tag:blogger.com,1999:blog-30499448.post7253506546954316781..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: God of the Operating RoomSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger38125tag:blogger.com,1999:blog-30499448.post-32323538644559533872019-11-28T21:25:48.742-08:002019-11-28T21:25:48.742-08:00Thanks for your comment and for sharing your story...Thanks for your comment and for sharing your story, JustDee. I wish you and your father well, and I understand how difficult it can be.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-89858166149086560632019-11-28T21:12:20.014-08:002019-11-28T21:12:20.014-08:00Thank you for this post. My 83-year-old dad had a...Thank you for this post. My 83-year-old dad had an episode about 2 1/2 years ago of severe abdominal pain. He ended up in surgery and it turned out his intestine (small, I think) was twisted. No infection or necrosis, was home from the hospital in 3 or 4 days. He complained about abdominal pain that came and went for the next 4 months. Had no appetite, had trouble eating, eating more than small amounts made him nauseated, etc. <br /><br />Four months later (and after he's gone from around 145 pounds to around 110 pounds at 5'11"), the severe pain started again. The intestine had twisted again and this time was necrotic. Six inches were removed. Over the next few months he dropped to 106 pounds, still had pain, couldn't eat without nausea, etc. etc. etc.<br /><br />He told me and my brothers last year that if anything ever happened to his intestine again, his family doctor and my stepmother had strict instructions that there was to be no more surgery. It's been difficult for me to accept that he would rather die than be operated on again. (That's my <b><i>Daddy</i></b>!) His mother and her siblings mostly lived well into their 80s. His father died at 75 but 6 of his 7 siblings lived past age 93. There's no reason to think my dad won't live another 10 years.<br /><br />So it's been hard. But I've had a year to think about it and ignore it by turns. Tonight I find this entry - I found your blog 3 or 4 days ago and have been working forward from the first entry I read and tonight have worked up to this one. Thanks to your insights and the comments from your readers, I finally understand much better what is going on in my dad's head. I understand much better what the aftermath of his surgeries were like for him. I still hope he dies at home of old age in about 10 years, but if the intestine twists again, now I finally think I can let him go instead of insisting that he suffer again.JustDeehttps://www.blogger.com/profile/03525144529759843013noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-9551896590640224152017-03-21T12:50:12.667-07:002017-03-21T12:50:12.667-07:00I also wondered if there was any injury during the...I also wondered if there was any injury during the first operation but I'll never find out that answer anyway lol. It was due to the first because the part that became necrotic was the terminal ileum... cecum & ileocecal valve.. and spread up. 2 and a half feet total was taken out Loche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-44522774714793144552017-03-21T10:21:14.576-07:002017-03-21T10:21:14.576-07:00The CO2 inflow is connected by a hose that comes f...The CO2 inflow is connected by a hose that comes from a machine that maintains the pressure at whatever level the surgeon requests.<br /><br />I asked about appendicitis because I was wondering if the initial pain you were having was due to the bowel ischemia and that you didn't have appendicitis. I also wondered if it was possible that there was injury to the blood supply during the original operation. Probably not.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-75616543123301931742017-03-21T09:38:59.381-07:002017-03-21T09:38:59.381-07:00I went to a horrible community hospital. The only ...I went to a horrible community hospital. The only great person there was my Surgeon. When I first went to the emergency room, screaming in pain, they ordered a CT scan and it showed nothing and I kept telling them they're missing something and that I know my body and I kept telling them I was going to die, they discharged me and I came back a couple hours later with an ambulance at 4am vomiting blood and the ER doctor told me he's not giving me an pain meds he said I was "faking my symptoms and not in any real pain and I'm only there because I was drug seeking and wanted narcotics".... I don't even take Tylenol. Never done drugs in my life. So they let me sit there for hours in pain and nurses were mocking me telling me to stop lying about my pain. Until my WBC shot up to 35.5 and heart rate was 140's and BP was very low. Then they ordered me another CT and it showed lots of fluid and air pockets, had immediate surgery and was septic inside with necrosis. The doctor told me if I didn't get the surgery when I got it i would've died. I was like, do you all believe me NOW that I wasn't "drug seeking"?.... it was a horrible traumatic experience. Got the C.Dif infection, wound infection, and abscess. When they were putting the JP drain in me, the nurse gave me too much fentanyl and my BP dropped to 60/40 so they gave me Narcan to wake me back up a little bit lol. The whole experience was dramatic and comically unfortunate. From the time the pain started till the time I had my surgery, it was around 26hrs of severe pain. Oh well