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Radiogirl
04-10-2010, 11:36 AM
Can anyone give me some advice for my sister Radiogirl? She had her surgery 10 days ago and still has not had a bowel movement. Her stomach, torso, and back are all swollen. She looks like she's 7 months pregnant! She's extremely tired, although we have cut back on the Percocet, believing it to be the culprit of the constipation. She has abdominal pain, and of course, back pain, now that she's cut back the Percocet. We've spoken to doctor's office twice in last 24 hours and he says it's not unusual.

Has anybody experienced this type of thing after surgery, or do you have any suggestions for relief. She's hardly eating anything at all, just nibbling on fruit and crackers; drinking lots of water because she's unbelievably thirsty.

Thanks for any light you can shed on her misery.
Marsha, her sister.

RitaR
04-10-2010, 11:38 AM
Did Dr. Lenke's office have any remedies?

ddb
04-10-2010, 01:49 PM
Pain meds can cause constipation. When discharged we were to call if no BM in a certain amount of time - so a call is probably needed. They may give her something to move things along. Our DR instructed me to give Miralax daily while on pain meds and it works wonderfully.

Best wishes - hope she feels better soon.

Dee

Pooka1
04-10-2010, 02:02 PM
Did her gut wake up?

Did it go back to sleep?

Should she be checked for ileus (sp?)?

I think a child on the group had that and I think Ti Ed had that. Maybe someone will chime in.

Good luck.

Radiogirl
04-10-2010, 02:08 PM
Yes, she does have ileus, or paralytic ileus (?) and they just said that means that peristalsis is not occurring because her gut didn't wake up yet... and they're not worried.

Pooka1
04-10-2010, 02:16 PM
Yes, she does have ileus, or paralytic ileus (?) and they just said that means that peristalsis is not occurring because her gut didn't wake up yet... and they're not worried.

If they knew it why was she allowed to eat and drink? Painful bloating is a given if the patient eats/drinks before the gut is moving as far as I know. This was strictly enforced with my kids as our surgeon considers it a setback.

Do they know she is drinking so much and eating a bit?

Susie*Bee
04-10-2010, 02:23 PM
I'm so sorry she's having this problem! I'm really surprised if she has an ileus that they let her go home. I had an ileus and was not allowed to eat or drink ANYTHING at all-- not even little sips of water, until there were signs of it waking up again. Those first little "blips" of gas were sooooo exciting! That was on day 5 for me. I wouldn't hesitate to call your sister's surgeon and see what you should do. Unless peristalsis is happening, there is no way, even with the best laxatives in the world, that anything is going to happen. At least I don't see how. This can be a true medical problem, and they should help you with it.

Let us know what happens, and please give her a gentle hug for me... and one for you too. It sounds like you are a wonderful sister.

TexEx
04-10-2010, 04:36 PM
My sister Melissa has similar problem. She had her surgery the same day Radiogirl. She took Milk if Magnesia and that helped alot. You will have to ask pharmacist for dosage.

Pam

LynetteG
04-10-2010, 05:41 PM
They gave me some kind of drink which tasted like lemon/lime and 12 hours later I had diarrhea. Now 2 days later the percocet backed me up again, so I ate lots of fruit and drank prune juice. So now it seems to be all working again.

sheri66
04-10-2010, 06:42 PM
Ativa sp? yogurt really works.And prune juice tastes disgusting I could not drink that but eating prunes worked for me.I hope she feels better soon.

Nitram
04-10-2010, 06:49 PM
My surgery was a little over three weeks ago and I have been battling constipation ever since. Once her bowels get going have her try Milk of Magnesia..it got me started again...but the relief was temporary as I got backed up again a few days later. I started drinking Citrucell twice a day and that did the trick for me. It's not fun to drink but after the constipation I had I'd do anything to not have it again. I have been fine for a week now having regular bowel movements... Have her try the citrucell, it's worked fantastic for me.

