Tuesday, February 21, 2012

Bye Bye "Bladder" - Gall that is!


So I took a little vacation at the Hotel-Hospital last week. 6 Days to be exact, and I left with one less organ. I've got some Gall! Or had some anyway.

Apparently I had a non-functioning gallbladder. Who knew?

To be really honest, I didn't. I went to the ER on Friday afternoon with some seriously annoying back pain and chest pain that wouldn't go away. I was actually worried it was a horrible flare up of the Big S with the worst Esophageal Spasm ever!! Or worse, cardiac, which is what made me take the march to the least fun place to go on a Friday night - but I must admit, the nurse in me googled and analyzed before making the trip and something told me it was the ol' gallbladder.

Gotta admit - at some point I really didn't care what the hell it was, I just wanted it to stop. But if I am being Tina Truthful here, I was mortified that it was my gallbladder. Why you ask? Well behind the scenes in medical land, they call gallbladder disease (or the presentation of) "The Five F's"

What are the five F's that would make me feel embarrassed about walking in the ER doubled over in pain. Well I'll tell ya;  Female, Fat, Forty, Fair, and Flatulent. - Nice!!!

But, I gotta say - that is kinda me (except I would love to differ on the Fat part. Damn Steroids!!!). I had been "really" flatulent of late, I am forty, fair and female and had the telltale sign of pain between my shoulder blades (which may I add is no joke). So I was a walking Gallbladder Billboard.

First off, whenever you go the ER - if you say chest pain "anything", you get a ticket to ride. You get a wristband to front of the line and pretty much get right in. Thank goodness cuz there is nothing worse than having to wait in the ER with a bunch of sick people (no offense - lol).

Once behind the magic curtain they did your standard cardiac workup. EKG and cardiac enzymes, which thankfully both came back normal. Then we were on to the abdominal ultrasound. I was wheeled back for the ultrasound, which I never realized how tender my right upper quadrant was, until she was jabbing me with an ultrasound probe. Again - who knew. Touch where the gallbladder is and it hurts. hmm.

It took a while for the radiologist to read, but once my doctor came in holding the results - it was like paper gold. That piece of paper pretty much determined my fate. And there it was.....some wall thickening (which they took to mean inflammation) and a suspicious finding on the gallbladder of which they thought was perhaps a polyp. And that was my first class ticket to admit. I was going in. They needed to make sure the wall thickening wasn't an acute infection and needed to find out what the mass was. This could only be done by a Hida Scan and they didn't perform them at night - so admit for Saturday morning test it was. Fine - Beam me up Scotty and while you do, hit me with some morphine.

Fast Forward to nothing by mouth since admit and Saturday morning for the Hida Scan. Was ready to get it on and get it done. Scan itself is super easy - just really long. You pretty much lay there while the camera takes pictures. It is nuclear imaging, so they inject you with radio-isotopes - but you don't feel anything from them and I was told, a reaction to them is rare. So pretty much you lay there. For an hour. Hungry. While they take pictures of you non-functioning gallbladder bite the dust. Then you go back to your room. And wait...for the Hospitalist (or whomever is following you) to show up and let you into the party.

When the doc showed up, he gave me the news. My gallbladder was not working. I had a 5% ejection fraction (anything below 50% is non-functioning) and because I had a non-functioning organ in my body, it needed to come out. They still didn't know what the mass was - but it was probably a polyp, which is more confirmation it had to come out, as gallbladder polyps can be cancerous - and even if benign, they apparently can become cancerous with time - so out it goes. Now I was told I needed to hurry up and wait for the surgeon. They were going to try to schedule surgery for the next day. Good Times. So because they wanted to schedule the next day, I was once again BAN from food for surgery. Party!

