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I need help.

I had an emergency appendectomy on October 26th, 2011.  Bowel movements and healing where as expected until 1 month later when I started having abdominal pain and constipation issues.  CAT scan shows an unknown abdominal mass that has yet to be resolved.  The pain and the constipation have continued and have become increasingly worse.  Pain is located around my navel and lower left quadrant.  Sense the CAT scan I have had an ultrasound and X-rays all showing an unknown mass.  Rectal exam did not find stool.  I do not have the urge to have a BM and no rectal pressure even with daily use of miralax.  It has been over 3 weeks and still no BM.

I am constantly tired, in continual pain that gets worse when I try to eat.  My appetite is poor and I can only manage a few bites before the pain has me in tears.  I'm also always feeling nauseous all the time now and fight the urge to vomit.  I almost feel dehydrated but I am keeping on up my liquids.  Only able to pass a small amount of gas once every 3-4 days.  2 weeks ago, I had some issues with random bruising but that has sense cleared up.  I have lost 7 lbs in the last month due to this illness and cannot afford to loose any more weight.  I am unsure if it's related but for the last 2 months my joints have been loose and aching.  Also the very top of my Cervical Spine(C1 and C2) keeps popping.  Recent blood tests show increased sed rate and high white blood cell count.  Temp between 99.5 and 100.7

I'm seeing a new Dr due to moving, and I'm not comfortable with what she's asking me to do and need to know if it's even safe at this point.  She would like me to take Miralax 3x daily, senna based oral laxative daily and fleet enema daily as well.

I have always had horrific experiences with laxatives.  When I take them, I experience uncontrollable shaking, feel as though the blood is rushing out of my limbs and face.  I get cold and numb in places.  Once that part passes I get hot, flushed and experience extreme sweating which continues until pain kicks in.  Waves of knife twisting in your guts pain that continues for hours, uncontrollable urge to void even after there is nothing left.  Stuck on the toilet vomiting, hot and cold flashes, sweating, shaking, weakness, dizzy, and feeling like I'm going to black out all the while moaning uncontrollably.  I have tried to tell the Dr, but she insists that I just need to do it anyway. If the min dose of a laxitive makes me feel that bad for aprox 12 hours, what will a full dose of both oral and rectal stimulant laxitives do when taken daily?

I do not have trust in this Dr and will be looking for another one, but I'm sick enough at this point that I can't afford the wait time as a new patient.  I feel like my Dr can't hear a word I'm saying.  Instead of explaining anything, she bullies her way into the treatment she see's fit.  She will insist on things and will not be told otherwise regarless of the actual facts.  At my last visit she was insisting my last bm was the consistancy of hard rabbit droppings, when in reality my stool has not been hard.

I am not only hesitant, but I'm also worried as to the safety of taking a combination of both oral and rectal stimulant laxatives on a daily basis, let alone with my reaction to laxatives.  I need advice and don't know what else to do.  I am a bit scared at this point and need to know what is going on with my body.

I do have a family history of early colon cancer and lymphoma.  I have also had various surgeries: Tubal ligation, Exploratory Surgery, Vaginal Hysterectomy, and recent Appendectomy
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1728693_tn?1332168862
Thin stool doesn't necessarily mean bad news, your colon could be spasming as it tries to get matter around the mass - probably only the soft stuff gets through as it can squeeze round. That can change the shape of your stool.

I'm not sure how HMOs work with referrals in the US, but I;m sure they try to keep specialist referrals to a minimum to keep costs down. I still can't imagine a good ER or clinic wouldn't do more to get to the root cause - especially with your imaging results. Did they give you a copy of your CT scan on disc that you can take to another doctor?
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1728693_tn?1332168862
I find it strange that there is an unresolved mass, you are in pain, and they haven't looked at a colonoscopy to see what's going on...?

It could be anything from a growth to impacted fecal matter - perhaps you should seek another opinion or walk in to an emerg to get re-evaluated?
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Avatar_f_tn
Thank you for taking the time to replay Kaneda.  Yes, I am in constant pain to the point I'm having trouble sleeping.  My husband says that when I do sleep I whimper every time I move.  Pain also gets so bad when I try to eat that I end up in tears.

My Dr has been insistent upon the fact that it is only constipation and feels there is no need to see a gastroenterologist.  My last visit was on Monday.  At that time, they did blood work.  Results show increased SED rate that indicates inflammation and a high white blood cell count.  With the results she is willing to refer me, but only if I follow the ordered treatment.

Everything I know about stimulant laxatives says you should not take them if you have the possibility of obstruction, fecal impaction, or abdominal pain of unknown origin.  I also know that you should not do a fleet enema if you are dehydrated and I am showing signs of this even with increased fluid intake.  This, combined with my reaction to stimulant laxatives, makes me worry about following her ordered treatment.  Without following the treatment, she will not make the referral.  My last Dr (before I moved) had told me if I started to have any of the indicators of colon cancer that I should have a colonoscopy ASAP due to family history (my grandfather passed due to colon cancer at 42).  At the beginning of all of this I had noted that stools had become narrow, almost ribbon like.  I was unsure if this was due to the appendectomy or not.

I would love to get a second opinion but I'm not sure where or how to go about getting that done, more than ready to change Dr's to someone that will actually listen to the symptoms instead of deciding what the symptoms are based on what she thinks is the most likely cause.  My husband, who attended my last appointment with me, also noted this and feels she may be lacking in intelligence.

