Weight Loss Surgery, Pt. 2

If you made it through the first long post, major props to you!  Warning though, this post may be even longer.  However, these next few phases of my surgery journey were the most difficult and critical to where I am now.  If interested, keep reading below!


Post-Surgery:
I ended up being sent home on Sunday, February 9th.  I thought from hearing others' experiences before surgery that I'd be able to go back home on my own and be pretty self sufficient.  However, that was not the case for me and I ended up going back to my parents' house.  It felt so good to get out of the hospital, and I was thrilled to be reunited with my pup! The doctors ended up sending me home with about 10 different medications to begin/continue using. During post-op they sent us home with 3 prescriptions for post-surgery, so I honestly was not expecting to go home on so many more.  One of the hardest parts post-surgery for me was figuring out my medication regimen, as they all had different schedules and it was very difficult to keep up with. Writing it all out on scrap paper ended up being the easiest option at the time, but it still wasn't easy to maintain.  While I loved being home, I was still struggling day-to-day with fatigue and meeting protein and fluid goals.  I vividly remember feeling like my entire body was so heavy that it would take all of my energy just to lift my arms to grab the phone or TV remote.  I remember having a hard time focusing on TV shows or conversations in general.  I ended up messaging my medical team a couple days after leaving the hospital to flag how I was feeling and to note that one of my incisions appeared more open than the others after taking a shower.  My surgeon's nurse reassured me that my symptoms were not of concern at the time, and likely lingering effects of the anesthesia and medications I was on, but she gave me symptoms to watch for incase they worsened. The nausea was hands down the most difficult part of my entire recovery.  The only protein shake I could moderately tolerate was Ensure milk chocolate, but after drinking that for a day it too started to make me gag and turn my stomach at the thought of drinking more. At that time, I was lucky to get 6-8g of protein in per day, and I needed to be at 40-60g/day.  The nausea also made it increasingly difficult for me to drink clear liquids as well, as I didn't want to put anything on my stomach.  I didn't actually throw up other than the first night in the hospital, but I constantly felt like I was going to.

Post-Op ER Visits:
On February 11th, I was finally feeling pretty good at home. I was feeling so good that I even talked to mom about the possibility of having Corey to take me home after he came over for dinner that evening.  That day was honestly the first full good day I'd had since surgery, and I was feeling so encouraged. Earlier that day I messaged the dietician to see if I could try some tomato soup with Fairlife Skim Milk in an attempt to get more protein in without a shake, and they approved.  So that evening of the 11th around 7pm, while Corey and my family ate dinner, I tried some tomato soup.  One sip of that soup and the nausea came back in full force.  I immediately pushed the bowl out of the way and I had to sit at the table for a bit, trying to hold back tears I felt so defeated.  I had also tried just some plain milk, and milk with protein powder added in, which too made my stomach turn.  Shortly after that sip I had to leave the table and go to the bathroom because I thought for sure I would throw up that time.  Nothing ever came up, but when mom came in to ask if I was ok I just burst into tears and all I could do was shake my head no.  Y'all, I felt absolutely awful!  We decided then to call the Bariatric Fellow on call at the hospital to talk with them about my symptoms and determine what I needed to do.  They suggested that I come into the clinic the following day to be evaluated.  I slept ok that evening, with the help of nausea meds, and the following morning I called their office the second they opened and they were able to get me scheduled for a 10am appointment.  When you go to clinic they triage and take your vitals first, and my heart rate was really high at that time (130+). I just remember feeling incredibly weak, nauseas, and overall awful.  I was finally able to meet with one of the fellows that morning and immediately broke into tears when she asked me how I was feeling.  I described to her all of my symptoms:  achy, nauseas, on-going diarrhea, limited intake of liquids and protein, etc.  After a quick exam and taking my vitals again the fellow noted that she wanted me to get admitted back to the hospital for dehydration and to run some additional testing.  However, the hospital was on divert that day and they had no beds, so I had to go to the ER.  I was triaged in the ER within about 30-45 minutes of our arrival, and I thought for sure that was my call back, but nope...another 1-2 hour wait expected.  I had never been in the ER before and let me tell you I NEVER want to go back again.  EVER!  A little over an hour later and we got called back and got a bed in the ER. They immediately got me connected to IV fluids, ran urine and lab samples, and scheduled me for a CT scan of my abdomen to check for leaks or any other surgery complications.  While we waited for the CT results I was on at least my 2nd bag of fluids, maybe even third, and was starting to feel better.  The WLS team wanted me to try and get a full 8oz (30g of protein) bottle of ensure down.  It took me about an hour but I was able to complete that bottle - the first since surgery.  Honestly I struggled getting that protein in, but I didn't think I had a choice and forced it down.  The CT results ended up coming back clear, and because they saw improvement with getting protein in and fluids they decided to send me home that night (worst decision ever!). They also prescribed a different nausea med to try that evening since the Zofran and Phenergan were no longer knocking out my nausea completely.

