Follow Up’s and IV Therapy

My next scheduled appointment is to see Dr. Frech. I see him a week after being discharged from the hospital. This is the first time I see him since I had surgery. He is excited to hear that some of my symptoms have been resolved. He goes over all the tests that were done in the ER and agrees with what they did. He also thinks that the pain I am having in my stomach is due to some form of closure/restriction that may be occurring at the surgical site (even though the barium swallow came back normal). He informs me that it is a simple fix, it requires an EGD. He can go in and dilate the closure to open it more which will allow food to go down easier. However, this procedure can’t be done for 6-8 weeks after the initial surgery. If it is done too soon, there is a risk of perforation, bleeding, and another surgery. We change some medications, mostly to liquid form. We will wait 6 weeks to see if anything improves or the procedure needs to be done. I am supposed to contact the office if I have any more problems before then.

The next follow up appointment I have is with Dr. Rasmussen. Unfortunately, he is called out for an emergency surgery and I get to see someone who doesn't know me or my case. I speak with him for only a short time. After staying in the hospital and explaining my case to so many different Dr.’s, I am not really in the mood to do it again. He thinks that my stomach still hurts because there isn't a lot of movement to push the food out. He gives me a prescription for Reglan (which has nasty side effects) and tells me to take it for 2 weeks.  I leave the office kind of annoyed that I wasn't able to ask Dr. Rasmussen any of my questions, but what can you do.

A week later, I am feeling extremely dehydrated and not any better. I call Dr. Rasmussen’s nurse and tell her my concerns. They decide that a round of IV fluids would be beneficial. I have this done; it helps for a day or two. I see Dr. Rasmussen two weeks later for another follow up. I am still having pain in my stomach and now the suspicion is spasms. He puts me on another medication to try. He says I just need to give myself more time to heal. I am still not eating or drinking much at this point.

A few days after my appointment, I start feeling extremely dehydrated again. I call Dr. Rasmussen’s nurse and once again they schedule an IV Therapy appointment with lab work. She also tells me that we just need to give it time. At this point, I am not OK with this answer. It has been 7 weeks since my surgery and I feel just as crappy as I did before. I am starting to regret having this surgery if this is the way I am going to feel. I decide to contact Dr. Frech’s office and see what he thinks I should do. I am informed that it is probably a good idea to do the scope and I agree.

The next day, I attend my first support group meeting. Dr. Rasmussen and his nurse are present at the meeting and I have a chance to talk to them. Dr. Rasmussen decides that since the IV Therapy helps so much, we will continue to do that for a month and then re-evaluate. I tell him about the scope that is scheduled for the following week, and he seems a little nervous about it. He wants a report at the next visit. I apologize for being a crummy patient and he tells me that he does care about my case; he is just in unchartered territory and is not sure what to do next.  The next scheduled appointment is for the scope. 

Sitting in the chair with my IV

ER and Hospital Stay #1

We go the ER on a Friday night. Bad idea. Everyone in the valley seems to be there. I get checked in and wait for what seems like an eternity. My Dad decides to call Dr. Rasmussen’s office and speak with the answering service. They inform him that they will contact the Dr. and then call back. They never call back so my Dad calls again. They then tell him that the Dr. is aware of the situation and is speaking the ER Dr. A few minutes later, the triage nurse comes to draw my blood in the lobby of the ER. After this is done, I am finally taken back to a room and allowed to lie down. The ER Dr. comes into the room right away and assesses the situation. I am given pain and nausea medication first and then taken down for a KUB x-ray. Once all the tests are done, the Dr. comes in to inform me that most of the tests are normal. However, Dr. Watts (assistant surgeon) wants to admit me for dehydration and monitor my condition. They will decide in the morning if I need a feeding tube.

I spend the first night in the hospital. This involves getting labs drawn at 3:00 in the morning again. In the morning, Dr. Hill comes in. He is the general surgeon on call for the weekend. He informs me Dr. Rasmussen is out of town and between him and his partners they will be handling my case while I am in the hospital. Over the next 2 days, I see Dr. Rasmussen’s 5 different partners. This also involves explaining my case to 5 different people. Dr. Hill decides first to order a CT scan of my abdomen. He wants to check the area of where the hernia surgery occurred and make sure there is nothing wrong. The CT scan is done and of course comes back normal. In the afternoon Dr. Cook and his partner come in and I explain my case again to them. They decide the best thing to do is get me hydrated and to the point I can eat something again. I get a couple different drips of medication and of course pain meds and Zofran. One of the drips is called Procalamine. This works wonders for me. It has amino acids as proteins, essential minerals, and glycerin for energy. It takes about 10 hours to infuse into the body and apparently it is not administered frequently because none of the nurses are sure how to give it to me. I get 2 giant bottles of this medication over the next 2 days. On the third day in the hospital, Dr. Garry comes into my room. He says if I do well today, I can go home tomorrow. I don’t really like that idea and strike a deal with him. He says if I can eat breakfast and keep it down, he will let me go home. I do just that. Yogurt it is. I am still having pain but I want out of the hospital. I get discharged that afternoon. 

