Post Appendectomy problems

[Maria S.]

I'm a 47 yr old white female. Med hx: Asthma with freq sinus infections due to allergies. 2 mnths ago I had an extensive abd surg for a gangrenous ruptured appendix. For the 1st 2-4 weeks post-op, I had daily low grade temps (99-100)and some abd discomfort. CAT Scan revealed the absence of abcesses or surg wound infections. The low grades resolved after heavy po a/b therapy. NOW, for the last 4 wks I have had constant mid-lower abd dull, achey (achy) pain (cramping), peaking when I eat, when I need to have BM, and AFTER the BM (get's real bad). I also have bad allergies, and when I have an asthma episode, or breathe, sneeze or cough hard, it triggers these abd cramps. BMs are irractic, sometimes not have one for 3-4 days, and then I will have 3-4 in single day. BMs are very loose, not fully digesteed, yet not true diarrhea. Cramps worsen with stress, or when I stand or walk for extended time; relieved when I sit or lay down. I do have hyperactive Bowel sounds. I do pass gas. I never feel like I've emptied my bowel after a BM. Just in the last 2 days, I starting having a sharper pain in my right upper quad when I stretch my torso.  What could all this be and could it be related to my recent surgery? Is this a normal recovery, or a possible complication? Could these be adhesions, and how are they dxed? My Gastroenterologist is doing a colonoscopy next week. What could the colonscopy tell us, that the CAT Scan didn't? I feel like my physicians are lack-a-daisical about it (sometimes not absorbing my entire hx). I do not want to have something casually missed that could be addressed and treated easily. (It almost seems a common trait with modern medicine, any more.) Some casual reference to IBS has been made, but most of the lit reference long hxs assoicated with this phenomenon, and psycho-social link, versus post infection/surg connection. I have never had "a nervous stomach" or any other remote GI problems prior to this. I am a RN, and have an incredibly high pain tolerance, so appreciate that I am not designing this pattern. It is real, and truly concerning me because it has declined my ability to return full;y back to work and my general quality of life. Please direct me where I should be going (diagnostically) with this. Thank you so much.

[Kevin Pho, MD]

Adhesions can be a possibility - but less likely if the CT did not show them.  

A colonoscopy will detect diseases within the bowel with more detail than a CT scan.  Things like colitis or inflammatory bowel disease can be seen via a colonoscopy.  This would be a reasonable test to consider in light of the recent non-revealing studies.  

If everything continues to be non-revealing, a diagnosis of irritable bowel syndrome can be considered.  This can especially be considered if there is alternative constipation with diarrhea.  If the symptoms are constipation-predominant, you can consider Zelnorm.  Increasing the amount of the fiber in the diet, as well as antispasmodic agents, can all be considered.

These options can be discussed with your personal physician or in conjunction with you GI physician.

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[surgeon]

At two months after such extensive intra-abdominal problems, things are a long way from back to normal inside. Adhesions could indeed be the problem, but in the absense of actual obstruction, I'd guess most surgeons would advise waiting, because it's highly likely to improve with more time. Unfortunately, it could be a few more months. It's hard to guess what colonoscopy might show at this point; it might be more uncomfortable than usual, given the likely persisting inflammation.

[ladyhawk0118]

Hello Maria-
This story sounds very familiar to me.  Last Jan.(2004) my appendix ruptured.  (I was 45 at the time)  I thought I had a stomach virus, so I didn't go to see the doctor until two weeks had passed.  By then I had a huge abscess, was hospitalized, pumped full of ABX and sent home.  At any rate, I finally had my appy surgery in July.  (almost 7 months after the fact!)  There was NOTHING there.  I had a stump where my appendix had been, which was shot with two staples.  There wasn't enough of it left to send to pathology.  My surgeon told my husband that I needed a colonsocopy because "things" can happen to your colon after a ruptured appy.  I had that done in August...clean.  I also had multiple CT scans and SBFT's, all normal. I continued to have diarrhea, low grade fevers (99-100.2) and abdominal pain.  I went to his office several times after my surgery complaining of these things. Like you, I was told to give it time, that I'd had a nasty mess in there and it was going to take time to heal.  So, I waited.  Then other things started happening.  In September I started having funky migrating joint pain, mouth sores and anal sores.  I had another colonoscopy in March.  Nothing.  I found another gastro doctor, and despite normal imaging studies and negative colonoscopies, I'm now being treated for Crohn's Disease.  I had several lab tests done to arrive at my DX.  My temp is finally normal after 18 months.  The pain and diarrhea...well, I still have it to a degree.  I know first hand how frustrating all of this is.  Hang in there, and don't give up.  If necessary, find another doctor that will listen to you.  It took 18 months to get someone that listenecd to me.  I'm still struggling, but not like I was. Take care.  Good luck.

[Maria S.]

