Thursday, August 25, 2011

Goodbye Gallbladder

Alison (my running buddy) & I had been diligently following Hal Higdon's 10-K training program for the novice. Well, I don't know if diligent is quite the right word - I had injured my knee during the Race for the Animals 2011 and had to take some time off from running. But, Alison was ready to complete the 10-K distance for the first time on Sunday, July 17, and I said I would gladly join her for the last 2 miles or so, to keep her motivated and get myself back in the running game. 

That morning and early afternoon, I was feeling a little nauseated, but I ignored it - I figured it would be fine. By the time Alison arrived, in the late afternoon, I was feeling a little woozy. She had already run just over 4 miles to get to my house, and I wasn't about to let her down by skipping out on a wimpy 2 miles. Alison & I keep each other motivated like that! 

The run was actually not too bad - it was lovely out, and we were keeping a nice slow-to-moderate pace. The run actually helped suppress the nausea, and it was exciting to be with Alison when she met such a big fitness goal! We got back to my place and chatted a bit before I drove Alison home. 

It was on the drive that I really began feeling sick. I thought I was going to have to pull over on the way home and throw up. Or die. I was wretched. I managed to get myself home, where I immediately collapsed on the couch and begged Adam to go get my favorite nausea remedy, Reed's Nausea Relief.

Under normal nausea conditions, this stuff is amazing. I have one of these, some water, and some saltine crackers, and I'll be feeling much better in 15-20 minutes. Not this time. I was on the couch, I was on the bathroom floor, I was kneeling over the toilet, I was walking around moaning like a woman in labor, and nothing was helping. I told Adam I thought something was wrong. 

He promptly rushed back to the store and came back with what he thought was the big guns: Pepto-Bismol. I don't like to take it, but, willing to try anything at this point, I complied. 30 minutes later, I was feeling even worse. I was sweating all over the place and was feeling real pain along with the nausea. Somehow, I managed to get myself out of running clothes and into a t-shirt & jeans before demanding Adam drive me to the ER. 

We went to Providence, which has practically been our second home this year, and I checked myself in. The ER was much less crowded than it had been on Valentine's Day, when Adam broke his arm. They took my vitals and gave me anti-nausea medication almost immediately, then sent me back to the waiting area until a room was open. It's hard to judge how long I was waiting, given the delirium that sort of pain can bring. I was  having flashbacks to an ER visit we'd made to Biloxi Regional in the summer of 2009 - I'd woke up in the middle of the night with sharp pains originating somewhere near my sternum. They told me I had heartburn, treated that, and sent me home. I was dubious then, and even more so during the intervening time period when I never ever had heartburn again. 

But, before I had time to ruminate further, I was called back into a room. It was much larger & fancier than the room we'd gotten in the ER on Valentine's Day - this one had its own bathroom, and a TV, and was at least twice the size. They asked me for urine & blood samples, then gave me an IV and immediately put some morphine in it. I was feeling a little better, although disoriented and a bit uncomfortable (I think the IV and the hospital gown had something to do with it). The doctor came in and asked to rate my pain, then poked me in various spots on my abdomen, trying to ascertain where the pain originated. He made that noncommittal hmm sound they must teach you in medical school, then left the room until the blood & urine test results were in. 

While waiting on the results, Adam & I contacted those people you immediately tell when you're in the ER - my dad, my sister, & anyone we had plans with in the next 24 hours. My dad came. The pain subsided a bit. The doctor came back and said my urine tests came back fine, but my blood tests indicated that I had an elevated white blood cell count. They were concerned that I was exhibiting early symptoms of appendicitis, so they ordered a CT scan. I'd never had one of those before, but the tech was great about explaining what she was doing while she was doing it. As she was injecting the contrast material, she warned me that I'd feel a warm tingling sensation throughout my body; I'm glad she added the part where it would feel like I had wet myself, because for a split second I was mortified that I'd peed myself! The CT Scan was done using some giant GE machine that looked rather like a plastic doughnut - I was lying on a platform that would slide me so my belly was in the doughnut hole. I'd have to breath in & out for a certain number of seconds while the machine was taking images. The tech said that often, people have trouble following the breathing instructions, but we got everything they needed the first time around. I'd like to thank my running, yoga, and singing habits for the breath control! 

I spent some more time chatting with Adam & my dad back in my ER room, feeling nervous about the results of the CT Scan. The doctor came back, and, instead of telling us what was wrong straight away, said "Well, I've reviewed your CT Scan" and then proceeded to knead my abdomen in various areas and ask me to rate how badly it hurt for several moments before ending our suspense: the elevated white blood cell count was due to an infected gallbladder; I had several stones in the gallbladder, and they weren't happy. I had what is called Acute cholecystitis, commonly referred to as a gallbladder attack. 

One of the good (or bad, depending on your viewpoint) things about Providence is that they always give you your options, even if the other options are clearly idiotic. The doctor immediately recommended that I be admitted to the hospital and scheduled for surgery as soon as possible, but also gave me the option of treating the infection with antibiotics and sending me home. I opted to be admitted, even though I was immediately overwhelmed with conflicting emotion. Maybe some of you have been a similar situation. While the gallbladder attack was some of the worst physical pain I've ever endured, including braces, I'd never had surgery. It was a scary concept. I cried a little bit, because I always cry - it's one of the traits I often wish I could change about myself. I asked my dad lots of questions about what the gallbladder does and what life would be like without it

When the ER nurse came in to check on me, I was visibly shaken. At least I got some crackers & juice out of the deal - by this time, it was 11pm, and I wasn't allowed to eat after midnight, in case I could be squeezed into the operating room schedule in the morning. Transport came and got me and took me to a rather small hospital room in 4G. 

