Every once in a while, I play the What If? game with myself, with the primary question being: What if I didn’t have weight loss surgery?
I do know that I have no way of predicting alternative choices or the future, but I know that if I continued on the path I was on, weighing over 300 lbs (and less than 25 lbs from weighing 350 lbs), I was facing the following:
- Fluid retention and cellulitis
- Heart issues
All of the above mentioned run in my family, and affected both my grandmother and mother, who was/is morbidly obese. And all of the above conditions can be brought on by, or further aggravated by, morbid obesity.
This last surgery knocked me for a loop. Mostly, I think, because there was no warning. In 2010, I knew my gallbladder was causing problems, and I knew it had to come out. In November of 2011, and January of 2012, I knew there was a twist somewhere in my small intestines (known as candy cane syndrome), and that the troublesome part of the scarred intestine had to be removed in order to prevent total strangulation.
But this surgery? Out of left field. I went to bed last Sunday night thinking my biggest problem was propping myself up on two pillows so I could breathe better, since the pneumonia was bad enough to cause breathing issues. And three hours later I woke up to some of the worst pain in my life, three hours after that I was told I had to have emergency surgery (with “or else you’ll die” being said between the lines), and three hours after that I was in surgery.
The trauma and shock of having an ulcer I didn’t know the existence of blow a hole in my small intestine (the part connected to the bottom of my stomach pouch) and allow gastric contents to leak into my abdominal cavity and slowly poison me has been a little much, I think. I’ll be honest with you: I have cried a lot over the past week, and not all of those tears have been shed because of the pain.
I am currently five days post-op from an emergency abdominal surgery (laparoscopic, thank god) for a perforated small intestine, due to an ulcer — an ulcer that I didn’t know I had — that exploded open, allowing the contents of my stomach pouch (nothing other than about an ounce of water and whatever acids may have been in there, thank goodness; I had been sick with pneumonia since the 13th and wasn’t eating much) and air to leak into my abdomen.
This happened very early Monday morning, around 3am. What I remember the most is getting out of bed, and other than feeling miserable from the pneumonia (chest tightness, frequent coughing, fever, alternating hot flashes & chills), I felt “okay” (I’d later find out that the sudden increase in my fever on Sunday, accompanied with the hot flashes and chills were most likely due to the bowel perforation). I went to the bathroom, and after using the toilet I took a very small sip of water from one of those 2oz Dixie cups – my intent was to “wet my whistle” before going into the kitchen for a bit of cheese or Greek yogurt (to pump up my pneumonia-induced protein deficit).
Immediately after taking that tiny sip of water the pain literally exploded in my abdomen, mostly centered, but a little to the left. If I hadn’t been sitting I would have fallen. In the time it took me to make my way back to the bedroom — I was in denial that something could be SO SERIOUSLY WRONG OUT OF NOWHERE — intense pain set in right on and in front of my left shoulder (I’d later find out that this is called “referred pain”, and is common with many urgent/emergency abdominal issues, including bowel perforations).
I spent about an hour in bed, trying to get comfortable — moving as little as possible, breathing deeply, adjusting my left arm to try and make my shoulder more comfortable, wishing and praying and begging for the pain to go away. But it didn’t. Shortly before 4am, I sat up and twisted a little to the right to try and alleviate the pain, and it immediately intensified by at least tenfold. Cue straight-from-a-movie-scene: me screaming and hyperventilating and yelling at Dan (my husband) to wake up and call and ambulance, him flying out of bed and asking repeatedly what was wrong as he scrambled to get his phone and dial 9-1-1.
A half hour later I was in the hospital’s emergency room, not very comforted by the EMTs’ suggestion of a pulled muscle from all of the coughing. My best friend Jason met me there (Dan stayed home with our children), and after pain medication (Dilaudid) was administered, I was taken for x-rays and a CT scan. Once back in my ER room I begged for more pain medication, but after the doctor came in with the results of the tests I didn’t have to beg — it was administered freely to keep me as comfortable as possible.
Results: perforated bowel (small intestine), just below my stomach pouch.
Time kind of blurs at this point, but I believe it was shortly before 7am that I was given this news, because I have timestamped messages on my phone where I texted my husband and my other best friend, Amanda, to let them know what was happening.
Because the bariatric surgeon at this hospital wasn’t familiar with my particular post-op “setup”, he told me he wouldn’t feel comfortable operating on me unless absolutely necessary, and asked if I would be willing to be transferred to my bariatric surgeon’s hospital, where she or one of her partners would operate. I agreed.
Shortly after 8am I was in an ambulance, the second one in four hours.
At 9am we arrived at my bariatric surgeon’s hospital.
A few minutes later Jason arrived, followed by Dan and our children. I hugged them all and told them I loved them.
I was left alone while the OR got ready. I remember lapsing in and out of consciousness, vomiting onto my hospital blanket, and experiencing pain. So much pain.
At 11:30am, or a little before — I don’t really remember the time — I was wheeled in the OR, where my bariatric surgeon was waiting for me.