Well nothing runs smoothly in a hospital when you are waiting on different docs from different departments. It's just the way it goes, so of course the surgeon didn't show up Saturday and because of that, no surgery Sunday. Starved for nothing. Surgeon did show on Sunday - gave  me the same schpeel as the other doc, but because of "The Big S" he wanted to get an EGD first to make sure the esophagus wasn't causing any of my pain or symptoms. I can respect that, very prudent. No prob. Again - NPO (nothing by mouth) for the day, as GI should be in shortly to get the EGD done and once done, surgery can be scheduled the next day. Alright - movement, forward motion - bring it on and lets get this party started. And wait...... for the GI doc to not show that day, so by 5:00 when I knew no doc was crazy enough to stay and do a scope, I begged to eat and was granted food until midnight. Ahhhhh.

So GI team showed on Monday and we got the scope scheduled and done. I had "been there - done that" before at the Mayo Clinic, but it is still anxiety producing to have a hose shoved down your throat. Choking Phobia Say What.... It's scary - but once that Fentanyl goes in, you pretty much don't care about much and once the Versed is in, you don't remember it anyway Win Win.

I tolerated the procedure just fine (as told to me by the doc) and it showed "gastritis" but nothing progressive as far as Scleroderma - which is amazing news. So Game on. Surgery on Tuesday. And you guessed it, nothing to eat again til surgery.

Day of surgery - I think I was handling it like a champ. I was cracking jokes and waiting patiently and hungrily for my chariot to arrive and take me to surgery. My husband was with me, so that helped. When I was in the OR and getting strapped (yes, strapped) to the table I was joking with the nurses that anesthesia must make me very confident cuz as I was wheeled from my Colo - I yelled "I am women hear me roar" and that is the last thing I remember, til I was waking up in recovery.

I asked the nurse how I did and she said, I did great and evidently this time - did a nice big cheerleader move with my arms and yelled YEA!! when I was awoken and wheeled from surgery. I am a pretty happy sick person, I must say!!

It takes a while for the groggy to wear off, and I hate it - so I fight it all the way. We're talkin'  Rin and Stimpy toothpick's in eyelids to keep me awake and shake off the post anesthesia grog. But I broke on free to the other side and did just fine. I did take some IV pain meds that night (which if you know me is a BIG deal, as I don't do pain meds) but I needed them. Vitals great, incisions great, labs great, everything was looking pretty good, so the hope was for discharge the next day (Wednesday) and success!! Wednesday it was....albeit, Wednesday afternoon after waiting on the docs, but after 6 days - I'll take it!

There were a few bumps along the road. I was NPO off and on for so long, my labs took a digger one day and I needed to start the IV fluids with K-Ryder (electrolyte replacement) and the surgeon said my gallbladder was badly inflammed and there were many adhesion's he needed to get through. My gallbladder had become affixed to my stomach. He almost had to revert to an open surgery, but thankfully pulled it off. Score!! That's one good Bingo!  So, other than a few minor glitches and a lot of hunger, I think it was a success. I am so grateful to be home and happy to report doing well.

The pathology report will take a week or so to come back, so I won't know what the little bugger was on my gallbladder until I see my surgeon for follow up next week. I am sure it is just fine, but I will keep you posted.

As far as The Big S and Gallbladder - well that was the big question, and delightfully, the MDs actually researched it. From what they could find, there is no correlation - which coincides with what my godspeeding googling found while waiting for surgery. Although I did find a correlation that "Acalculous" Gallbladder is found to be more acute and found more often in persons with chronic systemic disease.....so?
Acalculous gallbladder means - without stones (like mine) - so Who Knows?? Not specific to Scleroderma - but more prone to those with autoimmune disease? Possibly. If you dissect it down (like you know I do) - a low ejection fraction is a motility issue, and Scleroderma causes motility issues and is a systemic diseases. Hmm something to think about. Or not.....

For the record, though - The medical answer and consensus says, No there is no correlation between gallbladder diskinesia and Scleroderma. And if you are anything like me, once you have the disease you tend to blame EVERY ache and pain on it and dismiss it - so word to the wise. Not everything IS the Scleroderma. Sometimes it's your Gallbladder.  : - )