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Lea has developed gallstones that cause her to be uncomfortable with abdominal pain ranging from minor to miserable practically all the time. Gallstones are clumps of hard matter that develop in the gallbladder or bile duct when certain substances harden. The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. It is often today removed through a simple laparoscopic surgery (cholecystectomy) which removes the gallbladder through small incisions in the abdomen.
That surgery is not possible for Lea, because of the previous procedures performed during her acute necrotizing pancreatitis attack and recovery in Hartford in 2005-2006. The surgeons had initially given her only a fifteen percent chance of survival, and had enough complications to deal with in rescuing her major organs, they didn’t remove her gallbladder.
She has an eleven inch arched opening in the abdomen resulting from that initial surgery. In her case, the surgeons made an incision almost from hip to hip just below the ribs, and were not able to close it due to severe swelling. They had to let the wound heal from the inside out.
They removed skin from her thigh and stretched it over the bowels, stapling the graft to the upper and lower edges of the incision. She has had to wear an elastic wrap over her abdomen to keep her bowels from spilling out for the past thirteen years, removing it only to bathe. So, she has the constant pressure of the elastic wrap on her abdomen, and then when she has a meal, bread or pastry tends to swell as it absorbs liquids, squeezing the gallbladder. That can force a stone into the bile duct, which could trigger another pancreatitis attack the doctors have said she probably wouldn’t survive.
Consultations
We had consulted with several surgeons in recent years to inquire about getting the gallbladder removed, and they had each told us that they wouldn’t consider doing any surgical procedure except in emergency because it would be life threatening. The skin graft had grown attached to the bowels it covered, and trying to remove it to get to the gallbladder would likely tear holes in the bowels, exposing them to potential infection.
In late 2018, our primary care physician, Doctor Tony Aventa, referred us to a reconstructive surgeon with whom he had discussed her as a unique case. The doctors confirmed that she needs to undergo this procedure to avoid another pancreatitis attack.
We arranged a meeting in early 2019 to consult with the recommended surgeon, and found that he had already read through her case files, and also had discussed a possible procedure with a reconstructive plastic surgeon who specializes in difficult cases other surgeons shy away from for various reasons (mostly liability, I think). So, we later consulted with the plastic surgeon, and found that he, too, was willing, even excited, to do her gallbladder removal.
Because of her previous surgery, this would be five-or more hours of surgery to remove her skin graft, repair bowels that the graft is attached to, then lift the liver to access and remove the gall bladder. They said that they would reserve the surgical suite for the entire day in case there were unexpected complications. They would also require a highly qualified anesthesiologist due to the length of time she would be sedated, and highly skilled surgical nurses to assist with the many details of this precision surgery.
It is also possible that they may be able at that time to close up her ventral hernia, perhaps completely, by drilling into the lower rib bones, threading special cords through the holes, suturing to and pulling the muscle wall back up into, or near, their proper position. Following the surgery, there would be a two month, or more, recovery period, including extensive physical therapy to stretch and awaken the stomach muscles so she can stand erect again.
Alternatives
However, after much soul searching and prayer, she doesn’t feel that she is emotionally able to consider another major surgery, and doesn’t feel that she has the physical stamina to survive the follow-on physical therapy. So, while we were dealing with all the angst of that decision-making process, we were notified of a significant increase in rent when our apartment lease expires in April. The renewal rate is higher than we can afford for another year, so we began searching for alternatives.
We applied for financial/housing assistance through Travis County, but found that our social security income exceeds the county’s cutoff. They can only consider gross income, and can’t adjust for our extensive medical expenses. We also hired an apartment hunter to find us affordable housing in the Central Texas area so we could continue getting treatment by her current doctors, but, none became available for which we could qualify.
So, without the possibility of financial assistance, we have decided to move “back home” to Missouri when our lease expires. Lea still has a lot of family in our hometown area who can help me with caring for her, which will give me some time to pursue some personal interests. We have agreed to lease an affordable two bedroom, single bath, apartment back home that is a little smaller than what we have presently. So, we’re downsizing again.
