Surgery Decisions...Round 2

I go in to see Dr. Rasmussen to follow up with the feeding tube and to go over the results from the Barium Swallow.

Dr. Rasmussen is now sure that the surgery will need to be re-done based off the results of the barium swallow and the pictures that were taken. He says that for as many times as the surgical connection has been dilated, it should somewhat still be open. I agree. I feel like all the dilations have been a waste of time especially since now the connection is as narrow/closed off as it was from the very first dilation. The only thing that Dr. Rasmussen is unsure of is how exactly and what exactly he is going to do in the surgery. The ideal plan is to:

• ·         Hopefully do it laparoscopically (not open)
• ·         Repair the hiatal hernia (if it’s small enough, he will leave it alone. May cause more harm repairing it then good)
• ·         Not take any more stomach
• ·         Repair the connection. This is the big “unsure” part. He will try to do a lateral (side by side) connection, but also says he will do what my anatomy will allow him to do.

The next few steps involve going through the same process as the initial surgery with a few more Dr.’s visits, pre-op hospital appointments, and to try and not have a major panic attack and back out.

The bright side of this appointment is that I get to bump my feeding tube to only feed for 12 hours instead of 24 hours. Yipee!

I am not excited for the surgery this time around. I now know too much of what is going to happen and the process and the pain and all the complications that happened last time. Dr. Rasmussen also informs me that this time the surgery will be more complicated and has more risks. I will also have to be in the hospital longer. I am absolutely TERRIFIED!! I have started developing palpitations in public settings and at work. Only when I am home do they go away and my heart relaxes a little. However, even with all these horrible “what if’s” constantly running through my mind, the only thing that keeps me going is the fact that I trust Dr. Rasmussen with my life and know that he will do what is best for me.

Two weeks and counting. 

Barium Swallow and Feeding Tube

I have to fast for this procedure. I check into Radiology in the afternoon and am taken back to the procedure room. We start the usual stuff. I get changed into a gown and the nurse explains what they are going to do. The Dr. comes in that is going to do all the testing and place the tube. I take my position near the x-ray machine and start drinking all their lovely concoctions of barium. The test is completed and it’s time for the feeding tube to be placed.

I lay on my back underneath an x-ray machine and the fun begins. The first thing that happens is they inject a lidocaine jelly into my nose and have me snort it in. This will numb the cavity and throat. He begins sliding it through and I only gag 4 times as it goes in. It takes a good 10-12 minutes before it is all the way in place. The tube gets taped to my nose and cheek. He then brings me in the room to explain what he can see is going on from the x-rays.

The first is I have either another hiatal hernia or the one that was fixed in the initial surgery has come undone. Second, I now have a lovely case of reflux. And last, the surgical anastomosis (surgical connection) appears to be pinched off and is measuring at 1 cm (10 mm). This measurement is the same as when we first started doing the dilation procedures. 

So to me and the Radiologist, some form of the surgery needs to be re-done. How much of the surgery, neither of us know.

Machine that runs the feeding tube

Feeding tube bags that hold the "food"

Staying positive. Evening of feeding tube placement.

More Appointments

My next appointment is with Dr. Rasmussen. We go over the latest and greatest which included the ER visit and partial blockage and the 4^th dilation. He also decides at this appointment that the feeding tube has become necessary and doesn't want to wait any longer to have it done. He is also leaning more towards the idea that some part of the surgery will need to be re-done but will not consider re-doing the surgery until at least 6 months post-op and until I can stabilize and maintain my weight. How much of the surgery that needs to be re-done he is not sure of and decides to order another test. Another barium swallow is ordered right before the feeding tube will be placed. I am supposed to follow up with him a week after the feeding tube is placed.

I also see Dr. Frech before the feeding tube is placed to follow up with the last dilation. He 100% agrees with placing the feeding tube. When he goes back to look at all my numbers, it is shocking to hear how much I have really lost. He is also super leery about re-doing the surgery. He thinks it will be beneficial to leave the tube in place for 6-8 weeks and then pull it out and do a steroid injection into the surgical anastomosis. This can prevent inflammation and allow that area to heal better. He also suggests doing a side by side re-connection in the surgery. This involves cutting the old connection loose and bringing the intestine side by side and cutting it open 3-4 cm and then connecting that to the stomach. He wants to see me again in 6 weeks or before that if Dr. Rasmussen decides to do surgery.

At this point, I am confused at whose plan I want to go along with.