Lactose Intolerance...

Regular cow's milk is tearing my system up.  I have switched to soy and its better.  Cheese doesn't bother me - thank goodness, because cheese is a big contender in my protein intake.  

Turds, Crap, Excrement, Poo... Whatever you call it, its a Sh!tty Subject

Like it or not, sh!t happens.  For bariatric patients, sometimes it happens less often than for most people. Seriously, as a bariatric patient, in my own experience, I am much less "regular" than I was before surgery.  I first thought it was simply because of the reduced intake of an RNY patient, but as it turns out, I had an impaction/large bowel obstruction.  I think what caused it was I was eating a lot of cheese because it's high protein and I had switched to a multivitamin with iron, even though my iron levels were within normal limits. I hadn't gone for almost 2 weeks and I passed a couple of squeaks of air but that was it.  It was to the point that I couldn't eat or drink hardly at all other than a few sips of water throughout the day because my system was full from one end to the other.  I was miserable.  I was trying to work and it was to the point that I couldn't sit upright because it felt like I was sitting on a ball bat - not that I know what that feels like.

I called my Bariatric surgeon and because I did pass a couple of squeaks of air, he was confident that my large bowel wasn't totally obstructed since air was able to get through.  He told me what to try first to get it resolved; he told me to add fiber to my diet, stool softeners, laxatives, and to try Miralax (which I think was named that because its a Miracle-Laxative), but still -- nothing.  I called him again and told him there was no progress and he told me my last two options were laculose and an enema.  I opted for the laculose (gladly).  He called in the prescription and I went to another pharmacy (one that they didn't know me) and got a 6-pack of enemas. I figured it'd be a long night.  
 





I took one teaspoon of laculose (which it called for 15 ml (1 tablespoon) but all I could get down at that time was 1 tsp.  I'm not sure why, but thick syrupy consistency liquids make me go into spasms.  Another bariatric patient that has become a good friend of mine has the same problem, or she did right after surgery; not sure if its still an issue with her or not, but it certainly is for me. 


It took several hours, but it finally passed.  I have been impacted 2-3 more times since and am having a hard time finding a balance.  It seems to be either feast or famine.  I have had trouble with my bowels my whole life and had IBS before the gastric bypass.  Bad news, I still have IBS AFTER gastric bypass too.  :-(  This will probably be a life-long struggle for me.  Did you know that they have a chart for your poo?  Yeah -- they do. I added it below for you to see.  

I'm not sure if any of you have been to a colorectal surgeon or a gastroenterologist (GI doctor) but I have had the "pleasure".. I guess you could say... of going to both.  They show you this chart and make you tell them extensively about your poo.. the color, the texture, the shape, the volume, etc etc etc.  I've never met anyone else who talked so seriously about sh!t.  I understand more now than ever though, how important expelling your waste is from your body.  I learned that from my cat having mega colon. My husband and I watched her suffer for 4 of her 6 years we had her.  It ended up killing her in the end and she died in my arms.

So after going through that experience with our first pet, I am neurotically emphatic on making sure my babies (my dogs) go potty and that they are 'productive'.  I never dreamed that I would actually have to track it though for myself.  My IBS that I had before surgery always leaned toward diarrhea, so not going was never an issue.  Normally the complications with RNY are more geared toward dumping syndrome instead of constipation, but honestly its a mixture of both.  Some things that are supposed to give me dumping syndrome don't and the things that aren't supposed to make me dump, do.  Right after surgery, I dumped for 2 weeks solid; it didn't matter what I ate or even drank it made me incredibly ill.  I'm not sure what changed but one day it just went away..   

Just keep swimming

I am not sure what I expected after surgery but I've had a rough time but I've been okay.  I've surrounded myself with the people I care about the most and the people that care about me the most and have tried to make the best out of everything.  I don't regret the surgery and I'm not sorry I had it, but I wish there were some things that were different.


