Blockage

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MissMolly
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Location: Portland, Ore

Re: Blockage

Postby MissMolly » Tue May 23, 2017 9:31 am

Grousman:
I can empathize with the frustration and angst that you must be feeling as your wife continues to struggle with nausea/vomiting with little resolution despite the diverting colostomy.

On possibility to entertain would be "pseudo-obstruction." In some cases it is also referred to as paralytic ileus.

Pseudo-obstruction is the term used to describe obstruction-like symptoms (back-up of gastric fluids, nausea, vomiting, waves of abdominal pain) where there is no discernible physical obstruction. The root cause of pseudo-obstruction is dysfunction in the functionality of the intestinal tract. The functional motility of the GI tract can be either severely delayed or essentially come to a stand-still . . . and then resume some level of function. There is often a waxing and waning quality to the episodes.

I would certainly add pseudo-obstruction to the list of discussion topics with your wife's medical team.
- 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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juliej
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Joined: Thu Aug 05, 2010 12:59 pm

Re: Blockage

Postby juliej » Tue May 23, 2017 2:11 pm

GrouseMan wrote:Not a one of them has spent any time actually observing her, examining her before after one of these episodes. No ones sampled what she is throwing up taken pictures or run any tests on it. All they do is measure its volume. First thing I would do is stick a pH meter in in. Another thing is maybe look for some cells. Or something unusual in it. Nurses have seen it but I doubt any of the doctors.

I agree with you. It would be much better if her docs acted like system engineers (or research docs) instead of passively observing what's happening with your wife. Why aren't they doing an upper GI endoscopy to see if there's any abnormality of the stomach?

The presence of green bile make me think of a biliary obstruction, but her labs would show increased levels of bilirubin, alk phos, or other liver enzymes and you said her blood work was fine. The main enigma, at least to me, is that everything seems to be getting better since the colostomy except the vomiting. It must be a two-part problem - one part was an obstruction that the colostomy fixed and a second unknown issue. Wish her doctors would run more tests, look harder for probable causes, etc!

Oral Ativan comes in a sublingual form so the tablet can be dissolved under the tongue. Then none of it enters the stomach. You just let it dissolve for about 20 seconds and then refrain from swallowing for 2-3 minutes to allow it to be absorbed into the body. That's what I used for nausea after chemo. You might check if she's getting the sublingual form.

Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

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

Re: Blockage

Postby MissMolly » Tue May 23, 2017 3:06 pm

Grousman:
One of the more troubling aspects of cancer is that it can affect the motility (functionality) of the GI tract at a microscopic level asnrrmthe cancer becomes more widespread and disseminated.

It may be that your wife's cancer is impacting how her stomach and intestinal system is working, slowing its neuromuscular function. The result is often a waxing and waning of muscular propulsion, aka what I referred to earlier as pseudo-obstruction.

In your wife's case, this would correlate with her intermittent ability to eat and drink small amounts, only to later have episodic severe nausea and vomiting.

I had the unfortunate experience of experiencing pseudo obstruction. I had many presenting similarities to your wife. In my case, the surgeon placed an NG tube to decompress my intestinal tract.

When the intestinal tract slows to a crawl, the body perceives the backup building. The body often responds by increasing gastric secretions and bile in a vain attempt to flush the perceived obstruction open. The problem is . . there is no mechanical or physical obstruction. The problem is that the gut has "shut down" to a vary degree. The increase in gastrIc secretions can find only one way of passage, and that is through a strong reverse peristalsis reflex i.e. forceful vomiting.

When I had placement of the NG tube, it was not uncommon to have the suction receptacle fill with 3 liters of fluid in 12 hours.
This is similar to what you reported that your wife vomited in volume. Her stomach may be churning out gastric secretions on overdrive, as mine did, in an effort to flush through what her body is interpreting as an obstruction (which in actuality may be a pseudo-obstruction due to functional slowing of the distal intestinal system).

Anyway, it is a theory that you can give thought to.
- 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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GrouseMan
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Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Blockage

Postby GrouseMan » Tue May 23, 2017 8:19 pm

You may have hit the nail on the head MissMolly - After repeated requests that someone potentially look for the cause of this bloating and throwing up large quantities of bile green liquid. The palliative care doctor, promised me she would make sure the GI doctors were brought in to look at my wife's case. They were involved at the very start when they were asked if a Stent might work in opening up the colon that was blocked. They didn't think so as they and the surgeons were convinced the blockage was due to a tumor. They had not reviewed the case since the colon surgical team took over and performed the colostomy. The surgeons believed that if she was throwing up several days after the colostomy then there must be another blockage and the only fix would be dangerous radical surgery that she might not survive. So they wanted to try and manage it with anti-Nausea drugs which so far have proved to be pretty useless except to delay the inevitable and make her miserable while she waited for the eruption to take place.

