Abdominal Holocaust

Two weeks ago I underwent surgery to remove my spleen and half of my liver. Needless to say, this has dramatically affected my entire GI track, in addition to the rest of my guts. Since this blog is dedicated to everything that goes into my body (not only food), I figured it would make for an interesting post.

Please be aware of the graphic content that follows however, as it will be chock full of details that some people might find unpleasant.

A last look at my torso the night before surgery

Basically, I have been suffering from a strange pain/discomfort in my abdomen for roughly seven years. I had been to many doctors over the years in hopes of finding an answer, but even after extensive diagnostic testing and chasing hair-brained theories, nothing ever came of it. The general opinion was that "if it hasn't gotten worse all this time, then there's probably nothing wrong"... a sentiment that never quelled any of my fears or concerns.

Earlier this year though, in addition to this long-standing problem I started to notice a lot of other health issues and decided to try and run through the gamut of medical professionals again in hopes for relief. So in late March I randomly chose a new primary care doctor to see and told him about my immediate health concerns, and then mentioned the abdominal pain and the lack of a diagnosis regarding it. After hearing the details, he suggested I see a GI doctor and subsequently get a colonoscopy. Everything looked good from that end (pun intended), so then I went to get a hydrogen breath test to determine if there was any "bad bacteria" in my gut, and apparently the results were positive and I proceeded to take an extremely expensive antibiotic called Rifaximin. Of course, that had no effect and the GI finally issued some scans in addition to more blood work. An ultrasound and CT scan, and immediately followed by an MRI, revealed a cyst on my liver and spleen. Compared with the scans that I had previously had done about five years prior, the cyst on liver had more than tripled in size from 1cm to about 3.5cm in diameter, while the splenic cyst remained the same. The discovery of the cyst led my doctor to investigate the possibility that it was caused by a parasite (Echinococcosis), so I got a blood test as well as a referral to an infectious disease doctor and a liver surgeon. The first test was positive, but a second test was negative... so the data was inconclusive, but everyone was leaning towards removing just in case. My surgeon told me that the liver regenerates itself and that once a cyst exceeds 5cm in size that remove it no matter what, also that it was a "complex" cyst which puzzled him even further. With all the information at hand, I decided to go ahead and have it removed. After all, seven years is just an awfully long time to go around not having a clue what is wrong with your body.

Due to the complex nature of the procedure, it had to be open-surgery. Also, it was unsure as to whether my spleen would be removed until the surgeon opened me up to have a look. From what I was told, splenectomys are fairly common in surgery; many times people who are in car/other types of accidents will rupture their spleen and it has to be removed, which isn't a big problem because it "doesn't really do anything". But that's not entirely true, because the spleen does protect your body from three common viruses, including influenza, pneumonia and meningitis. So to prepare for that, I had to receive multiple vaccinations about a week or two prior to surgery. I also received the flu shot for the first time ever because apparently it's a good idea to have it whenever you're going to be shacking up in the hospital with a bunch of sickies for awhile. Apparently I will need to continue getting these vaccinations either every 1 or 5 years for the rest of my life... amazing.

Other than the vaccinations, I got a routine physical as well as a chest x-ray, blood work and two medications to start taking one week prior to surgery: Florastor and Albenza.

Florastor is an OTC pro-biotic that is supposed to encourage healthy bowel activity

Albenza (albendazole) is an anti-biotic used to treat the echinococcosis parasite; it was the infectious disease doctor's suggestion to treat for it even though the tests were conflicting. In the event I was infected with the parasite, and the contents of the cyst spilled into my abdominal cavity during surgery... basically I might have died.





Oh yeah, and the night before surgery of course I had to enforce a colon cleanse, which in this case involved drinking two bottle of magnesium citrate with a laxative chaser. Magnesium citrate comes in several flavors, I opted for the lemon-lime; it's like drinking the most over-sweetened, sour/bitter soda you can imagine. Luckily each bottle is only 10 oz, unlike when I had to drink a gallon of this stuff called Golytely/Trilytely for the colonoscopy prep. However in hindsight, I preferred the Golytely because it was way more effective than the mag citrate, AND tasted completely fine once I decided to mix it with Crystal Lite. But that's another story...

Checking in for surgery at St. Joseph Medical Center in Towson, MD

St. Joe's was the hospital I was born in almost exactly 29 years ago, I went to college at Towson University which is literally 2 blocks away... so I was hoping that meant that getting surgery there was a "good thing". In the prep area I was hooked up to my first IV line on the back of my left hand and put on a gown and a pair of those lovely TED stockings. I met with the anesthesiologist and my surgeon to go over some final things and then was whisked away to the operating room. In the OR, the anesthesiologist asked me to lean forward while sitting up while he prepared to insert an epidural into my back... and that was the last thing I remembered until I awoke in the recovery area.

