XPost: Not sure what to do............so sick

I'm really hoping someone can help me.  I got discharged from the hospital this morning after being admitted last week.  I had a GI bleed that they couldn't locate, but it seems to of resolved itself so no surgery yet.  I also have ulcers that I've had since May.  They have not healed at all despite Carafate 6 times a day and Protonix twice a day.  They sent me home with a PICC line because after blowing 6 veins that was the only option to get me fluids and get me rehydrated.  While in the hospital I got nausea meds every few hours and although I was still incredibly nauseous I kept clear liquids down okay for the most part. 

Since coming home I've gotten sick several times.  I actually got sick about 30 minutes afer I left the hospital and called my surgeon.  His response was "Well you didn't get sick the whole time you were in the hospital so I'm not sure what to tell you."  I didn't get sick because I was on meds every 4 hours to keep me from getting sick.  I wasn't sent home on anything for nausea.  He called me in some Phenergan, but I can't keep them down.  Fortunately I have some Phenergan suppositories from right after I had surgery.  They seemed to help some at first, but I am still stuggling.  I've kept down about 1/2 a cup of liquids today.

After him being so rude I'm scared to call about anything now.  Keeping even water down is still a struggle.  I'm staying on clear liquids until this passes, but I worry it won't pass.  How long does it take the body to get dehydrated?  What about malnourished?  I worry about the effects of not having anything substantial to eat in almost a week.  I tried to eat a little bit of pudding today with some protein powder added, but it came right up.  I vomited to the point that I was dry heaving.  I also tried to take my vitamins and I barely got them down when I got sick.  I know I'm lacking some vitamin because in the past week I went from losing no hair to losing it by the handfull.  .  

Would you call again?  Originally I was told upon admission that I would be going home on TPN feedings.  Well for whatever reason my surgeon decided against it.  I feel like at this point that is probably what I need.  My labwork looked "okay" according to my surgeon other than low potassium.  They gave me potassium through my IV during my hospital stay.  I guess since my blood work didn't show any severe deficiencies that I'm still alright, but how long can you go without food before your body starts to show signs of malnourishment?

I'm sorry this is all over the place.  I'm just really confused.  I'm so tired of being sick all the time.  I don't want TPN feedings, but if that is what it takes to get me healthy then so be it.  I just worry that my surgeon is being too conservative in his treatment and since he is 2 hours away I worry that I'm going to be really really ill by time he does something.

During the course of the day I have tried and failed to keep down popscicles, water, jello, gatorade, pedialyte (I'm desperate) and the pudding.  I can tell I'm dehydrated but nowhere near the point I was last week.  Last week I was so dehydrated my lips were cracked and bleeding, I was pale and my eyes almost looked bruised.  It was bad enough that I didn't even get triaged at the ER.  They started trying to get an IV within about 5 minutes.  I'm afraid my surgeon will make me get to that point before doing anything.

I'm to the point I'm questioning my decision to have RNY.  I did this to get healthy and I'm far from that.

 If all you are getting in as 1/2 cup of fluids I would go right to the nearest ER and at the very least get an IV.  You can go a while without food but not long at all without fluids.
I hope you feel better soon.
If your surgeon isn't taking your problems seriously I would be searching for another surgeon, or at least a PCP, to help with your follow up care.

I'm so sorry you are so sick. I think you should do something. The more dehydrated you are, the more nauseous you will feel. If you are still sick in the morning, just return to the ER or risk calling the surgeon or your primary care doctor. I hate when people are treated like this! Oh, that was such an stupid comment ..."well you didn't get sick the whole time...."Grrrrr, it makes me so angry!

What did he think, you went home and shoved your finger down your throat so you could get talked to so rudely? Sigh....I'm sorry, it just really gets me when doctors have that attitude! Please get help tomorrow, you should not be throwing up so much. A half cup is not enough.  Update us please.       Connie

I am a wee bit of a biotch, and I would call again. I would push that you had nausea and medication to deal with it while in the hospital. You need something to take from home. They make these great patches that go behind the ear, and you wear for 3 days. I dint know that it would completely meet your needs, but they would be worth trying.

The surgeon works for you. You are the customer. If you have question about nutrients, he needs to answer them. You should also have a plan, that he is a partner in.

I have heard that we can go weeks without food, but I have no scientific references to to show you.

