Concerned about pain after appendectomy

[maggi315]

hi,
I am new to the boards. My 13yo had an appendectomy last thursday, it was uneventful, not a lap, but not totally opened up either.

I actually have a long story to go with this, it has been amazing the poor care we have received in general. But the ped surgeon who we like finally came back from vacation, and we were operated on immediately (which should have been done 3 weeks earlier).

Anyway, I am a nurse and a midwife and have worked in women's health, so i am quite familiar with post op recovery and what to expect. I am growing concerned about my daughters recovery, in particular the lack of pain management.

She received morphine right before and for about a day after surgery. We ended up staying an extra night for the pain, although they told me it was gas (and wouldn't order something for gas, what's up with that, all the other units, even plastic surgery order mylicon or something, so I got her some gas meds and gave them to her myself). I knew it was more than that, she has a very high pain tolerance for pain and to see her doing OK, then curled up in the fetal position, I knew something was wrong.

We did all the usual; walking, rocking, drinking tons, starting to eat, trying to not take the morphine and take motrin instead, and the pain remained, coming in waves.

On the night after surgery, we noticed there was some bright red bleeding in her urine. the nurses dipped it and it continued to have blood, it was dismissed as nothing, but her left kidney is causing alot of pain for her, something that was present before surgery. Her kidney tests and urinalysis have been unremarkable.

She has been unable to have a bowel movement, despite herbal things like senna, lots of fluids, colace, and tums for gas pain. Her bowel sounds range from normal to hypoactive in certain parts.

the incision itself looks good, there is minimal swelling, however, what I am worried about is that her appendix pointed straight down towards her behind, so if there is an abscess or anything going on, I'm not sure we would catch it very easily.

the doctor and the other nurses seemed to dismiss our concerns and my concern over pain. when I called, I was told it was gas pain and that pain was normal. Well, maybe, but if it's so bad she is curled up in the fetal position and can't move, then shouldn't she be getting something stronger than tylenol and motrin?

On the units I have worked, we want a bowel movement within 72 hours AT THE LATEST and we are at 5 days, she did pass a speck and it hurt so bad, she collapsed at the toilet and we carried her back to bed.

So, any advice? I would just take her to the ER, but they have been HORRIBLE and dismissive, even with all the blood work, CT scan and ultrasound showing appendicitis, they sent us home! We had to wait for this surgeon to come to town to do the surgery. he has been great, he has a great reputation but I feel like something isn't right.

She could have developed an ileus by the incision site, there is very hypoactive or no bowel sounds near there.

No idea about the blood in urine? I seriously doubt an infection, she was treated with a z-pack and omnicef for 2 weeks, then gentamycin and cleocin for 10 doses in the hospital.

Any other ideas? It is hard for me to balance being a nursing professional and a mom. And I don't want to overreact, but sometimes I think I tend to underreact.

Thanks!

[Kenneth ©]

Actually many newer protocols for pain management involve acetaminophen and ibuprophen used in conjunction with each other. Adherence to the regimen (alternating on a strict time schedule) has proven very effective at managing pain. It was all I was offered for a full open surgery. It worked but was no where near as effective as the PRN morphine pump.

Gas pain post laparoscopic surgery is common.

Takes a few weeks to for the bowels to settle down. I recommend soluble fibre (psyllium) to help things along.

All this aside, I would just continue to press and keep taking her back to the ER. Squeaky wheel gets the grease and this is true in medicine as well.

[maggi315]

I haven't gotten any responses, but I have read through the archives.

right now, we are still at the point of lots of pain. And she has a very high pain tolerance,but tells me this pain is worse than the 3 weeks of appendicitis.

She had one bowel movement, then nothing for several days and her stomach started to bloat, so after trying all kinds of things, I gave her a small dose of enema to see if that would work. It did, very well, although it greatly increased the cramping.

We were all treated for the pinworm infection they found on her pathology report, and I don't know if that's contributing to her pain.

She is having pain all around the area, the incision itself still looks good, although there actually seems to be two new little bruises about 1 inch towards her belly button, not sure what's up with that.

