One week ago, today, Mark started to write about my gallbladder surgery. The surgery itself and the hours of immediate recovery went extremely well, confirming what the anesthesiologist had cheerfully said in our day-before-surgery phone conversation:  “You’re young and healthy – I don’t expect any complications.”

Young.  Wow.  I’ll be 50 this September.  Haven’t considered myself “young” in a while.

The “healthy” puzzled me at first:  how can one say that I am healthy when I have been struggling with persistent nausea and malaise for almost three months???  Yet, that wasn’t the health he was talking about.  It took me a moment to realize that he was talking about the blessed absence of any other health problems, the items he rattled off his list: no prior surgeries except for tonsils when I was maybe four and tubes in my ears when I was about 14, no problems with any medications, nothing neurological (Thank God), 140 lbs at 5’8″, no asthma, never had a stroke or heart attack, etc and so on – I guess in that sense I am healthy.   Definitely something to be grateful for.

While the surgery and immediate recovery did go extremely well – Mark took a short video of me walking, unaided, across the living room a mere six or so hours after the start of surgery, and I was almost euphoric the second day -, the days since then have been anything but straight-forward, linear recuperation.  I knew that walking and moving around would help with the healing, so I did that, and I am sure it helped.

What I wasn’t prepared for, though I should have known (because I did know but forgot), was the effect narcotics have on digestion:  serious constipation.  I should have started to take a laxative right with the very first pain pill I took, not wait until I realized two days later that, oh crap, I can’t go, with two days worth of stuff in my intestines.  Would have saved me some major discomfort.

Another lesson I learned, the very painful way the second night I was home, was that just because I’m in no pain doesn’t mean that I’m in no pain.  It means that the pain meds are doing their job.  Meaning:  the first evening, Mark set an alarm for 3:30 a.m. in the middle of the night, for me to take another dose of Norco (left-over prescription from the ER) – worked great.  The second night we didn’t (Mark would have but I thought nah, I’ll wing it).  Big mistake.  It took a miserably longer time for the meds to start taking effect than if I had kept the pain under control.  I wanted to get off the Norco as soon as possible, because I don’t like narcotics, and take Aleve or Tylenol instead.  Experimenting with different dosages kinda worked but I would probably not do it again.  Just take one or two pills every 4 – 6 hours as prescribed.

Walk and move and drink a lot, herbal teas for gas and bloating from the beginning would probably have alleviated at least some of the very uncomfortable gas and bloating.  The pictures Mark took of the incisions on my abdomen make me look like I’m pregnant.

The hardest part since last week though has been the return of the nausea.  Nausea is misery.  Every time I have a migraine (very infrequently), even while I am in pain, I say that I’d rather have ten migraines than one case of nausea or stomach flu.  I have had no reason to change my attitude about this.

Two concerns about the nausea:  first, why?  There must be a reason, and I would very much like to know what it is so we can take care of it.  (The thought was that my gallbladder, while perhaps not at the root of it, was at least contributing to it, so the surgery was a very good first step in the right direction.)  Second, even though I’ve been told many times that Phenergan is safe, and it does alleviate the nausea, I am concerned about covering up a symptom.

My mother’s second hip replacement surgery (surgery of the second hip) was unsuccessful, the replacement part never properly fused (?) with the bone.  Nobody knew, though, for many many months, because she was given very strong pain medication and was told to walk, walk, walk, and exercise, and do PT, which she faithfully did – and in effect damaged the hip even more.  She told me several times that on her own, without doctor’s orders, she would have taken much less pain medication, and therefore been alerted to something being wrong much sooner.  So, to be on the safe side, I called my surgeon’s nurse (one of the nicest people on this planet) who said that having the same symptoms as before the surgery is unfortunately not uncommon.  It may take a couple weeks for the nausea to completely go away.  Small meals, take it easy … And yes, Phenergan is safe to take as I need it.  Sigh.

In two days, I am starting to teach again; I asked several parents to move lessons to spread them out a bit – an hour and a half of highly focused attention at a time is probably all I want to handle for at least the next week or two.  My students have 100% of my attention 100% of the time they are with me; normally this is more invigorating than it is exhausting.  For the next week or two, we’ll do that in smaller steps.

(The following was originally posted by Mark on December 29 on our Journey site)

Today Sibylle is having her gall bladder removed. All signs have been pointing to this for several weeks now. While the various scans and test all show that her gall bladder is functioning, it seems to be at the root of her symptoms and all the doctors involved have said that it needs to be removed.

The surgery is scheduled for about 12:30 pm this afternoon, but check in was at 10:30 this morning. She is back in the preparation area now getting an IV setup, the blood pressure cuff and pulse monitors installed and being made ready. I will be allowed to join her once all of that is set, and stay with her until the surgery starts.

We both have good feelings about the GI doctor who scheduled the MRCP and about the surgeon who will perform the procedure today. We are both understandably nervous about today and its outcome. If this addresses the persistent nausea that has plagued her for the past three months it will be well worth it.