Dehydration is nothing to mess with. With RNY we can't catch up on fluids if we get too far behind. If you seriously believe you are getting dehydrated, go to the ER. Get the help you need. Don't wait for your surgeon to approve of you going. Take care of yourself and then when you do get ahold of him, kick his ass and demand that he work with you to get a solid plan for your recovery.

I hurt for everything you are going through, I think it's a fear for a lot of people. I am sending you many prayers and lots of positive energy.

Thank you all for your responses.  I ended up calling the surgeon on call who fortunately was not my surgeon.  He's calling me in some Zofran that dissolves under my tongue to try.  I'm going to send my DH to go get it.  He said if I'm not keeping fluids down by morning I need to come in for fluids. 

I think my surgeon is just frustrated with my still being sick.  I saw him at the beginning of the month and he said that I just have to ride this out and that the ulcer will eventually heal, but until then I need to deal with.  He said he's never had a patient who's ulcer did not heal.  My surgeon is incredibly nice 95% of the time, but his comments just rubbed me the wrong way.  I just want to feel better.  I have two young children to care for and I can't do that right now.  I can barely care for myself. 

I'm frustrated with the whole situation.  I was sick enough to get sent home with a PICC line, but they can't give me nausea meds through my PICC line?  Couldn't he prescribe me to get my meds via the PICC line so that I can give my stomach a break?  I honestly feel like if I could get my meds and nutrition via IV for a week or two that my ulcer would have the chance to heal.  Eating and drinking is so painful.  I always end up vomiting afterward which can't be helpful to the healing of the ulcer.

I am sorry you are having such a hard time. I had a miserable first 8 months post op due to "intractable nausea". I regreted my surgery hourly. I had a PICC, IV fluids, TPN etc.
 
 Dehydration begets nausea begats dehydration begets electrolyte imbalance begets "why the heck did I do this to myself?".  It is a vicious cycle.

If you have only had half a cup of flds today you definitely need some IV fluids through your PICC. Have you urinated since you can home from the hospital? If not that is a definite red flag. If you have and the phenergan is helping you keep something down now, you may be able to bypass a middle of the night ER visit and wait for your doc's office to open. He can send you to an infusion center for flds.Potassium can be addressed there too.
 
If you haven't peed and still can't keep anything down with phenergan PLEASE CALL YOUR DOCTOR OR GO TO THE ER.
 
Phenergan can make you sleepy and that makes it hard to get fluids in. Ask your doc for sublingual Zofran. It is a prescription medicine and melts under the tongue.There is a generic equivilent.

If you are concerned about protein you could try some of the clear Isopure protein ready to drinks.I would not worry much about protein or vitamin supplements at this point.You need to be properly hydrated.

I know its hard to post when you feel so bad,but please let us know how you are doing.

Did you lose while on the TPN?  I'm worried about not losing while on it.  Ultimately that isn't my main concern.  I just want to be healthy again.  I'm so sick of being sick all the time.

I've peed twice since coming home.  The first time it looked clear and normal the last time it was more concentrated and a bit darker.  Fortunately the Phenergan onlly makes me dizzy if I get it in my IV.  My husband is on his way to pick up the sublingual Zofran.  I'm praying that helps.  

I am a little worried about my protein.  I haven't gotten in enough protein for about 2 weeks now.  My labs were still within normal range, but at some point they are going to go down.  I've got Syntrax Nectar which I usually love, but I'm having a hard time with it staying down. 

As above Zofran a good option, and go to the ER for fluids if you are getting behind.  Sounds to me like you need to consult a gastroenterologist.  You probably saw one preop.  If you have PPO insurance call and make an appt. if you do not have PPO insurance call your PCP and get a referral asap.  Surgeons operate.  Long term management esp of complications isn't their forte.  Don't let his bad attitude and frustration intimidate you.  Get the medical attention you need today for hydration and nausea but ultimately I believe a GI doc is more appropriate to help manage this. 

Your number one concern is hydration right nw...stop wo raying. Stop worrying abou t weight loss.. I'd be at the er t oday for fluids. Susan

I'm actually getting fluids right now as I type this.  My surgeon was in the OR all morning so I haven't seen him yet, but his PA stopped by.  I'm not sure what the next step is but it sounds like they are going to admit me again.  

It's hard not to worry about weight loss.  After all I put my body through this with the goal of losing weight.  If they offer the TPN I will do it because I think my body needs it, but in the back of my mind am I worried about not losing or even gaining while on it?  Of course.  I think that is a valid concern.