Wednesday, July 27, 2011

Adios Gallbladder

I had my cholecystectomy. I was originally scheduled for 9:30, but got bumped up to 8. It's a good thing too, because I was the first one in and the very last one out for the day. The surgeon joked that I must get drunk on just one glass of wine. I was perfectly stable and everything, but I just couldn't wake up sufficiently. I finally went home (and back to sleep) almost 6 hours after surgery was over.

Like I mentioned a couple of weeks ago, I will really miss the hospital here. Marcus Daly Memorial Hospital...if you're ever passing through the area, don't be worried about stopping in for treatment.

Everyone was fabulous. My surgeon, Dr. Ilgenfritz did a great consult with me on Monday morning. He told me he's done laproscopic cholecystectomy hundreds of times and put my mind at ease about the recovery. He patiently answered all our questions and asked a lot of questions of his own. He came by my pre-op room again to be sure I was still okay with everything and he asked one more time in the OR if I had more questions. Since Josh had to go home with the girls, Dr. Ilgenfritz called him himself right after surgery to let him know how everything had gone. I'm not yet clear on why it was possible (since I wasn't awake enough to talk to him afterwards), but he was able to do the surgery through 3 incisions instead of the normal 4. I'm also not pumped full of air (perhaps that's what the 4th incision is for?). I think all of that likely has something to do with the fact that I'm rather skinny, but whatever the reason, I think it's leaving more comfortable than typical. When he found out I was nursing, he estimated I'd probably need to wait 6-8 hours after surgery to nurse. I really appreciated that, because a lot of doctors give a blanket "you can't nurse for 24 hours" or "you can't nurse for 48 hours" statement. Such a long time frame is usually wrong, so I was impressed he was going with a more evidence based answer.

My anesthesiologist, who I need to look up because I can't remember her name, was also wonderful. Like the surgeon, she appeared to be in her early 50's and very experienced. When she came in to talk to me, I let her know I was exclusively nursing a baby and that I'm a board certified lactation consultant. I had brought my medications and mother's milk book with me and she gladly went through every medication she'd use, let me look it up and let me tell her whether it was okay with nursing or not. We worked together to come up with medications that were best for the situation. I respect her expertise as an anesthesiologist and it was very refreshing to be afforded that same respect for my lactation expertise. After the surgery, I was hurting and I found out she even sent a nurse back to my room to get the book so she could look up a few pain med options and choose the best one that would be effective, but work with breastfeeding. I also appreciated that she wheeled me into the OR herself. When we were done talking, she did one last set of vitals, asked if I had more questions, put the versed in my IV and off we went.

Lastly, I had two great nurses with me all day. One was from Texas and got her nursing degree at UT. She saw my A&M sweatshirt and we talked Texas the rest of the time she did my pre-op prep (which she was very competent at). I had her again at the end of the day and she was great with the kids when Josh came to pick me up. She even took all three of them right outside the room and talked to them while Josh helped me get dressed. Right after surgery, I had a nurse with a little bit more "shy" bedside manner, but she was also very competent. When she helped me get up for a bathroom break and I got nauseous, she held an alcohol pad under my nose and told me to breathe deep. I've never heard of that before, but it worked like a charm much quicker than medication would have and I made it through the whole day without any puking (always a bonus).

