This is what an ulcer perforation looks like – dark-colored blobby masses (air and fluid) floating freely in the abdominal cavity. Those smallish masses cause a hell of a lot of a pain!
I am now one week and one day post-op, and feeling well enough to sit down and write about what happened last week.
August 1st, 2015 – 6:55am
Last Saturday morning (August 1st, 2015) began with me waking up a few minutes before my 7:00am alarm. I went to the bathroom, and came back into the bedroom at a run because then my alarm went off, and I didn’t want it to wake up Dan. Then I headed back out to the living room with the intent of turning on my laptop for some early morning work — only I never made it that far. All of a sudden my stomach, which felt kind of bloated when I had gotten up, started to really, really hurt. I was completely taken aback by the onset of such severe pain, and went back to the bathroom thinking maybe I had eaten something bad the night before – nope. I barely managed to brush my teeth and drag myself back into the bedroom when the pain really hit. At that very moment it felt exactly like intestinal hernia strangulation pain, complete with referred left shoulder pain. I scream-gasped at Dan to wake up and call for an ambulance.
August 1st, 7:30am
The EMTs — two Amish men with medical supplies and iPads — arrived, ran through the usual questions (which was really irritating at the time because I could barely talk around the pain, and I just wanted to get to an ER for help), helped me onto a gurney, loaded me into the ambulance, let Dan ride shotgun, and we left. Alyssa was still asleep, but Ryan had been awake since a few minutes past 7. Dan had already called my mom and she was on her way, and I had texted a neighbor and asked her to come over. As much pain as I was in I hated knowing Ryan was witnessing all of this – me in horrible, gasping pain; the EMTs; the gurney; the ambulance… we just reassured him over and over that I would be all right, and instructed him to stay in the house until Grandmom arrived (she arrived about 15 minutes later – in fact, she passed the ambulance I was in).
August 1st, 9:00am
Pain medication was finally administered – several doses of Dilaudid via IV. They took just the edge of my pain off, but it was enough that I could lie still and have an easier time of talking. The normal questions were asked, and Dan helped me answer them, and give the ER doctor and nurses my surgical history – gastric bypass, cholecystectomy, two small bowel resections, ulcer perforation in 2013 and hysterectomy in 2013, and intestinal hernia strangulation in May of 2015. But all the while I insisted on a CT scan to confirm what I knew by experience with this type of pain: either a strangulation or a perforation. The horrible, unrelenting abdominal pain, the severe left shoulder pain, the body-wide twitches and shudders from the severity of the pain, and an emotional sense of impending doom/death all added up to one or the other.
August 1st, 10:30am
The CT scan confirmed an ulcer perforation in the duodenum, the area of small intestine that is connected to the bottom of my stomach pouch. There were numerous, significant pockets of air and liquid all throughout my abdominal cavity. Once I was wheeled back to the ER, I was given more pain medication as well as two types of antibiotics.
August 1st, 2:30pm
I was transferred by ambulance to Hershey Medical Center, which is where I have had all of my bariatric-related surgeries. Once in their ER Dan and I were met by nurses who didn’t want to give me any additional pain medication until I told them “the story” all over again. At this point I was barely talking or moving because the pain was so horrendous; I could only lie there and gasp and cry. But I managed to lose my shit at the nurse when she and the doctor persisted – I believe my exact words were, “I’ve explained what happened to at least five people by now, and you have the CT scan images from the other ER. What part of “I have an ulcer perforation, and in excruciating pain, and will die if you don’t get me into an OR” do you not understand?”
August 1st, 3:00pm
Around this time quite possibly the stupidest doctor ever (who I later found out was one of the hospital’s fellows) came in and told me that because I didn’t “look” sick, he was simply going to admit me, have a nurse set up a PCA pump, and observe me for 24 hours and then do a repeat CT. Cue me losing my shit again and insisting on surgery and another doctor, that there’s no way waiting and seeing would do anything except kill me.
August 1st, 3:10pm
One of my bariatric surgeon’s co-surgeons did no more than walk into the room, take a glance at me and a glance at the blood pressure and heart rate monitor above me before saying he would be operating, and I’d be in the OR within an hour. At that point my blood pressure was continually around 100/55, and my heart rate had been steadily climbing from the mid-80s – it was now 115.
