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Posted 1/17/2011 3:34 AM (GMT 0)
There is also the option of having partial resection of the rectum. I had thought about complete removal before my planned bladder surgery. As far as I am informed a total resection/amputation is indeed associated with a high risk for nerve damage. But I found out that a subtotal resection does not carry such a high risk since mostly the nerve tissue very löw in your pelvic are so dense and important.
If I ever get bladder surgery I will ask for a partial resection of the rectum. Moreover, in your case, converting the loop ileo could reduce some pressure and the amount of mucus that is produced. Prior to my ileo I also had horrible rectal spasms and even after ileo I am not able to expel mucus. At first it had to be suctioned ou, but over time the amount of mucus that was produced decreased. Maybe the treatment of diversion colitis decreased the amount. When bowel is not used it tends to get inflammed. Maybe you should get this checked out.
so i think you would be better with an end ileo and that there is the chance of a decrease in mucus production afterwards. I still want to have a partial resection since I still get spasms but they are less and less intensive now.

Post Edited (pelztier86) : 1/16/2011 9:42:14 PM (GMT-7)

Posted 1/17/2011 3:43 AM (GMT 0)
Hodaya,

Peltz is correct in that the enteroclysis is more accurate than the Ct. Enterography. That is how I got my adhesions diagnosed out at Mayo Clinic. The radiology doc could tell the two of my loops of distal ileum did not expand when the gastrograffin contrast reached them. AND those were the two loops that were adhered to my rectum when the doc at Lahey did the lysis of adhesions and the needed ileostomy result of severe scarring from the 2006 unneeded sigmoid resection etc.

The reason I hesitated to mention this is that it is pretty intense. Plus it sounded like your first attack was post-op ileus and then that they had determined small bowel motility issue. BUT Peltz is correct, you could have both. The CT Enteroclysis is "do-able" but not pleasant. That is why most places have gone to the CT Enterography. BUT the enteroclysis IS more accurate. They put an NG tube down your nose, then they put a very fine wire down through the plastic tube and under fluoroscopy guidance they guide the tube out of your stomach and into the first part of your small intestine. Then they take the wire out leaving the tube in place. THen they put the gastrograffin down the NG tube. Then they inject iodine IV contrast. THEN they have to roll you one way and another to get the gastrograffin to move through your small intestine. The whole thing took me 2 hours and I literally had to be wheeled out of there. For a few days My chest still hurt where they had put the wire down the plastic tube to guide it out into my small intestine. BUT time healed. It does not hurt in your stomach or small intestine (the small intestine has no nerve endings.) BUT it takes an extremely well trained radiology doc to do this as it is a delicate procedure. BUT it certainly was well worth my while as that is how I found out I had two loops of adhered small intestine that were responsible for on-going small bowel obstructions and inability to eat for 13 months until the adhesions got cut at Lahey. So, well worth it. You would do fine if you found the right radiology doc to do this.

I would follow Peltz's advice and ask about this exam too. Rosemary
Posted 1/17/2011 3:54 AM (GMT 0)
WoW Peltz. We must be on at the same time. You have much knowledge I am glad you are sharing with Hodaya. SOme of your knowledge is way beyond mine, so I am glad you are dove-tailing on what I have suggested. No need for you to continue to feel misearable, Hodaya, as there are things that can be done. The simplest being rectum mucous suctioning. Mine is an end ileo and I do not even produce a ton of mucous with a fully intact colon and rectum, plus the suctionings and what I do get out myself keep me, in general, comfortable. Hodaya sounds like you are on track with getting your life back, but your case does need some fine tuning. Ask your doc about our suggestions. Tell him they have come from people who are actually dealing with these issues. That should give us some "qualifications" in his eyes. :-)

Rosemary

P.S. Hodaya, I am looking at Israel travel brochures. :-)
Posted 1/17/2011 9:51 PM (GMT 0)
Thinking I am going to end up at the doctor or ER. Started throwing up last night then thought I was a little better this morning so I ate breakfast. Started throwing up again, having stomach pain, and bowel movements are not frequent and when I have one it is wormy....not normal at all. Worried this is a partial obstruction or ileus occurring again.

I hate to even go to the doctor. It is getting embarrassing and explaining my history to an ER doctor is the worst. I am really getting tired of this but what else can I do.

Jen
Posted 1/17/2011 10:53 PM (GMT 0)
Jen,

Is the vomiting projectile (meaning with great force)?