As far as the local ER, it's a joke.  I would be lucky if they even took the time to examine me, let alone re-evaluate.  Recently a friend took someone in that passed a large blood clot while passing gas.  They did not evaluate him or do any tests; instead, they told him that he should make an appt with his PC Dr.  When he stated that, he did not have one they told him that he needed to work on that and sent him home.  This is just one example of the lack of care in the local ER, both my husband and I have also had bad experiences there.

Should I go ahead do the treatment so I can get the referral?  My instincts warn me against it, but it could be fear of the laxatives.
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681148_tn?1285160820
How far away do you live from the next town over?  If you're not too far, I would consider going that far away just to be seen in a different ER.  There is something wrong with the doctors in your little town.  After all, very likely if your friend were lucky enough to be able to get a PCP (primary), he would very likely have the colonoscopy right at the local hospital, since it sounds like you live in a small town.  Small town doctors wouldn't have the testing equipment anyway.  No one should be bleeding from the rectum just from passing gas.  Where I live, at least the ER has the courtesy of referring people where they can go for a primary care doctor.  There are even low income clinics who will take people who don't have any insurance and use a sliding fee based on income.  One of which I think is better than any of the state health clinics, because it at least isn't affiliated with such uncaring clinics.  And, because they are so good about being oriented toward integrative medicine with all the interns from the natural health college working side by side with them or using the office after hours when the main clinic is closed.  They don't listen to everything the natural doctors say, but they listen to enough that they're actually being helpful by using what they have learned from natural medicine.

You could try this:  You could try just ONE round of the Fleet enemas.  They come with two bottles usually.  If the first bottle is insufficient, it is still okay to use the second bottle.  After this, no matter what, don't use any more.  That would be where the problem would lie.  I was impacted after being in the hospital from a kidney issue.  I had problems with constipation before entering the hospital and still do, even though it is less than it was during the hospital stay.  They don't believe anyone who needs gluten free if their fancy blood tests are negative for Sprue and don't listen.  Even though there are other parts of the body that react to gluten, like the skin itself with eczema.  My colon also reacts to gluten or the constipation wouldn't have gotten worse during the hospital stay.  They didn't listen to me about this either, because they dismiss it as nothing but IBS, as if IBS is nothing.  I drink plenty of water, but they blamed me for the dehydration, like I did this to myself.  I know someone else who had the same unexplained kidney issue who was also blamed.  She, too, carries a water bottle around with her everywhere and didn't do it to herself either.  Still, that said, this local hospital sounds a lot better than the one you're dealing with.  That would totally rot to be dismissed like you have been when you are showing signs of autoimmune illness with the high SED rates.

You are correct that usually you should not use these enemas.  It is definitely a bad idea to use more than what I mentioned.  I don't know why your doctor is being such a jerk about not referring you until you use the enema when I know in my gut from what you're telling me that you are still going to need the referral to see a gastroenterologist.  I'm just a lay person such as yourself, and even I know there is something more going on here than ordinary constipation or fecal impaction.
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Avatar_f_tn
Thank you for your comments.  I have been debating driving the hour and a half to go see my old dr or pay a visit to the ER over there (the next town over with a decent hospital).  I managed to finally get in touch with my sister-in-law who is a nurse.  She told me with my reaction to the laxatives that it would be a bad thing, especially in my current condition, to take them.  Instead she recommended warm prune juice.

I did manage to go a little bit, but it caused so much pain right around my belly button and on my left side right at my waist line that I could hardly stand afterwards and it's continued to hurt and throb in those two areas.  I can also feel a hard lump in the painful, throbbing area above my navel.  The good news is that while I only passed a small amount it's given me a little bit of relief and the nausea is gone for the time being.

I don't feel this is just a basic constipation issue.  I don't quite know what's going on, but I do know my body.  I don't know if it could be adhesions or something else.  I had noticed a few days before my appendectomy that my stools where thinner than normal, almost flattened and this is not something that has changed.  When I have gone, it is still thin.  Also it's not hard like you would expect from constipation.
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1728693_tn?1332168862
Thin stool doesn't necessarily mean bad news, your colon could be spasming as it tries to get matter around the mass - probably only the soft stuff gets through as it can squeeze round. That can change the shape of your stool.

I'm not sure how HMOs work with referrals in the US, but I;m sure they try to keep specialist referrals to a minimum to keep costs down. I still can't imagine a good ER or clinic wouldn't do more to get to the root cause - especially with your imaging results. Did they give you a copy of your CT scan on disc that you can take to another doctor?
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Avatar_f_tn
Good news is that I got a referal to the gastroenterologist and he has schedualed me for an urgent sigmoidoscopy which I will have first thing in the morning.

I am a bit worried about the ripping/tearing pain that occured after using the laxitives while trying to have a bm.  I did get some liquid out, though it was not much.  After the pain I couldn't move or get off the toilet for 20+ mins and it still hurts in that area.  Current primary care dr is unconcerned with this or the continued throbbing pain in that area.

As of Monday I have lost 13 lbs in just a little over a month, and it's not weight I can afford to loose.  I've always been on the small side, with very little weight fluxuation over the last 15 yrs.  In fact I have jeans I bought nearly 14 years ago that still fit until I lost this weight.
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