CrazyCatLady

I was released home from the hospital today. Still feeling achy, sore, in pain (at times) and very very bloated in the abdomen. I am told that this...is my new life. For a while. Maybe longer. No one really knows. I was 296lbs on the day of my surgery, 277lbs on last friday, 289lbs today. My abdomen constantly feels like a waterballoon that is over filled - ascites. I am on Warfarin (Coumadin) for at least the next 6 months. My doctor drew a whole panel of blood work to check for pretty much every known genetic and disease process that could contribute to the formation of this clot. The worst part of this is not knowing when I will be able to return to feeling "normal" again. I am out of work. I had two job offers to start this past Monday; now, I have no idea if/when I will be safe to return to work again. Hospitalist said I was ok to work whenever, but when the abdominal pain hits...it takes me totally out of commission. Crying and writhing on the floor kind of pain, that dilauded IV hardly touched. I am out of money as of June 1st, have no health insurance. This is a nightmare. More updates to follow as they happen.

Still in the hospital - now am hoping to be out by Friday. Hematologist ordered a whole slew of lab work for the am, including genetic clot determinants, a variety of auto-immune disease markers (Lupus, Sjogrens, others), and some other random tests. I did not get to see the list, it was read for verification once just inside my hearing....I'll give more info when I have it. Abdominal ultrasound reveals my current PVT to be stable, which is good news, that being said, I am having rather persistant pain due to the back-pressure of blood and fluids into my spleen via the partially occluded portal vein. The surgeon that is following me had an earnest conversation this morning regarding the status of my over-pressurized spleen. Even though my spleen checks out fine now, I am still at risk for spleen infart, damage and/or death, as long as that clot exists. I have started my Coumadin, but my INR is raising at a crawl. Thank you for your continued prayers and thoughts

To answer a few questions: I have no personal or familial history of blood or clotting disorders. I do use chemical birth control (NuvaRing) to have periods - otherwise, my PCOS is severe enough that I go months without a cycle if I don't have chemical help. I have a hematologist following me while in the hospital, and basically indicated (not in so many words) that portal vein thrombi are not related to use of hormonal birth control ( which mainly effect clots in extremities), so I basically am a puzzling, fluke case. I am currently on continuous IV Heparin infusion of 1900units per hour. I started taking oral Warfarin tomorrow, and as soon as the two balance, I am will be bridged over to using just the oral Warfarin, probably for the next 6-12 months. I will need another Abdominal/pelvic CT in 3 months to ascertain the status of my clot. Thank you for your outpouring of support and prayers! Any other questions you have, I am happy to answer or I can be PMd.

To answer a few questions: I have no personal or familial history of blood or clotting disorders. I do use chemical birth control (NuvaRing) to have periods - otherwise, my PCOS is severe enough that I go months without a cycle if I don't have chemical help. I have a hematologist following me while in the hospital, and basically indicated (not in so many words) that portal vein thrombi are not related to use of hormonal birth control ( which mainly effect clots in extremities), so I basically am a puzzling, fluke case. I am currently on continuous IV Heparin infusion of 1900units per hour. I started taking oral Warfarin tomorrow, and as soon as the two balance, I am will be bridged over to using just the oral Warfarin, probably for the next 6-12 months. I will need another Abdominal/pelvic CT in 3 months to ascertain the status of my clot. Thank you for your outpouring of support and prayers! Any other questions you have, I am happy to answer or I can be PMd.

Surgeon I spoke with this morning quoted a 0.7% chance of a portal vein thrombosis complication with any gastric surgery. Always seems small and unlikely....until it happens to you >.<

Worse yet - sometimes your tastes don't change, but what your sleeve is willing to tolerate changes...I'm so glad I only purchased samples!

I'm another one that had their PCP dump them...but mine just dumped me over getting bariatric surgery period, not over going to Mexico...she called it "barbaric surgery". Awesome. The big thing, no matter which surgeon you go to and what country they practice out of...do your research. Ask those questions. Be confident in your choice...it's easier to combat superstition when you are armed with facts At the risk of sounding like a JG Wentworth commercial, I have side with Mews here...."It's your money...use it when you need it!". I'm pretty confident that you can withdraw from your 401k for medical expenditure over X amount. I have had patients come through my practice in the past year who had done just that for medical bills. May want to check with a CPA, they're usually have a pretty good knowledge base on such things. Good luck either way!