Do you have pain right above or right around the naval area?

Type an emumerated chronology in numbered one line phrases. Put the exact dates of all your surgeries and the exact dates of all your small bowel obstructions. Remember one event to a sentence in list format. This makes for easy reading for the ER doc.

End with the question, would a CT scan or other imaging test of your choice, show if I am having a small bowel obstruction? (THis lets them know that you know, yet gives them the choice of image test so you are not telling them what to do.) Trust me they know all about adhesions but docs will rarely admit to that because surgery is what causes adhesions. ANd surgery is what your surgeons have done. (Though needed surgeries, but docs are still super sensitive about the "A" word (Adhesions).

GLAD you are going to seek help. THis is nothing to wait on. If your small intestine kinks off, you will obstruct, if this is not dealt with, small intestine can rupture or die. Go and take your list. Let us know how you do.

Best of luck. Rosemary

P.S. Remember, there are docs who successfully treat adhesions, you are not stuck with this forever. Neither is Lizzie. It's all in finding the doc who is proficient at lysing them and setting you and your guts free from this.
Posted 1/18/2011 12:10 AM (GMT 0)
Hodaya,

IDEA FOR YOU!!!

I know that prune juice and some other juice work for you with your slow small bowel. BUT Have you tried salty hot liquids? Though I don't have the slow transit issue, I did notice that 10 minutes after I had a bowel of hot salty chicken broth, what I ate 20 minutes ago AND the chicken soup were all in the bag. It may not work THIS fast for you, but try something salty and hot, that seems to be a gut stimulant.

Rosemary
Posted 1/18/2011 1:07 AM (GMT 0)
Rosemary I don't have projectile vomitting just normal. Right now though there is nothing left to throw up so its just bile and watery. Also dry heaves. My bowels are not moving right now so that's not good. I am basically getting dehydrated. I am thirsty but can't drink due to nausea and vomitting. So I guess I will end up at the doctor to at least get fluids, and I am sure tests to see if anything is going on. My belly pain is right around the belly button. It is really tender but I'm not distended as of yet.

I am going to write everything down because when you feel bad it is really hard to tell doctors your whole history. It all just gets so confusing and they just look at me like I'm from Mars.

Jen
Posted 1/18/2011 3:51 AM (GMT 0)
Hi Jen,

I know, that is why I keep the written medical history in my purse. It is hard to even utter words when you are in crisis. Sounds like you need bowel rest (nothing by mouth) and an IV stat. Get to the ER now. Tell them you likely have a small bowel obstuction and need and IV now. Then have them call your surgeon's on-call. They will verify it's likely a partial sbo.

Good luck. Rosemary

If the belly pain is colicky and comes in waves you are likely obstructing.
Posted 1/18/2011 5:31 AM (GMT 0)
"If the belly pain is colicky and comes in waves you are likely obstructing."
that's pain from a mechanical obstruction from adhesions etc., at least most times.
Posted 1/18/2011 7:18 AM (GMT 0)

Hi Ladies,

 

I need to go back and do some catch-up reading, but I just wanted to give you the update on Lizzie before hitting the sack tonight. So sorry for the delay...I have more classes starting later this morning, so I've been trying to get ready for that.

 

They started tube feeds on Lizzie several days ago. Right now she has a nose tube, and her body is responding really well to the tube feeds. She has more strength and energy because her body is getting the nutrients it needs. Eating causes her horrible pain and distention, and those symptoms have been so much better with the tube feeds! The next step is probably a PEG tube so she can continue to get the nutrition she needs without the nose tube. Please pray this happens in the near future (as in this week!). Dr. Stocchi was fine with it two days ago, but a GI doc who doesn't know Lizzie or her case (ex: he didn't know she had an ileostomy) passed judgment very quickly and said some things he shouldn't have that were very upsetting. Lizzie's husband has been there with her during the long weekend, but he has to leave to go back to work tomorrow. Please pray that Dr. Stocchi comes to speak with them early tomorrow and that all systems are GO for the PEG tube. Lizzie really feels that this would be a huge step toward getting her life back, so pray it can happen soon and without issue.

 

As soon as I know more, I will let you all know, and I will get caught up with everyone too...I just need to get a little sleep before getting back into lectures and labs tomorrow! (More school...maybe I need to have my head examined too.)

 

Much love to you all!

