The verdict at present.

When I saw Dr. Zelko afternoon before last he mentioned that he wanted me to have a consult with a bariatric surgeon. If you live in my town – Portland – there are more than a few bariatric surgeons here. All, for the most part are nice enough people. Some are not. There are two major centers for bariatrics in Portland – one at OHSU, the other at Legacy.

I went through pre-ops for bariatrics with the Legacy program way back in 2001. The surgeon I was referred to is prominently known in our town- just brought in and highly touted to help spearhead the new program – and swamped with prospective patients. To sum up a long, drawn out, months-long process – suffice it to say that I left that program feeling blessed to have escaped! And then, blessed beyond compare to find Dr. Baltasar!

So – long explanation for my next statement: when Dr. Zelko said he wanted me to have a consult with a bariatric surgeon I panicked a little. I know more than just a bit about the behind the scenes stuff that goes on in the bariatric community in our town. I know medical professionals and hear what they have to say. I know pre-ops in these programs and with these surgeons and hear what they have to say. And I know post-ops and family members of these programs and these surgeons. I hear the good, the bad, and the ugly.

So I looked at Dr. Zelko and nodded and said, “Okay.” Trying hard not to look like the deer in the headlights!

“There’s a surgeon that’s been here in town a while, I want her to meet you and look over your chart and see what she thinks about all of this. I respect her opinion, and I think it would be a valuable thing. Her name is Dr. Halpin.”

Phew. Okay – not one of the ones I know so well that I wouldn’t want to see. (Sorry – just being brutally honest here!)

“Okay – sure. I’ll meet her.”

He also went on to say that he had talked to Dr. Halpin and given her a little run down of my case, and how my stomach tissue was not healing up well (where it’d been so long exposed to infection) and she had asked him, “Is she nutritionally compromised?” To which he responded, “Well, yeah… she’s been NPO more often than not and had some difficulty with eating when the abscess has been flared…” To which she responded, “Maybe getting her on more nutritionally sound footing would spur better healing.”

Okay – so I don’t know this doctor, but that was kind of an “ah ha” moment for all of us who have been here in the trenches of trying to get me well.

DUH!

Why didn’t we think of that? I mean we’ve been watching my labs and correcting the best we can, but some stuff just requires nutrition!

So he said maybe we’d start looking at the possibility of taking me NPO and putting the stomach to rest – while giving my body the nutrition it needed via either IV or feeding tube – for potentially as long as 6 or 8 weeks.

We talked about the possibility of maybe trying a re-do, or re-adjustment, or even placement of an additional stent to try and get the fistula closed. That’s a possibility in the cards, as well.

But he concluded by saying he wanted to know what Dr. Halpin thought and she’d be by to see me on Friday.

During the course of Thursday afternoon we learned that my PICC line – the blasted thing – had inched out again, and they’d have to pull it back to midline. And… of course… since TPN was seriously being bantied about, it would be imperative that I have a new PICC line. Did you know that I’m getting a bit of a reputation at this hospital – me and my PICC lines? Yeah, well suffice it to say that Betsy the wonderful and incredibly sweet IV nurse came and had the duty to give me my new PICC line and it wasn’t a walk in the park for anyone involved. We’re hoping this one holds on for a LONG time.

That evening I devoted quite a bit of time to getting online and trying to find out what I could about Dr. Halpin – looking for her CV and reading comments her past and present patients have made regarding their encounters with her. I was able to also get some input from some medical professionals who have had the opportunity to interact with her some. It was all pretty basic, positive stuff.

I was up bright and early Friday morning and nearly first thing one of Dr. Halpin’s residents came by to examine me and talk about the course of events I’ve been through. She was a very nice young doctor and I enjoyed getting to talk to her – I was impressed with her understanding of the nuances of the DS versus the other forms of bariatric surgeries. She said she’d be back later with Dr. Halpin and we’d talk further.

It was mid-morning by the time Dr. Halpin came by. She is very nice. Nice smile, firm handshake. She sat down and asked me to tell her about my history as a bariatric patient. I did. I told her the whole thing. She wanted specifics. When was the revision – November 10, 2008. How’d you recover? Perfectly – it was lap, no problems, pretty much a non-event. Ankle reconstruction when? March 2009, 6 weeks of non-weight bearing, toes above the nose. Then when I did start weight bearing – started taking ibuprofen – too much ibuprofen. How much? I told her. She winced. When did the abscess pain start? April 24, 2009 – probably about noon that day. And then I gave her the whole progression of the saga – oral antibiotics, got better for a little while, flared when I was in Denver with William at the end of April, got worse after I got back, went to the ER at St. V’s Mother’s Day weekend and that’s when they found the free air and collection that were the abscess at that point in time. Was hospitalized that weekend with IV antibiotics. Felt better, seemed to be okay for a while. By June it was flaring again – upper left quadrant abdominal pain, referred shoulder pain, fever – the same old set of symptoms. Then the referral to see Dr. Zelko, the endoscopy and colonoscopy with Dr. Koval, and then another round of oral antibiotics – which helped, again, for a little while. Which brought us up to July when I had my first hospitalization here at Good Sam. We covered it all, pretty much.