August 1st, 3:30pm
After a very slow, painful walk to the bathroom where Dan assisted me with just about everything, I signed anesthesia and surgery consent forms, was helped out of the rest of my clothing, was wheeled into the OR, and after answering the surgeon’s question about what they’d be doing today with “saving my life”, per my request I was quickly fitted with an oxygen mask and put out. My last memory of the OR is a nurse rubbing my shoulder while whatever was injected into my IV created a roaring sound in my head.
* * *
Dan said the surgery took about three and a half hours. As he promised he’d do his best to accomplish, my surgeon, Dr. S, was able to operate laparoscopically. Upon getting into my abdomen he found a 3mm perforated ulcer that was surrounded by approximately 25mm of necrotic (dead/dying) tissue. Bowel contents were all over my abdominal cavity, along with air pockets, and a lot of the “mess” was around my liver. Dr. S repaired the damage by grafting tissue and fat from my old stomach and wrapping it around the patched up area of my new stomach. He also did a thorough abdominal wash-out four times.
August 1st, sometime after 8:00pm
My first post-op memory is of being in recovery, waking up to pain so horrible all I could do was nod frantically when a nurse asked if I was pain. She told me she would give me something for pain, and then I was back out.
A little while later I was in my hospital room, and that’s when I really started to come to, which was unfortunate for me, because oh my god, the pain. The best way I can describe it is by letting you know that the pain I have now, eight days out from surgery, is normally the pain I wake up to right after surgery. That’s how bad the initial pain was. My abdomen felt swollen, tight, and full of lava. And my left shoulder still hurt.
* * *
I was in the hospital for five days. I went into surgery with an IV in my left inner arm. I came out of surgery with an IV in my right hand, an IV in my right foot, a PCA pump (first Dilaudid, then switched to morphine on Monday afternoon), oxygen, heart monitor, catheter, compression boots, a JP drain (tube shoved into my abdominal cavity to help drain out fluid), and a feeding tube. Needless to say, with cords and wires everywhere, I couldn’t have moved even if the pain was tolerable enough to allow me to.
Even with hitting the pain pump button every couple of minutes (it dispensed every four minutes), I still needed more pain medication for what was called “breakthrough pain”, but was really pain that was just so terrible and constant that even a damn PCA pump wasn’t enough to bring it down. My surgeon switched me from Dilaudid to Morphine in the hopes that the Morphine might work better, but I was still receiving Morphine injections directly into my IV to bring extra relief.
I wasn’t allowed out of bed until Tuesday. On one hand I was relieved: walking with that kind of pain would have been pretty awful; and I couldn’t imagine being able to walk with that awful pain and all of those damn cords and wires. But with the promise of removing the catheter and the IV in my foot, I agreed to walk. So both were accomplished. Walking was indeed painful, but it was nice to get rid of an IV as well as the catheter. I needed help getting out of and into bed, and I just about needed help in the bathroom, too. Besides pain, all of the IVs attached to the IV pump I had to drag along made things a little tricky. And, once the feeds began, I had another tube — a short one, at that — to worry about. And then there was the drain and its tube to worry about.
And yes, I said feeds. My surgeon warned me before surgery that I would most likely wake up with a feeding tube and a drain, and he came through with those promises. But here’s where it gets a little more interesting: the feeding tube was inserted through my abdominal wall into my old stomach, with the plan being that I would receive nutrients via the feeding tube to 4-6 weeks while my stomach pouch healed. But on Sunday evening I was allowed to suck on a few ice chips. On Monday I moved to sips of water. And on Tuesday I received my first “meal”: a bariatric stage 1 meal tray, which consisted of plain chicken broth, strawberry jello, and a caramel-flavored high protein drink. I had three teaspoons of the first, a bite of the second, and two sips of the third. These stage 1 meals continued throughout the week, along with the nutritional “feed” into the feeding tube into my stomach.
On Wednesday morning the PCA pump was removed and I was switched first to 4mg of Dilaudid every four hours, then 10mg of Percocet every four hours, then 10mg of liquid Vicodin every four hours; but when I was still sobbing with pain and begging for relief my regular bariatric surgeon, Dr. R, came in and first removed the JP drain (both icky and slightly painful, but a very quick process that was over almost as soon as it began), and then increased the pain medication to 10mg of Percocet every two hours, with breakthrough medication administered via IV as needed.
