Complications to my Sleeve Surgery

I'M HOME! It's awesome. I laid in a bed that didn't make my butt ache, I have the comforts of home(Oh familiar, home-potty, how I've missed you.) I have my lovely recliner. All the filtered water and Ice I can drink, and no one coming to poke me with needles every 4-6 hours...

Thank you, everyone, for the well wishes and keeping the home fires burning through my incomprehensible posts(those injected pain medicines are... WOW.). Today I tried to read the first post I made and I'm like... 1 in 5 sentences makes some sense. It wasn't my birthday, no idea where that came from. Or the Biotin. I was trying to use the Speech-to-Text function on my tablet and I think I was slurring my speech. Then my eyes were so blurry I couldn't read it back. So obviously I just clicked POST.

The following is going to be a very long post. I'm sharing it because I know that I'm not the only long-time Coumadin user to have surgery, and I want the information to be on the boards in case someone searches it, so I'm going to litter it with as many keywords as I can!

This is largely about complications to sleeve(or any abdominal surgery) where there is a history of prior abdominal surgery and therefore scar tissue inside/adhesions, coupled with long-term use of anticoagulation/Coumadin therapy. Along with my personal timeline.

If it were just one issue or the other, I don't think I would've had the problems I had. I'm very thankful that Dr. Rana is such a fantastic surgeon. He told me going in that the splenectomy I had at 11 would mean there was lots of scar tissue growing about the organs in my belly. He also told me that they might have to transfuse a little blood during the procedure because of the long-term Coumadin use makes people bleed more than they should.

Explanation of Coumadin stuffs: Even though there are steps to follow to get your blood into the surgically-appropriate INR range(International Ratio: method for measuring effectiveness of anticoagulation therapy) after being on Coumadin, when someone's been on it a long time, the surgery-appropriate INR number doesn't mean a whole lot. We got me to under 1.1, which was what the protocol calls for, but past that...  there's some aspect of Coumadin use that Modern Medicine does not have a test to measure for. The surgery could still be safe, but he'd just have to be prepared for battling bleeds while in there and have blood on standby, and those two things could increase surgery time.

Explanation of Adhesions in Abdomen and Surgical Effect: When you've had previous surgery, scar tissue forms like it does with any wound. The thing is that in the belly, that scar tissue can continue to grow and spread well past the original surgery site. When they do a sleeve(or RNY, or DS, or any surgery in the vicinity...) and you have a history of abdominal surgery, the first thing they must do before even really attempting to perform whatever surgery they've gone in for is to cut the organ(s) they're working on free of the scar tissue(it's like kudzu, crawls all over the place). Once they have the scar tissue trimmed away and the organ is no longer bound by these crawling scar-vines, then they can perform the actual surgery.

So you put these things together, and even though the methods they use for cutting also cauterize at the same time to minimize blood loss in modern surgeries, there's a lot of raw tissue in my gut that could bleed. Not like an actual blood vessel pumping blood out(it would've been easy to see that, and the blood loss would've been much quicker in that case) but all this freshly cut-on material... oozing blood.

Timeline of events for me:

• Thursday morning, 7am, surgery(sleeve + hiatal hernia repair). Went well. Went faster than he thought it would. Everything looked great. 1.5 hours long, rather than the 2+ he thought it would be.
• Uneventful Recovery. Went to room. Remember very little. Slept most of the day. Pain meds and nausea meds made it all good.
• Thursday afternoon: Tried to get me up. I remember scooting to the edge of the bed, and I remember sitting up with help... and that's all I remember. I either fainted or had a small seizure... or maybe both? My mom(NurseMom) was there and she said my eyes rolled back, my back arched and my neck arched and locked, jaw locked... and I fell back into the bed. I don't remember any of this. They got me back up in the bed(proper orientation) and after about 30 seconds I started breathing normally and things calmed down, they put my CPAP on me and I stayed unconscious for a while as the frenetic blood draws began.
• Thursday evening: Woke up. Didn't remember the episode. Didn't even really remember that we'd tried to stand me up. Tried to get up and start walking, no one would let me. Bound to bed... told I fainted and that the post-surgery catheter was staying in! I was not happy but...
• Not long after, started vomiting blood. Wasn't bright red. It was more brown with red in it... so not fresh. But very scary and unpleasant. That went on for a while. Once the tummy was cleared out, it didn't happen again, so there was no active bleed in my sleeve. It was old blood probably oozing during surgery and right after.
• Hemoglobin report: Before surgery, hemoglobin was 12.0(low end of normal for a woman of childbearing years), after surgery it was 9.8. Friday morning, it had trended down to 7.2. Friday afternoon started the first transfusion of 2 units of packed red blood cells. This should've taken my hemoglobin to 9.2, but it only took it to 8.6 because of the active bleeding. The bleeding was happening in my belly, but not in my actual stomach. So most likely diffuse scar-tissue bleeding from all the scar-vine trimming.
• Saturday morning, hemoglobin 8.2. Trending down down down and by Sunday afternoon, 7.2 again. Another transfusion of 2 units packed RBC. Immediate after, hoped for 9.2 hemoglobin, but it was 8.9. Better. Not bleeding as fast, so some clotting is happening.
• By Monday morning, my doctor had booked me into an OR for the afternoon, and we watched my hemoglobin bounce around, up and down... and after many nervous hours expecting to be going back in to the OR, it was cancelled. But one reading of the blood would be 9.7, then the next 9.0... and then 9.8... and they couldn't figure out what was going on--probably some kind of anomalous lab reports, but which ones were wrong--high or low? It took waiting until they saw a upward trend in both(8.9 becoming 9.0, becoming 9.1 and 9.7 becoming 9.8... etc) before they decided it was definitely on the rise and safe to go home. My body extended the time it took to do these tests because I'm a very hard stick and I'd already been stuck so much. There were times when they'd send multiple techs and none of them couldn't get blood from me. I also had 6 IV's infiltrate during my week-long stay. Fairly certain my veins are made of tissue paper... So my body did not make things easier at all...