In recovery immediately after surgery

So that photo looks like I'm still out of it, but I was just pretending to sleep while I asked my mom to take a photo of me. In fact, I was feeling pretty great as far as I remember. Surely I was drugged up beyond belief and I vaguely remember liking the nurse and asking her to come with me to the ICU. I also remember being ecstatic that I didn't wake up with the breathing tube still in.

Moved up to the MS-ICU

I guess the next thing I remember was being in the ICU which is where I would be hanging out for the next few days. As you can see here, I was hooked up to a plethora of shit:
- one IV in left hand
- one in my right wrist
- a BIG IV (CVC, or central venous catheter) in my neck
- the epidural in my back
- a tube going up my nose and into my stomach that was continuously pumping out brown "stuff"
- a drainage tube/collection ball coming out of my belly
- a catheter (for pee pee)
- a blood pressure cuff
- EKG leads
- and finally, these pulsating compression cuffs around my legs.
So yeah... there was a lot of shit going on. Needless to say, moving around was extremely cumbersome, making sure all of the 19 things didn't get unplugged in the process. There is almost no way to be comfortable in this situation.

The pain was being managed fairly well thanks to the epidural as well as a "pain pump" that I could use whenever I felt the need. They had explained exactly what drugs were going into me, but I really couldn't keep track of it. I was definitely getting Dilaudid and probably a few more morphine derived drugs, whatever it was kept me in a perpetual state of almost vertigo; my eyes simply couldn't focus on anything for longer than 2 seconds. This made responding to text messages, or reading anything for that matter, pretty much impossible.

The first hideous event post surgery happened the second day. Prior to this, I had been having problems with my breathing as well as this sensation of mucus that could not be cleared from the back of my throat (something like post-nasal drip, but different). It was mid-day and one of the nurses simply came in to check in on me, and I commented about not being able to clear my nose/throat due to the tube stuck in it, as well as the complete lack of coughing ability and energy to do so. All I remember is her trying to console me or something and repeatedly asking if "I was OK"... and then I became overly emotional, exacerbating the breathing issue even further. So there I am, freaking the fuck out because this nurse's pestering, along with my mother just sitting there staring at me, probably interjecting with statements like "I think it's all just hitting him at once" and "he has anxiety problems." I finally caught my breath enough to tell the nurse to get the hell out of there so I could calm down, and my mother asked if she could give me something to calm down. A few minutes later a guy from the respiratory department came in with a nebulizer, I guess thinking my airways were being constricted; which didn't help obviously, and they even came back to issue it again a few hours later. I'm not sure if this happened next or if it was another day, but I was finally given a dose of Ativan to chill me out... I guess it worked.

While in the ICU they pushed fluids like no one's business, I think changing out the bags 3 times a day. I'm not sure what the contents were, I assume some sort of saline/nutrient blend. A few times they came in and hooked me up to a bag of Phosphorus (?), as well as a bunch of random anti-biotics into the central IV and then a few shots of Potassium straight into my belly. I'm sure I'm forgetting more things that were shot into me; the only thing I would notice is that mildly cold feeling of this stuff surging through my neck and the faint aftertaste in my mouth, sort of similar to the sensation you get from a contrast dye before getting a CT scan or MRI.

Also, it was imperative for me to continue taking the Albenza and Florastor regularly; while the tube was still in my stomach, they would crush up the pills and mix them with water and directly inject them into my stomach... which actually wasn't weird at all. In fact, they might have used that same method for a few other things, but I don't remember.

2nd or 3rd day in the ICU, I think maybe the first time I moved from the bed to the chair

I was aware that I wouldn't be eating solid food for several days at least, so for the most part all I had was apple juice and water. But then on the 3rd day or so, a tray arrived in my room with cream of mushroom soup, sherbert, milk and some other shit... which really didn't make sense to me at all, why the hell would my first food be a heavy, dairy-based soup? At the time though I was hungry and ended up eating it, twice in fact, lunch and dinner. That proved to be the stupidest thing I could have ever done. My digestive track was no where near ready to handle anything, let alone that crap. So for the next two days I was nauseous beyond belief and could literally still taste/belch the soup for 48 hours, like it was just hanging out in the bottom of my stomach. For half of a day I begged to just vomit, but was terrified that doing so (if I was even physically able to) would rupture the incision somehow. During this period of extended nausea, I was given Zofran several times as well as Reglan, and maybe even something different. I think the drugs worked half of the time, but then it came down to me just having to force something in my stomach to get it back in check; this didn't happen until I was moved to the "regular" floor Tuesday night.

