An Octopus’s Garden

I think an octopus must have moved into our attic because the shoes keep dropping.

When last heard from, things were looking up. I had gone a few nights without venting overnight and we thought the worst was over. That lasted four days.

Now, nothing is staying in my stomach, not even fluids. Everything is venting out. Last night I drank a cup of peppermint tea. 10-15 minutes after I finished the tea, I closed off my vent bag for a miserable hour and a half after taking my meds. It felt like I was wearing a very tight corset, only inside my body. When I finally unclipped, David and I watched, eyes agog, as my vent bag rapidly filled with the tea.

Obviously, hydration is a concern. I get most of my hydration from my enteral feed, but that isn’t quite enough. Sunday night I did my TPN, so that was an extra liter of fluids that carried me through Monday. Yesterday, we went to my PCP’s office and got two liters of fluids infused. Tomorrow, I am getting bloodwork done away from TPN to assess my hydration level and we will go from there.

My GI has ordered a gastric emptying study for me to be done at Stanford. This is different than the Smart Pill test I had done back in June of 2022 that led to my official diagnosis. This will involve me eating a standardized meal of two mildly radioactive eggs and two pieces of toast. Then they check over the course of 4 hours to see what percentage of the radioactive eggs have left the stomach. She didn’t share her rationale for ordering the study nor do we know how long it will take to get me on the schedule. But thanks to Damaris and Drew, we think we may finally have a handle on the insurance hurdles we are likely to face.

However, and this is a huge however, that all depends on the ACA not being dismantled and us being able to retain our health insurance. Things are really scary out there right now.

David and I share a theory that the issue isn’t really my stomach as much as my small intestines. That the reason that the liquid isn’t moving through my gut is because my small intestines are also paralyzed. This theory is backed up by a barium test I took before my diagnosis back in 2022 that showed that thick liquids moved through my stomach just fine. But backed up once it hit my small intestines. And that barium was still in my guts two weeks later when I went for a CT scan to rule other things out.

But as the head of enteral feeding at NYU/Langone told us, nobody studies the small intestines because they are boring. And there is nothing that can be done for them. Thus it makes perfect sense that that would be the organ than would truly conk out on me.

Gratefully, I continue to be able to tolerate my enteral feeding, and I am now up to 50mls/hour, which it turns out, is my full feed on this formula. The 54mls/hour was established when I was on a different formula in larger containers.

The DME that send me my TPN and supplies is now supplying my enteral supplies too. I switched, in large part because they had me on an obsolete pump and were therefore sending 500 ml rather than 1liter bags which were no longer available. My new supplier has me on a new pump, but now they can’t get bags for the pump. They sent me 15 bags and told me to wash them out and use them a second time. David and I were unsure as to how sanitary that would be, so I turned to my tubie network and now we have 60 bags enroute to us. But, it is a nationwide issue, so I find myself hoping that whatever is causing the backlog will be resolved soon.

I don’t know where the bags are actually made, but they are assembled in Costa Rica. I now find myself monitoring the deteriorating relationship between the US and almost every other nation wondering what it will mean vis a vie my medical supplies.

So close…

It has been a while, but I have been occupied with a flare, a birthday party and a visitor. All in good time.

On January 29th, I was scheduled to see my GI NP. We arrived at the appointment and there were a bunch of staff people of buzzing around. Turns out that I was going to see my actual GI. The one that is impossible to get ahold of. The one who was adamantly opposed to me being on TPN. I wasn’t prepared.

I also wasn’t symptomatic. After a dramatic 6 months of hospitalizations and pain and drama, I was going to finally get to see my doctor in the flesh. Only I had nothing to tell her. Except that my nausea still sucked. She prescribed a new anti-emetic med. Spoiler alert: it didn’t work.

She also decided that I was constipated and prescribed Dulcolax. That’s it. Next time I see her is in July*.

If you have ever seen any movie ever, you know what is about to happen. The shit will now proceed to hit the fan. And it did. I started venting a fair amount from my G tube. And my pain increased. But, having blown my one chance to speak with my GI, all I can do is send her a message on the portal letting her know that my stomach had gone on the offensive. I gotta say, for a paralyzed organ, it can be very assertive at times.

Long story short, we play with adjusting my meds, didn’t make a difference, time passed and I am now doing much better.

But that alone just wasn’t enough to appease the universe’s need for chaos. I had recently started PT to build up my core strength because that can help with abdominal pain. I was working with a PT from the home nursing agency. She commented that I was one of her most able bodied patients. We started really small. But sometimes something small is all it takes. My back went out.

So now I have abdominal pain, copious venting and a spasming back. My back going out isn’t something new. For decades, I have been taking a med that works wonderfully when my back goes out. It is available OTC in Canada, but it requires a prescription in the US. In the past, I have always managed to make it back to Canada in time to restock. But I haven’t been to Canada since 2019 and I have run out of my supply.

It is the weekend, so I was just relying on heat and my pain management techniques while juggling the extra tube that comes with venting into a Farrell bag. It wasn’t super fun.

Because timing is everything my birthday was coming up, and David’s cousin was throwing me a crafting party that Sunday. I was really looking forward to the party. All 5 of the little cousins (ages 3-12) would be there, their parents and David’s aunt and uncle. I couldn’t just not go. Even though I wouldn’t be able to enjoy it as much as I had hoped, I wasn’t going to let feeling (really) crappy deny me my crafting party.

In the end, It was a great party and I loved it.

Monday, I get my back meds. Life becomes slightly more tolerable. Tuesday evening, David and I have a scare. I started suffering debilitatingly painful cramps. It was so bad that I had to stop my enteral feed. At this point, nutrition isn’t my issue. I am being double fed and am continuing to gain weight. Which is fine because it will help bolster me through future flares. What remains an issue for me is hydration. Especially when I am venting. Fortunately, it was already TPN night, so we didn’t have to worry about my hydration. But it did remind us why we are still grateful for the TPN giving us that extra bit of cushion when things don’t work quite right.

Wednesday, we remember that Dulcolax is known for painful cramping. I stop the Dulcolax. I am still venting and in pain, but I can resume enteral feeding and my back is slowly healing.

Then my brother arrives in town. It is good to see him, but once again, I am feeling very much like crap, albeit better than my birthday weekend. He wisely wanders around Marin county, exploring all of the natural beauty around us, largely on his own. When we are together we watch Wicked and wander downtown San Anselmo, where we pose in front of the Yoda statue in Imagination Park. . Then David and I pose in front of Indiana Jones.
Two white presenting siblings pose in front of a statue of Yoda. Two white presenting people. a man and a woman, pose in front of a statue of Indiana Jones in Imagination Park in San Anselmo.

I met with my RD last Friday, and she said that if we hadn’t had that one night when I couldn’t feed enterally, she would have just taken me off TPN completely. But she shares our concern about my hydration levels. Instead, she drops me down to TPN two nights a week. We are getting really close to me being able to take untimed showers and immerse my entire right arm in water.

I have now gone two nights without needing to vent overnight. My back is feeling almost back to itself. Just the slightest lingering ache. I have resumed my daily stretches. A purple magic ring has magically appeared in my house along with the promise of Zoom sessions with a certified Pilates instructor. Hopefully, she will be able to help me build my core. And I continue to learn how to manage my life with a body that marches entirely to the tune of its own drummer.

*But I do see one of her PAs in April.