Right after posting yesterday they decided Karen had become dehydrated. Her heart rate was up and they checked her inputs and outputs and noticed she had 2.5L loss for the day, and similar amounts the day before. So around midnight they gave her two liters of fluid via IV. Needless to say, she was up a bunch during the night to pee. So she started today out a bit tired, but did manage to catch up on sleep a bit throughout the day. They continued to give her a liter of fluid here and there throughout the day as well. Following their conclusion that she had become dehydrated, they discontinued several of the harsher constipation remedies, including magnesium citrate and the suppositories. I believe she's just on colace, MiraLAX and senna now. I had been a little concerned over what seemed to be a slowing down of her bowels, as she was only defecating a few times throughout the day. With the news of her dehydration and vast negative sums for ins and outs, I'm thinking her body is just getting use to bowel movements again and she is simply able to hold it longer.
Today's x-ray showed that she had passed the stool that had been backed up for so long. There wasn't any eureka moment when the stool passed, it must have broke up in chunks and snuck out in the diarrhea, or simply dissolved in with the rest. I think we may have been expecting a bit more of a change, or maybe even some semblance of a regular poop where she could say, "Hey, things are starting to go back to normal." Of course the biggest sign of her recovery is that her distension has continued to come down; the remaining distension could just be swelling from the surgery still.
Her heart rate is still slightly elevated from its norm, but her temperature and blood pressure are fine. The fluid coming from the wound looks more transparent and appears less and less like puss. The opening is still half an inch tall, and maybe two inches wide. I don't expect this is something we'll be able to notice a difference with from day to day. They told us it certainly won't be closed up before we go home, and a wound care nurse showed me how to bandage the wound. They'll show me again a couple times before we leave.
As part of our cautious return to food, they did an extended clamping trial of 6 hours. Again, this is where they disconnect the NG tube from suction and see how much they can take out of it after a set amount of time. If nothing much comes back, then things are working their way through the intestines. Karen passed the trial and the NG tube has come out. Her throat is still very irritated from the NG tube. Her voice is dry and scratchy sounding when she talks, like someone losing their voice. On the bright side, her diet has been switched from NPO to clear liquids. As you would expect she's quite happy about heading towards solid food again, as she has been really starving the past several days. This will be our third attempt to move back to solid food. We still have the stool softener and it's friends on board this time around, and she's taking much fewer pain medications now. Third time's a charm.
