More than you need to know about it, really

It wasn’t appendicitis.  My appendix was inflamed and we took it out (that’s what I do these days), but my surgeon thought it might have just been caught in the crossfire of the other issue.  Pathology later confirmed there was never any appendicitis.

It was acute small bowel volvulus: in pretty terms, when your small intestine ties itself in a bow and (as you can imagine) stops working after that.  A volvulus in and of itself is not uncommon; however, volvulvus of the small intestine (something occasionally seen in infants or young children as a birth defect) is extremely rare in adults.  So uncommon, in fact, that the studies on the issue show only a handful of cases every year, and there are only a couple studies I could find on it at all, quite frankly.

Because it’s so rare, the question of the hour is why did it happen to me?  Or, in medical terms, was this primary or secondary small bowel volvulus (i.e., did this happen on its own or did something cause this to happen)?  The obvious trigger is my hysterectomy — in fact, in the most recent study I could find, which identified 35 cases of acute small bowel volvulus in adults over a ten year span, 23 of those cases had had prior abdominal surgery.  However, in those cases, the cause of the volvulus was obvious: postoperative adhesions.

I had no adhesions.  I had no nicks, leaks, adhesions, or other obvious signs that something was amiss.  And I am pretty convinced, based on everything my surgeon had to say, that he checked thoroughly.  “Absolutely none,” he said emphatically in his quasi-German accent.

As for primary acute small bowel volvulus, because it is so rare, they have no idea what causes it.

But as I said when I thought it was appendicitis, could I be that unlucky?  The two surgeries surely have to be related in some way, even if it isn’t obvious.

Whether it was primary or secondary — and for the sake of my sanity I am assuming secondary — I will undergo a number of tests, including repeat scans, beginning in a few weeks when I have healed enough to see if we can learn anything else about why this happened.

Is it likely to occur again in the future?  Not necessarily — in the study I referenced above, three of the 35 patients had this happen more than once; however that was not explored further, and there really isn’t a reason to assume this would happen again, aside from the fact that we don’t have a reason why it occurred in the first place.

The one thing that is certain, though, is that in any case, immediate surgery is critical, and I am grateful that my CT scan showed enough junk and inflammation (even if it didn’t actually show them what was wrong) to get them to move quickly toward surgery. And as I mentioned in my previous post, the doctor on call in the ER was very firm that surgery was urgent (if only to deal with my ruptured-not ruptured appendix).

Pics in order:
1. surgery one, 1 day post-op (three total incisions inc. belly button);
2. surgery one, 3 weeks post-op;
3. surgery two, 1 week post-op, and 6.5 weeks from surgery one (one long incision, still taped, and one shorter incision exactly along my star tattoo — my surgeon was quite pleased with his creativity on that one).

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So now it’s back to recovery, though this one is much more difficult than the last.  Not all laparoscopic surgeries are alike, apparently.  I’m one week post-op and still struggle to get up and down, walk much, and move around.  I still feel shortness of breath and nausea when I first start walking, and if I sneeze or cough… well, I may as well be ripping my stitches out.  But I do feel some improvement (slowwwww improvement), and I am confident I’ll be able to go for some walks by the weekend — at least get out of the house!

I have another six weeks of restrictions (if we’re being honest, “at least 6 weeks” may be more what my surgeon said), which means, of course, no paddling, but also none of the other things I was looking forward to — like picking up the kids and swimming in the pool with them.  In April, I had planned a trip — a reward for getting through the other surgery! — to NC to paddle with the #1 female paddler in the world who is flying in from New Zealand.  It was only for a night, but I had a nice hotel room, and I was so looking forward to it.  I canceled it already — on Monday, when I was exactly 6 weeks out from my first surgery and had big exclamation marks on my calendar indicating the end of recovery.  That definitely hurt a bit.

But here we go again.  Hopefully by this time next week, my mornings will be recovery walks on the beach and sea glass in my pockets.  And maybe this time around, I won’t need winter coats and hats.

The Second Surgery

The kids had been sick for three days — fevers, stomachaches, one very random burst of vomit from Guy — so I assumed I had the stomach bug, too. I was queasy, thirsty, didn’t feel right. I fell asleep at lunchtime, picked the kids up from daycare early, and was happy to come back and rest on the couch with them that evening.  I went to bed still queasy, but otherwise fine.  Just a stomach bug.