So after haranguing everyone that would listen the GI doctor did take a look again, and thought that it might be a good idea to put in a tube that my wife could drain the excess bile liquid before she became uncomfortable. Not the GI docs procedure for doing this is to put a scope down and press it to a spot on the inside of your stomach turn on its light so they could see it through the skin and then poke back with heir finger trying to locate a good spot for it. Abdominal Mets make that a lot harder to do and the GI doctors think that their procedure would be too invasive. So they asked the interventional radiologists to do the procedure as they do many of them as well, but via fluoroscope imaging(??), and their procedure is less invasive. They felt this was a good plan and would relieve my wife's discomfort and perhaps greatly reduce her nausea. So - This is the plan for tomorrow, Probably in the morning - put in a drain tube that she will be able to control that will release the pressure and remove some of that liquid and perhaps prevent her from having to throw up. At that point maybe she can take in solid food without the fear of just throwing it back up. Who knows maybe after a while she may no longer need it?

The Palliative care doctor spoke with us for quite a while and also discussed Hospice (home or hospice center) vis Home after care. Also the ability to keep my wife comfortable. Main deal breaker in my mind is that if she choses to do Hospice she can no longer pursue treatment options. Her oncologist has only Lonsurf to offer her and he has had really nothing but disappointment in using that drug. Its expensive and he has not seen much benefit from its use. Can't probably get her enrolled in a clinical trail unless she gets some weight back on. She frankly looks like she is in her 70's right now. She is not enthused in using lonsurf either. So I suspect she will chose hospice now. So I fear this is the beginning of the end. We've no idea how long she has left or if she will ever get out again and do the things she loves. But I hope at least after tomorrow she wont be spending her last months throwing up multiple times a day feeling miserable.

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

bitchslapped
Posts: 1534
Joined: Tue Sep 09, 2014 3:23 pm
Location: PNW/USA

Re: Blockage

Postby bitchslapped » Tue May 23, 2017 11:19 pm

GrouseMan, Just a few quick lines here. When my DH got so thin he wanted to sleep on an air mattress we had (like those you buy @ Costco for extra guests). Had some of the hospice foam mattress topper some friends gave us (w/channels between foam), but suppose egg crate foam topper would work. I also had a very nice, puffy, quilted mattress pad on top of that. He could adjust the air to his comfort level.

Hospitals don't tell you this, but they have air mattresses too (available upon request). At least I asked the hospital & sure enough, they had "very few", but had them.
For my mother, I requested soap-free laundered sheets due to skin sensitivity.

Don't be shy.

Stressful times all the way around. Agree w/you regarding hospice (there is a time & place for it), sometimes hard to make that call. Hang in there.

Best wishes for some answers regarding nausea/vomiting & kudos to you for not drinking that doc's koolaid who wanted to send her home like that.
BS
DSS,35YO,unresect mCRC DX 7/'14,lvr,LN,peri,rib
FOLFOX+Avstn 4 Rnds d/c 10/'14
Stent 9/'14
FOLFIRI+Avstn 10/'14
Gone From My Sight 2/20/15
Me:garden variety polyps + precancerous polyp, diverticulitis
Carergver x2 DH,DM dbl occupancy,'03-'10
DH dx 47YO mCRC,'04-'07 fried x HAI
DM dx CC 85YO,CC,CHF,stroke,dementia,aphasia

aja1121
Posts: 214
Joined: Sat Jun 28, 2014 5:12 pm

Re: Blockage

Postby aja1121 » Wed May 24, 2017 3:05 pm

GrouseMan, I just wanted to say my husband has had a partial small bowel obstruction twice during his cancer journey. He, too, was vomiting up massive quantities of green liquid while still having small amounts of ostomy output. He was admitted for a long time (17 days on one occasion) and lost way too much weight/muscle each time. Both times an NG tube helped decompress his belly and the blockage passed on its own. I know everyone is different, but the NG tube might be a big help for the time being. Frankly, if she's been vomiting bile repeatedly in that quantity I'm surprised the surgeons didn't order an NG tube days ago. Like MissMolly said, ileus is not uncommon after abdominal surgeries.

