Husband broke down last night

[NHMike]

I was really hoping that your husband was recovering comfortably at home after the tough drive back home. He's very fortunate to have you managing all of this as it's a lot of work just to communicate what's going on healthwise to the Emergency Room staff what he has been through the past week. I hope that you're able to get some rest in-between all of the work that you're doing for him.

[LPL]

mpbser,
So sorry your DH has to deal with more pain and discomfort. Sometimes it's hard to know what is causing symptoms (at times it can also be a side effect of Medications supposed to help?). Sending good wishes that both of you can catch a break soon !

[mpbser]

Back in the ER. Vomiting, dehydration. MGH wants him to return to Boston. He does not want to go. I'm starting to lose it.

[Shana]

Back in the ER. Vomiting, dehydration. MGH wants him to return to Boston. He does not want to go. I'm starting to lose it.

So sorry to hear that your DH is going through all of this post surgery. I hope you can convince him to return to MGH, can they arrange for transportation or would you be expected to drive him there?

My two daughters were my primary caregivers when things were rough. My husband just didn't know what I needed or wanted and got frustrated so I was glad to have the girls take over.

I've been the caregiver in the past for my mother and I remember how difficult and exhausting it can be, hang in there.

Sending you strength and good wishes!

Shana

[MissMolly]

Mpbsr:
Your husband will do best returning to MGH ago be under the care of the surgical team who completed his transverse Colin resection.

One likely cause of the vomiting and dehydration would be "stranding." "Stranding" is the term used to describe heightened post-surgical inflammation in the abdomen. On a CT scan, the inflammation appears like long strands illuminated on imagery.

I had a case of severe stranding after an open laparotomy. The pain was intense (enough to make me cry). I had been home
for only 24 hours when I went back to the ER. I was admitted for IV narcotics, NG tube, hydration, and bowel rest. It took about 8-10'days to settle.

Did your husband have any food since her was home? One trigger of intense abdominal and intestinal inflammation (stranding) is too rapid of reintroducing foods after surgery or introducing foods that are too dense/too much insoluble fiber. Some people need a very gentle and soft diet in the early days after surgery.

Honestly, I felt like your husband' discharge from MGH was rushed. The extreme pain he experienced during the drive home was a sign of an intestinal tract that was still traumatized from the surgery itself. Your husband might have benefitted from an additional few days in the hospital initially.

I hope that things begin to ease for your husband and for you,
Karen

[NHMike]

Mpbsr:
Your husband will do best returning to MGH ago be under the care of the surgical team who completed his transverse Colin resection.

One likely cause of the vomiting and dehydration would be "stranding." "Stranding" is the term used to describe heightened post-surgical inflammation in the abdomen. On a CT scan, the inflammation appears like long strands illuminated on imagery.

I had a case of severe stranding after an open laparotomy. The pain was intense (enough to make me cry). I had been home
for only 24 hours when I went back to the ER. I was admitted for IV narcotics, NG tube, hydration, and bowel rest. It took about 8-10'days to settle.

Did your husband have any food since her was home? One trigger of intense abdominal and intestinal inflammation (stranding) is too rapid of reintroducing foods after surgery or introducing foods that are too dense/too much insoluble fiber. Some people need a very gentle and soft diet in the early days after surgery.

Honestly, I felt like your husband' discharge from MGH was rushed. The extreme pain he experienced during the drive home was a sign of an intestinal tract that was still traumatized from the surgery itself. Your husband might have benefitted from an additional few days in the hospital initially.

I hope that things begin to ease for your husband and for you,
Karen

2 days seemed rushed to me as well but I think that's due to pressure from insurance companies to keep inpatient stays short. The challenge would be getting him to MGH in so much pain and distress. It would seem like an ambulance would be the best transport so that he could be reclined and someone with medical training would be with him.

[mpbser]

Thank you, everyone. It has been a grueling day, to say the least. CT scan says that there is a small bowel obstruction. ER doc was totally cavalier about it. He's been admitted overnight under the care of the "hospitalist." Apparently, it's hard to tell exactly what is causing the obstruction. Thankfully, he was able to not vomit after the last IV administration of dilaudid (.5 mg) and has kept down some water taken orally. He has not eaten much at all today and I have no idea what is going to happen next.

[mpbser]

His discharge was TOTALLY rushed. My aunt, who has 30+ years of nursing experience in major hospital settings, is livid that they let him go when they did.

Yes, he has had some solid food everyday since the day after surgery or the day after the day after (I can't remember at this point). Friday night he had a nice dinner, digested well, and his last bowel movement was last night at 10pm. He's been so nauseated since yesterday evening that he hasn't eaten more than a half cup of applesauce and a couple crackers today. Yesterday evening at around 6:30 he had a small portion of leftovers from Friday night.

Our surgeon friend says that the next six hours will tell much more. If it's just a food blockage from narcotic intestinal stasis and too much too soon, then oral fluids will loosen things up and another CT scan or other imaging will show it as resolved or resolving. If it is an adhesion or stricture, then the OR is the only answer ultimately.

[jayanu]

Surgery vs. Chemo/Radiation or combination depends on the stage and type of the tumor.

My wife had Mucinous type vs. solid type and Chemo is considered not effective vs. surgery since no nodes were affected.
Surgery was successful and the CTC test (Circulating Tumor Cell) tests showed zero cells in the blood stream! Unfortunately, it came back in Liver, removed surgically and again it has come back in the lung so she will take Cheno since it is small- 6 mm and lung surgery is risky. Chemo will kill all micro cancer cells and then possibly surgery. Colon cancer's path is typical, Colon, Liver, Lungs, Bone and then Brain with some deviation depending on the person.

