Action, meet Consequence

I’m currently recovering from having half of my large intestine surgically removed. Even staring back at that sentence, it feels surreal. Reality still hasn’t sunk in yet.  You always think that it’ll never happen to you. Or, if it does, it won’t be so bad. Courtesy of an on-and-off relationship with laxatives, a few weeks ago I found myself needing emergency surgery.  Life has not been good lately, but the reasons don’t really matter right now. What’s important is that I wasn’t coping. I want to make it clear that I know laxatives don’t affect calorie absorption or weight loss beyond water/waste weight. It’s never been linked to my food consumption - there’s no correlation between calorie intake and laxative use. For me, it’s a form of self harm. To spend a day or two writhing in pain, going between bed and the bathroom. If it didn’t hurt, it wasn’t enough. It’s been an on-and-off issue for a long time, sometimes going 6 months to a year without touching them. But throughout July, I was taking heavy amounts of bisacodyl 2-4 times a week. Now, after these past few weeks, I never want to experience gastrointestinal pain again.   One morning, I woke up at 5am in excruciating pain. A 6/10, peaking to a screaming-crying 9/10 every 5-10 minutes. The worst pain I had ever felt. I hadn’t even taken laxatives for about a week, which was my first indication that something was seriously wrong. I considered an ambulance a couple of times, but that felt like an overreaction. S was going to be here at 11 for supports, and surely it could wait until then. Part of me actually thought (hoped) it might stop. At the emergency room, it took a while for them to figure out what was wrong. Was it my appendix? Ovaries? To be fair, I didn’t disclose my laxative abuse immediately. It could be entirely unrelated, and I didn’t want to embarrass myself. Silly me.

Part of my bowel had twisted around itself, and the tissue was dying. A volvulus. When they first told me it was a cecal volvulus, I just sighed, and finally told the doctor about the laxatives. 

“Yep, that’ll do it.”

