Slowly twisting..in the wind...twisting twisting

Well, the last couple weeks of my life have been...unexpected.

Embarked on a trip to Argentina with tons of plans and research and enthusiasm.

Flight to Buenos Aires was delayed like 3 hours, so we got to camp out on the floor of the Miami airport, waiting for our flight. OK, that sucks but we deal. First half-day in Buenos Aires was nice, if a bit subdued since it seems the entire city was shut down since it was Sunday. Almost no traffic, few people, most stores closed. We still got a nice walking tour down Calle Florida (the pedestrian shopping street where some of the shops were open) down past the Casa Rosada where we snapped some photos (including some of the neighboring historical buildings), all the way to San Telmo to find the Sunday antique market. We accidentally went into the local municipal market instead, which was fairly neat - lots of booths of antiques and old stuff, including lots of records, etc - and finally found ourselves at the antique market which was full of people and booths and neat art. We watched an elderly couple tango near the square, and bought some roasted peanuts from a street vendor, and then wandered into a cute little courtyard with cute little shops off of it. We then walked back up I think the Calle Defensa or something like that, which was also a quite busy street with street performers, street mimes, and a lot of shops and such. We wound up in a cafe to try some empanadas and local desserts (I got a gigantic dulce de leche flan which I had to eat mostly myself, while my friends split a dulce de leche crepe) for kind of a late afternoon snack, and finally wound up in Puerto Madero, where we were planning on having dinner. Since 5PM (after a 4PM snack) seemed way too early to eat, we started exploring the area before getting driven to cover by a sudden rainshower. We discovered that the entire port area was filled with a lot of restaurants but basically no stores, and broken up by several buildings of the Catholic University. We crossed the bridge over into the area across the water but only found more new looking upscale restaurants. Not the most exciting thing in the world, particularly since it was way before Buenos Aires dinnertime. We finally ended up going to the restaurant, Siga La Vaca, early. This was an Argentinian BBQ restaurant recommended by a friend, and I have to say it was rather disappointing. The salad bar was quite nice but the meat was all overcooked and there were no interesting cuts we were able to identify. What was impressive was that each of us got either a bottle of wine (full bottle), bottle of beer, or pitcher of soda with our meals, so we had a lot to drink (one wine, 3 sodas). We also got dessert - my chocolate volcano cake was huge and a bit overly sweet, but had a raspberry sauce and was decent. After dinner, we walked back to our hostel (V&S Hostel Club), passing by the back of Casa Rosada, as well as an arena where apparently a Bryan Adams concert was being held.

Got derailed the first morning (second day) when I woke up with severe lower abdominal pain, localized to the left lower abdomen (which meant very unlikely to be appendicitis unless I was backwards). Probably freaked out my friends who woke up to me whimpering on my bed and then running to the bathroom to dry heave. Fun for all! Of course, we had a flight to Trelew/Puerto Madryn in just a couple hours so all they could do was feed me motrin, pack my stuff up, and bundle me into the taxi to the airport. I vomited (sort of) again at the airport, and then curled up in a ball waiting for the plane. I really really wanted to see the penguins at Punta Tombo, especially since I'd arranged the tour and done the research, but by the time I got to Trelew airport, it was pretty evident I was in no shape to go bumping around in a bus and wandering around looking at stuff. The tour guide was very sweet and very concerned, and called for the shuttle bus to Puerto Madryn to pull over so they could transfer me aboard and get me to our hotel, where I spent the rest of the day napping and trying not to move so as not to aggravate the pain. By the time my friends returned in the late evening, I was feeling better, enough to partake of some of the Welsh pastries they brought me back from their Welsh tea, but not enough to go out to dinner with them. My meals that day therefore consisted of some powerbars and some Welsh pastries. Healthy! At least the hotel was nice - I highly recommend the Solar de la Costa. It's not downtown (apparently it's a 15 minute walk away) but it's on the waterline with a nice view, the rooms are clean and pretty and cute, the bathrooms are sparkling and large and modern, and if I had to hole up somewhere for a day, there are far worse places to do it! Like the V&S.

So, day 2 in Argentina for me: Wake up in pain. Travel in pain. Sit in (very nice) hotel in pain. Eat Welsh pastries.