Rich

Vali
04-10-2010, 07:59 PM
Hi Marsha, so to hear that Laura has this problem but unfortunately it seems to always seems to be the case with strong pain meds. On my worst day at home, I used Microlax (sp?) to get things going and then as my appetite was crappy, I drank Isowhey protein shakes with Flaxseed Meal twice daily and then ate two kiwi fruit before bedtime. I also used to drink between 2-3 litres of water per day. Our Pharmacist told me that if all else fails naturally, to take Coloxyl (stool softener) every 2nd day to keep things from packing up. I also stuck to eating mostly yoghurts and stewed fruits.
Hope this helps

ADMoul
04-10-2010, 08:17 PM
A friend of mine who is a rehab nurse strongly recommends the prune juice or prunes esp. in AM. She also says sometimes cold foods are more appealing than hot when you're feeling bad. That swelling is very normal and may be around for a while. I know sometimes my abdominal pain/bloating early on was worse than the back pain. I also can identify with the constant thirst. I think pain meds have something to do with that, too. I had to have a suppository to get things started in the hospital and took colace on a regular basis as long as I was taking percocet. Once I got away from the hospital food, I ate like I was on steroids and did not lose any weight with this surgery. Because I was eating pretty much normally, my system worked OK with the colace. I also walked around the house a lot in those early recovery days. Sometimes just a little bit of movement helps other things move. Am sorry Laura's so miserable right now. Would hope the Dr. would prescribe something or make some kind of recommendation to help her at this point.

RitaR
04-10-2010, 08:33 PM
I am so sorry Laura is having this problem. I just feel horrible for her! If I could do something for her I would believe me. I would have surely thought they would have addressed this before she left the hosp, although I know once I went (finally) at the hosp then they started looking at the day I could go home immediately. I was a little scared to leave so quickly, but it worked out okay in the long run anyway - I sure wish it would have for her. Although, I have had problems with constipation myself, but I've always been able to manage through each episode without anything, but it wasn't easy. If they said she had an ileus in the hosp, I would have thought they wouold have gotten an x-ray of it to determine the severity. Please give her my best and do not hesitate if I can do ANYTHING at all to help.

LindaRacine
04-10-2010, 09:08 PM
Hi...

The ileus is relatively common after a big spine surgery. Once it clears, your sister will feel like a totally new woman! There have been a lot of good recommendations. I'd recommend a trip to the store, and trying as many of the remedies as possible.

Regards,
Linda

jenparker
04-10-2010, 10:12 PM
Hi Laura

I also had surgery with Dr. Lenke in January. My bowels were just the same--my photos look like I was huge and pregnant and my x-rays show my bowels filled with lots of air.

I finally drank two bottles of magnesium citrate (? what they use for some types of bowel preps--ask at the drug store)--and then called Dr. Lenke's office begging him to let me use an enema (because he told me before that it was too harsh). Dr. Lenke said ok to the enema--t worked. It cleaned out all the old and from then on--prune juice, walking, lots of water, abdominal massage, etc. and no more problems.

Good luck!
Jennifer

titaniumed
04-10-2010, 10:55 PM
Marsha,

I'm sorry this is happening.

Jen is right! Magnesium Citrate oral solution. Its sold over the counter, and looks and tastes like a cherry soda. They use it for bowel prep. There are 24 hour pharmacy's open, call first. My hospital told me not to use x-lax.

I drank one bottle, works in about 3 hours.

I would recommend picking up some pedialyte, all her electrolytes will be exhausted and she will feel like a 12 volt battery with 1 volt left. Completely drained and totally wasted.

This is EXTREMELY painful as you have seen.

I would stop the crackers. Maybe switch to chicken broth. Go back to liquids only.