Xelox protocol supposedly does not have the side effect of losing weight or hair either.
Typically a surgeon will suggest surgery and Oncologist will recommend Chemo/Radiation - that is what they know!

Be informed, do take the second opinion. Accept the reality, get mad at God and the world if that helps but then get back to treatment. That is the best alternative vs. getting depressed. Take a high dose of Vitamin D3 as anti depressant!

[NHMike]

I'm glad he's been admitted and hopefully you can get some rest, when my mother had her heart attack, we had someone with her around the clock and it took a considerable toll on one of my sisters and took a toll on my health as well. This sister developed a number of conditions related to GI issues and a brain aneurism (fixed surgically at MGH). But she still has fairly severe GI issues.

I worked with a hospitalist the day I went to the ER. He changed my status from outpatient to observational which is in-between inpatient and outpatient. I had never heard of the position nor the status before. I worked at a Partners hospital when I was a teenager and for a year in college doing clerical and orderly work and found that a lot has changed since the old days. The hospitalist is and MD and he makes decisions on admitting and care from what I could tell.

Hopefully the doctors between the two hospitals can figure out the blockage issue and can fix it from the imaging.

[benben]

I was in the hospital for a 4 full days (although they said I could go at day 3 - I didn't want to go home with a drain tube sticking out of my abdomen so said I'd wait until that was removed).

Also for the first 3 days I had nothing but liquid diet. I drank 3 of some new type of boost drink that was supposedly supposed to help with post surgery healing.
And lots of Ice water and Iced tea and a few cups of decaf coffee those 3 days.

Definitely sounds like solid foods were introduced too quickly as well.

Hope he is doing better and heals soon.

[NHMike]

I was in the hospital for a 4 full days (although they said I could go at day 3 - I didn't want to go home with a drain tube sticking out of my abdomen so said I'd wait until that was removed).

Also for the first 3 days I had nothing but liquid diet. I drank 3 of some new type of boost drink that was supposedly supposed to help with post surgery healing.
And lots of Ice water and Iced tea and a few cups of decaf coffee those 3 days.

Definitely sounds like solid foods were introduced too quickly as well.

Hope he is doing better and heals soon.

The liquids for a few days and then a gradual return to solid food is the theme in the reversal journal thread too. They do have some additional issues with stuff coming out too fast or too slow but I've always heard that it's best to take it slow after surgery.

[MissMolly]

Mpbser:
The acute timing of your husband's small bowel obstruction sounds likely it is a combination of opiate induced constipation + too rapid introduction of solid foods and too much volume of food than his surgically traumatized intestines could tolerate.

Opiates/narcotics cause constipation that is uniquely different than standard functional constipation. Opiates act on the motility receptors of the intestines. Portions of the intestine become sluggish or fail to move/propel digested food material. The result is a gradual and insidious back-up of digested food material. Liquid poop may continue to pass through and around the areas of intestinal slowing/paresis while more densely weighted output continues to back up and cause a narrowing or stenosis or obstruction. Opiate induced constipation is a serious finding and not so easily alleviated.

Your husband may also be given lactalose or milk of magnesia along with liberal IV hydration - all in an attempt to liquefy the fecal backup and to flush it through and out.

I, myself, had a small bowel obstruction only 2 weeks ago. It was caused by adhesions complicated by OIC. I am on long-term opiates for avascular necrosis of both of my hips/jaw due to conrticosteroid use. My small bowel obstruction in this circumstance was every bit as painful and distressing as was a SBO solely due to adhesions that I experienced 3 years ago.

Opiate induced constipation (OIC) is not a laughing latter. Opiates cause several slowing of the intestinal tract by binding on motility receptions located in the lining of the intestinal tract. Some segments of the intestine are humming along while other segments of the intestine are at a stand-still. In my case, I was in the hospital for 7 days with IV fluids, NG tube, laxatives, and anti-inflammatories. I underwent a relatively simple laparotomy to snip away the offending adhesions after 5 days of conservative management.

Do not be disallusioned by a hospitalist being assigned as the attending physician. There are nice advantageous in having the hospitalist services. There is a hospitalist assigned to your husband on duty 24-7. If there is a need of any kind, the hospitalist is at the ready and can make changes to the plan iof care.

I have been out of the hospital for the past 5 days. My diet remains pretty much restricted to full liquids - with an occasional saltine. I can tolerate about 1/3 cup of liquidy-based food at a time.

If your husband's SBO is a variant of opiate induced constipation and post-operative inflammation you will want to keep his Foods to soft and easy to tolerate when he returns home, focus more on hydration (clear and thick liquids), and keep portion sizes small so not to overwhelm an already traumatized and inflamed intestinal tract.

Sending positive karma to both you and your husband,
Karen

[mpbser]

thank you for the tips, Miss Molly. I agree with what you believe caused all this to come on. he's holding down the water he's been drinking and they want him to drink orally because I guess that has the best effect on the small intestines and getting them going. he had a huge fart so that's a great sign. he has been in the ER this whole time and will hopefully be up in a room any minute now so he can rest. his local surgeon is going to visit him tomorrow as is his primary care physician. I feel comfortable enough with the situation now that I can finally get some decent sleep.

[mpbser]

If he hadn't been sent home so early, he would not have experienced so much pain on the ride home, would then not have needed so much of the oxy, and this could have all been prevented. I'm seriously pissed off.