Dear Lady,  Your words were very moving.  Sometimes I think I am going through mental health problems, because I am dealing with symptoms associated so strongly with anxiety, depression, etc.  But I have never resolved to this level. Isn't it frustrating to see such poor attention from medical staff (at times).  Thank God for folks like you and the managers of this web site, providing hope and other avenues.  It is dutifully more frustrating being a nurse.  I think I know better, and yet I wonder ....  God Bless you for sharing your story.  I am having my colonoscopy today.  I DO hope it is normal, but sometimes we need "something to treat and make it go away."  I do pray for your recovery.  Crohn's Disease is NOT easy.  I admire your strength and will to help others along the way.  Keep in touch with research.  You are fortunate that you now have good practitioners to watch the condition.  Keep active, alert, and above all, faithful.  Best, Maria

[ladyhawk0118]

Hello Maria-
Thank you for the kind words.

Hope all went well with your colonoscopy and you got good news.  

Yes, it's very difficult dealing with everything.  There were times I'd just start crying because I felt so bad, was so depressed and felt like I was being given the run around by all of my doctors.  I kept telling them I wasn't "crazy" but at times I think they had their doubts.  You're not "mental".  Trust me.  When I went in about my joint pain, a lot of rheumatology tests were ordered.  I think my doctor was shocked when my ANA came back 1:320. (I think he thought I was telling him a lie about the pain.)  I was sent to a rheumatologist and had an extensive workup for Lupus and MCTD...all negative.  I didn't know what to do or where to turn.  I felt awful, had no energy, had lost interest in everything, and wondered many, many times how/why I could still be alive. My WBC was still high, my red count/hgb. were still low, I'd lost almost 15 lbs., yet I couldn't get anyone to "do anything".  I was told it was IBS, adhesions, dehydration, post op inflammation...and one doctor actually told me he thought it was all in  my head!  I assured him it was EVERYWHERE but in my head.  Needless to say, I left his office in tears. I went straight to the health food store and bought every pill I could find for inflammation...came home and called my insurance company begging for another doctor for another opinion. You know your body better than anyone.  Listen to it.  If it's hurting, something isn't right.

I've done more research on appendicitis than probably anything in my life.  (that's how I found this site)
If you don't seem to be improving after the IBS/stress mgt. route, start asking questions about Crohn's.  There seems to be some link between Crohn's/appendicitis.  People who have a ruptured appy are at an increased risk (even tho small) of developing Crohn's Disease.  

It's been a long hard road for me.  Luckily I found a place where ppl support each other and offer advice. At least maybe you can find comfort in knowing you're not alone in your struggle.

Take care.  Keep in touch.
Ladyhawk

[Maria S.]

Good news, Lady.  My colonoscopy is negative.  IPS is suggested.  But also remarked was, "Sometimes when people get a negative CT Scan, their IPS soothes due to decrease stress of not knowing."  I can appreciate the association to stress, but gosh, it is such a psycho-social attachment putting alot of responsibility on MY stress management and "control" of emotions.  I'm willing to accept, after all, my body has gone through alot of stress (inflamatory, surgical), along with emotional stress (inability to return to our business and my work responsibility with full force), etc.  

I can relate to what you have gone through. Being a nurse, and owning our own Assisted Living Facility here in Florida, I have witnessed so much under diagnosis and medical (and nursing) carelessness, just because everyone is in a rush and rut. The rewards of the industry are gone, and now we see factories of CPT codes.  It is especially hard in my industry where I deal with the AGED, specializing in dementia disorders.  I see a TREMENDOUS amount of misdiagnosing and under (to non) treatments.  My residents are jokingly referred to have a diagnosis of "TMB"  or (hold on to your seat!) "Too Many Birthdays".  THis is where our medical society has reached.  Lack of empathy, lack of listening (sincere) skills, lack of discovery for the "what if's".  

You went through alot.  The episode of being told it was "all in your head" was not only disgraceful, but unethical and unprofessional.  It also showed lack of skill to do proper assessments and diagnostics, and I hope to dear God, you informed him of his deficiencies.  This should hold an impact in his medical ego.  This is the only way (besides litigations) that the medical community will respond.  

Don't take me wrong.  We have real good health professionals out there, but they are being out-numbered and suffocated by the others (the majority).  They sometimes are referred to "wierd" (I've heard it) by the ones that claim that they are go "too far", and "just looking for a diagnosis to get more money".  If they are guilty of over-investigating to get more money per case, I salute them over the ones that look at "Quantity" of under-diagnosed cases.

Too much wind this morning.  Keep in touch with your case.  Thank you so much for the inspiration and the "look out" fors you have provided me.  Believe me, I will keep looking out.  You have been an noble inspiration to me.

[Maria S.]

Thank you for your insight.  The same day my colonoscopy came back negative, I learned by liver enzymes were elevated.  SGOT/SGPT are 73/137 respectively.  Pre-Op they were 10/12.  Retake showed similar values. My GI man is looking into, considering new meds I was given to be causative agent (Zelnormin, etc.)  Should I be further concerned?  Do I need to bring attention in any specific direction?  Again, this is all new to me post appendectomy.  Thank You for your review.  Maria