As the stomach turns… Part 2

If you missed the beginning – here’s the link to Part 1.

So stink.

A perf.

But why?

While questions galore were going through my head I was sent up to my room on the floor, IV antibiotics were begun, and my fabulous husband went home and emailed Dr. Baltasar with what was going on, grabbed some things for me, and then at 2am – brought them back to me. Have I mentioned recently what an amazing husband I have? I often stop to ponder how I was chosen to be blessed so!

John and I talked quite a bit… Thoughts came to mind….

Adhesion ripped loose? We knew I had a boatload of them. I have had about a bazillion abdominal surgeries! And I’d been lifting the knee scooter in and out of the car – a lot.

A leak? This late – months and months and months after surgery? Unheard of!

What could have happened?

Whatever the cause, the cure, or so they were saying may include surgery.

I

DO NOT

NEED

OR WANT

ANOTHER

ABDOMINAL

SURGERY!

At about 5:00 am the morning of my admission (aka Mother’s Day – since we’d spent so many hours in the ER) a resident – a young woman – stopped by to talk to me. She hadn’t taken the time to read my chart. She thought I probably had a kidney stone. Then she thought the CT scan might be wrong. Then she said she didn’t know what she thought.

I eventually stopped her and asked, “Is it possible to see my own General Surgeon?”

“You have a General Surgeon?” she asked.

“Yes, Dr. Zelko. He did my hernia repair in 2003 and removed my belly button in 2004. Is there any way to talk to him?”

“Um, well, yeah… just a minute, I’ll be right back.” And she skedaddled out of there and never came back.

About half an hour later a young man entered the room and introduced himself as the resident with the group that would be the liaison to Dr. Zelko’s office (since I wasn’t at Dr. Z’s hospital of choice), and he asked me to start at the beginning and tell him the WHOLE story. After I’d given him the whole scoop he excused himself and said he’d be right back.

While he was out of the room Dr. Baltasar called. Yes from Spain. He does nice things like that. He’d seen John’s email, had replied to it with about 10 more – which included digital copies of my original DS x-rays, op report, discharge record, my revision x-rays – pre and post-op, the op report, and was wondering if he could convert the DVD of my surgery to an emailable file to send along to Dr. Zelko. I gave him the run down, told him my experiences thus far that morning and he gave his prescribed course of action:

  1. No surgery! If at all possible. (Is there any wonder why I love this doctor?!)
  2. Antibiotics are mandatory.
  3. Interventional Radiology to drain and/or tap and culture (depending on size of abscess) the collection and gas.
  4. An Upper GI study with both gastrografin and barium to try and determine if there was a leak.
  5. Keep him up to date!

Just as I finished my conversation with Dr. Baltasar the young resident returned. He had sat and read my entire chart, added notes from the conversation we’d had, and recounted to me his impressions of what he’d learned and asked if he was right. I was impressed. He did, by the way, get it right. Then I mentioned that I’d just gotten off of the phone with Dr. Baltasar – and the young resident was astounded. He asked if I thought Dr. Baltasar would be willing to speak with him. I said yes, I was sure he would. He said cool, he’d be back. A few minutes later he returned his partner that morning, a different young female resident. He’d given her the run-down; they’d conferred, and then decided to go to their attending to see if all three of them could get in on the conversation with Dr. Baltasar. It was a matter of minutes before I was giving them Dr. Baltasar’s phone numbers and directions on how to call to Spain. They left.

About an hour later they returned.

They all had smiles on their faces.

They all really liked Dr. Baltasar and agreed wholeheartedly with his prescribed course of action.

They also told me how fortunate I was to have a surgeon who not only knew who I was, but was so quick to offer pertinent records, impressions, experience, as well as a clearly defined course of action. They also mentioned that most surgeons that they knew – no matter where they were – would be willing to chat at such length (45 minutes) on a Sunday.

He’s a keeper, isn’t he, that Dr. B?

I smiled, nodded, and said, “Yes, that’s why I felt so privileged when he agreed to take me on as a patient.”

So, the course for the day was set. Remaining NPO (nothing by mouth). Getting in for an Upper GI study with both gastrografin and barium to determine if there was an active leak. And depending on what was found – going over the CT scans in my chart from the year prior and the one done in the ER the night before, setting a course of action. Oh, and no surgery if at all possible.

Hallelujah.

I was eventually taken to Upper GI.

Can I just ask here – how wrong is it to have it Mother’s Day, be NPO for the day, and then have to drink gastrografin and barium?! BLECH!

The good news – no leak found.

Review of CT scans found that the collection was really too small for Interventional Radiology to be needed.

They were pretty sure I’d be in the hospital a couple of days on continued IV antibiotics and fluids.

But….

I had to be in court on Tuesday!