I wish I would have thought to write on here before. It would have been nice to look back at pre-op. But what is done, is done. I was sleeved on Monday, April 16 2012 by Dr Alberto Aceves in Mexicali MX. Surgery was uneventful. The first couple of days post op were normal - some gas, a blown peripheral IV...normal things. I was released to home on Thursday, April 19th....I drove myself the 4+ hours back home. Since I have been home...each day, I have felt progressively worse - physically and mentally. Today I feel like I am at my bottom. I ache all over, from neck, through my abdomen, all the way to my hips. For the first time since surgery, I have nausea. It gets better when sitting, worse when standing and almost unstoppable when walking. My first two days home, I could walk a mile without issue (I'm a nurse - I spend my entire day walking, one mile is normally insignificant.) Today...I could barely manage to make it to the soup aisle in the supermarket and back to the car without total fatigue and agony. I have a tightness behind my sternum that never seems to go away. To top it - my stomach feels like it is on the LEFT side of my upper abdomen, and it is freaking me out. The left side of my abdomen continues as firm and tender to palpation since surgery, with minimal reduction. I can't tell if these things are normal, or if I am just being paranoid/psycho patient. I have been able to consume around 1 liter of fluids daily, and minimal protein. Every shake or supplement I have attempted has ended up with me curled up in bed, in agony. It feels like a lead weight in my chest and stays that way for 2 or 3 hours after consumption. I've tried watering it down, making it hot, cold, tepid...no dairy, no chocolate, unflavored...you name it. This is the worst decision I have ever made. I don't know how I'll live through it. Rationally, I know why I did it. I am 31, and 2 months ago I was diagnosed with Coronary Artery Disease. I am a Type 2 diabetic. I have exercise-induced asthma, I am (was) hypertensive. I had tried and failed diets for almost 15 years. I had to do something. But right now, sitting here crying over a bottle of sugar free Propel that I just can't seem to get down...I feel lost.

If I listed all the ones that I HAVEN'T been able to tolerate....holy moley, this would be a long list! So far, things I can tolerate (and when I say that, I mean palatable to taste and tolerated by sleeve...most do one but not the other): Syntha-6 chocolate Dymatize Chocolate Mint

A lot comes down to surgical technique, and why the drain is left in place. Some doctors use a drain for a secondary leak testing technique involving methylblue or another orally injestable method of testing for surgical line leaks. Realistically, a drain is not something you can simply "ask" your surgeon not to use, as I have seen come up many times in posts over the last several weeks. Penrose and JP (Jackson Pratt) drains are placed for the patient's well being, protection and healing. Realistically, the body can only reabsorb around 30ml of excess Fluid from surgical sites/abcesses/etc a day...this amount varies from patient to patient. If the surgical line along your new stomach is creating a higher fluid excess than your body can safely handle, placing a drain at the time of surgical close-up is the current standard-of-practice taught by the majority of highly ranked surgeons, both in bariatrics and otherwise. Without a drain (when one should really be used), the patient risks increase changes of abcess, seroma, etc... I had a Penrose drain placed in my upper left abdominal quadrant during my sleeve surgery. I drained about 60-90cc per day that it was in, and hurt like a mofo! Once it came out...immediate relief. My particular surgeon utelized a drain for the two above mentioned purposes: To channel away surgical drainage excess, and for the purpose of checking for leakage of stomach contents with oral methylblue on the 1st day post-op. It was very gratifying to NOT see blue show up in my little drain pouch, let me tell you! YES, they are uncomfortable - but a nesesary evil. If you have more questions about specific drain types and their care, feel free to PM me (Wound Care RN - I'll break it down in plain language, this is what I do for a living )

So I did contact my Dr's office...the response was to walk more, try to get some gas out, and let them know if I spike a fever, start vomiting or develop sharp/severe abdominal pain. I made a concerted effort to get in as many fluids as I could yesterday through this am, and still can only hit 1.5liters. Much more than that and the nausea evolves from nagging to threatening. Better luck today. If I can't bump it up in the next couple hours, I'll head over to the ER for some fluids and eval.

I would like to add a thought from our dear friends at Wikipedia: "A liquid diet is also used as a torture technique." Amen. A friend of mine who is a 2 year RNY post-op said to me: "No one enjoys the liquid diet...they simply survive it. If they're lucky."

Stinky man feet...where they've been wearing the same socks for a month through horse poo..... Just my clinical assessment

I am now 9 days post op and have been experiencing something odd. I used to be able to feel my stomach as "central" in my abdomen - just under my breastbone and southward. If I drank something cold on an empty stomach, I could feel it trace all the way straight down from my esophagus. Since surgery, I have had persistent soreness (no pain - normal for post-op, I know) only in my left upper abdominal quadrant. Also, I can feel my sleeve...on my left. Almost directly under my left breast, down by a handsbreadth. When I drink, I can feel the Fluid go straight down my esophagus, then jog over to the left and congregate in my sleeve. Has anyone else experienced this? I am tempted to ask my surgeon, but don't want to be a paranoid patient, lol!

