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Father About to Undergo Radical Surgery

13 years 5 months ago #5135 by Patricia
Wendy...remember this is the doctor who did not order the Golytely pre-op..so his surgery was with a full intestine.........He's probably impacted at this point. Pat

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13 years 5 months ago #5134 by wendy
I'm also aghast, intestinal obstructions are a real risk post op, but your father's experience sounds terrible and I'm very sorry to hear it. Sorry for him and you.

Let's hope these tactics will break up the obstruction and further surgery isn't necessary. Unless that would give immediate relief and no further pain and complications.

Good luck and please keep us posted.
Wendy

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13 years 5 months ago #5120 by Patricia
Harley....i'm just aghast..really.  The green stuff you saw was bile........his intestines backing up from the obstruction into the stomach.  The same thing happened to me l0 days after my surgery...a part of my small intestine got trapped under my ureter...they gave me some soup in the E.R. and i did a  Exorcist projectile vomit that went clear across the room.  I had to be re-opened and the intestine released.  That was the worst surgery for me to recover from...i was in the hospital 2 l/2 weeks and don't remember much of it as they drugged me beyond even my recognition.  They had never seen that happen before and as a result they are now tacking down the ureters at the hospital where i had my surgery.
 And believe it or not a lot of the doctors never think about hypokalemia....you HAVE to mention it to them.  His potassium levels need to be leveled out..otherwise he'll start having heart arythmias and all kinds of other problems.  Please advise them of all drugs he was using or is still using.  Thats very important.
 I don't think that leak is going to fix itself.  
 Is there anyway you can get a second consult on this?  A surgeon that actually does these all the time?  Time really is of the essence.  I'm so sorry you're having to see your father go thru this....I know you tried your best.  He made the decision and wouldn't let you interfere...but maybe its not to late to get the best person in there to fix the botched job. Pat

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13 years 5 months ago #5118 by harleygirl
Patricia, thanks to your sage advice, I called the doctor (why does it always have to be a weekend??!) He called back in about an hour, which is good for him, and when I described Dad's symptoms, he said to get to the ER immediately.

When we arrived, there was 1 doctor on duty and at that time he had 20 patients! Needless to say, we had a bit of a wait, but they did take us back immediately and started Dad on IV fluids. When the ER doc finally did get to us, he ordered nausea meds and an abdominal x-ray. Dad's abdomen has swelled to the size of a 9-month pregnant woman. He was in quite a bit of pain so they gave him some morphine and drew blood. His scrotum is swollen so much as to be unrecognizable. The urologist said to give it time and the fluid would reabsorb. In the meantime, my Dad has to sit on and walk this huge painful part.

The abdominal x-rays showed a bowel obstruction (which might explain why Dad hasn't had a bowel movement since last Wednesday in the hospital and then it was induced by a suppositor.) Dad's urologist finally arrived at the ER and immediately called a general surgeon in for a consult. Both agreed that they did NOT want to open him up again so soon after the 7.5 hour operation to remove the bladder and prostate. They decided to try to get the obstruction (or what they think is an obstruction) to break up with an NG tube. I never want my Dad to have to go through that again. You could hear him wretching and screaming all the way to the waiting room. When he heard he was going to have to have that awful tube again, he broke down and said he didn't think it was worth it. That was difficult to hear.

Both doctors felt a CT scan would tell them more of what they needed to know to see what was causing all my Dad's ailments, so the contrast was ordered and poured down the NG tube. He couldn't hold all that was ordered. Then the wait began. They transported us to a room where we waited for the CT contrast to stay in Dad's system the required hour before the scan. Three hours later no one had come to pick him up to take him for the scan! I had the nurse page the urologist since I had been told by the ER nurse that the contrast had a 3 hour life and I didn't want Dad to have to endure the stuff again. The doctor called radiology and someone was there to get Dad within minutes.