lolLoche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-9516684175221353402017-03-21T09:21:49.351-07:002017-03-21T09:21:49.351-07:00Yes very rare. Doctor said they've seen it hap...Yes very rare. Doctor said they've seen it happen in other laparoscopic bariatric procedures, but never for appendectomy. And yes they said I had acute appendicitis for the first operation, why do you ask? I remember waking up after the appendectomy in the PACU and screaming in pain and nurses kept giving me morphine and then dilaudid, it was excrutiating. I was in the PACU for 3 hrs and then they sent me home shortly after. I had excruciating pain for 4 days after that minimal procedure. Also, do you know who administers the co2 gas during the procedure? Is it the surgeon, anesthesiologist or physician assistant? I'm just curious who's in charge of pumping the gas Into the patient Loche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-72007732657828164472017-03-19T09:24:49.685-07:002017-03-19T09:24:49.685-07:00That is indeed a rare but not unknown event. I'...That is indeed a rare but not unknown event. I'm curious: was acute appendicitis found at the first operation?Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-77117358705793299572017-03-19T09:18:42.755-07:002017-03-19T09:18:42.755-07:00Incase anyone comes across this, I think my doctor...Incase anyone comes across this, I think my doctors finally found the cause of my necrotic bowel. :) it was because of the first surgery I had which was a laparoscopic appendectomy. They said sometimes with laparoscopic procedures what happens is, all the gas they pump your stomach up can sometimes put too much pressure on your intestines (or anywhere else) and it can cause poor blood circulation thus making you even more susceptible to a blood clot. So that's what happened to me and causes the mesenteric ischemia. It's rare but it does occur. My mistake for thinking "minimally invasive surgery" meant "minimal pain". lol boy was I wrong. Loche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-17982929220811065092017-03-14T18:19:02.702-07:002017-03-14T18:19:02.702-07:00Unfortunately no one knows yet. I still have to fo...Unfortunately no one knows yet. I still have to follow up with a hematologist to run blood tests for a possible blood clot disorder. That's their last resort, they told me that I may never find out how it happened. I'm a mystery case I guess. It might be interesting to mention that I had my appendix taken out laparoscopically 3 weeks before the dead bowel surgery (exploratory laparotomy)... I thought maybe that caused it somehow but doctors all told me it wasn't possible. Loche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-60897159192432506182017-03-14T17:03:53.971-07:002017-03-14T17:03:53.971-07:00I assume your surgeon can provide some insight int...I assume your surgeon can provide some insight into what might have been the cause.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-60090772922218724042017-03-14T16:56:52.482-07:002017-03-14T16:56:52.482-07:00I recently had an emergency surgery for dead bowel...I recently had an emergency surgery for dead bowel. 75cm of my ileum was taken out. 2months ago. I'm 23yr old female btw. I've been trying to find survival stories from other people who had this happen to them but I can barely find any at all... and it's kind of worrisome... it's crazy that this can happen out of nowhere Loche93https://www.blogger.com/profile/08346608493955384011noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-25652133216593312772013-01-24T14:04:39.096-08:002013-01-24T14:04:39.096-08:00Seems like a sort of bass-ackwards way for your bo...Seems like a sort of bass-ackwards way for your bosses to approach it. But good luck.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-77645412511532345112013-01-24T13:45:17.784-08:002013-01-24T13:45:17.784-08:00I am a writer for a medical device company and I h...I am a writer for a medical device company and I have recently been asked to write blogs appealing to surgeons. Not being a surgeon and all, I am not sure how to approach this. How do I entertain them? How do I get them to read this blog? How do I reach them? I would love your inputAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-91549648666280149292012-08-21T00:01:17.369-07:002012-08-21T00:01:17.369-07:00My grandmother had emergency surgery for dead bowe...My grandmother had emergency surgery for dead bowel earlier this year. Not doing the surgery wasn't even given as an option. She suffered with pneumonia for three months before she died. I wish we had known the side effects of this surgery before she got it. She only had one lung and she had asthma and a blocked heart, so her chances were already low. We weren't told this by any doctors. No one even told us that she was dying until two months after her surgery... She was 74. Most of the doctors and nurses pretended she would get better and didn't tell us the truth. Only one doctor told us the truth. We are thankful for his honesty. Knowledge and honestly is always a better choice. Amandahttps://www.blogger.com/profile/06189889811910187785noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-18802732534430315992011-12-20T20:50:41.591-08:002011-12-20T20:50:41.591-08:00AutumnHelva: It sounds like the right thing was do...AutumnHelva: It sounds like the right thing was done for your mom. Your being there through the end had to have been very difficult but, hopefully, something on which you can look back with comfort that you were able to do it.