Cont’d.

On March 11, 2010, in Uncategorized, by Andrea

Mmm...

Okay, so it’s been a crap ass couple of days.  Starting on Tuesday morning, I had the pain to end all pain.  Followed Wednesday with an EGD that set off a migraine that would not die.  Thursday had another bout of OMGPLEASEKILLMENOWBECAUSETHISREALLYMOTHERFUCKINGHURTS pain, but let’s add driving in an unfamiliar city with my kids in the backseat?!?  After I could breathe again (about an hour of sitting in an unfamiliar parking lot in Cary, NC — hi anyone who may have seen me!!) I went to my doc’s office where they decided that I REALLY needed a CT TODAY.

And so, I had a CT with contrast this morning.  This entailed me drinking 1/2 of the bottle of barium you see above.  People asked me what it tasted like — and I can’t tell you.  I don’t know what it tasted like — which is kinda scary?  In any case, I had half early this morning and was both scared and surprised to note that I’ve recently reviewed a protein shake that was worse than this was (despite the fact that I couldn’t distinguish a flavor…  very bad news for the protein shake in question.)

Go to the hospital.  Realize that my insurance has changed since last year and while I have hit my deductible (yay for an EGD), I still have to pay 10% of the cost of my scan.  (Last year it would have been covered in full.)  But hey, if I pay it in full today, they will give me a 30% discount!  I could talk about how much I really wish for a national health care initiative here — because the people who think the government will fuck us over with insurance?  Come look at how my expensive private pay is already doing it.  But I digress.

Get into the lobby of radiology, asked if I’m diabetic.  “No, I’m hypoglycemic.”  ???  “It means that my blood sugar goes too low if I don’t eat and then I pass out.”  “I wonder if I need to get blood work on you.. do you take medicine?”  Resolved, find a place to sit in the overly packed waiting room.  I begin to finish the other 1/2 of my barium per instructions.

At  some point, a woman comes in to sit next to me while I’m waiting.  Keep in mind that I’ve already got a pounding head from the drugs from the EGD on Tuesday, no food in my stomach, and off my maintenance meds for my headaches.  This lady reeks of stale cigarette smoke.  Not fresh smoke — I might have handled that better — but stale sweat and cig smoke.

Yeah, you guessed it.

So I barely keep the barium down and as I leave the restroom, the tech is ready for me.  I ask about getting pictures of the scan — for which I am given quite the disapproving glare.  I mean — if there could be a way to bottle this and use it at home I would have.  But I insist for at least ME looking at them “But we can’t tell you anything about them”  Yeah, like I expected you to anyway.

Get the IV for the IV contrast — my poor widdle vein is going to crap out soon and head into the CT room.

Now — if you’ve never had a CT, this is no big deal.  It doesn’t hurt at all.  It’s a big machine that has a table you lie on that moves in and out of an open ring (no enclosed spaces at all) and it tells you to hold your breath and then to breath again.  They do a scan w/o contrast, then start the IV.  This is, by far, the worst part as it makes you feel flush all over, a bit dizzy, and like you’ve peed your pants.  Then a few more scans, and then you’re done.

I took a quick glance at the screen — but disappointed that I couldn’t tell anything — including the size of my pouchie.  I would be interested to see how big it is these days, yannow?  But no.  And then am whisked out.

I pick up lunch for us, come home, take meds for the head, and immediately pass out for 3 hours.

I didn’t hear anything back today — although I’m not shocked.  I expect maybe Monday — Tuesday at the latest.  I get my occipital nerve block on Monday, and have two other appointments on Tuesday.. and already have a follow up with the GI on Thursday so we’ll just have to wait and see at this point.

I’m not sure if I want to hear something or not.  Hearing something would mean bad things.  But it would mean they know what’s wrong with me.  So I’m kinda torn.

Despite all of this, the question has been asked — “You’re still for WLS even through all of this?”

I’m going to say yes — a qualified yes, though.