The direction when I went home from the ER that day was to focus on protein and liquids, so both mom and I assumed I needed to get another bottle of ensure in that evening before bed.  So later that night I tried a bottle again and the nausea started to come back, as did the achiness.  I had to stop drinking it at that point, but got maybe half of the bottle in.  I remember being worried about the queasiness I felt that night and immediately took some more nausea meds and decided to go to bed.  Around 1am I woke up needing to use the bathroom, and the diarrhea and nausea were back in full force again.  After having diarrhea 2-3x in about 30 minutes, I went and took some more of the new nausea meds they had prescribed, and I almost immediately had to run to the bathroom and starting throwing up.  I was dry heaving more than anything, very little came up, but I felt absolutely terrible again.  It was about 2am at this point, and I knew something was wrong so I called mom's cell to wake her up and had her come to the bathroom.  We called the fellow on call again and they told us to come back to the ER immediately.  So at 2am on February 13th, mom and I grabbed our stuff and headed back to Durham Regional ER.  When we arrived that time the ER was packed, with very few seats available and filling fast.  It took over an hour to get triaged that night, and I had diarrhea at the ER four to five more times.  I was also still incredibly nauseas, but never actually threw up in the ER, though I almost wished I could to get rid of that feeling.  When we finally got triaged the nurse told us the wait for a room was 3-4 hours.  I just cried and begged her to call the fellow on call to see if they could just admit me.  We never heard back from that nurse or the fellow, so I don't know what happened with that conversation. After at least 3 hours of sitting in the ER waiting room with another man vomiting and a lady yelling about chest pain, we FINALLY got called back to a room around 6:30-7am.  It took at least another hour after that for a nurse to come in and actually put in an IV and start fluids. To say I was exhausted and feeling terrible is an understatement at that point.  The team was also worried that I may have CDiff and the nurse they gave me made me use a portable potty (aka a chair with a puke bucket attached below) to give them a stool sample in my room.  I have never been so embarrassed in my life.  That moment was just adding insult to injury.  They wouldn't even let me use a regular bathroom to pee until that test came back.  I told mom that moment was worse than having to use a hole in the ground in Africa when I was so sick.  Anyways, the nurse finally tried to give me an IV and you could tell she was so nervous and ended up sticking me but it wouldn't take.  She sent another nurse in who thankfully got an IV on the first try.  They started pushing fluids at that point and told me I was going to be admitted and they were getting a room ready for me upstairs (thank the Lord!!!!). Around 9:30am I finally got into a private room upstairs and they told us they wanted to do another upper GI X-ray to rule out any leaks or other complications the CT may have missed.  For the Upper GI X-ray you have to drink this awful chalky contrast drink while they run the scans.  I have to give major props to the X-ray technician though as she told me to go at my own pace and if I felt like I was going to be sick at all to stop.  I stayed in the hospital that night of course, and the following day the surgeon came in to let me know that all of the tests they had done came back negative and all looked good, which means they had ruled out surgery complications.  However, hearing my symptoms my surgeon was pretty sure the cause of all my issues was dehydration, a rough recovery, and a stomach virus as well.  He noted that the achiness I was feeling was not a standard symptom they see, and that he too had a stomach bug the week before.  We will never know 100% if it was a stomach bug or just an awful recovery, but he seemed pretty sure.  During my surgeon's visit that day he also recognized that the protein drinks seemed to be compounding the issues and he finally gave me the BEST news ever.  He told me to stop forcing protein and focus on hydration.  He said if I felt even a tiny bit nauseas or gagging with protein to stop immediately and go back to clear liquids. I could have hugged him in that moment y'all.  This was the BEST news I had gotten, and I immediately stopped drinking the shakes.  I was feeling much better on February 14th after tons of fluids and no protein, and was able to be released that night.

Follow Up Appointments:
After leaving the hospital on February 14th, I truly felt so much better.  No longer having to force protein made a world of difference and I was finally having multiple days in a row with no nausea. I was scheduled for a follow up visit on February 19th, and ended up seeing a different surgeon that day as mine was not in clinic.  That day I honestly felt pretty good, just still very weak.  When they took my vitals everything looked great except my heart rate which was at 122 while sitting. The surgeon that day was honestly stumped at why my heart rate was so high.  He ruled out the obvious causes like a blood clot, bowel obstruction, etc as I had no swelling in my legs, no pain, etc.  He noted at that time a slight chance it could be a pulmonary embolism (PE) but he wasn't convinced and we both agreed I'd head home and get checked again at my official 2-3 week post-op appointment the following Monday. That surgeon also approved for me to advance my post-op diet to the soft food stage early so that I could start getting some protein in.  I honestly believe my heart rate that day was due to how few calories I was getting in - I don't think my body had anything to pull on except my heart.  That night I got to start eating some scrambled eggs and praise the Lord they sat well and I felt SO good after eating them. After a great weekend with the Snyder family, I ended up going home to my apartment on February 22nd.  It felt so great to be home and I was honestly feeling really good at that point, despite the lingering fatigue.

