Friday, May 4, 2012

TMI: Where I've Been and How Bad It's Hurt

I've been missing from my blog for wow - nearly a month now. I was getting ready to post about the Hospice Hope Run on April 14, but the day after that event I started down a path that has been mind-boggling at best.

This post will be graphic, if you're not interested in a frank recounting of some bodily problems - best just skip this one. 

Weight loss surgery patients, RNY gastric bypass patients in particular, often have issues with finding the right balance in their digestive systems between constipation and diarrhea. Sometimes this is simply a matter of keeping fiber in your diet (naturally or by supplement) or by taking a regular dose of stool softeners.

I have had a moderately difficult time finding this balance since surgery - but it hadn't been anything near as disruptive as what I was about to experience.

The day after the 5K, I wasn't feeling much like cooking (frankly, I was very sore and rather hobbling about the house). We decided to order in Chinese food, and I chose an old favorite I hadn't had in a while: Mushu Chicken. The filling is amazing - primarily chicken and cabbage, shredded carrot and other ingredients in a slightly spicy sauce. Chinese "pancakes" come with it, but they're a little dense for me at this point, so I focused on the filling instead (which always is more than the pancakes would hold anyway).

Apparently, this was a bad choice - I'm thinking the relatively large cabbage pieces were a bit too hard to digest, and I ended up with constipation by Monday evening (after having left overs for dinner Monday night!). The problem continued for more than just a few days, and it felt like I may have developed a hemorrhoid. Significant difficulty and pain in passing bowel movements (though nothing hard, if anything, leaning toward liquid), and some bright red blood when wiping.

After a week of pretty significant pain, I gave in on Monday and called my bariatric surgeon's office. A new bariatric nurse is part of the team, and she took my call and while she agreed with my assessment of what was probably going on, she told me that it wasn't directly related to my surgery, so it wasn't really something they could help me with, and that I should see my primary care physician (PCP) if it didn't clear up in a week.

Frustrated, to say the least, a med-student friend of mine on Twitter encouraged me to call my PCP immediately rather than wait another week. I was able to get in that afternoon with one of the practice's PA's. She did a quick rectal exam (I screeched louder than I'm proud of) - said yes, I had an internal hemorrhoid, and prescribed a cream to be applied internally called Proctosol. She did say this could take several weeks to heal, but that the cream should help, along with sitz baths. Yeah...not so much.

Side note: we have a small bath tub - shallow, and not very long or wide. 100+ pounds ago I'd not have been able to get myself in and out of that for a sitz bath - I can do it now - maybe not as gracefully as I'd like, but no fit or access issues - a small victory amid all the pain.

It got to the point where I could barely sit normally to work (and I have a very comfy/supportive Herman Miller Aeron chair), and ended up clocking out of work early on Wednesday due to the pain. I resolved to not be brushed off again, and set my alarm to go into my PCP practice's walk-in clinic first thing in the morning on Thursday. Another PA saw me, and agreed more aggressive treatment was necessary - she switched the cream to Lidocaine (much more anesthetizing), and gave me a short course of Hydrocodone until I could get into a surgeon's office where they could either remove the hemorrhoid in their office, or arrange for a hospital outpatient procedure. I called out of work for Thursday and Friday.

Even the hydrocodone didn't really do much for me - over the weekend without it my pain would be up about an 8 on a scale of 0-10, and the hydrocodone would maybe knock it down to a 6. Monday I called out again, and then started having very very very dark brown (not quite black) stool, with pain topping a 9 on that scale, some hardness in my lower abdomen, and on top of all that - I vomited anything I tried to eat, which honestly hadn't been much for the last week - when it hurts to go that bad, you tend not to want to put anything through your system. I was surviving on Gatorade G2 (45 cal/20 oz bottle) and Yasso Frozen Greek Yogurt bars (70 cal/6g protein per bar).

We called my PCP's office and they told me to go to the ER - so off to Wake Forest Baptist Medical Center we went. Luckily - they either evaluated me as urgent enough, or they weren't very backed up, as I was taken back to a bed immediately. They did some blood work, another rectal exam (complete with additional shrieking for which I apologized for in advance), and decided I needed a CT scan. In all my medical adventures I'd not yet had one of those. They gave me a saline IV, a nice dose of morphine for the pain (morphine - my friend - my 'I don't really give a shit about the pain scale right now' lovely substance), and swept me off to CT. It was quite quick, and the contrast really didn't warm or give me a burning feeling like they said it might (maybe thanks to the morphine).

When the doc came back with results, he said blood work looked good, and it did appear again i had a hemorrhoid, and asked me what I wanted them to do (which I found a bit odd, but I ran with it). I said I was frustrated with now 2 full weeks of debilitating pain - I hadn't been able to work, I couldn't sit normally - either had to be laid back in my recliner kind of canted to one side (keeping pressure off the side where most of the pain was), or in bed. If a surgical procedure was necessary, I just wanted it done and over with. We had discovered that my appointment with the surgeon the next day may not include an actual procedure - if they decided it needed to be hospital outpatient, they'd have to schedule it for another day. The thought of additional days without relief was nearly unthinkable.

Doc said that he understood, and would probably feel the same way, but that performing that type of procedure in "emergent" circumstances tends to lead to poorer outcomes - more likelihood of infection and other complications, and that they'd feel more comfortable having the specialized surgeon taking a good look at the situation and treating me on Tuesday or later. I wasn't happy, but I understood. Then he dropped a bit of a bomb on me.