I also wanted to tell you how sorry I am that you're dealing with so much stress right now. I struggle with "beginning of the end" thinking each time my husband has a setback. It's scary and sad and maddening. You have been an amazing advocate for your wife all the way, and I know you will continue to be there for her no matter what.
05/23/14 DH dx Stage 3B rectal ca (age 41)
6/2014 chemorad | 10/2014 LAR, all nodes clean
FOLFOX x 10 | VATS/lung met | ileo reversal
09/15 local recurrence
10/15 colostomy
11/15 FOLFIRI x 4, major growth
02/16 tumor debulked
Stable ten months on Xeloda/Avastin
Growth on clinical trials NCT02024607 (BBI608 + FOLFIRI), NCT02817633 (anti-PD-1 + anti-TIM-3), NCT03175224 (c-Met inhibitor)
09/27/2018 started hospice
02/07/19 died

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

Re: Blockage

Postby MissMolly » Wed May 24, 2017 6:21 pm

Aja112:
Grouseman's wife does not have a small bowel obstruction in the usual sense of a blockage due to tethered scar tissue or a physical entity that kinks or otherwise restricts the flow of intestinal food contents.

Grouseman's wife has what is known as a pseudo-obstruction. In a pseudo-obstruction there is failure of the motility of all or a portion of the digestive tract. A loss of propulsion. It is analogous to a stroke with paresis of an arm or a leg. The intestinal tract comes to a crawl or a complete stop. Often there is a waxing and waning quality, the intestinal tract exhibiting some transient movement and then ceasing in its wave last ke movement - like a light bulb that is flickering before finally extinguishing.

Grouseman'a wife is having placement of either a G-tube (gastric tube) or a JG-tube (jejunal-gastric tube). Both are surgically placed with a punch-wound and indwelling tube that has an external port with an adjustable clamp. These are meant to be long term options to vent and drain the stomach and upper portion of the small intestine of normally produced gastric secretions and digestive enzymes. She will be able to open the clamp and drain her stomach when her intestinal tract is slow in its motility, lending to a backup of secretions. Venting of stomach should keep her from vomiting and ease her discomfort. The skin around the puncture wound can granulate and buildup, forming excessive tissue. If so, the area can be treated with liquid nitrogen to freeze the excessive tissue.

An NG tube is a tube snaked through the nose, down the esophagus, to the stomach. NG tubes are uncomfortable as they irritate the nose and upper GI tract, so known as the dreaded NG tube. NG tubes are a short term measure to decompress the stomach.

Grousman's wife was in desperate need to remedy the high volume of gastric fluids building up due to sluggish intestinal/stomach motility.

Prayers in earnest that she has found relief this afternoon. May God/higher power watch over her with His graces. And may He comfort grouseman's husband, who is rightfully tired and strained by the week's turn of events.
- K -
- 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.

jhocno197
Posts: 817
Joined: Mon May 11, 2015 9:33 pm

Re: Blockage

Postby jhocno197 » Wed May 24, 2017 9:03 pm

We had to get something for my husband called an alternating-flow air mattress. It was not outrageously expensive, and it made a big difference in his comfort level. He spent most of his time in bed. I found the mattress on Amazon; it lays on top of your regular bed. It has a pump that makes some noise, but it is not very loud.

I hope the plan to help her find relief works.
DH - dx Dec 2014, stage IV with bladder & peritoneal involvement - non-resectable
Colostomy
FOLFOX failed
FOLFIRI failed
Tumor actually distending pelvic skin
Not a candidate for last-ditch pelvic exenteration
Stivarga finally begun 2/19/16
Tumor growing/fungating
Lonsurf started 11/18/16
Died 3/10/17

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GrouseMan
Posts: 854
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Blockage

Postby GrouseMan » Wed May 24, 2017 9:37 pm

The procedure I though they were going to do today was postponed. I only found out when I had driven an hour to the hospital to arrive before 7:00 am. When I talked to my wife she said that the IR group that is going to perform the tube insertion, wanted to dot their i's and cross their t's apparently. She tried to walk some this morning, but the nausea was too much and she didn't want to throw up in the hallway. So after I got her situated again I told her once she was comfortable and asleep again - I would leave and come back later towards dinner (not that she can eat, but they bring it anyway). While I was gone - par for the course, the team that will put in the tube comes and explains the risks, perhaps other options (none of which she was enthused about) and told her it might only be a temporary fix (why that is I don't know as I wasn't there and my wife couldn't explain it to me). So after she texted me about that I made the drive back to the hospital. Tonight she was not in very good shape. They were preparing her for an NG tube which she apparently needed to have put in before the procedure tomorrow. After that was in (not a pleasant thing to watch let me tell you!) about 20 mins later she was throwing up green liquid again probably 2 liters, just as the X-Ray tech came in to get pictures to make sure the tube was actually in her stomach He came back later! They were not going to pump anything out tonight, but they needed it there for tomorrow. They still couldn't tell me when the procedure would be done tomorrow. I won't know until I get there tomorrow morning bright and shinny early. The dumb ass colon surgery resident that I wanted to deck the other day came and said that this tube should help (Duh why didn't he think of that in the first place 3 days ago!). Made the remark that after the procedure she should could probably go home that same day! I don't think so!