 

Allie

Posted 1/18/2011 6:13 PM (GMT 0)
Allie,

just a quick thought regarding Lizzies tube feeding. I also had a NG tube (yet extending into the dudenum due to my stomach dysmotility) for 4 months. it's a really nasty thing, and a PEG is less uncomfortable. However, there should be a trial of at least 2 weeks of tube feedings to see how they work and the intestine handles them before proceeding to a more permanent solution. Moreover, a PEG is normally placed via endoscopy and a little surgical intervention but it's not a surgically placed tube, that would be a g-tube.
If she has a NG tube and is better, I guess she has no stomach motility problems although she said sometime before that she did. However, there might be no actual stomach dysmotility but "only" impaired motility induced by the backing up from the slow small bowel. So by reducing the pressure and work for the small bowel, the slow gastric empyting could be reversed.
If she did have an actual motility problem of her stomach then she would not tolerate the tube feedings but I would tell her what I told you here nontheless - just to be sure.
A PEG can also be converted to a PEG-J. This means that the tube gets an extension which goes into the first part of the small bowel.

If she is stable on the tube feedings and tolerate them I guess her small bowel problems do stem mainly from adhesions rather from small bowel dysmotility. With an actual underlying small bowel dysmotility problem it would not really matter if the tube feedings or orally taken food went into the small bowel. Normally, when food enters the small bowel, the stomach has already made the food to become pretty liquid and small. At least if the small bowel dysmotility was severe (which one would have to assume with regard to Lizzies severe symptoms like vomiting and gross distension) then she could not tolerate the feedings as well, and her body would not respond to tube feedings that fast/well.

In contrast, tube feedings usually work quite well in people with adhesions since the normal small bowel motility is mostly preserved during fasting or when liquid nutrition is given, this can pass through narrowings and stiffened bowel loops. Adhesions induce a temporary mechnaical obstruction and as long as the passage is free there is no inherent motility problem. With a permanent mechanical obstruction (long stricture/volvulus/atresia, stenosis that occludes the lumen permanently, occluded lumen by cancer etc) tube feedings are contra-indicated. However, adhesions mostly cuase only temporary mechnical obstructions, when food enters the affected bowel loop. Most adhesions do not present with the classic narrowings unless they are such severe (as with in Rosemary's case). Narrowing/stenosis are ususally a feature of an inflammatory process like in chron's and even in those patients only those with a stenosis nearly/completely occluding the bowel lumen are highly at risk while being enterally fed and requires iv nutrition/surgical intervention.

And adhesions don't have to be visualized on imaging in any case as most adhesions do not cause identifiable narrowings and rather bowel loops that are suck together which imapirs motility in the segmentt; thus, one has to go inside/perform a laparatomy to be sure. With all her surgeries it's no wonder that she has a huge adhesion problem, especially if she belongs to the folks who easily develop adhesions.

Post Edited (pelztier86) : 1/18/2011 1:49:42 PM (GMT-7)

Posted 1/18/2011 7:27 PM (GMT 0)
Thanks Allie, good update. At least progress is being made. Peltz thanks for shedding light on this.

Peltz, I wish that you AND LIzzie's docs could get together AND That they would listen with open ears to what you have to say. You, as a patient with MUCH knowledge, I think possess knowledge that NO doc alone does. BUT everything you say sure makes sense to me. Maybe they will somehow have the knowledge collectively as a group that you have just so concisely and logically shared with us.

It is comforting to know that there is SOMETHING that can be done for her. If she ends up with one of these feeding tubes and that works for her, will she need to be hooked up for life? Or is it something that she could have at home and when it was time for a feed that she could just hook herself up, feed, and move on with her day and hopefully normal activities?

Although very different, at this point if any arrangement can be made for her and it worked, that would be the miracle she and we have been waiting for.

Rosemary
Posted 1/18/2011 7:29 PM (GMT 0)
Allie and Peltz, You'll will get a kick out of this. Mayo CLinic wrote me up as having a PEG tube (prior to my lysis of adhesions and ileostomy), which I did not! INteresting.

AND that GI of Lizzie's that didn't know she had an ileostomy, what was that all about?

Rosemary
Posted 1/18/2011 8:09 PM (GMT 0)
Allie, thanks for the update on Lizzie. my gosh.. i never thought it would have come to this for her.. a peg tube?? poor girl. i'm so sorry to hear all she's going through and really hope the drs can find a way to finally put an end to her misery. so worried about her.