Vitamins - What is recommended for RNY patients is two multivitamins a day plus three calcium citrates.  The chewable "bariatric"multivitamins are icky.  They are gritty, chalky, stink, and get stuck between my teeth and the taste of them lingers in your mouth and its just all kinds of nasty.  The opening of my pouch is the size of an M & M and so taking regular multivitamins are out as all of the ones I am aware of are huge.  So I went today and bought liquid multivitamins - which taste similar to the chewables but aren't AS bad.  I had to ask the pharmacist to help me find the calcium citrate - most of your calcium is calcium carbonate and not calcium citrate.  So anyway - the pharmacist found me some but they were huge.  He found me some "Petites" and they are just slightly bigger than an M & M.  I took two this afternoon and they seemed to go down okay.  So far, its after 1 am and they're still down. 


Pain - I had to come off of my NSAIDs (antiinflammatory meds).  If I have any pain in the future, the only over the counter anything I can take is Tylenol. 


Medication in general:  Everything bigger than an M & M has to be either in liquid form or crushed. 


Complications - The feet, the pain, the back, my left arm, the needle.  I never realized it would hurt so bad.

Infections - I got an infection in the biggest incision. 


Numbness/Nerve Compression - My back is still hurting deep and numb on the surface.  Its frustrating and the doc says it may be months before it gets any better.


Watching other people eat - It never bothered me before surgery but now, postop, it drives me insane. I hate to feel like I'm not included in family dinners but to be included and to be served jello while everyone else is eating meat and potatoes sucks.

I know everything is little and I really don't have anything to complain about and I know this was my choice, but making a change this big and trying to balance everything else in life is hard and the battle with my weight will be a constant struggle.  I just have to remember - just keep swimming.

Just Call Me "Complication Girl"

I was changing clothes last night to get into my jammies and I grabbed the bottom of my shirt to take it off and it was wet. I looked down and it was covered in blood.  I called for Johnny and my mom/sister. All came in and I laid back on the bed and Johnny was cleaning the blood to try to figure out where it was coming from and it was from the incision where he sutured the fascia of the muscle. The skin had opened and ruptured.  It was cloudy blood, which indicated to me an infection.  We cleaned and bandaged it back up and then had to make the decision of going to the E/R or wait for my surgeon the next morning.  I decided that I'd rather wait on my surgeon who knew me and not just let any Tom, Dick, or Harry poke and prod at me, not knowing my whole clinical condition and history.  I woke up in the middle of the night between four and five o'clock and the blood had flooded the bandage and had soiled/saturated my night gown.  I cleaned it up the best I could and put yet another bandage on it, this time with gauze rolled under it.  I called his office and his answering service told me at 7:30 that he'd want to see me at 9.  So I called about 10 til 9 and they said "oh he's in surgery and his first appointment is at 1".  So I changed the bandage again and piddled around waiting on 1 o'clock to get here.  I got there for my appointment and he told me it was infected (in which I was not shocked) and he numbed me up with shots of lidocaine, snipped out all of the sutures and opened the wound back up and packed it.  Now I'll have to pack the wound until it granulates out and forms fresh/healthy tissue. I go see him again in the morning at 9 am. Fortunately, he said it was one of the easier complications to treat and everything would be fine.  I was shocked though with my medical history of getting staph infections more  frequently than most that he would've put me on antibiotics but he didn't.  I guess antibiotics are more complicated with bypass patients, as they can't swallow anything bigger than a plain M & M and most of the antibiotics on the market are honkers! I'm pretty sore today where the sorest incision to start with has been manipulated and altered. Hopefully it'll be better tomorrow.

 

6 DAYS POSTOP

So lots has happened since I last checked in. I had my surgery and am still in the adjustment-transition period.  I was neurotic the week before surgery and did not get a single full night's rest the entire week.  I found myself tossing and turning and being wide awake at most hours of the night. The night before surgery, my mom told me I was "nesting", which she said was fine as long as I "didn't bring home a baby." I cannot explain why, but I just had this unsettled feeling about the whole thing. It wasn't fear, anxiety, or stress.  I had lots of questions, all of which were either answered by one of my doctors or other people in the support group. 