And here I am, five days post-op, miserable but recovering, still trying to deal with the primary emotion of FEAR that was so prevalent on Monday morning, up until they blessedly put me under general anesthesia, opened me up, and fixed me.
My bariatric surgeon said that I had an thumbnail-sized ulcer that perforated. She was able to easily remove that small portion of damaged intestine, reconnect my stomach pouch to my small intestine, and flush out my abdominal cavity.
I had a four day hospital stay that involved ’round-the-clock IVs (yes, multiple): fluids, three different antibiotics to combat both any possible infection from the perforated bowel as well as my pneumonia (the x-ray and CT scan also revealed that my pneumonia had gotten much worse, with my right lung nearly useless and on the verge of collapsing from all of the fluid and infection).
Over and over nurses and doctors asked if I had any symptoms: nausea or other digestive upset, discomfort, twinges of pain, anything. I had nothing. I had no idea anything was wrong until I took that tiny sip of water on Monday morning, and all hell broke loose inside my body.
I thought I was dying. And to have my fears confirmed, that I would have died without treatment, that the surgery was indeed an emergency and needed as soon as possible to save my life…it has been a lot to deal with. In addition to crying from the misery of recovery from surgery, I’ve cried from the fear and absorption of that fear and how very serious things were.
My bariatric surgeon thinks it was the “perfect storm” of events that brought on the ulcer: a lot of financial stress over the past year; family stress; getting careless and taking NSAIDs here and there, some caffeine pills (I don’t drink coffee), and especially from, per my surgeon’s experience, the caffeinated protein powder I have been using over the past couple of weeks. It was a fluke… these things don’t just happen frequently, or even often. In fact, only 5% of bariatric patients developer an ulcer, and the percentage of those patients that wind up in an operate-or-die situation from an ulcer is even smaller.
Fortunately, preventing this from happening ever again should not be too difficult, because I don’t drink soda, tea, or coffee, which all irritate stomach pouches, and stomachs in general, particularly those susceptible to ulcers. I will never consume caffeine in ANY form, except the occasional bit of chocolate, again. No more NSAIDS, ever, no matter how bad my headache or cramps. And while I do pretty good with laying low on spicy or other stomach/ulcer-irritating stuff except for occasionally, I’m going to cut back even more.
Also, my surgeon prescribed Protonix, an acid reducer. I’m currently taking it twice per day for three weeks, but when I see her for my follow-up, I’m going to request indefinite — or as many as she can give me — prescriptions for it, or something similar that perhaps isn’t so strong. Or, I’ll do as she suggested and purchase OTC acid reducers and take twice the recommended dosage.
Post-op care: I’m on a two week course of two different antibiotics, a three week course of Protonix, and I have liquid pain medication as well as anti-nausea medication to take as needed. My surgeon also prescribed Ativan for me to take as-needed to keep my stress levels down. Food-wise, I’m slowly working my way up from nothing at all Monday and Tuesday, to soup broth, to protein shakes, and as of today, a little bit of soup, a few spoonfuls of cream cheese, and three very-well-chewed pieces of tender chicken breast. I’m going slow because of the “trauma”, and because my pouch has no doubt tightened up from the surgery, and from my lack of appetite before surgery due to being sick. On the pneumonia-front, I am feeling a million times better: aside from a minor lingering cough, I’m pretty much back to “normal” (knock on wood).
So, that has been my weak…pain-filled, fear-filled, and miserable.
What can you take away from this? Follow all post-op dietary guidelines to the letter. No caffeine, no carbonated beverages, no NSAIDs; and if you’re prone to digestive issues such as heartburn or ulcers, lay low on spicy, fried, and fatty foods, too.
So this is what happens when you shop at a discount grocery store, and find two 12-pack cases of Greek yogurt for $3.00 apiece:
Needless to say, I shoved both of those suckers in my cart, dragged them home and Tetrised them into my refrigerator. I’m not a fan of the taste of Greek yogurt, but the flavored options are palatable, and I like how the fruit is separate from the yogurt (in Fage’s case, the fruit portion is in an entirely separate compartment!), since I can add just enough for flavor, but not enough to dump on. And hey, to a post-op gastric bypass patient, cheap Greek yogurt (Greek = even higher in protein than standard yogurt) is where it’s at.
Needless to say, I will be eating a LOT of yogurt in the coming days, especially since these particular yogurts were so cheap due to their up and coming expiration dates.
For me, when I get the hiccups, it’s usually after I’ve eaten the last bite of food that has made me feel full. If I feel any sense of fullness, it means I should stop now, because my stomach pouch is nearing capacity, and there’s no point in pushing things — that’s how I wound up in need of weight loss surgery to begin with. Plus, while I know some post-ops are able to stretch out their stomach pouches by over-eating, or deal with pushing things because their stomach pouch will eventually let things pass through to digest, that is not the case for me. My stomach pouch is a stubborn bitch, much like me. If I eat too much, there’s no “waiting for the fullness to pass”. It’s more like, “Wait as long as you want, stupid, but you will throw it up eventually.”