There is always the emergency room. If you go down to the hospital, mention that her distress level is at a 10. You will get in faster.
Ed

titaniumed
04-11-2010, 12:04 AM
I'm so sorry she's having this problem! I'm really surprised if she has an ileus that they let her go home. I had an ileus and was not allowed to eat or drink ANYTHING at all-- not even little sips of water, until there were signs of it waking up again. Those first little "blips" of gas were sooooo exciting! That was on day 5 for me. I wouldn't hesitate to call your sister's surgeon and see what you should do. Unless peristalsis is happening, there is no way, even with the best laxatives in the world, that anything is going to happen. At least I don't see how. This can be a true medical problem, and they should help you with it.

Let us know what happens, and please give her a gentle hug for me... and one for you too. It sounds like you are a wonderful sister.

I find it hard to believe also. Usually you are NPO, with an NG tube.
Ed

Radiogirl
04-11-2010, 05:34 AM
Hi it's Laura This is my first night home in my own bed and can't sleep a winkl I'm so upset with this ileus problem. I think I may go to emertgency room in the morning. I am so swollen I weigh 20 lbs more than when I left home. That is not an exageration. I can't get comfortable. I have even stopped ( or cut waaay down) on perocet already. Even tho I need it for my back pain. The only think I have not tried out of all the suggestions here is Magnesiium Citrate. I might try that in the morning and see if it works, if not I will go to ER. Problem is i had traveled to st louis for surgery and am now back in cleveland so i hope that's not a problem.

Sorry to vent I'm a bit scared as I do not wqnt to ruin my innards, like kidneys, etc. I am peeing every 10 minutes almost! Ugggg..this is much worse than the back surgery itself. So sad....

Laura

mgs
04-11-2010, 07:03 AM
Mag Citrate worked wonders for me, whereas the Miralax and the prescription stuff did zilch. Good luck!

huskymom
04-11-2010, 08:14 AM
Oh no, poor girl!!! Is she still in the hospital? If not, I can not believe they would let her go home without having a bowel movement. That was my problem, the MDs wouldnt let me leave the hospital until my bowels moved. If she is still in the hospital, they need to give her Magnesium Citrate. It was what we give patients (I am also RN and scoliosis surgery survivor) who absolutely can not have BMs and they gave that to me @ 10am and by 3pm I was discharged home:)
Hope this helps, tell her Melissa (Husky Mom) is thinking and praying for her:)

Pooka1
04-11-2010, 09:29 AM
Ugggg..this is much worse than the back surgery itself. So sad....

I'm so sorry. This is exactly what we were told.

As I understand it, it is completely avoidable by not eating or drinking until the gut wakes up. I don't know why some surgeons don't restrict food/drink until the gut starts moving again. The data are in as far as I know.

I hope you get some relief very soon.

titaniumed
04-11-2010, 10:23 AM
Laura

If nothing has happened by now, I would go down to the emergency room.

You have to worry about damage to you colon. Diverticulosis.

http://en.wikipedia.org/wiki/Diverticulosis

It happened to me. I know your pain.

Ed

Pooka1
04-11-2010, 10:32 AM
Ti Ed i think this page is more relevant...

http://en.wikipedia.org/wiki/Ileus


Postoperative Ileus

It is a temporary paralysis of a portion of the intestines typically after an abdominal surgery. Since the intestinal content of this portion is unable to move forward, food or drink should be avoided until peristaltic sound is heard from auscultation of the area where this portion lies.

Paralytic Ileus

Paralysis of the intestine. To be termed "paralytic ileus," the intestinal paralysis need not be complete, but it must be sufficient to prohibit the passage of food through the intestine and lead to intestinal blockage.

Paralytic ileus is a common side effect of some types of surgery. It can also result from certain drugs and from various injuries and illnesses. Paralytic ileus causes constipation and bloating. On listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel is inactive.

This passage repeats what you said about replacing electrolytes but I think they mean with an IV...


Nil per os (NPO or "Nothing by Mouth") is mandatory in all cases. Nasogastric suction and parenteral feeds may be required until passage is restored.

There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or, in severe cases (Ogilvie's syndrome), neostigmine.

If possible the underlying cause is corrected (e.g. replace electrolytes).

LindaRacine
04-11-2010, 11:26 AM
Hi Laura...