I had a friend that got stuck in a very, very long vehicle line trying to get back across the border at Tijuana - they ended up getting out of the van and using the pedestrian lane, then taking a cab to the airport so she could make her flight on time. God forbid that should happen to you...but where there's a will, there's a way!

Can I say a big factor being ignored here is comorbidities and their effect on post-op healing???? The majority of us (I won't say all - I am constantly amazed with the stories of folks getting bariatric surgery with less than BMI of 30 and no weight-related diseases...but that's the nurse in me talking ), had this surgery because we were either A) Very seriously obese, Had very serious weight-related diseases (diabetes, sleep apnea, degenerative bone changes, etc), or C) All of the above. It's a dirty thing that us fluffy folks don't like to talk about, but simply being overweight (let alone obese...or beyond) compromises our body's natural healing process in relation to surgery - especially the major invasive kinds. We become slower to heal, have higher infection rates, and significantly higher rates of things like dehissance, necrosis of tissue along surgical lines, leaks along surgical lines and generalized surgical complications. Let's then add further to that with the influence of the before-mentioned comorbidities: Diabetes slows wound healing and increases the risk of post-op complications. Sleep Apnea: ditto. I could go more into the "how" and "why"...but I don't want to go into a 3-page ramble So even with the PERFECT surgeon, the PERFECT surgical technique, the PERFECT nursing care, PERFECT patient post-op compliance....we are at higher risk for issues, simply put....because we are sick and fat. Which is why we invested in this life-saving procedure in the first place, right? I don't want anyone to think I am trying to deter people from surgery - far from it. I just believe that everyone should be well-educated before going under the knife.

I actually ended up quitting my job just before I was sleeved. Because about the time I decided I was really ready to take care of myself, I decided I deserved better than to spend the majority of my waking hours with an employer that undervalued me as an employee and as a person. It's been the best decision I ever made. Once I start feeling well enough to job hunt (hopefully this time next week, heh heh), I have the feeling I'll be more selective about where and with whom I work with.

I went to Mexico for my sleeve for a multitude of reasons. My insurance has complete and total exclusion on bariatrics of any type. I knew I would have to be self pay. When I started researching options, the only surgeons that were in my reach financially within the US were either very inexperienced or had shady reputations...and their prices did not include meds, or a variety of other fees. Additionally, I wanted my surgeon to have had many years of experience specifically with the sleeve. I found through my research that I was able to find a varied selection of Mexican surgeons that had this experience, as other countries (on aggregate) have been doing stand-alone sleeves longer than US surgeons. That is not to say that this is true for ALL US surgeons (don't flame me!), but it is distressing to see the number of US surgeons who have done a dozen or less sleeves being touted as "experienced". For me, it came down to being realistic about availability of funds combined with the surgical experience I was looking for. I had my sleeve surgery in a hospital staffed exclusively with BSN prepared RNs, with a nurse to patient ratio of 3:1. That is nearly unheard of in the US. My surgeon and his team visited me personally several times a day, both before and after my surgery. This is also virtually unheard of in the US. As a wound care nurse, I get to deal with a lot of post-op wrecks as far as bad surgical techniques, poor closures, etc. The fact that my doc did not 1, but 3 leak tests (one in the OR, a methylblue first day post op and fluorscopy 2nd day post op), and that I could only find a couple US surgeons that did the same (and they were both WAY out of my price/distance range) made a big difference to me. Being a Registered Nurse makes me a bit more than simply an "educated consumer" - I am intimately acquainted with the other side of the nurse's station, and how the politics in US hospitals and nursing can be a detriment to the patient. I know that going to Mexico may seem a little crazy. But it comes down to comfort and research. I had very strict standards that I wanted in both my surgeon and hospital facility - I was unable to find these standards in the US, so I looked elsewhere. Medical Tourism is a growing industry - can I tell you that I felt more pampered as a surgical patient abroad than I ever have when going to the local spa, a place that is supposed to be designed for pampering?? lol There are many, many stories on this board of why people have made the decision to leave country for surgery - whether to go to Mexico, India, or beyond. If you have further questions, feel free to PM me ~Asche, The Crazy Cat Lady

My mother is famous (infamous!) for saying: "Change comes from inspiration or desperation....so, which one are you?" I hated that phrase as a kid. Now I use it frequently.

