Gastroparesis Surgery- Pyloromyotomy

I had a surgery done on my stomach last week (6/22) to hopefully help my gastroparesis. Gastroparesis is a condition that causes the stomach to not empty fast enough. For me my stomach empties at 50% the speed of someone with "normal" digestion. Now it is important to note that some have better or worse gastric emptying scans and those numbers do not necessarily coordinate with symptoms.

I had had a botox injection into the pylorus muscle, which is the muscle that forms the sphincter between your stomach and intestines, back at the beginning of may. This test allowed us to see if I had symptom reduction by relaxing the pylorus. The botox injection helped me greatly, but it is only a temporary solution (normally 8-12 weeks, but can last up to 6 months). I had a greater appetite, decreased pain and bloating, less nausea, and could eat larger meals without as many symptoms after the injection.

Since the botox injection went so well I contacted my team up at Cleveland Clinic. The two doctors I see there, a GI specialist and a general surgeon, recommended that I undergo a surgery called a pyloromyotomy. This surgery permanently opened the pyloric sphincter. It is essentially a permanent version of the botox injection. Cleveland Clinic is one of the only places in the world to do this surgery endoscopically. This means that I do not have any incisions on the outside of my abdomen because they did the entire surgery through a tube and cameras down my throat into my stomach.

I went through a full day of testing and appointment at Cleveland Clinic the day before my surgery. I had blood work, EKGs, a chest x-ray, and appointments with anesthesia and my surgeon's nurse.  This was an all day project, but we were able to get it all done and were ready for surgery the next day!

They were very delayed on the day of my surgery, which was not much fun so I did not go back into surgery until about 4:30 in the afternoon. The procedure itself was only about 90 minutes, which is pretty short! They were able to intubate me without dislocating my jaw, so I was super happy about that! I did have some issues waking up from the anesthesia though, which I unfortunately remember! I was shaking uncontrollably; Not small shivers, but violent shaking. They were able to give me some medicine in my IV to control the shaking, but it took a short while to kick and that felt like an eternity. I also was coughing fiercely when I came out of anesthesia. This was probably because they had a breathing tube down my throat as well as the endoscopic equipment to do the surgery, so my throat was irritated form having all of the tubes in it. I was coughing so hard that they were concerned that I was going to throw up. Obviously they did not want me throwing up right after stomach surgery! They were able to get that calmed down after a while as well.

I got to my room that evening and was sadly placed on an NPO diet (stands for Nil per os in latin). which means that I could not have nothing by mouth. I was feeling pretty crummy because I was not even allowed to take my medications. The next morning I was taken down for something called an upper GI series. During this test I had to drink two different kinds of contrast and then they took x-rays in a number of different positions. This test was to ensure that there were no leaks in my stomach or intestines from where he made the incision to cut the pylorus muscle. It was not a painful test, but it was uncomfortable because I was not allowed to take my blood pressure and heart rate medications, so I was dizzy and feeling weak.  We made it through the test and I got to go back up to my room and rest for a little while.

Finally the nurse came in and said that my upper GI series looked good, so I was able to start on a clear liquid diet. A clear liquid diet is exactly what it sounds like: a diet that consists of only liquids you can see through. Jello, juice, frozen ices, broth, water, and popsicles are the staples of a clear liquid diet. It may not sound exciting, but after over 36 hours with NOTHING to eat or drink I was quite excited for a glass of water and popsicle!

I was discharged later that afternoon to go home since I was doing so well. I did not have any pain, but did have a fair amount nausea. When I was discharged I was able to start on a full liquid diet. This diet includes any liquids and any solid that is liquid at room temperature. I can have: pudding,  ice-cream (with no chunks or pieces), yogurt with no fruit in it, sherbet, creamy soups blended to have absolutely no chunks in them, and everything I could have on the clear liquid diet as well. I have since added in applesauce and smoothies with no chunks in them to help me have a little bit more variety. I have been using a lot of protein powder in my smoothies and milkshakes to help get some more protein into me. Needless to say after my popsicle and jell-o lunch the first thing we did when I was discharged was go get a milk shake! I will have to be on the full liquid diet for two weeks, but honestly I am so nauseated right now that I have no desire for solid food.

