Monday, January 24, 2011

Home again, home again -- jig, jiggety, jig

This is a copy of an email I wrote to Angelica and Stebbs and our Chaplain's wife this morning and asked them to share. I want to get it all out there as my ability to talk or be awake for long periods is not so good yet. This should provide most of the details I think. :)

Last night when I got home around 7pm, I sat down and began talking to my friend Stebbs who was at the house with my boys. Since all of this happened so quickly, I went back to the beginning and explained how I ended up having surgery within a virtual matter of hours.

That was the most I had spoken in days (especially in English) and the most I had been alert and focused, and after the conversation, I was exhausted. I realized that it might be better if I just wrote down what happened, get it all out there, and then when I see you in person or talk to you on Skype or email you, we already have the core information said and done. I just can’t talk for long periods of time and especially not to tell the same story.

I have not been feeling fantastic throughout this pregnancy. However, what was quite obviously morning sickness had begun to morph into something I just couldn’t define over the last few weeks. I ended up in the Clinic one day and they thought an appendicitis was possible but that heartburn was most likely the culprit. You’d think you could easily tell the difference between the two but pain radiates and sometimes I couldn’t come close to pointing to the point where it actually hurt.

I had told my friends during the last week that I was just feeling cruddy. And I was. But not terrible. However, Saturday morning I woke up in great pain. I went downstairs to take some Tylenol and fell onto the couch feeling as if I might throw up. I felt really bad – this was a whole new level of discomfort. It was accompanied by a bad headache and so I thought maybe this was just a full-body migraine. John would question me and try to figure out what was wrong, but neither of us had any idea what was going on. He checked the baby’s heart rate. 170’s. Baby was great. But I was not.

I cancelled attendance at a party on Saturday and Sunday and just stayed home. The only way I felt even sort-of okay was when I was laying flat on my back. I continued to take Tylenol every 6 hours and occasional codeine and prayed that this would just be a bad headache or heartburn that would clear. I was also having hot and cold flashes throughout the day although no obvious fever, and while I hadn’t vomited, the diarrhea had become worse with every passing hour. When I went to bed on Saturday night our assumption was that I had one of these nasty “Turkey bugs” that goes around Base – Americans exposed to new germs and foods and different sanitary procedures get them frequently (just ask Stebbs.)

On Sunday morning I woke up in bad shape yet again. And this time, when JB started exploring the source of the pain in my abdomen he discovered something that hadn’t been there the day prior – rebound pain – which basically means that when he pushed on my right side, it hurt, but when he released the push it KILLED! I would literally jump off the bed it hurt so bad. When this happened, John shook his head. I asked him why he was shaking his head and he said, “I think we have to go to the emergency room. This is classic for an appendicitis. I hope this isn’t what it is, but we can’t just sit around anymore.”

Neither of us wanted to make a weekend trip to Achibadem’s Emergency Room, but we felt that there wasn’t a choice. I had spoken to Angelica the day prior and she had said she could help with the kids on Sunday if we needed her. We knew their kids were early risers like ours so JB called them and thirty minutes later we had dropped the boys off and were on our way to the ER.

I should tell you that the Turkish hospital (Achibadem) is a great place. There are a few things that are different than America but if you weren’t looking closely you wouldn’t think you weren’t in the USA. The difference is in training. These doctors aren’t trained in America. They are trained in Turkey. That is a difference. But for something as routine as an appendectomy, we really had peace with the care we were receiving.

I went to the ER first. I had an ultrasound. I did a urine sample. I donated blood. About three hours later, I met with Dr. B. who JB works with on Base. (There are a few Turkish doctors who see Americans on Base a few days a week.) He’s a wonderful guy who speaks fairly good English. Dr. B decided to admit me and see if anything changed in a few hours although we were pretty sure it would not.

His basic diagnosis was the same as what JB thought -- appendicitis. However, being pregnant complicated that in so many ways. For instance, my white cell blood count (which indicates infection) was “normal” but it often is warped in pregnancy ( you don’t want the body to see the baby as something to attack.) They couldn’t get a good look at my appendix on ultrasound because, I’m pregnant. But many of my other numbers for infection were slightly elevated, the area around the appendix was inflamed and bothered. And the rebound pain was absolutely terrible which in and of itself can be reason to go to surgery.

They admitted me and a few hours later we were having a discussion about what we should do. Could they be sure it was an appendicitis? No. But did you want to let a possible infection creep in on a pregnant woman (or any person for that fact)? No. The major risk from the surgery was pre-term labor and that was our biggest fear as the surgery can cause contractions to begin. However, those can often be stopped and are not an immediate recipe for disaster. So, we decided to do the surgery.

But then the question of how to do the surgery came into play. Normally they would do this laparoscopic (easier recovery) but there were two things working against that for me: one was, I’m pregnant and while usually okay, poking around is not preferable. Secondly, I had had hernia surgery as a teenager and have a lot of scar tissue above my belly button making entrance nearly impossible. So, regular old surgery it was.