On the 3rd or 4th day I finally got to see what the incision looked like when they took the bandage off... I had no idea it was going to be that big.

Life in the ICU was horrible, but moving to a regular room wasn't exactly peachy keen either. I was a bit scared about not having the constant attention of a nurse as well as feeling the push to "get better, faster". At least I had begun to eat again, even though it was hospital food. Let's talk about hospital food...

This is the hospital menu. There's actually a decent amount of food options, including breakfast stuff, bakery items, cereals, fruit, vegetable sides, deli sandwiches, basic entrees, desserts, blah blah...

The only real problem I had was the lack of guidelines in terms of my prescribed diet. After the mushroom soup fiasco, I really didn't know what I should be eating. The only thing I remember is my surgeon coming in and maybe mentioning something about sticking with bland/soft foods... but no one explained what that meant exactly.

So here I am with this big menu, and I have no idea what I should be choosing. The only guidelines in it were for clear and full liquid diets, both of which I was apparently past anyway.

Ultimately I figured out that the operator on the phone that you talk to when you order knows what your current diet restrictions are, and will say "you can't order that"... and that's all. So I used my best judgement and for the most part just ate stuff like plain rice, toast, bagels, dry cereal, etc.

However if not knowing what you can eat isn't irritating enough, they completely fucked my orders at least twice... which is extremely aggravating when you think really hard about what you want, then wait an hour for it to come, only to find out they don't seem to care about order accuracy.

And of course, there were quite a few disgusting items from the get-go. The chicken soup tasted like it was diluted at a 1:10 ratio, angel food cake was harder than a dry scone and the jello... ::shudders:: The one thing that took my by surprise was the spaghetti and meatballs though, which was pretty good. Maybe it's because it was the first normal dish I ate, or that I was just surprised that I was allowed to eat meatballs... who knows. The other thing that helped me get along was good old Coke, which I got twice from outside sources. The "cola" that was available from the nurses' station tasted like diet sub-Shasta sugar water that had been sitting out for a week, then mixed with ice.

Besides trying to deal with the pain without the aid of an epidural or pain pump, I continued to take my two oral meds as well as working my way down to just Percoset for the pain. One of the last hideous experiences though was having the drainage tube removed. Just imagine a hold in your belly with a 6-8" tube shoved in there for about 6 days (just enough time for your body to probably start latching onto this foreign object), and then having a nurse literally rip it out. Even though I didn't look at it, it was fucking horrible and I kept visualizing it afterward. Also, it left this 1/2" HOLE in it's wake... just an open hole in your gut. Awesome.

I ended up staying in the hospital almost exactly one week, even though my bowels had not yet begun to resume activity again. When I got back home, or to my mother's house, it was another awkward and uncertain step. Mainly I was concerned with my wounds not being supervised and what I should do in terms of my diet. My doctor just said "eat whatever agrees with you", and that was not much help. All I know is that my mom's house is full of junky, processed, expired foodstuffs and that it might be pretty hard to maintain a healthy intake. As far as meds, I would take the Percoset for pain, the Florastor (which I just stopped after two days at home because I was sick of taking the stinky pills) and the Albenza, which apparently I am going to have to continue taking for another 3 months.

This was taken in the doctor's office last week, right before the staples where removed

Well, as I right this it is Sunday night, 16 days after surgery. I'm still at my mother's house recovering but don't know how much longer I will stay here. Getting the staples removed was a step in the right direction thankfully and none of the seems have burst as a result. As of 1-2 days ago, my bowels seem to be starting to work again... but that was only after enforcing a laxative regiment for the past 4-5 days, and I can't tell you how difficult and painful it is in the bathroom. That's probably my biggest concern right now along with the interior pain above the drainage entry point. But my diet is pretty much back to normal, or at least I don't see any problems with anything I'm eating; even went out for greasy ass pizza with Maciej the other day.

I'm scheduled to see the doctor again on Wednesday, just for another general follow up I guess; hopefully he'll actually have the results back from the pathology lab, too. All in all, I still kinda feel like I'm on the outside looking in on everything that's happened so far. The idea of remaining in this state for upwards of six weeks is pretty depressing, and also that I won't be able to get back to normal activity for 3 months... but of course, it's all relative as they say.

This has been quite a long-winded and probably overly strange post, but I wanted to share exactly what I've been "ingesting" for the past two weeks. I might post more updates as they occur, but hopefully the rest of this recovery will be uneventful.