Jen, what's going on?? pls let us know as soon as you're able to. hope things work out soon.

Rosemary and Sarah, thank you so much for your support and info. if only i could find a dr to take me seriously. honestly, i don't have much faith i will. but maybe i should just keep the way i am - as long as i manage with the juices etc. i mean it's not so bad, i just have to drink these juices and i'm happy. only if they quit working, then i'll seek help. well if they quit working i'll be so sick they will have to help me. but for now, so far so good.

Sarah, what is a partial resection of the rectum? can that give us relief? how much rectum is left after such a resection? how does it work? i don't know much if anything about this.

BTW, remember i wrote what the surgeon said about my lower hole of the loop ileo shut closed? well today i changed my wafer an i saw again (just like last week) a string of mucous coming out from the lower hole!! so how could he say it is shut closed??? i tell you the dr did look pretty tired that day..... lol. anyway i don't know if it matters and i'm just tired of it all.

again, thank you so much Rosemary and Sarah, your posts made me feel better.

oh Rosemary, i'm just SO THRILLED to have you come here and meet you... you know what, i think you should make it closer to March rather then May, that is if you'll be touring outside a lot, cuz if so, then May may be too hot when touring all day. let me know when it'll be, i can't wait!

oh and thanks for the idea about the salty broth. i'll try it and let you know if it helped.

Jenise, gosh i'm so sorry about all the issues you're still having. i hope something can be done to help you. you've also been struggling way too long.

Sarah, you had a peg tube too? gosh that sounds so scary. you have so much knowlege about all this, unfortunately, from your own experience, something i'll bet you wouldn't want to know about in the first place.

Posted 1/18/2011 8:50 PM (GMT 0)
please, keep in mind (for all of you who underwent surgeries): most adhesions do not cause identifiable narrowings but rather bowel loops that are stuck together which impairs motility in the segment
Posted 1/18/2011 9:51 PM (GMT 0)
a partial resection of the rectum just means that variable lenghts of the rectum are left. When you have UC or heriditary colon polyposis and get a prcotocolectomy, the procto stands for protectomy meaning removal of most of the rectum; what remains is usually the minimum lenght one needs to reconnnect the rectal stump with the anal canal and sphincter system to the small bowel by interposing a j-pouch (which s a pouch made from small bowel serving as a functional reservoir for stools, thus acting like a new rectum)

Any resection which does preserve the anal canal and sphincters are not considered as amputations or total evisceration which is mostly only done in cancer patients or in patients who have an intractable pouchtitis/inflammation of the puch/rectal stump. That way, the docs reassure themselves that they could potentially reverse the ileostomy sometime even if it was obvious that this time won't come.

By reducing the lenght of the rectum significantly, you reduce the amount of mucus that could be produced, and the more distal the rectum the less mucus is produced.A resection of all but the most distal part of the rectum w/ anal canal would probably result in complete or near-complete absence of production of mucus.
That's why I think that I should go for a partial/subtotal proctectomy since this surgery carries a significantly lesser risk for nerve damage in the pelvic area - though there are still some risks involved. Justt keep in mind: a removal of the rectum is an amputation (after which you can have phantome pain), a resection os just a resection though for the surgeon, it is pretty tricky annd difficult to operate in this area; that's why a total rectum removal/amputation is a really big surgery and a resection takes some time, too., and is not a short procedure.

Also, keep in mind that you also have a blind loop of bowel that still produces mucus in addition to your rectum.

Post Edited (pelztier86) : 1/18/2011 3:02:51 PM (GMT-7)

Posted 1/18/2011 10:02 PM (GMT 0)
Yes, I had an NG tube for more than 4 months; it failed as I could not tolerate the rate of feedings whoch would have been necessary to gain weight.
I then got my hickman line and iv.-nutrition

And yes, you run your feedings with a PEG at home. You can decide when they run and how long. However, you are limited by the rate of the feedings. If you tolerate them well you can run 120ml/h so you don't need much time. I could not do more than 60; otherwise I got nauseated and cramps.
Secondly, it depends on your nutritional needs, how much of the formula you have to run in.
Altogether these factors are different in the patients, but normally when feedings are well tolerated and can run on a normal rate and you have no exceptionally high caloric needs you caneven run them only at night, and get rid off the tube feedings for the whole day. It's really not that bad. When you want to be active during the day and you have to run them throughout the day (which I had to do) you can order a sepcial backpack where the pump and the bag with the formula can be stored. Then you are completely mobile, you only have the line through which the feeds run directly on your body but that does not limit your mobility at all. I have even heard people on tube feedings tell that they play basketball while being hooked up.
Posted 1/18/2011 10:59 PM (GMT 0)

Sarah, hopefully one of these days we will both get to cross Russia off our "to-do" list!