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-90657933382144726352011-12-20T20:30:19.717-08:002011-12-20T20:30:19.717-08:00Thanks for an interesting post. My mother died a c...Thanks for an interesting post. My mother died a couple of years ago in dead bowel, she was 84 years old. She went through the "peek and shriek" operation as I don't think the doctors were aware how bad the situation was before it was done. It took about 30 hours from the operation until she died and I'm thankful that she was given as much morphine as she needed to keep the pain awey, and in the end she was free from pain (due to the amount of morphine she had been given). Even if it took a long time for her to die, and felt even longer sitting by her side, I know that she preferred a quick death rather than waste away slowly, as we had discussed it after having seen my father slowly die from lung cancer for a year and a half.AutumnHelvahttps://www.blogger.com/profile/08232627922744641401noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-7006641485192146502011-08-09T22:56:57.691-07:002011-08-09T22:56:57.691-07:00Losing some parts of our body through surgery will...Losing some parts of our body through surgery will always have a side effect of an abnormal life. Indeed, there are some regrets for the patient, yet what matters most is that he/she is alive. But, how far is being alive to being normal, eh. Sometimes, this is also an ethical question, not just to doctors but even to nurses,when it comes to patient care. Is it important that the patient will be alive yet living in an abnormal way or painful way or let him/her die so that he/she will never feel pain anymore.<br /><br />Thanks for sharing,<br />Peny@<a href="http://www.pulseuniform.com/baby-phat.asp" rel="nofollow">Baby phat scrubs</a>Nurse and Hospital Storieshttp://penrocks123.typepad.com/noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-25787387793048515762009-09-02T19:05:53.397-07:002009-09-02T19:05:53.397-07:00Thanks, Jen. I really appreciate hearing that. As ...Thanks, Jen. I really appreciate hearing that. As you may have noticed, I'm losing my blog mojo of late; but I'm glad the earlier stuff is still getting some notice and doing some good.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-2039787997346486362009-09-02T18:38:41.494-07:002009-09-02T18:38:41.494-07:00Dr. Sid, I truely enjoy your blog. I have been a ...Dr. Sid, I truely enjoy your blog. I have been a med/surg nurse for 9 years. I have taken care of countless bowel surgeries and countless patients where family has pushed for surgery that prolongs the inevitable and where surgeons have leaned towards surgery when it may have prolonged and complicated the inevitable. It really can become six of one half dozen of another. <br />Reading your posts really does help to keep me centered! <br />Thankyou for all that you do!Jennoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-18500419330474355972009-05-14T12:30:00.000-07:002009-05-14T12:30:00.000-07:00My Mother died of dead bowel in July of 2007...her...My Mother died of dead bowel in July of 2007...her surgeon advised us to not put her through the surgery & to allow her to die in peace...he said he wouldn't do it to his Mother...my Mother really liked her surgeon & I hope to God we did the right thing to let her die in peace...she was such an independant person I believe it was what she would have wanted...but it's still so very hard to know whether you did the right thing...you always wonder...I so appreaciate him being honest with me...it's a very difficult decision & it will bother me the rest of my life...but I have to trust that our surgeon knew best. I have such great respect for surgeons!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-83741316036301517452008-09-27T20:14:00.000-07:002008-09-27T20:14:00.000-07:00Thank you for your quick response, your comments, ...Thank you for your quick response, your comments, and your suggestions. I did, in the end, think that it was right to do the CT scan; it isn't invasive and it answered a lot of questions. Amazingly, her GI system look quite good. The have confirmed that she had a mild heart attack and that a huge infection probably precipatated most of this crisis. She is responding a tiny bit to treatment; for example, her kidney function has returned and her heart has calmed down a little. A couple of blood transfusions have brought up her counts, etc. We have decided to wait until Monday before making any more decisions about her care, just maintaining the regiman she is on unless there is a major change one way or the other. Now the question is about her prognosis; the doctor thinks the infection is treatable and that he can get it under control, but he can't in any way predict her outcome in terms of her ability to live at least as active a life as she has been doing -- he said she would be very weak and would need a long convalescence, and she might or might not improve enough to be independent again. I don't want to "cure" her only to condemn her to ten or fifteen years in a nursing home -- that is definitely not what she wants. The struggle continues. It seems as though the "dead gut" diagnosis might have made it a lot easier -- we would have vetoed surgery and she would have died in peace...