The following week, on February 25th, I returned to clinic for my official post-op group.  My heart rate was still high that morning, despite having eaten that morning, but I continued on to the group portion of the class anyways.  I felt off during the first 30 minutes of that group, to the point I almost asked to see a doctor, but then those feelings went away and I felt good again.  The group appointments are always long and include multiple meetings with the clinical team, so I didn't get to the last section of my appointment with the surgeon until around 3-3:30pm. The PA ended up coming in first and she of course was concerned to see my heart rate so elevated and brought the surgeon in to see me.  My surgeon wasn't convinced it was a PE, but he thought maybe it was dehydration again.  They decided I should be sent to a CDU unit for observation, fluids, and labs, but they had no beds and I got admitted to the hospital...again.  Thankfully they were able to direct admit me that time, so I messaged the family to update them and figure out a plan for Jax, and drove over to the hospital.  I was pretty quickly taken to a room and the nurse quickly had the IV team come in.  I ended up needing the ultrasound team to put the IV in, which further lead them to believe it was dehydration (side note: that part was not fun, but my cute little niece FaceTimed me while they did it and acted as a great distraction!).  I honestly felt fine that time going into the hospital, but I was super frustrated that it may be dehydration as I had focused SO carefully to meet my 64oz each day and knew 100% I should not be dehydrated.  Mom and I talked and both agreed we were not leaving the hospital this time without some answers and clear direction on how to avoid another trip.  My lab work did show some low electrolyte, magnesium, and potassium levels so they continued to push fluid as well as magnesium and potassium.  I ended up getting a total of 8 bags of potassium and 2 potassium pills while in the hospital that time to get my numbers back up to where they should be. The team ruled out dehydration, but continued to push fluids anyways, which I was totally fine with! They did note that those low levels could lead to the higher heart rate, but even my surgeon still seemed stumped as to why my heart rate was so high. Due to that, mom and I insisted on seeing a cardiologist before I was sent home to be 110% sure nothing was wrong.  They ended up running an EKG that afternoon and after talking to the cardiologist they scheduled an Echo as well to rule out any issues.  The cardiologist came in and saw me later that afternoon and reassured both mom and me that she wasn't really concerned with the heart rate, especially after looking at the EKG and heart monitor reports they'd been running which both showed no issues.  She was pretty sure my body was just slowly recovering and my heart needed time to catch up to the quick weight loss I had experienced.  The cardiologist's PA even told us that really my heart rate should be up to 165 when exercising and they wouldn't be concerned until it hit like 190+ and stayed there.  However, to be safe they still ran the echo.  By the time they decided to run the echo it was too late in the day so I ended up having to stay a second night this go round.  I had the echo the following day, which came back clear, and I was discharged shortly after.  Long story short, the heart rate was concerning at first to my medical team because it could indicate an infection or other surgery complication.  We ruled ALL of those issues out, and had a cardiologist confirm my heart was healthy.  The plan from there was to continue my diet and try to get protein via food, remain hyper focused on hydration, and walk as much as I can to strengthen my heart up.

So where am I now?:
I came home on February 27th and have been at home ever since.  I'm getting stronger every single day, and slowly increasing my step count daily to help strengthen my body and heart.  I'm doing great on the soft food diet stage, and so far (knock on wood) I haven't eaten anything that my body doesn't agree with!  I have had no diarrhea or nausea since that second ER trip, and am so very VERY grateful for that!  My medical team did think it was a good idea to push my return to work date back to March 12th (originally March 5th), just to be sure I had an extra week to heal and build some strength. This journey so far has been much more difficult than I could have ever imagined.  I'm asked often if I'm glad I did this, and I don't know that I have an answer for that yet.  The mental side of this process is very difficult as I try to adjust to new food and life habits.  On the other hand though, I'm down 46 pounds from my highest weight (between Thanksgiving and Christmas), and 27 pounds of that is just since surgery.  I don't see the weight loss on my body yet, other than my feet and ankles, but it feels so good to see the number on the scale dropping and knowing this process is working. I am looking forward to my 3 month post-op class where my diet restrictions are lifted and I can eat any item my body can tolerate.  I will of course eat very small portions for the rest of my life, but right now I'm still restricted on what items I'm allowed to eat as my body finishes healing.  Overall, I'm grateful that my medical team was so thorough and did their due diligence to follow up and rule out any issues when I was not feeling well.  I'm also eternally grateful to my mom and family for all that they've done for me over the last few weeks.  I truly could not have done any of this without all of them by my side, especially mom who was with me every time I had to go into the hospital.

I know these posts were long, and honestly there is still a lot of information I haven't covered yet.  However, I hope this gives everyone a little more insight into the process I've been through.  My next post will be a FAQ guide where I'll try to answer more of the specific questions I receive frequently. Thanks for sticking through and reading all of this!