I’m for WLS as long as you don’t go into it blindly like I did.  As long as you realize that there are complications that could occur around any corner, that you have to be diligent with your supplements, that you have to do blood work often, that this sort of thing is common post-op.  Things that Beth goes through are a bit more rare, but ulcers and internal hernias are quite a bit more common post op and people need to be aware that these are very, very real possibilities that cannot be avoided.  We can avoid deficiencies by taking proper vitamins and watching out blood work like hawks.  But one can’t stop an intussusception or a hernia in Peterson’s Space.  Have WLS — but do so with your eyes open.

EGD.

On March 10, 2010, in Uncategorized, by Andrea

3/10/2010 Full sheet

Okay so I’m home and I’m still feeling pretty crappy — but not from the drugs exactly.  I have a crappy ass headache — either from a change of weather, a lack of carbs from the fast (although I’ve eaten?), a combination of the drugs and the above?  I don’t know and frankly I don’t really care at this point.  I just don’t feel good.

In any case, I’m back.  And because people want to know what to expect during these routine tests before and after RNY, thought I would document everything about it.

I got to the hospital (Franklin Regional Hospital in Louisburg, NC — and let’s be frank — it’s tiny, but decent) at 7:10am.  We’re a bit late — it’s a 45 minute drive, and it’s hard to get the kids up and around that early.  Shortly after, I go for labwork.  I’m a woman of childbearing years, so it’s “pee in a cup” time — but I’ve had RNY and I’ve not been allowed to have anything to drink since midnight so there is no pee to pee.  So I give her a vein.  She’s a bit shocked, but goes for it (and gets another 3 vials “just in case” they will need it.. I like this tech).

As soon as I’m done with that, I get called back to the pre-op area.  Kiss my kids good-bye (not because I’m worried but because Kaitlin gets sad if I don’t say bye).  Walk back, get changed, get my IV.  And immediately go back to the room.

This room, of course is pretty interesting.  Monitors, blood pressure monitors, cardiac monitors, computers, drug lockups, various equipment, nurses — some of which can be somewhat scary and intimidating.

I’m put on a cardiac monitor, a blood pressure cuff, O2, and oxygen saturation monitor.  While waiting for the doc, joke around with the nurses, but also discuss with the nurse why I’m there.  She’s familiar with RNY and by hearing what my pain is, she knows what tools to have on hand just in case there’s a suture that needs clipped or a staple that needs pulling, or whatnot.

As soon as the doc comes in, he signs the release for the meds and in goes the versed.  Pretty soon, I get a spray in my throat to help numb my throat that tastes horrible.  Another within a few moments — and yes I remember these.  I know she pops the fentanyl in and I remember asking if that’s what she pushed, and remember her saying “We’ll see you in a little while…”

I remember, for the first time, actually waking up this time, with the camera down my throat.

I’ve had several EGD’s — this being my 3rd with this doctor — and this is the first time I’ve ever woken up.

I know I panicked a bit.  I remember being told to calm down — and I remember seeing the nurse push more meds.

And then I remember waking up in recovery.

9/17/2008

I’ve included some photos for you from the two procedures.  I have to apologize — while we have multiple computers (6?), several game systems (4?), etc — we don’t have a scanner.  But we DO have two DSLR cameras so I can take photos of the photos..

First photos are from 9/17/2008.  These are the ones from when I had 3 ulcers on my anastomasis.  When looking at these photos, the white “spots” are the ulcers.

9/17/2008

9/17/2008 -- One large ulcer visible

9/17/2008 - Ulcer visible on the far upper left

9/17/2008 - All 3 ulcers visible (Largest towards the back, then one closest to front, and one to side)

So that’s what my pouch and anastomasis looked like in mid-September.  Was put on Carafate 4x a day and Prilosec 2x a day for a period of time — 3 months I think?  When I still had pain, we did exploratory surgery and discovered that I also had a ton of adhesions.  But it’s very obvious that I had quite a bit of ulceration.

Today?