I hope that you've had some relief by the time you read this. I agree with everyone about it being surprising that you were released from the hospital. I suspect there was some resident asleep at the switch.

I have a friend who had a huge revision surgery about 4 years ago. I saw her several times after surgery, and she was doing well. When I saw her the day before Thanksgiving, she was beyond miserable. She had developed an ileus, and it had set her recovery back to the beginning. She told me she wanted to die. Unfortunately, I couldn't see her on Thanksgiving, as I was entertaining. But, I was there on Friday afternoon, and I almost thought I was seeing someone else. She was walking around with a huge smile on her face. She felt absolutely wonderful. She was released that day. She went on to have a remarkable recovery in that she was off narcotics by three weeks postop.

I think it's almost always something other than our spines that cause us the most pain and distress while we're still in the hospital. Hang in there.... this too shall pass. ;-)

Regards,
Linda

Pooka1
04-11-2010, 11:37 AM
I am floored by how experienced surgeons don't restrict drinks and foods until the gut wakes up. I would bet my house they know about this issue!

Maybe they do and the patients ignore the restrictions?

I watched both my kids each suffer through terrible thirst for the three days until their gut woke up. If there wasn't a damn good reason for the suffering I never would have allowed it. As it turns out there is a damn good reason.

The "no eating/drinking" admonition was a "riot act" item per my take on what the surgeon said and how he said it. He wasn't going to have his patients having unnecessary setbacks if he could help it. There was no ignoring it.

titaniumed
04-11-2010, 12:04 PM
How could they release a patient if they have an ileus? They should not release a patient if they cannot eat. If you do not have the NG tube in, you will vomit quite often.

I know this from the gall stone Ileus I experianced 13 months post. That's why I thought I had an incisional hernia with a mechanical bowel obstruction. I was vomiting all the time. When I had my Ileus from the scoli surgeries, they wouldnít release me without that bowel movement. I wasnít vomiting because I had the NG tube inserted, that I hated so much. I wanted out of the hospital so bad, I was like Jack Nicolson in "One flew over the Cuckoo's nest". "Chief, lets go to Canada"

I donít think its an ileus, it seems more like constipation from opiates. They can tell with a stethoscope.

Having the Magnesium citrate and pedialyte on hand after the bowel movement, is one way without a hospital trip. Sipping on pedialyte is better than nothing and having the Magnesium citrate bottle on your shelf is better than another trip down to the hospital. I did a few of those!

I didnít have much luck with any of the stool softeners, I did them all, it was only after I went to emergency that they recommended the Magnesium citrate, and not x-lax. It works like drano. It will drop the Hoover dam.

I added it to my sig because it was one of the most painful events I ever experianced next to passing a large kidney stone. Everyone going into surgery, should have a bottle, just in case.

This is for extreme cases only. Laxitives should never be abused.
Ed

LindaRacine
04-11-2010, 12:12 PM
I am floored by how experienced surgeons don't restrict drinks and foods until the gut wakes up. I would bet my house they know about this issue!



Sharon...

I've had that same question for some time. This is just my suspicion, but I think that it may be that they know that the ileus is a very short term problem, but that inadequate nutrition in the early postop period can lead to a longer, harder recovery. Or, maybe it's so the patients aren't complaining about their spine pain. ;-)

--Linda

Pooka1
04-11-2010, 12:24 PM
Or, maybe it's so the patients aren't complaining about their spine pain. ;-)


:D Good one. :D

I assume the gut wakes up on or about Day 3 post op for most people. That's what happened with both my kids. Medical staff came in often and listened for gut sounds often. Each time I was hoping that they heard some so my kids could drink something. The issue of their thirst was among the saddest memories I have from the hospital stints. :(

If it turned out they didn't need to suffer I would have literally stood on some hospital administrator's desk. I suspect all parents would do the same so there must be a damn good reason for the policy.

I further assume that if the gut doesn't wake up in a reasonable amount of time that they support the patient with IV fluids until it does. This pain is completely avoidable.

