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oral v IV contrast

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oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 1:10 pm

I hope you guys can put my mind somewhat at ease - we -well my wife - is having first CT scan after 3 months of FOLFIRI, the last 2 of which were with Avastin. (She had emergency colon surgery in Jan hence the late Avastin).

Onc ordered IV AND oral contrast - please tell me he's just being very through.....

Also two (maybe three now) weeks ago she had abdominal x-ray to check for a blockage (wasn't any) onc's nurse way overdid the anti-diarreha stuff and gave her the constipation from hell...anyway x-ray was clear.

Onc was...well...I guess not "concerned" but "interested" as to why now around her stoma the abdominal wall is harder than before...I mean tumors cannot grown in TWO weeks, right???

A bit of background - she's been sleeping on her back only until she finally asked - begged - surgeon and onc whether she could sleep on side...she said it hurts/pulls/stuff "sloshes" around when she does side-sleeping - both said, oh, don't worry about it...so my question - and I guess hope - is this - is the hardness/discomfort around behind stoma (output is...very good) is it possibly "just" surgical scarring/adhesion and/or inflammation NOT cancer related as such??
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
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Re: oral v IV contrast

Postby betsydoglover » Thu Apr 26, 2012 1:39 pm

Hi Matthew -

I can't help you with stoma issues since I don't have one.

However, oral and IV contrast is normal for a CT scan. The point of oral contrast is to visualize the intestines better. IV contrast allows better views of lungs, liver, kidneys etc.

A CT scan without IV contrast is not terribly useful. Once while on Xeloda we did a CT scan without oral contrast - just to minimize GI irritation. Anyway, your wife's doc is ordering the normal thing.

Take care,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
6 cycles Xeloda + Avastin,
NED (PET every 3 mo)
Avastin only 10/09-5/11
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Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 1:41 pm

THANK YOU Betsy!!!!

THANK YOU!
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
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Re: oral v IV contrast

Postby sarabrooks83 » Thu Apr 26, 2012 2:43 pm

Yes! both contrasts are needed, just to fact check and make sure that nothing slips under the radar. In terms of your stoma question, here's what Dr. Kevin Passer recommends for caring for a stoma: https://www.healthtap.com/user_question ... stoma-site. I've had serious complications from mine (I won't get into the nitty gritty now :oops: ) so definitely make sure you talk to your doctor about why her stoma is harder now! Proper care is super important.
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Re: oral v IV contrast

Postby juliej » Thu Apr 26, 2012 2:48 pm

Hi, Matthew,

Oral and IV contrast is standard for a CT scan. The firmness around the stoma could be a parastomal hernia or adhesions (scar tissue) from the surgery. The CT scan will tell for sure, but I wouldn't worry about it any more than you have to.

I don't know why her onc and surgeon have been discouraging her from sleeping on her side. She should have been allowed to do that as soon as it felt comfortable. Sleeping on your side with an ostomy isn't the most comfortable thing, however. Your intestines get pretty rearranged during surgery, so a "sloshing feeling" is pretty common. Has she tried sleeping with a pillow near her abdomen for support? Or you might even try one of those body pillows that pregnant women use. Anything to give her abdomen a bit more support when she sleeps.

Hope this helps.
Julie
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 6/6/14, CEA<1
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Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 2:55 pm

A trillion thanks Julie! Yes she has tried to sleep on her side, and yes, we have the body pillow, but now she's not doing it until the scan.

I hope and pray indeed that it's "just" a hernia and the such - in the great scheme of things...that's nothing!

By the way - want to hear something funny - or nice? The hospital called the onc's office and asked (since that's where my wife had her surgery, etc etc) are you (onc) sure she can tolerate the oral contrast with the FOLFIRI + Avastin, plus she had massive inflammation in Jan when she had surgery.

So onc told hospital that the Rx was an "auto" Rx and he didn't think she'd do well with oral contrast - so it's IV only! (FOLFIRI was Mon-Wed - Wed AVasting - this week)
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
Joined: Sun Jan 22, 2012 4:04 pm

Re: oral v IV contrast

Postby SkiFletch » Thu Apr 26, 2012 2:57 pm

Sometimes a pillow under the knees when sleeping on your back helps too as it takes pressure off the abdomen and lower back.

I would also not worry in the least about the sloshing feeling and the hardness around the stoma. All are usually post-surgical normal things as Julie mentioned. She will learn from experience eventually that not every little twing or feeling has anything to do with cancer recurrence. I know, easier said than done right now, but I only say that because it is the truth. Glad to hear she can escape the oral contrast. That stuff makes my guts REALLY pissed off
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
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Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 2:59 pm

Thanks so much Ski - you know she's not the one worried - it is of course me!

I have to remind her about pillows under knees - I've been doing that myself since my herniated disk about 7 years ago!!!

