Background
For as long as she can remember, since she was a little child, Sibylle has not been able to eat very much at one time. The medical term for this is “early satiety.” Most meals Sibylle eats a small portion and sets her plate aside for later. In a couple of hours she is able to eat more.
Between the early satiety and a general dislike of junk food, Sibylle has never been able to gain weight. Her weight hovered around 115 pounds regardless of how much she managed to eat. Any time that she eats less she would immediately start to lose weight.
Megace
Working with our primary care physician Sibylle started taking a liquid hormone called Megace. Normally this drug is used to stimulate appetite in cancer patients. In Sibylle’s case it made her voraciously hungry. For the first time in her memory she was able to eat everything on her plate and want more. By August she had increased her average daily weight to 150 pounds. At that point the Megace dosage was reduced to try and maintain her weight.
Germany
In late September this year we took a week long trip to Germany to attend Sibylle’s 30 year high school reunion. On that trip we were both sick. I had diarrhea and Sibylle was severely nauseous. My symptoms ended after a few days but her’s didn’t. She had better days and worse days, but never really felt well after our trip. She was forced almost weekly to cancel or postpone lessons due to not feeling well.
An Attack
Early the morning of November 8th she had a very severe nausea attack. Normally a dose of Pepto Bismol helped but this morning she had three with no relief. About 7 am we took her to the emergency room as she was shaking, sweaty, and generally miserable.
While in the ER two tests were performed. An ultrasound and a CT (cat) scan. Combined these two tests showed the presence os “sludge” in her gallbladder, and that both her common bile duct and pancreatic duct were dilated more than is considered normal for a person of her age. By early afternoon her symptoms had abated enough for us to go home.
Phenergan
One of the prescriptions she was given that day was for an anti-nausea medicine called Phenergan. Between November 8th and December 15th she had daily dosages of Phenergan. She also drastically altered her diet. Eliminating anything rich or complex she has lived on boiled potatoes, steamed carrots, banana smoothies, avocados and lots and lots of Melba Toast crackers. (Added by Sibylle: and some cod, some salmon, zucchini, once or twice Thai red curry with chicken, pudding and strawberries from the Bamboo Buffet, greek yogurt. Thanksgiving was delicious, too.)
Around the middle of December she started to feel much better, so much so that she tried a large dish of ice cream one evening with no ill effect. She even had a second helping. Two nights ago, however, a small bite of cheese pizza caused a return of the nausea and a bout of diarrhea.
Doctor, Doctor
In a case of very unfortunate timing our primary care physician moved out of state. Our experience with the substitute physician two days after the ER was not encouraging or good. We asked around and got a recommendation for another physician and switched to her. The new doctor arranged a HIDA scan to measure the effectiveness of Sibylle’s gallbladder.
This scan uses a small amount of radioactive material to trace movement through the liver, gallbladder, the common bile duct, and small intestine. Due to some difficulties with the machine the first 30 minutes of the test were lost. Consequently the liver was not observed. However they were able to see the gallbladder function and measured it at 94%. The common bile duct also appeared to be functioning as material was traced into the small intestine.
Our new doctor also arranged a consultation with a surgeon to discuss gallbladder removal. The surgeon, being conservative, told us flatly that based on her test results he could not guarantee that removing the gall bladder would address her symptoms. He wanted more tests.
Today we met with a gastroenterologist to discuss her case history and see what he would recommend. There are two tests available. An ERCP or an MRCP. The ERCP uses an endoscope to view the junction of the common bile duct with the small intestine, and even the inside of the duct itself. Through the endoscope it is possible to remove small gallstones and widen the opening of the duct into the intestine. However, some percentage of patients develop pancreatitis as a result of this somewhat invasive test. Since Sibylle’s pancreas may already be unhappy, further irritating it doesn’t seem like a good idea.
The MRCP is an MRI focused on the common bile duct. It is entirely non-invasive but it can’t always find small gallstones, nor can it see the condition of the union between the duct and the small intestine. The GI doctor recommend the MRCP and a removal of Sibylle’s gallbladder.
At the time of the gallbladder surgery, the surgeon will inject some dye into the duct near the gallbladder and image its progress to the intestine. If that test indicates some issue with the duct, then post-operatively an ERCP will be performed.
MRCP
Next Tuesday morning Sibylle will have the MRCP performed, and hopefully soon thereafter, will have her gallbladder removed. Our research into this surgery indicates that she should be up and about within a couple of days. While using her Christmas break to accomplish this is less than exciting, we are hopeful that it will mean she’ll be back on her feet in time for the spring semester. And more importantly, that she be free of the persistent nausea that has plagued her for nearly three months now.
Knee, Physical, and Uterus
Just to make things more interesting there are several other medical appointments on the schedule for next week. I am to have my annual well-man physical Wednesday morning, Sibylle has a gynecological exam on Wednesday afternoon, and I am seeing a knee surgeon on Thursday to discuss a possible medial meniscus tear in my right knee.
