Interesting

I have noticed some interesting things since my surgical ERCP.  I was always kinda disappointed after my  gastric bypass that I was an inconsistent dumper at best.  I did this surgery this way because I wanted those very specific rules to help me eat right.  The inconsistency allowed me to test the waters which was always a little scary.

But since the surgical ERCP - I dump like a truck.  The littlest bit of sugar and I am miserable ... for hours!  I talked to my bariatric surgeon about it when I had my follow up appointment with him earlier this week.  He said it kind of made sense because now that they opened up the sphincter of oddi the bile, etc... is making it to the intestines much better - that would be assisting in the dumping syndrome.

Also, since the surgical ERCP my weight loss has kicked back in.  I have been quite steady for at least 8 months.  Now I am losing weight again.  I am down to a weight my scale has never seen and only 6 pounds from my goal weight!  I am more motivated than ever!  Especially since I am very limited in whatever exercise I can do because of my foot.  If I can't exercise I need to pay closer attention to what I'm eating.

Catching Up

Whew!  It's been a crazy couple of weeks.  I'm sorry I haven't posted.  Recovering from the surgical ERCP took way more out of me than I anticipated.  The hematoma that developed at one of the incision sites is still giving me a bit of grief.  I am getting it checked out tomorrow.  And last week we took a much needed family vacation to Orlando, FL.  So I am just now getting back into the swing of things.

I am feeling so much better.  I have felt like crap all summer long and I am finally feeling "right" again.  It is re-assuring to know that I wasn't losing my mind - something was wrong with me.  I'm hoping that this ERCP really fixes things and I don't have this problem again.  At least not for a while - I'm so done with hospitals right now.

Vacation was incredible.  I haven't had a vacation like that in years.  None of us wanted to leave at the end.  Usually by the end of vacation I'm ready to get back to the real world and I'm sick of all the people I'm with (yeah - you know who you are wink wink).  :)  I don't know if it's just the timing of the vacation after all the crap I've been through this summer, or if I maybe imbibed a little too much of the happy pills or pain killers and was just really enjoying myself, or what, but this vacation was simply heavenly.  We did go to Disney, but I think that even if we had not done that we still would have enjoyed ourselves immensely.  Everyone just had a really great time. 

Not everything went perfectly while we were there, but it was all good.  I had planned a surprise for the kids that would make me the coolest mom ever.  I got them tickets to a Jonas Brothers concert.  Unfortunately, there were flash floods in the area and they flooded the amphitheater the concert was at and the concert got cancelled.  So I'll have to find something else to make me the cool mom, I guess.

And as if on cue, when we got back - I could not walk without a lot of pain in my right foot.  Apparently, practically being in bed all summer is not conducive to then getting up and walking for 2 days through Disney, and I now have a stress fracture in that foot.  I think I may have officially kissed my chances of doing the Myrtle Beach Mini Marathon this year goodbye.  Whoever has the voodoo doll of me - seriously - I think I've paid my dues.  Whatever I did to you - I'm sorry - please stop.

Going Home

I have finally been cleared to go home!  Yeah!  I've been here for a week and I'm so ready to go home and sleep in my own bed and take a shower.

The pancreatitis pain is much better - the only pain I'm dealing with right now is a hematoma that has developed at one of my incisions.  The doctors are hoping that it will re-absorb on it's own - but it will take a while and until then it's pretty painful.

Thanks to everyone for your kind words and prayers through all of this.

Still Here

OK - going on day 7 at the hospital.  My pancreatitis that flared up after the operation seems to have calmed down a bit and my lypase levels are back in the normal range.  I was also put on clear liquids this morning.  Who knew chicken broth could taste so good.

I have also developed a large hematoma at one of the incision sites.  It hurts like the dickens and is very tender to the touch.  Right now they are just watching it and hoping that my body reabsorbs it. 

Other than that I'm finally starting to feel better - I even went for a little walk around the floor today.  Let's hope I'm moving in the right direction.