We talked about options, but she felt pretty certain that the primary concern at the moment was getting me nutritionally not just better – but SOUND, and putting my stomach to rest. We talked about the pros and cons of IV versus feeding tube. After feeling my gut and realizing how complex it was – she agreed with Dr. Zelko that IV was the way to go. She agreed that rushing right into any kind of open surgery was not an immediate need or answer – and felt optimistic that a positive outcome would ensue.

We ended up talking a bit about bariatrics in general. She mentioned she’d been at the conference in Madrid in December when Dr. Baltasar did a live surgery and presentation. Funny – I’d just left there! All in all, she was pleased to see where I started as a bariatric post-op, chalked the current issue up to inappropriate use of NSAIDs, and felt that it wouldn’t be an easy fix, but the right direction to take nonetheless.

She spent quite a bit of time sitting and talking and comparing notes. It was a very positive experience.

I wouldn’t mind having some more time to sit with her and ask her about her motivation for being in bariatrics, etc., but maybe some other time.

Suffice it to say I then had the heads up that 6 weeks of NPO was a very real potential. In the meantime my lunch of cream of tomato soup arrived, and I sipped on my apple juice. No one had written orders to take me NPO at that point in time, so I was to continue on as before until told otherwise.

It was about 7pm before Dr. Zelko made his way to my hospital room and collapsed in a chair. Poor guy – he’d had a crazy day with lots and lots of surgery in it. We talked about my impressions of having met Dr. Halpin, her proposed course of action, etc. I told him that I’m ready, willing, and able to go NPO for 6 weeks if that’s going to help get me better.

We talked about the possibility of a round two with the stent – to either add another one, or reposition this one or something to that effect. That would happen early on in the coming week if it were to happen – he was going to contact Dr. Swanstrom and ask what he thought.

I mentioned that Dr. Baltasar had forwarded to me five different papers he’d published over the past several years regarding these kinds of situations and asked if he wanted them. He said he most certainly did, and asked me to forward them on to Dr. Swanstrom as well. So I did.

And then he said that it was quite possible that I would be going home on TPN in the coming week. Maybe by mid-week. We’d see.

So here’s the calendar. I’m officially NPO for the whole day starting today, Saturday, September 19, 2009. That’s pretty much the rest of this month and all of the next.

September

M

T

W

T

F

S

S

 

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

       

 

OCTOBER

M

T

W

T

F

S

S

     

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

 

 

November

M

T

W

T

F

S

S

           

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

           

 

Frankly, I’m okay with it. I know others who have had to do it. I know from my last little stint on TPN that the hungry factor is brief and passing, and then you pretty much just don’t care.

So – last night – what did I dream about?

Food.

Go figure. LOL!

I may end up having to make a list of all of the foods I want to eat – and in what order, when I get the go ahead to start again! J

Advertisements

6 Comments Add yours

  1. Maureen says:

    ((((( Dina )))))
    How well I remember being NPO for the first 3 months of my DS journey and countless times over the last 4 years. You’re so right that it doesn’t take long at all to just get over it and the hunger goes away. Oddly enough I got tremendous satisfaction from watch the Food Network channel !!! I learned a lot about cooking and now fancy myself as a pretty darn good cook…lol

    Anyhow darlin’……and so it goes…..if this is going to do the trick then so be it. It does sound pretty logical to let your tummy sleep for awhile. I just hope this is going to do it for you.

    I sure do hope you get “out” next week. Let me know when you feel up to a phone call.

    Much love,
    Maureen

    1. dinamcb says:

      Maureen, you’ve been through so much sweetheart! Gosh girlfriend – I’ve really been praying that this is the start of a season of healing and restoration for both of us!

      Big hug, friend!

      dina

  2. Monica says:

    I’m praying it all works out for you. NPO for months isn’t fun (I did it with a feeding tube), but like you wrote, you get used to it.

    Wishing you the best, always 🙂

    1. dinamcb says:

      Thanks so much Monica! I’m always so thankful to hear from vetereans that they’ve ben there, done that, and are healthier on the other side for having done it. Your input is so appreciated, and your prayers a blessing to my heart!

  3. YDSH says:

    I have decided! We are going to Dave’s for our anniversary,

    1. dinamcb says:

      I’m totally holding you to that, mister! 🙂

      Wow – this will be 16 years in November, won’t it? We better start planning what we’re gonna order at Dave’s soon! I want to do it in style!

      Love,

      YDSLW

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s