That was a week ago.

That night, around 11, I woke up to a stabbing pain along my right side and waves of nausea that would have sent me scrambling, except that I could barely move against the painful spasms in my abdomen. The night was a long blur of moving back and forth between the bed and the bathroom, trying to find relief from the pain or the nausea (both seemed too optimistic), but neither came.  When it was time to get ready for work, I just shook my head at G, and curled back into a ball of misery.

It wasn’t long after he left that I realized something was wrong, and it might not just be a stomach bug.  The pain on my right side was becoming more acute.  If I hadn’t just had surgery, I said to my parents on the way to the emergency room, I would say it was my appendix — but surely I couldn’t be that unlucky?

The emergency room was a long, drawn-out nightmare. They had no beds available when we got there, so G (who had turned around on his way to work and met us there) and I waited in a small room — the pain for me was becoming intolerable at that point, and he was feeling helpless to do anything.  But finally, a bed opened up, and I don’t really have a good sense of time after that.  We got there early in the morning and the next actual time I remember is 8:30 pm when I was awake after surgery.

In between that was a lot of pain, a lot of nausea, and very little relief honestly.  At some point in the afternoon (mid-day? I don’t know), I had a CT scan.  It wasn’t long after that that the nurse came back into our room.  “Appendicitis,” she said.  I asked her to repeat herself.  All I heard was “another surgery.”  G said, “We should have taken that out last time.”

But the doctor came in and explained that actually they couldn’t see the appendix at all.  There was too much inflammation in that area on the scan.  There also appeared to be pockets of air.  His guess was that it had already ruptured.  At any rate, quick surgery was necessary.  He contemplated sending me to a university hospital but felt the wait would be too long, and he was also very confident in the surgeon on call (who several of the nurses said was the best surgeon they had, for what that is worth).

The issue of the serum sickness was a tricky one — obviously I haven’t yet identified what caused it last time because who knew I’d need that information less than three weeks later.  I still had all the paperwork on serum sickness from NIH and other sources printed out in my backpack, which I shared with the surgeon and the anesthesiologist.  Finally, after lots of conversation about it and a call to my GP, they agreed to switch one of the agents being used for general anesthesia, give me a strong dose of pre-op prednisone, and follow that up with antihistamines for the length of my hospital stay.  Agreeing to those terms, I finally signed the consent form for general anesthesia outside the OR and was asleep before the ink was dry.

The next thing I remember was G by my side that night.

“Did the doctor talk to you after surgery?” he asked.  “Did he tell you what it really was?”

 

A Long Break

I’ve been noticeably absent from the blog recently. It’s partly due to the plague that took me out last week and left me curled up in a ball of misery for the better part of a week. But it’s also due to summer’s uncanny ability to fill our days from sun-up to sun-down. We start our days at 4:30am with busy mornings hustling to daycare and work. At the end of the day, we sprint to get home by 6, and then we are on the clock to get things put away, cook and eat dinner, and change clothes so we can get to the pool by 7. Then we have a glorious hour of family time in the pool before it closes at 8. No one else is there in the evening – we have a private pool to swim with the kids, and it’s Nell’s favorite time of the day. Then it’s home, baths, and jammies, and we barely fall into bed before Guy’s eyes close.

So it’s been hard to keep up online. But I have a lot of photos to share, and I’ll get them up soon. And I’m very excited to share all the details of Nell’s 4th birthday party, which we held on the beach this weekend. She shared the event — pirates and mermaids — with her very best buddy, and it was a really great day.

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I may be slacking on the blog, but summer is definitely living up to its expectations. Life is good and full.

Fishing

Last weekend, we took the boat out on beautifully calm waters and let the kids do some fishing. Unfortunately we came home empty-handed and Nell announced she wanted to do some fishing with Grandpa.

And Grandpa delivered.

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Nell not only caught her first fish, but six more after that.

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Guy wanted to fish, too, but settled with throwing sticks in the water and rooting through Grandpa’s tackle box.

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It’s a pretty good life on the lake.