The end result of this bleeding is... Low in the belly where the blood has pooled? It probably would've been less painful in the end for me if they had gone back in even just to do cleanup of the area. My body will eventually absorb the blood, but blood is actually very caustic. So it is causing short-term damage while it's laying about there. Mostly that means lots of swelling and pain. It's an ordeal to pee(swollen bladder). My lower belly hurts far, far more than my incisions ever thought of hurting. And I'm so swollen that none of my underwear fits me!  

If you're a woman, during ovulation many women bleed a little from the site that the ovum is released. This is why the lower belly gets sore for a couple days after. It's a bit like that, but x50. It hurts from my bum to my belly button, and it's almost impossible to stand up without holding something with one hand to pull, and holding my belly with the other for support. I'm having to use a walker while at home just to get around, and I'm freaking GOING COMMANDO because tight underpants on that sore swollen belly? Makes the pain so much worse.  It's been a week since my surgery and I'm still about +15 pounds of bloat/swelling from day of surgery--all in the lower belly from the bleeding. It sucks even more than I can put into words!

Despite all this, I don't regret the surgery. In fact, I haven't even processed it yet that I've had the surgery. I realize that I was in the hospital, that I had to have surgery, and that my body feels REALLY BAD... but there's some kind of disconnect in there between: Ow, this hurts, I wish I hadn't been hit by that bus, and I've had the life-changing surgery I've been chasing hard for a year.

Rationally, I know it happened. I know I can only eat a tiny bit at a time. I know I'm hardly ever even slightly hungry. I know taking pills is an ordeal... and if one is not small enough and I take it, it just sits on top of my belly and dissolves and THAT sucks mightily. I'm doing the things that I should be doing--they sent me 4 oz of thinned yogurt for every meal(along with other hideous foods), and I'd save my little plastic 1oz measuring cups from pill times and measure 1 oz of yogurt at a time, and in 1.5-2hrs I could get 4 oz of thinned yogurt into me. Logically I know all these things add up to I GOT MY SURGERY YAY, but I just feel kind of disconnected from it right now. I don't feel like it's a bad thing, and I don't regret it, but I haven't started feeling excited I'd reached this first major milestone, and I really thought I would feel like that. It's more like: I had surgery. Huh.

Anyway, that's my long-long-long post. I hope it will be helpful to someone at some point. If I'd understood the extent/ramifications of the complications, I would've still had the surgery. But I also believe that patients who do the best are involved in their care and understand things that are going on/can happen to them. If I hadn't been prepared that bleeding could be a problem, I think it would've been harder on me mentally/emotionally when it became such a big problem. So, yeah, there's my motivation. Not to scare anyone off, but maybe not everyone will have such a great surgeon as I had, and will need to be attentive to their own bodies and look out for symptoms of blood loss.

I'm home now. I'm healing. I expect my enthusiasm to show up about the time I can stand up straight without whimpering or pee without taking half an hour :)

xo

Wow Darcy!  You sure are a trooper to go through all that and still have such a great attitude! I'm sorry you had such a rough time, but you're awesome for writing it up in such detail for others to learn from.

Hopefully it's all good from here on out! You're going to do great! :)

Darcy,

     Welcome home ! Your detailed, informative post will help many people. You had such a positive attitude prior to surgery, and worked hard to be as prepared as possible.  You are continuing this approach now! I have found that overcoming some challenges makes us value what we have worked so hard to accomplish even more ! I am confident that you will be a successful role model for sleevers yet to come !  Welcome to the losers bench !!!

Dang, that is a lot to go through. You continue to have an excellent attitude, even when feeling so poorly and dealing with pain issues. I hope the abdominal pain from the pooled blood improves rapidly for you. Take good care of yourself!

Just WOW!  You truly are a tough cookie!!  Love that your attitude hasn't changed.  This post will certainly help others!!  Glad you're on the mend and HOME!  Take it slow and you're be back to yourself in no time.

So glad you are home and on the mend.  Can't wait to hear 1) about your recovery 2) how you are feeling better each day (positive thoughts!) and 3) how your sleeve is amazing after you are feeling better.

Your post is a breath of fresh air.  I was so worried about you!

Tara

Thinking of you!  Thanks for keeping us updated.  I'm glad you have a mom who is a nurse and I'm glad you are finally home.  I didn't get any rest while I was in the hospital, and I'll bet you'll recover so much better in the comforts of your own home. 

I hope your surgery went well. I can't believe I missed it. And you're home already!? I'm trying not to be jealous... :)

I have been home since yesterday morning. I've got some help with my little guy while my husband is at work so I can take care of my needs (mostly walking, sleeping and sipping at this point). 

So glad to see you made to your bed!  Here's hoping you continue on a good path and have no setbacks!!