And then the question that got me the most riled up was that of anesthesia. They prefer not to put a pregnant woman out if at all possible. Really?! Oh my. So they want to do this awake. I was NOT thrilled about this idea but agreed that they could do an epidural if they could give me some other medicines to take the edge off. I really just wanted to go to sleep and wake up when it was all over, but I also wanted to do what was safest for our newest Kit.

I asked Dr. B when would we do this surgery, and he said, “We will do it now.” I met the anesthesiologist, Dr. T. She was a great gal who spoke fantastic English and was very comfortable and encouraging. She put me at relative ease with the idea of being awake for stomach surgery. Heck I had done it with a c-section, right? Somehow it didn’t feel the same.

I won’t get into all the details of the surgery. They offered to let JB join them but he opted not to which I think was a wise move. He just had to be the husband here and not the doctor. The operating room looked just like one in the U.S. It was very clean and professional. Everything went great. Dr. T gave me some medicines to get me quite high and about 90 minutes after it all started, it was all over. She left the epidural in overnight and I therefore was in next to ZERO pain for about the next 12-15 hours. It was wonderful!

I got out of surgery around 5pm on Sunday and was able to go home by 5pm on Monday. Not too bad. I am in the normal discomfort you would expect after stomach surgery. I am taking Percocet (which is safe in pregnancy). JB will stay home with me today (Tuesday) and then we will play the rest of the week by ear.

I must pause to say one more thing before I close. God is such a wonderful God. I truly felt the “fingerprints of God” while I was gone. My amazing friends Angelica Y. and Sarah Stebbs took over for us. And they weren’t alone. So many people rallied around us from afar to help take care of our family while were unable to. I cannot even begin to tell you what a blessing this was.

I only had one "low" moment and that came during lunch on Monday morning. I missed my boys something awful. The only TV stations were Turkish. We couldn't get the laptop to work to update our family at home. And I was supposed to eat something but they were bringing me Turkish food that while I like, just sounded terrible. The nurses spoke no English and so I'd been conversing in Turkish for nearly two days and was emotionally exhausted. I just started sobbing as I tried to eat some sort of Turkish food. It passed quickly but when JB asked what was wrong I just said, "I just want my Mom. I want to be in America. I want to eat American food. I want to watch American TV. I want to talk to the nurses in English." It was one of those cultural walls that I got over but was a bit daunting at the time.

I was in the hospital, nowhere near my family and with no phone to be able to call them, but I had a community of people stepping up and offering help to Angelica and Stebbs on our behalf. I’ll do more formal thank you’s later, but for now, just thank you. Thank you all so much. Thank you for your offers of help. Thank you for walking or playing with Scrubs. Thank you for signing up for a meal. Thank you for watching my boys. Thank you for praying for us. We felt complete peace in the hospital. We were at total ease despite the fact that we were in a foreign country with no family having a surgery after only a few hours of notice. And we were at ease. That is due to the network of people both on Base and back home who helped and prayed. We are touched beyond words.

I will write more on my blog in weeks to come, but I wanted to get one, big, explanatory email/post out there so that the main story has been told. I did talk to my Mom on Skype this morning and after just a few minutes, I am so out of breath. I want to try to avoid that.

Bless you all!


Anonymous said...

PTL! So thankful all is well with you and the baby! Take good care of yourself now. Don't over do it. You need to recover and build your strength back up for you and the baby.
Linda xoxo

Anonymous said...

So thankful with you...hugs and love Tante Jan and Oom Ed!

Rachel and Hans said...

Glad everything went well! Praying for a quick recovery!!

Anonymous said...

So glad it all went well! Praying for a quick recovery! bet the boys are ever so glad to have you home!! Sounds like you have awesome friends on base!! Take it easy! Happy Birthday John! Nancy and Tom

Anonymous said...



TAV said...

wow. what a story. THEY DID AN APPY WITH regional anesthesia?!??!! Hans, is that normal?

Rachel and Hans said...

Tara - Appy under regional is definitely an option. Laparoscopic appys are becoming increasingly popular (even for pregnant patients) and thus a general anesthetic is preferred
over an epidural/spinal because of the insufflation of air/CO2 into the abdomen. However, for an open appendectomy, I would definitely recommend an epidural/spinal. Neither general nor regional anesthesia has been shown to be "safer" or "better" than the other. Certain situations (non-reassuring airway exam, "full stomach", etc.) may sway an anesthesiologist one way or the other. However, it really comes down to provider and patient comfort with any specific technique. NO currently used anesthetic agents have been shown to have any teratogenic effects in humans when using standard concentrations at any gestational age. NSAIDs should be avoided if possible (especially in 3rd trimester), and large amounts of opioids before labor should be avoided as well, some say nitrous oxide should be avoided early in pregnancy . . . but that is about it.