I was discharged on Thursday evening with three weeks worth of extended release morphine, one week worth of Percocet for breakthrough pain, two weeks of once-daily blood thinner injections, more Protonix (prescription-strength proton pump inhibitor), and feeding tube supplies. Even though I wound up not needing the feeding tube like Dr. S feared I would, it must remain in place for a minimum of four weeks so that an adequate amount of granulated tissue grows around it – otherwise, if it’s removed too soon, I’ll wind up with a slow-healing wound that leads directly to my stomach, and/or a fistula. Both would be pretty nasty to have to deal with.
* * *
I’m now one week and one day post-op, and I’m still in a lot of pain – and I’m sure that a lot of the pain comes from the feeding tube. In the hospital it had to be opened early to drain out a lot of fluid and bile that had built up and was causing a lot of painful pressure. And, having both stomachs operated on as well as the top part of my small intestine doesn’t help. All of that together, combined with just having another abdominal surgery (strangulated intestinal hernia) on May 11th add up to a very, very miserable Jenn. I can barely get around. I’m just now getting in and out of bed on my own. My mom and 17 year old brother have been at our house since last Saturday morning. My mom is helping Dan take care of me, and she has been flushing my feeding tube (it sounds gross and is a bit squicky but it really doesn’t hurt – it simple involves slowly squirting 20ccs of water into the tube in order to keep it clean and free of clogs) and changing the bandaging around it (the incision around the tube oozes, and it’s fucking gross). She and Dan have taken turns with cooking and cleaning, and have been directing the kids and my brother with household chores. A household never realizes how much the mother does until suddenly the mother is down for the count…
Besides my mom helping me with keeping my feeding tube clean, I also have a visiting home nurse. Her first visit was on Friday, where she did a general assessment and figured out what needed to be done and what supplies to bring next time. She comes again tomorrow, and will probably come one more time this week, then once weekly until I’m able to get the tube removed (most likely during the first week of September, and most likely under sedation/during an EGD to check on my ulcers THANK FUCKING GOD).
* * *
I need to have Dan or my mom pick up one of those stupid coin batteries for my scale, because I’m very interested in seeing how much weight I’ve lost with this whole debacle. Last time, in 2013, I lost 12 pounds after having pneumonia, then an ulcer perforation, and then a four day hospital stay. This time around I didn’t have pneumonia, but I did have a six day hospital stay, and much stricter orders on food (I’m basically working my way up from liquids to soft solids to solids to meats, and I’m taking things very, very slow; and I’m eating very, very little – the last thing I want to do is throw up!).
* * *
So the big question here is what the fuck happened? How did I go from a completely healed ulcer in May of 2015 to a 3mm perforated ulcer surrounded by 25mm of necrotic tissue just eleven weeks later? The only non-mystery about that is the necrotic tissue: what may have saved me from a week or more of pain that built up and possibly an ER visit that turned up nothing was being on a strong dose of Clindamycin for the dog leash wound on my right ankle (go figure that the wound has healed up entirely, and all that’s left now is a scar).
I think I know what happened, and because I am going to be getting the opinion of a medical malpractice lawyer I won’t say much except this: several doctors insisted on Torodal injections and one insisted on both an injection and a high-dose prescription of Prednisone for my shoulder and back despite knowing my history with gastric bypass, a previously perforated ulcer, and active ulcers. Torodal is essentially NSAIDs on steroids on rocket fuel, so I can only imagine the damage several of them in quick succession did to my poor stomach pouch. I consider myself very, very lucky to have escaped with “just” coming close to dying but not actually dying, scaring my family half to death, a very painful surgery, a six day hospital stay, and a fucking feeding tube.
I was released from the hospital on Thursday evening, but even though I am tolerating fluids and food by mouth just fine, I’m stuck with this super-painful, super-gross feeding tube for at least another three full weeks. And this surgery, because the perforation was so bad, and because so much was operated on (BOTH stomachs, top part of small intestine, and abdominal muscle wall), and because I just had abdominal surgery 11 weeks ago, is easily the worst I’ve ever had. The pain I’ve usually woken up to in post-op is the pain I’m just now stepping down to. I’m now a week post-op and I am still utterly miserable and nearly crippled with post-op pain, especially in the area where the feeding tube was inserted and stitched into the muscle.
