Bowel-prep Prep

Today I bowel-prep for surgery tomorrow.  There’s really no actually need for this – it’s just in case of an emergency situation; were the doctor to knick my intestine or bowel or colon or other such part while performing the hysterectomy, it would be a lot easier for them to fix that situation if my bowel were clean.  So, clean it I shall.

Directions for Bowel-prep

As instructed, I went to Target yesterday where I purchased a 64ounce bottle of yellow Gatorade (which is now referred to as G-series and whatever number you happen to choose as part of your “workout”), a 8.3ounce bottle of Miralax, and some Dulcolax tablets.  I chilled the Gatorade over night as the directions explain most people prefer it that way.  I don’t prefer Gatorade at all – in fact, I think it’s pretty gross in any flavor/color.  But alas.

Other prepping involved moving a basket of magazines into the bathroom, making sure we have plenty of wipes in the bathroom as well, and charging my kindle and cell phone so that I can read and/or play Candy Crush Saga – you know, depending on my mood.  My BFF has also agreed to spend the day with me via phone call or even Facetime while I’m trapped in there!  She does love me.

This morning, I began to add the Miralax to the Gatorade, realizing that an 8.3 ounce bottle of powder was going to displace quite  a lot of the liquid (I, of course, realized this as the powder went in and the liquid poured out).  After figuring out the right proportions, I shook and shook the bottle, then put it back in the fridge.  I sat down to eat some breakfast – two cups of orange jello, shared with my two-year old son (how could I say no to him eating jello for breakfast if I was eating it for breakfast, even if it was on the couch with the TV on – ugh, bad mom, bad mom!).  I periodically returned to the fridge to shake the bottle – the last thing I want is to drink laxative sludge out of the bottom when, at that point, I’ll barely be getting the stuff down (I’ve read a lot of stories about vomiting half-way through).

At 10am, I sent my boys out for the morning and began to drink.  Even though the instructions said to start at noon, I’ve decided to start at 10am because I don’t want to be up all night doing this – I’m hoping this will all be over at a reasonable hour so I can catch up on Project Runway and hit the hay.

For scale – my ten-inch Macbook Air keyboard.

I won’t lie – I am extremely worried about this bowel cleanse, mostly that it won’t work.  I have a stomach of steel – very rarely does anything get me sick (at least, not in that direction).  I could see drinking this whole thing and then having nothing happen.  That also means I sent my boys away for nothing (or, that I could have gone with them to the Science Center!).  And that my prepping for this has been all for naught.  Because I’ve been trying to eat naturally/organically, this bottle of Gatorade makes me nauseous for more reasons than just its taste.  And, finding things to eat today (jello, broth, popsicles) that weren’t filled with corn syrup or other such goop, was nearly impossible.  I figure, after drinking that Barium smoothie a few days ago combined with whatever chemicals they’re going to pump me full of tomorrow, I’m screwed anyway, so a little corn syrup isn’t going to kill me – at least not today.

Twenty-four minutes in and I’d say I’m less than a quarter of the way through the bottle.  This is going to be a long two hours.   I’ll check-in again then!

Pre-op call

A brief update on the CT yesterday – it went fine, and I did not end up in the ER.  I still cannot stand that iodine injection – it feels like lava is coming out of your ears, coming up the back of your throat, and pooling between your legs.  But, it only lasts about a minute, so at least it’s over quickly.

The pre-op nurse called this afternoon.  My laparoscopic total hysterectomy is schedule for Monday at 11:30am.  I need to arrive at the hospital at 9:30am.  This is good – it means I can see my son before he goes to school that morning.  The nurse said I can keep taking all of my meds except for methotrexate (which I stopped two weeks ago) and I should stop taking  melatonin – when I said I was already having enough trouble falling asleep as this surgery gets closer, she said I’d be better off having a glass of wine.  Well, you don’t have to tell me twice!

I get blood work done frequently due to my RA and the medications I take for that; it’s always normal though.  My blood work from Wednesday came back and showed high and low markers in several categories, which I of course Googled and then read about on Wikipedia, as if I need more inaccurate information with which to terrify myself.  Doesn’t seem like anything is too bad, and most of it could have been the result of my binge on Panera chocolate chip cookies only a half hour before the test.  I’m guessing if there was a real problem, the doctor would have called by now, since he is the one who uploaded the blood results to my online chart.

On Sunday I get to do a bowel cleanse – stay tuned for fun details about that.