3/10/2010

3/10/2010

3/10/2010

3/10/2010

3/10/2010

3/10/2010

So what does all of this mean?

Well, there are no ulcers in my pouch.  There is not irritation in my pouch.  In fact, I was told it was one of the cleanest, healthiest looking stomachs seen by the Nurse who was taking care of me (not the Endo nurse, the recovery nurse).

So we are going to get a CT scan to rule out an internal hernia — which is the next thing.  And is a possibility since I did some heavy lifting on Sunday (mulching the front yard).  If that comes up negative, then the doc gets to order a new toy (and he’s a bit gleeful about it — he has to show a need for it with two patients — I’m number two..)  This new toy actually allows him to scope the remnant stomach — so yay for technology.  So for now I’m off the Carafate (since it won’t do me any good anyway), with no changes in diet and just adding Prilosec in case there’s ulceration in the remnant stomach.

This also goes to show that the occasional caffeine, coffee, soda, RedBull, spicy food, etc. will not hurt your pouch.  I mean, c’mon!  I had coffee on Monday morning before my attack, and some on Saturday morning — and I’m pink as can be.  Just goes to prove that these things are not as horrible as they’ve been vilified to be.

Now if you’ll excuse me?  I think it’s time for a nap.

Pain.

On March 9, 2010, in Uncategorized, by Andrea

Yuck in a bottle.

I’m no stranger to pain.

No, really.

I’ve had two kids — and any woman will tell you — this is no walk in the park.  The guys that might be reading this?  Count your lucky stars that you’ve never had to deal with the concept of pushing a watermelon out of a lemon-sized hole once, much less twice.  Consider yourselves even luckier that there was a repeat performance of the act that got the watermelon there in the first place.  On top of this, there’s the monthly fun, and the yearly indignity that isn’t exactly comfort.  Trust me — these are things that bring up the idea of “ow” pretty quickly for most women.  So there’s that.

On top of this, I suffer from daily chronic headache (yes, that’s daily — not frequent but daily) and frequent migraine.  I also have had a cluster headache a spinal headache if those weren’t enough for my headache portfolio.  If you’ve never had a spinal headache over a weekend?  My suggestion is to just not.  Cause, well, no.

This wasn’t a discussion just to say “nah nah nah nah boo boo” on how much my life blows.  Cause while it can, and does at times, I try not to discuss it much of the time.  I could — but really, what’s the freaking point?  I have enough on my plate to deal with without adding this kind of crap to my day.  Talking about it only depresses me more, and I’d rather not do that anymore than I have to — thanks, but no thanks.

No, this was just to highlight the fact that when I say I woke up in severe gut-wrenching, tear-inducing “Call the ER because I have a knife in my stomach, GIVE ME THE FUCKING CARAFATE!” pain — well, I mean it.

I was having a dream — of what, I’m not really sure to be honest.  I know that I was dreaming.  And all of a sudden, I was dreaming that my stomach hurt.  Badly.  And then, well, I was awake.  And my stomach hurt.  So I get up to get some of the Carafate that I have on hand — which I have on hand because my pouch had been bothering me of late — but nothing THIS horrible.  More of a “acidish” type deal.  And I take a dose of it.  And I go back to bed.

5-minutes later?  It hits.

Now, I want to make a few things clear.

1) I see a bariatric gastroenterologist.  He specializes in RNY patients.  I saw him not 2 weeks ago when I told him I was getting a bit tender, but not anything horrible.  He wrote the script for carafate and script-strength prilosec to self-treat as needed and made an appointment for 6 months.  We didn’t think anything was bad.
2) He has no problem with me drinking coffee (of which I had not been drinking coffee of late, actually..)
3) I had not been a bad girl with my food or drink — no alcohol, no “no-no” things — nothing really to put me in the #BBGC except for being off the Christmas Card list for a certain group.

