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?”

 

Thanksgiving Week Part I

I feel like I have lived three lives in the past week and a half, and we’re just digging out of the hole and getting caught up on life and work. A week ago last Friday (the Friday before Thanksgiving), we got the call from daycare that Guy was in rough shape.  He had been sobbing in a corner for most of the morning and refused to play, even when the kiddos went outside.  I picked him up before his naptime and took him home.  We suspected he had a back injury — he had taken a bad fall the day before, and he was clutching his back and saying ouchie.  As if to prove us right, a large bruise emerged around his tailbone and butt that day.

On Saturday, he seemed completely fine, and we thought everything had passed, but when he woke up on Sunday morning, his breathing was shallow and strained, and he was having difficulty swallowing.  By the time we got him to the ER, he had a fever of 102, and the bottom of his lungs had collapsed from the difficulty breathing.

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We don’t know the full extent of what he actually had — not all of the blood cultures came back before we were discharged — but the biggest issue was pneumonia.  (Having only dealt with pneumonia in the upper lobes of the lungs before, I didn’t realize that holding his lower back could be an indication of pneumonia in his lower back.)  By about dinnertime on Sunday, after X-rays, meds, and several bags of fluids, we were informed we would be moving upstairs for the night.  I had brought a packed bag with me — this wasn’t my first pneumonia rodeo.

By the next day, Guy was markedly better — motrin, antibiotics, and so many fluids that I could barely keep up with diaper changes, had him looking much more like himself.  (Except for the bed head.)

Singing Let it Go. We literally watched Frozen on a nonstop loop for our entire stay at the hospital. OMG.

20151123_082945 20151123_082952I really thought we were going to go home the next day, so I was honestly surprised when they informed me that because they suspected the pneumonia had been bacterial, Guy was required to get at least 72 hours of IV antibiotics before he could be discharged and switch to oral meds.

I wanted to cry.

But we made it, and we made it home before Thanksgiving — though not before he discovered how to stuff his diaper with cheerios, con the nurses out of cookies, and activate every button and alarm in his room.  (Did you know that if you turn off the electronic controls on the beds, the call button to the nurse still works all night long?  Serious shortfall in the system if you’re dealing with an antsy 2 year old.)

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The good news is that by the time we left, Guy was significantly better, and by the time he went back to school after the holidays, he had been on meds for more than a week and was probably the healthiest kid there.

I mean, look at this: like a Greek cookie god.

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Whoa.

I Know. It’s been a really, really long time.

It’s all a bit hazy, but here’s what I remember since the last time I posted (enhanced by cell phone pics from K)…

Last Friday, K arrived for the weekend — our very first guest house guest!  She stopped by Nellie’s school early and picked her up for an afternoon of girl bonding.

On Saturday night, we went out to a Japanese steak house to celebrate the big Three One.  I am not ashamed that a Japanese steak house was also my choice for my 13th birthday.  Hey, you like what you like.

It was Nellie’s first time around a hibachi grill, and she was fairly unimpressed.  She slept through the appetizers, and then showed off her tutu on the way out.

Shortly thereafter (and I mean within HOURS), a norovirus from Sydney attacked me.  And won, handedly.  After about ten hours of thinking the end [of the world] was near, G finally took me to the hospital (happy birthday to meeee).

K was kind enough to dress Nellie in purple (since it was Super Bowl Sunday) for their trip to Starbucks and subsequent playtime.

I actually never put my jersey on on Sunday, which is very sad, though the open-back hospital gown was–I am sure–equally awesome.

I was discharged in the afternoon shortly before the Super Bowl started, though I think it’s fair to say that I was far less excited than I should have been.  And instead of stuffed jalapenos and monster nachos and beer, we served chicken soup for the big game.

I’d like to say that was the end of it, but shortly into the second quarter it became clear that the norovirus had spotted G from across the room and was making a move.  G went down Sunday night.  And on Monday, as she drove away from us as quickly as possible, the norovirus ran after Kristin, and caught her somewhere north of here.

We’re slowly rejoining the world (and not stopping at Smoothie King for dinners anymore).  The blog is back, I promise — and I’ve got some terrific new house pics to post this weekend.  Happy Friday!

Down.

I tried to post several times in the very brief pockets of time I’ve had over the past week.  But each time, something else won out–usually I decided to lie face-down on Nellie’s nursery rug and pretend like the world didn’t exist.

You see, I’m sick.

And not just a little sick.

MEGA SICK.

The whole week when Nellie was Mega Sick, I kept thinking to myself, If only I could be sick instead of her, and she could be healthy.  And I don’t want to say takesies-backsies, but…

…if K weren’t here to help out, I think I would have left Nellie to the care of the puppies.

I mean, not really.

Did I mention MEGA SICK?

And I’m hoping this weekend is going to be a turnaround for me, and our house will be healthy once again.  Because we’ve been under a dark plague cloud for about three weeks now, and I’m sick of it! <–Punny

Here are some pictures of Nellie from the other weekend, drinking from a big girl cup when we went out to dinner.  Now she wants to drink from our cups constantly.  (Well, she also likes to make little fists and stick them in my cups and then lick the water off her hands, so she’s not “totally” grown-up.)

It probably doesn’t need to be mentioned, but I think this is how germs spread.