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Gastroenterology (Expert Forum)
80 yo woman w/severe pain post-radiation
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
80 yo woman w/severe pain post-radiation
by Leah77, Mar 13, 2006 12:00AM
Hello, this question is regarding my grandmother. 80 yo female who 9/2005 underwent removal of one kidney & ureter for stage 3 transitional cell carcinoma of the ureter. Underwent 6 wks radiation concentrated in that area. CT scans/lab work show no current evidence of cancer.
Since then has experienced increasing discomfort in her lower abdomen, gradual increase of pain. Now near constant very severe pain, 10+ on scale of 1-10, less midday, increase in evenings, cannot sleep. On darvocet as needed, wears off after 1 hour of slightly lessened pain(sorry don't have dosage). Pain typically wrapping around from front to back of lower abdomen, sometimes travelling up and down the side.
Food intake normal, elimination normal. Xray/CT scans show very little evidence of any structural issues, very little "narrowing" of intestines (sorry if not worded right!), slight evidence of diverticulosis (some pouches but not sufficient to explain condition). She is confined to bed because of lack of strength & severity of pain. Has been suggested that scar tissue could be responsible.
Has been in hospital 2 weeks now, drs disagree on what to do. On admission to hospital, dr felt possible intestinal obstruction, but now totally cleared without any change in pain level. Tried on lactose-free/low lactose diet, without improvement in condition. Surgeon will not perform surgery, says has never seen scar tissue result in that kind of pain. One dr wants laproscopy, but indecisive. Cannot do colonoscopy b/c she is too weak at this point.
Weight down from 96 lbs post-radiation to 88 lbs now. Until cancer, very healthy, active, no major medical problems. One dr suggested that the pain may be something she just has to live with. On levothyroxine for hypothyroid & xanax for anxiety (due to pain) & elavil (as of yesterday to try to improve current depression due to medical situation).
Any ideas?
Thank you!
Since then has experienced increasing discomfort in her lower abdomen, gradual increase of pain. Now near constant very severe pain, 10+ on scale of 1-10, less midday, increase in evenings, cannot sleep. On darvocet as needed, wears off after 1 hour of slightly lessened pain(sorry don't have dosage). Pain typically wrapping around from front to back of lower abdomen, sometimes travelling up and down the side.
Food intake normal, elimination normal. Xray/CT scans show very little evidence of any structural issues, very little "narrowing" of intestines (sorry if not worded right!), slight evidence of diverticulosis (some pouches but not sufficient to explain condition). She is confined to bed because of lack of strength & severity of pain. Has been suggested that scar tissue could be responsible.
Has been in hospital 2 weeks now, drs disagree on what to do. On admission to hospital, dr felt possible intestinal obstruction, but now totally cleared without any change in pain level. Tried on lactose-free/low lactose diet, without improvement in condition. Surgeon will not perform surgery, says has never seen scar tissue result in that kind of pain. One dr wants laproscopy, but indecisive. Cannot do colonoscopy b/c she is too weak at this point.
Weight down from 96 lbs post-radiation to 88 lbs now. Until cancer, very healthy, active, no major medical problems. One dr suggested that the pain may be something she just has to live with. On levothyroxine for hypothyroid & xanax for anxiety (due to pain) & elavil (as of yesterday to try to improve current depression due to medical situation).
Any ideas?
Thank you!
Doctor's Answer
by Kevin Pho, MD, Mar 14, 2006 12:00AM
, Mar 14, 2006 12:00AM
The exposure to radiation can cause inflammation within the bowels (i.e. radiation proctitis) leading to some of the symptoms described.
Colonoscopy is the ideal test. Other options would include a flexible sigmoidoscopy, or a scope with a pediatric colonoscope which may be more feasible.
If the tests continue to be negative, laparoscopy can be considered.
Another GI opinion can be obtained if the diagnosis and workup remain unclear.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
Colonoscopy is the ideal test. Other options would include a flexible sigmoidoscopy, or a scope with a pediatric colonoscope which may be more feasible.
If the tests continue to be negative, laparoscopy can be considered.
Another GI opinion can be obtained if the diagnosis and workup remain unclear.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
Member Comments (2)
by Leah77, Mar 13, 2006 12:00AM
Sorry - additional note - all current lab work & vital signs consistently normal.
by lunchlady, Apr 28, 2006 12:00AM
To: Maggie22
Your Grandmother's symptoms sound exactly like my symptoms. I was treated for cervical cancer (6wks of radiation & chemotherapy)a year ago. In January of this year I awoke with cramps in lower abdomin that went from front to back with a severe pain on my lower right side that would shoot pain down my leg. I was flat on my back because of pain and a lack of energy. I lost 15 pounds. I went to the emergency room because of the pain. I had a CAT scan, ultra sounds (vaginal & regular) an IVP, urine tests, blood tests, and a PET scan plus I saw 3 different doctors-Oncologist, radiologist, and internist. They could find nothing wrong. I was taking vicodin sometimes 2 pills at a time for 3 months. Finally my radiologist prescribed a really strong antibiotic (500 mg) that I took once a day for 10 days. The severe pain on my right side went away although when I touch that area it is still tender. I also regained my energy but it took a few weaks and have gained 5 pounds back of the weight I lost. I'm still not back to normal but I can function normally and only have to take a vicodin about once a weak. When all this started my Oncologist told me it was probably radiation side effects and that is what I believe it is. How is your grandmother?
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