So with this said, this was out of the blue.  Yesterday’s food choices?  Protein latte (32g, baybee!), Campbell’s soup for lunch (how horrible!), some Dreamfield’s pasta w/ marinara and parmesan cheese for dinner, and then an Isopure Smoothie for “dessert” (liquid peach-flavored chalk!  Another 32g!)  And not a single narcotic for my headaches to sit in my pouch all day.  Certainly nothing to piss off my pouch.

So at 4am I’m on my kitchen floor, rocking to and fro, with tears running down my face.  The husband, who is now panicked beyond belief is trying his best to figure out what to do.  “ER?  Walk?  Sit up?  Lay down?  Go to the couch?  Off the hard floor?  Drink something?  Pain killer?”  So we try a pain killer.

And for the record — pain killers are good — EXCEPT when you have an apparent gaping hole in your pouch.  Because when it hit?  OMGIWANNADIEPLEASEKILLMENOWPLEASEOMGPLEASEOMGWHERESTHEKNIFETHATISSTABBINGME?!?!  I thought I was about to faint when it hit — and there was NO mistaking when it hit.  Cause I saw stars.  And I was inside.

So another dose of Carafate.  And 10 Tums.  Glass of milk.  A discussion of protein and why it’s so vital to me and the healing process?

Why I couldn’t go to the local ER (they have a love affair with Toradol — the last time this happened?  They pushed a dose on me despite being told NO adamantly several times.)

And by 6am I could get out of my fetal ball on the kitchen floor and walk around — just in time to see our daughter up.

Yay!

So now I have a call in to my Bari-GI to see him this afternoon.  Not that I really have the time.  And I already know what the answer will be — an endoscopy to see what’s going on.  Not that I have the time for that, either.  But he’s super protective of us RNYers of his — and there are worse things in life, I suppose.

Now why am I sharing all of this with you?  It isn’t as if I enjoy baring my entire life for all to scrutinize..

Ulcers are a way of life for RNY patients.  My first 3 (all at once, FTW!) were not my doing.  I got them, most likely, after unknowingly getting a shot of Toradol during my labor with having my son.  At the time, I didn’t know they gave NSAIDs for labor — and I didn’t know to ask.  I never had taken a single aspirin or advil — but still got ulcers.

And there are many post-ops that get ulcers that follow the rules — these are a way of life after RNY.  The intestine is not meant to be attached directly to the gut.  There is supposed to be a valve to keep acid from getting to the intestine.  We don’t have that anymore.  Carafate and prilosec, and nexium, and such are quite common.  I see posts from newbies asking how long people are on their PPIs after surgery — and I’m thinking “this time” cause inevitably they will be on them again in a few years.  And it seems like I’ll be on them for life because when I go off them I get ulcers — again.

So I share this just so you can prepare — just in case.

Now if you’ll excuse me?  I need to go drink my breakfast.  Cause there will be no food…

Why no, my husband doesn’t hit me.

On January 27, 2010, in Uncategorized, by Andrea

I just bruise easily.

No, really, I do.  And have since surgery.

The latest.

Yeah, when you have to decide what you wear based on how your bruises will show, that’s not a good thing.

That one?  Have no clue how I got it.  That’s the same with 95% of all of my bruises.  And it came up this afternoon.  Want to know what we did today?  I slept off a headache with the kids.  No kidding.  I spent about 75% of the day curled up on the couch watching childrens’ television with one or both of them asleep with me… and for at least 3 hours of it, I was asleep as well.

At some point, I started the already loaded dishwasher, I fished a dead frog (RIP, Fwog.. I will miss you terribly) out of the new tank and fed the tank, took the dogs out to pee, and loaded the clothes washer.

THAT was my day — nothing bruise-worthy in sight.  Yet — that mark is what I got today.

And so yes, now the peanut gallery is saying “Andrea, have you had labs drawn?”

And I’m going to look at you for a moment until you remember to whom you are asking.

