Life: Episode V, SBO Strikes Back

For followers of this blog, you know I have been hospitalized for small bowel obstruction in 2004, 2005 and earlier in 2009 and later in 2009.

In 2004, there was a surgical intervention. One side-effect of a surgical intervention is the formation of scar tissue and possible adhesions. These raise the risk of future bowel obstruction episodes.

Think of the intestines as ribbons in a bowl (abdominal cavity). Normally, they slip and slide past each other without incident. But if one has scar tissue so they aren't so smooth in certain patches and they are sticky (adhesions), the ribbons will not always slip and slide past each other as smoothly and every once in a while they get stuck. At that point, the plumbing analog gives you the best picture - things get backed up!

And so it was at 2AM Thursday January 30. Sometimes, the pain goes away in an hour or so and I return to regular life. But by 8AM, the pain had not receded and I was concerned and phoned my primary care physician. He was booked for the day but slotted me in with one of the younger doctors in the office. J drove me to the office for the 10AM appointment.

The doctor had my medical history so she knew to ask about how the pain compared to previous episodes. She then listened for "bowel sounds" and then did a physical exam feeling different parts of my belly and asking where it hurt when she would press. My regular PCP swung by and they talked about my situation with me and agreed I should be sent to the ER at Santa Monica UCLA Orthopaedic Hospital.

view of north wing (photo using paper artist app)

ER's in big cities are busy places and the physical space of the ER often shows the signs of the wear and tear of lots of patients coming through. It took an hour or so before I was assigned an exam room. As I walked in, I could see patients in the hallways.

An IV line was put in, blood was drawn and I was given the "pink liquid" to drink for the CT scan. The pink liquid has bound iodine which allows the radiologist to see how well things are flowing/not flowing in my intestinal tract. One drinks the liquid a bit at a time and eventually when I drank enough of it and it had some time to work its way through my system, I was wheeled into the CT scanner for pictures. This was followed by another set of pictures with iodine introduced through the IV. The sensation of the iodine coursing throughout the body is unmistakeable hence the radiology technician always tells you in advance what you will experience so it won't be so alarming.

With the two sets of pictures completed, I was wheeled back to the ER exam room.

As I mentioned, the ER exam area is crowded with mere curtains separating the exam beds. The two patients nearest me were clearly elderly patients. I didn't actually see them but I could hear the doctors asking them questions. Since they could not hear well, the doctors and nurses were asking them questions quite loudly! And indeed, from the questions, their conditions were quite serious.

Eventually, the ER doc on my case came in and said, you got a partial small bowel obstruction and we are going to put a nasal gastric tube into you and admit you into the hospital.

The nurses came to put in the NG tube and explained what they would do. Having been through the procedure four times before, I knew the drill. Nonetheless, the sensation of having a plastic tube threaded into your nose and down your throat into your stomach is not something you ever get used to.

I was moved into a room in 4NW - fourth floor north wing. The low steady suction was turned on. I was given a shot for the nausea which would eventually recede as the NG tube took out backed up fluid in my stomach. The IV kept me hydrated, my potassium levels at the proper level, and provided calories. When evening rolled around they gave me a stomach acid blocker through the IV and a shot to stave of blot clots. The shot was into my belly fat!

Friday morning brought the morning blood draw, x-ray and visit by the surgical team. Later I was visited by the hospitalist. The hospitalist is like the primary care doctor but she/he works in the hospital. Both the surgeon and hospitalist seemed upbeat about my situation. SBO is not an uncommon reason for hospitalization and their plan was to let the NG tube work and avoid surgery if at all possible. They encouraged me to get up and walk around.

north facing window while walking the 4th floor (photo using paper artist app)

By Friday afternoon, they pulled out the NG tube and would observe me on Saturday. Saturday morning x-ray. They said it looked good so Saturday lunch, I had my first meal - the liquid diet. Saturday night I had my first regular meal. Sunday morning, I had a light breakfast and they cut me loose!

A huge thank you to the nurses and staff of 4NW! You guys/gals are terrific. And thanks to the docs - PCPs, ER, radiologists (never actual met them!), surgical consult team and hospitalists!

Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.