That's the latest. Work has been suffering and I have been pretty pissed off at some of my colleagues. Boss wants to talk to me when I am free ?? My poor dogs have been kenneled and not allowed to run the yard. One ended up with an eye infection and had to be taken to the vet. (My wife's BF is a vet tech and came and took her to our vet form me, and has kept her while eyes recover and quit itching). My mom has been bugging me about traveling up here from the south were she lives to help (No nothing she can do to help, and she would just piss off my wife). I am exhausted at night myself and am writing this with a sinus headache or something. Its pain between my eyes. Oh and I can't remember if I said this before but my nearly 100 year old grandfather passed away a week ago. Car driver side door won't open from the inside now and when locked that door remains unlocked but the security alarm goes off if you open that door. I feel like Job.

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

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LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Blockage

Postby LPL » Thu May 25, 2017 4:57 am

Dear GrouseMan,

Why is it that many things around us seams to decide to make life harder :evil: when we need it to 'just work'..

I also had stupid troubles with my car. And one day the gates to our house suddenly decided to brake down when I was in a big hurry to get to the hospital.
Our dog was just a small poppy when my DH got ill. The only one who could look after him for me got ill just as I needed her help. Had to take the poppy with me and leave him in the car (window open). So it was short, interrupted visits to DH and of course always(!!) the doctor came around when I had left the room for a while to go see to the dog.

Oh I wish all those added troubles you describe will stop/ease up for you!!!

Sending warm thoughts to you and hoping the procedure they will do will be a success for your wife /LPL

P.S. The wonderful hospital bed I mentioned before, that I was placed in at San Francisco General Hospital, was this one. http://www.hill-rom.com/usa/Products/Ca ... surg-beds/
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

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

Re: Blockage

Postby MissMolly » Thu May 25, 2017 8:33 am

Grouseman:
I am just now seeing your post this morning.

Your wife's care throughout this hospital admission has been more of a travesty than helpful and caring. Disjointed and lacking progressive problem-solving by the physicians who walk in and out when you are desperate for answers.

Your wife's pain is your pain.

I am deeply affected by the outpouring of frustration in your writing. I wish that I could place you in a golden cage and keep you free from additional personal distress.

The role of caregiver is painful in its own right. Driving back and forth to the hospital, several hours each day. The emotional and physical toll. It all adds up.

I hope upon hope that a workable plan takes form for bringing your wife some needed relief from the unrelenting nausea.

Push hard on the Palliative Care physician who is overseeing your wife's care. Their role is to sheppard ancillary physicians and keep everyone on track and on task. Ask of her to step up to the plate and coordinate what needs to be done.

My Palliative Carr MD calls the shots regarding my care. This physician, literally, can move mountains for me. Your wife's Palliative Care MD should have additional leverage to make things happen and do so with the utmost of care and respect for you and your wife.

May today be a better day, in all ways.
- 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.

jhocno197
Posts: 817
Joined: Mon May 11, 2015 9:33 pm

Re: Blockage

Postby jhocno197 » Thu May 25, 2017 9:08 pm

:( :( :(
DH - dx Dec 2014, stage IV with bladder & peritoneal involvement - non-resectable
Colostomy
FOLFOX failed
FOLFIRI failed
Tumor actually distending pelvic skin
Not a candidate for last-ditch pelvic exenteration
Stivarga finally begun 2/19/16
Tumor growing/fungating
Lonsurf started 11/18/16
Died 3/10/17

Lee
Posts: 6202
Joined: Sun Apr 16, 2006 4:09 pm

Re: Blockage

Postby Lee » Fri May 26, 2017 6:11 pm

You and your wife are in my thoughts and prayers.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

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

Re: Blockage

Postby MissMolly » Sat May 27, 2017 8:57 am

Grouseman:
Thinking of you with gentle kindness and sending you the strength of prayer throughout this day.
- K -
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.

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

Re: Blockage

Postby MissMolly » Sun May 28, 2017 5:08 pm

Grouseman:
You may be too exhausted by the spiraling demands of your wife's condition to post or write.

Perhaps you will stop by and log in momentarily. When you do, I want a missive to be here for you to receive.

I spent time each day in quiet reflection. I always read passages from the Common Book of Prayer. Please know that I continue to offer prayer in your name.

I believe that the collective thoughts and prayers of others can make a positive difference. The collective humanity and goodwill of others still exits.

Please know that many Colon Club members here are thinking of you and holding you in their hearts - me included.
- 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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