Seven days post–laparoscopic cholecystectomy and heavy menstrual bleeding with vaginal ulcers

46f, 5'4", 198 lb., Caucasian. History of: Type 2 DM, hypertension, asthma, hypothyroidism, ADHD, anxiety, and most ridiculously, Behçet's Disease. Medications: Mounjaro, Jornay PM, Lisinopril, Fluoxetine, Levothyroxine, Symbicort.

Apologies in advance for how long this will be. I began having what I assumed was heartburn the week of July 21. The night of July 26, I called 911 after seven hours of cyclical vomiting and intense pain below my breastbone, radiating to my back. Taken to ER; ultrasound and CAT scan with contrast performed. Both showed sludge and slight thickening. Given pain medication and anti-nausea via IV in the ER; continued vomiting and pain, though slightly improved.

Abnormal labs in the ER Sunday, July 27:
WBC: 20.5 x10^3/mcL 
Platelet: 440 x10^3/mcL
MPV: 7.1 fL (frequently low for me)
Neutro Absolute: 19.2 x10^3/mcL 
Lymph Absolute: 0.6 x10^3/mcL 
Neutro Auto: 93.8 % 
Lymph Auto: 3.0 % 
Respiratory rate: 21 br/min 
Blood pressure: 176/81
Sodium: 132 mEq/L 
CO2: 19 mEq/L 
Protein: 8.5 g/dL 
eGFR: 86 mL/min/1.73 m2

After ~five hours, I was admitted and told I'd be having emergency gallbladder removal the next day. Because of my elevated WBC, they checked my lactic acid to rule out a sepsis risk. That came back normal.

The afternoon of July 28, I had the easiest and most pain-free laparoscopic gallbladder surgery possible. Woke up feeling immediately better. Could tolerate food, drink, and alternated between oxycodone and extra-strength tylenol for the remainder of my stay. Able to walk, unassisted after a few hours, and use the toilet. Farted lots, to the delight of the nurses (that gas is no joke). After some back and forth, the hospital discharged me the following day (July 29).

I was later told that the gallbladder was perforated and necrotic, with minor adhesions to the liver. I can't remember if there was one gallstone hiding in the sludge or not. Gross/cool.

My WBC was still elevated at the time of my discharge, but was about half of its original level. Some other previously normal labs were now abnormal; I assumed this was because of the WBC evening out and post-surgery body recovery.

Abnormal labs pre-discharge , July 29:
WBC: 12.9 x10^3/mcL
RBC: 4.07 x10^6/mcL 
Hgb: 11.5 g/dL 
Hct: 33.9 %
MPV: 7.6 fL 
Neutro Absolute: 11.5 x10^3/mcL 
Lymph Absolute: 0.7 x10^3/mcL 
Neutro Auto: 88.4 % 
Lymph Auto: 5.1 % 
Calcium: 8.0 mg/dL
eGFR: 89 mL/min/1.73 m2 (frequently slight low for me)

I was discharged to my parents' care and was looking forward to some pampering from Mom and Dad. Three days later, my mother had to go to Urgent Care for a UTI. As we were getting ready to leave, my dad wasn't making much sense and slurring his words. We suspected a TIA or stroke. Called 911. He was belligerent and refused to go with them. Caught him later sneaking alcohol. He has a history of alcoholism, but this was very surprising—drinking during the day.

That night (August 1), I felt some burning/itching/discomfort at my labia/anus. Using my phone, I took photos of my labia and noticed many ulcers, some already breaking/about to bleed, some appearing to be sloughing off a white-gray film. I've only had a handful of Behçet's genital ulcers, but it was the symptom that finally got me the diagnosis after a history of bilateral uveitis, elevated autoimmune markers, and an undocumented history of tongue/cheek ulcers (I thought everyone got them!). My ulcers tend to present shortly before my period begins, and are very much driven by stress. So it all made sense.

The next day (August 2), stress was heightened as we had to call 911 again on Dad, who had a BAC of over .2 when we finally did convince him to go to the hospital (and wow, I checked the liquor cabinet and it was decimated. Empty bottles everywhere. Horrible illness). That night, I checked my vulva again and noticed that many of the ulcers were breaking (yay, almost over!) ... but that there were several towards the vaginal canal—which I've never experienced. And those were very red and bleeding—something I have also never experienced. [I can supply photos if anyone would want to see my leper-like ladyparts.]

Because my genital ulcers are so few and far between, my rheumatologist, back in 2023, did not want to put me on a systemic, but said to call him if I got them again. He's since left the practice; as I was seeing my PCP on Monday (August 4) for a post-discharge follow-up, I thought I'd bring it up to her first. She said, given how bad the ulcers looked, she is not surprised by the bleeding. Although she is not very experienced in Behçet's, she knows that steroids are commonly prescribed for ulcer outbreaks. However, given my recent surgery, diabetes, and the elevated WBC, she did not want to put me on oral steroids if she could avoid it. I have been using topical clobetasol but it's ... tricky, with all the bleeding.

Here's where I'm starting to get nervous. The blood is gushing out in very heavy spurts, and in those spurts it is very, very dark red. I inserted a tampon today (bad idea), and it was saturated within 90 minutes. It also irritated my ulcers, which, ... duh. I should've known better. I do have a fibroid that can make my menses more heavy with a constant gushing flow, but that has actually gotten better as I've gotten older. And the gushing really only began after I inserted and removed that one tampon, which makes me think it is related to ulcer irritations.

But I feel like dealing with the surgery, knowing how high my WBC was and how dangerously close to bursting my gallbladder was, the stress of my shifted family reality, my menses, and the worst Behçet's flare of my life has me feeling very unmoored. I can't tell if I should go to the ER for this (I did message my doctor and am awaiting a response). My instinct is to wait it out a few more days and see if the bleeding subsides (my periods are usually seven days, and this is day 3—I think—which is my heaviest day), but there are so many unknowns here that I just feel very overwhelmed and out of my depth. I am so sorry for how long this is, but I would really appreciate some medical hivemind giving me their opinions.

If it's relevant: I see my surgeon for the post-op appointment August 13. And, great news, my a1C is now 5.6, down from 6.6 in April when I started Mounjaro. Also down about 10% of my body weight—which is probably what murdered my gallbladder.