Update

Sibylle’s surgery was started about 15 minutes ago. If all goes well I should see the doctor for his post-operation report in about 90 minutes. Once Sibylle is moved from the recovery area to the preparation room I will be allowed to rejoin her. I spent about an hour and a half with her once she was prepped, until the surgical nurse came to get her. Sibylle had an IV started and had been given some Valium. The sedative effect of the Valium allowed her to doze most of the time we spent waiting. Shortly before she was taken to the operating room her doctor stopped by and explained what was going to happen.

After her surgery is completed she’ll spend some time in a recovery area, and once she is awake they’ll return her to the prep room.

It is very strange to be seated in the waiting area writing this knowing that she is being operated upon just down the hall. Fortunately I have the room to myself and therefore have turned the television off. I was tempted to hide the remote but decided that was passive-aggressive.

Post Surgery Update

I just spoke with the surgeon. The surgery went very well. Start to finish about 50 minutes. He said that he wasn’t able to inject dye into the duct between the gallbladder and the common bile duct as it was too small. So no imaging of bile flow during the surgery. There will be a follow up visit in two weeks with the surgeon to assess how things are going. Hopefully this alleviates her symptoms. He said that sludge or sand in the gall bladder (which she had) often causes more problems than a gall stone. The stone can’t pass the feeder duct into the common bile duct, whereas the sludge/sand can.

Three to five days of immediate recovery and then a week or so to return to full activities.

Whew.

The Morning After

Sibylle was discharged from the hospital at 6:00 pm Thursday evening. Seven and a half hours after we checked her in to out-patient surgery. She spent about an hour in recovery from 2:00 pm to 3:00 pm, and then dozed and rested in her room until 6:00. She was able to eat some red jello (the staple of hospital food), drink some water, and munch on a few ice chips.

After we were home she took a pain pill prophylactically and slept for an hour or so. The hospital warned us that her right shoulder could be quite sore as a result of the surgery and that walking around and movement would help alleviate that pain. So after her nap we took a meandering walk through the house going from room to room. She had a smoothie for dinner and then spent some time sitting in her desk chair writing and reading email. Around 10:30 pm she had a double dose of pain medication and we went back to sleep. (Added by Sibylle: the Norco is actually left-over from the prescription the ER gave me on November 8. Since pain had never been much of an issue, I had taken only one pill, once, not even for gallbladder pain but after the pelvic ultrasound to follow up on uterus issues they found while I was in the ER. The prescription says to take “one to two” pills every 4 – 6 hours. Last night, right before bed, I did take two pills, so I guess technically it wasn’t even a double dose.)

With two cats in the house, one of which loves to climb on and lay on people, she put a pillow over her stomach. With the blankets on top of the pillow to hold it in place she was nicely padded in case Taz jumped on her unexpectedly. We set an alarm for 3:30 am, which was about an hour prior to the pain med’s 6 hour span, and she took one more pill.

This morning she awoke with no appreciable pain or discomfort. One or two of the four incisions made yesterday is a bit tender to touch, but she is not in any pain. She was able to dress herself and make her morning tea.

By any measure this whole adventure seems to be going wonderfully well. We know that days two and three are often the hardest in terms of discomfort or pain, but so far her experience has been a very good one.

When I told parents that I have to reduce my teaching hours, I explained that it was for health reasons. Some parents were very alarmed and concerned, thinking that I had some terrible and mysterious illness.  I don’t.  But my gut feeling was that I would get sick if I didn’t cut back.

This past Tuesday, I woke up in the very early morning, feeling nauseated.  This happens once in a great while, and a dose of Peptobismol either makes me vomit and consequently feel better and ready to go back to bed and sleep, or it alleviates the nausea = go back to bed and sleep.  On Tuesday, I was on my third dose of Pepto and the nausea only got worse.  Mild cramps, a bit of pain, but mostly nausea so bad I was shaking, had the chills, sweat running down my face and body.  Mark was very concerned when he saw how bad it was.  My robe was soaked with sweat, I was shivering.  He put a towel on the space heater we have in the bathroom and as soon as it was warm wrapped it around me, then added another towel to the space heater, repeat.  The warmth helped with the chills, but the nausea did not get any better.

We had had egg salad for lunch the day before, and I had a spoonful of the left-over in the evening.  The left-over had been sitting on the counter all afternoon; I knew it was probably NOT a good idea to eat it, should have thrown it away, but – stupidity.  We were sure what I had Tuesday morning was a mild form of food-poisoning.

About three hours after I first woke up sick, we decided to go to the ER.  I was practically on my knees, begging the triage nurse to give me something, anything!, to make the nausea go away.  Vitals first, bloodtest, more questions, and then finally an IV with meds to stop the nausea.

We spent most of the day in the ER.  Blood test (nothing really wrong, except something with my white blood cells), later more meds for nausea and then also for pain, more questions, the nurse’s suspicion that this actually looks like something related to the gall bladder, later sonogram, then CT scan to clarify /confirm the sonogram.

By 3:30 they sent us home.  The very powerful nausea and pain meds had made me drowsy, dopey, so Mark put me straight to bed when we got home.  Through texting, we had kept Jonathan and Chris updated throughout the day, and Jonathan decided that he wanted to come up and see me.  He arrived shortly after we got home.  After a bit, he and Mark went to the pharmacy to fill the prescriptions from the hospital.