Let's hope this works

OK - so I had a laparoscopic transgastric approach endoscopic retrograde cholangiopancreatography with sphincterotomy yesterday.  Apparently my Sphincter of Oddi was very narrow - about the size of a pin head.  When the surgeon went in and cut it open he said that the bile and sludge really started to flow.  So he feels the surgery was a success and he said he has a 99% success rate with this procedure.  While I'm not at all happy that I had one more thing go wrong this year, I am at least relieved that we have found a reason for it, and everyone feels that I will stop having bouts of pancreatitis now and will start to feel much better.

Unfortunately, one of the side effects of the procedure I had done is that I actually have another bout of pancreatitis.  This is because they were in there messing with it.  It's not as bad as my past bouts by any means - but it means that I will be here in the hospital through the rest of the weekend as pancreatitis is nothing to mess with.

I also just started itching really bad all over.  We think it is a reaction to the morphine I had in the OR.  All I know is I'm about to scratch my ever lovin' skin right off.  EVERYTHING itches.  And I am quite sore from the surgery - it was laparoscopic so that helps - but it appears as though they bruised one of my ribs with one of the trocars.  All the extra skin makes things difficult and there was a lot of tugging and pulling.

So I have been here in the hospital for 6 days - will be here for 7 or 8 at this point.  It's kinda lonely.  I miss my family and my bed.

Stir Crazy

OK - so it's been 5 days in the hospital.  I'm going a little stir crazy here.

That's all.

Thanks for listening.

Plan of Attack ... Finally

After being in the hospital for 4 days I have finally met with the right doctors and we have a plan of attack.  I won't go into all of the details around the cluster that has been my life in the hospital.  Major mass confusion on my condition and the resulting communication around it was a nightmare.  The important thing is this:

The MRCP that was done did not show any stones in the bile ducts - it showed enlarged ducts - not uncommon after the gallbladder has been removed.  But my blood work shows that when I have these attacks not only do my pancreatic enzymes elevate - so do my liver enzymes.  This is evidence that whatever is going on is affecting my liver - almost like things are backing up there.  So while the MRCP is not really showing anything definitive - the bloodwork is indicating that there is a problem. 

So the next step would be an ERCP which is an endoscopic procedure (a camera down the throat) that would allow the doctor to visualize the ducts and do a sphincterectomy to relax that muscle.  As I previously stated that is difficult after you have had gastric bypass surgery.  So instead of it being endoscopic - it will now be done laparoscopically and surgically.  They are looking to specifically go in and make a cut in the Sphincter of Oddi to allow that muscle to stop acting like a dam.

All of this will be done tomorrow afternoon whenever the GI Surgeon and Dr. Enochs can coordinate their schedules in the operating room together.

Seems pretty straightforward doesn't it?  I have been in the hospital since Monday afternoon and just today at lunch was allowed clear liquids.  I have to now stop because of the procedure I'm having tomorrow.  This has been absolutely crazy.  I'm really ready to be done with doctors and hospitals and being poked and proded.  I'm ready to be done with all the pain I have had.  I don't get bored easily.  But I have been BORED being here the past 4 days.  It looks like I will be here until at least Saturday now.  Today I was told I was the most sane person on the floor - this after I unleashed the Wrath of Pam in order to get SOMEONE - ANYONE to tell me what the heck is going on.  That can't be good!  :)

Was it worth it?

So I have been asked twice today if I think that my gastric bypass was worth it in light of the rare complications I have suffered in the past year that seem to be connected to my altered anatomy.

My answer ... YES!  115 pounds does not come off this quickly without some ramifications.  But they are gone and I am so much better in every way because of it.

The saga continues

Since I have been home from the hospital last week I have continued to deal with twinges of pain and a headache that won't quit.  I have not felt "right".  I followed up with my PCP (the most wonderful Dr. Josh Bloom) as well as with my GI Doc (the equally wonderful Dr. Hutzenbuhler).  Dr. Bloom was stumped and felt I needed to give my body a break from all the "noise" and just rest.  He felt that the physiological and psychological stresses that I have been under were causing my body to just cry UNCLE.  I couldn't agree more.