Even with checking for leaks at immediate post-op, leaks can still develop due to a multitude of factors: Over eating/drinking (stretching the pouch and causing hairline leaks along suture line), necrosis of stomach tissue along surgery line, failure to properly heal....any time you have a long staple/suture/surgical line, you have these risks. Be vigilant.

Tomorrow I will be a full week post-op. As a wound care nurse, I was overly pleased that my wounds are pretty much totally healed - yay! Still a little soreness at the lap keyhole where my penrose drain was, but nothing too bad. In many ways, my recovery has gone beautifully. I was able to lean over and pick things off the floor at 4 days post op, can walk pretty well (though I'm slow), drove home 5 hours on 3rd post-op day. On the other hand....my sleeve is a tempermental tyrant (we call him Cthulu Jr.). He won't tolerate plain Water in any form - tepid, warm, cold - I get terrible cramping and bubbles, often resulting in that gut-wrenching kind of gas. My sense of smell has become hypersensitive - on the drive home, my husband opened a bag of Doritos in the car and it felt like my stomach was going to come up through my nose. It's been the only time I had really terrible nausea. My doc has me on clears until 10 days post op, and I've yet to make my Fluid goal of 60 oz a day yet - I'm lucky to hit 30oz. Even watered down, anything with sugar gives me terrible cramping diarrhea - apple juice, white grape juice, clear VitaminWater. I have attempted liquid Protein twice (once with Isopuke, once with Nectar), both times with extreme discomfort. I had 3 sips over 30 minutes, and then it sat in my abdomen like a lead weight for nearly 2 hours. Chest felt tight and I generally felt unwell. WTF? This has been such a change for me. In the past, I was the master of my stomach....even if it said "I'm full!", I would just shove more food into it! Now, I am at the mercy of this tiny abdominal tyrant who gurgles and churns constantly. It's like when my daughter was an infant, before I figured out what her different cries meant and they all sounded the same....is it hungry? Is it full? is it angry?? I can't tell! The worst is those gurgles that I have learned to identify as "Oh my God, find a bathroom...high-speed liquids coming through!". Ugh! It starts bubbling at my low abdomen and progresses in one long, writhing motion up to my esophagus...and I've got about 90 seconds to find a toilet. Sorry, probably TMI. I thought I was prepared for post-op - heck, I've taught bariatric classes! But I feel like a n00b. ~Asche, The Crazy Cat Lady

I had a bariatric patient at my last job who recommended a Protein called "About Time". It is 100% whey protein with no artificial sweeteners of any type - uses natural Stevia for sweetness. http://www.tryabouttime.com/ I have tasted one flavor, Birthday Cake, and it was pretty decent. Their website offers samples, or you can order single-use bottles off of LuckyVitamin.com to try all the flavors Hope this helps, Asche, The Crazy Cat Lady

My surgery was on Monday (April 16), and when I was released from the hospital on Thursday morning, I drove the 5 hours home to Tucson. It was doable, but man was I tired and cranky when I got home. In summary: doable, but YMMV.

Totally forgot to mention the clothes thing: I wore a set of clothes to the hospital (duh), packed a set of yoga pants (even though 2 sizes bigger than I normally wear - hurt too much to wear, just didn't get used), one set of HUGE pjs (for when I wanted to wander around and not have on a semi see-thru hospital gown) and clothes to go home in. Since I brought my husband with me, we shared one piece of luggage, which I made him carry (lololol....ahem), and he had his laptop bag for his techno junk. Just used hospital gowns while I was there, no need to lug extra that may or may not be used. Also: agree with others about not worrying too much about bringing Protein, etc. Gatorade and the like can be purchased pretty much anywhere, and those first few days post-op, your main focus is getting down those fluids, which is tough enough on it's own. Walk sip walk sip walk sip. GasX, Crystal Lite powder packs and bullion cubes/etc are about all you need. Even then, you new tummy may reject things you bring - if that happens, don't be bummed. My new equipment (I call him Cthulu...because he's an evil tyrant >.< ) has decided that it doesn't like plain Water at any temp, or the majority of crystal lite flavors. Post-op, you just have to go with what your tummy will accept, and it's tough to anticipate in advance. Sorry to ramble - sounds like you're off to a great start with your packing!

Just wanted to chime in - heating pad is a MUST. Spent my second night curled around mine like a newborn, it was the only thing that kept my sanity with all that dratted gas. Other things I was glad I brought - crystal light (cause my new tummy HATES plain Water. With a passion!), and a ton of lip balm. Wish I would have brought a powerstrip! My hubby and I are technophiles - the 4 plugins that were in our room just didn't cut it for fan, cell phone charger, heating blanket, laptop cord, alarm clock, and other sundries.