Bowel Obstruction Update-Long

 Sorry they are so few and far between...I'm just physically worn out.

Saw my OB on Tuesday and my mom with with me.  She told the OB she is only concerned about me since the baby has everyone else concerned about her.  I asked if I could deliver vaginally and he said he thought so but would defer to the perinatologist regarding that.  He also gave me pain meds without tylenol so I wouldn't have to worry about that.  He set me up for a growth scan for today to make sure the baby was ok.  I've lost 12lbs in 2 weeks and 20lbs from my hospital discharge date.  My mom tried to convince the OB to take the baby at 36 weeks but he already told me in the hospital that if the baby is growing, they will not take her before 39 weeks.  The OB wanted me to talk to the perinatologist about my pain management since I can only eat when I take pain meds.  I can't eat too much because if I do, I throw it back up.  I am still off work because my OB said with the amount of stress my body is under trying to maintain a pregnancy with less than 1000 calories a day is too much.  He does not want me to go into labor.

At my growth scan, the baby is still measuring a week ahead of scheduled.  She is is 3lbs 8oz and is measuring in the middle of the growth chart.  When I asked about pain meds, the perinatologist disagreed that I should be on pain meds because they cause constipation.  I told him the GI has me on MOM as much as I want to prevent that.  He said my bariatric surgeon needs to correct the obstruction before I give birth. I told him that my surgeon will not do it because he does not want to risk pre-term labor on a healthy baby and the GI agreed with the surgeon.  The perinatologist said he would rather I get the obstruction fixed and not be on pain meds.  I see him again in 4 weeks.  I see my OB next week.  

I feel really frustrated because I feel that everyone is passing me around without getting any solutions.  One doctor won't do the surgery, one doctor recommends it.  One doctor says to do whatever it takes to try to eat, one doctor said no more pain meds.  I want to eat so bad, but it hurts so much when I don't take the pills.  No one is giving me any options.  I'm lactose intolerant, so I can't drink milkshakes or ice cream.  Boost and Ensure make me nauseous and I throw up.  I eat as much as I can, but I'm pretyy much hungry all day.   All they can say is "eat more", but no way how to do it.  

To top it all off, a lactation consultant called today to talk to me about the benefits of breast feeding.  When I told her about all my issues-GB, bowel obstruction, can't eat, on pain meds- she said that I really needed to try to breast feed for the good of the baby.  I know breast feeding is best, but how can you tell me after I inform you that I have an obstruction that I need to figure out how to eat 500 more calories to do so a day.  I almost broke down in tears.  She made me feel so bad because I said I didn't know if I could do it since I don't know how much more weight I will lose in the next 10 weeks, I didn't know if breast feeding would be a smart move.  

That is all for now.  I'm going to try and eat some canned peaches.  

 Of course we all know that breast feeding is best.  But it has to be best for you as well.  Don't let her her make you feel guilty.  I personally feel that if you need surgery post baby that formula will be best for all of you.  Recovery will be stressful enough but that's just my .02.  

Wow! What an ordeal! I'm so sorry you're dealing with all of this.  Don't you just wish you could have all of the docs sit around a table and come up with a single solution that is good for the baby AND you!  Have they thought about putting you on IV nutrition or doing something like that?  It sounds like expecting you to "just eat more" is a pretty unrealistic solution!  It is so hard when everyone has a different answer and they all just pass the buck on to the next doc.  I hope you get some answers (and relief) soon!

yikes!... any chance you can bring in a fresh pair of eyes so to say? to get a new look and point of view at the situation?.. worry about this first.. then breast feeding later...

I agree that worry about the breast feeding after you have the baby. But so you know, you aren't alone about the guilt. Every book and lactation consultant pushes all the great benies of BFing but someone needs to consider you as well. I know many smart adults today who had little (2 wks) or no BFing. You are not doomed to have stupid ugly sick babies because we had to feed them formula.

I am sorry you are going through such a hard time. Just try to picture holding that sweet baby in your arms to help get you through the hard times.

Its true pain meds causes constipation but pain causes stress on the baby and yourself. There is a fine line you have to dance for everyone involved.

::hugs:: I wish I could help you more.

You poor thing!!  I can't imagine how frustrated you must be feeling!!  They're passing you around because they are all afraid to make a wrong decision.... 

DO not  give a thought to the breastfeeding right now.  You have way too much on your mind.  AND do not give a thought to what the lactation consultant said and DO NOT let her make you feel bad!  It's they're job to try to get everyone to BF.  Without a doubt we know it's best, but she doesn't seem to have a full grasp on what you are going through here!!

Sounds to me like the perinatologist, the GI and the surgeon all need to have a face to face conference.  Can you ask them to do that, or at least to have a telephone conference?  Or get a 2nd Perinatologist opinion??   I can't imagine the anxiety you must feel. 

Sounds though, that despite the weight loss, baby is hanging in there like a trooper and that's great!  I wish peace of mind for you!  And truly hope the docs come up with a definitive plan of action soon!