He said that the CT scan did show a suspect lymph node near my rectum - it could very well just be my body doing what it was supposed to in fighting the problem with the hemorrhoid, but that it needed to be looked at closer, to rule out unrelated malignancy.

Um, malignancy? Wow, the last thing I need is ass cancer, seriously. I know this was a precautionary statement on his part, but my stressed mind really didn't need that thought. We went home, I took the last of my hydrocodone, and spent a good deal of Tuesday in the tub trying to relieve the pain before my 2pm appointment with the surgeon.

By the time Michael was able to get me there, I was in tears - pain up about a 9, and barely able to sit - quite awkwardly, with only a little of one butt cheek on the chair. It felt like I had a peach just inside my ass.

I had to fill out what felt like reams of paperwork - they wanted my current prescription meds in 3 different places (as a bypass patient that list is verrrry long, and I got frustrated and finally said "see other sheet" instead of writing it all out multiple times).

When we got into the exam, the nurse clearly saw my distress, and asked about my pain - I lost it at that point and just started sobbing. The doctor came in quickly, and had to do another rectal exam (so tired of fingers up my butt at this point). I about hit the ceiling from the pain. He asked me to lay completely on my stomach and poked around a bit more, and declared that I had an abscess that was not only internal, but had spread externally - so it was actually crossing that anal sphincter area. Yeah, I was legitimately in pain.

So the solution to an abscess is to lance it. This generally hurts no matter where it is, but they needed to numb the area with multiple Novocaine shots - right around my anus, about the most sensitive and nerve filled places on the body.

I honestly couldn't control myself - I was sobbing and shrieking hysterically as he injected the Novocaine, trying to muffle some of it in the pillow on the exam table, and squeezing the hell out of the Man's hand as he squatted next to me up at the head of the table.

Once that was "numbed" (and I use that quite loosely), they lanced it - meaning sliced it open (I don't know exactly how big the cut was, I'm assuming half an inch roughly) - and then pushed about to drain what was accessible to him. Additional sobbing and hysterics accompanied that effort. They packed it with an odd gauze tape and then put additional regular gauze pads in my butt crack and taped them in place - when I finally got dressed it felted like I had a wash cloth stuffed between my cheeks.

He gave me a prescription for percocet (oxycodone) and a strong antibiotic and sent me home with instructions to continue the warm sitz baths and to call back on Wednesday if I didn't experience significant symptom improvement.

The percocet at least helped knock me out more, but I woke up in just as much pain as I had been in the day before - while it didn't feel like I had a peach up my butt anymore, it still felt like I had at least a golf ball up there. I called in the afternoon, and was told to continue the sitz baths, to double up the percocet, and to call back Thursday morning to get a time to come in (doc is in surgery most of the day Thursday, so his nurse was going to try and time it so I wouldn't have to sit and wait in the office too long).

We finally got back in Thursday about 3:30 - he made another small lance in it and drained just a small amount of fluid - he didn't bother with the Novocaine, since that seemed to distress me more than the actual lancing, and I agreed with him. He said the infection looked much improved, though clearly there was some still there. Our choices were to continue the antibiotics, sitz baths, and percocet since it seemed to be working, or admit me to the hospital for more invasive surgery. His preference was to avoid the surgery unless absolutely necessary. When I asked how long I'd be impaired enough not to be able to work, he said 3-4 more days would probably be required - so that if I wasn't in a position to work on Monday morning, to call him immediately and he'd make time to see me for further evaluation. I asked for (and got) another prescription for percocet, since he'd had me double up on the first one, I didn't want to risk running out over the weekend.

I'll admit that today, Friday, things are feeling somewhat better - but as the percocet fades, the pain still comes back up to a 5 or 6 - but that's a good improvement over an 8 or 9. Hoping that goes down at least a point a day through the weekend.

My biggest challenge now will be getting back on track with my nutrition and hydration - I would be surprised to have gotten more than 30oz of non-protein-shake liquids in a day, and there's only been a few days in the last 2 weeks where I've actually been able to get a shake down. I've probably been existing on 200-300 calories a day. Not healthy upside to that, is that I'm down an extra 10 pounds. As Fuzz would way, I tend to do this the hard way.

Any food that's not near liquid has been sitting in my stomach like lead bricks - I think I'm going to have to be very careful and start with getting 2 shakes a day in (which will get me my protein requirements) and slowly adding back soft foods before solids as I did post-op. 

I do have my 6 month follow up with him on May 31, and we'll be having a significant discussion about bowel movement management and how NOT to have this happen again.

I must shout out to my fellow WLS program patients Maggie, Jen, and Gail - all of whom have offered emotional support, and though I ended up not needing it, offers of transportation to some of these appointments, as the Man's work schedule is not easy to bend, and I have no business driving on percocet.

And of course, I cannot forget my Twitter peeps - @MargaretNrthwd for encouraging me to get to my PCP, @KrispyLove for her friendship and medical knowledge, and dozens of others for their emotional support and willingness to listen to me whine about my ass for nearly 3 weeks now.

So that's where I've been - and it's hurt like hell.

I'll hopefully be posting about the 5K and getting you my overdue 5-month results in the next few days.

-- Annie

1 comment:

  1. So sorry to hear how hard it's been for you. I hit a rough patch at one point and was impacted. Not fun. Glad to know you're on the road to recovery.