Susie*Bee
04-11-2010, 12:47 PM
I've had that same question for some time. This is just my suspicion, but I think that it may be that they know that the ileus is a very short term problem, but that inadequate nutrition in the early postop period can lead to a longer, harder recovery. Or, maybe it's so the patients aren't complaining about their spine pain. ;-)

--Linda

Linda-- do you REALLY think there could be inadequate nutrition??? I know with my ileus (because of it) I was hooked up to an IV for those 5 days. I have often joked about the amount of calories that must be in the IV solution as I gained 8 lbs. during my hospital stay and just ate lightly once my ileus was over. I do gain weight easily, so the weight gain was disappointing but not surprising-- and I do think I was getting plenty of nutrition from the IV... :rolleyes: Surely if they know you aren't to eat or drink anything at all, they would provide your needed fluids and nutrition through an IV.

This whole situation is puzzling. Why invite trouble when it is totally avoidable?

titaniumed
04-11-2010, 01:10 PM
They fed me some sort of "superfood" through my IVs and that probably contributed to my gall stone formation. I read that that happens to approx 11% of us. My ileus went on for 9 days.


Here is something interesting
http://www.medpagetoday.com/pdf/MEVH04/pages.cfm?section=05-treatment.cfm

Of course, I like easy solutions, they recommend chewing sugarless gum.
Ed

Singer
04-11-2010, 02:52 PM
I hope things have improved by now...

I distinctly remember not having anything to eat or drink until they heard bowel sounds, about 2 or 3 days post-op. I didn't "go" til around 9 days post-op, when I was given a suppository -- not very glamerous, but it worked. Once I got home, I took a capful of MiraLax every day while I was on painkillers and that worked great.

I think I would go to the ER if I were that bloated and in that much discomfort.

joyfull
04-11-2010, 03:29 PM
I remember that when I spoke to Lindy, the nurse at Dr. Boachie's office, she told me I would be sitting up and eating real food on the day after surgery! I'm sure that's what she said. I subsequently decided to go with Dr. Lonner, but I remember being surprised and pleased with that pronouncement. I"m not sure what his policy is. Now, I'm curious to find out.

ADMoul
04-11-2010, 04:37 PM
Hi Joy, I had no food/drink restrictions from Dr. Lonner once I was out of ICU. In fact, I would have preferred starting a little more gently. The hospital sent a regular diet meal almost from day 1 and NYU's food is not so great, believe me. I didn't eat much for the first few days because nothing was appealing and I was still swollen and bloated. Was on regular liquids by mouth, no IV once I left the ICU. On my trip home we stopped at a TGIFriday's for lunch and I don't think a restaurant meal (even of that quality) ever tasted so good :)!

LindaRacine
04-11-2010, 06:08 PM
Linda-- do you REALLY think there could be inadequate nutrition??? I know with my ileus (because of it) I was hooked up to an IV for those 5 days. I have often joked about the amount of calories that must be in the IV solution as I gained 8 lbs. during my hospital stay and just ate lightly once my ileus was over. I do gain weight easily, so the weight gain was disappointing but not surprising-- and I do think I was getting plenty of nutrition from the IV... :rolleyes: Surely if they know you aren't to eat or drink anything at all, they would provide your needed fluids and nutrition through an IV.

This whole situation is puzzling. Why invite trouble when it is totally avoidable?

http://www.ncbi.nlm.nih.gov/pubmed/15741982
http://www.ncbi.nlm.nih.gov/pubmed/9654632

Doodles
04-11-2010, 06:51 PM
Laura--
I hope by the time you see this you are OK again. I know when I was there the BM was a big deal before being able to leave the hospital. A few weeks later at home I again had the problem and it was awful. I tried everything and finally Miralax worker for me--or maybe it was a combination of the prune juice, and every other over the counter thing I could find for those few days. It's miserable and I hope it's over soon. I too don't understand how you got out of there without the mandatory BM!! Janet

Pooka1
04-11-2010, 07:18 PM
My kids were released without a BM but they damn well would NOT have been released if there were no gut sounds!