Then I went to see Dr. Hutz.  She said I was presenting with classic symptoms of having a stone stuck somewhere - like in my common bile duct or pancreatic duct (remember that I haven't had a gallbladder since 06).  We decided to follow up with an MRCP - which is basically an MRI of that area.  She said there were some problems - one is they wouldn't find a stone - which could also mean that I'm getting them and passing them but the act of passing them is painful.  Two is they would find a stone.  Normally you would then need an ERCP.  An ERCP is like an upper endoscopy - they just go down further past the stomach - and use the instruments in the endoscope to perform manometry on the Sphincter of Oddi (doesn't that sound like a bad word?).  It's actually a pretty simple procedure - in and out.  Problem is - not for someone who has had gastric bypass surgery - visualizing the SOD, etc... is very difficult.

I saw Dr. Hutz Monday morning and on Monday afternoon I started in with the pain again.  At work again.  This time it was accompanied by pretty bad vomitting.  I called Dr. Hutz and she sent me to the ER.  Have I mentioned I hate the ER?  I was there in extreme pain for over 6 hours before I was seen by a doctor.  I hate the ER!  By then I was so dehydrated they had a heck of a time getting an IV started - 6 times they tried!  They finally had to use doppler to find a good vein - even then they had a hard time threading the catheter.

I was admitted again.  My blood work was fine, but I was still having pain despite the good pain meds and obviously something is going on here.  So I was made comfortable for the evening and this morning an MRCP was performed.  The MRCP did not show any stones, but did show that the ducts and sphincter were dilated and inflamed.  So this fed the idea that I could be getting stones (or small stones) and passing them - causing these "attacks" - or I had some sludge build up at the SOD and it was acting kind of like a dam.  Dr. Hutz consulted with some other GI surgeons about how an ERCP could be done on a gastric bypass patient.  A former partner of hers does have some experience with this and consults with my bairatric surgeon (the incomparable Dr. Enochs) on a regular basis for them.  Dr. Enochs actually goes to the OR with them and helps them to visualize what they need to do the sphincterectomy.

So that is the plan - to have a sphincterectomy done here in fairly short order.  I don't have too many other details than that, but I am encouraged that I'm not just being told "We don't know what's wrong with you."  Pissy Pam takes up residence here at Rex when you tell her you don't know why she's in pain or when it will stop or get better.  :)

So the sag continues and I will update everyone on what is found and done next.  Thank you to everyone who has been praying for me - it means a lot to me and is very helpful.

Where do I go from here?

So I spent 3 days as a guest of Rex Hospital for my bout with Pancreatitis.  The only thing we learned while I was there was that no one knows why I had the Pancreatitis. I don't have a gallbladder anymore and the ultrasound they performed did not show any left over stones or sludge in the bile ducts.  The other common cause of Pancreatitis is alcohol - I don't drink enough to cause that - I may have one drink a week at this point.  The other thing that was discovered during my stay at Rex was that the surface of my liver is rough and uneven - it should be smooth.  So I was tested for several liver diseases.  None of them came back as positive.  So that begs the question - why is my liver like that (supposedly scarred - almost like cirhosis)?  Did the problem with my liver cause the pancreatitis? 

And more importantly ... What the hell?  I mean seriously?  Who has all this stuff happen to them in such a short amount of time and it's not connected somehow?  Everyone I talk to says that it can't be connected to the kidney tumor.  Fine.  But I had an attack like this just in May - so it can't be idiopathic - it must somehow be connected to SOMETHING else I have going on.  The gastric bypass surgery?  My malabsorption due to the gastric bypass?  The abdominal CT scan and the upper endoscopy I had showed nothing out of the ordinary there.  And let's not forget that the day before all this happened I had my wisdom tooth removed.  I was put on percocet (nothing new there) and amoxicillin for that.  I feel like my body is attacking itself.  So either someone seriously has a voo doo doll of me and is having a lot of fun with it, or there is something systemic going on here.  I need answers.  I need to know I'm not going insane. 

But somehow I feel like I'm not going to get any answers.