Post reversal complications - need advice

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JerryY
Posts: 3
Joined: Tue Nov 15, 2016 6:59 am

Post reversal complications - need advice

Postby JerryY » Tue Apr 04, 2017 1:54 pm

Hi everyone,

Long time lurker here and I'll apologize in advance for not having a signature. Wife is Stage IV CC with mets to liver and spread to abdomen. She's 52 and has been in the fight for 13 months now. Things were going well late last year and doctors had the cancer under control. Wife decided to get her Ileostomy reversed. Her oncologist supported the decision, feeling that a break in chemo would not be too detrimental IF things went smoothly. He was about ready to move her to maintenance chemo. Her colorectal surgeon was a little more cautious, saying that any surgery is a risk and asked if she really wanted to do this. Bottom line was that the ostomy never agreed with her and she could not wait to get rid of it.

Anyways, had the surgery in mid January and initially everything went well. Bowel function returned immediately and she was home in four days and feeling pretty good. She was walking on the treadmill about a week later. We were thankful that FINALLY something in this miserable ordeal had gone well. We spoke too soon. Three weeks after the reversal, she came down with severe pain and had to go back to the hospital. They identified infection at the repair site and an abscess. Treatment was placement of two abdominal drains to address the fluid from the infection and the abscess and she was given antibiotics. The infection caused an ileus and she was very distended again. I should note that the surgeon eyeballed cancer spread to the wall of the abdomen and on the outside of the large colon during the procedure and likened it to grass seed, saying that a CT Scan would not pick up on this. She was in the hospital for a couple weeks and was finally sent home on TPN because the ileus still wasn't rectified. One of the abdominal drains was left in to address the remaining fluid.

At the next follow up visit to check on the drain, the interventional radiology doctor said that the drain had been left in too long and caused a fistula and now stool was draining. We are several weeks into this latest challenge and the fistula still has not closed up. The bigger issue is that my wife is constantly in severe pain, which the oncologist is treating with a great deal of dilaudid. She is back on chemo as of four weeks ago, with the onc saying that it's not an ideal time to do this, but we really don't have much of a choice. She is two rounds in already and her CEA has had an immediate drop. That is the one bit of good news we've had in all this. However, her ileus continues and she literally cannot take a bite of solid food without feeling horrible. Besides the severe abdominal pain, she is also having severe nausea and the anti-nausea meds aren't really helping too much. The surgeon is blaming everything on the cancer, saying that she will get relief from the pain when the chemo knocks the cancer back and also when the fistula is closed and the drain is removed. The oncologist doesn't disagree with this, but quite frankly seems a little puzzled by her pain and ileus. Thank God for the TPN or else she would have wasted away to nothing by now.

Sorry to ramble, but we are in a bad spot and wondering if she will ever feel well again. I'm happy to provide more information, but my main question is, is there anything that we might be missing? She gets scanned every four weeks to check on the fistula and those are showing that the bowel is less swollen and that there aren't any new tumors. This is very frustrating because even though she hated the Ileostomy, she actually was feeling pretty good and eating a normal diet. She was even back in spin classes and doing some stuff with her personal trainer. Now just taking a shower or walking down the stairs is a real challenge and she hasn't enjoyed solid food in weeks.

For those of you who are going through this or have gone through it, God Bless you. Any suggestions or input would be helpful.

JudeD59
Posts: 726
Joined: Sun Apr 12, 2015 12:16 pm

Re: Post reversal complications - need advice

Postby JudeD59 » Tue Apr 04, 2017 4:10 pm

I haven't experienced any of the issues your wife is dealing with, so I don't have any suggestions or advice, but I just wanted to say that I'm sorry you both are having such an awful time of it and I'll be keeping you in my thoughts and prayers. I've had to deal with drains multiple times over the years, but never a fistula. Hopefully another member will have some experience with this and can offer some helpful advice.

Judy
56 yrs old, wife, mother to 4 daughters
RC Stage II T3N0M0 DX April 2, 2015
6 cm. mid-rectum-CEA 121
Xeloda and radiation finished 06/15/15- CEA 242
CEA right before surgery 81
LAR performed 8/12/15 Temporary ileostomy
CEA 10-21-15 1.6
PET scan 11-4-15 All clear
Port installed 11/11/15
Folfox started 11/18/15
Folfox stopped due to bad reaction
Reversal 2/17/16
CEA 2/3/16 1.7
CEA 3/31/16 1.3
CT Scan 4/12/16 All Clear
Port removed 4/21/16
CEA 5/24/17 1.4

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Post reversal complications - need advice

Postby MissMolly » Tue Apr 04, 2017 9:15 pm

Jerry:
Wow . . . you and your wife are trudging through a difficult and complex post-reversal course.

I had the misfortune of enduring several months of small intestine ileus due to vagal nerve damage incurred during surgery to relieve a small bowel obstruction due to adhesions. It was a bleak period of my life.

It is difficult to know what may be the cause of your wife's ileus. Does the origin of your wife's ileus lie the manhandling of her intestines during the reversal?; due to the post-operative infection and abscess, creating toxins that are negating the intestinal motility? due to the cancer studding noted by the surgeon; other unexplained cause/source? Better knowing why the leus has taken hold would help in defining a strategy to re-boot the intestine.

My medical team did give me IV Reglan (generic name metocolopramide) to help reawaken my intestinal tract. It was not fully helpful but it was somewhat helpful. Reglan is also available as an oral medication.

Note: Reglan is primarily used to treat slow emptying of the stomach (gastroparesis). It acts to intubate the small intestine as a secondary benefit through its action on the stomach (increased stomach motility then propels material to and through the duodenum and jejunum of the small intestine, like squeezing a toothpaste tube from the top sends a strip of toothpaste toward the tip).

You will see a listing of contraindications. Reglan is contra-indicated where there is known intestinal obstruction. That is, Reglan should not be used where there exists a physical obstruction (mass, tumor, kink of scar tissue); you do not want to stimulate forceful intestinal contractions in the presence of a mechanical intestinal obstruction. Ileus is not a mechanical obstruction. Ileus is a functional obstruction (aka pseudo-obstruction) - where the motility of the small intestine has slowed to a crawl or is non-existent. Reglan can be used in the presence of a functional obstruction. A functional obstruction being ileus or pseudo-obstruction. I wanted to clarify this distinction because it is pertinent in your wife's situation.

I also found the practice of basic yoga poses/postures beneficial. The stretching and movement of yoga serves like an internal massage of the intestines, nudging them along. Poses that incorporate elongation of the body and rotation of the upper body/thorax against the lower body/pelvis are particularly helpful. Downward dog, warrior pose. The poses and postures need not be complicated or the making of a human pretzel. Simple, basic poses and postures are A-OK. The goal is to stretch and move the body so as to stretch and move the intestines. Intestinal massage.

Keep faith and hope,
- Karen -
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.


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