Complication or coincidence?

[Evenkeel 5]

I was floating along just fine until last Thursday, which was three weeks post-op. That day I had horrible upper and lower abdominal pain all day. I had terrible gas and six bowel movements, which got looser as the day went along, ending in yellow diarrhea. Friday it was better but by day's end it was back to horrible pain and yellow diarrhea again. Middle of the night I woke up in pain so bad I thought I was going to pass out, had another bowel movement, and it eventually passed. Saturday morning I called my surgeon, was told to just do fluids that day, and if it didn't get better to go to the ER. The pain was better all day but still had a BM that evening, same thing. This morning I woke up nauseous and in pain, took my morning meds and felt gaggy just swallowing Water. A half hour later I had a similar BM and decided it was time to go the ER.

They did blood work and a contrast CT and said everything was normal. I'm supposed to be having an upper endoscopy tomorrow to check for a stricture but my surgeon (who did see me in the ER) isn't sure that's the issue with all of the symptoms that I'm having. The upper pain is on the left below my ribs, center under my sternum, and right below my ribs straight through to my back. The lower abdominal pain is crampy and all over. The upper pain comes and goes and is worse when I eat or drink, though it does happen even when I'm not. It's sharp/stabby and crampy/dull/burning. No fever or vomiting. The only pain when pressing on my abdomen is on the left side.

Does this sound familiar to anyone? I'm at my wit's end. I can't eat or drink anything at this point without massive pain and nausea. The thought of anything besides water turns my stomach. I don't know what will happen if they don't find a stricture. I hadn't even progressed much as far as diet. The day before the symptoms started I tried scrambled eggs, which sat fine in my stomach. I've been off of surgical pain meds since five days post op, was walking miles every day, had loads of energy and was doing fine. My incisions are totally healed. I'm totally stumped.

[Evenkeel 5]

For anyone interested, my endoscopy was normal. Esophagus, stomach, and upper intestine looked fine. My staple line is still healing. They took biopsies and the results should be available today or tomorrow. I called my surgeon right afterward who said to just stay with Clear liquids, that it's probably a bug and it'll pass. I asked how long I should put up with it since even drinking Water makes me gaggy and puts me in horrible pain. I was told if the pain is too much I should go to the ER. I feel like what they're telling me is that as long as I'm not actually vomiting that I'm meeting their description of "tolerating" fluids and they won't look any further.

I now haven't had anything by mouth since midnight Sunday night. I had six BMs yesterday, all brown diarrhea, and two so far today. I'm in more pain today than yesterday and am going back to the ER when my wife gets home from work in a few hours. I will be a very squeaky wheel who won't be ignored. If anything, at this point in healing I cannot afford to not be taking in fluids or Protein.

[ocgirl15 667]

The yellow BM does seem like a bug... But how scary this so soon after surgery. You did the right thing working with surgeon. Hope you feel better soon!!!

[KristenLe 5,979]

@@Evenkeel Do you still have your gallbladder? Did they check your GB and pancreas?

[Evenkeel 5]

I do have my gb. They checked both in the CT and said they were fine. My gb was also fine at my pre-op gb ultrasound. I'm not convinced, though. I have a long history of a set of the same specific reoccurring but long-lasting (four weeks plus) gb-type symptoms with varying vague diagnoses from different doctors. I've never had a HIDA scan, though. My family history is incomplete because I know nothing about my dad's side. My mom's side has no history of gallbladder issues so they look at that, the fact that I have no vomiting, and rule out gallbladder issues with normal CT scans. I also have severe GERD that is controlled by omeprazole. Complicating that, I have fibromyalgia, which several rheumatologists have said is probably secondary to another autoimmune disorder but they haven't found enough information in bloodwork to figure out what it is. I was recently told by another specialist that I likely have Ehlers-Danlos Hypermobility, something that was all ready suspected by my family doctor (who follows me for my fibro and laundry list of other issues) and myself. That can cross-type with other variants of EDS, some of which can cause issues with the digestive system, and that would also explain issues I have with my heart that my mother's side also does not have a history of. My mom's side actually has no history of any of my issues besides obesity.

Sooooooooo...yeah. I woke up Thursday feeling a million times better but continue to have issues. The bowel issues are gone but the upper pain is still there. I'm struggling to eat but can stay hydrated. I follow up with my surgeon on Wednesday. If I'm still having issues I'm going to ask for a HIDA scan if he doesn't have his own plan of action. If he has no plan of his own and refuses a scan I will be presenting myself at a higher-level medical system. I can't afford to not be able to take in enough Protein for so long.

[KristenLe 5,979]

@@Evenkeel I had several GB attacks before finally having to have emergency surgery to remove a very enlarged and infected gallbladder. I never once vomited during those attacks. I don't believe the CT scan see sludge either which could be the issue. It's common for GB issues to worsen after WLS. Hope they have some answers and you feel better soon!