The doctor doesn't want to give her pain meds since her bowels aren't working. I'm still worried that there are adhesions, a bowel was knicked, or that she has an ileus.

today, she seemed fine part of the day, then curled up in a ball and told me she wanted to go back in the hospital and get more morphine that she couldn't take it.

It's also stressing her out, she is supposed to go to school on Monday, she's been out three weeks, and now with the pain not decreasing and actually seeming to get worse, she isn't sure she can make a full day.

Anyway, that's our update, I'm hoping more people post or i find more info in the archives. Especially about ileus, parasites, and post op pain complications.

[Kenneth ©]

Stop dealing with the issue yourself and take her to another doctor. Three weeks is a bit too long for things not to be getting better.

[maggi315]

We did end up taking her to someone else, they did an xray series to look for obstruction. None was found. They also recommended probiotics, which don't seem to be making a difference.

She continues to vomit several times per day, sometimes a little, more like gagging or dry heaving, other times her food. She has an appetite, but does have nausea that comes and goes.

We had more bloodwork and urine work done. Urine is clean, but still some red blood cells, but less than before. bloodwork still have elevated eosinophils, but less than before. total WBC is 6.3, down from 10 at the time of her surgery.

I did some research on pinworms and appendicitis and found that it is actually not that uncommon. and once the eosinophil count begins to rise, that can be a sign that the pinworms have left the normal area, in the rectum and large intestine.

She came home from school today crying, saying both her stomach area was cramping and her lower abdominal area, across the bottom. Normal bowel sounds.

I have called several doctors, and no one really has an answer as to why she continues to have pain. She is also have insomnia problems, and generally feels miserable.

her incision site and the area around it look great.

I'm not sure what the next step will be, I might ask our pediatrician to do another cat scan and ultrasound to see if there is anything else going on. Her GI doctor also mentioned doing an upper GI series, but I do hate to do that right now.

anyway, just wanted to update. I am frustrated and tired from dealing with this issue so long!

[Kenneth ©]

Indeed, it is always worse when it is your child! I hope you get some answers soon.

[moy]

[QUOTE=maggi315;10397]I haven't gotten any responses, but I have read through the archives.

right now, we are still at the point of lots of pain. And she has a very high pain tolerance,but tells me this pain is worse than the 3 weeks of appendicitis.


do you have an email address so i can email you?...i'm new to this and not sure how it works yet

[pymnsappida]

Something in a recent post. A very strong verbal resemblance. Im not saying any more than that because, hopefully, Im completely wrong, and by saying more might be pissing someone off.

There is nothing I can do about it unless, as bugman says, she comes forward.

She possibly wont listen.
Problem is shes at that age, and while I trust this forum and those regulars and de-lurkers within, her posting here which is the real worry, rather than her just being here opens up the question of what other forums is she posting on and what dangers is she exposing herself to?

[glenfoxman]

Hi girls

Well, I am starting to become concerned for one of my girlfriends...She has three children and is pregnant with her fourth...and she has become quite depressed lately...after a lot of talking to her she finally confided in me that she and her husband were having problems....apparently he has become what I think is emotionally abusive she told me he calls her stupid and yells at her often and he isnt showing any interest in her pregnancy...I feel so sorry for her as she has so much on her plate...I can tell she is becoming less and less herself she is usually bright and bubbly and smiling and lately she is just so down...

What advice should I give her? I dont know what to say....Her partner seems like a normal guy to me but I guess that is only when I am around...

Any advice you could give me would be greatly appreciated
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[Dracle]

im taking Canada Labs Masteron Prop at the moment bc i jus finished my other bottle of British Dragon Masteron Prop....the BD masteron was alot darker in color and hurt wen injected in shoulders n legs...worked well....the Canada Labs one is alot clearer and doesnt hurt after injection even in shoulders n legs.....my question is could it be possibly fake or maybe diluted since its much more clearer and have no pain after injection...i feel like im puttin water in?......cant really tell i have gains from it only done 5ml gains i have now could b from the BD masteron and Test that im stackn with..........thank you guys