I’ll write more tomorrow, and need to gather my thoughts and paperwork and get in touch with a lawyer (I went from no ulcers on May 11th to a 3mm perforated ulcer on August 1st, and the only thing that changed were several doctors insisting on Torodal injections for my back and shoulder — while promising that they would not cause stomach irritation, and knowing my history with gastric bypass surgery, a previous ulcer perforation (2013), and problems with 1-2 active ulcers up until this past winter), but for now I’ll leave you with a picture Dan took of me and Alyssa’s beloved Ender (she left him with me for company) on the 3rd (two days after surgery):
You probably have seen many people wearing gold or silver charm bracelets and perhaps you have one of these items of jewellery yourself, but have you ever wondered where they come from and what the origins of this trend are? The history of charm bracelets dates back further than you might think. In fact, charm bracelets are not just a recent invention – they have been around for thousands of years and they are one of the most long lasting and important styles of jewellery. So let’s take a look at the origins of this type of jewellery and learn more about its history.
Charm Bracelets Date Back to the Origins of Mankind
If you have a beautiful gold or silver charm bracelet that you like to wear, you are carrying on a long tradition that has been part of culture since prehistoric times. Early people started to wear charms because they represented magic, offered protection, had spiritual significance or symbolised love. If you look back in history all the way to the Stone Age, people had begun to make jewellery from clay, shells and animal bones.
We have found evidence of people making charms that dates back a long time, such as some shell artefacts from 75,000 years ago that were found in Africa and some intricately carved ivory figurines in south-western Germany made from mammoth tusks that date back to over 30,000 years ago. These were the very first examples of mankind wearing charms.
Bronze Age Changed Jewellery Making
As technology evolved during the Bronze Age, jewellery making became a much more sophisticated process. The early charms were made from rock crystal, lapis lazuli and other semi-precious gems. They were sometimes inscribed with designs and they were thought to have special powers. It was the Babylonians who started to wear charms on bracelets, in around 700 BC.
In ancient Egypt charms were believed to have the power to scare away evil spirits, enhance fertility, protect people in the afterlife and bring good luck. In the Middle Ages knights would wear charms and amulets in order to protect themselves in battle. They would also be displayed as symbols of political standing, family origin and profession.
Charm Jewellery in the 20th Century
In the early 20th century Queen Victoria made charms very trendy and they started to become a popular style of decorative fashion jewellery. Many people would wear glass beads, small lockets and family crests on their bracelets.
It was the Industrial Revolution that really changed the way that jewellery was made. The machines that were invented during this time allowed jewellery to be manufactured on a larger scale, rather than made by hand one at a time. This made charms and other jewellery more affordable for the average person. That meant that more and more people owned charms and this jewellery trend grew even more.
In the World War II era the charm bracelet became an extremely popular fashion trend and soldiers would bring home charms as souvenirs for their sweethearts from the European cities that they were stationed in. The trend of the charm bracelet continued into the 1950s when screen icons such as Joan Crawford and Elizabeth Taylor wore charm bracelets in their movies. Many women wanted to follow in their style footsteps and wear charm bracelets as well, so they started to buy this type of jewellery in large quantities.
The Modern Charm Bracelet
Charm bracelets became even more popular in the 1990s, as the general economic boom meant that more women could start collecting jewellery and accessories. Charm bracelets are still popular to this day and they are worn by women all over the world. Whether you are looking for inexpensive charms, bohemian jewellery or high end luxurious bracelets made from gold or silver, there is a charm bracelet out there for everyone. These days’ charms are used to represent what is important and meaningful to the wearer, such as family, friends, loved ones, children, pets, hobbies, religion and other aspects of life.
Since charms and charm bracelets have been around for this long, they are sure to remain popular for a very long time. Why not treat yourself to a charm bracelet so that you can take part in this fashion trend that dates back to the beginning of mankind? Take a look at the great range of charms available online and find the perfect one to suit your personal style.
Status report as best as I can recall: The pain started at 7am at a 10 and stayed at a 10 until I went into surgery at 6pm. 3mm perforated ulcer w/ necrosis for a total damaged area of 25mm. Significant air pockets all throughout abdominal cavity. Three hour laparoscopic surgery. I woke up with two IVs, a Dilaudid PCA pump, a catheter, a drain, and a feeding tube. I will be in the hospital for at least a week.