This is not a move that I, personally, am looking forward to making, considering that we have to find new doctors. But, it is what she wants, so that she can be with her family. She left home with me when we married fifty-five years ago, and we have always lived away from them. She has decided that she wants to go “back home,” and I feel that I owe her that after all she has been through. Even though we will be leaving our medical professionals, and relocating where medical services of the same quality are not as available, I feel that I am being led to make this move.
I think it likely the Lord has found another use for us there. He will have His hand in all that we do, and the decisions we make. I have prayed much, and realize that this is probably our final chapter, and this is what my Lord wants me to do with it. I get this feeling that He is making me “buck up,” face the future, and pass through this door He has opened. And, through that open door is all of our friends and family beckoning us to “come back home.” That is a heartwarming sight! Turn the page. New chapter.
I’m very happy to relate a glimpse of hope for reducing the amount of pain Lea has suffered through for the past several years. Our long time primary physician has tended to Lea’s medical needs, and has seen her discomfort continue to increase as the scar tissue surrounding her ventral hernia has thickened and made her breathing more difficult.
In the last three or four years the scar tissue has begun to calcify and become increasingly less flexible, making it hard for her to take a deep breath. The ventral hernia is covered only by a skin graft, requiring that she wear an elastic binder 24 x 7 to protect and support the area. Since it has to wrap all the way around her body, it holds in body heat and is hot and uncomfortable.
Complicating the abdominal pain she experiences from the hernia is the recent appearance of gall stones. We knew she had sludge in her gall bladder before we went to vacation in Maine. in 2005. In fact, our primary physician had run some tests on her abdomen due to frequent abdominal discomfort, and said, “Some day your gall bladder will get bad enough you’ll ask me to take it out. But, for now, it isn’t necessary.” A few months later she spent six months in Hartford CT hospital with acute necrotizing pancreatitis, and given a 15% chance of survival.
Over the past two years we have consulted a few Austin surgeons to see if there was any way to remove her gall bladder, but to no avail. The remarks we got were, “Only as a last resort,” and, “Only in an emergency.” Meanwhile, her pain and discomfort continued to increase. She was prescribed meds for the pain and for the chronically ill depression. She no longer has bouts of pain; it is constant debilitating pain, and she struggles to be active.
Our family doctor recently referred us to a surgeon of his acquaintance who specializes in difficult, sometimes leading edge, high risk, surgeries that most other surgeons won’t consider. We soon met with him, and he told us that he felt optimistic that Lea could get some relief from reconstructive surgery. As he examined her abdomen, he gently pinched and lifted the skin graft to confirm that there were spots where it was not latched to the bowels.
Completing his examination, he stated that he is proposing a 5+ hour reconstructive surgery that would include removing the skin graft to expose the bowels so they could expose the gall bladder so it can be removed. He estimated that would take about three hours, with skin graft removal taking up the first two hours. Then the reconstructive surgery to reattach the bottom edge of her ventral hernia to the lower ribs would take another two or more hours. It is that lower part that contains her erectile muscles, so the reattachment will require a couple months of physical therapy to get those back into use.
All of his proposal hinges on the agreement of a particular plastic surgeon he would want to assist with the surgery. He stated that this particular plastic surgeon does excellent work on reconstructions, and that he is likely to see this surgery as one he would be interested in undertaking. He cautioned that this would be a high risk, major surgery, with Lea under anesthesia the entire time, and that they would reserve the surgical suite for the entire day in case they need extra time to complete the procedure.
With our approval, he set up a consultation with this second surgeon later this month. And, with that, we got a glimpse of hope, a little lifting of the spirit, and a cautious feeling of some pending relief. We know this is all part of God’s plan for our lives, and we pray for strength, patience, and peace that His plan for us will enter the next chapter. Life with Him is a page turner!
Surviving God's Woodshed 