The CT scan showed major fluid in the abdomen and the blood work showed a massive white cell count. However, Dad never ran a fever. The urologist suspected a urine leak where he had joined the ureter to the conduit. He called it a "uronoma" or something like that. He ended up assembling a team that night around 10pm to use a scan to guide him to place a pelvic drain to drain all the fluid from the abdomen. (Yes, this is the same surgeon who forgot to order bowel prep.) For some reason, the radiologist placed the pelvic drain in Dad's buttocks in a spot right in the middle of the cheek where it really hurts to lay on it! The drain is hooked to a big bag like a night drainage bag and is draining steadily what looks like blood to me. When he was first hooked up to the NG tube on Sunday, the green acid stuff just poured out. No wonder he was feeling nauseated!

After the initial fluid was drained off, he seemed to perk up a bit and I spent the night in his room and he slept most of the night. They took more x-rays this morning and the urologist and general surgeon both said that they saw gas in the colon which was a good sign. His white cell count has also gone down due to massive antibiotics they are giving him: Zosyn and Flagyl. They aren't sure yet what the bacteria is, or if they are the haven't told me. Another x-ray is scheduled for tomorrow to determine if any progress is being made. We haven't had gas or bowel movement this time in yet.

Today they put in a PICC line and were going to take out his staples. The urologist put him back on intravenous food today. He hasn't walked since we got to the ER on Sunday. With the extra 2 bags beside his Foley night bag that they have him hooked up to all the time, walking is going to be a challenge.

He still feels lousy and lethargic and has pain from the drain in his butt cheek. It's amazing to me that he went from eatng 3 meals a day on Friday when he was dismissed from the hospital and walking the halls five times that day, to lethargic, vomiting, weak, and back in the hospital on Sunday. This is a horror story. How much more poking and prodding and tubes and stitches can one man take? Especially an 80-year old. He said to me today: "I was feeling so good before the surgery. I wish I had not had it." I don't blame him. When he leaves the hospital, the pelvic drain will go with him until it is clear. The radiologist and urologist both think that if we can get the area dry, the leak will heal itself. I pray they are right.

Sorry for the lengthy post, but a lot has happened since Sunday.

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13 years 5 months ago #5059 by Patricia
Harley...call the doctor.  Your father probably has hypokalemia due to loss of potassium from the diuretics he's using.  He needs to be diagnosed now.  All his symptoms lethargy, nausea, lack of appetite plus the use of a diuretic would cause this.
 What pills did they send him home with?  He should be on an antibiotic...a stool softener...Gas-X is safe for the gas pains....and nausea can be treated with phenergan.
 No he should not have a lot of blood at this stage...a few clots normal...
 Has he had an x-ray of his lungs to rule out any clots...how is his breathing?
 Did he have the swelling of his legs or leg in the hospital?  Did anyone do a doppler to rule out a DVT?
 Call the doctor or take him to an emergency room.     Pat

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13 years 5 months ago #5058 by harleygirl
Dad came home from the hospital yesterday after a stay of 10 days. I am not surprised that he is sleeping a lot as sleep was hard to come by in the hospital. Today he has complained of being weak and didn't walk much. He also had nausea and has no appetite.

Last night I noticed that his night drainage bag had red liquid in it that had an appearance similar to melted red popsicles. I know that this is blood, but is it normal to see blood in the night bag? There was no bleeding for the last 6 or 7 days in the hospital. Could all the movement and the trip home have stirred something up?

Also, he is having really bad gas pains and is constipated. I know walking helps the gas pains, but as I said, he really didn't feel up to a lot of walking today. Mom gave him some Milk of Magnesia and I bought some Phazyme gas relief pills but he hasn't taken them yet. He is also complaining about a sharp pain in his back when he takes a deep breath. He had this pain in the hospital and one of the doctors assigned to his case said he thought it was "musculo-skeletal pain."

I have to keep reminding myself that we are not even TWO weeks out of surgery and that Dad has to recover at his own pace. I'm just not sure what would warrant a call to the urologist. Is lethargy, weakness, nausea, no appetite, gas pains and constipation to be expected after a surgery of this magnitude? He also has a lot of swelling (edema) and is taking the same diuretic that he was before surgery. We put those tight white stockings back on him to try to help with the swelling. He just can't seem to get comfortable.

The discharge info they sent home with him had lots of blanks with no info filled in (like "if your temperature goes above ____"...with no number filled in. Nice.

What was your experience like after leaving the hospital?

Thanks.

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