Update

Yesterday's ERCP (an endoscopic procedure) went well. When I had the one on November 3, 2009, they overdid it with the anesthesia. My dad thinks that perhaps they did not take into account that I was also on a pretty healthy dosage of morphine at the time. This time, I was not on any heavy duty painkillers, and I would not let them give me any. They mentioned another possibility, but since I am allergic to non-steroidal anti-inflammatory drugs (ibuprofen, aspirin, etc.), they could not do that. Either way, I am glad I did not let them give me narcotics, because I came out from under the anesthesia just fine.

Before going under anesthesia, I did talk with my GI doctor briefly. Apparently this remaining pseudocyst is not resolving, because there is a leak in the pancreatic duct. I did ask him why the radiologist needed to talk with him so urgently, and it turns out he was just wanting an update.

I did not talk with my GI doctor after the ERCP, but he did talk to my dad. It is my understanding that I have made a lot of progress in the last six weeks. They replaced the stent in the pancreatic duct, and hopefully things will heal up this time.

It sounds like I will have a follow up with the radiologist next week. My guess is they will inject dye into the drain catheter again (better that than into my veins).

And the Other Shoe Drops

When I had my last CT scan on December 2, 2009, the radiologist who I saw that day indicated he wanted to do another one early the next week. However, for whatever reason, that did not happen. I did end up getting a lower dosage of my pain meds so I could start tapering off them, and when I went to my GI doctor's office to pick up the prescription, they set up an appointment for Wednesday, December 16, 2009.

When I saw the doctor, he told me my surgery may end up being sooner than later, and it might not just be my gallbladder that is removed. He said that they may have to remove the distal portion of my pancreas. The first thing that came to mind for me was whether or not that meant I would end up needing insulin, but he told me a person only needs part of their pancreas to regulate blood sugar.

He did a really good job of explaining stuff, but I still do not quite understand it all. The remaining pseudocyst is apparently communicating with the duodenum, which is why the drainage out of it has looked bilious. There may also be a blockage contributing to the problem. I know he placed a stent in the pancreatic duct during the last ERCP (an endoscopic procedure). If I understood correctly, it was because the duct was damaged due to the pancreatitis. However, there may be a chance the duct is not sealing up right, and that could also be causing some issues. He did indicate he wanted to do another one, so that has been scheduled for this upcoming week before Christmas (trying to get as much done before the end of the year, because my health insurance deductible and co-insurance start over on January 1). He also mentioned that even though the surgeon did not want to do surgery until the last psuedocyst resolved, he may have to go ahead and do surgery and rig it so it drained through the digestive system.

I have also been having some issues with the insertion point for the remaining drain, so I called the nurse practitioner I have dealing with. She indicated she would call in a prescription for something I could use and that she would leave a new drain bag at reception in radiology. Then she mentioned that the radiologist needed to talk with my GI doctor about something. She said something about how they probably would not schedule any procedures next week, so I told her that I had an ERCP scheduled. She indicated that the radiologist she worked for would need to talk to my GI doctor that afternoon. So, I am not sure what else is going on yet, but apparently something is.

Waiting for the Other Shoe to Drop

I know I have been really quiet lately, but the road to recovery has had a lot of obstacles. I had a CT scan on October 26, 2009 which ended up showing that the pancreatic psuedocysts they had discovered on the previous CT scan were evolving. Then I ended up going back to the ER the next morning (October 27, 2009). I felt horrible, was in pain, was throwing up, and had chills. Turns out I was reacting to abruptly stopping my pain meds. Apparently it did not occur to the hospitalist who had discharged me on October 5 that I needed to gradually reduce the dosage of pain meds I was on.

On November 3, 2009, they did the endoscopic procedure that they had tried to do previously. This is when I learned about the pseudocysts evolving and found out one was invading my liver.

They overdid it with the anesthesia. Prior to this, I had had anesthesia on four different occasions. The first time, I was not able to breathe when I came out from under the anesthesia. The second time, it was even worse. The other two times, I had a great nurse anesthetist (I specifically requested him for the second of those two procedures), and I had no problem coming out from the anesthesia. This time I did not have the problems breathing like I had the first two times. However, I felt too sedated to breathe, and it took a very conscious effort to make sure I did breathe. I also tried going to work the next day, but I was unable to function and ended up having my dad come get me after a couple of hours. My boss told me to stay home the next day, which I did. Then I ended up having a couple of drains put in on November 6, 2009.

The drains were put in by a radiologist under a sedative and local anesthetic. They did a CT scan without the dye and contrast to see the pseudocysts and figure out where to place the drains. They put one in one of the pseudocysts on my pancreas and the other was put into the one that was invading my liver.