CT again

I’m in the waiting room before my CT scan.  I have to drink this within 45 minutes:

950ml of Berry Smoothie Contrast Dye

Stay tuned to find out if this scan ends with as much excitement as my last one!

Shocking Discoveries

I am shocked by what I learned from Dr. Balk this morning – according to her, women who’ve had postpartum depression are 4 times as likely to suffer depressive symptoms during menopause. I have asked every doctor I’ve met about this, and all have said there’s no evidence or no connection or no studies that have been done.  So now I’m about a hundred times more terrified.  However, after telling Dr. Balk about my postpartum depression, she really believes that the episode was more psychological than hormonal – that it was triggered by several emotional events combined with an ineffective anti-depressant.  She suspects that I might be just fine after the surgery and have no real emotional reaction to the menopause because I’m well medicated now.

I’m also shocked by how irresponsible I’ve been lately.  Today I went through my purple folder looking for the forms I needed for my PCP, Dr. Stern, to sign before my surgery on Monday – as in, five days from now.  Turns out I was supposed to see her, get my blood work, and have a CT all at least two weeks before surgery.  And, I was supposed to stop taking fish oil, also two weeks before surgery.  I have done none of these things.  So, I had the blood work done, the CT is scheduled for tomorrow, and I’m going to stop taking the fish oil now!  I’m sort of shocked to discover how lackadaisical I’ve been about preparing for this surgery.

The most shocking discover of my day, though, was what I found while digging through my purple folder as I sat in my PCP’s waiting room.  Behind my blood work order was a diagnosis sheet – it’s what I get after every appointment with any doctor explaining what happened at the appointment.  This one said, “ovary cancer” and had a diagnosis code for CA-125 blood work.  I felt myself lose all of the breath in my lungs – was there something someone wasn’t telling me?  I then realized that the diagnosis sheet wasn’t mine.  It was for another woman.  The nurse must have grabbed it with my own diagnosis sheet and not realized they were stuck together.

Surprisingly, my breath didn’t come back, and instead I felt tears come to my eyes.  Sonya Gall, a complete stranger, has ovarian cancer.  She was in the doctor’s office at the same time as me – perhaps this was when she first learned her diagnosis.  Or maybe she was there for treatment.  Regardless, I was surprised by how sad I felt for Sonya.  I sat there staring at the paper, not knowing what to do with it.  Throwing it away seemed like a bad omen for her (sort of the way I feel about throwing away photographs).  So I tucked it back into the folder where it will stay, part of my collection of documentation about this journey.

Third Opinion on HRT

Dr. Sukumvanich said “no hrt.”  Dr. Brufsky said “yes hrt.”  So, I sought a third opinion to try to see if I could get a majority vote on one side or the other.  These are my notes from meeting with Dr. Balk.

HRT?

There’s no right answer – risks v. benefits; because of history of BRCA and DCIS, there is a risk of recurrence of breast cancer.   Does estrogen alone increase risk of breast cancer? – probably not.  Hormones could react differently for a BRCA carrier, but that hasn’t been studied.  Would put me on estrogen immediately if I hadn’t had the DCIS.  I’d rather have cancer than go through the PPD symptoms again.  Mood – will estrogen keep my mood stable? – yes.  Four-fold chance of having depressive episode after surgery after having PPD.  Surgical menopause – will lose hormones immediately (within three days) – loss of testosterone can affect well being/mood/libido.  Mood change can happen very quickly.  Pros of hormones — mood, cardiac benefit, bone health.  She leans more toward to giving me the estrogen – benefits outweigh the risks.  Short course for a few years of low dose.  Transdermal estrogen is better (patch, not pill) — don’t increase triglycerides, don’t raise clotting proteins, more natural, steady sustained level — medium dose patch

Other options

Possible that the Viibryd I’m already on could work for hot flashes.  Effexor is an option.  Lifestyle modification for cardiac health.  Acupuncture – well studied for hot flashes, helps with sleep.  Was the PPD more psychological than hormonal – because I was on an ineffective anti-depressant.  Balk does the acupuncture – she will do it for me.  Yoga, hypnosis, mindfulness stress reduction.

Eating Soy

Minimal effects.  Don’t actively get a lot of it, but don’t avoid it entirely.  Tofu maybe once a week.

Fruits + Veggies, then whole grains, then proteins

Next step:

If I sink into the abyss, call Dr. Barwell (psychiatrist) first.  Then, call Dr. Balk and she’ll prescribe a patch over the phone.