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-80417475377677900102008-09-27T08:26:00.000-07:002008-09-27T08:26:00.000-07:00anonymous: you have my sympathy. These are the mos...anonymous: you have my sympathy. These are the most difficult of situations. I really can't answer the "should I" questions from this far away: they're hard enough when one knows the whole picture.<BR/><BR/>I can say a couple of general things: being very anemic isn't consistent with dead gut, because usually when that's what's going on, fluid shifts are such that the blood gets "thicker," and red blood cell counts tend to rise. So either it's not dead gut, or there are other things going on as well. Also, if it is dead gut and it's been going on for 40+ hours, it may well be that surgery won't be able to turn things around. If there hasn't been a surgical consult, it would be a consideration, just to cover the bases. On the other hand, you describe a situation in which many surgeons might choose not to intervene.<BR/><BR/>Having made the decision for my own father, I know how terrible it is. Part of it, I think, is that family are as sure as they can be that all appropriate measures have been taken and that the decision to withdraw feels right.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-79577442783369961432008-09-27T02:33:00.000-07:002008-09-27T02:33:00.000-07:00My beloved 84-year old cousin is in the hospital a...My beloved 84-year old cousin is in the hospital as we speak, with ventilator and a star wars atmosphere of tubes and monitors around her. She has been in very good health and has hardly ever been sick in her whole life. My cousin has never wanted any extreme measures taken and has made her wishes know to all. She is critically ill now, with virtually her whole system broken down. The hospitalist suspects "dead gut syndrome and has arranged tests to confirm/reject the diagnosis. I woke up from a sound sleep a couple of hours ago convinced that my cousin wanted the tubes gone and the testing cancelled and to be left in peace, come what may. I talked with the SCU nurse, who was very calming, and I wrote a long email about the situation to my minister in response to her earlier communications. Then I looked up "dead gut" and found this blog -- perhaps an mircle? God at the computer? Anyway, I have read the blog and the comments; knowing that there is a community that is wrestling with these questions provides a lot of comfort and helps solidify my own thoughts. Mind you, we have not yet reached this particular diagnosis; if the diagnosis is positive for "dead gut" I am certain that the answer will be no invasive intervention. My question is, though, should we even go through the mechanics of the diagnostic testing? Should I ask them to remove the ventilator and let things proceed naturally, which is what she has always wanted (she has expressed this opinion vehemently and repeatedly)? Or is it premature? Should we at least get a diagnosis before we give up? This is what I know is wrong now: no kidney function, no blood pressure, on a ventilator, very anemic (is having a couple of transfusions), urinary tract infection/sepsis, atrial fibrillation, dehydradeted, no response to any of the medications administered for the past approximately 40 hours...what do you think? Thanks for listening and for commenting.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-55686161280337499822008-08-25T20:20:00.000-07:002008-08-25T20:20:00.000-07:00anonymous: actually, my most recent post was just ...anonymous: actually, my most recent post was just a few weeks ago. As to your point, there's nothing I said in this post that disagrees with it. I think you might even have missed the point: there are lots of gray zones, there are no absolutes, and making a decision requires bringing to bear all the knowledge, skills, and sensitivities we have.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-62183042084453348932008-08-25T19:44:00.000-07:002008-08-25T19:44:00.000-07:00Since no posts have been made in 2 years, I don't ...Since no posts have been made in 2 years, I don't even know if this is worth saying here, but after reading over the site, I felt compelled to at least mention this point;<BR/>As you admit, you don't know much of the HX of the pt. That's understandable. What I have an issue with, is age discrimination. If a surgery would work for someone in their 20's, and a 90 yro. presents, with the same required surgery to treat a similar problem, why not at least give it a try? I also undertand the delemma of trying to make that decision on your own. It seems to me that being in the Medical Field, gives us an oppertunity to guide those who have no training, into doing what is, dare I say, "right," based on ethics and our knowledge base. Remeber the 'go forth and do no harm' thing? Sometimes by doing nothing, can cause harm. <BR/>Please understand, I am NOT challenging your decision making, whatsoever! In my personal perspective, it would be far better to try and resolve a problem, than do nothing, and simply accept the results.<BR/>I do respect, from what I have read here, that in most cases, you will do what you can as expertly and with the upmost attention to detail. <BR/>In closing, age isn't always the best definitive choice, though popular. The elderly are getting stronger, with advances in medicine, and life expectancy goes up each year. Truely something to consider.Anonymousnoreply@blogger.com