Bad luck: ER/Hospital Stay Again

Last week I started to get fairly backed up and my stomach was highly distended. By Wednesday night I was in terrible pain. I went to the ER Thursday morning. They diagnosed me with small bowel obstruction. I was checked into the hospital and they put in a nasogastric tube through my nose and into my stomach to suck out air and fluid which helped. The tube stayed in until 1:30PM on Friday, so basically 24 hours. It was a long brutal night. By 10AM on Friday morning, the pain from the tube and hunger pains was hard to take. Luckily I was able to check out after dinner time as long as I was able to handle some soft food like mashed potatoes. I am on a soft diet this weekend. Lots of liquids. Somehow I keep having some bad luck. I don't know if this is a chemo side effect as I know the chemo can upset the flora balance, but I don't think so. Just unlucky. Onward... -JR

Hey JR, that sure does suck. While I was reading your post I was wondering if this was related to your chemo, but when I got to the end it sounded like you had concluded it wasn't. Regardless, it sounds rough and that tube must have been the worst! Hope you're back on the mend quickly!

Just had the exact same situation last weekend....I was admitted thru the ER last Fri Aug 5th.....had my NG tube thru Sunday early afternoon when I was discharged. This is 5 th time this has happened in the last 10 years. BTW, my hospital is very good at lots of morphine for pain, phenergen for sedation and nausea, and Ativan for anxiety....I stayed heavily sedated till Sunday...at my request....primarily for the discomfort of the NG tube....man I hate that thing.

As for the cause of a SBO.....many times due to internal adhesions which cause the small intestine to bind and kink on itself.....usually these adhesions are caused by a prior surgery or radiation therapy. I am in the midst of chemo but don't think this is the cause.

What an ordeal!

Did you have your pelvic LNs radiated? Maybe call your RO and let him know.

- Allen

Hope you'll continue to mend through the weekend...take care

Geeze JR. Sorry to hear about that. I'm not good with tubes, regardless of what end of approach they use.

Do you honestly think, Tall Allen, that none of the doctors addressing this case don't know this, given they know his history? ....and would his RO simply give him a prescription without even examining him?

Sheepguy said...
Do you honestly think, Tall Allen, that none of the doctors addressing this case don't know this, given they know his history? ....and would his RO simply give him a prescription without even examining him?

I agree with Mel's sarcastic comments (lol). From CaliJR's comments, it appears that he was treated (appropriately) for the emergent symptoms -- that's what ER doctors do. The fact that CaliJR is thinking that chemo may have caused it, leads me to believe that the radiation cause was not discussed. Getting to the root cause and preventing further episodes is not an emergency, and is often left to the primary doctor. It is actually unusual that the whole pelvis is radiated; so, lacking access to his full treatment plan, it is entirely possible that the ER doctors did not know that and wouldn't even think to ask.

Yes, doctors often call in scrips for medicines to treat common symptoms. His RO has access to the patient's ER records - what diagnostic tests do you imagine the RO can do in his office that wasn't already done in the ER? For example, when I had frequent urination after my SBRT, I just called my doctor and he called the scrip in. It was a common and expected symptom. What else could he possibly do for me?

I can see we have a long way to go in teaching you how to work with doctors.

- Allen

Well, geez, Mr. Compiler, how could Tall Allen not know something?

Sheepguy-

Mesalamine is a fairly safe drug. I'm not saying it has no SEs (all drugs have SEs) - just that it's fairly safe - more so than, say, Flomax. Informing the ER that one has had radiation is a far cry from explaining the details of which areas were contoured - only the RO would know that. Unless the ER docs talked to the RO, which I'd wager they didn't, they'd have no way of knowing that the patient had this unusual treatment. Doctors are not omnicient. I assure you that most ROs already know the value of the drug and don't have to be informed by the patient. The patient does have to inform the RO, however, that there has been a problem. Doctors are not mind readers.

As you learn about patient empowerment, (and, frankly, you seem to be the only one on HW who doesn't get it -- maybe everyone else understands something you have yet to learn?) you will see there is nothing wrong, and a lot right, with a patient asking a doctor about medicines, treatments, or diagnostic techniques. The doctor is under no obligation to prescribe a drug or deliver a patient-requested treatment, but he is under an obligation to explain why or why not, benefits and risks. Doctors don't dictate to patients (patients are unlike your sheep in that respect) and patients don't dictate to doctors -- they engage in shared decision making.

You obviously don't understand the concept of "paternalistic" vs "shared decision making." But, thank God, you've already lost that battle. Doctors have been indoctrinated into the shared decision model in medical schools for the last 25 years at least. I think you might find that shared decision-making serves you better - most patients and doctors do. Why not give it a try?

- Allen

A relevant story.....

Friend of mine, diagnosed with G7(3+4), 2 years ago, decided to do AS. Or maybe more accurately, watch and wait, I.e. Not very ACTIVE Surviellance (I've discussed the story before).

Recently, he had an MRI, which showed the primary lesion very close to the edge of the capsule, and he felt it was time to act. The Dr wanted to do another biopsy. He didn't want yo go thru another biopsy and then have to wait 6-8 weeks before surgery (which he has more or less decided on, although at my urging, he's agreed to see an RO re SBRT before making a final decision).

He ran this by me, knowing that I've done a lot of reading of my own when I was diagnosed. I'm certainly no Tall Allen, but my comment to him was, that I would ask the Dr, since he was already diagnosed, and confirmed positive for g7 by Epstein, 2 years ago, and based on MRI results, decided it's time to act, what purpose would the biopsy serve in his case? But to ask it in a serious, rather than argumentative way.

He did. The Drs response was pretty much " well, I guess you are right. If you've decided to act, I guess there isn't really anything to be accomplished with another biopsy.

This Dr is Cgief of Urology of a major teaching hospital and well regarded in Urology world.

So the moral of the story is, yes, to shared decision making. If for no other reason, than Drs are human, they have good days and bad days, they don't always think of every angle, and they make mistakes. And that's ok, as long as they are open to discussion with an educated (I.e.empowered) patient.
Just my two cents

Sheepguy,

TA is correct. I have over 36 years of hospital pharmacy practice working with hundreds of physicians. Over the years, the pendulum has swung to patient empowerment and education. The old style physicians can still be a..holes about it. But the good ones, truly appreciate the new article and polite questions. You are correct that it is not good for a patient to "strong arm" a physician to get their way. I must say that that the poorly informed patient that gets his info from RedBook does irritate physicians. Guys like TA who put out the effort to learn and take responsibility for their own bodies are truly appreciated in this "new medical world".
What TA does is echo the most current literature, restate the standards of practice based on current evidence and interprets it in a way that men on this site can understand. He is not practicing medicine, just supplying us the information researched by the best physicians.

Paul

Well all... a spirited discussion. Thanks for the well wishes and the advice on the possible causes. I will discuss with my RO. My RO is attached to the hospital that I checked into. I did let them know I finished IMRT in May when I was in the ER, but I don't think that Doc thought to much about it. He was concerned about relieving my pain and getting the blockage gone and fixed. On Friday before I checked out, the admitting doctor told me to discuss the issues with my primary doc, my RO, and my Med Onc because he told me that he doesn't know what caused it as it could be anything. So I have my next chemo round Wednesday and I will discuss this with Dr Lam, and I will call my RO and discuss this week and see him next week. Thanks all. -JR