Obstruction and rupture - again

[Adragon]

I mentioned earlier that I have been hospitalized every three weeks for the last year for ileus or bowel obstruction following an appendectomy that turned out to be a ruptured bowel with a lot of infection.  I have seen the surgeon regularly, and when I’m hospitalized he usually uses an NG tube, which I hate, to suction out my stomach.  I was also seeing a vascular surgeon because an angiogram showed some ischemia in my stomach artery and that could apparently cause pain.  Anyway, last Sunday I woke up with my usual I've-waited-too-long symptoms of heavy sweating, vomiting, confusion, pain etc.

I managed to shower and call a cab for the emergency room (cheaper than an ambulance and less embarrassing in case of a false alarm).  I don't remember much until Wednesday when I woke up with lots of tubes and being told I had been in surgery for an emergency procedure to remove a total obstruction caused by an adhesion and resection my bowel.  I was there through today (so six days).  I was also told that a urologist had been consulted since I had stopped passing urine and that I had a bunch of kidney stones, which I need to have checked out, but they really can’t do much until I recover from the surgery.

I am told that bowel obstructions, ileus, the ischemia and kidney stones can all cause severe pain.  Is this true?  In that case I don't really know what the symptoms mean.  I was hoping that I could say, for example, if my abdomen hurts and I'm nauseated, it’s a bowel obstruction, but that may not be true.  Also, do these things somehow trigger one another or am I just lucky this way.  Finally, I was my usual charming self - disoriented, confused, unable to answer questions and generally a real pain in the a** to the hospital staff and the surgeon.  We kind of got into it when he asked me the rate-your-pain-from-1-to-5 question and I said "27".  He said it couldn't be that bad, but with everything; I was more uncomfortable than I have ever been.  What am I doing wrong?  Everyone says I have the best surgeon in the state, and I believe it.  But I keep getting sicker and it seems like it's not going to improve.

I had a really nice crying jag in the hospital.  The nurses and techs were very nice (one of them asked if it would help if she braided my hair - yes, I'm a guy but I have long hair).  I sort of snapped at her, but in retrospect, it's probably something my sister would have said.  So...I'm sort of ashamed of myself.  The surgeon when he was refused to release me on Friday said, "When you get out of this hospital you're not coming back!"  I don't know if he meant they wouldn't accept me again or that he wanted to be sure I wouldn't come right back because I was released too early.  Unfortunately, I'll probably find out what he meant.

If there's a question in here, I'd appreciate an answer.  My stepmother said that I just need to take lots of zinc and stool softeners and I'll be fine.  Is she right?

Adragon

[Kevin Pho, MD]

Hello - thanks for asking your question.

Surgeon has kindly addressed your question in his comments below.  Hopefully the surgery you had would be a cure for the problems you have been having.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

First of all, no, the conditions don't cause one another: you just drew a pretty short straw. But the good news is you might have been cured of your pattern of obstructions by the recent operation. It's not guaranteed, of course, but it's certainly possible that what was done fixed the recurring problems and that any adhesions which form from the current go-around will not lead to further problems. I'd guess that if your kidneys stopped working, it was related to the perforation and the ensuing problems that that causes, and not related to the stones. They will need to be addressed, however. Yes, ischemia can cause pain. When it's a chronic situation caused by a narrow artery, it typically is pain which occurs after eating, and, as opposed to the cramps and distention of an obstruction, is more likely steady pain, and not with distention. As to your implied question of how you can tell the difference, you might not be able to. But maybe you're starting to learn that when you get ANY severe abdominal pain, you need to have it checked. The docs and hospitals get the (formerly) big bucks to figure it out so you don't have to.

[Adragon]

Thanks for your support and helpful advice.  You confirmed (more eloquantly) what another a local doctor told me about not waiting until I was in real trouble to go to the ER and get it checked.  I've always been afraid of going in too soon or for the wrong reason (whatever that is).  I hear from you that it's OK not to wait until I can prove I need to be there and to get help sooner rather than later.  He said not to worry about appearing over anxious, just do what you need to do.

I hope you're right about this maybe being a solution.  The surgeon said "I can see obstructions, and adheasions and scarring, but I can't see pain."  I guess he means that the mechanical problems are gone and I'll have to see about the pain going too.  Right now, I feel better than I have in a year.

Thanks again!

Adragon