Day 3 I was determined not to miss out on everything, and I was feeling better, so I went on the Peninsula Valdes tour with everybody. The tour we originally booked - Tito Bottazzi - had mechanical problems with their bus so they were over an hour late. My friends got fed up and called our company from the first day - Cuyun Co - who had a later departure, and we ended up going with them. Though not before Tito Bottazzi showed up (even though our hotel had called them to cancel). Slightly awkward. That was not the best time of the year to visit Peninsula Valdes (mid-April) so we didn't see that many animals, but we did see some, which was nice. The area around there is all very flat, dry steppe - lots of brush but not very interesting landscape, so we all ended up sleeping a great deal on the bus since there were long transits between every stop. I discovered that I could look at animals if they weren't too far from where the bus stopped, but walking or standing for a while wasn't fun, so I ended up squatting on paths taking photos, or just sitting and staying behind when there was a longer walk involved. Saw a couple elephant seals, a cute colony of Magellanic penguins in the side of a hill, some guanacos (big llama looking mammals), armadillos (trundling their way across the parking lots), rheas (I think - ostrich looking birds), and lots and lots of sea lions. Less than you'd usually see, but more sea lions than any other animal. We were told how there is a colony of I believe 21 orcas in the area, and of these only 7 know how to do the beaching behavior that apparently only these orcas do, where they deliberately beach themselves in order to catch baby sea lions during high tide. And of those 7, only 2 of them teach it to others. Unfortunately we weren't there during high tide but apparently a few had been spotted that morning at 7am. Had a very late lunch in Puerto Piramides, the final stop on our tour (all the other places you usually eat were closed for the season) and then headed back to Puerto Madryn. At this point I was starting to feel worse again, though not nearly as bad as the previous day, so I opted to stay in the hotel (where I watched a ton of silly American TV subtitled in Spanish) while my friends went to get dinner in the city. This time they brought me back a ham sandwich =).

Day 4 was partially a travel day, as we caught a bus back to Trelew to fly back to Buenos Aires. I still wasn't feeling very hot, so I stayed in the hostel (not nearly as nice - I had a top bunk b/c everyone was afraid of falling off, and everytime I moved, which was frequently b/c I was so uncomfortable from the abdominal discomfort, the whole thing swayed) while my friends explored the city. They booked all of us to go see a tango show that night at the Cafe Tortoni, assuming I'd be better by then, so I hobbled my way the 8 blocks to the restaurant, through some really unpleasant smoke in the air (turns out the farmers outside Buenos Aires decided to try to clear land by burning it, it got out of hand, and Buenos Aires ended up filled with smoke for days) to watch the show. Had my first real meal in days there - a beef steak with salad - and watched a rather amusing show that started off with all this drama we didn't understand b/c it was all in Spanish, but finally went into entertainment we did understand - singing, tango dancing, band playing, and these two amazing dancers with these long cords they whipped around themselves and struck on the floor to make noise, creating some elaborate rhythms and neverending movements of their arms. That was pretty neat. The walk there and back not so fun, but at least I got to see some genuine Argentinian *something* in Buenos Aires, having missed all the other activities of the day.

That night we were rather concerned about how long the pain was lasting and I found my ER doctor sister online, so there was medical consultation late into the night. Having ruled out most urgent things, we decided to just manage the pain and hope it went away.

Thursday we traveled to Iguazu Falls - that was a pure travel day b/c we left too late to really do much in Buenos Aires (we walked to a nearby mall where I once again parked myself in a chair while everyone else wandered around) and got to Iguazu too late to actually do anything there. We checked into our rather cutely rustic little hotel - the Riotropic - that was way off the main drag (as in, through the red unpaved mud roads), asked our very nice hotel owner for info, and then took a taxi into town for dinner. After making stops to get money from the ATM, we wound up at the El Quincho del Tío Querido which was really good. We all really enjoyed that restaurant. Three of us got dishes with the local river whitefish, the surubi, which was tender and yummy. One of us was smart and got the Lomo Michael which was a beef tenderloin cooked to perfection in a delicious sweetish sauce that we all sopped up and kept eating long after we couldn't eat any more meat. There was live music and a nice waiter, as well as fresh blended fruit drinks, and we were all very happy with the restaurant. After dinner, my friends went souvenir shopping while I found a stump to sit on, and then walked to buy us more water from a supermarket while I...found a bench to sit on. The same taxi driver took us back to our hotel, where we hit the sack so we'd be rested for a long day exploring the falls the next day.