 

Hodaya, Rosemary, and Sarah, thanks for bring up the possible nerve damage issue when the rectum is removed. I haven't asked my surgeon if he would remove my rectum (my guess is no), but the possibility of nerve damage does give me pause. I guess I really don't know what to do...last night, for example, I was able to get some stool out, but after walking out of the bathroom, I could feel my entire pelvic floor and lower abdomen spasming and cramping- basically felt like really bad period cramps from the ribcage down. On one hand, maybe doing less is more (surgically), but on the other hand, I just want the pain gone! However, I guess there's no telling what the result might be. If I ended up with debilitating nerve pain, I might be stuck because I cannot get within 10 feet of narcotic pain medication without my bowel completely shutting down. Following surgery, I get pain meds for the shortest amount of time possible because my bowel sounds won't kick up until 3-ish days after all meds have been stopped, and a heck of a  lot of walking. I know the suctioning process would be incredibly painful for me, as I can barely handle anything inserted rectally (heart rate goes through the roof, sweating, pain, horrible nausea, dizziness...full-out vagal response).

 

My parents now know about my secret appointment with my surgeon tomorrow. The office's automated appointment reminder system called the house phone last night, and blew my cover. The possibility of this happening never crossed my mind because last time the call went to my cell phone. My mom immediately got defensive and accused me of having an agenda. She demanded to know why I had scheduled another appointment with my surgeon because "our" (her) plan was to see my gastroenterologist before seeing my surgeon again, pick his brain, and have him write a letter to my surgeon with his recommendations. I tried to play it cool and just said that I had some questions I wanted to ask my surgeon. She wasn't amused. My dad, however didn't react as I thought he would. Instead he said, "I have been thinking about that actually. Have they tested for any spinal nerve problem? What if what you actually need to correct the problem is back surgery?" I have seen a chiropractor for years with no result (except losing $40/appointment); I do have scoliosis and kyphosis, but they are not to the degree that anyone would consider doing surgery. Some kyphosis is visible just by looking at me, but you can't tell I have scoliosis unless you look at an x-ray. I'm sure my parents will want to bring a neurologist into the mix too. I guess my question remains...do I keep my no-longer-secret appointment with my surgeon or see my GI doc first? What do you all think?

 

Jenise, please keep us posted on your appointment in Oklahoma. I hope you find some southern hospitality down here :) Many prayers that your daughter is able to fully turn her life around!

 

Cleveland wants Lizzie to keep on the NG tube and feeds for the next month then come back for a follow-up. At that time, they will decide on a PEG. The plan as of now is for her to go home on Thursday.

 

Allie

Posted 1/18/2011 11:38 PM (GMT 0)
So Peltz,

One thing you're saying is that even though small intestine may be open on all these scans, if it is adhered to other small bowel loops though not squeezed in as in a narrow, then the small bowel does not peristalse normally due to scar tissue on the outside of it keeping it from squeezing food through it like it could if it were totally free?

I think I see. WOW! Scary but likely true. I think I understand what you are saying.

Allie, Thanks for your update and your email. . You sure have a full plate. From all we have all seen and what I have been through, when surgery is concerned I say "Less is more." You could be given a numbing agent rectally if you ever needed a suctioning so that would not be a big issue even with the pelvic floor issues you have. I would not risk nerve pain from rectum removal as nerve pain is like a lightening bolt. I had that once for 7 months in my arm and it is not tolerable. Makes one scream out involuntariy. Luckily 13 nerve blocks cured my arm nerve pain, but if it had not, I would have been stuck with it. And you are right, narcotics bring the bowel to a screeching halt. Keep your appointment and go for it. SOunds like Dad is coming around. Mom will too. Glad you played it cool. That will help mom come around faster if this does not become a contest between the two of you. Trust me from my experience with my mom everything was a contest. Just my experience.

Hodaya, March I have a Bahama trip but will look at April or maybe even next March for Israel. It would be soooo cool to meet.

Peltz, good to hear the feeding tube can be portable. I'm sure at this point Lizzie would be delighted if something worked and she could gain energy from whatever source and be mobile and "well". It would be different but aren't we all? Mobility is crucial. This may work for her. I think they are right in trying non-surgical methods as that would beget more adhesions.

Jen, good look with that trip to the ER.

Rosemary
Posted 1/18/2011 11:52 PM (GMT 0)
Rosemary,

yeah you got it. A further important reason why enteral feedings usually work well in patients with partial mechanical, temporary obtruction due to adhesion is that the enteral feeds enter the small bowel with a steady rate, in small amounts, limiting and reducing the need for distension for the small bowel (when food enters it, the bowel always becomes a little wider/distended - as an "adaption mechanism") , With adhesions that make the bowel loops to be stuck together (on their "out-side"/surface) the distension ability of the small bowel and its motility are impaired.It literarily is trapped by the surrounding scar tissue which causes conglutination of the small bowel loops. Adhesions do nothing more than being an excellent glue/sticker. By the way, the word adhesions comes from the Latin word for sticker/sticking together

With a permanent mechanical osbtruction ( a tumor that occludes the lumen) enteral nutrition cannot work and is even dangerous.

Post Edited (pelztier86) : 1/18/2011 6:25:03 PM (GMT-7)

Posted 1/19/2011 1:24 AM (GMT 0)
WOW! PEltz,

So what do you make of this?

Prior to having the end of my small intestine lysed free from dense adhesions on my rectum in 2007 result of the "over-done, unneeded" surgery of 2206, I would always get a small bowel obstruction 2 days after I had to take a gallon of colyte bowel prep to move stool down through severe narrowings in my lower colon and rectum (scarring was within the wall of my colon not bands of scar tissue outside of it, but it could not peristalse poop along for that reason.)

Anyway, the next day after one of these horrid "bowel prep's" I would eat my jello, chicken broth, and other "light things". Then the next day, I would have a small bowel obstruction. THis went on month after month for 13 months.

Is it because the liquid bowel prep I had to take to move stool through my colon was taken in rapidly into my stomach and small intestine because you have to drink that stuff rapidly?

1. I always wondered why the timing was two days after. Any thought on this? I KNOW it had something to do with rapid distention of small intestine, that is why I tried so hard to get the lysis of small bowel adhesions and the ileostomy before I had to do much more of these "bowel preps." As I was afraid small or large bowel was going to rupture.

2. Since the lysis of adhesions and ileostomy so far anyway, I've been OK and transit seems to be normal. ON the CT enterography all was open, but as you say, small bowel may still be adhered to other loops. I do know that anything dense like mashed potatoes makes concrete in me despite drinking a lot of fluid, and I have to melt it down with grape juice and hot tea. BUT on the last trip I had severe ileostomy diarrhea, took immodium AND that thickening apple/peach/pectin conconction, then had this concrete like stool that I had to get through me with hot tea and grape juice. BUT the stoma did pump out that severely hardened ilestomy poop which sure is not normal consistency. I would LIKE to think if I had any imminency of recurrence of small bowel obstruction, it sure would have happened with that. As it was, I passed the bag of hardest ilestomy output I think on record. ANy thoughts on this? (I obviously will only take the immodium if ever needed again, minus any thickening food in addition.)

Some of the stuff you understand and present so logically I think is way beyond most docs. I know you have had practice in doing this due to your own complex issues. BUT, I am surprised with your understanding and clarity of expression, that they sometimes just blow you off. Or maybe they just don't have an answer because they don't get it. BUT you would think some of them would at least say, "everything you are saying makes perfect sense, but we just don't have an answer for you." You are from Germany right? Maybe the defensive doc thing exists over there too? Too bad they can't just utter the words: "We don't know" in cases where they don't. Sure would save us a whole lot of grief.

I am willing to be that you will be able to figure out your own health issues and eventually connect with a doc that gets it too. You know too much to not do this.

Thanks for any light you may be able to shed on my 2 questions above. Even my atty who WAS a very brilliant surgeon said many of my questions may never be able to be answered for closure purposes even with settlement of my suit. This may be true, but I think you can answer a few even my reviewers can't.

Thanks, Rosemary
Posted 1/19/2011 1:27 AM (GMT 0)
Just a quick note for everyone to remember: I added it in my previous post.

With adhesions, the bowel is literarily trapped by the surrounding scar tissue which causes conglutination of the small bowel loops. Adhesions do nothing more than being an excellent glue/sticker. By the way, the word adhesions comes from the Latin word for sticker/sticking together
Posted 1/19/2011 1:39 AM (GMT 0)
On of my goals is to get a law passed where the risk of and the definition of small bowel obstruction be added to every elective pelvic surgical consent form. If this had been made clear to me I would never have had my elective hysterectomy in 1995, which 10 years later cause the slipping of the small bowel loop into the rectovaginal septum, then mistaken for the sigmoid colon, and the unneeded removal of my sigmoid colon, and all that followed. Though I got no symptomatic small bowel adhesions from the hysterectomy, had I been warned of the risk, I would not have elected that surgery. Heavy periods would have ceased at menopause anyway.

They are now discovering that women who have repeated C-sections (of which they are doing more of these days) eventually get small bowel adhesion obstructions. Surgeons know of this risk, why do they not let the patients know of the risk to make it really INFORMED consent?

Just a thought. Rosemary
Posted 1/19/2011 2:21 AM (GMT 0)
Ok, Rosemary, back to your questions.
1. I think the reason why you got the small bowel obstructions after intake of large amounts of this nasty stuff in a short time is that your small bowel had to adapt to a very large incoming volume within few minutes which has to result in a greater distension of the intestine than with normal foods - in any patient undergoing this procedure. However, the ability of your intestine to handle large volumes and to adapt to them by distension was impaired due to the adhesions stucking the bowel loops together.
As the adhesions became more and the tissue besame harder due to the sticker (= adhesions) and less capable of peristalsis the obstructions increased and the amount of oral intake you tolerated decreased.

Bowel preps also stimulates the motility by causing osmotic diarrhea. When you have a mechanical subocclusion which you have with adhesions and especially when you take in large volumes in this situationthis can indeed get dangerous,ruptures are possible. As the inherent motility of the bowel is preserved with adhesions the enormous pressure from the hypercontractility of the bowel Loops proximal to the mechanical obstruction hits the bowel loop stuck in adhesions. When you really have a mechanical obstruction, especially when it is totally lumen-occluding you must not use any bowel prep for that reason.

It seems logic that you having no history of an inherent motility problem regained a normal transit/motility after successful lysis. So most times your motility is completely normal. It is only impaired when you eat food your bowel does not handle well and may trigger the bowel loops with potentially yet slight scar tissue and decreased ability to distend and move. So i would guess: the more the type of food you consume requires the ability of the bowel for full and free distension and moving the higher the risk is for an obstruction. As long as you eat a diet that require only normal distension (no fiber) you should Be ok most times. Food that delays transit in normal people (like bananas, potatoes) or drugs that decrease motility require and cause a greater distension due to increased transit time. So the possible occurence of obstruction is directly linked with the factor of required luminal distension.

Post Edited (pelztier86) : 1/18/2011 9:56:01 PM (GMT-7)

Posted 1/19/2011 4:08 AM (GMT 0)
Peltz,

Thanks so much for taking the time and putting in all this effort to clarify things that should have and could have been clarified by my docs so long ago even after "the fix". Not that I'm criticizing those who saved my life, but I fully understand your explanation and likely this is what they know but don't verbalize to me in response to my questions. So, I continue to eat bland, take in quite a bit of fluid spaced out through the day, take my supplements, and barring anything unforeseeen, should be OK.

This sheds a LOT of light on why my lysis and ileo surgeon did not want me taking any more of that bowel prep once he agreed to do my lysis and ileo surgery. BUT what he did not understand was that was the only thing that would get poop through all that scarred colon and then through my rectum which was also scarred at a right angle. I did end up having to take it anyway, as the lysis and ileo surgery did not happen until 2 months after he agreed to take me on as a patient. That was the longest two months out of the whole 13! BUt, I did what I had to do and no rupture occurred, by the grace of God, I guess. Some intuition told me he was afraid of rupture, but he did not say so.

I understood every word you said. Thanks so much.

I hope for you that you can find someone who will listen fully to you and do what they can to allow you have a successful productive life. You would be a super doctor! Intellectual capacity to say the least AND ability to communicate to people. The world needs those like you to enter the medical profession. Best wishes, Rosemary
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