I hardly ever get the hiccups, and when I do, it’s almost always when I’ve had something “dense”, such as soup, or my homemade sour-cream-packed pancakes. In any case, as I’ve learned through experience, when I get the hiccups, it means put the fork or spoon down, because even just one more bite means throwing up.
Whenever I speak to anyone about life as a post-op, the first thing I tell them is, “Get used to drinking protein shakes every day for the rest of your life”. The second thing I tell them is, “Get used to taking vitamins every day for the rest of your life”. And the third thing? “Get used to vomiting”.
Vomiting is gross. But for post-ops, it’s not as gross, because the new stomach pouch created by the surgery produces little to no stomach acids. So, food tastes exactly the same coming up as it did going down. And since you’re eating very small amounts, and chewing the crap out of meats and vegetables in order to minimize the risk of what I call Pouch Rejection, not only does the food not taste any different, but it also comes up pretty easily (unless it’s ground beef — in which case, be prepared to throw up what feels like ground up gritty stones).
Why do post-ops vomit? Here are the most common reasons:
- Eating too much
- Eating too fast
- Not chewing food well enough (creating what I call Stuckage, which leads to Pouch Rejection)
- Drinking while eating
- For no reason at all
For me, after the first couple of months of a slight learning curve where I quickly learned what was compatible and what wasn’t (sometimes: chicken; quite often: beef; almost always: steak, unless it’s filet mignon and even then, chewed to smithereens), For No Reason At All is the most common reason why I throw up. It’s annoying, because what works some days might not work other days…just because. There’s an official term for this, by the way: Esophageal and Gastric Motility Disorder. In laymen’s terms, it means that your esophagus and/or stomach pouch get stupid sometimes and forget that food is supposed to go down, and not up. I had a big problem with this the first couple of months after surgery, and went through a couple of tests (including an endoscopy) to rule out anything else other than the upper portion of my digestive tract being idiotic.
With all that said, when, and yes I say WHEN, you feel the urge to vomit, it’ll be a purely physical urge, with no accompanying nausea. Don’t wait it out hoping it will go away: just vomit it up and be done with it. I promise, you’ll feel a million times better afterward.
The abdominal pain is back. Just five weeks shy of a year after my last abdominal surgery (bowel resection), and it returned. It was on Friday, December 21st, and I was at a smorgasboard (I know, I know – the irony of a gastric bypass person at a buffet. It doesn’t escape me, either.) with Dan (husband), Alyssa and Ryan (our children), our friend Jason, and two of his friends. I may have eaten a few bites too many, but not enough to cause me to vomit, which is what will almost always happen if I overeat. But still, it shouldn’t have caused the abdominal pain that it did.
But still, I brushed it off. It was the week before Christmas, so things were hectic, I hadn’t reached my daily protein goals for nearly a week, and hadn’t I had a couple of bites of roughage vegetables?
It’s now two weeks and a day since that night, and I hate to admit it, but I will: abdominal pain has been a near daily occurrence since the 21st. On a pain scale of 1-10 the worst was the night when it was an 8 – I had abdominal pain originating from a source near or on a shared nerve, because my back hurt, too. It took two Tylenol PMs, a swig of Nyquil, and a pain pill to finally knock me out. Every other instance has been somewhere between a 4 and a 7.
I mentioned the pain in passing to Dan, but since there’s nothing he can do, and we’ve been down this road before (resulting in two surgeries), and we’ve got other things to worry about, and HE has to deal with his share of physical pain because of his Fibromyalgia, not to mention it’ll be another couple of weeks, if not a month or so, until I have health insurance again… well, I haven’t really talked about it. Or brought attention to it. I drag myself through it, and for the most part, suffer silently.
Tonight it hit again, shortly before dinner. That was close to an hour ago, and thank god it went away, but the toll its almost daily presence is taking on me must finally be noticeable, because Dan said to me, “I’m worried. Why haven’t you told me?” And my answer, which is the truth: I don’t want to worry you.
And also: I don’t want to focus on or become preoccupied by something that I cannot currently address with anything other than hope, pain medication when it gets beyond tolerable, and sheer willpower to function despite of it.
2012 was a crazy, busy year, but I did excellent with taking my vitamins every day, and for the most part I did great with taking in at least 60g of protein each day. I reached my goal weight of 160 lbs last fall, and I’m hovering now in the high 150s – but I’d really like to get to 150. And so, my official bariatric/health goal of 2013 is:
Get down to 150 lbs
Protein goes hand-in-hand with that goal, because if post-ops don’t consume enough protein, then any calories consumed are stubbornly held onto. Also, protein is vital for muscle support/development, as well as energy.
So, my secondary official bariatric/health goal of 2013 is:
Consume at least 75g of protein per day
The protein powder I use most often (Target brand, whey isolate, chocolate-flavored) has 25g of protein per scoop. Three shakes per day accomplishes my protein goal easily enough, and hopefully maintaining a higher level of protein consumption will help me in shedding these last few pounds (8, as of today).