Re: Post Op recovery / to Karyn

[Guest guest]

Karyn,

The incisional hernia became evident during my third hospital stay courtesy of

the panc attacks which returned in mid July. I think it was the end of July or

beginning of August. I was using the bathroom and all of a sudden saw this fist

size bulge sticking out of my lower left abdomen - right about where my left

ovary used to be. It didn't hurt and it totally disappeared when I laid down.

My GI looked at it the next day and said it was nothing to worry about. He

didn't even bother telling me what it was. I decided on my own that it was

probably a hernia even though I really didn't even know what a hernia was. I

mean, I've heard of people having hernias, but I always thought they probably

hurt. Sure enough, when I got home and researched, it was a classic hernia. I

had my left ovary and an egg sized cyst removed in Feb 2001. The GYN said he

had a very hard time removing the ovary and cyst as they were adhered to my

intestines. He said they could have been causing all kinds of bladder, back,

and stomach problems. It was 8 days after that surgery that my health took a

major turn around. I ended up turning down the disability retirement. My panc

problems diminished to the point that the pain was mostly just an occasional

annoyance.

Anyway, when I showed the bulge to the surgeon that did my gastric bypass

(weight loss surgery) he said it definitely had to be repaired - the sooner the

better. He said as long as it could be pushed back in, it was not an emergency

situation, but it could become an emergency at any time. He said to make sure I

didn't let myself get constipated (I'm on narcotic pain med daily so that is

tough). He said if it got to the point that it could not be pushed in, I'd have

to have surgery immediately. He wanted to get my panc problems stabilized

before repairing the hernia. My GI was saying I needed surgery on my bile duct

to remove adhesions, which he believed were causing my panc problems. The

surgeon that did my bypass said he was not qualified to do surgery in the area

of the bile duct/pancreas. He said that is a tricky area and only a surgeon

with specialized experience should be allowed to go near it. He also said that

the hernia could be repaired at the same time they did surgery on the bile duct.

So, I went from August to December with the hernia getting larger. It was

causing more and more problems. I had to push it in to have a BM and even

sometimes to urinate. It occasionally burned and I had mild pain from it. I

went to a second general surgeon who said the same thing as the surgeon that did

my bypass. The hernia needs to be repaired but I needed surgery on the bile

duct and the surgery could be done at the same time but only by a surgeon with

experience in the bile duct/pancreas area. I was sent to a hepatobiliary

surgeon. He disagreed with my GI and said that if adhesions were the problem I

didn't need him as " any general surgeon " could do the surgery. He poo-poo'd the

hernia and said it was no big deal, just leave it alone. The GI, hepatobiliary

surgeon, and my internal med doc all laughed at my hubby's theory that maybe the

hernia was blocking things up and was part of the problem with my pain, nausea,

vomiting, elevated panc and liver enzymes. I was sent to a 4th surgeon who

specializes in surgery on the panc/bile duct area. The minute he felt the

hernia, he said, " I think that may be a lot of your problem right there. " He

said if I had to push it in to have a BM and I could feel and hear stuff

swishing around in it, it could be causing all kinds of problems. He said he

didn't think the GI was right about adhesions around the bile duct but he would

take a very good look since the hernia needed to be repaired ASAP. I saw him on

a Wednesday and he would have done the surgery the next day but he wanted me off

coumadin for 5 days so he did the surgery the following Monday. He said he

would not know if it was an incisional or inguinal hernia til he got in there.

He told me if it was incisional, the repair would be different and there would

be a 'great deal' more pain with the surgery. The bulging hernia did end up

being an incisional hernia. I really figured it would because one of the scars

from my laparscopic ovary/cyst removal was smack dab in the center of the

hernia. The surgeon said the hernia was even larger than it had seemed from the

outside. He also found a small inguinal hernia lower in the groin. He said it

was most likely congenital and probably not the source of any problems since it

was still rather small. He repaired both hernias. He found no adhesions at all

anywhere in the area of the pancreas/bile duct.

As for the diet, I was given a regular diet the entire time in the hospital.

Technically, I have had only 4 or 5 documented cases of acute pancreatitis.

I've also had about 5 or 6 additional episodes with significantly elevated liver

enzymes. I've had many, many more episodes with basically normal labs.

I'm not 100% sure that the surgeon thinks the episodes of elevated panc and/or

liver enzymes were caused by the hernia, but he definitely thinks many of the

episodes of pain, nausea, and vomiting were caused by the hernia. He said the

only way we will know for sure is if I quite having the episodes after the

hernia is repaired. It's only been 5 days since the hernia(s) were repaired but

so far so good.

I do still have a stent in my bile duct which was put in the end of August. I

will have an ERCP to remove the stent and also a liver biopsy on Dec 27th.

I am truly an unusual case. I rarely do things in the classic manner. I also

have systemic lupus, which throws a curve into the equation.

I do think the hernia has something to do with the whole scenario. It just

seems odd that it was after the ovary/cyst was removed in Feb 2001, that I quit

having all the panc problems. Then just a week or two after the panc problems

resurfaced in July 2002, this hernia shows its ugly face. Time will tell if it

was to blame for many of my problems.

W