surgery

As I write this, I am sitting on a long couch in a big hospital room watching my beautiful wife resting after her first good day since being admitted to the hospital last Saturday. This is her 9th (!) day in the hospital, and hopefully her last or next to last. She should be going home with me tomorrow or the next day (Wed).

The Punchline:
Julie is doing pretty well now. The boys are doing great.

The Story (the short version… trust me, this is the short version):
With direction from the Labor & Delivery dept, I took Julie to their triage unit last Saturday about 5:30pm because she was complaining of increasingly severe pain in her abdomen that she likened to a gall bladder attack (interesting because she hasn’t had a gall bladder for 17 years). The OB nurses and doctor monitored the babies and Julie, and determined she wasn’t having any contractions nor were the babies stressed, they were doing great. They sent us down to the ER where Julie finally received some serious pain shots because by then her pain was in the 10-out-of-10 range. After about 6 hours in the ER and several pain shots, they decided they would send her home with some oral pain meds and instructions to follow up with her doc on Monday, but when she threw up from the pain on the way out of the parking lot, we quickly returned to the ER where they gave her another shot and finally admitted her to the hospital at about 3am. They drugged her up pretty good and she was able to sleep a little bit (she vaguely remembers this time). In the morning, her pain returned with a vengeance, and with a fear of appendicitis and no more treatment options there, the docs decided to transport her to the main medical facility downtown for a possible MRI and followup with the perinatologists. So Julie got a 25 mile ambulance ride downtown with me following closely behind.

Now in the complication unit of the labor & delivery department, her pain was back in full force and the meds they were giving her were not working at all. She was subjected to an ultrasound looking for an inflamed, or worse, a burst appendix. They never found her appendix at all which is not too troublesome since pregnancy tends to dramatically shuffle your innards around. So, since her pain was not getting better and the docs were still very concerned about her appendix, the surgeons and the perinatologists concurred that a minimal CT scan would be necessary to determine what the problem was. We agreed. Julie drank the 48ozs of contrast needed for the procedure and got wheeled down to the CT. The radiologists cut the CT short because they immediately saw all the contrast had remained in her stomach.

Radiology, Surgical, and Perinatology Diagnosis based on the CT scan: Small Bowel Obstruction; either a complete obstruction caused by adhesions from the removal of that darn gall bladder, or an ilius (twisting) caused by a couple of twins pushing up on her bowels. Of course, this is all exacerbated by being pregnant with twins.

Surgeons’ recommendations: 1) stop all intake 2) insert NasoGastric (NG) tube to continually remove all contents from her stomach. This should relieve the compression of her stomach on her small intestine and hopefully open the obstruction. If not, surgery would be required and since she’s pregnant, surgery is major laparotomy (not the kind done with scopes, but exploratory). Sunday was a long, long day.

Julie had the NG tube in for 48 hours and removed after she was able to hold down some liquid and show that it had passed out of her stomach. Surgery had been avoided! (at least for now).

Now the problem was getting enough nutrition without forcing the issue and causing another obstruction. Julie had been on IV nutrition, vitamins, iron, and fluids (that’s four different IVs in case you were counting) since getting the tube and in order to go home, she needed to be able to ingest enough calories and protein orally. She hadn’t eaten anything since before going to the hospital in the first place. She’s had so many IVs in her arms she has track marks all up and down them and they are really irritated, she does not want to get stuck again. She has been slowly eating foods starting with liquids and progressing to solid foods, but yesterday she probably ate too much (which wasn’t actually that much at all) and she started having pretty bad pain again so today is strictly liquid. The docs won’t let her go home until she can get enough nutrition orally without any pain or nausea.

So here she is, resting with a growling stomach after a good pain free day of an all liquid diet. We think she will go home tomorrow or the next day at the latest and remain on a liquid diet for the remainder of the pregnancy. Fingers crossed that she will not have to return for IVs or the obstruction. Tanner and Tucker are doing great through all this, I don’t think they even know anything out of the ordinary is going on.

I don’t want to ever see Julie in the kind of pain she was in during this and I pray she never has to experience it again. It was miserable, scary, and very worrisome. Thank you everyone for you thoughts and prayers through all this. We truly feel blessed.

Roland, Julie, T ‘n’ T.