[Evenkeel 5]

Thank you. Sludge is exactly what I'm suspecting and what I'm hoping would show up on a HIDA scan, along with reduced function. I'm just so sick of all this.

[Evenkeel 5]

The results of my biopsies came back. The stomach ones were normal. The intestinal ones showed "acute lymphocytic infiltrates consistent with celiac disease." My surgeon said there are a few other markers to look for to be celiac and I don't believe I've ingested any gluten in a few months. It could also indicate something else autoimmune. Now I have to see the gastroenterologist. My surgeon said to keep doing what I'm doing if it works for me. *sigh*

[jess9395 5,449]

I never had vomiting with my gallbladder. And the symptoms do sound like that. Regardless of family history the key risk factors are the F's-- fat, female, fair and fertile (child bearing years). And yeah ct scan can't see sludge.

My daughter has EDS and while I know there are digestive issues involved (and she has some) it's rarely the acute symptoms you describe.

As for celiac, you know they can't test for that when you are gluten free. And there is a simple blood test these days to look for it (my understanding is it still has to be confirmed but it's a strong indicator with this simple test.)

Have you seen a rheumatologist? They are the ones who might be able to connect the dots--celiac, EDS, autoimmune.

But the gallbladder seems like the culprit to me!

[Evenkeel 5]

I've seen rheumatologists before for other chronic pain issues but not for this. It would take forever to get into one, the last time took over six months, and I know for a fact that the ones here in town wouldn't entertain an EDS diagnosis. They'd want to send me to a geneticist and the wait list is two years long. My concern with the celiac thing is if I haven't been exposed to it for a few months, why would I be showing symptoms now? I've read many studies now where it does happen that celiac "activates" after major surgery and mimics gallbladder symptoms but the gluten component is missing. He also didn't say whether the villi were flattened. I tried cheese this weekend and confirmed that milk is an absolute no-go but it didn't cause as much of the gallbladder-y pain, just stomach and gas pain.

I wonder if the GI doc will do some allergy and gluten testing anyway. Gluten seems to be in everything, so it's possible I was exposed without knowing it. I've had a chronically elevated SED rate for a few years now, slightly so, that the last rheumy blamed on being overweight after testing for inflammatory processes came back negative (his words.) Looking at autoimmune possibilities, lupus and spondylosis seem to fit the bill looking at the big picture, with Sjogren's a distant third. I've been tested for ankylosing spondylitis in the past based on chronic pain symptoms and was negative but now I see only 30-some% of people actually carry the marker for it. All of that really doesn't matter because the first-line treatments all seem to be the same: prednisone, which I can't have because of the gastric bypass. I asked my surgeon about it when I was in the hospital since he thought it was IBS and he said no because it's a steroidal anti-inflammatory. So yeah, now it's just seeing what the GI doc has to say.

[beachlizard 18]

What was the final answer?

Sent from my iPhone using the BariatricPal App

[Evenkeel 5]

No resolution yet. I had a very frustrating visit with a gastro, who said "if it'/ not celiac then I don't know what it is." I was tested for celiac, which was negative. My follow-up is today. He did an IgA along with the celiac panel and I don't know that result. That might give an additional clue. I think the rheumatologist is my next stop, though.

[Evenkeel 5]

He suggested genetic testing for celiac even after asking if gluten-containing food caused me issues and me telling him no, and then said that even if the testing showed I carried the gene it didn't mean I had it. :/ I asked what the IgA result was, knowing that if it was normal then there was no point in doing genetic testing. When he saw it was normal he said there was no point in doing the genetic testing. *sigh* He said again he has no clue and that he could follow up again in three months if I wanted him to. I declined, and he said I could come back if needed. Basically, back to square one.

[FunkyMunkyBrat 205]

Have any of them done the HIDA scan?? I had 1 single attack of feeling like a knife being stabbed into my right side stomach that the initial pain gradually decreased through the night(I worked nights) to a dull ache that the only way I can describe it is.. Felt like I had a super irritated pea in my belly that depending how I moved would cause me more pain.. They sonogrammed my gallbladder didn't see stones so my doc diagnosed m with IB.. After a year and no better and having learned about it being possible to have infection or sludge without stones showing up in sonogram I said I wanted a HIDA scan.. My GB was functioning at 20‰.. They took it out

Munky

Edited October 20, 2016 by FunkyMunkyBrat

[Evenkeel 5]

No HIDA scan, but ultrasounds and a CT scan at different times have showed a normal gallbladder. This is more of a dull/crampy and deep pain that is either just in in the middle or all the way across under my ribcage.