My surgeon was great and he didn't do anything wrong, but I did have a few complications, most of which were related to my size.  First off, let me say I was down 73 lbs the morning of surgery.  My goal weight from 513 was 445 and I weighed in at 440 in preop.  

Even with my drastic weight loss:

• The operation took six hours instead of two
• I had eight small incisions instead of the six anticipated
• I am having loads of pain and numbness
• My liver was "Floppy" and he had to use extra retractors to hold it back to operate on me.  If I had not have lost the weight preop, then he could not have done the surgery
• The OR table I was on was either too short or I was scooted too far down on it and my feet were pressed hard against the foot rest, so by the time I came out of the 6 hr surgery and preop and recovery, my feet were killing me.  They had me try to get up and walk but the soles of my feet were sore to the touch. They hurt to even touch the ground.
• He had to put more air in me for the laproscopic portion than most people to have the most room to work with possible, which means more gas to get out of my tissues later, which means you have to work the air out of your tissues by exercise, burping it out or tooting it out. Most of mine came from burping, which was incredibly painful but so it tooting postop. It hurts like hell too.  
• I ended up staying two nights in the hospital instead of one.  
• When he was using the curved stapler inside to create my pouch, it malfunctioned (from what i understand) and staple line busted out and he had to create a smaller pouch (approximately 1 oz instead of 2 oz) and its shaped a little different than most other RNY pouches. 
• While suturing the staple line, a curved sutural needle popped off into my abdomen and he couldn't find it.  They did an x-ray during surgery but didn't find anything.  My surgeon thinks it fell behind my spleen and when they got me up to walk after surgery, that it probably did fall to my pelvis or should fall to my pelvis and he said that scar tissue should form around it and it should not give me any problems.  I asked him if it would dissolve and he said no that it was surgical stainless steel.  I think knowing I have a needle stuck inside me is more of a mental issue with me rather than an actual medical issue. He said it happens to other surgeons all the time and their patients do fine, but I am the first one it has ever happened to for him and you could tell it really bothered him.  Its not that he's a bad surgeon at all - because he's not, he's excellent and the level of care he has for his patients is exponential to other surgeons I have encountered either through my job or having other operations myself. He didn't have to tell me and my family about the needle incident and didn't have to be up-front and honest about it, but he was.  He didn't try to talk to me about it while I was sedated or under any kind of anesthesia, he waited until around 9 pm that night to come back and discuss the complications with me when I was lucid and responsive.
• I finally got up to walk after surgery, but could only walk from the bed to the restroom.  I had a hard time trying to urinate.  I sat on the toilet for an hour the first time and just couldn't go.  (That was around 5:30-6:30 pm). My surgeon came back to see me later that evening and I told him about my not peeing issue and he said they put in a catheter during surgery and drained my bladder and he wasn't that worried about it because I was producing urine good during surgery, but if I didn't pee before 11 pm, for the nurses to go ahead and cath me again.  Let me be the first to tell you, at 10:45 pm, I was in that bathroom trying my best to pee. Finally at 10:58 pm, I peed.It wasn't like the dam  broke, it was just piddles here and there.  It burned and was bloody from all of the trauma I had been through that day.Since surgery, every time I have gone to pee, its at least a 15 min ordeal, if not an hour; they are incredibly painful.
• My surgeon told me before he released me that my bowels would probably lock up from the pain meds and nature of the surgery.  I had a BM the Saturday night before surgery and I finally had one post-op today.  So I went 8 days without one and it was incredibly painful and bloody.  I went to potty again this afternoon and I thought I had started my period in the middle of all of this (showing God does have a sense of humor) but no, was totally rectal bleeding.  Will call my surgeon in the morning to see when he can see me
• i had five iv's and I kept blowing veins. 

                                                                                                                                                                                                          
My pain level has went up since I came home and got off the morphine pump and they cut my hydrocodone syrup dose (which tastes like lemon pledge mixed with kerosene) in half with me coming home from 30 ml/6 hr to 15 ml/6 hr.  I had some left over morphine pills from a previous surgery that I had been hoarding until I needed them for emergency and believe me, this fit into that category.  

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ITEMS THAT HAVE HELPED ME: