Advice needed for Radiogirl from her sister

[jenparker]

I had the same/Contact Dr. Lenke

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]

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]

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]

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]

Mag Citrate worked wonders for me, whereas the Miralax and the prescription stuff did zilch. Good luck!

[huskymom]

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]

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]

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]

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]

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]

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]

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 wouldn’t release me without that bowel movement. I wasn’t 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 don’t 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 didn’t 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]

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]

Or, maybe it's so the patients aren't complaining about their spine pain. ;-)

Good one.

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]

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... 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?