Or at least, I tried to hit the sack. Intensely uncomfortable all night long (the pain wasn't very severe but it was persistent whenever I lay down in any position, so I had to sit up), I couldn't sleep until like 4am, and everyone was waking up at 7am so I decided to try to sleep longer and meet them in the park at noon. I actually felt better after sleeping, took a cab to the park (where I discovered I didn't have enough Argentinian pesos to pay both the entrance fee and the cab driver, so I ended up getting slightly ripped off paying him with US cash) and actually got to see a large portion of the Argentinian park. I missed the Isle de San Martin and most of the Lower Circuit, but I did the Devil's Throat circuit, the Upper Circuit, one of the Iguazu Jungle Explorer tours where we took a 4x4 into the jungle (saw a toucan or two), then a boat down the river to the falls, including a dousing under the San Martin falls, and part of the Lower Circuit in order to walk back from the boat dock. That day I only needed to sit from time to time (like on the train to the Devil's Throat and maybe twice on the walk there) but was able to climb the stairs out of the boat and actually run to the trailhead before they closed it of the upper circuit. So that was a good day. Dinner was at El Charo in Puerto Iguazu, where we each got a tenderloin (lomo) steak with a different sauce. Not as good as El Quincho but decent.

Our last day in Argentina was again a travel day. We weren't flying out until 2pm from Iguazu but no one wanted to hit the park again (they saw all the trails) and the intense rainfall from about 3am until 9am completely obliterated any thought I might have of trying to do the remaining trail in the park myself. Instead, we just bummed around the hotel until noon, and then took a cab to the airport. I wasn't feeling stellar, though nowhere as bad as Monday, so I was still sitting a lot in the airport. From the local airport, we cabbed (long ride) directly to the international airport, and then did some duty free shopping there. Dinner was some fairly lame sandwiches at the only restaurant inside security - overpriced and undertasting, oh well. The plane ride back was unpleasant and long (11 hours to Dallas, 2 hour layover, then another 3 hour flight) but finally I was home, where my bf was happy to see me and alarmed to see me sit almost immediately on the floor after seeing him at the baggage claim.

Sunday I slept much of the day and hung out with my bf, feeling not great but not totally in pain either.

Monday I had an appointment scheduled for a physical already, rather conveniently, so I ended up spending the day in the Palo Alto Medical Foundation (PAMF), getting tests (ultrasounds, urine test, blood draw) and bouncing around the center. I felt ok that day - able to walk around, go to downtown Mountain View for lunch, etc. No tenderness on exam, pain levels were low, so my doctor wasn't overly worried (though she did make sure to get a thorough history and do all the appropriate tests). She thought it was probably an ovarian cyst and ordered the ultrasound to check, but cysts are fairly typical and get reabsorbed without intervention so there wasn't too much concern.

Tuesday I felt ok - went to work, walked to get a burrito (and then sat down when we got there), but then left early b/c I wasn't feeling stellar.

Wednesday I woke up in severe pain, worst pain so far. Like, sobbing pain. That wasn't fun at all. However, it took until my sister got off work at the ER and came by to see me around 2pm before I actually did anything about it - she made me go to the ER. There was tenderness definitely when she tried to do a belly exam, and the pain got really bad at one point while she was there. She thought at the time maybe it was diverticulitis b/c it wasn't presenting as she'd expected for an ovarian cyst, and we still hadn't gotten results back from my doctor. We got to the ER at the hospital closest to my house, and only after we had been admitted did we finally get a hold of my doctor (she only works MWF) and find out the results of my ultrasound on Monday. I apparently had a 9cm solid mass on my left ovary with some complex free fluids in my pelvic area. They weren't sure what it was. Hearing these results, the ER decided to do another ultrasound, this one with flow (to see if there is blood flowing to/from the ovary) b/c the concern was about torsion - that the ovary would have twisted on itself and cut off the blood supply. They also found a 9cm solid mass which they couldn't really tell what it was, but they thought there was flow to an area they thought was my ovary. Consulted over the phone, their gynecologist on-call (who never saw my ultrasound or me) said he wanted to go in with open surgery and remove the ovary. Whoa there. Neither my sister nor I liked the sound of that, and my sister was particularly concerned. After talking to various gynecologists she knew and trusted, who all said they'd go in laparoscopically first and try to save the ovary before resorting to removing it or open surgery, we decided to check out of the first ER AMA and go to UCSF.