And I was leaving for Tucson for our niece’s graduation from Medical School on Thursday!

I HAD TO GET OUT!

And I told them so!

They smiled a bit indulgently, said they didn’t think that was likely, but would see about it. In the meantime they made sure I had morphine available to me if I needed it, and would check with Dr. Zelko’s office, and get back to me on when I could start eating again.

Great.

Whiny, wasn’t I?!

So, I settled down, and tried not to fret.

Suffice it all to say that eventually it was decided that since I wasn’t getting sicker, they’d given me a couple (really very good) meals, and that I’d been getting IV antibiotics, and that they couldn’t find a leak, and that the abscess was small – too small to even drain, that they’d cut me loose. Monday afternoon I was released to home – just in time to carry through with my many plans! That was May 11th, the day I was discharged.

So did the Court date thing. Flew to glorious, warm, toasty, wonderful Tucson. Watched our beautiful niece graduate from Medical School. (We are SO proud! She’s going to be a general surgeon!) Had a fabulous time with the five nieces – as well as John’s brother and my sister-in-law. I just gotta say – I know off topic – but we rarely have the chance to do these sorts of things – take trips and spend time with distant family – and honestly, it was a balm to my soul! Did you know I’m a great-aunt? Like four times over?! They are the cutest, sweetest, most wonderful girls. Just like the five nieces. Sigh. I miss them.

Anyway, came home. Saw my PCP the day after we got back, and she said, “You know – I know you didn’t see Dr. Zelko while you were in the hospital, but he knows your gut. I want you to schedule an appointment with him and have him up to speed – on everything that’s gone on. You want him in the loop. I want him in the loop.” So I made the appointment – I would see him ten days following. About a week prior to my appointment with him I got a call from him – at home – at 6:30 pm.

He said, “Dina, Dr. Zelko. Just sitting here going over your file, and I really think we need to send you for a follow-up CT. So I scheduled you. Can you be there on Monday morning?” I told him I could, and then he went on to spend about 40 minutes with me on the phone, going over the course of events, how I was doing, etc.

Went for the follow-up CT on the Monday. On the Wednesday saw Dr. Zelko. He was happy – and optimistic. The CT showed the collection had reduced considerably – probably in half, and that the gas bubbles were gone. Hooray. So he started asking me questions. And after a moment, his eyes came to rest on my casted foot, and he looked up at me and with a dawning realization asked me, “Whatcha been taking for pain?”

“You know me,” I said, “I hate narcotics. I’ve been taking the 600 mg ibuprofen that I buy in Spain.”

“How much? Starting when?”

“Well, let’s see…. I had surgery on the ankle March 4th. Was non-weight-bearing – toes above the nose – for the first six weeks. Then I got this walking cast. So, that was April 9th when I started putting weight on the ankle. I had a walker to start with.”

“How much?”

“Hmmmm… Well… Sometimes I would take two of the 600’s. Sometimes I’d take three of the 600’s.”

“In the same day?” He asked, his eyebrows rising.

“Um, yeah. But I’ve always taken a lot of it. I hate narcotics – I hate the way they make me feel. I don’t normally take them every day, but I will admit to going through quite a bit since the ankle surgery.” I answered.

“More than 4500 mg a day?”

“Well… maybe? Let’s see – if I took 2 or 3 every 4 to 6 hours… Um. Yeah.”

“Oh Lord!” He hung his head into his hands. “You have a teeny tiny little tummy. Lots less room for things to break down and dissolve – sometimes, pills like this will rest on the bottom of your stomach, especially when you take more than one – for you – your suture line – and erode the tissue.” He got up, grabbed my chart, read the recent reports – Upper GI included. “There’s a note here on the Upper GI that says you have a huge amount of reflux going on right now – but no signs of change. Is this new?”

“Yes – it’s been awful since April.”

“When did all of this pain, fever, nausea stuff start?” He asked.

“April 24th.”

“Which actually makes total sense. You’ve got to have a micro perf somewhere – or did. And might also have an ulcer.”

So… an order was written for an endoscopy, and a referral to a gastroenterologist Dr. Zelko thought highly of was given. By Friday I was meeting the gastroenterologist – Dr. Koval – who is totally awesome and totally gets WLS – even the DS! He looked at my family history and asked if I’d consider making it a dual procedure – endoscopy and colonoscopy. I said sure, since I’d be asleep anyway. I was scheduled for June 15th.

Honestly – the prep was the worst part. I was pretty whiny about it! J I went, had the procedure – have no memory of it whatsoever – and was given the report – everything was beautiful. No perf, erosion, ulcer visualized – at all. And no colonoscopy repeat needed until I’m 55.

Huh.

Go figure.

…to be continued…

Part 1

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