Healing at Home

I have a follow up appointment with Dr. Rasmussen’s Nurse Practitioner at 1 week to have the drain removed from my stomach. Also at this this appointment, I learn I have oral thrush from all the antibiotics I received in surgery as well as cold sores all in my nose due to the stress my body is under. I am pretty miserable but am still trying my best to drink what I am required. I am also given samples of a multi-vitamin the office gives to bariatric patients that are not hard on the stomach. I am scheduled to see the surgeon in another week.

The next follow up at the surgeon’s office goes well. This appointment is 2 weeks post-op. The incisions are healing well and I am only in a slight amount of pain from the actual surgery. The thrush is still not gone but the cold sores are. I am given a prescription for more mouth rinse for the oral thrush. I have started to develop this pain in my stomach that only occurs any time I eat or drink. This has caused me to pretty much stop eating and drinking which in turn makes me feel weak all of the time. I share this with Dr. Rasmussen and we decide to just give some more time to heal. It may also be that the thrush has spread to my stomach and that is causing the pain.

Three days later, I wake up in excruciating pain. I feel dizzy and lightheaded and am dry heaving. I call Dr. Rasmussen’s office and talk with his nurse. He decides to order an esophogram. This is the barium swallow test that I had done the day after surgery. This will check to see if everything is still connected properly and there are no leaks. I have this test done at the hospital in the late afternoon. Once the test is done, I am sent home. I spend the next few hours being miserable and dry heaving. I cannot lift my head off the pillow without feeling the need to pass out. Dr. Rasmussen’s office staff calls at 5:00pm on a Friday evening and lets me know the results were normal. I ask her what I am supposed to do and she doesn't offer any remedies.

I wait a few more hours before I decide to move again. I get up out of bed and the first thing I do is pass out. The world goes black a few minutes again after I come too. At this point, I begin to freak out a little. I manage to find my phone and call for help. My Dad decides that he has seen enough and hauls me off to the Emergency Room.

Hospital Stay

The next few days are a blur. I don’t remember anything that happened the first day. One of the first things I do remember is the leak test. Only because they make me drink a barium chalky substance after they just cut me all apart and put me back together. Pretty gross and pretty painful. I find out an hour later when Dr. Rasmussen comes by that I passed the leak test and am no allowed to start drinking. I also have to start training my stomach to only have 3-4oz. of fluids in an hours’ time frame.

Family, friends, and co-workers come to visit but most of their visits are a blur. I have the best family and friends in the world. They fill my room with balloons, and flowers, and even presents. By the time I left the hospital, there was room for nothing else.

I am kept pretty doped up so I don’t remember a lot of what happened in the hospital. I get the catheter taken out on the second day, only to be re-cathed that night due to not putting anything out. That’s always a pleasant experience you can’t really forget. I get my blood drawn at 3:00 in the morning every single day I am there.  Vitals happen all through the night. I basically don’t sleep, unless I am on the drugs. I get moved to a full liquid diet 2 days in which includes carnation instant breakfast drinks and broths. I am weaned off of all the lovely meds. I am feeling pretty good and want so badly to go home. I am discharged on Saturday (4 day hospital stay). 

Gutless

I can’t believe today is finally here. I have waited for so long and have already been through so much, I just want to feel better and am hoping that this is the beginning to that. I start this whole process by fasting from 11:00pm the night before. This includes water, breath mints, and gum. I don’t sleep a wink the entire night.

I check into the hospital at 5:30am. I first have some more labs done. I go back into the Same Day Surgery department where all my vitals are taken. I am then led into a room and told to change into a gown and socks. Once I do all this, the nurse comes into the room and we begin the real fun. She starts this process off easy by going over my health history and asking me questions. I get compression socks hooked up to my legs, this prevents blood clots from forming until I can get up and walk. I then have to take some heartburn medication for my reflux; this stuff tastes pretty dang awful. Once all this is done, it is time to start the IV. She tries three times. Another nurse comes in and tries 3 times. Then the Anesthesiologist comes in and he takes the gold. He tries 7 before he gets a tiny vein in my hand on the eighth try. In the middle of all this pain and chaos at 6:00 in the morning, Dr. Rasmussen comes in and signs a couple papers in my chart, makes sure I haven’t changed my mind and answers some more questions from my nervous parents. After he leaves the room, the OR nurse comes in talks to me for a minute and then leaves. Then an OR tech comes in and puts a hat over my hair. All of this happens while I am still being poked. At this point I have been poked so many times that I am getting nauseous. The Anesthesiologist notices this and puts a patch behind my ear to help with the nausea. Once he gets the IV in (14 sticks in total) he instantly gives me versed. I don’t remember anything after this and I hate it. I hate not being in control of things I do or say. I don’t remember saying goodbye to my parents, being wheeled out of the room, or even going into the OR.

