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Appendicitis

posted May 25, 2012, 11:12 AM by Brian Taylor   [ updated May 31, 2012, 7:12 PM ]

Last week I had emergency surgery for an acute appendicitis. This blog entry is more for me to remember everything that happened, but if you learn something about appendicitis and what to look for, more the better.

Saturday afternoon, May 12, 2012, I started to experience some discomfort in my lower abdomen. I thought at first that something I’d eaten hadn’t agreed with me. It didn’t stop me from going for a run, but I did cut the run short. That evening at a backyard barbecue I was very uncomfortable and didn’t feel like eating or drinking anything. I could hear my stomach ‘sloshing’ and I felt a bit bloated. I thought it might be intestinal gas. We were taking our moms to a play that night, but I left the play after about 20 minutes and came home. At home I threw up all the liquid in my stomach, and then went to bed. I thought there was a chance of an obstructed bowel as I’d had constipation for a few weeks (due to a very low-carb diet) and I hadn’t had a bowel movement for a couple of days.

On Sunday, we took our moms to Mother's Day brunch at JTC. I drove Maria and Dorothy down and stayed for a glass of water and then went home to bed. I really had no appetite and felt like I had absolutely no energy. I had slept very badly the night before, not being able to find a comfortable position. My legs were also going into cramps quite frequently. All Sunday I either lay in bed or on our window bench. At one point Mia Bella jumped onto my stomach and I cried out in pain. That should have been a red flag. I hadn't complained of specific acute pain in my lower right quadrant until then. The thought of appendicitis crossed my mind, but I always assumed the pain would be worse, of the sort that makes you double-over in agony. The only thing I ate on Sunday was a chocolate shake (about as far out of character as you could possible imagine for me given that I’d been averaging 30 grams of carbs per day for the previous month). I wanted something palatable that would stay down, but I wasn't remotely hungry.

On Monday I left for school in the morning feeling very hot, with beads of sweat on my forehead and upper lip. I had a very light teaching day, with only two classes, one of which was writing a test. Nevertheless, I had to drag myself around and felt extremely drained. I came home and went to bed. Maria had suggested going to emergency, but I didn’t think it was that bad. I had made an appointment to see my doctor on Tuesday. Maria was going to head out to her art class, but on the recommendation of her friend Kathy, we went to UBC emergency at 7:15 p.m. It took a few hours for a doctor to see me, but when he did finally see me he was very confident that I had appendicitis and called a surgical team at VGH to set everything up. Maria drove me to VGH and we arrived at around 11. It took about an hour for the surgeon to see me. There was some talk of doing a CT scan, but neither the surgeon, nor his resident thought there was any doubt that it was appendicitis. There was a very serious car accident that took precedence so I slept in the observation room until 1:30 at which time I was taken up to a bed in the reconstructive orthopedics ward! I was sharing a room with three women in their 70s who’d undergone knee and hip replacements.

On Tuesday, at 7:50 a.m. I was taken down to the pre-op and at 8:30 a.m. I was taken into the O.R. A new surgeon was on shift by this time, Dr. Panton, and he performed a laparoscopic appendectomy. He called Maria at about 10:30 once the surgery was over. He told Maria that the appendix was perforated and had ruptured 24 to 48 hours prior to surgery. He told Maria that if the surgery were delayed even by half an hour I might have died. He said the situation was still life threatening and very perilous for the next few days. The infected area was large and he had to spend a significant amount of time cleaning everything out. There were a number of possible complications and infections that could arise. Maria was, needless to say, in a bit of shock.

I was put on two different intravenous antibiotics. I also had a tube coming out of my abdomen below my belly button that was draining my peritoneal cavity. Maria visited me with my mother that afternoon. I was still wiped out and in some pain. That evening I had my first hospital meal – the chicken broth was horrendous, but the apple juice tasted good. I recalled reading that the body uses up to 5,000 calories when recovering from something like surgery. I was on a continuous IV drip with a solution of 5% dextrose at 125 ml per hour (sometimes bumped up to 200 ml per hour when a new antibiotic bag was hooked up). So, the IV was providing me with somewhere between 600 and 960 calories per day. In the 24 hours after surgery I probably only consumed another 300 calories, mostly in the form of sugar (apple juice). I don’t know how you’re supposed to get better on a starvation diet like that.

I didn’t sleep much Tuesday night because I couldn't get comfortable and the room was not quiet (one of the women required a breathing apparatus to sleep and it was very noisy). Wednesday’s breakfast included some insipid cream of wheat, served in the lovely heavy plastic bowls that the hospital uses. I could still smell the chicken broth on the bowl, but I took as much of the cream of wheat as I could in an effort to get my bowels working again. On Wednesday the nurse told me I had to start walking and using the toilet instead of the urination ‘jugs’ in bed. The IV was pumping me with between 3 liters and 4.8 liters of fluid per day in addition to what I was drinking, so I was peeing a lot! It was very difficult and painful to get out of bed, but not too painful walking. It was, however, much more difficult than I had imagined it would be. But once I started walking I felt much better. The various gases both inside my intestines and in my peritoneal cavity (they pump you full of CO2 to perform the surgery) seemed to settle out much better with walking. I walked a few more times that day, including around the ward. The view from different rooms was quite nice. The weather was terrific and I was on the 14th floor. That night, when I couldn’t sleep I got up and walked the ward for about 30 minutes.

I had a number of visits from friends and relatives and I’m grateful for the time taken to come visit me and the encouragement offered. I received excellent advice and had lots of questions answered by my cousins Suzy and Cameron and also from Kathy, Ja and Kunakar, and Joe.

On Thursday morning I was visited for a second time by Dr. Panton and two of his team. Dr. Panton liked everything he saw including the colour of the fluid draining from my abdomen. He ordered the drain removed, the IV disconnected and said I could go home. Maria was a bit shocked at this, expecting at least a week of hospitalization, but I was extremely happy. I don’t know how anybody gets better in hospital. I don’t think I slept for more than two hours continuously and the food was truly awful. Maria and her friend Kathy picked me up at 10:30 a.m. and took me home. I immediately slept for a couple of hours and commented on feeling better just getting out of the hospital. Just sitting on my own bed felt better. It was so much more comfortable than the beds in the hospital.

Maria had to phone Dr. Panton the next day because I had been sent home with a prescription for painkillers, but not antibiotics. I wanted to make sure that a mistake hadn't been made. Sure enough, I was supposed to be taking antibiotics and somehow I left the hospital without the correct prescriptions. During the phone conversation Dr. Panton told Maria that my recovery was 'fantastic'.

I went for walks outside every day, post discharge, and felt a little stronger each day. My weight dropped quite a bit after discharge. I think this was because I was quite bloated upon release and it took a few days for all the water to come out of my system. My appetite was good though and I ate lots of carbs in an effort to get my bowels working again, even Haagen-Dazs!

I am very grateful for all the kind words, visits, phone calls and cards. It’s nice to know I’m loved and appreciated. I don’t wish my experience on anyone, so make sure you learn about McBurney’s point. If you draw a line from the belly-button to the anterior superior iliac spine (the prominent part of your hip bone), McBurney’s point is two-thirds of the way along the line, starting at the belly-button. That’s the location of the appendix and will be very tender in an appendicitis. In my case it was indeed very tender, although not until the second day of discomfort. This is also typical. Don’t wait to get help once you notice this tenderness!