Friday, January 11, 2013

All I Want For Christmas is Major Abdominal Surgery

Warning: Very. Lengthy. Post.

Quite awhile ago (oh, probably a year...and shush, I know) I noticed this feeling like I had a tennis ball stuck under my lower right rib cage. I only felt this while I was lying down, like when I was trying to go to sleep at night. It didn't hurt, exactly, more just like a pressure. So, naturally, being me, I ignored it.

Well, it didn't go away. I started noticing it more often, and during the day, and while I was sitting and standing. Just this pressure. Occasionally there would be real pain with it, but it wasn't there all the time. So I ignored it.

Finally it was there all the time, and it was hard to take a deep breath. It wasn't going away. So I called my doctor's office to have them take a look at it. This was in October. My PA checked it out, and agreed that it was palpable, but that she didn't really know what it was. She referred me to a local surgeon, who would be the one who would have to treat it anyway, she said. Amazingly, I was able to get in for an appointment just two days later.

The surgeon didn't seem particularly impressed or indicate that she could feel anything at all. Kind of made me think that it was all in my head, in fact. But, she referred me for a CT scan of the area "just in case" and made a followup appointment for me for three weeks later.

The CT scan was on Oct 29th. My followup appointment was on Nov 14th. Now that I had finally decided to do something about this, I was terribly impatient to get results and find out what was going on. But noooooo, I had to wait another 2.5 weeks.

November 14th FINALLY came, and again the surgeon just kind of brushed everything off. She sort of just tossed into the conversation that oh, by the way, the CT scan showed a "large paraesophageal hernia", and oh yeah, that my stomach was on the wrong side. (Seriously. The stomach is supposed to be on the left side. Mine's on the right. Figures.) She said she'd have to refer me to a surgeon down in Portland, because nobody in our area did that kind of surgery anymore. Yay. More running around.

*Sidebar for a little medical lesson:
The diaphragm separates the abdominal and chest cavities. There is a small opening in the diaphragm, the hiatus, where the esophagus enters and connects to the stomach. The most common hiatal hernia, the sliding hiatal, is when the stomach -and- the lower esophageal joint slide through the hiatus into and out of the chest cavity. A very uncommon type of hiatal hernia, the paraesophageal hernia (PEH), is where the lower esophageal joint stays in the abdomen, and just the stomach squeezes up into the chest. Only about 5% of hiatal hernias are paraesophageal. PEHs are dangerous because they can strangulate. In addition to that, the stomach -never- comes back down into the abdomen of its own accord, and in fact continues to push further and further into the chest cavity. When a PEH is symptomatic, as mine was, surgery is ALWAYS indicated.
*End sidebar. ;)

Because of the Thanksgiving holiday and, quite frankly, some ball-dropping between the two medical offices, I didn't find out when my appointment with the new surgeon was until after Thanksgiving. Aaaaand, the soonest they could get me in was December 12th.

By this time I was more than a little bit of a nervous wreck. I was having a very hard time taking any deep breath of any kind, eating most foods made me nauseous and fairly often I ended up vomiting. I lost ten pounds in about three weeks. (Can't really complain about that, although the method sucked.)

My parents drove me down to Portland because I really didn't feel up to driving myself that distance. There was a long wait in the waiting room, followed by an even longer wait in the exam room, before the doctor came in. I have to say, I was thoroughly unimpressed by this time. And -this- was the guy who was supposed to operate?

Well, he was MUCH better in person, and it turns out he's just incredibly overbooked because he's the best one in the area to do this type of surgery and he keeps having emergency stuff pop up on him. We talked everything over, and he was just excellent at explaining everything that was going on and what he was going to do, and putting me at ease. I also found out that about half of my stomach was in my chest cavity and that when I had the emergency surgery back in 2008, the scans showed the hernia then! (And nobody mentioned it!) The doctor did find it very interesting that I didn't have any symptoms of GERD, which usually goes hand-in-hand with hiatal hernias. He said that it was also very unusual to have such a large hernia and have it be so symptomatic at my age. Apparently I'm a few decades younger than his usual PEH patient.

His nurse set aside a surgery date for me at Maine Medical Center (my insurance required it to be at a major hospital rather than at the smaller clinic that he does many of the procedures at) for February 15th, but told me not to even bother to write down the time because she was going to get me in earlier than that; she just had to have me on the books first.

Well. The woman does NOT screw around. My appointment with the surgeon was on December 12th. She called me on December 17th to tell me that my surgery had been rescheduled for December 19th. Holy fuck!!

Well, not so fast. Turns out another of the emergency cases popped up for the doctor, so she called me back later that night to tell me that it had been moved to December 21st. And yes, that date stuck.

SO. December 21st I stopped eating or drinking anything after midnight, drove down to Portland with my parents, went to Maine Med and finished up registration (which had been done mostly over the phone on the 19th and 20th) and at about 2:30 they went in laparoscopically and did something like this:

(Not me, and not done at the same hospital or by the same team, but similar procedure)

So anyway. One night in the hospital, and now I'm in the long, irritating recovery stages. Liquid diet for a few days has now progressed to some solid foods (although they don't always work out). It'll take about 8 weeks, give or take, to get back to my regular diet. I've just finished week 3. *sigh* There's a long list of no-no foods, and no carbonated beverages, caffeine, or alcohol for 8 weeks. The last foods that I should add back are breads (naturally---I'm a carb addict!) and steak, since those are the hardest to digest. It's very much a two-step-forward-one-step-back process. For example, last night I tried macaroni and cheese. Mushy, right? You'd think that'd be ok, fairly easy to digest. Yeah, no. My stomach was not pleased. However, I -was- able to tolerate a Wicked Whoopie pie. :D

I have five little scars on my abdomen that will eventually fade (mostly). I've still got some swelling in the area, although that's going down now. I'm still restricted on what I can do, mostly to avoid straining the abdominal area, so things like not lifting or doing a lot of bending or twisting, and if I caught a stomach virus and started vomiting, I would have to go straight to the ER because that kind of intra-abdominal pressure could rip out everything. (And there's a really nasty virus going 'round. Lovely.)

I have to keep reminding myself that I've had major abdominal surgery, even though I -look- fine and a lot of the time I -feel- ok. I get tired incredibly easily, and if I eat the wrong food I have an amazing amount of pain in my stomach or digestive tract (I know, TMI, but isn't this whole thing, really?). I have to be careful and take care of myself, and *gasp* ask for help. None of those are things I'm good at. Gah. Well, I'm learning. Kind of. :P

Anyway. That was my Christmas vacation. ~mk

p.s. (and I could totally have summed this ENTIRE entry up into this: yeah, I had some surgery in December to pull about half of my stomach out of my chest cavity. Weird, huh?) ~mk

p.p.s. I also find it interesting that I'm apparently having surgery every two years these days. Ginormous tumor/cyst removed (along with an ovary) in 2008; endometrial ablation in 2010; paraesophageal hernia repair in 2012. Seriously, WTF? ~mk

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