As far as the gallbladder saga in general: I posted about all the drama back in February and then we did an EGD in April, but we weren't getting any good answers. My gallbladder ultrasound showed sludge, but not stones and I wasn't a clear cut candidate for surgery. Then the attacks got more spaced out and less severe. I began to think all of this was at least partially due to tension, so I started seeing a massage therapist, who told me I had a rib out. I went to a chiropractor a few times (yes, my ribs were jacked up) and the back pain component pretty much went away, but the abdominal pain kept happening and seemed to change. The more recent attacks felt like all the ab muscles on my right side were tensing up and I'd have this lump just to the left of my midline that was really tender to the touch. Still, the attacks were spacing out and I was hopeful they'd go away as I got further from the pregnancy and Secora began nursing less (pregnancy is the only gallbladder disease risk I have). Also, my attacks only ever happened at night. Never during the day, and didn't have a strong correlation to eating fatty foods. Then last week it happened Wednesday night. And Thursday night. And Friday night. And I was still quite sore during the day. All of this was different. I went to the convenient care clinic in the hospital Saturday and was fussed at because "they're for sore throats and stuff" and they palpated my abdomen, which was sore all over. They told me to go home and call my doctor on Monday (the surgeon is not at all happy this happened). Saturday night it happened again and early Sunday morning I went to the ER in tears. I happened to get the same doctor I had 2 months ago when I went to the ER. He asked if I'd gotten the HIDA scan like he suggested to check my gallbladder function (I hadn't, because the attacks virtually disappeared after that visit), but he was very gentle with me and didn't chastise me for not listening. He ran blood work and discovered I had pancreatitis and sent me for an abdominal CT so I could be reassured I didn't have cancer or something and they were missing it. CT is usually not good for gallbladder diagnostics, but in my case it showed up just fine and there were a lot of the kind of stones that can easily spill out of the gallbladder and wreak havoc on the pancreas. They put me on "nothing by mouth" orders, observed me during the day, let me go home at night because I was doing a lot better and needed to be with Secora and insisted I see the surgeon the next day. 8am on Monday, Josh called the surgeon's office and he answered the phone himself because the office staff wasn't there yet. Even though he was booked up, he fit me in for a consult that morning because of what was going on. And that led us to the surgery. After he finished removing my gallbladder, he cut it open and said it was filled with a strange mucousy substance he hasn't seen before. The guy has been doing laproscopic chloecystectomy since 1990 and who knows how many open ones he did before that. "Huh, never seen THAT before" is a phrase I have heard multiple times from very experienced health care professionals for various reasons. I guess I'm just unique. Perhaps the strange contents accounts for the somewhat atypical symptoms I was having. I'm kind of glad there was something weird in there though, because that means it really did need to come out and this wasn't all for nothing. I was also very concerned about side effects of the surgery (you read horror stories of "bile salt induced diarrhea", which basically means you need to be 2 steps from a toilet anytime you eat), but I've already enjoyed a subway sandwich and baked potato chips without any ill effects, so while I'm not gonna go eat pizza tomorrow, I have more confidence that this isn't going to require denying myself every yummy food known to man for the rest of my life.

Whew!! Sorry for the novel. Other people's postings about this sort of stuff is what helped me learn more and make decisions through all of this, so I wanted to pay it forward for the next friend who wakes up at 2am with excruciating side pain.

5 comments:

Sharon said...

I am glad you are feeling better. I went 8 years in pain because I was just too scared for surgery. After 5 kids it was so bad and when I couldn't lift my head off the pillow knew it was time to get it out. My gallbladder had turned to gangrene and they said if I had waited one more day I would have been in really bad shape. One day after surgery I was up and felt so good after feeling so bad so long that the surgery pain was no problem. I am not skinny but only had two incisions plus my belly button. Coffee, salads, corn were the things I could not eat. Now nothing bothers me. I just wish I had not waited so long. Marti went a long time before they took hers out too. Our 2nd daughter needs hers out. I don't remember so many young mothers having problems when I was the age of you girls. Hope you feel better soon. Sharon Sebesta

Karen said...

I'm so glad you finally got this taken care of! I had mine checked when I came home from TX, but I wasn't a candidate either and still not. So glad you are recovering well and hopefully traveling won't mess it all up.

Rachel said...

It sounds like you had about as good of an experience with this that you could have. That is interesting you didn't have any soreness from the air they blow into your abdomen. I had laproscopy in college, back when I was about 110 pounds, and that was the worst part of all of it. I was sore in my shoulders and back for days from all that air. Will you get news from your surgeon soon about what was really going on with your gallbladder and why it was so strange?

The Hills said...

Interesting....I know my gallbladder wasn't in the regular place either, it was more central than normal, so maybe that's why it was easier to see on CT and get to without air?? I don't think they do any pathology on it, once it's out, it's out. Having gunk sit in there is a big risk for gallbladder cancer though, so that does reassure me that it needed to be done. I meant to ask for pictures of it and totally forgot b/c we were looking up all the meds. I'm hoping it's standard protocol to take pics and I can see them at my follow up, but I doubt it.

Today I'm hurting a lot. Never took anything more than advil for labor and delivery or recovery, but I've been on the vicodin around the clock for this. I'm okay if I don't move, but even talking too much hurts today. They told me today would be the worst, so I'm just looking forward to the weekend! Haven't had any trouble with food.

The Hills said...

Oh and Rachel...they keep trying to give me zofran and talking about nausea (before and after the surgery). I'm not having good let downs right now b/c of the pain, but I'm anxious to see if the nausea while nursing goes away. I'm wondering if this was part of the hyperemesis problem. I've had a weird twingey cramp in my right side ever since I was pregnant with Sierra, so it's possible this has been going on with atypical symptoms since then.

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