Even after that, the surgeons went back and forth.  “It’s a cecal volvulus” “No, you might just be really constipated, we’ll monitor you overnight” “It’s definitely a volvulus, you need surgery now" The lead up to the surgery was scary. They talked about the possibility of a stoma. But at that point, I would’ve done anything just to make the pain stop. In the morning, I went in to surgery. I needed a right hemicolectomy. They removed a total of 33cm (13”). And because they need a large opening to actually get it out, they couldn’t do keyhole surgery, so it was a full open laparotomy. From end to end, the incision measures 17cm (6.7”), ignoring the curves. So I'm going to have one hell of a scar. Unfortunately, that was not the end of it. While in the ICU after the surgery, my blood pressure was getting dangerously low. My hemoglobin levels kept dropping. Until the next morning, when it all came to a head. My blood pressure hit the dirt. Six nurses rushing in, clear the room, hit the alarms, get the doctor. They gave me two units of blood, more albumin, more fluids. It feels dramatic to call it a ‘near death experience’, but I honestly thought I was dying.  What a stupid way to go. Even then, I hate to admit, I couldn’t help but think “so this is how anorexia will kill me, and I’m still going to die fat”. But there was no panic. No ‘please help me’. Just a quiet “thank you for taking care of me”.  I felt an overwhelming sense of calm. Apart from a regret that I was going to die ‘fat’, I felt ready. I was happy that it was a result of my anorexia that would kill me, even if I wasn’t at my thinnest. I always thought I would panic when facing death. That I’d be scared and try to fight and bargain and plead, that I’d be suddenly full of regret for my actions. But I just felt calm and truly ready.  And that’s kind of terrifying now to know. I am 32 years old, and I am ready to die.  After 45 minutes, they stabilized me, then confirmed on CT that I was bleeding internally. So, back to surgery to fix the leak, along with five more units of blood.  I was in the ICU for five days, followed by a week on the surgical ward. I spent the first 2-3 days vomiting dark ‘coffee grounds’ blood. I couldn’t sleep, it was so constant. They would usually have an NG tube placed to aspirate the stomach contents, but when I woke up with one after the second surgery, apparently they had to hold me down to stop me pulling it out, and eventually agreed to remove it.  The pain was intense. I didn’t think the post-surgical pain could be worse than the volvulus itself, but I was wrong. The first time getting back on my feet had me in tears. But each day, it got a bit easier.  They only had me on liquids for less than a week, though I needed a bit of a push to start attempting solids again, even though it was the best way to get my bowels working again. I was so afraid it would make the pain worse. Everything felt like lead in my stomach. It felt like everything was so swollen, there wasn’t any space for anything.  It took about 10 days before my bowels starting moving again. I won’t go into too much detail, but the first week was incredibly painful and difficult. Things have since settled down, but they said it’ll take a few months before I find my ‘new normal’. Because the large intestine, pulls water out of the stool, BMs will be more watery. It'll take some time to figure out how things will be different, and a lot of it is 'wait and see'. I’ve been home for a couple of weeks now, and I’m struggling. The pain is mostly manageable with over-the-counter painkillers at this point, but I’m so incredibly exhausted. I can barely bring myself to get out of bed. Apart from it being a major surgery, and open vs keyhole, I think needing the second surgery has also affected how long healing will take, not to mention being at a sub-optimal weight and intake. I have been eating a little more since I came home than I was beforehand, but still no where near where it should be. Even for protein intake, my dietitian said that healing from surgery I should be getting about 80g a day! I rarely even hit 25g. It's been a main focus with her for quite a few months now. I still can’t bring myself to work supplement shakes into my daily intake, even though I know they would help.  My weight has been dropping since I stopped drinking. This past Tuesday, I hit 6 months sober, so I guess I have that going for me.  For a quick recap, I initially gained a lot when I first started drinking in 2016. I spent a long time bouncing around the 60's range. Around 2020, when I first started cutting back on the alcohol, it started slowly coming off. Just a couple of kilos each year, nothing drastic.  Since I stopped drinking completely, it’s picked up speed. When I had my last drink, I was 62.5kg (137lb, BMI 18.8). This week, I hit 52.1kg (114lb, BMI 15.7). Over 10kg now. I felt like I was doing okay with it before the surgery, but now, I’m really feeling the effects. I'm trying to process everything that’s happened in the past few weeks, and I can’t shake this nagging thought, knowing that I’ve done this to myself. The nights have been the hardest. When the world is quiet, there’s nothing left to do, I’m worn out both physically and mentally, and it’s just me and my thoughts. I knew the risks. I knew this could happen. And I did it anyway.  My body will never be the same again, inside or out. And it’s all my own damn fault.  This isn’t the first time I’ve been hit with the permanent effects of anorexia. I’ve had osteoporosis since I was 21, and have already begun to lose height (at my last DEXA scan, I was 182.1cm). I don't bounce back in the same way I did when I first got sick. Not to mention the myriad psychological effects after 15+ years of this.  But this, this is the most drastic. It’s not even just the scar. My bowels will never work the same again. It will effect me every single day for the rest of my life. And while it could’ve been worse, and I was lucky to avoid needing a stoma, it’s something so needless, something that could have been easily avoidable.  I did clear the house of laxatives within the first week of being home. I don’t think I would’ve touched them again anyway, but best not to find out. Even in that last month when I was using them heavily, I was often vomiting them up. I would take them over the course of an hour, have sugar-free mints to suck on in between, anything to try to combat the nausea. It was like my body was trying to tell me something, but I refused to listen.  For now, my GP wants me to get bloods done more often. Although most of it was my large intestine, they did remove 10.5cm (4.1”) of my small intestine, where nutrients are absorbed. So she wants to keep a closer eye on things, because it can be unpredictable. Beyond that, I’m still not sure what the future will look like. Some questions I’m too afraid to ask (will it increase my risk for other bowel issues in the future?), some things it’s just ‘wait and see’.  So, I guess that’s it. I really fucked up this time. 

xxBella

Sobriety, Surgery & Other Musings

It’s been almost 9 weeks since my last drink. 8 weeks and 6 days, to be precise.

I’m not too sure how it happened. It wasn’t really a planned thing - it started off unintentionally. A couple of times I was planning to drink, I ended up not feeling up to it. Then, after the first 10-ish days, it seems to start to get easier. I start feeling good about it. I start going through days without even thinking about it.

Then, I realise I’ve set a new personal best, and I want to keep it going. Three weeks became four, became six, became eight, and here I am. Last year, I went 15 days without a drink after I had my wisdom teeth out, and that was the longest I’d gone in many years (probably since 2016, when I started drinking heavily), but I hadn’t been able to repeat it. I fell into a comfortable routine of moderation, drinking once a week, maybe twice if it was a bad week.