The nausea has been really intense for me. I have a nausea medication called phenegran, which has been taking the edge off a little bit. It is not working that well and the other typical medication used to treat nausea, zofran, does not help me at all. I spoke with my surgeon's nurse today and she is going to call in a prescription for something called a scopolamine patch. This is a small patch that is put behind your ear to help with nausea and vomiting.  I use this patch when I have surgery to help prevent the nausea and vomiting I have after anesthesia, so we know they work well for me. I am waiting on a call from the pharmacy to tell me they are ready, so I am hoping I can get those on and start getting some relief from the nausea. The nurse also recommended I do an IV infusion of fluids every day instead of the every other day that I typically do. Due to the nausea and not eating and drinking enough they are very concerned I will become dehydrated. We are doing our best to prevent that and I am extremely grateful that I have my port to help me stay hydrated!

I will go back in about 6 weeks to see both my gastroenterologist and my general surgeon to check up on how things are doing. We will not know if the surgery worked until I can begin eating solid food again. I would appreciate prayers for this nausea to stop soon!

Surgery Day

So with the crazy schedule I have had recently I have been behind on updating! We are actually up at Cleveland Clinic right now and I am waiting to go back for surgery! I am having a procedure called a pyloroplasty on my stomach. This procedure permanently opens the valve at the bottom of your stomach to help allow food to pass through easier. I will post a more full update later, but I wanted to let everyone know I am headed back into surgery. This is number 8 under general anesthesia and I always do remarkably well, so we are not concerned. My two requests are that they control nausea and vomiting and that they do not dislocate my jaw! As long as they do those two things I will be happy!  I will be in the hospital for at least one night and we are hoping to go home tomorrow.

I will update as soon as I can! As always prayers are appreciated!

Hip Surgery

 Wow I am way overdue on an update on my hip! It has been a crazy month, that is for sure! My husband and I moved into our new fixer upper house here in Cincinnati. It is not our first home we have owned, but it is our first fixer upper! It has been so much fun to work on the house, but also extremely time consuming! Then my brother moved in with us! I am so excited to have him with us and get to spend so much time together! We haven’t lived together, or even in the same city, for about 8 years so I am beyond thrilled he is here! I also started my summer semester for grad school. I am taking a 5-week intensive neuroscience class, so that has been tons of work on top of my other two classes! All that to say that I have been incredibly busy since my hip surgery!

The surgery itself went extremely well! It was done at a Children’s hospital and they were just exceptional! It was a relatively quick procedure, about 2.5 hours, and they did not find anything that they did not expect to find. They were so accommodating for my service dog Reilly as well!

The surgeon did not end up needing to remove any bone from my femur or pelvis bone, which is wonderful. He did not expect to need to, but we were not 100% sure until he opened me up. If he would have had to take of bone it would have been a longer and harder recovery. He did have to anchor down the cartilage, but we expected that. The cartilage was torn away from the bone, so he basically pinned it down. In addition to anchoring the cartilage he trimmed off the dead pieces of the cartilage. When a tear happens the edges of the cartilage get ragged and began to die. Overall it was a very straightforward surgery and the doctor was very pleased with how it went!

I woke up in recovery and got to my room with no issues. The pain was very minimal and I was feeling pretty good! My hip was more sore and stiff than painful. I did not take any of the strong pain medications that they offered me. I was instructed to take muscle relaxers for 5 days after the surgery and Tylenol for a week. I did this as instructed, but I did not take anything stronger than that! It was a huge relief to not be in a significant amount of pain.

I, unfortunately, have to be on crutches. Even though there is no pain the surgeon wants to give the joint capsule a chance to heal. He had to open the join capsule, which is a sack that contains all of the cartilage and fluids that make up the hip joint, so there is always a chance that this capsule could become damaged if you do not let it heal for an adequate amount of time. I thought it would be two weeks that I would have to be on crutches, but it turns out it will be almost 6 weeks. There was a slight miscommunication with the surgeon’s office regarding the amount of time I would be on crutches, so I was disappointed by that. I still have another 1.5 weeks left on crutches and I am so ready to be done with them!!!! I am looking forward to the day that I can be rid of them for good! I was on them for about 3 months about 6 years ago, so it was very much like riding a bike in the sense that I got back in the swing of using them very quickly.

I go back to the orthopedic surgeon next Friday, so he will do an evaluation then and hopefully clear me to wean off the crutches and start physical therapy back up. I will let you all know how that appointment goes and will be updating about another surgery I have coming up as well!

I leave you with an adorable photo of my service dog Reilly and I in recovery after the surgery