The surgery starts at 8:00am (I am a ½ hour delayed due to the IV issues) and lasts pretty close to 4 hours. My poor parents sit in a waiting room this entire time, waiting to hear good news. Dr. Rasmussen comes out and talks to them after the surgery is over. The surgery went very well. They were able to remove most of the stomach and create a new stomach pouch that is about the size of 2 thumbs (1 thumb bigger than anticipated, Yippee). The hiatal hernia was smaller than anticipated so they were able to just pull it back down and staple it. The new roux limb is now 40cm which is exactly how long Dr. Rasmussen wanted it. I am now what my family calls gutless. I will have a leak test done in the morning. He is anticipating my stay to be 3-4 days. 

Flowers and balloons filled my room!!

Pre-op Class and Hospital Pre-op Appointment

I go to the pre-op class offered by my Dr.’s office a couple of weeks before surgery. They have everyone there that is going to have gastric bypass surgery within the next couple of weeks attend this class. The pharmacist from the hospital is there, the nutritionist, and the Dr.’s nurse. They each take turns going over what will happen from the point we check into the hospital until we are discharged. We are then allowed to ask any questions that we might have pertaining to our individual situations and surgeries. Pretty informative class.

Two days before surgery, I have my pre-op appointment at the hospital. At this appointment I meet with a pre-screen nurse. She goes over what will happen as well. She then goes over the health history and asks any pertinent questions. They draw some tubes of blood. I ask any questions. Appointment over.

I am now ready for surgery. They call me the night before surgery. I am to check into the hospital at 5:30am. Here we go, ready or not, this is actually going to happen. 10 years of suffering and not knowing and in just a few days I should finally feel better, right? 

Nutritionist Meeting and New Food Diet

My first appointment before surgery includes meeting with a Nutritionist/Dietitian. I only have to attend one appointment whereas those who have the gastric bypass surgery for weight loss have several appointments. I will briefly go over the stages of how I am supposed to eat after the surgery based off of the information from this appointment.

One week before surgery: begin liquid high-protein diet. This includes drinking protein shakes. I opt for Slim Fast High Protein. I need to consume about 70 grams of protein and about 900 calories a day. No more solid food.

Stage 1: Post-op Day 1 & 2, this occurs while in the hospital. Once the barium swallow x-ray is completed and there are no leaks in the new surgical connection, you can progress to this stage. Only clear liquids. Non-carbonated. No calories. No sugar. No caffeine. Allowed to sip 2-3 oz. of water per hour.

Stage 2: Post-op day 3 (discharge diet). Clear liquids combined with full liquids. Clear liquids include no sugar or artificially sweetened liquids. Salty liquids are encouraged. Full liquids include protein-rich liquids. At this stage you are supposed to consume 48-64 oz. of liquid but are only allowed to sip 3-4 oz. per hour. This total amount should be split between clear and full so I should be consuming 24-32 oz. of clear liquids and 24-32 oz. of full liquids.

Stage 3: 2 weeks post-op. Increase clear liquids to 64+ oz. daily. Replace full liquids with protein-rich foods. These must be soft, moist, diced, ground, or pureed. Only a couple of tablespoons of food are tolerated at each meal. Eat 3-6 times a day. Examples of food at this stage are eggs, deli meat, fish, cottage cheese, yogurt, and refried beans. Also at this stage you are no longer allowed to drink with your meals. You must stop drinking ½ hour before you eat and then do not drink anything else until ½ hour after you stop eating. This is a new lifetime rule. This is because the liquid can move the food too quickly through the new pouch and your body will not be able to absorb the nutrients from the food you are eating. Too much liquid can also cause discomfort. You need to give the body the longest amount of time to absorb the nutrients because in a gastric bypass patient, the new intestinal route bypasses the duodenum and first part of the jejunum which is mainly responsible for absorbing most of the nutrients from the food that is eaten.

Stage 3: 4 weeks post-op. Continue advancing diet as tolerated. If you can eat high-protein foods and tolerate them, you can start adding well-cooked soft vegetables and fruit. You must always eat protein first before eating anything else.  At this stage, about 2 oz. (or less) of food is consumed, also new lifetime rule. At this stage, you aren't allowed to consume rice, bread, and pasta.

Stage 4: 6 weeks post-op and beyond. Advance diet as tolerated to healthy solid foods. Diet must consist of healthy, adequate protein, fruits, vegetables, and whole grains. 60 grams of protein a day must be consumed while only eating 2 oz. of food at each sitting. I am allowed to add grains and starches back in at this point as long as they are whole grain and I am not losing any more weight.

I leave this appointment a little overwhelmed with all the new information. It is not a matter of if I can do this, but can I make this commitment to change my life forever? I again begin to weigh in my mind what is worse, following this new food plan or being sick every day.