Of course, it helps when I start to see the scales move. For the last 8 or so years, there hasn’t been a lot of movement, after the initial big gain when I started drinking. Looking back at my records, I seem to have lost about 2kg a year since then, with a few years that didn’t have much movement. But the losses have been so incredibly slow, it doesn’t feel like much.

Then, when I stop drinking, I start to see the lower intakes add up. I start having weeks where every day had an intake of three digits. And I liked seeing that in my log. I start to see the scales move, faster than they have for years. So far, for this year, I’m down 4-5kg - and it’s basically all been in the time since I’ve stopped drinking. Dietitian is keeping a close eye on me, and is Setting Goals again, but I’m not particularly worried. 

The less calories I consume, the less calories I want to consume. And the idea of wasting 1,000+ calories to get drunk just doesn’t seem worth it.

My birthday is tomorrow, and it’s looking like it’ll be my first sober birthday since I was maybe 16. Between the years of smoking, and the years of drinking, it’s been a long time. Usually, I would buy something different to drink for birthdays and Christmas etc, a nice little treat instead of my usual wine and spritzers. I haven’t even bought anything, not wanting to tempt fate. I figure that if I do decide to drink on the day, I can just get same-day delivery, but at this point I have no plans to. It’s always a sad time of year, especially with mum’s birthday next week, but it’s just one of those things I guess I need to figure out how to navigate without always leaning on alcohol. 

I always say that it’s not forever. That’s too much to consider. The goal has always been moderation, not abstinence, I’ve always wanted to be able to just have a couple of glasses of wine with dinner, but I don’t really know if I can. Maybe I could. But part of me just doesn’t want to break the sober streak, I want to see it get to 10 weeks, to 12 weeks. There is something about streaks that I never want to break, whether it’s MyFitnessPal (5,216 days as of today!), Duolingo, Wordle, or my sober streak.

The other recent news is that, about three weeks ago, I ended up needing surgery. 

I’d had a tiny lump for maybe a couple of years now. It was barely noticeable, a tiny bump, perhaps the size of a pea under the skin. So I never got it checked out, because it wasn’t causing any issues, and I didn’t feel comfortable having it looked at as it was situated on my butt cheek. It seemed like the most embarrassing thing. So I just assumed it was a harmless little cyst, just chilling.

Then, in the space of a few days, it blew up. Day by day, it slowly got worse, going from the size of a pea to an egg in less than a week, the pain increasing in step with the size.

I realized it couldn’t wait two weeks to see my regular GP (bad timing for her to be overseas!). I started to worry about things like sepsis, and my anxiety started to peak. Thankfully I was able to get in to see a female doctor, at least. She gave me two antibiotics, but said it would probably need surgery, and if it wasn’t improving within 24 hours, I would need to go to the hospital. 

The next day, it was still getting worse. Thankfully, I had my bestie support worker, S, that morning, so she took me to the hospital. I saw a doctor within 15 minutes, the surgeon an hour or two later. I was in surgery 6 hours after arriving, and home almost exactly at the 24 hour mark.

The concept of surgery and general anesthesia makes me incredibly uncomfortable. It squicks me out, more so than worrying about the pain. I hate the idea of going under. It’s always scary to me, and it was my first time doing it completely alone. When I had my bronchoscopy, I had mum there to hold my hand. When I had my wisdom teeth out, S was there the whole way until I was out. I had a bit of a teary moment when the staff moved me down to get ready for surgery, just a little sniffly. When I woke up, I just cried for a while. I don’t know why I always cry when I’m coming out of anesthesia.

But at least it’s done. It immediately felt so much better, even though I now had a big gaping open wound. When it was first done, I could see the layers of fat. I just wanted to stick my fingers in and rip it out. 

All that to say, I’m feeling much better now. The first 3-5 days home were pretty bad, and I tried to avoid  movement as much as possible. It took about a week to get my energy back and start getting back on my feet and back to my normal routine. It’s mostly better now, as long as I don’t sit directly on it. I’m out of the woods now, but boy, that was a hell of a week.

Shameless hospital selfie. I always feel so weird without piercings 

The cats are getting along well, most of the time. I still separate them if I’m not around to supervise them. Zazu constantly wants to be around Sephi, but she just wants to be left alone, which does sometimes end with her bapping him across the face. But most of the time, they are co-existing in peace, and that’s all I can ask for. 

Nurse Sephi taking good care of me post-surgery 

xxBella