BM happened on day 9 or 10 ... insurance never would have covered them hanging around at the hospital past 5-6 days just to have a BM. :eek:

Gut sounds was sufficient for release at least for my two kids.

Susie*Bee
04-11-2010, 07:26 PM
http://www.ncbi.nlm.nih.gov/pubmed/15741982
http://www.ncbi.nlm.nih.gov/pubmed/9654632

Thanks for the info, Linda. I would have thought necessary nutrients would be supplied through an IV if needed.

Laura-- I'm hoping and praying you'll be over this problem soon.

TobyT
04-11-2010, 07:32 PM
Tammy has had really no constipation problems due to the fact that they got her going in the hospital.

Follow this link (http://en.wikipedia.org/wiki/Lactulose) and read up on the medication, totally safe, I am somewhat surprised this has not been addressed with this medicine.....HIGHLY EFFECTIVE...

Toby

titaniumed
04-12-2010, 12:17 AM
Linda and Toby

Thx for the links. Good info.

Ed

Radiogirl
04-12-2010, 06:05 PM
Hi Everyone and thanks for your concern and comments. The good news is I FINALLY had my first bowel movement today. It was such a happy moment :) The reason I think I was discharged from the hospital early was because they had given me an enema which produced just a tiny bit of bowel movement. Even though my stomach was distended. Then nothing happened for several days. On Friday (was discharged Weds) I called back to the Dr. office and Dr. Lenke's nurse said it could be paralytic ileus. I never saw the exray in the office so wasn't sure it showed up on it or not. Her recommendation was to walk. So, then last Saturday I flew home and suffered through til Sunday, when I went to the ER here where I live. They did see a paralytic ileus and gave me 2 enemas one being soap suds and the other was a Fleet enema. They recommended I be admitted to the hospital but I decided to give it one more day before we did that. Last night before bedtime I drank a whole bottle of magnesium citrate and still nothing happened. Then today middle of the day I did an epsom salts enema and that finally did the trick!!! I was afraid I was going to end back up in the hospital if nothing had happened today.

To end on a good note, my back is very straight yet very swollen. I am already so happy even though I had to go through a lot of crap, litterlly!!! :)

Thanks ... you guys are so valuable and make this process easier to get through.

Laura

Vali
04-12-2010, 06:19 PM
Tammy has had really no constipation problems due to the fact that they got her going in the hospital.

Follow this link (http://en.wikipedia.org/wiki/Lactulose) and read up on the medication, totally safe, I am somewhat surprised this has not been addressed with this medicine.....HIGHLY EFFECTIVE...

Toby

I wonder if this is the same as the brown sugar and water that they give babies for constipation? ( i'm no science prof).

mbeckoff
04-12-2010, 11:43 PM
I do hope she feels better soon. I am suffering from constipation right now as I am on pain pills and cannot eat fruit or the bran cereal that was helping keep me regular.

Melissa

titaniumed
04-13-2010, 12:14 AM
Laura,
Wow, wow, wow! You must feel much better now.

Now what do I do with my signature? I never heard of a soap suds enema. Ahhh... there is always something new.

Ed

JenniferG
04-13-2010, 03:59 AM
Congratulations on the BM Laura! :p It's a major step, that's for sure. :o

Melissa, are you drinking lots of water? My grandmother used to drink a cup of hot water on awakening and swore by it. I'm sure we could come up with loads of old fashioned remedies for diabetics if we thought about it.

gmw
04-13-2010, 11:18 AM
Laura -- Good to hear you've had some relief. I can only imagine how rough it has been for you.

Melissa -- Sorry to hear you're having issues as well, but so glad to see you have a date now.

mbeckoff
04-13-2010, 11:58 AM
Laura, Glad to hear that you are finally feeling somewhat better.

I started Miralax last night and I am feeling much better today.

Have a great day

Melissa