THANK YOU!!!!
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
Joined: Sun Jan 22, 2012 4:04 pm

Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 3:04 pm

Ski I know this is off topic but - we're just under 2,000 cals per day - can't seem to cross that barrier - she gets about half of that - about 55% - from a GNC protein/calorie supplement (where would we be w/out the bodybuilders) her protein intake is at least ok, but the fullness and the can't and the won't is hard to overcome. Thankfully this one powder/shake from GNC she actually likes (and by the way it actually does taste good)...any other ideas?

I know the liver involvement makes eating harder, the chemo makes eating harder, but any ideas?

She has now become 1000000% lactose intolerant, so NO milk, BUT now she can eat yoghurt again - yeah! - 170 cals in a little cup...

Other than that lots of fruit juice, gatorade, etc...
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
Joined: Sun Jan 22, 2012 4:04 pm

Re: oral v IV contrast

Postby juliej » Thu Apr 26, 2012 4:46 pm

I'm happy to hear she doesn't need the oral contrast. The Irinotecan in Folfiri is hard enough on the intestines without adding contrast. Especially with an ileostomy, it seems like an overkill since the oral contrast is just coming out in the bag anyway.

Is she having trouble gaining back the weight from her surgery? I lost 15 pounds after my LAR surgery. I was lean to start with (which the surgeon liked), but then I had a hard time putting the weight back on (which the surgeon didn't like). I used a protein powder too and tried to eat calorie dense foods -- nuts, seeds, nut butters, granola, avocados, and protein bars. It takes work, especially if you are active, but after a few months I was back at my normal weight.
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 6/6/14, CEA<1
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Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 4:57 pm

Hi Julie...thanks so much for the reply!

She lost 60 pounds from Dec thru Feb...colon surgery was....eemergency
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
Joined: Sun Jan 22, 2012 4:04 pm

Re: oral v IV contrast

Postby SkiFletch » Thu Apr 26, 2012 5:18 pm

Wowzers, that's a lot of weight in a short time. Some may yell at me for this, but whatever, your wife needs calories; are there any forms of fast food she likes? It sounds wierd, but it's OK to eat some of that stuff if she likes it right now. She needs calories and most of it is PACKED with them. As julie mentioned, nuts are a great source of calories, although her guts may or may not appreciate them. I found takeout Mexican or Indian to be what I craved on chemo, and that's pretty calorie-laden food as well. And don't forget the other bodybuilder standby, eggs ;).
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
SkiFletch
 
Posts: 6280
Joined: Mon Dec 07, 2009 3:39 pm
Location: Buffalo, NY

Re: oral v IV contrast

Postby Matthew » Thu Apr 26, 2012 5:24 pm

Well the lucky thing is she's six foot tall could handle the weight loss... nut she hates eggs won't eat it
..eating is hard between the can't and won't eat


There does not seem to be much left....
DH to WONDERFUL wife (43 yrs old) of 21 years!!!
Dx 12 Jan 2012
Hospital - 13 Jan 2012 - 26 Jan 2012 removed sig colon 8cm tumor/colostomy
3.5cm met to liver
a few 1 to 2 mm mets to lungs
FOLFIRI - Feb 13, 2012 - add Avastin -mid-March 2012
Matthew
 
Posts: 181
Joined: Sun Jan 22, 2012 4:04 pm

Re: oral v IV contrast

Postby juliej » Thu Apr 26, 2012 5:26 pm

Yikes! Like Fletch said, that's a lot of weight. I tried to eat nutrient-rich foods, not just calorie-rich foods. That was hard to do, but I wanted to gain back muscle, not just fat. Does she exercise? Even going for a short walk before a meal stimulates the appetite and makes it easier to eat. What were her favorite comfort foods before surgery? Try making high calorie versions of those. Also, it helped me to snack on high-calorie foods and drinks right before bedtime. That ensured the calories were being stored rather than used up by my activities.
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 6/6/14, CEA<1
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juliej
 
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Re: oral v IV contrast

Postby dianne052506 » Thu Apr 26, 2012 5:39 pm

Matthew,
Good job on the hospital's part asking about the oral contrast. I'm on the chemo-for-life plan, and have been on XELIRI (irinotecan +Xeloda)/Avastin for two years. Since I'm getting the irinotecan every 4 weeks, if I have a scan with oral contrast, it has to be right near the end of the 4 weeks. If the irinotecan were more frequent, there would be no way I could handle the contrast. My poor GI system just can't take it. Even with as much time as possible between the irinotecan and oral contrast, I still have to ask the hospital for some special assistance. I will end up throwing up (even with gastrofin). I will end up with immediate diarrhea and urgency issues that take another day to calm down. We're in a fairly small town, and I've been doing it long enough that the people at the hospital know me and haven't minded finding me a place right near a restroom. My onc takes pity on me and schedules the oral contrast only ever other scan.

Best wishes to you and your wife. Sounds like she's lucky to have you in her corner!
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again
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