On Wednesday, I slept most of the day.  Wednesday evening I felt much better but still quite wobbly on my feet – no surprise given that I had eaten hardly anything for two days …

I am still not sure what happened.  The intense and unrelenting nausea and strong but relatively tolerable pain would suggest food-poisoning – but I didn’t have diarrhea; the kind of pain (location and the fact that it was radiating into shoulder, even jaw) would suggest gall bladder – but the (lack of) intensity of the pain wasn’t typical gall bladder.  To cover both eventualities, I promised Mark that I would never ever again eat left-over unrefrigerated egg salad (at this point the mere thought of egg salad – fresh or left-over – nauseates me); and I have made changes to my diet to be more friendly to my liver, gall bladder, and pancreas.

Every day is getting better. Thursday I went for a walk in the sunshine around our “bean” (our block is bean-shaped), yesterday I attended a morning business meeting and a concert at night; but I delayed going back to teaching until this morning.  I chose a family with three of my most favorite students (yes, I do have favorites) and shortened their lessons to half-hour lessons which was still an hour and a half at the end of which I was wiped out.

If I am careful I hope to be back to normal teaching by Monday.

It’s that time of year again.

That time, toward the end of July, when I wish I could just fast-forward to August 18 when the Fall Semester starts.  The time until then is so stressful because it holds so many unknowns:  I am not sure how many students will enroll this fall; I don’t yet have the schedules of the ones who will enroll; many parents do not yet have a schedule because especially sports don’t get scheduled until school starts. 

Of course I want the best schedule for everyone – their favorite time, siblings together, conveniently together of course, and so on.  I’ve been bugging Mark to see if there’s some kind of software to help with the scheduling but there are so many variables (on my part) that it just wouldn’t work.  There is scheduling software available, commercially – I googled – but most of them put the scheduling into the parents’ hands.  As much as parents may think that it should be either first-come-first-serve or work by some sort of seniority – that’s not how I schedule.  I want to pick and choose and reconsider and change until I feel that the schedule fits everyone, me included, as perfectly as possible.

In addition to the stress of the unknown, it’s been hot.  Hot and humid and miserable.  Yesterday was the first day in I can’t remember how long that Mark and I were able to ride our bikes.  Well, enjoy to ride our bikes. 

Hot means that we run the a/c which means that in regular intervals there is the noise from the blower (fan?) which is particularly noticeable at night.  We don’t sleep well. 

On top of everything else, I am going back to Germany the first two weeks in August, for the fifth time this year, this time to finalize the closing of my mother’s apartment.  She lived in that apartment for 37 years, I grew up in it.  Several years ago, when my mother and I discussed end-of-life issues and how she would like me to deal with things after her death (we had no idea that she would die so soon), I had already asked her to make sure her landlord knew that I would want to hold on to the apartment for a while after.  The idea of her dying and my having to close the apartment right away was unbearable.  She understood and accepted.  I found among her many many handwritten notes one she had written to herself, to that effect.

I am so very fortunate to have had Mark’s understanding and support with this.  One week after I arrive in Germany in August, it will have been exactly six months since her death.  She herself hadn’t been home in her apartment since about October or November when she left for what was meant to be her over-winter vacation in Turkey. 

It’ll be trying, and I expect emotional upheaval. 

Strangely, and this may be some weird survival technique, I don’t expect the stress from the preparations for the Fall Semester and the stress from the closing of my mother’s apartment to compound each other. On the contrary.  (And this is where it gets weird.)  I am good at completely focusing on one thing, by pushing other things aside.

I am already organizing, long-distance from here in the States, the apartment closing; and I will be working, long-distance, on the Fall Semester scheduling while in Germany.   When the stress from the piano preparations gets too much, I can take a break and take care of my mother’s apartment.  And the other way around.  Use either as a distraction from the other. 

I’ll be glad when it’s August 18.

I live in the old part of Olathe, where the houses are small and the trees are tall.  Hardly anyone here has a real lawn, it’s more like just lots of grass with some weeds here and there.  In my backyard, the first flowers to appear in the spring are usually dandelions and those prolific purple groundcovers (name?), and tiny plants with tiny sky-blue blossoms that look like they just fell out of the sky, and violets (the weed, not the kind you buy at the store).  I especially love the cheerful dandelion yellow – which happens to be my favorite crayon color, too.  It’s a rare sight to see the “chemlawn” guy drive through our area.  People here don’t have much money, and a weed-free, year-round-green lawn is not a top priority.

I recently came across a cute little peom that, years ago, I enjoyed reading to my young students.  The poem is called “Dandelions everywhere” and was written by Aileen Fisher.  I had copied it onto a worksheet and included a coloring picture; that way they would be able to have it at home and hopefully re-read it or have it read to them, for the young ones who didn’t read just yet. 

Looking at it now, I realize, with sorrow, that it would probably be meaningless to the students I have here in the greater Kansas City area: sadly,  they have perfect lawns, with not a weed in sight.  I’m afraid to even try to share this poem with them, I don’t think I could bear their asking me, “What’s a dandelion?”