The last time we had been at the hospital overnight, we had stayed on the 8th floor, in the orthopedic unit. Lemme tell ya, they got it nice up there--big, new rooms, armchairs that turned into a guest bed, DVD players, nice views--there was none of that in 4G. My room was tiny, the nurse had to bring Adam a cot, and while I did have a TV with cable, there was certainly no DVD player. Nevertheless, we settled in for the night - Adam went home to feed the cats and grab a few things, while I posted a status to Facebook and left a voicemail for my boss. 

A few moments after my Facebook post, I got a call from my aunt. She was making sure that I was okay, and that I had opted for the surgery. Her husband (my uncle) had his gallbladder removed earlier this year, and he had let several gallbladder attacks occur before opting for the surgery. She told me his gallbladder was gangrenous when they finally removed it. It probably looked something like this:

I certainly didn't want a gangrenous gallbladder! I felt a little better after talking to my aunt, or better enough to watch HGTV well into the night before finally drifting off to sleep, anyway. It's hard to get good sleep in the hospital (unless they've given you the good drugs, but I'd only been given antibiotics & fluids since the morphine in the ER), especially when your vitals are being monitored rather closely. 

In the morning, I met with the surgeon, Dr. Zink of Portland Surgeons, PC. She really set my mind at ease. She told me that up to 30% of people in their 20s and 30s have gallstones, but wouldn't know it - many are small and don't cause any pain. She admitted that we don't really know what causes gallstones, although there are plenty of guesses and correlations. After looking at my chart & talking to me a bit about my lifestyle, she said she thought this was most likely a hereditary issue (I know for certain that my grandmother, great-grandmother, and two aunts had their gallbladders removed, and it was very unlikely that I would have to make any dietary changes in the long run to accommodate my new digestive system. 

Dr. Zink really did a great job explaining the surgery to me - the procedure done these days is called laparoscopic cholecystectomy, and she had previously performed over two hundred of these babies. She even made me a little sketch while she was explaining everything:
The way she drew the stones makes the gallbladder look sad.
The surgery is performed under general anesthesia, during which they make four small cuts in your belly - for me, one in my belly button, one just below my sternum, and two on my right side somewhere in between. The laproscope (a thin, lighted tube) is inserted into one of the cuts, while the other instruments are inserted through the others. While they're inserting everything, they pump gas into your stomach, so the surgeon can see better. As Dr. Zink explained it to me, they make a couple snips to detach your gallbladder from the bile duct and the liver, then pull that sucker out. She did tell me that she always orders a cholangiogram during surgery - this x-ray is done to make sure they aren't snipping the bile duct and to make sure nothing else is stuck in there. Here's an awesome animated video of the procedure:

While I was waiting to find out when my surgery would be, I got a call from my uncle, who actually works at the Providence Medical Center. He wanted to make sure that I had agreed to the surgery - by the time he had called, I had already signed all the waivers, which included verbiage stating I'd allow Providence to dispose of all the left over parts. No keeping the gallstones in a jar for me, but hey, I still have a sketch! About 10 minutes after I got off the phone with my uncle, somebody from surgical transport came to fetch me. Adam & I were escorted to one of the waiting rooms on the surgery floor, which is when I started to freak out. 

It's hard to convince your limbic system that what you understand on an intellectual level means there is no cause for alarm. My blood pressure skyrocketed. I could hear the grumpy old man on the other side of the partition complaining about how cold it was and how long it was taking, and I wondered what he was in for. The very nice OR nurse tried to reassure me, saying the surgery would be a breeze! Soon enough, the anesthesiologist came in and put something in my IV to relax me. I'm not sure what it was they gave me, but I was very loopy within seconds. We were on the way to the OR, the anesthesiologist was asking me questions, and I could barely form the words to respond. I couldn't tell you now what he was asking me. 

I remember getting to the OR and thinking it looked like a storage room and felt like a fridge - on TV, you always see operating rooms as these fairly pristine, large rooms. This room was about the size of the old mailroom in my office, and there were tons of boxes stacked along the walls. Dr. Zink was putting on her scrubs. The other people in the OR moved me from the stretcher onto the operating table. They told me what they were doing, although I could barely acknowledge what I was hearing. They strapped me down at mid-calf and mid-thigh, telling me that sometimes patients have jerky legs when they're under. Then, a mask was put on my face. Maybe 30 seconds later, I heard the anesthesiologist tell me he was administering the medication that would put me under - and that was it. 

There's no fade-out when they put you under. I didn't even count backwards from ten. The next thing I was aware of, I was waking up in the post-op room and I couldn't speak - the breathing tube had really done a number on my throat. Adam told me that I was in surgery for just over an hour, but I napped for a good three hours afterwards. When I came to around 4:30pm, the nurse brought me a popsicle, both to help with my still-store throat & to see if I could eat anything. My voice wasn't right until the next day, but the popsicle certainly helped. My dad, my sister & Maria (our former roommate - she's like family) all stopped in during the evening to check up on me. I watched more HGTV and ate some rather terrible hospital food; while I was not restricted to the liquid diet menu, they did advise that I eat something light and not too fatty. The night passed without incident, unless you count the tech who woke me up at 4am to draw blood.

The next morning, Dr. Zink came to see me again, and let me know that I was going to be released. She said everyone was great, except this one little thing where there were some gallstone bits that had escaped into my main bile duct, and if I felt any, you know, excruciating pain in the next few days, that I'd need to come back to the hospital. With that reassuring send-off, I was homeward bound to begin my recuperation and eventually, my new, gallbladder-less life.

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