On Veteran's Day (November 11, 2009), the surgeon informed me they could not do my gallbladder removal (scheduled for November 19, 2009) at this point, because it could kill me. He did not offer any other explanation, and frankly I was too shocked to ask. I called my GI doctor's office the next day, and they contacted the surgeon. He told them he was worried about the pseudocysts rupturing and causing peritonitis. I have had peritonitis, and frankly, pancreatitis hurts more.

Two days later (November 13, 2009), I was in for another CT scan. I had been running a fever of 102 according to my thermometer, and I was told to call if that happened. One good thing that came out of it was that they discovered the psuedocyst on the liver had resolved, so they removed the drain.

Later that night, I felt really sick and texted my stepsister. She is a nurse and her partner is a professor of nursing. My stepsister decided to come over and check my vitals and brought her partner with her. I also called my dad as a precautionary measure. I had a fever, but we determined my thermometer was not giving accurate readings, so we do not know how high it was.

I ended up going to the ER, and this time I got in right away. They decided to admit me for pain management and bowell rest, and then they discovered I had an elevated white count, so the hospitalist who took my case ordered high powered antibiotics.

Low and behold, I ended up on the same floor I had been on during the last week and a half of my previous hospital stay. At least I was not in the same room (which it turned out was right under where the helicopters landed--okay so there was an empty floor between that floor and the roof, but it did not really do much to muffle the noise).

I have to admit, I was not quite as easy going this time. I was frustrated about being sick and in pain. They did another CT scan on Monday (November 16, 2009) and discovered the other pseudocysts were getting bigger. If not for the fact that I had already had a shot of blood thinner that day, they would have put in another drain that day, so they scheduled it for the next day (November 17, 2009).

Since they did not give us a specific time, my dad ended up being at the hospital all day (on his birthday no less). My stepmother got to the hospital sometime either right before the procedure or during. I cannot remember which--my memory is a little hazy on that. I do remember asking the radiologist where he was going to put it, and he indicated it would be about the same level as the other.

However, that was not the case. It turns out he could get a the one he had thought he would not be able to get to. So I ended up with a drain inserted pretty much right below my right breast very close to the diaphragm. I was in so much pain when they got me back up to my room that I consented to the pain pump that I had refused earlier that morning.

The pain pump did little good. It was not set to deliver a consistent dosage, so I only got pain killer when I pushed the button, and it was set on a 15 minute lock out. I apparently slept for a little bit that evening, but I woke up sometime before nine, and according to the nurse assigned to me that night, I did not fall back asleep until sometime after 4:30 a.m. The syringe in the pain pump ran out early--big surprise there--that had happened to me three times during my previous stay. This time I told them to take it away. When they started it, they neglected to tell me they would have to start another IV to run my antibiotics and pepcid. However, I would not let them--I told them to stop the pain pump while the other stuff ran. That did not go over very well with the nurse I had during the day shift (we had a bit of a personality conflict the last time I had been in too). Of course they would not do it without the doctor ordering it.

The doctor ended up switching me over to a patch, which worked somewhat better, but there were times I had to ask for more painkiller.

Friday (November 20, 2009), they did another CT scan. This time they gave me some Zofram ahead of time to see if it kept me from getting sick from the dye. No such luck. About a minute after they injected it, I got sick. Getting sick put me in incredible pain, and by the time I got back upstairs, I was in so much pain, all I could do was ask for painkillers. Dad had to explain to the nurse what had happened.

The doctor ended up deciding to keep me there over the weekend, because he did not want to send me home and risk something going wrong. However, on Sunday (November 22, 2009), I had another hospitalist, and she indicated she would discharge me if Interventional Radiology okayed it. Later that afternoon, the surgeon came to see me and he indicated I was not being discharged. However, that was not the case. Apparently the hospitalist signed off on the order that morning, contingent upon Interventional Radiology's approval. Around 6:30 p.m. a nurse came in and told me I was being discharged, so I called my dad. Turns out they had gone out of town for dinner. Fortunately a couple of friends had come to visit, so they took me home.

I went back to work Wednesday (November 25, 2009) then had two days off for the holiday. I ended up staying home both Thursday and Friday, but I did go to Thanksgiving dinner at a friend's house on Saturday.

Two days ago (December 1, 2009), I had a follow up appointment with my GI doctor. They tried flushing the drain that was causing discomfort, because it was barely draining. However, the saline solution started coming back out. Oddly enough, the other one went into overdrive.

Yesterday (December 2, 2009), I had another CT Scan, and they tried injecting the dye into the catheter . Today they called me and told me they could remove the drain that was causing so much pain, but that they needed me to come in for another CT scan tomorrow. The painful drain is out, and I have already contacted my GI doctor's office about getting a lower dosage of pain patches so I can gradually stop using them.

I am really trying not to worry about what tomorrow's CT scan will find, but I feel like I am waiting for the other shoe to drop. The radiologist who looked at the CT scan yesterday apparently spent a lot of time looking at it, and there is some concern about where the catheter from the remaining drain is. I guess I will have to just wait and see.