Problems stemming from emergency surgery

[nvaughan3]

What is the name of your state? Michigan


In July 2004, after several trips to the emergency room following roughly 4 weeks of continous vomiting, my 23 year old GF was diagnosed with Gestational Trophoblastic Disease (of the molar pregnancy variety). She was sent to surgery the same night as diagnosis, had a DNC, and was sent to ICU for nearly a week.

Happily, her HCG levels have gone to zero and despite lingering thyroid problems and some signs that the cancer has metastasized in her lungs, she in great health and of course her family and I are glad that she survived her cancer scare without even having to undergo chemo.

However, she experiences urinary incontience on a frequent basis. Loss of urgency is apparent as well as stress induced leakage (sneezing, coughing, etc.) We think it was a result of a botched catheter insertion or removal during her care. Following surgery they inserted a catheter which was immediatly removed because of extreme pain. After 12 hours or so in care they were forced to insert another one because she was immobile. Apparently there were many problems with both the insertion and removal of this catheter, and three nurses were called to remove it before one was actually able to.

Her oncologist referred us yesterday to a urologist, who said upon initial examination there is nothing he could think of resulting from a DNC or a catheter procedure that could cause her incontinence. While she is scheduled for a full workup in about three weeks, to have a cystometrogram and a cystoscopy, she was precribed detrol LA in the meantime to see if that fixed the problem.

I guess what I'm trying to find out, and what I don't understand from her urologists visit is if this is a normal outcome from the procedures she endured.

If further information is needed I will be glad to post it.

 

[ellencee]

my 23 year old GF was diagnosed with Gestational Trophoblastic Disease (of the molar pregnancy variety). She was sent to surgery the same night as diagnosis, had a DNC, and was sent to ICU for nearly a week.

I believe the cause of the problem(s) has to do with why her condition required nearly a week in an intensive care unit.

Hopefully, with time this will resolve.

EC

 

[nvaughan3]

With all respect, I don't quite know what you mean. Beyond the diagnosis of her cancer, the reason she required 5-6 days in ICU was because she sustained heavy blood loss in surgery (4 units blood, 2 transfusions) and had a resting heart rate of 150-170 for several days after surgery despite a multitude of drugs to calm her heart.

 

[panzertanker]

how long ago was this?

If I read correctly, she currently has mets to the lung?

 

[rmet4nzkx]

With all respect, I don't quite know what you mean. Beyond the diagnosis of her cancer, the reason she required 5-6 days in ICU was because she sustained heavy blood loss in surgery (4 units blood, 2 transfusions) and had a resting heart rate of 150-170 for several days after surgery despite a multitude of drugs to calm her heart.

HGC supresses TSH, thus the Tachycardia is possible from hyperthyridosis or if she also had some antibodies, HCG rises/falls doubles every 48-72 hours so there could be someTachycardia until the HCG returned to normal, you did note the thyroid problems. Was she tested for any bleeding disorders?

 

[nvaughan3]

As I said in the first post, it happened July 2004.

She has no bleeding disorders.

Yes, they did note 2 small nodules in her lungs. They are currently monitoring it on a long-range plan with no intent to do anything unless they grow larger.

As it was explained to us her extremely abundant HCG levels (2.5 million) caused her thyroid problems.

But we still don't know why she has incontinence problems and as I said her urologist has told us he can't think of any mechanical way that it could have resulted from the surgery. We obviously believe there is a direct linkage because she's 24 and had no problems prior to the surgery.

 

[rmet4nzkx]

As noted there is a direct relationship between HCG and TSH, hers was an extreme relationship. The symptoms she presented with are called hyperthyroidosis or Thyroid storm. The tachycardia andl GI symptoms noted in her case are typical of thyroid storm. Her urinary incontinence are not typical, but they may be consistent with hyperautonomia associated with thyroid storm. In other words chemical imbalances caused by Thyroid storm may have caused her incontinence, incontinence is also a symptom of hypothyroid the rebound effect of her recovery, the same symptom can result from either extreem in thyroid function. Her rapid recovery following surgery suggests that thyroid storm may be responsible more so than the catheter although you may associate it not knowing the chemical causes also causing incontinence, the urologists findings also found not damage from the catheter Supressed TSH results in many changes in body function and takes time to return to normal after. I have had two instances of hyper thyroid activity, one pregnancy related and one related to a drug interaction causing a catecholamine cascade, I was in the bathroom almost constantly it takes the body time to recover from such trauma. Is she seeing an endocronologist, she may need a thorough endocrine workup including thyroid antibodies.

 

[nvaughan3]

Interesting, I did not know that.

She is scheduled for a couple of urology tests, including one where they said they'd put a small catheter in her and inject water, then subject her to various stresses to see how her body reacts (I don't have the names of the tests in front of me).

Hopefully the problems go away, or the Detrol LA she was prescribed last week works.