At UCSF, they looked at the ultrasound that the first ER had sent along, but said that it was really hard to tell what was what, so they tried another one. The gynecology resident in the ER was really nice with great bedside manner (and her ultrasound skills really impressed my sister). She did the ultrasound and found that it was really hard to determine exactly what was what - she saw the mass but wasn't convinced she saw an ovary, so she wondered if the mass *was* the ovary. She wanted to get a better picture, so she ordered a formal ultrasound with a non-portable machine and an ultrasound tech. In the meantime, I had taken a couple vicodin I had leftover from a gum procedure, and was feeling a lot better (but also, the pain seemed to subside b/c there was less tenderness). So we sat around the ER for quite some time until I finally could get the ultrasound after midnight, and some time after that until they could come consult with me. After much consultation with various residents, radiologists, etc, they decided that I definitely needed surgery but they didn't want to do emergency, middle of the night surgery if they didn't have to. In the middle of the night they're understaffed, the people working have been doing long shifts are tired, they're calling in people who were asleep at home to work... better and safer if they can do it during the day. And after the last ultrasound and given that some 12 hours after I took the vicodin, the pain still wasn't too bad, they decided to send me home and try to get the surgery done on Friday.

So, Thursday morning. I wake up feeling much better and refreshed after the first real night of sleep I think I'd gotten in a week and a half (every night in Argentina I basically woke up every hour or couldn't sleep). I was happy b/c there was essentially no pain - my bf was immediately concerned b/c they had said no pain = ovary dead. But after poking around some I decided there was still tenderness and standing still had pain, so I must be ok. But I was being lazy and poking around my computer - I showered, made some phone calls, etc, but never got around to having breakfast. Good thing. At 11:30, I got a phone call from the gynecology resident on the morning shift, who had reviewed my films with their sonographer, and they were very concerned about torsion and asked me to come in right away. You're not supposed to eat or drink for 8 hours before surgery (which is why I didn't get to eat or drink basically from 2pm onwards the previous day) but I had had a bit of Gatorade after waking up, so there was some concern about that. We went through all the pre-op stuff, I got everything explained to me (and asked of me) by a whole bunch of different people - the residents, the attending, the anesthesiologist, etc and finally, around 3:30PM, I went into surgery. Laparoscopic surgery, with the intention of saving the ovary if possible.

Post-op, I took longer waking up than anyone expected (on my side, I felt like I was getting a really good nap and was super-reluctant to wake up b/c I was so comfortable). I have vague memories of the doctors saying stuff about it going well and saving the ovary, but I really was out of it for quite some time. By the time I "woke up" enough for them to move me from a bed into a chair and get my bf in, my sister had to leave. I ended up having to hang out there for another 2-3 hours because they want proof you can urinate before you leave and I was so severely dehydrated I basically went through like a liter of water and 2 liters of IV fluids and still barely could produce any urine at all. So I just dozed in my chair while my poor bf sat there and watched my pulse drop as I fell asleep and then spike up again as I woke up. Finally, they sent me home.

I didn't really find out until the next day when I was really coherent what had happened. Apparently they went in and discovered that the 9cm mass *was* my ovary, filled with old blood and blood clots. Seems there had been a hemmorhagic cyst which burst, which is why my ovary was so large and where the fluids all came from. The ovary was twisted twice on itself (they kept giving me the example of a kinked garden hose) so they untwisted it, sucked out as much of the blood and blood clots as they could, and checked out my other ovary and other organs to make sure they were normal. They got the ovary back down to around 5cm, which is still larger than normal, but they left it in b/c even though it was still "purple and angry looking" by the conclusion of surgery, recent literature suggested that leaving it in, it should recover. They don't know how long the blood flow was cut off, they don't know when the hemorraghic cyst burst or the exact pathology of what happened over those 2 weeks and why I got pain when I did. Seems likely that the bulk of the twisting happened that Wednesday - hence the greater pain - and that maybe the cyst burst on the Monday in Argentina, which is why it hurt more there. The persistent pain was due to maybe the fluids from the cyst irritating my insides, and maybe from intermittent torsion of the oversized ovary. At any rate, we won't know for several weeks whether everything is ok or if the ovary was too damaged to recover. There is still some chance of it torsing again, so I'm being rather psychosomatic about every bit of pain I feel, but for now I've just felt normal recovery pains.

The team working on me were really great at UCSF - the recovery nurse followed up on me the next day, the resident followed up on me the day after, the attending followed up a little less than a week later. They all explained everything a lot, were really kind, and worked hard to save my ovary and do as minimally invasive a surgery as possible.

So this is me now - back at work (been "working from home" for several days but not doing much b/c I just didn't want to or couldn't focus) writing long blog posts, able to be up and about, getting tired a bit more easily physically than usual, with some pain, but generally feeling much better.

And I'm flying off to New Orleans tomorrow.