OF COURSE I had labs drawn!  My bleeding time is milliseconds slow.  As in “yes, it’s low, but not enough that you should get that kind of deep purple bruising by sleeping with kids on a couch” low.  In fact, one of the bleeding time tests was NORMAL.  Bzah?  Wha?  So as soon as my package from Vitalady gets here, of course I’ll be starting on some K.

Husband and I used to do martial arts.  We used to practice Aikido — the one where people wear these black skirt looking things and would throw each other around hard onto the mats.  We enjoyed it — it was wonderful, and peaceful.  It’s one of the truly defensive martial arts — and it’s one in which you use your enemies’ aggression and momentum against them — so you have to actually be thinking.

But I bruised.  Badly.

In the art, we would practice arm holds.  And some people would grab my forearms enough to really hurt.  Each night I’d go home and ice my forearms — and every day after, I’d be bruised.  At the time, I didn’t realize it was because I was taking crap vitamins at the behest of my surgeon, was in the rapid weight loss phase so in poor health anyway, etc.  But it was embarrassing, because people would tell me I needed to leave my abusive relationship.

And then, one night, husband hurt his neck with a throw and we ended up in the ER around 4am.  His neck, combined with my arms (that, being young and stupid, did not get covered up) got us counseled about abusive relationships.  They assumed he was hurting me, and I retaliated and that’s why he was in the ER — and of course, we were denying everything.

And now, I’m bruising.  Again.  And it’s bad.  Again.

So if you see me in long sleeves, don’t assume it’s cause my husband is beating on me — just ask me if I’m taking my vitamin K and iron.

Live in Cinci and hypoglycemic?

On January 19, 2010, in Uncategorized, by Andrea

Go be a labrat.

UC HEALTH LINE: Be Aware of Blood Sugar Post Gastric Bypass

CINCINNATI—People with type 2 diabetes who have gastric bypass surgery often leave the hospital without the need for previously prescribed diabetes medications.

Researchers and doctors believe this health benefit is related to changes in the body’s circulating hormones—particularly an increase of insulin secretion. Insulin is the hormone that controls the level of glucose (sugar) in the blood.

Marzieh Salehi, MD, a diabetologist with UC Health University of Cincinnati Physicians whose research is focused on the effect of weight-loss surgery on glucose metabolism, cautions that although there can be huge benefits for diabetic patients who undergo gastric bypass surgery, a group of patients experience severely low levels of blood sugar (hypoglycemia)—especially following a meal and typically several years after surgery. Symptoms of hypoglycemia often aren’t recognized until they become debilitating or life-threatening.

Salehi says that many patients with type 2 diabetes who qualify for gastric bypass surgery rely on anti-diabetic medications like insulin injections to regulate glucose in the body. These same patients often leave the hospital following surgery with normal glucose control without taking any medications.

“It’s possible,” says Salehi, “that gastric bypass increases gut hormone secretion or nervous system activity, which in turn increases insulin secretion and improves glucose metabolism in a majority of patients after surgery.

“However,” she adds, “there is a population of gastric bypass patients who, following surgery, develop high levels of endogenous insulin secretion, resulting in dangerously low glucose levels, or hypoglycemia. These glucose abnormalities due to too much insulin secretion represent an extreme effect of gastric bypass surgery.”

Salehi, who sees weight-loss surgery patients with glucose abnormalities at the UC Health Diabetes Center, says symptoms of hypoglycemia include shakiness, sweating, dizziness, light-headedness, weakness, confusion and difficulty speaking. More severe symptoms include seizure and cognitive abnormalities. Hypoglycemia can be life-threatening without proper monitoring or treatment.

“If hypoglycemia goes unnoticed, the body can become accustomed to low sugar and patients can then lose their awareness to low sugar. It is essential to seek help if any of these symptoms develop after gastric bypass surgery.”

Salehi is currently conducting a National Institutes of Health-sponsored study to determine how glucose metabolism is affected by gastric bypass surgery. For more information, call Leslie Baum, registered nurse and study coordinator, at (513) 558-0201.

To schedule an appointment with the UC Health Diabetes Center, call (513) 475-8200.

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