HELP: Cholangiocarcinoma, severe abdominal pain, fecal impaction
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I forgot to mention the prunes Kris so thanks for the reminder on them. My dad had them a lot for breakfast each day and in the hospital here they are on the menu each day as part of the breakfasts. I love prunes myself and have a handfull each day of dried ones as well for breakfast. I know they are not everyones cup of tea but my dad felt that they helped him along with the lactulose as well.
Thanks again.
Gavin
Pyderman –
Fecal impaction is very tough to deal with but it can be. We see it a lot with chronic pain medications use. I would almost guarantee the pain meds caused this and once she gets the impaction gone then she should probably take something routine to keep it from happening again. I am with Gavin that Lactulose works quite well and may be just then thing right now. Another trick we use is warmed prune juice with a dose of Milk Of Magnesia (not sure if they would can it the same over there)……we call it a brown cow….you may ask about it to get her going.
My husband has a terrible time with constipation since his surgery and the fact that he takes chronic low dose pain meds for his arthritis. He takes 250mg of stool softener twice daily and then a total of four 8.6 mg Senokot divided into two doses. Then he also found a black cherry and apply juice that helps too.
But definitely stay ahead of it rather than trying to play catch up but don’t stop the pain medications even though that seems to be the right thing….you want her comfortable and the impaction will clear.KrisV
Hi Pyderman,
My dad had some issues with constipation as well and for that he used Lactulose which seemed to work quite well for him. He tried Movicol as well but that didn’t really work too well for him so his GI guy put him on the lactulose instead. He took it twice a day, morning and night and it worked better for him than the Movicol.
Found a link for you that I hope is of use –
http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/Patient/page3
I too hope that the onc and the pain team can get this under control for your mum and please let us know how she gets on with this.
My best wishes to you and your mum,
Gavin
Pyderman……I hope for others to chime in on this as well. Constipation is a distressing side effect of opioid treatment and for that reason it is combined with laxatives.
We have reports on subcutaneous methylnaltrexone for the use of extreme impaction and I recall the below clinical trial:
http://www.ncbi.nlm.nih.gov/pubmed/18440447
Personally, I believe that the oncologist and pain specialist should be able to address your Mom’s issues and for your Mom to be more comfortable very soon .
Hoping that by tomorrow the symptoms will have eased dramatically.
Hugs,
MarionHi all,
My mother has had abdominal pain – masked by strong pain killers including Oxynorm – since her diagnosis with cholangiocarcinoma late last year.
Normally the drugs control the pain, but last weekend, it got out of hand, and she had to go to hospital. Following admission, she had a blood test and X-Ray. Bloods are fine. X-ray showed fecal impaction. The stated aim was then to first clear the fecal impaction, then deal with any residual pain. 3.5 days have elapsed. My mother has only had two very small bowel movements, and an end to the fecal impaction is not in sight. This is further complicated by the fact that she is nauseous, and taking an oral constipation drug (Movicol) increases her nausea. As such, she has not been able to take Movicol as much as the team would have liked. She has been given two enemas, to little effect. Her appetite is almost non-existant.
I have three concerns:
[list=*]
[*]There is a chicken & egg situation – the medical team is saying that Oxynorm may have caused the fecal impaction in the first place. Yet they continue to administer it regularly (now by drip). They have acknowledged that there is a bit of a chicken & egg situation (they want to ease her pain but the drugs they are giving her may be ultimately preventing her pain from easing).[/*]
[*]My mother has been moved to an oncology pain management ward. One would think that given that the current diagnosis is a bowel blockage, she should be in the hands of gastroenterology experts, and only handed back to oncology once this had been dealt with. As it is, while she has been seen once by an gastroenterologist on Day #1, she has since only been attended to by an oncologist and pain management doctors (keeping in mind that an oncologist is an expert in cancer, and a pain management doctor is a specialist in pain management). Neither are specialists in bowel issues.[/*]
[*]While I of course want to see my mother pain free, I also want the underlying causes to be unearthed and dealt with, not papered over with what is approaching almost palliative care right now. A CT scan has been taken today, with results due tomorrow, but I am still concerned that the focus is on pain management rather than root cause discovery. I am also concerned that it will be an oncologist (not a gastroenterologist) reviewing the scan.[/*]
[/list]I would very much appreciate all and any input, particularly from members who have experienced fecal impaction, or who have had loved ones who have experienced it. What do you make of the focus of the medical team? Should I be giving them the doubt that what is happening here is a measured, well thought-out process, or should I be worried that they’re dropping the ball or not focus on the root cause?
Thanks
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