Best wishes to you!
Linda

Maybe you could try eating/drinking a non-dairy based shake or ice cream. My husband is lactose intolerant, so I've gotten to know the non-dairy world pretty well. There's a brand of Ice Cream called So Delicious (and a premium once called Purely Decadent) that is coconut milk based (but not very coconut flavored) that tastes great.
You can also buy a coconut based milk substitute by them and Silk is now making a coconut milk as well. They taste much better than soy milk. They are lower in protein, but it does have other good things in it.

http://www.turtlemountain.com/

I also use Spiru-Tein shakes a lot, most of theirs are dairy free also and you can mix them with something other than milk. They aren't the higest protein shake out there, but they actually taste pretty decent. If you use the coconut milk to make it I will warn you it comes out extra thick, you can eat with a spoon. The chocolate, vanilla, cookies and cream, blueberry, and cappucino are all good.

http://www.spiru-tein.com/products/keyword.asp?whichPage=1&s earchVar=spiru%2Dtein&pageSize=

Start putting your foot down and insist that all three drs get together - in person or telephonically - and discuss what's best for you & the baby basedon information each of them know...not individual knowledge.  I'd also tell the lactation consultant to take a flying leap.  Right now you're just trying to get this baby here healthy and strong - while staying healthy yourself.  Breast fed or forumla fed, once the baby's here, you can decide at that time whether you're up to breast feeding or if formula will work better for your personal situation.  And if you decide to try bf...there are lactation specialists who can help at that time...and who might also be concerned for you too.  If you decide to formula feed...good for you...it's your decision. 

If your drs refuse to meet up (in person or telephonically)...find a team of drs who will.  I have no idea where you're at...but you might consider the 'Cleveland Clinic.'  They have teams of drs who do consult together for all sorts of illnesses and medical conditions - and they will give you the best advice they can.  Hopefully your insurance would cover them.  They have an online form you fill out providing all the details of your situation, including test results etc (your drs are required to provide them to you), and then they'll make an appointment for you to come in to see them.  I think they do basic stuff over the phone...not sure on that....but it's worth looking into.  I don't know if there are other clinics around who do this also...but I've heard a lot of good re the Cleveland Clinic.

Best wishes.

 Thanks for all the the support.  I had a mental breakdown last night in my husband's lap.  All cried out and feeling less stressed.

I plan on talking to my OB next week about all the conflicting medical advice I have received.  I also plan on telling him that if he agrees with the perinatologist, he needs to find a surgeon that will repair the obstruction since my bariatric surgeon and the GI consult both agree this is not the time (I called my surgeon again today and he said since the baby is healthy, he is not risking preterm labor to fix a partial obstruction).  If he can't find a doctor, then he needs to come up with plan B.  There are only 2 options: treat the obstruction, or treat the pain.  

I'm in Missouri and have an HMO, so the Cleveland Clinic isn't an option.  My mom is a nurse at the hosptial where I'm being treated, and she is wrangling everyone today to discuss my case.  My surgeon is in Kansas and does not have privilages at the Missouri hosptial, but based on our conversation today, I understand why he does not want to risk the surgery at this time.  The obstruction could fix itself after I deliver, or with risk of pre-term labor the baby could be born with a CNS deficit that she may not have had if she was allowed to gestate normally.  Also, the perinatologist has not presented a plan to find out if her lungs are mature and if not , what can be done to mature them.  If the obstruction becomes complete, or if her growth is impeded, he would then fix it.  Basically, if the perinatologist wants surgery, he needs to make sure the baby is at a level of optimal survival before he requests it.

I tried ice cream yesterday and it did not go well.  I don't like Silk or any of the other milk replacements.  I've been auditioning protein drinks for the past few days and I can't find one that doesn't make me nauseous or causes dry heaves.  

TPN is not an option per my last OB appointment because of the risk of infection from the IV.  The OB was not confortable with using an NG tube with my pouch.  He said with my body being under so much stress due to the obstruction, weight loss and pregnancy that introducing IV feedings is not the best thing.  I think it's funny that I'm not strong enough for TPN, but I'm strong enough to handle obstruction repair surgery.  

As for the lactation consultant, my husband called her today and basically broke off a piece of his mind.  He basically told her unless she's here watching me cry over only being able to eat 3 bites of french toast that she has no right to tell me to figure out how to put 500 more calories in my diet.  He said I asked for her professional opinion, not her personal one and that if she cannot separate the 2 she shouldn't be a consultant, she should be a lactation lobbyist.  She apologized to him about the "miscommunication".  I did smile with that one.

 I haven't been on for a while, but my question is, is it and actual obstruction or an intussusception. I have had 4 intussusceptions now. The 1st one at 17 weeks pregnant. For some reason when I was pregnant it wouldn't correct itself, but when I wasn't it did..possibly the uterus pressure on bowel or scar tissue?? 
Anyway, an actual obstruction means the bowel is dying or dead..that's an emergency surgery right there. BUT an intussusception would mean that there is a chance that all you need would the surgeon to pull it apart. This can be done laproscopically. It's very fast. I was told the issue to the baby would be how long you would be under during surgery and if blood gets on the uterus is causes preterm labor in many situations. Typically with and intussusception they cut that portion of the bowel out because it can happen again..BUT my surgeon said that bowel was healthy enough and he just quickly pulled it out and closed me up.. saving the baby's life.
I will be praying for you and baby. This is so scary, so painful, and so frustrating!