed nothing, one dr also did a follow thru where i drank this liquid and nothing, but again that was days following the episode. I had one so severe last night I thought, this is so much worse and I would die. I finally fell asleep, on my right side, and woke up fine until I had lunch. The next one, I will definately get to the hospital and demand they check further. I have been telling my husband for years that I thought it was a blockage, only way it seems to want to come out is up, and we both know that doesn't work well. I am so glad I found your article, I hope all is well for you. Thanks again...Lori

Tonya Kubo said...

Your intestine may be kinking, though that would be rare. As I've said before, you just have to be an advocate for your own care. Don't give up!